Widening the sphere of influence: using a tool to extend extrapersonal visual space in a patient with severe neglect

We report evidence that visual representations of space close to the body can be extended when a patient uses a tool to explore the environment. HB had severe neglect of left and far spatial regions which was determined more by how locations were visually perceived than by how they were represented tactilely or through proprioception. His ability to detect visual targets in left and far space was improved, however, when he held a tool. He also had limited tactile/proprioceptive knowledge about the location of his hand. These data suggest that by holding a tool, HB's more intact representation of near, visual space could be extended to include stimuli presented at a distance from his body. This extension of space improved his detection of visual stimuli. We discuss the implications of the results for the nature of our internal representation of space.