First saccades reveal biases in recovered neglect

Hemispatial neglect affects the ability to explore space on the side opposite a brain lesion. This deficit is also mirrored in abnormal saccadic eye movement patterns. The present study investigated if the recovery of neglect is also reflected in saccadic eye movements. Patient AF, who displayed strong hemispatial neglect 1 month post-right thalamic stroke, had largely recovered 3 months later when tested on visual exploration tasks of the Behavioural Inattention Test. At this stage, AF was tested on a visual search task while his eye movements (direction, latencies and amplitudes of first saccades) and manual reaction times were recorded. The experimental conditions differed with respect to stimulus number and distracter type and increased in difficulty. AF correctly generated saccades into the neglected field when the target was presented alone. In contrast, a considerable left/right difference was present for all multiple-stimulus search displays. Although recovered from neglect in standardized assessment, AF showed a strong rightward bias resulting in highly asymmetric response times and eye movement behaviour. We conclude that eye movement patterns are far more susceptible to remaining spatial impairments and can thus provide a sensitive means to assess the extent of neglect recovery.