Seeing fearful body language overcomes attentional deficits in patients with neglect

Survival depends to some extent on the ability to detect salient signals and prepare an appropriate response even when attention is engaged elsewhere. Fearful body language is a salient signal of imminent danger, easily observable from a distance and indicating to the observer which adaptive action to prepare for. Here we investigated for the first time whether fearful body language modulates the spatial distribution of attention and enhances visual awareness in neurological patients with severe attentional disorders. Patients with visual extinction and hemispatial neglect following right parietal injury have a rightward attentional bias accompanied by loss of awareness for contralesional left stimuli, especially when competing stimuli appear to the right. Three such patients were tested with pictures of fearful, happy, and neutral bodily expressions briefly presented either unilaterally in the left or right visual field, or to both fields simultaneously. On bilateral trials, unattended and task-irrelevant fearful bodily expressions modulated attentional selection and visual awareness. Fearful bodily expressions presented in the contralesional unattended visual field simultaneously with neutral bodies in the ipsilesional field were detected more often than left-side neutral or happy bodies. This demonstrates that despite pathological inattention and parietal damage, emotion and action-related information in fearful body language may be extracted automatically, biasing attentional selection and visual awareness. Our findings open new perspectives on the role of bodily expressions in attentional selection and suggest that a neural network in intact fronto-limbic and visual areas may still mediate reorienting of attention and preparation for action upon perceiving fear in others.