Sensory and spatial components of somaesthetic deficits following right brain damage

We instructed patients with right brain damage (RBD) and somatosensory extinction, hemispatial neglect, or both to verbally report light touches delivered to the left hand, to the right hand, or simultaneously to both hands in two experimental situations. In the "anatomic" situation, each hand was in its homonymous hemispace; in the "crossed" one, each hand was held across the corporeal midline, in its heteronymous hemispace. Under both single and the double stimulation conditions, RBD patients detected stimuli delivered to the contralesional hand with lower accuracy in the anatomic than in the crossed position. This result suggests that somaesthetic deficits can be due not only to sensory but also to attentional factors, depending on the spatial position of the hands. Processing of sensory information in primary areas should not be influenced by the hemispatial position of the stimulated body part. These results suggest that somaesthetic deficits may stem not only from damage of primary sensory areas, as classically held, but also from damage of higher-order areas where information about stimuli, body parts, and extrapersonal space is integrated. Finally, the results show that sensory and attentional components of the deficit can be dissociated by using a very simple clinical test.