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note
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For several reasons, V.R. is an ideal case for testing our hypothesis that the processes underlying visual filling-in will remain intact in parietal extinction. First, her lesion is primarily cortical, but she has no visual field cuts. The clinical phenomenon of extinction can be observed in several kinds of neurological patients but may arise for different reasons after the occurrence of distinct lesions [such as partial sensory loss (4) in patients with subcortical lesions]. Patients with mainly cortical damage (like V.R.) show deficits that are more attentional in nature and therefore provide the critical test for our present hypothesis; however, unlike V.R., many cortical patients have visual field cuts that render them unsuitable for our tests. Second, the large extent of V.R.'S cortical lesion places considerable constraints on the neural substrate for the preserved visual filling-in that we find within the intact tissue. Finally, although extinction is relatively common for a brief period after unilateral brain damage, it is often transient. In this respect, V.R. is also a particularly useful case; her disorder remained stable over many months, permitting the extensive testing documented here.
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V.R.'s small left-hemisphere lesion had occurred 2 years before the right-hemisphere stroke, causing a transient right-sided homonymous hemianopia which resolved completely and no other symptoms. At the time of the present investigations, V.R. had full visual fields. There was no evidence of unilateral left neglect when conventional measures were used, including line-bisection and cancellation tasks; but V.R. showed consistent extinction of contralesional stimuli in the visual, tactile, and auditory modalities on confrontation. The experiments reported here were conducted between 1 and 24 months after the right-hemisphere stroke.
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All stimuli were displayed on the active matrix screen of a Macintosh PowerBook 540, controlled by VScope software [J. T. Enns and R. A. Rensink, VScope Software Manual: Vision Testing Software for the Macintosh (Micropsych Software, University of British Columbia, Vancouver, Canada, 1992)]. The viewing distance was 50 cm. Circular inducers were 5.1° in diameter, with a center-to-center separation of 10.2° horizontally and 7.4° vertically (all drawings are to scale, so that other visual angles may be derived).
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The duration for which the target segments were removed was determined before each experiment by a titration procedure aimed at producing 75% correct detections for unilateral left trials. This duration was 500 ms in experiment 1, 100 ms in experiment 2, and 250 ms in experiment 3.
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Within each experiment, all the conditions were implemented during a single session and in counterbalanced order, to rule out any influences of practice or long-term recovery on the comparisons of interest.
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In experiments 1, 3, and 4, V.R. completed four blocks of 36 trials, the two possible display types being blocked with their order counterbalanced in an ABBA design. In experiment 2, V.R. completed six blocks of 36 trials in an ABBAAB design. Each block always contained 16 bilateral, 8 unilateral left, and 8 unilateral right trials for a particular display type, plus 4 catch trials, all in a random order.
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In experiment 1, V.R. detected 12 out of 16 (12/16) unilateral left events and 15/16 unilateral right events of the inner type; and 15/16 unilateral left plus 16/16 unilateral right events of the outer type. She correctly reported the absence of any target event on all catch trials. In experiment 2, V.R. detected 23/24 unilateral left events and 24/24 unilateral right events for left-inner displays; and 24/24 unilateral events (left and right) for left-outer displays. For both display types in experiment 3, she detected 16/16 unilateral events (left and right), and made no false-positive responses on catch trials; likewise for experiment 4.
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The sequence of events in each trial was similar to that in experiments 1 through 4. A central fixation cross was displayed for 500 ms. This was replaced by a pictured cube (maximum height 10.8°, maximum width 14.6°) with perspective and shading cues constructed to yield a 3D shape. The "nearest" vertical edge of the cube appeared at the center of the screen, in line with fixation. One second later, a black horizontal bar appeared for 150 ms to the left or right of the cube (unilateral trials); or two bars appeared simultaneously for 150 ms on either side (bilateral trials, as illustrated); or no bars appeared (catch trials). The cube remained visible until V.R. reported whether there had been any bar on the right, left, both sides, or neither side. Each block of trials had the same structure as previously. The three display types were blocked in an ABCCBA order.
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For all three display types in experiment 5, V.R. detected every unilateral stimulus on the left and right and correctly reported the absence of any bars on all catch trials.
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We thank V.R. for her willing participation. J.B.M. was supported by a National Health and Medical Research Council (Australia) Neil Hamilton Fairley Fellowship, G.D. by the Biotechnology and Biological Sciences Research Council (UK), and J.D. by the Wellcome Trust (UK). We thank J. Bradshaw, J. Duncan, J. Pierson, I. Robertson, C. Rorden, and S. Tripathy for comments on the manuscript.
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