NEUROPSYCHOLOGY OF VISUAL-SPATIAL PROCESSES School-Neuropsychology Post-Graduate Certification Program 1 Presented By Robb Matthews, PhD, LSSP, HSPP, NCSP October 15, 2016 THIS COMPILED LECTURE MATERIAL IS COPYRIGHTED BY KIDS, INC. AND CANNOT BE USED IN ANY FORM OUTSIDE OF THE KIDS, INC. S SCHOOL NEUROPSYCHOLOGY POST-GRADUATE CERTIFICATION PROGRAM OR THE SCHOOL NEUROPSYCHOLOGY ALUMNI CONNECTION BLACKBOARD SITE WITHOUT THE EXPRESS WRITTEN CONSENT FROM KIDS, INC. 2 Copyright KIDS, Inc. 1
OUTLINE Visual Cortex Neuroanatomy Striate visual cortex Extrastriate cortex Dorsal and ventral streams Ventral Stream Damage Dorsal Stream Damage Visual-Spatial Processing subcomponents within a school neuropsychological model 3 4 Copyright KIDS, Inc. 2
5 6 Copyright KIDS, Inc. 3
7 8 Copyright KIDS, Inc. 4
9 OUTLINE Neuroanatomy of the visual cortex Striate visual cortex Extrastriate cortex Dorsal and ventral streams Ventral Stream Damage Dorsal Stream Damage Visual-Spatial Processing Subcomponents within a school neuropsychological model 10 Copyright KIDS, Inc. 5
VISUAL CORTEX WITHIN THE OCCIPITAL LOBE The striate cortex is indicated in red. The striate cortex is the initial projection area within the occipital lobe for perception. (Luria s primary zone) Functions include: perception of color, sensitivity to contrast, ability to detect fine details, and temporal (time) resolution. VISUAL CORTEX WITHIN THE OCCIPITAL LOBE The striate cortex Copyright KIDS, Inc. 6
VISUAL CORTEX WITHIN THE OCCIPITAL LOBE OUTLINE Neuroanatomy of the visual cortex Striate visual cortex Extrastriate cortex Dorsal and ventral streams Damage to the ventral stream Damage to the dorsal stream Visual-Spatial Processing Subcomponents within a school neuropsychological model 14 Copyright KIDS, Inc. 7
VISUAL CORTEX WITHIN THEOCCIPITAL LOBE The extrastriate cortex is colored in yellow and orange. Neurons in the striate cortex send axons to the extrastriate cortex, where perception of objects takes place. (Luria s secondary zone). 15 The visual cortex can be divided into smaller regions (Brodemann Areas) that have known specific functions (e.g., V8 - color perception, LO - object recognition, V7 - visual attention). 16 Copyright KIDS, Inc. 8
BRODEMANN 17 17 OUTLINE Neuroanatomy of the visual cortex Striate visual cortex Extrastriate cortex Dorsal and ventral streams Ventral Stream Damage Dorsal Stream Damage Visual-Spatial Processing Subcomponents within a school neuropsychological model 18 Copyright KIDS, Inc. 9
DORSAL AND VENTRAL STREAMS Both the what and the where aspects of visual perception are important. 19 TWO STREAMS OF VISUAL ANALYSIS Dorsal stream ascends to the posterior parietal cortex recognizes where the object is located and whether it is moving. Occipital-parietal pathway. Functions include: perception of movement, location, visual attention, and control of eye and hand movements. Ventral stream moves forward to the inferior temporal cortex recognizes what an object is and what color it has. Occipital-temporal pathway. Functions include: perception of objects 20 Copyright KIDS, Inc. 10
VISUAL CORTEX WITHIN THE OCCIPITAL LOBE OUTLINE Neuroanatomy of the visual cortex Striate visual cortex Extrastriate cortex Dorsal and ventral streams Ventral Stream Damage Dorsal Stream Damage Visual-Spatial Processing Subcomponents within a school neuropsychological model 22 Copyright KIDS, Inc. 11
PROSOPAGNOSIA Failure to recognize faces, including close friends or relatives 23 Fusiform Cortex Fusiform gyrus is the colorized area with the fusiform face area denoted in green The development of this region may be a result of extensive experience looking at faces. The fusiform face area is underdeveloped in people with autism, potentially resulting from/in insufficient motivation to become an expert in recognizing people s faces. 24 Copyright KIDS, Inc. 12
VENTRAL STREAM DAMAGE Two forms of visual agnosia or impaired ability to recognize visual information: Associative visual agnosia - characterized by relatively good object perception and the but the inability to recognize what is perceived. AKA Recognition without meaning. May result from damage to axons connecting the visual association cortex with regions of the brain used for verbalization and thinking in words. Children with this disorder can copy drawings, but not produce them from memory Children with this disorder can describe or mime actions appropriate to the objects they see, but cannot recognize them. 25 VENTRAL STREAM DAMAGE Apperceptive visual agnosia - a visual impairment that results in inability to name objects while still able to describe details and recognize objects by touch. While able to effectively allocate attention to locate the object and perceive the parts, these individuals are unable to group the parts together and name the object accurately. Deficits seem to occur because of damage to early-level perceptual processing 26 Copyright KIDS, Inc. 13
OUTLINE Neuroanatomy of the visual cortex Striate visual cortex Extrastriate cortex Dorsal and ventral streams Ventral stream damage Dorsal stream damage Visual-Spatial Processing Subcomponents within a school neuropsychological model 27 DORSAL STREAM ACTIVATION DURING MENTAL ROTATION - AN FMRI STUDY. Dr Gary Egan, Howard Florey Institute in collaboration with Associate Professor John Watson and Ms Katherine Podzebenko, University of Sydney. 10 adults were instructed to determine whether alphanumeric characters were normal or mirror-reversed. A bilateral dorsal stream in the intraparietal region was noted to activate. Egan and colleagues identified right hemispheric dominance was more prominent. 28 Copyright KIDS, Inc. 14
SIMULTANAGNOSIA A patient with dorsal simultanagnosia may report only one of the four items contained in the image to the left, and disregard the rest. 29 Other Symptoms of Balint's syndrome Optic Ataxia -difficulty reaching for objects with visual guidance Ocular Apraxia -deficit in visual scanning 30 Copyright KIDS, Inc. 15
OUTLINE Neuroanatomy of the visual cortex Striate visual cortex Extrastriate cortex Dorsal and ventral streams Ventral stream damage Dorsal stream damage Visuospatial Processing Subcomponents within the Integrated SNP/CHC Model 31 INTEGRATED SNP/CHC MODEL AND VISUOSPATIAL PROCESSES Facilitators/ Allocating and Working Speed and Efficiency Inhibitors Maintaining Attention Memory of Cognitive Processing Cognitive Processes: Visuospatial Auditory Learning and Memory Executive Acquired Knowledge: Acculturation Knowledge Language Abilities Reading Achievement Written Language Achievement Mathematics Achievement Basic Sensorimotor Sensory Fine Motor Visual-Motor Visual Gross Motor Capabilities: Functions Functions Integration Skills Scanning Functions Social-Emotional, Cultural, and Environmental Factors 32 Copyright KIDS, Inc. 16
VISUAL-SPATIAL PROCESSING SUBCOMPONENTS Subcomponent Area of the Conceptual Model Visual Attention Allocating and maintaining attention facilitators/ inhibitors Visual-Motor Integration Sensory-motor functions Visual-Motor Planning Executive processes Visual (Spatial) Memory Learning and memory processes Visual Spatial Perception This section Visual Spatial Reasoning This section Visual Scanning / Tracking Sensory-motor functions 33 INTEGRATED SNP/CHC MODEL: VISUOSPATIAL PROCESSES Broad Classification Visuospatial processes 2 nd Order Classification Visual spatial perception Visual spatial reasoning 3 rd Order Classification Visual discrimination and spatial localization Visual-motor constructions Qualitative behaviors Recognizing spatial configurations Visual gestalt closure Visuospatial analyses with and without mental rotations 34 Copyright KIDS, Inc. 17
IMPACT OF VISUOSPATIAL PROCESSING DEFICITS A visuospatial processing disorder it can severely impact learning potential and social functioning. Reading and math both rely heavily on the use of symbols and accurate visual perception is vital. 35 IMPACT OF VISUOSPATIAL PROCESSING DEFICITS Writing also has a large visuospatial component. Students with visual perception problems may have difficulties with directionality, letter and number reversals, handwriting spacing, discriminating shapes from a whiteboard, recognizing missing details within a partial visual object (visual closure), etc. these issues can impact the ability to copy information between planes and/or complete information matching tasks 36 Copyright KIDS, Inc. 18
IMPACT OF VISUOSPATIAL PROCESSING DEFICITS Visual perceptual difficulties may manifest in social problems due to difficulties recognizing nonverbals cues such as facial expressions gestures, eye contact, posture, etc. Visual Problems Some may be related acuity problems that can be addressed by corrective lenses. Some may be perceptual in nature and require consultation with a developmental ophthalmologist. 37 MEASURES OF VISUOSPATIAL PERCEPTION Selected Subtest: Description Range Visual Discrimination and Spatial Localization NEPSY-II - Arrows Total: Two arrows from many are chosen by letter label, which are thought to point to the center of the target. 5 to 16 years NEPSY-II - Picture Puzzles Total: A large picture divided by a grid with four smaller pictures taken from sections of the larger picture is presented. The student identifies the location on the grid of the larger picture from which each of the smaller pictures was taken. 7 to 16 years NEPSY-II - Route Finding Total: A schematic map with a target house is presented and the student is asked to find that house in a larger map with other houses and streets. TVPS-3 - Visual Discrimination: Matching a target design among a set of designs on the same page. 5 to 12 years 4-0 to 18-11 years 38 Copyright KIDS, Inc. 19
MEASURES OF VISUOSPATIAL PERCEPTION Selected Subtest: Description Visual Motor Constructions DAS-II - Pattern Construction: Imitating constructions made by the examiner with wooden blocks, colored tiles, or patterned cubes. KABC-II Triangles: Recreating shapes that were modeled by examiner. NEPSY-II - Block Construction Total: Reproducing 3-dimensional constructions from models or 2- dimensional drawings under time constraints. WISC-V - Block Design: Re-creation of a constructed model or a picture of a block design within a specified time limit. WNV - Object Assembly: Putting puzzle pieces together to form a meaningful whole. Range 2-6 to 17-11 years 3-0 to 18-0 years 3 to 16 years 6 to 16-11 years 4-0 to 21-11 years 39 MEASURES OF VISUOSPATIAL REASONING Selected Subtest: Description Range Recognizing Spatial Configurations DAS-II - Matching Letter-Like Forms: Multiple-choice matching of shapes that are similar to letters. KABC-II - Block Counting: Counting 3-dimensional cubes. 2-6 to 8-11 years 3 to 18 years TVPS-3 - Spatial Relationships: Choosing one design that is different from the rest. 4 to 18-11 years 40 Copyright KIDS, Inc. 20
MEASURES OF VISUOSPATIAL REASONING Selected Subtest: Description Range Visual Gestalt Closure KABC-II - Gestalt Closure: Figuring out what a picture is when it has been partially erased or obscured. RIAS - What s Missing: Naming a missing part of a visual picture. TVPS-3 - Visual Closure: Matching an incomplete pattern with a completed design. TVPS-3 - Visual Figure-Ground: Finding one design among many within a complex background. 3 to 18 years 3 to 94 years 4 to 18-11 years WISC-V - Picture Completion: Naming a missing part of a visual picture. 6 to 16-11 years WJIV-ECAD - Visual Closure (Gv): Verbally naming a drawing or picture that has been altered in some way. 2-7 to 7- years 8-9 with ID 41 MEASURES OF VISUOSPATIAL REASONING Test Subtest: Description Age/Grade Range Visuospatial Analyses with/without Mental Rotations NEPSY-II - Geometric Puzzles Total: A picture of a large grid containing several shapes is presented, then the student matches two shapes outside of the grid to two shapes within the grid. SB5 - Nonverbal Visuospatial Processing: Ability to identify, analyze, and mentally rotate or assemble visual images, geometric shapes, or natural objects occurring in spatial arrangements. TVPS-3 - Form Constancy: Finding a design embedded within another object. 3 to 16 years 2 to 85+ years 4 to 18-11 years WRAVMA Matching: Looking at a visual "standard" and select the option that "goes best" with it. 3 to 17 years 42 Copyright KIDS, Inc. 21
MAJOR REFERENCES Blumfled, H. (2010). Neuroanatomy Through Clinical Cases 2 nd edition. Sunderland, MA: Sinauer Associates. Carlson, N. R. (2007). Physiology of Behavior 6 th edition. Boston, MA: Allyn and Bacon. Hale, J. B., and Fiorello, C. A. (2007). School Neuropsychology: A Practitioners Handbook. New York: The Guilford Press. Miller, D. C. (2013). Essentials of school neuropsychological assessment 2 nd edition. Hoboken, NJ: Wiley. 43 Copyright KIDS, Inc. 22