Brain and Cognition 59 (2005) 215–224 www.elsevier.com/locate/b&c 0278-2626/$ - see front matter  2005 Elsevier Inc. All rights reserved. doi:10.1016/j.bandc.2005.06.003 Poor hand-pointing to sounds in right brain-damaged patients: Not just a problem of spatial-hearing Francesco Pavani a,¤ , Alessandro Farné b,d , Elisabetta Làdavas c,d a Dipartimento di Scienze della Cognizione e della Formazione, Università degli Studi di Trento, Rovereto, Italy b Espace et Action, UMR-S 534, INSERM and Université Claude Bernard, Bron, France c Dipartimento di Psicologia, Università degli Studi di Bologna, Bologna, Italy d CSRNC, Centro Studi e Ricerche in Neuroscienze Cognitive, Cesena, Italy Accepted 1 June 2005 Available online 19 August 2005 Abstract We asked 22 right brain-damaged (RBD) patients and 11 elderly healthy controls to perform hand-pointing movements to free- Weld unseen sounds, while modulating two non-auditory variables: the initial position of the responding hand (left, centre or right) and the presence or absence of task-irrelevant ambient vision. RBD patients suVering from visual neglect, unlike RBD patients with- out neglect and healthy controls, showed a systematic rightward error in sound localisation, which was modulated by the non-audi- tory variables. Localisation errors were exacerbated by initial hand-position to the right of the body-midline, and reduced by the leftwards initial hand-position. Moreover, for the visual neglect patients, mere presence of ambient vision worsened localisation errors. These results demonstrate that although hand-pointing to sounds has often been considered a straightforward approach to investigate sound-localisation abilities in brain-damaged patients, in some patients it may actually reveal localisation deWcits that reXect a combination of impaired spatial-hearing and spatial biases from other sensory modalities (i.e., vision and proprioception).  2005 Elsevier Inc. All rights reserved. Keywords: Spatial-hearing; Stroke; Right-hemisphere lesion; Visual neglect; Sound localisation; Multisensory integration; Hand-pointing; Proprio- ception 1. Introduction Hand-pointing to sounds is one of the most com- monly used tasks when investigating sound-localisation abilities in patients who suVered brain lesions (e.g., Bisiach, Cornacchia, Sterzi, & Vallar, 1984; Cornelisse & Kelly, 1987; Clarke, Bellman, Meuli, Assal, & Steck, 2000; Pavani, Farné, & Làdavas, 2003; Pinek & Brouchon, 1992; Pinek, Duhamel, Cavé, & Brouchon, 1989; RuV, Hersch, & Pribram, 1981; Sanchez-Longo & Forster, 1958). In the typical setting, the patient sits in the centre of a semicircle of speakers and is required to indicate the origin of a delivered sound with a pointing movement of the dominant hand. Performance of brain- damaged patients in this type of task is usually less accurate compared to healthy controls, with the largest localisation errors often being reported for brain-dam- aged patients with lesions in the right hemisphere (e.g., Bisiach et al., 1984; RuV et al., 1981). Contrary to its apparent ease, however, hand-pointing to sounds is a computationally complex task for the brain. Spatial information about the target sound and the responding-hand have to be combined across diVerent senses and reference frames (Cohen & Andersen, 2002). The spatial position of the sound (speciWed through hear- ing and initially coded with respect to the head; e.g., see Blauert, 1983) must be reconciled with the spatial coordi- nates of the starting position of the responding hand * Corresponding author. Fax: +39 0464 483554. E-mail address: francesco.pavani@unitn.it (F. Pavani).