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      Anosognosia for Motor Impairment Following Left Brain Damage

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          Abstract

          Anosognosia for motor impairment has been linked to lesions of the right hemisphere. However, left hemisphere damaged patients have often been excluded from investigation because of their associated language deficits. In this study we assessed anosognosia for motor disorders in a group of left hemisphere damaged patients using 2 tools that assess the presence of unawareness—a structured interview that is a common method of assessment of anosognosia in clinical settings, and a new tool, the Visual-Analogue Test for Anosognosia for Motor Impairment (VATAm; Della Sala, Cocchini, Beschin, & Cameron, in press). The structured interview relies heavily on language and enquires about general motor ability whereas the VATAm is less dependent on language abilities and enquires about specific motor tasks. Results suggest that the frequency of anosognosia in left brain damaged patients may have been underestimated due to methodological reasons, and that anosognosia for motor impairment can also be associated with lesions of the left hemisphere.

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          Most cited references25

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          When the brain loses its self: prefrontal inactivation during sensorimotor processing.

          A common theme in theories of subjective awareness poses a self-related "observer" function, or a homunculus, as a critical element without which awareness can not emerge. Here, we examined this question using fMRI. In our study, we compared brain activity patterns produced by a demanding sensory categorization paradigm to those engaged during self-reflective introspection, using similar sensory stimuli. Our results show a complete segregation between the two patterns of activity. Furthermore, regions that showed enhanced activity during introspection underwent a robust inhibition during the demanding perceptual task. The results support the notion that self-related processes are not necessarily engaged during sensory perception and can be actually suppressed.
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            Awareness of the functioning of one's own limbs mediated by the insular cortex?

            Normally, we are aware of the current functions of our arms and legs. However, this self-evident status may change dramatically after brain damage. Some patients with "anosognosia" typically are convinced that their limbs function normally, although they have obvious motor defects after stroke. Such patients may experience their own paretic limbs as strange or as not belonging to them and may even attribute ownership to another person and try to push their paralyzed limb out of bed. These odd beliefs have been attributed to disturbances somewhere in the right hemisphere. Here, we use lesion mapping in 27 stroke patients to show that the right posterior insula is commonly damaged in patients with anosognosia for hemiplegia/hemiparesis but is significantly less involved in hemiplegic/hemiparetic patients without anosognosia. The function of the posterior insular cortex has been controversially discussed. Recent neuroimaging results in healthy subjects revealed specific involvement of this area in the subject's feeling of being versus not being involved in a movement. Our finding corresponds with this observation and suggests that the insular cortex is integral to self-awareness and to one's beliefs about the functioning of body parts.
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              Raven's coloured progressive matrices: normative values on 305 adult normal controls.

              The use of Raven's Coloured Progressive Matrices (PM 47) in experiments with brain-damaged patients is briefly reviewed. Because norms for adults are still not available, normative data were calculated on 305 normals; corrections for age and education and centile allocation of the scores are furnished.
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                Author and article information

                Journal
                Neuropsychology
                Neuropsychology
                American Psychological Association
                0894-4105
                1931-1559
                March 2009
                : 23
                : 2
                : 223-230
                Affiliations
                [1 ]Psychology Department, Goldsmiths University of London
                [2 ]Dipartimento di Riabilitazione, Azienda Ospedaliera S. Antonio Abate Gallarate, Italy
                [3 ]Aberdeen Royal Infirmary, Scotland
                [4 ]Institute of Psychiatry, King's College, University of London
                [5 ]Human Cognitive Neuroscience, Psychology, University of Edinburgh
                Author notes
                Correspondence concerning this article should be addressed to Gianna Cocchini, Department of Psychology, Goldsmiths University of London, London SE14 6NW, England E-mail: g.cocchini@ 123456gold.ac.uk
                Article
                neu_23_2_223 2009-02621-010
                10.1037/a0014266
                2672046
                19254095
                ca2de4c1-6f0e-4474-be76-c4d4e036af98
                © 2009 American Psychological Association.

                This article, manuscript, or document is copyrighted by the American Psychological Association (APA). For non-commercial, education and research purposes, users may access, download, copy, display, and redistribute this article or manuscript as well as adapt, translate, or data and text mine the content contained in this document. For any such use of this document, appropriate attribution or bibliographic citation must be given. Users should not delete any copyright notices or disclaimers. For more information or to obtain permission beyond that granted here, visit http://www.apa.org/about/copyright.html.

                History
                : 6 September 2007
                : 17 July 2008
                : 18 August 2008
                Categories
                Articles

                Clinical Psychology & Psychiatry
                anosognosia,left hemisphere,motor deficit,aphasia,unawareness
                Clinical Psychology & Psychiatry
                anosognosia, left hemisphere, motor deficit, aphasia, unawareness

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