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Unawareness for Motor Impairment and Distorted Perception of Task Difficulty

Published online by Cambridge University Press:  24 August 2017

Gianna Cocchini ,
Nicoletta Beschin  and
Sergio Della Sala
Gianna Cocchini*
Affiliation:
Department of Psychology, Goldsmiths University of London, United Kingdom Blackheath Brain Injury Rehabilitation Centre and Neurodisability Service, London, United Kingdom
Nicoletta Beschin
Affiliation:
Clinical Neuropsychology Unit, Rehabilitation Department, Hospital S. Antonio Abate, Gallarate (Varese), Italy
Sergio Della Sala
Affiliation:
Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, United Kingdom
*
Correspondence and reprint requests to: Gianna Cocchini, Psychology Department, Goldsmiths University of London, New Cross, London SE14 6NW, UK. E-mail: [email protected]
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Abstract

Objectives: Anosognosia for motor impairment is a complex syndrome that can manifest itself under different forms, guiding patients’ behavior and task decisions. However, current diagnostic tools tend to evaluate only more explicit aspects of anosognosia (asking the patients about their motor abilities) and fail to address more subtle features of awareness. We have developed a new assessment measure, the ECT (Errand Choice Test), where patients are asked to judge task difficulty rather than estimate their own impairment. Methods: We assessed awareness in a group of 73 unilateral left- and right-brain damaged (30 LBD and 43 RBD, respectively) patients by means of the VATAm, which explicitly requires them to evaluate their own motor abilities, and the ECT. A control group of 65 healthy volunteers was asked to perform the ECT under two conditions: Current condition (i.e., using both hands) and Simulated conditions (i.e., simulating hemiplegia). Results: A total of 27% of the patients showed different performance on the VATAm and ECT, 21% of the patients showing lack of awareness only on VATAm and 6% only on ECT. Moreover, despite the ECT identified a higher frequency of anosognosia after RBD (33.3%) than LBD (27.6%), this hemispheric asymmetry was not significant. Remarkably, anosognosic patients performed very similarly to controls in the “current condition”, suggesting that anosognosic patients’ ability to perceive the complexity of each task per se is not altered. Conclusion: Different methods may be able to tackle different aspects of awareness and the ECT proved to be able to detect less evident forms of awareness. (JINS, 2018, 24, 45–56)

Keywords

AnosognosiaUnawarenessHemiplegiaAssessmentBrain damageImplicit
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 24 , Issue 1 , January 2018 , pp. 45 - 56
Copyright
Copyright © The International Neuropsychological Society 2017 

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References

REFERENCES

Albert, M.L. (1973). A simple test of visual neglect. Neurology, 23, 658–664.CrossRefGoogle ScholarPubMed
Appelros, P., Karlsson, G.M., & Hennerdal, S. (2007). Anosognosia versus unilateral neglect. Coexistence and their relations to age, stroke severity, lesion site and cognition. European Journal of Neurology, 14, 54–59.CrossRefGoogle ScholarPubMed
Appelros, P., Karlsson, G.M., Seiger, Å., & Nydevik, I. (2002). Neglect and anosognosia after first-ever stroke: Incidence and relationship to impairment and disability. Journal of Rehabilitation Medicine, 34, 215–220.CrossRefGoogle Scholar
Baier, B., & Karnath, H.-O. (2008). Tight link between our sense of limb ownership and self-awareness of actions. Stroke, 39, 486–488.CrossRefGoogle ScholarPubMed
Baier, B., Vucurevic, G., Müller-Forell, W., Glassl, O., Geber, C., Dieterich, M., & Karnath, H.-O. (2014). Anosognosia for hemiparesis after left-sided stroke. Cortex, 61, 120–126.CrossRefGoogle ScholarPubMed
Berti, A., Bottini, G., Gandola, M., Pia, L., Smania, N., Stracciari, A., & Paulesu, E. (2005). Shared cortical anatomy for motor awareness and motor control. Science, 309, 488–491.CrossRefGoogle ScholarPubMed
Berti, A., Làdavas, E., & Della Corte, M. (1996). Anosognosia for hemiplegia neglect dyslexia and drawing neglect: clinical findings and theoretical considerations. Journal of International Neuropsychological Society, 2, 426–440.CrossRefGoogle ScholarPubMed
Berti, A., Làdavas, E., Stracciari, A., Giannarelli, C., & Ossola, A. (1998). Anosognosia for motor impairment and dissociations with patients’ evaluation of the disorder: theoretical considerations. Cognitive Neuropsychiatry, 3, 21–44.Google Scholar
Beschin, N., & Robertson, I.H. (1997). Personal versus extrapersonal neglect: A group study of their dissociation using a reliable clinical test. Cortex, 33, 379–384.CrossRefGoogle Scholar
Bisiach, E., & Geminiani, G. (1991). Anosognosia related to hemiplegia and hemianopia. In G.P. Prigatano & D.L. Schacter (Eds.), Awareness of deficit after brain injury: Clinical and theoretical issues (pp. 17–39). New York: Oxford University Press.Google Scholar
Bisiach, E., Perani, D., Vallar, G., & Berti, A. (1986). Unilateral neglect: Personal and extra-personal. Neuropsychologia, 24, 759–767.CrossRefGoogle ScholarPubMed
Buchtel, H., Henry, T., & Abou-Khalil, B. (1992). Memory for neurological deficits during the intracarotid amytal procedure: A hemispheric difference. Journal of Clinical Experimental Neuropsychology, 14, 96–97.Google Scholar
Carpenter, K., Berti, A., Oxbury, S., Molyneux, A.J., Bisiach, E., & Oxbury, J.M. (1995). Awareness of and memory for arm weakness during intracarotid sodium amytal testing. Brain, 118, 243–251.CrossRefGoogle ScholarPubMed
Cocchini, G., & Della Sala, S. (2010). Assessing anosognosia for motor and language impairments. In G. Prigatano (Ed.), The study of anosognosia (pp. 123–144). New York: Oxford University Press.Google Scholar
Cocchini, G., Beschin, N., & Della Sala, S. (2002). Chronic anosognosia: A case report and theoretical account. Neuropsychologia, 40, 2030–2038.CrossRefGoogle ScholarPubMed
Cocchini, G., Beschin, N., & Jehkonen, M. (2001). The Fluff test: A simple task to assess body representation neglect. Neuropsychological Rehabilitation, 11, 17–31.CrossRefGoogle Scholar
Cocchini, G., Beschin, N., Cameron, A., Fotopoulou, A., & Della Sala, S. (2009b). Anosognosia for motor impairment following left-brain damage. Neuropsychology, 23, 223–230.CrossRefGoogle ScholarPubMed
Cocchini, G., Beschin, N., Fotopoulou, A., & Della Sala, S. (2010). Explicit and implicit anosognosia or upper limb motor impairment. Neuropsychologia, 48, 1489–1494.CrossRefGoogle ScholarPubMed
Cocchini, G., Gregg, N., Beschin, N., Dean, M., & Della Sala, S. (2009a). VATA-L: Visual-analogue test assessing anosognosia for language impairment. The Clinical Neuropsychologist, 8, 1379–1399.Google Scholar
Crawford, J.R., & Garthwaite, P.H. (2007). Comparison of a single case to a control or normative sample in neuropsychology: Development of a Bayesian approach. Cognitive Neuropsychology, 24, 343–372.CrossRefGoogle ScholarPubMed
Dean, M.P., Della Sala, S., Beschin, N., & Cocchini, G. (2017). Anosognosia and self-correction of naming errors in aphasia. Aphasiology, 31(7), 725–740.CrossRefGoogle Scholar
Della Sala, S., Cocchini, G., Beschin, N., & Cameron, A. (2009). VATAm: Visual-analogue test for anosognosia for motor impairment: A new test to assess awareness for motor impairment. The Clinical Neuropsychologist, 23, 406–427.CrossRefGoogle Scholar
Di Legge, S., Fang, J., Saposnik, G., & Hachinski, V. (2005). The impact of lesion side on acute stroke treatment. Neurology, 65, 81–86.CrossRefGoogle ScholarPubMed
D’Imperio, D., Bulgarelli, C., Bertagnoli, S., Avesani, R., & Moro, V. (2017). Modulating anosognosia for hemiplegia: The role of dangerous actions in emergent awareness. Cortex, 92, 187–203.CrossRefGoogle ScholarPubMed
Di Rosa, E., Mapelli, D., Arcara, G., Amodio, P., Tamburin, S., & Schiff, S. (2017). Aging and risky decision-making: New ERP evidence from the Iowa Gambling Task. Neuroscience Letters, 640, 93–98.CrossRefGoogle ScholarPubMed
Durkin, M.W., Meador, K.J., Nichols, M.E., Lee, G.P., & Loring, D.W. (1994). Anosognosia and the intracarotid amobarbital procedure (Wada Test). Neurology, 44, 978–979.CrossRefGoogle ScholarPubMed
Dywan, C., McGlone, J., & Fox, A. (1995). Do intracarotid barbiturate injections offer a way to investigate hemispheric models of anosognosia? Journal of Clinical and Experimental Neuropsychology, 17, 431–438.CrossRefGoogle Scholar
Feinberg, T.E. Anosognosia and confabulation. (1997). In T.E. Feinberg & M. Farah (Eds.), Behavioral neurology and neuropsychology (pp. 369–390). New York: McGraw-Hill.Google Scholar
Fotopoulou, A., Pernigo, S., Maeda, R., Rudd, A., & Kopelman, M.A. (2010). Implicit awareness in anosognosia for hemiplegia: Unconscious interference without conscious re-representation. Brain, 133, 3564–3577.CrossRefGoogle ScholarPubMed
Fotopoulou, A., Rudd, A., Holmes, P., & Kopelman, M. (2009). Self-observation reinstates motor awareness in anosognosia for hemiplegia. Neuropsychologia, 47(5), 1256–1260.CrossRefGoogle ScholarPubMed
Gainotti, G. (2005). Emotions, unconscious processes and the right hemisphere. Neuro-Psychoanalysis, 7, 71–81.Google Scholar
Gainotti, G., D’ Erme, P., Villa, G., & Caltagirone, C. (1986). Focal brain lesions and intelligence: a study with a new version of Raven’s Colored Matrices. Journal of Clinical and Experimental Neuropsychology, 8, 37–50.CrossRefGoogle ScholarPubMed
Garbarini, F., Rabuffetti, M., Piedimonte, A., Pia, L., Ferrarin, M., Frassinetti, F., & Berti, A. (2012). ‘Moving’ a paralysed hand: Bimanual coupling effect in patients with anosognosia for hemiplegia. Brain, 135, 1486–1497.CrossRefGoogle ScholarPubMed
Garbarini, F., Piedimonte, A., Dotta, M., Pia, L., & Berti, A. (2013). Dissociations and similarities in motor intention and motor awareness: the case of anosognosia for hemiplegia and motor neglect. Journal of Neurology, Neurosurgery, and Psychiatry, 84, 416–419.CrossRefGoogle ScholarPubMed
Gialanella, B., & Mattioli, F. (1992). Anosognosia and extrapersonal neglect as predictors of functional recovery following right hemisphere stroke. Neuropsychological Rehabilitation, 2, 169–178.CrossRefGoogle Scholar
Gialanella, B., Monguzzi, V., Santoro, R., & Rocchi, S. (2005). Functional recovery after hemiplegia in patients with neglect: The rehabilitative role of anosognosia. Stroke, 36, 2687–2690.CrossRefGoogle ScholarPubMed
Gilmore, R.L., Heilman, K.M., Schmidt, R.P., Fennell, E.M., & Quisling, R. (1992). Anosognosia during Wada testing. Neurology, 42, 925–927.CrossRefGoogle ScholarPubMed
Grotta, J., & Bratina, P. (1995). Subjective experiences of 24 patients dramatically recovering from stroke. Stroke, 26, 1285–1288.CrossRefGoogle ScholarPubMed
Hartman-Maeir, A., Soroker, N., & Katz, N. (2001). Anosognosia for hemiplegia in stroke rehabilitation. Neurorehabilitation and Neural Repair, 15, 213–222.CrossRefGoogle ScholarPubMed
Hartman-Maeir, A., Soroker, N., Oman, S.D., & Katz, N. (2003). Awareness of disabilities in stroke rehabilitation- A clinical trial. Disability and Rehabilitation, 25, 35–44.CrossRefGoogle ScholarPubMed
Hartman-Maeir, A., Soroker, N., Ring, H., & Katz, N. (2002). Awareness of deficits in stroke rehabilitation. Journal of Rehabilitation Medicine, 34, 158–164.CrossRefGoogle ScholarPubMed
Heilman, K.M. (2014). Possible mechanisms of anosognosia of hemiplegia. Cortex, 61, 30–42.CrossRefGoogle ScholarPubMed
Hibbard, M.R., Stein, P.S., Gordon, W.A., & Sliwinski, M. (1992). Structured assessment of depression in brain damaged individuals (SADBD): administration and scoring manual. New York: Mt Sinai Center.Google Scholar
House, A., & Hodges, J.R. (1988). Persistent denial of handicap after infarction of the right basal ganglia: A case study. Journal of Neurology, Neurosurgery, and Psychiatry, 51, 112–115.CrossRefGoogle ScholarPubMed
Jenkinson, P.M., Preston, C., & Ellis, S.J. (2011). Unawareness after stroke: A review and practical guide to understanding, assessing, and managing anosognosia for hemiplegia. Journal of Clinical and Experimental Neuropsychology, 33(10), 1079–1093.CrossRefGoogle ScholarPubMed
Kaplan, R.F., Meadows, M.E., Cohen, R.A., Bromfield, E.B., & Ehrenberg, B.L. (1993). Awareness of deficit after the sodium amobarbital (Wada) test. Journal of Clinical Experimental Neuropsychology, 15, 383.Google Scholar
Kaplan-Solms, K.L., & Solms, M. (2000). Clinical Studies in Neuropsychoanalysis: Introduction of a Depth Neuropsychology. London: Karnac Books.Google Scholar
Karnath, H.O., Baier, B., & Nägele, T. (2005). Awareness of the functioning of one’s own limbs mediated by the insular cortex? Journal of Neuroscience, 25, 7134–7138.CrossRefGoogle ScholarPubMed
Katz, S., Ford, A.B., Moskowitz, R.W., Jackon, B.A., & Jaffe, M.W. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185, 914–919.CrossRefGoogle Scholar
Lu, L.H., Barrett, A.M., Schwartz, R.L., Cibula, J.E., Gilmore, R.L., Uthman, B.M., & Heilman, K.M. (1997). Anosognosia and confabulation during the Wada test. Neurology, 49, 1316–1322.CrossRefGoogle ScholarPubMed
Maeshima, S., Dohi, N., Funahashi, K., Nakai, K., Itakura, T., & Komai, N. (1997). Rehabilitation of patients with anosognosia for hemiplegia due to intracerebral haemorrhage. Brain Injury, 11, 691–697.Google ScholarPubMed
Mahoney, F.I., & Barthel., D.W. (1965). Functional evaluation: The Barthel index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Marcel, A., Tegnér, R., & Nimmo-Smith, I. (2004). Anosognosia for plegia: Specificity, extension, partiality and disunity of bodily unawareness. Cortex, 40, 19–40.CrossRefGoogle ScholarPubMed
Marková, I.S., & Berrios, G.E. (2014). The construction of anosognosia: History and implications. Cortex, 61, 9–17.CrossRefGoogle ScholarPubMed
Mograbi, D., & Morris, R.G. (2013). Implicit awareness in anosognosia: clinical observations, experimental evidence, and theoretical implications. Cognitive Neuroscience, 4, 181–197.CrossRefGoogle ScholarPubMed
Morin, A. (2007). Self-awareness and the left hemisphere: The dark side of selectively reviewing the literature. Cortex, 43, 1068–1073.CrossRefGoogle ScholarPubMed
Morin, A. (2017). The “self-awareness–anosognosia” paradox explained: How can one process be associated with activation of, and damage to, opposite sides of the brain? Laterality: Asymmetries of Body, Brain and Cognition, 22(1), 105–119.CrossRefGoogle Scholar
Moro, V., Pernigo, S., Zapparoli, P., Cordioli, Z., & Aglioti, S.M. (2011). Phenomenology and neural correlates of implicit and emergent motor awareness in patients with anosognosia for hemiplegia. Behavioural Brain Research, 225, 259–269.CrossRefGoogle ScholarPubMed
Moro, V., Pernigo, S., Tsakiris, M., Avesani, R., Edelstyn, N.M.J., Jenkinson, P.M., & Fotopoulou, A. (2016). Motor versus body awareness: Voxel-based lesion analysis in anosognosia for hemiplegia and somatoparaphrenia following right hemisphere stroke. Cortex, 83, 62–77.CrossRefGoogle ScholarPubMed
Moro, V., Scandola, M., Bulgarelli, C., Avesani, R., & Fotopoulou, A. (2015). Error-based training and emergent awareness in anosognosia for hemiplegia. Neuropsychological Rehabilitation, 25(4), 593–616.CrossRefGoogle ScholarPubMed
Nardone, I.B., Ward, R., Fotopoulou, A., & Turnbull, O.H. (2007). Attention and emotion in anosognosia: Evidence of implicit awareness and repression? Neurocase, 13, 438–445.CrossRefGoogle ScholarPubMed
Nathanson, M., Bergman, P.S., & Gordon, C.G. (1952). Denial of illness: Its occurrence in one hundred consecutive cases of hemiplegia. Archives of Neurology and Psychiatry, 68, 380–387.CrossRefGoogle ScholarPubMed
Nurmi, M.E., & Jehkonen, M. (2014). Assessing anosognosias after stroke: A review of the methods used and developed over the past 35 years. Cortex, 61, 43–63.CrossRefGoogle Scholar
Orfei, M.D., Robinson, R.G., Prigatano, G.P., Starkstein, S., Rüsch, N., Bria, P., Caltagirone, C., & Spalletta, G. (2007). Anosognosia for hemiplegia after stroke is a multifaceted phenomenon: a systematic review of the literature. Brain, 130, 3075–3090.CrossRefGoogle ScholarPubMed
Palmer, E.C., & David, A.S. (2013). More work on lack of awareness and insight in healthy people and psychiatric patients will assist model building. Cognitive Neuroscience, 4, 206–207.CrossRefGoogle ScholarPubMed
Pazzaglia, M., Pizzamiglio, L., Pes, E., & Aglioti, S.M. (2008). The sound of actions in apraxia. Current Biology, 18, 1766–1772.CrossRefGoogle ScholarPubMed
Pia, L., Neppi-Modona, M., Ricci, R., & Berti, A. (2004). The anatomy of anosognosia for hemiplegia: A meta-analysis. Cortex, 40(2), 367–377.CrossRefGoogle ScholarPubMed
Pia, L., Spinazzola, L., Rabuffetti, M., Ferrarin, M., Garbarini, F., Piedimonte, A., & Berti, A. (2013). Temporal coupling due to illusory movements in bimanual actions: Evidence from anosognosia for hemiplegia. Cortex, 49, 1694–1703.CrossRefGoogle ScholarPubMed
Piedimonte, A., Garbarini, F., Rabuffetti, M., Pia, L., Montesano, A., Ferrarin, M., & Berti, A. (2015). Invisible grasps: Grip interference in anosognosia for hemiplegia. Neuropsychology, 29(5), 776–781.CrossRefGoogle ScholarPubMed
Preston, C., Jenkinson, P.M., & Newport, R. (2010). Anosognosia for hemiplegia as a global deficit in motor awareness: evidence from the non-paralysed limb. Neuropsychologia, 48, 3443–3450.CrossRefGoogle ScholarPubMed
Prigatano, G.P. (2014). Anosognosia and patterns of impaired self-awareness observed in clinical practice. Cortex, 61, 81–92.CrossRefGoogle ScholarPubMed
Prigatano, G.P., & Weinstein, E.A. (1996). Edwin A. Weinstein’s contributions to neuropsychological rehabilitation. Neuropsychological Rehabilitation, 6, 305–326.CrossRefGoogle Scholar
Ramachandran, V.S. (1995). Anosognosia in parietal lobe syndrome. Consciousness and Cognition, 4(1), 22–51.CrossRefGoogle ScholarPubMed
Ramachandran, V.S., & Blakeslee, S. (1998). Phantoms in the brain: The sound of one hand clapping. New York: William and Co.Google Scholar
Ramachandran, V.S., & Rogers-Ramachandran, D. (1996). Denial of disabilities in anosognosia. Nature, 382, 501.CrossRefGoogle ScholarPubMed
Spinnler, H., & Tognoni, G. (1987). Standardizzazione e taratura italiana di test neuropsicologici. The Italian Journal of Neurological Sciences, 6(Suppl 8).Google Scholar
Starkstein, S.E., Jorge, R., Mizrahi, R., Adrian, J., & Robinson, R.G. (2007). Insight and danger in Alzheimer’s disease. European Journal of Neurology, 14, 455–460.CrossRefGoogle ScholarPubMed
Turnbull, O.H., Fotopoulou, A., & Solms, M. (2014). Anosognosia as motivated unawareness: the ‘defence’ hypothesis revisited. Cortex, 61, 18–29.CrossRefGoogle ScholarPubMed
Turnbull, O.H., Jones, K., & Reed-Screen, J. (2002). Implicit awareness of deficit in anosognosia? An emotionbased account of denial of deficit. Neuropsychoanalysis, 4, 69–86.CrossRefGoogle Scholar
Vocat, R., Staub, F., Stroppini, T., & Vuilleumier, P. (2010). Anosognosia for hemiplegia: A clinical-anatomical prospective study. Brain, 133, 3578–3597.CrossRefGoogle ScholarPubMed
Wade, D.T. (1992). Measurement in neurological rehabilitation. Oxford: Medical Publications.Google ScholarPubMed
Wilson, B.A., Cockburn, J., & Halligan, P. (1987). Behavioural inattention test. Flempton: Thames Valley Test Company.Google Scholar