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Conceptual- and production-related predictors of pantomimed tool use deficits in apraxia.

ABSTRACT: Apraxia following left hemisphere stroke disrupts pantomimed tool use (PTU), a task that requires the integrity of a number of cognitive and motor processes. Although previous studies have identified that apraxics have deficits in (1) the integrity of/access to stored tool-use gesture representations, (2) deficits in intrinsic (body-based) coordinate control, and (3) abnormal reliance on visual feedback, no study to date has simultaneously tested the relative contribution of these three deficits to poor PTU performance. In this study we assessed 38 chronic left hemisphere stroke survivors on tests of PTU and the 3 component processes. We then attempted to predict PTU with the component scores using hierarchical regression to control for overall stroke severity and the possibility of correlated component scores. Results showed that over half of the variability in PTU was predictable, with the strongest independent predictor being a test of intrinsic coordinate control without visual feedback. A test of the integrity of/access to stored representations also predicted PTU. These results confirm and extend previous claims that conceptual- and production-related factors affect PTU, even after considering that deficits in both factors are commonly observed to varying degrees in apraxic patients.

SUBMITTER: Jax SA

PROVIDER: S-EPMC4167573 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Conceptual- and production-related predictors of pantomimed tool use deficits in apraxia.

Jax S A SA Rosa-Leyra D L DL Buxbaum L J LJ

Neuropsychologia 20140805

Apraxia following left hemisphere stroke disrupts pantomimed tool use (PTU), a task that requires the integrity of a number of cognitive and motor processes. Although previous studies have identified that apraxics have deficits in (1) the integrity of/access to stored tool-use gesture representations, (2) deficits in intrinsic (body-based) coordinate control, and (3) abnormal reliance on visual feedback, no study to date has simultaneously tested the relative contribution of these three deficits ...[more]

PMID: 25107676

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Project description:Pantomime has a long tradition in clinical neuropsychology of apraxia. It has been much more used by researchers and clinicians to assess tool-use disorders than real tool use. Nevertheless, it remains incompletely understood and has given rise to controversies, such as the involvement of the left inferior parietal lobe or the nature of the underlying cognitive processes. The present article offers a comprehensive framework, with the aim of specifying the neural and cognitive bases of pantomime. To do so, we conducted a series of meta-analyses of brain-lesion, neuroimaging and behavioural studies about pantomime and other related tasks (i.e. real tool use, imitation of meaningless postures and semantic knowledge). The first key finding is that the area PF (Area PF complex) within the left inferior parietal lobe is crucially involved in both pantomime and real tool use as well as in the kinematics component of pantomime. The second key finding is the absence of a well-defined neural substrate for the posture component of pantomime (both grip errors and body-part-as-tool responses). The third key finding is the role played by the intraparietal sulcus in both pantomime and imitation of meaningless postures. The fourth key finding is that the left angular gyrus seems to be critical in the production of motor actions directed towards the body. The fifth key finding is that performance on pantomime is strongly correlated with the severity of semantic deficits. Taken together, these findings invite us to offer a neurocognitive model of pantomime, which provides an integrated alternative to the two hypotheses that dominate the field: The gesture-engram hypothesis and the communicative hypothesis. More specifically, this model assumes that technical reasoning (notably the left area PF), the motor-control system (notably the intraparietal sulcus), body structural description (notably the left angular gyrus), semantic knowledge (notably the polar temporal lobes) and potentially theory of mind (notably the middle prefrontal cortex) work in concert to produce pantomime. The original features of this model open new avenues for understanding the neurocognitive bases of pantomime, emphasizing that pantomime is a communicative task that nevertheless originates in specific tool-use (not motor-related) cognitive processes. <Please insert Graphical abstract here>.

Project description:In neurological patients, a lack of insight into their impairments can lead to possibly dangerous situations and non-compliance in rehabilitation therapy with worse rehabilitation outcomes as a result. This so called anosognosia is a multifaceted syndrome that can occur after brain damage affecting different neurological or cognitive functions. To our knowledge no study has investigated anosognosia for apraxia of common tool-use (CTU) so far. CTU-apraxia is a disorder frequently occurring after stroke that affects the use of familiar objects. Here, we introduce a new questionnaire to diagnose anosognosia for CTU-apraxia, the Visual Analogue Test assessing Anosognosia for Naturalistic Action Tasks (VATA-NAT). This assessment is adapted from a series of VATA-questionnaires that evaluate insight into motor (VATA-M) or language (VATA-L) impairment and take known challenges such as aphasia into account. Fifty one subacute stroke patients with left (LBD) or right (RBD) brain damage were investigated including patients with and without CTU-apraxia. Patients were assessed with the VATA-L, -M and -NAT before and after applying a diagnostics session for each function. Interrater reliability, composite reliability as well as convergent and divergent validity were evaluated for the VATA-NAT. Seven percent of the LBD patients with CTU-apraxia demonstrated anosognosia. After tool-use diagnostics this number increased to 20 percent. For the VATA-NAT, psychometric data revealed high interrater-reliability (τ ≥ 0.828), composite reliability (CR ≥ 0.809) and convergent validity (τ = -0.626). When assessing patients with severe aphasia, the possible influence of language comprehension difficulties needs to be taken into account for interpretation. Overall, close monitoring of anosognosia over the course of rehabilitation is recommended. With the VATA-NAT we hereby provide a novel assessment for anosognosia in patients with CTU-apraxia. For diagnosing anosognosia we recommend to combine this new tool with the existing VATA-M and -L subtests, particularly in patients who demonstrate severe functional deficits.

Project description:So far, the large and expanding body of research on meditation has mostly focussed on the putative benefits of meditation on health and well-being. However, a growing number of reports indicate that psychologically unpleasant experiences can occur in the context of meditation practice. Very little is known about the prevalence and potential causes of these experiences. The aim of this study was to report the prevalence of particularly unpleasant meditation-related experiences in a large international sample of regular meditators, and to explore the association of these experiences with demographic characteristics, meditation practice, repetitive negative thinking, mindfulness, and self-compassion. Using a cross-sectional online survey, 1,232 regular meditators with at least two months of meditation experience (mean age = 44.8 years ± 13.8, 53.6% female) responded to one question about particularly unpleasant meditation-related experiences. A total of 315 participants (25.6%, 95% CI: 23.1 to 28.0) reported having had particularly unpleasant meditation-related experiences, which they thought may have been caused by their meditation practice. Logistic regression models indicated that unpleasant meditation-related experiences were less likely to occur in female participants and religious participants. Participants with higher levels of repetitive negative thinking, those who only engaged in deconstructive types of meditation (e.g., vipassana/insight meditation), and those who had attended a meditation retreat at any point in their life were more likely to report unpleasant meditation-related experiences. The high prevalence of particularly unpleasant meditation-related experiences reported here points to the importance of expanding the scientific conception of meditation beyond that of a (mental) health-promoting and self-regulating technique. We propose that understanding when these experiences are constitutive elements of meditative practice rather than merely negative effects could advance the field and, to that end, we conclude with an overview of methodological and conceptual considerations that could be used to inform future research.

Dataset Information

Conceptual- and production-related predictors of pantomimed tool use deficits in apraxia.

Publications

Conceptual- and production-related predictors of pantomimed tool use deficits in apraxia.

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