The role of the right parietal lobe in anorexia nervosa.

BACKGROUND: Patients with anorexia nervosa (AN) overestimate their size despite being severely underweight. Whether this misperception echoes an underlying emotional disturbance or also reflects a genuine body-representation deficit is debatable. Current measures inquire directly about subjective perception of body image, thus distinguishing poorly between top-down effects of emotions/attitudes towards the body and disturbances due to proprioceptive disorders/distorted body schema. Disorders of body representation also emerge following damage to the right parietal lobe. The possibility that parietal dysfunction might contribute to AN is suspected, based on the demonstrated association of spatial impairments, comparable to those found after parietal lesion, with this syndrome. METHOD: We used a behavioral task to compare body knowledge in severe anorexics (n=8), healthy volunteers (n=11) and stroke patients with focal damage to the left/right parietal lobe (n=4). We applied a psychophysical procedure based on the perception, in the dark, of an approaching visual stimulus that was turned off before reaching the observer. Participants had to predict whether the stimulus would have hit/missed their body, had it continued its linear motion. RESULTS: Healthy volunteers and left parietal patients estimated body boundaries very close to the real ones. Conversely, anorexics and right parietal patients underestimated eccentricity of their left body boundary. CONCLUSIONS: These findings are in line with the role the parietal cortex plays in developing and maintaining body representation, and support the possibility for a neuropsychological component in the pathogenesis of anorexia, offering alternative approaches to treatment of the disorder.

Grasping an illusion.

In the present study we attempted to determine the nature of the visual analysis that is performed on an object in order to grasp it. We required eight healthy subjects to reach and grasp a wooden bar which was superimposed over the shaft of the Müller-Lyer illusion. Vision of both the hand and the bar was allowed. Three different bar lengths were used. Two additional control tasks in which the subjects were required to reproduce the length of the shafts were carried out. The results showed that hand shaping while grasping the bar was influenced by the illusion configurations on which it was superimposed. However, this effect was smaller than that observed in the two tasks of length reproduction. These results support the notion that visual analysis performed on the object of a grasp movement is global and takes into account the object itself, as well as its relationships with surrounding cues. We propose, as suggested previously for reaching movements (Gentilucci, M. et al., Neuropsychologia, 1996, 34, 369-376), two partially independent stages during visuo-motor integration for grasping an object. In the first stage, the object is coded inside an object-centred frame of reference. In the second stage it is transposed in an egocentric frame of reference, in which the spatial relations between object and agent are computed. In this second stage the influence of cues surrounding the target is minimized.

Looking for the agent: an investigation into consciousness of action and self-consciousness in schizophrenic patients.

The abilities to attribute an action to its proper agent and to understand its meaning when it is produced by someone else are basic aspects of human social communication. Several psychiatric syndromes, such as schizophrenia, seem to lead to a dysfunction of the awareness of one's own action as well as of recognition of actions performed by others. Such syndromes offer a framework for studying the determinants of agency, the ability to correctly attribute actions to their veridical source. Thirty normal subjects and 30 schizophrenic patients with and without hallucinations and/or delusional experiences were required to execute simple finger and wrist movements, without direct visual control of their hand. The image of either their own hand or an alien hand executing the same or a different movement was presented on a TV-screen in real time. The task for the subjects was to discriminate whether the hand presented on the screen was their own or not. Hallucinating and deluded schizophrenic patients were more impaired in discriminating their own hand from the alien one than the non-hallucinating ones, and tended to misattribute the alien hand to themselves. Results are discussed according to a model of action control. A tentative description of the mechanisms leading to action consciousness is proposed.

Confusion between silent and overt reading in schizophrenia.

The present study was aimed at investigating whether schizophrenic patients are impaired in monitoring their own speech. In particular, we attempted to assess their ability to discriminate between overt and covert speech in a reading task, in order to verify whether they can correctly recollect the modality in which an internally generated action is produced. Subjects were asked to read either silently or aloud, items from a list of words. After a delay of 5 min, they were required to indicate in a new list which words had been read previously (either silently or overtly), or had never been presented during the reading task. With respect to normal controls, schizophrenic patients showed a significant bias to report that they had read aloud words which they had actually read silently, or which were absent during the reading task. The results are discussed in relation to recent neuroimaging studies on inner and overt speech in hallucinating schizophrenic patients. Our data favour the hypothesis that the inability to correctly discriminate between inner and overt speech may play a role in the onset of schizophrenic hallucinations.

Right-handers and left-handers have different representations of their own hand.

The visual control of our own hand when dealing with an object and the observation of interactions between other people's hand and objects can be involved in the construction of internal representations of our own hand, as well as in hand recognition processes. Therefore, a different effect on handedness recognition is expected when subjects are presented with hands holding objects with either a congruent or an incongruent type of grip. Such an experiment was carried out on right-handed and left-handed subjects. We expected that the different degree of lateralisation in motor activities observed in the two populations [J. Herron, Neuropsychology of left-handedness, Academic Press, New York, 1980.] could account for the construction of different internal hand representations. As previously found [L.M. Parsons, Imaged spatial transformations of one's hands and feet, Cogn. Psychol., 19 (1987) 178-241.], in order to identify handedness, subjects mentally rotated their own hand until it matched with the presented one. This process was confirmatory, being preceded by an implicit visual analysis of the target hand. Presentation of hands holding objects with congruent or incongruent types of grip influenced handedness recognition at different stages in right-handed and left-handed subjects. That is, the mental rotation stage was affected in right-handed subjects, whereas the initial phase of implicit hand analysis was affected in left-handed subjects. We suggest that in handedness recognition, left-handers relied more on a pictorial hand representation, whereas right-handers relied more on a pragmatic hand representation, probably derived from experience in the control of their own movements. The use of different hand representations may be due to differential activation of temporal and premotor areas.

Haptic information differentially interferes with visual analysis in reaching-grasping control and in perceptual processes.

We used an interference paradigm in order to study integration between haptic and visual information in motor control and in perceptual analysis. Subjects either reached and grasped a visually presented sphere or matched its size with their left hand while manipulating with their right hand another sphere whose size could be smaller or greater. In four experiments haptic analysis of the manipulated sphere could be either automatically incorporated with or explicitly dissociated from visual analysis. In a fifth experiment reaching-grasping and matching were executed with the right hand, whereas manipulation was executed with the left hand. Manipulation with the right hand influenced finger shaping during grasping with the left hand when the sizes of the two objects were different. Interference was observed mainly in those experiments in which haptic analysis could be automatically integrated with visual analysis. In the matching task, no effect was observed. Finally, manipulation with the left hand did not produce any interference effect on reaching-grasping and matching executed by the right hand. The results of the present study suggest that somesthetic information is integrated with visual information only in sensorimotor transformations. In addition, they support the notion that the left hemisphere together with the right hemisphere is involved in the control of left hand reaching-grasping movements.

On orienting the hand to reach and grasp an object.

Subjects were required to reach and grasp a parallelepiped, the position, orientation and size of which were varied. The kinematics of reaching and grasping movements was studied in full vision and in no vision conditions. Both direction and movement amplitude of reaching were affected by object orientation. Conversely, both the time course of finger axis orientation and the angular displacement of the hand at wrist were influenced by object position. These results were not modified by the absence of visual control. Finger aperture during grasping was affected by both object size and orientation. This latter result was not due to a distorted size perception, as shown by a control matching experiment. Taken together, the results of the present study suggest the integration between distal and proximal components during reaching and grasping.

Eye position tunes the contribution of allocentric and egocentric information to target localization in human goal-directed arm movements.

Subjects were required to point to the distant vertex of the closed and the open configurations of the Müller-Lyer illusion using either their right hand (experiment 1) or their left hand (experiment 2). In both experiments the Müller-Lyer figures were horizontally presented either in the left or in the right hemispace and movements were executed using either foveal or peripheral vision of the target. According to the illusion effect, subjects undershot and overshot the vertex location of the closed and the open configuration, respectively. The illusion effect decreased when the target was fixated and when the stimulus was positioned in the right hemispace. These results confirm the hypothesis that both egocentric and allocentric information are combined in order to encode target position in space. When movements are directed to foveal targets, decreasing effects of allocentric cues, as shown by decreasing the illusion effect, could be due to enhanced efficiency of the egocentric system. That is, information on eye position when target is fixated can be used to precisely establish its spatial relations with the body. In addition, a more accurate analysis of allocentric information is hypothesized when the target is positioned in the left hemispace. In other words, our data confirm the notion that the right cerebral hemisphere is involved in space representation.

Gaze discrimination is unimpaired in schizophrenia.

Interpersonal communication is largely dependent on interpretation of facial expression and emotion. Difficulties in face processing, and more specifically in gaze discrimination, have been described in schizophrenic patients. According to Baron-Cohen (Mindblindness. M.I.T. Press, Cambridge, MA, 1995), gaze discrimination relies on the functioning of a specific cognitive module, the Eye Direction Detector (EDD). It has been proposed [Rosse et al. (1994) Gaze discrimination in patients with schizophrenia: preliminary report. American Journal of Psychiatry 151, 919-921] that an impairment in gaze discrimination is present in schizophrenia, and plays a fundamental role in inducing the paranoid symptoms reported by many patients. However, in the previous studies, gaze direction detection and interpretation of gaze have never been completely dissociated. The present experiment attempts to test the schizophrenics' skill in a simple gaze direction detection task. A series of photographic portraits of models looking at different directions have been presented to 22 schizophrenic patients and 36 control subjects. For each portrait subjects were asked to determine whether gaze was directed to the right or to the left by pressing a keyboard key. A forced choice paradigm was used. No differences were reported between schizophrenic patients and control subjects. That is, in the present paradigm, schizophrenic patients did not show any specific impairment in detecting the direction of gaze of the portraits. The results are discussed according to the notion that a dissociation is present in schizophrenia between implicit and explicit processes. The present case illustrates how the more automatic elementary functions, such as the detection of gaze direction, may be spared in schizophrenic patients, whereas explicit cognitive functions are likely more affected.

[Basic cognitive-perceptive module in schizophrenics]. / Etude d'un module cognitif perceptif élémentaire chez les schizophrènes.

A specific deficit in gaze discrimination has been hypothesized for schizophrenic patients (Rosse et al., 1994). Gaze discrimination is a basic ability for animals as well as for human beings. It plays an important role in mutual control of social interactions. According to Baron-Cohen (1995), sensitivity to eye gaze relies on a specific cognitive module, the Eye Direction Detector (EDD). The author distinguishes three basic functions of the EDD; first, the EDD is involved in eyes detection; second, the EDD is used in order to establish direction of gaze, and specially to compute whether the eyes one is looking at are directed to the subject or somewhere else; third, the EDD is implied in interpretation of gaze as seeing. Rosse et al. (1994) tested subjective impressions concerning gaze discrimination in a group of schizophrenic patients. Schizophrenics reported the subjective impression of being looked at by the portraits significantly more often than controls. The authors concluded that a specific impairment in gaze detection is present in the patients, and that it may be responsible for the paranoid symptoms often reported in schizophrenia. However, it seems difficult to assert that a response bias in schizophrenics toward perceiving faces as looking at them results from the deficit of an elementary perceptual module responsible for the detection of eye-direction. Rather we suspect such a bias to be the consequence of an impairment of the more complex level of mindreading, responsible for the interpretation of gaze as seeing in terms of mental states. The aim of the present experiment was to test in a more specific way the elementary gaze discrimination system. A series of portraits of models looking at five different directions (-30 degrees, -15 degrees, 0 degree, 15 degrees, 30 degrees), have been presented to 22 schizophrenic patients and 36 normal control subjects. In each trial one portrait was presented. Subjects were asked to determine the direction of its gaze by pressing the "z-key" (left side of the keyboard) if the portrait was looking to the left, and the "/-key" (right side of the keyboard) if the portrait was looking to the right. For each trial, we recorded both the side of the response (left key or right key) and the corresponding reaction time (RT). For the purpose of the analysis, the mean numbers of left responses were computed for each subject. The mean numbers of left responses recorded for each direction of gaze did not significantly differ between patients and controls. That is schizophrenic patients are not impaired in the gaze discrimination task used in the present study. In Rosse's experiment, subjects were required to decide whether the portrait on the screen was looking at them or not. On the contrary, in our task, subjects were simply required to state whether gaze was directed to the right or to the left. No explicit judgment was required as to whom or what gaze was directed. Therefore, we can assume that the present paradigm investigated the functioning of a more basic process than that tested by Rosse et al. Our data are consistent with those reporting that basic cognitive processes are unimpaired in schizophrenia, whereas explicit processes are extensively affected.

Locomotor body scheme.

The concept of body schema has been introduced and widely discussed in the literature to explain various clinical observations and distortions in the body and space representation. Here we address the role of body schema related information in multi-joint limb motion. The processing of proprioceptive information may differ significantly in static and dynamic conditions since in the latter case the control system may employ specific dynamic rules and constraints. Accordingly, the perception of movement, e.g., estimation of step length and walking distance, may rely on a priori knowledge about intrinsic dynamics of limb segment motion and inherent relationships between gait parameters and body proportions. The findings are discussed in the general framework of space and body movement representation and suggest the existence of a dynamic locomotor body schema used for controlling step length and path estimation.

Visual distractors differentially interfere with the reaching and grasping components of prehension movements.

In the present study we addressed the issue of how an object is visually isolated from surrounding cues when a reaching-grasping (prehension) movement towards it is planned. Subjects were required to reach and grasp an object presented either alone or with a distractor. In five experiments, different degrees of elaboration of the distractor were induced by varying: (1) the position of the distractor (central or peripheral); (2) the time when the distractor was suppressed (immediately or delayed, with respect to stimulus presentation); and (3) the type of distractor analysis (implicit or explicit). In addition, we tested whether the possible effects of the distractor on reaching-grasping were due to the use of an allocentric reference centered on it. This was obtained by comparing the effects of the distractor with those of a stimulus, the target of a placing movement successive to the reaching-grasping. The results of the five experiments can be summarized as follows. The necessary condition for an interference effect on both the reaching and the grasping components was the central presentation of the distractor. When the information on the distractor could be immediately suppressed, an interference effect was observed only on the grasp component. In the case of delayed suppression, an effect was found on the reaching component. Finally, when an overt analysis of the distractor was required, the interference effect disappeared. Two main conclusions have been drawn from the results of the present study. First, comparison between properties of the target and surrounding cues is performed by two independent processes for reaching and grasping an object. The process for the grasp relies more on allocentric cues than that for the reach. Second, when surrounding stimuli are automatically analyzed during visual search of the target, the process of visuo-motor transformation can incorporate their features into the target. In contrast, overt analysis of surrounding stimuli is performed separately from that of the target. Finally, the data of the present study are discussed in support of the premotor theory of attention.

Implicit visual analysis in handedness recognition.

In the present study, we addressed the problem of whether hand representations, derived from the control of hand gesture, are used in handedness recognition. Pictures of hands and fingers, assuming either common or uncommon postures, were presented to right-handed subjects, who were required to judge their handedness. In agreement with previous results (Parsons, 1987, 1994; Gentilucci, Daprati, & Gangitano, 1998), subjects recognized handedness through mental movement of their own hand in order to match the posture of the presented hand. This was proved by a control experiment of physical matching. The new finding was that presentation of common finger postures affected responses differently from presentation of less common finger postures. These effects could be not attributed to mental matching movements nor related to richness in hand-finger cues useful for handedness recognition. The results of the present study are discussed in the context of the notion that implicit visual analysis of the presented hands is performed before mental movement of one's hand takes place (Parsons, 1987; Gentilucci et al., 1998). In this process, hand representation acquired by experience in the control and observation of one's and other people's hand gestures is used. We propose that such an immediate recognition mechanism belongs to the class of mental processes which are grouped under the name of intuition, that is, the processes by which situations or people's intentions are immediately understood, without conscious reasoning.

Tactile input of the hand and the control of reaching to grasp movements.

The role of tactile information of the hand in the control of reaching to grasp movements was investigated. The kinematics of both reaching (or transport) and grasp components were studied in healthy subjects in two experimental conditions. In one condition (control condition) subjects were required to reach and grasp an object that could have two sizes and that could be located at two distances from the viewer. In the other condition (anaesthesia condition) the same movements were executed, but anaesthesia was provided to the subjects' fingertips. In both conditions vision of the hand was prevented during movement. Anaesthesia affected mainly the kinematics of the first phase of grasping, that is, the finger-opening phase. This phase was lengthened and maximal finger aperture increased. In contrast, the duration of the successive phase (finger-closure) was poorly modified. The reaching component was also impaired by anaesthesia. Although the total extent of hand path and the spatial relations between the finger aperture and closure phases did not change between the two conditions, hand path variability increased. This occurred during transport deceleration phase and after the increase in variability of finger path. In addition, the whole movement was slowed down. The results of the present experiment suggest that tactile signals at the beginning and at the end of movement can be used to compute grasp time and to optimise grasp temporal parameters. Alternatively, signals from tactile receptors can be involved in encoding the position sense of the fingers. When this input is lacking, the control of grasp and in particular that of finger-opening phase can be impaired. Finally, the effect of the grasp impairment on the reaching component supports the notion that the coordination between reaching and grasping involves the whole temporal course of the two components.

Language and motor control.

We investigated the possible influence of automatic word reading on processes of visuo-motor transformation. Subjects reached and grasped an object on which the following Italian words were printed: "VICINO" (near) or "LONTAN" (far) on an object either near or far from the agent (experiments 1, 2); PICCOLO (small) or "GRANDE" (large) on either a small or a large object (experiment 4); and "ALTO" (high) or "BASSO" (low) on either a high or a low object (experiment 5). The kinematics of the initial phase of reaching-grasping was affected by the meaning of the printed words. Namely, subjects automatically associated the meaning of the word with the corresponding property of the object and activated a reach and/or a grasp motor program influenced by the word. No effect on initial reach kinematics was observed for words related to object properties not directly involved in reach control (experiment 3). Moreover, in all the experiments, the presented words poorly influenced perceptual judgement of object properties. In experiments 5-7, the effects of the Italian adjectives "ALTO" (high) and "BASSO" (low) on reaching-grasping control were compared with those of the Italian adverbs "SOPRA" (up) and "SOTTO" (down). Adjectives influenced visual analysis of target-object properties, whereas adverbs more directly influenced the control of the action. We suggest that these effects resemble the structure of a sentence, where adjectives are commonly referred to nouns, and adverbs to verbs. In other words, class of words and, in a broad sense, grammar influenced motor control. The results of the present study show that cognitive functions such as language can affect visuo-motor transformation. They are discussed according to the notion that a strict relation between language and motor control exists, and that the frontal cortex can be involved in interactions between automatic word reading and visuo-motor transformation.

Unconscious updating of grasp motor program.

Grasp modification during prehension movements was studied in response to slight variations of somesthetic information about object size. Three experiments were carried out. In experiment 1 eight subjects were required to reach and grasp an object whose size could either increase or decrease, whereas its visual image remained unmodified. The object size was changed during the experiment with uninformed subjects after a block of trials during which visual and somesthetic information were congruent. At the end of the experiment subjects were required to reproduce the size of the object with their fingers (matching test). Results showed that maximal grip aperture during prehension as well as finger aperture in the matching test were modified according to variation in object size, although no subject realized that the object had changed during the experiment. Grasp time was also altered by object size change. Greater and earlier adaptation in maximal grip aperture, as well as perturbation of grasp time, were observed for decrease than for increase in object size. However, complete compensation was never reached for both parameters. Constant confidence in vision could have prevented both complete compensation and conscious detection of object change. This was investigated in two additional experiments. In experiment 2 visual information was made unreliable by informing subjects about variation in grasped object size. This led to greater and earlier modification in maximal grip aperture than in experiment 1. Grasp time was kept almost constant regardless of size variation. In experiment 3 vision of the stimulus was prevented and no information on change in object size was given to subjects. The results of experiment 3 were similar to those of experiment 1, although modification in maximal grip aperture was larger for increase in object size. Correspondingly, grasp time was more affected by increase than by decrease in object size. The results of the three experiments suggest that kinematic parameters usually considered as dependent on object properties, such as maximal grip aperture, were modified in order to compensate perturbation of temporal parameters. This modification induced a "pragmatic" knowledge of object size (as showed by the results of the matching test), although awareness was not reached.

Perception of self-generated movement following left parietal lesion.

Three apraxic patients with lesions in the left parietal cortex were required to execute finger movements with either hand, while the visual feedback they received about the movement was manipulated systematically. We used a device which allowed us to present on a video monitor either the patient's hand or the examiner's hand simultaneously performing an identical or a different movement. In each trial, patients were required to decide whether the hand shown on the screen was their own or not. Hand movements produced in response to verbal command included simple (single-finger extension) and complex gestures (multi-finger extension). Ownership judgements were analysed and compared with those produced by six normal controls and two non-apraxic neurological patients. Apraxic patients and controls accurately recognized their own hand on the screen (own movement condition) and correctly identified the viewed hand as the examiner's when it performed a movement different from their own movement (incongruent movement condition). However, when the viewed hand was the examiner's hand executing their own movement (congruent movement condition), apraxic patients were significantly more impaired than controls. When the results were analysed as a function of gesture type, the number of correct responses was significantly lower for apraxic patients with respect to controls only for complex gestures. Interestingly, when patients executed the finger gestures inaccurately, they still failed to recognize the examiner's hand as alien, and claimed that the correct movement presented on the screen was their own. These results confirm that parietal lesions alter the representational aspects of gestures, and suggest a failure in evaluating and comparing internal and external feedback about movement. We conclude that the parietal cortex plays an important role in generating and maintaining a kinaesthetic model of ongoing movements.