Hand movements that change during psychotherapy and their relation to therapeutic outcome: An analysis of individual and simultaneous movements.

Hands are, compared to other body parts, the body parts that display the most gestural movements during an interaction and their movement is sensitive to reveal anxiety states. However, psychotherapy research focuses on movement synchrony of different body parts to be an indicator of improved symptoms. The present study investigates symptoms in social anxiety disorder and considers both, individual and simultaneous hand movements. 56 video recordings of 28 patient-therapist dyads with patients with social anxiety at the beginning and in the end of psychotherapy were analyzed. Two independent blind certified raters analyzed the hand movement behavior using the NEUROGES® analysis system for nonverbal behavior concerning individual movement units and the simultaneous overlaps between the patients' and therapists' movement units. Simultaneous overlap change negatively correlated with symptoms (LSAS week eight-measurement, r = -.52; and week 15-measurement, r = -.52; BDI pre-measurement, r = -.54). The patients' right hand movement at the end of the psychotherapy correlated significantly with therapeutic alliance (HAQ post-measurement; r = .55). Hand movement behavior analysis should be considered in psychotherapy research in combination with movement synchrony as a measurement parameter related to therapeutic process and outcome. Enriching previous findings, this study indicates that simultaneous movement change is related to symptoms and therefore a process-sensitive parameter in psychotherapy.

What's in a name? That which we call Multiple Sclerosis Fatigue.

Very limited progress has been made to date in the treatment of debilitating Multiple Sclerosis (MS) daily onset symptoms. These daily symptoms include motor, sensory, and cognitive impairments as well as an overwhelming feeling of tiredness, often referred to as "MS fatigue." Although widely cited as a main cause of inability to work and poor quality of life in patients with MS, daily onset MS-related tiredness continues to defy definition, and, consequently, measurement and treatment. Beginning with a historical overview of observations of daily onset MS-related tiredness, this Topical Review demonstrates how the misnomer "MS fatigue" has introduced ongoing misunderstanding for patients, investigators, clinicians, and therapists. Finally, combining current findings in clinical neuroscience with the striking set of long-standing commonalities present throughout the past 200 years of clinical observations, we underscore the immediate necessity for conceptual and applied change, to be initiated by the renaming of this distinct syndrome.

The revised NEUROGES-ELAN system: An objective and reliable interdisciplinary analysis tool for nonverbal behavior and gesture.

As visual media spread to all domains of public and scientific life, nonverbal behavior is taking its place as an important form of communication alongside the written and spoken word. An objective and reliable method of analysis for hand movement behavior and gesture is therefore currently required in various scientific disciplines, including psychology, medicine, linguistics, anthropology, sociology, and computer science. However, no adequate common methodological standards have been developed thus far. Many behavioral gesture-coding systems lack objectivity and reliability, and automated methods that register specific movement parameters often fail to show validity with regard to psychological and social functions. To address these deficits, we have combined two methods, an elaborated behavioral coding system and an annotation tool for video and audio data. The NEUROGES-ELAN system is an effective and user-friendly research tool for the analysis of hand movement behavior, including gesture, self-touch, shifts, and actions. Since its first publication in 2009 in Behavior Research Methods, the tool has been used in interdisciplinary research projects to analyze a total of 467 individuals from different cultures, including subjects with mental disease and brain damage. Partly on the basis of new insights from these studies, the system has been revised methodologically and conceptually. The article presents the revised version of the system, including a detailed study of reliability. The improved reproducibility of the revised version makes NEUROGES-ELAN a suitable system for basic empirical research into the relation between hand movement behavior and gesture and cognitive, emotional, and interactive processes and for the development of automated movement behavior recognition methods.

Persistent Postconcussive Symptoms Are Accompanied by Decreased Functional Brain Oxygenation.

Diagnostic methods are considered a major concern in the determination of mild traumatic brain injury. The authors examined brain oxygenation patterns in subjects with severe and minor persistent postconcussive difficulties and a healthy control group during working memory tasks in prefrontal brain regions using functional near-infrared spectroscopy. The results demonstrated decreased working memory performances among concussed subjects with severe postconcussive symptoms that were accompanied by decreased brain oxygenation patterns. An association appears to exist between decreased brain oxygenation, poor performance of working memory tasks, and increased symptom severity scores in subjects suffering from persistent postconcussive symptoms.

Impact of Diversification on Movement Self-Perception and Movement Performance in University Sports Students.

Purpose: It has been acknowledged that accurate movement self-perception is a crucial prerequisite for reaching high levels of movement expertise in sports. The influence of distinct educational environments (specialization vs. diversification) on movement self-perception has thus far, however, mainly been tested in short-term investigations. Method: Therefore, a longitudinal study spanning two-and-a-half years was conducted with sports students from two conceptually different sports study programs. A total of 72 sports students from a convergent-oriented program (COSP, n = 38) and a diversification-oriented study program (DOSP, n = 34) participated in the standardized BAST® movement analysis at the beginning and end of their studies. Results: While, at the end of their sports studies, COSP showed no significant changes in movement self-perception, DOSP students' movement self-perception increased significantly in five out of eight movement tasks of the BAST®. DOSP students, furthermore, developed a strong relationship between movement self-perception and movement performance at the end of their sports studies. Conclusion: Sports students benefit from engaging in a broad variety of different sports, allowing them to develop an accurate movement self-perception in relation to their movement performance. The influences of divergent learning experiences and diversification on movement self-perception, as well as, practical implications for the development of process-oriented learning environments that promote students' movement performance by refining movement habits or adapting new movement patterns, were discussed.

Hemispheric differences of motor execution: a near-infrared spectroscopy study.

Distal movements of the limbs are predominantly controlled by the contralateral hemisphere. However, functional neuroimaging studies do not unequivocally demonstrate a lateralization of the cerebral activation during hand movements. While some studies show a predominant activation of the contralateral hemisphere, other studies provide evidence for a symmetrically distributed bihemispheric activation. However, the divergent results may also be due to methodological shortcomings. Therefore, the present study using functional near-infrared spectroscopy examines cerebral activation in both hemispheres during motor actions of the right and left hands. Twenty participants performed a flexion/extension task with the right- or left-hand thumb. Cerebral oxygenation changes were recorded from 48 channels over the primary motor, pre-motor, supplementary motor, primary somatosensory cortex, subcentral area, and the supramarginal gyrus of each hemisphere. A consistent increase of cerebral oxygenation was found for oxygenated and for total hemoglobin in the hemisphere contralateral to the moving hand, regardless of the laterality. These findings are in line with previous data from localization [1-3] and brain imaging studies [4-6]. The present data support the proposition that there is no hemispheric specialization for simple distal motor tasks. Both hemispheres are equally activated during movement of the contralateral upper limb.

Production of co-speech gestures in the right hemisphere: Evidence from individuals with complete or anterior callosotomy.

INTRODUCTION: A right-hand preference for co-speech gestures in right-handed neurotypical individuals as well as the co-occurrence of speech and gesture has induced neuropsychological research to primarily target the left hemisphere when investigating co-speech gesture production. However, the substantial number of spontaneous left-hand gestures in right-handed individuals has, thus far, been unexplained. Recent studies in individuals with complete callosotomy and exclusive left hemisphere speech production show a reliable left-hand preference for co-speech gestures, indicating a right hemispheric generation. However, the findings raise the issue if the separate right hemisphere is able to also generate representational gestures. The present study challenges the proposition of a specific right hemispheric contribution to gesture production by differentiating gesture types including representational ones in individuals with complete callosotomy and by including individuals with anterior callosotomy in whom neural reorganization is less extensive. METHODS: Three right-handed individuals with complete commissurotomy (A.A., N.G., G.C.) and three right-handed individuals with anterior callosotomy (C.E., S.R., L. D), all with left hemisphere language dominance, and a matched right-handed neurotypical control group (n = 10) were examined in an experimental setting, including re-narration of a nonverbal animated cartoon and responding to intelligence questions. The participants' video-taped hand movement behavior was analyzed by two independent certified raters with the NEUROGES-ELAN system for nonverbal behavior and gesture. Unimanual right-hand and left-hand gestures were classified into eight gesture types. RESULTS: The individuals with complete and anterior callosotomy performed unimanual co-speech gestures with the left as well as the right hand, with no significant preference of one hand for gestures overall. Concerning the specific gesture types, the group with complete callosotomy showed a significant right-hand preference for pantomime gestures, which also applied to the callosotomy total group. The group with anterior callosotomy displayed a significant left-hand preference for form presentation gestures. As a trend, the callosotomy total group differed from the neurotypical group as they performed more left-hand egocentric deictic and left-hand form presentation gestures. DISCUSSION: The present study replicates the finding of a substantial left-hand use for unimanual co-speech gestures in individuals with complete callosotomy. The proposition of a right hemispheric contribution to gesture production independent from left hemispheric language production is corroborated by the finding that individuals with anterior callosotomy show a similar pattern of hand use for gestures. Representational gestures were displayed with either hand, suggesting that in particular right hemispheric spatial cognition can be directly expressed in gesture. The significant right-hand preference for pantomime gesture was outstanding and compatible with the established left hemispheric specialization for tool use praxis. The findings shed a new light on the left-hand gestures in neurotypical individuals, suggesting that these can be generated in the right hemisphere.

Phasic and repetitive self-touch differ in hemodynamic response in the prefrontal cortex-An fNIRS study.

Introduction: Each individual touches the own body several 100 times a day. While some researchers propose a self-regulatory function of self-touch, others report that self-touching increases nervousness. This controversy appears to be caused by the fact that researchers did not define the kind of self-touch they examined and actually, referred to different types of self-touch. Thus, kinematically defining different types of self-touch, such as phasic (discrete), repetitive, and irregular, and exploring the neural correlates of the different types will provide insight into the neuropsychological function of self-touching behavior. Methods: To this aim, we assessed hemodynamic responses in prefrontal brain areas using functional near-infrared spectroscopy (fNIRS) and behavioral responses with NEUROGES®. Fifty-two participants were recorded during three specific kinematically types of self-touch (phasic, irregular, repetitive) that were to be performed on command. The recently developed toolbox Satori was used for the visualization of neuronal processes. Results: Behaviorally, the participants did not perform irregular self-touch reliably. Neurally, the comparison of phasic, irregular and repetitive self-touch revealed different activation patterns. Repetitive self-touch is associated with stronger hemodynamic responses in the left Orbitofrontal Cortex and the Dorsolateral Prefrontal Cortex than phasic self-touch. Discussion: These brain areas have been reported to be associated with self-regulatory processes. Furthermore, irregular self-touch appears to be primarily generated by implicit neural control. Thus, by distinguishing kinematically different types of self-touch, our findings shed light on the controverse discussion on the neuropsychological function of self-touch.

Post-concussion symptoms and clinical reaction time performance of athletes with a history of concussion.

BACKGROUND: The symptom presentation after sport-related concussion is highly subjective, while the clinical test of reaction time (RT) has been presented as an objective tool to the effects of sport-related concussion. A multimodal assessment approach supports concussion management; therefore, it is appropriate to explore the relationship between modals. The aim of the present study is to investigate the relationship of clinical RT and post-concussion symptom (PCS) score, number of experienced concussions, and time since concussion. METHODS: Based on retrospective concussion history, 53 athletes were selected for this study. Athletes were questioned using a standardized questionnaire to obtain concussion history data, such as number of cumulative concussions and date of most recent concussion. Symptom scores were gathered through Sport Concussion Assessment Tool. A clinical RT test was used to obtain RT data. RESULTS: A significant positive correlation was found between RT and the PCS score. A linear regression revealed that the PCS score but neither the cumulative number of experienced concussions, nor the time post-concussion significantly predicts increased RT. Reaction time positively correlates with the symptoms neck pain, dizziness, balance problems, light sensitivity, feeling slowed down, feeling like in a fog, do not feel right, drowsiness, and irritability. CONCLUSIONS: This study presents that the PCS score particularly predicts increased RT after sport-related concussions. Furthermore, a specific set of symptoms significantly impacts the RT of athletes. The results suggest that not a single symptom drives the relationship between PCS score and RT, highlighting the heterogeneity of this injury.

Impaired recognition of nonverbal expressions of emotions in depressed individuals.

INTRODUCTION: Depressive individuals are impaired in the recognition of emotions in others'. Recent research suggests that the recognition of nonverbal expressions of emotions in other people may depend on the analysis of bodily rather than facial expressions. Therefore, we investigated if an impaired recognition of emotions by depressed individuals is body part specific. METHODS: Clinically diagnosed depressed and healthy matched controls were instructed to identify nonverbal expressions of positive (happiness), neutral, and negative emotions (sadness) via the face, the body, or the body and face. RESULTS: Depressed participants responded significantly less correctly overall when compared to non-depressed individuals. The recognition of nonverbal expressions of happiness by the body negatively predicted the Beck Depression Inventory II (BDI-II) score. DISCUSSION: The data revealed that the impaired recognition of nonverbal expressions of emotions in others by depressed individuals is not body part specific. Nevertheless, depressive symptoms seem to be related to the recognition of bodily expressions of happiness. Future studies must address whether impairments of depressive individuals are related to nonverbal expressions of the whole body.

Hyperactive movement behaviour of athletes with post-concussion symptoms.

OBJECTIVE: Observations of hyperactive (/restless, agitated) behaviour as a consequence of mild traumatic brain injuries (mTBI) in sports are inconclusive as reduced or slowed movement behaviour is also commonly described post-concussion. This might be grounded in the fact that the movement behaviour of athletes has not been systematically investigated during standardized settings and with objective methods of nonverbal movement analysis. Thus, we investigate whether symptoms after mTBI in sports are characterized by a hyper- or hypoactive movement behaviour experimentally. METHODS: Three matched groups of 40 athletes were investigated: 14 symptomatic and 14 asymptomatic athletes with a mTBI; and 12 non-concussed athletes. Four certified raters analysed with a standard analysis system for nonverbal behaviour each athlete's hand movement activity, hand movement contacts, and resting positions that were displayed during a videotaped standardized anamnesis protocol. RESULTS: Symptomatic athletes spend significantly more time with act apart hand movements and less time with closed rest positions when compared to non-concussed athletes. Post-concussion symptom (PCS) scores positively correlate with act apart hand movements. A linear regression analysis revealed that act apart hand movements significantly predict the PCS score. CONCLUSIONS: Athletes with increased symptoms after mTBI move their hands in a hyperactive and restless manner. Increased act apart hand movements, i.e., when both hands move simultaneously without touching each other, indicate a motoric destabilization in symptomatic athletes' behaviour that might be related to impaired inhibitory motor control systems. Future diagnoses should concern the systematic analysis of the nonverbal movement behaviour as a potential behavioural marker of symptoms after mTBI.

Nonverbal Hand Movement Durations Indicate Post-Concussion Symptoms of Athletes.

Methods of post-concussion diagnosis are still under debate with regard to sensitivity, objectivity, reliability, and costs. Spontaneous displays of nonverbal hand movement behavior during interaction are indicative of psychopathology and are relatively simple to record and analyze. Increased continuous (irregular) body-focused hand movement activity in particular indicates psychopathologies that overlap in symptomatology with those of sport-related concussions (SRCs). We therefore hypothesized that the duration of "irregular," "on body," and "act on each other" hand movements is increased in athletes with SRC who suffer from post-concussion symptoms. Three matched groups of 40 athletes were investigated: 14 symptomatic athletes with a concussion, 14 asymptomatic athletes with a concussion, and 12 non-concussed athletes. Using the Neuropsychological Gesture (NEUROGES)-Elan analysis system, four certified raters analyzed all nonverbal hand movements that were displayed during a videotaped standardized anamnesis about concussion history, incidence, course of action, and post-concussion symptoms. The duration of irregular Structure units among symptomatic athletes was significantly longer compared with asymptomatic athletes. Irregular, on body, and act on each other hand movement durations correlated with post-concussion symptoms. Whereas the duration of irregular units significantly predicted the post-concussion symptom score, working memory performances showed only marginal effects. Increased duration of irregular hand movement units indicates post-concussion symptoms in athletes with SRC. Because the recording of spontaneous displays of nonverbal hand movement behavior is relatively simple and cost efficient, we suggest using the neuropsychological analysis of hand movement behavior as a future diagnostic parameter of concussion management protocols.

Not just contact sports: significant numbers of sports-related concussions in cycling.

BACKGROUND: Although sports-related concussions (SRCs)/mild traumatic brain injuries in contact sports have recently received much attention, investigation of SRCs in cycling - a sport yielding some of the highest percentages of SRC - remains strikingly limited. In particular, rates of incidence, cycling-specific causes, and potential long-term effects of SRC have not been examined in this sport. Here, a retrospective online survey was used to investigate the incidence and potential long-term effects of SRCs among cyclists. METHODS: A cycling-specific questionnaire was developed and administered to 2792 cyclists via an online survey. First, participants were asked about their acute symptomatology, and secondly, cycling-specific items and concussion history were addressed. RESULTS: Of the 999 cyclists whom completed the questionnaire, 23.8% had experienced a concussion. Incidence of concussion was significantly higher in cyclists who were club members, who cycled more than 200 kilometers per week, and who wore a helmet. Cyclists with a history of concussion complained significantly more often about headaches, pressure in the head, sensitivity to light, confusion, and irritability. CONCLUSIONS: Concussions in cycling are a serious injury with a high incidence relative to other sports. Although wearing a helmet reduces the risk of severe brain injury, interesting, the present results show a relation between helmet use, participation in cycling clubs, and increased concussion incidence. These data are in line with the growing number of findings showing that athletes with a history of concussion report more symptoms.

Generation of co-speech gestures based on spatial imagery from the right-hemisphere: evidence from split-brain patients.

It has been claimed that the linguistically dominant (left) hemisphere is obligatorily involved in production of spontaneous speech-accompanying gestures (Kimura, 1973a, 1973b; Lavergne and Kimura, 1987). We examined this claim for the gestures that are based on spatial imagery: iconic gestures with observer viewpoint (McNeill, 1992) and abstract deictic gestures (McNeill, et al. 1993). We observed gesture production in three patients with complete section of the corpus callosum in commissurotomy or callosotomy (two with left-hemisphere language, and one with bilaterally represented language) and nine healthy control participants. All three patients produced spatial-imagery gestures with the left-hand as well as with the right-hand. However, unlike healthy controls and the split-brain patient with bilaterally represented language, the two patients with left-hemispheric language dominance coordinated speech and spatial-imagery gestures more poorly in the left-hand than in the right-hand. It is concluded that the linguistically non-dominant (right) hemisphere alone can generate co-speech gestures based on spatial imagery, just as the left-hemisphere can.

Speech-independent production of communicative gestures: evidence from patients with complete callosal disconnection.

Recent neuropsychological, psycholinguistic, and evolutionary theories on language and gesture associate communicative gesture production exclusively with left hemisphere language production. An argument for this approach is the finding that right-handers with left hemisphere language dominance prefer the right hand for communicative gestures. However, several studies have reported distinct patterns of hand preferences for different gesture types, such as deictics, batons, or physiographs, and this calls for an alternative hypothesis. We investigated hand preference and gesture types in spontaneous gesticulation during three semi-standardized interviews of three right-handed patients and one left-handed patient with complete callosal disconnection, all with left hemisphere dominance for praxis. Three of them, with left hemisphere language dominance, exhibited a reliable left-hand preference for spontaneous communicative gestures despite their left hand agraphia and apraxia. The fourth patient, with presumed bihemispheric language representation, revealed a consistent right-hand preference for gestures. All four patients displayed batons, tosses, and shrugs more often with the left hand/shoulder, but exhibited a right hand preference for pantomime gestures. We conclude that the hand preference for certain gesture types cannot be predicted by hemispheric dominance for language or by handedness. We found distinct hand preferences for specific gesture types. This suggests a conceptual specificity of the left and right hand gestures. We propose that left hand gestures are related to specialized right hemisphere functions, such as prosody or emotion, and that they are generated independently of left hemisphere language production. Our findings challenge the traditional neuropsychological and psycholinguistic view on communicative gesture production.

Neural Control of Posture in Individuals with Persisting Postconcussion Symptoms.

INTRODUCTION: Postural instability has been shown to characterize individuals who suffered from long-term symptoms after mild traumatic brain injury. However, recordings of neural processes during postural control are difficult to realize with standard neuroimaging techniques. Thus, we used functional nearinfrared spectroscopy to investigate brain oxygenation of individuals with persistent postconcussion symptoms (pPCS) during postural control in altered environments. METHODS: We compared brain oxygenation and postural sway during balance control in three groups: individuals suffering from pPCS, individuals with a history of mild traumatic brain injury but without pPCS, and healthy controls. Individuals were investigated during postural control tasks with six different conditions: i) eyes opened, ii) eyes closed, and iii) blurred visual input, each while standing a) on a stable and b) an unstable surface. RESULTS: In all groups, during the eyes closed/unstable surface condition as compared with the other conditions, the postural sway increased as well as the brain oxygenation in frontal brain cortices. In the most difficult balance condition, as compared with the other two groups, subjects with pPCS applied more force over time to keep balance as measured by the force plate system with a significantly greater activation in frontopolar/orbitofrontal areas of the right hemisphere. CONCLUSIONS: As subjects with pPCS applied more force over time to control balance, we propose that with regard to cognitive processes, the increase of cerebral activation in these individuals indicates an increase of attention-demanding processes during postural control in altered environments.

Co-speech hand movements during narrations: What is the impact of right vs. left hemisphere brain damage?

Persons with brain damage show deviant patterns of co-speech hand movement behaviour in comparison to healthy speakers. It has been claimed by several authors that gesture and speech rely on a single production mechanism that depends on the same neurological substrate while others claim that both modalities are closely related but separate production channels. Thus, findings so far are contradictory and there is a lack of studies that systematically analyse the full range of hand movements that accompany speech in the condition of brain damage. In the present study, we aimed to fill this gap by comparing hand movement behaviour in persons with unilateral brain damage to the left and the right hemisphere and a matched control group of healthy persons. For hand movement coding, we applied Module I of NEUROGES, an objective and reliable analysis system that enables to analyse the full repertoire of hand movements independent of speech, which makes it specifically suited for the examination of persons with aphasia. The main results of our study show a decreased use of communicative conceptual gestures in persons with damage to the right hemisphere and an increased use of these gestures in persons with left brain damage and aphasia. These results not only suggest that the production of gesture and speech do not rely on the same neurological substrate but also underline the important role of right hemisphere functioning for gesture production.

Brain oxygenation patterns during the execution of tool use demonstration, tool use pantomime, and body-part-as-object tool use.

Divergent findings exist whether left and right hemispheric pre- and postcentral cortices contribute to the production of tool use related hand movements. In order to clarify the neural substrates of tool use demonstrations with tool in hand, tool use pantomimes without tool in hand, and body-part-as-object presentations of tool use (BPO) in a naturalistic mode of execution, we applied functional Near InfraRed Spectroscopy (fNIRS) in twenty-three right-handed participants. Functional NIRS techniques allow for the investigation of brain oxygenation during the execution of complex hand movements with an unlimited movement range. Brain oxygenation patterns were retrieved from 16 channels of measurement above pre- and postcentral cortices of each hemisphere. The results showed that tool use demonstration with tool in hand leads to increased oxygenation as compared to tool use pantomimes in the left hemispheric somatosensory gyrus. Left hand executions of the demonstration of tool use, pantomime of tool use, and BPO of tool use led to increased oxygenation in the premotor and somatosensory cortices of the left hemisphere as compared to right hand executions of either condition. The results indicate that the premotor and somatosensory cortices of the left hemisphere constitute relevant brain structures for tool related hand movement production when using the left hand, whereas the somatosensory cortex of the left hemisphere seems to provide specific mental representations when performing tool use demonstrations with the tool in hand.

Pantomiming tool use with an imaginary tool in hand as compared to demonstration with tool in hand specifically modulates the left middle and superior temporal gyri.

Neuropsychological lesion studies evidence the necessity to differentiate between various forms of tool-related actions such as real tool use, tool use demonstration with tool in hand and without physical target object, and pantomime without tool in hand. However, thus far, neuroimaging studies have primarily focused only on investigating tool use pantomimes. The present fMRI study investigates pantomime without tool in hand as compared to tool use demonstration with tool in hand in order to explore patterns of cerebral signal modulation associated with acting with imaginary tools in hand. Fifteen participants performed with either hand (i) tool use pantomime with an imaginary tool in hand in response to visual tool presentation and (ii) tool use demonstration with tool in hand in response to visual-tactile tool presentation. In both conditions, no physical target object was present. The conjunction analysis of the right and left hands executions of tool use pantomime relative to tool use demonstration yielded significant activity in the left middle and superior temporal lobe. In contrast, demonstration relative to pantomime revealed large bihemispherically distributed homologous areas of activity. Thus far, fMRI studies have demonstrated the relevance of the left middle and superior temporal gyri in viewing, naming, and matching tools and related actions and contexts. Since in our study all these factors were equally (ir)relevant both in the tool use pantomime and the tool use demonstration conditions, the present findings enhance the knowledge about the function of these brain regions in tool-related cognitive processes. The two contrasted conditions only differ regarding the fact that the pantomime condition requires the individual to act with an imaginary tool in hand. Therefore, we suggest that the left middle and superior temporal gyri are specifically involved in integrating the projected mental image of a tool in the execution of a tool-specific movement concept.