A combined therapy for limb apraxia and related anosognosia.

Left hemisphere stroke frequently leads to limb apraxia, a disorder that has been reported to impact independence in daily life and rehabilitation success. Nonetheless, there is a shortcoming in research and availability of applicable trainings. Further, to date, anosognosia for limb apraxia has largely been neglected. Therefore, we developed a Naturalistic Action Therapy that trains object selection and application with an errorless learning approach and which includes supported self-evaluation. The current study presents the results of two stroke patients participating in the training. The procedure entailed two baseline and one post-training sessions including standardized limb apraxia and anosognosia assessments as well as 18 naturalistic action tasks. The training consisted of 15 sessions during which 4-6 of the 18 naturalistic action tasks (e.g., pour water into a glass, make a phone call) were trained. Both patients showed improvement in trained and untrained tasks as well as in standardized apraxia and anosognosia assessments. Training effects appeared strongest for the trained items. The procedure is documented in detail and easy to administer and thus may have the potential to be applied by relatives. The results of this pilot-study are promising and suggest that the approach is suitable for further evaluation.

A Meta-analysis on the neural basis of planning: Activation likelihood estimation of functional brain imaging results in the Tower of London task.

The ability to mentally design and evaluate series of future actions has often been studied in terms of planning abilities, commonly using well-structured laboratory tasks like the Tower of London (ToL). Despite a wealth of studies, findings on the specific localization of planning processes within prefrontal cortex (PFC) and on the hemispheric lateralization are equivocal. Here, we address this issue by integrating evidence from two different sources of data: First, we provide a systematic overview of the existing lesion data on planning in the ToL (10 studies, 211 patients) which does not indicate any evidence for a general lateralization of planning processes in (pre)frontal cortex. Second, we report a quantitative meta-analysis with activation likelihood estimation based on 31 functional neuroimaging datasets on the ToL. Separate meta-analyses of the activation patterns reported for Overall Planning (537 participants) and for Planning Complexity (182 participants) congruently show bilateral contributions of mid-dorsolateral PFC, frontal eye fields, supplementary motor area, precuneus, caudate, anterior insula, and inferior parietal cortex in addition to a left-lateralized involvement of rostrolateral PFC. In contrast to previous attributions of planning-related brain activity to the entire dorsolateral prefrontal cortex (dlPFC) and either its left or right homolog derived from single studies on the ToL, the present meta-analyses stress the pivotal role specifically of the mid-dorsolateral part of PFC (mid-dlPFC), presumably corresponding to Brodmann Areas 46 and 9/46, and strongly argue for a bilateral rather than lateralized involvement of the dlPFC in planning in the ToL. Hum Brain Mapp 38:396-413, 2017. © 2016 Wiley Periodicals, Inc.

Trainability of affordance judgments in right and left hemisphere stroke patients.

Whenever we are confronted with action opportunities in everyday life, e.g., when passing an opening, we rely on our ability to precisely estimate our own bodily capabilities in relation to the environmental conditions. So-called affordance judgments can be affected after brain damage. Previous studies with healthy adults showed that such judgments appeared to be trainable within one session. In the current study, we examined whether stroke patients with either right brain damage (n = 30) or left brain damage (n = 30) may similarly profit from training in an aperture task. Further, the role of neuropsychological deficits in trainability was investigated. In the administered task, stroke patients decided whether their hand would fit into a presented opening with varying horizontal width (Aperture Task). During one training session, patients were asked to try to fit their hand into the opening and received feedback on their decisions. We analyzed accuracy and the detection theory parameters perceptual sensitivity and judgment tendency. Both patients with right brain damage and patients with left brain damage showed improved performance during training as well as post training. High variability with differential profiles of trainability was revealed in these patients. Patients with impaired performance in a visuo-spatial or motor-cognitive task appeared to profit considerably from the target-driven action phase with feedback, but the performance increase in judgments did not last when the action was withdrawn. Future studies applying lesion analysis with a larger sample may shed further light on the dissociation in the trainability of affordance judgments observed in patients with versus without visuo-spatial or motor-cognitive deficits.

100 years after Liepmann-Lesion correlates of diminished selection and application of familiar versus novel tools.

100 years ago, Liepmann highlighted the role of left ventro-dorsal lesions for impairments in conceptual (rather ventral) and motor (more dorsal) related aspects of apraxia. Many studies thereafter attributed to an extended left fronto-temporo-parietal network. Yet, to date there are only few studies that looked at apraxic performance in the selection and application of familiar versus novel tools. In the current study we applied modern voxel-based lesion-symptom mapping (VLSM) to analyze neural correlates of impaired selection and application of familiar versus novel tools. 58 left (LBD) and 51 right brain damaged (RBD) stroke patients participated in the Novel Tools Test (NTT) and the Familiar Tools Test (FTT) of the Diagnostic Instrument for Limb Apraxia (DILA-S). We further assessed performance in control tasks, namely semantic knowledge (BOSU), visuo-spatial working memory (Corsi Block Tapping) and meaningless imitation of gestures (IML). Impaired tool use was most pronounced after LBD. Our VLSM results in the LBD group suggested that selection- versus application-related aspects of praxis and semantics of familiar versus novel tool use can be behaviorally and neuro-anatomically differentiated. For impairments in familiar tool tasks, the major focus of lesion maps was rather ventral while deficiencies in novel tool tasks went along with rather dorsal lesions. Affected selection processes were linked to rather anterior lesions, while impacted application processes went along with rather posterior lesion maps. In our study, particular tool selection processes were rather specific for familiar versus novel tools. Foci for lesion overlaps of experimental and control tasks were noticed ventrally for semantic knowledge and FTT, in fronto-parietal regions for working memory and NTT, and ventro-dorsally for imitation of meaningless gestures and the application of NTT and FTT. We visualized our current interpretation within a neuroanatomical model for apraxia of tool use.

Is This Within Reach? Left but Not Right Brain Damage Affects Affordance Judgment Tendencies.

The ability to judge accurately whether or not an action can be accomplished successfully is critical for selecting appropriate response options that enable adaptive behaviors. Such affordance judgments are thought to rely on the perceived fit between environmental properties and knowledge of one's current physical capabilities. Little, however, is currently known about the ability of individuals to judge their own affordances following a stroke, or about the underlying neural mechanisms involved. To address these issues, we employed a signal detection approach to investigate the impact of left or right hemisphere injuries on judgments of whether a visual object was located within reach while remaining still (i.e., reachability). Regarding perceptual sensitivity and accuracy in judging reachability, there were no significant group differences between healthy controls (N = 29), right brain damaged (RBD, N = 17) and left brain damaged stroke patients (LBD, N = 17). However, while healthy controls and RBD patients demonstrated a negative response criterion and thus overestimated their reach capability, LBD patients' average response criterion converged to zero, indicating no judgment tendency. Critically, the LBD group's judgment tendency pattern is consistent with previous findings in this same sample on an affordance judgment task that required estimating whether the hand can fit through apertures (Randerath et al., 2018). Lesion analysis suggests that this loss of judgment tendency may be associated with damage to the left insula, the left parietal and middle temporal lobe. Based on these results, we propose that damage to the left ventro-dorsal stream disrupts the retrieval and processing of a stable criterion, leading to stronger reliance on intact on-line body-perceptive processes computed within the preserved bilateral dorsal network.

[Formula: see text] Limb apraxia profiles in different clinical samples.

Objective: Limb apraxia is a motor cognitive disorder that has been mainly studied in patients with dementia or left hemisphere stroke (LHS). However, limb apraxia has also been reported in patients with right hemisphere stroke (RHS), multiple sclerosis (MS) or traumatic brain injury (TBI). This study's aim was to report detailed praxis performance profiles in samples suffering from these different neurological disorders by use of the Diagnostic Instrument for Limb Apraxia (DILA-S).Method: 44 LHS patients, 36 RHS patients, 27 patients with dementia, 26 MS and 44 TBI patients participated. The diagnostics included the imitation of meaningless and meaningful hand gestures, pantomime of tool-use, single real tool-use as well as a multistep naturalistic action task (preparing breakfast).Results: Apraxia occurred in all tested samples but to a varying degree and with dissimilar profiles. LHS patients demonstrated most severe deficits in pantomime, but they were also vulnerable to deficits in real tool-use. Dementia patients showed high incidence rates of apraxia in almost all subscales of the DILA-S. RHS patients demonstrated difficulties in imitation and pantomime of tool-use, but they did not show severe difficulties with real tool-use. TBI patients appeared challenged by multistep naturalistic actions. The tested MS sample did not show clinically relevant symptoms in the DILA-S.Conclusion: Different types of patients display varying limb apraxic symptoms detectable by the DILA-S. In these limb apraxia susceptible populations, testing should be warranted as standard. Prospectively, individual error profiles may be helpful for shaping motor cognitive training.

Does it fit? - Trainability of affordance judgments in young and older adults.

Will I fit into the overcrowded subway? Advanced aging can change our abilities associated with accurately judging the fit between perceived environmental properties and our own actual physical capabilities (affordance judgments). Two experimental studies examined the effects of aging and trainability in affordance judgments. Participants were asked to decide whether their hand fits into a given opening (Aperture Task). We used a detection theory approach to evaluate different judgment characteristics. Study 1 demonstrated that older (N = 39) compared to younger adults (N = 39) produced rather conservative judgments, but did not differ in perceptual sensitivity. Distributions of Hit and False-Alarm rates, as well as risk-perception statements (DOSPERT questionnaire), indicated a heightened concern about potential consequences of misjudgments in older adults. In Study 2, 20 younger and 22 older adults were trained by actually trying to fit their hand into each presented opening. Training included acoustic, haptic and visual feedback. Compared to pre-training, both groups demonstrated significant increases in accuracy when assessed post-training and after a one-week follow-up. While younger adults improved in perceptual sensitivity in post-training as well as in follow-up, the older group adjusted their tendency towards less conservative judgments in both following sessions. Our results are consistent with affordance models that propose a complex and dynamic interplay of different neural processes involved in this skill. Future studies are needed to further elucidate that interplay and the trainability of affordance judgments.

Correction: Does it fit?-Trainability of affordance judgments in young and older adults.

[This corrects the article DOI: 10.1371/journal.pone.0212709.].

Does it still fit? - Adapting affordance judgments to altered body properties in young and older adults.

Actor-related affordance judgments are decisions about potential actions that arise from environmental as well as bodily and cognitive conditions. The system can be challenged by sudden changes to otherwise rather stable actor references e.g. due to accidental bodily injuries or due to brain damage and resulting motor and cognitive constraints. The current study investigated adaptation to suddenly artificially altered body properties and its reversibility in healthy young versus older adults. Participants were asked to judge whether they would be able to fit their hand through a given horizontal opening (Aperture Task). Body alterations were induced by equipping participants with one hand splint for 24 hours that enlarged the hand in width and height. Participants were tested before and directly after putting the splint on as well as after a habituation period of 24 hours. To assess reversibility, participants were tested again directly after removing the splint and one day later. Judgment accuracy values and detection theory measures were reported. Both, young and older adults judged more conservatively when body properties were altered compared to initial judgments for normal body properties. Especially older adults showed major difficulties in such quick adaptation. Older adults' judgment accuracy as well as perceptual sensitivity were significantly lowered when body properties were suddenly altered. Importantly, lowered judgment performance occurred for both, the splinted as well as the non-splinted hand in older adults. Only after 24 hours of habituation, older adults tended to regain initial performance levels showing adaptive behavior to the altered condition. Removing the hand splint for one day was sufficient to reverse these adaptive effects. Our study results suggest that aging slows down adaptation to sudden bodily alterations affecting actor-related affordance judgments. We propose that these altered processes may go along with uncertainty and a heightened concern about potential consequences of misjudgments. Clearly, future studies are needed to further elucidate the underlying processes of adaptation in affordance judgments. These may reveal major implications for the aging society and its associated problems with an increased risk of falling or stroke related bodily constraints.

It takes two to pantomime: Communication meets motor cognition.

For over a century, pantomime of tool use has been employed to diagnose limb apraxia, a disorder of motor cognition primarily induced by left brain damage. While research consistently implicates damage to a left fronto-temporo-parietal network in limb apraxia, findings are inconsistent regarding the impact of damage to anterior versus posterior nodes within this network on pantomime. Complicating matters is the fact that tool use pantomime can be affected and evaluated at multiple levels. For instance, the production of tool use gestures requires the consideration of semantic characteristics (e.g. how to communicate the action intention) as well as motor features (e.g. forming grip and movement). Together, these factors may contribute substantially to apparent discrepancies in previously reported findings regarding neural correlates of tool use pantomime. In the current study, 67 stroke patients with unilateral left-brain damage performed a classic pantomime task. In order to analyze different error characteristics, we evaluated the proper use of grip and movement for each pantomime. For certain objects, healthy subjects may use body parts as representative for the object, e.g. use of the fingers to indicate scissors blades. To specify the pathological use of body parts as the object (BPO) we only assessed pantomime items that were not prone to this response in healthy participants. We performed modern voxel-based lesion analyses on MRI or CT data to determine associations between brain injury and the frequency of the specific types of pantomime errors. Our results support a model in which anterior and posterior nodes of the left fronto-temporo-parietal network contribute differentially to pantomime of tool use. More precisely, damage in the inferior frontal cortex reaching to the temporal pole is associated with an increased frequency of BPO errors, whereas damage to the inferior parietal lobe is predominantly linked to an increased frequency of movement and/or grip errors. Our work suggests that the validity of attempts to specify the neural correlates of limb apraxia based on tool use pantomime depends on differentiating the specific types of errors committed. We conclude that successful tool use pantomime involves dissociable functions with communicative aspects represented in more anterior (rather ventral) regions and motor-cognitive aspects in more posterior (rather dorsal) nodes of a left fronto-temporo-parietal network.

Does it fit? - Impaired affordance perception after stroke.

Affordance perception comprises the evaluation of whether our given bodily capabilities and properties of the environment allow particular actions. Typical impairments after left brain damage in motor cognition as well as after right brain damage in visuo-spatial abilities may affect the evaluation of whether interactions with objects are possible. Further it is unclear whether deficient motor function is accounted for when deciding upon action opportunities. For these purposes we developed a paradigm with two tasks that differ in their type of demands on affordance perception and tested it in healthy young adults (Randerath and Frey, 2016). Here, we applied one of these two tasks in stroke patients and age matched healthy participants. A sample of 34 stroke patients with either left (LBD) or right brain damage (RBD) and 29 healthy controls made decisions about whether their hands would fit through a defined horizontal aperture presented in various sizes, while they remained still. Data was analyzed using a detection theory approach and included criterion, perceptual sensitivity and diagnostic accuracy as dependent variables. In addition we applied modern voxel based lesion analyses to explore neural correlates. Compared to controls, both patient groups demonstrated lower perceptual sensitivity. As predicted, increased motor cognitive deficiencies after left brain damage and visuo-spatial deficits after right brain damage were associated with worse performance. Preliminary lesion analyses demonstrated that next to lesions in ventro-dorsal regions, damage in the cortex-claustrum-cingulate pathway may affect perceptual sensitivity. Results were similar for left and right brain damage suggesting a bilateral network. Accordingly, we propose that perceptual sensitivity for affordance based judgments is a capability depending on motor-cognitive and visuo-spatial processing, which frequently is deficient after left or right brain damage, respectively. Further research on diagnostics and training in affordance perception after brain damage is needed.

Geographic mobility, family, and maternal variables as related to the psychosocial adjustment of military children.

The present study examined maternal and family factors and family mobility as related to mothers' and children's reports of the psychological adjustment of children in military families. Participants were 86 mother-child dyads in U.S. traditional military families. Children's reports of loneliness, peer relationships, fear of negative evaluations, and self-esteem were predicted by family cohesiveness, children's reports of their relationships with their mothers, and the length of time they had lived in their current residence, but not their rate of mobility (i.e., number of moves in the child's lifetime divided by the child's age). In contrast, maternal depressive symptoms predicted children's depressive and anxious behaviors, and both maternal depressive symptoms and children's perception of their relationship with their mothers predicted children's aggression and noncompliance. Results suggest that moving may not be as important as other aspects of maternal functioning and family relationships for the psychosocial adjustment of children in military families.