Critical brain regions for tool-related and imitative actions: a componential analysis

Non-invasive brain stimulation in limb praxis and apraxia: A scoping review in healthy subjects and patients with stroke

Non-invasive brain stimulation (NIBS) techniques are widely used in research settings to investigate brain mechanisms and increasingly being used for treatment purposes. The aim of this study was to systematically identify and review the current literature on NIBS studies of limb praxis and apraxia in healthy subjects and stroke patients with a scoping review using PRISMA-ScR guidelines. MEDLINE-PubMed, EMBASE and PsycINFO were searched. Inclusion criteria were English peer-reviewed studies focusing on the investigation of limb praxis/apraxia using repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation (tDCS). Fourteen out of 139 records met the inclusion criteria, including thirteen studies with healthy subjects and one with stroke patients. The results of our systematic review suggest that in healthy subjects NIBS over left inferior parietal lobe (IPL) mainly interfered with gesture processing, by either affecting reaction times in judgment tasks or real gesturing. First promising results suggest that inhibitory continuous theta burst stimulation (cTBS) over right IPL may enhance gesturing in healthy subjects, explained by transcallosal facilitation of left IPL. In stroke patients, excitatory anodal tDCS over left IPL may improve limb apraxia. However, larger well powered and sham-controlled clinical trials are needed to expand on these proof-of-concept results, before NIBS could be a treatment option to improve limb apraxia in stroke patients.

Chopstick operation training with the left non-dominant hand

Background

Training a non-dominant hand is important for rehabilitating people who are required to change handedness. However, improving the dexterity in using chopsticks with a non-dominant hand through training remains unclear. This study is aimed to measure whether chopstick training improves non-dominant hand chopstick operation skills and leads to acquisition of skill levels similar to those of the dominant hand.

Methods

This single-blinded randomized controlled trial enrolled 34 healthy young right-handed subjects who scored >70 points on the Edinburgh Handedness Questionnaire Inventory. They were randomly allocated to training or control groups. The training group participated in a 6-week chopstick training program with the non-dominant left hand, while the control group did not. Asymmetry of chopstick operation skill, perceived psychological stress, and oxygen-hemoglobin concentration as a brain activity measure in each hemisphere were measured before and after training.

Results

Participants in the training group had significantly lower asymmetry than those in the control group during the post-training assessment (F[1,30] ≥ 5.54, p ≤ 0.03, partial η² ≥ 0.156). Only perceived psychological stress had a significantly higher asymmetry during the post-training assessment (t[15] = 3.81, p < 0.01).

Conclusion

Six weeks of chopstick training improved non-dominant chopstick operation skills, and a performance level similar to that of the dominant hand was acquired.

Altered Inferior Parietal Functional Connectivity is Correlated with Praxis and Social Skill Performance in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) have difficulties perceiving and producing skilled gestures, or praxis. The inferior parietal lobule (IPL) is crucial to praxis acquisition and expression, yet how IPL connectivity contributes to autism-associated impairments in praxis as well as social-communicative skill remains unclear. Using resting-state functional magnetic resonance imaging, we applied independent component analysis to test how IPL connectivity relates to praxis and social-communicative skills in children with and without ASD. Across all children (with/without ASD), praxis positively correlated with connectivity of left posterior-IPL with the left dorsal premotor cortex and with the bilateral posterior/medial parietal cortex. Praxis also correlated with connectivity of right central-IPL connectivity with the left intraparietal sulcus and medial parietal lobe. Further, in children with ASD, poorer praxis and social-communicative skills both correlated with weaker right central-IPL connectivity with the left cerebellum, posterior cingulate, and right dorsal premotor cortex. Our findings suggest that IPL connectivity is linked to praxis development, that contributions arise bilaterally, and that right IPL connectivity is associated with impaired praxis and social-communicative skills in autism. The findings underscore the potential impact of IPL connectivity and impaired skill acquisition on the development of a range of social-communicative and motor functions during childhood, including autism-associated impairments.

Effect of body-part specificity and meaning in gesture imitation in left hemisphere stroke patients

Previous studies showed that imitation of finger and hand/arm gestures could be differentially impaired after brain damage. However, so far, the interaction between gesture meaning and body part in imitation deficits has not been fully assessed. In the present study, we aimed at filling this gap by testing 36 unilateral left brain-damaged patients with and without apraxia (20 apraxics), and 29 healthy controls on an imitation task of either finger or hand/arm meaningful (MF) gestures and meaningless (ML) movements, using a large sample of stimuli and controlling for the composition of the experimental list. Left-brain damaged patients imitated ML finger worse than hand/arm movements, whereas they did not show the same difference in MF gesture imitation. In addition, apraxic patients imitated finger movements worse than hand/arm movements. Furthermore, apraxic patients' imitation performance was equally affected irrespective of the action meaning, whereas non-apraxic patients showed better imitation performance on MF gestures. Results suggest that MF gestures are processed as a whole, as imitation of these gestures relies on the stored motor programs in long-term memory, independently of the body part involved. In contrast, ML movements seem to be processed through direct visuo-motor transformations, with left-brain damage specifically disrupting imitation performance of the more cognitive demanding finger movements.

Oscillatory entrainment of neural activity between inferior frontoparietal cortices alters imitation performance

The frontoparietal mirror network is activated when an individual performs a goal-directed action and observes another person's intentional action. It has been speculated that the distinct frontal and parietal regions might work together to participate in the imitation process, which translates an observed movement into an identical action. We aimed to determine the relationship between the frontoparietal mirror network and imitation by applying transcranial alternating current stimulation (tACS) to exogenously modulate oscillatory neural activity in the left inferior frontal gyrus and the left inferior parietal lobule. In total, 45 young adults participated in this study. The participants were randomly assigned to the three tACS groups (synchronous, desynchronous, and sham; 55 Hz enveloped by 6 Hz). Before and during tACS, the participants performed the gesture matching task and the gesture imitation task. Application of synchronous tACS over the left frontoparietal cortices significantly improved the performance of gesture matching and the meaningless gesture imitation relative to the baseline performance. Desynchronous tACS deteriorated the gesture matching performance relative to the baseline results. The oscillatory entrainment of neural activity between components of the frontoparietal mirror network is considered to alter imitation performance by modulating neural information relating to the goals of actions in the frontal cortex and the means of observed actions in the parietal cortex. To the best of our knowledge, this is the first study that reveals that the rhythmic communication between components of the frontoparietal mirror network has a functional role in imitation.

From shape to meaning: Evidence for multiple fast feedforward hierarchies of concept processing in the human brain

A number of fMRI studies have provided support for the existence of multiple concept representations in areas of the brain such as the anterior temporal lobe (ATL) and inferior parietal lobule (IPL). However, the interaction among different conceptual representations remains unclear. To better understand the dynamics of how the brain extracts meaning from sensory stimuli, we conducted a human high-density electroencephalography (EEG) study in which we first trained participants to associate pseudowords with various animal and tool concepts. After training, multivariate pattern classification of EEG signals in sensor and source space revealed the representation of both animal and tool concepts in the left ATL and tool concepts within the left IPL within 250 ​ms. Finally, we used Granger Causality analyses to show that orthography-selective sensors directly modulated activity in the parietal-tool selective cluster. Together, our results provide evidence for distinct but parallel "perceptual-to-conceptual" feedforward hierarchies in the brain.

Structural organization of the praxis network predicts gesture production: Evidence from healthy subjects and patients with schizophrenia

Hand gestures are an integral part of social interactions and communication. Several imaging studies in healthy subjects and lesion studies in patients with apraxia suggest the praxis network for gesture production, involving mainly left inferior frontal, posterior parietal and temporal regions. However, little is known about the structural connectivity underlying gesture production. We recruited 41 healthy participants and 39 patients with schizophrenia. All participants performed a gesture production test, the Test of Upper Limb Apraxia, and underwent diffusion tensor imaging. We hypothesized that gesture production is associated with structural network connectivity as well as with tract integrity. We defined the praxis network as an undirected graph comprised of 13 bilateral regions of interest and derived measures of local and global structural connectivity and tract integrity from Finsler geometry. We found an association of gesture deficit with reduced global and local efficiency of the praxis network. Furthermore, reduced tract integrity, for example in the superior longitudinal fascicle, arcuate fascicle or corpus callosum were related to gesture deficits. Our findings contribute to the understanding of structural correlates of gesture production as they first present diffusion tensor imaging data in a combined sample of healthy subjects and a patient cohort with gestural deficits.

Structural Disconnection of the Tool Use Network after Left Hemisphere Stroke Predicts Limb Apraxia Severity

Producing a tool use gesture is a complex process drawing upon the integration of stored knowledge of tools and their associated actions with sensory-motor mechanisms supporting the planning and control of hand and arm actions. Understanding how sensory-motor systems in parietal cortex interface with semantic representations of actions and objects in the temporal lobe remains a critical issue and is hypothesized to be a key determinant of the severity of limb apraxia, a deficit in producing skilled action after left hemisphere stroke. We used voxel-based and connectome-based lesion-symptom mapping with data from 57 left hemisphere stroke participants to assess the lesion sites and structural disconnection patterns associated with poor tool use gesturing. We found that structural disconnection among the left inferior parietal lobule, lateral and ventral temporal cortices, and middle and superior frontal gyri predicted the severity of tool use gesturing performance. Control analyses demonstrated that reductions in right-hand grip strength were associated with motor system disconnection, largely bypassing regions supporting tool use gesturing. Our findings provide evidence that limb apraxia may arise, in part, from a disconnection between conceptual representations in the temporal lobe and mechanisms enabling skilled action production in the inferior parietal lobule.

Dysbalanced Resting-State Functional Connectivity Within the Praxis Network Is Linked to Gesture Deficits in Schizophrenia

Patients with schizophrenia frequently present deficits in gesture production and interpretation, greatly affecting their communication skills. As these gesture deficits can be found early in the course of illness and as they can predict later outcomes, exploring their neural basis may lead to a better understanding of schizophrenia. While gesturing has been reported to rely on a left lateralized network of brain regions, termed praxis network, in healthy subjects and lesioned patients, studies in patients with schizophrenia are sparse. It is currently unclear whether within-network connectivity at rest is linked to gesture deficit. Here, we compared the functional connectivity between regions of the praxis network at rest between 46 patients and 44 healthy controls. All participants completed a validated test of hand gesture performance before resting-state functional magnetic resonance imaging (fMRI) was acquired. Patients performed gestures poorer than controls in all categories and domains. In patients, we also found significantly higher resting-state functional connectivity between left precentral gyrus and bilateral superior and inferior parietal lobule. Likewise, patients had higher connectivity from right precentral gyrus to left inferior and bilateral superior parietal lobule (SPL). In contrast, they exhibited lower connectivity between bilateral superior temporal gyrus (STG). Connectivity between right precentral gyrus and left SPL, as well as connectivity between bilateral STG, correlated with gesture performance in healthy controls. We failed to detect similar correlations in patients. We suggest that altered resting-state functional connectivity within the praxis network perturbs correct gesture planning in patients, reflecting the gesture deficit often seen in schizophrenia.

Predictors of Arm Nonuse in Chronic Stroke: A Preliminary Investigation

Background. Nonuse (NU) after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that NU is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been directly tested, and we have poor understanding of the predictors of NU. Objective. We aimed to provide preliminary evidence regarding demographic, neuropsychological (ie, apraxia, attention/arousal, neglect), and psychological (ie, self-efficacy) factors that may influence NU in chronic stroke. Methods. Twenty chronic stroke survivors with mild to moderate sensory-motor impairment characterized by the Upper-Extremity Fugl-Meyer (UEFM) were assessed for NU with a modified version of the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use in spontaneous versus forced conditions. Participants were also assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy. Using stepwise multiple regression, we determined which variables predicted AAUT NU scores. Results. Scores on the UEFM as well as attention/arousal predicted the degree of NU (P < .05). Attention/arousal predicted NU above and beyond UEFM (P < .05). Conclusions. The results are consistent with the importance of attention and engagement necessary to fully incorporate the paretic limb into daily activities. Larger-scale studies that include additional behavioral (eg, sensation, proprioception, spasticity, pain, mental health, motivation) and neuroanatomical measures (eg, lesion volume and white matter connectivity) will be important for future investigations.

Technition: When Tools Come Out of the Closet

People are ambivalently enthusiastic and anxious about how far technology can go. Therefore, understanding the neurocognitive bases of the human technical mind should be a major topic of the cognitive sciences. Surprisingly, however, scientists are not interested in this topic or address it only marginally in other mainstream domains (e.g., motor control, action observation, social cognition). In fact, this lack of interest may hinder our understanding of the necessary neurocognitive skills underlying our appetence for transforming our physical environment. Here, we develop the thesis that our technical mind originates in perhaps uniquely human neurocognitive skills, namely, technical-reasoning skills involving the area PF within the left inferior parietal lobe. This thesis creates an epistemological rupture with the state of the art that justifies the emergence of a new field in the cognitive sciences (i.e., technition) dedicated to the intelligence hidden behind tools and other forms of technologies, including constructions.

Limb and face apraxias in frontotemporal dementia: A systematic scoping review

PURPOSE

To investigate the literature for frequencies, profiles and neural correlates of limb and face apraxias in frontotemporal dementia (FTD).

METHOD

The search conducted in Ovid Medline, PsycINFO and Scopus yielded 487 non-duplicate records, and 43 were included in the final analysis.

RESULTS

Apraxias are evident in diverse forms in all clinical variants of FTD within the first four years of the disease. Face apraxia and productive limb apraxia co-occur in the behavioural and nonfluent variants. The logopenic variant resembles Alzheimer's disease in terms of pronounced parietal limb apraxia and absence of face apraxia. The semantic variant exhibits conceptual praxis deficits together with relatively preserved imitation skills. Concerning the genetic variants of FTD, productive limb apraxia is common among carriers of the progranulin gene mutation, and subtle gestural alterations have been documented among carriers of the chromosome 9 open reading frame 72 gene mutation before the expected disease onset. The data on neural correlations suggest that the breakdown of praxis results from bilateral cortical and subcortical damage in FTD and that Alzheimer-type pathology of the cerebrospinal fluid increases the severity of limb apraxia in all of the variants. Face apraxia correlates with degeneration of the medial and superior frontal cortices.

CONCLUSIONS

Each of the clinical variants of FTD exhibits a characteristic profile of apraxias that may support early differentiation between the variants and from Alzheimer's disease. However, the screening procedures developed for stroke populations seem insufficient, and a multifaceted assessment tool is needed. Although valid and practical tests already exist for dementia populations, a concise selection of test items that covers all of the critical domains is called for.

Neural dynamics of grip and goal integration during the processing of others' actions with objects: An ERP study

Recent behavioural evidence suggests that when processing others’ actions, motor acts and goal-related information both contribute to action recognition. Yet the neuronal mechanisms underlying the dynamic integration of the two action dimensions remain unclear. This study aims to elucidate the ERP components underlying the processing and integration of grip and goal-related information. The electrophysiological activity of 28 adults was recorded during the processing of object-directed action photographs (e.g., writing with pencil) containing either grip violations (e.g. upright pencil grasped with atypical-grip), goal violations (e.g., upside-down pencil grasped with typical-grip), both grip and goal violations (e.g., upside-down pencil grasped with atypical-grip), or no violations. Participants judged whether actions were overall typical or not according to object typical use. Brain activity was sensitive to the congruency between grip and goal information on the N400, reflecting the semantic integration between the two dimensions. On earlier components, brain activity was affected by grip and goal typicality independently. Critically, goal typicality but not grip typicality affected brain activity on the N300, supporting an earlier role of goal-related representations in action recognition. Findings provide new insights on the neural temporal dynamics of the integration of motor acts and goal-related information during the processing of others’ actions.

Revisiting the Functional Anatomy of the Human Brain: Toward a Meta-Networking Theory of Cerebral Functions

For more than one century, brain processing was mainly thought in a localizationist framework, in which one given function was underpinned by a discrete, isolated cortical area, and with a similar cerebral organization across individuals. However, advances in brain mapping techniques in humans have provided new insights into the organizational principles of anatomo-functional architecture. Here, we review recent findings gained from neuroimaging, electrophysiological, as well as lesion studies. Based on these recent data on brain connectome, we challenge the traditional, outdated localizationist view and propose an alternative meta-networking theory. This model holds that complex cognitions and behaviors arise from the spatiotemporal integration of distributed but relatively specialized networks underlying conation and cognition (e.g., language, spatial cognition). Dynamic interactions between such circuits result in a perpetual succession of new equilibrium states, opening the door to considerable interindividual behavioral variability and to neuroplastic phenomena. Indeed, a meta-networking organization underlies the uniquely human propensity to learn complex abilities, and also explains how postlesional reshaping can lead to some degrees of functional compensation in brain-damaged patients. We discuss the major implications of this approach in fundamental neurosciences as well as for clinical developments, especially in neurology, psychiatry, neurorehabilitation, and restorative neurosurgery.

Acquisition of chopstick-operation skills with the non-dominant hand and concomitant changes in brain activity

Despite their common use as eating utensils in East Asia, chopsticks require complex fine motor-skills for adequate operation and are thus most frequently used with the dominant hand; however, the effect of training time on the proficiency of using chopsticks with the non-dominant hand, as well as the brain activity underlying changes in skill, remain unclear. This study characterised the effect of time spent training in chopstick operation with the non-dominant hand on chopstick-use proficiency and the related brain activity to obtain data that may help individuals who are obliged to change handedness due to neurological disease to learn to use their non-dominant hand in performing daily activities. Thirty-two healthy right-handed students were randomly allocated to training (n = 16) or control (n = 16) groups; the former received 6 weeks of training in chopstick use with their non-dominant (left) hand, and the latter received none. After training, significant improvements in the execution speed and smoothness of upper extremity joints were observed in the training group. Moreover, left dorsolateral prefrontal cortex activity significantly decreased, and bilateral premotor cortex activity significantly increased across training. These results indicated that 6 weeks of chopstick training with the non-dominant hand effectively improved chopstick operation.

A Role for the Action Observation Network in Apraxia After Stroke

Limb apraxia is a syndrome often observed after stroke that affects the ability to perform skilled actions despite intact elementary motor and sensory systems. In a large cohort of unselected stroke patients with lesions to the left, right, and bilateral hemispheres, we used voxel-based lesion-symptom mapping (VLSM) on clinical CT head images to identify the neuroanatomical correlates of the impairment of performance in three tasks investigating praxis skills in patient populations. These included a meaningless gesture imitation task, a gesture production task involving pantomiming transitive and intransitive gestures, and a gesture recognition task involving recognition of these same categories of gestures. Neocortical lesions associated with poor performance in these tasks were all in the left hemisphere. They involved the pre-striate and medial temporal cortices, the superior temporal sulcus, inferior parietal area PGi, the superior longitudinal fasciculus underlying the primary motor cortex, and the uncinate fasciculus, subserving connections between temporal and frontal regions. No significant lesions were identified when language deficits, as indicated via a picture naming task, were controlled for. The implication of the superior temporal sulcus and the anatomically connected prestriate and inferior parietal regions challenges traditional models of the disorder. The network identified has been implicated in studies of action observation, which might share cognitive functions sub-serving praxis and language skills.

EEG Processing to Discriminate Transitive-Intransitive Motor Imagery Tasks: Preliminary Evidences using Support Vector Machines

It is known that brain dynamics significantly changes during motor imagery tasks of upper limb involving different kind of interactions with an object. Nevertheless, an automatic discrimination of transitive (i.e., actions involving an object) and intransitive (i.e., meaningful gestures that do not include the use of objects) imaginary actions using EEG dynamics has not been performed yet. In this study we exploit measures of EEG spectra to automatically discern between imaginary transitive and intransitive movements of the upper limb. To this end, nonlinear support vector machine algorithms are used to properly combine EEG-derived features, while a recursive feature elimination procedure highlights the most discriminant cortical regions and associated EEG frequency oscillations. Results show the significance of $\gamma ( 30 -45$ Hz) oscillations over the fronto-occipital and ipsilateral-parietal areas for the automatic classification of transitive-intransitive imaginary upper limb movements with a satisfactory accuracy of 70.97%.

Neural correlates of differential finger gesture imitation deficits in left hemisphere stroke

Behavioural studies in apraxic patients revealed dissociations between the processing of meaningful (MF) and meaningless (ML) gestures. Consequently, the existence of two differential neural mechanisms for the imitation of either gesture type has been postulated. While the indirect (semantic) route exclusively enables the imitation of MF gestures, the direct route can be used for the imitation of any gesture type, irrespective of meaning, and thus especially for ML gestures. Concerning neural correlates, it is debated which of the visuo-motor streams (i.e., the ventral steam, the ventro-dorsal stream, or the dorso-dorsal stream) supports the postulated indirect and direct imitation routes. To probe the hypotheses that regions of the dorso-dorsal stream are involved differentially in the imitation of ML gestures and that regions of the ventro-dorsal stream are involved differentially in the imitation of MF gestures, we analysed behavioural (imitation of MF and ML finger gestures) and lesion data of 293 patients with a left hemisphere (LH) stroke. Confirming previous work, the current sample of LH stroke patients imitated MF finger gestures better than ML finger gestures. The analysis using voxel-based lesion symptom mapping (VLSM) revealed that LH damage to dorso-dorsal stream areas was associated with an impaired imitation of ML finger gestures, whereas damage to ventro-dorsal regions was associated with a deficient imitation of MF finger gestures. Accordingly, the analyses of the imitation of visually uniform and thus highly comparable MF and ML finger gestures support the dual-route model for gesture imitation at the behavioural and lesion level in a substantial patient sample. Furthermore, the data show that the direct route for ML finger gesture imitation depends on the dorso-dorsal visuo-motor stream while the indirect route for MF finger gesture imitation is related to regions of the ventro-dorsal visuo-motor stream.

Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia-A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond

Behavioral variant frontotemporal dementia (bvFTD) is the second leading cognitive disorder caused by neurodegeneration in patients under 65 years of age. Characterized by frontal, insular, and/or temporal brain atrophy, patients present with heterogeneous constellations of behavioral and psychological symptoms among which progressive changes in social conduct, lack of empathy, apathy, disinhibited behaviors, and cognitive impairments are frequently observed. Since the histopathology of the disease is heterogeneous and identified genetic mutations only account for ~30% of cases, there are no reliable biomarkers for the diagnosis of bvFTD available in clinical routine as yet. Early detection of bvFTD thus relies on correct application of clinical diagnostic criteria. Their evaluation however, requires expertise and in-depth assessments of cognitive functions, history taking, clinical observations as well as caregiver reports on behavioral and psychological symptoms and their respective changes. With this review, we aim for a critical appraisal of common methods to access the behavioral and psychological symptoms as well as the cognitive alterations presented in the diagnostic criteria for bvFTD. We highlight both, practical difficulties as well as current controversies regarding an overlap of symptoms and particularly cognitive impairments with other neurodegenerative and primary psychiatric diseases. We then review more recent developments and evidence on cognitive, behavioral and psychological symptoms of bvFTD beyond the diagnostic criteria which may prospectively enhance the early detection and differential diagnosis in clinical routine. In particular, evidence on specific impairments in social and emotional processing, praxis abilities as well as interoceptive processing in bvFTD is summarized and potential links with behavior and classic cognitive domains are discussed. We finally outline both, future opportunities and major challenges with regard to the role of clinical neuropsychology in detecting bvFTD and related neurocognitive disorders.

Movement Imitation via an Abstract Trajectory Representation in Dorsal Premotor Cortex

Humans are particularly good at copying novel and meaningless gestures. The mechanistic and anatomical basis for this specialized imitation ability remains largely unknown. One idea is that imitation occurs by matching body configurations. Here we propose an alternative route to imitation that depends on a body-independent representation of the trajectory path of the end-effector. We studied a group of patients with strokes in the left frontoparietal cortices. We found that they were equally impaired at imitating movement trajectories using the ipsilesional limb (i.e., the nonparetic side) that were cued either by an actor using their whole arm or just by a cursor, suggesting that body configuration information is not always critical for imitation and that a representation of abstract trajectory shape may suffice. In addition, imitation ability was uncorrelated to the ability to identify the trajectory shape, suggesting that imitation deficits were unlikely to arise from perceptual impairments. Finally, a lesion-symptom mapping analysis found that imitation deficits were associated with lesions in left dorsal premotor but not parietal cortex. Together, these findings suggest a novel body-independent route to imitation that relies on the ability to plan abstract movement trajectories within dorsal premotor cortex.SIGNIFICANCE STATEMENT The ability to imitate is critical for rapidly learning to produce new gestures and actions, but how the brain translates observed movements into motor commands is poorly understood. Examining the ability of patients with strokes affecting the left hemisphere revealed that meaningless gestures can be imitated by succinctly representing only the motion of the hand in space, rather than the posture of the entire arm. Moreover, performance deficits correlated with lesions in dorsal premotor cortex, an area not previously associated with impaired imitation of arm postures. These findings thus describe a novel route to imitation that may also be impaired in some patients with apraxia.

Action Observation for Neurorehabilitation in Apraxia

Neurorehabilitation and brain stimulation studies of post-stroke patients suggest that action-observation effects can lead to rapid improvements in the recovery of motor functions and long-term motor cortical reorganization. Apraxia is a clinically important disorder characterized by marked impairment in representing and performing skillful movements [gestures], which limits many daily activities and impedes independent functioning. Recent clinical research has revealed errors of visuo-motor integration in patients with apraxia. This paper presents a rehabilitative perspective focusing on the possibility of action observation as a therapeutic treatment for patients with apraxia. This perspective also outlines impacts on neurorehabilitation and brain repair following the reinforcement of the perceptual-motor coupling. To date, interventions based primarily on action observation in apraxia have not been undertaken.

Repetitive Transcranial Magnetic Stimulation Over the Left Posterior Middle Temporal Gyrus Reduces Wrist Velocity During Emblematic Hand Gesture Imitation

Results from neuropsychological studies, and neuroimaging and behavioural experiments with healthy individuals, suggest that the imitation of meaningful and meaningless actions may be reliant on different processing routes. The left posterior middle temporal gyrus (pMTG) is one area that might be important for the recognition and imitation of meaningful actions. We studied the role of the left pMTG in imitation using repetitive transcranial magnetic stimulation (rTMS) and two-person motion-tracking. Participants imitated meaningless and emblematic meaningful hand and finger gestures performed by a confederate actor whilst both individuals were motion-tracked. rTMS was applied during action observation (before imitation) over the left pMTG or a vertex control site. Since meaningless action imitation has been previously associated with a greater wrist velocity and longer correction period at the end of the movement, we hypothesised that stimulation over the left pMTG would increase wrist velocity and extend the correction period of meaningful actions (i.e., due to interference with action recognition). We also hypothesised that imitator accuracy (actor-imitator correspondence) would be reduced following stimulation over the left pMTG. Contrary to our hypothesis, we found that stimulation over the pMTG, but not the vertex, during action observation reduced wrist velocity when participants later imitated meaningful, but not meaningless, hand gestures. These results provide causal evidence for a role of the left pMTG in the imitation of meaningful gestures, and may also be in keeping with proposals that left posterior temporal regions play a role in the production of postural components of gesture.

The left ventral premotor cortex is involved in hand shaping for intransitive gestures: evidence from a two-person imitation experiment

The ventral premotor cortex (PMv) is involved in grasping and object manipulation, while the dorsal premotor cortex (PMd) has been suggested to play a role in reaching and action selection. These areas have also been associated with action imitation, but their relative roles in different types of action imitation are unclear. We examined the role of the left PMv and PMd in meaningful and meaningless action imitation by using repetitive transcranial magnetic stimulation (rTMS). Participants imitated meaningful and meaningless actions performed by a confederate actor while both individuals were motion-tracked. rTMS was applied over the left PMv, left PMd or a vertex control site during action observation or imitation. Digit velocity was significantly greater following stimulation over the PMv during imitation compared with stimulation over the PMv during observation, regardless of action meaning. Similar effects were not observed over the PMd or vertex. In addition, stimulation over the PMv increased finger movement speed in a (non-imitative) finger-thumb opposition task. We suggest that claims regarding the role of the PMv in object-directed hand shaping may stem from the prevalence of object-directed designs in motor control research. Our results indicate that the PMv may have a broader role in 'target-directed' hand shaping, whereby different areas of the hand are considered targets to act upon during intransitive gesturing.

Bilateral functional connectivity at rest predicts apraxic symptoms after left hemisphere stroke

Increasing evidence indicates that focal lesions following stroke cause alterations in connectivity among functional brain networks. Functional connectivity between hemispheres has been shown to be particularly critical for predicting stroke-related behavioral deficits and recovery of motor function and attention. Much less is known, however, about the relevance of interhemispheric functional connectivity for cognitive abilities like praxis that rely on strongly lateralized brain networks. In the current study, we examine correlations between symptoms of apraxia-a disorder of skilled action that cannot be attributed to lower-level sensory or motor impairments-and spontaneous, resting brain activity in functional MRI in chronic left hemisphere stroke patients and neurologically-intact control participants. Using a data-driven approach, we identified 32 regions-of-interest in which pairwise functional connectivity correlated with two distinct measures of apraxia, even when controlling for age, head motion, lesion volume, and other artifacts: overall ability to pantomime the typical use of a tool, and disproportionate difficulty pantomiming the use of tools associated with different, competing use and grasp-to-move actions (e.g., setting a kitchen timer versus picking it up). Better performance on both measures correlated with stronger interhemispheric functional connectivity. Relevant regions in the right hemisphere were often homologous to left hemisphere areas associated with tool use and action. Additionally, relative to overall pantomime accuracy, disproportionate difficulty pantomiming the use of tools associated with competing use and grasp actions was associated with weakened functional connectivity among a more strongly left-lateralized and peri-Sylvian set of brain regions. Finally, patient performance on both measures of apraxia was best predicted by a model that incorporated information about lesion location and functional connectivity, and functional connectivity continued to explain unique variance in behavior even after accounting for lesion loci. These results indicate that interhemispheric functional connectivity is relevant even for a strongly lateralized cognitive ability like praxis and emphasize the importance of the right hemisphere in skilled action.

Distortion of Visuo-Motor Temporal Integration in Apraxia: Evidence From Delayed Visual Feedback Detection Tasks and Voxel-Based Lesion-Symptom Mapping

Limb apraxia is a higher brain dysfunction that typically occurs after left hemispheric stroke and its cause cannot be explained by sensory disturbance or motor paralysis. The comparison of motor signals and visual feedback to generate errors, i.e., visuo-motor integration, is important in motor control and motor learning, which may be impaired in apraxia. However, in apraxia after stroke, it is unknown whether there is a specific deficit in visuo-motor temporal integration compared to visuo-tactile and visuo-proprioceptive temporal integration. We examined the precision of visuo-motor temporal integration and sensory-sensory (visuo-tactile and visuo-proprioception) temporal integration in apraxia after stroke by using a delayed visual feedback detection task with three different conditions (tactile, passive movement, and active movement). The delay detection threshold and the probability curve for delay detection obtained in this task were quantitative indicators of the respective temporal integration functions. In addition, we performed subtraction and voxel-based lesion-symptom mapping to identify the brain lesions responsible for apraxia and deficits in visuo-motor temporal integration. The behavioral experiments showed that the delay detection threshold was extended and that the probability curve for delay detection was less steep in apraxic patients compared to controls (pseudo-apraxic patients and unaffected patients), only for the active movement condition, and not for the tactile and passive movement conditions. Furthermore, the severity of apraxia was significantly correlated with the delay detection threshold and the steepness of the probability curve in the active movement condition. These results indicated that multisensory (i.e., visual, tactile, and proprioception) feedback was normally temporally integrated, but motor prediction and visual feedback were not correctly temporally integrated in apraxic patients. That is, apraxic patients had difficulties with visuo-motor temporal integration. Lesion analyses revealed that both apraxia and the distortion of visuo-motor temporal integration were associated with lesions in the fronto-parietal motor network, including the left inferior parietal lobule and left inferior frontal gyrus. We suppose that damage to the left inferior fronto-parietal network could cause deficits in motor prediction for visuo-motor temporal integration, but not for sensory-sensory (visuo-tactile and visuo-proprioception) temporal integration, leading to the distortion of visuo-motor temporal integration in patients with apraxia.

The relationship between co-speech gesture production and macrolinguistic discourse abilities in people with focal brain injury

Brain damage is associated with linguistic deficits and might alter co-speech gesture production. Gesture production after focal brain injury has been mainly investigated with respect to intrasentential rather than discourse-level linguistic processing. In this study, we examined 1) spontaneous gesture production patterns of people with left hemisphere damage (LHD) or right hemisphere damage (RHD) in a narrative setting, 2) the neural structures associated with deviations in spontaneous gesture production in these groups, and 3) the relationship between spontaneous gesture production and discourse level linguistic processes (narrative complexity and evaluation competence). Individuals with LHD or RHD (17 people in each group) and neurotypical controls (n = 13) narrated a story from a picture book. Results showed that increase in gesture production for LHD individuals was associated with less complex narratives and lesions of individuals who produced more gestures than neurotypical individuals overlapped in frontal-temporal structures and basal ganglia. Co-speech gesture production of RHD individuals positively correlated with their evaluation competence in narrative. Lesions of RHD individuals who produced more gestures overlapped in the superior temporal gyrus and the inferior parietal lobule. Overall, LHD individuals produced more gestures than neurotypical individuals. The groups did not differ in their use of different gesture forms except that LHD individuals produced more deictic gestures per utterance than RHD individuals and controls. Our findings are consistent with the hypothesis that co-speech gesture production interacts with macro-linguistic levels of discourse and this interaction is affected by the hemispheric lateralization of discourse abilities.

Task- and domain-specific modulation of functional connectivity in the ventral and dorsal object-processing pathways

A whole-brain network of regions collectively supports the ability to recognize and use objects-the Tool Processing Network. Little is known about how functional interactions within the Tool Processing Network are modulated in a task-dependent manner. We designed an fMRI experiment in which participants were required to either generate object pantomimes or to carry out a picture matching task over the same images of tools, while holding all aspects of stimulus presentation constant across the tasks. The Tool Processing Network was defined with an independent functional localizer, and functional connectivity within the network was measured during the pantomime and picture matching tasks. Relative to tool picture matching, tool pantomiming led to an increase in functional connectivity between ventral stream regions and left parietal and frontal-motor areas; in contrast, the matching task was associated with an increase in functional connectivity among regions in ventral temporo-occipital cortex, and between ventral temporal regions and the left inferior parietal lobule. Graph-theory analyses over the functional connectivity data indicated that the left premotor cortex and left lateral occipital complex were hub-like (exhibited high betweenness centrality) during tool pantomiming, while ventral stream regions (left medial fusiform gyrus and left posterior middle temporal gyrus) were hub-like during the picture matching task. These results demonstrate task-specific modulation of functional interactions among a common set of regions, and indicate dynamic coupling of anatomically remote regions in task-dependent manner.

A Tale of Two Visual Systems: Invariant and Adaptive Visual Information Representations in the Primate Brain

Visual information processing contains two opposite needs. There is both a need to comprehend the richness of the visual world and a need to extract only pertinent visual information to guide thoughts and behavior at a given moment. I argue that these two aspects of visual processing are mediated by two complementary visual systems in the primate brain-specifically, the occipitotemporal cortex (OTC) and the posterior parietal cortex (PPC). The role of OTC in visual processing has been documented extensively by decades of neuroscience research. I review here recent evidence from human imaging and monkey neurophysiology studies to highlight the role of PPC in adaptive visual processing. I first document the diverse array of visual representations found in PPC. I then describe the adaptive nature of visual representation in PPC by contrasting visual processing in OTC and PPC and by showing that visual representations in PPC largely originate from OTC.

Tool selection and the ventral-dorsal organization of tool-related knowledge

Tool selection is a cognitive process necessary for tool use, and may rely on distinct knowledge under different conditions. This fMRI experiment was designed to identify neural substrates mediating tool selection under different conditions. Participants performed a picture‐matching task that presented a recipient object and an action‐goal, and required the selection of the best tool object from among four candidates. Some trials allowed selection of the prototypical tool, whereas others forced selection of either a functionally substitutable or impossible tool. Statistical contrasts revealed significantly different activation between Proto and Sub conditions in frontal, parietal, and temporal lobes. The middle temporal gyrus (MTG) bilaterally, and the right posterior cingulate were more strongly activated by prototypical tool selection, and left inferior parietal lobule (IPL), intraparietal sulcus (IPS), middle frontal gyrus, and precuneus were more strongly activated when selecting substitutable objects. These findings are concordant with previous neuroimaging studies of tool use knowledge in demonstrating that activation of the MTG represents functional knowledge for conventional tool usage, and activation of the IPL/IPS supports action (i.e., praxic) knowledge representations. These results contribute to the literature that dissociates the roles of ventral and dorsal streams in tool‐related knowledge and behavior, and emphasize the role of the left hemisphere for processing goal‐directed object interactions.

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.

Abstract Representations of Object-Directed Action in the Left Inferior Parietal Lobule

Prior neuroimaging and neuropsychological research indicates that the left inferior parietal lobule in the human brain is a critical substrate for representing object manipulation knowledge. In the present functional MRI study we used multivoxel pattern analyses to test whether action similarity among objects can be decoded in the inferior parietal lobule independent of the task applied to objects (identification or pantomime) and stimulus format in which stimuli are presented (pictures or printed words). Participants pantomimed the use of objects, cued by printed words, or identified pictures of objects. Classifiers were trained and tested across task (e.g., training data: pantomime; testing data: identification), stimulus format (e.g., training data: word format; testing format: picture) and specific objects (e.g., training data: scissors vs. corkscrew; testing data: pliers vs. screwdriver). The only brain region in which action relations among objects could be decoded across task, stimulus format and objects was the inferior parietal lobule. By contrast, medial aspects of the ventral surface of the left temporal lobe represented object function, albeit not at the same level of abstractness as actions in the inferior parietal lobule. These results suggest compulsory access to abstract action information in the inferior parietal lobe even when simply identifying objects.

Come together: human-avatar on-line interactions boost joint-action performance in apraxic patients

Limb apraxia (LA) is a high-order motor disorder linked to left-hemisphere damage. It is characterized by defective execution of purposeful actions upon delayed imitation, or verbal command when the actions are performed in isolated, non-naturalistic, conditions. Whether interpersonal interactions provide social affordances that activate neural resources different from those requested by individual action execution, which may improve LA performance, is unknown. To fill this gap, we measured interaction performance, behavioral and kinematic indexes of left-brain damaged patients with/without LA in a social reach-to-grasp task involving two different degrees of spatio-temporal interactivity with an avatar. We found that LA patients' impairment in coordinating with the virtual partner was abolished in highly interactive conditions (where patients selected their actions on-line based on the behavior of the virtual partner) with respect to low interactive conditions (where actions were selected beforehand based on abstract instructions). Voxel-based-Lesion-Symptom-Mapping indicated that impairments in low-interactive conditions were underpinned by lesions of premotor, motor and insular areas, and of the basal ganglia. Our approach expands current understanding of the behavioral and neural correlates of interactive motor performance by highlighting the important role of social affordances, and provides novel, potentially important, views on rehabilitation of higher-order motor cognition disorders.