The impact of left hemisphere stroke on force control with familiar and novel objects: neuroanatomic substrates and relationship to apraxia

“Left and right prefrontal routes to action comprehension”

Successful action comprehension requires the integration of motor information and semantic cues about objects in context. Previous evidence suggests that while motor features are dorsally encoded in the fronto-parietal action observation network (AON); semantic features are ventrally processed in temporal structures. Importantly, these dorsal and ventral routes seem to be preferentially tuned to low (LSF) and high (HSF) spatial frequencies, respectively. Recently, we proposed a model of action comprehension where we hypothesized an additional route to action understanding whereby coarse LSF information about objects in context is projected to the dorsal AON via the prefrontal cortex (PFC), providing a prediction signal of the most likely intention afforded by them. Yet, this model awaits for experimental testing. To this end, we used a perturb-and-measure continuous theta burst stimulation (cTBS) approach, selectively disrupting neural activity in the left and right PFC and then evaluating the participant's ability to recognize filtered action stimuli containing only HSF or LSF. We find that stimulation over PFC triggered different spatial-frequency modulations depending on lateralization: left-cTBS and right-cTBS led to poorer performance on HSF and LSF action stimuli, respectively. Our findings suggest that left and right PFC exploit distinct spatial frequencies to support action comprehension, providing evidence for multiple routes to social perception in humans.

The challenge of apraxia: Toward an operational definition?

The diagnosis of limb apraxia relies mainly on exclusion criteria (e.g., elementary motor or sensory deficits, aphasia). Due to the diversity of apraxia definitions and assessment methods, patients may or may not show apraxia depending on the chosen assessment method or theory, making the definition of apraxia somewhat arbitrary. As a result, "apraxia" may be diagnosed in patients with different cognitive impairments. Based on a quantitative and critical review of the literature, it is argued that this situation has its roots in the evolution from a task-based approach (i.e., the use of gold standard tests to detect apraxia) toward a process-based approach, namely, the deconstruction of the conceptual or production systems of action into multiple cognitive processes: language, executive functions, working memory, semantic memory, body schema, body image, visual-spatial skills, social cognition, visual-kinesthetic engrams, manipulation knowledge, technical reasoning, structural inference, and categorical apprehension. The coexistence of both approaches in the current literature is a major challenge that stands in the way of a scientific definition of apraxia. As a step toward a solution, we suggest to focus on symptoms, and on two complementary definition criteria (in addition with traditional exclusion criteria): Specificity (i.e., is apraxia explained by the alteration of cognitive processes specifically dedicated to gesture production?), and consistency (i.e., is the gesture production impairment consistent across tasks?). Two categories of limb apraxia are proposed: symptomatic apraxia (i.e., gesture production deficits that are secondary to more general cognitive impairments) and idiopathic apraxia (i.e., gesture production deficits that can be observed in isolation). It turns out that the only apraxia subtype that fulfills exclusion, specificity, and consistency criteria is limb-kinetic apraxia. A century after Liepmann's demonstration of the autonomy of apraxia toward language, the autonomy of this syndrome toward the rest of cognition remains an open question, while it poses new challenges to apraxia studies.

Limb apraxia and the left parietal lobe

Limb apraxia is a heterogeneous disorder of skilled action and tool use that has long perplexed clinicians and researchers. It occurs after damage to various loci in a densely interconnected network of regions in the left temporal, parietal, and frontal lobes. Historically, a highly classificatory approach to the study of apraxia documented numerous patterns of performance related to two major apraxia subtypes: ideational and ideomotor apraxia. More recently, there have been advances in our understanding of the functional neuroanatomy and connectivity of the left-hemisphere "tool use network," and the patterns of performance that emerge from lesions to different loci within this network. This chapter focuses on the left inferior parietal lobe, and its role in tool and body representation, action prediction, and action selection, and how these functions relate to the deficits seen in patients with apraxia subsequent to parietal lesions. Finally, suggestions are offered for several future directions that will benefit the study of apraxia, including increased attention to research on rehabilitation of this disabling disorder.

Learning, remembering, and predicting how to use tools: Distributed neurocognitive mechanisms: Comment on Osiurak and Badets (2016)

The reasoning-based approach championed by Francois Osiurak and Arnaud Badets (Osiurak & Badets, 2016) denies the existence of sensory-motor memories of tool use except in limited circumstances, and suggests instead that most tool use is subserved solely by online technical reasoning about tool properties. In this commentary, I highlight the strengths and limitations of the reasoning-based approach and review a number of lines of evidence that manipulation knowledge is in fact used in tool action tasks. In addition, I present a "two route" neurocognitive model of tool use called the "Two Action Systems Plus (2AS+)" framework that posits a complementary role for online and stored information and specifies the neurocognitive substrates of task-relevant action selection. This framework, unlike the reasoning based approach, has the potential to integrate the existing psychological and functional neuroanatomic data in the tool use domain. (PsycINFO Database Record

Critical Motor Involvement in Prediction of Human and Non-biological Motion Trajectories

OBJECTIVES

Adaptive interaction with the environment requires the ability to predict both human and non-biological motion trajectories. Prior accounts of the neurocognitive basis for prediction of these two motion classes may generally be divided into those that posit that non-biological motion trajectories are predicted using the same motor planning and/or simulation mechanisms used for human actions, and those that posit distinct mechanisms for each. Using brain lesion patients and healthy controls, this study examined critical neural substrates and behavioral correlates of human and non-biological motion prediction.

METHODS

Twenty-seven left hemisphere stroke patients and 13 neurologically intact controls performed a visual occlusion task requiring prediction of pantomimed tool use, real tool use, and non-biological motion videos. Patients were also assessed with measures of motor strength and speed, praxis, and action recognition.

RESULTS

Prediction impairment for both human and non-biological motion was associated with limb apraxia and, weakly, with the severity of motor production deficits, but not with action recognition ability. Furthermore, impairment for human and non-biological motion prediction was equivalently associated with lesions in the left inferior parietal cortex, left dorsal frontal cortex, and the left insula.

CONCLUSIONS

These data suggest that motor planning mechanisms associated with specific loci in the sensorimotor network are critical for prediction of spatiotemporal trajectory information characteristic of both human and non-biological motions. (JINS, 2017, 23, 171-184).

Impaired Communication Between the Dorsal and Ventral Stream: Indications from Apraxia

Patients with apraxia perform poorly when demonstrating how an object is used, particularly when pantomiming the action. However, these patients are able to accurately identify, and to pick up and move objects, demonstrating intact ventral and dorsal stream visuomotor processing. Appropriate object manipulation for skilled use is thought to rely on integration of known and visible object properties associated with “ventro-dorsal” stream neural processes. In apraxia, it has been suggested that stored object knowledge from the ventral stream may be less readily available to incorporate into the action plan, leading to an over-reliance on the objects’ visual affordances in object-directed motor behavior. The current study examined grasping performance in left hemisphere stroke patients with (N = 3) and without (N = 9) apraxia, and in age-matched healthy control participants (N = 14), where participants repeatedly grasped novel cylindrical objects of varying weight distribution. Across two conditions, object weight distribution was indicated by either a memory-associated cue (object color) or visual-spatial cue (visible dot over the weighted end). Participants were required to incorporate object-weight associations to effectively grasp and balance each object. Control groups appropriately adjusted their grasp according to each object’s weight distribution across each condition, whereas throughout the task two of the three apraxic patients performed poorly on both the memory-associated and visual-spatial cue conditions. A third apraxic patient seemed to compensate for these difficulties but still performed differently to control groups. Patients with apraxia performed normally on the neutral control condition when grasping the evenly weighted version. The pattern of behavior in apraxic patients suggests impaired integration of visible and known object properties attributed to the ventro-dorsal stream: in learning to grasp the weighted object accurately, apraxic patients applied neither pure knowledge-based information (the memory-associated condition) nor higher-level information given in the visual-spatial cue condition. Disruption to ventro-dorsal stream predicts that apraxic patients will have difficulty learning to manipulate new objects on the basis of information other than low-level visual cues such as shape and size.

Motor and Visuospatial Attention and Motor Planning After Stroke: Considerations for the Rehabilitation of Standing Balance and Gait

Attention and planning can be altered by stroke, which can influence motor performance. Although the influence of these factors on recovery from stroke has been explored for the upper extremity (UE), their impact on balance and gait are unknown. This perspective article presents evidence that altered motor and visuospatial attention influence motor planning of voluntary goal-directed movements poststroke, potentially affecting balance and gait. Additionally, specific strategies for rehabilitation of balance and gait poststroke in the presence of these factors are discussed. Visuospatial attention selects relevant sensory information and supports the preparation of responses to this information. Motor attentional impairments may produce difficulty with selecting appropriate motor feedback, potentially contributing to falls. An original theoretical model is presented for a network of brain regions supporting motor and visuospatial attention, as well as motor planning of voluntary movements. Stroke may influence this functional network both locally and distally, interfering with input or output of the anatomical or functional regions involved and affecting voluntary movements. Although there is limited research directly examining leg function, evidence suggests alterations in motor and visuospatial attention influence motor planning and have a direct impact on performance of gait and balance. This model warrants testing comparing healthy adults with individuals with stroke.

Force control in chronic stroke

Force control deficits are common dysfunctions after a stroke. This review concentrates on various force control variables associated with motor impairments and suggests new approaches to quantifying force control production and modulation. Moreover, related neurophysiological mechanisms were addressed to determine variables that affect force control capabilities. Typically, post stroke force control impairments include: (a) decreased force magnitude and asymmetrical forces between hands, (b) higher task error, (c) greater force variability, (d) increased force regularity, and (e) greater time-lag between muscular forces. Recent advances in force control analyses post stroke indicated less bimanual motor synergies and impaired low-force frequency structure. Brain imaging studies demonstrate possible neurophysiological mechanisms underlying force control impairments: (a) decreased activation in motor areas of the ipsilesional hemisphere, (b) increased activation in secondary motor areas between hemispheres, (c) cerebellum involvement, and (d) relatively greater interhemispheric inhibition from the contralesional hemisphere. Consistent with identifying neurophysiological mechanisms, analyzing bimanual motor synergies as well as low-force frequency structure will advance our understanding of post stroke force control.

Tool use disorders after left brain damage

In this paper we review studies that investigated tool use disorders in left-brain damaged (LBD) patients over the last 30 years. Four tasks are classically used in the field of apraxia: Pantomime of tool use, single tool use, real tool use and mechanical problem solving. Our aim was to address two issues, namely, (1) the role of mechanical knowledge in real tool use and (2) the cognitive mechanisms underlying pantomime of tool use, a task widely employed by clinicians and researchers. To do so, we extracted data from 36 papers and computed the difference between healthy subjects and LBD patients. On the whole, pantomime of tool use is the most difficult task and real tool use is the easiest one. Moreover, associations seem to appear between pantomime of tool use, real tool use and mechanical problem solving. These results suggest that the loss of mechanical knowledge is critical in LBD patients, even if all of those tasks (and particularly pantomime of tool use) might put differential demands on semantic memory and working memory.

The role of left supplementary motor area in grip force scaling

Skilled tool use and object manipulation critically relies on the ability to scale anticipatorily the grip force (GF) in relation to object dynamics. This predictive behaviour entails that the nervous system is able to store, and then select, the appropriate internal representation of common object dynamics, allowing GF to be applied in parallel with the arm motor commands. Although psychophysical studies have provided strong evidence supporting the existence of internal representations of object dynamics, known as “internal models”, their neural correlates are still debated. Because functional neuroimaging studies have repeatedly designated the supplementary motor area (SMA) as a possible candidate involved in internal model implementation, we used repetitive transcranial magnetic stimulation (rTMS) to interfere with the normal functioning of left or right SMA in healthy participants performing a grip-lift task with either hand. TMS applied over the left, but not right, SMA yielded an increase in both GF and GF rate, irrespective of the hand used to perform the task, and only when TMS was delivered 130–180 ms before the fingers contacted the object. We also found that both left and right SMA rTMS led to a decrease in preload phase durations for contralateral hand movements. The present study suggests that left SMA is a crucial node in the network processing the internal representation of object dynamics although further experiments are required to rule out that TMS does not affect the GF gain. The present finding also further substantiates the left hemisphere dominance in scaling GF.

Two action systems in the human brain

The distinction between dorsal and ventral visual processing streams, first proposed by Ungerleider and Mishkin (1982) and later refined by Milner and Goodale (1995) has been elaborated substantially in recent years, spurred by two developments. The first was proposed in large part by Rizzolatti and Matelli (2003) and is a more detailed description of the multiple neural circuits connecting the frontal, temporal, and parietal cortices. Secondly, there are a number of behavioral observations that the classic "two visual systems" hypothesis is unable to accommodate without additional assumptions. The notion that the Dorsal stream is specialized for "where" or "how" actions and the Ventral stream for "What" knowledge cannot account for two prominent disorders of action, limb apraxia and optic ataxia, that represent a double dissociation in terms of the types of actions that are preserved and impaired. A growing body of evidence, instead, suggests that there are at least two distinct Dorsal routes in the human brain, referred to as the "Grasp" and "Use" systems. Both of these may be differentiated from the Ventral route in terms of neuroanatomic localization, representational specificity, and time course of information processing.

Cortical dynamics of sensorimotor integration during grasp planning

Our sensorimotor interactions with objects are guided by their current spatial and perceptual features, as well as by learned object knowledge. A fresh red tomato is grasped differently than a soft overripe tomato, even when those objects possess the same spatial metrics of size and shape. Objects' spatial and perceptual features need to be integrated during grasping, but those features are analyzed in two anatomically distinct neural pathways. The anterior intraparietal sulcus (aIPS) might support the integration of those features. We combine transcranial magnetic stimulation (TMS) interference, EEG recordings, and psychophysical methods to test aIPS causal contributions to sensorimotor integration, characterizing the dynamics of those contributions during motor planning. Human subjects performing grasping movements were provided with visual information about a target object, namely spatial and pictorial cues, whose availability and information value were independently modulated on each trial. Maximally informative visual cues, irrespective of their spatial or perceptual nature, led to enhanced motor preparatory activity early during movement planning, and to stronger spatial congruency between finger trajectories and target object. Disturbing aIPS activity with single-pulse TMS within 200 ms after object presentation reduced those electrophysiological and behavioral indices of enhanced motor planning. TMS interference with aIPS also disturbed subjects' ability to use learned object knowledge during motor planning. These results indicate that aIPS is necessary for the fast generation of a new motor plan on the basis of both spatial and pictorial cues. Furthermore, as learned object knowledge becomes available, aIPS comes to strongly depend on this prior information for structuring the motor plan.

Anticipatory scaling of grip forces when lifting objects of everyday life

The ability to predict and anticipate the mechanical demands of the environment promotes smooth and skillful motor actions. Thus, the finger forces produced to grasp and lift an object are scaled to the physical properties such as weight. While grip force scaling is well established for neutral objects, only few studies analyzed objects known from daily routine and none studied grip forces. In the present study, eleven healthy subjects each lifted twelve objects of everyday life that encompassed a wide range of weights. The finger pads were covered with force sensors that enabled the measurement of grip force. A scale registered load forces. In a control experiment, the objects were wrapped into paper to prevent recognition by the subjects. Data from the first lift of each object confirmed that object weight was anticipated by adequately scaled forces. The maximum grip force rate during the force increase phase emerged as the most reliable measure to verify that weight was actually predicted and to characterize the precision of this prediction, while other force measures were scaled to object weight also when object identity was not known. Variability and linearity of the grip force-weight relationship improved for time points reached after liftoff, suggesting that sensory information refined the force adjustment. The same mechanism seemed to be involved with unrecognizable objects, though a lower precision was reached. Repeated lifting of the same object within a second and third presentation block did not improve the precision of the grip force scaling. Either practice was too variable or the motor system does not prioritize the optimization of the internal representation when objects are highly familiar.

Size-weight illusion and anticipatory grip force scaling following unilateral cortical brain lesion

The prediction of object weight from its size is an important prerequisite of skillful object manipulation. Grip and load forces anticipate object size during early phases of lifting an object. A mismatch between predicted and actual weight when two different sized objects have the same weight results in the size-weight illusion (SWI), the small object feeling heavier. This study explores whether lateralized brain lesions in patients with or without apraxia alter the size-weight illusion and impair anticipatory finger force scaling. Twenty patients with left brain damage (LBD, 10 with apraxia, 10 without apraxia), ten patients with right brain damage (RBD), and matched control subjects lifted two different-sized boxes in alternation. All subjects experienced a similar size-weight illusion. The anticipatory force scaling of all groups was in correspondence with the size cue: higher forces and force rates were applied to the big box and lower forces and force rates to the small box during the first lifts. Within few lifts, forces were scaled to actual object weight. Despite the lack of significant differences at group level, 5 out of 20 LBD patients showed abnormal predictive scaling of grip forces. They differed from the LBD patients with normal predictive scaling by a greater incidence of posterior occipito-parietal lesions but not by a greater incidence of apraxia. The findings do not support a more general role for the motor-dominant left hemisphere, or an influence of apraxia per se, in the scaling of finger force according to object properties. However, damage in the vicinity of the parietal-occipital junction may be critical for deriving predictions of weight from size.