Body representation in people with apraxia post Stroke- an observational study

Key constructs of body awareness impairments post-stroke: a scoping review of assessment tools and interventions

PURPOSE

To summarise body awareness assessment tools and interventions relevant for stroke rehabilitation using a framework that categorises key body awareness constructs, disorders and impairments.

MATERIALS AND METHODS

Online electronic databases and trial registries were searched from inception until July 2021, in addition to hand searching reference lists of included studies and reviews. Study selection included any study design where the investigation involved assessing and/or intervening in body awareness following stroke. Data were extracted based on predefined criteria by two independent reviewers and mapped to the emergent framework.

RESULTS

The final analysis included 144 papers that reported 43 assessment tools and 8 types of interventions for body awareness. Consensus was reached on a synthesised body awareness framework. This comprised specific impairments and disorders, constructs, sub-categories and main categories leading to the overarching term of body awareness. Clinical and psychometric properties of the assessment tools were not reported or poorly evaluated, and the interventions lacked robust study designs and rigorous methods.

CONCLUSIONS

The framework produced will enable future research and clinical practice to be based on consistent concepts and definitions. Clinicians can also use this information to cautiously select assessment tools and/or interventions but are reminded of the limitations identified in this review.Implications for rehabilitationThere is limited understanding, compounded by inconsistent terminology and definitions regarding body awareness after stroke.A synthesized framework to define key constructs and definitions of body awareness is proposed.Assessment tools and interventions reported in the literature are mapped to the proposed framework.Psychometric properties of available tools are reported.Significant work remains to refine concepts of body awareness, develop and evaluate assessment tools and interventions.

Pantomime of tool use: looking beyond apraxia

Pantomime has a long tradition in clinical neuropsychology of apraxia. It has been much more used by researchers and clinicians to assess tool-use disorders than real tool use. Nevertheless, it remains incompletely understood and has given rise to controversies, such as the involvement of the left inferior parietal lobe or the nature of the underlying cognitive processes. The present article offers a comprehensive framework, with the aim of specifying the neural and cognitive bases of pantomime. To do so, we conducted a series of meta-analyses of brain-lesion, neuroimaging and behavioural studies about pantomime and other related tasks (i.e. real tool use, imitation of meaningless postures and semantic knowledge). The first key finding is that the area PF (Area PF complex) within the left inferior parietal lobe is crucially involved in both pantomime and real tool use as well as in the kinematics component of pantomime. The second key finding is the absence of a well-defined neural substrate for the posture component of pantomime (both grip errors and body-part-as-tool responses). The third key finding is the role played by the intraparietal sulcus in both pantomime and imitation of meaningless postures. The fourth key finding is that the left angular gyrus seems to be critical in the production of motor actions directed towards the body. The fifth key finding is that performance on pantomime is strongly correlated with the severity of semantic deficits. Taken together, these findings invite us to offer a neurocognitive model of pantomime, which provides an integrated alternative to the two hypotheses that dominate the field: The gesture-engram hypothesis and the communicative hypothesis. More specifically, this model assumes that technical reasoning (notably the left area PF), the motor-control system (notably the intraparietal sulcus), body structural description (notably the left angular gyrus), semantic knowledge (notably the polar temporal lobes) and potentially theory of mind (notably the middle prefrontal cortex) work in concert to produce pantomime. The original features of this model open new avenues for understanding the neurocognitive bases of pantomime, emphasizing that pantomime is a communicative task that nevertheless originates in specific tool-use (not motor-related) cognitive processes.

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Does the body talk to the body? The relationship between different body representations while observing others' body parts

The way human bodies are represented is central in everyday activities. The cognitive system must combine internal, visceral, and somatosensory, signals to external, visually driven information generated from the spatial placement of others’ bodies and the own body in the space. However, how different body representations covertly interact among them when observing human body parts is still unclear. Therefore, we investigated the implicit processing of body parts by manipulating either the body part stimuli’ posture (conditions a and b) or the participants’ response body posture (conditions c, d, and e) in healthy participants (N = 70) using a spatial compatibility task called Sidedness task. The task requires participants to judge the colour of a circle superimposed on a task‐irrelevant body part picture. Responses are facilitated when the spatial side of the responding hand corresponds to the spatial code generated by the hand stimulus's position with respect to a body of reference. Results showed that the observation of the task‐irrelevant body parts oriented participants’ attention and facilitated responses that were spatial compatible with the spatial position such body parts have within a configural representation of the body structure (i.e., Body Structural Representation) in all the five experimental conditions. Notably, the body part stimuli were mentally attached to the body according to the most comfortable and less awkward postures, following the anatomo‐physiological constraints. Moreover, the pattern of the results was not influenced by manipulating the participants’ response postures, suggesting that the automatic and implicit coding of the body part stimuli does not rely on proprioceptive information about one's body (i.e., Body Schema). We propose that the human body's morphometry knowledge is enriched by biomechanical and anatomo‐physiological information about the real body movement possibilities. Moreover, we discuss the importance of the automatic orienting of attention based on the sidedness within the context of imitational learning.