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

A preliminary study of white matter disconnections underlying deficits in praxis in left hemisphere stroke patients

Limb apraxia is a higher-order motor disorder often occurring post-stroke, which affects skilled actions. It is assessed through tasks involving gesture production or pantomime, recognition, meaningless gesture imitation, complex figure drawing, single and multi-object use. A two-system model for the organisation of actions hypothesizes distinct pathways mediating praxis deficits via conceptual, 'indirect', and perceptual 'direct' routes to action. Traditional lesion- symptom mapping techniques have failed to identify these distinct routes. We assessed 29 left hemisphere stroke patients to investigate white matter disconnections on deficits of praxis tasks from the Birmingham Cognitive Screening. White matter disconnection maps derived from patients' structural T1 lesions were created using a diffusion-weighted healthy participant dataset acquired from the human connectome project (HCP). Initial group-level regression analyses revealed significant disconnection between occipital lobes via the splenium of the corpus callosum and involvement of the inferior longitudinal fasciculus in meaningless gesture imitation deficits. There was a trend of left fornix disconnection in gesture production deficits. Further, voxel-wise Bayesian Crawford single-case analyses performed on two patients with the most severe meaningless gesture imitation and meaningful gesture production deficits, respectively, confirmed distinct posterior interhemispheric disconnection, for the former, and disconnections between temporal and frontal areas via the fornix, rostrum of the corpus callosum and anterior cingulum, for the latter. Our results suggest distinct pathways associated with perceptual and conceptual deficits akin to 'direct' and 'indirect' action routes, with some patients displaying both. Larger studies are needed to validate and elaborate on these findings, advancing our understanding of limb apraxia.

The neural correlates of limb apraxia: An anatomical likelihood estimation meta-analysis of lesion-symptom mapping studies in brain-damaged patients

Limb apraxia is a motor disorder frequently observed following a stroke. Apraxic deficits are classically assessed with four tasks: tool use, pantomime of tool use, imitation, and gesture understanding. These tasks are supported by several cognitive processes represented in a left-lateralized brain network including inferior frontal gyrus, inferior parietal lobe (IPL), and lateral occipito-temporal cortex (LOTC). For the past twenty years, voxel-wise lesion symptom mapping (VLSM) studies have been used to unravel the neural correlates associated with apraxia, but none of them has proposed a comprehensive view of the topic. In the present work, we proposed to fill this gap by performing a systematic Anatomic Likelihood Estimation meta-analysis of VLSM studies which included tasks traditionally used to assess apraxia. We found that the IPL was crucial for all the tasks. Moreover, lesions within the LOTC were more associated with imitation deficits than tool use or pantomime, confirming its important role in higher visual processing. Our results questioned traditional neurocognitive models on apraxia and may have important clinical implications.

Rewiring the evolution of the human hand: How the embodiment of a virtual bionic tool improves behavior

Humans are the most versatile tool users among animals. Accordingly, our manual skills evolved alongside the shape of the hand. In the future, further evolution may take place: humans may merge with their tools, and technology may integrate into our biology in a way that blurs the line between the two. So, the question is whether humans can embody a bionic tool (i.e., experience it as part of their body) and thus if this would affect behavior. We investigated in virtual reality how the substitution of the hand with a virtual grafting of an end-effector, either non-naturalistic (a bionic tool) or naturalistic (a hand), impacts embodiment and behavior. Across four experiments, we show that the virtual grafting of a bionic tool elicits a sense of embodiment similar to or even stronger than its natural counterpart. In conclusion, the natural usage of bionic tools can rewire the evolution of human behavior.

Hemispheric asymmetry of hand and tool perception in left- and right-handers with known language dominance

Regions in the brain that are selective for images of hands and tools have been suggested to be lateralised to the left hemisphere of right-handed individuals. In left-handers, many functions related to tool use or tool pantomime may also depend more on the left hemisphere. This result seems surprising, given that the dominant hand of these individuals is controlled by the right hemisphere. One explanation is that the left hemisphere is dominant for speech and language in the majority of left-handers, suggesting a supraordinate control system for complex motor sequencing that is required for skilled tool use, as well as for speech. In the present study, we examine if this left-hemispheric specialisation extends to perception of hands and tools in left- and right-handed individuals. We, crucially, also include a group of left-handers with right-hemispheric language dominance to examine their asymmetry biases. The results suggest that tools lateralise to the left hemisphere in most right-handed individuals with left-hemispheric language dominance. Tools also lateralise to the language dominant hemisphere in right-hemispheric language dominant left-handers, but the result for left-hemispheric language dominant left-handers are more varied, and no clear bias towards one hemisphere is found. Hands did not show a group-level asymmetry pattern in any of the groups. These results suggest a more complex picture regarding hemispheric overlap of hand and tool representations, and that visual appearance of tools may be driven in part by both language dominance and the hemisphere which controls the motor-dominant hand.

Localizing apraxia in corticobasal syndrome: a morphometric MRI study

Apraxia localization has relied on voxel-based, lesion-symptom mapping studies in left hemisphere stroke patients. Studies on the neural substrates of different manifestations of apraxia in neurodegenerative disorders are scarce. The primary aim of this study was to look into the neural substrates of different manifestations of apraxia in a cohort of corticobasal syndrome patients (CBS) by use of cortical thickness. Twenty-six CBS patients were included in this cross-sectional study. The Goldenberg apraxia test (GAT) was applied. 3D-T1-weighted images were analyzed via the automated recon-all Freesurfer version 6.0 pipeline. Vertex-based multivariate General Linear Model analysis was applied to correlate GAT scores with cortical thickness. Deficits in imitation of meaningless gestures correlated with bilateral superior parietal atrophy, extending to the angular and supramarginal gyri, particularly on the left. Finger imitation relied predominantly on superior parietal lobes, whereas the left angular and supramarginal gyri, in addition to superior parietal lobes, were critical for hand imitation. The widespread bilateral clusters of atrophy in CBS related to apraxia indicate different pathophysiological mechanisms mediating praxis in neurodegenerative disorders compared to vascular lesions, with implications both for our understanding of praxis and for the rehabilitation approaches of patients with apraxia.

Knowing "what for," but not "where": Dissociation between functional and contextual tool knowledge in healthy individuals and patients with dementia

OBJECTIVE

Semantic tool knowledge underlies the ability to perform activities of daily living. Models of apraxia have emphasized the role of functional knowledge about the action performed with tools (e.g., a hammer and a mallet allow a "hammering" action), and contextual knowledge informing individuals about where to find tools in the social space (e.g., a hammer and a mallet can be found in a workshop). The goal of this study was to test whether contextual or functional knowledge, would be central in the organization of tool knowledge. It was assumed that contextual knowledge would be more salient than functional knowledge for healthy controls and that patients with dementia would show impaired contextual knowledge.

METHODS

We created an original, open-ended categorization task with ambiguity, in which the same familiar tools could be matched on either contextual or functional criteria.

RESULTS

In our findings, healthy controls prioritized a contextual, over a functional criterion. Patients with dementia had normal visual categorization skills (as demonstrated by an original picture categorization task), yet they made less contextual, but more functional associations than healthy controls.

CONCLUSION

The findings support a dissociation between functional knowledge ("what for") on the one hand, and contextual knowledge ("where") on the other hand. While functional knowledge may be distributed across semantic and action-related factors, contextual knowledge may actually be the name of higher-order social norms applied to tool knowledge. These findings may encourage researchers to test both functional and contextual knowledge to diagnose semantic deficits and to use open-ended categorization tests.

The parietal architecture binding cognition to sensorimotor integration: a multimodal causal study

Despite human's praxis abilities are unique among primates, comparative observations suggest that these cognitive motor skills could have emerged from exploitation and adaptation of phylogenetically older building blocks, namely the parieto-frontal networks subserving prehension and manipulation. Within this framework, investigating to which extent praxis and prehension-manipulation overlap and diverge within parieto-frontal circuits could help in understanding how human cognition shapes hand actions. This issue has never been investigated by combining lesion mapping and direct electrophysiological approaches in neurosurgical patients. To this purpose, 79 right-handed left-brain tumour patient candidates for awake neurosurgery were selected based on inclusion criteria. First, a lesion mapping was performed in the early postoperative phase to localize the regions associated with an impairment in praxis (imitation of meaningless and meaningful intransitive gestures) and visuo-guided prehension (reaching-to-grasping) abilities. Then, lesion results were anatomically matched with intraoperatively identified cortical and white matter regions, whose direct electrical stimulation impaired the Hand Manipulation Task. The lesion mapping analysis showed that prehension and praxis impairments occurring in the early postoperative phase were associated with specific parietal sectors. Dorso-mesial parietal resections, including the superior parietal lobe and precuneus, affected prehension performance, while resections involving rostral intraparietal and inferior parietal areas affected praxis abilities (covariate clusters, 5000 permutations, cluster-level family-wise error correction P < 0.05). The dorsal bank of the rostral intraparietal sulcus was associated with both prehension and praxis (overlap of non-covariate clusters). Within praxis results, while resection involving inferior parietal areas affected mainly the imitation of meaningful gestures, resection involving intraparietal areas affected both meaningless and meaningful gesture imitation. In parallel, the intraoperative electrical stimulation of the rostral intraparietal and the adjacent inferior parietal lobe with their surrounding white matter during the hand manipulation task evoked different motor impairments, i.e. the arrest and clumsy patterns, respectively. When integrating lesion mapping and intraoperative stimulation results, it emerges that imitation of praxis gestures first depends on the integrity of parietal areas within the dorso-ventral stream. Among these areas, the rostral intraparietal and the inferior parietal area play distinct roles in praxis and sensorimotor process controlling manipulation. Due to its visuo-motor 'attitude', the rostral intraparietal sulcus, putative human homologue of monkey anterior intraparietal, might enable the visuo-motor conversion of the observed gesture (direct pathway). Moreover, its functional interaction with the adjacent, phylogenetic more recent, inferior parietal areas might contribute to integrate the semantic-conceptual knowledge (indirect pathway) within the sensorimotor workflow, contributing to the cognitive upgrade of hand actions.

A fist bump in a political meeting? The influence of social context on affordance selection

Historically, understanding human cognition such as action processing has been a challenging issue in cognitive neuropsychology and the more we know about cognition, the more we shape it as a complex, multi-determined phenomenon that is embedded in a social context. The present study aimed at understanding how the social context could influence affordance selection. We hypothesized that affordance selection would be modulated by social context and that a given hand configuration would be considered appropriate or not, as a function of the presence or absence of social context. Twenty-six healthy participants were asked to judge the appropriateness of three variants of 10 hand-object interactions based on photographs presented with or without a visual, social context. In our results, hand configurations were intrinsically acceptable or not, but this effect was modulated by the social context. A three-step model of the influence of social context on affordance selection was proposed, according to which selection depends on social norms, in the form of social knowledge and social context analysis.

Mechanisms and neuroanatomy of response selection in tool and non-tool action tasks: Evidence from left-hemisphere stroke

The ability to select between potential actions is central to the complex process of tool use. After left hemisphere stroke, individuals with limb apraxia make more hand action errors when gesturing the use of tools with conflicting hand actions for grasping-to-move and use (e.g., screwdriver) relative to tools that are grasped-to-move and used with the same hand action (e.g., hammer). Prior research indicates that this grasp-use interference effect is driven by abnormalities in the competitive action selection process. The goal of this project was to determine whether common mechanisms and neural substrates support the competitive selection of task-appropriate responses in both tool and non-tool domains. If so, the grasp-use interference effect in a tool use gesturing task should be correlated with response interference effects in the classic Eriksen flanker and Simon tasks, and at least partly overlapping neural regions should subserve the 3 tasks. Sixty-four left hemisphere stroke survivors (33 with apraxia) participated in the tool- and non-tool interference tasks and underwent T1 anatomical MRI. There were robust grasp-use interference effects (grasp-use conflict test) and response interference effects (Eriksen flanker and Simon tasks), but these effects were not correlated. Lesion-symptom mapping analyses showed that lesions to the left inferior parietal lobule, ventral premotor cortex, and insula were associated with grasp-use interference. Lesions to the left inferior parietal lobule, postcentral gyrus, insula, caudate, and putamen were associated with response interference in the Eriksen flanker task. Lesions to the left caudate and putamen were also associated with response interference in the Simon task. Our results suggest that the selection of hand posture for tool use is mediated by distinct cognitive mechanisms and partly distinct neuroanatomic substrates from those mapping a stimulus to an appropriate motor response in non-tool domains.

Investigating the effects of the aging brain on real tool use performance-an fMRI study

Introduction

Healthy aging affects several domains of cognitive and motor performance and is further associated with multiple structural and functional neural reorganization patterns. However, gap of knowledge exists, referring to the impact of these age-related alterations on the neural basis of tool use-an important, complex action involved in everyday life throughout the entire lifespan. The current fMRI study aims to investigate age-related changes of neural correlates involved in planning and executing a complex object manipulation task, further providing a better understanding of impaired tool use performance in apraxia patients.

Methods

A balanced number of sixteen older and younger healthy adults repeatedly manipulated everyday tools in an event-related Go-No-Go fMRI paradigm.

Results

Our data indicates that the left-lateralized network, including widely distributed frontal, temporal, parietal and occipital regions, involved in tool use performance is not subjected to age-related functional reorganization processes. However, age-related changes regarding the applied strategical procedure can be detected, indicating stronger investment into the planning, preparatory phase of such an action in older participants.

Taxonomic and thematic relations rely on different types of semantic features: Evidence from an fMRI meta-analysis and a semantic priming study

Taxonomic and thematic relations are major components of semantic representation but their neurocognitive underpinnings are still debated. We hypothesised that taxonomic relations preferentially activate parts of anterior temporal lobe (ATL) because they rely more on colour and shape features, while thematic relations preferentially activate temporoparietal cortex (TPC) because they rely more on action and location knowledge. We first conducted activation likelihood estimation (ALE) meta-analysis to assess evidence for neural specialisation in the existing fMRI literature (Study 1), then used a primed semantic judgement task to examine if the two relations are primed by different feature types (Study 2). We find that taxonomic relations show minimal feature-based specialisation but preferentially activate the lingual gyrus. Thematic relations are more dependent on action and location features and preferentially engage TPC. The meta-analysis also showed that lateral ATL is preferentially engaged by Thematic relations, which may reflect their greater reliance on verbal associations.

Shared and distinct routes in speech and gesture imitation: Evidence from stroke

Dual-route models of high-level (praxis) actions distinguish between an "indirect" semantic route mediating meaningful gesture imitation, and a "direct" sensory-motor route mediates meaningless gesture imitation. Similarly, dual-route language models distinguish between an indirect route mediating production and repetition of words, and a direct route mediating non-word repetition. Although aphasia and limb apraxia frequently co-occur following left-hemisphere cerebrovascular accident (LCVA), it is unclear which aspects of these functional-neuroanatomic dual-route architectures are shared across praxis and language domains. This study focused on gesture imitation to test the hypothesis that semantic information (and portions of the indirect route) are shared across domains, whereas two distinct dorsal routes mediate sensory-motor mapping. Forty chronic LCVA and 17 neurotypical controls completed semantic memory and language tasks and imitated 3 types of gesture stimuli: (1) labeled/"named" meaningful, (2) unnamed meaningful, and (3) meaningless gestures. The comparison of accuracy between meaningless versus unnamed meaningful gestures examined the benefits of semantic information, while the comparison of unnamed meaningful versus named meaningful imitation examined additional benefits of linguistic cueing. Mixed-effects models examined group by task interaction effects on gesture ability. We found that for patients with LCVA, unnamed meaningful gestures were imitated more accurately than meaningless gestures, suggesting that semantic information was beneficial, but there was no benefit of labeling. Reduced benefit of semantic information on gesture accuracy was associated with lesions to inferior frontal and posterior temporal regions as well as semantic memory performance on a pictorial (non-gesture) task. In contrast, there was no relationship between meaningless gesture imitation and nonword repetition, indicating that measures of direct route performance are not associated across language and action. These results provide preliminary evidence that portions of the indirect semantic route are shared across the language and action domains, while two direct sensory-motor mapping routes mediate word repetition and gesture imitation.

Novel objects with causal event schemas elicit selective responses in tool- and hand-selective lateral occipitotemporal cortex

Tool-selective lateral occipitotemporal cortex (LOTC) responds preferentially to images of tools (hammers, brushes) relative to non-tool objects (clocks, shoes). What drives these responses? Unlike other objects, tools exert effects on their surroundings. We tested whether LOTC responses are influenced by event schemas that denote different temporal relations. Participants learned about novel objects embedded in different event sequences. Causer objects moved prior to the appearance of an environmental event (e.g. stars), while Reactor objects moved after an event. Visual features and motor association were controlled. During functional magnetic resonance imaging, participants viewed still images of the objects. We localized tool-selective LOTC and non-tool-selective parahippocampal cortex (PHC) by contrasting neural responses to images of familiar tools and non-tools. We found that LOTC responded more to Causers than Reactors, while PHC did not. We also measured responses to images of hands, which elicit overlapping responses with tools. Across inferior temporal cortex, voxels' tool and hand selectivity positively predicted a preferential response to Causers. We conclude that an event schema typical of tools is sufficient to drive LOTC and that category-preferential responses across the temporal lobe may reflect relational event structures typical of those domains.

Transcranial direct current stimulation to the left dorsolateral prefrontal cortex enhances early dexterity skills with the left non-dominant hand: a randomized controlled trial

BACKGROUND

The left dorsolateral prefrontal cortex (DLPFC) is involved in early-phase manual dexterity skill acquisition when cognitive control processes, such as integration and complexity demands, are required. However, the effectiveness of left DLPFC transcranial direct current stimulation (tDCS) on early-phase motor learning and whether its effectiveness depends on the cognitive demand of the target task are unclear. This study aimed to investigate whether tDCS over the left DLPFC improves non-dominant hand dexterity performance and determine if its efficacy depends on the cognitive demand of the target task.

METHODS

In this randomized, double-blind, sham-controlled trial, 70 healthy, right-handed, young adult participants were recruited. They were randomly allocated to the active tDCS (2 mA for 20 min) or sham groups and repeatedly performed the Purdue Pegboard Test (PPT) left-handed peg task and left-handed assembly task three times: pre-tDCS, during tDCS, and post tDCS.

RESULTS

The final sample comprised 66 healthy young adults (mean age, 22.73 ± 1.57 years). There were significant interactions between group and time in both PPT tasks, indicating significantly higher performance of those in the active tDCS group than those in the sham group post tDCS (p < 0.001). Moreover, a greater benefit was observed in the left-handed assembly task performance than in the peg task performance (p < 0.001). No significant correlation between baseline performance and benefits from tDCS was observed in either task.

CONCLUSIONS

These results demonstrated that prefrontal tDCS significantly improved early-phase manual dexterity skill acquisition, and its benefits were greater for the task with high cognitive demands. These findings contribute to a deeper understanding of the underlying neurophysiological mechanisms of the left DLPFC in the modulation of early-phase dexterity skill acquisition.

TRIAL REGISTRATION

This study was registered in the University Hospital Medical Information Network Clinical Trial Registry in Japan (UMIN000046868), Registered February 8, 2022 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053467.

Gesture profiles distinguish primary progressive aphasia variants

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by progressive language deficits. There are three main variants of PPA - semantic (svPPA), logopenic (lvPPA), and nonfluent (nfvPPA) - that can be challenging to distinguish. Limb praxis may also be affected in PPA, but it is unclear whether different variants of PPA are associated with differences in gesture production. Prior research with neurotypical individuals indicates that the left temporal lobe is a critical locus of manipulable object and hand posture representations. Moreover, when imitating gestures, individuals whose strokes include the left temporal lobe show reduced benefit of gesture meaning and disproportionate impairment in hand posture as compared to arm kinematics. We tested the hypothesis that svPPA - who typically exhibit primarily temporal lobe atrophy - would differentially show these expected patterns of gesture imitation performance. Nineteen participants with PPA completed meaningful and meaningless gesture imitation tasks, and performance was scored for hand posture and arm kinematics accuracy. Generalized logistic mixed-effect regression models controlling for dementia severity showed overall benefits from gesture meaning, and greater impairments in hand posture than arm kinematics. We also found that svPPA participants were the most impaired in gesture imitation overall. Critically, there was also a significant three-way interaction of group, meaning, and gesture component: only svPPA participants showed relative impairments of hand posture for meaningful gestures as well as meaningless gestures. Thus, unlike lvPPA and nfvPPA, the hand postures of svPPA failed to benefit from gesture meaning. This research extends prior findings on the role of the temporal lobe in hand posture representations associated with manipulable objects, and is the first to indicate that there may be distinct gesture imitation patterns as a function of PPA variant. Characterizing componential gesture deficits in PPA may help to inform differential diagnosis, compensatory communication strategies, and cognitive praxis models of PPA.

Limb Apraxias: The Influence of Higher Order Perceptual and Semantic Deficits in Motor Recovery After Stroke

Stroke is a leading cause of disability worldwide. Limb apraxia is a group of higher order motor disorders associated with greater disability and dependence after stroke. Original neuropsychology studies distinguished separate brain pathways involved in perception and action, known as the dual stream hypothesis. This framework has allowed a better understanding of the deficits identified in Limb Apraxia. In this review, we propose a hierarchical organization of this disorder, in which a distinction can be made between several visuomotor pathways that lead to purposeful actions. Based on this, executive apraxias (such as limb kinetic apraxia) cause deficits in executing fine motor hand skills, and intermediate apraxias (such as optic ataxia and tactile apraxia) cause deficits in reaching to grasp and manipulating objects in space. These disorders usually affect the contralesional limb. A further set of disorders collectively known as limb apraxias include deficits in gesture imitation, pantomime, gesture recognition, and object use. These deficits are due to deficits in integrating perceptual and semantic information to generate complex movements. Limb apraxias are usually caused by left-hemisphere lesions in right-handed stroke patients, affecting both limbs. The anterior- to posterior-axis of brain areas are disrupted depending on the increasing involvement of perceptual and semantic processes with each condition. Lower-level executive apraxias are linked to lesions in the frontal lobe and the basal ganglia, while intermediate apraxias are linked to lesions in dorso-dorsal subdivisions of the dorsal fronto-parietal networks. Limb apraxias can be caused by lesions in both dorsal and ventral subdivisions including the ventro-dorsal stream and a third visuomotor pathway, involved in body schema and social cognition. Rehabilitation of these disorders with behavioral therapies has aimed to either restore perceptuo-semantic deficits or compensate to overcome these deficits. Further studies are required to better stratify patients, using modern neurophysiology and neuroimaging techniques, to provide targeted and personalized therapies for these disorders in the future.

The parietal lobe evolution and the emergence of material culture in the human genus

Traditional and new disciplines converge in suggesting that the parietal lobe underwent a considerable expansion during human evolution. Through the study of endocasts and shape analysis, paleoneurology has shown an increased globularity of the braincase and bulging of the parietal region in modern humans, as compared to other human species, including Neandertals. Cortical complexity increased in both the superior and inferior parietal lobules. Emerging fields bridging archaeology and neuroscience supply further evidence of the involvement of the parietal cortex in human-specific behaviors related to visuospatial capacity, technological integration, self-awareness, numerosity, mathematical reasoning and language. Here, we complement these inferences on the parietal lobe evolution, with results from more classical neuroscience disciplines, such as behavioral neurophysiology, functional neuroimaging, and brain lesions; and apply these to define the neural substrates and the role of the parietal lobes in the emergence of functions at the core of material culture, such as tool-making, tool use and constructional abilities.

Gesture meaning modulates the neural correlates of effector-specific imitation deficits in left hemisphere stroke

BACKGROUND

Previous studies on left hemisphere (LH) stroke patients reported effector-specific (hand, fingers, bucco-facial) differences in imitation performance. Furthermore, imitation performance differed between meaningless (ML) and meaningful (MF) gestures. Recent work suggests that a gesture's meaning impacts the body-part specificity of gesture imitation.

METHODS

We tested the hypothesis that the gesture's meaning (ML vs MF) affects the lesion correlates of effector-specific imitation deficits (here: bucco-facial vs arm/hand gestures) using behavioural data and support vector regression-based lesion-symptom mapping (SVR-LSM) in a large sample of 194 sub-acute LH stroke patients.

RESULTS

Behavioural data revealed a significant interaction between the effector used for imitation and the meaning of the imitated gesture. SVR-LSM analyses revealed shared lesion correlates for impaired imitation independent of effector or gesture meaning in the left supramarginal (SMG) and superior temporal gyri (STG). Besides, within the territory of the left middle cerebral artery, impaired imitation of bucco-facial gestures was associated with more anterior lesions, while arm/hand imitation deficits were associated with more posterior lesions. MF gestures were specifically associated with lesions in the left inferior frontal gyrus and the left insular region. Notably, an interaction of effector-specificity and gesture meaning was also present at the lesion level: A more pronounced difference in imitation performance between the effectors for ML (versus MF) gestures was associated with left-hemispheric lesions in the STG, SMG, putamen, precentral gyrus and white matter tracts.

CONCLUSION

The current behavioural data show that ML gestures are particularly sensitive in assessing effector-specific imitation deficits in LH stroke patients. Moreover, a gesture's meaning modulated the effector-specific lesion correlates of bucco-facial and arm/hand gesture imitation. Hence, it is crucial to consider gesture meaning in apraxia assessments.

Improved gesturing in left-hemispheric stroke by right inferior parietal theta burst stimulation

Objectives

Apraxia is a common syndrome of left hemispheric stroke. A parieto-premotor-prefrontal network has been associated with apraxia, in which the left inferior parietal lobe (IPL-L) plays a major role. We hypothesized that transcranial continuous theta burst stimulation (cTBS) over the right inferior parietal lobe (IPL-R) improves gesturing by reducing its inhibition on the contralateral IPL in left hemispheric stroke patients. It was assumed that this effect is independent of lesion volume and that transcallosal connectivity is predictive for gestural effect after stimulation.

Materials and methods

Nineteen stroke patients were recruited. Lesion volume and fractional anisotropy of the corpus callosum were acquired with structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Each patient had pseudorandomised sessions with sham or with stimulation over the IPL-R or over the right inferior frontal gyrus IFG-R. Gesturing was assessed in a double-blinded manner before and after each session. We tested the effects of stimulation on gesture performance using a linear mixed-effects model.

Results

Pairwise treatment contrasts showed, that, compared to sham, the behavioral effect was higher after stimulation over IPL-R (12.08, 95% CI 6.04 - 18.13, p < 0.001). This treatment effect was approximately twice as high as the contrasts for IFG-R vs. sham (6.25, 95% CI -0.20 - 12.70, p = 0.058) and IPL-R vs. IFG-R vs. sham (5.83, 95% CI -0.49 - 12.15, p = 0.071). Furthermore, higher fractional anisotropy in the splenium (connecting the left and right IPL) were associated with higher behavioral effect. Relative lesion volume did not affect the changes after sham or stimulation over IPL-R or IFG-R.

Conclusion

One single session of cTBS over the IPL-R improved gesturing after left hemispheric stroke. Denser microstructure in the corpus callosum correlated with favorable gestural response. We therefore propose the indirect transcallosal modulation of the IPL-L as a promising model of restoring interhemispheric balance, which may be useful in rehabilitation of apraxia.

Representation of motion concepts in occipitotemporal cortex: fMRI activation, decoding and connectivity analyses

Embodied theories of semantic cognition predict that brain regions involved in motion perception are engaged when people comprehend motion concepts expressed in language. Left lateral occipitotemporal cortex (LOTC) is implicated in both motion perception and motion concept processing but prior studies have produced mixed findings on which parts of this region are engaged by motion language. We scanned participants performing semantic judgements about sentences describing motion events and static events. We performed univariate analyses, multivariate pattern analyses (MVPA) and psychophysiological interaction (PPI) analyses to investigate the effect of motion on activity and connectivity in different parts of LOTC. In multivariate analyses that decoded whether a sentence described motion or not, the middle and posterior parts of LOTC showed above-chance level performance, with performance exceeding that of other brain regions. Univariate ROI analyses found the middle part of LOTC was more active for motion events than static ones. Finally, PPI analyses found that when processing motion events, the middle and posterior parts of LOTC (overlapping with motion perception regions), increased their connectivity with cognitive control regions. Taken together, these results indicate that the more posterior parts of LOTC, including motion perception cortex, respond differently to motion vs. static events. These findings are consistent with embodiment accounts of semantic processing, and suggest that understanding verbal descriptions of motion engages areas of the occipitotemporal cortex involved in perceiving motion.

Electrophysiological correlates of action monitoring in brain-damaged patients: A systematic review

Action monitoring is crucial to the successful execution of an action and understanding the actions of others. It is often impaired due to brain lesions, in particular after stroke. This systematic review aims to map the literature on the neurophysiological correlates of action monitoring in patients with brain lesions. Eighteen studies were identified and divided into two groups: studies on monitoring of one's own actions and studies on monitoring of the actions of others. The first group included EEG studies on monitoring of self-performed erroneous and correct actions. Impaired error detection (decreased error-related negativity) was observed in patients with lesions in the performance-monitoring network, as compared to healthy controls. Less consistent results were shown for error positivity and behavioral error monitoring performance. The second group of studies on monitoring of others' actions reported decreased mu frequency suppression, impaired readiness potential in the affected hemisphere and decreased EEG indices of error observation (observed error positivity and theta power) in stroke patients. As a whole, these results indicate distinct patterns of impaired neurophysiological activity related to monitoring one's own versus others' actions in patients with brain lesions. EEG recordings of this dissociation in the same patients might be a useful index of motor recovery, and therefore, potentially also beneficial in rehabilitation protocols.

Brain intrinsic connection patterns underlying tool processing in human adults are present in neonates and not in macaques

Tool understanding and use are supported by a dedicated left-lateralized, intrinsically connected network in the human adult brain. To examine this network’s phylogenetic and ontogenetic origins, we compared resting-state functional connectivity (rsFC) among regions subserving tool processing in human adults to rsFC among homologous regions in human neonates and macaque monkeys (adolescent and mature). These homologous regions formed an intrinsic network in human neonates, but not in macaques. Network topological patterns were highly similar between human adults and neonates, and significantly less so between humans and macaques. The premotor-parietal rsFC had most significant contribution to the formation of the neonatal tool network. These results suggest that an intrinsic brain network potentially supporting tool processing exists in the human brain prior to individual tool use experiences, and that the premotor-parietal functional connection in particular offers a brain basis for complex tool behaviors specific to humans.

Action imitation via trajectory-based or posture-based planning

Imitation is a significant daily activity involved in social interaction and motor learning. Imitation has been theorized to be performed in at least two ways. In posture-based imitation, individuals reproduce how the body should look and feel, and are sensitive to the relative positioning of body parts. In trajectory imitation, individuals mimic the spatiotemporal motion path of the end effector. There are clear anecdotal situations in which one might benefit from imitating postures (when learning ballet) or trajectories (when learning to reach around objects). However, whether these are in fact distinct methods of imitation, and if so, whether they may be applied interchangeably to perform the same task, remain unknown. If these are indeed separate mechanisms that rely on different computational and neural resources, a cost should be incurred when switching from using one mechanism to the other within the context of a single task. Therefore, observing a processing cost would both provide evidence that these are indeed two distinct mechanisms, and that they may be used interchangeably when trying to imitate the same stimulus. To test this, twenty-five healthy young adults performed a sequential multitasking imitation task. Participants were first instructed to pay attention to the limb postures or the hand path of a video-recorded model, then performed a neutral, congruent, or incongruent intervening motor task. Finally, participants imitated the modeled movement. We examined both spatial and temporal imitation accuracy as well as individual spatial consistency. When the primary task involved imitating trajectories, analysis of individual consistency suggested a processing cost: movements following the posture-matching intervening task were less consistent with baseline (neutral) performance, suggesting performance may be disrupted by the incongruence. This effect was not observed when imitating limb postures. In summary, we present initial evidence for a difference between posture matching and trajectory imitation as a result of instructions and intervening tasks that is consistent with the existence of two computationally distinct imitation mechanisms.

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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Brain Dynamics of Action Monitoring in Higher-Order Motor Control Disorders: The Case of Apraxia

Limb apraxia (LA) refers to a high-order motor disorder characterized by the inability to reproduce transitive actions on commands or after observation. Studies demonstrate that action observation and action execution activate the same networks in the human brain, and provides an onlooker’s motor system with appropriate cognitive, motor and sensory-motor cues to flexibly implementing action-sequences and gestures. Tellingly, the temporal dynamics of action monitoring has never been explored in people suffering from LA. To fill this gap, we studied the electro-cortical signatures of error observation in human participants suffering from acquired left-brain lesions with (LA+) and without (LA–) LA, and in a group of healthy controls (H). EEG was acquired while participants observed from a first-person perspective (1PP) an avatar performing correct or incorrect reach-to-grasp a glass action in an immersive-virtual environment. Alterations of typical EEG signatures of error observation in time (early error positivity; Pe) and time-frequency domain (theta band-power) were found reduced in LA+ compared with H. Connectivity analyses showed that LA+ exhibited a decreased theta phase synchronization of both the frontoparietal and frontofrontal network, compared with H and LA–. Moreover, linear regression analysis revealed that the severity of LA [test of upper LA (TULIA) scores] was predicted by mid-frontal error-related theta activity, suggesting a link between error monitoring capacity and apraxic phenotypes. These results provide novel neurophysiological evidence of altered neurophysiological dynamics of action monitoring in individuals with LA and shed light on the performance monitoring changes occurring in this disorder.

Proprioception-based movement goals support imitation and are disrupted in apraxia

The ability to imitate observed actions serves as an efficient method for learning novel movements and is specifically impaired (without concomitant gross motor impairments) in the neurological disorder of limb apraxia, a disorder common after left hemisphere stroke. Research with apraxic patients has advanced our understanding of how people imitate. However, the role of proprioception in imitation has been rarely assessed directly. Prior work has proposed that proprioceptively sensed body position is transformed into a visual format, supporting the attainment of a desired imitation goal represented visually (i.e., how the movement should look when performed). In contrast, we hypothesized a more direct role for proprioception: we suggest that movement goals are also represented proprioceptively (i.e., how a desired movement should feel when performed), and the ability to represent or access such proprioceptive goals is deficient in apraxia. Using a novel imitation task in which a robot cued meaningless trajectories proprioceptively or visually, we probed the role of each sensory modality. We found that patients with left hemisphere stroke were disproportionately worse than controls at imitating when cued proprioceptively versus visually. This proprioceptive versus visual disparity was associated with apraxia severity as assessed by a traditional imitation task, but could not be explained by general proprioceptive impairment or speed-accuracy trade-offs. These data suggest that successful imitation depends in part on the ability to represent movement goals in terms of how those movements should feel, and that deficits in this ability contribute to imitation impairments in patients with apraxia.

Does spatial perspective in virtual reality affect imitation accuracy in stroke patients?

Imitation is an important daily activity involved in social interactions, motor learning, and is commonly used for rehabilitation after stroke. Moreover, deficits in imitation of novel movements commonly occur after left hemisphere stroke (LCVA) in the syndrome of limb apraxia. In the current study, we used a novel virtual reality (VR) imitation paradigm to assess two factors that have remained underexplored in novel movement imitation: the imitation of complex, dynamic full-arm movements, and the effect of spatial perspective. VR holds promise as a tool for a number of clinical assessments and treatments, but has very rarely been studied in the context of imitation or diagnosis of apraxia. Thirty participants (18 with LCVA and 12 age- and education-matched controls) wore a VR headset and observed and imitated an instructor avatar demonstrating arm movements. Three spatial perspectives were examined within-subjects: first-person, third-person mirror, and third-person anatomical. Movements of the ipsilesional (left) arm were recorded and qualitatively coded for accuracy compared to the instructor avatar. Participants also completed embodiment questionnaires, a measure of limb apraxia (imitation of video-recorded meaningless movements), and three computerized background tasks that were hypothesized to evoke some of the same processing requirements of each of the three perspective conditions: a block-matching task, a block-mirroring task, and a mental rotation task. Imitation accuracy was highest in the first-person perspective, consistent with predictions, but did not differ between third-person mirror and anatomical. Surprisingly, patients and controls performed similarly on the imitation task for all spatial perspectives, with overall modest accuracy in both groups, and both patients and controls felt a moderate level of embodiment of their own avatar. Higher imitation accuracy related to quicker block-matching reaction times and higher mental rotation accuracy, regardless of perspective, but was unrelated to imitation of video-recorded meaningless movements. In sum, virtual reality provides advantages in terms of experimental manipulation and control but may present challenges in detecting clinical imitation deficits (limb apraxia).

The noun-verb distinction

The comparison between nouns and verbs has been a topic of interest for many researchers over the last 50 years. This comparison, and subsequent behavioral and (partly) anatomic dissociation, has allowed researchers to delve into many topics including the behavioral architecture of the language system and its neural correlates, the underlying nature of the linguistic impairment in individuals with different neurologic disorders, the assessment of language treatment protocols, and the proposal of new protocols aimed to protect the language system of individuals undergoing surgery for brain tumors and epilepsy. Specific to the left temporal lobe, classic accounts have shown its relevance for the processing of nouns and less for the processing of verbs. Nonetheless, more recent accounts indicate that different areas in the left temporal lobe can subserve different functions for the processing of both nouns and verbs. In this chapter, we outlined an overview of key findings of the study of nouns and verbs, with a particular focus on the left temporal lobe. This chapter contextualizes the literature on category-specific impairments and neural correlates of nouns and verbs with linguistic and psycholinguistic theories, and provides new ways to investigate and understand the intricacies of this comparison.

Distinct cognitive components and their neural substrates underlying praxis and language deficits following left hemisphere stroke

Apraxia is characterised by multiple deficits of higher motor functions, primarily caused by left hemisphere (LH) lesions to parietal-frontal praxis networks. While previous neuropsychological and lesion studies tried to relate the various apraxic deficits to specific lesion sites, a comprehensive analysis of the different apraxia profiles and the related (impaired) motor-cognitive processes as well as their differential neural substrates in LH stroke is lacking. To reveal the cognitive mechanisms that underlie the different patterns of praxis and (related) language deficits, we applied principal component analysis (PCA) to the scores of sub-acute LH stroke patients (n = 91) in several tests of apraxia and aphasia. Voxel-based lesion-symptom mapping (VLSM) analyses were then used to investigate the neural substrates of the identified components. The PCA yielded a first component related to language functions and three components related to praxis functions, with each component associated with specific lesion patterns. Regarding praxis functions, performance in imitating arm/hand gestures was accounted for by a second component related to the left precentral gyrus and the inferior parietal lobule. Imitating finger configurations, pantomiming the use of objects related to the face, and actually using objects loaded on component 3, related to the left anterior intraparietal sulcus and angular gyrus. The last component represented the imitation of bucco-facial gestures and was linked to the basal ganglia and LH white matter tracts. The results further revealed that pantomime of (limb-related) object use depended on both the component 2 and 3, which were shared with gesture imitation and actual object use. Data support and extend the notion that apraxia represents a multi-componential syndrome comprising different (impaired) motor-cognitive processes, which dissociate - at least partially - from language processes. The distinct components might be disturbed to a varying degree following LH stroke since they are associated with specific lesion patterns within the LH.

Functional Connectivity and Networks Underlying Complex Tool-Use Movement in Assembly Workers: An fMRI Study

The aim of this study was to identify the functional connectivity and networks utilized during tool-use in real assembly workers. These brain networks have not been elucidated because the use of tools in real-life settings is more complex than that in experimental environments. We evaluated task-related functional magnetic resonance imaging in 13 assembly workers (trained workers, TW) and 27 age-matched volunteers (untrained workers, UTW) during a tool-use pantomiming task, and resting-state functional connectivity was also analyzed. Two-way repeated-measures analysis of covariance was conducted with the group as a between-subject factor (TW > UTW) and condition (task > resting) as a repeated measure, controlling for assembly time and accuracy as covariates. We identified two patterns of functional connectivity in the whole brain within three networks that distinguished TW from UTW. TW had higher connectivity than UTW between the left middle temporal gyrus and right cerebellum Crus II (false discovery rate corrected p-value, p-FDR = 0.002) as well as between the left supplementary motor area and the pars triangularis of the right inferior frontal gyrus (p-FDR = 0.010). These network integrities may allow for TW to perform rapid tool-use. In contrast, UTW showed a stronger integrity compared to TW between the left paracentral lobule and right angular gyrus (p-FDR = 0.004), which may reflect a greater reliance on sensorimotor input to acquire complex tool-use ability than that of TW. Additionally, the fronto-parietal network was identified as a common network between groups. These findings support our hypothesis that assembly workers have stronger connectivity in tool-specific motor regions and the cerebellum, whereas UTW have greater involvement of sensorimotor networks during a tool-use task.

Gesture errors in left and right hemisphere damaged patients: A behavioural and anatomical study

OBJECTIVE

Erroneous gesture execution is at the core of motor cognition difficulties in apraxia. While a taxonomy of errors may provide important information about the nature of the disorder, classifications are currently often inconsistent. This study aims to identify the error categories which distinguish apraxic from non-apraxic patients.

METHOD

Two groups of mixed (bucco-facial and limb) and bucco-facial apraxic patients suffering from stroke were compared to non-apraxic, left and right hemisphere damaged patients in tasks tapping the ability to perform limb and bucco-facial actions. The errors were analysed and classified into 6 categories relating to content, configuration or movement, spatial or temporal parameters and unrecognisable actions. Furthermore, an anatomical investigation (VLMS) was conducted in the whole group of left hemisphere damaged patients to investigate potential correlates of the various error categories.

RESULTS

Although all the above error typologies may be observed, the most indicative of mixed apraxia is the content-related one in all the typologies of actions (transitive and intransitive), and configuration errors in transitive ones. Configuration and content errors in mouth actions seem to be typical of bucco-facial apraxia. Spatial errors are similar in both apraxic and right brain damaged, non-apraxic patients. A lesion mapping analysis of left-brain damaged patients demonstrates that all but the spatial error category are associated with the fronto-parietal network. Moreover, content errors are also associated with fronto-insular lesions and movement errors with damage to the paracentral territory (precentral and postcentral gyri). Spatial errors are often associated to ventral frontal lesions.

CONCLUSIONS

Bucco-facial and mixed apraxic patients make different types of errors in different types of actions. Not all errors are equally indicative of apraxia. In addition, the various error categories are associated with at least partially different neural correlates.

Altered Gesture Imitation and Brain Anatomy in Adult Prader-Willi Syndrome Patients

OBJECTIVE

To explore motor praxis in adults with Prader-Willi syndrome (PWS) in comparison with a control group of people with intellectual disability (ID) and to examine the relationship with brain structural measurements.

METHOD

Thirty adult participants with PWS and 132 with ID of nongenetic etiology (matched by age, sex, and ID level) were assessed using a comprehensive evaluation of the praxis function, which included pantomime of tool use, imitation of meaningful and meaningless gestures, motor sequencing, and constructional praxis.

RESULTS

Results support specific praxis difficulties in PWS, with worse performance in the imitation of motor actions and better performance in constructional praxis than ID peers. Compared with both control groups, PWS showed increased gray matter volume in sensorimotor and subcortical regions. However, we found no obvious association between these alterations and praxis performance. Instead, praxis scores correlated with regional volume measures in distributed apparently normal brain areas.

CONCLUSIONS

Our findings are consistent in showing significant impairment in gesture imitation abilities in PWS and, otherwise, further indicate that the visuospatial praxis domain is relatively preserved. Praxis disability in PWS was not associated with a specific, focal alteration of brain anatomy. Altered imitation gestures could, therefore, be a consequence of widespread brain dysfunction. However, the specific contribution of key brain structures (e.g., areas containing mirror neurons) should be more finely tested in future research.

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.

Suggestions for Improving the Investigation of Gesture in Aphasia

Purpose When we speak, we gesture, and indeed, persons with aphasia gesture more frequently. The reason(s) for this is still being investigated, spurring an increase in the number of studies of gesture in persons with aphasia. As the number of studies increases, so too does the need for a shared set of best practices for gesture research in aphasia. After briefly reviewing the importance and use of gesture in persons with aphasia, this viewpoint puts forth methodological and design considerations when evaluating gesture in persons with aphasia. Method & Results We explore several different design and methodological considerations for gesture research specific to persons with aphasia, such as video angle specifications, data collection techniques, and analysis considerations. The goal of these suggestions is to develop transparent and reproducible methods for evaluating gesture in aphasia to build a solid foundation for continued work in this area. Conclusions We have proposed that it is critical to evaluate multimodal communication in a methodologically robust way to facilitate increased knowledge about the relationship of gesture to spoken language, cognition, and to other aspects of living with aphasia and recovery from aphasia. We conclude by postulating future directions for gesture research in aphasia.

Treating limb apraxia via action semantics: a preliminary study

Limb apraxia is evident in approximately 50% of patients after left hemisphere cerebral vascular accident (LCVA) and increases disability and caregiver dependence. Individuals with apraxia exhibit abnormalities in spatio-temporal aspects of gesture production and/or in knowledge of tool-related actions (action semantics). This preliminary study of three LCVA participants aimed to (i) explore the efficacy of a novel Action Network Treatment (ANT) that focused on improving the semantic association between tool actions and other types of tool knowledge, an intervention inspired by successful semantic network treatments in aphasia (e.g., Edmonds et al., 2009), and (ii) explore whether there are individuals with apraxia who benefit from ANT relative to a version of a comparatively well-studied existing apraxia treatment (Smania et al., 2006; Smania et al., 2000) that shapes gesture via focus on practicing the spatio-temporal aspects of gesture production (Tool Use Treatment or TUT). One participant demonstrated treatment benefits from both ANT and TUT, while another only benefited from TUT. These findings indicate that our novel semantic network strengthening approach to gesture training may be efficacious in at least some individuals with apraxia, and provide a foundation for future study of the characteristics of people with apraxia who benefit from each approach.

Neural encoding and functional interactions underlying pantomimed movements

Pantomimes are a unique movement category which can convey complex information about our intentions in the absence of any interaction with real objects. Indeed, we can pretend to use the same tool to perform different actions or to achieve the same goal adopting different tools. Nevertheless, how our brain implements pantomimed movements is still poorly understood. In our study, we explored the neural encoding and functional interactions underlying pantomimes adopting multivariate pattern analysis (MVPA) and connectivity analysis of fMRI data. Participants performed pantomimed movements, either grasp-to-move or grasp-to-use, as if they were interacting with two different tools (scissors or axe). These tools share the possibility to achieve the same goal. We adopted MVPA to investigate two levels of representation during the planning and execution of pantomimes: (1) distinguishing different actions performed with the same tool, (2) representing the same final goal irrespective of the adopted tool. We described widespread encoding of action information within regions of the so-called “tool” network. Several nodes of the network—comprising regions within the ventral and the dorsal stream—also represented goal information. The spatial distribution of goal information changed from planning—comprising posterior regions (i.e. parietal and temporal)—to execution—including also anterior regions (i.e. premotor cortex). Moreover, connectivity analysis provided evidence for task-specific bidirectional coupling between the ventral stream and parieto-frontal motor networks. Overall, we showed that pantomimes were characterized by specific patterns of action and goal encoding and by task-dependent cortical interactions.

Semantic and action tool knowledge in the brain: Identifying common and distinct networks

Most cognitive models of apraxia assume that impaired tool use results from a deficit occurring at the conceptual level, which contains dedicated information about tool use, namely, semantic and action tool knowledge. Semantic tool knowledge contains information about the prototypical use of familiar tools, such as function (e.g., a hammer and a mallet share the same purpose) and associative relations (e.g., a hammer goes with a nail). Action tool knowledge contains information about how to manipulate tools, such as hand posture and kinematics. The present review aimed to better understand the neural correlates of action and semantic tool knowledge, by focusing on activation, stimulation and patients' studies (left brain-damaged patients). We found that action and semantic tool knowledge rely upon a large brain network including temporal and parietal regions. Yet, while action tool knowledge calls into play the intraparietal sulcus, function relations mostly involve the anterior and posterior temporal lobe. Associative relations engaged the angular and the posterior middle temporal gyrus. Moreover, we found that hand posture and kinematics both tapped into the inferior parietal lobe and the lateral occipital temporal cortex, but no region specificity was found for one or the other representation. Our results point out the major role of both posterior middle temporal gyrus and inferior parietal lobe for action and semantic tool knowledge. They highlight the common and distinct brain networks involved in action and semantic tool networks and spur future directions on this topic.

Anatomical correlates of recovery in apraxia: A longitudinal lesion-mapping study in stroke patients

OBJECTIVE

This study investigates the clinical course of recovery of apraxia after left-hemisphere stroke and the underlying neuroanatomical correlates for persisting or recovering deficits in relation to the major processing streams in the network for motor cognition.

METHODS

90 patients were examined during the acute (4.74 ± 2.73 days) and chronic (14.3 ± 15.39 months) stage after left-hemisphere stroke for deficits in meaningless imitation, as well as production and conceptual errors in tool use pantomime. Lesion correlates for persisting or recovering deficits were analyzed with an extension of the non-parametric Brunner-Munzel rank-order test for multi-factorial designs (two-way repeated-measures ANOVA) using acute images.

RESULTS

Meaningless imitation and tool use production deficits persisted into the chronic stage. Conceptual errors in tool use pantomime showed an almost complete recovery. Imitation errors persisted after occipitotemporal and superior temporal lesions in the dorso-dorsal stream. Chronic pantomime production errors were related to the supramarginal gyrus, the key structure of the ventro-dorsal stream. More anterior lesions in the ventro-dorsal stream (ventral premotor cortex) were additionally associated with poor recovery of production errors in pantomime. Conceptual errors in pantomime after temporal and supramarginal gyrus lesions persisted into the chronic stage. However, they resolved completely when related to angular gyrus or insular lesions.

CONCLUSION

The diverging courses of recovery in different apraxia tasks can be related to different mechanisms. Critical lesions to key structures of the network or entrance areas of the processing streams lead to persisting deficits in the corresponding tasks. Contrary, lesions located outside the core network but inducing a temporary network dysfunction allow good recovery e.g., of conceptual errors in pantomime. The identification of lesion correlates for different long-term recovery patterns in apraxia might also allow early clinical prediction of the course of recovery.

Structural connectivity differs between males and females in the brain object manipulation network

Object control skills are one of the most important abilities in daily life. Knowledge of object manipulation is an essential factor in improving object control skills. Although males and females equally try to use object manipulation knowledge, their object control abilities often differ. To explain this difference, we investigated how structural brain networks in males and females are differentially organized in the tool-preferring areas of the object manipulation network. The structural connectivity between the primary motor and premotor regions and between the inferior parietal regions in males was significantly higher than that in females. However, females showed greater structural connectivity in various regions of the object manipulation network, including the paracentral lobule, inferior parietal regions, superior parietal cortices, MT+ complex and neighboring visual areas, and dorsal stream visual cortex. The global node strength found in the female parietal network was significantly higher than that in males but not for the entire object manipulation, ventral temporal, and motor networks. These findings indicated that the parietal network in females has greater inter-regional structural connectivity to retrieve manipulation knowledge than that in males. This study suggests that differential structural networks in males and females might influence object manipulation knowledge retrieval.

Characterising factors underlying praxis deficits in chronic left hemisphere stroke patients

Limb apraxia, a disorder of skilled action not consequent on primary motor or sensory deficits, has traditionally been defined according to errors patients make on neuropsychological tasks. Previous models of the disorder have failed to provide a unified account of patients' deficits, due to heterogeneity in the patients and tasks used. In this study we hypothesised that we may be able to map apraxic deficits onto principal components, some of which may be specific, whilst others may align with other cognitive disorders. We implemented principal component analysis (PCA) to elucidate core factors of the disorder in a preliminary cohort of 41 unselected left hemisphere chronic stroke patients who were tested on a comprehensive and validated apraxia screen. Three principal components were identified: posture selection, semantic control and multi-demand sequencing. These were submitted to a lesion symptom mapping (VBCM) analysis in a subset of 24 patients, controlled for lesion volume, age and time post-stroke. The first component revealed no significant structural correlates. The second component was related to regions in inferior frontal gyrus, primary motor area, and adjacent parietal opercular (including inferior parietal and supramarginal gyrus) areas. The third component was associated with lesions within the white matter underlying the left sensorimotor cortex, likely involving the 2nd branch of the left superior longitudinal fasciculus as well as the posterior orbitofrontal cortex (pOFC). These results highlight a significant role of common cognitive functions in apraxia, which include action selection, and sequencing, whilst more specific deficits may relate to semantic control. Moreover, they suggest that previously described 'ideomotor' and 'ideational' deficits may have a common neural basis within semantic control. Further research using this technique would help elucidate the cognitive processes underlying limb apraxia, its neural correlates and their relationship with other cognitive disorders.

Manual praxis and language-production networks, and their links to handedness

While Liepmann was one of the first researchers to consider a relationship between skilled manual actions (praxis) and language for tasks performed "freely from memory", his primary focus was on the relations between the organization of praxis and left-hemisphere dominance. Subsequent attempts to apply his apraxia model to all cases he studied - including his first patient, a "non-pure right-hander" treated as an exception - left the praxis-handedness issue unresolved. Modern neuropsychological and recent neuroimaging evidence either showed closer associations of praxis and language, than between handedness and any of these two functions, or focused on their dissociations. Yet, present-day developments in neuroimaging and statistics allow us to overcome the limitations of the earlier work on praxis-language-handedness links, and to better quantify their interrelationships. Using functional magnetic resonance imaging (fMRI), we studied tool use pantomimes and subvocal word generation in 125 participants, including righthanders (N_RH = 52), ambidextrous individuals (mixedhanders; N_MH = 31), and lefthanders (N_LH = 42). Laterality indices were calculated both in two critical cytoarchitectonic maps, and 180 multi-modal parcellations of the human cerebral cortex, using voxel count and signal intensity, and the most relevant regions of interest and their networks were further analyzed. We found that atypical organization of praxis was present in all handedness groups (RH = 25.0%, MH = 22.6%; LH = 45.2%), and was about two and a half times as common as atypical organization of language (RH = 3.8%; MH = 6.5%; LH = 26.2%), contingent on ROI selection/LI-calculation method. Despite strong associations of praxis and language, regardless of handedness and typicality, dissociations of atypically represented praxis from typical left-lateralized language were common (~20% of cases), whereas the inverse dissociations of atypically represented language from typical left-lateralized praxis were very rare (in ~2.5% of all cases). The consequences of the existence of such different phenotypes for theoretical accounts of manual praxis, and its links to language and handedness are modeled and discussed.

Scene context shapes category representational geometry during processing of tools

Tools are ubiquitous in human environments and to think about them we use concepts. Increasingly, conceptual representation is thought to be dynamic and sensitive to the goals of the observer. Indeed, observer goals can reshape representational geometry within cortical networks supporting concepts. In the present study, we investigated the novel hypothesis that task-irrelevant scene context may implicitly alter the representational geometry of regions within the tool network. Participants performed conceptual judgments on images of tools embedded in scenes that either suggested their use (i.e., a kitchen timer sitting on a kitchen counter with vegetables in a frying pan) or that they would simply be moved (i.e., a kitchen timer sitting in an open drawer with other miscellaneous kitchen items around). We investigated whether representations in the tool network reflect category, grip, and shape information using a representational similarity analysis (RSA). We show that a) a number of regions of the tool network reflect category information about tools and b) category information predicts patterns in supramarginal gyrus more strongly in use contexts than in move contexts. Together, these results show that information about tool category is distributed across different regions of the tool network and that scene context helps shape the representational geometry of the tool network.

Nonverbal Semantics Test (NVST)-A Novel Diagnostic Tool to Assess Semantic Processing Deficits: Application to Persons with Aphasia after Cerebrovascular Accident

Assessment of semantic processing capacities often relies on verbal tasks which are, however, sensitive to impairments at several language processing levels. Especially for persons with aphasia there is a strong need for a tool that measures semantic processing skills independent of verbal abilities. Furthermore, in order to assess a patient’s potential for using alternative means of communication in cases of severe aphasia, semantic processing should be assessed in different nonverbal conditions. The Nonverbal Semantics Test (NVST) is a tool that captures semantic processing capacities through three tasks—Semantic Sorting, Drawing, and Pantomime. The main aim of the current study was to investigate the relationship between the NVST and measures of standard neurolinguistic assessment. Fifty-one persons with aphasia caused by left hemisphere brain damage were administered the NVST as well as the Aachen Aphasia Test (AAT). A principal component analysis (PCA) was conducted across all AAT and NVST subtests. The analysis resulted in a two-factor model that captured 69% of the variance of the original data, with all linguistic tasks loading high on one factor and the NVST subtests loading high on the other. These findings suggest that nonverbal tasks assessing semantic processing capacities should be administered alongside standard neurolinguistic aphasia tests.

Developmental Dyspraxia in Children With Learning Disorders: Four-Year Experience in a Referred Sample

OBJECTIVE

The term apraxia is clearly understood in adult behavioral neurology, with assessment of gesture central to the diagnosis. In contrast, the concept of "developmental dyspraxia" has been more problematic. In an effort to better specify its potential significance, we describe preliminary practice-based evidence for understanding developmental dyspraxia acquired within a theoretical framework informed by both adult behavioral neurology and a neuroconstructivist appreciation of neurodevelopmental disorders. Specifically, we describe the experience of a diagnostic clinic for children with learning disorders that adopted this framework and compare clinical characteristics of children diagnosed with dyspraxia with those of children diagnosed with dyslexia during the same time period.

METHOD

The dyspraxia diagnosis was based on the presence of impaired gesture and/or cognitive problems with planning. Over the target period, 71 children were diagnosed with dyspraxia and 114 children were diagnosed with dyslexia. Twenty-nine of the 71 children with dyspraxia were also diagnosed with dyslexia. Domains assessed included early developmental milestones, neurologic findings, cognition, speech and language, academic skills, and psychosocial functioning.

RESULTS

Compared to the dyslexia group, children with dyspraxia (with or without dyslexia) had more problems with speech and language planning and planning in everyday life. Children with dyspraxia without dyslexia had more frequent early motor delays and deficits in visuospatial production than the other groups. The dyslexia groups predictably demonstrated poorer single word reading and phonologic processing compared to the dyspraxia only group (all P < .01).

CONCLUSIONS

A neurologic finding of impaired gesture in children with learning disorders may signal a broader neurodevelopmental profile of developmental dyspraxia with both theoretical relevance and meaningful implications for evaluation and treatment. Cognitive problems with planning are particularly relevant.

Toward brain-heart computer interfaces: a study on the classification of upper limb movements using multisystem directional estimates

OBJECTIVE

Brain-computer interfaces (BCI) exploit computational features from brain signals to perform a given task. Despite recent neurophysiology and clinical findings indicating the crucial role of functional interplay between brain and cardiovascular dynamics in locomotion, heartbeat information remains to be included in common BCI systems. In this study, we exploit the multidimensional features of directional and functional interplay between electroencephalographic and heartbeat spectra to classify upper limb movements into three classes.

APPROACH

We gathered data from 26 healthy volunteers that performed 90 movements; the data were processed using a recently proposed framework for brain-heart interplay (BHI) assessment based on synthetic physiological data generation. Extracted BHI features were employed to classify, through sequential forward selection scheme and k-nearest neighbors algorithm, among resting state and three classes of movements according to the kind of interaction with objects.

MAIN RESULTS

The results demonstrated that the proposed brain-heart computer interface (BHCI) system could distinguish between rest and movement classes automatically with an average 90% of accuracy.

SIGNIFICANCE

Further, this study provides neurophysiology insights indicating the crucial role of functional interplay originating at the cortical level onto the heart in the upper limb neural control. The inclusion of functional BHI insights might substantially improve the neuroscientific knowledge about motor control, and this may lead to advanced BHCI systems performances.

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.