Anosognosia for hemiplegia is the denial of neurologically-caused paralysis, and it often co-occurs with a number of distortions of belief and emotion such as somatoparaphrenia and an exaggeration of negative affect towards minor health complaints. The salience of these latter symptoms led early investigators to propose explanations of AHP which construed it as a process of motivated self-deception against the overwhelming anxiety and depression that knowledge of deficit would otherwise cause, and which was observed in hemiplegic patients without the anosognosia. (...) Since some influential critiques of this approach, however, theories of this kind have largely been rejected on the grounds that they are inappropriately “psychogenic.” What has replaced them are a class of theories which explain the lack of awareness in terms of neurocognitive deficit, with the deficit in question variously described by researchers as involving spatial awareness, motor control, and other capacities. In this paper I argue – contra claims in the literature – that the patterns of explanation which are characteristic of the psychodynamic theory are not incompatible in principle with the notion that the illness involves neurocognitive deficit. That means that these patterns of explanation can be preserved where they make good sense of the obscure attitudinal and emotional symptoms that occur in AHP – symptoms that are otherwise difficult to explain. I suggest some ways in which this fact could be accommodated by deficit theories of the illness which are based on motor deficit. (shrink)

Anosognosia for hemiplegia is a lack of awareness about paralysis following stroke. Recent explanations use a ‘forward model’ of movement to suggest that AHP patients fail to register discrepancies between internally- and externally-generated sensory information. We predicted that this failure would impair the ability to recall from memory whether information is internally- or externally-generated . Two experiments examined this prediction. Experiment 1 demonstrated that AHP patients exhibit a reality monitoring deficit for non-motor information , whilst hemiplegic controls without anosognosia perform (...) like age-matched healthy volunteers . Experiment 2 explored if this deficit occurs when AHP patients discriminate performed, imagined, or observed movement. Results showed impaired reality monitoring for movements in AHP and nonAHP patients relative to HVs. Findings suggest that reality monitoring processes not directly related to movement, together with a failure to reality monitor movements, contribute to the pathogenesis of AHP. (shrink)

The sense of embodiment is vital for self recognition. An examination of anosognosia for hemiplegia—the inability to recognise that one is paralysed down one side of one’s body—suggests the existence of ‘online’ and ‘offline’ representations of the body. Online representations of the body are representations of the body as it is currently, are newly constructed moment by moment and are directly “plugged into” current perception of the body. In contrast, offline representations of the body are representations of what the body (...) is usually like, are relatively stable and are constructed from online representations. This distinction is supported by an analysis of phantom limb—the feeling that an amputated limb is still present—phenomena. Initially it seems that the sense of embodiment may arise from either of these types of representation; however, an integrated representation of the body seems to be required. It is suggested information from vision and emotions is involved in generating these representations. A lack of access to online representations of the body does not necessarily lead to a loss in the sense of embodiment. An integrated offline representation of the body could account for the sense of embodiment and perform the functions attributed to this sense. (shrink)

The study of anosognosia has witnessed an unprecedented increase in interest over the last 20 years. This has resulted in numerous empirical investigations as well as theoretical writings on the nature of human consciousness and how disorders of the brain may influence the person's subjective awareness of a disturbed neurological or neuropsychological function. This edited text summarizes many of the advances that have taken place in the field of anosognosia. It reviews research findings on anosognosia for hemiplegia following stroke, Anton's (...) syndrome, and a variety of disorders in which impaired self-awareness is common. It also provides suggestive guidelines for the management and rehabilitation of persons who have anosognosia or impaired self-awareness. (shrink)

Anosognosia is literally ‘unawareness of or failure to acknowledge one’s hemi- plegia or other disability’ (OED). Etymology would suggest the meaning ‘lack of knowledge of disease’ so that anosognosia would include any denial of impairment, such as denial of blindness (Anton’s syndrome). But Babinski, who introduced the term in 1914, applied it only to patients with hemiplegia who fail to acknowledge their paralysis. Most commonly, this is failure to acknowledge paralysis of the left side of the body following damage to (...) the right hemisphere of the brain. In this paper, we shall mainly be concerned with anosognosia for hemiplegia. But we shall also use the term ‘anosognosia’ in an inclusive way to encompass lack of knowledge or acknowledgement of any impairment. Indeed, in the construction ‘anosognosia for X’, X might even be anosognosia for some Y. (shrink)

This collection of essays focuses on the interface between delusions and self-deception. As pathologies of belief, delusions and self-deception raise many of the same challenges for those seeking to understand them. Are delusions and self-deception entirely distinct phenomena, or might some forms of self-deception also qualify as delusional? To what extent might models of self-deception and delusion share common factors? In what ways do affect and motivation enter into normal belief-formation, and how might they be implicated in self-deception and delusion? (...) The essays in this volume tackle these questions from both empirical and conceptual perspectives. Some contributors focus on the general question of how to locate self-deception and delusion within our taxonomy of psychological states. Some contributors ask whether particular delusions - such as the Capgras delusion or anosognosia for hemiplegia - might be explained by appeal to motivational and affective factors. And some contributors provide general models of motivated reasoning, against which theories of pathological belief-formation might be measured. (shrink)

Disability imagery, whether photographs, posters, or verbal or written discourse, comprises multiple viewpoints or gazes, ranging from the impaired physical body to the disabling social environment. In some instances, photographic image and accompanying text combine to reinforce the notion of persons with disabilities as helpless and needy people. These conceptualizations not only emphasize obvious prejudices and limited thinking about persons with disabilities, but also illustrate the consequences: persons with disabilities tend to assimilate the oppressive images constructed by society. In order (...) to create positive images of, for example, persons with brain injury, epilepsy or hemiplegia, we need to develop a disability consciousness that allows us to re-imagine (dis)ability in ways that value individual identity. In so doing, we raise critical questions about self and other. (shrink)

Hysteria has been the subject of controversy for many years, with theorists arguing about whether it is best explained by a hidden organic cause or by malingering and deception. However, it has been shown that hysterical paralysis cannot be explained in any of these terms. With the recent development of cognitive psychiatry, one may understand psychiatric and organic delusions within the same conceptual framework. Here I contrast hysterical conversion with anosognosia. They are indeed remarkably similar, though the content of their (...) respective delusions is the opposite. In hysterical paralysis, patients are not aware of their preserved ability, whereas in anosognosia for hemiplegia, patients are not aware of their disability. Four main explanations have been provided to account for anosognosia: metacognitive, attentional, motor, and motivational views. I will apply each of these accounts to hysterical paralysis and show that, at each level, hysterical conversion is the reverse of anosognosia. I will suggest that hysterical paralysis results from the interaction between attentional somatosensory amplification and affective inhibition of action. (shrink)

Event-related desynchronization, as a proxy for mirror neuron activity, has been used as a neurophysiological marker for motor execution after mirror visual feedback. Using EEG, this study investigated ERD upon the immediate effects of single-session MVF in unimanual arm movements compared with the ERD effects occurring without a mirror, in two groups: stroke patients with left hemiplegia and their healthy counterparts. During EEG recordings, each group performed one session of mirror therapy training in three task conditions: with a mirror, with (...) no mirror, and with a covered mirror. An asymmetry index was calculated from the subtraction of the event-related spectrum perturbations between the C3 and C4 electrodes located over the sensorimotor cortices contralateral and ipsilateral to the moved arm. Results of the effect of task versus group in contralateral and ipsilateral motor areas showed that there was a significant effect of task condition at the contralateral motor area in the high beta band at C3. High beta ERD showed that the suppression was greater over the contralateral hemisphere than it was over the ipsilateral hemisphere in both study groups. The magnitude of low beta ERD in patients with stroke was more suppressed in contralesional C3 under the no mirror compared to that of the covered mirror and similarly more suppressed in ipsilesional C4 ERD under the no mirror compared to that of the mirror condition. The correlation analysis revealed that the magnitude of ERSP power correlated significantly with arm severity in the low and high beta bands in patients with stroke, and a higher asymmetry index in the low beta band was associated with higher arm functioning under the no-mirror condition. There was a shift in sensorimotor ERD toward the contralateral hemisphere as induced by MVF accompanying unimanual movement in both stroke patients and healthy controls. The use of ERD in the low beta band as a neurophysiological marker to indicate the relationships between the amount of MVF-induced ERD attenuation and motor severity, and the outcome indicator for improving stroke patients’ neuroplasticity in clinical trials using MVF are warranted to be explored in the future. (shrink)

Hemiparetic stroke in adulthood often results in the grouped movement pattern of the upper extremity flexion synergy thought to arise from an increased reliance on cortico-reticulospinal pathways due to a loss of lateral corticospinal projections. It is well-established that the flexion synergy induces reaching constraints in individuals with adult-onset hemiplegia. The expression of the flexion synergy in individuals with brain injuries onset earlier in the lifespan is currently unknown. An early unilateral brain injury occurring prior to six months post full-term (...) may preserve corticospinal projections which can be used for independent joint control and thus minimizing the expression of the flexion synergy. This study uses kinematics of a ballistic reaching task to evaluate the expression of the flexion synergy in individuals with pediatric-onset hemiplegia (PH) ages six to seventeen years. Fifteen individuals with brain injuries before birth (n = 8) and around full-term (n = 7) and nine age-matched controls with no known neurological impairment completed a set of reaches in an admittance controlled robotic device. Descending drive, and the possible expression of the upper extremity flexion snergy, was modulated by increasing shoulder abduction loading. Individuals with early PH achieved lower peak velocities when reaching with the paretic arm compared to controls however no differences in reaching distance were found between groups. Relative maintenance in reaching seen in individuals with early brain injuries highlights minimal expression of the flexion synergy. We interpret this conservation of independent control of the paretic shoulder and elbow as the use of more direct corticospinal projections instead of indirect cortico-reticulospinal pathways used in individuals with adult-onset hemiplegia. (shrink)

This volume provides, for the first time, multidisciplinary perspectives on the problem of awareness of deficits following brain injury. Such deficits may involve perception, attention, memory, language, or motor functions, and they can seriously disrupt an individual's ability to function. However, some brain-damaged patients are entirely unaware of the existence or severity of their deficits, even when they are easily noticed by others. In addressing these topics, contributors cover the entire range of neuropsychological syndromes in which problems with awareness of (...) deficit are observed: hemiplegia and hemianopia, amnesia, aphasia, traumatic head injury, dementia, and others. On the clinical side, leading researchers delineate the implications of awareness of deficits for rehabilitation and patient management, and the role of defense mechanisms such as denial. Theoretical discussions focus on the importance of awareness disturbances for better understanding such cognitive processes as attention, consciousness, and monitoring. (shrink)

Facial fat grafting techniques often offer impressive surgical results. However, fatal complications, such as irreversible cerebral ischemia, blindness, and hemiplegia are associated with them. We have presented a case report of a patient who presented with a massive cerebral infarction, a serious complication of facial autologous fat injection. The patient was a 28-year-old female who experienced motor dysfunction of the left extremities, which was accompanied with loss of consciousness immediately following fat grafting for facial augmentation. Imaging studies suggested that the (...) patient had a large cerebral infarction on the right frontal, temporal, and parietal lobes due to complete occlusion of her right external carotid artery. Emergency decompressive craniectomy was completed in addition to multiple follow-up medical treatments. The patient recovered after 4 months with reduced motor function in her left upper extremity. This report further summarizes published cases of massive cerebral ischemia after facial injection of autologous fat, as well as lists high-risk facial areas and critical warnings. (shrink)

A referral was made to our Cardiac Transplant Program for a patient who was in the New Jersey Prison System. The Medical Director of the New Jersey Department of Corrections called regarding a 39-year-old inmate who was being treated in a New Jersey hospital that has a unit for prisoners from a nearby cor- rectional facility. The referring physician described the patient to our Medical Director of heart transplantation as a “murderer” who had been incarcerated since 1987 and sentenced to (...) prison for 30 years without eligibility for parole before completion of his 30-year sentence. The patient was being treated in the CCU of the facility and according to preliminary studies, was suffering from a possible dilated cardiomyopathy. There was evidence of a prior cerebrovascular accident (etiology unknown) with a dense hemiplegia of the left side. The patient was alert but unable to care for himself. There were a number of specific tests necessary to evaluate the patient's candidacy for heart transplantation before actually placing him-on a waiting list. However, the transplant director was uncertain about having the patient brought to our facility for further testing and called some members of the Transplant Selection Committee team to discuss the case. (shrink)

This book proposes a novel and rigorous explanation of consciousness. It argues that the study of an aspect of our self-consciousness known as the ‘feeling of embodiment’ teaches us that there are two distinct phenomena to be targeted by an explanation of consciousness. First is an explanation of the phenomenal qualities – 'what it is like' – of the experience; and second is the subject's awareness of those qualities. Glenn Carruthers explores the phenomenal qualities of the feeling of embodiment using (...) the tools of quality spaces, as well as the subject's awareness of those qualities as a functionally emergent property of various kinds of processing of these spaces. Where much recent work on consciousness focuses on visual experience, this book rather draws evidence from the study of self-consciousness. Carruthers argues that in light of recent methodological discoveries, awareness must be explained in terms of the organization of multiple cognitive processes. The book offers an explanation of anomalous body representations and, from that, poses a more general theory of consciousness. Ultimately this book creates a hybrid account of consciousness that explains phenomenology and awareness using different tools. It will be of great interest to all scholars of psychology and philosophy as well as anyone interested in exploring the intricacies of how we experience our bodies, what we are and how we fit into the world. -/- . (shrink)