Another perspective on anosognosia: Self-observation in video replay improves motor awareness

Abstract

Anosognosia for hemiplegia (AHP), or unawareness of motor deficits contralateral to a brain lesion, has lasting negative implications for the management and rehabilitation of patients. A recent, bedside psychophysical intervention, namely self-observation by video replay, lead to a lasting remission of severe AHP in an acute stroke patient (Fotopoulou, A., Rudd, A., Holmes, P., & Kopelman, M. (2009). Self-observation reinstates motor awareness in anosognosia for hemiplegia. Neuropsychologia, 47, 1256–1260). This procedure has been adjusted and applied here, as the basis of two intervention protocols administered independently to two patients with severe AHP. The first study used multiple, successive sessions of video-based self-observation in an acute patient, targeting first the awareness of upper limb and subsequently lower limb paralysis. The second study used a single session of video-based, self- and other-observation in a patient at the chronic stage following onset. Both protocols also involved elements of rapport building and emotional support. The results revealed that video-based self-observation had dramatic, immediate effects on awareness in both acute and chronic stages and it seemed to act as an initial trigger for eventual symptom remission. Nevertheless, these effects did not automatically generalise to all functional domains. This study provides provisional support that video-based self-observation may be included in wider rehabilitation programmes for the management and restoration of anosognosia.

Keywords:

• Anosognosia
• Motor awareness
• Perspective
• Video replay
• Neurorehabilitation

This work was funded by an European Research Council (ERC) Starting Investigator Award for the project “The Bodily Self” No. 313755 to A.F. and by the Italian Ministry of Education, University and Research (Progetti di Ricerca di Interesse Nazionale PRIN 2009), the Italian Ministry of Health (Project Code: RF-2010-2312912) to V.M., and a Commonwealth Scholarship, an Oppenheimer Memorial Trust Fellowship, and a Neuropsychology International Fellowship Award from the British Psychological Society in conjunction with the British Neuropsychological Society to S.B.

We thank the patients and their relatives for their kindness and willingness to take part in the study. We are also grateful to Cristina Bulgarelli and Michele Scandola for their help in collecting data and statistical analysis. No conflicts of interest were reported.