Error-based training and emergent awareness in anosognosia for hemiplegia

Abstract

Residual forms of awareness have recently been demonstrated in subjects affected by anosognosia for hemiplegia, but their potential effects in recovery of awareness remain to date unexplored. Emergent awareness refers to a specific facet of motor unawareness in which anosognosic subjects recognise their motor deficits only when they have been requested to perform an action and they realise their errors. Four participants in the chronic phase after a stroke with anosognosia for hemiplegia were recruited. They took part in an “error-full” or “analysis of error-based” rehabilitative training programme. They were asked to attempt to execute specific actions, analyse their own strategies and errors and discuss the reasons for their failures. Pre- and post-training and follow-up assessments showed that motor unawareness improved in all four patients. These results indicate that unsuccessful action attempts with concomitant error analysis may facilitate the recovery of emergent awareness and, sometimes, of more general aspects of awareness.

Keywords:

• Anosognosia for hemiplegia
• Rehabilitation
• Action planning
• Emergent awareness
• Judgments of Action Test

This work was funded by the Italian Ministry of Education, University and Research - Progetti di Ricerca di Interesse Nazionale [PRIN 2009] and the Italian Ministry of Health [Project Code: RF-2010-2312912] to V.M; by the European Union's Seventh Framework Program [FP7-ICT-2009-5 contract grant no.: 257695 (VERE Project)] to M.S. and by an European Research Council, Starting Investigator Award for the project ‘The Bodily Self’[N°313755] to A.F.

We thank the patients and their relatives for their kindness and willing participation in the study and the physiotherapists and the physicians of Sacro Cuore Don Calabria Hospital for their cooperation.