The Motor Unawareness Assessment (MUNA): A new tool for the assessment of Anosognosia for hemiplegia

ABSTRACT

Introduction: Anosognosia for hemiplegia (AHP) is a condition in which patients with paralysis are unaware of their motor deficits. Research into AHP is important for improving its treatment and providing insight into the neurocognitive mechanism of motor awareness. Unfortunately, most studies use assessments with widely recognized limitations.

The study aims at developing a psychometrically validated assessment of AHP.

Method: We developed a 40-item Motor Unawareness Assessment (MUNA) and administered it to 131 right-hemisphere stroke patients. Principal Component Analysis (PCA) was used to identify the underlying factor structure. Receiver Operating Characteristics (ROC) analysis was used to determine diagnostic cutoffs, and Area Under the Curve (AUC) analysis used to assess these cutoffs. Relationships with demographic, clinical and neuropsychological variables were explored.

Results: Five factors were identified: explicit motor awareness, implicit motor awareness, impaired sense of ownership, agency and illusory movement, and emotional reactions. Established cutoffs had excellent sensitivity and specificity. Clinical, neuropsychological and demographic variables did not predict overall MUNA score but were related to specific subcomponents.

Conclusion: The MUNA can differentiate various facets of AHP and provides a detailed profile of (un)awareness. The MUNA can therefore provide robust assessment for research purposes and assist clinicians when developing targeted rehabilitation.

KEYWORDS:

• Anosognosia for hemiplegia
• motor awareness
• asomatognosia
• emotions in body awareness
• bodily awareness assessment

Disclosure statement

In accordance with Taylor & Francis policy and our ethical obligation as researchers, we are reporting that we do not have a financial and/or business interests in a company that may be affected by the research reported in the enclosed paper.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the British Psychological Society [Neuropsychology International Fellowship Award]; Commonwealth Scholarship Commission [Scholarship]; Fondazione Cassa di Risparmio di Verona Vicenza Belluno e Ancona [ROL10782-COD.SIME 2018.0898] ; Ministero dell’Istruzione, dell’Università e della Ricerca [2017N7WCLP] ; Oppenheimer Memorial Trust Fellowship [Fellow ship]; European Research Council[Starting Investigator Award for the project ‘The Bodily Self’ No. 313755];University of Hertfordshire [University of Hertfordshire studentship].