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Buxbaum, L. J.

Publications and source records attributed to Buxbaum, L. J..

14 recordsLinked to original sources

Novel tool use does not depend on mechanical reasoning: evidence from apraxia

A hallmark of human intelligence is the ability to use tools. Yet the cognitive processes supporting this ability remain debated. One contemporary view holds that mechanical reasoning is central for tool use, especially in the case of tools with which we have no prior experience. However, previous support for the role of mechanical reasoning often relies on circular logic, wherein poor performance on novel tool-use tasks is taken as evidence that impaired mechanical reasoning causes tool-use deficits in limb apraxia. To address this limitation, we independently assessed mechanical reasoning and novel tool use in separate tasks in individuals with limb apraxia, and compared their performance to individuals without apraxia. We also examined whether these two abilities are similarly associated with other cognitive abilities including motor imagery, mental rotation of non-body objects, general reasoning, and spatial working memory. Finally, we explored brain-behavior relationships using support vector regression lesion-symptom mapping. Our behavioral and imaging data together showed that mechanical reasoning does not underlie novel tool-use deficits in apraxia. Graphical analysis further revealed that novel tool use and mechanical reasoning loaded onto distinct latent clusters: novel tool use was strongly associated with other praxis abilities yet separable from cognitive abilities that require reasoning and mental simulation, whereas mechanical reasoning was primarily linked to other high-level reasoning abilities but not tool use. These findings challenge the notion that mechanical reasoning is central to tool-use ability, and instead suggest that tool use is more likely to be an intuitive or automatic process.

neuroscience↗

Upregulating action semantics with neuromodulation and gesture observation to facilitate verb retrieval in aphasia

Although many individuals with chronic aphasia respond to language therapy, there remains a need for adjunctive interventions that can enhance treatment response. Approaches targeting multiple modalities, such as gesture cueing, and neuromodulation techniques, such as transcranial magnetic stimulation, have shown promise for supporting language recovery. The present pilot study investigated whether enhancing activation of the action semantic network could facilitate verb production in individuals with chronic aphasia. Participants were recruited as a convenience sample and completed a within-subject design in which all individuals received each condition. Two non-linguistic methods of activating the action semantic network were evaluated: (1) pantomimed gesture cues to prime action concepts and (2) intermittent theta-burst stimulation to the left posterior middle temporal gyrus (pMTG), an intact action-semantic network node in our participants. We examined individual and combined effects of gesture priming and stimulation to test whether a combined approach would yield additive or interactive benefits. Using a Bayesian generalized linear mixed-effects model, we observed a moderate interaction between gesture priming and stimulation site. Contrary to predictions, combining gesture priming with pMTG stimulation did not produce additional benefits over either intervention alone. Instead, pMTG stimulation attenuated the priming advantage observed under vertex stimulation, and gesture priming attenuated the advantage observed with pMTG stimulation alone. Posterior estimates provided substantial preliminary evidence for this interaction in our pilot sample size. These findings suggest that combined activation of the action semantic network through gesture and neuromodulation approaches may not benefit verb retrieval above and beyond each approach alone.

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Causes and consequences of unawareness (anosognosia) of tool-action errors after left-hemisphere stroke

Many individuals with limb apraxia after left-hemisphere stroke exhibit a lack of awareness of their tool-related action errors, i.e., unawareness of apraxia (UA; also called anosognosia of apraxia). Little is known about the prevalence of UA, the relationship between UA and apraxia severity, or its underlying mechanisms. Here, we assessed both the causes and consequences of UA. Based on a mechanistic model, we hypothesized that UA may arise because of deficits in representations signaling how tool-related movements should look and feel - a component of action knowledge - and that degradation of this knowledge impedes the detection of mismatches between planned and actual tool-related actions. We further predicted that a consequence of UA is a reduction in error-correction attempts. Fifty-six individuals with chronic LCVA gestured to show how to use tools. Immediately after the gesture production task, participants were asked if they made any errors. All participants also completed an action knowledge task to measure the integrity of tool-related movement goals. Individuals were denoted as exhibiting UA if they performed below a normative cutoff for apraxia yet reported making no errors. Our sample included 21 individuals with apraxia; of these, nearly half (48%) exhibited UA. These two groups made a comparable number of gesture errors and were of equivalent stroke severity, yet individuals with UA had significantly more impaired action knowledge. Additionally, individuals with UA were less likely to attempt to correct their errors compared to individuals who were aware of their apraxia. These data are consistent with the hypothesis that action knowledge (how tool actions look and feel) serves a key role in error detection and awareness of apraxia and may contribute to the difficulties with everyday tasks experienced by many people with apraxia. Abbreviated SummaryThibault et al. show that individuals who are unaware of their tool-use errors (unawareness of apraxia) are selectively impaired at representing how tool-related movements look and feel (action knowledge). Action knowledge may be a central component for the detection of tool-use errors made by individuals with apraxia in everyday tasks. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=135 SRC="FIGDIR/small/715610v2_ufig1.gif" ALT="Figure 1"> View larger version (41K): org.highwire.dtl.DTLVardef@a935beorg.highwire.dtl.DTLVardef@1075db2org.highwire.dtl.DTLVardef@987485org.highwire.dtl.DTLVardef@109fc62_HPS_FORMAT_FIGEXP M_FIG Graphical Abstract C_FIG

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Dissociation between physical reasoning and tool use in individuals with left hemisphere brain damage

Many everyday tasks, from chopping vegetables to catching a ball, require understanding both how objects respond to physical forces and how to use them effectively. These capacities, tool use and physical reasoning, are often assumed to rely on shared cognitive and neural mechanisms. At some level, this correspondence is expected: using an object typically requires understanding its physical properties. However, both capacities are complex and multicomponential, so the relationship between them may vary across levels of representation and task demands. Here, we asked whether third-person physical reasoning about object dynamics can dissociate from tool use (i.e., performing a tools typical action, such as using a hammer to drive a nail) in individuals with left-hemisphere stroke. We tested 11 patients, five of whom showed impairments in tool use. Physical reasoning was assessed using a novel collection of tasks probing judgments about mass, velocity, and timing across static and dynamic scenes. Tool use was evaluated using a classic gesture-to-sight task, a pantomime-based measure in which participants are shown pictures of familiar tools and asked to demonstrate how each would be used. We identified an individual-level dissociation: patient I.A.* showed impairment in gesturing the use of objects despite preserved physical reasoning, often outperforming neurotypical controls. This pattern was complemented by patient N.P., who showed the reverse profile, with intact tool use gestures but difficulties in some physical reasoning tasks. These findings suggest that the ability to reason about the physical world and tool use can dissociate behaviorally and be independently disrupted by brain damage. This challenges the view that physical reasoning and tool use draw on the same underlying cognitive and neural mechanisms and suggests that at least some of their components are distinct.

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Competition between tool and hand motion impairs movement planning in limb apraxia

Tool use is a complex motor planning problem. Prior research suggests that planning to use tools involves resolving competition between different tool-related action representations. We therefore reasoned that competition may also be exacerbated with tools for which the motions of the tool and the hand are incongruent (e.g., pinching the fingers to open a clothespin). If this hypothesis is correct, we should observe marked deficits in planning the use of incongruent as compared to congruent tools in individuals with limb apraxia following left-hemisphere stroke (LCVA), a disorder associated with abnormal action competition. We asked 34 individuals with chronic LCVA (14 females) and 16 matched neurotypical controls (8 females) to use novel tools in which the correspondence between the motions of the hand and tool-tip were either congruent or incongruent. Individuals with LCVA also completed background assessments to quantify apraxia severity. We observed increased planning time for incongruent as compared to congruent tools as a function of apraxia severity. Further analysis revealed that this impairment predominantly occurred early in the task when the tools were first introduced. Lesion-symptom mapping analyses revealed that lesions to posterior temporal and inferior parietal areas were associated with impaired planning for incongruent tools. A second experiment on the same individuals with LCVA revealed that the ability to gesture the use of conventional tools was impaired for tools rated as more incongruent by a normative sample. These findings suggest that tool-hand incongruence evokes action competition and influences the tool-use difficulties experienced by people with apraxia. Significance StatementPrior research indicates that competition between different representations associated with moving or using tools must be resolved to enable tool use. We demonstrated that competition may be exacerbated when tool and hand motions are incongruent (e.g., pinching the hand opens a clothespin), resulting in tool-use impairments particularly for individuals with greater severity of limb apraxia, a disorder known to be associated with action competition abnormalities. Lesions in posterior portions of the brains tool use network were associated with impairments in planning incongruent tool actions. This study thus demonstrates that tool-hand incongruence may invoke competition between motions of the hand and tool-tip, which individuals with limb apraxia have difficulty resolving to properly use tools.

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Cognitive neuropsychological and neuroanatomic predictors of naturalistic action performance in left hemisphere stroke: a retrospective analysis

Individuals who have experienced a left hemisphere cerebrovascular accident (LCVA) have been shown to make errors in naturalistic action tasks designed to assess the ability to perform everyday activities such as preparing a cup of coffee. Naturalistic action errors in this population are often attributed to limb apraxia, a common deficit in the representation and performance of object-related actions. However, naturalistic action impairments are also observed in right hemisphere stroke and traumatic brain injury, populations infrequently associated with apraxia, and errors across all these populations are influenced by overall severity. Based on these and other data, an alternative (though not mutually exclusive) account is that naturalistic action errors in individuals with LCVA are also a consequence of deficits in general attentional resource availability or allocation. In this study, we conducted a retrospective analysis of data from a group of 51 individuals with LCVA who had completed a test of naturalistic action, along with a battery of tests assessing praxis, attention allocation and control, reasoning, and language abilities to determine which of these capacities contribute uniquely to naturalistic action impairments. Using a regularized regression method, we found that naturalistic action impairments are predicted by both praxis deficits (hand posture sequencing and gesture recognition), as well as attention allocation and control deficits (orienting and dividing attention), along with language comprehension ability and age. Using support vector regression-lesion symptom mapping, we demonstrated that naturalistic action impairments are associated with lesions to posterior middle temporal gyrus and anterior inferior parietal lobule regions known to be implicated in praxis; as well the middle frontal gyrus that has been implicated in both praxis and attention allocation and control. Together, these findings support the hypothesis that naturalistic action impairments in people with LCVA are a consequence of apraxia as well as deficits in attention allocation and control.

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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.

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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.

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Single-Case Disconnectome Lesion-symptom Mapping: Identifying Two Subtypes of Limb Apraxia

Influential theories of skilled action posit that distinct cognitive mechanisms and neuroanatomic substrates support meaningless gesture imitation and tool use pantomiming, and poor performance on these tasks are hallmarks of limb apraxia. Yet prior research has primarily investigated brain-behavior relations at the group level; thus, it is unclear whether we can identify individuals with isolated impairments in meaningless gesture imitation or tool use pantomiming whose performance is associated with a distinct neuroanatomic lesion profile. The goal of this study was to test the hypothesis that individuals with disproportionately worse performance in meaningless gesture imitation would exhibit cortical damage and white matter disconnection in left fronto-parietal brain regions, whereas individuals with disproportionately worse performance in tool use pantomiming would exhibit cortical damage and white matter disconnection in left temporo-parietal brain regions. Fifty-eight participants who experienced a left cerebrovascular accident took part in a meaningless gesture imitation task, a tool use pantomiming task, and a T1 structural MRI. Two participants were identified who had relatively small lesions and disproportionate impairments on one task relative to the other, as well as below-control-level performance on one task and not the other. Using these criteria, one participant was disproportionately impaired at meaningless gesture imitation, and the other participant was disproportionately impaired at pantomiming tool use. Graph theoretic analysis of each participants structural disconnectome demonstrated that disproportionately worse meaningless gesture imitation performance was associated with disconnection among the left inferior parietal lobule, the left superior parietal lobule, and the left middle and superior frontal gyri, whereas disproportionately worse tool use pantomiming performance was associated with disconnection between left temporal and parietal regions. Our results demonstrate that relatively focal lesions to specific portions of the Tool Use Network can be associated with distinct limb apraxia subtypes. HighlightsO_LIDistinct subtypes of apraxia are supported by distinct neuroanatomic substrates. C_LIO_LIFronto-parietal lesions are associated with meaningless imitation deficits. C_LIO_LITemporo-parietal lesions are associated with tool use pantomiming deficits. C_LIO_LIStructural connectivity among cortical areas supports a distributed praxis system. C_LI

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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. Spatiotemporal imitation accuracy was greatest after a neutral intervening task, and worst after posture matching. When the primary task involved imitating trajectories, the data 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 of a partial dissociation 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.

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Efferent Retargeting in Above-Knee Amputees is Positively Related to Phantom Limb Pain

Many individuals who undergo limb amputation experience persistent phantom limb pain (PLP). The underlying mechanism of PLP is unknown, but the phenomenon has been associated with reorganization in sensorimotor cortex following amputation. The traditional view is that cortical reorganization degrades the missing limbs representation. However, recent work suggests that an amputated limbs cortical representation remains intact and that reorganization reflects a retargeting of efferent projections to residual muscles proximal to the amputation site. Evidence of retargeting has only been shown in individuals with upper limb amputations, and the relationship of retargeting to PLP is controversial. This study assessed retargeting and its relationship to PLP in 10 individuals with lower limb amputations. We recorded electromyographic (EMG) activity in a residual thigh muscle (vastus lateralis, VL) in patients with above-knee amputations during cyclical movements of the foot. VL activity on the amputated side was compared to that recorded on patients intact side while they moved their phantom and intact feet, respectively. VL activity in the patient group was also compared to VL activity from a sample of 9 control participants with no amputation. We show that phantom foot movement is associated with greater VL activity in the amputated leg than that seen in the intact leg as well as that exhibited by controls. The magnitude of residual VL activity was also positively related to ratings of PLP. These results provide the first support for retargeting in lower limb amputees and suggest that retargeting is related to the experience of phantom pain. New and NoteworthyPrevious work has only examined retargeting in upper limb amputees. This study provides evidence for retargeting in lower limb amputees and suggests that retargeting is related to phantom limb pain.

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Structural Disconnection of the Tool Use Network After Left Hemisphere Stroke Predicts Limb Apraxia Severity.

Producing a tool use gesture is a complex process drawing upon the integration of stored knowledge of tools and their associated actions with sensory-motor mechanisms supporting the planning and control of hand and arm actions. Understanding how sensory-motor systems in parietal cortex interface with semantic representations of actions and objects in the temporal lobe remains a critical issue, and is hypothesized to be a key determinant of the severity of limb apraxia, a deficit in producing skilled action after left hemisphere stroke. We used voxel-based and connectome-based lesion symptom mapping with data from 57 left hemisphere stroke participants to assess the lesion sites and structural disconnection patterns associated with poor tool use gesturing. We found that structural disconnection between the left inferior parietal lobule, lateral temporal lobe (left middle temporal gyrus) and ventral temporal cortex (left medial fusiform gyrus) predicted the severity of tool use gesturing performance. Control analyses demonstrated that reductions in right-hand grip strength were associated with motor system disconnection, bypassing regions supporting tool use gesturing. Our findings provide causal evidence that limb apraxia may arise, in part, from disconnection of conceptual representations in the temporal lobe from mechanisms enabling skilled action production in the inferior parietal lobule.

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Predictors of arm non-use in chronic stroke: a preliminary investigation

BackgroundThe phenomenon of non-use after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that non-use is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been tested, and we have poor understanding of the characteristics of individuals who exhibit non-use.\n\nObjectiveWe aimed to provide preliminary evidence regarding the demographic, neuropsychological, and psychological factors that may influence non-use in chronic stroke.\n\nMethodsTwenty chronic stroke survivors (10 left and 10 right hemisphere stroke) with mild-to-moderate sensory-motor impairment on the upper extremity Fugl-Meyer (UEFM) were assessed with the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use and quality of movement in \"spontaneous\" versus \"forced\" conditions. Participants were als assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy (confidence in arm movement). Using stepwise multiple regression, we determined whether demographic information and/or performance on these measures predicted AAUT non-use scores.\n\nResultsScores on the UEFM as well as attention/arousal and self-efficacy predicted the degree of non-use. Attention/arousal predicted non-use above and beyond UEFM.\n\nConclusionsGiven the complexity of the non-use phenomenon, it follows that a combination of impairment, attention/arousal, and perceived confidence predicted non-use behavior. That a measure of attention/arousal predicted non-use behavior above and beyond sensory-motor functioning highlights the importance of motivated engagement to drive use of the paretic limb. Larger-scale studies incorporating additional measures (e.g., mental health, lesion volume and white matter connectivity, pain, motivation) will be important for future investigations.

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Movement imitation depends on an abstract trajectory representation in dorsal premotor cortex

Humans are particularly good at copying novel and meaningless gestures. The mechanistic and anatomical basis for this specialized imitation ability remains largely unknown. One idea is that imitation occurs by matching body configurations. Here we propose an alternative route to imitation that depends on a body-independent representation of the trajectory path of the end-effector. We studied a group of patients with strokes in the left frontoparietal cortices. We found that they were equally impaired at imitating movement trajectories using the ipsilesional limb (i.e., the non-paretic side) that were cued either by an actor using their whole arm or just by a cursor, suggesting that body configuration is not always critical for imitation and that a representation of abstract trajectory shape may suffice. In addition, imitation ability was uncorrelated to the ability to identify the trajectory shape, suggesting a dissociation between producing trajectory shapes and perceiving their paths. Finally, a lesion-symptom mapping analysis found that imitation deficits were associated with lesions in left dorsal premotor but not parietal cortex. Together, these findings suggest a novel body-independent route to imitation that relies on the ability to plan abstract movement trajectories within dorsal premotor cortex.\n\nSignificance StatementThe ability to imitate is critical for rapidly learning to produce new gestures and actions, but how the brain translates observed movements into motor commands is poorly understood. Examining the ability of patients with strokes affecting the left hemisphere revealed that meaningless gestures can be imitated by succinctly representing only the motion of the hand in space, rather than the posture of the entire arm. Moreover, performance deficits correlated with lesions in dorsal premotor cortex, an area not previously associated with impaired imitation of arm postures. These findings thus describe a novel route to imitation that may also be impaired in some patients with apraxia.

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