Crossed apraxia: implications for handedness

The pantomime of mental rotation: Left-handers are less lateralized

INTRODUCTION

The conceptualization of skilled hand movements (praxis) may be grounded in hemispherically specialized functions. However, a left-hemispherical advantage of (tool-use) pantomime gestures and a right-hemispherical advantage of spatial gestures may be more prominent in right-handed than left-handed individuals. We therefore investigated the hypothesis that right-handed but not left-handed individuals show a superiority of the left hemisphere (/right-hand preference) for the execution of pantomime (rotation of an object) gestures as well as a right-hemispherical superiority (/left-hand preference) for gestures that depict spatial information (/positioning of an object).

METHODS

20 right- and 20 left-handed participants were asked in two experiments to demonstrate with their two hands how to move tachistoscopically (in the left (LVF) or right visual hemifields (RVF)) presented geometric objects of different rotations into an identical final position. Two independent blind raters evaluated the videotaped hand gestures employing the Neuropsychological Gesture (NEUROGES) Coding System.

RESULTS

In contrast to left-handed individuals, right-handed individuals present increased pantomime - rotation gestures with the right hand and pantomime - position gestures with the left hand during stimuli presentation in either visual field. Left-handers showed significantly increased left-hand pantomime - rotation gestures during stimulus presentation within the LVF (only).

DISCUSSION

Right-handed individuals increase their pantomime - rotation gestures with the right hand to depict motion but use their left hand for pantomime - position gestures to describe spatial relations of the objects. Left-handers do not show a clear lateralization of the right and left hand with regards to either handedness or hemispherically lateralized motor functions. The hemispherical lateralization of praxis functions is therefore more pronounced in right-handed than left-handed individuals.

Context-sensitive computational mechanistic explanation in cognitive neuroscience

Mainstream cognitive neuroscience aims to build mechanistic explanations of behavior by mapping abilities described at the organismal level via the subpersonal level of computation onto specific brain networks. We provide an integrative review of these commitments and their mismatch with empirical research findings. Context-dependent neural tuning, neural reuse, degeneracy, plasticity, functional recovery, and the neural correlates of enculturated skills each show that there is a lack of stable mappings between organismal, computational, and neural levels of analysis. We furthermore highlight recent research suggesting that task context at the organismal level determines the dynamic parcellation of functional components at the neural level. Such instability prevents the establishment of specific computational descriptions of neural function, which remains a central goal of many brain mappers - including those who are sympathetic to the notion of many-to-many mappings between organismal and neural levels. This between-level instability presents a deep epistemological challenge and requires a reorientation of methodological and theoretical commitments within cognitive neuroscience. We demonstrate the need for change to brain mapping efforts in the face of instability if cognitive neuroscience is to maintain its central goal of constructing computational mechanistic explanations of behavior; we show that such explanations must be contextual at all levels.

Manual praxis and language-production networks, and their links to handedness

While Liepmann was one of the first researchers to consider a relationship between skilled manual actions (praxis) and language for tasks performed "freely from memory", his primary focus was on the relations between the organization of praxis and left-hemisphere dominance. Subsequent attempts to apply his apraxia model to all cases he studied - including his first patient, a "non-pure right-hander" treated as an exception - left the praxis-handedness issue unresolved. Modern neuropsychological and recent neuroimaging evidence either showed closer associations of praxis and language, than between handedness and any of these two functions, or focused on their dissociations. Yet, present-day developments in neuroimaging and statistics allow us to overcome the limitations of the earlier work on praxis-language-handedness links, and to better quantify their interrelationships. Using functional magnetic resonance imaging (fMRI), we studied tool use pantomimes and subvocal word generation in 125 participants, including righthanders (N_RH = 52), ambidextrous individuals (mixedhanders; N_MH = 31), and lefthanders (N_LH = 42). Laterality indices were calculated both in two critical cytoarchitectonic maps, and 180 multi-modal parcellations of the human cerebral cortex, using voxel count and signal intensity, and the most relevant regions of interest and their networks were further analyzed. We found that atypical organization of praxis was present in all handedness groups (RH = 25.0%, MH = 22.6%; LH = 45.2%), and was about two and a half times as common as atypical organization of language (RH = 3.8%; MH = 6.5%; LH = 26.2%), contingent on ROI selection/LI-calculation method. Despite strong associations of praxis and language, regardless of handedness and typicality, dissociations of atypically represented praxis from typical left-lateralized language were common (~20% of cases), whereas the inverse dissociations of atypically represented language from typical left-lateralized praxis were very rare (in ~2.5% of all cases). The consequences of the existence of such different phenotypes for theoretical accounts of manual praxis, and its links to language and handedness are modeled and discussed.

Specialization of the left supramarginal gyrus for hand-independent praxis representation is not related to hand dominance

Data from focal brain injury and functional neuroimaging studies implicate a distributed network of parieto-fronto-temporal areas in the human left cerebral hemisphere as playing distinct roles in the representation of meaningful actions (praxis). Because these data come primarily from right-handed individuals, the relationship between left cerebral specialization for praxis representation and hand dominance remains unclear. We used functional magnetic resonance imaging (fMRI) to evaluate the hypothesis that strongly left-handed (right hemisphere motor dominant) adults also exhibit this left cerebral specialization. Participants planned familiar actions for subsequent performance with the left or right hand in response to transitive (e.g., "pounding") or intransitive (e.g. "waving") action words. In linguistic control trials, cues denoted non-physical actions (e.g., "believing"). Action planning was associated with significant, exclusively left-lateralized and extensive increases of activity in the supramarginal gyrus (SMg), and more focal modulations in the left caudal middle temporal gyrus (cMTg). This activity was hand- and gesture-independent, i.e., unaffected by the hand involved in subsequent action performance, and the type of gesture (i.e., transitive or intransitive). Compared directly with right-handers, left-handers exhibited greater involvement of the right angular gyrus (ANg) and dorsal premotor cortex (dPMC), which is indicative of a less asymmetric functional architecture for praxis representation. We therefore conclude that the organization of mechanisms involved in planning familiar actions is influenced by one's motor dominance. However, independent of hand dominance, the left SMg and cMTg are specialized for ideomotor transformations-the integration of conceptual knowledge and motor representations into meaningful actions. These findings support the view that higher-order praxis representation and lower-level motor dominance rely on dissociable mechanisms.

Callosal apraxia: a 34-year follow-up study

Loss of ability of the left upper limb (LUL) to correctly produce spatial and temporal components of skilled purposeful movements was reported 34 years ago in a woman with a callosal infarction. To learn about recovery, we recently reexamined this woman. This woman was tested for ideomotor apraxia by asking her to pantomime to command and to seeing pictures of tools. Whereas she performed normally with her right upper limb, her LUL remained severely apraxic, making many spatial (postural and movement) errors. Initially, she did not reveal loss of finger-hand deftness (limb-kinetic apraxia), and when tested again with the coin rotation task, her left hand performance was normal. Without vision, she could name objects placed in her left hand but not name numbers written in this hand. Since this woman had a callosal lesion, failure to recover cannot be accounted for by left hemisphere inhibition of her right hemisphere. Although failure for her LUL to improve may have been related to not using her LUL for skilled actions, her right hemisphere was able to observe transitive actions, and this failure of her LUL to produce skilled purposeful movements suggests her right hemisphere may have not had the capacity to learn these movement representations. Without vision, her ability to recognize objects with her left hand, but not numbers written on her left palm, suggests graphesthesia may require that her left hand did not have access to movement representations important for programming these numbers when writing.

Brain lateralization of complex movement: neuropsychological evidence from unilateral stroke

Complex movement (CM) refers to the representation of a goal-oriented action and is classified as either transitive (use of tools) or intransitive (communication gestures). Both types of CM have three specific components: temporal, spatial, and content, which are subdivided into specific error types (SET). Since there is debate regarding the contribution of each brain hemisphere for the types of CM, our objective was to describe the brain lateralization of components and SET of transitive and intransitive CM. We studied 14 patients with a left hemisphere stroke (LH), 12 patients with a right hemisphere stroke (RH), and 16 control subjects. The Florida Apraxia Screening Test-Revised (FAST-R, Rothi et al., 1988) was used for the assessment of CM. Both clinical groups showed a worse performance than the control group on the total FAST-R and transitive movement scores (p<0.001). Failures in Spatial and Temporal components were found in both clinical groups, but only LH patients showed significantly more Content errors (p<0.01) than the control group. Also, only the LH group showed a higher number of errors for intransitive movements score (p=0.017), due to lower scores in the content component, compared to the control group (p=0.04). Transitive and intransitive CMs differ in their neurocognitive representation; transitive CM shows a bilateral distribution of its components when compared to intransitive CM, which shows a preferential left hemisphere representation. This could result from higher neurocognitive demands for movements that require use of tools, compared with more automatic communication gestures.

Differential mechanisms of action understanding in left and right handed subjects: the role of perspective and handedness

The ability to comprehend outcomes of skilled action is important for understanding the world around us. Prior studies have evaluated the perspective an action is performed in, but few have evaluated how handedness of the actor and the observer interact with action perspective. Understanding handedness affords the opportunity to identify the role of mirroring and matched limb action encoding, which may display unique strategies of action understanding. Right and left-handed subjects were presented with images of tools from egocentric or allocentric perspectives performing movements by either a left or right hand. Subjects had to judge the outcome of the task, and accuracy and latency were evaluated. Our hypothesis was that both left and right-handed subjects would predict action best from an egocentric perspective. In allocentric perspectives, identification of action outcomes would occur best in the mirror-matched dominant limb for all subjects. Results showed there was a significant effect on accuracy and latency with respect to perspective for both right and left-handed subjects. The highest accuracies and fastest latencies were found in the egocentric perspective. Handedness of subject also showed an effect on accuracy, where right-handed subjects were significantly more accurate in the task than left-handed subjects. An interaction effect revealed that left-handed subjects were less accurate at judging images from an allocentric viewpoint compared to all other conditions. These findings suggest that action outcomes are best facilitated in an internal perspective, regardless of the hand being used. The decreased accuracy for left-handed subjects on allocentric images could be due to asymmetrical lateralization of encoding action and motoric dominance, which may interfere with translating allocentric limb action outcomes. Further neurophysiological studies will help us understand the specific processes of how left and right-handed subjects may encode actions.

Lateralization of cognitive functions in aphasia after right brain damage

PURPOSE

The lateralization of cognitive functions in crossed aphasia in dextrals (CAD) has been explored and compared mainly with cases of aphasia with left hemisphere damage. However, comparing the neuropsychological aspects of CAD and aphasia after right brain damage in left-handers (ARL) could potentially provide more insights into the effect of a shift in the laterality of handedness or language on other cognitive organization. Thus, this case study compared two cases of CAD and one case of ARL.

MATERIALS AND METHODS

The following neuropsychological measures were obtained from three aphasic patients with right brain damage (two cases of CAD and one case of ARL); language, oral and limb praxis, and nonverbal cognitive functions (visuospatial neglect and visuospatial construction).

RESULTS

All three patients showed impaired visuoconstructional abilities, whereas each patient showed a different level of performances for oral and limb praxis, and visuospatial neglect.

CONCLUSION

Based on the analysis of these three aphasic patients' performances, we highlighted the lateralization of language, handedness, oral and limb praxis, visuospatial neglect and visuospatial constructive ability in aphasic patients with right brain damage.

Right hand, left brain: genetic and evolutionary bases of cerebral asymmetries for language and manual action

Most people are right-handed and left-cerebrally dominant for language. This pattern of asymmetry, as well as departures from it, have been reasonably accommodated in terms of a postulated gene with two alleles, one disposing to this common pattern and the other leaving the direction of handedness and language asymmetry to chance. There are some leads as to the location of the gene or genes concerned, but no clear resolution; one possibility is that the chance factor is achieved by epigenetic cancelling of the lateralizing gene rather than through a chance allele. Neurological evidence suggests that the neural basis of manual praxis, including pantomime and tool use, is more closely associated with cerebral asymmetry for language than with handedness, and is homologous with the so-called "mirror system" in the primate brain, which is specialized for manual grasping. The evidence reviewed supports the theory that language itself evolved within the praxic system, and became lateralized in humans, and perhaps to a lesser extent in our common ancestry with the great apes. WIREs Cogn Sci 2012, 3:1-17. doi: 10.1002/wcs.158 For further resources related to this article, please visit the WIREs website.

Parieto-frontal network in humans studied by cortico-cortical evoked potential

Parieto-frontal network is essential for sensorimotor integration in various complex behaviors, and its disruption is associated with pathophysiology of apraxia and visuo-spatial disorders. Despite advances in knowledge regarding specialized cortical areas for various sensorimotor transformations, little is known about the underlying cortico-cortical connectivity in humans. We investigated inter-areal connections of the lateral parieto-frontal network in vivo by means of cortico-cortical evoked potentials (CCEPs). Six patients with epilepsy and one with brain tumor were studied. With the use of subdural electrodes implanted for presurgical evaluation, network configuration was investigated by tracking the connections from the parietal stimulus site to the frontal site where the maximum CCEP was recorded. It was characterized by (i) a near-to-near and distant-to-distant, mirror symmetric configuration across the central sulcus, (ii) preserved dorso-ventral organization (the inferior parietal lobule to the ventral premotor area and the superior parietal lobule to the dorsal premotor area), and (iii) projections to more than one frontal cortical sites in 56% of explored connections. These findings were also confirmed by the standardized parieto-frontal CCEP connectivity map constructed in reference to the Jülich cytoarchitectonic atlas in the MNI standard space. The present CCEP study provided an anatomical blueprint underlying the lateral parieto-frontal network and demonstrated a connectivity pattern similar to non-human primates in the newly developed inferior parietal lobule in humans.

Cerebral lateralization of praxis in right- and left-handedness: same pattern, different strength

We aimed to investigate the effect of hand effector and handedness on the cerebral lateralization of pantomiming learned movements. Fourteen right-handed and 14 left-handed volunteers performed unimanual and bimanual tool-use pantomimes with their dominant or nondominant hand during fMRI. A left hemispheric lateralization was observed in the right- and left-handed group regardless of which hand(s) performed the task. Asymmetry was most marked in the dorsolateral prefrontal cortex (DLPFC), premotor cortex (PMC), and superior and inferior parietal lobules (SPL and IPL). Unimanual pantomimes did not reveal any significant differences in asymmetric cerebral activation patterns between left- and right-handers. Bimanual pantomimes showed increased left premotor and posterior parietal activation in left- and right-handers. Lateralization indices (LI) of the 10% most active voxels in DLPFC, PMC, SPL, and IPL were calculated for each individual in a contrast that compared all tool versus all control conditions. Left-handers showed a significantly reduced overall LI compared with right-handers. This was mainly due to diminished asymmetry in the IPL and SPL. We conclude that the recollection and pantomiming of learned gestures recruits a similar left lateralized activation pattern in right and left-handed individuals. Handedness only influences the strength (not the side) of the lateralization, with left-handers showing a reduced degree of asymmetry that is most readily observed over the posterior parietal region. Together with similar findings in language and visual processing, these results point to a lesser hemispheric specialization in left-handers that may be considered in the cost/benefit assessment to explain the disproportionate handedness polymorphism in humans.

Electrical excitability of the angular gyrus

The angular gyrus (AG) is a circumscribed area between the parietal and temporal lobes and its exact function is not clear. The purpose of the present study was to investigate the feasibility of intraoperative electrical stimulation of the AG in humans. The AG was electrically stimulated in five cases with the assistance of neuronavigation. Two different stimulation techniques were applied: bipolar cortical stimulation and monopolar cortical stimulation. After monopolar cortical stimulation, a compound muscle action potential was recorded from the contralateral arm muscles in three patients. In the remaining two patients no compound muscle action potential was elicited after monopolar cortical stimulation. The latency of the recorded compound muscle action potential from the thenar muscle ranged from 30.3 to 32.7 milliseconds and from the two forearm flexors was 28.7 and 29.7. Bipolar stimulation generated a motor response in the contralateral extremity in three research subjects but no motor response in two. Response was obtained in all three research subjects with the combination of 40 Hz and a duration of 4 or 6 seconds. Because this is to their knowledge the first report demonstrating a functional output of Exner's area to the motor cortex, it would be difficult to suggest all the pathways and functions of this complex connectivity. The aim of the pilot study presented here was to investigate the feasibility of electrical stimulation of the AG. The findings presented here show that intraoperative electrical stimulation of the AG is possible. Although the results are limited by the small number of patients investigated, they are encouraging and suggest that it is worthwhile to continue research in this area.

Tool use, communicative gesture and cerebral asymmetries in the modern human brain

Determining the brain adaptations that underlie complex tool-use skills is an important component in understanding the physiological bases of human material culture. It is argued here that the ways in which humans skilfully use tools and other manipulable artefacts is possible owing to adaptations that integrate sensory-motor and cognitive processes. Data from brain-injured patients and functional neuroimaging studies suggest that the left cerebral hemisphere, particularly the left parietal cortex, of modern humans is specialized for this purpose. This brain area integrates dynamically representations that are computed in a distributed network of regions, several of which are also left-lateralized. Depending on the nature of the task, these may include conceptual knowledge about objects and their functions, the actor's goals and intentions, and interpretations of task demands. The result is the formation of a praxis representation that is appropriate for the prevailing task context. Recent evidence is presented that this network is organized similarly in the right- and left-handed individuals, and participates in the representation of both familiar tool-use skills and communicative gestures. This shared brain mechanism may reflect common origins of the human specializations for complex tool use and language.

Tool use, communicative gesture and cerebral asymmetries in the modern human brain

Determining the brain adaptations that underlie complex tool-use skills is an important component in understanding the physiological bases of human material culture. It is argued here that the ways in which humans skilfully use tools and other manipulable artefacts is possible owing to adaptations that integrate sensory-motor and cognitive processes. Data from brain-injured patients and functional neuroimaging studies suggest that the left cerebral hemisphere, particularly the left parietal cortex, of modern humans is specialized for this purpose. This brain area integrates dynamically representations that are computed in a distributed network of regions, several of which are also left-lateralized. Depending on the nature of the task, these may include conceptual knowledge about objects and their functions, the actor's goals and intentions, and interpretations of task demands. The result is the formation of a praxis representation that is appropriate for the prevailing task context. Recent evidence is presented that this network is organized similarly in the right- and left-handed individuals, and participates in the representation of both familiar tool-use skills and communicative gestures. This shared brain mechanism may reflect common origins of the human specializations for complex tool use and language.

What puts the how in where? Tool use and the divided visual streams hypothesis

An influential theory suggests that the dorsal (occipito-parietal) visual stream computes representations of objects for purposes of guiding actions (determining 'how') independently of ventral (occipito-temporal) stream processes supporting object recognition and semantic processing (determining 'what'). Yet, the ability of the dorsal stream alone to account for one of the most common forms of human action, tool use, is limited. While experience-dependent modifications to existing dorsal stream representations may explain simple tool use behaviors (e.g., using sticks to extend reach) found among a variety of species, skillful use of manipulable artifacts (e.g., cups, hammers, pencils) requires in addition access to semantic representations of objects' functions and uses. Functional neuroimaging suggests that this latter information is represented in a left-lateralized network of temporal, frontal and parietal areas. I submit that the well-established dominance of the human left hemisphere in the representation of familiar skills stems from the ability for this acquired knowledge to influence the organization of actions within the dorsal pathway.

Apraxia: a review

Praxic functions are frequently altered following brain lesion, giving rise to apraxia - a complex pattern of impairments that is difficult to assess or interpret. In this chapter, we review the current taxonomies of apraxia and related cognitive and neuropsychological models. We also address the questions of the neuroanatomical correlates of apraxia, the relation between apraxia and aphasia and the analysis of apraxic errors. We provide a possible explanation for the difficulties encountered in investigating apraxia and also several approaches to overcome them, such as systematic investigation and modeling studies. Finally, we argue for a multidisciplinary approach. For example, apraxia should be studied in consideration with and could contribute to other fields such as normal motor control, neuroimaging and neurophysiology.

Right unilateral jargonagraphia as a symptom of callosal disconnection

We report the case of a right-handed patient who exhibited right unilateral jargonagraphia after a traumatic callosal hemorrhage. The lesions involved the entire corpus callosum, except for the lower part of the genu and the splenium. The patient's right unilateral jargonagraphia was characterized by neologisms and perseveration in kanji and kana, and was more prominent in kana than kanji. The jargonagraphia was similar to that observed in crossed aphasia, except that agraphia occurred only with the right hand. The patient also showed right unilateral tactile anomia and right tactile alexia, along with right-ear extinction on a dichotic listening test for verbal stimuli, which suggested that language function was lateralized to the right hemisphere. Since this patient had learned to write with his right hand, kinesthetic images of characters were thought to be formed and stored dominantly in the left hemisphere. We suggest that the callosal lesions disturbed the interhemispheric transfer of information for the dual-route procedures for writing in the right hemisphere, allowing the kinesthetic images of characters stored in the left hemisphere to be processed freely, resulting in the right unilateral jargonagraphia. At least two factors seem to explain that kana was more defective than kanji. First, writing in kana, which is assumed to be processed mainly via a sub-word phoneme to grapheme conversion route, might depend more strongly on lateralized linguistic processing than writing in kanji. Second, kanji, which represent meaning as well as phonology, with much more complicated graphic patterns than kana, are assumed to be processed in both hemispheres.

Hemispheric specialization for the visual control of action is independent of handedness

The idea that visually guided action is independent of visual perception has been supported by neurological, neuropsychological, and behavioral studies. In healthy subjects, evidence for this distinction has come from psychophysical studies of the effects of visual illusions on perceptual judgments and object-directed grasping. This evidence is limited, however, by the fact that virtually all studies have involved right-handed subjects using their dominant hand, which is presumably controlled by the left hemisphere. There is tentative evidence from earlier neurological studies that the left hemisphere may in fact play a special role in the integration of visual and motor information during grasping. We designed two experiments to test this idea. The first experiment involved pictorial illusions, which are known to have robust effects on perceptual judgments but little influence on grasping. Right- and left-handed subjects reached out and grasped objects embedded in two different visual illusions with either their dominant or their nondominant hand. For both right- and left-handed subjects, precision grasping with the left hand, but not with the right, was affected by the illusions. In a follow-up experiment, we examined precision grasping in a more natural setting and showed that left-handed subjects use their nondominant (right) hand significantly more as compared with right-handed subjects. We conclude that visuomotor mechanisms encapsulated in the left hemisphere play a crucial role in the visual control of action and that this hemispheric specialization evolved independently of handedness.

[Apraxia--neuroscience and clinical aspects. A literature synthesis]

Apraxic phenomena occur in various neurological conditions. Selective motion control is viewed as the basic capacity to make fine and precise, isolated or independent face or limb movements. Its deficit can indicate limb-kinetic apraxia if it is not explained by paresis, somatosensory deafferentation, or ataxia. The core deficit in ideomotor apraxia could be deficient movement representations, i.e. the combination of invariant features of intrinsic and extrinsic coding for a given movement, which are most important when movements have to be performed outside their typical context. Ideational apraxia would be defined by a semantic deficit related to action. Frontal apraxia is characterised by an action-sequencing deficit. A detailed model is proposed regarding processes relevant to praxis.

A distributed left hemisphere network active during planning of everyday tool use skills

Determining the relationship between mechanisms involved in action planning and/or execution is critical to understanding the neural bases of skilled behaviors, including tool use. Here we report findings from two fMRI studies of healthy, right-handed adults in which an event-related design was used to distinguish regions involved in planning (i.e. identifying, retrieving and preparing actions associated with a familiar tools' uses) versus executing tool use gestures with the dominant right (experiment 1) and non-dominant left (experiment 2) hands. For either limb, planning tool use actions activates a distributed network in the left cerebral hemisphere consisting of: (i) posterior superior temporal sulcus, along with proximal regions of the middle and superior temporal gyri; (ii) inferior frontal and ventral premotor cortices; (iii) two distinct parietal areas, one located in the anterior supramarginal gyrus (SMG) and another in posterior SMG and angular gyrus; and (iv) dorsolateral prefrontal cortex (DLFPC). With the exception of left DLFPC, adjacent and partially overlapping sub-regions of left parietal, frontal and temporal cortex are also engaged during action execution. We suggest that this left lateralized network constitutes a neural substrate for the interaction of semantic and motoric representations upon which meaningful skills depend.

Crossed right hemisphere syndrome following left thalamic stroke

In most right-handed people, language and motor functions are more reliant on systems of the left hemisphere while several non-linguistic visuo-spatial and attentional processes depend more on the right hemisphere. The rare exceptions to these rules provide important clues as to what functions co-lateralise, and are thus crucial for models of cerebral specialization. Here we report on the case of a patient, who, after a lesion restricted to the left thalamic region, showed signs normally associated with right hemispheric injury including motor impersistence, visuo-spatial dysfunction and poor comprehension of facial expression. Language abilities were spared and no signs of apraxia were present, in spite of his right hand, foot and eye preference, a pattern normally associated with conventional cerebral dominance. In spite of his other right hemispheric signs, the patient showed no signs of hemi-spatial neglect. The patient's pattern of spared and impaired abilities is compared and contrasted with other rare cases of crossed right hemisphere syndrome.

A Dissociation between the Representation of Tool-use Skills and Hand Dominance: Insights from Left- and Right-handed Callosotomy Patients

The overwhelming majority of evidence indicates that the left cerebral hemisphere of right-handed humans is dominant both for manual control and the representation of acquired skills, including tool use. It is, however, unclear whether these functions involve common or dissociable mechanisms. Here we demonstrate that the disconnected left hemispheres of both right- and left-handed split-brain patients are specialized for representing acquired tool-use skills. When required to pantomime actions associated with familiar tools (Experiment 2), both patients show a right-hand (left hemisphere) advantage in response to tool names, pictures, and actual objects. Accuracy decreases as stimuli become increasingly symbolic when using the left hand (right hemisphere). Tested in isolation with lateralized pictures (Experiment 3), each patient's left hemisphere demonstrates a significant advantage over the right hemisphere for pantomiming tool-use actions with the contralateral hand. The fact that this asymmetry occurs even in a left-handed patient suggests that the left hemisphere specialization for representing praxis skills can be dissociated from mechanisms involved in hand dominance located in the right hemisphere. This effect is not attributable to differences at the conceptual level, as the left and right hemispheres are equally and highly competent at associating tools with observed pantomimes (Experiment 4).

Crossed apraxia of speech: A case report

The present study reports on the first case of crossed apraxia of speech (CAS) in a 69-year-old right-handed female (SE). The possibility of occurrence of apraxia of speech (AOS) following right hemisphere lesion is discussed in the context of known occurrences of ideomotor apraxias and acquired neurogenic stuttering in several cases with right hemisphere lesion. A current hypothesis on AOS-the dual route speech encoding (DRSE) hypothesis-and predictions based on DRSE were utilized to explore the nature of CAS in SE. One prediction based on the DRSE hypothesis is that there should be no difference in the frequency of occurrence of apraxic errors on words and non-words. This prediction was tested using a repetition task. The experimental stimuli included a list of minimal pairs that signaled voice-voiceless contrasts in words and non-words. Minimal-pair stimuli were presented orally, one at a time. SE's responses were recorded using audio and videotapes. Results indicate that SE's responses were characterized by numerous voicing errors. Most importantly, production of real word minimal pairs was superior to that of non-word minimal pairs. Implications of these results for the DRSE hypothesis are discussed with regard to currently developing perspectives on AOS.

Linguistic and neuropsychological deficits in crossed conduction aphasia. Report of three cases

This study describes the linguistic and neuropsychological findings in three right-handed patients with crossed conduction aphasia. Despite the location of the lesion in the right hemisphere, all patients displayed a combination of linguistic deficits typically found in conduction aphasia following analogous damage to the left hemisphere. Associated cognitive deficits varied across the three patients. In addition, all cases showed deficits classically attributed to non-dominant hemisphere damage (visuoperceptual deficits and reduced figural memory). As a result, lesion-behaviour relationships in our study sample indicate both dominant and non-dominant qualities of the right hemisphere.

Crossed aphasia: an analysis of the symptoms, their frequency, and a comparison with left-hemisphere aphasia symptomatology

This study presents a thorough analysis of published crossed aphasia (CA) cases, including for the first time the cases published in Japanese. The frequency of specific symptoms was determined, and symptomatology differences based on gender, familial sinistrality, and CA subtype were investigated. Results suggested that the CA population is comparable to the left-hemisphere patient population. However, male were significantly more likely than female CA subjects to show a positive history of familial sinistrality. Typical right-hemisphere (i.e., nonlanguage-dominant) symptoms were frequent but rarely carefully reported or assessed. Results are compared with previous CA reviews and left-hemisphere aphasia. Suggestions for a more systematic assessment of the CA symptomatology are presented.

Effects of bromocriptine in a patient with crossed nonfluent aphasia: a case report

OBJECTIVE

Because studies have shown some positive effects of the dopaminergic agent bromocriptine for improving verbal production in patients with nonfluent aphasia, we examined its effect in a patient with an atypical form of crossed nonfluent aphasia from a right hemisphere lesion.

DESIGN

Open-label single-subject experimental ABAB withdrawal design.

PATIENT

A right-handed man who, after a right frontal stroke, developed nonfluent aphasia, emotional aprosodia, and limb apraxia.

INTERVENTION

Escalating doses up to 20mg of bromocriptine in 2 separate phases.

MAIN OUTCOME MEASURES

We measured verbal fluency (words/min in discourse, Thurstone letter fluency), expression of emotional prosody, and gesture production.

RESULTS

The patient showed substantial improvement in both verbal fluency measures and no significant improvement in gesture or emotional prosody. Verbal fluency improvements continued in withdrawal phases.

CONCLUSIONS

Our results are less likely caused by practice or spontaneous recovery because we observed little improvement in emotional prosody and gesture tasks. Verbal fluency improvements during treatment and withdrawal phases suggest that the effects of bromocriptine may be long-lasting in its influence on the neural networks subserving verbal initiation.

Upper and lower face apraxia: role of the right hemisphere

The aim of this study was to evaluate face apraxia in left- and right-hemisphere-damaged patients both in the acute and chronic stage of their disease. Two newly devised tests that assess movements of the upper and lower face districts were employed. On the whole, the proportion of left-hemisphere-damaged patients showing face apraxia were 46 and 68% for upper and lower face, respectively. A substantial proportion of right-hemisphere-damaged patients also showed face apraxia, i.e. 44% upper face and 38% lower face. Concomitant variables such as general severity, locus of lesion, language or visuo-spatial impairments, presence of neglect, interval from stroke, peculiarity of clusters of items or scoring procedures did not account for these results. These findings suggest that face apraxia in some patients may affect movements of the upper face district and that the right hemisphere plays a significant part in both upper and lower face praxis.

Limb apraxias: higher-order disorders of sensorimotor integration

Limb apraxia comprises a wide spectrum of higher-order motor disorders that result from acquired brain disease affecting the performance of skilled, learned movements. At present, limb apraxia is primarily classified by the nature of the errors made by the patient and the pathways through which these errors are elicited, based on a two-system model for the organization of action: a conceptual system and a production system. Dysfunction of the former would cause ideational (or conceptual) apraxia, whereas impairment of the latter would induce ideomotor and limb-kinetic apraxia. Currently, it is possible to approach several types of limb apraxia within the framework of our knowledge of the modular organization of the brain. Multiple parallel parietofrontal circuits, devoted to specific sensorimotor transformations, have been described in monkeys: visual and somatosensory transformations for reaching; transformation of information about the location of body parts necessary for the control of movements; somatosensory transformation for posture; visual transformation for grasping; and internal representation of actions. Evidence from anatomical and functional brain imaging studies suggests that the organization of the cortical motor system in humans is based on the same principles. Imitation of postures and movements also seems to be subserved by dedicated neural systems, according to the content of the gesture (meaningful versus meaningless) to be imitated. Damage to these systems would produce different types of ideomotor and limb-kinetic praxic deficits depending on the context in which the movement is performed and the cognitive demands of the action. On the other hand, ideational (or conceptual) apraxia would reflect an inability to select and use objects due to the disruption of normal integration between systems subserving the functional knowledge of actions and those involved in object knowledge.