A preliminary study of white matter disconnections underlying deficits in praxis in left hemisphere stroke patients.

Limb apraxia is a higher-order motor disorder often occurring post-stroke, which affects skilled actions. It is assessed through tasks involving gesture production or pantomime, recognition, meaningless gesture imitation, complex figure drawing, single and multi-object use. A two-system model for the organisation of actions hypothesizes distinct pathways mediating praxis deficits via conceptual, 'indirect', and perceptual 'direct' routes to action.

Parietal control of hand movement.

The parietal lobe has been implicated in the sensorimotor control and integration that supports the skillful use of our hands to reach for, grasp, and manipulate objects in the environment. This area is involved in several circuits within the classic subdivisions of the dorsal stream. Recently, the dorsal stream has been further divided into a "dorso-dorsal" and a "ventro-dorsal" streams.

Limb Apraxias: The Influence of Higher Order Perceptual and Semantic Deficits in Motor Recovery After Stroke.

Stroke is a leading cause of disability worldwide. Limb apraxia is a group of higher order motor disorders associated with greater disability and dependence after stroke. Original neuropsychology studies distinguished separate brain pathways involved in perception and action, known as the dual stream hypothesis.

Neural Correlates of Hand-Object Congruency Effects during Action Planning.

Selecting hand actions to manipulate an object is affected both by perceptual factors and by action goals. Affordances may contribute to "stimulus-response" congruency effects driven by habitual actions to an object. In previous studies, we have demonstrated an influence of the congruency between hand and object orientations on response times when reaching to turn an object, such as a cup.

Characterising factors underlying praxis deficits in chronic left hemisphere stroke patients.

Limb apraxia, a disorder of skilled action not consequent on primary motor or sensory deficits, has traditionally been defined according to errors patients make on neuropsychological tasks. Previous models of the disorder have failed to provide a unified account of patients' deficits, due to heterogeneity in the patients and tasks used. In this study we hypothesised that we may be able to map apraxic deficits onto principal components, some of which may be specific, whilst others may align with other cognitive disorders.

Theta burst stimulation in humans: a need for better understanding effects of brain stimulation in health and disease.

Repetitive transcranial stimulation (rTMS) paradigms have been used to induce lasting changes in brain activity and excitability. Previous methods of stimulation were long, often ineffective and produced short-lived and variable results. A new non-invasive brain stimulation technique was developed in John Rothwell's laboratory in the early 2000s, which was named 'theta burst stimulation' (TBS).

Antiplatelet therapy for transient ischaemic attack and minor ischaemic stroke.

Transient ischaemic attacks carry an increased risk of large ischaemic stroke in the 90 days after an event. Patients need to be seen within 24 hours in a dedicated clinic to start secondary prevention. This editorial reviews evidence for consideration of early dual antiplatelet therapy after a transient ischaemic attack.

Factors Influencing Manipulation of a Familiar Object in Patients With Limb Apraxia After Stroke.

Previous studies have shown that hand actions to visual objects are affected both by perceptual factors and by action goals. Our aim was to study how these processes affected hand actions in chronic stroke patients, based on whether they had limb apraxia. Twenty-two left hemisphere, chronic stroke patients were measured on neuropsychological tasks of limb apraxia, which was identified in a subgroup of 10 patients.

A Role for the Action Observation Network in Apraxia After Stroke.

Limb apraxia is a syndrome often observed after stroke that affects the ability to perform skilled actions despite intact elementary motor and sensory systems. In a large cohort of unselected stroke patients with lesions to the left, right, and bilateral hemispheres, we used voxel-based lesion-symptom mapping (VLSM) on clinical CT head images to identify the neuroanatomical correlates of the impairment of performance in three tasks investigating praxis skills in patient populations. These included a meaningless gesture imitation task, a gesture production task involving pantomiming transitive and intransitive gestures, and a gesture recognition task involving recognition of these same categories of gestures.

Factors influencing planning of a familiar grasp to an object: what it is to pick a cup.

We assessed the factors influencing the planning of actions required to manipulate one of two everyday objects with matching dimensions but openings at opposite ends: a cup and a vase. We found that, for cups, measures of movement preparation to reach and grasp the object were influenced by whether the grasp was made to the functional part of the object (wide opening) and whether the action would end in a supinated as opposed to a pronated grasp. These factors interacted such that effects of hand posture were found only when a less familiar grasp was made to the non-functional part of the cup (the base).

Deficits in Limb Praxis in Patients With Obsessive-Compulsive Disorder.

There is recent evidence of deficits in praxis in patients with primary dystonia. Obsessive-compulsive disorder (OCD) has been linked to disorders of higher-order motor function, such as dystonia. However, no clear mechanism underlying such a relationship has been found.

Limb apraxia and the "affordance competition hypothesis".

Limb apraxia, a disorder of higher order motor control, has long been a challenge for clinical assessment and understanding (Leiguarda and Marsden, 2000). The deficits originally described in limb apraxia (Liepmann, 1920) have been classified by the nature of the errors made by the patients leading to, namely, ideational and ideomotor apraxia. The dual stream hypothesis (Goodale and Milner, 1992) has been used to explain these categories: ideational apraxia is thought to relate to a deficit in the concept of a movement (coded in the ventral stream).

Theta-burst transcranial magnetic stimulation to the prefrontal cortex impairs metacognitive visual awareness.

We used a recently developed protocol of transcranial magnetic stimulation (TMS), theta-burst stimulation, to bilaterally depress activity in the dorsolateral prefrontal cortex as subjects performed a visual discrimination task. We found that TMS impaired subjects' ability to discriminate between correct and incorrect stimulus judgments. Specifically, after TMS subjects reported lower visibility levels for correctly identified stimuli, as if they were less fully aware of the quality of their visual information processing.

Altered dorsal premotor-motor interhemispheric pathway activity in focal arm dystonia.

Given the possible role of dorsal premotor cortex (PMd) in the pathophysiology of dystonia, we used transcranial magnetic stimulation (TMS) methods to study PMd and PMd-primary motor cortex (M1) interactions in patients with focal arm dystonia. Here, we tested the connectivity between left PMd and right M1 as well as the intracortical excitability of PMd in 11 right-handed patients with focal arm/hand dystonia and nine age-matched healthy controls. The results showed that excitability of the inhibitory connection between PMd and M1 was reduced in patients, but there was no significant difference to healthy subjects in the excitability of the facilitatory connection.

Wallerian degeneration of the corticofugal tracts in chronic stroke: a pilot study relating diffusion tensor imaging, transcranial magnetic stimulation, and hand function.

Objective: This study tested the hypothesis that degeneration of the corticofugal tracts (CFTs) is related to poor functional outcome in the upper limb after stroke.

Methods: . The authors used diffusion tensor imaging to determine the degree of white matter integrity of the CFT (FA(AH/UH)) in chronic stroke patients and controls.

Effects of rTMS conditioning over the fronto-parietal network on motor versus visual attention.

Many studies have shown that visuospatial orienting attention depends on a network of frontal and parietal areas in the right hemisphere. Rushworth et al. [Rushworth, M.

Acute changes in frontoparietal activity after repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex in a cued reaction time task.

Lesion and functional imaging studies in humans have suggested that the dorsolateral prefrontal cortex (DLPFC), ventrolateral prefrontal cortex (VLPFC), and intraparietal sulcus (IPS) are involved in orienting attention. A functional magnetic resonance imaging study supplemented by a behavioral experiment examined the effects of 5 Hz repetitive transcranial magnetic stimulation (rTMS) conditioning to the right and left DLPFC on reaction times and synaptic activity as indexed by changes in the blood oxygenation level-dependent (BOLD) signal during a cued choice reaction time task. Orienting precues were either correct (valid) or incorrect (invalid) with respect to the subsequent move cue.

Frequency specific changes in regional cerebral blood flow and motor system connectivity following rTMS to the primary motor cortex.

Repetitive transcranial magnetic stimulation (rTMS) to the human primary motor cortex (M1) causes bidirectional changes in corticospinal excitability depending on the stimulation frequency used. We used functional brain imaging to compare the effects of 5 Hz and 1 Hz-rTMS on local and inter-regional connectivity within the motor system. Regional cerebral blood flow (rCBF) was measured as a marker of synaptic activity at rest and during freely selected finger movements.

Theta burst stimulation of the human motor cortex.

It has been 30 years since the discovery that repeated electrical stimulation of neural pathways can lead to long-term potentiation in hippocampal slices. With its relevance to processes such as learning and memory, the technique has produced a vast literature on mechanisms of synaptic plasticity in animal models. To date, the most promising method for transferring these methods to humans is repetitive transcranial magnetic stimulation (rTMS), a noninvasive method of stimulating neural pathways in the brain of conscious subjects through the intact scalp.