University of Konstanz, Konstanz, Germany; Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany.
University of Konstanz, Konstanz, Germany; Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland.
Cortex. 2022 Jan;146:1-23. doi: 10.1016/j.cortex.2021.10.002. Epub 2021 Oct 20.
100 years ago, Liepmann highlighted the role of left ventro-dorsal lesions for impairments in conceptual (rather ventral) and motor (more dorsal) related aspects of apraxia. Many studies thereafter attributed to an extended left fronto-temporo-parietal network. Yet, to date there are only few studies that looked at apraxic performance in the selection and application of familiar versus novel tools. In the current study we applied modern voxel-based lesion-symptom mapping (VLSM) to analyze neural correlates of impaired selection and application of familiar versus novel tools. 58 left (LBD) and 51 right brain damaged (RBD) stroke patients participated in the Novel Tools Test (NTT) and the Familiar Tools Test (FTT) of the Diagnostic Instrument for Limb Apraxia (DILA-S). We further assessed performance in control tasks, namely semantic knowledge (BOSU), visuo-spatial working memory (Corsi Block Tapping) and meaningless imitation of gestures (IML). Impaired tool use was most pronounced after LBD. Our VLSM results in the LBD group suggested that selection- versus application-related aspects of praxis and semantics of familiar versus novel tool use can be behaviorally and neuro-anatomically differentiated. For impairments in familiar tool tasks, the major focus of lesion maps was rather ventral while deficiencies in novel tool tasks went along with rather dorsal lesions. Affected selection processes were linked to rather anterior lesions, while impacted application processes went along with rather posterior lesion maps. In our study, particular tool selection processes were rather specific for familiar versus novel tools. Foci for lesion overlaps of experimental and control tasks were noticed ventrally for semantic knowledge and FTT, in fronto-parietal regions for working memory and NTT, and ventro-dorsally for imitation of meaningless gestures and the application of NTT and FTT. We visualized our current interpretation within a neuroanatomical model for apraxia of tool use.
100 年前，Liepmann 强调了左侧腹侧-背侧损伤在动作失用的概念（更腹侧）和运动（更背侧）相关方面的作用。此后，许多研究将其归因于扩展的左侧额颞顶叶网络。然而，迄今为止，只有少数研究关注动作失用症在选择和应用熟悉与新颖工具方面的表现。在当前的研究中，我们应用现代基于体素的病变-症状映射（VLSM）分析损伤对熟悉与新颖工具选择和应用的神经相关性。58 名左侧（LBD）和 51 名右侧（RBD）脑损伤中风患者参加了新颖工具测试（NTT）和熟悉工具测试（FTT）的诊断性肢体失用症仪器（DILA-S）。我们还评估了控制任务的表现，即语义知识（BOSU）、视空间工作记忆（Corsi 块敲击）和无意义手势模仿（IML）。LBD 后工具使用受损最明显。我们在 LBD 组中的 VLSM 结果表明，动作和语义的选择与应用相关方面以及熟悉与新颖工具的使用可以在行为和神经解剖学上进行区分。对于熟悉工具任务的损伤，病变图的主要焦点是腹侧，而新颖工具任务的缺陷与背侧病变有关。受影响的选择过程与较前的病变有关，而受影响的应用过程与较后的病变图有关。在我们的研究中，特定的工具选择过程对于熟悉与新颖工具是相当特殊的。实验和控制任务的病变重叠焦点在腹侧为语义知识和 FTT，在前顶叶区域为工作记忆和 NTT，在腹侧-背侧为无意义手势的模仿和 NTT 和 FTT 的应用。我们在工具使用失用症的神经解剖学模型中可视化了我们当前的解释。
