Thibault Simon, Wong Aaron L, Buxbaum Laurel J
bioRxiv. 2025 Mar 15:2024.07.01.601398. doi: 10.1101/2024.07.01.601398.
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.
已证实，经历过左半球脑血管意外（LCVA）的个体在旨在评估诸如泡一杯咖啡等日常活动能力的自然动作任务中会出错。该人群中的自然动作错误通常归因于肢体失用症，这是一种在与物体相关动作的表征和执行中常见的缺陷。然而，在右半球中风和创伤性脑损伤患者中也观察到自然动作受损，而这些人群很少与失用症相关，并且所有这些人群中的错误都受到总体严重程度的影响。基于这些及其他数据，另一种（并非相互排斥）的解释是，LCVA患者的自然动作错误也是一般注意力资源可用性或分配不足的结果。在本研究中，我们对一组51名完成了自然动作测试的LCVA患者的数据进行了回顾性分析，同时还进行了一系列评估实践能力、注意力分配与控制、推理以及语言能力的测试，以确定这些能力中哪些对自然动作受损有独特的影响。使用正则化回归方法，我们发现自然动作受损可由实践缺陷（手部姿势排序和手势识别）以及注意力分配与控制缺陷（注意力定向和分散），连同语言理解能力和年龄来预测。使用支持向量回归-病变症状映射，我们证明自然动作受损与已知与实践有关的颞中回后部和顶下小叶前部区域的病变有关；以及与已知与实践以及注意力分配与控制有关的额中回病变有关。总之，这些发现支持了这样的假设，即LCVA患者的自然动作受损是失用症以及注意力分配与控制不足的结果。
