In recent decades, the research traditions of (first-person) embodied cognition and of (third-person) social cognition have approached the study of self-awareness with relative independence. However, neurological disorders of self-awareness offer a unifying perspective to empirically investigate the contribution of embodiment and social cognition to self-awareness. This study focused on a neuropsychological disorder of bodily self-awareness following right-hemisphere damage, namely anosognosia for hemiplegia (AHP). A previous neuropsychological study has shown AHP patients, relative to neurological controls, to have a specific deficit in third-person, allocentric inferences in a story-based, mentalisation task. However, no study has tested directly whether verbal awareness of motor deficits is influenced by either perspective-taking or centrism, and if these deficits in social cognition are correlated with damage to anatomical areas previously linked to mentalising, including the supramarginal and superior temporal gyri and related limbic white matter connections. Accordingly, two novel experiments were conducted with right-hemisphere stroke patients with (n = 17) and without AHP (n = 17) that targeted either their own (egocentric, experiment 1) or another stooge patient’s (experiment 2) motor abilities from a first-or-third person (allocentric in Experiment 2) perspective. In both experiments, neurological controls showed no significant difference between perspectives, suggesting that perspective-taking deficits are not a general consequence of right-hemisphere damage. More specifically, experiment 1 found AHP patients were more aware of their own motor paralysis when asked from a third compared to a first-person perspective, using both group level and individual level analysis. In experiment 2, AHP patients were less accurate than controls in making allocentric, third-person perspective judgements about the stooge patient, but with only a trend towards significance and with no within-group, difference between perspectives. Deficits in egocentric and allocentric third-person perspective taking were associated with lesions in the middle frontal gyrus, superior temporal and supramarginal gyri, with white matter disconnections more predominate in deficits in allocentricity. This study confirms previous clinical and empirical investigations on the selectivity of first-person motor awareness deficits in anosognosia for hemiplegia and experimentally demonstrates for the first time that verbal egocentric 3PP-taking can positively influence 1PP body awareness.
The Motor Unawareness Assessment (MUNA): A new tool for the assessment of Anosognosia for hemiplegia
