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Background: Defective pantomime of tool use is a hall mark of limb apraxia. Contextual information has been demonstrated to improve tool use performance. Further, knowledge about the potential impact of technological aids such as augmented reality for patients with limb apraxia is still scarce.Objective: Since augmented reality offers a new way to provide contextual information, we applied it to pantomime of tool use. We hypothesize that the disturbed movement execution can be mitigated by holographic stimulation. If visual stimuli facilitate the access to the appropriate motor program in patients with apraxia, their performance should improve with increased saliency, i.e., should be better when supported by dynamic and holographic cues vs. static and screen-based cues.Methods: Twenty one stroke patients and 23 healthy control subjects were randomized to mime the use of five objects, presented in two Environments (Screen vs. Head Mounted Display, HMD) and two Modes (Static vs. Dynamic) resulting in four conditions (ScreenStat, ScreenDyn, HMDStat, HMDDyn), followed by a real tool demonstration. Pantomiming was analyzed by a scoring system using video recordings. Additionally, the sense of presence was assessed using a questionnaire.Results: Healthy control participants performed close to ceiling and significantly better than patients. Patients achieved significantly higher scores with holographic or dynamic cues. Remarkably, when their performance was supported by animated holographic cues (e.g., striking hammer), it did not differ significantly from real tool demonstration. As the sense of presence increases with animated holograms, so does the pantomiming.Conclusion: Patients' performance improved with visual stimuli of increasing saliency. Future assistive technology could be implemented upon this knowledge and thus, positively impact the rehabilitation process and a patient's autonomy. published

BACKGROUND: Treatment adherence is fundamental in multiple sclerosis (MS) management. Adherence rates vary significantly between studies, ranging from 30% to almost 90%, depending on assessment method and medication type. This study aimed to identify patient-related categories associated with treatment modification or discontinuation in people with MS receiving either first- or second-line treatment. METHODS: Semistructured interviews were performed with 23 people with MS: 11 receiving first-line treatment and 12 receiving second-line treatment. Medication history, experiences with previous medications, decision-making processes regarding immunotherapy, adherence behavior, and reasons for adherence/nonadherence were explored using open-ended questions. Qualitative content analysis was performed using a combined deductive-inductive approach in building a coding frame. Differences in coding frequencies were compared between the two groups and analyzed quantitatively. Cohen’s kappas of 0.76 for people with MS receiving first-line treatment and 0.64 for the second-line sample were achieved between the two coders. RESULTS: One key reason for nonadherence reported by first-line–treated people with MS was burdensome side effects, and for adherence was belief in medication effectiveness. In people with MS receiving second-line treatment, lack of perceived medication effectiveness was a key category related to changes in or discontinuation of immunotherapy. Reasons for adherence were positive illness beliefs/perceptions and belief in highly active disease. Intentional nonadherence was a major issue for first-line treatment and less relevant for second-line treatment. CONCLUSIONS: These results indicate specific differences in factors mitigating adherence in people with MS receiving first- and second-line treatment.

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Fatigue is a common and disabling symptom in patients with Multiple Sclerosis (PwMS). Its pathogenesis, however, is still not fully understood. Potential psychological roots, in particular, have received little attention to date. The present study examined the association of childhood adversities, specific trait characteristics, and MS disease characteristics with fatigue symptoms utilizing path analysis. Five hundred and seventy-one PwMS participated in an online survey. Standardized psychometric tools were applied. The Childhood Trauma Questionnaire (CTQ) served to assess childhood adversities. Trait variables were alexithymia (Toronto Alexithymia Scale; TAS-26) and early maladaptive schemas (Young Schema Questionnaire; YSQ). Current pathology comprised depression (Beck’s Depression Inventory FastScreen; BDI-FS) and anxiety symptoms (State-Trait Anxiety Inventory; STAI-state), as well as physical disability (Patient determined Disease Steps; PDDS). The Fatigue Scale for Motor and Cognitive Functions (FSMC) was the primary outcome variable measuring fatigue. PwMS displayed high levels of fatigue and depression (mean FSMC score: 72; mean BDI-II score: 18). The final path model revealed that CTQ emotional neglect and emotional abuse remained as the only significant childhood adversity variables associated with fatigue. There were differential associations for the trait variables and current pathology: TAS-26, the YSQ domain impaired autonomy and performance, as well as all current pathology measures had direct effects on fatigue symptoms, accounting for 28.2% of the FSMC variance. Bayesian estimation also revealed indirect effects from the two CTQ subscales on FSMC. The final model fitted the data well, also after a cross-validation check and after replacing the FSMC with the Chalder Fatigue Questionnaire (CFQ). This study suggests an association psychological factors on fatigue in Multiple Sclerosis. Childhood adversities, as well as specific trait characteristics, seem to be associated with current pathology and fatigue symptoms. The article discusses potential implications and limitations. published

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For over a century, pantomime of tool use has been employed to diagnose limb apraxia, a disorder of motor cognition primarily induced by left brain damage. While research consistently implicates damage to a left fronto-temporo-parietal network in limb apraxia, findings are inconsistent regarding the impact of damage to anterior versus posterior nodes within this network on pantomime. Complicating matters is the fact that tool use pantomime can be affected and evaluated at multiple levels. For instance, the production of tool use gestures requires the consideration of semantic characteristics (e.g. how to communicate the action intention) as well as motor features (e.g. forming grip and movement). Together, these factors may contribute substantially to apparent discrepancies in previously reported findings regarding neural correlates of tool use pantomime. In the current study, 67 stroke patients with unilateral left-brain damage performed a classic pantomime task. In order to analyze different error characteristics, we evaluated the proper use of grip and movement for each pantomime. For certain objects, healthy subjects may use body parts as representative for the object, e.g. use of the fingers to indicate scissors blades. To specify the pathological use of body parts as the object (BPO) we only assessed pantomime items that were not prone to this response in healthy participants. We performed modern voxel-based lesion analyses on MRI or CT data to determine associations between brain injury and the frequency of the specific types of pantomime errors. Our results support a model in which anterior and posterior nodes of the left fronto-temporo-parietal network contribute differentially to pantomime of tool use. More precisely, damage in the inferior frontal cortex reaching to the temporal pole is associated with an increased frequency of BPO errors, whereas damage to the inferior parietal lobe is predominantly linked to an increased frequency of movement and/or grip errors. Our work suggests that the validity of attempts to specify the neural correlates of limb apraxia based on tool use pantomime depends on differentiating the specific types of errors committed. We conclude that successful tool use pantomime involves dissociable functions with communicative aspects represented in more anterior (rather ventral) regions and motor-cognitive aspects in more posterior (rather dorsal) nodes of a left fronto-temporo-parietal network., Highlights • Two core left hemisphere networks are involved in tool use pantomime. • Pathological use of BPO strategy correlated with rather anterior lesions. • Motor-cognitive errors associated with rather posterior lesions. • A pathway model integrating communicative vs motor-cognitive aspects is discussed.

The Naturalistic Action Therapy approach was designed to train patients with impaired real tool-use and related anosognosia. The manual contains a description of example tasks trained in our laboratory. In addition video-material and evaluation sheets were designed to facilitate its application. The therapy concept can and is anticipated to be adapted for miscellaneous tasks of daily living that may need to be trained in a rehabilitation institute or at home. The main neurorehabilitation principles of the Naturalistic Action Therapy are shaping, errorless learning and performance monitoring. Thus far the approach has been tested in single stroke patients. Patients with hemiparesis, aphasia or neglect can be trained with this therapy form. However, as a requirement, patients need to understand simple task instructions. published

Actor-related affordance judgments are decisions about potential actions that arise from environmental as well as bodily and cognitive conditions. The system can be challenged by sudden changes to otherwise rather stable actor references e.g. due to accidental bodily injuries or due to brain damage and resulting motor and cognitive constraints. The current study investigated adaptation to suddenly artificially altered body properties and its reversibility in healthy young versus older adults. Participants were asked to judge whether they would be able to fit their hand through a given horizontal opening (Aperture Task). Body alterations were induced by equipping participants with one hand splint for 24 hours that enlarged the hand in width and height. Participants were tested before and directly after putting the splint on as well as after a habituation period of 24 hours. To assess reversibility, participants were tested again directly after removing the splint and one day later. Judgment accuracy values and detection theory measures were reported. Both, young and older adults judged more conservatively when body properties were altered compared to initial judgments for normal body properties. Especially older adults showed major difficulties in such quick adaptation. Older adults' judgment accuracy as well as perceptual sensitivity were significantly lowered when body properties were suddenly altered. Importantly, lowered judgment performance occurred for both, the splinted as well as the non-splinted hand in older adults. Only after 24 hours of habituation, older adults tended to regain initial performance levels showing adaptive behavior to the altered condition. Removing the hand splint for one day was sufficient to reverse these adaptive effects. Our study results suggest that aging slows down adaptation to sudden bodily alterations affecting actor-related affordance judgments. We propose that these altered processes may go along with uncertainty and a heightened concern about potential consequences of misjudgments. Clearly, future studies are needed to further elucidate the underlying processes of adaptation in affordance judgments. These may reveal major implications for the aging society and its associated problems with an increased risk of falling or stroke related bodily constraints. published

Will I fit into the overcrowded subway? Advanced aging can change our abilities associated with accurately judging the fit between perceived environmental properties and our own actual physical capabilities (affordance judgments). Two experimental studies examined the effects of aging and trainability in affordance judgments. Participants were asked to decide whether their hand fits into a given opening (Aperture Task). We used a detection theory approach to evaluate different judgment characteristics. Study 1 demonstrated that older (N = 39) compared to younger adults (N = 39) produced rather conservative judgments, but did not differ in perceptual sensitivity. Distributions of Hit and False-Alarm rates, as well as risk-perception statements (DOSPERT questionnaire), indicated a heightened concern about potential consequences of misjudgments in older adults. In Study 2, 20 younger and 22 older adults were trained by actually trying to fit their hand into each presented opening. Training included acoustic, haptic and visual feedback. Compared to pre-training, both groups demonstrated significant increases in accuracy when assessed post-training and after a one-week follow-up. While younger adults improved in perceptual sensitivity in post-training as well as in follow-up, the older group adjusted their tendency towards less conservative judgments in both following sessions. Our results are consistent with affordance models that propose a complex and dynamic interplay of different neural processes involved in this skill. Future studies are needed to further elucidate that interplay and the trainability of affordance judgments. published