Over- and underestimation of motor ability after a stroke: Implications for anosognosia

Abstract

We administered a discrepancy-based measure of anosognosia for hemiplegia (AHP) to a group of 42 right-brain-damaged (RBD) and left-brain-damaged (LBD) stroke patients with varying levels of functional motor ability. In addition to the expected (anosognosic) pattern of overestimation of motor function in some RBD patients, we found an equal and opposite underestimation in some others, both RBD and LBD. We also found that around a quarter of self-estimation error could be predicted directly from actual ability, such that patients with poorer motor function tended to overestimate, and vice versa. This pattern suggests that some misestimation is attributable simply to statistical regression. However, even after adjusting for this regression effect, levels of overestimation were significantly greater in RBD patients, while LBD patients were more likely to underestimate their motor ability.

Hemispheric Differences in Self-evaluation Errors of Upper Extremity Movement in Patients with Chronic Stroke

“…Thus, the patients with RHD in our study might be less concerned about their errors or unsuccessful use of the more-affected arm. In contrast, patients with LHD express catastrophic reactions to their disease and are often in a low mood (Carson et al, 1973;Fowler et al, 2018); therefore, they may have more concerns about their errors and unsuccessful trials made by the more-affected arm in this study. Interestingly, there was no difference in self-evaluation error even after accurate feedback from clinicians (self-evaluation error at test: −0.74 ± 1.09, self-evaluation error at retest: −0.76 ± 0.76, p > .05 in LHD, and self-evaluation error at test: −0.13 ± 1.09, self-evaluation error at retest: 0.18 ± 0.76, p > .05 in RHD).…”

“…This cut-off Hemispheric Differences in Self-evaluation Errors of Upper Extremity Movement in Patients with Chronic Stroke 3 allowed for a small proportion of evaluation errors that would occur in the self-awareness judgments of a human being (Della . A mean selfevaluation error greater or smaller than these cut-off scores indicated an over-or underestimation of UE performance, respectively (Fowler et al, 2018). The mean score between the cut-off scores was defined as the correct estimation.…”

“…For example, patients with LHD who often use the more-affected arm may be more likely to underestimate their performance if they have more unsuccessful experiences. One recent study showed that patients with LHD following acute-to-subacute stroke tend to underestimate their ability during upper extremity movement (Fowler, Della Sala, Hart & McIntosh, 2018). In contrast, the patients with RHD tend to overestimate (Fowler et al, 1973), and a similar trend is found in both stroke (Marcel et al, 2004) and traumatic brain injury populations (Mizuno, 1991;Prigatano, 1996).…”

Self-awareness and underestimation of cognitive abilities in patients with adult temporal lobe epilepsy after surgical treatment

“…Relative reports may thus be influenced by social desirability and/or expectation levels. Furthermore, UCA patients are likely to be more depressed than other patients with TLE and may therefore underestimate cognitive function, as reported in other studies of patients with neurologic disease [68,69].…”

Anosognosia for Hemiplegia and Falls After Stroke

“…As a result, three left-sided stroke patients with diagnosed aphasia were able to communicate and participate in the assessment. This is relevant in that previously published studies focused on right-sided lesions, potentially excluding the aphasic population, which may have minimized the impact of AHP on stroke survivors (Antoniello & Gottesman, 2020; Barrett, 2021; D’Imperio et al, 2017; Fowler et al, 2018; Kirsch et al, 2021).…”