Motor awareness in anosognosia for hemiplegia: experiments at last!

Anosognosia for hemiplegia (AHP) is the apparent inability to acknowledge contralesional paralysis, typically following right-hemisphere lesions. Here, we review studies that regard AHP as a specific deficit of motor awareness and explain its symptoms by employing an established computational model of motor control. These accounts propose that AHP arises from a breakdown in the monitoring of intended and actual movement. First, we critically examine physiological and behavioural experiments, which attempt to provide an account of AHP by verifying the presence or absence of motor intentions. We then review more recent experiments that endeavour to empirically address the hitherto unexplored role of motor intentions and internal representations of movements in AHP patients' non-veridical (illusory) awareness of movement. Finally, we consider implications of AHP research for clinical practice and the understanding of motor awareness more generally. We conclude that the false experience of movement in AHP may provide insight into what occurs when the mechanism responsible for monitoring and correcting significant discrepancies between predicted and executed actions is impaired. The system seems to continue to operate by deceiving awareness.