Reply to: “1.5 Dissociation” of somatoparaphrenia for the upper limb and neglect for the lower limb following a thalamic stroke presenting as flaccid hemiparesis: rehabilitation applications and neuroscience implications
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This interesting case study reports on a patient who subsequent to a right thalamic hematoma developed a left hemiparesis, left extrapersonal and personal hemineglect and somatoparaphrenia, but only for the arm not the leg. It is not specifically mentioned whether this patient had also anosognosia for her hemiplegia or if somatoparaphrenia, a disturbed sense of ownership of her arm, was dissociated from intact awareness of her motor deficit, as recently described in five patients by Invernizzi et al. (2013).
We doubt about the usefulness of the term “1.5 Dissociation” because extrapersonal and possibly personal neglect was probably present for the lower and the upper limb.
Somatoparaphrenia of one limb alone is rare, it has been described for the leg by Barkman (1925) and ourselves (Perren et al. 2015) and for the arm by the authors of the present letter. However, there might be a bias since in bedside testing it is more common to ask, “Whose hand is this?” then asking the same questions for the foot.
The very interesting aspect of this case is that, despite neglect, motor rehabilitation efforts in shifting attention towards the paralyzed side were partly successful for the leg, but failed completely for the somatoparaphrenic arm. Could this be due to the altered ownership? If yes, could motor rehabilitation be improved when attention was directed towards the “alien” rather than the “own” limb?
The unique case of Bottini et al. (2002) of a patient with somatoparaphrenia in whom dense tactile imperception in the left hand got dramatically recovered when she was instructed to report touches delivered to her niece’s hand, rather than to her own hand, gives hope that such a strategy might even work for motor rehabilitation.
- Barkman A (1925) De l’anosognosie dans l’hémiplégie cérébrale: contribution Clinique a l’étude de ce symptôme. Acta Med Scand 52:235–254Google Scholar