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Dissociated active and passive tactile shape recognition: a case study of pure tactile apraxia

机译:分离的主动和被动触觉形状识别:纯触觉失用症的案例研究

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摘要

Disorders of tactile object recognition (TOR) may result from primary motor or sensory deficits or higher cognitive impairment of tactile shape representations or semantic memory. Studies with healthy participants suggest the existence of exploratory motor procedures directly linked to the extraction of specific properties of objects. A pure deficit of these procedures without concomitant gnostic disorders has never been described in a brain-damaged patient. Here, we present a patient with a right hemispheric infarction who, in spite of intact sensorimotor functions, had impaired TOR with the left hand. Recognition of 2D shapes and objects was severely deficient under the condition of spontaneous exploration. Tactile exploration of shapes was disorganized and exploratory procedures, such as the contour-following strategy, which is necessary to identify the precise shape of an object, were severely disturbed. However, recognition of 2D shapes under manually or verbally guided exploration and the recognition of shapes traced on the skin were intact, indicating a dissociation in shape recognition between active and passive touch. Functional MRI during sensory stimulation of the left hand showed preserved activation of the spared primary sensory cortex in the right hemisphere. We interpret the deficit of our patient as a pure tactile apraxia without tactile agnosia, i.e. a specific inability to use tactile feedback to generate the exploratory procedures necessary for tactile shape recognition
机译:触觉对象识别(TOR)障碍可能是由于主要的运动或感觉缺陷或触觉形状表示或语义记忆的较高认知障碍所致。对健康参与者的研究表明,探索性运动程序的存在与提取物体的特定属性直接相关。从未有脑损伤的患者描述这些程序的纯粹缺陷而没有伴随的诊断障碍。在这里,我们介绍了右半球梗死的患者,尽管感觉运动功能完好,但左手TOR受损。在自发探索条件下,二维形状和物体的识别严重不足。形状的触觉探索变得混乱,探索程序(例如轮廓跟踪策略)对于确定物体的精确形状是必不可少的。但是,在手动或口头引导的探索下对2D形状的识别以及在皮肤上追踪到的形状的识别均完好无损,这表明主动和被动触摸之间的形状识别不相关。左手感觉刺激过程中的功能性MRI显示保留了右半球中剩余的初级感觉皮层的激活。我们将患者的缺乏症解释为纯粹的触觉性失用症,而没有触觉失常,即无法使用触觉反馈来产生触觉形状识别所必需的探索性程序

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