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Brain Advance Access published online on August 22, 2003
Brain, doi:10.1093/brain/awg266
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© 2003 The Guarantors of Brain

Article

Impairments of trunk movements following left or right hemisphere lesions: dissociation between apraxic errors and postural instability

Lucia Spinazzola 1, Roberto Cubelli 2, and Sergio Della Sala 3*

1 Azienda Ospedaliera S. Antonio Abate, Gallarate (VA), Italy
2 Istituto di Psicologia, Università di Urbino, Italy
3 Neuropsychology Research Group, Department of Psychology, University of Aberdeen, Aberdeen AB24 2UB, UK

* Corresponding author. E-mail: sergio{at}abdn.ac.uk.

Received 14 December 2002 ; revised 19 June 2003 ; accepted 22 June 2003

Abstract

Stroke patients present with apraxic or postural deficits involving trunk movements. Praxis and posture control have been associated with the functions of the left and the right hemisphere, respectively. For the first time, in this study the occurrence of apraxic and postural components in trunk movement deficits following right and left hemisphere lesions were investigated in the same participants. Twenty-three patients with left (L/pt), 12 with right (R/pt) hemisphere lesion, and 30 healthy controls were evaluated with a 21-item test assessing the imitation of meaningless, symbolic and reaching movements presented twice on visual or proprioceptive modality. Erroneous, motor responses of the trunk were classified as postural (compensations to overcome stability or asymmetry deficits) or apraxic (execution errors not due to biomechanical constraints). Postural instability reactions were significantly more frequent among the R/pts, whilst apraxic responses were overwhelming within the L/pts. The findings are consistent with the view that the left hemisphere is dominant for praxis and suggest that this dominance be extended to trunk praxis. The results also support the hypothesis that trunk postures are coded in relation to the environment by a representational system. A widespread network, mainly sitting in the right hemisphere, subserves this postural system. The distinction between praxic and postural deficits in executing trunk movements should be kept in mind when evaluating trunk movement difficulties shown by stroke patients, in following up their recovery or when tailoring rehabilitation programmes.

Keywords: stroke; apraxia; posture; trunk
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