Neural Underpinnings of Gesture Discrimination in Patients with Limb Apraxia

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Abstract
Limb apraxia (LA), is a neuropsychological syndrome characterized by difficulty in performing gestures and may therefore be an ideal model for investigating whether action execution deficits are causatively linked to deficits in action understanding. We tested 33 left brain-damaged patients and 8 right brain-damaged patients for the presence of the LA. Importantly, we also tested all the patients in an ad hoc developed gesture recognition task wherein an actor performs, either correctly or incorrectly, transitive (using objects) or intransitive (without objects) meaningful conventional limb gestures. Patients were instructed to judge whether the observed gesture was correct or incorrect. Lesion analysis enabled us to evaluate the relationship between specific brain regions and behavioral performance in gesture execution and gesture comprehension. We found that LA was present in 21 left brain-damaged patients and it was linked to frontal and parietal lesions. Moreover, we found that recognition of correct execution of familiar gestures performed by others was more impaired in patients with LA than in nonapraxic patients. Crucially, the gesture comprehension deficit correlated with damage to the opercular and triangularis portions of the inferior frontal gyrus, two regions that are involved in complex aspects of action-related processing. In contrast, no such relationship was observed with lesions centered on the inferior parietal cortex. The present findings suggest that lesions to left frontal regions that are involved in planning and performing actions are causatively associated with deficits in the recognition of the correct execution of meaningful gestures.