Rehabilitation and Modulation aimed at ameliorating awareness in Anosognosia for Hemiplegia

Abstract

Objective. Anosognosia for hemiplegia is a multifaceted syndrome that has a detrimental impact on the patient. Various theories based on behavioural and neuroanatomical data have been proposed to explain the mechanisms underlying the symptoms. These approaches have resulted in the development of a number of different procedures aimed at reducing symptoms or enhancing residual awareness. The article reviews rehabilitation attempts and their effects on individual cases and groups of patients. Methods. A selection of material was made using indexed articles published between 1987 and 2019. The inclusion criteria were: i) the presence of a neuropsychological assessment and ii) the presence of one or more methods specifically used to reduce AHP symptoms, or to enhance residual forms of awareness. Results. The review indicates that intervention procedures have moved from bottom-up to more cognitive and metacognitive approaches. In fact, initially anosognosia for hemiplegia was considered to be a co-occurrent symptom of other neuropsychological conditions (e.g. spatial neglect) and interventions were borrowed from the rehabilitation techniques that had had success in relieving these other disorders. When anosognosia was identified as an independent syndrome and residual forms of awareness were demonstrated, procedures attempting to modulate awareness started to focus on specific components of the disease, such as visual perspective, motor monitoring and the updating of beliefs. Conclusions. Although further research is needed in this field, the most recent approaches seem to give more stable, lasting results than earlier methods. A timeline for interventions relating to anosognosia is suggested, and ethical issues are also discussed.