Ghislaine Aubin

Unusual use of objects after unilateral brain damage. The technical reasoning model

It has been suggested that gesture engrams, conceptual knowledge and/or the ability to infer function from structure can support object use. The present paper proposes an alternative view which is based upon the idea that object use requires solely the ability to reason about technical means provided by objects. Technical means are abstract principles which are not linked with any object representation (e.g., cutting involves the opposition between dense and permeable material). The technical reasoning model predicts that the inability to perform technical reasoning should impair performance in any situation requiring the use of objects (in a conventional way or not). Twenty left brain-damaged (LBD) patients, 11 right brain-damaged (RBD) patients and 41 healthy controls were examined on experimental tests assessing the conventional use of objects (e.g., screwing a screw with a screwdriver), conceptual knowledge about object function, pantomime of object use and recognition of object utilization gestures. We also designed the Unusual Use of Objects Test, which demands unusual applications of objects to achieve a purpose for which the usually applied object is not provided (e.g., screwing a screw with a knife). The key findings are that only LBD patients have more difficulties on the Unusual Use of Objects Test than controls or RBD patients, and that the severity of their impairment is correlated with that on conventional use of objects. Correlations with tests assessing conceptual knowledge as well as with tests of pantomime of object use and recognition of object utilization gestures were weaker. These results support the technical reasoning model and question the role of conceptual knowledge and gesture engrams in object use. Since the technical reasoning model also predicts two distinct technical disorders, the discussion focuses on the existence of these disorders in regard to individual performance profiles obtained in the Unusual Use of Objects Test.

Object utilization and object usage: A single-case study

ABSTRACT It has been suggested that both conceptual knowledge and the ability to infer function from structure can support object use. By contrast, we propose that object use requires solely the ability to reason about technical ends. Technical ends (e.g., cutting) are not purposes (e.g., eating), but the technical way to achieve them. This perspective suggests that there is no mutual relationship between technical ends and purposes since the same purpose (e.g., writing) can be achieved thanks to distinct technical ends (graving, tracing), and, inversely, the same technical end (e.g., tracing) can achieve different purposes (making up, writing). Thus, conceptual knowledge might determine which technical end is usually associated with a given purpose. To contribute to the discussion, we described the behaviour of a female patient with left temporal lobe lesions and bilateral frontal lobe lesions following a closed-head injury. Conceptual knowledge was impaired. She encountered difficulties in demonstrating the use of objects in isolation (e.g., using a screwdriver without the screw). The presence of a recipient (e.g., using a screwdriver with the screw) improved her performance. The performance was also normal when asked to perform unusual applications of objects to achieve a goal for which the usually applied object was not provided (e.g., screwing a screw with a knife). Consistent with the theoretical framework supported here, her performance profile suggests an intact ability to reason about technical ends (i.e., utilization), in the presence of a defective ability to determine the usual relationship between technical ends and purposes (i.e., usage).

Different constraints on grip selection in brain-damaged patients: Object use versus object transport

The present study discusses the presence of different constraints on action selection during object use versus object transport. Sixteen left brain-damaged (LBD) patients, 10 right brain-damaged (RBD) and 35 healthy controls were examined on a grip preference test consisting of a grasping-to-transport and a grasping-to-use condition. Assessment included a general praxis testing (pantomime production, object utilization gesture recognition and object use). We also reported the case of a close-head injury patient (DR) with an atypical behavioural pattern. Our results supported the different constraint hypothesis. While several LBD and RBD patients performed inappropriate grips in the grasping-to-transport condition, only two patients (L2 and DR) used inappropriate grips in the grasping-to-use condition. No correlation was found between the two conditions of the grip preference test and measures of the general praxis testing. The discussion focuses on the nature of constraints on grip selection during object use and object transport.

Virtual reality and neuropsychological assessment: The reliability of a virtual kitchen to assess daily-life activities in victims of traumatic brain injury

ABSTRACT Traumatic brain injury (TBI) causes impairments affecting instrumental activities of daily living (IADL). However, few studies have considered virtual reality as an ecologically valid tool for the assessment of IADL in patients who have sustained a TBI. The main objective of the present study was to examine the use of the Nonimmersive Virtual Coffee Task (NI-VCT) for IADL assessment in patients with TBI. We analyzed the performance of 19 adults suffering from TBI and 19 healthy controls (HCs) in the real and virtual tasks of making coffee with a coffee machine, as well as in global IQ and executive functions. Patients performed worse than HCs on both real and virtual tasks and on all tests of executive functions. Correlation analyses revealed that NI-VCT scores were related to scores on the real task. Moreover, regression analyses demonstrated that performance on NI-VCT matched real-task performance. Our results support the idea that the virtual kitchen is a valid tool for IADL assessment in patients who have sustained a TBI.

Discrepancy between social and nonsocial decision-making under uncertainty following prefrontal lobe damage: the impact of an interactionist approach.

ABSTRACT Deficits in decision-making are thought to contribute significantly to socio-behavioral impairments of patients with frontal lobe damage. The purpose of this study was to test the hypothesis of whether the inappropriate social behavior of patients with frontal lesions can be viewed as the product of a general failure of decision-making ability or as the result of socio-cognitive impairment. We studied a group of patients with prefrontal lesions (FL patients, n = 15) and a group of matched healthy controls (n = 30) on the Iowa Gambling task (IGT) of nonsocial decision-making, environmental dependency phenomena (EDP) during social interaction, and the “reading the mind in the eyes” and “character intention task” of theory of mind (TOM) tasks. The FL patients were impaired in both TOM and EDP protocols but, surprisingly, they behaved appropriately in the IGT. In addition, FL patients with EDP did not differ in executive functioning, IGT and TOM measures from those who did not demonstrate these behavioral disorders. The right orbitofrontal cortex was associated with social decision-making deficits. By adopting an interactionist approach, this study raises the possibility of identifying components of social and nonsocial decision-making, which could be helpful in understanding the behavioral disorders of FL patients.

Arithmetic word-problem-solving in Huntington’s disease

The purpose of this study was to examine executive functioning in patients with Huntingtons disease using an arithmetic word-problem-solving task including eight solvable problems of increasing complexity and four aberrant problems. Ten patients with Huntingtons disease and 12 normal control subjects matched by age and education were tested. Patients with Huntingtons disease performed the solvable problems significantly worse than the normal control subjects, but there was no difference in performance between the two groups in inhibiting aberrant problems. These results suggest that early Huntingtons disease patients exhibit a precocious impairment in their ability to plan the resolution of complex arithmetic word problems without deficit in their ability to eliminate aberrant problems. This dissociation of performance fits with what we have found in such patients using script-sequencing tasks (Allain et al., 2004) and with neuropsychological data obtained by Watkins et al. (2000). These results are consistent with what is known about the neuropathological progression of Huntingtons disease in which neuronal loss progresses in a dorso-to-ventral direction and with what was shown in patients with circumscribed frontal lobe damage. In these patients, impairments in planning solvable word problems were more frequent when lesions were in the lateral prefrontal regions.

An integrative view of Luria’s perspective on arithmetic problem solving: The two sides of environmental dependency

Introduction: A. R. Luria was the first author to hypothesize that executive dysfunction can lead to specific deficits in arithmetic problem solving, showing that patients’ performance depends on the structure of the tasks. Cummings (1995. Anatomic and behavioral aspects of frontal-subcortical circuits. Annals of the New York Academy of Sciences, 15, 1–13) proposed the term “environmental dependency” to define such behavioral disorders triggered by the characteristics of the test and pointed out also the role of executive impairments. Few studies compare executive functioning and problem solving in brain-damaged patients, and none have examined the question from this point of view. Thus, the main aim of the present paper was to study the relationship between environmental dependency and executive functions. Method: Fifty neurological patients with frontal, subcortical, and posterior brain lesions were compared to 45 matched healthy controls and were divided into two groups (dysexecutive/nondysexecutive) according to their performances on executive tasks. Then, we confronted the results of the two groups on an experimental protocol designed in accordance with Luria’s proposals. We made also comparisons between groups on the basis of lesion location. Results: Our findings indicate a high association between executive functions and environmental dependency, showing that dysexecutive patients’ performances were dependent on task demands. In addition, a specific frontal behavior not associated with executive functions and characterized by the solving of insoluble problems was highlighted. Conclusion: The discussion focused on the interest to take into account the methodological and clinical contributions of environmental dependency. Based on our findings and theoretical arguments, we highlight the need to fractionate this concept.

Frontal versus dysexecutive syndromes: relevance of an interactionist approach in a case series of patients with prefrontal lobe damage.

ABSTRACT The concepts of “frontal” and “dysexecutive” syndromes are still a matter of debate in the literature. These terms are often used interchangeably but can be distinguished when considering specific frontal behavioural deficits which occur during social interaction. Despite being of interest for the clinical assessment and care management of patients with anterior brain damage, few studies have tried to disentangle the specificity of each syndrome. We report the case of eight patients with frontal lobe damage who were assigned to one of two groups based on whether or not they showed a dysexecutive syndrome. The nondysexecutive group differed from the dysexecutive group in showing environmental dependency phenomena, behavioural disorders triggered by social interaction. By adopting an interactionist perspective, this pilot study contributes to defining more precisely the distinction between “frontal” and “dysexecutive” syndromes. The discussion focuses on the potential interest of the interactionist approach in designing appropriate methodologies of assessment and rehabilitation of patients with frontal lobe syndrome.

Decision-making of Prefrontal Patients with the Iowa Gambling Task: Unexpected Spared Performances and Preliminary Evidence for the Need of Alternative Measures

Objective. Human decision-making is a growing area of research most commonly associated with the Iowa Gambling Task (IGT), which was first developed to assess patients with prefrontal cortex (PFC) damage. The IGT is now considered an appropriate task to predict behavioral disorders in various clinical populations. However, several studies have questioned the validity and reliability of the task, arguing that its particular payoff scheme may influence the decision-making process in terms of sensitivity to gain-loss frequency (GLF) rather than long-term outcome (the basic assumption of IGT). Despite the potential significance of this assertion for the diagnosis of decision-making deficits, few studies have addressed the influence of GLF on IGT performances in clinical populations, and there is no study to date that involves patients with prefrontal lobe damage. Method. We tested 17 patients with PFC damage and 17 matched healthy controls with the IGT to analyze influence in choice behavior of both long-term outcomes and GLF. Results. There was a difference between groups in the GLF score, but none between groups in the long-term outcome variable (the traditional measure). Our findings demonstrate that only control subjects seemed able to consider both long-term outcome and GLF. Conclusions. The discussion focuses on the contribution of empirical data, which may have implications for the clinical assessment of decision-making ability with the IGT.