UCLP CENTRE FOR NEUROREHABILITATION
MONTHLY SEMINAR
Thursday 13th November 2014, at 5.15 pm
Lecture Theatre 33 Queen Square
Restoring Awareness Following Stroke: The Royal Road to
Mechanisms
Dr Aikaterini (Katerina) Fotopoulou
Aikaterini (Katerina) Fotopoulou, PhD, studied cognitive neuropsychology and theoretical
psychoanalysis at UCL before completing her PhD in cognitive neuroscience at the University of
Durham, UK. She is currently a Reader at UCL, where she hold an ERC Starting Investigator Award
and leads 'KatLab', a group of researchers focusing on topics and disorders that lie between
neurology and psychology. Katerina also runs the London Neuropsychoanalysis Group on:
‘Psychodynamic Neuroscience and Neuropsychology’. She is the editor of the volume: Fotopoulou, A.
Conway, M.A. Pfaff, D. From the Couch to the Lab: Trends in Psychodynamic Neuroscience. Oxford
University Press, 2012.
From Dr Fotopoulou about the lecture: When right hemisphere stroke causes paralysis, striking
awareness deficits concerning the paralysed limbs may also occur. The study of ‘anosognosia for
hemiplegia’ (AHP; the apparent unawareness of paralysis) and somatoparaphrenia (the belief that
one's limbs belong to someone else) can provide unique insight into the mechanisms of action
awareness and body ownership, respectively. Such symptoms are more common
than previously thought and are a specific, negative prognostic sign, affecting patients recovery over
and above other cognitive and sensorimotor deficits. Unfortunately, experimental investigations of
such phenomena are scarce, clinical trials are non-existent and there is currently no available
treatment.
Methods. I will present single-case and group studies using novel bedside, experimental and clinical
approaches and lesion mapping to reveal the role of faulty motor forward signals, interoceptive
deficits and higher order deficits. Methods include creating visual illusions of movement via realistic
rubber-hands and providing sensorimotor feedback via video recordings and mirror-viewing.
Results and Discussion. The results suggest that that motor forward signals may have a profound
influence on the on-line representation of one’s actions. Other lesions in cortical and subcortical
areas, e.g. insula, basal ganglia, parietal cortex and the limbic system also contribute to
unawareness. Body ownership is differentially influenced by 1st and 3rd perspectives on the body and
the latter can be used as simple, non-invasive and cheap psychophysical manipulations that can
cause unprecedented symptom reversal in post-stroke symptoms previously considered intractable.
This work offers potential for a major emphasis change in clinical treatment of higher-order deficits
following stroke. I will discuss the potential transition from behavioral adaptation and psychological
adjustment to targeted cognitive and behavioural training capable of leading to structural and
functional reorganisation and `plasticity'.