Sense of agency in schizophrenia: A reconciliation of conflicting findings through a theory-driven literature review.

The sense of agency is the experience of being the author of self-generated actions and their outcomes. Both clinical manifestations and experimental evidence suggest that the agency experience and the mechanisms underlying agency attribution may be dysfunctional in schizophrenia. Yet, studies investigating the sense of agency in these patients show seemingly conflicting results: some indicated under-attribution of self-agency (coherently with certain positive symptoms), while others suggested over-attribution of self-agency. In this review, we assess whether recent theoretical frameworks can reconcile these divergent results. We examine whether the identification of agency abnormalities in schizophrenia might depend on the measure of self-agency considered (depending on the specific task requirements) and the available agency-related cues. We conclude that all these aspects are relevant to predict and characterize the type of agency misattribution that schizophrenia patients might show. We argue that one particular model, based on the predictive coding theory, can reconcile the interpretation of the multifarious phenomenology of agency manifestations in schizophrenia, paving the way for testing agency disorders in novel ways.

Forearm bisection task suggests an alteration in body schema in patients with functional movement disorders (motor conversion disorders).

OBJECTIVES: To explore potential alterations of the Body Schema, the implicit sensorimotor representation of one's own body, in patients with Functional Movement Disorders (FMD, Motor Conversion Disorders), characterized by neurological symptoms of altered voluntary motor function that cannot be explained by typical medical conditions. This investigation is prompted by the potential dissociation from their reportedly intact sense of ownership. METHODS: 10 FMD patients and 11 healthy controls (HC) underwent the Forearm Bisection Task, aimed at assessing perceived body metrics, which consists in asking the subject, blindfolded, to repeatedly point at the perceived middle point of their dominant forearm with the index finger of their contralateral hand, and a psychometric assessment for anxiety, depression, alexithymia, and tendency to dissociation. RESULTS: FMD patients bisected their forearm more proximally (with an increased shift towards their elbow equal to 7.5%) with respect to HC; average bisection point was positively associated with anxiety levels in the whole sample, and with the tendency to dissociation in the FMD group. CONCLUSIONS: FMD patients perceive their forearm as shorter than HC, suggesting an alteration of their Body Schema. The Body Schema can go through short- and long-term updates in the life course, mainly related to the use of each body segment; we speculate that, despite FMD being a disorder of functional nature, characterized by variability and fluctuations in symptomatology, the lack of sense of agency over a body part might be interpreted by the nervous system as disuse and hence influence the Body Schema, as deficits of organic etiology do.

Sensory Attenuation Deficit and Auditory Hallucinations in Schizophrenia: A Causal Mechanism or a Risk Factor? Evidence From Meta-Analyses on the N1 Event-Related Potential Component.

BACKGROUND: Sensory attenuation (SA), the dampened perception of self-generated sensory information, is typically associated with reduced event-related potential signals, such as for the N1 component of auditory event-related potentials. SA, together with efficient monitoring of intentions and actions, should facilitate the distinction between self-generated and externally generated sensory events, thereby optimizing interaction with the world. According to many, SA is deficient in schizophrenia. The question arises whether altered SA reflects a sufficient mechanism to explain positive symptoms such as auditory hallucinations. A systematic association of reduced auditory SA in hallucinating patients would support this hypothesis. METHODS: We conducted a series of meta-analyses on 15 studies on auditory SA in which the N1 component of event-related potential-electroencephalogram signals was measured during talking (self-generated sensory signals condition) or when listening to prerecorded vocalizations (externally generated sensory signals condition). RESULTS: We found that individuals with schizophrenia did show some auditory SA because their N1 signal was significantly attenuated in talking conditions compared with listening conditions. However, the magnitude of such attenuation was reduced in individuals with schizophrenia compared to healthy control participants. This phenomenon generalizes independently from the stage of the disease, the severity of positive symptoms, and whether patients have auditory hallucinations or not. CONCLUSIONS: These findings suggest that reduced SA cannot be a sufficient mechanism for explaining positive symptoms such as auditory hallucinations in schizophrenia. Because reduced SA was also present in participants at risk of schizophrenia, reduced SA may represent a risk factor for the disorder. We discuss the implications of these results for clinical-cognitive models of schizophrenia.

The influence of arm posture on the Uznadze haptic aftereffect.

The role of arm posture in the Uznadze haptic aftereffect is investigated: two identical test stimuli (i.e., spheres, TS) clenched simultaneously appear haptically different in size after hands have been adapted to two spheres (adapting stimuli, AS) differing in size: the hand adapted to a small AS feels TS bigger than the hand adapted to a big AS. In two experiments, participants evaluated the haptic impressions of two TS after adaptation by finding their match on a visual scale. In Experiment 1, all tasks were carried out with arms either uncrossed or crossed. In Experiment 2, only the matching task was performed with arms either uncrossed or crossed while adaptation was conducted by continuously changing arm posture from uncrossed to crossed and vice versa. The illusion occurred irrespectively of arm posture; however, its magnitude was smaller when adaptation was carried out in the classical condition of uncrossed arms. Results are discussed in light of two functional mechanisms: low-level somatotopic mapping (i.e., stimuli conformation) and high-level level factors (i.e., arm posture) that could modulate the haptic perception. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sense of body ownership and body agency in schizophrenia.

Recent research suggests that embodiment sensations (sense of body ownership and sense of body agency) are altered in schizophrenia. Using a mirror box illusion setup, we tested if the anomalous embodiment experience depends on deficient processing of visuomotor synchrony, disrupted processing of movement mode, or both. The task required participants to press a lever with their index while looking at the image of the experimenter's hand moving on a similar lever. The illusion of embodiment could arise because looking toward the direction of their own hand the participant saw the reflection of the experimenter's hand visually superimposed to his own one through a mirror. During the illusion induction, we systematically varied visuomotor asynchrony (4 delays were imposed on the movement of the experimenter's hand) and the mode of movement (the participant could perform active vs. passive movements). The strength of the illusion of embodiment of the external hand was assessed with explicit judgments of ownership and agency. Patients' data showed an anomalous modulation of ownership with respect to visuomotor synchrony manipulation and an altered modulation of agency with respect to both visuomotor synchrony and movement mode manipulations. Results from the present study suggest that impairments affecting both the processing of temporal aspects of visuomotor signals and the processing of type of movement underlie anomalous embodiment sensations in schizophrenia. Hypotheses about potential deficits accounting for our results are proposed.

I am the metre: The representation of one's body size affects the perception of tactile distances on the body.

Humans must ground the perception of one's body in a mental representation to move in space and interact with objects. This representation can be temporarily altered artificially. In the full-body illusion (FBI), participants see a virtual (or filmed) body receiving a tactile stimulation. When participants receive touches on their body similarly to the seen one (i.e., homologous location and synchronous timing), they embody the seen alien body. While the subjective embodiment of alien bodies of different sizes has been already manipulated with the FBI, it remains unexplored whether the body-metric perception is impacted too. We first developed a new setup for the FBI using 360° videos to favour the embodiment. The FBI was induced for bodies of three sizes adopting anatomical and non-anatomical viewpoints, and we measured the subjective embodiment. The results suggest that humans can embody normal size or bigger bodies seen from anatomical viewpoints, but not smaller ones. We then investigated if the FBI modulates the body-metric representation. We found that the resized bodies' vision affects the perception of one's body-metric representation, but this was independent of the embodiment, suggesting that the FBI alters the body representation at different levels with a specific impact.

Body-Space Interactions: Same Spatial Encoding but Different Influence of Valence for Reaching and Defensive Purposes.

The space around our body, the so-called peripersonal space, is where interactions with nearby objects may occur. "Defensive space" and "Reaching space", respectively, refer to two opposite poles of interaction between our body and the external environment: protecting the body and performing a goal-directed action. Here, we hypothesized that mechanisms underlying these two action spaces are differentially modulated by the valence of visual stimuli, as stimuli with negative valence are more likely to activate protective actions whereas stimuli with positive valence may activate approaching actions. To test whether such distinction in cognitive/evaluative processing exists between Reaching and Defensive spaces, we measured behavioral responses as well as neural activations over sensorimotor cortex using EEG while participants performed several tasks designed to tap into mechanisms underlying either Defensive (e.g., respond to touch) or Reaching space (e.g., estimate whether object is within reaching distance). During each task, pictures of objects with either positive or negative valence were presented at different distances from the participants' body. We found that Defensive space was smaller for positively compared with negatively valenced visual stimuli. Furthermore, sensorimotor cortex activation (reflected in modulation of beta power) during tactile processing was enhanced when coupled with negatively rather than positively valenced visual stimuli regarding Defensive space. On the contrary, both the EEG and behavioral measures capturing the mechanisms underlying Reaching space did not reveal any modulation by valence. Thus, although valence encoding had differential effects on Reaching and Defensive spaces, the distance of the visual stimulus modulated behavioral measures as well as activity over sensorimotor cortex (reflected in modulations of mu power) in a similar way for both types of spaces. Our results are compatible with the idea that Reaching and Defensive spaces involve the same distance-dependent neural representations of sensory input, whereas task goals and stimulus valence (i.e., contextual information) are implemented at a later processing stage and exert an influence on motor output rather than sensory/space encoding.

Bliss in and Out of the Body: The (Extra)Corporeal Space Is Impervious to Social Pleasant Touch.

Slow, gentle stimulation of hairy skin is generally accompanied by hedonic sensations. This phenomenon, also known as (positive) affective touch, is likely to be the basis of affiliative interactions with conspecifics by promoting inter-individual bindings. Previous studies on healthy humans have demonstrated that affective touch can remarkably impact behavior. For instance, by administering the Rubber Hand Illusion (RHI) paradigm, the embodiment of a fake hand enhances after a slow, affective touch compared to a fast, neutral touch. However, results coming from this area are not univocal. In addition, there are no clues in the existing literature on the relationship between affective touch and the space around our body. To overcome these lacks, we carried out two separate experiments where participants underwent a RHI paradigm (Experiment 1) and a Visuo-Tactile Interaction task (Experiment 2), designed to tap into body representation and peripersonal space processing, respectively. In both experiments, an affective touch (CT-optimal, 3 cm/s) and neutral touch (CT-suboptimal, 18 cm/s) were delivered by the experimenter on the dorsal side of participants' hand through a "skin to skin" contact. In Experiment 1, we did not find any modulation of body representation-not at behavioral nor at a physiological level-by affective touch. In Experiment 2, no visuo-tactile spatial modulation emerged depending upon the pleasantness of the touch received. These null findings are interpreted in the light of the current scientific context where the real nature of affective touch is often misguided, and they offer the possibility to pave the way for understanding the real effects of affective touch on body/space representation.

Psychometric properties of the embodiment scale for the rubber hand illusion and its relation with individual differences.

The Rubber Hand Illusion (RHI) opened the investigation of the sense of body ownership in healthy people. By putting in slight contrast vision touch and proprioception, healthy people embody a fake hand in one's body representation. The easiness of the procedure, typically measured with a set of questions that capture the subjective experience, favoured its blooming. However, validation studies of embodiment questionnaires are lacking, and the individual differences that contribute to the embodiment received little attention. In our study, 298 participants underwent an RHI procedure following both synchronous and asynchronous (control) visuo-tactile stimulations. The study had multiple aims: (a) to explore the psychometric structure of a 27-items questionnaire largely used in the literature; (b) to build a psychometrically efficient scale to measure embodiment-related phenomena; (c) to explore whether and how individual differences (empathy, self-esteem and mindfulness) are associated with the experience of illusion. We found a relatively simple structure consisting of three components: embodiment of the rubber hand, disembodiment of the biological hand, physical sensations experienced during the procedure. The scales designed were psychometrically reliable and theoretically meaningful, encompassing 18 of the original items. Finally, by adopting a network analysis approach, we found that the embodiment is directly related to empathy and self-esteem, while disembodiment and physical sensation are unrelated to individual personality traits. The study provides substantial evidence to use the embodiment scale as a standard questionnaire for future RHI studies. Additionally, the correlations with personality traits suggest that the embodiment induced by the RHI deeply integrates with the complexity of the individuals and their differences.

Behavioral and Physiological Evidence of a favored Hand Posture in the Body Representation for Action.

Motor planning and execution require a representational map of our body. Since the body can assume different postures, it is not known how it is represented in this map. Moreover, is the generation of the motor command favored by some body configurations? We investigated the existence of a centrally favored posture of the hand for action, in search of physiological and behavioral advantages due to central motor processing. We tested two opposite hand pinch grips, equally difficult and commonly used: forearm pronated, thumb-down, index-up pinch against the same grip performed with thumb-up. The former revealed faster movement onset, sign of faster neural computation, and faster target reaching. It induced increased corticospinal excitability, independently on pre-stimulus tonic muscle contraction. Remarkably, motor excitability also increased when thumb-down pinch was only observed, imagined, or prepared, actually keeping the hand at rest. Motor advantages were independent of any concurrent modulation due to somatosensory input, as shown by testing afferent inhibition. Results provide strong behavioral and physiological evidence for a preferred hand posture favoring brain motor control, independently by somatosensory processing. This suggests the existence of a baseline postural representation that may serve as an a priori spatial reference for body-space interaction.

See What You Feel: A Crossmodal Tool for Measuring Haptic Size Illusions.

The purpose of this research is to present the employment of a simple-to-use crossmodal method for measuring haptic size illusions. The method, that we call See what you feel, was tested by employing Uznadze's classic haptic aftereffect in which two spheres physically identical (test spheres) appear different in size after that the hands holding them underwent an adaptation session with other two spheres (adapting spheres), one bigger and the other smaller than the two test spheres. To measure the entity of the illusion, a three-dimensional visual scale was created and participants were asked to find on it the spheres that corresponded in size to the spheres they were holding in their hands out of sight. The method, tested on 160 right-handed participants, is robust and easily understood by participants.

Body illusion and affordances: the influence of body representation on a walking imagery task in virtual reality.

It is well known that our body works as a fundamental reference when we perform visuo-perceptual judgements in spatial surroundings, and that body illusions can modify our perception of size and distance of objects in space. To date, however, few studies have evaluated whether or not a body illusion could have a significant impact on the way individuals perceive to move within the environment. Here, we used a full-body illusion paradigm to verify the hypothesis that an altered representation of the legs of the individuals influences their time-to-walk estimation while imaging to reach objects in a virtual environment. To do so, we asked a group of young healthy volunteers to perform a task in which they were required to imagine walking towards a previously seen target location in a virtual environment, soon after receiving the body illusion; we required participants to use a response button to time their imagined walk from start to end. We found that participants imagined walking faster following the illusion elicited by the vision of longer legs presented from an anatomical perspective, as compared to when experiencing standard legs in the same position.This difference in imagined walking distance decreased when the object to reach was displayed farther, suggesting a fading effect. Furthermore, taking into consideration the baseline error in walking time estimation in VR, we noticed a specific influence of the long anatomical legs in reducing the perceived time needed to reach an object and a general increase in the percentage of error when the same legs are presented in a non-anatomical orientation. These findings provide evidence that body illusions could influence the way individuals perceive their locomotion in the spatial surrounding.

No efficacy of transcranial direct current stimulation on chronic migraine with medication overuse: A double blind, randomised clinical trial.

BACKGROUND: Transcranial direct current stimulation was suggested to provide beneficial effects in chronic migraine, a condition often associated with medication overuse for which no long-term therapy is available. METHODS: We conducted a randomised controlled trial to assess long-term efficacy of transcranial direct current stimulation. Adults diagnosed with chronic migraine and medication overuse were assigned to receive in a 1:1:1 ratio anodal, cathodal, or sham transcranial direct current stimulation daily for five consecutive days, along with standardised drug withdrawal protocol. Primary outcome was 50% reduction of days of headache per month at 12 months. Co-secondary outcomes were 50% reduction of days of headache per month at 6 months, reduction of analgesic intake per month, and change in disability and quality of life, catastrophising, depression, state and trait anxiety, dependence attitude and allodynia intensity. Patients were not allowed to take any migraine prophylaxis drug for the entire study period. RESULTS: We randomly allocated 135 patients to anodal (44), cathodal (45), and sham (46) transcranial direct current stimulation. At 6 and 12 months, the percentage of reduction of days of headache and number of analgesics per month ranged between 48.5% and 64.7%, without differences between transcranial direct current stimulation (cathodal, anodal, or the results obtained from the two arms of treatment, anodal plus cathodal) and sham. Catastrophising attitude significantly reduced at 12 months in all groups. There was no difference for the other secondary outcomes. CONCLUSIONS: Transcranial direct current stimulation did not influence the short and long-term course of chronic migraine with medication overuse after acute drug withdrawal. Behavioral and educational measures and support for patients' pain management could provide long-term improvement and low relapse rate.Trial registration number NCT04228809.

Sensory- and Action-Oriented Embodiment of Neurally-Interfaced Robotic Hand Prostheses.

Embodiment is the percept that something not originally belonging to the self becomes part of the body. Feeling embodiment for a prosthesis may counteract amputees' altered image of the body and increase prosthesis acceptability. Prosthesis embodiment has been studied longitudinally in an amputee receiving feedback through intraneural and perineural multichannel electrodes implanted in her stump. Three factors-invasive (vs non-invasive) stimulation, training, and anthropomorphism-have been tested through two multisensory integration tasks: visuo-tactile integration (VTI) and crossing-hand effect in temporal order judgment (TOJ), the former more sensible to an extension of a safe margin around the body and the latter to action-oriented remapping. Results from the amputee participant were compared with the ones from healthy controls. Testing the participant with intraneural stimulation produced an extension of peripersonal space, a sign of prosthesis embodiment. One-month training extended the peripersonal space selectively on the side wearing the prostheses. More and less-anthropomorphic prostheses benefited of intraneural feedback and extended the peripersonal space. However, the worsening of TOJ performance following arm crossing was present only wearing the more trained, despite less anthropomorphic, prosthesis, suggesting that training was critical for our participant to achieve operative tool-like embodiment.

A new clinical evaluation of asomatognosia in right brain damaged patients using visual and reaching tasks.

INTRODUCTION: The term asomatognosia refers to a unilateral disturbance of body ownership following a cerebrovascular incident. Patients with asomatognosia consider the contralesional limbs as missing or having disappeared from awareness. This neuropsychological disorder modifies body ownership in terms of perceptual experience, visual identification and sense of belonging of contralesional body parts. In the literature, asomatognosia is usually tested by using verbal scales. METHOD: In this study, we first developed a new test to assess asomatognosia that includes a visual identification task and a reaching task. We examined 16 healthy participants and 20 right brain damaged patients. The participants were asked to identify, reach and touch their left hand when positioned in peripersonal space, in presence of an extraneous hand (belonging to the examiner). We analyzed how the deficit is modulated by the reciprocal positions in space of the two limbs, the relationship with personal neglect and the anatomical correlate using a Voxel-based Lesion Symptom Mapping (VLSM) analysis with CT data. RESULTS: The results show that the asomatognosia cannot be simply considered as one of the many manifestations of personal neglect but should be taken into account as a "productive" disorder characterized by the misidentification of the own hand with an extraneous hand. The VLSM analysis of patients with asomatognosia revealed the involvement of the inferior and middle frontal lobe. CONCLUSIONS: The novel task that has been developed in the present study could be used as an objective tool to measure this specific disorder of body ownership or to uncover subclinical conditions of asomatognosia.

Defective Embodiment of Alien Hand Uncovers Altered Sensorimotor Integration in Schizophrenia.

The observation that people with schizophrenia misattribute the source of their own actions has led to the hypothesis that they suffer from altered sensorimotor processes underlying sense of agency. Furthermore, rubber hand studies suggest an abnormal experience of embodiment in schizophrenia. However, this latter finding is based on a procedure that elicits ownership sensations for a fake hand by visuo-tactile stimulation, leaving the agency subcomponent of embodiment relatively untouched. By using a visuo-motor version of the embodiment illusion able to actively elicit also sense of agency for an alien hand, we tested whether the putative sensorimotor deficits are also involved in altering embodiment sensations in schizophrenia. Subjective (questionnaire) and perceptual (forearm bisection performance) indexes of the embodiment illusion were collected. Differently from controls, both the explicit agency component and the implicit body metrics update were not modulated by the extent of visuo-motor congruency in participants with schizophrenia. We conclude that motor prediction and/or temporal binding window impairments may alter the feeling of embodiment and body representation in schizophrenia.

The dynamic nature of the sense of ownership after brain injury. Clues from asomatognosia and somatoparaphrenia.

The sense of ownership is the feeling that a body part belongs to ourselves. Brain damage may disrupt this feeling, leading to somatoparaphrenia (SP), i.e., the delusion that one's limbs belong to someone else. This delusional feeling is typically associated with profound motor and somatosensory deficits. We reviewed the cases of SP reported so far in the literature outlining the clinical and neuroanatomical profile of SP. We then investigated and reported three new peculiar cases of SP that allow new insights into the theoretical framework of this neuropsychological condition. We thus propose an innovative theoretical account that integrates previous evidence and the new cases described. We suggest that a defective update of the ongoing dynamic representation of the body finalised to perception and action, may be the key for the disownership feelings of patients with SP. The erroneous spatial representation of the limb contralateral to the lesion would have the logical consequence of delusional misattribution of the seen own arm.

Somatosensory cortical representation of the body size.

The knowledge of the size of our own body parts is essential for accurately moving in space and efficiently interact with objects. A distorted perceptual representation of the body size often represents a core diagnostic criterion for some psychopathological conditions. The metric representation of the body was shown to depend on somatosensory afferences: local deafferentation indeed causes a perceptual distortion of the size of the anesthetized body part. A specular effect can be induced by altering the cortical map of body parts in the primary somatosensory cortex. Indeed, the present study demonstrates, in healthy adult participants, that repetitive Transcranial Magnetic Stimulation to the somatosensory cortical map of the hand in both hemispheres causes a perceptual distortion (i.e., an overestimation) of the size of the participants' own hand (Experiments 1-3), which does not involve other body parts (i.e., the foot, Experiment 2). Instead, the stimulation of the inferior parietal lobule of both hemispheres does not affect the perception of the own body size (Experiment 4). These results highlight the role of the primary somatosensory cortex in the building up and updating of the metric of body parts: somatosensory cortical activity not only shapes our somatosensation, it also affects how we perceive the dimension of our body.

The standard posture of the hand.

Perceived limb position is known to rely on sensory signals and motor commands. Another potential source of input is a standard representation of body posture, which may bias perceived limb position toward more stereotyped positions. Recent results show that tactile stimuli are processed more efficiently when delivered to a thumb in a relatively low position or an index finger in a relatively high position. This observation suggests that we may have a standard posture of the body that promotes a more efficient interaction with the environment. In this study, we mapped the standard posture of the entire hand by characterizing the spatial associations of all 5 digits. Moreover, we show that the effect is not an artifact of intermanual integration. Results showed that the thumb is associated with low positions, while the other fingers are associated with upper locations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Electrophysiological correlates of action observation treatment in children with cerebral palsy: A pilot study.

Action Observation Treatment (AOT) has been shown to be effective in the functional recovery of several clinical populations. However, little is known about the neural underpinnings of the clinical efficacy of AOT in children with Cerebral Palsy (CP). Using electroencephalography (EEG), we recorded µ rhythm desynchronization as an index of sensorimotor cortex modulation during a passive action observation task before and after AOT. The relationship between sensorimotor modulation and clinical outcomes was also assessed. Eight children with CP entered the present randomized controlled crossover pilot study in which the experimental AOT preceded or followed a control Videogame Observation Treatment (VOT). Results provide further evidence of the clinical efficacy of AOT for improving hand motor function in CP, as assessed with the Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function Scale (MUUL). The novel finding is that AOT increases µ rhythm desynchronization at scalp locations corresponding to the hand representation areas. This effect is associated to functional improvement assessed with the MUUL. These preliminary findings, although referred to as a small sample, suggest that AOT may affect upper limb motor recovery in children with CP and modulate the activation of sensorimotor areas, offering a potential neurophysiological correlate to support the clinical utility of AOT.