Restoring awareness: a review of rehabilitation in anosognosia for hemiplegia

Disturbances in body awareness offer important insights into neurocognitive processes involved in the construction of the bodily self. This review will focus on a specific disorder of awareness, namely, anosognosia for hemiplegia (AHP), or the denial of motor deficits contralateral to a brain lesion. Recently some progress has been made towards the management and rehabilitation of AHP, however to date no evidence-based treatment exists. Firstly, recent research on AHP will be reviewed, with the aim of providing an overview of the etiology, clinical presentation and assessment of the syndrome, as well as the major neurological and neuropsychological explanations. This article will then focus on recent advances in the management and rehabilitation of AHP, using a case study example of intervention-based (i.e. video replay) motor awareness recovery (Fotopoulou, Rudd, Holmes & Kopelman, 2009). Finally, a dynamic theoretical model of the multifaceted nature of anosognosia, using a predictive coding framework, will be proposed and future directions for research will also be discussed.