Self-observation reinstates motor awareness in anosognosia for hemiplegia

We report a patient with severe anosognosia for hemiplegia, who recovered instantly and permanently when viewing herself in a video replay. We believe the observed dramatic reinstatement of the patient's awareness related to her self-observation 'from the outside' (3rd person perspective) and 'off-line' (at a time later than the actual attempt to execute a movement); her anosognosia had been unaltered when she observed her plegic arm in her ipsilateral visual field (self-observation from a 1st-person perspective and 'on-line'). To our knowledge, the role of self-observation in videos or mirrors has not being assessed in AHP to date. Our study provides preliminary evidence that, when right hemisphere damage impairs the ability to update one's body representation, judgements relying on 3rd-person and off-line self-observation may be spared in some patients and may facilitate 1st person awareness. (C) 2009 Elsevier Ltd. All rights reserved.