The finding:
Contrary to classical teaching in neuropsychiatry, which classifies it as a confabulatory disorder, anosognosia for limb hemiplegia stemming from nondominant parietal lobe infarction is more complex and heterogeneous than previously thought.

Strength and weaknesses:
Study design (subjects were interviewed as well as behaviourally observed for tasks) is a strength.  The major limitation is the small sample size. 

Relevance:
This fascinating paper is highly recommended reading, briefly reviewing the hypothesized neuroscientific bases of conscious sensory perception, followed by the history of anosognosia which until recently was usually classified and taught as a confabulatory disorder comparable to the confabulations of Anton and Korsakoff syndromes. Recent evidence questions this teaching with new theories of how anosognosia in hemiplegia including defects in response-prediction, kinesthetic sense, spatial neglect, and left-right confusion (allochiria); these diverse theories motivated the present study.  The study was unique in that it relied not only on interviews with patients but on direct behavioural observations during motor tasks in order to develop a more refined phenomenological understanding. That the authors found that anosognosia was commonly transient, heterogeneous, internally inconsistent within individual patients, and phenomenologically complex offers information to guide the approach when managing patients suffering from this intriguing condition, rather than anticipating a more predictable, “classic” confabulatory state.

Type of study (EBM guide):
Cohort study

The finding:
Contrary to classical teaching in neuropsychiatry, which classifies it as a confabulatory disorder, anosognosia for limb hemiplegia stemming from nondominant parietal lobe infarction is more complex and heterogeneous than previously thought.

Strength and weaknesses:
Study design (subjects were interviewed as well as behaviourally observed for tasks) is a strength.  The major limitation is the small sample size. 

Relevance:
This fascinating paper is highly recommended reading, briefly reviewing the hypothesized neuroscientific bases of conscious sensory perception, followed by the history of anosognosia which until recently was usually classified and taught as a confabulatory disorder comparable to the confabulations of Anton and Korsakoff syndromes. Recent evidence questions this teaching with new theories of how anosognosia in hemiplegia including defects in response-prediction, kinesthetic sense, spatial neglect, and left-right confusion (allochiria); these diverse theories motivated the present study.  The study was unique in that it relied not only on interviews with patients but on direct behavioural observations during motor tasks in order to develop a more refined phenomenological understanding. That the authors found that anosognosia was commonly transient, heterogeneous, internally inconsistent within individual patients, and phenomenologically complex offers information to guide the approach when managing patients suffering from this intriguing condition, rather than anticipating a more predictable, “classic” confabulatory state.

Type of study (EBM guide):
Cohort study