Brain lateralization of complex movement: neuropsychological evidence from unilateral stroke.

Complex movement (CM) refers to the representation of a goal-oriented action and is classified as either transitive (use of tools) or intransitive (communication gestures). Both types of CM have three specific components: temporal, spatial, and content, which are subdivided into specific error types (SET). Since there is debate regarding the contribution of each brain hemisphere for the types of CM, our objective was to describe the brain lateralization of components and SET of transitive and intransitive CM. We studied 14 patients with a left hemisphere stroke (LH), 12 patients with a right hemisphere stroke (RH), and 16 control subjects. The Florida Apraxia Screening Test-Revised (FAST-R, Rothi et al., 1988) was used for the assessment of CM. Both clinical groups showed a worse performance than the control group on the total FAST-R and transitive movement scores (p<0.001). Failures in Spatial and Temporal components were found in both clinical groups, but only LH patients showed significantly more Content errors (p<0.01) than the control group. Also, only the LH group showed a higher number of errors for intransitive movements score (p=0.017), due to lower scores in the content component, compared to the control group (p=0.04). Transitive and intransitive CMs differ in their neurocognitive representation; transitive CM shows a bilateral distribution of its components when compared to intransitive CM, which shows a preferential left hemisphere representation. This could result from higher neurocognitive demands for movements that require use of tools, compared with more automatic communication gestures.