A distributed network critical for selecting among tool-directed actions.

Tools pose a challenge to the need to select actions appropriate for task goals and environmental constraints. For many tools (e.g., calculator), actions for "using" and "grasping-to-move" conflict with each other and may compete during selection. To date, little is known about the mechanisms that enable selection between possible tool actions or their neural substrates. The study of patients with chronic left hemisphere stroke, many of whom are deficient in tool-use action (apraxic), provides an opportunity to elucidate these issues. Here, 31 such patients pantomimed or recognized tool use actions for "conflict" and "non-conflict" tools. Voxel-based lesion-symptom mapping (VLSM), lesion subtraction, and tractographic overlap analyses were used to determine brain regions necessary for selecting among tool-directed actions. Lesions to posterior middle temporal gyrus (pMTG) and anterior intraparietal sulcus (aIPS) tended to impair production of use actions similarly for both conflict and non-conflict tools. By contrast, lesions to the supramarginal gyrus (SMG), inferior frontal gyrus (IFG)/anterior insula, and superior longitudinal fasciculus (SLF) specifically impaired production of use actions for conflict tools. Patients' errors on conflict tools suggested inappropriate selection of grasping actions and difficulty selecting single actions. Use/grasp conflict had no effect on action recognition. We suggest that the SMG/SLF/IFG pathway implements biased competition between possible tool actions, while aIPS and pMTG compute the structure-based and skilled use actions, respectively, that constitute input to this competitive process. This is the first study to demonstrate a reliable link between a characteristic of single tools (i.e., their association with different use and grasp actions) and action selection difficulties. Additionally, the data allow us to posit an SMG-involved subtype of apraxia characterized by an inability to resolve action competition.