ArticlePublisher preview availableLiterature Review

Motor awareness: a model based on neurological syndromes

Authors:
Valentina Pacella at University School for Advanced Studies IUSS Pavia
Valentina Pacella
Valentina Moro at University of Verona
Valentina Moro
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract and Figures

Motor awareness is a complex, multifaceted construct involving the awareness of both (i) one’s motor state while executing a movement or remaining still and (ii) one’s motor abilities. The analysis of neurological syndromes associated with motor disorders suggests the existence of various different components which are, however, integrated into a model of motor awareness. These components are: (i) motor intention, namely, a conscious desire to perform an action; (ii) motor monitoring and error recognition, that is, the capacity to check the execution of the action and identify motor errors; and (iii) a general awareness of one’s own motor abilities and deficits, that is, the capacity to recognize the general state of one’s motor abilities about the performance of specific actions and the potential consequences of motor impairment. Neuroanatomical correlates involving the parietal and insular cortices, the medial and lateral frontal regions, and subcortical structures (basal ganglia and limbic system) support this multi-component model. Specific damage (or disconnections) to these structures results in a number of different disorders in motor awareness, such as anosognosia for hemiplegia and apraxia, and a number of symptoms which are specific to motor intention disorders (e.g., the Anarchic Hand Syndrome and Tourette’s Syndrome) or motor monitoring (e.g., Parkinson’s and Huntington’s diseases). All of these clinical conditions are discussed in the light of a motor awareness model.
Cortical and subcortical structures involved in motor awareness as emerging from neurological patients. For each section, gray matter structures are shown in the lateral (left) and medial (right) view, while white matter tracts are shown for visualization purposes only in the medial (right) view. a Gray and white matter structures involved in the awareness of motor intention. Gray matter structures are highlighted in red. b Gray (highlighted in dark blue) structures involved in the awareness of motor execution. c Gray and white matter structures involved in the awareness of general motor abilities. Gray matter structures are highlighted in teal. ACC Anterior Cingulate Cortex, Ag Angular gyrus, C Caudate, CC Corpus Callosum, Ci Cingulum, FAT frontal aslant tract, FST fronto-striatal tract, GM Gray Matter, Ins Insula, PMc Premotor Cortex, Pre-SMA pre-Supplementary Motor Area, Pu Putamen, SLF I first branch of the superior longitudinal fasciculus, SLF II second branch of the superior longitudinal fasciculus, SLF III third branch of the superior longitudinal fasciculus, SMA Supplementary Motor Area, SMg Supramarginal gyrus, TP Temporal pole
Cortical and subcortical structures involved in motor awareness as emerging from neurological patients. For each section, gray matter structures are shown in the lateral (left) and medial (right) view, while white matter tracts are shown for visualization purposes only in the medial (right) view. a Gray and white matter structures involved in the awareness of motor intention. Gray matter structures are highlighted in red. b Gray (highlighted in dark blue) structures involved in the awareness of motor execution. c Gray and white matter structures involved in the awareness of general motor abilities. Gray matter structures are highlighted in teal. ACC Anterior Cingulate Cortex, Ag Angular gyrus, C Caudate, CC Corpus Callosum, Ci Cingulum, FAT frontal aslant tract, FST fronto-striatal tract, GM Gray Matter, Ins Insula, PMc Premotor Cortex, Pre-SMA pre-Supplementary Motor Area, Pu Putamen, SLF I first branch of the superior longitudinal fasciculus, SLF II second branch of the superior longitudinal fasciculus, SLF III third branch of the superior longitudinal fasciculus, SMA Supplementary Motor Area, SMg Supramarginal gyrus, TP Temporal pole
… 
of the anatomical correlates of motor awareness disorders. Gray matter structures are represented in the black boxes. Dotted boxes indicate white matter tracts. Structural and functional connections between the structures are represented by black arrows. The colored lines surround the structures that have been found to be directly lesioned in the disorders of each motor component, such as (from left to right) (i) motor execution (blue lines), (ii) motor intention (red line), and (iii) general motor abilities (teal line). Colored crosses indicate abnormal connectivity that has been found in the disorders of each motor awareness component, namely motor execution (blue crosses), motor intention (red crosses), and motor execution (teal crosses). ACC Anterior Cingulate Cortex, BG Basal Ganglia, CC Corpus Callosum, Ci Cingulum, IFG Inferior Frontal Gyrus, Ins Insula, P Parietal cortex, SMA Supplementary Motor Area, T Temporal lobe
of the anatomical correlates of motor awareness disorders. Gray matter structures are represented in the black boxes. Dotted boxes indicate white matter tracts. Structural and functional connections between the structures are represented by black arrows. The colored lines surround the structures that have been found to be directly lesioned in the disorders of each motor component, such as (from left to right) (i) motor execution (blue lines), (ii) motor intention (red line), and (iii) general motor abilities (teal line). Colored crosses indicate abnormal connectivity that has been found in the disorders of each motor awareness component, namely motor execution (blue crosses), motor intention (red crosses), and motor execution (teal crosses). ACC Anterior Cingulate Cortex, BG Basal Ganglia, CC Corpus Callosum, Ci Cingulum, IFG Inferior Frontal Gyrus, Ins Insula, P Parietal cortex, SMA Supplementary Motor Area, T Temporal lobe
… 
Figures - available from: Brain Structure and Function
This content is subject to copyright. Terms and conditions apply.
A preview of this full-text is provided by Springer Nature.
Learn more
Content available from Brain Structure and Function
This content is subject to copyright. Terms and conditions apply.
Vol.:(0123456789)
1 3
Brain Structure and Function (2022) 227:3145–3160
https://doi.org/10.1007/s00429-022-02558-y
REVIEW
Motor awareness: amodel based onneurological syndromes
ValentinaPacella1,2 · ValentinaMoro3
Received: 6 December 2021 / Accepted: 24 August 2022 / Published online: 6 September 2022
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022
Abstract
Motor awareness is a complex, multifaceted construct involving the awareness of both (i) one’s motor state while executing
a movement or remaining still and (ii) one’s motor abilities. The analysis of neurological syndromes associated with motor
disorders suggests the existence of various different components which are, however, integrated into a model of motor aware-
ness. These components are: (i) motor intention, namely, a conscious desire to perform an action; (ii) motor monitoring
and error recognition, that is, the capacity to check the execution of the action and identify motor errors; and (iii) a general
awareness of one’s own motor abilities and deficits, that is, the capacity to recognize the general state of one’s motor abilities
about the performance of specific actions and the potential consequences of motor impairment. Neuroanatomical correlates
involving the parietal and insular cortices, the medial and lateral frontal regions, and subcortical structures (basal ganglia
and limbic system) support this multi-component model. Specific damage (or disconnections) to these structures results
in a number of different disorders in motor awareness, such as anosognosia for hemiplegia and apraxia, and a number of
symptoms which are specific to motor intention disorders (e.g., the Anarchic Hand Syndrome and Tourette’s Syndrome) or
motor monitoring (e.g., Parkinson’s and Huntington’s diseases). All of these clinical conditions are discussed in the light of
a motor awareness model.
Keywords Motor awareness networks· Model for motor awareness· Motor execution· Motor intention· Motor
monitoring· Sense of agency· Anosognosia
Introduction
When considering motor awareness, one can imagine two
partially different situations: (i) the presence and execution
of an actual movement, of whose an individual is or is not
aware, and (ii) a more general acknowledgement of one’s
own motor abilities (i.e., “I can move that part of my body”;
“I can do that action”—e.g., using a spoon, walking) and
limitations (i.e., “I cannot run a marathon”).
Experiencing the awareness of a movement (or acknowl-
edging an inability to perform it) is the result of various
different, integrated, cognitive components that are related
to the person’s motor state. These might concern an inten-
tion to move or stay still, a sense of being the agent of an
action, an ability to predict sensorimotor feedback, and the
monitoring of the execution of a movement. The ability to
experience one’s own body has been recently introduced
as a necessary component for motor awareness. Specifi-
cally, interoceptive signal processing has been ascribed to
the individual’s voluntary sense of movement, with the will
to move emerging from the perceived body signals (Ganos
etal. 2015a). Indeed, the multisensory integration of infor-
mation coming from the body contributes to motor aware-
ness as it allows the individual to maintain a sense of bodily
self (Craig 2009) and the representation of their own body
in terms of proprioception and limb position in space (Sirigu
etal. 1991; Coslett etal. 2008; Romano etal. 2013) during
the execution of a movement. Moreover, the feeling of being
in control of one’s own actions defines the sense of agency,
which also contributes to the aware motor performance and
* Valentina Pacella
valentina.pacella.90@gmail.com
* Valentina Moro
valentina.moro@univr.it
1 Groupe d’Imagerie Neurofonctionnelle, Institut des Maladies
Neurodégénératives-UMR 5293, CNRS, CEA University
ofBordeaux, 33076Bordeaux, CS, France
2 Brain Connectivity andBehaviour Laboratory, Sorbonne
Universities, Paris, France
3 NPSY.Lab-VR, Department ofHuman Sciences, University
ofVerona, Lungadige Porta Vittoria 17, 37129Verona, Italy
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... However, this question was not considered in the final score because of difficulties categorizing responses that did not provide sensory-specific information, which were the focus of the current study. Kinaesthetic sensations were not included in this assessment, as these represent feelings associated with motor awareness (Moro et al., 2021;Pacella and Moro, 2022;Beccherle et al., 2023) rather than with body ownership. ...
View
What I think she thinks about my paralysed body: Social inferences about disability-related content in anosognosia for hemiplegia
Article
  • Jun 2024
  • J NEUROPSYCHOL
The neuropsychological disorder of anosognosia for hemiplegia (AHP) can offer unique insights into the neurocognitive processes of body consciousness and representation. Previous studies have found associations between selective social cognition deficits and anosognosia. In this study, we examined how such social cognition deficits may directly interact with representations of one's body as disabled in AHP. We used a modified set of previously validated Theory of Mind (ToM) stories to create disability‐related content that was related to post‐stroke paralysis and to investigate differences between right hemisphere damage patients with ( n = 19) and without ( n = 19) AHP. We expected AHP patients to perform worse than controls when trying to infer paralysis‐related mental states in the paralysis‐related ToM stories and explored whether such differences depended on the inference patients were asked to perform (e.g. self or other referent perspective‐taking). Using an advanced structural neuroimaging technique, we expected selective social cognitive deficits to be associated with posterior parietal cortex lesions and deficits in self‐referent perspective‐taking in paralysis‐related mentalising to be associated with frontoparietal disconnections. Group‐ and individual‐level results revealed that AHP patients performed worse than HP controls when trying to infer paralysis‐related mental states. Exploratory lesion analysis results revealed some of the hypothesised lesions, but also unexpected white matter disconnections in the posterior body and splenium of the corpus collosum associated with a self‐referent perspective‐taking in paralysis‐related ToM stories. The study has implications for the multi‐layered nature of body awareness, including abstract, social perspectives and beliefs about the body.
View
View
View
View
Feeling of Ownership over an Embodied Avatar's Hand Brings About Fast Changes of Fronto-Parietal Cortical Dynamics
Article
Full-text available
  • Dec 2021
When we look at our body parts, we are immediately aware that they belong to us and we rarely doubt about the integrity, continuity, and sense of ownership of our body. Despite this certainty, immersive virtual reality (IVR) may lead to a strong feeling of embodiment over an artificial body part seen from a first-person perspective (1PP). Although such feeling of ownership (FO) has been described in different situations, it is not yet understood how this phenomenon is generated at neural level. To track the real-time brain dynamics associated with FO, we delivered transcranial magnetic stimuli over the hand region in the primary motor cortex (M1) and simultaneously recorded electroencephalography (EEG) in 19 healthy volunteers (11 male/8 female) watching IVR renderings of anatomically plausible (full-limb) versus implausible (hand disconnected from the forearm) virtual limbs. Our data show that embodying a virtual hand is temporally associated with a rapid drop of cortical activity of the onlookers’ hand region in the M1 contralateral to the observed hand. Spatiotemporal analysis shows that embodying the avatar’s hand is also associated with fast changes of activity within an interconnected fronto-parietal circuit ipsilateral to the brain stimulation. Specifically, an immediate reduction of connectivity with the premotor area is paralleled by an enhancement in the connectivity with the posterior parietal cortex (PPC) which is related to the strength of ownership illusion ratings and thus likely reflects conscious feelings of embodiment. Our results suggest that changes of bodily representations are underpinned by a dynamic cross talk within a highly-plastic, fronto-parietal network.
View
The auditory brain in action: Intention determines predictive processing in the auditory system—A review of current paradigms and findings
Article
Full-text available
  • Sep 2021
According to the ideomotor theory, action may serve to produce desired sensory outcomes. Perception has been widely described in terms of sensory predictions arising due to top-down input from higher order cortical areas. Here, we demonstrate that the action intention results in reliable top-down predictions that modulate the auditory brain responses. We bring together several lines of research, including sensory attenuation, active oddball, and action-related omission studies: Together, the results suggest that the intention-based predictions modulate several steps in the sound processing hierarchy, from preattentive to evaluation-related processes, also when controlling for additional prediction sources (i.e., sound regularity). We propose an integrative theoretical framework—the extended auditory event representation system (AERS), a model compatible with the ideomotor theory, theory of event coding, and predictive coding. Initially introduced to describe regularity-based auditory predictions, we argue that the extended AERS explains the effects of action intention on auditory processing while additionally allowing studying the differences and commonalities between intention- and regularity-based predictions—we thus believe that this framework could guide future research on action and perception.
View
Updating beliefs beyond the here-and-now: The counter-factual self in anosognosia for hemiplegia
Article
Full-text available
  • May 2021
The syndrome of anosognosia for hemiplegia, or the lack of awareness for one’s paralysis following right hemisphere stroke, can provide unique insights into the neurocognitive mechanisms of self-awareness. Yet it remains unclear whether anosognosia for hemiplegia is a modality-specific deficit of sensorimotor monitoring, or whether domain-general processes of attention and belief-updating converge to cause anosognosia for hemiplegia. Using a Bayesian learning framework, we formalised and empirically investigated the hypothesis that failures to update anosognosic beliefs can be explained by abnormalities in the relative uncertainty (i.e. precision) ascribed to prior beliefs versus sensory information in different contexts. We designed a new motor belief-updating task that manipulated both the temporal (prospective and retrospective) and spatial (hemispace most affected by inattention and hemispace less affected by inattention) conditions in which beliefs had to be updated, and we validated its sensitivity to anosognosia for hemiplegia in 26 patients with right hemisphere stroke. We then computed and empirically tested two different Bayesian predictors of prospective beliefs using two proxies for precision in anosognosia for hemiplegia patients: (i) standardised, neuropsychological measures of objective attention abilities, i.e. visuospatial neglect scores, and (ii) subjective uncertainty reports, i.e. confidence ratings. Our results suggest that while neglect does not affect local, sensorimotor error monitoring, it does seem to affect the degree to which observed errors are used to update more general, prospective beliefs about counterfactual motor abilities in anosognosia for hemiplegia. Difficulties in such ‘counterfactual’ belief-updating were associated with disruptions in tracts of the ventral attentional network (i.e. superior longitudinal fasciculus connecting the temporo-parietal junction and ventral frontal cortex) and associated lesions to the insula, inferior parietal cortex and superior temporal regions. These results suggest that self-awareness extends beyond local, retrospective monitoring, requiring also salience-based, convergence of beliefs about the self that go beyond the ‘here-and-now’ of sensorimotor experience.
View
The Role of White Matter Disconnection in the Symptoms Relating to the Anarchic Hand Syndrome: A Single Case Study
Article
Full-text available
  • May 2021
  • BSRCCS
The anarchic hand syndrome refers to an inability to control the movements of one’s own hand, which acts as if it has a will of its own. The symptoms may differ depending on whether the brain lesion is anterior, posterior, callosal or subcortical, but the relative classifications are not conclusive. This study investigates the role of white matter disconnections in a patient whose symptoms are inconsistent with the mapping of the lesion site. A repeated neuropsychological investigation was associated with a review of the literature on the topic to identify the frequency of various different symptoms relating to this syndrome. Furthermore, an analysis of the neuroimaging regarding structural connectivity allowed us to investigate the grey matter lesions and white matter disconnections. The results indicated that some of the patient’s symptoms were associated with structures that, although not directly damaged, were dysfunctional due to a disconnection in their networks. This suggests that the anarchic hand may be considered as a disconnection syndrome involving the integration of multiple antero-posterior, insular and interhemispheric networks. In order to comprehend this rare syndrome better, the clinical and neuroimaging data need to be integrated with the clinical reports available in the literature on this topic.
View
Awareness is in the eye of the observer: Preserved third-person awareness of deficit in anosognosia for hemiplegia
Article
  • Mar 2022
  • NEUROPSYCHOLOGIA
In recent decades, the research traditions of (first-person) embodied cognition and of (third-person) social cognition have approached the study of self-awareness with relative independence. However, neurological disorders of self-awareness offer a unifying perspective to empirically investigate the contribution of embodiment and social cognition to self-awareness. This study focused on a neuropsychological disorder of bodily self-awareness following right-hemisphere damage, namely anosognosia for hemiplegia (AHP). A previous neuropsychological study has shown AHP patients, relative to neurological controls, to have a specific deficit in third-person perspective taking and allocentric stance (the other unrelated to the self) in higher order mentalizing tasks. However, no study has tested if verbal awareness of motor deficits is influenced by perspective-taking and centrism and identified the related anatomical correlates. Accordingly, two novel experiments were conducted with right-hemisphere stroke patients with (n = 17) and without AHP (n = 17) that targeted either their own (egocentric, experiment 1) or another stooge patients (allocentric, experiment 2) motor abilities from a first-or-third person perspective. In both experiments, neurological controls showed no significant difference in perspective-taking, suggesting that social cognition is not a necessary consequence of right-hemisphere damage. More specifically, experiment 1 found AHP patients more aware of their own motor paralysis (egocentric stance) when asked from a third compared to a first-person perspective, using both group level and individual level analysis. In experiment 2, AHP patients were less accurate than controls in making allocentric judgements about the stooge patient, but with only a trend towards significance and with no difference between perspectives. As predicted, deficits in egocentric and allocentric third-person perspective taking were associated with lesions in the middle frontal gyrus, superior temporal and supramarginal gyri, and white matter disconnections were more prominent with deficits in allocentricity. Behavioural and neuroimaging results demonstrate the intersecting relationship between bodily self-awareness and self-and-other-directed metacognition or mentalisation.
View
Volition and “free will”
Preprint
  • Jan 2022
Philosophers have debated the “free will” for centuries, yet it is only in recent years that voluntary actions have become an object of investigation for cognitive neuroscience. This review begins by attempting a definition of volition (i.e., the mental state associated specifically with voluntary actions) that could be relevant for cognitive neuroscience. We then review the neuropsychology of volition. Alterations in voluntary behaviour in neurological and psychiatric patients first suggested the possibility that specific cognitive processes of volition have specific bases in the brain. These findings counter traditional dogmas that human volition is somehow ineffable, and instead suggest that voluntary actions depend on specific brain circuitry that is accessible to scientific investigation.The second part of the review focuses on the experimental psychology of volition. A number of studies have combined a systematic manipulation of experimental conditions, and recording of brain processes associated with voluntary action. We argue that this combination is most likely to identify the brain processes specifically associated with volition, and we therefore review these studies systematically. For example, several studies link the Readiness Potential of the EEG to preparatory conscious preplanning of actions. Further, a meta-analysis of neuroimaging studies (PET/ fMRI) reveals a distinctive pattern of activations for choosing one among many possible actions - a key element of volition. The medial frontal cortex appears to make a key contribution to both these biomarkers of volition.
View
Rehabilitation and modulation aimed at ameliorating awareness in anosognosia for hemiplegia
Article
  • Mar 2021
Anosognosia for hemiplegia is a multifaceted syndrome that has a detrimental impact on the patient. Various theories based on behavioural and neuroanatomical data have been proposed to explain the mechanisms underlying the symptoms. These approaches have resulted in the development of a number of different proce- dures aimed at reducing symptoms or enhancing residual aware- ness. The article reviews rehabilitation attempts and their effects on individual cases and groups of patients. A selection of material was made using indexed articles published between 1987 and 2019. The inclusion criteria were: i) the presence of a neuropsychological assessment and ii) the presence of one or more methods specifically used to reduce AHP symptoms, or to enhance residual forms of awareness. The review indicates that intervention procedures have moved from bottom-up to more cognitive and metacognitive approaches. In fact, initially anosognosia for hemiplegia was considered to be a co-oc- current symptom of other neuropsychological conditions (e.g. spa- tial neglect) and interventions were borrowed from the rehabilitation techniques that had had success in relieving these other disorders. When anosognosia was identified as an independent syndrome and residual forms of awareness were demonstrated, procedures attempting to modulate awareness started to focus on specific components of the disease, such as visual perspective, motor monitoring and the updating of beliefs. Although further research is needed in this field, the most recent approaches seem to give more stable, lasting results than earlier methods. A timeline for interventions relating to anosognosia is suggested, and ethical issues are also discussed.
View
Conscious intention and human action: Review of the rise and fall of the readiness potential and Libet’s clock
Article
  • Sep 2021
  • CONSCIOUS COGN
Is consciousness—the subjective awareness of the sensations, perceptions, beliefs, desires, and intentions of mental life—a genuine cause of human action or a mere impotent epiphenomenon accompanying the brain’s physical activity but utterly incapable of making anything actually happen? This article will review the history and current status of experiments and commentary related to Libet’s influential paper (Brain 106:623–664, 1983) whose conclusion “that cerebral initiation even of a spontaneous voluntary act …can and usually does begin unconsciously” has had a huge effect on debate about the efficacy of conscious intentions. Early (up to 2008) and more recent (2008 on) experiments replicating and criticizing Libet’s conclusions and especially his methods will be discussed, focusing especially on recent observations that the readiness potential (RP) may only be an “artifact of averaging” and that, when intention is measured using “tone probes,” the onset of intention is found much earlier and often before the onset of the RP. Based on these findings, Libet’s methodology was flawed and his results are no longer valid reasons for rejecting Fodor’s “good old commonsense belief/desire psychology” that “my wanting is causally responsible for my reaching.”.
View
The Motor Unawareness Assessment (MUNA): A new tool for the assessment of Anosognosia for hemiplegia
Article
Introduction: Anosognosia for hemiplegia (AHP) is a condition in which patients with paralysis are unaware of their motor deficits. Research into AHP is important for improving its treatment and providing insight into the neurocognitive mechanism of motor awareness. Unfortunately, most studies use assessments with widely recognized limitations. The study aims at developing a psychometrically validated assessment of AHP. Method: We developed a 40-item Motor Unawareness Assessment (MUNA) and administered it to 131 right-hemisphere stroke patients. Principal Component Analysis (PCA) was used to identify the underlying factor structure. Receiver Operating Characteristics (ROC) analysis was used to determine diagnostic cutoffs, and Area Under the Curve (AUC) analysis used to assess these cutoffs. Relationships with demographic, clinical and neuropsychological variables were explored. Results: Five factors were identified: explicit motor awareness, implicit motor awareness, impaired sense of ownership, agency and illusory movement, and emotional reactions. Established cutoffs had excellent sensitivity and specificity. Clinical, neuropsychological and demographic variables did not predict overall MUNA score but were related to specific subcomponents. Conclusion: The MUNA can differentiate various facets of AHP and provides a detailed profile of (un)awareness. The MUNA can therefore provide robust assessment for research purposes and assist clinicians when developing targeted rehabilitation.
View
Doing it Wrong: A Systematic Review on Electrocortical and Behavioral Correlates of Error Monitoring in Patients with Neurological Disorders
Article
  • Jan 2021
  • NEUROSCIENCE
Detecting errors in one’s own and other’s actions is a crucial ability for learning and adapting behavior to everchanging, highly volatile environments. Studies in healthy people demonstrate that monitoring errors in one’s own and others’ actions are underpinned by specific neural systems that are dysfunctional in a variety of neurological disorders. In this review, we first briefly discuss the main findings concerning error detection and error awareness in healthy subjects, the current theoretical models, and the tasks usually applied to investigate these processes. Then, we report a systematic search for evidence of dysfunctional error monitoring among neurological populations (basal ganglia, neurodegenerative, white-matter diseases and acquired brain injury). In particular, we examine electrophysiological and behavioral evidence for specific alterations of error processing in neurological disorders. Error-related negativity (ERN) amplitude were reduced in most (although not all) neurological patient groups, whereas Positivity Error (Pe) amplitude appeared not to be affected in most patient groups. Also theta activity was reduced in some neurological groups, but consistent evidence on the oscillatory activity has not been provided thus far. Behaviorally, we did not observe relevant patterns of pronounced dysfunctional (post-) error processing. Finally, we discuss limitations of the existing literature, conclusive points, open questions and new possible methodological approaches for clinical studies.
View