The rehabilitation of motor deficits following stroke relies on both sensorimotor and cognitive abilities, thereby involving large-scale brain networks. However, few studies have investigated the integration between motor and cognitive domains, as well as its neuroanatomical basis. In this retrospective study, upper limb motor responsiveness to technology-based rehabilitation was examined in a sample of 29 stroke patients (18 with right and 11 with left brain damage). Pretreatment sensorimotor and attentional abilities were found to influence motor recovery. Training responsiveness increased as a function of the severity of motor deficits, whereas spared attentional abilities, especially visuospatial attention, supported motor improvements. Neuroanatomical analysis of structural lesions and white matter disconnections showed that the poststroke motor performance was associated with putamen, insula, corticospinal tract, and frontoparietal connectivity. Motor rehabilitation outcome was mainly associated with the superior longitudinal fasciculus and partial involvement of the corpus callosum. The latter findings support the hypothesis that motor recovery engages large-scale brain networks that involve cognitive abilities and provides insight into stroke rehabilitation strategies.

Apraxia is a well-known syndrome characterized by the sufferer’s inability to perform routine gestures. In an attempt to understand the syndrome better, various different theories have been developed and a number of classifications of different subtypes have been proposed. In this paper review, we will address these theories with a specific focus on how the use of objects helps us to better understand upper limb apraxia. With this aim, we will consider transitive versus intransitive action dissociation as well as less frequent types of apraxia involving objects, i.e. constructive apraxia and magnetic apraxia. Pantomime and the imitation of objects in use are also considered with a view to dissociating the various different components involved in upper limb apraxia. Finally, we discuss the evidence relating to action recognition and awareness of errors in the execution of actions. Various different components concerning the use of objects emerge from our analysis and the results show that knowledge of an object and sensory-motor representations are supported by other functions such as spatial and body representations, executive functions and monitoring systems.

Pragmatic impairments are largely documented, yet rarely considered in clinical practice, also owing to a poor characterization of pragmatic profiles across conditions, as well as some overlap with theory of mind (ToM) in the conceptualization of pragmatics. Here, we present the outcome of a 10-year programme that started with creating a novel test, the Assessment of Pragmatic Abilities and Cognitive Substrates (APACS)–which we evolved by its application alongside ToM assessment in seven clinical groups (i.e. amyotrophic lateral sclerosis, multiple sclerosis, right-hemisphere stroke, Parkinson’s disease, traumatic brain injury, schizophrenia and dyslexia). The multistudy cross-diagnostic analysis of 454 participants revealed that receptive pragmatic skills were impaired in all clinical groups compared with controls, with schizophrenia showing the most severely impaired profile, whereas expressive pragmatic skills were impaired in four neurological conditions (i.e. Parkinson’s disease, amyotrophic lateral sclerosis, right-hemisphere stroke and traumatic brain injury). The association with ToM was limited to receptive pragmatics and was moderate in the whole sample. Overall, pragmatic impairment emerged as a diffuse feature of neurological and psychiatric illnesses, which contributes to defining complex socio-communicative phenotypes but cannot be equated to a social cognition deficit and should hence be the target of specific assessment and intervention. This article is part of the theme issue ‘At the heart of human communication: new views on the complex relationship between pragmatics and Theory of Mind’.

Cognitive impairment after stroke is heterogeneous: there is no strict correspondence between brain damage and magnitude of deficit or recovery. Protective factors such as cognitive or brain reserve have been invoked to explain the mismatch. Here, we consider the opposite point of view: the instances in which this protection is overturned. We leveraged on multitasking to stress the brain’s processing limits and unveil deficits that may be missed by standard testing in a sample of 46 patients with unilateral subacute to chronic stroke and no sign of lateralized spatial-attentional disorders at neuropsychological paper-and-pencil tests. Multivariate analyses identified a phenotype of patients with high susceptibility to multitasking, showing stark contralesional spatial awareness deficit only when multitasking. Multivariate brain-behavior mapping based on lesions location and structural disconnections pointed to the Multiple-Demand System, a network of frontal and fronto-parietal areas subserving domain-general processes. Damage in this network may critically interact with domain-specific processes, resulting in subtle and yet invalidating deficits. Indeed, these patients (one-third of the sample) presented worse performance in tests evaluating activities of daily living and domain-general abilities. We conclude that the theoretical construct of susceptibility to multitasking helps understanding what marks the passage to clinically visible deficits after brain damage.