{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"bioRxiv"}],"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:24:44Z","timestamp":1793809484076,"version":"4.6.1"},"posted":{"date-parts":[[2026,4,2]]},"group-title":"Neuroscience","reference-count":74,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"award":["#R01NS115862"],"award-info":[{"award-number":["#R01NS115862"]}],"id":[{"id":"https:\/\/ror.org\/001d55x84","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>Many individuals with limb apraxia after left-hemisphere stroke exhibit a lack of awareness of their tool-related action errors, i.e., unawareness of apraxia (UA; also called anosognosia of apraxia). Little is known about the prevalence of UA, the relationship between UA and apraxia severity, or its underlying mechanisms. Here, we assessed both the causes and consequences of UA. Based on a mechanistic model, we hypothesized that UA may arise because of deficits in representations signaling how tool-related movements should look and feel \u2013 a component of action knowledge \u2013 and that degradation of this knowledge impedes the detection of mismatches between planned and actual tool-related actions. We further predicted that a consequence of UA is a reduction in error-correction attempts. Fifty-six individuals with chronic LCVA gestured to show how to use tools. Immediately after the gesture production task, participants were asked if they made any errors. All participants also completed an action knowledge task to measure the integrity of tool-related movement goals. Individuals were denoted as exhibiting UA if they performed below a normative cutoff for apraxia yet reported making no errors. Our sample included 21 individuals with apraxia; of these, nearly half (48%) exhibited UA. These two groups made a comparable number of gesture errors and were of equivalent stroke severity, yet individuals with UA had significantly more impaired action knowledge. Additionally, individuals with UA were less likely to attempt to correct their errors compared to individuals who were aware of their apraxia. These data are consistent with the hypothesis that action knowledge (how tool actions look and feel) serves a key role in error detection and awareness of apraxia and may contribute to the difficulties with everyday tasks experienced by many people with apraxia.<\/jats:p>\n                <jats:sec>\n                  <jats:title>Abbreviated Summary<\/jats:title>\n                  <jats:p>Thibault et al. show that individuals who are unaware of their tool-use errors (unawareness of apraxia) are selectively impaired at representing how tool-related movements look and feel (action knowledge). Action knowledge may be a central component for the detection of tool-use errors made by individuals with apraxia in everyday tasks.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Graphical Abstract<\/jats:title>\n                  <jats:fig id=\"ufig1\" position=\"float\" fig-type=\"figure\" orientation=\"portrait\">\n                    <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"715610v3_ufig1\" position=\"float\" orientation=\"portrait\"\/>\n                  <\/jats:fig>\n                <\/jats:sec>","DOI":"10.64898\/2026.03.31.715610","type":"posted-content","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T22:10:32Z","timestamp":1775167832000},"source":"Crossref","is-referenced-by-count":0,"title":["The role of deficient action knowledge in unawareness (anosognosia) of tool-action errors after left-hemisphere stroke"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5480-2055","authenticated-orcid":false,"given":"Simon","family":"Thibault","sequence":"first","affiliation":[{"name":"Jefferson Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, PA 19027, USA"},{"name":"Centre de Recherche en Psychologie et Neurosciences, Aix-Marseille Universit\u00e9, 13003 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rand","family":"Williamson","sequence":"additional","affiliation":[{"name":"Jefferson Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, PA 19027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron L.","family":"Wong","sequence":"additional","affiliation":[{"name":"Jefferson Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, PA 19027, USA"},{"name":"Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel J.","family":"Buxbaum","sequence":"additional","affiliation":[{"name":"Jefferson Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, PA 19027, USA"},{"name":"Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026110407251017000_2026.03.31.715610v3.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2010.05447.x"},{"key":"2026110407251017000_2026.03.31.715610v3.2","doi-asserted-by":"crossref","unstructured":"Buxbaum LJ , Kal\u00e9nine S. 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