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It is often noticed that patients with anosognosia for hemiplegia may claim movement of the paralysed limb. Babinski, 1-2 and Babinski and Joltrain, 3 who coined the term anosognosia, noted that one patient, when requested to move a plegic arm, responded "Voila, c'est fait." Many subsequent examiners have confirmed this observation. 4-9 We have suggested the term "illusory limb movement"(ILM) 10 to describe the phenomenon. We consider it to be a form of confabulation 11 which differs from phantom limb phenomena in various ways. 10
Some studies have shown an association between anosognosia for hemiplegia and confabulation. For instance, Feinberget al 12 found that patients with anosognosia for hemiplegia and hemianopia tended to confabulate about visual stimuli in the neglected hemispace. However, Luet al 13 found that patients with epilepsy undergoing anaesthesia of either hemisphere during Wada testing produced confabulations regarding tactile stimuli regardless of the presence or absence of anosognosia for hemiplegia. However, as Liuet al 13 pointed out, neither of the above studies assessed for the presence of confabulations directly concerned with the patient's motor weakness. In fact, confabulations directly involving the movement of the limb have never been systematically studied.
We studied a group of patients with right hemispheric lesions, with and without ILMs to examine the relation between ILMs and anosognosia for hemiplegia and related phenomena.
Methods
All patients referred to the neurobehaviour service over a 4 year period were included in the study if they met the following criteria: (1) right cerebral infarction; (2) near total left upper limb paralysis; (3) sufficiently alert, cooperative, and communicative to answer a series of questions. A total of 11 patients participated. All patients were examined within 1 week of onset of hemiplegia. The study was approved by the investigational review board of the medical centre.
Clinical data are summarised in table 1 . Left arm strength was rated on a scale of 0 to 5 utilising the criteria of the Medical Research Council of Great Britain 14 with 1 representing minimal contraction and 0 total paralysis. Sensory impairment was assessed for pin, touch, and position. Cognitive impairment was tested via the mini mental state examination. 15 Hemispatial neglect was measured with a 40 item cancellation task. Anosognosia for hemiplegia was...