The common emerging factor in<unk>  is that the primary motor cortex controlling<unk>  movement is isolated from premotor cortex influences but remains generally intact in its ability to execute movements of the<unk> . A 2009 fMRI study looking at the temporal sequence of activation of components of a cortical network associated with voluntary movement in normal individuals demonstrated "an anterior-to-posterior temporal gradient of activity from supplemental motor area through premotor and motor cortices to the posterior parietal cortex". Therefore, with normal voluntary movement, the emergent sense of agency appears to be associated with an orderly sequence of activation that develops initially in the anteromedial frontal cortex in the vicinity of the supplementary motor complex on the medial surface of the frontal aspect of the hemisphere (including the supplementary motor area) prior to activation of the primary motor cortex in the pre-central gyrus on the lateral aspect of the hemisphere, when the<unk>  movement is being generated. Activation of the primary motor cortex, presumed to be directly involved in the execution of the action via projections into the corticospinal component of the pyramidal tracts, is then followed by activation of the posterior parietal cortex, possibly related to the receipt of recurrent or re-afferent somatosensory feedback generated from the periphery by the movement which would normally interact with the efference copy transmitted from primary motor cortex to permit the movement to be recognized as self-generated rather than imposed by an external force. That is, the efference copy allows the recurrent afferent somatosensory flow from the periphery associated with the self-generated movement to be recognized as re-afference as distinct from ex-afference. Failure of this mechanism may lead to a failure to distinguish between self-generated and externally generated movement of the limb. This anomalous situation in which re-afference from a self-generated movement is mistakenly registered as ex-afference due to a failure to generate and successfully transmit an efference copy to sensory cortex, could readily lead to the interpretation that what is in actuality a self-generated movement has been produced by an external force as a result of the failure to develop a sense of agency in association with emergence of the self-generated movement (see below for a more detailed discussion). A 2007 fMRI study examining the difference in functional brain activation patterns associated with<unk>  as compared to non-alien "volitional" movement in a patient with<unk>  found that<unk>  movement involved anomalous isolated activation of the primary motor cortex in the damaged hemisphere contralateral to the<unk> <unk> , while non-alien movement involved the normal process of activation described in the preceding paragraph in which primary motor cortex in the intact hemisphere activates in concert with frontal premotor cortex and posterior parietal cortex presumably involved in a normal cortical network generating premotor influences on the primary motor cortex along with immediate post-motor re-afferent activation of the posterior parietal cortex. Combining these two fMRI studies, one could hypothesize that the<unk>  behavior that is unaccompanied by a sense of agency emerges due to autonomous activity in the primary motor cortex acting independently of premotor cortex pre-activating influences that would normally be associated with the emergence of a sense of agency linked to the execution of the action. As noted above, these ideas can also be linked to the concept of efference copy and re-afference, where efference copy is a signal postulated to be directed from premotor cortex (activated normally in the process associated with emergence of an internally generated movement) over to somatosensory cortex of the parietal region, in advance of the arrival of the "re-afferent" input generated from the moving limb, that is, the afferent return from the moving limb associated with the self-generated movement produced. It is generally thought that a movement is recognized as internally generated when the efference copy signal effectively "cancels out" the re-afference. The afferent return from the limb is effectively correlated with the efference copy signal so that the re-afference can be recognized as such and distinguished from "ex-afference", which would be afferent return from the limb produced by an externally imposed force. When the efference copy is no longer normally generated, then the afferent return from the limb associated with the self-generated movement is mis-perceived as externally produced "ex-afference" since it is no longer correlated with or canceled out by the efference copy. As a result, the development of the sense that a movement is not internally generated even though it actually is (i.e. the failure of the sense of agency to emerge in conjunction with the movement), could indicate a failure of the generation of the efference copy signal associated with the normal premotor process through which the movement is prepared for execution. Since there is no disturbance of the sense of ownership of the limb in this situation, and there is no apparent physical explanation for how the owned limb could be moving in a purposive manner without an associated sense of agency, a cognitive dissonance is created which may be resolved through the assumption that the goal-directed limb movement is being directed by an<unk> " unidentifiable external force with the capacity for directing goal-directed actions of one's own limb. Disconnection It is theorized that<unk>  results when disconnection occurs between different parts of the brain that are engaged in different aspects of the control of bodily movement. As a result, different regions of the brain are able to command bodily movements, but cannot generate a conscious feeling of self-control over these movements. As a result, the sense of agency that is normally associated with voluntary movement is impaired or lost. There is a dissociation between the process associated with the actual execution of the physical movements of the limb and the process that produces an internal sense of voluntary control over the movements, with this latter process thus normally creating the internal conscious sensation that the movements are being internally initiated, controlled and produced by an active self. Recent studies have examined the neural correlates of emergence of the sense of agency under normal circumstances. This appears to involve consistent congruence between what is being produced through efferent outflow to the musculature of the body, and what is being sensed as the presumed product in the periphery of this efferent command signal. In<unk> , the neural mechanisms involved in establishing that this congruence has occurred may be impaired. This may involve an abnormality in the brain mechanism that differentiates between "re-afference" (the return of kinesthetic sensation from the self-generated "active" limb movement) and "ex-afference" (kinesthetic sensation generated from an externally produced 'passive' limb movement in which an active self does not participate). This brain mechanism is proposed to involve the production of a parallel "efference copy" signal that is sent directly to the somatic sensory regions and is transformed into a "corollary discharge", an expected afferent signal from the periphery that would result from the performance driven by the issued efferent signal. The correlation of the corollary discharge signal with the actual afferent signal returned from the periphery can then be used to determine if, in fact, the intended action occurred as expected. When the sensed result of the action is congruent with the predicted result, then the action can be labelled as self-generated and associated with an emergent sense of agency. If, however, the neural mechanisms involved in establishing this sensorimotor linkage associated with self-generated action are faulty, it would be expected that the sense of agency with action would not develop as discussed in the previous section. Loss of inhibitions One theory posed to explain these phenomena proposes that the brain has separable neural "premotor" or "agency" systems for managing the process of transforming intentions into overt action. An anteromedial frontal premotor system is engaged in the process of directing exploratory actions based on "internal" drive by releasing or reducing inhibitory control over such actions. A 2011 paper reporting on neuronal unit recording in the medial frontal cortex in human subjects showed a clear pre-activation of neurons identified in this area up to several hundred milliseconds prior to the onset of an overt self-generated finger movement and the authors were able to develop a computational model whereby volition emerges once a change in internally generated firing rate of neuronal assemblies in this part of the brain crossed a threshold. Damage to this anteromedial premotor system produces disinhibition and release of such exploratory and object acquisition actions which then occur autonomously. A posterolateral temporo-parieto-occipital premotor system has a similar inhibitory control over actions that withdraw from environmental stimuli as well as the ability to excite actions that are contingent upon and driven by external stimulation, as distinct from internal drive. These two intrahemispheric systems, each of which activates an opposing cortical "tropism", interact through mutual inhibition that maintains a dynamic balance between approaching toward (in other words, with "intent-to-capture" in which contact with and grasping onto the attended object is sought) versus withdrawing from (that is, with "intent-to-escape" in which distancing from the attended object
Alien hand syndrome
Hunan hand syndrome
Split hand syndrome
Elejalde syndrome
Achard syndrome
Scimitar syndrome
Reynolds syndrome
Duane-radial ray syndrome