The Motor Unawareness Assessment (MUNA): A new tool for the assessment of Anosognosia for hemiplegia

Valentina Moro, Sahba Besharati, Michele Scandola, Sara Bertagnoli, Valeria Gobbetto, Sonia Ponzo, Cristina Bulgarelli, Aikaterini Fotopoulou, Paul M Jenkinson

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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.
Original languageEnglish
Pages (from-to)91-104
Number of pages15
JournalJournal of Clinical and Experimental Neuropsychology
Issue number1
Publication statusPublished - 15 Feb 2021


  • Anosognosia for hemiplegia
  • asomatognosia
  • bodily awareness assessment
  • emotions in body awareness
  • motor awareness


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