Action planning in a virtual context after prefrontal cortex damage

Patients with frontal lobe lesions are known to encounter severe problems in the organisation of their behaviour in everyday life. Script generation tasks assess the subject's conceptual ability to formulate and evaluate a coherent and structured plan of action. In the present study, we investigated to what extent neuropsychological deficits observed at the conceptual level of action knowledge lead to impairments in action execution. We examined seven patients with prefrontal cortex damage and sixteen normal subjects. Subjects were first asked to verbally formulate a plan of action and then to use this knowledge for 'executing' the actions in a virtual 3-dimensional interactive apartment presented on a computer screen. The results indicated that the presence of the realistic context improved patients' performance. However, specific impairments were observed in patients in the execution condition, namely actions slips, omissions, failure in initiating actions and purposeless displacements. Moreover, an analysis of planning time showed that, differently of the patients group, normal subjects spent more time during plan execution as compared to plan generation. These results suggest that after a frontal lobe lesion a defective formulation of a routine plan might affect the execution of the corresponding course of actions.