Tactile enumeration: A case study of acalculia

Enumeration is one of the building blocks of arithmetic and fingers are used as a counting tool in early steps. Subitizing-fast and accurate enumeration of small quantities-has been vastly studied in the visual modality, but less in the tactile modality. We explored tactile enumeration using fingers, and gray matter (GM) changes using voxel-based morphometry (VBM), in acalculia. We examined JD, a 22-year-old female with acalculia following a stroke to the left inferior parietal cortex. JD and a neurologically healthy normal comparison (NC) group reported how many fingers were stimulated. JD was tested at several time points, including at acute and chronic phases. Using the sensory intact hand for tactile enumeration, JD showed deficit in the acute phase, compared to the NC group, and improvement in the chronic phase of (1) the RT slope of enumerating up to four stimuli, (2) enumerating neighboring fingers, and (3) arithmetic fluency performance. Moreover, VBM analysis showed a larger GM volume for JD relative to the NC group in the right middle occipital cortex, most profoundly in the chronic phase. JD's performance serves as a first glance of tactile enumeration in acalculia. Pattern-recognition-based results support the suggestion of subitizing being the enumeration process when using one hand. Moreover, the increase in GM in the occipital cortex lays the groundwork for studying the innate and primitive ability to perceive and evaluate sizes or amounts-"sense of magnitude"- as a multisensory magnitude area and as part of a recovery path for deficits in basic numerical abilities.