Interest in sensorimotor cortex involvement in higher cognitive functions has recently been revived, although whether the cortex actually contributes to the simulation of body part movements has not yet been established. Neurosurgical patients with selective lesions to the hand sensorimotor representation offer a unique opportunity to demonstrate that the sensorimotor cortex plays a causal role in hand action simulations. Patients with damage to hand representation showed a selective deficit in simulating hand movements compared with object movements (Experiment 1). This deficit extended to objects when the patients imagined moving them with their own hands while maintaining the ability to visualize them rotating in space (Experiment 2). The data provide conclusive evidence for a causal role of the sensorimotor cortex in the continuous update of sensorimotor representations while individuals mentally simulate motor acts.