B. Orgass

Do Specific Attention Deficits Need Specific Training

The efficacy of game-like computerised adaptive training programmes for intensity aspects of attention (alertness and vigilance) and selectivity aspects of attention (selective and divided attention) was studied in patients with left or right focal brain damage of vascular aetiology. Each patient received consecutive training in the two most impaired of the four attention domains. Control tests were performed by means of a standardised computerised attention test battery comprising tests for the four attention functions. Assessment was carried out at the beginning and after each of two training periods of 14 one-hour sessions each. There were significant specific training effects for both intensity aspects (alertness and vigilance), and also for response time in the selective attention and error rate in the divided attention task. For selectivity aspects of attention, reaction time also improved after training of basic attention domains. The application of inferential single case procedures revealed not o...

The concept of the body schema: A critical review and some experimental results.

Summary The concept of the body schema is widely used, in clinical neurology and in neuropsychological research, to explain a great variety of disturbances. A historical review demonstrates that the classical authors have by no means developed an unequivocal, let alone unitary concept. Subsequent use and misuse has virtually emptied the theoretical construct of its previous meaning. The most important clinical signs and symptoms which are termed “disturbances of the body schema” are discussed in detail, on the basis of experimental results. Neither autotopagnosia, nor finger agnosia, nor “right-left disorientation” are unitary in nature. All of these disturbances appear in various types, brought about by varying underlying neuropsychological deficit, such as aphasia, spatial disorientation or general mental disorder.

Visuo-cognitive performances in patients with unilateral hemispheric lesions

SummaryThree factorial reference tests for Speed of Visual Closure (Cs), Flexibility of Visual Closure (Cf) and Perceptual Speed (P) were given to 41 patients with unilateral retro-rolandic brain lesions. The tests were: the Street Test (for Cs), the Gottschaldt Test (for Cf) and the test Form Perception from the GATB (for P). By means of analyses of variance the influence of hemispheric side and intrahemispheric locus of lesion, of aphasia and of visual field defect (VFD) was studied.Aphasia was related only to impairment in Gottschaldts test. In none of the experimental tests an independent main effect of side or intrahemispheric locus of lesion or of VFD was found. However, in Streets test as well as in Form Perception, patients with right-sided lesion plus VFD were more impaired than any other subgroup. It could be demonstrated that neither VFD per se nor hemispheric side of lesion alone could account for this finding. It is suggested that the presence of VFD in the patients with right-sided lesions does not act on test performance as a defect in visual function but stands for a critical localization of lesion.ZusammenfassungEine Gruppe von 41 Patienten mit einseitigen retrorolandischen Großhirnläsionen wurde mit drei faktoriellen Referenztests für „Speed of Visual Closure“ (Cs), „Flexibility of Visual Closure“ (Cf) und „Perceptual Speed“ (P) untersucht. Es wurden verwendet: der Street-Test (für Cs), der Gottschaldt-Test (für Cf) und der Test „Form Perception“ aus der GATB (für P). Mittels Varianzanalysen wurden die Auswirkungen von Seitigkeit und intrahemisphärischer Lokalisation sowie von Aphasie und Gesichtsfelddefekten auf die Testleistungen geprüft.Aphasie beeinflußte nur die Leistung im Gottschaldt-Test. Selbständige Haupteffekte für Seitigkeit und intrahemisphärische Lokalisation der Läsionen sowie für Gesichtsfelddefekte wurden nicht gefunden. Sowohl im Street-Test als auch im Test Form Perception waren jedoch Patienten mit rechtsseitigen Läsionen, die zugleich Gesichtsfelddefekte hatten, signifikant schlechter als jede andere Untergruppe. Es konnte gezeigt werden, daß weder der Gesichtsfelddefekt für sich noch die rechtsseitige Hirnschädigung allein dieses Ergebnis erklären. Nach diesen Befunden muß man annehmen, daß bei den rechtsseitig geschädigten Patienten die Gesichtsfeld-einschränkung nicht unmittelbar die Testleistungen beeinflußt, sondern vielmehr eine für diese Leistungen kritische Lokalisation der Hirnläsion anzeigt.

An experimental investigation of finger agnosia

THE SYMPTOM of finger agnosia has been the subject of extensive theoretical considerations. The controversial positions defended by various investigators have been recently reviewed by Bentonl and by Kinsbourne and Warrington.2 It appears from the literature that there does not exist an uncontested definition of this peculiar symptom, nor is there agreement on the appropriate method of testing for it. The original concept suggested by Gerstman

A cross-validation study on the token test

implies that the essential feature is the inability to differentiate single fingers, either on the patient’s own hand or on the hand of another person. Testing procedures include verbal and nonverbal tasks. Most of these have been assembled by Benton‘ into a comprehensive battery of finger tests. Recently, Kinsbourne and Warrington2 have proposed five new tests, four of which are nonverbal in nature. These tasks require the awareness of the order of the fingers and of the structure of the hand. Apparently, however, these methods are not fully comparable with the clinical methods used to test the identification of single fingers. Previous studies of this problem have been based on single cases or on highly selected groups. The latter holds true also for the 32 subjects examined by Kinsbourne and Warrington. Therefore, it appeared useful to carry out another investigation of finger agnosia using various finger tests, verbal and nonverbal, with a large group of unselected braindamaged patients. The starting point was a study of the so-called Gerstmann ~yndrome.~ In agreement with Benton,s we reached the conclusion that the common denominator of these symptoms is an aphasic disturbance. This view has been corroborated in another study of right-left disorientation,G which is another component of the Gerstmann syndrome.

Impairment in visual recognition of geometric figures in patients with circumscribed retrorolandic brain lesions.

Abstract The cut-off score of 11 errors on the Token Test, proposed by O RGASS and P OECK (1966), was applied to a larger sample of brain damaged patients. Whilst 93% of aphasics were correctly identified, 22 per cent of non-aphasic patients were misclassified. Therefore, this cut-off score proved to be unsatisfactory. The discriminating power of the TT, however, was again confirmed: Applying the cut-off score optimal for this sample (23 errors), 91 per cent of aphasics were correctly classified and only 5% of the non-aphasics were misclassified. A moderate influence of age and PIQ on the TT-scores was found. The implication of this results is discussed.

A qualitative study on token test performance in aphasic and non-aphasic brain damaged patients

Abstract Twenty patients with left-sided and 21 patients with right-sided circumscribed retrorolandic brain lesion were given Gottschaldts Test, Bentons Visual Retention Test and several tests for pertinent control variables. Analyses of variance demonstrated, that aphasic patients were inferior to left-sided patients without aphasia. There was no difference in the performance of aphasic and right brain damaged patients. Visou-spatial disturbance was associated with lesions of either hemisphere. The impairment of the aphasic patients was not due to language disturbance per se , nor to severity of brain lesion. Rather, presence of aphasia indicated a locus of lesion critical for the performances tested.

Das Verständnis für Nomina mit spezifischer Referenz bei aphasischen Patienten

Abstract The performance of 100 aphasic and 100 non-aphasic brain damaged patients in part V of the TT was subjected to a qualitative analysis. The items were ranked according to the frequency of errors occurring in each of the subgroups. The distribution of rank order of errors was compared across aphasic and non-aphasic patients. An attempt was made to determine whether the items most critical for either group were the same as those identified by Whitaker and Noll [9] in a study of normal children. Finally, the linguistic or psychological properties determining the ease or difficulty of a given item for either group were considered. The performance characteristics of aphasic adults and normal children on the Token Test were different. In the aphasic subgroup, the Whitaker and Noll items were, in fact, clustered in the lower half of the rank-ordered distribution. However they accounted for only 37 per cent of the total errors. Therefore, the linguistic hypothesis suggested by Whitaker and Noll did only partly explain the aphasic patients failure.

Gerstmann Syndrome Without Aphasia: Comments on the Paper by Strub and Geschwind

SummaryThere are conflicting views in the literature whether or not the understanding of names of body-parts can be selectively impaired in aphasic patients. Therefore, we have examined 45 chronically aphasic patients of various subtypes comparing body-part comprehension and object comprehension.Performances in both experimental tests were highly correlated. A selective comprehension deficit for body-parts could not be demonstrated. The same was true for understanding of colour names. The theoretical and practical implications of these findings are discussed. In particular, the diagnosis of autotopagnosia seems not to be justified in aphasic patients if it is based on impaired understanding of body-parts.ZusammenfassungEs besteht in der Literatur keine Übereinstimmung darüber, ob das Verständnis für Namen von Körperteilen bei Aphasikern häufig selektiv gestört sein kann. Wir haben daher an 45 chronisch aphasischen Patienten der verschiedensten Untertypen eine experimentelle Untersuchung ausgeführt: Das Verständnis für Körperteilnamen wurde verglichen mit dem Verständnis für Objektnamen.Die Leistungen in den experimentellen Tests korrelierten hoch miteinander. Eine selektive Verständnisstörung für Namen von Körperteilen konnte nicht nachgewiesen werden. Dasselbe gilt für das Verständnis von Farbnamen. Die theoretische und praktische Bedeutung dieser Befunde wird diskutiert. Insbesondere wird darauf hingewiesen, daß bei einem aphasischen Patienten die Diagnose einer Autotopagnosie nicht gerechtfertigt ist, wenn sie sich auf mangelhaftes Verständnis für die Namen von Körperteilen stützt.