1) The document discusses signs associated with lesions in the frontal and parietal lobes. Tests are described to assess functions localized to these regions like motor skills, memory, attention, and language abilities.
2) Parietal lobe signs include sensory deficits, agnosias like finger agnosia, and apraxias involving how to complete tasks. Tests evaluate two-point discrimination, graphesthesia, and stereognosis.
3) Both lobes are involved in executive functions and attention. Tests mentioned include the Wisconsin Card Sorting Test, Trail Making Test, and Stroop Test.
3. Functional region of the frontal lobe
• I Primary motor area
• II. Premotor area
• III. Frontal eye fields
• IV. Dorsolateral prefrontal cortex
• V. Orbital and basal areas
• VI. Supplementary motor area and anterior cingulated gyrus area
4. Clinical Assessment of frontal lobe sign
• History, Examination and formal tests :
Abnormal behavior, speech disorder, urinary incontinence, Frontal
gait(magnetic gait) , weakness of limbs
• Test sense of smell.
• Frontal release reflexes
Grasp reflex
Sucking reflex (pout, snout, rooting)
Palmo-mental reflex
Glabellar tap reflex
5. Emotional make-up and personality is best assessed by
history from family / friends & observation.
•Abstraction and judgment are assessed by proverb
interpretation and similarities.
•E.g explain in your own words the meaning of
•Don’t cry over spilled milk
•Similarity between mango and orange, car and airplane.
6. Attentionand memory
• Alternative sequence (e.g. copying MNMN)- Attention
• Motor Luria’s ‘fist-edge-palm’ test
• Go/no-go
• Digit span test: Measure of short term memory
9. To assess perseveration and abstract thinking.
Measure of executive function.
Consists of four key cards and 128 response cards.
Wisconsin Card Sorting Test(WCST)
10. Trail Making Test
• Test for visual attention and task switching.
.
• In Part A, the circles are numbered 1 – 25
• In Part B, the circles include both numbers (1 –
13) and letters (A – L); (i.e., 1-A-2-B-3-C, etc.).
15. Tests for cortical sensations
A. Two point discrimination
: Calipers or compass
used.
Sites – Palms (8-15 mm)
Dorsum (2-3cm)
Back (3-4 cm).
16. B. Graphesthesia :
Done with pencil or swab stick.
sites – palms, fingers and face.
C. Stereognosis :
• No preliminary visual demo given.
• ex: key, pen or coin
17. ASOMATAGNOSIAS
• Inability to feel, recognize, or be conscious
of one’s own specific body parts or bodily
conditions.
ANOSAGNOSIA
• Denial of illness
HEMI NEGLECT
• Neglect on one side of body in dressing and
grooming.
19. Tests for finger agnosia
• Inability to name , point or recognize
fingers on oneself or others.
1. Non verbal finger recognition
2. Verbal finger recognition
20. Tests for right – left confusion
Identification on self
.
Crossed commands on self
Identification on examiner
Crossed commands on examiner
.
21. Tests for calculations
Components – Rote tables (add, multiply,
etc) Recognition of signs (+ , - , * )
Basic arithmetic(carrying, borrowing)
Spatial alignment of written
calculations
• Verbal rote examples : what is 4 plus 6 ?
• Verbal complex examples : what is 21 / 5 ?
22. • Written complex examples :
• Pt with rt.
hemisphere lesion
& left neglect.
• Pt with rt. parietal
hematoma –
showing poor
alignment and
calculation errors.
23. APRAXIA AND PARIETAL LOBE
• An inability to carry out a commanded task
despite the retention of motor and sensory
function
25. IDEOMOTOR APRAXIA (“how to do”)
• Most common type of apraxia
i. Buccofacial apraxia
ii. Limb apraxia
iii. Whole body apraxia
26. IDEATIONAL APRAXIA (“what todo”)
• Able to do individual tasks, but
cann't integrate them as a
whole.
• ‘Conceptual apraxia’ - inability to
recognise the use of objects.
(object agnosia)
27. CONSTRUCTIONAL APRAXIA
• Constructional ability/praxis
(visuoconstructive ability)
• Non dominant parietal lobe
• Area
17
IPL (kinesthetic analysis of visual
patterns done here)
Premotor
area
28. DRESSING APRAXIA
• Not a true apraxia.
• Combination of spatial disorientation
and visuospatial inattention.
29. VISUAL DISORDERS
• Optic radiation passes through Inferior part of
the parietal lobe – incongruous homonymous
hemianopia or an inferior quadrantanopia.
• Rt. angular gyrus - Left sided visual neglect.
30. AUDITORY NEGLECT
• In right parietal lesions are initially unresponsive to
voices or noises on the left side.
• Main lesion - right superior lobule.
The dorsolateral frontal cortex is concerned with planning, strategy formation, and executive function.
The frontal operculum contains the centre for expression of language.
The orbitofrontal cortex is concerned with response inhibition
Broca's area: expressive language, i.e. language production.
Frontal eye field area :Voluntary eye movements
The primitive reflexes are present in normal babies. As the CNS matures, frontal lobe cells develop and begin to inhibit these reflexes. They may reappear with brain damage or disease
Attention is the patient’s ability to attend to a specific stimulus without being distracted by external, internal or environmental stimuli.
An example is to ask the patient to tap the knee when the examiner says "Stop" and not to tap when the examiner says "Go"
“repeat 3-5; 7-5-8; 3-9-4-8..” N: >5 increasing sequence of no
A two year child has a digit span of 2, 3yr- 3, 4yr- 4, 5yr- 5, 6yr-6 and 7yr to adult- 7
Using A F S normal individual more than 10 also check for repitation no less than 8 abnrmal
Trail Making Test consist of 25 circles distIn
Part A, the circles are numbered 1 – 25, and the patient should draw lines to connect the numbers in ascending order.
ributed over a sheet of paper
In Part B, the circles include both numbers (1 – 13) and letters (A – L); as in Part A, the patient draws lines to connect the circles in an ascending pattern, but with the added task of alternating between the numbers and letters (i.e., 1-A-2-B-3-C, etc.).
Test of inhibition response
Patients are asked to state the color in which words are printed rather than the words themselves
failed inhibition
PRIMARY SOMASTHETIC AREA Body image representation
SOMASTHETIC ASSOCIATION AREA Body in space and Tactile discrimination
SUPERIOR PARIETAL LOBULE connections with all lobes) Visual spatial properties Visual attention, 3 D analysis of body space interactions
cingulate gyrus and prefrontal cortex . Therefore they mediate influence of emotion, attention and motivation
INFERIOR PARIETAL LOBULE reading , calculations
Angular gyrus & Supra marginal gyrus- they have interconnections with visual, auditory, somasthetic, supr. colliculus, LGB and other lobes
Cortical defect is essentially to one of sensory discrimination i.e impaired ability to integrate and localize stimuli.
Inability to recognize part of one’s body.
Ask pt. to close both eyes – respond as ‘one’ or ‘two’.
Single and double points to be differentiated
Compare with other side
Tongue 1mm
Lips-4 mm
Digits like 1-9 , or shapes/symbols used.
abnormal side done first and then normal side.
(perception of one’s body and the relations of bodily parts to one another)
Even when patients are told that the body part belongs to them, many will deny the reality and remain firm in their belief that it is not a part of them.
It’s the lack of awarence or insight in pt to understand that suffered from any disease, refuse medication and trt.
Shave only one side or use only one sleeve of shirt.
Fail to use one side of body, even though paralysis is not present
Denial and neglect - non-dominant parietal lesions.
Parietal lobe is – “ Lobe of hand ”.
Hand is extensively represented
Parietal lobe gathers information regarding various objects through hand
An example of bilateral asomatognosia and is due to lesion in left dominant. inferior parietal lobule (angular gyrus).
with pt eyes closed, touch one of his fingers. Ask him to touch the same finger of examiner, with eyes open.
Examiner places hand in some irregular position and asks pt – “ point to my middle finger”
ex : show your left foot
ex : with your right hand touch your left ear
ex : point my right elbow
ex : with your left hand point my right foot
Lt parietal lesions – inability to understand and carry out numericals.
Severe acalculia = Anarithmetria.
Rt parietal lesions – inability to align numbers and to do complex computations (borrowing, carrying, etc).
But, pt can do problems in his head.
Defect - unable to show, but uses the object. –
unable to do whole task, but does individual tasks.