4. READING AND WRITING : ALEXIA and
AGRAPHIA
• VWFA-visual word form area
• Equivalent to Auditory phoneme perception
area.
• Left occipito-temporal sulcus & left fusiform
gyrus.
6. Reading with comprehension
• Visual information from the
left occipital lobe reaches
directly the left fusiform
gyrus.
• From the rt occipital lobe
has to cross over to (corpus
callosum)reach the left
fusiform GYRUS.
• ANGULAR GYRUS-
interpretation of visual-
verbal materials.
9. Reading
CONDITIONS FEATURES
BROCA’S APHASIA OFTEN IMPAIRED(THIRD ALEXIA)
WERNICKE’S APAHSIA IMPAIRED FOR COMPREHENSION,
READING ALOUD
GLOBAL IMPAIRED
CONDUCTION APHASIA INABILITY TO READ ALOUD, SOME
COMPREHENSION
TRANSCORTICAL MOTOR INTACT
TRANSCORTICAL SENSORY IMPAIRED
TRANSCORTICAL MIXED IMPAIRED
ANOMIC APHASIA INTACT
10. ALEXIA WITHOUT AGRAPHIA
• PURE/POSTERIOR ALEXIA
• CAN NOT : read and
understand
• CAN UNDERSTAND: words
spelled aloud, written on the
palm
• Visual function intact(Naming
objects)
• left occipital lobe with
splenium
• Left PCA infarcts
ALEXIA WITH AGRAPHIA
• CENTRAL ALEXIA
• Aquired illiteracy
• Unable to read or write
• Dominant ANGULAR gyrus
15. THIRD ALEXIA
• Inability to comprehend syntax
• “Ravana was killed by rama” vs “ Rama killed
Ravana”
• Seen in Broca’s aphasia
16. OTHER ALEXIAS
SURFACE ALEXIA
• Grapheme to phoneme
conversion problem
• Irregular orthography
• CAN read: mint,dog,cat
• CAN NOT read: pint, dough,
laugh
•
PARALEXIA(DEEP)
• Problem of READIN ALOUD
• SEMANTIC paralexia –m.c
• Eg: infant read as baby
17. WRITING
CONDITIONS FEATURES
BROca’s APAHSIA IMPAIRED(DYSMORPHIC, AGRAMMATICAL)
WERNICKE’S APHASIA WELL FORMED PARAGRAPHIC
GLOBAL APHASIA IMPAIRED
CONDUCTION APHASIA VARIABLE
TRANSCORTICAL MOTOR APHASIA INTACT
TRANSCORTICAL SENSORY APHASIA IMPAIRED
TRANSCORTICAL MIXED APHASIA IMPAIRED
ANOMIC APHASIA INTACT (EXCEPT FOR ANOMIA)
24. CONCEPTUAL AND IDEATIONAL
APRAXIA(Ochipa’s model)
• PRAXIS conceptual system has 3 types of
knowledge
Knowledge of objects and tools
Knowledge of actions
Knowledge of organization of actions in a
sequence
• 1st two impaired in conceptual A.
• 3rd knowledge in ideational A.
25. Transitive movements
• Movements or pantomimes where an object is
used
1. Act of omission(forgets to spread the Paste)
2. Act of misuse(uses key instead of hammer)
3. Act of mislocation(holds the pen upside down)
26. IDEOMOTOR
• ABNORMALITIES of the action production
system
• Perform poorly on pantomime
• Significant improvement with object.
27. LIMB KINETIC APRAXIA
• PREMOTOR CORTEX
• Deficit confined to finger and hand
movements c/l to the lesion regardless of the
hemispheric side, with preservation of power
28. OTHER APRAXIA’S
• Eg .how to drink using a straw, whistle , cough
• Ventral pemotor cortex
BUCCO-FACIAL
APRAXIA
• Genu and body
• Unilateral apraxia of the non dominant limb
CALLOSAL
APRAXIA
• Inability to generate voluntary saccades to a
visual target
OCULOMOTOR
APRAXIA
• High level gait disorder
• NPHGAIT APRAXIA
37. IDEOMOTOR APRAXIA
• PANTOMIME using a hammer or a
screw driverTRANSITIVE
• Wave good bye, salute
INTRANSITIVE
MOVEMENTS
• Imitation of meaningful and
meaningless posturesIMITATION
ACTUAL TOOL
USE
43. LIMBKINETICAPRAXIA Ask the patient to oppose their
thumb to their index , middle , ring
and little fingers in rapid succession
Ask the patient to imitate some
random hand position
47. ACALCULIA• PRIMARY acalculia
• A basic defect in computational ability
• Left angular gyrus
ANARITHMIA
• SECONADRY ACALCULIA
• Alexia for numbers
• Also in central alexia & alexia without agraphia
ALEXIC
ACALCULIA
• Difficulty in Written arithmetics
• Carrying over problem
• Mental arithmetics better than written calculation
• Rt . PARIETAL pathology
SPATIAL
ACALCULIA
48. Testing procedure
1. FORWARD and backward counting
2. Symbolic transcoding
1. Numerical to verbal: 109---- one hundred nine
2. Verbal to numerical: vice versa
3. Reading and writing arithmetic signs
4. Mental calculation(add,subsract,multiply,divide)
5. Written calculation
6. Aligning numbers in columns for adding.(eg.
32+333+3456+2)
7. Arithmetic problems requiring planning. (perform the
ebove calculation)
49.
50. FINGER AGNOSIA
• Inability to recognise , distinguish or name
fingers
1. patients own hand
2. examiners hand
3. Drawing of a hand.
• m.C problems index, middle and ring fingers
51. Testing procedure
1. Hands visible: identification of fingers touched by the
examiner
2. Hands visible: identification of examiners fingers
3. Hands hidden: identification of fingers touched by the
examiner
4. Hands hidden: identification of pairs fingers
simultaneously touched by the examiners.
52. RIGHT LEFT DISORIENTATION
• Inability to identify right & left sides of
1. Own body
2. Person seated opposite
3. Photograph/drawing
• Patients also have problems with
1. Up & down
2. Above & below
3. Over & under
53. Testing procedure
ORIENTATION TOWARDS OWN BODY
1. Naming single lateral body parts touched
2. Pointing to single lateral body parts on verbal
command
3. Executing double uncrossed movements on
command(touch left ear with left hand)
4. Executing double crossed movements on verbal
command(touching left ear with right hand)
54. ORIENTATION TOWARDS CONFRONTING
EXAMINER OR PICTURE
1. Naming single lateral body parts shown by the
examiner
2. Pointing to single lateral body parts on verbal
command
3. Imitating double uncrossed movements on
command(touch left ear with left hand)
4. Imitating double crossed movements on verbal
command(touching left ear with right hand)
55. COMBINED ORIENTATION TOWARDS ONE’S
OWN BODY AND CONFRONTING PERSON.
Placing the right hand of the patient on
confronting persons left ear
56. AGRAPHIA
• Aquired abnormalities of writing
• called apraxic agraphia
• Not associated with alexia
• The usual missing element in incomplete
gerstmann
57. AGRAPHIA
• anterior(BROCA’s)-agrammatism with spelling
mistakes
• Posterior(WERNICKE’S)-unintelligible & non-
sensical
Aphasic
agraphia
• Correct letters and words
• Problem with orientation on a paper
• eg,. Moving on to the next line, wider space on
one side
Visuospatial
agraphia
• Language formation is correct along with spatial
arrangement
• Handwriting loses its personal
characters(becomes a scrawl)
Apraxic
agraphia
58. Testing procedure
A. Spontaneous writing:
1. Interpretation of cookie theft picture
2. Why have u come here?
B. Writing to dictation
C. copying
74. 3. marking locations of objects with
respect to the patient
• Ask the patients to report ten objects in the
room seating him in the middle of the room.
1. Neglect: report items items from only one side
2. Hemianopia: try to compemste by moving their
head a7 eyes to the contralesional space.
75. CONSTRUCTIONAL APRAXIA
• Inability to copy drawings or three
dimensional constructions accurately.
• No difficulty in making relevant individual
movements.
• commonly used diagrams:
1. Necker’s cube
2. Intersecting pentagons
76.
77. EXPLOSION OF THE CONSTITUENT PARTS
SIMPLIFICATION OF THE
DRAWINGS
78. DRESSING APRAXIA(DA)
• Automatic spontaneous capacity for dressing
oneshelf is lost
• Not a true DA if due to ideational or
ideomotor apraxia
• TEST: put on a jacket given to the patient
upside down with its sleeves deliberately
turned upside down.
81. EGOCENTRIC DISORIENTATION
• Dysfunction of localization in space by vision
• Can identify objects
• Have trouble reaching for them & navigating around
them
• Can localize auditory stimuli
• Judge relative location btw objects using proprioceptive
inputs
82. Examples(egocentric d.)
• Bump into things
• Unable to negotiate paths even in familiar
territory
• May walk directly into an obstacle even when
he can see it
• While going towards towards the door the
patient towards the wall & then search for the
door
83. Testing
1. Ask the pt to point in the direction of the
object
2. Touch an object in the visual field
3. Judge the distance of an object
4. Count the no.of objects on a paper placed on
the table
84.
85. Count the number of dots without
pointing at them(ACE)
86. HEADING
DISORIENTATION
• Allocentric
orientation lost
• Can localize objects
wrt their body
• Unable to describe
route fam. Places
• Can not Draw maps
familiar places
• POSTERIOR
CINGULATE
LANDMARK
AGNOSIA
• Inability to
recognize
landmarks
• LINGUAL GYRUS
ANTEROGRADE
DISORIENTATION
• Inability to aquire
novel topographic
memory
• Getting lost easily
in unfamiliar places
• Eg. Tell me the way
to the bathroom to
a hospitalized
patient
• PARA-
HIPPOCAMPUS
• Common in AD
Editor's Notes
ALSO important in color integration and facial recognition.
Visual information from the left occipital lobe reaches directly the left fusiform gyrus.
From the rt occipital lobe has to cross over to (corpus callosum)reach the left fusiform GYRUS.
Or the grapheme perception sysytem
ANGULAR GYRUS- interpretation of visual-verbal materials.
paralexia
Third alexia is agrammatism or difficulty understanding grammars
ALEXIA’S ARE OF TWO TYPES
WE LL HAVE A LOOK AT THE CENTRAL ALEXIA IN PARIETAL LOBE FUNCTION
Copies written language as if it was a foreign language.
Color naming impaired
Which means he has alexia and not aphasia
Explaination: a disconnecgion between the rt intact visual cortex and the left angular gyrus.
Like wernicke’s where reading is impaired more than auditory perception
INFERIOR PARIETAL LOBULE : CONCEPTUAL SYSTEM
SUP. PARIETAL LOBULE: PRODUCTION SYTEM
FAILURE TO RESPOND TO AVERBAL COMMAND
FAILURE TO IMITATE
FAILURE TO HANDLE AN OBJECTY CORRECTLY
FAILURE TO IDENTIFY MOVEMENT PERFORMED BY THE BY THE EXAMINER
MEDIAL PATHWAY : REACHING THE OBJECT
LATERAL PATHWAY: GRASPING AND MANIPULATION THE OBJECT
Transitive movements: activities requiring objects
Act of omission ,misuse and mislocation
Transitive poor in ideational
Improvement with transitive in ideomotor
Spatial errors are the most characteristic
What is the device will u use to put this nail through
For example I m brushing my teeth
Mistakes have been discussed
PANTOMIME MEANS TO EXPRESS MEANINGS WITH GESTURES
TRANSITIVE DOES NOT MEAN WE HAND OVER AN OBJECT TO THE PATIENT
HE KNOWS THE SEQUENCE BUT SEEMS TO HAVE A PROBLEM USING PREVIOUSLY USED THINGS
Posterior part of the dominant inferior parietal lobule.
Carrying over in additions and multiplications
Aquired loss of the ability to perform calculation task
Aquired abnormalities of writing: agraphia
They have been asked to describe the cookie jar picture.
Just like the speech
Handwriting a scribble(APRAXIC AGRAPHIA)
APRAXIC AGRAPHIA
Orientation on a page(VISUOSPATIAL AGRAPHIA)
Multiple streams of sensory data to form a body schema which determines relationship of our body parts to ourselves and to other objects in extra personal space.
Rt-represenattional
One thing we must have noticed is that in all of these cases it’s the keft side of the hemifield that’s neglected.
Important clue could be ……neglect start scanning the page from the right in contrast to normal persons who do so from the left side (bcoz of the writing)
Cortical brain region –angular gyrus of the rt parietal lobe
Despite their visual loss, hemianopic patients direct more eye movements towards their contralesional blind side during visual search [2], [8]. In contrast, the scanpaths of hemineglect patients typically ignore contralesional space [2], [3]. During line bisection, when subjects have to indicate the middle of a line segment [9], hemianopic patients bias their perceived midpoint slightly towards the contralesional side [10], [11], [12], [13] whereas hemineglect patients make large bisection errors towards the ipsilateral side [14], [15]. Studies of eye movements during line bisection show that hemianopic patients cluster fixations at both the contralesional end of the line and a second central location just contralesional to the true midpoint, while hemineglect patients fail to explore the contralesional space and show a broad ipsilesional distribution of fixations
Lets see how does a person with left hemianopia bisects the lines.
Contrary to belief ………………….