This document discusses tests and assessments used to evaluate functions of the parietal lobe, including: - Koh's block design task to evaluate constructional apraxia - Tests for visual object agnosia like the Gollin figures test - Assessments of symbolic synthesis like acalculia tests - Tests of complex spatial relations like the multiple choice Benton test - Route finding tasks like following maps between points on the floor - The interlocking finger test as a screening for parietal lobe dysfunction - Syndromes associated with parietal lesions are discussed, including Gerstmann syndrome and Balint syndrome.

1. Parietal lobe 2

2. • Construction apraxia

3. Koh’s block design task
• Koh’s wooden blocks coloured differentlty
on each surface
• Series of designs to be constructed using
a pattern card
• Pt may make open square/ keeps blocks
on top of pattern
• Shows little dissatisfaction with his efforts
• Unable to grasp mistake even when
pointed out

5. Tests for visual object agnosia
• Gollin figures test
• Mooney closure faces test – requires
whole percept to be formed from a series
of cues which do not make a normal
partial form of the figure
• Unconventional views tests –
Photographs of common objects taken
from unusual view point

8. Judgement of stimulus
orientation
• Another tactile perceptive function
• Direction of tactile stimulation applied to
palm
• B/L impairment in ( R) PL lesion
• C/L impairment in (L ) PL lesion

9. Symbolic (quasi spatial)
synthesis
• Acalculia – pt with dominant PL lesion can
understand & remember a problem , may
even think of certain rules appropriate for
its solution , but are unable to carry out the
necessary operations
• Difficulties in reading where regular
scanning of a text is imp.

10. Acalculia
• Rote tables – addition, subtraction ,
multiplication
• Arithmetic concepts
• Recognition of signs
• Correct spatial alignment for written
calculation

11. • (L) frontal lobe plays some role in
egocentric space
• ( R ) parietal lobe concerned more with
extra personal space

12. VOSP
• Cube analysis
• Number Location
• Line orientation judgement

14. 1
2
3
5
8
9
7
5

15. Tests for complex spatial relations
• Multiple choice version of Benton visual
retention test- demands memory retention
of relatively complex, abstract ,spatial
figures which are shown for 5- 10 sec
• Stick test – shown simple arrangement of
sticks & asked to copy alongside or
opposite the examiner( requires
constructional ability also )

17. • Pool reflection test –Pt shown a sample
pattern , asked to select from multiple
choice array the pattern which reflects
sample rotated at 180 deg in fronto
parrellel plane
• Map test – ask to draw map of the state or
country. If unable, examiner draws & asks
pt to mark familiar places
• Village scene test – shown model of
village, & choose correct photograph
representing scene from six photographs ,
one of which is correct & others are similar
views with spatial relations of features of
scene are altered before being
photographed

19. Route finding difficulties
• Pt may be able to give adequate verbal
description of familiar routes , but unable
to execute them either by drawing or
taking them in real life
• 4 basic disorders –
–Topographical amnesia-long stored or
recent
–Perceptual disorder of location & relative
position of objects
–Topographical agnosia- inability to
recognize objects that serve as
landmarks
–UL spatial neglect

20. Tests
• Locomotion map following test (Semmes
maps or Weinstein maps)- 9 large dots are
placed on floor & the pt handed a map
showing simple route between these
points.Pt must follow the route by walking
between the dots , but keeping the map in
the same orientation to his own body
through out .Turning the map to preserve
its orientation with respect to points on
floor is not allowed

23. Form assembly task
• Visuo constructive task
• Assemble geometrical pieces with
different lengths of lines & different angles
to form a square
• Perceptual deficits underlie constructional
difficulty in pt with (R ) rather than (L) PL

25. • Visual disorientation
• Loss of ability to localize objects
• Absolute localization- inability to determine
the position of objects in relation to
themselves
• Impaired estimation of distance
• Relative localization

26. • Conduction aphasia
• Paraphasia in spontaneous language
• Impaired repetition
• Normal comprehension
• Often associated with acalculia
• Lesion- arcuate fasciculus near parietal
operculum

27. Gerstman syndrome
Described by Josef Gerstmann in 1930
Finger agnosia
Acalculia
R- L disorientation agraphia
Agraphia
Lesion site - dominant parieto occipital
region (angular gyrus )

28. Finger agnosia
• 1st described by Jules Badal (French
ophthalmologist)
• Inability to appreciate the position of a finger
among the rest
• Actually only a faulty finger localisation
• Usually B/L
• Thumb & little finger usually correctly identified
middle 3 confused
• Gerstmann considered it as a localised form of
autopagnosia

29. Acalculia
• Difficult mental arithmetic-
• Inability to do written sums
• Inability to align figures correctly in rows
• Write no. to dictation
• Distinguish hundreds from thousands or
tens of thousands
• Arrange no. in order of magnitude
• Unable to enumerate odd/even no. in
series /count backwards
• Inability to use abacus

30. Agraphia
• Spontaneous writing & writing on
command more affected than copy
righting
• Literal – difficulty with letters only
• Verbal – difficulty with words
• Irregular & tremulous script, misspelling ,
semantic & syntactial errors- nonsense
dysgraphia
• Site – inferior parietal lobule

31. R- L disorientation
• Disorientation affects all parts of own body
/ that of others
• Ask to touch (L) ear with ( R ) hand
• Identification in examiner
• Check in crossed positions

32. • Gerstmann tetrad notable stage in
interpretation of parietal lobe functions
• No longer considered a pure syndrome
• Tetrad need not be always present
• If 3 or more components , the lesion likely
larger one extending outside the angular
gyrus

33. Associated features
• Apraxia
• Amnestic dysphasia
• Alexia
• (R ) hemianopia & neglect
• ( R ) hemiparesis
• Pain agnosia

34. Balint syndrome
• Lesion – B/L parieto occipital convexity
• Optic ataxia- disturbance in reaching
target under visual control
• Oculomotor apraxia ( psychic paralysis of
gaze )
• Failure to shift gaze to commands
• Eyes wander till it falls on object by
chance
• Reflex eye movements normal

35. Balint syndrome
• Decreasd visual attention of peripheral visual
fields
• Simultanagnosia
• Visual attention only to objects in the axis of
fixation & peripheral stimuli not seen
– Inability to appreciate the meaning of whole
though individual parts are well rocognised
–VF normal
–See “forest as trees”

36. Interlocking finger test
• Fast & simple bed side screening test for
PL dysfunction
• Ask to imitate Std set of 4 interlocking
finger figures
• Poor scoring correlated most highly with
standard measures of parietal lobe
dysfunction
Auditory short term memory impairment
may occur with parietal lesions

37. Changing concepts of
organisation of sensory cortex
• Old view : different parts of body represented in
a homologous pattern in sensory & motor area
• Newer concept : motor cortex contain a mosaic
of 10 anatomically & functionally different areas
• Similarly post parietal lobe also has multiplicity
of areas
• Motor & parietal cortex reciprocally connected
• These circuits represent the basic element of the
cortical motor system