Clinicopsychological investigations of local brain lesionsNörobilim
Professor Luria’s book thus marks a further and decisive step toward the eventual coalescence of neurology and psychology, a goal to which only a few laboratories on the East and West have been devoted over the last decades. The book is unique in its organization. The first half deals with observations and interpretations concerning the major syndromes of man’s left cerebral hemisphere:
Those grievous distortions of higher functions traditionally described as aphasia, agnosia, and apraxia. There is also a detailed and brilliant analysis of the syndrome of massive frontal-lobe involvement. The entire second half of the book is given over to a painstaking description of Professor Luria’s tests, many of them introduced by himself, and set out in such detail that anyone could repeat them and thus verify Professor Luria’s interpretations. The two halves of the book are equally challenging and original. In the first, more theoretical, section, Professor Luria gives an account of the major syndromes in terms that reject with the same force the traditional localizationist view -the notion of discrete centers for different aspects of language, of calculation or writing- and the opposite view of holistic function of the cerebral hemisphere, a view clearly incompatible with clinical and experimental fact. In a similar way, Professor Luria’s re-analysis of agnosia and apraxia reveals inadequacies of these clinical shorthand expressions, he points out that more elementary sensory and motor changes shade into the allegedly isolated aspects of distorted “higher” function, whether of recognition or skilled movement. As a result of this balanced approach, a further traditional distinction falls by the wayside—the traditional opposition in the description of aphasia between the “instrumental” and “noetic” views, that is, between.
Those who believe that language is merely disturbed as a tool, with intelligence essentially intact, and those who believe that the trouble with language is simply one of several manifestations of an underlying change of intelligence. The theoretical position adopted by Professor Luria himself in the face of these incredibly perplexing syndromes is most intriguing. He invokes cerebral reflexes as the basic elements of behavior. Yet careful reading reveals a remarkable restraint in the postulation of specific interruption of normal connections between different brain regions as the origin of major syndromes. This sort of approach to sensorimotor coordination requires a new way of looking at the major brain syndromes in man. It becomes particularly fruitful in dealing with the baffling changes in human behavior after lesions of the frontal lobes, an area of furious controversy where Professor Luria reaches conclusions (he claims there is an essential disturbance of “intention”) which are identical with those reached in our own laboratory on the basis of quite different clinical and experimental data. The second half of the book with its rich descriptions of tests will be at least as influential as the first. Here one is struck primarily by the disarming simplicity of methods, nearly all suitable for bedside conditions, few requiring more than the examiner’s voice, a few blocks, or paper and pencil. If one has had the privilege of observing Professor Luria and his staff in action at the Burdenko Institute in Moscow, one doubly appreciates the choice of his tasks, because he deals with large numbers of brain tumor cases, week after week; his assessment of these cases -the “neuropsychological” report- goes onto their clinical charts, together with other diagnostic techniques such as X-ray evaluations and electroencephalograms. Where the situation demands it, Professor Luria is quite willing to employ more elaborate experimental techniques, such as the recording of eye movements, especially in cases of frontal-lobe involvement.
Luria goes on to discuss agnosia, apraxia, and various other issues associated with brain lesions as well as his diagnostic methods. Luria clearly took Vygotsky's book on the higher mental functions as his starting point, he is unstinting with his praise for Vygotsky's work, and he used it to illuminate a new field. If you are even marginally interested in these issues, or in Russia psychology, I highly recommend the book.
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