A Patient with damage in the Parietal Cortex: by Ryan Kelly



	All individuals in this world are potential victims for some type 
of brain damage whether it be cancer or some type of lesion.  
Unfortunately, brain damage is not sight specific causing every part of 
the brain to be potentially altered.  In this specific case the study 
has been focused on the region of the parietal cortex and it's 
responsibilities.  Specifically, this study will be looked at from a 
patient who has suffered a lesion in the left parietal lobe.  Also, 
because of it's importance, I will zoom in on the right parietal lobe 
too, and it's behavioral effects due to a lesion.  First, to get a 
basic understanding of a healthy parietal cortex and it's functions, it 
will be examined first.
	The parietal lobe is located near the back of the brain, towards 
the top of the head (Carlson, 2001).  Overall, it's assumed that it 
facilitates spatial perception and allows a sensation of the body's 
position in the body  (2001).  Basic functions that it is responsible 
for are location for visual attention, touch perception, goal directed 
voluntary movements, and manipulation of objects (Zaidel, 1994).  If 
any type of damage takes place in the parietal lobe an individual could 
experience a malfunction of one of these characteristics.  In the past, 
individuals experiencing a lesion or any other type of brain damage to 
the parietal cortex have developed many pre-dispositions, and have lost 
a major part of the working brain.  Such characteristics are 
represented by the inability to attend to more than one object at a 
time, the inability to name an abject (Anomia), and the inability to 
locate the words for writing (Agraphia), among many others (Zaidel, 
1994).  The point is these patients suffering from these types of 
disabilities have to deal with an altered perception of the world; a 
perception that one time was considered normal before the lesion took 
place.  Basically, their thinking capabilities have decreased extremely 
and they have to conform to the new weaknesses of their brain.
	Damage to the left parietal lobe can result in what is called 
"Gerstmann's Syndrome" (Zaidel, 1994).  A patient suffering from this 
syndrome could develop behavioral effects that include right/left 
confusion, difficulty with writing, and difficulty with mathematics 
(1994).  It can also produce disorders of language (aphasia) and the 
inability to perceive objects normally (agnosia).  A patient who has 
developed aphasia and agnosia has to change there basic everyday 
activities.  Many individuals are never able to develop a normal life 
again because of the brain damage they have developed.  They have to 
design a new life.  This task can be overwhelming for some individuals 
causing severe psychological deficits.  For example, in a specific case 
study, a forty six year old man was complaining about a reoccurring 
acute confusional state.  Certain symptoms that he listed of having 
were agitated visual problems.  He said that he was able to see letters 
written on the board but that he was unable to process them.  After a 
visual field examination, they stated that he had a right/left 
disorientation (Turkenberg, 1988).  The CT scan showed that he had a 
lesion in the left parietal cortex.  Doctors predicted that other 
behavioral effects that may occur due to this lesion is alcalculia 
(difficulty in calculation), agraphia (difficulty in writing), 
right/left disorientation, and finger agnosia (difficulty in 
identifying the fingers and naming them (Zaidel, 1994).  Because of 
these altered behaviors this individual will spend a large amount of 
his future learning about how to cope with his new mental 
representation.  
	Since there are two sides to the parietal cortex there can be a 
mix in behavioral effects, depending on which side develops a 
malfunction.  If the superior parietal lobe (SPL) becomes damaged it 
can lead to problems in visually guided action in the context of intact 
perception and awareness, whereas damage to the inferior parietal 
cortex (IPL) can potentially produce deficits in visual perception and 
awareness with relatively preserved action (Anderson, 1995).  Also, the 
parietal cortex is divided into two sections, the left and right sides.  
The right side has different tasks compared to the left, so if an 
individual develops a lesion on the right side there can be different 
symptoms.  Individuals who have a lesion on the right side of the 
parietal cortex have a chance of developing unilateral neglect, in 
which they lose awareness for visual events on the contralesional side 
(left) of space.  In this type of case the patient might have a hard 
time carrying out tasks on the left side, compared to the right.  For 
example, he/she might forget to eat the food on the left side of the 
plate unintentionally, while all the food is gone on the right side.  
They might also be unaware of shaving the right side of the face while 
not even touching the left side.  One other effect is having a hard 
time reading the words on the left side of a printed page in a book 
(Berkowitz, 1992).  
	It is possible for both sides of the parietal lobe to be damaged 
also.  Bilateral damage is when both sides of the parietal lobe have 
sustained lesions.  This can cause Balints Syndrome, a visual attention 
and motor deficit (Berkowitz, 1992).  Characteristics of this 
occurrence are inability to voluntarily control gazing and ocular 
apraxia.  
	An individual who sustains a lesion in the parietal cortex can 
typically suffer strong psychological problems.  As it was pointed out 
earlier, this individual will have to cope with life in a new designed 
way.  In one study, selected patients reported that the environment 
appears to be confused and jumbled and they have a tough time judging 
the location of two objects relative to one another.   Other ongoing 
concerns that a patient may experience are self esteem levels, conflict 
management, fatigue, stress, anxiety, and assertiveness, among others 
(Berk, 2001).  Basically the life of the patient has done a half 
rotation.  Different doctors and therapists are aides in helping the 
patient learn how their new brain works.  Patients have to learn a new 
way about going on with life.  Doctors help them create substitutions 
for how to read and write, plus how to overcome other malfunctions that 
have arisen (Berk, 2001).  For instance, if a patient has suffered from 
verbal apraxia, he/she has to learn a new form of communication whether 
it be speech clarification or some other alternative.  Relationships 
with others can be a problem, especially if the patient has lost the 
will to communicate.  Perhaps the biggest problem for a patient who has 
sustained a lesion in the parietal cortex is financing the whole 
recovery.  Not only do they have to pay for there physical and mental 
disability they have to pay for it also.  The mental health systems and 
medical programs have to combine in helping these individuals overcome 
an unstable environment.
	Since there can be many different effects from a lesion in the 
parietal cortex, doctors have not been able to create one type of cure 
or rehabilitation program for the patients.  There are to many areas to 
focus on and each one brings individual problems.  Each patient will be 
different in how they deal with this ordeal.  There is no one answer in 
dealing with a malfunction in the parietal cortex because they are all 
different in some way.  Plus, the psychological effects have a wide 
range too.  As we head into the future it will continue to be a long 
journey in developing a substitution for the parietal cortex if it 
becomes injured.           



References:

Anderson, R. A. (1995).  Coordinate transformations and motor planning 
in posterior parietal cortex, in M.S. Gazzaniga (ed.), The Cognitive 
Neurosciences, MIT Press, pp. 519-532).

Berk, L. E.  (2001).  Human Development.  Needham Heights, 
Massachusetts:  Allyn and Bacon.

Berkowitz, L.  (1992).  The Working Brain.  New York:  Wiley-
Interscience.

Carlson, R. L.  (2001).  Physiology of Behavior.  Needham Heights:  
Allyn and Bacon.

Turkenberg, J.L., Swaab, D.F., Endert, E., Lawrence, A.L., and van de 
Poll, N.E.  Brain Research Bulletin, 1988, 21, 215-224.

Zaidel, W. D.  (1994).  NeuroPsychology.  San Diego, Ca:  Academic 
Press.



Parietal Cortex
Spouse and other family members
Sheila Herbst

	When a family member has determined they are dealing with a tumor 
that is on the parietal cortex of the brain.  The parietal cortex is 
located in the cerebral cortex which may be anatomically defined as the 
higher order center of the central nervous system.  It is composed of 
embryological divisions, called lobes (with gyri and sulci) which are 
functionally interdependent, though organized and localized with 
respect to primary attributes such as motor, sensory, emotion, and 
special senses.  There are intimate associations of these regions with 
high order subcortical regions as well as the brain stem and spinal 
cord. (Crammond, 1997)
	I had discovered that located in the primary parietal lobe there 
are essentially four submodalities of somatic sensation: Pain, Thermal, 
Touch-Pressure and Position-Kenesia (ie. Limb position and sense of 
joint movements).  Somatosensory cortex is highly organized by input 
source—and the body regions capabilities of the greatest sensitivity 
occupy the greatest amount of the somatosensory cortex.  Pathways 
contain somatosensory information from the body and from the head—the 
dorsal column-medial lemniscation system, the spinothalamic system, and 
the trigeminalthalamic system and trigeminoreticular system. (Carlson, 
1998)
	The tumor can be either benign or malignant.  If the tumor is 
benign then it is made up of benign (harmless) cells and has distinct 
boundaries.  Surgery alone may cure this type of tumor.  If it is 
malignant then the tumor is life-threatening.  It might be malignant 
because it consists of cancer cells or it may be malignant due to its 
location.  A brain tumor even though it consists of benign cells is 
malignant due to the location.  This spouse is suffering form a life-
threatening tumor because of the location in the parietal cortex. 
(ABTA, 1991)
	The causes of brain tumors are unknown, which bothers family 
members the most.  To know that science has not been able to determine 
how brain tumors start is what scares family members the most.  Due to 
the fact that we do not know how they start we are unable to prevent 
them from occurring. Environmental agents, familial tendencies, viral 
causes, and other possibilities are under investigation.  However they 
know that brain tumors are not contagious which brings me a relief for 
the family. (ABTA, 1991)
	Symptoms that are caused form having a tumor on the parietal lobe 
vary.  Seizures, speech disturbances if the tumor is in the dominant 
(usually left) hemisphere and loss of ability to write (agraphia) are 
common symptoms.  Also spatial disorders, such as difficulty with body 
orientation in space or recognition of body parts may also occur. 
(ABTA, 1991)
	 I have found many support groups for the family to get involved 
in to help them deal with all the new changes they are about to 
encounter.  National Brain Tumor Foundation Support Group Listings 
1(800) 934-CURE (2873) Cancer Care Counseling Line 1 (800) 813-HOPE 
(4673) National Family Caregivers Association                    1 
(800) 896-3650 Well Spouse Foundation 1 (800) 838-0879 Wellness 
Community (310) 453-2300 (National Headquarters.  Being able to have a 
network of people to help the family cope with such hard issues will 
help the patient as well.  When the family is able to deal with the 
issue of a tumor and have a positive outlook to be supportive then the 
family will be better off. (NBTF, 2000)
	The NBTF Support Network is a telephone service for brain tumor 
patients and their families in which individuals can be connected to 
other brain tumor survivors or caregivers. These NBTF volunteers offer 
information, stories, support, and an understanding ear. If you are 
interested in being connected to another survivor or caregiver please 
call the Patient Services Department at (800) 934-CURE or send us 
email.  These types of services are located almost everywhere and 
families should take advantage of them. (NBTF, 2000)
	Lesions and electrophysiological studies indicate the parietal 
lobes play a role in visual and spatial attention and in computing the 
spatial coordinates of visual input.  Fewer studies have investigated 
the role of the parietal lobe in auditory spatial processing and an 
extensive comparison of visual and auditory spatial processing in 
humans with parietal lobe lesions has yet to be conducted.  We have 
studied such localization abilities in a Balint's syndrome patient (RM) 
who has bilateral parietal lobe lesions.  The results indicated that 
this patient had a significant deficit in both visual and auditory 
localization relative to age-matched controls.  Unlike the controls, 
however RM's auditory localization ability either matched or exceeded 
his visual localization ability depending on the task.  Accordingly, RM 
exhibited "auditory capture" but not "visual capture" under conditions 
where control subjects showed the opposite pattern.  These results are 
consistent with the hypothesis that the parietal lobes are involved 
with creating multiple spatial representations in shifting form one 
spatial reference point to another, but suggest that these parietal 
structures are not necessary for the integration of multiple sensory 
stimuli resulting in capture effects. (Phan, 2000 Abstract from author)
	Dealing with either a tumor or a lesion is difficult for family 
members and patients.  The surgery that may be involved can be very 
stressful for those involved.  Dealing with the brain and having any 
type of surgery is very dangerous.


References:

American Brain Tumor Association.  A Primer of Brain Tumors.  ABTA, 
1991.

Carlson, Neil R.  Physiology of Behavior.  Allyn and Bacon: 1998.

Crammond, Donald J.  Trends in Neurosciences.  Elsevier Science Ltd. 
February 1997, Volume20.

Haupt, C. and U. Ancker.  "Therapy of Brain Tumors"  November 1995.  
http://cancer.med.upenn.edu/cancernet/95/nov/711551.html#25

Marangolo, Paola and Enrico Di Pace.  Journal of Cognitive 
Neuroscience. MIT Press, November 1998, Volume 10.

National Brain Tumor Foundation.  
http://www.braintumor.org/pservices/bsbtfaq.asp#1 

Phan, M. L. and K. L. Schandel. Journal of Cognitive Neuroscience. MIT 
Press, July 2000, Volume 12.

Powell, Michael.  BMJ: British Medical Journal. BMJ Publishing Group, 
April 2000.



Jennifer Crawley
Social Worker


I've been working as a social worker for quite a long time now.  
Just recently it was my first time that I have the chance to work with 
a man that has apraxia of speech. Apraxia of speech is to refer to all 
surface articulatory disorders resulting from motor speech programming 
deficits.  The first time I met him is when he first found out that he 
had cancer.  The doctor found a tumor that was on his left parietal 
cortex.  The only thing they were able to do was removal the tumor.
		
Before the surgery, he was hesitating in going through with the 
surgery and I reinsured him that it was the right thing to do. When I 
would meet with him, he was very talkative in a smarty pants way.  The 
doctors told him of all the consequences and the worst scenario would 
be not able to talk. I advised him going to therapy before hand to help 
deal with the change but of course he didn't take my advice. At the 
time in his life he had all he every wanted, kids, a perfect wife and 
the job of his dreams. He was well known in the town and a good 
accountant.
		
After the surgery, I visited him once a week to see how things 
were holding up.   He couldn't talk much or even tried to make eye 
contact.  I could tell that this was the turning point in his life.  
When the doctor released him, he started to mumble a lit bit, but still 
couldn't make any words out. I could see in his eyes that he was 
already depressed and didn't want to see anyone.  He just sat in the 
room while his wife took care of the kids and the house. He was being 
very stubborn and acted like he didn't even exist. 
		
After a couple of weeks went by, I started to visit him more 
frequently.  Now he was able to speak about five words in about two 
minutes.  There were long pauses in between each word and on a good day 
there would be about three to five rehearsal of a word.  His wife was 
getting worried and wanted my help to get him on the road of recovery. 
During my visit, I would give him a list of control phrases for 
example; I have to go to the bathroom and a topic specific dictionary 
of words or other symbols.  He started to communicate better and wasn't 
getting so flustered. Once the break through he wanted to go back to 
work.
		
When he did take that next step, people were staring at him and 
all of his friends wanted to come and talk to him.  They never realized 
that he wasn't the same guy. I knew that he trying very hard to not let 
that bring him down.  I gave some advice to see a therapist and gave 
him the information about a support group that helps people like him.  
For once he finally realized that it was time to seek help.  The group 
did wonders, he learned to control the number of rehearsals for a word 
and he felt like he was getting the hang of things.  During the group 
sessions he saw others with devices and they can communicate a lot 
better than just writing things down on paper.  I looked around and 
found what he was looking for.  The talking word board system, it is a 
symbol and content free so that symbol sets are completely flexible and 
can be selected commensurate with the user's cognitive, linguistic and 
visual skills.  He takes it to work and things slow progressed.  With 
the new device and the group therapy, he is starting a new that he can 
deal with.  He knows now that talking is not the most important part of 
communication, facial and eye contact is what he enjoys the most. 
		

As time goes on, technology is developing fast and who knows what 
else can be offered to people with speech impairment.  
		


	Bibliography

	Acquired Apraxia Of Speech in Aphasic Adults. Paula Square –storer. 
Taylor and Francis, 1989. 


	Sarah Soper
Lesion to Parietal Cortex- Neurologist

	The cortex of the cerebrum in the human brain is divided into 
four surface lobes: frontal, parietal, temporal, and occipital. Each 
area has its own set of functions and responsibilities that are 
associated with specific behaviors of the body (Mader,1997). The 
parietal lobe in particular has sensory areas that are responsible for 
the sensations of temperature, touch, pressure, and pain from the skin. 
It is this portion of the brain that receives nerve impulses from 
certain sense organs so that we can register, carry out implied 
actions, and understand our sensory experiences (Mader,1997). 
	Neurology is the medical science that deals with the study of the 
nervous system and the disorders that affect it(Wilkinson,1999). So, in 
the case of a lesion to part of the brain, a neurologist would be one 
to study the individual on a neuronal level. Finding and measuring 
synapse patterns and their chemical usage within the various brain 
parts and using this information to provide knowledge for the field, as 
well as feedback to the patient as far as diagnosis and 
prognosis(Wilkinson,1999). 
A lesion is damage to some part of the brain caused by various 
instances, including a head trauma or a stroke. What generally happens 
with lesions is the damaged portion of the brain can no longer function 
to the full ability or in the same way as it had previously, leading to 
a change in behavior (Mader,1997). Often, lesions to any part of the 
cortex will lead to apraxia, which is characterized by the loss of the 
ability to initiate or carry out very familiar learned movements 
despite having the desire and physical capability to do so 
(Faglioni,1985). 
Lesions to the parietal cortex have been shown to cause both 
ideomotor and ideational apraxias. Ideomotor apraxia is the inability 
to carry out a motor command. A person with this damage would have 
difficulty pulling their hand from a fire or pointing to an object of 
desire (Faglioni,1985). Ideational apraxia is the inability to create a 
plan for or idea of a specific movement. A person with this damage 
would have difficulty drawing a specific figure or reaching to scratch 
an itchy nose (Faglioni, 1985). It has been shown that parietal damage 
brings about apraxia by severing the pathways transmitting visual and 
audio-verbal information to the sensomotorium (Faglioni,1985). This 
means that sensory information coming in would not make it through the 
circuit that would tell the muscles how to react to this information.


The job of a neurologist is to help diagnose what exactly is happening within the 
central nervous system of the patient based on a personal account of 
the symptoms from the patient as well as observed behavioral 
differences from what is normal by the doctor. A neurologist will take 
the behavioral information and correlate it with the available 
knowledge of brain activity and function and attempt to pinpoint 
exactly where a problem is going on (Wilkinson,1999). If a patient were 
to come in complaining that they did not have control over the movement 
of their arm, the neurologist would ask questions to find out exactly 
what the patient could and could not do with their arm and other parts 
of the body. Generally the symptoms would point to a specific region of 
the brain that is affected and perhaps even more refined, the specific 
neuron pathway that no longer functions (Wilkinson,1999). Once the 
affected area is discovered it is time to figure out what can be done 
about it. Optimally the damaged area can be repaired through the work 
of a neurosurgeon and begin transmitting information properly for 
normal behavior. Often though, this is not possible and a patient has 
to spend considerable time with a neuropsychologist in order to relearn 
how to manage their lives as functionally as possible.


Faglioni,P. & A. Basso. Historical Perspectives on Apraxia.       
3-44. Advances in Psychology: Neuropsychological Studies of 
Apraxia and Related Disorders. Oxford:  North-Holland,1985.


Mader, S.L. Inquiry Into Life. Boston: WCB/McGraw-Hill,  	      
	1997.


Wilkinson, I.M.S. Neurology 3rd edition. Oxford: Blackwell 	Science, 
1999. 
	
		
	Apraxia of Speech-A Neurosurgeons Perspective
by Tom Cave                                                                            


The patients presenting problem is a neurogenic phonologic selection 
and sequencing problem called apraxia of speech. Patients will report 
that they have a clear idea of what they intend, but cannot get the 
speech sequence started, or keep it rolling once it is started. (Human 
Communication Disorders, Shames and Wiig) The etiology for apraxia of 
speech is brain damage-most likely a unilateral,left hemisphere lesion 
involving the third frontal convolution (Language Intervention 
Strategies in Adult Aphasia, Chapey). Damage can occur from the robbing 
of nutritional requirements from surrounding healthy tissue or the 
pressing and impinging of a growing mass of cells on surrounding 
tissue.
 
The Skull contains the brain, the cerebrospinal fluid (csf), and blood.  
Whenever any one of these three components increases in volume, 
intracranial pressure rises.  A tumor increases the mass contained 
within the skull and may block the flow of csf.  Nausea, vomiting, and 
headaches are created by pressure in the brain caused by the growing 
tumor and by the accumulation of csf.  All of which are symptoms 
reported by the patient.

When volume increases, the brain may be compromised in several ways: 
structures may be displaced; signal transmission may be impaired; 
nerves may be compressed; possibly fatal hemorrhaging may occur; the 
optic nerve may become swollen; and accumulation of csf may develop 
(Oncology World.Com). All of which may complicate surgery.

The presence of a sustained increase in intracranial pressure can be 
significant in the assessment of a patient within a neurological 
disorder.  The normal range for intracranial pressure is between 50 and 
180 mm H2O, however our patient has an abnormally high reading of 200 
mm H20.  Any condition that causes an increase in volume in one or more 
of the structures within the cranium will cause an increase in pressure 
with in the contained area (Miller-Keane Medical Dictionary 2000).  The 
patients recent history then indicates the possibility of a brain 
tumor.

Braintumors are abnormal growths of tissue found inside the skull.  The 
word tumor is used to describe both abnormal growths that are new 
(neoplasms) and those present at birth (congenital tumors).

No matter where they are located in the body, tumors are usually 
classed as benign (non cancerous) if the cells that make up the growth 
are similar to other normal cells, grow relatively slowly, and are 
confined to one location.  Tumors are called malignant (cancerous) when 
the cells are very different from normal cells, grow relatively 
quickly, and can spread easily to other locations.

When a doctor suspects a brain tumor because of a patients symptoms one 
can turn to a number of specialized tests and techniques to confirm the 
diagnoses.  The first test is often a traditional neurological exam, 
which checks; reflexes, hearing, sensation, movement, balance, and 
coordination.

The next step in diagnosing brain tumors often involves X-rays or 
imaging techniques and laboratory tests that can detect the presence of 
a tumor and provide clues about its location and type.  Computed 
tomography (CT) and magnetic resonance imaging (MRI) have dramatically 
improved the diagnosis of brain tumors.

For my patient I have opted to use a MRI because it can often 
distinguish more accurately between healthy and diseased tissue.  MRI 
gives better pictures of tumors located near bone than CT, does not use 
radiation as CT does, and provides pictures from various angles that 
can enable one to construct a three dimensional image of the tumor (Web 
MD).

The MRI scan revealed a tumor in the lateral posterior cortex in 
Brodmann's area 40 (Journal of Neuroscience, Jonides et al).

A surgeon may have difficulty in knowing where a tumor ends and the 
normal brain begins.  Consequently, prior to surgery a volumetric 
stereotaxis will be performed. Volumetric stereotaxis is a method for 
gathering, storing and reformatting imaging derived three dimensional 
volumetric information defining an intracranial lesion with respect to 
the surgical field.  With this technique a surgeon can plan and 
simulate the surgical procedure beforehand, reach deep seated or 
centrally located tumors employing the safest and least invasive route 
possible.  Advantages for patients include: the smallest possible skin 
incision, craniotomy and brain invasion; a more complete tumor removal 
can be accomplished with less risk to surrounding tissue; and 
postoperative neurological results are better (Patrick J. Kelly, MD).

Prior to surgery small markers (feducials) that show up in an MRI are 
applied to the patients head.  The patient is placed in an MRI unit and 
a series of images are obtained.  This data is transferred to a 
computer in the operating room.  The computer reconstructs the MRI 
images and produces a three dimensional picture of the head and lesion 
in three planes.  After the patient is anesthetized, the head is pinned 
in a head frame to rigidly hold it in place.  The feducials are 
registered on the MRI and are matched to the corresponding feducial on 
the patients head.  The latter is accomplished with a pointer 
containing an array of light emitting diodes.  A receiver positioned 
near the operating table registers the position of the diodes and thus 
the position of the head feducials.  This information is transferred 
directly to the computer.  The pointer can then be used to direct the 
surgeon to the lesion with no more than a 1-2 mm error (Your 
Surgery.Com).

A parietal craniotomy is to be performed.  This entails making a trap 
door in the skull to expose its contents.  An incision must be made in 
the scalp and the scalp is then peeled back to expose the bone of the 
skull.  One or several holes (about ˝ inch in diameter) are made in the 
skull using a special saw.  Then the plate of bone is removed, exposing 
the outer membrane covering the brain-or dura mater.  The dura mater is 
cut and the surface of the brain is thus exposed.  The operation to 
remove the tumor proceeds.  When this is completed, the dura is usually 
closed with sutures and the bone plate is replaced.  The scalp is then 
closed (Patrick J. Kelly, MD).

After surgery,a biopsy is performed by taking a small sample of tissue 
from the tumor.  By examining the sample under a microscope a 
pathologist can tell what kind of cells are in a tumor, looking for 
certain changes that signal cancer; abnormal growth in the cell 
membranes and problems in the cell nuclei.  Using this information, the 
pathologist provides a diagnosis of the tumor type.  The tumor may also 
be classified as benign or malignant which helps predict the likely 
outcome for the patient after surgery.

Tumor and surgery can result in swelling inside the cranium.  
Consequently, a prescription to reduce this swelling will be provided 
in the form of dexamethasone, methylprednisolone, or prednisone (Web 
MD).






References:

Human Communication Disorders. Shames and Wiig pgs. 501 and 510.
Language Intervention Strategies in Adult Aphasia. Roberta Chapey. 
Pg.424.
Oncology World. Com
Miller-Keane Medical Dictionary 2000
Web MD. National Institute of neurological Disorders and Stroke.
Journal of Neuroscience 4/22/01, Jonides et al.
Patrick J. Kelly, MD. http://mcns 10. med.nyu. edu/tumor/brain.
Your Surgery.Com
Web MD, Brain and spinal cord tumors.


Parietal Lesion- Neuropsychological Perspective
BY: Laramie Lesina


I saw the patient two days after a lesion occurred in the parietal lobe 
of the brain. The patient is a fifty year old Caucasian male with no 
previous serious medical history. The man was involved in an automobile 
accident and was thrown from the vehicle experiencing serious open head 
injuries. These injuries resulted in lesions to the right and left 
hemispheres of the parietal lobe.


The parietal lobe is located just behind the frontal lobe in the 
cerebral hemisphere and is separated from it by a shallow groove called 
the central sulcus. The parietal lobe is the sensory area responsible 
for sensations of temperature, touch, pressure and pain from the skin. 
Its association areas function speech and the use of words, thoughts, 
and feelings (Parietal Lobes). 


Damage to the left parietal includes, right and left confusion, 
difficulty writing and difficulty with mathematics. It can also produce 
disorders of language and the inability to perceive objects normally 
(Parietal Lobe Functions).


Damage to the right parietal hemisphere includes, contralateral 
neglect, which can impair many self-care skills such as dressing and 
washing. Right side damage can also cause difficulty in making things, 
denial of deficits, and drawing ability (Parietal Lobe Functions).


Upon psychological evaluation, the left hemisphere of the parietal lobe 
seems to have suffered the most damage, but the right parietal damage 
is also of a concern. The left hemisphere of the parietal lobe is 
associated with language and perception. I have concluded that this 
individual is experiencing several types of apraxia due to the severity 
of the accident and the head injures that the patient has.


When assessing for Ideomotor Apraxia I requested that the patient 
demonstrates the usage of a tool, I asked if he could show me how to 
cut with scissors. I noticed that the patient was having difficulties 
with his hands, as he seemed to randomly move them in space. After he 
displayed this disoriented behavior I concluded that Ideomotor Apraxia 
was apparent.


The patient also suffers from Ideational Apraxia due to the fact that 
he cannot perform a series of acts in sequence even though he can 
perform these tasks individually. This area of apraxia results from a 
loss of the conceptual knowledge associated with objects and the 
overall goal of the activity sequence (Behavioral Neuropsychology).


The third type of apraxia the patient suffers from id Buccofacial 
Apraxia. He has difficulties performing skilled movements with his 
lips, tongue, face, larynx and pharynx. He has been substituting verbal 
expressions for the movements; this is a classic sigh of Buccofacial 
Apraxia (Behavioral Neuropsychology).In my opinion the patient suffers 
from verbal apraxia. He now has the inability to produce sentences and 
communication id very hard for the patient. His frustration is very 
noticeable.


I will request a Physical Therapist for help with walking, transfers 
and wheelchair help throughout the facility. An Occupational Therapist 
will be provided for help with visual and perceptual tasks as well as 
ADL activities (Activities if daily living). A speech Therapist will be 
used to help establish and direct communication between patient and 
staff as well as the communication with his family members. The Speech 
Therapist will monitor whether or not the staff is communicating 
appropriately with the patient. A Recreational Therapist will assist in 
the rehabilitation process by interacting with the patient by doing 
things that the patient is interested in doing; the therapist will also 
assist with the speech rehabilitation team. To complete the 
rehabilitation team there will be a team of nurses to assist with the 
patients' immediate commands, bowl and bladder function as well as skin 
care.


My prognosis for this individual is fair. The head injuries that he has 
suffered from are severe but not untreatable. He will need to have an 
extensive rehabilitation team for the first few months of recovery. 
Followed by outpatient rehabilitation for at least one year.


References:

	 Clinical Neuropsychology: Behavioral Neuropsycholoy. [Online], 
Available: http://nanonline.org/NANdistanCE/mtbi/ClinNeuro/apraxia.html
	Parietal Lobe Function: Parietal Lobes [Online], Available: 
http://www.neuroskills.com/tbi/bparieta.html

Parietal Lobes. [Online}, Available: 
http://www.mnerbody.com/text/nerv43,html

Copyright © 2001, Dr. John M. Morgan, All rights reserved - This page last edited 7 - May, 2001
If you have any feedback for the author, E-mail me