Soviet Psychology

ISSN: 0038-5751 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/mrpo19

On The Disturbance of Intellectual Operations In

Patients With Frontal Lobe Lesions

A. R. Luriya & L. S. Tzvetkova

To cite this article: A. R. Luriya & L. S. Tzvetkova (1967) On The Disturbance of Intellectual
Operations In Patients With Frontal Lobe Lesions, Soviet Psychology, 6:2, 3-6

To link to this article: http://dx.doi.org/10.2753/RPO1061-040506023

Published online: 19 Dec 2014.

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A. R. Luriya and L. S. Tzvetkova
Downloaded by [New York University] at 02:08 26 June 2016
(Department of Psychology, Moscow State University)
ON THE DISTURBANCE OF INTELLECTUAL OPERATIONS
IN PATIENTS WITH FRONTAL LOBE LESIONS
It is well known that lesions of the posterior
(parieto-occipital) and frontal lobes of the brain
lead to structurally disparate disturbances in
intellectual operations.
Whereas in patients with posterior (parieto-
occipital) lobe lesions, the orienting basis of
intellectual activity is preserved and only indi-
vidual intellectual operations (such as the pos-
sibility of simultaneous comparison of different
descriptions) are disturbed, patients with fron-
tal lobe lesions exhibit a contrary picture.
While individual operations are potentially pre-
served, it is often the orienting basis of an in-
tellectual act which is affected, and the selec-
tivity of intellectual processes governed by a
given program is disrupted (1, 2).
Heretofore, we have restricted ourselves to an
analysis of disturbances which appear in solv-
ing arithmetical problems. In the present re-
port, we shall explore disturbances manifested
in another type of intellectual operation, i.e.,
those involved in outlining and recounting a
written text. Particular attention has been given
3
Voprosy psikhologii, 1967, -
13(4), 102-106
to an analysis of the orienting basis of this type
of activity.
The patients were presented with a relatively
simple text. They were to read it through and
recount it orally. Then they were asked to out-
line their recitation. In this way, they were
placed in a situation that required a special
orientation toward the conceptual structure of
the text. For a control, the same patients were
asked to relate some event in their life and to
outline this account.
The study involved a comparative analysis of
patients with parieto- occipital and frontal lobe
lesions.
It is recognized that work with a written text,
like other intellectual tasks, exhibits the most
essential aspects of the intellectual act. For a
coherent account of any event, it is first of all
necessary to set out certain ideational points
of reference to establish the pattern of narra-
tion; then the individual episodes must be dis-
tinguished and coordinated with each other,
showing their interrelatedness. This prelimi-
 4 SOVIET PSYCHOLOGY
nary analytic- synthetic activity is immediately
transformed into a detailed narrative.
The construction of an outline of a perused text
sets forth the most complicated requirements
for the orienting basis of an intellectual act.
To compose such an outline, it is necessary to
divert ones attention from the direct exposition
of the material and to break down the text into
i t s ideational components. Each of these com-
ponents acts as an ideational reference point in
forming an outline. These points may be marked
out only in the final result of an active conscious
activity to extract the essential point of the ma-
terial (A. A. Smirnov [4]). All these processes
(breaking down the text into components, isolat-
Downloaded by [New York University] at 02:08 26 June 2016
ing the ideational points of reference in the text,
and determining the points of primary and sec-
ondary importance and the relationship between
them) a r e the principal components of any intel-
lectual activity.
The analysis of a text into i t s ideational com-
ponents and the extraction of the main thought
from each of these, i.e., the ability to ignore
unessential details, is an active process requir-
ing a preliminary orientation to the material
and the maintenance of a goal-directed, analytic-
synthetic activity,
In our study, we found that in work with a
written text, as in the solution of arithmetical
problems (cf. r3]), the disturbance of this process
shows s h a r p differences between patients of the
two test groups.
Patients with frontal lobe lesions exhibited
striking defects in work with a written text.
These defects were already apparent in the
simple recounting of the perused text.
Descriptive texts containing several trains of
thought were often recounted fragmentarily by
these patients: only isolated, sometimes unre-
lated, facts were presented. They were not able
to discern the chief thought of the text, to mark
out a unified pattern of exposition, and some-
times they included in their recount incidental
associations which occurred to them while read-
ing and consequently were unable to give a uni-
fied, consistent presentation of the perused ma-
terial.
The disturbances characteristic of these pa-
tients were also manifested when they recounted
relatively simple narrative texts; sometimes
these recounts followed the text very closely,
often the individual fragments of the exposition
were unrelated, and sometimes the sequence of
the exposition was interrupted by incidental as-
sociations which occurred while reading the
text.
A careful analysis showed that all these de-
fects were attributable to the fact that these pa-
tients did not make a special effort to analyze
the ideational structure of the text; the exposi-
tion followed the formal plan of the text, rather
than the patients formulating their own outline,
This fact was especially outstanding when the
patient was asked to make his own outline of
narration first, and then to relate its content.
Often the patient was totally incapable of such
a task.
Thus, the patient Bog, (56 years old, higher
education, senior scientific assistant) had been
admitted to a rehabilatory training course after
removal of a tumor in the post-frontal lobes of
the left hemisphere. The patient clearly mani-
fested a post-frontal lobe syndrome, with inac-
tivity, lack of spontaneity, clumsy persevera-
tions, and inertness of stereotypes occurring
in the motor as well as the speech apparatus,
The patient was asked to read and recount orally
a story by G. Skrebitzkiy and V. Chaplin, Look
Out the Window. The patient almost word for
word recounted the content of this story but was
completely unable to outline it.
When asked to formulate an outline of the
story, the patient said: outline ... well . , ,
yes ... .
the first point, that is . . of course!
the first is.. ..
. look out the window , (pause)
.. -
. well, and then the second is look out the
.
window (laughs) and there you w i l l see , . the
whole window is decorated with white designs
and the trees also ... (then the patient again
glided off into a simple exposition of the storys
content).
Patient Urb. (30 years old, middle education)
underwent several operations in 1960-1963.
First a tumor (oligodendroglioma) which occu-
pied the anterior sections of the right frontal
lobe w a s removed. This was followed by extir-
 VOL. VI, NO. 2
pation of a tumor in the posterior sections of
the right frontal lobe, and finally another tumor
in the posterior-medial sections of the left fron-
tal lobe w a s removed,
This patient, like the previous one, was able
to communicate the content of stories quite tex-
tually, with all details. Thus, for example, he
had no difficulty in recounting L. N. Tolstoys
story The Eagle. However, he completely
failed in his attempts to outline the story. To
the testers questions: how did the story begin;
what was the main thought in the first part of
the text? the patient answered: about an eagle
and his nest. When asked to first give an out-
line of the story, the patient immediately passed
Downloaded by [New York University] at 02:08 26 June 2016
to a simple recount of the text: Next the people
simply took away his fish, the devils, and went
away. The eagle is our tsar, and thats the way
they treated him! He flew back to his young
without the fish, and there they were peeping,
asking for something to eat, but the eagle was
tired ... , etc. (Extract from report of July 12,
1963.) Analogous difficulties were observed in
patients of this group when they attempted to
narrate some known or experienced event. They
were able to narrate a known episode or series
of episodes, but they were unable to formulate
a preliminary outline, nor were they capable of
relating a story in accordance with an outline.
Hence, to write a composition on a slightly
known theme requiring preliminary reflection
and the construction of a basic plan of exposition
was completely beyond the capabilities of these
patients.
The same patient Bog. related a journey to
the South, 1 traveled to the South. The South,
the land of plenty, beautiful country. Yes, I went
there. There grow the plane trees, beeches,
hornbeam, rosalia ... there is the sea. Where
. .
you can bathe and get a tan . , etc. However,
this is the outline he made for this same story:
1) The South is a land of the sun; 2) The South
is the land of happiness; 3) My journey (pause)
... thats all.
In response to a request for a more detailed
outline from the moment of departure, the pa-
tient wrote: 1) My journey to the South; 2) My
journey to the land of plenty; 3) My journey . . .
5
(pause)... thats all.
Further attempts to encourage the patient to
make an outline were without result.
The same phenomenon was observed in patient
Bor. (50 years old, middle school teacher) who
had had a tumor removed from the left temporal
lobe in 1963. When asked to relate something
about the North, she said: The North means
the cold and lack of fruit ... thats all, whats
more ... (pause). When requested to relate
something more detailed, she retorted: Well,
..
what are more details . I simply cant ... I
will tell about Shadrinsk, I lived there and know
the place, but dont know how to tell about it , ,.
there is much snow, severe frost ... there are
. .
difficulties with water . you must wait your
turn for a bath ... there are many dogs ...
every house has a mean dog .. , the houses are
of wood. They fell trees. Thats all.
Thus, when working with a written text, as
when solving arithmetical problems, patients
with frontal lobe lesions are incapable of isolat-
ing essential relationships and cannot compose
a preliminary outline. The orienting basis of
intellectual activity leading to the construction
of a plan for further exposition is profoundly
disturbed in these patients.
Patients with parieto-occipital lesions dis-
played a totally different syndrome.
In contrast to patients with frontal lobe lesions,
patients of this group exhibited pronounced de-
fects in both the nominative function of speech
and in its logico-syntactical structure. This is
sharply reflected in the detailed narrative
speech of the patients. Sometimes they have
difficulty in constructing a sentence, and even
more in constructing an entire coherent narra-
tive. For this reason, these patients experienced
considerable difficulty in fulfilling the task of
reciting a perused text. However, in contrast to
patients with frontal lobe lesions, they managed
a story outline with relative ease. Even though
they still exhibited the described speech defects,
they were aware of the central point in each
ideational unit, not infrequently expressed this
in two o r three words, and were able to formu-
late an outline, although with considerable speech
difficulties.
 6 SOVIET PSYCHOLOGY
Patient Bub. (39 years old, higher education)
with residual symptoms of thromboembole in the
left medial cerebral artery and a syndrome of
gross semantic aphasia, spatial disorientation,
acalculia, defective oral expression, was exam-
ined by the same procedure. After several at-
tempts to given a coherent account of the content
of a story about the adventures of Odysseus, the
patient was still unable to fulfill this task. How-
ever, he quite rapidly composed a precise out-
line for the story, consisting of the following
-
points: 1) Odysseus a brave and clever man;
2) The journey of Odysseus; 3) His encounter
with Cyclops; 4 ) Scylla and Charybdis; 5) Odys-
seus and the people. (Extracts from report of
Downloaded by [New York University] at 02:08 26 June 2016
January 12, 1963.)
The same phenomenon w a s observed in the
patient L., who had had an arachnoid endothelioma
removed from the left occipital parasagittal re-
gion in 1961, after which a syndrome of spatial
disorientation, pronounced semantic and anam-
nestic aphasia, and acalculia remained.
The patient w a s asked to tell about a journey
to the South. She experienced considerable dif-
.
ficulty in fulfilling the task. In the South , ,
it is hot ... there is... ...
vegetation espe-
cially southern ... there . .. . .
it. Oh1 good
heavens1 Really, I know all about it, Ive seen
it .. .but I cant say anything. There are trop-
ical plants .. . ...
and ...
and there are peo-
ple live .. .there . . . oh! I cant! (refusal).
The speech of the patient was interrupted by
pauses and accompanied by pronounced emotional
reactions,
But when asked to make an outline of the story,
the patient wrote, formulating each point with
difficulty: 1) Departure from Moscow; 2) Sketch
of the landscape along the way; 3) Approaching
southern regions; 4) Characteristics of nature
and the beauty of the South; 5) Return home,
Analogous phenomena were observed in her
attempts to cope with an outline for a story on
a theme based on a personal experience of the
patient. Thus, when she w a s asked to make an
outline of a story on the theme The North she
said: =First, how it all began ... . ..
this how
...
should I say it well, anyway... the excur-
sion, no ... ...
no no excursion, the prepara-
tion for departure to the North, And then, the
second point, well, .. the beginning... how
should I say it? Well, lets say the beginning of
the journey. The next point .. . ..
that we , no
.. . well, yes, I have it, the interesting things
met along the way, Next, arrival, so, then ...
the forests, No, thats not what I mean, I want
..
to tell about , no, about the arrival in the
North, How beautiful it is, different from where
..
we live, unusual , this can be expressed in
the outline as .. . northern beauty. And then ...
who lives there, whats the correct way to say
it? The inhabitants of the North, right? And
now, something must be said about the animals,D
etc. (Extract from report of February 25, 1962.)
The data obtained demonstrate quite convinc-
ingly the essence of the difficulties experienced
by patients with parieto-occipital lesions and
make it possible to establish the fundamental
differences in the intellectual processes of pa-
tients with parieto-occipital and frontal lobe
lesions. Whereas in patients with parieto-oc-
cipital lesions the orienting basis of intellectual
activity remains intact, and the main defects
are associated with disturbances in the ability
to formulate the subject verbally, patients with
frontal lobe lesions retain this ability, and the
main defect is found in a disturbance of the ori-
enting basis of intellectual activity and the abil-
ity to program that activity, i.e., to extract a
system of ideational relationships as a guide for
subsequent exposition.
References
1. Luriya, A. R. Narustheniye stroyeniya
deystviya p r i porazhenii lobnykh doley mozga.
Dokl. Akad. Pedag. Nauk RSFSR, 1962, No. 5.
2. Luriya, A. R. & Khomskaya, Ye. D. Narush-
eniye intellektualnykh operatzii pri porazheni-
yakh zadne-lobnoy oblasti. Dokl. Akad. Pedag.
Nauk RSFSR, 1962, No. 0,
3. Luriya, A. R. & Tzvetkova, L. S. Neyro-
psikhologicheskiy analiz resheniva zadach bo1-
nymi lokalnykh porazheniyakh mozga. Moscow:
Prosvyashcheniye, 1966.
4. Smirnov, A. A. Psikhologiya zapominaniya.
Moscow: Akad. Pedag. Nauk RSFSR, 1946.