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Reprinted from
TRANSACTIONS OF THE
AMERICAN NEUROLOGICAL ASSOCIATION
1950
PATTERNS IN PERCEPTION ON SIMULTANEOUS TESTS OF
FACE AND HAND
MORRIS B. BENDER
MAX FINK
AND
MARTIN GREEN
NEW YORK
In previous studies we found that the method of double simultaneous
stimulation showed defects in sensation (extinction) which were not apparent on routine single stimulation. In testing two different regions of the
body and various combinations it was found that extinction was apt to
occur most often in the hand and least in the face. Conversely, “dominance”
was greatest in the face and least in the hand. In the present communication we wish to report the results obtained on simultaneous stimulation of
the face and the hand (the face-hand test) in groups of subjects with the
following conditions: 1) aphasia without hemiparesis or hemisensory syndrome; 2) aphasia with severe mental changes; 3) organic mental syn—
drome; 4) schizophrenia; 5) no disease of the brain (normal adults) and
6) normal children between the ages of four to ten years. Patients in groups
2 and 3 showed severe memory defects, confusion, poor orientation, difficulties in calculation and other symptoms characteristic of diffuse disease
of the brain.
Method: The subject was instructed to close his eyes. When this was
done his face (cheek) and contralateral hand (any part of the hand or
fingers) were touched Simultaneously. Care was taken to make the two
stimulations of equal intensity. As soon as the stimuli were applied the
subject was asked to report what he felt, and following this, where he felt
the sensation. Identical tests were carried out with light rubbing and pin
prick stimulations.
Results: Under these conditions the subject gave either of the following
responses on the first examination: a) a touch on the face only (face
dominance), implying no Sensation in the hand (extinction) ; b) a touch on
both sides of the face (there being “displacement” from the hand to the
ipsilateral face) ; or c) a touch on the face and contralateral hand. In the
(a) response the subject was asked whether he felt still another stimulus.
The reply was either in the negative, or there was uncertainty or vague
approximation. This question suggested to the subject that there were two
stimulations so that on subsequent tests he was expectant of more than
one stimulus.
In the (b) type of response the subject mislocalized or displaced the
sensation evoked in the hand toward the ipsilateral face. Since the mislocalization was towards the face it appeared as if the face determined the direc250
�251
Perception
in
al.——Patterns
Bender, et
of
type
a
this
was
that
therefore,
said,
be
might
It
than
tion of the displacement.
common
less
was
displacement,
or
(b),
Response
dominance.
face
the
patients
in
often
most
seen
was
(b)
Response
extinction.
or
(a)
testing.
response
repeated
despite
persisted
and
with the organic mental syndrome,
comment.
special
needs
no
and
normal
expected
the
was
face
The (c) response
ipsilateral
the
when
noted
werealso
Extinction and displacement
including
tested,
subjects
the
all
In
tested.
sides
and hand were simultaneously
left
and
right
the
between
difference
no
was
there
aphasia,
with
those
-
'
of the body.
the
in
shown
is
various
groups
the
in
obtained
results
Analysis of the
following table:
Hand
;/,’//
Group
Face Response
Extinction or
Displacement
Number of
Subjects
2
‘4
22
20
5
53
'
3
20
.
0
14
24
,
19
‘
0
6
20
'
Response
_
9
12
15
12
1
Face and Head
Response
‘
2
6
28
0
'
‘
-
0
0
0
.
j
.
l
l
of
is
dominance
there
whenever
that
obvious
is
it;
foregoing
the
From.
the
hand
in
Dominance
face.
the
in
is
it
apparent
another
over
sensation
the
in
one
"uniformly
almost
found
was
dominance
Face
once.
notedonly
did
was
patients
These
2
and
3)..
(groups
changes
mentalwithsevere
in.
_
subjects
few
a
In
repeated'testing.
after
hand
even
the
not report sensation in
were
or
stimuli,
two
were
there
told
the
were
patients
after
even
stances,
percept
one
only
reported
they
stimuli,
of
the
of
asked to watch the application
sides
both
of
stimulation
simultaneous
cases
Inthese
one.
displaced
these
that
or
objection
the
excluding
thus
correctly,
the face was reported
once.
things
at
_.
two
perceive
do
or
able
to
not
were
those
in
and
patients
with
aphasia
subjects
in
dominance
face
of
The'incidence,
in
..
patients
1 and 4) was less. In contrastto
with schizophrenia (groups
correctly
sensations
both
1
4
reported
and
in
those
groups
2» and 3,
the
hrst
groups
done
not
had
soon
if
they
trials,
fourth
third
or
second,
the
domiface
on
of.
incidence
the
5)
adults
(group
normal
of
the
In
group
the
trial.
on
found
only
it
was
though
even
significant,
still
but
least,
dominance
nance was
face
of
incidence
the.
children
normal
of
series
In
trial.
a
dominance
first
face
children
3.
In
2
and
young
in
groups
as
the
same
almost
was
examination.
first
the
after
trials
several
tested
was present even
hand
were
the
than
other
body
of
the
When theface and parts
The
apparent.
still
was
dominance
face
3,
2
and
in" groups
calf,
simultaneously
thigh,
penis,
(breast),
trunk
shoulder,
face,
was
dominance
order of
hand.
and
foot, arm
.
.
_
�252
Weights
(IL—Discrimination
of
Bender, et
CONCLUSION
In a wide variety of subjects the phenomena of extinction and displace-
consistent
A
demonstrated.
stimulation
simultaneous
were
ment on double
dominant
most
face
the
which
in
was
established
of
pattern perception was
and
abnormal
the
in
both
noted
These
findings were
and the hand the least.
the normal subjects. In the abnormal subjects with severe mental changes,
be
that
consistent
they
may
extinction
were so
face dominance and hand
used as a sign of diffuse disease of the brain, but only when found to persist
after repeated examinations.
The pattern of dominance, as well as the phenomenon of extinction,
be
to
brain
diffuse
disease,
with
in
appear
patients
which are so prominent
exaggerations of the patterns found in the normal subjects, especially
children.
�um
II mama! 0'
MES 0! I‘M!
w
3mm
my-
A!
Harris 3. Bender, ILD.
Pink, IL».
m
and
lax-tin anon, LB.
of
lumbar
fipi‘ffinfi
'75;
Buivenity cones. of Mieinc,
555
Sinai
City.
tort
lelpiul, In
m lupin
'
101E
law
c
fiy Edi-y,1 and that Haunt
3.11m.
from
the
mum;
grant
a
”starch
by
part)
(in
This work was aided
a.
by
grant
and
part)
(in
service
Public
With
of
math,
Institutes
Inc
York
.
city.
in
Cmbral
of
In
council
his:
Coordinating
the
I‘m
�1.'
Previously it was shown thst exsnihstioh of the cutaneous
uodelitiec by the method or double siuultsneous etisnlstion
elicited defects in perception which were not sppsrent on single
“extinctiont”
”obscuration,”
The
ss
defects,
desctihed
etihhlstion.
"displacement” and "eliesthesis'.were observed in groups of
or
the centrsi nervous
disesse
diffuse
with
localixed
or
patients
systen (1) (a) (3). In esch group the defects in cutaneous per»
most
were
stimulation
double
sismitsneous
obtsined
on
ception
of
the
rhe
fece.
hand
the
sud
object
in
the
lesst
in
appsrent
or
the
was
responses
determine
to
patterns
investigation
present
in nonnsi subjects, sduits and children,to simultaneous stisu1s~
Yarns
"fece~hs.nd”
observe~
head
and
teat
the
face
of
the
tion
tions in this nonnsl group were then cospsred to sole extent with
the responses of pstients with orgshic mental syndrases, sphssis
sud cchisophrenis.
IAEIR£égc
the ”non-s1“ subjects were children and sdulte.
These
there.
subjects were persons attending hcspitsl clinics, in
was no evidence or disesce or the brsin; and school children, start
of
disorder
manifest
who:
no
was
there
sud
in
students,
personnel
been
had
Hone
of
then
previously
system;
the central nervous
exslined by the nethod or double sisultsneous stimulation. the
to
according
sge:
three
into
groups
classified
were
subjects
12
“adults”
end
6
over
end
years.
7
to
3
children or to
it years,
For comparison with the noml goup we studied patients on
'There
were three
Bellevue
wards
of
Psychiatric
the
iospitsl.
the
sod
lo
attempt
sphssis.
psychoses
~
organic
schizophrenia,
group:
whom
�2.
.uno and. to separately study each or the clinionl typo: of
schisophronil. float of tho puticntu ours or the paranoza, mixed
or iinplc vurietiel of Iohixophrenin. the patient: uith organic
montnl changes showed doreota 1n nonorw, orient¢t1on and
onloulution, a: wall In other signs and symptom: oharuoteriltio
or dxtruoo dileIIO of tho brain. Tho clinical diagnoael in loot
of,those onuou was Althoincr'n dilt&§c, urtorionolcrotio onoop~
haloputhy, severe oorobrll ordain, brain tumor or toxic ano¢p~
who
with
thou
mm
uphuu.
lubjootl
mommy.
ohnrnotcriltio difficultiob in columnioation. Theta who had a
oonoolitant hmnipnroail or I huuiscnlory aorta? noticeable on
single Itilnlation war. not inorudod in thin Curios.
m
'3th
maroon:
2h: subject val instruotcd to‘olouo tho cyan. When thia
1p3111tcéll
(chock)
and
tho
oontrav
done
or
either
tho-root
it:
our.
hand
ninnltnnooully
on.
(any
hand
digit.)
at
or
part
lateral
touohcd or stroked with tho examiner‘s ringorl. the subject:
whoa
two
sonsntionn;
only one percept
one
or
either
reported
no: reported tho subject was naked 1: than. at: 3:111 unothor,
and 1: no, to indiooto its loontion and quality.
Following the initial trial, in each subject, tho opposite
chuck Ind hand aura stimulatod 1n the 1.80 nunnor. Those tout:
poquepoatod and tho result: reoordod, until tho subject: oon~
who
those
In
both
auhjootl
otinnli
correctly.
nistontly roportod
toiled to localize tho two Itinuli oorruotly otter at: or eight
word
an
touted
t1oo~ttoc,'hand~
body
the
of
0th.:
part:
triala,
room-hand
tho
with
uumung
ma, “mama, penis-hand, em,
tout.
�otinuleé
eerie! ot.stndies pin prick
tions sere used in s sinilsr fsshion.w In both series, cere use
taken to apply the stimuli at the me time and with the em
thst'snhdects
who‘nede consistentt
was
spherent
intensity. It
he
would
correct as soon es the stinuli were
errors in reporting
rsther
thsn sinnltsneoutly, even if the
spplied consecutively
tine leg betseen stinuli was that or one or two nonente. It was
slso necesssry to use neive norssl subjects, since sthects
previously tested did not show the.petterns noted below.
In e second sepsrste
8
ones;
lhe responses obtained on the tnce~hsnd test fell into four
groups: (s) s touch on the face and the hsnd, indicstins the
correct end expected perception; (h) e touch on the fees only,
in
the head; (c) I touch on both sides or
implying no eensstion
the tees: and (d) s touch on the bend only, implying none on the
race. flhen only one stimulus III reported the subject use ssked
if there uss any other sensstion. the oocesionsl reply sue that
there use snother percept, and the sthsct correctly pointed to
the second locus. lhny hdhaects, however, reported thst they hsd
not perceived snother stimulus, neuslly sdding the state-cut: ”In
use not paying sttention - do it seein' or, ”I'm not sure - Isvhe
of
here"
end
somewhere
the
the
was
direction
in
over
pointing
it
side of the body or the poorly felt stimulus. In some instances,
second
while correctly locslising the
percept, they Iinnteered
the ststenent: "It use not es strong es the other one,“ or "It
doesn't seen as sharp.”
Before we proceed with the results we rust define the
connnnicstions
other
the failure or the
need.
In
special terns
�#.
luhjoet to report ohm or two ninnltnnmaunly applied stimuli ha:
of
been called “tbs phhnhnenon
gunnery extinction“ hr ”extinction“
1n
utid
wharu
stinmlu;
tho
poreeived
or
body
the
(1). the part
Ill
uxnultanuhulh
to he "danihnnt” ta the part of thh body where thn
Itinnlun nun net perceived, or parceivcd faintly. the latter
aensatieh
was terncd ”obnouration.'
or
a
the
diminution in
quality
whah tho uuhject ruparted tun nonnatiehn, hut ninloenlilod one or
thun, the "ditplhccncnt' a: a peroapt in .315 to hire oeeurrea (2).
ndsplaccnentu Ir. ununlxy 1n the direction or tht daninnnt
’ntinnxup and as: he puttinl hr eqnpxgte. rhe‘dilplaccucnts nttcd
man»
chock
the
side.
of
hand.to
th1§.ner1gp
tn.
were
:ran.the
in
Rarely did the displscahehts cedar to the hack or thauldor.
tram
the
nthhdpoint
{hm
snalyuod
result;
\Ih1t1h1‘2r1hxs
uqrt
of initial and nuhluqnont
thee¢hnnd test with touch
trilla.
en
Ithhlltion
tn. initill trial
or the
Inhjcetn, taco
deninnnec uuu appurant 1h :11 use granny. 'lhrc_thnn half or such
and
none in thc
race
the
in
the
schnation
udulta
rcported
nonntl
hand. lhrno Cubdoetn ninlaehlisod tho lentation 1n the hand to
thn £160. In thn green: of hon-n1 children 90! under the use of
hand
the
percept
hiuloealizcd
thee
the
or
hereopt
:1: reported only
tha
{teeddhinhnoe
in
a:
also
1:
seen
face.
the
Ibis
pattern
to
children tram 7~12 years of age hat.th a 10:30: extent.
hand
the
adults‘reportod
or the ham-ll suhjaotl, five
indtidl
or
example
dinplaeenont
In
thn
an
trial.
only
Ittnulus
noted.
hand
was
tram race to
by
hand
extinction
or
by
daninanee
face
or
Ill pattern
the
more
apparent
was
tune
even
th
hind
percopt
of.the
dinplncclant
1n nornnl
�in thn patients aznninad. Xt uun.noat evident in patients with
arggnic gantal chanset, 935 or when did not repert bath stimuli
corrnctly. In callinntion. or uchixqphrunio lub:ectn and patinntu
with aphnail runponneu lililnr to thnse of thc annual adult were
observed on tum intill trial.
land doninnnoe was accllionllii seen in the patient and
vital: in tn. net-:1 Iahjpat. In «use. of hand dominance the
race'
not
the
reported
the
but
percent; It was seen
manual
I
in the initial trial
on
m
five different net-11 Malta
..
In
the”
instano§3. tun nubaoct ropnrtod both.ttanu11 carrectiy oh
nubaoauunt tinting. In the patidntt with organic mental changes
hand dauinnnee III In inconntant rtupanto and rcpeated touting the
sale day or on unbloquant dawn danonntrated thy amt! usual
poruiutunt pattern or
dominanco.
""
'
rm
1
stilulttion
,Rolponso on initini
roueh
19ml Adult
lam]. «mm,
low emu.
Totalicorrcot Pace
Only luaowraae land Only
160
77
15
3
5
3-6
564
m
23
18
a
7.12
76
33
27
9
2
7:
26
n5
1
2
syndrome 120
9
9n
n
3
o
o
Schisoyhranin
(“malt-niried)
mute luau:
trill
.
i
Apmu
Submgguont
I
23
Erialla or the
12
83
11
narnti adult.
uh» nude
errata
initial trial, #3 were correct on the uecond and 12 on the
third triul. In a to! sub: '“Vffliaur. five at Ii: trill! var.
the
nucOIsary berare the tun stimuli Into corructly localised.
than.
on
�6.‘
ta be annual, althuugh complete psychologiaal
(tennion
during
that
noted
VII
anxiety
It
the
with
to'ploaae)
interfered
desire
strong
callinltton,er.n
annual
:11
aubaeetl,
In
rncognition
the
of
ntiauli.v
torruct
early
aubjoets ware Inlunnd
tent. wcro.not dune.
the
IIB
correct
once
those
rosponae
with
anxiety,
including
abtn1npd (oven
all
fitter
an
was
iith
elicited
error.)
it
trials
number
warn
or
if
n¢cncd
a
an
tritll
It
many
aubnequont_teut1ns.:
”aét“
axmnlnntion,
the
at
the
into
neoenuary_ror tn. anbaect'ta set
evon
cccurutoly,
trtcr
the
ha
ntinnli
riported
the
once
in
tad
set,
of
any WI;
”9,10.an
in
that
was
apparent
child
annual
wanna
th:
it
In testing
inst canon Inn: tail: war. nocolsnry.h¢£ore the correct rotpanse
was «enlistently elicited. Alta, tan child at. not tlltya
dayu.
many
over
tasting
lopeutcd
tubaugunnt
touting.
an
correct
of
Ibis
tuna
daninlncc,
in:
shin
tbs
patterns
hauever, olicittd
natod in 36 of tho 56 childrtn tottqd, ‘In a number of instances
than
and
reportcd
tho
stimuli
appz1¢nttan
can
o;
Intchcd
en. child
was
thy
But
repeated
an
test
noon
corroetly.
percept1onn
tbs
t;
stimulus.
on.
repertod
child
tho
«my
with tm «you acted.
min
or
“int”
the
tn»
in:
not
into
could
tho
get
ehild
evident
that
It
oxtninntion, even with viaunl anal.
311
In
children.
in
not
wag
apparunt
vary
thin diffieulty
t6
the
76
give
the
failed
17
at
anly
(age:
7-12)
the older group
correct renponse utter th; inititl tau trials.
1.:
at the nae-hand
on
the reports obtained
repeated.
A:
relieved
connintent
s
pattern.
test: in mgr-:1 nubjecta also
tubsocti.
on tbs initial trial, face daninnncc was trivalent in all
or
or‘
obsmatien
(a)
extinction
by
It was: unite,” uthor
"
tr:
m
�8.
or
the
autumn
te
displacement
fees, or
er
me
atmii
”.in aevertl insteneea the displacement we. in a direction tantra
(1)) by
O3
'
em taco.
In contrast to normal adults, patient; with organic mental
change: were unuhie te regert the two stimuli earreetly even
utter many triele. When_the yetient reported the pereept in ane
teet eorreetly, he frequently failed on tubuequent testing; It
was tine Ipperent that touting en subsequent‘daye etiii elicited
in
and
er
stimuli.
extinction
dieeinemt
m: u ntrang
who
made
seldom
unmet:
to
tn error
apparently
subject:
centreet
on subsequent tritiu, day: after the initial examination. the
responses obteined in this group demanetrated the pattern: at tee.
teetffl
deninnnee in meet or the
niepiaeenent of the hind percept
to the tune was frequent. In tame instances dieplneement or
extinctien was preeent deepite the {get that the putiont watched
the applitutiea of the etinnii to the fete and hand. Extinetien
was very taxman en hencieterni or heterologoun teeting while
~
fine
apparent
dilpieoenent
neatly
on heterolegeun
teats.
514;
the
and
nyhneie patient:
the uehisephrenie
reports
gayb
which were «1:111: te normal adulte. After the first tie trial:
the pertentnge of errer in hand sensation was slightly higher
than in the normal greup. reraietent bistrre reepoaeee were
elicited from a number or the schizophrenic Inbdeetl. lheee
reperte inelufied multiple responses to mingle or daubie stimuli,
pereietent displacement: to one area from any other body area,
ineonsittent
verve
end 'mimrreveruls or localiutien.
day:
As
normal
the
to
free
with
an
day
examinetien_and
eating
consecutive
an
the
aphasia
subject
Iehixephrenie
touting
or
idnlt,
M
�days roiled to elicit extinction phenonehe once the
been eccorltely reported before.
test
hen
‘
comparison of the reeponeee or each or theoe groove to
nultiple teeting in chain in fig. 1.
A
firfi
54’”
Pin Phick Btiuuietioh: It in known thet the type or
etinuiue epplied influence: the result: in perception. To
denonetrete the importance or thie rector einiier groups of
subject: were tested ueing two pin prick ineteed or two touch
etilnletione. With pin prick etinnieticn ct tece end hencflfece
dominance wee egein uehiteet in all the groupe. however, the
incidence of error in perception of the pin prick in the head
III lower than with e touch etinnloe. Ihe reeulte are recorded
in IhhflcIIt
Elna! II
:1
'
afizaiififmfi’fim
lttei
tor-ll
Adult
correct Pace only Feccqrece Hind an}:
68
51
15
2
c
flannel child, 3~6 yearn #5
lorlml Child,7~12 your! 39
50
Schizophrenin
16
26
2
1
25
1h
0
0
36
13
9
1
arsenic lentei syndrome #7
9
33
3
2
Repeated testing with two pine in the nccnfii adult subject:
elicited the correct reeponeee in the initiel three trieie. Fever
at the chiloren figificd to report the teat eccuroteiy after the
initiel trials. ~It we: poeeibie ih_e hunter or instance: to
alternate touch and pin prick etieuietiohe, end demonstrate extinction
to touch, but correct localization to pin prick. loreover, with
�m.
abre intehae pih prick atianlatieh, extinction and diaplaeeaant
were lean frequently ebaerved.
vzheae phendaena, haaely extinction and diaplaeeaent were
eveh.nbre apparent in the patiehta with erzahie mental ayadreaea.
Bdaplaeeaeht or touch ltd-311 eauld be alternated with oerreet
Idealiaatibn of pin brick atzaulatiah. A ddubihatxon or touch tb
the fade had pin prick te the hand evinced the edubinetibn at
displacement and obaenratioh, an the patient reported “a teach
an the fade, and a dull the en the other aide {or the face).'
Pin prick to the eheak and teach to the hand raaulted 1n extinction
hand
the
pareept; be, oeeaaiehally, the rephrt or a pin prick
of
both an the cheek and hand.
rhe aehizephrenie aubaeete were able to loealiae the pin
prick accurately after the initial ten trials, an had the aerial
mule: .
Blflaflbazfll:
mains the nethbd er dabble ainnltaneoua
atinulatibn in
teuta or the face and the hand a eenaiateht pattern bf reapeneea
baa been observed in a variety hr aubaeota. the atinnlua to the
m.’ 1: non readily perbeived than the one 1:: the me. «never,
the pareept in the race influences the due in the hand,
frequently canning the displacement of aehaatibh. 1h1a pattern a:
reapbhaee haa been repeatedly deaehatrated in bath the annual and
abnormal eubJeeta, and 1a aahireet 1h extinetibn, obaeuratibn and
diablaeeaant. Extinction 1: abet and diaplaeeaeht :- leaet
frequent. In eatinetien, the race pereept 1a correetly reperted aa
te quality and leans, but the hand attanlua 1a not perceived at all;
In all hf the rereading teat: or patient or abrnaz aubJeeta§*uhether
By
�11;
'
tha reaponaaa were aaeurate tr not, it uaa notod that tbs
stiuuius
yointad
to the face
tirat.
aubjaet almost invariably
pattoived
and
1a
ourrectly
hand
perecpt
tha
Octaaianally
iooaliaed, but anamnea a qualitative differonce, always of
diaifintion. In displaeunant tha percent in the hand 1: 113*
such
an
the
or
rage,
tho
it
direttitn
the
face, or
localiscd tn
to tan ahauldor er nuak. In aunt instance: if tha taco cud tho
hand at the lama aid: are stimulated, tho lubaeet occasionally
1a
thaae
phnnancna
of
1n
lane
the
taco.
raporta tut paroapta
ah:
or
these
un1eh
one
with
the
rrtquancy
haphaaard. nail.
varia«
druga,
be
attention,
observed
affected
by
may
erraeta 1:
tion in atilnli, ate., it: pattern 1: eonaiatent.
Thea. raaponaaa to tha face-hand teat arc undifiad by nan:
(b)
attenttan.
factor]
arc
flame
influnnning
of
tbs
fa)
factora.
or
atinnlna,
(a)
type
of
stimuli,
(0)
simultanaity
d:
subject,
aga
(o) atrensth a: stilnlua, (t) locua of atilnlation and (3) internal
with
tha
fragment,
Etna;
alter
fatter! lax
atate or organiaa.
afipeur
do
change
net
but
and
that
displaccnaut
which Ixtinetien
tbs pattern or face dalinanso.
1a
in
factor
of
tha
teat
a.na:or
Iuardnaaa
the aubaact'a
80th
attention
extinntiun.
a:
thy
phannncnon
of
tho appearance
’)(
awarenaai€£)1n.a
and priviona axpnrionoa tun bring stimuli to
two
to
were
informed
who
Itinnli
that
unra
adulta
atria: or twanty
Baoauaa
proviaua
of
applied
abouad
extinction
parcepta.
be
non.
tan
abet-nary
rcaerd
ta
uaa
intluensa.a response it
experience
in.ha1ve
flatbed
aw
this
aubjccta.
tha.f1ndinga on initial trial
At
the
Ian»
wan
aintniacd.
experience
or
previoua
en. tactar
number
the
”alert"
for
he
the
on
tine tbs aubjcct was not apt to
'
�of stimuli he an: ta reeeive. cannequently ene night nay thet
the reason the subject perceived only one Itinulul or perceived
ene and diupleeed the
the
other
at
he
atinnluu
in
that
pefifypt
4
was not peying ettentlen. this aritieinn may be valid but the
Iiznifieant fact
it
9
//¢w
»
%
that the error III always aide in the hand
and net in_the‘teee. I: it were mere inattention one utula expect
50! or the single response: ta dauble einultaneeue stimulation
ta be in the hand end 50% in.the flee. But this type or ehance
enter was not ebterved. it the single reepenaes ta double
lilultaneeul Iti-nluticn 95% were at the fete percent and 5% at
the hand pereept. Iain pettern of race daninnnee or hand extinction
examinetionl.
further
during
subsequent
eitublilhed
Ill
lereovee,
when dinplneenent II. seen in normal aubJeetn, it was to the
race and not ta the hand.
ihin pattern at face daninnnee to deuble tinultnneaul
stimulation was fauna to be exnggereted in nan-.1 young children,
when
83$ deuanetrated either 33nd.extinetion or displeoenent
at
er the hand pereept to the face an the initial triel. loreover,
this high percentage of face duuinnet reiponnet peruisted on
eubuequent trielE. In the elder children ulna tece delineate
we: consistently demonstrable. It It: noted that the younger the
ahild, the more distinct In: thie puttern of race daninnnee.
awn extinetion night he Ittributed to an mummy to
perceive two ltflluli at once. Ehiu particulir detect has been
noted in patient: with severe until change? (“Zlf'fifievm in
patient: with severe lentel changed or in young children itinuli
epplied to both cheek: or both hands or.eny other two hanglegonn
body even: were correctly reported as tee uenentione. Ihere it:
_
�neither extinetion nor displacement. aaldstein'eKohuervatien,
therafere, cannot be used an an explnnetion for hand extinetion.
what
matter
daninanne
in
noted
apparent
flee
that
at
It is
types or etimnlltion was used. Simulteheoun pin prick stimulation:
revealed the pattern of face daninenee, elthaugh with e leaner
frequency than touch etinhiltiona. ether duteneeua utinuletion
such :1 two tuning forks, hot and cold telperature tuhel, rtpetitive
rubbing and repetitive pin prick Itianletian were Ipplied and
neniteet
regardless of the cuteneeun utilnletiun
race daninence is
flied.
inphrtmee of the ainulteneity or the ”man. has nlrudy
been alluded to. In eubJeetn in when extinctidn In: persistent,
consecutive epplieetion or the stimuli invariably resulted in
the permeption or two stimuli. In actual Idultn consecutive
the
nun-L1
the
on
the
even
of
two
trial,
we
ma.
etiluletion
extihetioa.
never resulted in
-euuni
thin
thy
nerd
ntinuli
intensity.
at
these
ethdien
In
aux-aux,
the
for
in
inn-pom:
the
in
pattern
mum
eliciting
”I.
stimuli here teemingly mare readily perceived than equal etiuuli.
After the first few trials the etheet was able to perdeive the
two stimuli, even it one we: pnintul and the other not. In
and
diaextinction
mental
hhuevee,
with
chnhses,
organic
patient:
quality,
the
wide
dinorepency in
pleeenent were manifest despite a
of the stimuli. aw Altering the etrength a! the Itinhli, it ran
hand
the
at
the
tram
extinction
response
pdlaihle to alternate
th
teak)
the'
ta
diepleaenent
were
hand
the
stieuli
percept (if
.gheek (if the head stimuli were utrang). The sneeze than extinhtien
ulst
the
the
at
by
quality
elidited
altering
run
displacement
to
The
'
‘
�13.
touch
the
to
,Ievertheleac,
frna
prick.
pin
that
ia
atiunli,
a
at.
a,ua
oe'aaa
the part: of the body being aianltanecnaly atianlated are
have
patterna.
theae
I!
etudying
consideration
in
another
already alluded to the fact that extinction ie anat cannon in
the hand and leaat in the face. In teating other body areaa the
incidence of extinction and diaplaceaent ia leaa than in teating
and
ahcnlder
thigh nay
hand.
and
the
testing
the face
Ithat is,
not elicit extinction or cbacnraticn,where the faceehand teat will.
Alec, in patients with leaicnn or the brain or apinal cord,
the pattern or relationahip cf the body parts tc aiaultaneoua
atinnlaticn.nay be altered in a characteriatic haniaenaery or
”level leaicn' ayndreae. Aa fer the aignificance cf the pattern
be
can
the
leaning
before
prayer
further atndiea are neceaaary
would
be
time
purely
thin
deducticn.aade
Any
at
interpreted.
that
by
gained
atating
ia
nothing
For
inatance,
speculative.
dcainance
(7).
of
inpliea
order
aenccry
rcatral
a
daninance
face
Such hypetheaia ia ccntradicted by at leaat one tact, naaely the
‘chaervaticn that when the hand and fact are atimlated eimltanecualy
data
are
hand.
after'ncre
Perhapa
the
dcninatea
over
the fact
accumulated a aatiafactcry theory night he obtained.
,
QUIIIRI:
hand
haa
and
race
the
cf
teata
in
pattern in perception
method
cf
the
abnaraal
and
anh:ecta.hy
been elicited in actual
dcnble simultaneous atianlaticn of cutanacua uhdalitiea.
hand
the
of
percent
extinction
by
Face delinance, aaniteat
an
a
in
seen
the
hand
to
race,
the
or
percent
or dicplaceaent
the~
and
in
non-a1
the
adulte,
in
naniteatcd
normal phancaencn,
aeriea.
the
exasined
in
and
anhaaie
cchiacphrenia
with
patienta
A
�15.
with
in
m
in
menu:It 1: mcntod young «mum
and
what
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the
«unfit.»
bran
in
an...”
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um.
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1:
at
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or
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166-1685 19195
tuna-Mon.
�PATTERNS IN PERCEPTION
By:
‘I
0—m—
ON
SIMULTANEOUS TESTS OF FACE AND HAND
Morris B. Bender, M.D., Max Fink, M.D., and Martin Green,
In previous studies we found that the method of double
M.D.
simultaneous stimulation showed defects in sensation (extinction)
testing
In
which
routine
were not apparent on
single stimulation.
;
the
two
of
body and various combinations it was
different
regions
\,
found that extinction was apt to occur most often in the hand and
least in the face. Conversely, "dominance" was greatest in the face and
least in the hand. In the present commuhication we wish to report
simultaneous
on
obtained
the results
stimulation of the face and the
hand (the face-hand test) in groups of subjects with the following
conditions: 1) aphasia without hemiparesis or hemisensory syndrome;
2) aphasia with severe mental changes; 3) organic mental syndrome;
disease
5)
of the
no
4) schizophrenia;
,‘
brain (normal adults) and 6)
four
of
between
normal children
the ages
to ten years. 'Patients in
5
2
showed
and
severe memory defects, confusion, poor orientation,
groups
difficulties in calculation and other symptoms characteristic of
diffuse disease of the brain.
Method: The subject was instructed to close his eyes. When
this was done his face (cheek) and contralateral hand (any part of
the hand or fingers) were touched simultaneously. Care was taken to
make two stimulations of equal intensity. As soon as the stimuli
were applied the subject was asked tox°eport what he felt, and following
this, Where he felt the sensation. Identical tests were carried out
with light rubbing and pin prick stimulations.
Results: Under these conditions the subject gave either of the
following responses on the first-examination: a) a touch on the face
only (face dominance), implying no sensation in the hand (extinction);
.
$1.1mMuTfizA
kfiWJqM 5.4.1:.
�2.
b) a touch on both sides of the face (there being "displacement"
from the hand to the ipsilateral face); 0r 0) a touch on the face
and contralateral hand. In the (a) response the subject was asked
whether he felt still another stimulus. The reply was either in
the negative, or there was uncertainty or vague approximation.
This question suggested to the subject that there were two
stimulations so that
than one stimulus.
on
subsequent tests he was expectant of more
In the (b) type of response the subject mislocalized or
displaced the sensation evoked in the hand toward the ipsilateral
face. Since the mislobalization was towards the face it appeared
as if the face determined the direction of the displacement. It
might be said, therefore, that this was a type of face dominance.
Response (b), or diaplacement, was less common than response (a)
or extinction. Response (b) was seen most often in the patients
with the organic mental syndrome, and persisted despite repeated
testing. The (c) responSe was the expected normal and needs no
special comment.
Extinction
and displacement were
also noted
the ipsilateral face and hand were simultaneously tested. In all the
subjects tested, including those with aphasia, there was no
difference between the right and left sides of the body.
Analysis of the results obtained in the various groups is
shown in the following table:
when
�3.
Group
of
Subjects
Number
1
15
2
12
3
Face Response
Extinction or
Face and Hand‘ Hand Response
Response
~
Displacement
9
6
O
12
O
O
22
20
2
O
4
20
14
6
O
5
55
24
28
6
20
l
l
From
-
p
.
19
o
it
is obvious that whenever there is
sensation over another it is apparent in the face.
the foregoing
dominance of one
p
Dominance in the hand was noted only once.
dominance
Face
was found
almOSt uniformly in the
subjects with.severe mental changes (groups
2 and 5.) These patients did not report sensation in the hand even
after repeated testing. In a few instances, even after the patients
were told there were two stimuli, or were asked towratch the application of the stimuli, they reported only one percept or displaced one.
In these cases simultaneous stimulation of both sides of the face
was reported correctly, thus excluding the objection that these
patients were not able to<io or perceive two things at once.
The incidence of face dominance in subjects with aphasia and
those
in
with schizophrenia (groups 1 and 4) was less. In contrast
to patients in groups 2 and 5, those in groups 1 and 4 reported both
sensations correctly on the second, third or fourth trials, if they
had not done so on the first trial.‘ In the group of normal adults
(group 5) the incidence of face dominance was least, but still
'
significant,
a
even though
it
was found only on the
first trial.
series of normal children the incidence of face dominance
was
In
�In young children face
dominance was present even several trials after the first examina-
almost the same as in groups
2 and
5.
tion.
the face and parts of the body other than the hand
were tested simultaneously in groups 2 and 3, face dominance was‘
The
order of dominance was face, shoulder, grunk
apparent.
still
When
(breast), penis, thigh, calf, foot, arm and hand.
In
Conclusion:
a wide variety of subjects the phenomena of
extinction and displacement on double simultaneous stimulation were
demonstrated. A consistent pattern of perception was established
in which the face was most dominant and the hand the least. These
findings were noted in both the abnormal and the normal subjects.
-In the abnormal subjects withseVere mental changes, face dominance
and hand extinction were so consistent that they may be used as a
sign of diffuse disease of the brain, but only when found to persist
after repeated examinations.
The pattern of dominance, as well as the phenomenon of
extinction, which are so prominent in patients with diffuse brain
disease, appear to be exaggerations of the pattern found in the
normal subjects, especially children.
I
�
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Patterns in perception on simultaneous tests of face and hand. Trans Am Neurol Assoc. 1950;51:250-2. (abstract).
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mfp-02-01-001-2a-003
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1950
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Bender, Morris B.; <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>; Green, Martin
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The Max Fink Collection
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[Two preprints] and a reprint. Reprint from Transactions of the American Neurol Assoc. 1950;51:250-2. (abstract).
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<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>;
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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