http://exhibits.library.stonybrook.edu/mfp/files/original/a1c70b872beb13c5b56dba9ecef3099b.pdf de32dee2acdbbfa2e67eb3cd0c31e52d PDF Text Text Simultaneous of Perception Tactile Stimuli in Normal Children Max Fin/z, M.D. and Morris B. Bender, M.D. Normal adults readily identify and localize tactile stimuli applied simultaneously to the face and the hand (the “face-hand test”).1 While half the subjects perceive stimuli incorrectly on the initial trial, all are accurate by the tenth trial of the test. Young children, however, find the task of identification and localization of two skin stimulations difficult. They report only one of the two stimuli, or, if they report the two, frequently mislocalize one of them. The omission or mislocalization of stimuli is not haphazard but follows a consistent pattern in which stimuli to the face are readily appreciated (“most dominant”) while those to the hand are not (“least dominant”). In order to determine the pattern of “dominance” in children and the age at which such tactile perceptual tasks are correctly performed, a study of normal children was undertaken. The responses of children to the face-hand test and to simultaneous tactile tests of other body parts were ascertained. SUBJECTS AND METHOD Three hundred normal children between the ages of three and 15 were examined. They were from a neighborhood child care center, from the wards and clinics of Bellevue Hospital, and children of neighbors and friends. They were without manifest disorder of the nervous system. A few children at two and a half years of age were included in the three year age group, but younger children were generally not able to comprehend the test. The subjects were examined individually, but there were many who were examined in a day-room in full view of other children. The child was engaged in play and when toys were available they were used to gain his confidence and interest. At some time during play, the face-hand test was introduced. From the department of neurology and psychiatry, New York University College of Medicine and the Bellevue Hospital, New York City. This work was aided in part by a fellowship grant from the National Foundation for In- fantile Paralysis, and by a grant-in—aid from the Coordinating Council for Cerebral Palsy in New York City, Inc. Read at the fourth annual meeting of the American Academy of Neurology, Louisville, Kentucky, April 24, 1952. 27 Reprinted from NEUROLOGY, Minneapolis, January, 1953, Vol. 3, No. 1 �28 NE UROLOGY For the face—hand test, the child was told: “I (examiner) am going to touch you,” and he was to “touch the same place I touch.” He was asked to close his eyes. The examiner, with the fingers, then touched simultaneously a cheek and the dorsum of the contralateral hand of the subject. The child was asked what he felt, and to point to the sites stimulated. After this response, the child was asked to close his eyes again, and now the opposite cheek and hand were similarly stimulated and the report recorded. If only one response was given to this trial, the child was asked if there had been another stimulus anywhere else. Following these two trials, the cheek and hand on the same side of the body were tested in a similar fashion. The fifth and sixth trials were not of asymmetric body parts but simultaneous stimulation of both cheeks or both hands. The following various types of stimulation were used: heterologous stimula— tion of asymmetric body parts on opposite sides, as right cheek and left hand; homolateral stimulation of asymmetric body parts on the same side of the body, as right cheek and right hand; and homologous stimulation of symmetric body parts, as both cheeks or both hands. Such tests were repeated in each child until at least ten trials were recorded. Subsequent tests of other body parts, performed in a similar fashion, were introduced until at least 20 consecutive trials were observed in each subject. A number of modifications had to be introduced for young children. Many would not play the game with eyes closed, but insisted on keeping their eyes open. In such cases the tests were applied with eyes open. Also, a large number of three and four year old children insisted on pointing to the examiner’s hands and face on the initial trials. For these children, a few trials of single touch stimuli applied to the thigh, chest or hand were introduced, until they grasped the concept of pointing to their own bodies after the stimulation. These single trials were carried out with eyes open. After the series of double simultaneous stimulation tests were completed, single stimuli were applied to various body parts to exclude from the normal focal difficulties. with subjects any sensory group The children were asked what they had felt and to point to the places stimulated. Verbal reports of the locus of stimulation were not accepted. It was occasionally noted that children would correctly name the parts stimulated, i. e., the cheek and hand, but then point to both cheeks, or to two places on one cheek. It seemed as if naming the locus yielded more accurate responses than did pointing. These tactile tests were repeated on consecutive days, or subsequently after a lapse of a few days or weeks in some children. At such times, cutaneous stimuli other than light touch were added to the testing. These included repetitive touch (rubbing), single pin prick, and repetitive pin pricks. RESULTS Incidence of errors: Young children made many errors on face-hand tests. Eighty per cent of children under the age of six failed to localize both stimuli �PERCEPTION OF TACTILE STIMULI IN CHILDREN I00 m 2, E ,_ 9 II m p. k no: m at “J ,— uzJ u o: to u. 100 90 (“C9, ‘ 80 85 70 L2 so 2 | 4 5 6 7 8 9 IO I2 ll .‘N‘K ‘ . '\ x. _ __ “t“ c: In a. 3 '_ ‘~~. \._x_x_‘. - \K 3 0 \,\,. -----------.‘ I‘. E 20 ‘ \ LA— 30 ‘. .- 8 so c: 0 4o o 30 40 ‘- 60 o. 50 -------------- 70 Z 60 \ ' 90 r: ~-.. a . ,_\.-___..‘ 29 _ 3 ......... . YEARS 5 YEARS 7 YEA S .----I ~~~~~ o .......... 9 YEARS L345 NUMBER OF TRIAL AGE Graph 1. Graph 2. during the initial ten trials of the face—hand test; many of these even with eyes open. In the older children the number of failures fell sharply (graph 1) so that only 2 per cent of children in the 11 to 15 year age groups continued to make errors after the initial ten trials. Apparently the ability to identify two simultaneously applied tactile stimuli was directly related to the age of the child. This ability was also related to the number of previous trials of the face-hand test. In table 1 the trial of the test after which the child was consistently correct is recorded. The last column of the table includes all the subjects who made errors in the first ten trials, and on many trials of the test beyond the tenth. Graph 2 illustrates this relation for selected age groups. Type of testing: In these studies homolateral and heterologous stimulations were carried out at random. Errors were made by subjects of all age groups in tests of either type. Homologous tests, such as both cheeks, or both hands, randomly interspersed in the testing after the fourth trial, elicited correct reof this served clue While all the older to in as a some cases. nearly sponses TABLE 1 NUMBER OF TRIALS OF THE FACE-HAND TEST NECESSARY FOR PERSISTENT CORRECT RESPONSES ( Age 3 4 5 6 7 8 9 10 ll 12 13—15 Total Number of Subjects 39 34 37 36 26 22 23 20 21 24 29 Touch Stimuli) 1 2 — — — — — 2 — —— l 4 2 2 6 8 6 2 6 8 3 7 4 10 Trial Correct 3 4 5 6 7 l l 1 l 6 3 4 5 2 4 6 — —— 3 2 2 — 5 4 l 6 4 l 8 9 — 2 1 — 2 — l — — —- — 2 2 5 4 — — 1 2 2 1 — 2 2 2 — 1 — — — — 1 — — — — l 2 1 — -- — — — l 2 l l — 1 — —— — 2 Errors Beyond 10 Trials 34 28 28 22 10 4 3 2 0 2 0 �30 NE UROLOGY children that two stimuli were being applied, it did not seem to alter the results in the younger children. In these subjects subsequent trials of the face-hand test were incorrectly reported, even though the responses to the symmetric stimuli had been correct. The perception of symmetric stimuli was much better than asymmetric stimuli. Subsequent testing: Of the total group of children studied, face—hand tests were repeated at varying intervals subsequent to the initial testing in 40 children. Of the children under the age of six, subsequent testing elicited the same difficulties with face—hand tests as was evident on the initial examination. In a few children over six years of age, who seemed to have grasped the concept of two stimulations in the initial testing, errors were manifest on subsequent days. It was as if many trials were necessary for successful learning of the task, and then, even though the task was successfully completed, the learning was temporary. These observations are in contrast to those made in normal adults, in whom subsequent testing did not elicit the errors of the initial test.1 Type and pattern of responses: The errors (table 1) made by children on repeated trials of the face-hand test were of six types: (a) a touch on the cheek only, implying no perception in the hand; (b) a touch on each cheek, implying a mislocalization of the stimulus applied to the hand; (0) a touch on the cheek, and a second touch on the shoulder, neck or elbow, implying a partial mislocalization of the stimulus applied to the hand; (d) a touch on the hand only, implying no perception in the cheek; (e) a touch on each hand implying a mislocalization of the cheek stimulus to the hand; and (f) one or two touches on the examiner’s body, implying a mislocalization away from the child’s body. Face dominance (responses (I, b, c) was apparent in all age groups. It was most manifest as extinction“ of the stimulus to the hand (response a), and was seen in 62 per cent of the errors. Mislocalization of the hand stimulus to the cheek (displacement) was observed in 31 per cent of the errors. While most of the displacements were observed in tests involving cheek and hand on opposite sides of the body, 7 per cent of the errors were displacements from the hand to the cheek in the simultaneous stimulation of homolateral body parts, e. g., right cheek and right hand. At such times the child pointed to the cheek once, saying “a touch here,” and then, moving his fingers 2 to 3 centimeters lower on the cheek, saying “and here.” Other types of displacement were infrequent. There were partial displacements from the hand to the shoulder or neck. Mislocalization of a stimulus across the midline of the body, known as allesthesia,3 was occasionally apparent in the stimulus to the hand on heterologous testing. Furthermore, children *The failure to report one of two simultaneous stimulations has been called “extinction” of a stimulus? The mislocalization of a percept to the homologous body part of the second stimulus is called “displacement.” The mislocalization of a percept in the direction of the second stimulus is called “partial displacement.” In each instance, the stimulus which is correctly reported is said to be “dominant.” �PERCEPTION OF TACTILE STIMULI IN CHILDREN 31 under five years of age frequently mislocalized the initial stimulation away from their body to parts of the examiner’s body or into space (response 7‘). This phenomenon, known as exosomesthesia,4 persisted in some children despite repeated stimulations with the child’s eyes open, and despite the examiner’s insistence that it was the child who had been touched. Another phenomenon was seen during homolateral testing. The child reported only the stimulus applied to the cheek. If the examiner asked insistently, “Did you feel another touch anywhere else?”, a number of children hesitatingly pointed to the symmetrical point in the Cheek on the opposite side of the body. In order to determine whether this was a unique or a systematic phenomenon, tests of other body parts were carried out. In homolateral tests of foot and hand, shoulder and hand, and cheek and foot, the same phenomenon was observed. The child first reported only the foot, the shoulder or the cheek—and then, when the examiner insisted on a second locus, pointed to the opposite foot, shoulder or side of the face. Furthermore, in some young children the phenomenon appeared on single stimulation. Single stimuli applied to any body part were localized correctly. If the examiner then insisted that there had been a second stimulus, the child pointed hesitatingly to the symmetric part on the opposite side of the body. As already indicated, hand dominance (responses d and e) was infrequent. It was observed in 7 per cent of the errors on face-hand tests. In all subjects in whom it was apparent, subsequent trials of the face-hand test manifested the pattern of face dominance. Relation of hand and foot: In tests of parts of the body other than the face and hand, the hand was always least dominant and the cheek the most. Simultaneous tests of foot and hand, the foot-hand test, were introduced after the initial ten trials of the face-hand test in most children. In the foot-hand test, foot dominance was apparent in 51 per cent of the responses (see table 2). It was demonstrated by hand extinction, by displacement of hand stimuli to the foot, and by partial displacement to the thigh, knee and leg. TABLE 2 FOOT-HAND TEST ( Touch Stimulation Bilateral Ipsilateral Stimuli) Total Trials 53 48 Responses Correct 21 23 Foot 17 16 Hand 1 3 F oot— Foot 10 3 Partial F t.—F t. 2 3 HandHand 2 O Other stimuli: A small group of children who made errors in tests repeated at varying intervals were examined with other cutaneous stimuli. Extinction and displacement phenomena were present in face-hand tests using pin prick, repetitive pin prick and repetitive touch (rubbing) stimulations. While the number of errors with these stimuli were fewer than with touch stimuli, the �32 NE UROLOGY still extinction hand of and dominance face was apparent. pattern DISCUSSION The ability to identify and localize simultaneous stimuli separated from each other at some distance is a complex function which gradually develops during the first decade of life. It is a relatively unstable ability, for many Focal discriminations. such disturb of the the in state can organism changes cerebral disease as in hemiplegia5 or parietal lobe lesions,2 spinal cord lesions,2 and diffuse brain diseases such as toxic states, senility and inflammatory conditions6 can so alter tactile discrimination that the phenomena of extinction and displacement become prominent. Errors in simultaneous tactile tests are the of the trials few initial the test—during adults normal in during apparent period of learning.1 Persons subjected to large doses of barbiturates,6 electroshock therapy6 or anesthesia7 also manifest such inability. A prominent feature in all groups is the uniformity of face dominance. When discrimination of simultaneous stimuli is interfered with, for whatever stimuli the in hand and the stimuli not the made to in the are errors reason, to the face. The corollary of “face dominance” is “hand extinction.” It, too, is apparent in all subjects and under the variety of conditions studied. Furthermore, in an “order of dominance” other body parts are between these two limits. Studies in patients with hemiplegia5 and patients with severe mental of dominance order revealed have disease6 of brain result an a as changes of face-shoulder—trunk-thigh-foot and hand. Insofar as these other body parts were studied in these children, a similar order was observed. Since dominance is evident in young children, it appears that the pattern of dominance is an inherent function of the organism. This childlike way of responding to simultaneous tactile stimuli is exposed and exaggerated in adults under a variety of pathologic conditions. these of dominance rostral to explain has Cohn a theory suggested Recently observations.8 Our observations are not in accord with such a theory. The dominance of the foot to the hand in children, as well as the dominance of with of series hand in the two foot and to patients large buttock, thigh penis, diffuse brain dysfunctionfv9 make such an explanation untenable. with in with children normal in findings patients of findings Comparison those with children in the On mental findings comparing syndrome: organic previously reported in patients with severe mental changes due to brain dysfunction,6 a close similarity in performance is observed. In both groups the ability to discriminate simultaneous stimuli is limited. On non-homologous tactile tests, such as the face—hand test, errors are made on initial and subdisis the of stimulus most While extinction frequent trials. error, a sequent with a and children both In errors is occur patients, common. placement done be stimuli. of Furthermore, frequently testing cutaneous may variety with eyes open, and in many instances with repeated verbal clues that there is of factor The not prommade. still and learning are stimuli, errors two are inent Since testing on subsequent days will elicit the previous patterned errors. �PERCEPTION OF TACTILE STIMULI IN CHILDREN 83 In Gestalt terms, patients with organic mental defects and children have diffi— culty in extracting a complex sensory “figure” from the “background” of the total sensory “field.” Significantly in each group there is no difficulty in identifying simultaneous stimuli if the stimuli are applied in symmetric regions of the body, such as each hand or both sides of the face. Here, each stimulus figure has a common background in terms of body image, namely the hand.10 Face dominance is apparent in both groups. It is manifest not only on tests of face and hand but also on tests of face and other body parts. Also, insofar as it was tested, the order of dominance for other body parts is similar. While extinction and displacement are the most frequent types of error, other phenomena are elicited in both children and patients. Partial displacements, e. g., the mislocalization of the percept from the hand to the shoulder or neck on the face-hand test, are occasionally observed. The phenomena of allesthesia and exosomesthesia are seen in the more severely affected patients and in the youngest children; both are frequently associated in the same subjects. In allesthesia, the subjects usually localize the cheek stimulus correctly but mislocalize the hand stimulus to the opposite hand or elbow, In exo— somesthesia, the stimuli are mislocalized either to space in front of the subject or to the examiner’s body. This phenomenon was frequent in the youngest children, and despite the examiner’s urging that the child point to its own body, the child persisted in such mislocalizations until a trial of the face-hand test was performed with eyes open. In addition to these phenomena which appear spontaneously, patients with organic mental syndrome also manifest another response to simultaneous stimulation first noted in children, i. e., on homolateral testing only one stimulus (the cheek) is spontaneously reported; but when the examiner insists, the second is mislocalized to the opposite cheek. Since the patients show so many similarities to young children in their responses, it was predicted that they would also show this phenomenon. In a series of patients with severe mental changes, homolateral tests of the cheek, hand, foot, shoulder and thigh were applied. When only one stimulus was reported, the examiner asked for the locus of the second stimulus. Responses were obtained in 20 per cent of the patients, and in each one the second stimulus was mislocalized to the symmetric body part. Furthermore, in some subjects the same phenomenon was observed with single stimulation. This phenomenon appears to be similar to the completion phenomenon described in Gestalt literature as “closure” and “good continuation.” These are usually described for other sensory modalities. When a circle is tachistoscopically exposed in the visual field so that half falls on a hemianopic field, or if a cross is exposed so that the center falls in the blind spot, many subjects report a complete circle or cross. This “completion” occurs for “good” figures. In simultaneous tactile studies, symmetric figures appear to be the “good” or “strong” figures. �NE UROLOGY 34 CONCLUSIONS Ability to identify and localize asymmetric simultaneous tactile stimuli develops gradually during the first decade of life, and is present in 80 per cent of normal children by the age of eight. Symmetric stimuli are more readily localized and this ability is well developed in normal three year old children. 2. The errors on asymmetric (bilateral and ipsilateral) stimulation involve either extinction (only one of the two stimuli is reported), or displacement (one or both stimuli are mislocalized). Whenever extinction and displacement occur, stimuli to the face tend to be correctly reported. This face dominance is found at all age levels tested. 8. One can conclude that extinction and displacement of tactile stimuli, as well as face dominance, constitute a normal and consistent pattern of rechilin these addition In children. observe, in to one can responses sponse dren under six years of age, the phenomena of allesthesia, exosomesthesia and partial displacement as normal reactions to simultaneous tactile stimulation. 4. The difficulties in recognition of simultaneous tactile stimuli, as shown by young children, reappear in the same fashion in adult patients With focal or diffuse dysfunction of the brain. The abilities of tactile discrimination acquired by the child during growth are lost by the adult who develops mental changes as a result of cerebral damage. 1. REFERENCES M. B.; FINK, M., and GREEN, M.: Patterns in perception on simultaneous tests 0f face and hand, Th Am. Neurol. A- 751 250, 1950; BENDER, M. B.; FINK, M., and GREEN, M.: Patterns in perception on simultaneous tests of face and hand, Arch. Neurol. 5‘ P sychiat. 661355, 195.12. BENDER, M. B.: Extinction and prec1p1tation of cutaneous sensations, Arch. Neurol. 8c Psychiat. 54:1, 1945; KOLB, L.: Observations on the somatic sensory extinction phenomenon and the bOdY sch—eme after unilateral resection of the posterior central gyrus, Tr. Am. Neurol. A' 75: 1950' 3- BENDER’ M' 3'; WORTH, 5' B" and CRAMER’ J“: Organic mental syndrome w‘th phenomena of extinction and allesthesia, Arch. Neurol. & Psychiat. 59:273, 1948. 4' SHAMRO’ M . F .'’ FINK’ M. ’ and B ENDER ’ M. B.: Exosomesthesra, or the phenomenon 1c e ment of sensation into extra p er o f di spa 8‘ Psychiat. 68:481’ Neurol. Arch. space, $109221 717, 1949. 1. BENDER, _ 5' _ _ M. F and Extinction phenomenon in FELL , A . W, .. hemiplegia, Arch. Neurol. 8c Psychiat. 62: BEND-ER M B . SHAPIRO SCHAP- M. 3,; The face-hand test as a diagnostic sign of organic mental syndrome, Neurology 2:46, 6. PINK, M_; GREEN, M" and BENDER, 1952, J” and M. B.: Perceptual patterns during recovery from general anesthesia, J_ Neurol., Neurosurg. & Psychiat. 14:316, 1951_ 8 . COHN, R., and RAJNES, G. N.: On certain aspects of the sensory organization of the human brain: A study in rostral dominance as determined by ipsilateral simultaneous stimulation Tr Am Neurol A '74'162 1949. COHN, R.: On certain aspects of the human brain: sensory organization of the . . .1 f A Ch‘d‘en’ II Neurolsggljylfllgastlrgsfiommancem 7_ JAFFE, BENDER, 1 9. GREEN, M., FINK, M., and BENDER, M. B.: . . . Order 0 f dominance in cutaneous perception. Tr. Am. Neurol. A. In press. 10. JAFFE, J., and BENDER, M. B.: The factor of symmetry in the perception of two simultaneous cutaneous stimuli, Brain 75: part 2, 167-176’ 1952’ �All, [:w.,¢ffl (f P Aflu‘ f 1 \. 3/“5 ”a...” «w 0' V -—« ‘ "1“" ‘3'". :’ I ‘1 - momswammanual I! W swam new m cm h I“ m, I.B.*’ ' and MM! 3. Bind”. Id). mun-11:16:11.0. ’0 «mum»: 11» 3.11m mama, 1m: 1m: mum tar mama. 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In the“ eubjeete “ohm teet mm amarmtu Warm, even though the reenmeee to the ”metric etinuu m been amt.perception of mute «m: an moi: better this: “metric “mu. “tenant MM‘ or the totel of ammo“ emu, m I'm-bend teete were «Noemi; tflele or the ‘l‘he A ’ . reputed at “mm tntemle eubeeemt to initial touting in to children. or the children under the ace an. mmumt tut-1m engage the em ditfiaultiee emu teete over 6 um me etmutione the of “cum evident an the mute). examination. In e ten children or «use, who seemed to lave the concept or two in the auntie). tenths, emu were meanest on W �5._ lubiOQnflnt mooaum 43):. It III 1mm a; it'unay trials aura nooonuary tar of the tuk. and aim, mm though the tuk Inna-unrully aunplotod, tho laurntnz uni tauparlrw. than: abacrvutxonn are in central: to that: undo in nernnl Odnltl. in lawn tubaoqnant flouting did not ultelt tho error! 0: Ch. initiil cost (1). $223,535,!Itt953lggbggggggggg; by mum, on Muted its arrow: m (Ethic I) and. mu. or m tum-Inna m: am at an typed: (n) u touoh on the chuck only. implying an pcrcoption in an. hand; (b) a touch on ouch chock. tnvlyins I Italoclllsntian of thc stinulna :pplicd to the bind: (a) a touch on thn dutch, and u aecend tuueh on the uh auldnr. neck or elbow, implying u partial tion or the act-ulna upleud to tan hand; (d) a touch on n13100¢11la~ tbs hand only, Ilplring no porodpttoa 1n thn chock; (a) n taucu on cash hand implying a niuloealisattan at the chuck stimulus to thn bind. and (f) on. or tun taught: on tut alaninor's body. implying a um W m- Illlocllillw the «Inw- body. Flea "dalinundo” (rtspanuoo a, £9 3) an: appurvnt 1n I11 as. grdupl. It nun Inst unnzthnt as c:t1nction* or the uttnulun to the hand (response 3). tad II! Icon in 6a! of thc errata. lialocnlizatton or the hand Itilnlut tn ch. chock (dtnplnoqnnnt) wt: obaorvod in 31! or en. 03:93.. flail. Hunt at thy dinplaocnnutl var. obnorvud ‘03:: involving in abnok and hind an appetite class or the body. I! of tho aurora was: ddnpllaclauts tram the hand to tun shack in tho w I rm 1m ‘*vwr‘ Trt“7~ «*~ 1* urn 9 ?“ie' 4L1“ .r‘mr 3 "'1 anon dlzlod “untinatian' at a nut-alum. Ifll omnlilatton or x gore t to tho hdualasduu bod? part of thy nueand stdlmnnn tn dulled «up tomcat.” at a wept 1n the “mum of the ltdond act-min. 1:unlmnmum culled "partial In much instinct, tho ntzluznl which 1: corruotly rapewtuddiaplncunnut.” 1: said to be “dominant.“ . m w �6. sinnltunoans ntflnnlattua at hannzutavll body parts. 0.3. right ¢hsok and right hand. At auah tilt. the chilc Iould point to the catch once, saying ”a touch hit..” and than. raving his finger: 5-3 can. lint! an the aback, 3&7. ”and hurt.“ 0th.: typcn at «Laplaoa-nat Hurt turraquont. intro wort partial dimplaocnnntl frnn‘thn hand ta the nhauldcr or nook. llllocalisltian or .- anuzmu (3) t stinhlu: mat!!! the uidliuo of tho body, known m ”mama: imam in the «mm. to the touting. rurthoanuro, childrin under {Iva years or as. :rvqulntly'ninlooulssnd ta. Initial utiuulation away tram thair body to part: of tho nan-anor*a boar 9: into space (rampant. r). rhi- pupae-aaan. known a: ifioflHIOIihllil (u), per-11:06 in OHIO children despit- rupeutad lt1-n1a330an vita tn. child'- are: open. and despite tan ell-Lucr'u tastntcnat that 1: III the child hand an hutcralacoun that had beta tauahnd. A Anothor phannnnnoa III Inna during ho-mlatovnl touting. ihe child uuuld ropnrt only tn. ttxunlun applied to the check. It the uxtntnor askod insistinsly. ‘Bid yuu r001 anothnr touch anywhnro also?" alanine: at nhildrun quld hanttatingly point to the syn-etrlanl point‘ln tan ordor to chock on tho apposito side or the body. detomnxnp uhofihar this vac a unigua or I Iritalntte phenanonon. In tout. or «that bed: parts var. carried out. In henolcternl tests or root and hand. showman: Ind hand. and about and rant. the It.» phanoInnan.flla ohm-twee. in. «E114 txrnt reported only the feat, tho thauldor er ‘a. catch - and thou, whoa tho attains? inaxated a acoand locus. point-d to the appositu fact, guanine» an aids of thy rice. on Furthanlaro, in non. young «aileron, tho phnnulanou appeared on linslc :ttnulatiou. singlu atannli applied in any body part would bi correctly localixac. It tho ‘mlninor adv insisted that "tram , _,_, L¥=§ ‘&:‘-’ �7. churn had bcon a Iguana skinning. the child petntod hnl1tltznaly appease aid. e: um body. uni-ms pm on to m an 0.1mm indium. and 4mm“ (mpmu g and g) an tnnu-hnnd was intrnqunnt. It nus abnothd 1n 7’ of in. crrarl tents. In all tubdcatl 1n wasn't: an: appurunt, uuhuoqucnt a: tan ruao~hnnd tout unairnatnd can pn‘%crn at run. A. trial. dcnlnnnoo. other sun had: aggggggggg£,§ga§,gag;zgg§L, In taut. or part. or ulnar! 10¢It admin-at uhnn tho ran. and hand, tun hand It. loot. salultunooun tent: or 190$ and hand. tn. toot~annd tout. worn introdaaod after the initial ton 8:111! at tn. taco-hand tact 1n Inn: ohildrtn. In 8h. feat-hind tent. feet 11). dauinnnao In: taparont in 5x! at tho rcupanloa (In. that: and th. cup-k tho nanitoat by hand axttnottou; by dinning-nun: a: hand actual: and to uh. tout; and by par£111 displucullut to the this». knot, 1.3. who and. Irruru §§§55;5L,A 3-513 area» or childrou. It was with 0th.: in tents repentod at varrtns tutorVIJu warn nunltnod cutuusoun Itinnli. Izttnotian Qua allpllaulant phone-nan.unro prick prettnt 1n tacoohnad tent. Etta: pin pr1ok. rupotxtivc pin uuaxo tn. gumbo: at and rcpotitivo touoh (rubbing) attlulitionl. tuudh uttunzi.m orrorl with than. stimuli I‘l‘ town: than with of tuna dunialnoc and bind untiuotzon In: ntill laplrcnt. ~ W pattern ability to idontitr tad 100311£0 sepnruhod tron ouch 9th.» at nun» «titans. Th. ntnultanoonn lit-n11 LI 3 culplcx runntion 1: agenda of 1110. It grudullly dcvnlup: during tn. £12.: tho attic of tho a relatichy unltahlo ab1lity. tar Inn: china»: in otrobrnl alt-n:grannimn eta diutnrb tuna disarm-tnntlonn. focal which �8. in heeipiegie (5) er perietei lobe ieeione (a); epinei cord leeiane (23); end difruee brain dieeeeee ee taxie etetee, seniiity end inflammatory aenditiane (6) zen eo alter tactile dieerininetiaa that the phenunene of extinction and diepieeelent became pruninent. lrrere in simultaneoue teetiie teete ere apparent in aerial eduite flaring the initiel tee trieie at the tent -- during the period or “learning” (1). Pereene eubaeotod to ierge doeee or barbituratee (6), electromehook therepy (6) or eneetheeie (7) eieo leniteet such en inability. ' pro-inent feature in all sreupe ie the unifornity of race dominance. when dieerieinetion or eieuiteneeue stimuli in interfered with, for thetever reeeon, the errors are made in the etmluli to the head and not in the etinnii to the tece. The cavalier: or “face delinenee” ie “hand extinction.“ it, too. is apperent in e11 etheete end under the variety or ccnditioue studied. further-ere, in en ”order or daninenee” other body peril ere A tee limite. Bennie: in petieute with helipiegie (5) end petiente with eevere mental chensee ee e reeuit or brain between theee dieeeee (6) here revealed an order at equinenee or teee~ehoui¢er~ trunkathixh-teot and bend. Ineorar ee theee other body parts were etudied in theee children, e eieiler order tee observed. Since dominance ie evident in young children, it eppeere that the pattern or dominenae in en inherent function or the arsenien. This chidiheed new of reeponding to einniueneaue tactile stimuli in expoeed end exaggerated in edulte ander e variety or pathological oonditione. Recently Cohn bee suggested a theory at reetrli dominance to explein theee obeervetione (8). Our oheervetione are not in accord with each a theory. The dominence of the-toot to the hand in �9. children, an wall I. the douinlnco of penis, buttock, that and thigh to the hand in two large aerial of patients with diffuae bruin artfunction (6, 9) Elk. such an explination untenable. a in lethal Childrun with Findiggu‘;g PM oclparins Eh. tinfiinsu in ohildron with than. prawiounly roportod in patient. with .QVOTC Inuit: chtngos an. to hrnin dylrunetian (6), a clot. nililnriey in pariah-anon in obturvod; In both group: tn. ability to dilcrilihtti Silaltnntoul Itiluli in lilitod. 0n aon—hanolosous tactilu touch. Inah II the rte-«hand hatt, error: it. 0n and: on initial and suhncnunnt triulu. Hhilo astinntioa or a thinning 1! the unit Iroquant error. diaplhoalnnt 1! cannon. In both childvun and viii-nth, errors occur with a vurioty at cutnnoons Iii-n11. lurthnmnmrv. touting In: tritulntly h. done with 01': open, and in sin: ihntcnooa. with ropaatod Vtrhal ulna: that than. tr. ewe atiluli and still arr!!! Ito undo. 1h. {later or learning 1: not pro-inont niuoo touting on tableau-ht any: will olioit tho previous pattctnod errata. In Gottfllt tum-n. patient. with organic anneal dctocta and ohildron have dirtiauity in extracting a ao-piua non-cry ”right!” frun thy ”buneroani” of the total Ionlary "field.” Significantly in each group inure in no difficulty in idantitying. linultanoaua Iii-uli if thy stimuli are applied in syn-attic regions at tho body, Inch it each hind or both 3140. ot-thn than. 3390, each Itilnlun figure ha. a cal-an background in turns of body insgo, unholy, en. "mm." (in), In both groups. that dalinlnco it apparcnt. It in InnlfGIt not only on test. of tuna and hund but Illa on teats or that had othcr body part3. Alto, innotlr II it II! tostod, thn order of dunintnec for othcr body part. in lililnr. while extinction and displaculont are the halt frequent typco �10. or error, othcr annualanu are elicitcd in both children ind patinnta. Partial dinplusoamnta. 0.5. tan uislocalisation of thc pochpt tram tho hand to in. nhaulder or neck on the racowhnnd test, It. cool-ioually obnervod. Th. phcaonnnn or ”allouthnsia" Ina ”axe-anesthesia“ are seen in the more severely affictcd patiatn and an. raunxoat childrvn; bath are franunntly unlooiuted in the same subjeeta. In nllcpthoaia, tat uuhjootu usually localine tbs chock ltinmluu correctly but niuloauliuc the hand Itilulus to thc appetitt hand or clbav. In cxosaunathouia, the ttinnli are ninlocslizod either to Iptcc in front of th: subject er to the uxnnincr'i body. This phcuancnon was frequent in the youngest ohildrcn, Ind despit¢ the nan-ingr'a urging the child pdrnilted in web the cum to point to its on niuloellisationn until I trial of the flag-hand toot nus perfornnd m, with eye: open. nation to than phenomena mm- apantaneaualy, patient: with orgtaio umutul syndruno also naniront Iuother respaano In sauna to simultaneous stimulation rirut noted in children. 1.3., an honolnteral rice-hand testing only on. stimulus (the aback) in spontaneously reported; but yuan tho examintr insists. tbs second it ninlocnlixod ta thn apposite chuck. since the pationtl than IO Ian: niuiltritics in their reapoaacs to young children, it was prodiatod that they would ulna ahcu this phnnannnau. In I series a! patient. with tavern nautal chins... hamolateral taut: or the cheek, nine. (out, thouldor and thigh wart avplicd. ”bun uni: ant nth-alum III reported, the aI-inor Inked for the loan. at the scoond ntinulua. Runyon... varb obtained in 20% of thc patientl, and in each one tn. second utiuulus an: uinlcotlixod to thy ayunetric body part. Purthornarv, in none subjects tbs name phenomenan III observed with single utilnlntion. �11. This phone-soon sppssrs to ho sisilsr to tho cosplstiou phone-soon described iu dostslt litersturs ss 'closurs” sud ”good oontinnstion.” fhsss srs—usoslly describsd for othsr ssnsory Iodslitiss. Uhsn s circle is tschistoscopicslly sxpossd in tho visual risld so thst hslr fslls on s hssisnopic risld. or it s cross is exposed so thst tho contor tolls in tho blind spot, ssny subjects rsport s cosplsts circls or cross. This ”cosplsticn' occurs for “good” figurss. In sisnltsnsous tsctilc studios, syn-stric figurss spoosr to to tho "good“ or ”strong" figurss. W ’ l. shility to idshtiry sud locsliss ssyI-stric simultaneous tsctilc stisuli dsvslops grsduslly during ths first docsds of lits, using prsssnt in 80‘ or nornsl childrsn by tho sac of sight yssrs. Syn-stric stfl-uli soc smrs oosdily locslissd and this shility is ssll dsvolopsd in non-s1 three your old children. 2. the own on umtric (hilstsrsl sud ipsilstsrdl) sti-nlstion involvs sithor extinction (only cos of the two stisuli is rsportsd). or displscslsnt (cos or both stimuli srs nislocsliscd). Hhsnsvsr sxtihcticn and displscsssnt occur. stimuli to tho tscs tend to to corrsotly rspostsd. this "fscc dcsdnshcs' is found st sll sgs lsvsls tsstsd. 3. ans can concluds thst sstincticn sud displsoslsnt or tsetils stisnli. ss ssll ss rscs dosinshcs, oonstituts s now-s1 sud consistent pottsrn ct rsspohss in childrsn. In sddition to thsss rssponsss ons osn observe, in childrsn under six yssrs or age, tho phsncsons or sllssthssis, sacsosssthssis sad psrtisl displscsssnt ss nonssl resctions to silultsnsous tsctils sttlnlstion. h. rho difficulties in rscosnitioh ct silnltsasons tsctils stimuli, ss shown by young childrsn, rssppssr in tho sons rsshion �12. in adult patient! with focal or dittuuo dyutuaatian or the bwltn. The abilities or taettlc discrimination acquired by the child aura»; growth are lost by tbs adult who develop: Inntal change. an I rniulfi of cerebral Gianna. �13. fllFMGE m, 1;; (a) 1. and mm, 11.: Pattern. in pox-owner! l. rm. tut. or no. and hand. Tram.An.umol.Auoc.l ILL, tn 31-111mm: 250-252, June, 1950. ' W, PINK. I. mm. 11.3.,tutu 8:) alumnae“: or no: and hand. §_6_g_ mm, unutionn. a. (3) ._ 309mb“, 1951. 11.: in perception Pattern: mh.nm1.tn Mutt" and pmlpttation of autumn ntmtien ”chasm-111.Iul'lzomnt.l 2.}. 1-9. July, 195. 11.3.; «11m extinction In: Observttionu on tho scuttle of thc unilaton'liinuction utter body and the phone-anon patent: central gym... $311.43.!mol.Auoc., 15}. June. 1950. 11.11.. mm, 3.3. and mm, 1.: tax-mun ”111111 amore“ mm, of extinction and ant-than. Amhgmflfiflnhut. with (D) 3. 355.362, and um 1101.3, 9mm 11.3.: humane-u, or the I. or1.,dnpnocunt rm, I. andormm situation into exam-personal men. human 7111 preparation). 1. 31112130, 5. SHAPED. NJ. and SCEM’PILL, 1.3.: ntinntion I.B., mm, phone-anon 1n 11.111103“. mh.£om1.trnzah1ut.l Q. 7174'”, Decanter, 19kg. $3.1 m two-dune tent is tad m, m, stagnant“ sign or organic until Imam. umlm‘ g; It. I!” a 6. FIRE, 7. J. and mm, ILB. Parceptual ptttomu during maven um, IMIthOIiI. J. gurolquhzcmt.‘ .134. moral rm 316—321, 3951. 136.58, x ' (a) com, R. and RAM, 0.3.: 011Aeon-tun "peat. of the unnory organisation or the has»: but!" study in rental «drum. n «teamed by unilateral umltmomn stimulation. mm.m.nm1. """""""""""""'""'"""" 8. ”.00., It! 10. Mo 19%. or the union crewman at certain “poet: A dwinunoc 111 children. or 11. rantml Itudy the bum brain: (11) ' 169, com, Rd On ”union, 3;, 119-122 (nu-ch) 1951. 31., ”It, I. and mm. 11.3.: 0rd» of ammo. 1n tactile mm, perception. (in prepmtion). the are. tint: J. and mm II.B.: m tutor or ulna-ybe1n911111121106)? ””8, (to or two simultaneous 311th “1.1111. Min, �m; mm or May or the now-83M mt aw Comet Rupmurp. (Touch 1‘93- Nahum ' sex-nu) WAGorgoot manure. effluent: 3 39 t 31» 5 37 ,6 36 7 26 8 22 9 23 10 20 11 21 12 an 13-1529 iggggglgg rump-mm all " 1025 ~-1_-11-.2 ~~1.22»1~ .21321--».‘, --125n~2. 1262~122~ £63-21-a- 28‘sal--26515-1--6821-1-21 3746 -3..n106#21~-2 33 ‘28 28 22 -_ 10 x 3 a 0 2 o �W Foot-Band iblt (Touch Stimuli) '8!IIBIITIUR"“TU!I£ IRIALS .0 00 O Foot n , Ft.~lt. Kind talatoral 53 21 17 1 10 2 2 Ipuilaturnl #8 23 16 3 3 3 0 �" FER CENTOF GROUP ,, I: \. 4’ PER CENT ERROR AFTER k O! 39V 8 N O (,J O 43 O U1 O ERRORS MAKTNG IO 63 O K TRIALS \l O 03 O «0 O OOI �THE MOUNT SINAI HOSPITAL NEW YORK CITY MONTHLX NEUROLOGICAL RESEARCH SEMINAR TUESDAY 27, NOVEMBER BOARD ROOM - 2nd 8:30 P. 1951 M. FLOOR ADMINISTRATION BUILDING EQGMM THE PERCEPTION OF MUETIPLE STIMULI Ia II. DR. MEX FINK AND DR. MARTIN GREENE: TACTILE D.D.S. DR. ROBERT L. KAHN AND DR. EDWIN A PATTERNS WEINSTEIN: OF RESPONSES ON (UNTITIED PAPER) DR. W. S. CHAIRMAN BATTERSBY �} r l x } um um. W“; % flu—é“: 145m’ "I 5’44. 1’31“ _ 4L ‘ 3, ,. I Q ~ ‘ _n ‘flu‘ I... A..— "-4 A4— ‘fl‘ N11,, ’ .‘ “ ������Fluid Spinal Findings Following Cerebral Angiography Joseph M. Stein, M.D. and Max Fink, M.D. WITH increasing use of cerebral angiography, the problem arose as to whether the procedure, of itself, produced changes in the cerebrospinal fluid. Fortyeight hours after angiography a spinal fluid examination in a patient suspected of a brain tumor revealed a cloudy fluid with 3,000 white blood cells per cu. mm. Prior to angiography the fluid had been clear, colorless and without any cells. As no information concerning the relationship of pleocytosis to angiography was available, it was decided to study the changes in the spinal fluid by the usual clinical methods. Spinal fluids from 21 patients were examined prior to and following angiography. Lumbar punctures prior to angiography were done at various intervals, but all punctures following angiography were performed between 12 and 24 hours after the procedure. In each instance the spinal fluid was exam— ined for color, cell count and total protein content. All angiograms were percutaneous, using 35 per cent Diodrast as the contrast medium. Maximal Diodrast volume was 70 ml. at one procedure. While the majority of patients were subjected to unilateral carotid punctures, bilateral punctures were done in four, and combined bilateral carotid and vertebral punctures in one patient. Either intravenous Pentothal (14 cases) or local procaine (seven cases) anesthesia was used. RESULTS Of the 21 subjects, significant changes in the spinal fluid following angiography were seen in only two cases. In one, a patient with a cerebral angiomatous malformation and multiple aneurysms, 5,000 red blood cells per cu. mm. were seen in a pink spinal fluid. In the second, a patient with a chromophobe adenoma of the pituitary gland, the protein content of the spinal fluid changed from 89 to 151 mg. per cent; also, seven lymphocytes per cu. mm. were recorded when previously there had been none. In all other subjects, changes in color, protein content and cell count were not significant. Three subjects showed transient hemiparesis following anFrom the department of neurology and psychiatry, New York University College of Medi— cine and the neurologic service (third division) and psychiatric division, Bellevue Hos— pital, New York City. Reprinted from NEUROLOGY, Minneapolis, February, 1953, Vol. 3, N0. 2 137 �NE UROLOGY 138 giography, and in none of these were there significant changes in the spinal fluid. Since Diodrast can cause changes in membrane permeability,1 and the spinal fluid reflects such changes, it could be postulated that a relationship between complications following angiography and changes in the spinal fluid might exist. Such changes were not demonstrated in the present cases. F urther investigations with more exacting techniques for protein determination and protein differentiation are indicated. CONCLUSIONS Neither a marked pleocytosis nor a marked increase in protein content of the spinal fluid are usual concomitants of Diodrast angiography. It may be concluded that when such spinal fluid changes are found they are unrelated to the procedure. REFERENCE 0.: Cerebral angiography: Tolerance for contrast media of diodrast type, 1. OLSSON, J. Neurol, Neurosurg., 1949. 6c Psych, 12:312, �afnuéwlc4’43hm 774449711 Min-1. KM spam: main findings mnmm mum: mug-play Alon/«4J7? 4.5;}2 zlr" 777': 137-? L/r—s g- If...” no 3"}! ”in. l“ Bax flak $.13. inoronuiag II. or norohrul ungiogrlyhr up i!!! toot aoarruncoa with in. )robluu of uhothcr tho proaodurn.?ut itaolr. pruduaad dhnagoo in the earnbrospianl fluid. rawtyunéght hour: utter ungiegrnphg; a spinal fluid unanianttca int: yqtimut In.unme900%“ o: a and; 27mm with blood tall: pow cubic willltcr. ?tlew to unsiegruphy eh. {lama and without any any. ma how infant“ clan containing tan rolgtleaahlp or pluoaytouta to ungtuguufiny in. avgllablo. 1% Ian aoasdod to study flu. dhanfiog 1h tho spinal Wick m mu m. mum . a.“ am. ”mm. llnid by fibe_unus1 01131931 nnfihndu. ‘ Spinal fluids tram tuouty-uno pationta wank $munincd print to and running mum-33mg. 1mm: pun-mm Mar to nag!“— phy tor. don. at various ia$¢rvnln._huk :11 pun-tufics rolluuinu Ina glogruphy uumo partarnma hofiuoonyln anfl SQ hear: fiitor in» procew tying: {tula can «hunlncd for 00109. 0011 gaunt ‘nd total protein ooatnnt. £11 angiogru-I Inn. pnruutaaonua. uniac;aifl aladraut an Eh. «entrant Infilllm Hand-:1 dioarunt doing. via 70'. a! an. atsa Isaac, “anal. Eh. aujoritx at pgticnta wort auh1oato¢ to unilateral anvctid puuttnruug hilnwurnl gunnturua vat. dam. in fan: putluntn darn. In Ogah {uncanno ch» 3 an! canbinofi bilazqrul suretzd and v.:%.hrn1 in «at. Eifihar intravunoun ponaothal (I! an...) a: local nrmuntun (v 0....) uaaaehnain van 3308. 3 �gggultgt or uh. twentybonp‘nnbjootl, signirionnt «nausea in the ”spinnl fluid thlloving-angiogruphy warn anon in only two out... In «an. a pttiunt with n acrobtul nugiountoua malformation and multiplo unnuryunu, 6000 rod blood «.11: pl? cubic millitor won. in a pinkidh colorod spinal fluid. In the uncond. u pationt with n ohrauophobo adonaln or the pituitary gland, thy pictoll content of tho lbinnl fluid oh‘ngod Iran 89 uilligrml por'uone ta 161 3111151.: par cant. Alto. lava: lynphonyton per aubio mils noon lilihor wort I And racowdod whoa prbviaunly thorn bud boon noun. In ‘11 nth.» nubjootu. chanson in 90102. praz-in aunt-n: call count war. no: significant. Ebro. subjects aurforod trsnn- in.noao wcro thnr. significant august. in tun apinul fluid. In two subjectl. fine apinnl fluid romainod an» ohangod. In thy third. far aronntod :04 blood cell: and twa nymphooytoo per eubio nillilitor turn notod, what. non. had boon inacn prior to thy pron-aura. Binao diodrune can onus. ohungon in membran- perusubilsey (1}. find tho spinal fluid reflect. august: in cm. manna... u my be paw-ha than a. rel-Mon menu ounplicntiann find such change: axintn. audh changun Into not do- iont haniparonil. and nonntrntod hart. vurchsr inyuatigntioaa vith.noro oxnoting tooha bio: for protein dutorninntion and protein ditrurontiation are in» diontod. W . ploooytonin nor a ngrkad inoronno in protoiu content of an. [pinnl fluid urn uuuul oonoanituntu or aiodrn-t angiogruphy. it'nuy ho aonaluaod Shut ihon Inch apin;l fluid chanQOa urn found. thqy uri unrolatod to an: groundnut. llithnr : lurkod �HO! £3523 ' Angiogmphy: relax-ma. {for 01am. 0.: 00113an 01' Contact M1. Diner“: . o J. Roux-o]... Mum-m... a: hymns. 33:313—816. (am. i949. �x- "e" ' " "-’ - 1' ' I?“ .. J- A" J , ~ ~‘,"~’rnr -m. _.—»,-nn,v~..wni~ ~- 1-... . l“. 9,, .w. Presented at the Fourth Annual Meeting - American Academy Louisville of Neurology - April, 24, 1952 Dr. Costello, Members, and Guests of the Academy: In the course of sensory studies by the method of dou- learned that normal adults readily identify and localize the tow stimuli within the ini- ble simultaneous stimulation, we tial Young ten trials of the test. children, however, seemed could not identify both sti- to make persistent errors. They muli, or if identifying the tWO stimuli} they could not localize them. In order to study the responses and their relation to the age of the subjects, face-hand tests-~the prototype of simultaneous tactile tests—~were applied to 300 normal children ranging in ages from 5 to 15 years. The children were all without manifest disorder of the hervous system, and were from child care centers, hospital clinics and children of neighbors and friends. In the course of some nlay with each child, the examiner introduced the fiace-hané test. In this test, the child closes his eyes, and the examiner, with his fingers, simultaneously touches the subject's cheek and dorsum of his contralateral hand. The child is asked to point to the places where he per- the child is asked to close his eyes, and the test repeated-~with opposite cheek and hand stimulated. Subsequently cheek and hand on the same side of the body and simultaneous stimulation of both sides of the face, or both hands are included. At least ten consecutive trials of the face-hand test are recorded for ceived each tje child. stmmuli, and the report is recorded. Again �2. Eighty percent of children under six years of age failed to localize both stimuli correctly during the initial ten trials. The number of errors fell off sharply among the older children, so that only 2% of children in the 11-15 year age groups continued to make errors after the tenth trial.\ This is represented in the first graph--.. Apparently the ability to localize two simultaneously applied tactile stimuli is directly related to the ageof the subject. This same relationship is represented in the second graph. The percent of the subjents in each age group making errors on each trial of the test is compared for representative age groups. Ihe older children manifest an ability to learn from previous trials of the test while the younger chil- dren do not. incorrect responses of all children were of two types--failure to identify one dfithe two stimuli, called "extinction", hr, identifying two stimuli but mislocalizing The 'one of them termed "displacement". Extinction of hand stimuli observed in of the errors, while displacement was in 51%. The preponderance of errors were in the perception of the stimulus to the hand. The stimulus to the cheek was almost was 62% correctly reported. This ability to identify the cheek stimulus in preference to the stimulus to the hand was pre— viously observed in normal adults and termed "face dominance." always face dominance was uniformlylapparent in the children of all age groups in theseries. The errors were apparent in tests involving the cheek and hand on Opposite sides of the body as well as cheek and Such ! i �5. I ’ ‘ I" hand on the same side of the body. WhileverrorSawere frequent in tests of face and hand, chillren made no errors in identi- fying symmetric stimuli, as both cheeks. In the younger children, partial displacement from hand to homolateral shoulderder or neck, or displacements from a hand to the oppo- site hand(allesthesia), or even into snace in front of the child(exosomesthesia) were seen. The incidence of these dis-placements was less than 4%. Since these phenomena were so apparent in younger children and became less frequent with increasing age, it was concluded that extinction and the varieties I of displacement are normal phases in the degqlopment of the response to simultaneous tactile stimuli. In normal adults and older children, such phenomena are apparent during the initial trials only. From these studies it was concluded that the phenomena ’of extinction and displacement are normal phases in the dev elopment of the perception of simultaneous tactile stimuli. Face gew A Ar: 4,»- a. v12.w_ at all age level; and is an inherent pattern of organization of function. Ihe perception of simultaneous tactile stimuli is directly related to chronological dominance is observed age, being gradually develOped in the first decade of life, and being well developed in 80% of children by the age of 8 years. e MW. ._ L. �EBRUPHYSIOLUGY “¢ ,_ 4, .4. lAB'RATOT‘Y HILLSIDE HOSPITAL GLEN OAKS. N. Y. é 0......w...y -,..‘u.- ’. ”luau s..»—..._ Perception of Simultaneous Tactile Stimuli *in Normal Children wrvq Ira ‘ r , A» “WV-'1.......;.,...«-_'.... [Wax Kin/L, M.D. and Morris B. Bender, M.D. r 1w l . V» ~4M-I’an‘,‘ . “and” ...-...a_.~.......~.w:..c- Amman...» .. -_. .w Normal adults readily identify and localize tactile stimuli applied simul1 taneously to the face and the hand (the "fface--l1and test”). While half the subjects perceive stimuli incorrectly on the initial trial, all are accurate by the tLIItlI tIi Il oi the I:.est Young children, however, find the task of identification and localization of two skin stimulations difficult. They report only one of the two stimuli, or, if they report the two, frequently mislocalize one of them. The omission or mislocalization of stimuli is not haphazard but follows a consistent pattem in which stimuli to the face are readily appreciated (" most dominant" ) while those to the hand are not (' least dominant” ). lII mdeI to determine the pattern of' dominance” in children and the age which such tactile peiceptual tasks are correctly performed, a study of at normal children was undeitaken. The responses of children to the face- hand test and to simultaneous tactile tests of other body parts were ascertained. SUBJECTS AND METHOD . ca...” .‘firw' -‘-—<-“-~»—« — ' \, Three hundred normal children between the ages of three and 15 were examined. They were from a neighborhood child care center, from the wards and clinics of Bellevue Hospital, and children of neighbors and friends. They were without manifest disorder of the nervous system. A few children at two and a half years of age were included in the three year age group, but younger children were generally not able to comprehend the test. The subjects were examined individually, but there were many who were examined in a day-room in full view of other children. The child was engaged in play and when toys were available they were used to gain his confidence and interest. 'At some time during play, the face-hand test was introduced. From the department of neurology and psychiatry, New York University College of \icdicinc and the Bellevue Hospital, New York City. This work wIs aided in part by a fellowship grant from the National Foundation for In- fantile Paralysis, and by a grant-in-aid from the Coordinating Council for Cerebral Palsy in New York City, 'Inc. Read at the fourth annual meeting of the American Academy of Neurology, Louisville, Kentucky, April 24, 1952. 27 Reprinted from NEUROLOGY, Minneapolis, January, 1953, Vol. 3, No. 1 ,. ’ 4 I» J �’3 NEUROLOGY 28 ._»--.A:::’mwww Nu... .. P... I. . ,u.‘ w» 'm ....-w)»...._»:,..- .. “1'3““- :7 —y’u«~¢_-'”’(, . A a ""‘f-u-mmfir »« ...._,......> .I, . ww‘.MF—b—4w‘ For the face- hand test, the child was told: "I (examiner) am going to touch you, and he was to "touch the same place I touch." He Was asked to close his eyes. The examiner, with the fingers, then touched simultaneously a cheek and the (lorsum of the contralateral hand of the subject. The child was asked what he felt, and to point to the sites stimulated After this response. the child was asked to close his eyes again, and now the opposite (both and hand were similarly stimulated and the report recorded. If only one Itsponse was given to this trial, the child was asked if there had been another stimulus anywhere else. Following these two trials, the cheek and hand on the same side of the body were tested in a similar fashion. The fifth and sixth trials were not of asymmetric body parts but simultaneous stimulation of both cheeks or both hands. The following various types of stimulation were used: heterologous stimulation of asymmetric body parts on opposite sides, as right cheek and left hand; homolateral stimulation of asymmetric body parts on the same side of the body, as right cheek and right hand; and homologous stimulation of symmetric body parts, as both checks or both hands. Such tests were repeated in each child until at least ten trials were recorded. Subsequent tests of other body parts, performed in a similar fashion, were introduced until at least 20 consecutive trials were observed in each subject. A number of modifications had to be introduced for young children. Many would not play the game with eyes closed, but insisted on keeping their eyes open. III such cases the tests were applied with eyes open. Also, a large number of three and four year old children insisted on pointing to the examiner’s hands and face on the initial trials. For these children, a few trials of single touch stimuli applied to the thigh, chest or hand were introduced, until they grasped the concept of pointing to their own bodies after the stimulation. These single trials were carried out with eyes open. After the series 'of double simultaneous stimulation tests were completed, single stimuli were applied to various body parts to exclude from the normal group any subjectswith focal sensory difficulties. The children were asked what they had felt and to point to the places stimulated. Verbal Ieports of the locus of stimulatiOn were not accepted. It was occasionally noted that children would correctly name the parts stimulated, i. e., the cheek and hand, but then point to both cheeks, or to two places on one check. It seemed as if naming the locus yielded more accurate responses than did pointing. These tactile tests were repeated on consecutive days, or subsequently after a lapse of a few days or weeks in some children. At such times, cutaneous stimuli other than light touch were added to the testing. These included repetitive touch (rubbing), single pin prick, and repetitive pin pricks. _ . . . ~‘~- .mh—wwyfln NJ,“ e., .va RESULTS .....-..-~_.- «-~ - ' ’ children made many errors on face-hand tests. Eighty per cent of children under the age of six failed to localize both stimuli I ncidcnce‘of errors: Young , 2mm, �PERCEPTION OF TACTILE STIMULI IN CHILDREN 29 iooJ 90‘ 3 < 60 E .. 704 9 6° . '1 3 50a S ‘0 :2 i g a: 0: “‘ , _ . ~....._.. 1“ 90 5 \.\ 70‘ 3 5 ‘- 604 ‘ “\ \‘\ \ 10‘ \“ ‘~.‘ /\ . . 304 ’i H.“ . 3 2° ‘~. 5‘56739Dll12046 ‘ U ”M " “~- J vans -- -- s vans ' ‘04 3 x . so g . -\ . no x3 \s 30‘ ' \-\...-. ‘4‘. nuns ..... ' -~-- 9 , ‘K vans n '5J4ST709210MEG names Y CF TRIAL AGE Graph 1. , m~w-~m \‘x‘ ‘ it 6'20 2f IOO l g D- I: ~—«—-~-..‘..__;__....~_ x Graph 2. during the initial ten trials of the face-hand test; many of these even with eyes open: In the older children the number‘of failures fell sharply (graph 1) so that only 2 per cent of children in the 11 to 15 year age groups continued to make errors after the initial ten trials. Apparently the ability to identify two simultaneously applied tactile stimuli was directly related to the age of the child. This ability was also related to the number of previous trials of the face-hand test. In table 1 the trial of the test after which the child was consistently correct is recorded. The last column of the table includes all the subjects who made errors in the first ten trials, and on many trials of the test beyond the tenth. Graph 2 illustrates this relation for selected age groups. Type of testing: In these studies homolateral and heterologous stimulations were carried out at random. Errors were made by subjects of all age groups in tests of. either type. Homologous tests, such as both cheeks, or both hands, randomly interspersed in the testing after the fourth trial, elicited correct‘respouses in nearly all cases. While this served as a clue to some of the older .W....m~. TABLE . a . . t (Touch Stimuli) c . m-‘Wn Age ...._.-.m..;. 3 4 Total Number of Subjects 39 S4 37 36 26 5 6 7 8 9 10 WWM..W~«.».-.A_. 1 NULIBER OF TRIALS OF THE FACE-HAND TEST NECESSARY FOR PERSISTENT CORRECT RESPONSES 11 12 13—15 ‘22 - 23 20 21 24 29 2 1 3 Trial Correct 4 5 6 8 - — 1 2. 4 -- 1 6 6 3 2., 4 2 5 -2 1 — - -2 1 — — 1 — 1 -3 1 8 2 6 6 8 3 7 4 10 2 . 4 5 2 4 6 -— 5 4 I 6 4 1 1 2 2 2 2 - — l 2 1 1 1 1 — 1 — -1 — 2 2 9 2 ,- - — — 2 - - - 2 l - 2 — 1 — - - — Errors Beyond 10 Trials 34 ' 28 28 22 10 4 3 2 0 2 0 �NEUROLOGY p , it did not seem to alter the hildrcn that two stimuli were being applied, trials of the insults in the younger children. In these subjects subsequent the responses to the lee-hand test were incorrectly reported, even though stimuli was of mmetric stimuli had been correct. The perception symmetric ,iuch better than asymmetric stimuli. of children studied, face-hand Subsequent testing: Of the total group to the initial testing in fusts were repeated at varying intervals subsequent of six, subsequent testing elicited it) children. ()f the children under the age on the initial examhe same. difficulties with facc~hand tests as was evident seemed to have grasped who six years of age, ,nation. In a few children over manifest on were errors in the initial testing. ghc concept of two stimulations learnsuccessful for 3ubsequcnt days. It was as if many trials were necessary completed, successfully task was the ‘iig of the task, and then, even though These observations are in contrast to those made ‘gie learning was temporary. elicit the errors of the {i normal adults, in whom subsequent testing did not tidal ".4 I test.1 (table 1) made by children on Type and pattern of responses: The errors six of types: (a) a touch on the i'peated trials of the faCe-hand test were touch on each cheek, heck only, implying no perception in the hand; (b) a the hand; (0) a touch implying a mislocalization of the stimulus applied to neck or elbow, implying in the cheek, and a second touch on the shoulder, the hand; ((1) a touch on to stimulus applied partial mislocalization of the in the check; (6) a touch on each he hand only, implying no perception cheek stimulus to the hand; and (f) of land implying a mislocalization the examiner’s body, implying a mislocalization away pie-or two touches on the grom the child’s body. all age groups. ’It was Face dominance ( respbnses a, b, c) was apparent in hand the (response a), and host manifest as extinction“ of the stimulus to hand stimulus to of the Mislocalization .'as seen in 62 per cent of the errors. of the errors. While cent 31 observed in per he cheek (displacement)i was and hand cheek in tests involving observed {rest of the displacements were displacements of the were errors 7 in opposite sides of the body, per cent of homolateral stimulation simultaneous the in check the hand to tom the child pointed the times such At hand. ody parts, e. g., right cheek and right 2 to 3 his fingers b the cheek once, saying 5‘a touch here,” and then, moving lentimeters lower on the cheek, saying “and here.” Other types of displacel‘nent were infrequent. There were partial displaceshoulder or neck. Mislocalization of a stimulus ;ients from the hand to the occasionally apparfeross the midline of the body, known as allesthesia,3 was children Furthermore, testing. hand heterologous the on to int in the stimulus p , - “ ,, simultaneous stimulations has been called "extinction” :The failure to report one of 'two of of the second a percept to the homologous body part 3i a stimulus.2 The mislocalization of the direction the in of mislocalization a percept iimulus is called "displacement." The the stimulus which is each " instance, In displacement.” artial is called lacond stimulus iorrectly reported is ‘said. to e "dominant." . i . . , l . �PERCEPTION OF TACTILE STIMULI IN CHILDREN 31 under five years of age frequently mislocalized the initial stimulation away from their body to parts of the examiner's body or into space (response f). This phenomenon, known as exosomesthcsia,‘ persisted in some children despite repeated stimulations with the child's eyes open, and despite the examiner's insistence that it was the child who had been touched. Another phenomenon was seen during homolateral testing. The child reported only the stimulus applied to the cheek. If the examiner asked insistently, “Did you feel another touch anywhere else?", a number of children hesitatingly pointed to the symmetrical point in the check on the opposite side of the body. In order to determine whether this was a unique or a systematic phenomenon, tests of other body parts were carried out. In homolateral tests of foot and hand, shoulder and hand, and cheek and foot, the same phenomenon was observed. The child first reported only the foot, the shoulder or the cheek—and then, when the examiner insisted on second locus, pointed a to the opposite foot, shoulder or side of the face. ,Furthermore, in some young children the phenomenon appeared on single stimulation. Single stimuli applied to any body were localized correctly. part If the examiner then insisted that there had been a-seeond sti‘mulus,'the 'ch'ild— pointed hesitatingly to the symmetric part on the opposite side of the body. As already indicated, hand dominance (responses (1 and e) was infrequent. It was observed in 7 per cent of the errors on face-hand tests. In all subjects in whom it was apparent, subsequent trials of the face-hand test manifested the pattern of face dominance. Relation of hand and foot: In tests of parts of the body other than the face and hand, the hand was always least dominant and the cheek the most. Simultaneous tests of foot and hand, the foot-hand test, were introduced after the initial ten trials of the face-hand test in most children. In the foot~hand test, foot dominance was apparent in 51 per cent of the responses (see table 2). It was demonstrated by hand extinction, by displacement of hand stimuli to the foot, and by partial displacement to the thigh, knee and leg. - _‘ _ _ . .- _-~qu.-. ‘ 7 TABLE 2 FOOT-HAND TEST _W&-u.~.“.~w (Touch Stimuli) 5......“ Stimulation Total Trials .., -_._... is a- Bilateral Ipsilateral 53 48 Correct 21 23 Foot 17 16 Responses FootHand Foot 1 3 10 3 Partial Hand- 2 3 2 0 Ft.-Ft. Hand ”ma—”Ayug. .. . A .. r M»~..-.._—t_.. I Otlzcr stimuli: A small group of children who made errors in tests at varying intervals were examined with other cutaneous stimuli. repeated Extinction and displacement phenomena were present in face-hand tests using pin prick, repetitive pin prick and repetitive touch (rubbing) stimulations. \Vhile the number of errors with these stimuli were fewer than with touch stimuli, the i , ,_ ' �w“ o a. ‘NHJa-w ' 32 . NEUROLOGY I still apparent. pattern of face dominance and hand extinction was _ ._ f DISCUSSION __ NM... . ~‘ak ,..,~ .... -V~’W~¢-—/“A... -Mww ,rw ‘r f ,. ‘....-._..u-n-. v“\——»\‘ ‘. < r 3 The ability to identify and localize simultaneous stimuli separated from each other at some distance is a complex function which gradually develops for many during the first decade of life. It is a relatively unstable ability, Focal discriminations. such changes in the stateiof the organism can disturb lesions,2 cord lobe lesions,2 spinal cerebral disease as in hemiplegia" or parietal and diffuse brain diseases such as toxic States, senility and inflammatory conditions" can so alter tactile discrimination that the phenomena of extinction, and displacement become prominent. Errors in simultaneous tactile tests are of the test—«luring the apparent in normal adults during the initial few trials of doses barbiturates," electroperiod of learning.1 TPersons subjected to large such inability. shock therapy“ or anesthesia" also manifest A prominent feature in all groups is the uniformity of face dominance. When discrimination; of simultaneous stimuli is interfered with, for whatever in the stimuli reason, the errors are made in the stimuli to the hand and not It, too, extinction.” is "hand dominance" _to the face. The corollary of "face Furstudied. of conditions 'is apparent in all subjects and under the variety these two between thermore, in an "order of dominance" other body parts are mental with and severe patients limits. Studies in patients with hemiplegia“ of dominance order revealed have disease“ an of brain result a as changes other these body parts of face—shouldcr-trunk-thigh-foot and hand. Insofar as dominance Since observed. order similar was these children, in a studied were of dominance is an is evident in young children, it appears that the pattern inherent function of the organism. This childlike way of responding to simultaneous tactile'stimuli is exposed and exaggerated in adults under a variety of pathologic conditions. has suggested a theory of rostral dominance to explain these Recently observations." Our observations are not in accord with such a theory. The dominance of the foot to the hand in children, as well as the dominance of with penis, buttock, foot and thigh to the hand in two large series of patients untenable. such make explanation an diffuse brain dysfunction,“ Comparison of findings in normal children with findings in patients with organic mental syndrome: On comparing the findings in children with these previously reported in patients with severe mental changes due to brain dysfunction,6 a close similarity in performance is observed. In both groups the ability to'discriminate simultaneous stimuli is limited. On non-homologous tactile tests, such as the face-hand test, errors are made on initial and subdissequent trials.‘ While extinction of a stimulus is the most frequent error, with a placement is eommon. In both children and patients, errors» occur be done frequently Furthermore, stimuli. cutaneous testing may variety of with eyes open, and in many instances with repeated verbal clues that there of learning is not promare two stimuli, and still errors are made. The factor the elicit will patterned errors. previous days on subsequent inent since testing mgvfi . ; ' ' vb...“ .. ,r» ...- -,4‘-.;.,.va‘ . A. w, .. ~’M"|,.I vauy—as , " ' m-.. .... v -.... *qu...‘ {U thn A ' -....;..W" A... .‘- " " "‘W , A AA i. 1 1» 1 1 1 l i ‘ �PERCEPTION OF TACTILE STIMULI IN CHILDREN ‘ 3‘3 In Gestalt terms, patients with organic mental defects and children have difficulty in extracting a complex sensory "figure” from the "background" of the total sensory "field.” Significantly in each group there is no difficulty in identifying simultaneous stimuli if the stimuli are applied in symmetric regions of the body, such as each hand or both sides of the face. Here, each stimulus figure has a common background in tenns of body image. namely the hand.” Face dominance is apparent in both groups. It is manifest not only on tests of face and hand but also on tests of face and other body parts. Also, insofar as it was tested, the order of dominance for other body parts is similar. ' While extinction and displacement are the most frequent types of error, other phenomena are elicited in both children and patients. Partial displacements, e. g., the mislocalization of the percept from the hand to the shoulder or neck on the face-hand test, are occasionally observed. The phenomena of allesthesia and exosomesthesia are seen in the more severely affected patients and in the youngest children; both are frequently associated in the same subjeets. In allesthesia, the subjects ,usually localize the cheek stimulus correctly but mislocalize the hand stimulus to the opposite hand or elbow. In exo~somesthesia,—the stimuli are mislocalized either to space in front of the subject or to the examiner’s body. This phenomenon was frequent in the youngest children, and despite the examiner’s urging that the child point to its own body, the child persisted in such mislocalizations until a trial of the face-hand test was performed with eyes open. In addition to these phenomena which appear spontaneously, patients with rganie mental syndrome also manifest another response to simultaneous stim. ulation first noted in children, i. e., on homolateral testing only one stimulus (the cheek) is spontaneously reported; but when the examiner insists, the second is mislocalized to the opposite cheek. Since the patients show so many similarities to young children in their responses, it was predicted that they would also show this phenomenon. In a series of patients with severe mental changes, homolateral tests of the cheek, hand, foot, shoulder and thigh were applied. When only one stimulus was reported, the examiner asked for the locus of the second stimulus. Responses were obtained in 20 per cent of the patients, and in each one the second stimulus was mislocalized to the symmetric body part. Furthemiore, in some subjects the same phenomenon was observed with single stimulation. This phenomenon appears to be similar to the completion phenomenon described in Gestalt literature as “closure" and “good continuation.” These are usually described for other sensory modalities. \Vhen a circle is taehistoscopically exposed in the visual field so that half falls on a hemianopic field. or if a cross is exposed so that the center falls in the blind spot, many subjects report a complete circle or cross. This “completion” occurs for “good" figures. In simultaneous tactile studies, symmetric figures appear to be the "good” or "strong" figures. R‘f. , » — “A... .......~-........1 ~ — - AI.- jar-rs: x ., r;'34 �l _‘ Amw— 9 , ..»—-w»4 ‘-‘*V—~.. » ._......-.-... Ms- 34 '1 CONCLUSIONS 1. Ability , NE U ROLOCY , to identify and localize asymmetric simultaneous tactile stimuli develops gradually during the first decade of life, and is present in 80 per cent of normal children by the age of eight. Symmetric stimuli are more readily localized and this ability is well developed in normal three year old children. 2. The errors on asymmetric (bilateral and ipsilateral) stimulation involve either extinction (only one of the two stimuli is reported), or displacement (one or both stimuli are mislocalizcd). Whenever extinction and displacement occur, stimuli to the face tend to be correctly reported. This face dom-’ inance is found at all age levels tested. 3. One can conclude that extinction and displacement of tactile stimuli, well as as face dominance, constitute a normal and consistent pattern of rein children. ,In addition to these responses one can observe, in chilsponse dren under six years of age, the phenomena of allesthesia, exosomesthesia and partial displacement as normal reactions to simultaneous tactile stimulation. 4. The difficulties in recognition of simultaneous tactile stimuli, as shown by young children, reappear in the same fashion in adult patients with focal or diiluse dysfunction of the brain. The abilities of tactile discrimination acquired by the child during growth are lost by the adult who develops mental changes as a result of cerebral damage. i . f . .. .-.-~vku-»~‘. .. , _ - - - . REF E1112. ’CES M. B.; FINK, M., and GREEN, M.: Patterns in perception on simultaneous tests of face and hand, Tr. Am. Neurol. A. 75: 2'50, 1950; BENDER, M. B.; FINK, M., and GREEN, M.: Patterns in perception on simultaneous tests of face and hand, Arch. Neurol. & l’sychiat. 662355, 1951. BENDER, M. B.: Extinction and precipitation of cutaneous. sensations, Arch. Neurol. 61 Psychiat. 54:1, 1945; Kora, L.: Observations on the somatic sensory extinction phenomenon and‘ the body scheme after unilateral resection of the posterior central gyrus, Tr. Am. Neurol. A. 75: 1950. BISNDER, M. 13.; WOR'I‘IS, S. 8., and CRAMER, 1.: Organic mental syndrome with phenomena of extinction and allesthesia, Arch. Neurol. 8t Psychiat. 59:27}, 1948. SHAPIRO, M. F.; PINK, M., and BENDER, M. 13.: Exosomesthesia, or the phenomenon of displacement of sensation into extra-personal space, Arch. Neurol. 8t Psychiat. 68:481, 1.. BENDER, -<.»»N.-.~,.--~c¢-v--_.a . _ . .. .,.....-._..a..- . .. . . 1952. ’ M. 8.; SHAmno, M. F., and SCHAPPELL, A. W1: Extinction phenomenon in hemiplegia, Arch. Neurol. 61 Psychiat. 62: . BENDER, t l l e I lbs: - 3w 1?, M . Q33. (TFGJN'zX’UwAaQ , i l l 5...”... . . . . 717, 1949. FINK, M.; GREEN, M., and BENDER, M. 13.: The face-hand test as a diagnostic sign of organic mental syndrome, Neurology 2:46, . r 1952. JAFFE, J., and BENDER, M. B.: Perceptual patterns during recovery from general anesthesia, J. Neurol., Neurosurg. a Psychiat. 14:316,1951. COHN, R., and Rum-:5, G. N.: On certain aspects of the sensory organization of the human brain: A study in rostral dominance as determined by ipsilateral simultaneous stimulation. Tr. Am. Neurol. A. 74:162, 1949. COHN, R.: On certain aspects of the sensory organization of the human brain: II. A study of rostral dominance in children, Neurology 1:119, 1951. GREEN, M., FINK, M., and BENDER, M. 3.: Order of dominance in cutaneous perception. Tr. Am. Neurol. A. In press. JAFFB, 1., and BBNDER, M. 8.: The factor of symmetry in the perception of two simultaneous cutaneous stimuli, Brain 75: part 2, 167-176, 1952. , . l .. .- .-—-.... -~..—....- __.. ‘me—M . Mums—can 7—. . �PERCENT OF GROUP ERRORS MAKING 03 U" mo O _ m u ZCmeD A m OT: m finch? u m o........v..m.o . _i 2% (be; /C1{»c {ram 62' (2» , — x? "55"” 512/ p i M1144}; ZI“:.Y&A‘4 6A., 1M (.4: V7 “"' c / d4 A [7 5‘" r’,'. :e 7§~<1 593%“ 75/075 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Published Works Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Perception of simultaneous tactile stimuli in normal children. Neurology. 1953 Jan; 3(1): 27-34. And, Spinal Fluid Findings Following Cerebral Angiography. Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-02-01-001-8-012 Date A point or period of time associated with an event in the lifecycle of the resource 1953 Creator An entity primarily responsible for making the resource <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>; Bender, Morris B. Subject The topic of the resource Published Works -- Articles and Reviews Relation A related resource The Max Fink Collection Description An account of the resource 8 items. 1: Reprint from NEUROLOGY, Minneapolis, January, 1953, Vol.3, No.1. Read at the fourth annual meeting of the American Academy of Neurology, Louis-ville, Kentucky, April 24. 2: [preprint] and graph. 3: Monthly Neurological Research Seminar, Nov. 27, 1951, Mount Sinai Hospital, New York City. 4: Report of Activities. 5: 2 items - Spinal Fluid Findings Following Cerebral Angiography; Reprint from NEUROLOGY, Minneapolis, February, 1953, Vol. 3, N0. 2 AND [preprint]. 6: Presentation at the Fourth Annual Meeting - American Academy of Neurology - April 24, 1952, Lousiville; presented to Dr. Costello, members, and guests of the Academy. 7: Xerox of Perception of Simultaneous Tactile Stimuli in Normal Children. 8: graph. Rights Information about rights held in and over the resource <a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a> Source A related resource from which the described resource is derived Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York). Language A language of the resource en-US Format The file format, physical medium, or dimensions of the resource application/pdf Publisher An entity responsible for making the resource available Contributor An entity responsible for making contributions to the resource Published