http://exhibits.library.stonybrook.edu/mfp/files/original/ec4cf1a3f19d135cdae9a13c9adf5bf5.pdf 067f3d4f0480ecc6b50bb9561e8d4277 PDF Text Text Standardization of the Face-Hand Test Martin A. Green, M.D. and Max Fin/z, M.D. the face-hand test, has been introduced in previous studies and the responses of normal subjects and of patients with psychiatric disorders described in detail?“ The test consists of applying touch or pinprick stimuli simultaneously to the face and hand while the subject’s eyes are closed. The subject is then asked to describe and to localize the percepts. Two general types of responses occur. The two stimuli may be perceived and localized correctly, or the subject may perceive only one stimulus and either not perceive the other (phenomenon of extinction) or mislocalize the second stimulus (phenomenon of displacement).7 Most often the mis— localization or displacement occurs to another part of the subject’s body, but occasionally there is displacement into extrapersonal space or onto the examiner (exosomesthesia).R Displacement of stimuli across the midline of the body (allesthesia) may also occur.” Normal adults show errors in perception on the initial trials of the facehand test. Characteristically these errors consist of extinction of the stimulus to the hand whereas the face stimulus is perceived correctly (phenomenon of face dominance). As tests are repeated the errors disappear so that by the tenth trial nearly all subjects correctly perceive both stimuli and then continue to be correct on subsequent trials. This type of response has been termed a “negative face-hand test.” It occurs not only with normal adults but also in patients with schizophrenia, depression, or severe anxiety. In contrast, patients with an organic mental syndrome show extinction and displacement after ten trials of testing or as long as testing is continued. Such a response is termed a “positive face-hand test.” A “positive face-hand test” is also manifested by normal children, normal aged persons, and mental defectives. Because of the differential response of these several groups of subjects, the face-hand test has become useful clinically in detecting the presence of organic brain disease. During the course of our studies, however, it has been noted that patients with an organic mental syndrome vary greatly in the type and A SIMPLE PERCEPTUAL TEST, From the department of neurology of the Mount Sinai Hospital and the Hillside Hos— pital, New York City. This work was aided in part by fellowships from the United States Public Health Serv— ice (Dr. Green) and the National Foundation for Infantile Paralysis (Dr. Fink). Reprinted from NEUROLOGY, Minneapolis, March 1954, Vol. 4, No. 3 211 �NEUROLOGY 21:2 frequency of perceptual errors. Also, subjects without organic brain disease occasionally manifest a positive face—hand test. The questions which arise from these observations are: 1) Is it possible to classify or standardize the different types of errors occurring in subjects with a positive face-hand test? 2) Is there a correlation between the types of responses and different groups of subjects? 3) Is there a type of response which can be said to occur only in patients with severe disease of the brain? The present study is an attempt to answer these questions. IVIETHOD AND RESULTS Previous records of the face-hand test were reviewed for almost 1,000 patients with organic mental syndrome, normal adults, and schizophrenic adults, as well as lesser numbers of normal children, normal aged persons, and sub— jects with mental deficiency, depression, and severe anxiety. Additional groups of some of these subjects were also tested in a systematic manner with dif— ferent types of stimuli. The criteria used to formulate a standardization of the face—hand test were: 1) type of perceptual error; 2) frequency of various errors with different stimuli (touch, rubbing or scratching, and pinprick); 3) effect on the frequency of errors when the subject observes the application of stimuli (factor of attention). Fifteen to 30 trials of the test were usually done for each subject. TABLE 1 FEATURES OF POSITIVE FACE-HAND TESTS (Persistent errors after 10th trial) One—plus Extinction only with touch stimuli. Two-plus Extinction with touch, rubbing, and pinprick stimuli. Occasional dis— placement with touch stimuli. Three-plus Extinction and displacement with touch, rubbing, and pinprick stimuli. F our—plus Same as three-plus with at least one of the following features: a) exosomesthesia, b) allesthesia, C) frequent perseveration, d) occurrence of errors while subject watches the stimuli being applied. Based on these criteria, it was possible to divide patients showing a posi— tive face-hand test into four groups. The characteristic responses for each group are summarized in table 1. These responses with examples are described more fully in the following paragraphs. One-plus face-hand test: Subjects in this group show errors only of extinction and not of displacement. These errors occur only with touch stimuli. When pinprick is used, both stimuli are perceived correctly, although errors will again appear when touch stimuli are reintroduced. Case 1.—A 64 year old man with mild diabetes was admitted with a history of difficulty in walking for the previous year and a half. For at least the same period of time he had been depressed, slept and ate poorly, and was impotent. The only neurologic finding was a slow, hesitant, shuffling gait. There was no evidence of peripheral vascular disease. The patient appeared depressed, showed psychomotor retardation, and cried readily. The sensorium was intact. Spinal fluid, electroencephalogram, and roentgenograms of �STANDARDIZATION OF FACE—HAND TEST 213 the spine were normal. The diagnosis was involutional psychosis, depressed type. The gait difficulties were thought to be secondary to the depression. This patient showed a one-plus response on the face-hand test. A sample of his responses follows: Stimulus touch touch touch touch touch touch touch touch touch touch touch pinprick pinprick pinprick pinprick touch touch Location right cheek—left hand left cheek—right hand right cheek—right hand left cheek—left hand right cheek—left cheek right hand—left hand right cheek—left hand left cheek—right hand left cheek—left hand right cheek-right hand left cheek—left hand right cheek—left hand left cheek—right hand right cheek—right hand left cheek—left hand right cheek—left hand left cheek—right hand Response right cheek left cheek right cheek left cheek correct correct right cheek correct correct right cheek left cheek correct correct correct correct correct left cheek Type of error extinction extinction extinction extinction extinction extinction extinction extinction Comment: Although this type of response occurs in patients with cerebral disease, it is not always characteristic for this group. It is also observed in patients with depression, as this case illustrates, and may occur in anxiety states, schizophrenia, and, occasionally, in normal adults. T wo-plus face—hand test: In this group extinction occurs with pinprick and rubbing stimuli as well as with touch stimuli. These errors may be just as frequent with both types of stimuli or may be more conspicuous with touch than with pinprick or rubbing. Displacement is not present, as a rule, but may occur on an occasional trial. Case 2.—A 72 year old man had a five week history of mental and behavioral changes. These consisted of disorientation, confused behavior, and intermittent mutism. Examination showed an organic mental syndrome characterized by partial disorientation, defects in recent memory, evasions and circumlocutions in answering questions, denial of illness, and pain asymbolia. There were no other neurologic disabilities. The spinal fluid, electroencephalogram, and skull roentgenograms were normal. A pneumoencephalogram showed an increased amount of air over the cerebrum and increase in the size of the ventricles. This patient’s responses on the face-hand test characterize the two-plus type of response. A sample of these responses follows: Stimulus Location Response Type of error touch left cheek—right hand left cheek extinction touch extinction right cheek—left hand right cheek left cheek—left hand touch left cheek extinction touch extinction right cheek—right hand right cheek touch correct right cheek—left cheek touch correct right hand—left hand touch extinction right cheek right cheek—left hand left cheek—right hand left cheek extinction pinprick �214 NE UROLOGY Stimulus pinprick pinprick pinprick pinprick Location. right cheek—left hand left cheek—left hand right cheek—right hand left cheek—right hand Response correct left cheek right cheek left cheek Type of error extinction extinction extinction Comment: This response occurs most often in patients with cerebral dis— ease, although occasionally patients with anxiety states, depression, or schizophrenia may also exhibit it. It is not seen in normal adults. Three-plus face-hand test: This group is characterized by the occurrence of displacement as well as extinction with both touch and pinprick stimuli. The frequency of extinction and displacement may be equal or unequal and, likewise, the number of errors with touch and pinprick will be variable. Case 8.——A 57 year old chronic alcoholic was found in the street in a stuporous condition. His breath had an alcoholic odor and there was a laceration over his right forehead. There were no focal neurologic signs. During the first hospital day the patient gradually became fully conscious. Speech was rambling and at times almost incoherent. He was completely disoriented and had severe memory defects with confabulation. He expressed paranoid ideas and was hostile and assaultive. There were no hallucinations. Spinal fluid and skull roentgenograms were normal. The diagnosis was acute and chronic alcoholism with deterioration. A sample of this patient’s responses on the face-hand test, indicative of a three-plus response, follows: Stimulus touch touch touch touch touch touch touch pinprick pinprick pinprick pinprick Location right cheek—left hand left cheek—right hand right cheek-right hand left cheek—left hand left cheek—right hand right cheek-left hand right hand—left hand right cheek—left hand left cheek—right hand right cheek—right hand left cheek—left hand Response right cheek-left cheek right hand—left hand right cheek correct left cheek right cheek—left cheek correct right cheek—left cheek left cheek—right cheek right cheek ' left cheek Type of error displacement displacement extinction extinction displacement displacement displacement extinction extinction Four-plus face-hand test: This group shows the most severe perceptual errors. In addition to frequent extinction and displacement, as seen in the three—plus group, one or all of the following phenomena may be seen with touch and pinprick stimuli: l) exosomesthesia; 2) allesthesia; 3) frequent perseveration of responses; 4) occurrence of perceptual errors even while the subject keeps his eyes open and sees the areas stimulated. Case 4.—A 60 year old man had a three year history of disorientation, forgetfulness, and loss of interest. On examination he showed a severe organic mental syndrome manifested by complete disorientation, marked memory defects, and inability to calculate. He was alert and cooperative. There were no other neurologic signs. Spinal fluid and skull roentgenograms were normal. The electroencephalogram showed moderate, diffuse, bisynchronous slowing with slow alpha. A pneumoencephalogram disclosed abnormal increased amounts of air in the subarachnoid spaces overlying the cerebral cortex. A sample of the patient’s responses, indicating a four-plus face-hand test, follows: �STANDARDIZATION OF FACE-HAND TEST Stimulus touch touch Location right cheek—left hand left cheek—right hand touch touch touch touch touch pinprick pinprick pinprick pinprick right cheek—right hand left cheek—left hand right hand-left hand right cheek—left hand left cheek—right hand right cheek—left hand left cheek—right hand right cheek—right hand left cheek—left hand pinprick ( eyes open ) right cheek—left hand Response right cheek left cheek— extrapersonal space right cheek right cheek correct right cheek—left cheek left cheek—left hand right cheek—left cheek left cheek right cheek left cheek— extrapersonal space right cheek— 215 Type of error extinction exosomesthesia extinction perseveration displacement allesthesia displacement extinction extinction exosomesthesia exosomesthesia extrapersonal space Comment: Three-plus and four-plus responses invariably indicate disease of the brain. They are never found in normal adults or in patients with psychogenic disorders. These responses have been occasionally seen, however, in normal children under the age of six,4 aged persons without manifest disease of the brain,6 and mental defectives.10 The distribution of responses of children and aged persons are related mainly to age. The youngest children and the oldest adults show three-plus and four-plus responses. With changes in age away from these extremes, one-plus and two-plus responses become more frequent. Of the subjects with mental deficiency, those with the lowest mental age have three-plus and four-plus responses, while one-plus and two-plus responses predominate in subjects with higher mental ages. Table 2 summarizes the distribution of the four different types of responses among the various groups of subjects. Only patients with an organic mental syndrome show three-plus and four-plus responses. Such responses may be considered diagnostic of an organic mental syndrome. DISCUSSION In answer to the questions raised at the outset of this paper, our results indicate that four general types of positive face-hand tests occur and that TABLE 2 PERCENTAGE FREQUENCY OF ONE-PLUS TO FOUR-PLUS POSITIVE FACE—HAND TEST IN DIFFERENT GROUPS OF SUBJECTS ‘ ............. ................... Patients with anxiety states ............. Organic mental syndrome Normal adults (below 60 years of age) Schizophrenic adults Patients with psychogenic depression (all age groups included) . . . ............. . Negative F-H test Oneplus 10 99 7 nearly all occasional occasional 70 22 all nearly l Twoplus 25 0 Three- plus 33 O F ourplus 25 0 rare never never rare never never 0 0 8 �216 NEUROLOGY these types can be correlated with different groups of subjects (table 2). Our attention was focused mainly on whether there was a type of response which occurred only in patients with severe disease of the brain. All adult subjects with a three-plus or four-plus response have organic brain disease. Such responses are never seen in normal subjects or patients with psycho— genic disorders, even though these groups may occasionally Show one-plus or two-plus responses. Patients with cerebral disease manifesting a four-plus response invariably show the severest or most advanced form of mental changes. Otherwise there is no good correlation between the type of positive face-hand test and the severity of sensorial defects. Some patients with severe mental changes may have only a two—plus response. In addition, 10 per cent of patients with an organic mental syndrome have a negative face-hand test. It is realized that the use of a one to four—plus nomenclature for the groups implies an increasof because used This nomenclature of cerebral was dysfunction. degree ing convenience and such an implication is not intended. This classification of a positive face-hand test should be useful clinically. In testing neurologic patients, the exact type of positive face—hand test should be recorded, rather than the designation “the face-hand test was positive” as has been done until now. Such a procedure will make it easier to judge whether the type of positive face-hand test indicates definite cerebral disease or whether it may be a manifestation of anxiety or depression. The use of such a classification will also make it easier to compare the response of patients at different times during their illness. In addition, it is valuable in clinical experimental work, for it has been applied in studies of the effects of drugs on perception and the responses of patients to electroshock treatment. In such studies alteration in perception can be measured by observing the duration and incidence of the variety of positive face-hand tests during the periods of testing. SUMMARY A standardization of the face-hand test is presented. A positive face-hand test is designated as one in which errors persist after the tenth trial. Four classes of positive face-hand tests are recorded. A one-plus face-hand test consists of extinction only with touch stimuli. A two-plus response is char- acterized by extinction with pinprick and rubbing stimuli, as well as with touch stimuli. A three—plus response consists of extinction and displacement with touch, rubbing, and pinprick stimuli. A four-plus response has all the characteristics of a three-plus response and in addition at least one of the following features: a) exosomesthesia; b) allesthesia; c) perseveration of observes while the of (1) applicasubject even errors occurrence responses; tion of the stimuli. Three-plus and four-plus responses invariably indicate disease of the brain in subjects over the age of six years. One-plus and twoplus responses occur in patients with brain disease but are also manifested disorders. with adults and of normal number small psychogenic patients a by �STANDARDIZATION OF FACE-HAND TEST 217 Patients with a four-plus response show the severest mental changes but the converse is not true. There is no correlation between the severity of the mental changes and the type of positive face-hand test manifested. Usefulness of this classification in the study of patients clinically and in experimental work is suggested. REFERENCES 1. BENDEn, M. B., FINK, M., and GREEN, M.: Patterns in perception on simultaneous tests of face and hand, Arch. Neurol. & Psychiat. 66: 355, 1951. [O . BENDER, M. B., and FINK, M.: Tactile per— ceptual tests in the differential diagnosis of psychiatric disorders, J. Hillside Hosp. 1:21, 1952. . FINK, M., GREEN, M., and BENDER, M. B.: The face-hand test as diagnostic sign of disease of the brain, Neurology 2:46, 1952. . FINK, M., and BENDER, M. B.: Development of perception of simultaneous tactile stimuli in normal children, Neurology 3:27, 1953. . IAFFE, J., and BENDER, M. B.: Perceptual patterns following general anesthesia, ]. Neurol., Neurosurg. 81 Psychiat. 14:316, 1951. 6. GREEN, M. A., and BENDER, M. B.: Cutaneous perception in the aged, Arch. Neurol. 6: Psychiat. 69:577, 1953. The phenomenon of sensory . BENDER, M. B.: displacement, Arch. Neurol. & Psychiat. 65: 607, 1951. . SHAPIRO, M. F., FINK, M., and BENDER, M. B.: Exosomesthesia or displacement of cutaneous sensation into extrapersonal space, Arch. Neurol. & Psychiat. 68:481, 1952. 9. BENDER, M. B., and NATHANSON, M.: Patterns in allesthesia and their relation to disorder of body scheme and other sensory phenomena, Arch. Neurol. & Psychiat. 64:501, 1952. 10. FINK, M., GREEN, M. A., and BENDER, M. B.: Perception of simultaneous stimuli by mentally defective subjects, J. Nerv. & Ment. Dis. 117: 43, 1953. �EIWRDIZATION OF m FAGEwm MT 3y “mm I. ‘0 “NC“, Do und In: rank. n. n. ibis tort 1;: e status Publia Hoalth dation of n‘% ' _fi{ p 9'» 1 arson) and survioo (Br. thy Huttonnl ‘ <" ' ’ ' ” Faun- Infantila Paralysis (Dr. Pink). Eran an. Dognvunont or Hourology at thn noun: stnui Hospital and tho 311 lid. Houpitnl. �Introduetiunt In priviaul studies a tinplo poro‘ptufil taut, uh. rnoia hnnd fiast. was intradnoed and tha rbnfionnon bf normal anbjtetn 1nd or pationta with ptyohittrio d1noranrl w¢r¢ dglcribod 1n dbttil (lab). Tho tout aanniuta or applying tough or pinpriok .ltinnli nimnltnnsounly to tha tact und.hund uhilo the aubjuot‘n ayes hr. closed. it. lubjoot in than aambd to annariba and to lootliso thn poraapta. Two gannrul type: or roaponsol Gaunt. who five stimuli may bu poreoivod and localized oorruotly. 0r, thn nubjoae may piranivo only on. atiuulus and cithor*nat porn enivo the ofihtr (phnnennnan at astinotian) or maniacaliaa thn sooand stimulus (phannmnnon or diuplacaannt) (7). fiaét ottcn ~fih¢ mislaealiuntién or diaplaéqnnnt «can»! to anathnr pirt at tho wubjoot’s body, but oooailunally thtrn 1n dilplaaahont into oxtrtparuonnl apnea or onto thy axmnxncr‘(axoaamolthnaia) (8). Difiplgotnoht at stimuli turns: the midlino or thn body ($110.» thosln) nu: also onenr (9). flornnl adult: show 0r§oru 1n perception.au tbs initinl ‘ r mu.- a: I tho tuna-hum 4 «at. cmctcrnuaaxy than error: sonaiut or oxxznetion of thy thinning to fin; hand than... tho raga Itimnlna is perceived aorrcotly (phcnamonon at face again,nnuo). A: thn that: arc ropoatad thy error: d£luppoar so thnt by th. tonth trial nearly :11 subjcctu norraetly paragQfia both stimuli and than oontinnu to bq corruat on tubauqunnt trigll. This typo or roaponno has bran tonmnd a “nagativo raco~hnnd tout.“ It ooourn not only with manual adult: but also in pttzontn �2. ‘vith :6h1uayhruniu, dtproaaion. or savor. anxiety. Kn contrast to tho proo¢d1ng aubjaats, pa§1nnts w1th tn uorganio mnntnl nyndrumn aha! qxt1not1on and displnecnant Artur 10¢ tr1a1: or toating ar-II long It touting 1- continued. Such t npupcnlc~1n‘tpnmnd u ”posit1vu {nonwhind tout." A *poaitivu ftoo~hnnd tout" 13 claw unnLroutod by normnl uh1ldrtn, normal ugud,p¢auann. Ind:mantnl dofoat1vol. Bananas of thy dirforont1a1 rnlpenao of thaao aoviral swung! at luhjoetl, an. faoo~hnnd test has banana astral ul1n~ toally 1n dataating tho prosoneo or orggn1e brain d1aoAIo. During the court: or our stud1al, hawovor.,1t ha: boan noted >that pntiants with 1n grannie nantql syndrann Vtrylgrontly 1n the type and traquancy or porcoptuul Grrort. Also; nfibjactn I ' without organ1o brt1n é1aoalo occasionally mnn1t¢at a pauitivc raccuhnnd test. 1h: quantionn finish arias from that. abnorvutionn an: 1) .1: 11'. poneiblo to elmxfi or mandamus an. autumn 'typu: or orrafa aouurr1ng 1n'1gbjooti v1th I panit1v§ fteowhnnd 80:12:13) In fibfiro A oorrulnt1on botuuon thb typca or roqpannol and dirrorun1_gr¢upa or aub:¢atn?; 3) in than. a typ. or ronponno Ih1ah can bu ugid to ocaur gal: in pitifintl v1th_nav¢ro 61301:et uh. bra1n? the proncnt Itfidy is an uttqipt to ‘nalur than. questionapv I. 04 1 d B! ‘ t lb roviornfi our provleus record: gt ‘ 1h! tuna-hand 103% in nlmnat 1000 pat1onta with organic mnntnl syndroma, normal adults, and Inhiaoyhrohia adults. an wall an in longer numdam. born of normal.ohildrun, normal 130d porlena, and ambient: with �3. m.nt:1ld¢rieigncy. dnprnaulon and lottrn anxiuty. Additional stamp! of menu of than. uubjcotl taro 31-0 toatna in a lyutmm— gtic mannar'vifih filrtoront typaa of stimuli. The aritoria ulna to fonmultt. a Itandnrdixntion or the raaouhrnd tout wire; 1) typo of poraoptunl 2) frnQunney of various arrays (touch, rubbing at nergtehing. and p1n~' crrnr: airroront stimuli prick): 3) offset on thy troguoney or orroru vh¢n tho cubjoet noes tha appliantion at tho I§1IM11 (taotcr or dttcntien). Firtaon to thirty tritla at tho tait wuro naually done for wifih Onah cubjoet. « criterig, it in: possiblo to divida pa § tianti sharing a positive ftoomhnha tqst into {our group:. Th» oharaaterintie rouponnu: for etch gréup arc summarized in Tabla I. 'ThoIoAroapann g with oxnmplo; art angeribad morn fully in tho {allowing par‘grapha. Based an.thnUO Fuataruu a: Ponitzvo~nuac-aana’roatn _(vors1£tont prrorn attdr 10t§ firiil) W 1 M." Situation Extinction W Wm» 1 am plan mt1not1on with tough, und dinpltéo— anly with tauah stimuli rubbing. and 'mant with P181314“ touch, rubbing stimuli. ,tnd pinpriak occasionul stimuli 41: laocmant Ii tauah ‘ u)oxolamauthsaiu b)nllaathsai‘ ‘ , nttmuli. a: thug... with n: loaat can or uh. following {autumn ‘ o)trnquont porn¢v~ «ration d)qc¢urr¢nen of errors while just watch»: sub~ ithmuli buing nppliod. uh? �h. gnoePlgn.Fheoen§gd Tout: Tho subjects in thia group that error: only at Ixtinatioh and not at displahanant. Thou. errata oaour only with tauoh stimuli. Whon pinpriak is usod. both utinnli up. poruoivoa aornootly, although arrhra will agnhn appatr lhln touhh stimuli urn rhihtroduaod. Gun. 1: tad with 3 A 6h your aid huh with mild dinhotpl pus t6n1fi* xi your hiltary a! dittiaulty in walking. Fbr at I... patina 0: than hm had boon dnprogacd, alnpe .and ht. pearly. and It. impatanfi. 'Tho only unurologiaul finding was t slow, halitant, nhurfllng shit. Thor» was nh ovidnnn: 10am: tho ot‘poriphortl vuioulhr dis-coo. Eh. pationt‘nppoarud doproiaod, 'IhoVGd payahanotor rotnrdutian, tnd dried handily. The non» aorium in: intact. Spinal fluid, slactrocnhaphulogrtm, ertys at tho spin. ward normal; who tional psychoazu. dopranlod type. hheught to he sccahdnry to thi diagnosis In: involuu The gait difficultiau tar. dnpronhion. _ this patient thalcd l anonpluaerIpanlfi tout. A sample at his ruxponaaa follows: on tho tau-«hand ‘ ‘ Stimulus gggatiog touch right ohnak*lott hand ’ wypg of figugcns; firrar right shook: axeinotion hoxtinntion 10ft shack tough loft chock-right touah' right ehaokwright hand right South 10ft annex—loft hand touch right ohhak~lnrt ahock earnest» aerroet right handwlott hand right ohsaknloft hand right dhaok tauah touch and hand Int: chagh about» uxtinotioh cxtinotion ' extinction �5. lart ahnak~r1ght hand left «human 2mm tauah touch touch right man 101“: pinpriok pinyrick pinprl ck pinprick touoh> entrust eon-cot. riwt aha-ehwrigfi hand mud“: hand right absoknlort-hand lore dh¢ek»right hand right nhotkwright hand 1am; ehcokdgft ma‘ right «haiknlgrt hund wt ”chock-avian: hum loft . ~ chock check axnination «attraction aorrooh correct garnet“ «may ‘ aorroot 1st: abut: .munctxm ggggggfi; Althnugh thia typc or.rcnpanno aoafira in patiwntl teach aorabrnl diuaano, 1t 1: not dlway: entruatcvistie for this group. It is Also abhcrvué‘tn patiunts Iifihéaprolaion, wifih : thlg anal illuitratas} aehisofihranin, and. ocassiénally,'1n nunnnl a¢ulta; P; V,Eh.0+H Id ’rt In this graup axtinction ooeurt Iifih pinpriek nag rubbing stimuli a: lull én‘vith taudh #tim» all. than; arrora mgy ha junfi an froqugnt with bafih.typta at stimuli er may be met. conspiauouj\vith-tauah‘fihnn with pinfi prick or'rubbinga Biapluaunnnt 1; not yrbsnntg an a rule. and may occur xn anxioty at§t¢t, an & 7 L , but may auour on Case 1!: '1 tn,aoedligna1 téinls 72 year o;d man had a 5 ' . WIOK history of anneal and bahnxioral;ohangoae Eben. ganniatcd ar'éiaor10n~ tatian. confused bdhnviar. and intarldtéant muslin; On oxnmp inntion thara Inn gn organic mnntql lyndran. charactarisod by partial dinoriontation. 60:00:: in ruannt unwary, OthianI �Z~g‘ s7”! ind otteumloauhlann 1n annu¢r1ng quastians, daninl or 1113..“j and pain uuynhoiit. Thar. var. no ofihor nunrolagioal dilw mutton. mo spin-.1 mum. olootraonaaphuagm. and “all xnrnys Ibru ndrmal. A pnaufiooneaphalognmn unusua'un 1n¢ro.nad «flaunt of air ovor uh. aorobrum and inaroaaa in tha 3110 at tha ventricles. was: pat1¢nt§a raafionloa'on tho tuco-hugd taut untran- torls. tho tvaapgul typa at ruaponao. spannon taller: samplc of thnsc raw A \ a ‘ 3352395; Tg£;o;t _“§au¢h aggntgan 1.x: abnohuright hand 10ft «hack axfiinotian tcudh right ahaak~1at£ hnnd right thinstion ' 3tg55;un left r.t§ugna tbuah V. tough touch toudh ’ right right right right enaok~1a;m hand ‘” ' unsurpright hana din:k-1.ft-ahodk hundnlurt hand «hookvlhft hand lgtt ahnuk Oxtlnntinn right chnub extinction‘ about «errant eorruat ' pinpriek loft ghostwright hand right chock wyxtinstian 1.1: chuck oxtinctian pinpriok ptnprick pinpriok pinprlok right ahcokalort hand oorreat 1.x: ehaakwlort ngna right chant~r1ght hand lart ' oxtinutidn oxtinctian 10ft chick cxtinotion 1¢ft ahhek~right hind adamant: Thin ruaponaa eocuru mast urban 1n pntianta with cornbrul 6119110 altheugh oncasianally ptt£¢ntl with anxigty itibfllp dnprossion or duhinophronia naq'alto cxhibit it. It in not soon in nounnl ndulta. ahflak right ehnok �0‘: 75 gaggovgggg §33A~§g§§ ruAtt IhAA by thy ooaurrunco of diApLAeanAnt bath touch And pinprick atzmuli. group wall AA who And displaoumanm 1A chArAatAriAAd Axtinction with frAquAnoy of extinction AA , any bA’Aqual cr unsquAl And. likAAiAA, Aha number 0: errors Aibh touch And pinpriak'will bu AArAAbIA. 6139 III: strict in the holia odor There AArA hoapital ntuporoun oundition. A And thArA AAA thA pAtiAnt rumbling And caaplataly diacriuntod gnnfahulation. 31A brAAth hAd an Alena HA 3 lAAArAtion gradually bAoAAA fully oonaaioun. At tihnn Alnolt inoohArAnt. EA AAA. And had AAVArA salary axprAAAAd pArAnoid idAAA and A3AAA1§1VA._ whArA Aura And Akull X-rAJA AArA nanmAl. Th. diAgnosil Asamplq of thin pAtiAnt'a A tout. indiactivo or giggyggg saw. A ggaation my“ dunk-daft hand . touch loft touch right touch urt chum-hrs hAnd Quota-wright ham. ' mamm hum! touch right aha-kaloft uhAARArxsht hAnd hAnd loft hoatilo III aunt. fluid and taco-hand fallow-t right abuzz- ‘ with EpiuAl T§£§ogf 333223;; ' lnft AAA AAA rAAponAAA on Ah. thrAAapluA rauponsa, touch dAtAAtA no hAllueihAtianA. .Ahronie ALedholium with anteriorAhion. ” found in AAA ovor his right torAhAAd. no fooAl nnurologieAl signs. During uh. tirut AAy SpAAAh WA» 57 yoAr old chrenio Alcdhalio A chock ‘ diuplmmnt . hand;mm 1cm; hum! displaemne right about anemone»: came: lcts aback extination right diaplaeAaont loft ahAAk~ ohAAk �touch right hand-10ft pinpriak ; pinpriak hand comet right ahaok~lort hnnd A)right left an: 1m; chfiokumght hand I pinpriak pinpviek Fb ' ‘ ' right chock-«right. hand lcrt «hank-lnrt‘hnnd Flu; Hand chaokn diaplaoamant «bank cheat» right ahnek right ohm: lfitt ; aback displaefimnnt . oxemauon axtinutien ‘oat This greup shown tho aovcrast poréoptual arrara. In addiiion to rr$quont «xtination lné ainplaeomnnt, an noon in thn thrno~p1us group, on. or .11 at fiba folloiing , with touah and pinprlak afiimnli: 1) uxunanalthnninx 2) allouthoditi 3) truqnnnt pur~ agvcratian at responlttt h) tho oocurrcnnn or paranptunl arrorn ngn-uhzid find aubjoat kaopu hxl'cytu opan and 109: tht Irilfl fibenamnnn may be mean flimuntud. Gas: 60 ycnr old man hgd a thrai your hiatary or disoricntution, forgatrulnnla. ‘ndVIOIl of intaraut. an axum~ 1n£ti¢u h. ahawqa a 3.1.». argania mantal nyndroun manirnqttd by cauploto disaritnt‘tian, marked,m¢mary actuati, and inabilo ity to atliulato. H. In: alart and cooporteivo. whore wire no other naurological algal. Spinal fluid gnd akull Xbrnya XVI ‘uuro manual. A EEG-abound anagruto, diffuse. biaynahranoul alaning with 110! alpha. A pneumnonnephalogrum discloscd dbnormal increasod amount: of air in th» aubnrachnoid apnea: overlying the anrobrti eortox. A Iamplo of tho pationt'u rnuponuua. indicating a four. plus tacowhnnd tott, tollavla ’ f �95 Stimulus. tough touah Typa . mastic»: ' right obnokuloft hand 19ft chnekhright hand ‘ » of Emu Rcaw‘ right aback axtinctian left oxosomoathoslu :- chatk~ oxtruporuonnl apa¢o tough right thehwright touch loft touch tnunh right handplaft hand right ahaak~lort hand tench loft aback-right pinpriak right aback-loft ptnpriak pinpriek pinpriok 10ft chookbright hand lart right ahookaright right 10ft ohuak~lort h:nd 1.1% chook- axoaanosthnaiu pinpriek right chopkwleft right oxaaamaathclia (ayes Open) . r. . . adamant: 1 hand chnokwlerfi hand right «hank right cheek torrent right aha¢k~ qxtinetion poraevoration aiaplaeanant hand 10ft chock 10ft ehaak10ft hand allouthaslt hand right displtaunant hand hand 10ft ohnak~ aback ohock . dho¢k «xeraporlonal span. shack» nztrtparuannl oxtinatien txtinctian :pton rhrno—plun and roufiwplul vniponsos invarisbly inninatogdinoani of thofibrain. inn: 1:. nnvur fauna in normal fidults or in patiants with plyahogonin diuordgru. I fihnaa rbaponses have bash oocasionnlly noon, howuvor, 1n nerull childrnn undsr the as. at at; (h); agad potions withuut (6) had manual dnroetivna (19). manifoat disaaso or thfi brain rho diltrdbution of tha ruapanseu a! the ohildron and ugod poruanl are rolatnd ntinly ta ago. in. yaungnnt childrun and tho oldnlt adult. show thruo~p1u1 ind rourwplub rulponqon. �16. Wifih thin. «hangs: in age away tram untruunu, ono~plun Ind Iroqunht. or the tubjccbs lith.nnntal dtfiei¢nny, than. with in. lowgat annual agthavo fibroeoplun':nd teurvpluj roupannaa whila ona~plus and two91ua rcapensoa prndaminutu in nubjnota with highnr’mnntal twowplua rulponsaa baoama mare _ I aguu‘ II aummurises thn dintribution a: tbs four different typaa at rulpnnyeu twang tbs variau: groups or aubjoetl. Gnly Tabln ‘pgtlonts with In argania mmntal syndrana.nhow unreguplus and rourbplua teaponaoa. Such roapunaes may be aansidorad ditgu nbstio or an organic unntul ayndrumn. mm ;; Prwqusnay or 0n¢~P1uu to Faun-Elna Tfiat in Dirforant Gwoupa nogntlvu Gaga Pku Organic Hantal syndruua adult: (below your: a: as.) Norunl taut 60 99% Schizophrtnia Adult. Patimntu with anxiety nnarly Patients with plyahn~ -7o% states , asarly genie dnproasian (all age grnupa inaludad) W! "' 19% Tue? Three Paar- Plgg‘ Plus 7% 25% 33% 25% 15 o o a dooaa~ :11 Paaittvo at Subjects Four~P1un P§uu P;ul rarg new.» navor ionglly oooas- ray. navar‘ novor all tonsil: 22% 85 o o , In unavor to the questions railed in tn» introduation, our rounltu indicnto that four gonoral typos of paaitiva �.11. faooahand touts occur‘gnd that than. typo: «an bo carrolatod with airfaront greupn at aubjoats (Tablc II). Our attention Ill fauna-d mainly on thg question cf fihathar there in: a typ. or rouponse which oeaurrod only in pubinnts with savart 4180330 of chi bra1n._ All adult subjootn with u thrionplun . - or rourwplua v.3ponno haw. orgtn1o brain dictate. Suéh rua uponaou 1:3 nave: icon in manual subjgatu er patient: with payahogan1l disardnrn, even though than. group. any oocunlonnlly than onnnplun or twonplua traponnnn. ' Patigntn with atrabral dinette manifesting a four-plus nonpango invaritbly that tho novonast or must udvunnod foam of mantul abungal. Othorulao thaw. in nu good aorrolat1an botwoon thy typo at pou1tivo tiéowhand tout 1nd tho soverreyv 9f thn unhaorial daroatn. 3am: putionta with aovnro monfial ahnngps may'havo anxy; two«p1ua vouponso. 1n additian, 105‘ or pationtu with an orgnnIo manealinyndromn.hnvh a magazivo faaa~hand taut, It is rhalisod that tho use of I one to taut» plun nonnnoiutur. £6» Eh. groups umplies an inoronfiing dagruc or aeropral'dyatunation. This namnnslntumo van used because of aonvonicnaa and aunh an implicition in not intended. Th1; olauitiaatlnn af 3 poauin rues-hand test should be useful elinioglly. 'In téufiing nouiologioal patients, uh. cxaat type or positive taco-hand tout Ihauld be renordpd. rather thtn tha datlgnation ”the tao§~haad test was positivo' until nan. Bach a proeoduro «111 makd 1t Judgo whatnot tha typo or poaitivo runomhand fiont as has buon don. aasiar to indicatcs dotinita oorabrnl discus. or whnthnr manifcptntiou at tnzitty or dapruauian. who it may be c use or much a ' �12. alanairication will also make it easier to ounpuio tho roayenno or patlontl at diffcrtnt tin»: during thuir illniaa. In ad» dition, 1t. 1. “1mm. in cumin). “perm-am work, for it has bean aypllod in studio: or thn urfpetn otdrugn on pircaption, and tho rutponlal at pat1¢nta t6 olootrouhook truatu want. in aueh Itudioa altnrution in pottuptian can be mat» . stand by abaovwing tbs duration and tho incidnnao cf thn varioty at positive tano~hnnd tests during tho period: of teating. Sulnagz: ' stundardizttian of tha {tonohand tout in prntontod. A positive faoouhnnd taut it danorihod In on. in uhiéh orrart portint .13.: tho_tunth trial. Pour clause: of positivo tuto— A hdnd teats urn racerdod. ann~p1ua fnoo~hand A tott aensiafil of oxtination only with touch stimuli. A tro~plun renponso is charuatoriaod by axt1notion with p1npr1ck und rubbing atims uli, fl as ‘ill an Iith touch stimuli. thrna~p1us nonponno tontlata or oxtinoticn and displaeumont 11th tough. rubbing, tad pinpriak stimuli. A rourbplup runyonao ha. til tho tharhl aotariatica of a throu~p1ul response and invadditian at least one at thn following ronturos: a) Oxasamntthoaia; b) ulleathnlinz A . c) poraovonntion af roaponnasz d) ooourrenao or errors even whilo tha subject 8063 tbs application at the stimuli. Throo~ plus and four-plus weaponnea invaritbly indicate dinette of tbs bra1n in subject: evor tho ago of :11 yours. 0no~plua and trauplun roapqnaea occur in ptt1antn with brain disnaac amall number of normal adult: and but are 3139 maniteathd by a ptt1ontn with paychogonia‘diaoranrt. Patients with a faur~plul �I “‘"’ 13l- tho ”want maul change; but flan canny“ 1.8 not Ema. morn is no corraluion human t)» unrity of the manta), uhmgu m4 tho or punitive: rum-hind z'oapcmao show taut tn. awaited. m unfulnbu or this the study at panama clinically and in it indicatad. _ cluuu‘iutim in 01$“:de work �I -m...‘ ‘ ‘ hm W l: BEXEER, ‘BENDER. in hhn :nd GREEK, fl.: .é.:355. 1951. K.B.: FINE, «option on sinnlt 2. . 3.3.; on: tout: of fans and hsnu. and FINK, Hg: airfarontill gufiiglgfido H032. Patterns in par» M. Arab. Tactile parcoptual taata diagnouia or payohiutriu diuordnrl. ital. 1952. 3. FIRE. 3.: GREEHA M. and BERDER, M.B.: The faoe~hnnd test. nign of diieasa of the bruin. yourologz‘g: :3 dig zontio .7. , FIKK, H. and.BENU£R. K.B.x . simmltnnnout 1327p 1953* J“FFE' Duvnlopmnnt tactilu stimuli in 5' ‘nd 333933* unsathanin. ggggral ,3 W md- 7. 8'. BENDER, a H.B.z SHAPIRQ. HiF0‘ BEHDER, M.B.: Th9 phcncmanun PM, . 3 «hi .‘ghzslé, . 'Wmcx. and nonnnl childronw agggggggz “'B-' Pofocptunl pace-an: follavinsj. .3 urcgflc a: ,GREBH. at pdrcqptian or .3 entanooun‘pcroaytion 1n uh. £29.35“. 1953» er Ionaory diuplucunynt. @607. E. and 1951- Vii-159””. “‘8‘; Exosmnthuin or displacannnt or outnnoonu nonnation inté axtraporaondl upuca‘ figg§.fliggo;.&Pnzah15§. 駧hfll,‘1952. 9. ‘nfiann, 3.5. and Hamunnaen, u.: Pattorna 1n alloltbouia tad thair rulation to disordnr of boay sebum. and other: scnsery phnnamann. Arah.xourol.&9azehiat. ég3501, 1952. 10. fl.B¢t y.".Pt19n or I!" GREEN, MuAu ”4 51mm tanaaua stimuli b montully aorontiva subjects. J-nOPV‘aatnm:3; m1 3. 1953. m. W. � 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 Standardization of the face-hand test. Neurology. 1954 Mar; 4(3): 211-7. Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-02-01-001-14-018 Date A point or period of time associated with an event in the lifecycle of the resource 1954 Creator An entity primarily responsible for making the resource Green, Martin A.; <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a> 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 [Preprint] and Reprint. Reprint from NEUROLOGY, Minneapolis, March 1954, Vol.4, No.3 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