This is an extensive summary of the book 'Clinical Neuropsychology' that is required for the specialization course Clinical Neuropsychology. It includes all chapters and is written in English.
Chapter 1 - Clinical Neuropsychology: a historical
outline
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1.1 Introduction
- today, clinical neuropsychologist = psychologist who specialises in the assessment and
treatment of problems related to brain diseases or disorders
- historically: initially dominated by psychiatrists and neurologists
- scientists were always convinced that there was a link between brain and behavior
- Hippocrates: - 400 BC
- all abnormal behaviors and emotions stem from the workings of the brain
- tried to convince others that it was incorrect to attribute symptoms to God etc.
- Ancient Greeks&Romans: - body contains four elements: air, water, fire and earth
- served by fours humours: blood, phlegm, yellow and black bile
- humours have to be balanced for mental and physical functioning
- Claudius Galen: - AD 129-217, very influential
- beliefs of romans and greeks
- Renaissance -> revival of science and medicine, 14th century -> more independent thinking
1.2 Cell Theory
- question of localisation has always been important
- Where should we locate the soul or mind, how does the mind affect the body and which organs
play a role?
- Ancient Greeks: - three different forms of soul
1. For survival via food intake (present in plants)
2. For the activities of an organism in relation to environment (as in animals)
3. Higher order soul for distinguishing between good and bad
-> called this psychikon hegemonikon = the guiding principle
-> Latin: spiritus animales
- people are the only beings who had all three forms
- Plato and Hippocrates: highest soul is located in the brain (also the general consensus)
- Aristotle: highest soul is located in the heart
- Ventricles -> were called cells
- Cells were considered to be the site of the mind
- Mind was divided into different functions
- First cell: receive information from the various senses = census communist (The combined
senses)
- Second Cell: believed to interpret images (representations) + affective component
- Third Cell: memory = memoria
- Cell theory still forms the basics of our ideas about cognitive psychology -> essential
characteristic: system of information processing
- Theory does not consider individual differences
- Emergence of ideas about individual differences -> personality (or formally: character)
- Physiognomy: interpretation of the face (Aristotle) and body, reflective of character
- 1750s, Physiognomy began to flourish due to the work of Johann Lavanter
1.3 Descartes: an undivided mind
- René Descartes, during Renaissance area
- Started off by doubting everything; decided to build only on insights that in his view were
irrefutable -> ‘I think, therefore I am’
- People could be regarded as being composed of two substances, the body and the mind
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- Body = res extensa & mind = res cogitans
- Mind is not material, and does not take up any space but is located in a specific place in the brain
—> middle, not spread over two halves: epiphysis / pineal gland
- Mind as a kind of manager
- Messages are sent throughout body via the nerves and messages are sent back via memory ->
resulting in movement ( basically describing reflexes)
- Not agreed on today, today more materialistic
- Next step taken by Gall
1.4 Gall and the Localisation Issue
- Gall’s fresh perspective was motivated by Lavater’s work
- To scientist Gall, It was not logical that behavior could be read from the face
- Based his theory on insights about the construction and function of the brain
- Assisted by Johann Spurzheim: -> spread ideas of phrenology to England
- Phrenology -> reading personality etc. from skull and bumps on head, localisation
- Idea that cortex is crucial and that there are specific locations is correct
- Gall was a German physician
- Constructed new plans for psychology: organology and craniology
- first assumed that all psychological functions are innate
- each of the function belongs to one independent organ
- broke with view of traditional general information processing mind
- functions are located on the cortex (previously perceived as ‘dehydrated crust’)
- Gall’s most important proposition: Psychological functions are independent
- Assumed that people vary in their aptitude for certain unctions
- if one function is better, this means it is better organised and of a large size
- as early as fetal development
- the larger the size of an organ, the skull will form a bump
- gall also accepted effects of brain injury as proof -> concluded the language is behind the eyes in
front of brain
- View was unacceptable to the church
- Gall still believed in a soul
- Jean Pierre Floures: systematically caused damaged to pigeon brains, concluded that it was the
degree of damage rather than location of lesion that causes deficits
1.5 The Clinic-Anatomical Method
- Bouillaud thought localisation was correct
- language in front part of brain
- Clinico-anatomical Method: method to test localisation ideas by charting the specific loss of
function in patients with focal encephalopathy
- Paul Broca: - presented speech loss of patient tan / Mr Leborgne
- unable to utter any other word than ‘tan’
- lesion at front of this brain->side, bottom go the third convulsion of the frontal lobe
= Broca’s area
- mechanism for producing words is thought to be there
- postulated that language is localised on left side of the brain (unusual at the time)
- Jean-Martin Charcot: - promoted clinical-anatomical method
- believed in localisation
- recognised new medical conditions, such as ALS, MS and Tourette’s
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- Broca found many other language disorders -> models with centres for the varied sub-functions
- Wernecke: - separate centre for word recognition
- temporal lobe, auditory pathway
- disorder caused by either damage to centre or connecting pathway (disconnection)
- did not see brain as collection of functions, rather an instrument in which sensory
stimuli were linked to motor reaction
- Britain: - dominant view was Empiricism, promoted by John Locke
- Empiricism = no innate characteristics, all is learned
- principle of associations
- Jackson: One should not confuse the location of a lesion that resulted in a specific loss of
function with the location of a function
- Some people tend to believe in description of Cognitive functions that involves modules, while
others are believers of neural networks
1.6 Holism
- 1900: opposition to localisation movement
- Pierre Marie opposed traditional view of aphasia as a single language disorder
- Von Monakow: coherence within the nervous system is stronger than locationalists believe
- Freud: no independently operating centres, but much overlap and coherence
- Goldstein: Gestalt Movement, functioning of brain is important for the ability to reflect on
incoming stimuli (without it, solely reaction) = abstract attitude
- Following a brain injury, people react more directly and lack the abstract attitude
- Henry Head: devalued locationalists as diagram makers
1.7 Luria: a global model
- Russian Aleksandr Romanovitsj Luria (1902-77) attempted a synthesis of euro psychological
facts
- Numerous clinical observations during WW2
- First to focus on rehabilitation of patients with cognitive disorders
- Balance between holistic and localisation views
- Regarded brain as a single complex functional system within which various subsystems
contribute to joint activity
- Functional subsystems are results of interactions between developing child and its environment
-> change due to learning processes
- Cerebral substrate of learned task is different to one that has not been learned yet
- Functional system is flexible and adaptive
- Never possible to draw direct conclusions about the responsible subsystem, so never possible to
draw conclusions about the relative intactness of or damage to specific brain regions
- But also a locationalist
- Functional Architecture of the brain:
1. Three continually interacting functional units, related to subcortical, posterior and
anterior brain areas (‘activation’, ‘input’ and ‘output’)
2. Three hierarchically organised levels of processing, related to primary, secondary and
Tertiary zones in the brain
3. Behavior that is or is not regulated by language processes, related to the right and left
Hemisphere, respectively
- all three functional units are involved in mental activity
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