Sensorimotor disturbances in patients with lesions of the parietal cortex.

Somatosensory and motor disturbances of hand function were examined in 9 patients with parietal lobe lesions. A quantitative score was used for the elaboration of sensorimotor profiles displaying the relative degree of functional impairment. In patients with anterior parietal lobe lesions somaesthesis was clearly more disturbed than motor function. Simple aspects of somaesthesis (surface sensibility, two-point discrimination, position sense) were disturbed to about the same degree as complex somatosensory (tactile recognition) tasks. On the other hand, patients with lesions of the posterior parietal lobe showed preferential impairment of complex somatosensory and motor functions (exploratory and manipulative finger movements). In 4 patients, analysis of motor behaviour by means of an optoelectronic system showed that reaching, formation of hand aperture and target acquisition were less disturbed than manipulative behaviour. Finger movement trajectories during dynamic digital palpation of objects were grossly deranged in the patients with posterior parietal damage. The temporal characteristics of the finger movements during active touch were completely destroyed. This leads to a breakdown of the finely tuned digital scanning process required for the sequential sampling of mechanoreceptive information. Remarkably, these patients could produce the exploratory finger movements imitatively. The motor disability of the parietal hand does not lie in the loss of the kinetic memory to perform these movements, but in the loss of their evocation by appropriate sensory stimuli. This deficit is not due to a lack of somatosensory information because that may be relatively well preserved. It is concluded that the motor disturbance in posterior parietal lobe disease lies essentially in the conception and execution of the spatiotemporal movement patterns necessary to bring those receptors into action which would normally provide the information about tactile objects. This illustrates the intricate mutual dependence of the spatiotemporal organization of receptor activation by movement and of the formation of movement trajectories on the basis of adequate sensory processing.