Christensen - Luria and Neuropsychological Rehabilitation

N E U R O P S Y C H O L O G I C A L R E H A B I L I T A T I O N , 1 9 9 6 , 6 (4 ), 2 7 9 ± 3 0 3
A le x a n d r R o m a n o v ich L u ria (1 9 0 2 ± 1 9 7 7 ):
C o n tr ib u tio n s to N eu r o p sy c h o lo g ic a l R eh a b ilita tio n
A n n e -L ise C h r iste n se n a n d C a rla C a e ta n o

U niversity of C o pen h a g en , D enm a rk
INTR OD UC TION
A . R . L u ria h a s p ro v id ed a n a p p ro ac h to th e reh a b ilitation o f b ra in in ju ry
so lid ly ba sed o n a co m p reh en s iv e m o d el o f b rain fun c tio n in g steep ed in
th e trad itio n o f S ov iet p sy ch o lo g y a n d th e w o rk o f V y g ot sk y in pa rticu la r.
H is m o d el stresses a ph y sio lo gica l ba sis o f h igh er co rtic al fu n ctio n in g th a t
is d y n a m ic in n a tu re a nd w h ich p ro vid es th e p rem ise o n w h ich ev a lu a tio n
a n d trea tm e nt o f b ra in in ju r y is fo u nd ed .
A lex a n d r R o m a n o v ich L u ria w a s a m a n o f pa ssio n , w h o w a s stim u la ted
b y th e in co rp ora tion a n d ex pa n sio n o f k n o w led g e, a n d w a s p a rticu la rly
in tere sted in h o w co m p lex hu m an b e h av io u r d e ve lo p s, a n d h ow , fo llo w in g
illn ess o r in ju ry , it is resto red . H is co n trib u tio n to th e ® eld w as ex ten siv e
a n d im p ressiv e, y et h e w as m o d est , a lw a y s rea d y to give c red it to th o se
w h o h a d co n trib u ted to th e d ev elo p m en t o f his id ea s. H is en th u sia sm fo r
lifeÐ h e ha d m a n y in terests (su ch as art a n d literatu re ), a n d h ob b ies (su ch
a s p h o to g ra p h y) b esid e s n e uro p sy ch o lo gy Ð h is k in d n ess, a n d rea d y
a v aila b ility to o th ers, m a d e him in v ig o ratin g to b e w ith a n d ch a llen g in g
to k n o w . A s K a rl H . P rib ra m (1 9 66 ) o nc e sta ted , `ò n e ca n a g ree a n d
d isa g ree w ith L u ria, y es. Ig no re h im , ne v er’ ’ (p . x iv ). It w a s, h o w ev er, h is
k een in tellec t co m p lem en ted b y a d eep e m p a th y th a t m a d e h im a su p erb
clin icia n a b le to a p p reciate fu lly the rich n ess o f th e in d iv id u a l.
T h ese p erso n a l attrib u tes, co m b in ed w ith h is scien ti® c p u b lica tio n s,
h a v e resu lted in L u ria b e in g reco g n ised b y co n tem p o ra ry p sy ch o lo g ists
a n d reh a b ilita tio n w o rk ers a s `à fo u n d in g fa th er o f n eu ro p sy ch o lo g y ’ ’
(G o ld b e rg, 1 9 9 0, p . 1), a n d his w o rk b ein g p ra ised a s ha v in g ``th e so u n d est
th eo retica l p rin cip les su p p o rtin g co g n itiv e reh ab ilita tio n a s a v ia b le clin ica l
p ro ced u re’ ’ (S oh lbe rg & M a teer, 1 9 89 , p . 1 1 ).
H is resea rch in to th e reh a b ilita tio n o f b ra in in ju ry w a s ra th er a la te
in tere st (i.e. co m m en cin g d u rin g W o rld W ar II), an d d iŒe red fro m h is
R e q u e s ts fo r r e p r in ts s h o u ld b e se n t to A n n e -L is e C h r is te n s e n , C e n te r fo r R e h a b ilita tio n
o f B r a in In ju r y , U n iv e r s ity o f C o p e n h a g e n , D e n m a r k .
Ó 1 9 9 6 P s y c h o lo g y P r e ss . A n im p r in t o f E r lb a u m (U K ) T a y lo r & F ra n c is L td
280 C H R IS TEN SEN AN D C AETAN O
ea rlier w o rk w h ich w a s in cro ss-cu ltu ra l a n d d ev elo p m en ta l p sy ch o lo g y ,

b u t w a s a lso b a sed o n h is in ter est in b ra in fu n ctio n in g . T h ro u g h o u t h is
life, h ow ev e r, L u ria co n tin u ed to exp a n d a nd rev ise h is th eo retic al a n d
p ra ctica l ap p lica tio n o f b ra in ± b eh a v io u r rela tion sh ip s, su ch th at h is life
w o rk is rich in d iv ers ity a n d ap p lica b ility . L u ria (1 97 9 ) h im self sta tes
th a t a lth o u g h `ìn late r y ea rs th e su rfac e ap p ea ra n ce o f m y resea rch
ch a n g ed a gre at de al . . . th e ce n tra l th em es th a t h a d g u id ed m y in itia l
eŒo rts rem aine d ’ ’ (p . 2 7 ). S o m e o f th ese cen tra l the m es sh a ll n o w b e
d isc us sed in th e lig h t o f L u ria ’ s c o n tem p o ra ry m ilie u a n d p a rticu la rly a s
th ey re la te to L u ria’ s a p p ro a ch to th e e va lu a tio n a n d trea tm en t o f b ra in
in ju ry.
L UR IA’S C ONTEM P OR AR Y M IL IEU: C UL TUR AL,

FAM IL IAL AND ED U C ATIONAL INF L UENC ES
A b rief o v erv iew o f L u r ia ’ s ea rly life ex p erien ces w ill b e m ad e a lth o u g h
th is h a s a lrea d y b e en d escrib ed in L u ria ’ s o w n re¯ ectio n s (L u ria , 19 7 4 ), b y
h is d a u gh ter (E . L u ria, 1 9 9 0), a n d in L u ria ’ s a u to b io g rap h y (19 7 9 ).
L u ria ’ s fam ily w a s o n e of m a n y th at w ere a Œec te d b y th e 1 91 7
rev o lu tio n , n o t o n ly in p o sit iv e p ra ctica l w a y s, b ut also in id e olo g ica l
ch a n g es. L u ria (1 9 7 6), n o te s th a t, ``. . . the atm o s p he re su rro u n d in g m y
in itial w o rk w a s q u ite d iŒeren t fro m th e q u ie t a tm o sp h ere aro u n d w estern
sch o la rs . . . the fa n ta stica lly stim u la ting a tm o sp h ere o f an a ctiv e m o v in g
so ciety, th e stim u la tin g in ¯ u en ce o f a rev o lu tio n , th e stro n g ly d ecisiv e
feelin g o f b e in g p a rt o f a w h o le so ciety tha t m a k es trem en d o u s p ro g ress in
a v ery sh o rt tim e . . . ev e ryb o d y felt h e w as p a rt o f a g rea t m o v em en t o f
u n iq u e h isto rica l sig n i® ca n ce . . . a n d th a t h e h a d h is o w n p lace in th ese
trem e nd o us h isto ric al ev e n ts’ ’ (p . 3 ).
L u ria ’ s fa m ily is d escrib ed b y h is d a u gh ter , E len a L u ria (19 9 0 ) a s w ell
ed u ca ted , h is fath er w a s a d o cto r in terested in p sy ch o so m a tic m ed icin e,
a n d d escrib ed b y L u ria (1 97 4 ) a s a ``w ell-k n ow n a n d ta len ted th e rap ist ’ ’
(p . 25 4 ), a n d h is m o th er w a s e du c ated a s a d en tist in P o la nd . T h is h ig h ly
a ca d em ic tra d itio n (w ith e ac h o f th e resp e ctiv e m em b ers o f th e fam ily
co n trib u tin g scien ti® ca lly to th eir ® eld ) w a s co n tin u ed b y L ur ia in h is
m a rry in g L a n a , a p ro fe sso r a n d m ed ical d oc to r, an d in th eir d a u g h ter,
E len a , o b tain in g a D o cto r o f S c ien ce d eg ree. A sister o f L u ria w a s also a
n o ted p syc h ia trist.
L u ria (1 9 79 ) h im self rem a rk s, ``m y fa m ily w a s ty p ica l o f w h a t in R u ssia
is ca lle d `th e in tellig en tsia ’ . W e co n sid er ed o u rselve s p ro g ressiv e a n d h a d
n o relig io u s tra d itio n s. A lth o u g h w e w ere sym pa th etic to th e rev o lu tio n a ry
m o v em en t, w e w ere n o t d irectly in vo lv ed in it’ ’ (p . 1 8 ).
In su ch a n a tm o sp h ere , L ur ia re ad w id ely o f F reu d a s w ell a s ex p o sin g
h im self to th e h u m a n istic p h ilo so p h ica l id ea s o f th e G erm a n ro m a n tic
AL EXAN D R R O M AN O VI C H L UR IA 281
tra d itio n , esp ec ia lly th o se w o rks w hich criticised th e lim itatio n o f

la b o ra to ry p sy ch o lo g y (L u ria , 19 7 9 ; G o ld b erg , 1 9 9 0 ). H is fo rm a l stu dies
co n sis ted o f co m p letin g g y m n a siu m in 1 91 8 , a n d en ro llin g in th e fa cu lty o f
so cial scie nc e p ro g ra m m e a t K a za n U n iv e rsity (19 1 8 ± 1 92 1 ) a n d th en
en ro llin g in m e d ica l sch o o l.
L u ria w a s m u ltilin g u al, sp ea k in g G erm a n a n d F ren ch at h o m e, a n d at
g y m n a siu m stu d yin g L a tin a n d G reek . H e w a s a lso ¯ u en t in E ng lish . A fter
co m p letio n of h is soc ia l scien c e stu d ies, L u ria w o rk e d a s a la b o rato ry
a ssista n t in the In stitu te o f th e S cien ti® c O rga n isatio n o f L ab o u r, stu d y in g
th e eŒe ct o f ``h a rd w o rk o n m en ta l a c tivity ’ ’ (L uria, 1 97 9 , p . 26 ), w h ile
m a in ta in ing a n um b er o f d iŒeren t in ter ests, fo r e xa m p le, sta rtin g a
jo u rn a l, o f w h ich o n ly tw o issu es w ere p u blish ed (L u ria , 1 97 6 , p . 1 0 ) a n d
o rg a n isin g a p syc h o an a ly tica l circle. A fa v o u rite m em o ry o f L u ria ’ s
co n ce rnin g th e latter w a s th a t o f receiving a rep ly fro m F re u d (a fter h e
h a d in fo rm ed F re ud o f the g ro u p ), a d d ressed to h im a s ``Se h r g eeh rter
H e rr P resid en t’ ’ (H on o u rab le M r. P resid en t), w h ic h h e fo u n d to b e
a m u sin g . H e w a s a t tha t tim e 1 7 y ea rs o ld .
L UR IA’S INTELL EC TUAL INF L UEN C ES

N e uro p sy ch o log ica l (o r co g n itiv e) reh a b ilita tio n d id no t ex ist a t th e tim e
o f L u ria’ s in tro du ctio n to p sy ch o lo g y . In fa ct, p sy ch o lo g y , a s it is k n o w n
to d a y, w a s still stru g glin g to e vo lve in to a u n iq u e d iscip lin e. L u ria ’ s
co n trib u tio n s, h o w ev e r, m u st p rim a rily b e u n d ersto o d w ith in th e c on tex t
o f S o v iet p syc ho lo gy . M ec acc i (1 9 77 / 1 9 7 9), n o tes th a t S o v iet p sy ch o lo g y
fo cu sed sp ec i® ca lly o n th e rela tio n sh ip b etw ee n th e b ra in a n d th e ro le o f
h isto ry a n d cu ltu re in h u m a n d ev elo p m en t. O f eq u a l im p o rta n ce w a s th e
em ph a sis p la ced o n th e p h y sio log ic al b a sis o f p sy ch o lo g ica l p ro cesses (e .g .
S ech e no v 18 2 9 ± 19 0 5 ), a n d th e ro le o f n eu ro lo g ica l m ech an ism s o f
m o v em en t via fe ed ba ck (e.g . B ern stein 18 9 6 ± 1 9 6 6 ). M a rxist p rin cip les
w ere, o f co u rse, a lso cen tra l to th e id eo log ica l un d e rp in n in g s o f th e
v a rio u s th eo retica l fram ew o rk s, esp ecia lly in th e w ork o f V y g o tsk y (1 8 96 ±
1 9 34 ).
L u ria (1 9 74 ) n o te s th at in R u ss ia , th e ® rst p sy ch o lo g ica l in stitu te
o n ly ca m e in to b eing in 1 9 1 1, altho u g h th e ® rst p sy ch o lo g y la b o rato ry
h a d b een fo u n de d in 1 88 5 b y B ek h terev in K a za n (L u ria , 1 97 6 , p . 1 2 ).
U n fo rtu n a tely , p syc h o lo g y b eca m e d ivide d into w h at L u ria term ed
`èx p la na to ry ’ ’ a n d ``d e scrip tiv e’ ’ sch o ols. T h e form er h e d e® n ed as, ``th e
a p p lic ation o f scien ti® c criteria to th e a n a ly sis o f elem en ta ry fo rm s o f
m e nta l ac tivity w ith a n eg lect o f its h ig h er fo rm s’ ’ a n d th e la tter a s
a tten d in g to ``h ig h er form s o f co n scio u sn ess, (b u t) w h ic h . . . reje cted . . .
a n a tu ral-scien ti® c, ca u sa l p o in t o f v iew ’ ’ (L u ria , 1 9 7 4, p p . 2 5 6 ± 2 5 7 ).
H o w ev er, it w as th e scien ti® c atm o s ph e re o f the 1 92 0 s th at estab lish ed
th e ® rst g en era tio n o f So v ie t p syc ho lo gists. L u ria reco u n ts th a t th e

la tter o p p os ed the ide alistic tra d itio n s o f p re-r evo lu tio na ry R u ssia n
p h ilos o p hy a n d p sy ch o lo g y , w h ich stressed th a t p sy ch o lo g y sh o u ld n o t
b e a sub ject o f th e n a tu ra l scien c es, a n d th a t th e p sy ch e ex isted
in d ep e nd en tly o f th e b rain . R a th er, th ey p referre d th e in tro d u ctio n o f
ex a ct p sy ch o lo gical ex p erim en tat io n , a s ex em p li® ed b y th e d e velo p m en t
o f ex p erim en ta l la b o ra to ries in th e 1 8 80 s. T h u s, P a vlov a n d B ek h terev
d ev elo p ed o b jec tive m eth o d s to stu d y h u m a n b eh a v io u r b a sed o n th e
a ssu m p tio n o f th e re¯ ex n a tu re o f m en ta l p ro cess es. T h is ap p ro a ch w a s
ro o ted in th e w o rk o f S ech en o v w h o m L u ria (1 97 4 ) reg ard e d a s ``th e
fa th er o f R u ssia n p h y sio lo g y a n d o f scie nti® c p sy ch o lo g y ’ ’ (p . 25 6 ).
S ech e no v, a cco rd ing to L u ria , d e® n ed th e p h ysio lo g ica l a n alys is o f
co m p lex m en ta l a ctiv ity in S o viet p syc ho lo gy fo r th e ® rst h alf o f th e
tw en tieth ce n tu ry .
L u ria w a s a lw a y s c o m m itted to the e xp erim en ta l m eth o d , a n d
sp eci® ca lly to m ak in g u se o f d irect o b serv a tio n a s th e b a sis fo r
u n d ersta n d in g hu m an b eh a v io u r, th e p u rp o se o f w h ich w a s to fo rm u la te
th eo ries o f p ra ctica l v a lu e w hile sim u lta n eo u sly a c k n ow led g in g th e
ric h ne ss an d v a riety o f h u m a n b eh a v io u r. L u ria (1 9 7 6) sta tes, `Ì . . .
m a d e a d ecisio n . . . (a fte r rea d in g H oÈ Œd in g ’ s E ssa y s o n em p irica l
p sy ch olo gy ) . . . n ev er, o h n e ver sh a ll I en ter th e ® eld o f th a t `scien ce’
lim ited b y a b stra ct sch em es an d d ry `ph ilo so p h ic al’ d isco u rses’ ’ (p . 8 ).
T h u s, a s e arly a s th e 1 9 2 0s, w h en h e w o rk ed a t K o rn ilo v ’ s ex p erim en ta l
p sy ch o lo g ic al la b o rato ry in M o sco w , L u ria’ s d esire w as to `àp p ly
o b jec tiv e m e th o d s to the stu d y o f em o tion a l situ a tio n s th a t w e re a n
in teg ra l p a rt o f p eo p le’ s liv es’ ’ (L uria , 19 7 9 , p . 36 ), a s h e w ish e d to m o v e
b ey o n d th e p u rely p h y sio lo g ica l ev a lu a tio n s of co g n itiv e fu n ctio n s
em ph a sised at th e Institu te . L u ria (1 9 7 9), d iscu ssin g h is e arly in te rest in
p sy ch o lo g y , sta tes `Ì w an ted a p sy ch o lo g y th a t w o u ld a p p ly to rea l
p eo p le , a s th ey liv e th eir liv es, n o t a n in tellectu a l a b stra ctio n in a
la b o ra to ry ’ ’ (p. 2 3 ). L u ria w as a lso d issa tis® ed w ith th e pu r ely d esc rip tiv e
a p p ro ac h o f p syc ho lo gy , a s h e w ish ed , ra th er, to fo rm u la te ``co n cre te fa cts
o f th e m en ta l life o f ind ivid u als th a t g en era te g en era l ex p la n ato ry la w s’ ’
(p . 2 3), in d ica tin g h is p referen ce fo r b a sin g b rain± b e ha v io u r p rin c ip les o n
d ire ct o b serv a tio n .
E len a L u ria (1 99 0 ) co rro b o ra tes th is, w h en d escribin g h er fa th e r’ s
rea ctio n to F r eu d ’ s w riting s. S h e sta tes th a t w h ile rem ain in g in tere ste d in
F reu d ’ s th eo retica l cla im s, L u ria g rew scep tical o f th e su b jectiv ity o f
F reu d ’ s m eth o d s. L u ria ’ s in te rest, it a pp e ars, w as b ase d o n th e h o p e th a t
p sy ch o a n a ly tic th eo ry w o uld serv e a s th e fo u n d atio n fo r re co n cilin g th e
p u rely d escrip tiv e an d p u rely red u ctio n istic p ersp ectiv es of the d a y in to a
m o re in te g rated a p p ro a ch . O n e o f th e ea rlie st w a y s in w h ich L u ria
a ttem p ted th is w a s to m ea su re the ``su b co n scio u s’ ’ th ro u g h m o to r a n d
v isce ral resp o n ses . T h ese ex p erim en ts resu lted in o n e o f h is e a rliest

b o o k s, T h e n atu re o f hu m a n co n¯ icts (L u ria, 1 9 3 2 ), b ein g p ub lish ed , a n d
a lth o u g h h e la ter c riticised th is p erio d o f h is w o rk , it is ev id en t h e still
a p p reciated th e sp irit in w h ich it w a s co n d u cted : ``T h e a p p lic atio n o f a ll
th ese o b ject iv e m eth od s to em o tio na l situa tio n s, fu ll o f life a n d
o b serv a b le p h en o m en a w as o f c o u rse m u ch ne arer to rea l ps yc h olo gica l
a n a ly sis th a n w a s th e d ry sch em a ta o f K orn ilo v ’ s `R e acto lo gy ’ a n d
a lth o u g h th e w h o le se ries o f e xp erim en ts w a s ra th er n a iv e a n d h a d n o
so lid th eo retica l b a ck g ro un d it w a s o f a n in terest a n d o f a p rac tica l
v a lu e’ ’ (L u ria , 19 7 6 ; p . 19 ).
L u ria ’ s d esire fo r a n ex p erim en ta l m e th o d , h o w e ve r, w a s also stro n g ly
in ¯ u en ce d b y w h a t h e d esc rib ed a s a ``ro m a n tic’ ’ ra th er th a n a
``cla ssica l’ ’ scien c e, an d a s su ch , h e p referre d th e em p h a sis to b e o n
b eh a v io u ra l o b serv at io n an d sin g le c ase stu d ies ra th er th an o n g en era l-
isa tio n s b a sed o n g ro u p stu d ies. T h is w a s in ¯ u en ced , in p a rt, b y stu d y in g
th e G e rm a n n eo -K a n tia n s (e.g . D ilth ley), a n d stu dy in g w ith G esta lt
p sy ch o lo g ists in B erlin w h o en rich ed h is scien ti® c d e velo p m en t. T h u s,
L u ria w ish ed to p reserv e th e rich n ess o f in d iv id u a l d iŒeren ce s w h ile
g en era tin g p rin cip le s o f fu n ctio n ing th a t allo w ed fo r a h o listic u n d er-
sta n d in g o f b eh a vio u r.
F u rth e rm o re, L u ria (1 9 7 9) w ish ed to ``cre a te a n ew , co m p reh en siv e
a p p ro ac h to h um an psy ch o lo g ica l p ro cesse s’ ’ (p . 4 0 ), w hich w a s co n sisten t
w ith th e sp irit o f p o st-rev o lu tion a ry R u ssia n p sych o lo g y, a n d w h ich h e
a ch iev e d a s p a rt o f th e ``tro ik a ’ ’ (a s V y g o tsk y, L eo n tiev a nd L u ria c alled
th em selve s) in th e 1 9 2 0s a n d 1 9 30 s. L u r ia (1 97 6 , p . 2 3 ) sta tes: ``T h e aim o f
o u r w o rk w as v ery clea r, a lth o u g h a little to o am bitio u s, w h ich w a s
u n d ersta n d a ble g iv en th e g en era l clim a te o f th e tim e a n d th e a tm os p h ere
o f th e n ew ly o rg an ized in stitu te . . . It w a s clea r th at n eith e r th e o ld
classica l su b jective psy ch o lo g y , n o r th e o v ersim p li® ed a ttem p ts to red u ce
th e w h o le w ea lth o f co n scio u s h u m a n a ctio n to a sim p le sc h em e o f re¯ ex es
w a s ac cep ta ble. N ew w ay s h a d to b e fo u n d , a n d it w a s V y g o tsk y w h o
fo resa w th ese n ew w a y s a n d b eg a n th e in c red ib le c o m p lex w o rk o f
rec on stru c tin g the o ld p sy ch o lo g y , rejectin g th e o v ersim p li® ed a ttem p ts o f
re¯ ex o log y o r rea cto lo g y (R us sia n va ria n ts o f b eh a v io rism ), w h ich w ere
v ery p o p u la r a t th e tim e.’ ’ T h us psy ch o lo gy re q uired a n ew sy n th es is, fo r
a s L u ria (19 7 9 ) sta tes, ``T h e n atu ra lists a n d m e n ta lists h a d arti® c ia lly
d ism em b ered p sy ch o lo g y , it w a s h is (V y g o tsk y’ s) g o a l, a n d o u r task , to
cre ate a n ew sy ste m th at w o u ld sy n the size th ese c o n¯ ictin g ap pro a ch es’ ’
(p . 4 1).
T h is w a s d o n e b y elab o ra tin g u p o n th e co n cep t th at th e ba sic u n its o f
p sy ch o lo g ic al an alysis w e re fu n ctio n s, ea ch o f w h ich rep re sen ted sy stem s
o f elem en ta ry a cts th a t co n tro lled o rg a n ism ± en v iro n m e n t rela tio n s. T h is
co n ce pt w a s la ter to b e ce ntra l to L u ria ’ s fo rm u latio n o f a co m p reh en siv e
u n d ersta n d in g o f bra in fu n ctio n in g a nd , a s su c h, to th e ev a lu a tio n a n d

reh a b ilita tio n o f bra in in jur y.
L u ria ’ s d ev o tio n to V y g o tsk y is ev id en t in th e fa ith fu l a n d co n sisten t
m a n n er in w h ich h e c red ited the la tter’ s co n trib u tio n s to his o w n w o rk
th ro u g ho u t h is life tim e. V y g o tsk y a pp ro a ch ed p hy sio lo g y a n d p sy ch o lo g y
in a n o v el w a y . In ¯ u en ced by M a rxist ide o lo g y, h e stresse d a h isto rica l
a n d , in p a rticu lar , a d ialectica l± m aterialist p e rsp ectiv e, w h ich ac co rd in g to
M ec ac ci (19 7 7 / 1 97 9 ) ca n b e d e® n ed a s co n sid erin g th e rela tio n sh ip
b etw een q u a lity a n d q u an tity , i.e. th e p ro b lem o f th e re la tio n sh ip s
b etw een diŒeren t fo rm s an d lev els of th e o rga n is atio n of m a tter. A n
a ssu m p tio n is m a d e th a t m ate ria l tran sfo rm atio n le ad s to q u a n titativ e a n d
q u a lita tiv e c h an g es w h er ein th e la tte r p ro d u ces n ew p h en o m en a th a t n o
lo n g er h a ve th e p ro pe rties o f th e ph e n o m en a fro m w h ich th ey a re
tra n sform ed . T h u s, V y g o tsk y reg ard e d m en ta l p ro cess es a s q u a lita tiv ely
d iŒe ren t fro m n eu ro p h ysio lo g ica l re¯ e x pro c esses, i.e. co m p lex co g n itiv e
a cts w ere reg a rde d a s p ro d u cin g a p ro fo u n d qu a litativ e c h a ng e in th e
relatio n sh ip b e tw e en stim u lu s a n d re sp on se. T he crea tio n o f a n ew
stim u lu s to d irect a n d reg u la te b eh a vio u r w as te rm ed th e ``stim u lu s±
m e an s’ ’ . E x a m p les o f ``crea ted stim u li’ ’ a re la n gu a g e, ca lcu latio n , a rt,
w ritin g , m a p s, etc. L a n g u ag e, esp ecia lly , is v ie w e d a s h a vin g a
fu n d a m en ta l ro le in th e g ro w th o f co m p lexity o f m en ta l a ctiv ity b eca u se
it n ec essita tes th e u n i® c atio n o f elem en ta ry fu n ctio n s, a s fo r ex a m p le, in
co lou r ide n ti® ca tio n w h er e the in teg ration o f v isio n a n d m em o ry is
n ece ssa ry to p erm it th e en d resu lt o f re co gn isin g o r n a m in g a co lo u r.
T h u s, a s a resu lt o f V y g o tsk y ’ s in ¯ u en c e, w h a t b eca m e o f in crea sin g
im p or tan ce to th e ``tro ik a ’ ’ , a n d w h a t w as to b e co m e term ed th e
``h isto rica l± cu ltu ra l’ ’ a p p ro ac h , w a s th a t co m p lex co g n itiv e fu n ctio n s
sh o u ld b e in terp reted as so cial in o rig in , i.e . o ccu rrin g th ro u g h in tera ctio n
w ith o th er p eo p le, b ein g stru ctu red th ro u gh sp e ech m ed ia tio n a n d
co n scio us ly fu n ctio n in g in a self-reg u la ted m a n n er (L u ria , 19 6 3 , 1 96 6 ).
In th e reh a b ilitatio n p ro cess, L ur ia stressed th e ro le o f c o nsc io u s
a w a ren ess in pa rticu lar .
W ith in th e co n tex t o f su ch in ¯ u en ces, a n d th e c om p letio n o f h is m e dica l
tra in in g in th e 1 93 0 s w h ich h e a ttrib ut ed to ``re co gn izin g th e sign i® ca n ce
w h ich na tu ra l scien ce p rep a ratio n h a s fo r th e stu d y o f p syc h o lo g y’ ’ (L u ria ,
1 9 74 , p . 2 5 4 ) a n d , in p artic u la r, w ith the fo u n d atio n o f V y go tsk y ’ s id ea s,
L u ria , th erefo re, em b ark ed o n d ev elo p in g a n in crea sin g ly co m p reh en siv e
a n d in te g rated a p p ro ac h to th e p h y sio lo g ica l b a sis o f b eh a v io u r. It w a s
W o rld W a r II, h o w ev er, th a t w as to b e the m o st sig n i® c an t co n trib u to r to
L u ria ’ s d eve lo p m en t o f th e ev a lu a tio n an d reh a b ilita tio n m eth o d s fo r
p a tien ts w ith lo ca lised b rain lesio n s, fo r a s L u ria (1 97 9 ) sta tes, `ìt w a s
d u rin g th e w ar an d its a fterm a th th a t n eu ro p sy ch o lo g y b eca m e a fu ll-
¯ ed g ed scien c e’ ’ (p . 14 0 ).
L UR IA’S M OD EL OF B R AIN FUN C TIO NIN G

L u ria w a s a n e xtra o rd in a rily in n o v ative th in k er w h o in teg rate d th e m a n y
co m p lex id ea s an d a p p ro a ch es to m en ta l a ctiv ities o f h is co n tem p o ra ry
m ilieu in to a m e an in gfu l a n d co m p reh e ns iv e th eo ry o f b rain fu n ctio n in g
b a sed o n w h a t to d ay co u ld b e ca lled a sy stem ic or cy b e rne tic
ep iste m o lo g y . L u ria ’ s a p p ro ach to b ra in fu nc tio n in g an d reh a b ilita tio n
is, th erefo re, d iv ers e a n d b ro ad ly b ased b u t, n o ne th eless, cen tred o n
sp eci® c p rin cip les a n d te n ets d eriv ed fro m d ire ct o bse rva tion a l stu d ie s. A
b rie f o verv iew w ill b e g iv en o f th e m ajor ten ets th at m a k e u p L u ria ’ s
m o d el o f b rain fu n ctio n in g .
F unctional Systems
T h e co n cep t o f fu n ctio n a l sy stem s is cru cia l to u nd e rstan d in g L u ria ’ s
ev a lu a tio n an d reh a b ilitatio n m eth o d s, a s it is th e p rem ise o n w h ich h e
b a ses h is a n a ly sis o f in ju ry . L u ria (1 9 7 3) reg a rds co m p lex h ig h er c o rtica l
fu n ctio n s as th e co o rd in a ted eŒe ct o f sev era l b ra in are as w o rkin g to ge th er,
w h ere sp eci® c bra in reg io n s a re spe cia lised fo r p articu la r asp ec ts o f
fu n ctio n a l ac tivity (i.e. serv in g a s ``link s’ ’ ) in reg io n s o f spe ci® city. T h ese
reg io n s a re o rg a n ised in a h iera rc h ica l o rd er a n d in th e p ro cess o f
d ev elo p m en t a re in ¯ u en c ed b y in tera ctio n w ith th e e n viro nm en t. T h e
co m p lex ity o f the inter ac tio n b etw e en reg io n s a llo w s n o t o n ly fo r ¯ e xib ility
d u rin g d ev elo p m en t, b u t also h a s the p o ten tia l fo r restru ctur in g a fter
in ju ry.
T h u s, in d e® n in g a fu n ctio n a l sy stem in th is m a n n er, L u ria a ch iev e s a n
in term ed ia te po sitio n in h is a p p ro ach to b ra in fu n ctio n in g , n eg atin g b o th a
strict ``lo calisa tio n ist’ ’ a nd ``m a ss a ctio n / eq u ip o ten tia lity ’ ’ a p p ro ach : T h e
fo rm er relies o n o ne co rtica l a rea b ein g resp o n sib le fo r o n e p a rticu la r
b ra in fu n ctio n , w h erea s th e la tter stresse s th a t th e en tire n eo co rtex
p a rticip a tes in e a ch be h a viou r, a nd th a t ea ch p a rt o f a g iv en a rea is
eq u a lly a b le to en co d e o r p ro d u c e th e b eh a vio ur n o rm a lly co n tro lled b y a n
en tire a rea .
T h e fu n ctio n a l sy stem s p ro p ose d b y L u ria in tera ct a cro ss thre e
fu n ctio n a l u n its in a hiera rch ica l an d re cip ro ca l m an n er. T he se u n its
w h ich are b ase d o n stru ctu ral a n d fu n ctio n a l g ro u n d s w ill b e d e scrib ed
b rie ¯ y b elo w .
The F unctional Units

A cc or d in g to L u ria ’ s m o de l o f b ra in fu n c tio n in g, n o rm a l ac tiv ity is
d ep en d e n t o n th ree g lo b a l u n its th at g u id e all oth er m en ta l fu n ctio n s (see
F ig . 1 ), n a m ely, (1 ) th e ® rst fu n ctio n a l u n it, situ a te d in th e b ra in stem a n d
FIG. 1. T h e th r e e fu n c tio n a l u n its .
th e m e dia l su rfa ces o f th e ce reb ra l h em is p h eres; it is g en era lise d in its

fu n ctio n a n d reg u la tes lev el o f a ctiv a tio n a n d state o f vigila n ce, (2 ) th e
sec on d fu n ctio n a l u n it th at lies o n th e la teral su rfa ces, p o sterio r to th e
ce ntra l su lcu s a n d w h ich p red o m in an tly re giste rs, a n a ly ses a n d sto res
in fo rm a tio n th ro u gh `àn a ly sers’ ’ (o r se nso ry m o d a lities), w h ic h a re
m o d a lity -sp eci® c a n d w h ich co n sist o f a sen se o rg a n p eriph er ally , a
sen so ry n erv e o r p ro jectio n p a th w ay , a p rim a ry co rtex a n d a n a sso cia ted
sec on d a ry co rtex, (3 ) th e th ird fu n ction a l u n it, i.e. th e a rea a n terio r to th e
ce ntra l su lcu s w h ich p ro g ra m m es an d co n tro ls m en ta l a ctiv ity a n d
b eh a v io u r.
B rie¯ y sta ted , th e in te rn a l o rg a n isa tio n of th e latte r tw o fu n ctio na l u n its
co n sis ts o f th ree h iera rch ica lly a rran g ed zo n e s. T h e p rim a ry a rea s p erfo rm
h ig h ly sp ec i® c fu n ctio n s, th e seco n d u n it receiv es ta ctile-k in a e sth etic,
a u d ito ry a n d v isu a l sen so ry p rojectio n s, a nd the th ird u n it in itia tes
in d ividu al m u scu la r co n trac tio n s. T h e seco n d a ry an d tertia ry co rtica l a rea s
h a v e a n in crea sin g ly in te g rativ e fu n ctio n , fo r ex am p le, th e sec o n d u n it
in teg ra tes th e fu n ctio n o f th e th ree sen so ry m o da lities, a n d th e th ir d u n it
reg u la tes b e ha v io u r. T h e tertia ry a rea s, in p a rticu la r, a re reg a rd ed a s

p erfo rm in g in ter m o d al sy n th esis o f a no n -sp e ci® c ch a ra cter. T h u s, if th ere
w ere to b e a lesio n in a p rim a ry a rea, a m od a lity -sp ec i® c, n o n -in teg ra tiv e
fu n ctio n w o u ld b e im p a ired a s th ese are as receive an d sen d im pu lses to
a n d fro m th e p erip h er y. If a lesio n w ere to b e in a sec o nd ary o r tertia ry
a rea , th e in te g rativ e a sp ects o f a fu n ctio n w o u ld b e im p aired as th e
sec on d a ry are as a re v ie w ed a s syn th esisin g sen so ry recep tion in to c o m p lex
w h o les a n d th e tertia ry a reas a s p rep a ring p ro g ra m m es fo r a ctio n in a
m o d a lity -sp eci® c m an n er (L u ria , 1 96 2 / 1 96 6 ).
F u n ctio n al syste m s a re d esc rib ed b y L u ria (1 9 7 3) a s a n y b eh a v io u ra l
fu n ctio n th a t m a in ta in s a sta ble go al bu t u ses d iŒe ren t asp ec ts of o p era tiv e
b eh a v io u r to co m e to a d esir ed resu lt. L a n g u ag e, h o w e ve r, is re ga rd ed a s
b eing o f p a rticu la r sig n i® can c e, in tha t it is v ie w e d a s th e m ea n s by w h ich
a ll o th er m en ta l fun c tio n s c an b e articu la ted . L u ria’ s m etho d s o f
ev a lu a tio n a n d reh a b ilita tio n sh a ll n ow b e d iscu sse d a s th ey rela te to h is
m o d el o f b rain fu n ctio n .
L UR IA’S EVAL UATION M ETH OD

L u ria ’ s e va lu a tio n m eth o d is b a sed o n an in d iv id u a lise d, q u a lita tiv e
m e th o d o log y , w h ich re¯ ects a R u ssia n rath er th a n W estern trad itio n . K o lb
a n d W ish aw (1 9 90 ) de scrib ed th e ad v a n ta g es o f L u ria ’ s (1 96 2 / 1 9 66 , 1 9 66 )
ev a lu a tio n m eth o d , fo rm alised b y C h risten se n (19 8 9 ) as: (1 ) it is b a sed o n
th eo retica l p rin ciples o f n eu ro p syc h olo g ica l fu n ctio n in g , ``m a k in g th e
in terp reta tio n a lo g ica l c o nc lu sio n o f th e the o ry’ ’ (p . 7 61 ), (2 ) it is
th o ro u gh , in e xp en siv e, ¯ ex ib le, a n d b rief, ta k in g a b o u t o n e h o u r to
a d m in iste r, a n d (3 ) it m ea su res th e a c tu a l b e ha v io u r o f th e in d iv id u a l
ra th er th a n in ferred c og n itive p ro cesses, th u s ``m a k in g in te rp reta tio n m o re
stra ig h tfo rw a rd ’ ’ (p . 7 6 1). H o w ev er, th e d isad v a n tag es a re, (1 ) th e sco rin g
is su b je ctiv e a n d b ase d o n clin ic al ex p erien c e, th erefo re req u ir in g th a t th e
n eu ro p sy ch o lo g ist h as exten s iv e tra in in g in a dm in istra tio n , a n d (2 ) n o
v a lid a tio n stud ies are p re sen te d . T h e la tter is o f m o re serio u s co n cern ,
sin c e va lid a tio n a n d relia b ility stu d ies a re in trin sic to th e W estern tra d itio n
o f n eu ro p sy ch o lo g y . F ew , if a n y, c ro ss-va lid a tio n an d co n stru ct v a lid ity
stu d ies ha v e b een rep o rted u sin g L uria’ s in v estig a tio n m e th o d , d u e
p ro b a b ly to th e very n a tu re o f th e m eth od .
L u ria (19 8 4 ) d escrib es th e e va lu a tio n p ro cess a s b e in g th e a n a ly sis o f
d istu rb a n ces in th e h iera rch ica lly co n stru cted m oto r, ta ctile± k ina esth etic,
v isu a l, a n d a u d ito ry a n a ly sers. L o ca lisa tio n o f a d istu rb an ce refers to th e
id e nti® c a tio n o f a ``co n stella tio n o f co o p era tin g zo n es’ ’ (p . 17 ) o f c o rtica l
a n d su b co rtica l stru ctu res . T h ese m a k e u p a sp eci® c a ctiv ity ra th er th a n
referrin g to a sp eci® c are a o f cereb ra l tissu e. In o rd er to d e ® ne a
d istu rb a n ce o f a p a rticu lar a ctiv ity , th erefo re, th e sp eci® c co m p o n en ts th a t
m a k e u p th e ac tiv ity m u st b e d esc rib ed an d ``th e n e u ro d yn a m ic co n d itio n s

n ece ssa ry fo r th e co m p letio n o f th e a ctio n ’ ’ (p . 1 7 ) m u st b e a n a ly sed . A s
su ch , lo cal b rain lesion s d o n o t resu lt in th e d istu rb a n ce o f a sin g le
p sy ch o lo g ic al fu n ctio n , b u t ra th er o f a g ro up o f p sy ch o lo g ical p ro cess es.
B a sed o n T eu b e r’ s ``d o u b le d isso cia tio n ’ ’ p rin cip le L u ria, th erefo re, p o sits
th a t a co m m o n fa cto r w ill b e p resen t a cro ss th e g rou p o f d istu rb ed
p ro cess es a n d th a t th is c o m m o n fa cto r id en ti® es a sp eci® c fu n ctio n a l a rea
th a t h as b een im p a ired . H o w ev er, in tac t fu nc tio n a l sy stem s w hich d o n o t
in c lu d e th is fa cto r w ill n o t re¯ e ct d e® c its.
T h u s, fo r ex a m p le, in le ft o ccip ito ± p arietal d a m a g e, d istu rb a n ces in
sp a tia l o rien ta tio n , a rith m etic, a n d in th e u n d ersta n d in g o f co m plica ted
g ra m m a tica l stru ctu res, o ccu r b eca u se th ey sh are th e c o m m o n facto r o f
sp a tia l an a ly sis a n d sy n th esis, w h ile fo r ex a m p le , th e p ercep tio n o f m u sic
o r th e u n d ersta n d in g o f la n gu a g e rem a in in ta ct as th ese d o n o t sh a re th is
co m m o n fa cto r. H o w ev er, in left tem p o ra l re gio n d a m a g e, d istu rb a n ces in
th e p ercep tio n o f la n g u ag e a n d w ritin g o ccu r d ue to th e co m m o n fa cto r o f
th e ac o u stic an a ly sis o f so u n d b ein g im p a ired , b u t o th er fu n ctio n s su ch a s
sp a tia l o rien tation , a rith m e tic a n d g ra m m a tica l p ro ced u res a re n o t
d istu rb ed b eca u se th ey d o n o t inc lu d e th is fa cto r. T h e relia b ility o f resu lts
is fo u n d in th e pro cess o f ``sy n d ro m e a na ly sis’ ’ w h ere th e ge n eral sig n s
a m o n g th e resu lts o f th e a sso rted tests a re gro u p ed to g eth er in to a u n i® ed
sy n d ro m e, co m p o sed o f ex te rn ally h e te rog e n eo u s, b u t in tern a lly in ter-
related sy m p to m s.
A s a re su lt o f th e th e ore tica l fo u n d a tio n o n w h ich th e in ve stiga tion is
b a sed , th e ap p ro a ch is ph en o m e n o lo g ica l a n d in tera ctiv e. T h ere is a
tru stin g , th era p eu tic relatio n sh ip b etw een p atie n t an d n eu ro p sy ch o lo g ist
w h ere em p h a sis is p la ced on a co lla b o rative , p ro b lem so lv in g, w o rk in g
relatio n sh ip . T h e la tter refers sp eci® ca lly to a n o n g o in g p ro ce ss o f ta sk
m o d i® c atio n , fo r ex a m p le , g iv in g th e pa tien t m o re tim e o r ex p la n a tio n s o f
h o w to co m p lete a ta sk , a llow in g th e p a tien t to co py ta sk s, o r ask in g th e
p a tien t to g iv e h is o r h e r p erc ep tio n o f th e ta sk, e tc . so a s co n sta n tly to
p ro v id e feed b a ck a b o u t th e un iq u e ch a ra cteristics of th e p a tien t’ s stren gth s
a n d de ® cits, to ev a lu a te ex istin g co m p en sa tio n stra teg ies, a n d / or to
id e ntify altern ativ e p ro b lem -solvin g p o ssib ilities. B ase d o n o b serv a tio n s
b y C h risten sen o f L u ria’ s w o rk in g m eth od in h is la b o rato ry d u rin g th ree
v isits in 1 9 7 0, 1 9 73 , a n d 1 97 5 , a few p erso n a l m em o ries ca n be a d d ed .
L u ria ex a m ine d sp eci® c p a tien ts su rrou n d ed b y h is staŒ a n d g u ests. A s a
g u est, o n e w a s sea ted in a n a rm ch a ir n ex t to L u ria ’ s d esk . T h e p a tien t
w o u ld be fa cin g L u ria . A staŒ n eu ro p sy ch o lo g ist w ou ld p resen t da ta
a b o u t th e p a tien t u n d er d iscu ssio n (see F ig . 2 fo r an ex a m p le o f th e
p a tien t reco rd sh eet) a n d L u ria w o u ld co m m en t, a sk in g q u e stio n s a n d
d isc us sin g issu es in a h ig h ly in v o lv ed m a n n er su ch tha t th e p atien t w a s
in c lu d ed a n d , a s suc h , w a s su p p o rted a n d give n a sen se o f im p o r ta n ce.
FIG. 2. P a tie n t r e c o rd s h e e t.
T h e in v estig a tio n th a t fo llo w ed (co n d u cted b y L u ria ) w a s d o n e in a n

a u th o rita tive a n d serio u s m a n n er, clea rly fo llo w in g a lo g ica l se qu en ce o f
in q u ir y. A n o n g o in g d ialog u e b etw e en L u ria an d th e p a tien t c rea te d a
sen se o f en g a g em en t a n d go o d h u m o u r fo r ev ery o n e ta kin g p a rt. A s a
g u est, o n e w ou ld so m etim es b e a sk ed to p a rticip a te in d ecid in g w h a t th e
n ex t step o f th e in v estig a tio n sho u ld in clu d e a n d w h a t w a s p ro p o sed w a s
th en pe rfo r m ed . T h e p a tien t’ s reac tio n w o u ld in d ica te w h e th er th e
in terv en tion w a s a p p ro p ria te o r n o t a n d , in th is w ay , it w a s a lea rn in g
p ro cess fo r th e g u est a s w ell.
It m u st b e stre ssed th a t th e d ia g n o stic n eu ro p sy ch o lo gical in v estig a tio n
p la y ed a v ery im p o rta n t ro le be ca use th e p o ssib ility o f o b tain in g o b jectiv e
d a ta thro u g h o th er m etho d s w e re sca rce. H o m sk a y a , w h o h ea d ed th e
electro en cep h a lo g ra p h y la b o rat ory , w a s th e m a in la b o ra to ry co n trib u to r,
b u t a p a rt fro m th at, n eu ro p sy ch o lo g y w a s th e d ia gn o stic m eth od m o st
relied u p o n . D u rin g C h risten sen ’ s ® rst v isit, a n um b er o f p rev io u s p a tien ts
w ere b ein g re-ex a m in ed so a s to co n® rm in itia l ne u rop syc h olo g ica l
ev a lu a tio n s. T h es e p a tien ts w e re th o se w h o h a d b e en sen t h om e fo r 1± 2
m o n th s b eca u se the o n ly ® n d in g s d u ring th e ® r st sta y a t th e h o sp ita l w ere
th o se fro m th e n e uro p sy ch o log ic al ev a lu a tio n . O ften , th e n ew in v estiga -
tio n s a lso g av e n eu ro lo g ical evid en ce o f p ath o lo g y , a n d p ro v id e d ev id e nc e
o f th e d irec tio n in w h ich a tum o ur w a s gro w in g .
T h e reh ab ilita tiv e w ork co n d u c te d d u ring C h risten sen ’ s v isits to o k plac e
a t th e L a b o ra to ry o f N eu ro p sy ch o lo g y a n d S p e ech R e ha b ilita tio n ,
H o sp ital o f N erv ou s D isea ses o f th e F irst M ed ica l In stitu te, 1 1 R o sso lim o
S treet, M o sco w , w h er e a few ro o m s w e re k ep t fo r p a tien ts w h o h a d
rec en tly b ee n o p era ted u p on . L .S . T sv etk o va w a s in ch a rg e o f th is `ù n it’ ’

a n d L u ria v isited a t lea st o n ce a w ee k to discu ss th e ca ses, w h ere
d isc us sio n s b etw een th em co n cern in g th e ory a n d th e ap p ro p riate m eth o d s
fo r tra in in g w ere co n d u cted in a h ig h ly a n im ated m a n n er. (F or th o se
in tere sted , T sv etk o v a ’ s w ritin g s illu stra te de ve lo p m en ts in reh a b ilita tio n
su b seq u en t to L u ria .)
P a tien ts g en era lly sta y ed fo r p e rio d s o f 3 ± 4 m on th s, h o us ed in g ro u p s
o f six , sh arin g th e sa m e ro o m , a lth o u g h tra in in g w a s in d iv id u a lly
a d m in iste red , 2 ± 3 ho u r s d a ily . M o st of th e p a tie n ts w ere a ph asic a n d
sp eci® c m aterial th a t h a d b een d ev elo p ed fo r th e d iŒeren t a p h a sic
su b g ro u p s w a s u se d. W h en to ge th er, th e p a tien ts w o uld typ ica lly b e
in tera ctin g soc ia lly , w ith re la tive s p resen t. T re atm en t, h o w eve r, w a s o n ly
co g n itive in orien tatio n , b u t L u ria ’ s em p a th ic a pp ro ach crea ted o p p o rtu -
n itie s fo r a m o re h o listic un d e rstan d in g o f e ach p a tien t.
A s m a n y p a tien ts liv e d a g rea t d ista n ce fro m M o sco w , th eir rela tiv es
h a d u su a lly b een w ith th em fo r th e m a jo rity o f th e tim e th ey w ere
h o sp ita lised an d , as su c h, w ere in stru cted in train in g p ro ced u res to a ssist
th em w h en th ey retu rn ed h o m e. T h ey w e re also req u este d to retu rn a fter
3 ± 4 m o n th s, fo r a fu rthe r tra in ing p erio d .
In sum , the im p ressio n g a in ed w a s o n e in w h ich L u ria w a s o p e n to
id e as, resp ect fu l o f th e in ve stiga tio n s p erfo rm ed b y o the rs, a n d a lw a y s
ea g er to sh are h is k no w led g e w ith h is co lla b o rato rs, h is gu ests, a n d th e
p a tien ts th em selv es. F ig u re 3 sh o w s L uria a t w o rk d u rin g th is tim e.
C h risten sen (1 9 89 ) n o tes th a t th e ev a lu a tio n p ro cess b eg in s w ith h isto ry
ta k in g o f th e sta tu s of th e p atie n t, w h ich inc lu d es lev el o f aw a ren ess, a n d
em otion al, m o tiv a tio n al, a n d pe rson a lity fa cto rs. T h is is fo llo w e d b y a
series o f pre lim ina ry tests, a n d th erea fter, a m o re se lectiv e p ro cess w h e rein
a fu rth er d eta iled e va lu a tio n is m a d e, su c h th a t th e n eu ro p sy ch o lo g ist n o t
o n ly id e nti® e s a rea s of stren gth a n d w ea kn e ss, b u t a lso g en era tes
h y p o the ses a b o u t w h y a co m p lex p sy ch o lo g ica l ta sk h a s fa iled . T h is
req u ir es a n u n d ersta n d in g o f th e o rg a n isa tio n o f th e n erv o u s sy stem a n d
k n o w led g e a b o u t w h a t a n in ju r y h a s do n e to th e bra in ’ s stru c tu re a n d its
p h y sio lo g ic al a ctiv ity .
T h e e xa ct p roc ed u re fo r th e ev a lu a tio n is co m p re he n siv ely d escrib ed in
L u ria ’ s n eu ro ps yc ho lo g ic al in vestig a tio n (C h risten sen , 19 8 4 ), a n d else w h e re
(e.g . C h risten sen , 1 9 8 9).
L UR IA ’S R EH AB IL ITA TIO N M ETH O D

L u ria ’ s g en era l a p p ro a ch to reh a b ilita tio n is exten s iv ely d iscu ssed in tw o
p rim ary sou rces, n am e ly a b o o k , n o w o u t o f p rin t, en titled R esto ratio n of
fu n ctio n a fter b rain in ju ry , in it ia lly p u b lish ed in R u ssia n in 1 9 4 8 a n d la ter
FIG. 3. L u r ia a t w o rk in th e 1 9 7 0 s .
in E ng lish (1 9 6 3), a n d a n article b y L u ria , N a yd in , T sv etk o v a, a n d

V in a rsk a y a p u b lish ed in 1 96 9 .
C en tra l to L u ria ’ s co n cep t o f reh a b ilitatio n is th e n o tio n th a t d ia g n o ses
a n d trea tm en t a re in trin sica lly rela ted a n d th a t b o th in ta ct a s w ell a s
d istu rb ed fu n ctio n in g n eed s to b e tak en in to a cco u n t. F u rth erm o re, L u ria
(1 9 48 / 1 96 3 ) reg a rd s the e Œects o f co rtica l in ju ry a s d ep en d en t n o t o n ly o n
th e ex ten t of d a m a ge b u t a lso o n w h at ro le th e d a m a ge d are a p la y s w ith in
a fu n ction a l sy stem . H e also reg a rd s d iŒeren ces in th e ty p e o f in ju ry a n d
th e p rem o rb id fea tu res o f p erso n ality a s ca u sin g v a ria tio n s in th e ra te a n d
su cce ss o f reh a b ilita tio n . L ur ia rega rd s th e initia l p erio d o f reh a b ilita tio n
a s lik ely to b e a cu te h o sp ita lisa tio n , b ut th erea fter, view s th e u se o f
sp ecia lly crea ted re h a b ilita tio n u n its a s n ece ssa ry. L u ria ’ s g o a l is to retu rn
th e in d iv id u a l to a p ro d u ctiv e lifesty le a s so o n a s is fea sib le .
W ith in th is fra m ew o rk , th ere fo re, fo u r ge ne ral reh a b ilita tive p rin cip les
a re p resc rib ed , n a m ely : (1) R esp ect fo r th e u n iq u en ess an d v a rie ty o f
fu n ctio n a l sy stem s acro ss in d iv id u a ls, su ch th at a d iŒe ren tia l a n a ly sis o f
th e n eu ro p sych o lo g ica l b a sis o f a d istu rb a n ce is re q uired an d , a s su ch , a
u n iq u e trea tm en t a p pro a ch fo r ea ch in d iv id u a l is p ro v id ed . (2) M a k e u se
o f a n in ta ct lin k (co n trib u tin g a rea ) to rep la ce a d am ag ed on e , fo r
ex a m p le , rep la ce th e a co u stic a n a ly sis o f a w o rd b y v isu a l a n alys is. (3 )
A llo w fo r p rev io u sly in te rna lised a cts to b e exter n alised , th ro u g h sp eech o r
o th er ex te rn al a id s, u n til th e p erso n is a b le to rein co r po ra te the b eh a v io u r
in a n a u to m a tic m a n n er. (4 ) U se feed b a ck co n sta n tly to p ro v id e p a tien ts

w ith in fo rm a tio n o f th eir stren g th s a n d w ea k n esse s, a n d m o re im p o rta n tly ,
to id en tify th e p ro cess b y w h ich th ey c o m p lete the task , su ch th a t
co m p a riso ns ca n b e m a d e b etw e en th e p erfo rm ed a ct a n d th e o rig in a l
p la n , so as to co rrect fo r m ista k es.
T h ese p rin cip les o f reh a b ilitation are b ased o n L u ria ’ s co n cep tu alisa tio n
o f th e resto ra tio n o f fu n ctio n w h ich L u ria et a l. (1 96 9 ) reg a rd as o ccu rrin g
in th ree p red o m in a n t w a y s, n a m ely (1 ) th ro u g h d e-in h ib itio n , typ ica lly
a ch iev e d in the a cu te sta ge s th ro u gh su rp rise o r d istra ctio n ta sk s g iv en to
th e p a tien t. T h is m a y also b e a ch iev ed th ro u g h p h a rm a co lo g ic al m ea n s so
a s to fa cilitate sy n a p tic tra n sm issio n if d istu rb a n ce o f fu n ctio n is reg a rd ed
a s o ccu rrin g b e cau se of a tem p o ra ry m a lfu n ction in g o f sy n a p tic
tra n sm issio n, (2 ) b y tra n sfer o f fu n ctio n to the o p p o site h em isp he re,
a lth o u g h L u ria ca u tio n s th at th is p ro cess is like ly to b e lim ited in its
e cac y if the re is m a rk ed h em isp h eric a sym m etry , a n d ® n a lly (3) b y
reo rg a n isa tio n o f th e fun c tio n a l sy stem s.
F u n ctio n al reo rga n isatio n is b a sed on th e in co rp o ra tio n o f n ew
a Œeren ta tio n in to th e d istu rbe d fu n ctio n a l sy stem a n d ca n ta k e plac e
eith e r b y elem en ta ry in tra -sy stem ic reo rg a nisation , by intra -sy stem a tic
co n cep tu a l reo rga n isa tio n , o r b y in ter-sy stem ic reo rg a n isa tion , p ro v id ed ,
th ere h a s n o t b e en : (1) a sev ere d eg ree o f lo w ered co rtica l a ctiv ity , o r
sev ere fro n tal in ju ry su ch th at the p a tien t is n o t a b le to tak e a n a ctiv e pa rt
in th e reo rg a n isa tio n o f th e reh a bilita tio n p ro ce ss, an d (2 ) th at seco n d a ry
a n d tertia ry zo n es o f th e co rte x a re n o t to o ex ten sive ly d a m a g ed to a llo w
fo r resid u a l co m p e nsa tio n. F u rth erm o re, th e gre ate r th e le ve l o f p re m o rb id
sk ill a cq u isition , th e gre ate r th e po ssib ilities o f co m p en sa tio n . L u ria a lso
stresses th e im p o rta n ce o f th e ``p rem o rbid p erso n a lity ’ ’ (i.e. w h at to d a y
w o u ld , in p a rt, b e term e d th e co g n itiv e sty le of a n ind ivid u a l), n o tin g , fo r
ex a m p le , w h eth er a p erso n typ ica lly u sed v isu a l, sp eec h ± m o to r o r ab stra ct
a u x ilia ry sch em es in p ro b lem so lv in g , a nd th en usin g th ese o b serv a tio n s to
h elp g u id e re h ab ilita tio n p la n n in g . F in a lly , L u ria reg ard s m o tiva tion a s
cru cia l to the reh a b ilita tio n p ro cess. B y th is L uria m e an s th at in ord e r fo r
reh a b ilita tio n to o ccu r, th e lev el o f a w a ren ess th e p a tien t h a s a n d th e
a b ility to w o rk co n scio u s ly o n sp eci® c ta sk co m p o n en ts th a t p rev io u sly
w ere p erfo rm ed a u to m a tica lly , m u st b e ta k en into ac co u n t, i.e. th e less
a w a re th e p a tien t, th e less lik ely reh a b ilitatio n is to b e su cce ssfu l.
T h u s w ith in th e pa ra m e te rs d e scrib ed a b ov e, th e th ree typ e s o f
fu n ctio n a l reo rga n isatio n m a y o c cu r. T h e ex am p les p ro vid ed b elo w a re
ta k en fro m L u r ia ’ s o w n w ritin gs so a s to illu strate a s clea rly as p o ssible
th e d iŒe ren t ty p es o f fu n ctio n a l o rg a n isa tio n a nd his a pp ro a ch to
reh a b ilita tio n. F u rth er ex a m p les o f reh ab ilita tio n p ro ced u res b a sed o n
L u ria ’ s a p pro a c h m a y b e fo u n d elsew h e re (C h risten se n, 1 9 8 6 , 19 8 9 ;
C h risten se n, M a lm ro s, & T o w n es, 1 9 87 ).
Elementary Intra- systemic R eorganisation

E lem e n tary in tra-sy stem ic reo rg a n isa tio n re fe rs to th e tra n sfer o f fu n ctio n
w ith in th e sam e fu n ctio n a l syste m b u t p e rfo r m ed a t a lo w e r leve l o f
o rg a n isa tio n b y sy stem s th a t rely o n a u tom a tic, re¯ e x fu nc tio n in g .
T y p ica lly , th is fo rm o f reo rg a n isa tio n oc cu rs a fter lesio n s to p rim a ry
p ro jec tio n a rea s in th e co rtex w h er e, fo r ex a m p le, in h em ipa resis,
o rg a n isa tio n o f fu nc tio n is ta k en o v er b y th e n o n -a Œected lim b . H o w ev er,
sec on d a ry a n d tertia ry co rtic al are as a lso n eed to b e in tac t to allo w fo r th e
in teg ra tio n o f pa rticu la r fu n ctio ns. T h is ty p e o f reo rg an isa tio n of th e
fu n ctio n a l sy stem s m a y o ccu r au to m a tica lly , q u ick ly , a n d m a y b e w ith o u t
th e p atien t’ s c o n scio u s p artic ip a tio n .
Intra- systemic C onceptual R eorganisation

In tra -sys te m ic co n ce ptu a l reo rg a n isa tio n a lso relies o n reo rg a n isa tio n
w ith in th e sam e fu n ctio n a l sy stem , b u t h ere th e v o lu n ta ry co n tro l o f a n a ct
is em p h a sised a n d h ig h er co rtica l pro c esses su c h a s sp eech a re n eed ed to
co m p lete a ta sk th at p revio u sly d id n o t n e ed su ch h ig h er c o rtica l
in v o lv em en t. T y p ica lly, lesio n s to th e se co n d ary a n d tertia ry c o rtica l
zo n es re su lt in d istu rb a n ce o f m o re co m p lex co g n itiv e fu n ctio n s ra th er
th a n th e co m p lete lo ss o f an y o n e elem e nta ry fu nc tio n suc h as v isio n o r
h ea rin g as, fo r ex a m p le, in p rim a ry zo n e d e® cits. If th ere is a lo ss in o n e o r
m o re o f th e b asic e lem e n ts req u ired fo r a Œeren t in teg ra tio n , th en som e
fo rm s o f a g no sia , d y sp rax ia o r a red u ce d ra n g e o f sim u lta n e ou s p e rcep tio n
m a y oc cu r.
T h u s, in in jur ies to th e seco n d ary zo n e of th e lan g u a g e a rea , fo r
ex a m p le , d iŒeren tiatio n a n d d iscrim in a tio n b etw een sep ara te so u n d s
ca n n o t b e m a d e n o r c an d iŒeren ces b e ca teg o rised a n d , a s su ch , th e
sen sa tio n s are n o lo n g er g en era lised in to a sy stem , th erefo re, b ein g
p erce iv ed o n ly as u n d iŒe ren tia ted n o ise. In su ch ca ses, L u ria su g g ests th a t
resto ra tio n o f fu n ctio n can o n ly b e a cq u ire d th ro u g h co n scio u s, g o a l-
d ire cted a ctiv itie s th at im p ro v e d iŒeren tia tio n b y crea tin g a w are n ess a n d
co n scio us o rg a nisation so a s to in clu d e n ew rela tio n sh ip s w ith in th e
fu n ctio n a l sy ste m .
T h is p ro cess o f fu n ction a l reo rg a n isa tio n o ccu rs m o re g ra d ua lly th a n
elem en ta ry in tra -sy ste m ic fu n ctio n in g , a nd th e a u to m a tisa tio n o f
fu n ctio n ge n era lly o ccu rs on ly a fter in ten siv e an d lo n g -term train in g .
F u rth erm o re, th e le n gth o f tim e ta k en an d th e eŒo rt re q uired to
resto re fu n ctio n is re la tive to ho w d iŒe ren t the n ew c o m p o n en tia l
a n a ly sis o f a task is co m p a red to th e p rev io u s m a n n e r in w h ich it w a s
co n stitu ted .
Inter- systemic R eorganisation

W h en o n e o r m o re cru cia l elem en ts in a fu n ctio n al sy stem h a ve b een
d a m a g ed , L u ria su g g ests th a t in ter-sy stem ic reo rg an isa tio n o ccu rs th ro u g h
reh a b ilita tio n. H ere , elem en ts w hich h a v e n o t b een p re viou s ly u sed in a
p a rticu la r co g n itiv e a ct are in c lu d ed a s n ew link s fro m d iŒeren t fu n ctio n a l
sy stem s. T h is is p a rtic ular ly p ertin e n t in situ a tio n s w h ere a Œere nt feed b a ck
p a th w a y s in sen so ry sy ste m s a re d a m ag ed , o r in th e p rim a ry zo n es w h ere
su b stitu tio n o f a ltern a tiv e inta ct a na ly se rs ca n m o re re ad ily b e in teg ra ted .
T h is fo rm o f re o rga n isatio n is m o re ea sily ach iev ed in a d u lts a s th ese
m o d a lities h a v e a lre ad y b ee n fu lly d ev elo pe d, w h ere as in ch ild ren th ey
w o u ld still b e in th e p ro cess o f d ev elo p m en t a n d , th e refo re, w ou ld n o t b e a s
a ccess ib le o r e cien t fo r th e resto ra tio n of fu n ctio n o f an im p aired syste m .
S o m e d e® cits th a t m a y rely o n th is fo rm o f fu n ctio n a l reo rg a n isa tio n
a re p ro p rio ce ptive d iso rde rs w h ere lo ss o f sm o o th ne ss o f h a b itu a l
m o v em en ts o ccu rs, o r in h ig h ly co m p lex fo rm s o f co g n itiv e activ ity su ch
a s in w ritin g, ca lcu la tio n , sp eech , etc. T h u s, fo r ex a m p le, in a p ra x ia ,
d e® cits ca n b e co m p e n sa te d fo r b y usin g a n a lte rn ativ e fu n ctio n a l
m o d a lity , e.g. v isu a l feed b a ck m ech a n ism s. T h is fo rm o f reo rg an isa tio n ,
h o w ev er, is reg a rd ed b y L u ria as th e m o st d i cu lt to a ch ieve a n d ,
th erefo re, m a y req u ire th e lo n ge st p erio d o f tra in in g, a n d m ax im al,
co n scio us ly eŒortfu l p a rticipa tio n o f th e p atien t. E v en th e n, L u ria n o tes,
o n ly p artial a u to m a tisa tio n o f fu n ctio n m ay o ccu r.
T h e d iŒeren t typ es o f resto ra tio n o f fu n ctio n s m en tio n ed a b o v e, h o w eve r,
d o n o t o ccu r in a s clea r-cu t a m a n n er a s th ey a re p resen ted . R a th e r, in th e
clin ica l stu d ies L u ria (1 9 48 / 1 9 63 ) p rese n ts, in ter - an d in tra -system ic
fu n ctio n in g a p p ea r to o c cu r in dy na m ic in terp lay . F u r th erm o re, a lth o u g h
th e m ech a n ism s by w h ich reo rg a n isa tio n of fu n ction a l sy stem s o c cu rs a re
id e nti® e d , a n d th e ro le o f th e th era p ist is d e ® n ed (a s a ssistin g th e p a tie n t in
p in p o in tin g stren g th s an d w ea k n esses so a s to h elp th e p a tien t d ev elo p
co m p e nsa to ry m ea su res in m a ste rin g sp eci® c task s), L u ria n o n e th eless
ca u tio n s th a t resto ra tio n o f fu n ctio n is n o t a n ea sy ta sk a n d is d i cu lt to
a ch iev e in p a tien ts w ith fo ca l b ra in lesio n s, in th at it req u ires, co n sta n t,
co n scio us co n tro l an d d em a n d s co n sid erab le eŒo rt from th e pa tie n t.
R EH AB IL ITATIO N OF SP EC IF IC SYND R O M ES
M otor F unctions
L u ria (1 94 8 / 19 6 3 ) p o sits th at c o m p en sa tio n o f d e® cits o cc urs a t (1 ) lo w er
le ve ls o f in teg ra tio n , i.e. resu ltin g in d iso rd ers o f to n e an d co o rd in a tio n , a s
w ell a s in p a reses, a n d (2 ) in h ig h er lev els o f in teg ra tio n , w h ere c o m p lex
p u rp o siv e m o v em e n t is lo st, re sultin g in th e `àp ra xias’ ’ . In th e fo rm er,
w h en lesio n s a re lo ca lised in th e p y ra m id a l tra ct, o r w h en th ere is
d estru ction o f th e an terio r cen tra l g y ru s, co m p en sat io n is reg a rd ed b y

L u ria a s b ein g p o ssib le o n ly b y tran sferr in g m o ve m en t fro m o n e lim b to
a n o th er.
A s a ge ne ral ru le, L u ria (19 4 8 / 19 6 3 ) n o tes th a t rest ora tio n o f m o to r
fu n ctio n s ca n h a rd ly e ver b e a ch iev ed b y rep etitive, p h y sica l tra in in g a n d
th a t th e d efects a ssoc ia ted w ith th e lesio ns m a y be so v aried th a t th e ® rst
esse ntial ta sk is a lw ay s to id en tify w h ic h p a rticu la r lin k in the m o to r
sy stem h a s h a d th e grea test d am a g e, so as to d e® n e th e sp eci® c
ch a ra cteristics o f the d isru p ted m o to r a ct. L in k s th a t m a k e u p th e
m o to r sy stem in clu d e m u scle p ow er an d to n e, kin ae sth etic a Œeren t
im p ulses to m a in ta in c on tro l o ve r m o v em en ts, the o p tic± sp a tial a Œeren t
sy stem to reg u la te m o v em e n t in ex te rn al sp ac e, g en era lisa tio n a n d
in teg ra tio n o f m o to r in n erv a tio n s, go a l-settin g , a n d th e ca p a city to
reg u la te th e activ it y b y sp ee ch (L u ria , 1 97 3 ; C h risten sen , 1 9 84 ).
A t lo w e r lev els o f m o to r in teg ra tio n , to h elp o v erco m e m o to r d iso rd ers
ca u sed b y lesio n s to th e aŒe ren t sy stem s, in tra -sy stem ic reo rg a n isa tio n
ty p ica lly o ccu rs b y th e in tro d u ctio n o f ad d itio n a l a Œe ren t stim u li w h eth er
co n scio us ly p erceive d b y th e p atien t o r n o t, a s fo r ex a m p le in th e u se o f
electrica l stim u la tio n . In ter-sy stem ic reo rga n isatio n m a y a lso o cc ur at
lo w er lev els of m o to r in teg ratio n in ca ses w h ere th e su b -co rtic a l sy stem s
ca n n o t co rrect fo r d e® cits. L u r ia (1 9 6 3) u ses P ark in son ’ s d isea se to
illu strate h o w , in im p ed im en ts o f c om p lex m o to r m o v em en ts suc h a s th e
sp o n ta ne o u s rh y th m ic o p era tio n s of th e h a n d o r w alk in g , fo r ex am p le, u se
m a y b e m a d e o f h ig h er co rtica l fu n ctio n s. L u ria p ro v id es a n ex a m p le o f
th e u se o f a h ig h er co rtica l fu nc tio n in th ese ca ses a s u se o f th e v isu a l±
sp a tia l ® e ld in stea d . F o r exa m p le, w a lkin g o n a ¯ o o r w ith lin es d ra w n o n
it, su ch th a t ``. . . vo lu nta ry m o vem en t (is) re in fo rced b y re sp o n ses to
ex tern a l v isu a l stim u la tio n . . . (a n d ) . . . the ch a in o f au to m a tic a ctiv ity is
(th erefo re) stren g the n ed b y re-a ctiv ity ’ ’ (p . 87 ).
H o w ev er, at h ig h er lev els o f m o to r in teg ra tio n (i.e . w h ere d e® c its in
co m p lex p u rp o siv e m o vem en ts resu lt, g en era lly te rm ed a p ra x ia ), co n -
ce ptu a l in tra-sy stem ic o r in te r-sy stem ic reo rg a n isa tio n o c cu r m o re re ad ily .
L u ria em p h a sise s, ® rstly , th e u se o f ex tern a l a id s w h ich serv e a s g u id es
u n til th ey a re inter n alised in a n a u to m a tic m a n n er a n d ® n a lly in teg ra ted ,
a lb eit n ot a s eŒe ctiv e a s p rem o r b id fu n ctio n in g in itially , b u t w h ich m a y
im p ro ve o ver tim e. Se co n d ly , a ll su p er¯ u ou s a cco m p a n yin g m o v em en ts
a re m in im ised b y sim plify in g ta sk s, a n d th ird ly , th e m o st sign i® ca nt m o to r
a cts a re tran s fe rred to th e less d isa b led p a rt o f th e lim b . C o n cep tu a l in tr a-
sy stem ic reo rga n isa tio n is also reg a rd ed b y L u ria as b eing p a rticu la rly
p ertin en t to th e fu n ctio n a l re co n stru ctio n o f ``k in etic m elo d ies’ ’ (i.e. w h ere
a c h a in o f iso la ted im p u lses is co n so lid a te d into co m p lex m o v em en ts) , a n d
w h ere g o al-d irected b eh a v io u r is essen tia l in b o th in itia tin g a n d
term in atin g a m oto r act. T hu s, p a rticu la rly in ca ses o f p ersev era tio n o f
a m o to r ac t, L u ria su g g ests th a t if a ta sk is form u la ted d iŒeren tly (i.e.

g iv en a n ew m ean in g ), th e p atie n t sh o u ld b e a b le to m o v e o n fro m o n e
ta sk to th e n ex t e c ien tly , a s a n ew a Œere n t syst em is in tr o du c ed .
S im ila rly , in sp a tia l a pra x ia , w h ere v isu a l± sp a tia l in teg ra tio n is d istu rb ed
a s a resu lt o f o ccip ital± p arietal reg io n d a m ag e, L u ria state s th a t th e
p u rp o se o f in tra -sy ste m ic reo rga n isation is ``to tra n sfer th e a ctio n
d istu rb ed by d isin teg ra tio n o f its sp a tia l sch em es to th e lev el o f p u rp o siv e
o rg a n isa tio n , o r to turn fro m th e d ire ct sp a tial syn th es is o f th e m o vem en t,
w h ich th e pa tie n t is in ca p a b le o f d o ing to its co n scio u s sy n th esis’ ’ (p . 9 2 ).
In ter-sy stem ic reo rg a n isa tio n , h o w ev er, is reg a rd ed a s th e m a in m eth o d
o f c o rrectio n th at o ccu rs in reo rga n isa tio n o f m o to r a ctiv ity at h ig h er
le ve ls o f in teg ra tio n . S p ec i® c ex a m p le s a re a lso p ro v id ed b y L u ria (1 9 63 )
o f th e trea tm en t o f th e d iŒeren t k in d s o f a p rax ia. F o r ex am p le, w ith
tem p o ra l lo b e lesio n s, w h ere th e m o to r p erfo rm a n ce o f rh yth m ic g ro u p -
in g s b e co m es im p aired b ec au se o f m em o r y d i cu ltiesÐ L u ria e m p h asises
relyin g o n ve rb al o r k in a esth etic stru ctu res to a lte r th e co n cep tu a l p a ttern
o f th e m o to r a ct a n d to a llo w fo r a u xilia ry a Œe ctiv e lin k s fro m fu n ctio n s
o f p reserv ed p o sterio r p o rtio n s o f th e co rtex to b e us ed . A n o the r ex am p le
is p ro vide d in sp a tia l a p ra x ia , w h ere ta ctile p erc ep tio n o f d irect io n is
p ro v id ed as an altern ative to v isu a l o rien ta tio n in sp a ce. F u rthe r, sp ec i® c
ca se stud ies a re p resen ted as reg ard s th e trea tm en t o f v ario us ty p es o f
a p ra xia (L u ria , 19 4 8 / 1 96 3 , p p . 93 ± 1 16 ).
``G nostic’’ ( P erceptual Integration) F unctions

L u ria ’ s (1 94 8 / 19 6 3 ) de scrip tio n o f reh ab ilita tio n o f g n o stic fu n ctio n s is
p red o m in an tly o f d e® cits in v isu a l fu n ctio n s, i.e. th e v isu al a gn osias w h ich
in c lu d e, (1 ) sim u lta n eo u s a g n o sia , i.e. th e n a rrow in g o f th e ® eld o f v isu a l
p erce p tio n w he re o n ly o n e o r tw o o b jects m a y b e p erc eiv ed a t a tim e
a lth o u g h th e in itial p erce p tio n a n d ev a lu a tio n o f su ch o bjects is
co m p re he n siv e a n d , (2) sp a tia l a gn o sia , w hich ca u ses d i cu lties in sp a tia l
o rie nta tio n . R e org a n isa tio n o f fu nc tio n is view ed as o cc u rrin g p r im a rily
th ro u g h in tra -sy stem ic co n cep tu al an d in ter-sy stem ic fu n ctio n al reo rga n -
isa tio n .
A n exa m p le o f in tra -system ic co n cep tu a l reo rg an isa tio n is p ro v id ed in
sim u lta ne o us ag n o sia , w h er e w h en rea d in g , fo r ex a m p le, th e reco g n itio n o f
o n ly o n e o r tw o lette rs a t a tim e o ccu rs, a n d reh ab ilita tio n is fo cu se d o n
th e w id en ing o f th e p ercep tio n o f le tters b y g ro u p in g the m to g eth er an d b y
im p ro vin g th e d iŒu se n a ture o f pe rip h era l v isio n . T he la tte r is a ch iev ed b y
tea ch in g p a tien ts to `è x pe ct’ ’ p a rticu la r g ro u p s o f letters, an d b y tra in in g
th em to p erceive th e b eg in n in g o f w o rd s a s a reg u la r ® x e d g ro u p in stea d .
In tw o ca se stu d ies of th e reh a b ilitation o f sp a tia l a gn o sia , L u ria (1 9 48 /
1 9 63 , p p . 12 9 ± 1 33 ), em p h a sises th e u se o f p re serve d co m p o n e n ts o f in ta ct
v isu a l p erc ep tio n to m a k e p o ssib le a co n scio u s a n a ly sis o f th e fu n d a m en ta l

sp a tia l co o rd in a tes, i.e. left, rig h t, e tc . F e ed b a ck is th en p ro v id ed o n th e
v isu a l co m p a rison s m a d e b etw e en co rrectly an d inc o rrectly ex ecu ted ta sk s.
E m p h a sis is a lso p lac ed o n u sin g v erb al in stru ctio n s th a t are m em o rised ,
a n d o n o th er ex tern a l aid s su c h a s m a p s, o r u s in g p a rts of th e b o d y to
d istin g u is h left fro m righ t, fo r ex am p le. L u ria reg ard s suc h fo rm s o f
reh a b ilita tio n a s m a k in g u se o f the in tra -sy stem ic co n cep tu a l re org a n isa -
tio n o f fu n ctio n .
E xa m p les o f in te r-sy stem ic reo rg an isa tio n a re d escrib ed in ca ses w h ere
p a tien ts n o t o n ly ha v e d i cu ltie s in g en era l visu al in teg ra tio n , b ut also in
rea d in g a n d w ritin g . W ith d i cu ltie s o f ge ne ral visu al in teg ra tio n ,
em ph a sis is p la ce d o n d ev elo p ing a ltern a tiv e k in aest h etic resp o n ses to a
ta sk (o n e ex a m p le g iv en is th e tra cin g o f o u tlin es o f th e o b jects b ein g
o b serv ed , i.e. u sin g a tact ile m o d a lity ).
L u ria ’ s ap pro a ch in trea tin g v isu a l a lex ia , i.e. the d isrup tio n o f
p erce p tio n of le tters o r w o rd s, is to train the pa tien t to rely o n tac tile
k in a esth etic p ro cess es ra th er th a n visu al m e an s. In o p tic litera l alex ia (i.e.
co n fu sio n o f letters sim ila r in o u tlin e), L u ria (1 94 8 / 19 6 3 ) n o te s th a t in o n e
ca se, ta ctile sca n n in g w a s in itia lly rep la ce d b y visu al scan n in g u n til th e
p a tien t co u ld reco g n ise th e lette rs h e h ad p rev io u sly fo rg o tten (p . 12 1 ).
H o w ev er, L u ria sta te s th a t co m p en sa tio n o f se vere o p tic ag n o sia (w h ere
th e p a tien t is a b le to id en tify on ly pro m in en t v isu al a spe cts), is la rg ely
d ep en d e n t on th e in ta ct v isu a l fu n ctio n s o f th e p a tien t. T h e la tter a llo w s
th e p a tien t to so lve p ro b lem s by g u essin g w h at th e w h o le v isu a l fo rm is,
a lth o u g h th e resid u a l a b ility m a y be o n ly to id en tify o n e co m p o n en t of a n
o b jec t. T h e em p ha sis o f reh a b ilitatio n , in th is c ase , th e refore , is to rep la ce
h a p h az a rd g u essing b y sy stem a tic a n a ly sis.
Speech F unctions
L u ria ’ s reh a b ilita tiv e tech n iqu e s fo r the re h ab ilita tio n o f sp eec h h a v e
b een de scrib ed elsew h ere (L u ria, 1 94 7 / 1 9 70 ); C h riste n sen , R a n d ru p
Je nse n , a n d R is b erg (19 8 9 ) p ro v id e a su m m a ry o f L u r ia ’ s n eu ro lin gu istic
th eo ry a n d ca se in fo rm atio n o f th e ev alua tio n p ro cess, a n d K a g a n a n d
S a lin g (1 9 92 ) o Œer a su m m a ry o f L u ria’ s de scrip tio n o f fu n ctio n a l
reo rg a n isa tio n in a p h a sia (p p . 7 0 ± 73 ). T h u s, o n ly a brief d iscu ssio n o f
sp eec h fu n ctio n s w ill b e p resen ted h ere . L u ria (1 94 8 / 1 9 63 ) b ro a d ly
reg a rd s resto ra tio n o f a rticu la ted sp eec h a s o ccu rrin g th ro u g h ``p ro fo u n d
fu n ctio n a l reco n stru ctio n , w ith th e tra n sfer of sp eech to th e lev el o f
co n scio us a ctio n an d su b seq u en t au to m a tiza tio n ’ ’ (p . 1 5 4). T h e rest ora -
tio n o f rece p tiv e lan g u a ge c an d iŒer w id ely in its in te rn al stru ctu re, th u s
L u ria b eliev es it is o n ly b y an a lysing th e sp eci® c asp ec ts o f th e in tern a l
stru ctu re o f th e d efect, th a t retra in in g is m a d e p o ssib le. In L u ria’ s v iew
th ere are tw o prim a ry d istu rb an ces o f rece p tiv e sp eech , n a m ely a

d istu rb a n ce in h ea rin g th e so u nd s o f sp eech , a n d a d istu rb a n ce in th e
u n d ersta n d in g o f co m p le x struc tu res o f sp eech .
In ter-sy stem ic fun c tio n in g ty p ica lly o ccu rs th ro u g h a u d io v isu a l cu ein g .
H o w ev er, in tra -sy stem ic re org a n isa tio n o cc u rs in a n u m b er o f d iŒeren t
w a y s. F o r ex am p le, in aŒe ren t m o to r a p h asia , d ue to a pra x ic d istu rb an c es,
th e m a in d i cu lty is in th e u se o f co rrect in tern al artic u la to ry p a ttern s
su ch th at a letter is u su ally rep la ced b y a n o th er letter o f sim ila r
a rticu la tio n . T h u s, re sid u a l fu n ctio n s a re u sed to tra in th e p a tien t to
p ro d u ce th e req u ired so u n d s. H o w ev er, in eŒeren t m o to r ap ha sia (w h ere
th e seq u en ce o f so u n d s form in g ph o n etic p a ttern s a re d isin teg ra ted ),
em ph a sis is plac ed o n sim p le so u n d co m b ina tio n a n d ex te rna l aids su ch a s
su p p o rtiv e g estu res, b u ild in g w o rd s from in d iv id u a l cu t-o u t letters, a n d
® n a lly th e a n a ly sis of m o rp ho lo gica l a n d sem a n tic asp ec ts o f w o rd s. W ith
rec ep tiv e lan g u a ge d i cu lties o f p h o n e m ic so un d s (sen so ry a p h a sia ),
em ph a sis is p la ced o n retra in in g th e p a tien t to a n a ly se so u n d co m p o sitio n
o f w o rd s co rrec tly a n d to d ev elo p a c on sta n t classi® ca tio n o f th e so u n d s
in to g rou p s. T y p ica lly th is req u ires resto ra tio n o f th e p a tie n t’ s p h o n em ic
h ea rin g , b y u sin g w o rd m ea n in g s, w ritin g (i.e. u sin g lette rs to d iŒeren tia te
so u n d s) a n d u sin g o th er sig ns (e .g . v isu a l d ep ictio n s of a rticu lato ry
p h en o m e n a, o r tact ile ex p erien ces, suc h a s to u ch in g th e la ry nx w h ile
p ro d u cin g so u n d s) to aid in th e reco g n itio n o f so u n d s.
T o e sta b lish th e m e an in g o f w o rd s , p re cise so u n d d e® n itio n is
em ph a sised as w ell a s co n so lid a tin g m ea n in g b y visu al a id s a nd b y
co m p a riso n o f w o rd s w ith sim ilar sou n d s b ut d iŒeren t m ea n ing s. F in ally ,
w o rd fam ilie s an d sem a n tic c ateg o ries are w o rk e d o n . T o facilita te
g en era lisation , lea rn in g th e w o rd w ith d iŒeren t in ton a tio n s is a lso use d ,
a n d / o r a n a ly sin g w o rd s in to co m p o n en t pa rts.
If th ere is disturb a n c e o f th e g ram m atica l form s o f sp eech , w h ile
in d ividu al w o rd s a n d u n d ersta n d in g o f p h ra ses rem a in in ta ct (se m a n tic
a p h a sia ), th e em p h a sis is o n tea ch in g th e p a tie n t to un d erst an d in ¯ ectiv e
a n d p rep o sitio n a l c o n struc tio n s, eith e r thro u g h v erb a l a n a ly sis o r th ro u g h
v isu a l a id s. L u ria n otes, h o w ev er, th a t th is fo rm o f resto ra tio n o f fu n ctio n
is ra rely fu lly in tern a lised in a n a u tom a tic m a nn e r.
In w ritin g d istu rb a n ces (ty p ica lly asso cia ted w ith a Œeren t m o to r
a p h a sia ) a co u stic a n d k in a esth etic p ro ce sses m a y b e d istu rb ed a n d m o re
ra rely , th e v isu a l a n d m o to r im a g e reten tio n o f letters. T h u s, resto ra tion o f
fu n ctio n is d e pe n de n t o n th e co rrec t a n a ly sis o f w h ich a sp ect o f w ritin g is
d istu rb ed , fo r eŒective reh a b ilita tio n to o ccu r. In sen so ry a p h a sia , w h ere
th ere is d i cu lty in d istin g u ish in g b etw ee n p h o n em e s, v isu a l id eo g ra m s a re
u su a lly p reserv ed a n d th ese a re th u s u se d to a ssist in th e rec og n itio n o f
so u n d s a n d le tters to w h ich th ey co rresp o n d . In aŒe ren t m o to r a p h a sia ,
L u ria fo u n d th e u se o f visu al a n a ly sis (to id e ntify th e sh ap e o f th e
a rticu la to ry ap pa ra tu s), w h en m ak in g th e co rres p o nd in g v erb a l a rticu la -

tio n s to b e u sefu l. In eŒeren t m o to r a p ha sia , th e m a in d e fect in w ritin g is
th e lo ss o f th e sou n d p a tte rn o f th e w h o le w o rd , alth o u g h in d iv id u a l letters
fro m d ic tio n rem a in in ta ct. E m p h a sis in tre atm e nt , th erefo re, is p la ced o n
w ritin g after sp eak in g in th a t th is b yp a sses th e rec all o f an in tern a l w o rd
p a ttern . In so m e ca ses, L u ria n o tes tha t th is en a b led th e p a tien t to b ec o m e
in d irectly aw a re o f th e so u n d p a ttern o f w o rd s a n d , th erefo re, to lea rn to
w rite m o re q u ick ly b y w h isp erin g to h im self.
F rontal F unctioning
F ro n tal lo b e lesio n s, ty p ica lly in th e p rem o to r area , a re ch a ra cterise d b y
L u ria (1 9 4 8/ 19 6 3 ) a s re su ltin g in th e lo ss o f ``sp o n tan eo u s th o u g ht’ ’ , su ch
th a t p re serv ed co gn itiv e fun c tio n s can n o t b e eŒe ctiv ely u tilise d, a lth o u g h
th e lo g ica l stru ctu re o f a bstra ct rea so n in g is in ta ct. In essen ce, L u ria
reg a rd s th e p erso n as h a v in g a n in a b ility to cre ate an in n er p la n o f
th in k in g w h ich h e d escrib es a s th e in a b ility to crea te ``certa in in tern a l
d y n a m ic p a ttern s fo r p ro d u cin g sm oo th ¯ ow in g k in etic m elod ies a n d
in tern a l sp ee ch w h ich . . . is esse n tia l fo r fu lly d e v elo p ed th o u gh t’ ’ (p. 21 2 ).
L u ria ’ s trea tm en t re co m m en d a tio n is to en co u ra g e n a rrative sp eec h b y
p ro v id in g ex te rn al stru ctu rin g, fo r e xa m p le, p ro m p tin g th e p a tien t a n d
th en a sk in g th e pa tien t to im a g ine h e o r sh e is ta lk in g to a pe rso n a sk in g
th ese q u e stio n s. A n o th er o p tio n is to su g g est a serie s o f `àu x ilia ry sign s’ ’ ,
su ch a s v isu a l a id s, p lan n in g, an d stru c tu ring c on tex ts, e tc ., to serv e a s
``p eg s’ ’ o n w h ic h to ``h a n g th e n a rrative ’ ’ (p. 2 1 3 ).
S ev ere (esp ec ia lly b ilatera l) fro n ta l lo b e le sio n s resu lt in , (1 ) la ck o f
a w a ren ess, (2) in a bility to co n cen tra te o n `ìn te rna l in ten tio n ’ ’ (p . 2 35 ), (3 )
d istu rb a n ces in self-m o nitorin g , a n d (4 ) distu rb an ce s in go a l-d irected
a ctiv ity . T h u s, th e p atie n t is o ften reg a rd ed b y o th ers a s la ck in g in
m o tiv a tio n , b e in g im p u lsiv e in ta sk co m p letio n , a nd a s h a v in g u n d erg o n e
a p ro fo u n d p erso n a lity ch a n g e. T h ese c h an g es c rea te gre at d i cu lties in
reh a b ilita tio n eŒo r ts, a lth o u g h th e tech n ica l sk ills req u ire d b y th e p a tien t
fo r task c om p letio n a re in ta ct. T h e reh a b ilitative fo cu s is, th erefo re, to
rep lac e th e la ck o f in ter n al stru ctu re b y p r o vidin g ex tern a l stru ctu re. T h is
o ccu rs in th e fo rm o f m on ito rin g w h ich L u ria lik en s to th a t req u ir ed a t a n
ea rlier d ev elo p m e nta l pe rio d (p rio r to ag es 4± 7 ), i.e . w h en th e fro n tal lo b es
h a v e n o t y et co m p lete d th eir n eu ro n a l d iŒeren tia tio n . F ig u re 4 p ro v id es a n
ea rly ex a m p le o f o n e o f th e reh a bilita tio n eŒo rts m ad e fo r a fro nt al p a tien t
(L u ria , 19 4 8 / 19 6 3 ).
F in a lly , a lth o u g h L u ria d o es n o t ex p licitly d ea l w ith th e reh a b ilita tio n
o f a tten tio n a n d m e m o ry d e® cits, it is a p p a ren t th a t h is a p p ro a ch , i.e. o n e
b a sed o n a so un d e va lu a tio n o f th e p rim ary p ro b lem , w ill b e sim ila r to
th a t de scrib ed a b o v e. T y p ica lly, th e reh a bilita tio n p ro ced u re a d h ered to b y
F I G . 4. E x a m p le o f fr o n ta l p a tie n t’ s re h a b ilita tio n e Œo r ts (L u r ia 1 9 6 3 , p . 2 5 1 ). R e p r in te d

w ith p e r m iss io n .
L u ria in v o lv ed a 2 ± 3 m o n th tra in ing p erio d (in v o lv in g fam ily m e m b ers

w h en n e ed ed ), a t th e co m p letio n o f w h ich the p a tien t w a s sen t h o m e to
a llo w for in teg ra tio n o f lea rn in g. W h ile at h o m e th e p atie nt a nd fam ily
w o u ld m ak e reg u la r v isits to th e reh a b ilita tio n u n it. T h er eafter, th e p a tien t
w o u ld b e read m itted to th e reh a b ilita tio n u n it fo r a few w eek s to re in fo rce
p rev io u s train in g . L u ria w as co n sisten tly of th e o p in io n th a t u ltim ate ly th e
p a tien t sh o uld return to a p ro d u ctiv e so cia l a n d w o rk en viro n m en t a s so o n
a s po ssib le.
It is n o tew o rth y th at cu rren tly in reh a b ilitation litera tu re, L u ria ’ s
co n trib u tio n s a re eith er im p lic itly o r ex p lic itly a ck n o w le dg ed . F o r
ex a m p le , in re cen t litera tu re, co n scio us a w a ren ess a n d its im p lic atio n fo r
n ew lea rn in g h a s co m e u n d er in crea sed scru tin y a s a n im p o rtan t v a ria b le
in ¯ u en cin g th e e ca cy o f th e reh a b ilita tio n p ro cess (e.g . P rig a ta n o &
S ch a cter, 1 99 1 ). F u rth erm o re, c erta in settin g s, an d in p a rticu lar, a t th e
C en ter fo r R eh ab ilita tio n o f B ra in In ju ry (C h risten sen & T ea sda le , 1 99 5 ),
a L u ria n -b a sed a p p ro a ch is, in p a rt, a d h ered to fo r th e ev alu atio n o f a n d

trea tm en t p la n n in g o f in d iv id u a l p a tien ts.
C ONC L USIO N
L u ria o Œered a u n iq u e c on trib u tio n to n eu ro p sy ch o lo g y in th a t h e
p ro v id ed a m o d el fo r th e c o nc ep tu a lisa tio n o f co m p le x co g n itiv e a ctiv ity ,
a llo w in g th e m o st co m p lica ted h u m an o rga n to b e u n d ersto o d fu n ctio n -
a lly . P rib ra m (19 7 8 ) n o tes th a t ``h e re la te d p h y sio lo g y a n d p sych o log y in a
tru ly d ia le ctic fa sh io n , to tra n scen d th e d u a lity o f m in d a n d b ra in in a
so p h istica te d sing le discip lin e’ ’ (p . 1 3 7). H is ap p ro ach a llow ed fo r th e
ev a lu a tio n an d th e reh a b ilitatio n o f b rain inju ry to b e u n d ersto o d fro m a
co m p re he n siv e th eo retical b a sis, a n d a s su ch , p ro vide d th e fo u n d a tio n fo r
th e co n tem po ra ry co n tex t o f reh a b ilita tio n. G o ld b erg (1 99 0 ) n o te s tha t h e
co n trib u ted `à lo gic o f ex a m in a tio n w hich in sp ite o f its m eth od o lo g ica l
lo o sen e ss . . . o Œers a n ex trem ely sy stem a tic in tern al o rga n iz ation a n d
d im en sio n a liza tion o f co g n itio n b ec au se it is ro o te d in a co h esiv e b ra in ±
b eh a v io u ra l m o d e l’ ’ (p . 8 ). F u rth erm o re, co n cern in g h is reh ab ilita tiv e
m e th o d s, P rig ata n o et a l. (1 9 8 6) n o te th a t, `Ìt is by fa r th e m o st m o d ern
v iew th a t h a s b ee n p ro d u ced in th e scien ti® c litera tu re. Still, n o sy stem a tic
b o d y o f resea rch h as tested L u ria’ s rev o lution a ry an d h eu ristic co n ce p ts’ ’
(p . 5 4).
N a tu rally , sin ce th e tim e o f L u ria ’ s w ritin gs, th ere h a v e b een fu rth er
a d v an ce s in b ra in resea rch a n d fu rth er v a ria tio n s o n m o d els o f b ra in
fu n ctio n in g , an d th e trea tm en t o f b ra in in ju ry . T h ese c u rren t a d v an ces in
rese arch , in a s m uc h a s th ey co n tin u e to p r ov id e a co h eren t th eo ry o f
b ra in fu nc tio n an d ex p a n d o n clin ica l u sefuln ess, a re ve ry m u c h in th e
sp irit o f A lex an d er R o m a n o v itsch L u ria. T h e leg ac y o f A . R . L u ria h a s
p ro v id ed , a n d n o d o u b t w ill c o ntinu e to p ro v id e, a n im p etus fo r fu tu re
ex p a n sio n in th e ® eld .
A s L u ria (1 97 4 ) h im self sta te d : ``. . . w h ile p eo p le co m e an d g o , th e so lid
w o rk rem ains, a n d . . . th e w o rk w h ich h as be en a cco m p lish ed th ro u g h th e
eŒo rts o f th e in divid u a l in v estig a to r w ill b e co n tin u ed in th e fu tu re b y
v irtu e o f its o w n intern a l lo g ic . I ca n on ly h o p e tha t this w ill be th e resu lt
in m y ow n ca se.’ ’ (p. 2 8 8 ).
R EFER ENC ES
C h r is te n s e n , A -L . (1 9 8 4 ). L u r ia ’ s n e u r o p s y c h o lo g ic a l in v e s tig a tio n (2 n d e d .). C o p e n h a g e n :
M un ksga ard.
C h r is te n s e n , A -L . (1 9 8 6 ). A p p ly in g L u r ia ’ s th e o r y to th e re h a b ilita tio n p r o c e ss o f b r a in
d a m a g e . I n B . U z z e ll & Y . G r o s s (E d s .), C lin ica l n e u r o p sy c h o lo g y o f in te rv e n tio n (p p . 1 6 9 ±
1 7 7 ). B o s to n : M a r tin u s N ijh o Œ.
C h r is te n s e n , A -L . (1 9 8 9 ). T h e n e u r o p s y c h o lo g ic a l in v e s tig a tio n as a th e r a p e u tic an d

r e h a b ilita tiv e te c h n iq u e . I n D .W . E llis & A -L . C h r is te n s e n (E d s .), N e u r o p s y c h o lo g ic a l
tr e a tm e n t a fte r b r a in in ju r y (p p . 1 2 7 ± 1 5 6 ). B o st o n : K lu w e r A c a d e m ic P u b lis h e r s.
C h r is te n s e n , A -L ., M a lm r o s, R ., & T ow nes, B .D . (1 9 8 7 ). R e h a b ilita tio n p la n n e d in
a c c o r d a n c e w ith th e L u r ia n e u r o p sy c h o lo g ica l in v e s tig a tio n : A c a s e h is to r y o f a p a tie n t
w ith le ft-s id e d a n e u r ism . N e u r o p s y c h o lo g y , 1 , 4 5 ± 4 8 .
C h r is te n s e n , A -L ., R a n d r u p J e n s e n , L ., & R isb e r g , J . (1 9 8 9 ). L u r ia ’ s n e u ro p s y c h o lo g ic a l a n d
n e u r o lin g u is tic te s tin g . J o u r n a l o f N e u r o lin g u is tic s , 4 , 1 3 7 ± 1 5 4 .
C h r is te n s e n , A -L ., & T e a sd a le, T .W . (1 9 9 5 ). A c lin ic a l a n d n e u r o p s y c h o lo g ica l led p o s t-a c u te
r e h a b ilita tio n p r o g ra m m e . I n M .A . C h a m b e r la in , V .C . N e u m a n , & A . T e n n a n t (E d s .),
T r a u m a tic b r a in in ju r y r e h a b ilita tio n : I n itia tiv e s in s e r v ice d e liv e r y , tr e a tm e n t a n d m e a s u rin g
o u tc o m e (p p . 8 8 ± 9 8 ). N e w Y o r k : C h a p m a n & H a ll.
G o ld b e r g , E . ( 1 9 9 0 ). T r ib u te to A lex a n d r R o m a n o v ic h L u r ia (1 9 0 2 ± 1 9 7 7 ). In E . G o ld b e r g
(E d .), C o n t e m p o r a r y n e u r o p s y c h o lo g y a n d th e le g a c y o f L u r ia . H ills d a le , N J ; L a w r e n c e
E r lb a u m A s s o c ia te s I n c .
K a g a n , A ., & S a lin g , M .M . (1 9 9 2 ). A n in tr o d u c t io n to L u ria ’ s a p h a sio lo g y : T h e o r y a n d
a p p lica tio n (r e v . e d .). B a ltim o re : P a u l H . B ro o k e s .
K o lb , B ., & W is h a w , I .Q . ( 1 9 9 0 ). F u n d a m e n ta ls o f h u m a n n e u r o p s y c h o lo g y (3 r d e d .) . N e w
Y o r k : W .H . F r e e m a n & C o .
L u ria , A .R . (1 9 3 2 ). T h e n a tu re o f h u m a n c o n ¯ ict s. (R e p r in te d 1 9 7 6 ). N e w Y o r k : L iv e r ig h t.
L u ria , A .R . (1 9 6 3 ). R e s to r a tio n o f f u n c tio n a fte r b ra in in ju ry ( B a s il H a ig h , T ra n s .). L o n d o n :
P e rg a m o n P r e s s (O r ig in a l w o rk p u b lis h e d , 1 9 4 8 ).
L u ria , A .R . (1 9 6 6 ). H ig h e r c o rt ica l fu n c tio n s in m a n . (r e v . e d .) (B a s il H a ig h , T r a n s.). N e w
Y o r k : B a s ic B o o k s . (O r ig in a l w o r k p u b lis h e d 1 9 6 2 )
L u ria , A .R . (1 9 7 0 ). T r a u m a tic a p h a s ia : It s s y n d r o m e s , p s y c h o lo g y a n d tr e a tm e n t (D o u g la s
B o w d e n , T ra n s .). T h e H a g u e : M o u to n (O rig in a l w o r k p u b lis h e d , 1 9 4 7 ).
L u ria , A .R . (1 9 7 3 ). T h e w o r k in g b r a in : A n in tro d u c tio n to n e u r o p s y c h o lo g y (B a s il H a ig h ,
T r a n s .). N e w Y o r k : P e n g u in B o o k s .
L u ria , A .R . (1 9 7 4 ). A .R . L u r ia . I n G . L in d z e y (E d .), A h is to ry o f p sy c h o lo g y in a u to -
b io g r a p h y . V o l. 6 (p p . 2 5 1 ± 2 9 2 ). N e w Y o r k : R u s s e l & R u s s e l.
L u ria , A .R . (1 9 7 6 ). T h e lif e o f a p s y c h o lo g ist in r e tr o s p e c t. U n p u b lis h e d m a n u s c rip t.
L u ria , A .R . (1 9 7 9 ). T h e m a k in g o f m in d . I n M . C o le & S . C o le (E d s.) , T h e m a k in g o f m in d :
A p e r s o n a l a c c o u n t o f S o v iet p s y c h o lo g y (p p . 1 7 ± 1 8 8 ). C a m b r id g e : H a r v a r d U n iv e r s ity
P ress.
L u ria , A .R . (1 9 8 4 ) . I n tr o d u c tio n . I n A -L . C h ris te n s e n , L u r ia ’ s n e u r o p s y c h o lo g ic a l in v e s tig a -
tio n (2 n d e d .). C o p e n h a g e n : M u n s k g a a r d .
L u ria , E . (1 9 9 0 ). T h e s to r y o f th e lif e o f A le x a n d e r R o m a n o v itc h L u r ia . I n H . F o r c h h a m m e r
(E d .), L u r ia le c tu r e s : S o v iet c o n tr ib u tio n s o f 1 9 9 0 (p p . 1 1 ± 1 9 ). C o p e n h a g e n : H a n s R e itz e ls
F o rla g .
L u ria , A .R ., N a y d in , V .I ., T sv e tk o v a , L .S ., & V in a r s k a y a , E .N . (1 9 6 9 ). R e s to r a tio n o f
h ig h e r c o rt ica l fu n c tio n fo llo w in g lo c a l b r a in d a m a g e . I n P .J. V in k e n & G .W . B r u y n
(E d s.), H a n db oo k of c lin ic a l n e u ro lo g y (p p . 3 6 8 ± 4 3 3 ). A m s te r d a m : N o rth H o lla n d
P u b lis h in g C o .
M e c a c c i, L . ( 1 9 7 9 ). B r a in a nd h ist o r y : The re la tio n s h ip b e tw e e n n e u r o p h y s io lo g y and
p sy c h o lo g y in so v iet r e s e a r c h (H e n r y A . B u c h te l, T ra n s .). N e w Y o r k : B r a u n n e r / M a z e l
(O rig in a l w o r k p u b lis h e d , 1 9 7 7 ) .
P r ib r a m , K .H . (1 9 6 6 ). P re fa c e . I n A .R . L u r ia . H u m a n b r a in a n d p s y c h o lo g ic a l p r o c e s se s (B a s il
H a ig h , T r a n s .). N e w Y o r k : H a r p e r & R o w (O r ig in a l w o rk p u b lis h e d , 1 9 6 3 ).
P r ib r a m , K .H . (1 9 7 8 ) . O b itu a ry Ð I n m e m o r y o f A le x a n d e r R o m a n o v its c h L u ria . N e u r o -
p sy c h o lo g ia , 1 6 , 1 3 7 ± 1 3 9 .
P r ig a ta n o , G .P ., F o r d y c e , D .J ., Z e in e r, H .K ., R o u e c h e , J .R ., P e p p in g , M ., & W o o d , B .C .
(E d s.). (1 9 8 6 ). N e u r o p sy c h o lo g ica l r e h a b ilita tio n a ft e r b r a in in ju r y . B a ltim o r e : Johns
H o p k in s U n iv e r s ity P r e ss .
P r ig a ta n o , G .P ., & S c h a c t e r, D .L . (E d s .). (1 9 9 1 ). A w a r e n e s s o f d e ® c it a fte r b r a in in ju r y :
C lin ic a l a n d th e o r e t ica l iss u e s . N e w Y o r k : O x fo r d U n iv e r sity P r e s s .
S o h lb e r g , M .M ., & M a te e r , C .A . (1 9 8 9 ). In tr o d u c tio n to c o g n itiv e r e h a b ilit a tio n : T h e o r y a n d
p ra c tic e . N e w Y o r k : G u ilfo r d P re s s .

Christensen - Luria and Neuropsychological Rehabilitation

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Christensen - Luria and Neuropsychological Rehabilitation

Încărcat de

Drepturi de autor:

Formate disponibile

N E U R O P S Y C H O L O G I C A L R E H A B I L I T A T I O N , 1 9 9 6 , 6 (4 ), 2 7 9 ± 3 0 3

A n n e -L ise C h r iste n se n a n d C a rla C a e ta n o

ea rlier w o rk w h ich w a s in cro ss-cu ltu ra l a n d d ev elo p m en ta l p sy ch o lo g y ,

L UR IA’S C ONTEM P OR AR Y M IL IEU: C UL TUR AL,

tra d itio n , esp ec ia lly th o se w o rks w hich criticised th e lim itatio n o f

L UR IA’S INTELL EC TUAL INF L UEN C ES

th e ® rst g en era tio n o f So v ie t p syc ho lo gists. L u ria reco u n ts th a t th e

v isce ral resp o n ses . T h ese ex p erim en ts resu lted in o n e o f h is e a rliest

u n d ersta n d in g o f bra in fu n ctio n in g a nd , a s su c h, to th e ev a lu a tio n a n d

L UR IA’S M OD EL OF B R AIN FUN C TIO NIN G

The F unctional Units

FIG. 1. T h e th r e e fu n c tio n a l u n its .

th e m e dia l su rfa ces o f th e ce reb ra l h em is p h eres; it is g en era lise d in its

reg u la tes b e ha v io u r. T h e tertia ry a rea s, in p a rticu la r, a re reg a rd ed a s

L UR IA’S EVAL UATION M ETH OD

m a k e u p th e ac tiv ity m u st b e d esc rib ed an d ``th e n e u ro d yn a m ic co n d itio n s

T h e in v estig a tio n th a t fo llo w ed (co n d u cted b y L u ria ) w a s d o n e in a n

rec en tly b ee n o p era ted u p on . L .S . T sv etk o va w a s in ch a rg e o f th is ``u n it’ ’

L UR IA ’S R EH AB IL ITA TIO N M ETH O D

in E ng lish (1 9 6 3), a n d a n article b y L u ria , N a yd in , T sv etk o v a, a n d

in a n a u to m a tic m a n n er. (4 ) U se feed b a ck co n sta n tly to p ro v id e p a tien ts

Elementary Intra- systemic R eorganisation

Intra- systemic C onceptual R eorganisation

Inter- systemic R eorganisation

d estru ction o f th e an terio r cen tra l g y ru s, co m p en sat io n is reg a rd ed b y

a m o to r ac t, L u ria su g g ests th a t if a ta sk is form u la ted d iŒeren tly (i.e.

``G nostic’’ ( P erceptual Integration) F unctions

v isu a l p erc ep tio n to m a k e p o ssib le a co n scio u s a n a ly sis o f th e fu n d a m en ta l

th ere are tw o prim a ry d istu rb an ces o f rece p tiv e sp eech , n a m ely a

a rticu la to ry ap pa ra tu s), w h en m ak in g th e co rres p o nd in g v erb a l a rticu la -

F I G . 4. E x a m p le o f fr o n ta l p a tie n t’ s re h a b ilita tio n e Œo r ts (L u r ia 1 9 6 3 , p . 2 5 1 ). R e p r in te d

L u ria in v o lv ed a 2 ± 3 m o n th tra in ing p erio d (in v o lv in g fam ily m e m b ers

a L u ria n -b a sed a p p ro a ch is, in p a rt, a d h ered to fo r th e ev alu atio n o f a n d

C h r is te n s e n , A -L . (1 9 8 9 ). T h e n e u r o p s y c h o lo g ic a l in v e s tig a tio n as a th e r a p e u tic an d

S-ar putea să vă placă și