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dyscalculia is usually associated with the other elements of the Gerstmann syndrome Computational dif culty may also be part of the more complex visuospatial abnormality of the nondominant parietal lobe; there is then dif culty in the placing of numbers in speci c spatial relationships while calculating In such cases, there is no dif culty in reading or writing the numbers or in describing the rules governing the calculation, but the computation cannot be accomplished correctly with pencil and paper Hecaen has made a distinction between this type of anarithmetia and dyscalculia; in the latter, the process of calculation alone has been disturbed; in the former, there is an inability to manipulate numbers and to appreciate their ordinal relationships Recognition and reproduction of numbers are intact in both An analysis of how computation goes awry in each individual case is therefore required Lesions of the superior parietal lobule may interfere with voluntary movement of the opposite limbs, particularly the arm, as pointed out by Holmes In reaching for a visually presented target in the contralateral visual eld and to a lesser extent in the ipsilateral eld, the movement is misdirected and dysmetric (the distance to the target is misjudged) This disorder of movement, mentioned above in the general discussion of parietal signs and sometimes referred to as optic ataxia, resembles cerebellar ataxia and may be explained by the fact that cortical areas 7 and 5 receive visual projections from the parastriate areas and proprioceptive ones from the cerebellum, both of which are integrated in the multimodal parietal cortex Areas 5 and 7, in turn, project to frontal areas 6, 8, and 9, where ocular scanning and reaching are coordinated Ideomotor and Ideational Apraxia As discussed extensively in Chap 3, patients with parietal lesions of the dominant hemisphere who exhibit no defects in motor or sensory function lose the ability to perform learned motor skills on command or by imitation They can no longer use common implements and tools, either in relation to their bodies (eg, brushing teeth, combing hair) or in relation to objects in the environment (eg, a doorknob or hammer) The patient holds the implement awkwardly or seems at a loss to begin the act It is as though the patient had forgotten the sequences of learned movements The effects are bilateral It is of interest that, in both agraphia and acalculia, the motor defect is intertwined with some of these agnosic defects; hence the term apractognosia seems appropriate for the combined problem From the above descriptions, it is evident that the left and right parietal lobes function differently The most obvious difference, of course, is that language and arithmetical functions are centered in the left hemisphere It is hardly surprising, therefore, that verbally mediated or verbally associated spatial and praxic functions are more affected with left-sided than with right-sided lesions It must also be realized that language function involves cross-modal connections and is central to all cognitive functions Hence cross-modal matching tasks (auditory-visual, visual-auditory, visual-tactile, tactile-visual, auditory-tactile, etc) are most clearly impaired with lesions of the dominant hemisphere Such patients can read and understand spoken words but cannot grasp the meaning of a sentence if it contains elements of relationship (eg, the mother s daughter versus the daughter s mother, the father s brother s son, Jane s complexion is lighter than Marjorie s but darker than her sister s ) There are similar dif culties with calculation, as just described The recognition and naming of parts of the body and the distinction of right from left and up from down are learned, verbally mediated spatial concepts that are disturbed by lesions in the dominant parietal lobe.

eight minutes for an operational management person and the difference has nothing to do with any sort of difference in knowledge base It has to do with the types of data The C level, they are looking to get the information that they need and then go manage and grow the business They don t get the big bucks for sitting and taking hours out of their day to understand the metrics of their business Their responsibilities are to run the business so the two to three minutes is all they can afford or their time is not being spent wisely As for the operational management this person is going to have a more detailed dashboard with more specific information around the execution of their business processes and therefore will require more time to understand and probably start to dig deeper into the details and statistics behind the information This could also link to having additional drilldown reports available linked to this dashboard or possibly drill-through reports that could be used So, let s not take our time and develop a dashboard that makes you feel as though you re sitting for the SATs each time you go to read it

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Visual Disorders with Parietal Lesions A lesion deep to the inferior part of the parietal lobe, at its junction with the temporal lobe, involves the geniculocalcarine radiations and result in an incongruous homonymous hemianopia or an inferior quadrantanopia; but just as often, in practice, the defect is complete or almost complete and congruous An alexia or components of the Gerstmann syndrome may be associated If the lesion is small and predominantly cortical, optokinetic nystagmus is usually retained; with deep lesions, it is abolished, with the target moving ipsilaterally (see Chap 14) From time to time, severe left-sided visual neglect results from a lesion in the right angular gyrus (see Mort and colleagues) The problem in its more severe forms is evident from casual observation of the patient s behavior or in drawings made by the patient which omit features on the left side; but here a more pervasive syndrome of hemispatial neglect, discussed earlier, may be responsible In keeping with others, the aforementioned authors have con rmed that visual neglect can occur after focal lesions in the posterior medial temporal lobe (supplied by the posterior cerebral artery, in contrast to the middle cerebral artery supply of the angular gyrus of the inferior parietal lobule); however, they also maintain, on the basis of MRI studies in stroke patients, that lesions in the the superior temporal lobe, previously implicated, are not responsible for visual neglect With posterior parietal lesions, as noted by Holmes and Horrax, there are de cits in localization of visual stimuli, inability to compare the sizes of objects, failure to avoid objects when walking, inability to count objects, disturbances in smooth-pursuit eye movements, and loss of stereoscopic vision Cogan observed that the eyes may deviate away from the lesion on forced lid closure, a spasticity of conjugate gaze ; we have been able to elicit this sign only rarely Visual Disorientation and Disorders of Spatial (Topographic) Localization Spatial orientation depends on the integration of visual, tactile, and kinesthetic perceptions, but there are instances in which the defect in visual perception predominates Patients with this disorder are unable to orient themselves in an abstract spatial setting (topographagnosia) Such patients cannot draw the oor plan of their house or a map of their town or of the United States and cannot describe a familiar route, as from home to work, for example, or nd their way in familiar surroundings In brief, such patients have lost topographic memory This disorder is almost invariably caused by lesions in the dorsal convexity of the right parietal lobe, and it is separable from the anosognosia discussed earlier A common and striking disorder of motor behavior of the eyelids is seen in many patients with large acute lesions of the right parietal lobe Its mildest form is a disinclination to open the lids when spoken to This gives the erroneous impression that the patient is drowsy or stuporous, but it will be found that a quick reply is given to whispered questions In more severe cases, the lids are held shut and opening is strongly resisted, to the point of making an examination of the pupils and fundi impossible Auditory Neglect This defect in appreciation of the left side of the environment is less apparent than is visual neglect, but it is no less striking when it occurs Many patients with acute right parietal lesions are initially unresponsive to voices or noises on the left side, but the syndrome is rarely persistent Special tests, however, demonstrate, in many of these patients, a displacement of the direction of the perceived origin of sounds toward the left This defect.

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