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gait inappropriately in our opinion, because the term apraxia is best used to describe psychic inability to carry out a commanded or learned motor task, not an ingrained one (page 48) What is meant by these terms has never been clearly speci ed, but broadly speaking, they signify a loss of the ability to use the lower limbs in the act of walking that cannot be explained by weakness, loss of sensation, or ataxia The patient retains these fundamental motor and sensory functions when examined in bed and can even make motions that simulate walking while seated or reclining As detailed in Chap 7, the resultant pattern is a slowed, slightly imbalanced, and short-stepped gait with the torso and legs not properly in phase when placed in motion, to which may be added the feature of magnetic gait, where one or both feet appear to be stuck to the ground as the body moves forward Probably the basal ganglia and their connections to the frontal lobes are involved in these cases As mentioned, the steps are shortened to a shuf e and balance is precarious; with further deterioration, the patient can no longer walk or even stand (a condition called astasia-abasia) Cerebral paraplegia in exion is the end stage; the affected individual lies curled up in bed, unable even to turn over (see Chap 7 for further discussion) Less is known about the extreme degrees of hyperactivity ( organic drivenness ) induced in the macaque by bilateral lateralorbital lesions and occasionally observed in humans after encephalitis or trauma, as noted below Possibly, compulsive behavior (including tic) is related in some manner to this state and more particularly to caudatal-frontal lesions In many instances, patients with frontal lobe lesions are inclined to manipulate objects placed before them (utilization behavior) or to imitate the gestures of others Incontinence is another manifestation of frontal lobe disease Right- or left-sided lesions involving the posterior part of the superior frontal gyrus, the anterior cingulate gyrus, and the intervening white matter result in a loss of control of micturition and defecation (Andrew and Nathan) There is no warning of fullness of the bladder or of the imminence of urination or bowel evacuation, and the patient is surprised at suddenly being wet or soiled Less complete forms of the syndrome are associated with frequency and urgency of urination during waking hours The patient is embarrassed unless an element of indifference is added when the more anterior (nonmotor) parts of the frontal lobes are the sites of disease In the spheres of speech and language, a number of abnormalities other than Broca s aphasia appear in conjunction with disease of the frontal lobes laconic speech, lack of spontaneity of speech, telegraphic speech (agrammatism), loss of uency, perseveration of speech, a tendency to whisper instead of speaking aloud, and dysarthria These are more prominent with left-sided lesions and are fully described in Chap 23 In sum, one can say that all parts of the frontal lobes are involved in all spheres of motor activity, from the planning stages to ultimate execution This applies not only to willed movement but to all postural reactions and habitual activity as well Cognitive and Intellectual Changes In general, when one speaks of cognitive and behavioral aspects of frontal lobe function, reference is made to the more anterior (prefrontal) parts rather than the motor and linguistic parts Here one faces a paradox These most recently developed parts of the human brain, sometimes called the organ of civilization, have the most elusive functions The effects of lesions of the frontal lobes were rst divulged.

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