BRAIN AND COGNITION 2, 12!

+134 (1983)

Comments on a Standardized Version of Luria’s Tests

T. V. AKHUTINA AND L. S. TSVETKOVA

Moscow University

Appreciation is expressed for the work of Golden’s group in the selection of

Luria’s tests, the standardization of their administration, the collection of norms,
and the evaluation of the reliability and validity of the Luria-Nebraska test
battery. However, questions are raised concerning the ability of the test to
efficiently handle topical diagnosis and to construct rehabilitation programs. Concern
is expressed over the possible vulgarization of Luria’s doctrine of functional
systems and the loss of predictive power in Luria’s tests through neglect of
qualitative information and methodology. Suggestions are made as to how Luria’s
qualitative methodology might be incorporated in a standardized version of a
neuropsychological examination.

Charles J. Golden and his coauthors in 1978-1979 published a series

of articles on a standardized neuropsychological battery derived from
tests developed by A. R. Luria. Using Smith’s (1975) analysis, the Golden
group identify four major tasks for psychological testing in brain-injured
patients: (1) as an aid in diagnosis; (2) the establishment of baseline data;
(3) estimation of a patient’s prognosis; and (4) assistance in the design
of rehabilitation programs (Golden, 1979, 1980; Golden, Hammeke, &
Purish, 1978; Hammeke, Golden, & Purish, 1978). An assumption is
made that the above tasks can be accomplished most effectively by
procedures involving both qualitative and quantitative approaches.
Luria believes that overt behavior is a result of cooperation among
different areas of the brain. The pattern of interacting areas responsible
for given behavior is called a functional system. Each area of the brain
participates as a rule in several functional systems, making its own specific
contribution (“factor” in Luria’s terms) to system functioning. Hence,
the injury of any brain area results in disturbance of those functional
areas which are within the injured area. Thus a functional system may
be disturbed as a result of an injury to any brain area which participates

Editorial assistance and text revisions were provided by Ellen Genrich Rusling. Requests
for reprints should be sent to Dr. Tatiana Akhutina, Psychology Department, Moscow
University, pr. Marxa, 18 Moscow, USSR.

129
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Copyright 0 1983 by Academic Press, Inc.
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130 AKHUTINA AND TSVETKOVA

in its functioning; each time the disturbance will be specific, depending

on the “factor” which this area contributes to the functional system.
Consequently, only qualitative analysis of the specific character of function
disturbances enables one to establish which brain area is disturbed.
Golden’s group accepts Luria’s approach to qualitative analysis stating,
“the role of the neurodiagnostician is to isolate the specific point at
which a client’s functional systems have been interrupted” (Golden,
1979, 1980; Golden et al., 1978). The group’s intention was to standardize
Luria’s procedures while retaining as closely as possible the qualitative
nature of his tests. For this purpose they (1) selected a fixed set of tests;
(2) standardized Luria’s test procedures; (3) standardized the evaluation
of test results by establishing normative data for this purpose; and (4)
ascertained the reliability and validity of the new battery of tests.
Christensen’s (1975) presentation of Luria’s diagnostic procedures were
used for creating the battery. The selected tests were examined on groups
of patients with brain lesions and on nonneurological patients. An analysis
of the battery’s validity showed that 252 tests (out of 269 initial tests)
made it possible to distinguish the patients of both groups at the .05
level of probability (Christensen, 1975).
A system of valuations was created by the Golden group in which test
scores were divided into 11 sections. These sections were not taken from
Luria but from Christensen (1975). The sections include motor skills,
pitch rhythm skills, impressive speech, expressive speech, intellectual
functions, and so on. The test valuations within each of the sections are
summed, yielding 11 summary scores. Three additional scoring indices
were also created. Two of them involve summary scores of motor and
tactile tests for right and left hands separately. The third index, the
pathognomic scale, sums the scores of the 32 most discriminative tests.
A further analysis confirmed the ability of 14 of the above mentioned
summary scores to discriminate nonneurological (control) patients, schizo-
phrenic patients, and patients with local and diffuse brain lesions, with
88-93% efficiency (Purish, Golden, & Hammeke, 1978). The Golden
group then published the norm data taking into account the age and
education of patients (Marvel, Golden, Hammeke, Parish, & Osmon,
1979) as well as data on cross validation of the battery in differentiating
patients with brain lesions (Moses & Golden, 1979).
However, in our way of thinking, the most important factor for checking
the effectiveness of the battery is the analysis of the test battery’s ability
to differentiate patients with varied localization of the lesion. Discriminant
analysis of data obtained in testing 60 patients with right-sided, left-
sided, and diffuse brain lesions proved to be effective in specifying the
side of lesion in 59 cases (Purish et al., 1979).
Data on the effectiveness of the battery in defining the site of the brain
injury were presented by Lewis, Golden, Moses, Osmon, Purish, &
 LURIA’S TESTS 131

Hammeke (1979) at the 1978 APA conference. The authors tested the
ability of the battery to localize lesions in one of the four areas of each
of the hemispheres: frontal, sensory-motor, temporal, or occipital-parietal.
Discriminant analysis of the summary scores made it possible to classify
correctly 22 out of the 24 patients with right-sided lesions and 29 out of
36 patients with left-sided lesions. Thus, correct localization took place
in 85% of the cases. These results are higher than or coincide with the
results obtained by other neuropsychological batteries based on the quan-
titative principle of evaluation. However, they are much lower than the
results obtained by Luria’s qualitative nonstandardized method of analysis.
Luria’s method makes it possible to classify diagnosis correctly in 95-
97% of cases with greater specification of localization; e.g., it is possible
to differentiate in frontal lesions between posteric+frontal, basal-frontal,
and convexital-frontal parts (Lewis et al., 1979).
The apparent decrease of method efficiency in the standardization of
Luria’s tests would seem not to be the result of the peculiarities of the
quantitative approach, but rather a deficiency in carrying out that approach.
The evaluation of test performance is done in such a way that only a
fraction of the potential wealth of information available through Luria’s
tests is utilized.
As mentioned previously, qualitative analysis is fundamental to the
method worked out by Luria for the examination and description of
function impairment. The authors of the standardized version consider
that they are providing it, since the set of tests in each section is sufficiently
diverse for qualitative evaluation. And indeed, the sets of tests are sufficient
for this purpose.
However, the Golden group’s scoring system evaluates only either
complete or partial ability to fulfill a test, i.e., the quantity and not the
quality of test performance. Even in those cases when a double evaluation
of test performance is used, a differentiation of a patient’s behavior is
not assumed. Thus, for example, when testing visual-spatial organization
of motor action, the mistakes are not differentiated as to their nature:
perseveration, wrong position of hand in space, or echopraxia, resulting
from general inactivity of the patient.
Different types of erroneous test performance conditioned by different
primary factors are described in detail in Luria’s works. The data in
summarized and schematic form are presented by Christensen (1975).
However, these data were not used by the Golden group in developing
a scoring system for their test battery.
Also, in the evaluation procedure all the test scores within a section
are summed up, resulting in further loss of information about the quality
of higher psychic functional impairment. Within this procedure, the qual-
itative diversity of the tests within the sections is practically lost. The
general section scores, i.e., evaluation of motor functions, expressive
132 AKHUTINA AND TSVETKOVA

speech, reading, counting, fix only the degree of function impairment.

They do not reflect the quality of performance. Thus classification of
higher psychic functional impairment is not carried out. This inevitably
results in errors of diagnosis.
Considerable data could be obtained with adequate qualitative analysis.
Thus analysis of performance in the motor section could allow the dis-
tinguishing of defects of spatial organization of movements arising after
lesions in the parietal-occipital zone, defects of kinesthetic organization
of movements arising after lesions in the inferior parietal area, defects
of dynamic praxis found with injuries of the posterior frontal zones of
the left hemisphere, various “nonspecific” errors testifying to the pathology
of subcortex areas, or general brain inactivity.
From this writer’s point of view, in working out the scoring system,
the Golden group did not take into account the qualitative diversity of
most of the tests and their different possible interpretations. A way of
data scoring which would make it possible to retain information about
the quality of test performance was not developed; i.e., the Golden group
adopted Luria’s tests but they did not make use of the fundamental
method of qualitative analysis, which implies classification of the defect
and the pinpointing of the primary defect (“factor”) which has brought
about a certain picture of function disturbance.
It is quite possible that Golden’s group would reply that qualitative
analysis does take place in their test battery. They assume that it must
be carried out with the analysis of scale scores distribution (Golden,
1980). Moreover, when interpreting scale scores, a clinician can make
use of the raw data in separate tests.
Nevertheless, it seems to us that these two possibilities do not change
the situation. Because of the fact that qualitative differences in test
performance are not taken into consideration and the test implications
are leveled in general scores, the possibility of qualitative analysis of
distribution patterns of scale scores is rather limited. Only a clinician
with experience in qualitative analysis can make good use of individual
test performance. And, as the Golden group recognizes, psychologists,
who are used to working with quantitative methods, usually lack such
experience.
We consider that the reviewed test battery with its present scoring
system can solve effectually only one task: the evaluation of the degree
of higher mental function impairment. To enable it to solve the other
three tasks (see above (Smith, 1975)), the battery needs further devel-
opment. We are convinced that it should proceed along the lines of
objectivization and standardization of the method of qualitative analysis.
Bearing in mind the many-valued character of most of the tests, it is
necessary to work out a system of evaluation of every test in accordance
with the principal factors for the given test. Scores on every factor could
 LURIA’S TESTS 133

be summed up, not only within a section, but among sections. The general
scores could then be used to make up a profile curve. For example, the
“kinesthetic organization of movements” factor could comprise evaluation
of certain tests from the motor section, expressive speech section, and
rhythm section. Such a procedure implies complication of the original
evaluation, but also makes possible classification of the syndrome; which,
in its turn, allows one to solve the task of topical diagnosis, draw up
rehabilitation education programs, and forecast the further dynamics of
the patient’s state.
In summary, we can say that the American scientists have tackled
one of the most pressing neuropsychological problems. As a starting
point, they have chosen the highly promising theoretical and methodo-
logically adequate neuropsychological examination created by Luria. The
American neuropsychologists have accomplished a great and important
task in selecting the tests, standardizing their administration, collecting
normative data with the age and education correction, and evaluating
the validity and reliability of the battery. They have worked out an
effective and comprehensive test battery, making it possible to evaluate
the conditions of higher mental functions. However, it seems to us that
the battery is not fully effective in fulfilling the tasks of topical diagnosis
and the construction of rehabilitation and teaching programs, as it does
not follow consistently Luria’s principle of qualitative analysis, which
was originally accepted by the American scientists as fundamental to
the makeup of the battery.
Hence our dual attitude toward the work of the Golden group-on the
one hand, we welcome the initiative of the American scientists in the
extensive introduction of Luria’s ideas; on the other hand, we see the
risk of the vulgarization of Luria’s doctrine and the discrediting of his
principles and methods through their misuse and wrong application. We
are of the opinion that the creation of a standardized version of the
neuropsychological examination should be continued. If Luria’s basic
principles are maintained, such a version can be most useful.
We believe that it would be fruitful for further development of the
standardization of Luria’s method to combine the efforts of researchers:
both those who traditionally use the qualitative methods evolved by
Luria, and those who employ standardized statistical methods of data
analysis.
REFERENCES
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Golden, C. J. 1979.Identification of specific neurological disorders using double discrimination
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Golden, C. J. 1980.A standardized version of Luria’s neuropsychological tests: A quantitative
and qualitative approach to neuropsychological evaluation. In S. B. Filskov & T. J.
Boll (Eds.), Handbook of clinical neuropsychology. New York: Wiley.
134 AKHUTINA AND TSVETKOVA

Golden, C. J., Hammeke, T. A.. & Purish, A. D. 1978. Diagnostic validity of standardized
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