Human Figure Drawing Test Interpretation Manual Pdf

[Kellye Tunks]

Thehuman figure test for personnel selection is also called the Machover test. As its name indicates, the test is based on the drawing of a human figure. This test aims to identify significant personality traits of the subject.

The test as a projective application consists of drawing a human figure as an expression of specific needs or conflicts. Artistic aspects of the drawing are not taken into consideration for the evaluation but the theme of the draw, its position, and its dimension. The cost of the test is low and it is easy to apply.

The Machover test is usually useful in those without much academic training or who have difficulty expressing themselves orally. The subject is presented with a piece of paper, accompanied by a pencil and eraser. And they have to draw a picture of a human figure.

The test facilitator should record, step by step, the time taken to draw each part of the drawing. Likewise, it is important to record the parts that the subject drew first. At the end of the first drawing, they will be asked to draw a person of the opposite sex.

Clinical experience is based on the fact that, when a human figure is drawn, it associates with certain conflicts, impulses, and anxieties of the subject. In some way, the figure comes to represent the subject themselves.

According to some experts, it is proven that when a person is drawn, it can represent a deep expression of the personality of the one who draws it. When someone tries to draw a person, they have to solve certain differences, difficulties, and problems in reaching a model that satisfies them.

A human figure test is a form of psychodiagnostic used for more than 60 years. Yet, its methods are of varied use and little codified. Over time, the appearance of some publications transformed certain speculations into frequently accepted rules.

Some authors find the conclusions of the test are quite subjective. On the other hand, the test ranks fifth among the methods used, for example, by about 43% of all psychologists in the Czech Republic. As for personality diagnostic methods, the test ranks second.

When we speak of validity, we refer to the ability of an instrument to measure what it should. If we talk about the draw of a person; it is difficult to verify that a gesture of the mouth, the size of the eyes, or what is drawn first is an accurate indicator of personality aspects such as aggression or other personal characteristics.

I draw great comfort that I fall in line with the great artists over the centuries who have also struggled with this area of drawing. Van Gogh, for example, began his prolific art career drawing figures in static poses. During the first two years of his career he spent ALL of it mastering drawing. He struggled with problems of proportion as you can see from the drawing on the left below.

For example, ever found human heads challenging to draw?! I do! Its baffling why this is so. In answer to why this is, we over emphasise the features, not the foreheads and hair because that is where our day to day focus lies when interacting with one another. We have to re-train our brains to understand the science of proportion in an un-emotive way. That is why you will often see me sketching the head last in my drawings! I need the rest of the body to gauge the size of the head.

Why include this painting in this article and what does it have to do with stick men and drawing the human figure? To me this painting symbolises not only deconstructing the human anatomy but also stripping it right back to basic shapes. It is not particularly transcribed in an accurate way. The genius result, however, is that the nude descending is still recognisable as a human form.

One of the first things I have noticed about drawing stick men is that you quickly define what type of human drawing you could finally produce. You could be representational with your stick man or more cartoon like. I seem to veer between the two in my sketchbooks. I like to get as close to accurate as I can and enjoy deconstructing an image in order to capture it.

When stuck always think first about the shapes that you see. My confidence has grown out of the practice I have put in drawing humans in blocks of shapes! My brain then automatically identifies the shapes visually.

As you become adept at sketching the human figure understanding the anatomy that lies beneath it will become of more interest and your drawing will become more selective. Thank goodness that Leonardo did all the heavy lifting for us when it came to anatomical studies. His anatomical studies of muscles and arms is only the start of an extensive fascination of dissecting the human body on paper. As you become more familiar with the human body your drawing practice will become easier and more fluid so as you draw make sure you really pay attention and look at the anatomy in front of you. Life drawing is an excellent activity to support you develop this knowledge! You will instinctively be able to head to drawing directly on the paper in your own style as you get to know the subject material better.

Believe it or not basic stick men can get you started on complicated human poses too. When you get stuck just imagine the stick man pose and build your drawing from there. You can draw lines at a slant to describe tilts of shoulders or limbs for example. This too can help you work out foreshortening and perspective by drawing lines relative to a pose.

I explore all of this in my online sketch course taking you from a stick man to a human figure in 3 simple steps. Check it out here if you are interested in learning how to start drawing the human figure. The course includes an hour tutorial as well as supporting pdfs to get you started.

How many of us have started to draw and realise that we run out of room to complete a full figure? Most frustrating! When starting to draw try to learn to tackle the human figure in the whole. You will then naturally be able to gauge sizing and shaping as you become more experienced. You could even start by simply drawing a stick man on the page to ensure you get everything down. (You can see I have sketched in my stick man lines above. They help anchor the drawing further.) This leads neatly onto my second lesson area of using an environment or setting to help you build your confidence drawing the human figure.

If you have ever flipped through my very early sketchbooks you will see that there are practically NO humans and lots of objects. This is rightly the place to start if you are a sketchbook beginner for lots of reasons. The thought of drawing a human let alone capturing the likeness was always a daunting one. To break this down I started to explore how I could add people into my sketching. I have included a 7 minute video as part of this section talking you through my personal progress and confidence building when it has come to drawing the human figure. I have gradually built human figure sketching into the environments of my sketchbook and you can too!

I love how placing a person in an environment brings added credibility to your drawing! These two sketches depicting a Saturday morning were done in my small sketchbook. Watching TV and going for a bike ride. The yellow chair and bicycle help me anchor my figures. Forget for a moment that the sketches themselves may feel or seem advanced. It helps to look for abstract shapes, the angles and curves and aspects of the person and objects surrounding them that help you get them down on paper. I used the clothes (folds of lumpy dressing gown) and angular shapes of the bicycle to help me in these two sketches but also broke down the shapes I could see. Remember too that a good place to start when sketching people is with friends and family as you are more likely to be comfortable with them. The small sketchbook format can support you draw faster than a larger piece of paper.

Observation and practice is key. An exercise I run through on my Sketch from Scratch People course is a page full of human characters in different poses but drawn in the space of 30 seconds to a minute per person on the page. A sketchbook page is the best place for this type of exercise. This may very well start with stick men, which is not a bad place to start. I envy a good stick man!

Look as much as you possibly can, as this will support your brain develop your hand to memory skill. Imagine the stick man as the skeleton of the figure you are drawing. Remember the earlier action point when it comes to stick man drawing.

a) If the figure is moving, loosen up your style. Your lines should be loose and applied relatively quickly. (Remember the stick men exercise of between 30 seconds to 1 minute? This feeds into your experience of sketching quickly.) You may opt for ink as you grow in confidence which is a great medium for conveying movement. I particular love how the artist @suhitasketch achieves fluidity in her human sketching using ink and bright colour. I also use paint too, a light wash that flows with the shape of the person sketched to emphasise movement. Sketches will appear more dynamic, even if the subject is only playing Lego or watching TV. Simple poses can often be the most impactful.

b)Pay attention to the fold of the clothes. Observing where they fold or hang can make a big difference to the dynamic of a picture. Zig zags imply creasing or bends of a body. Skirts or dresses are more complex. Different textures ranging from wool through to cotton may enable you to use different types of pencil stroke. You may also want to use the way light falls across figures to help you (as I have done in the sketch of the two children in chairs!) Keep it simple.

My one piece of advice is that you may as well as enjoy it and build the human figure into the anatomy of your daily sketching. Get used to going through a process that helps you uncover your style even if its a bumpy journey to get there finding it.

Introduction

Students studying audiological testing enter the clinic with varying degrees of competency regarding the interpretation of acoustic reflex threshold (ART) test results. If a student clinician becomes lost in the maze of right and left, ipsilateral and contralateral "boxes" - often associated with the fairly common, but rather ghastly, 2x2 ART table, then clinical speed may be compromised as a student tries to recall the connection between pathology location and memorized tables. This tutorial reviews the basics of ART pattern interpretation with a clear, simple model for use as a teaching/learning tool for supervisors and students. This model is also shown as it relates to the traditional 2x2 table for cross reference. Students should be aware that the actual anatomical structures and "real life" clinical interpretations are more complex than those shown with this simple model, but this tutorial is intended as an approachable introduction. What follows are six introductory pieces of information and then a step-by-step illustrated guide to simple ART interpretation.

Six Introductory Pieces of Information

First, students must study the anatomy and physiology associated with the ART including the outer, middle, and inner ear structures, the vestibulocochlear nerve (VIII cranial nerve), and structures in the central auditory nervous system (CANS); specifically, auditory structures located at the level of the lower brainstem including the cochlear nuclei, superior olivary complex and facial nerve (VII nerve) nuclei. For this tutorial, students must be aware that the facial nerve innervates the stapedius muscle and that the stapedius muscle contraction is responsible for the acoustic reflex threshold in humans.

Second, the nature of a reflex must be understood. A reflex occurs when a signal is transmitted along a sensory neuron to an interneuron to a motor neuron causing a contraction of the muscle tissue innervated by the motor neuron. This is below the level of cognitive control; in other words, patients do not have to think about it. This is why one pulls a hand quickly away from a hot pot without thinking first, "Wow, my hand is burning" (that comes later) and this is why the stapedius muscle contracts in response to a loud sound, even though the patient does not consciously control the action. When a loud sound enters a normal ear, the stapedius muscle will contract on both sides regardless of which ear is stimulated. Therefore, the ART is a bilateral ("two side") reflex.

Third, the word ipsilateral (ipsi) means "same side" and contralateral (contra) means "opposite side". These terms refer to where the ART is measured relative to where the loud sound is presented. If the ART is measured on the same side in which a loud sound is presented, then it is an ipsilateral ART. If the signal is measured on the opposite side to that in which the loud sound is presented, then it is a contralateral ART. One additional way to remember this is: if the tone is presented on the probe side, then it is an ipsilateral ART. If the tone is presented on the earphone side, it is a contralateral ART.

Forth, "right" and "left" in ART testing refer to the ear that is stimulated by the loud sound. If the signal goes into the right ear and the ART is measured in the right ear, it is called a right ipsilateral ART. If the signal goes into the right ear and ART is measured in the left ear, it is called the right contralateral ART. Note that some audiologists reverse this and use a non-standardized method, which can be confusing (see Emanuel (2004) for more details).

Fifth, the response pattern can suggest a site of lesion, but other tests are necessary for confirmation. One can suspect, but cannot diagnose, site of lesion based solely on the results of ART testing.

Sixth, commercially available diagnostic bridges for testing ARTs are capable of producing high intensity stimuli (e.g., 120 dB HL and higher) and there is documentation in the literature that ART testing can cause permanent hearing loss and tinnitus (e.g. Hunter, Ries, Schlauch, Levine, & Ward, 2000). Although some authors have recommended a maximum presentation level of 110 dB SPL (Wilson & Margolis, 1999), there are no standards for safe presentation levels for pure tone stimuli. OSHA (1983) recommends a limit of 115 dBA for brief duration noise, but a pure tone results in a greater amount of energy concentrated over a smaller area of the basilar membrane compared with noise. In addition, some individuals are uniquely sensitive to the effects of loud sound. Therefore, clinicians should exercise caution in the presentation of loud sounds as well as be familiar with the literature in this regard.

With these six pieces of information in mind, students are ready to proceed to this ART model.

Acoustic Reflex Threshold (ART) Model

Figure 1 provides a model of the acoustic reflex pathway. It bears just about no resemblance to the actual anatomical structures which are extremely small, three dimensional and much more complex in terms of the nerve projections. However, this figure illustrates the main ART pathways and most of the key structures.

Figure 1. A simple model of the acoustic reflex pathway. The acronyms are as follows: ME = middle ear, IE = inner ear, VIII = vestibulocochlear nerve, CN = cochlear nucleus, SOC = superior olivary complex, VII = facial nerve. Note: (1) two of the structures in the pons (SOC and VII nucleus) are shown together for simplicity. They are actually separate structures. (2) A branch of the facial nerve ends at the stapedius muscle and the stapes is shown as a stirrup-shaped stick figure. (3) Some nerve projections are omitted for simplicity.

Imagine first a normal right ear and trace the pathway of a loud signal. The signal enters the right ear, travels through the outer, middle (ME) and inner ear (IE), along the VIII nerve, to the brainstem. When the signal reaches the brainstem, the signal arrives first at the cochlear nucleus (CN). From here, the signal travels to both right and left superior olivary complexes and both right and left facial nerve (VII) nuclei. The signal is sent from both facial nerve nuclei to both facial (VII) nerves, which results in a contraction of both stapedius muscles. Thus, both stapes bones are pulled outward and downward, in a direction away from the inner ear. This action makes it harder for energy to travel through the middle ear (increase in impedance/decrease in admittance). The lowest intensity level at which this contraction is measurable is the ART.

The Four Reflex Categories

Highlighted in red (right ear) and blue (left ear) in the following four diagrams are the pathways taken by the signal for right ipsilateral (Figure 2), right contralateral (Figure 3), left ipsilateral (Figure 4) and left contralateral (Figure 5) pathways.

Figure 2. Right ipsilateral pathway.

Figure 3. Right contralateral pathway.

Figure 4. Left ipsilateral pathway.

Figure 5. Left contralateral pathway.

The information from this ART model can be translated into the traditional 2 x 2 ART table (Table 1) for ease of comparison with other textbooks. A normal ear should yield present ARTs from 500 to 2000 Hz at normal levels. This is shown with Normal or N, Present (or P), or Within Normal Limits (WNL) in all of the boxes in the table. The exact notation will depend on the clinical site. For the remainder rest of this tutorial, Normal (N) will be used. Normative values can be found in a number of sources (e.g., Gelfand, Schwander, & Silman, 1990; Silman & Gelfand, 1981; various audiology textbooks) and will not be discussed here. With the normal model and 2x2 table in mind, next examine what happens to the ART pattern for various auditory pathologies.

Table 1. Bilateral normal ART results.

Cochlear Pathology

Imagine first a right cochlear pathology. The signal will affect the ART once the damage to the cochlea has reached a certain degree. For a cochlear hearing loss with air conduction thresholds below about 50 dB HL, the ART should resemble a normal ear. As the hearing threshold increases, the chances of an elevated or absent reflex increase.

Notice in Figure 6 that a right cochlear pathology is highlighted. Any pathway that crosses the damaged area will be affected by the cochlear pathology. So the ART will be absent or elevated whenever the signal is presented to the right ear, regardless of where it is measured. A signal entering the normal left ear will be unaffected, so ARTs will be present for stimuli to the left ear. Thus a pattern of elevated/absent responses on the right side (both ipsilateral and contralateral) and present/normal responses on the left side (both ipsilateral and contralateral) would be the pattern associated with a cochlear pathology on the right side. Table 2 shows this finding in a standard ART table.

Figure 6. Cochlear pathology, right ear. Note that right ipsilateral and right contralateral ARTs are elevated/absent and left ipsilateral and left contralateral ARTs are present.

Table 2. Cochlear pathology, right ear. Whenever a tone enters the left ear, the ART is present/normal. Whenever a tone enters the right ear, the ART is elevated or absent. Note that the abnormal responses are located in the same row (both right ear).

Vestibulocochlear nerve pathology

A vestibulocochlear (VIII) nerve pathology (Figure 7, Table 3) would result in the same pattern as a cochlear pathology; however it is much more likely that ARTs will be absent or unusually elevated compared with a cochlear pathology. Elevated/absent ARTs which do not agree with the hearing loss (again, consult normative values) are a cause for suspicion of retrocochlear pathology. Keep in mind the ART should be tested in combination with a battery approach for differential diagnosis as it is not a perfect test. For example, in an analysis of published studies, Turner, Shepard, and Frazer (1984) found 73% sensitivity and 90% specificity for prediction of acoustic neuroma (more correctly called a vestibular schwannoma) using the ART, so there is plenty of room for error in this test.

Figure 7. Vestibulocochlear nerve pathology, right side. Note that right ipsilateral and right contralateral ARTs are absent/elevated and left ipsilateral and left contralateral ARTs are present/normal.

Table 3. VIII nerve pathology, right ear. Whenever a tone enters the left ear, the ART is normal. Whenever a tone enters the right ear, the ART is elevated/absent. The ART pattern is identical to the cochlear pattern but the response is more likely to be absent in a vestibulocochlear nerve pathology or unusually elevated compared with normative values for cochlear hearing loss.

Facial Nerve Pathology

Facial nerve pathology causes a distinct ART pattern; specifically, ARTs are missing whenever ART is measured on the affected side (Figure 8, Table 4). This same pattern can also be seen if there is a problem with innervation of the stapedius muscle, dysfunction of the stapedius muscle, or disconnect between the stapedius muscle and the stapes. Often, facial nerve pathology is associated with other signs of facial nerve involvement, including a facial droop or history of VII nerve palsy (e.g., Bell's palsy).

Figure 8. Facial nerve pathology, right side. Note that anything that is measured on the right side will be affected. This includes right ipsilateral and left contra.\

Table 4. Facial nerve pathology, right side. Whenever an ART is measured in the right ear (right ipsilateral and left contralateral) it is absent. Note the absent responses are in opposite corners of the box.

Middle Ear Pathology

Middle ear pathology will affect the signal "coming and going." In more useful terms, the middle ear pathology can decrease the intensity of the signal going into the ear and it can interfere with the ability to measure the ART. Figure 9 illustrates the location of the pathology and Tables 5 and 6 illustrate two examples of possible ART patterns for middle ear pathology. Table 5 shows a milder condition causing ARTs to be elevated and Table 6 shows a more severe condition, such as that seen in chronic otitis media, in which the entire middle ear cavity is filled with fluid. Middle ear pathologies may also cause bizarre ART responses such as an ART recording that deflects in a direction that is opposite of normal, which may be seen in stiffening pathologies such as otosclerosis, or a pulsing on the ART, which may be a result of a mass growing through the inferior wall of the tympanum (middle ear cavity). This paper will not cover these more advanced ART findings.

Figure 9. Middle ear pathology, right side. Note that anything that goes through the right ear or is measured in the right ear can be affected, depending on the severity of the pathology.

Table 5. Mild middle ear pathology, right ear. ART may be affected for signals traveling through the right ear (right ipsilateral, right contralateral) or signals measured in the right ear (right ipsilateral, left contralateral).

Table 6. Severe middle ear pathology, right ear. ART will be absent for signals traveling through the right ear and signals measured in the right ear. Left ipsilateral would be unaffected.

Intra-Axial Brainstem Pathology

This is the point when basic ART pattern interpretation is less straightforward. "Textbook" intra-axial brainstem pathology (Figure 10) causes missing contralateral reflexes and present ipsilateral reflexes (Table 7), but, as the saying goes, very few patients read the textbooks before coming into the clinic. This same pattern of missing contralateral reflexes can also be observed if you test ARTs using supra-aural earphone cushions for patients with bilateral collapsing ear canals; thus, be wary of this pattern in patients with unusually small or narrow, slit-shaped ear canals.

Figure 10. Small intra-axial brainstem pathology. A classical finding is missing contralateral responses, but this can also be seen with bilateral collapsing ear canals. One or both ipsilateral responses may also be missing, depending on the exact location.

Table 7. Small intra-axial brainstem pathology (small). All contralateral ARTs are absent. All ipsilateral ARTs are present. This is a "textbook" pattern which will actually vary depending on the exact location and the structures that are compressed.

In actual practice, ARTs associated with intra-axial brainstem pathology will vary tremendously depending on exactly where the pathology is located and how large it is. As brainstem structures are very small, a small intra-axial pathology can cause pressure on a number of structures, causing ARTs to be affected on both sides. Figure 11 and Table 8 illustrate the ART results for a larger intra-axial pathology.

Figure 11. Larger intra-axial brainstem pathology. Depending on the location, size, and the extent to which surrounding structures are compressed, some or all of the responses will be absent. Due to the larg