Drawing ability in four young children with congenital unilateral brain lesions

Impoverished details with preserved gist in remote and recent spatial memory following hippocampal and fornix lesions

INTRODUCTION

Cognitive Map Theory predicts that the hippocampus (HPC) plays a specialized, time-invariant role in supporting allocentric spatial memory, while Standard Consolidation Theory makes the competing prediction that the HPC plays a time-limited role, with more remote memories gaining independence of HPC function. These theories, however, are largely informed by the results of laboratory-based tests that are unlikely to simulate the demands of representing real-world environments in humans. Validation of these theories is further limited by an overall focus on spatial memory of newly encountered environments and on individuals with extensive lesions to the HPC and to surrounding medial temporal lobe (MTL) regions. The current study incorporates naturalistic tests of spatial memory based on recently and remotely encountered environments navigated by individuals with lesions to the HPC/MTL or that are limited to the HPC's major output, the fornix.

METHODS

Four participants with bilateral HPC/MTL and/or fornix lesions drew sketch maps of recently and remotely experienced neighbourhoods and houses. Tests of the appearance, distances, and routes between landmarks from the same real-world environments were also administered. Performance on the tasks was compared to that of control participants closely matched in terms of exposure to the same neighbourhoods and home environments as well as to actual maps.

RESULTS

The performance of individuals with fornix/MTL lesions was found to be largely comparable to that of controls on objective tests of spatial memory, other than one case who was impaired on remote and recent conditions for several tasks. The nature of deficits in recent and remote spatial memory were further revealed on house floorplan drawings, which contained spatial distortions, room/structure transpositions, and omissions, and on neighbourhood sketch maps, which were intact in terms of overall layout but sparse in details such as landmarks.

CONCLUSION

Lab-based tests of spatial memory of newly learned environments are unlikely to fully capture patterns of spared and impaired representations of real-world environments (e.g., peripheral features, configurations). Naturalistic tasks, including generative drawing tasks, indicate that contrary to Cognitive Map Theory, neither HPC nor MTL are critical for allocentric gross representations of large-scale environments. Conversely, the HPC appears critical for representing detailed spatial information of local naturalistic environments and environmental objects regardless of the age of the memory, contrary to Standard Consolidation Theory.

From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy

Recent neuroimaging studies allowed us to explore abnormal brain structures and interhemispheric connectivity in children with cerebral palsy (CP). Behavioral researchers have long reported that children with CP exhibit suboptimal performance in different cognitive domains (e.g., receptive and expressive language skills, reading, mental imagery, spatial processing, subitizing, math, and executive functions). However, there has been very limited cross-domain research involving these two areas of scientific inquiry. To stimulate such research, this perspective paper proposes some possible neurological mechanisms involved in the cognitive delays and impairments in children with CP. Additionally, the paper examines the ways motor and sensorimotor experience during the development of these neural substrates could enable more optimal development for children with CP. Understanding these developmental mechanisms could guide more effective interventions to promote the development of both sensorimotor and cognitive skills in children with CP.

New insights from children with early focal brain injury: Lessons to be learned from examining STEM-related skills

The study of cognitive development in children with early brain injury reveals crucial information about the developing brain and its plasticity. However, information on long-term outcomes of these children, especially in domains relevant to science, technology, engineering, and math (STEM) remains limited. In the current review, our goal is to address the existing research on cognitive development of children with pre- or perinatal focal brain lesion (PL) as it relates to children's STEM-related skills and suggest future work that could shed further light on the developmental trajectories of children with PL. We argue that examining STEM-related development in children with PL will have broader implications for our understanding of the nature of the plasticity children with PL exhibit as well as address theoretical questions in the field regarding the foundation skills for STEM, including visuospatial and mathematical skills.

The weak coherence account: detail-focused cognitive style in autism spectrum disorders

"Weak central coherence" refers to the detail-focused processing style proposed to characterise autism spectrum disorders (ASD). The original suggestion of a core deficit in central processing resulting in failure to extract global form/meaning, has been challenged in three ways. First, it may represent an outcome of superiority in local processing. Second, it may be a processing bias, rather than deficit. Third, weak coherence may occur alongside, rather than explain, deficits in social cognition. A review of over 50 empirical studies of coherence suggests robust findings of local bias in ASD, with mixed findings regarding weak global processing. Local bias appears not to be a mere side-effect of executive dysfunction, and may be independent of theory of mind deficits. Possible computational and neural models are discussed.

Drawing on either side of the brain

Although both the cerebral laterality of processing visual information and human drawing skill have long been sources of investigation, there is not much empirical work combining the two. In this study, an attempt was made to explore if known different specialisations of the two cerebral hemispheres could help in predicting qualities of drawings produced by each hand. For this purpose, an amateur artist who is able to draw with either the left or the right hand produced a series of realistic drawings of 3D objects. Then 28 participants rated the drawings for several predetermined perceptual and aesthetic properties. The participants judged drawings made with the left hand as superior to those made with the right hand. Given that the right hemisphere controls the left hand, we suggest that this hand might also benefit from the more direct access to lateralised areas that are involved in the processing aspects of visual information and spatial properties (e.g., depth and shading). These perceptual processes may thus play an important role in the ability to draw realistic depictions of objects.

Developmental changes in the processing of hierarchical shapes continue into adolescence

The present study was designed to trace the normal development of local and global processing of hierarchical visual forms. We presented pairs of hierarchical shapes to children and adults and asked them to indicate whether the two shapes were the same or different at either the global or the local level. In Experiments 1 (6-year-olds, 10-year-olds, adults) and 2 (10-year-olds, 14-year-olds, adults), we presented stimuli centrally. All age groups responded faster on global trials than local trials (global precedence effect), but the bias was stronger in children and diminished to the adult level between 10 and 14 years of age. In Experiment 3 (10-year-olds, 14-year-olds, adults), we presented stimuli in the left or right visual field so that they were transmitted first to the contralateral hemisphere. All age groups responded faster on local trials when stimuli were presented in the right visual field (left hemisphere); reaction times on global trials were independent of visual field. The results of Experiment 3 suggest that by 10 years of age the hemispheres have adult-like specialization for the processing of hierarchical shapes, at least when attention is directed to the global versus local level. Nevertheless, their greater bias in Experiments 1 and 2 suggests that 10-year-olds are less able than adults to modulate attention to the output from local versus global channels-perhaps because they are less able to ignore distractors and perhaps because the cerebral hemispheres are less able to engage in parallel processing.

The impact of early unilateral brain injury on perceptual organization and visual memory

Studies of young children with early unilateral brain injury have suggested that while hemispheric differences in visuospatial processing appear to be present early in development, the young brain is better able to compensate for injury than when the injury occurs later, after networks have been established. The aim of this study was to determine if this pattern continues later in development when these children are given a challenging task: the Rey-Osterrieth Complex Figure. Experiment 1 included longitudinal data from ten children with early left hemisphere (LH) injury and nine children with early right hemisphere (RH) injury. Injury was presumed to be due to a prenatal or perinatal stroke. Compared with typically developing children, both groups were poorer in copying the figure. With development, these children produced reasonably accurate drawings but continued to use the most immature and piecemeal strategy. In Experiment 2, copy and immediate memory drawings from the 19 children with early unilateral brain injury were collected at a single age (11-14 years). Eight of the ten children with LH injury organized their memory reproductions around the core rectangle but included relatively few additional details. In contrast, only two of the nine children with RH injury organized their memory reproductions around the core rectangle and all but one produced the figure in a piecemeal manner. The results from both studies demonstrate the continuation of subtle deficits in visuospatial analysis with development but also the continued capacity for compensation.

Neural plasticity and cognitive development

It has been well documented that the effects of early occurring brain injury are often attenuated relative to later occurring injury. The traditional neuropsychological account of these observations is that, although the developing neural system normally proceeds along a well-specified maturational course, it has a transient capacity for plastic reorganization that can be recruited in the wake of injury. This characterization of early neural plasticity is limited and fails to capture the much more pervasive role of plasticity in development. This article examines the role of neural plasticity in development and learning. Data from both animal and human studies show that plasticity plays a central role in the normal development of neural systems allowing for adaptation and response to both exogenous and endogenous input. The capacity for reorganization and change is a critical feature of neural development, particularly in the postnatal period. Subtractive processes play a major role in the shaping and sculpting of neural organization. However, plasticity is neither transient nor unique to developing organisms. With development, neural systems stabilize and optimal patterns of functioning are achieved. Stabilization reduces, but does not eliminate, the capacity of the system to adapt. As the system stabilizes, plasticity becomes a less prominent feature of neural functioning, but it is not absent from the adult system. The implications of this broader view of plasticity for our understanding of development following early brain damage are discussed.

A hierarchical analysis of block design errors in children with early focal brain damage

This study investigated the differential effects of very early damage to the left hemisphere (LH) or right hemisphere (RH) on visuospatial processing. Twenty-two children who had suffered either LH or RH strokes in the pre- or perinatal period were included in the study. The Block Design subtest of the Wechsler Intelligence Scale for Children-Revised (Wechsler, 1974) was used. Each missed item was coded as either a global error (e.g., broken configuration), local error (e.g., incorrect details), or time fail error (i.e., not completed within the allotted time). Results showed that the LH lesion and RH lesion groups had similar full scale IQs, verbal IQs, and performance IQs and were within the average to low average range. Block Design scaled scores were also within the average to low average range and did not significantly differ between the 2 lesion groups. Error analysis revealed, however, that the RH focal lesion group produced a significantly higher percentage of global errors than did the LH lesion group, whereas the LH lesion group produced a significantly higher percentage of local errors than did the RH lesion group. The groups did not differ on their percentage of time fail errors. These results are consistent with previous findings that suggest that the RH is involved in more global aspects of visual processing, whereas the LH mediates the more detailed, local aspects of visual information. The fact that these differences in processing are present after such early focal damage implies that hemispheric specialization for visuospatial processing occurs very early in brain development.

Narrative discourse in children with early focal brain injury

Children with early brain damage, unlike adult stroke victims, often go on to develop nearly normal language. However, the route and extent of their linguistic development are still unclear, as is the relationship between lesion site and patterns of delay and recovery. Here we address these questions by examining narratives from children with early brain damage. Thirty children (ages 3:7-10:10) with pre- or perinatal unilateral focal brain damage and their matched controls participated in a storytelling task. Analyses focused on linguistic proficiency and narrative competence. Overall, children with brain damage scored significantly lower than their age-matched controls on both linguistic (morphological and syntactic) indices and those targeting broader narrative qualities. Rather than indicating that children with brain damage fully catch up, these data suggest that deficits in linguistic abilities reassert themselves as children face new linguistic challenges. Interestingly, after age 5, site of lesion does not appear to be a significant factor and the delays we have witnessed do not map onto the lesion profiles observed in adults with analogous brain injuries.

The Effects of Early Environment on the Development of Functional Laterality in Morris Maze Performance

The current study examined the contribution of early postnatal experience to the functional lateralisation of spatial ability in the male rat. Litters were handled (H) or non-handled (NH) during the first 20 days of life, and three males from each litter were tested in the Morris water maze in adulthood. Two subjects from each litter were monocularly tested, one with the right eye patched and the other with the left eye patched. A third subject in each litter was tested with both eyes open. Handling interacted with Eye Patch for time and distance measures. Performance of Right- and Left-Patched rats was equivalent for the NH group, but the H subjects tested with the Right Patch outperformed H subjects with the Left Patch. These results confirm studies that found spatial navigation performance to be lateralised to the right hemisphere in male rats. The data indicate that functional asymmetry of spatial navigation behaviour in the adult male rat is sensitive to environmental influences during early development.

The development of drawing in children with congenital focal brain injury: evidence for limited functional recovery

Children with pre- or perinatal injury to right hemisphere (RH) brain regions show impairment of spatial integrative functions similar to that observed among adults with comparable injury. Unlike adults, children show considerable improvement with development on a range of spatial construction tasks which require spatial integration. Such gains could reflect true recovery of spatial integrative abilities. Alternatively, the improvement could be more limited in scope, reflecting the development of compensatory strategies which are task specific and allow the children to circumvent, rather than overcome, their primary spatial disorders. The studies presented here examined this distinction within the context of drawing tasks in which the child was first asked to draw a house and then an impossible house. The impossible house task was designed to examine the extent to which children rely on graphic formulas in generating organized drawings. The results showed that while all of the children with RH injury make considerable progress in free drawing into the school age period, they are very reliant on the use of graphic formulas. When given a task which requires them to alter their drawings, they did not change the spatial configuration of the depicted object. Rather they found alternate ways to render the object 'impossible'.

Cognitive neuropsychology and its application to children

Cognitive neuropsychology has been used successfully in the analysis of adult neuropsychological disorders in both verbal and nonverbal domains. When applied to children, it aims to construct models on the basis of functional lesions manifest within developing systems and provides a theoretical framework within which patterns of intact and deficient skills can be charted over time. These patterns constrain possible underlying models. In highlighting potential individual differences in the acquisition of skills and indicating intact skills within subjects, cognitive neuropsychology may also enable a precise description of the locus of difficulty and potential circumventory routes for remediation around it. The theoretical assumptions of cognitive neuropsychology and issues relevant to its methodology are discussed, including the terminology and principles of modularity, the significance of individual differences and the use of case studies, the dynamics of developing systems, current views on plasticity, and distinctions between developmental and acquired disorders. The application of cognitive neuropsychology to children is discussed in relation to three cognitive areas: face recognition disorders, language disorders and arithmetical disorders. These illustrate the similarities that there are between many developmental cognitive neuropsychological disorders and those seen in adults following brain injury. Models derived from studies of adults are helpful in enabling understanding of both face recognition disorders and arithmetical disorders in childhood. Within language systems, a variety of different types of disorder are evident, which not only relate to receptive and productive difficulties but differentially affect the core components of the language system. All of the disorders discussed illustrate the limitations of functional plasticity in development. In each case, there is not a generalised deficit resulting from degradation of capabilities independent of task requirements. Rather, there are focal and selective disorders which affect subcomponents of cognitive systems. In some cases, genetic factors may constrain compensatory mechanisms.

Functional brain reorganization in children

Developmental brain plasticity in association with focal brain injury is dependent on a number of factors, including age of the individual at the time of injury, size and topography of the brain lesion, maturational state of the brain system injured, integrity of brain areas surrounding and contralateral to the lesion, presence and duration of epilepsy, and medication effects. Recently developed functional neuroimaging tools now make it possible to study non-invasively several aspects of human brain functional reorganization in response to injury. Clinical models which are suitable for the study of developmental brain plasticity include patients who have undergone cortical resections for the alleviation of intractable epilepsy, patients who have sustained unilateral cerebrovascular insults at various periods of development, patients with chronic progressive unilateral brain injury such as in the Sturge-Weber syndrome, and patients with early sensory deprivation such as blind or deaf subjects. Although evidence of functional brain reorganization can be demonstrated in these models, it is emphasized that the neurobiological rules that govern intrahemispheric versus interhemispheric reorganization of function in the brain are, at present, poorly understood.

Evidence of altered dominance in children with congenital spastic hemiplegia

The study aimed at investigating lateralization effects and signs of transfer and crowding in children with congenital lateralized brain damage with the aid of a dichotic listening test, a chimeric test, and verbal and nonverbal neuropsychological tests. Thirty-three children with spastic hemiplegia and 86 control children (age 5.0-12.0 yr) were assessed. Children with left-hemisphere damage (n = 17) were found to have a pathological left-ear advantage for verbal material, and children with right-hemisphere damage (n = 16) were found to have a pathological right visual half-field advantage for visual material. Children with left-hemisphere damage and a left-ear advantage on the dichotic test were also found to have a right visual half-field advantage on the chimeric test, which was regarded as a sign of reversed dominance. No verbal or nonverbal differences emerged between the left-hemisphere and the right-hemisphere damage groups, nor did differences emerge when the children were reclassified by considering children with left hemisphere damage and signs of reversed dominance as having damage to the nondominant hemisphere. It was concluded that although lateralized brain damage may alter the dominance for verbal and visual functions, there is still considerable inter-individual variability with respect to inter- and intrahemispheric neural adjustment to damage. The dichotic and the chimeric tests did not indicate the presence of brain damage accurately, but they indicated the lateralization of damage in children with stated abnormality with a high degree (91.3%) of accuracy.

Executive function abilities in autism and Tourette syndrome: an information processing approach

This study used information processing paradigms to provide a detailed examination of executive function abilities in autism. The performance of non-retarded autistic children was compared with that of two matched control groups, one with Tourette Syndrome and the other developmentally normal. Autistic subjects performed as well as controls on tasks requiring global-local processing and inhibition of neutral responses. In contrast to both control groups, however, the autistic sample was significantly impaired on a measure of cognitive flexibility. The performance of children with Tourette Syndrome did not differ from that of normal controls on any task. These results refine our knowledge about executive dysfunction in autism and suggest a new conceptual framework and general method for investigating the cognitive underpinnings of neurodevelopmental disorders.

Face recognition in children with early right or left brain damage

Development of face processing after unilateral brain lesions sustained before one year of age was assessed in children aged between seven and 10 years by various tasks involving face processing. Each child was paired with an age- and IQ-matched control. There were three unilateral right-hemisphere lesions and three unilateral left lesions. The results showed that some of the skills relative to face processing were preserved (or recovered?), whereas other skills were severely impaired; the pattern varied from one child to another. The existence of these dissociations shows that preservation of low-level visual processing together with exposure to the appropriate stimuli for several years is by no means sufficient for face processing skills to develop normally.

Spatial grouping activity in young children with congenital right or left hemisphere brain injury

Spatial grouping abilities were examined in 20 preschool-aged children with right or left hemisphere congenital focal brain injury, and a group of age-matched normal control children. Children were presented with a series of spontaneous grouping tasks in which they were given small sets of blocks and asked to play with them. Although the children with focal brain injury played as actively with the blocks as normal children, the constructions they produced differed systematically. Across eight measures of spatial grouping both children with right and left hemisphere injury were delayed compared to normal children. In addition, the behavioral profiles for the two groups of children with focal brain injury were qualitatively different. Data for the children with RH injury suggested difficulty organizing objects into coherent spatial groupings, while data from the children with LH injury suggested difficulty with local relations within the spatial arrays. These findings are consistent with data reported for adults on spatial construction tasks. Developmental trajectories in the 3- to 4-year age period suggest, further, that the spatial integrative deficits observed in the children with RH injury are persistent. When the children began to produce spatial constructions using complex grouping procedures, those constructions were heaps or disordered clusters. In contrast, when children with LH injury began to use complex procedures, they generated the types of constructions usually associated with those procedures in normal children, e.g., arches, enclosures, and symmetries. These data were found within a cross-sectional study of 20 children and confirmed in a series of six longitudinal case study reports of three children with RH and three with LH injury. The data confirm our previous reports of spatial integrative deficit associated with early RH injury and present the first indication of spatial encoding deficits in children with LH injury.

Schizophrenia: a disease of interhemispheric processes at forebrain and brainstem levels?

The evidence is convincing that each human cerebral hemisphere is capable of human mental activity. This being so, every normal human thought and action demands either a consensus between the two hemispheres, or a dominance of one over the other, in any event integrated into a unity of conscious mentation. How this is achieved remains wholly mysterious, but anatomical and behavioral data suggest that the two hemispheres, and their respective bilateral, anatomical-functional components, maintain a dynamic equilibrium through neural competition. While the forebrain commissures must contribute substantially to this competitive process, it is emphasized in this review that the serotonergic raphé nuclei of pons and mesencephalon are also participants in interhemispheric events. Each side of the raphé projects heavily to both sides of the forebrain, and each is in receipt of bilateral input from the forebrain and the habenulo-interpeduncular system. A multifarious loop thus exists between the two hemispheres, comprised of both forebrain commissural and brainstem paths. There are many reasons for believing that perturbation of this loop, by a variety of pathogenic agents or processes, probably including severe mental stress in susceptible individuals, underlies the extraordinarily diverse symptomatology of schizophrenia. Abnormality of features reflecting interhemispheric processes is common in schizophrenic patients; and the 'first rank' symptoms of delusions or hallucinations are prototypical of what might be expected were the two hemispheres unable to integrate their potentially independent thoughts. Furthermore, additional evidence suggests that the disorder lies within, or is focused primarily through, the raphé serotonergic system, that plays such a fundamental role in consciousness, in dreaming, in response to psychotomimetic drugs, and probably in movement, and even the trophic state of the neocortex. This system is also well situated to control the dopaminergic neurons of the ventral tegmental area, thus relating to the prominence of dopaminergic features in schizophrenia; and the lipofuscin loading and intimate relation with blood vessels and ependyma may make neurons of the raphé uniquely vulnerable to deleterious agents.