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Babik I, Cunha AB, Srinivasan S. Biological and environmental factors may affect children's executive function through motor and sensorimotor development: Preterm birth and cerebral palsy. Infant Behav Dev 2023; 73:101881. [PMID: 37643499 DOI: 10.1016/j.infbeh.2023.101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Disruptive biological and environmental factors may undermine the development of children's motor and sensorimotor skills. Since the development of cognitive skills, including executive function, is grounded in early motor and sensorimotor experiences, early delays or impairments in motor and sensorimotor processing often trigger dynamic developmental cascades that lead to suboptimal executive function outcomes. The purpose of this perspective paper is to link early differences in motor/sensorimotor processing to the development of executive function in children born preterm or with cerebral palsy. Uncovering such links in clinical populations would improve our understanding of developmental pathways and key motor and sensorimotor skills that are antecedent and foundational for the development of executive function. This knowledge will allow the refinement of early interventions targeting motor and sensorimotor skills with the goal of proactively improving executive function outcomes in at-risk populations.
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Affiliation(s)
- Iryna Babik
- Department of Psychological Science, Boise State University, Boise, ID, USA.
| | - Andrea B Cunha
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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2
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Beneventi H, Løhaugen GC, Andersen GL, Sundberg C, Østgård HF, Bakkan E, Walther G, Vik T, Skranes J. Working Memory Training in Norwegian Children with Cerebral Palsy (CP) Show Minimal Evidence of Near and No Far Transfer Effects. Dev Neurorehabil 2023; 26:364-370. [PMID: 37740724 DOI: 10.1080/17518423.2023.2259985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
In children with cerebral palsy (CP), learning disabilities are well documented, and impairments in executive functions, such as attention, inhibition, shifting and working memory, represent significant burdens on patients, their families and the society. The aim of this study was to evaluate whether Cogmed RM working memory training could improve working memory in children with CP and investigate whether increased working memory capacity would generalize to other cognitive functions. Twenty-eight children completed the training and the results were compared to a waitlist control group (n = 32). The results yielded three main findings. First, children with CP improved with practice on trained working memory tasks. Second, the intervention group showed minimal near transfer effects to non-trained working memory tasks. Third, no effects on cognitive and behavioral far transfer measures were found.
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Affiliation(s)
- Harald Beneventi
- Department of Paediatric Habilitation, Stavanger University Hospital, Stavanger, Norway
| | - Gro Cc Løhaugen
- Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
- Department of Clinical and Laboratory Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro L Andersen
- Department of Clinical and Laboratory Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Cerebral Palsy Register of Norway, Habilitation Center, Vestfold Hospital Trust, Tønsberg, Norway
| | - Cato Sundberg
- Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| | - Heidi Furre Østgård
- Department of Clinical and Laboratory Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ellen Bakkan
- Department of Paediatric Habilitation, Stavanger University Hospital, Stavanger, Norway
| | - Geir Walther
- Department of Child and Adolescent Psychiatry, Vestfold Hospital Trust, Tønsberg, Norway
| | - Torstein Vik
- Department of Clinical and Laboratory Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Skranes
- Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
- Department of Clinical and Laboratory Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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3
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From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Frolek Clark G, Niblock J, Crane Vos T, Lieberman D, Hunter EG. Systematic Review of Occupational Therapy Interventions to Enhance Cognitive Development in Children 0–5 Years: Part 1, Identified Diagnoses. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2021. [DOI: 10.1080/19411243.2021.1959480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Deborah Lieberman
- Vice President Practice Improvement, American Occupational Therapy Association, Inc, USA
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5
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Sleep, cognition and executive functioning in young children with cerebral palsy. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:285-314. [PMID: 33641797 DOI: 10.1016/bs.acdb.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Children with cerebral palsy (CP) are at higher risk for sleep disturbances than their typically developing peers. In typically developing young children, lack of sufficient sleep results in deficits in cognition, behavior and executive functioning. Unfortunately, research on sleep in infancy rarely focuses on children with neurodevelopmental disabilities. Studies of older children with CP demonstrate that roughly half of children with CP have a sleep disorder, though screening for sleep disorders in children with CP is not routinely performed. Given the high prevalence of sleep abnormalities in older children with CP and the resulting adverse effects on functioning, understanding sleep derangements and how they affect cognition and executive functioning in these children at earlier ages is critical. In this chapter, we present the state of the evidence for sleep characteristics, cognition and executive functions for infants and toddlers 0-3years old with CP.
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Hoffman RM, Trevarrow MP, Bergwell HR, Embury CM, Heinrichs-Graham E, Wilson TW, Kurz MJ. Cortical oscillations that underlie working memory are altered in adults with cerebral palsy. Clin Neurophysiol 2021; 132:938-945. [PMID: 33636609 DOI: 10.1016/j.clinph.2020.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/24/2020] [Accepted: 12/20/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This investigation used magnetoencephalography (MEG) to identify the neurophysiological mechanisms contributing to the altered cognition seen in adults with cerebral palsy (CP). METHODS Adults with CP (GMFCS levels I-IV) and demographically-matched controls completed a Sternberg-type working memory task during MEG. Secondarily, they completed the National Institutes of Health (NIH) cognitive toolbox. Beamforming was used to image the significant MEG oscillatory responses and the resulting images were examined using statistical parametric mapping to identify cortical activity that differed between groups. RESULTS Both groups had a left-lateralized decrease in alpha-beta (11-16 Hz) power across the occipital, temporal, and prefrontal cortices during encoding, as well as an increase in alpha (9-13 Hz) power across the occipital cortices during maintenance. The strength of alpha-beta oscillations in the prefrontal cortices were weaker in those with CP during encoding. Weaker alpha-beta oscillation within the prefrontal cortex was associated with poorer performance on the NIH toolbox and a higher GMFCS level. CONCLUSIONS Alpha-beta aberrations may impact the basic encoding of information in adults with CP, which impacts their overall cognition. Altered alpha-beta oscillation might be connected with gross motor function. SIGNIFICANCE This experimental work highlights the aberrant alpha-beta during encoding as possible neurophysiological mechanism of the cognitive deficiencies.
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Affiliation(s)
- Rashelle M Hoffman
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Hannah R Bergwell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Christine M Embury
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | | | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA.
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7
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Di Lieto MC, Pecini C, Brovedani P, Sgandurra G, Dell'Omo M, Chilosi AM, Guzzetta A, Perazza S, Sicola E, Cioni G. Adaptive Working Memory Training Can Improve Executive Functioning and Visuo-Spatial Skills in Children With Pre-term Spastic Diplegia. Front Neurol 2021; 11:601148. [PMID: 33551960 PMCID: PMC7854548 DOI: 10.3389/fneur.2020.601148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
Pre-term spastic diplegia (pSD) due to periventricular leukomalacia is a form of cerebral palsy in which weaknesses in executive functions are reported beyond the core visuo-spatial deficits. The study aimed at improving executive functioning and visuo-spatial skills with an evidence-based training focused on working memory in children with pSD. The intervention study followed a stepped wedge design. 19 children with pSD (11 female and 8 male; age range: 4;1-13;1 years), mild to moderate upper limb impairment and Verbal Intelligence Quotient (VIQ) >80 participated to the study. The children were trained with a home-based adaptive working memory training (CogMed®) over a 5-week period. The primary outcome measure was the CogMed Improvement index; pre- and post-test explorative neuropsychological assessment was conducted with a subset of tests from the NEPSY-II battery. Working memory training in children with pSD significantly improved trained working memory abilities (CogMed indices) as well as non-trained skills, such as visuo-spatial skills, inhibition of automatic responses and phonological processing. The results suggest that standard rehabilitation schedules for children with pSD should be integrated with trainings on executive functions.
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Affiliation(s)
- Maria Chiara Di Lieto
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Chiara Pecini
- Department of Education, Language, Interculture and Psychology, University of Florence, Florence, Italy
| | - Paola Brovedani
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Dell'Omo
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Anna Maria Chilosi
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Perazza
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Elisa Sicola
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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8
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Alamer A, Melese H, Adugna B. Effectiveness of Action Observation Training on Upper Limb Motor Function in Children with Hemiplegic Cerebral Palsy: A Systematic Review of Randomized Controlled Trials. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:335-346. [PMID: 32982541 PMCID: PMC7501989 DOI: 10.2147/phmt.s266720] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/21/2020] [Indexed: 11/23/2022]
Abstract
The purpose of this review was to evaluate and examine the current best evidence for the effectiveness of action observation therapy on upper limb function rehabilitation in children with hemiplegic cerebral palsy. A comprehensive search of literature published between September 2010 and May 2020 was conducted using the following electronic databases: PubMed, Google Scholar, the Physiotherapy Evidence Database (PEDro), EMBASE, Cochrane library, and Scopus. Only randomized controlled trials evaluating the effect of action observation therapy on upper limb motor function in children with hemiplegic cerebral palsy were included. PEDro scale was used to assess the risk of bias of included trials. This study was reported according to the guideline of the PRISMA statement. The overall methodological quality of the studies was done using the PEDro scale and GRADE approach. The primary outcome measures of this review were the Melbourne Assessment Scale, Assisting Hand Assessment scale to evaluate physical function and structures. Furthermore, the ABILHAND-Kids test, and Box and Block Test primary outcome measures were used to determine the subjects’ activities and participation. Nine randomized controlled trials involving 234 participants were analyzed. The overall quality of evidence was rated from moderate to high. This review suggests action observation therapy was found to be a promising intervention for upper limb rehabilitation in children with cerebral palsy.
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Affiliation(s)
- Abayneh Alamer
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Haimanot Melese
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Belaynew Adugna
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Tibebe Ghion Comprehensive Specialized Hospital, Bahirdar University, Bahirdar, Ethiopia
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9
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Kim DH. Comparison of short- and long-time action observation training (AOT) on upper limb function in children with cerebral palsy. ACTA ACUST UNITED AC 2020. [DOI: 10.3233/ppr-190145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Do Hyun Kim
- Department of Physical Therapy, Uiduk University, Gyeongsangbuk-do, Republic of Korea
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10
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Freire TC, Osório AAC. Executive functions and drawing in young children with cerebral palsy: Comparisons with typical development. Child Neuropsychol 2019; 26:635-648. [PMID: 31752569 DOI: 10.1080/09297049.2019.1694648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is evidence that school-aged children with cerebral palsy (CP) may present deficits in executive functions (EF) greater than would be expected considering their intellectual ability. However, no studies have focused on characterizing EF in this group at an earlier critical period - the preschool years. Furthermore, and given evidence from typically-developing (TD) children, deficits in EF are associated with potential detrimental effects on social and educational development - which can include drawing. Our aim was to compare preschool children with CP, matched in chronological age and intellectual ability with a group of TD children, regarding their executive functioning and drawing abilities. In addition, we examined the relationships between these variables in each of the groups. Twenty-eight children were evaluated in executive functions and drawing tasks. Differences were found in some aspects of cognitive flexibility and inhibitory control, but not in working memory. Additionally, the quality of the drawings was significantly poorer in the CP group. In the TD group, there was an association between greater inhibitory control (but not cognitive flexibility or working memory) and drawing quality. In the CP group, although non-significant, medium-sized correlations were observed between drawing and several aspects of executive functioning. Overall, our results suggest more similarities than differences in the executive functioning of children with CP (and preserved cognitive ability) and TD children. However, there were still important between-group differences in their drawing abilities. There was also a distinct pattern of associations between drawing and executive functions in the clinical group.
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Affiliation(s)
- Tania Cristina Freire
- Departamento de Arte e Reabilitação, Associação de Assistência à Criança Deficiente , São Paulo, Brazil
| | - Ana Alexandra Caldas Osório
- Programa de Pós-Graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie , São Paulo, Brazil
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11
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Maioli C, Falciati L, Galli J, Micheletti S, Turetti L, Balconi M, Fazzi EM. Visuospatial Attention and Saccadic Inhibitory Control in Children With Cerebral Palsy. Front Hum Neurosci 2019; 13:392. [PMID: 31780913 PMCID: PMC6856641 DOI: 10.3389/fnhum.2019.00392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
Cerebral palsy (CP) is a non-progressive syndrome due to a pre-, peri- or post-natal brain injury, which frequently involves an impairment of non-motor abilities. The aim of this article was to examine visuospatial attention and inhibitory control of prepotent motor responses in children with CP showing a normal IQ or mild cognitive impairment, measuring their performance in oculomotor tasks. Ten children (9–16-year-old) with spastic CP and 13 age-matched, typically developing children (TDC) participated in the study. Subjects performed a simple visually-guided saccade task and a cue-target task, in which they performed a saccade towards a peripheral target, after a non-informative visual cue was flashed 150 ms before the imperative target, either at the same (valid) or at a different (invalid) spatial position. Children with CP showed severe executive deficits in maintaining sustained attention and complying with task instructions. Furthermore, saccadic inhibitory control appeared to be significantly impaired in the presence of both stimulus-driven and goal-directed captures of attention. In fact, patients showed great difficulties in suppressing saccades not only to the cue stimuli but also to the always-present target placeholders, which represented powerful attentional attractors that had to be covertly attended throughout the task execution. Moreover, impairment did not affect in equal manner the whole visual field but showed a marked spatial selectivity in each individual subject. Saccade latencies in the cue-target task were faster in the valid than in the invalid condition in both child groups, indicating the preservation of low-level visuospatial attentive capabilities. Finally, this study provides evidence that these impairments of executive skills and in inhibitory control, following early brain injuries, manifest in childhood but recover to virtually normal level during adolescence.
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Affiliation(s)
- Claudio Maioli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Falciati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Luisa Turetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michela Balconi
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Elisa M Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
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12
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Abstract
Prepotent response inhibition and temporal perception abilities were explored in a sample of individuals with cerebral palsy relative to typically developing peers. The extent to which inhibitory control difficulties might affect temporal processing was also investigated. For this purpose, two inhibitory control tasks and two duration estimation tasks were given to the groups of cerebral palsy and typically developing children. Results showed inhibition and temporal perception problems in the group with cerebral palsy. A relationship was found between inhibition and temporal estimation performances, which indicates that inhibitory control contributes, at least partially, to acquisition of the temporal processing ability.
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Affiliation(s)
- Mercedes Cabezas
- BOBATH Foundation.,National Distance Education University (UNED)
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13
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Sakash A, Broman AT, Rathouz PJ, Hustad KC. Executive function in school-aged children with cerebral palsy: Relationship with speech and language. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 78:136-144. [PMID: 29853333 PMCID: PMC6033269 DOI: 10.1016/j.ridd.2018.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 04/03/2018] [Accepted: 05/22/2018] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND AIMS Although children with cerebral palsy (CP) are at an increased risk for developing speech, language, and executive function (EF) impairments, little is known regarding the relationship among these risk factors. The current study examined how different profiles of speech and language impairment might be associated with impairments in EF skills in school-aged children with CP. METHODS AND PROCEDURES Forty-seven school-aged children with CP were included. Each child contributed between one and four data points for a total of 87 data points. Children were classified into speech and language profile groups at each data point. EF skills were examined using the Behavior Rating Inventory of Executive Function questionnaire. OUTCOMES AND RESULTS Compared to a mean of 50 from a normative population of children, mean scores on all measures of EF were significantly elevated for all groups (p<.05). The proportion of children with CP with elevated EF scores was significantly higher for all groups compared to the expected proportion in a normal population of children (p<.05). CONCLUSIONS AND IMPLICATIONS Children with CP who do not have impairments in speech or language may be at risk for EF difficulties which may negatively affect social communication, academic performance, and functional independence.
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Affiliation(s)
- Ashley Sakash
- Waisman Center, University of Wisconsin-Madison, United States.
| | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Katherine C Hustad
- Waisman Center, University of Wisconsin-Madison, United States; Department of Communication Sciences and Disorders, University of Wisconsin-Madison, United States
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14
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Hoare B, Ditchfield M, Thorley M, Wallen M, Bracken J, Harvey A, Elliott C, Novak I, Crichton A. Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study. BMC Neurol 2018; 18:63. [PMID: 29739443 PMCID: PMC5938804 DOI: 10.1186/s12883-018-1070-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 05/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child’s ability to use their two hands to perform bimanual tasks. Methods/Design This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6–12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain – lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive – standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location. Discussion This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the development of novel methods to improve both cognitive and motor outcomes in children with unilateral cerebral palsy. Trial registration ACTRN12614000631606; Date of retrospective registration 29/05/2014.
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Affiliation(s)
- Brian Hoare
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC, 3168, Australia. .,School of Occupational Therapy, La Trobe University, Bundoora, VIC, 3168, Australia. .,Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia.
| | - Michael Ditchfield
- Department of Diagnostic Imaging, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Margaret Wallen
- School of Allied Health, Australian Catholic University, North Sydney, NSW, 2060, Australia
| | - Jenny Bracken
- Department of Diagnostic Imaging, Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia
| | - Adrienne Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work, Curtin University, Bentley, 6102, Western Australia, Australia.,Department of Paediatric Rehabilitation, Princess Margaret Hospital, Washington, WA, Australia
| | - Iona Novak
- Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, PO Box 6427, Frenchs Forest, NSW, 2086, Australia
| | - Ali Crichton
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC, 3168, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia
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15
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Abstract
PURPOSE To explore factors contributing to variability in cognitive functioning in children with cerebral palsy (CP). METHOD A geographical cohort of 70 children with CP was assessed with tests of language comprehension, visual-spatial reasoning, attention, working memory, memory, and executive functioning. Mean age was 9;9 years (range 5;1-17;7), 54.3% were girls, and 50.0% had hemiplegic, 25.7% diplegic, 12.9% quadriplegic, and 11.4% dyskinetic CP. For the participants with severe motor impairments, assessments were adapted for gaze pointing. A cognitive quotient (CQ) was computed. RESULTS Mean CQ was 78.5 (range 19-123). Gross motor functioning, epilepsy, and type of brain injury explained 35.5% of the variance in CQ (F = 10.643, p = .000). CONCLUSION Twenty-four percent had an intellectual disability, most of them were children with quadriplegic CP. Verbal comprehension and perceptual reasoning scores did only differ for the 21% with an uneven profile, of whom two-thirds had challenges with perceptual reasoning.
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Affiliation(s)
- Kristine Stadskleiv
- a Department of Clinical Neurosciences for Children, Oslo University Hospital , Oslo , Norway
| | - Reidun Jahnsen
- a Department of Clinical Neurosciences for Children, Oslo University Hospital , Oslo , Norway.,b Department of Research, Sunnaas Rehabilitation Hospital , Nesodden , Norway
| | - Guro L Andersen
- c Vestfold Hospital Trust, The Cerebral Palsy Register of Norway , Tønsberg , Norway.,d Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
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Seo SM. The impact of group occupational therapy using a cueing system on executive function of preschool-aged children with brain lesions. J Phys Ther Sci 2018; 30:339-342. [PMID: 29545709 PMCID: PMC5851378 DOI: 10.1589/jpts.30.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/29/2017] [Indexed: 12/05/2022] Open
Abstract
[Purpose] This study investigates the effects of group occupational therapy using a
cueing system on the executive function of preschool-aged children with brain lesions.
[Subjects and Methods] Six preschool-aged children with brain lesions participated in this
study. A 24-session occupational therapy program (1 session/week, 50 minutes/session)
designed based on a cueing system was administered to examine the changes in the
participants’ executive function. The behavior rating inventory of executive
function-preschool (BRIEF-P) was used to check the magnitude of improvement of executive
functions after therapy. [Results] A Wilcoxon signed rank test revealed that occupational
therapy significantly improved all domains, indices, and the global executive composite in
the BRIEF-P. [Conclusion] The occupational therapy intervention incorporating a type of
cognitive behavioral approach known as the cueing system may assist improving executive
functions in preschool-aged children with brain lesions
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Affiliation(s)
- Sang-Min Seo
- Department of Occupational Therapy, Seoul Metropolitan Children’s Hospital: 260 Heungneungno, Naegok-dong, Seocho-gu, Seoul 06801, Republic of Korea
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Cognitive functioning in dyskinetic cerebral palsy: Its relation to motor function, communication and epilepsy. Eur J Paediatr Neurol 2018; 22:102-112. [PMID: 29108712 DOI: 10.1016/j.ejpn.2017.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/25/2017] [Accepted: 10/15/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a disorder of motor function often accompanied by cognitive impairment. There is a paucity of research focused on cognition in dyskinetic CP and on the potential effect of related factors. AIM To describe the cognitive profile in dyskinetic CP and to assess its relationship with motor function and associated impairments. METHOD Fifty-two subjects with dyskinetic CP (28 males, mean age 24 y 10 mo, SD 13 y) and 52 typically-developing controls (age- and gender-matched) completed a comprehensive neuropsychological assessment. Gross Motor Function Classification System (GMFCS), Communication Function Classification System (CFCS) and epilepsy were recorded. Cognitive performance was compared between control and CP groups, also according different levels of GMFCS. The relationship between cognition, CFCS and epilepsy was examined through partial correlation coefficients, controlling for GMFCS. RESULTS Dyskinetic CP participants performed worse than controls on all cognitive functions except for verbal memory. Milder cases (GMFCS I) only showed impairment in attention, visuoperception and visual memory. Participants with GMFCS II-III also showed impairment in language-related functions. Severe cases (GMFCS IV-V) showed impairment in intelligence and all specific cognitive functions but verbal memory. CFCS was associated with performance in receptive language functions. Epilepsy was related to performance in intelligence, visuospatial abilities, visual memory, grammar comprehension and learning. CONCLUSION Cognitive performance in dyskinetic CP varies with the different levels of motor impairment, with more cognitive functions impaired as motor severity increases. This study also demonstrates the relationship between communication and epilepsy and cognitive functioning, even controlling for the effect of motor severity.
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Sleep disturbances and behavioural and emotional problems in preschool children with bilateral cerebral palsy. SOMNOLOGIE 2017. [DOI: 10.1007/s11818-017-0121-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sørensen K, Liverød JR, Lerdal B, Vestrheim IE, Skranes J. Executive functions in preschool children with cerebral palsy--Assessment and early intervention--A pilot study. Dev Neurorehabil 2016; 19:111-6. [PMID: 24840746 DOI: 10.3109/17518423.2014.916761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the level of executive functioning among preschool children with cerebral palsy (CP) and evaluate effects of the Program Intensified habilitation (PIH). METHODS In this non-randomized, prospective study, 15 preschool children with CP, and their parents attended the PIH for a 1-year period. Executive functions were evaluated using the Behavior Rating Inventory of Executive functions-Preschool version (BRIEF-P), filled out by parents and preschool teachers. RESULTS Before PIH, scores of executive function difficulties were close to the general population mean. After PIH, fathers and preschool teachers reported reduced levels of executive difficulties on, respectively, the Emergent Metacognition Index and the Flexibility Index on the BRIEF-P. Mothers reported no changes. CONCLUSION The children in our sample showed age-appropriate levels of executive functions before attending PIH. Some aspects of executive skills difficulties were reduced after PIH. Using BRIEF-P contributed to the differentiation of cognitive strengths and weaknesses among the children.
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Affiliation(s)
- Kristian Sørensen
- a Child Habilitation Unit, Department of Pediatrics , Sørlandet Hospital HF , Kristiansand , Norway
| | - Janne Risholm Liverød
- b Adult Habilitation Unit, Department of Rehabilitation , Sørlandet Hospital HF , Kristiansand , Norway , and
| | - Bjørn Lerdal
- a Child Habilitation Unit, Department of Pediatrics , Sørlandet Hospital HF , Kristiansand , Norway
| | - Ida E Vestrheim
- a Child Habilitation Unit, Department of Pediatrics , Sørlandet Hospital HF , Kristiansand , Norway
| | - Jon Skranes
- a Child Habilitation Unit, Department of Pediatrics , Sørlandet Hospital HF , Kristiansand , Norway .,c Department of Laboratory Medicine, Children's and Women's Health, Medical Faculty , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
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Gosling AS. Recent advances in the neuroimaging and neuropsychology of cerebral palsy. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:55-63. [DOI: 10.1080/21622965.2015.1074914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ego C, Orban de Xivry JJ, Nassogne MC, Yüksel D, Lefèvre P. Spontaneous improvement in oculomotor function of children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:630-644. [PMID: 25462523 DOI: 10.1016/j.ridd.2014.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/16/2014] [Indexed: 06/04/2023]
Abstract
Eye movements are essential to get a clear vision of moving objects. In the present study, we assessed quantitatively the oculomotor deficits of children with cerebral palsy (CP). We recorded eye movements of 51 children with cerebral palsy (aged 5-16 years) with relatively mild motor impairment and compared their performance with age-matched control and premature children. Overall eye movements of children with CP are unexpectedly close to those of controls even though some oculomotor parameters are biased by the side of hemiplegia. Importantly, the difference in performance between children with CP and controls decreases with age, demonstrating that the oculomotor function of children with CP develops as fast as or even faster than controls for some visual tracking parameters. That is, oculomotor function spontaneously improves over the course of childhood. This evolution highlights the ability of lesioned brain of children with CP to compensate for impaired motor function beyond what would be achieved by normal development on its own.
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Affiliation(s)
- Caroline Ego
- ICTEAM, Université catholique de Louvain, Louvain-la-Neuve, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
| | - Jean-Jacques Orban de Xivry
- ICTEAM, Université catholique de Louvain, Louvain-la-Neuve, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
| | - Marie-Cécile Nassogne
- Neuropediatric Department, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
| | - Demet Yüksel
- Ophthalmology Department, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
| | - Philippe Lefèvre
- ICTEAM, Université catholique de Louvain, Louvain-la-Neuve, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
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Stadskleiv K, von Tetzchner S, Batorowicz B, van Balkom H, Dahlgren-Sandberg A, Renner G. Investigating executive functions in children with severe speech and movement disorders using structured tasks. Front Psychol 2014; 5:992. [PMID: 25249999 PMCID: PMC4157461 DOI: 10.3389/fpsyg.2014.00992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 08/21/2014] [Indexed: 11/17/2022] Open
Abstract
Executive functions are the basis for goal-directed activity and include planning, monitoring, and inhibition, and language seems to play a role in the development of these functions. There is a tradition of studying executive function in both typical and atypical populations, and the present study investigates executive functions in children with severe speech and motor impairments who are communicating using communication aids with graphic symbols, letters, and/or words. There are few neuropsychological studies of children in this group and little is known about their cognitive functioning, including executive functions. It was hypothesized that aided communication would tax executive functions more than speech. Twenty-nine children using communication aids and 27 naturally speaking children participated. Structured tasks resembling everyday activities, where the action goals had to be reached through communication with a partner, were used to get information about executive functions. The children (a) directed the partner to perform actions like building a Lego tower from a model the partner could not see and (b) gave information about an object without naming it to a person who had to guess what object it was. The executive functions of planning, monitoring, and impulse control were coded from the children's on-task behavior. Both groups solved most of the tasks correctly, indicating that aided communicators are able to use language to direct another person to do a complex set of actions. Planning and lack of impulsivity was positively related to task success in both groups. The aided group completed significantly fewer tasks, spent longer time and showed more variation in performance than the comparison group. The aided communicators scored lower on planning and showed more impulsivity than the comparison group, while both groups showed an equal degree of monitoring of the work progress. The results are consistent with the hypothesis that aided language tax executive functions more than speech. The results may also indicate that aided communicators have less experience with these kinds of play activities. The findings broaden the perspective on executive functions and have implications for interventions for motor-impaired children developing aided communication.
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Affiliation(s)
- Kristine Stadskleiv
- Department of Psychology, University of OsloOslo, Norway
- Section of Paediatric Neuro-habilitation, Department of Clinical Neurosciences for Children, Oslo University HospitalOslo, Norway
| | | | - Beata Batorowicz
- CanChild Centre for Childhood Disability Research, McMaster UniversityHamilton, Canada
| | - Hans van Balkom
- Behavioural Science Institute, Radboud University NijmegenNijmegen, Netherlands
| | | | - Gregor Renner
- Catholic University of Applied SciencesFreiburg, Germany
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Løhaugen GCC, Beneventi H, Andersen GL, Sundberg C, Østgård HF, Bakkan E, Walther G, Vik T, Skranes J. Do children with cerebral palsy benefit from computerized working memory training? Study protocol for a randomized controlled trial. Trials 2014; 15:269. [PMID: 24998242 PMCID: PMC4226979 DOI: 10.1186/1745-6215-15-269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 06/11/2014] [Indexed: 11/28/2022] Open
Abstract
Background Cerebral palsy (CP) is the most common motor disability in childhood (2 to 3 per 1000 live births), and is frequently accompanied by cognitive impairments and behavioural problems. Children with CP are at increased risk of attention deficit disorder with or without hyperactivity (Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)) including working memory deficits. The primary aim of this study is to evaluate if cognitive training may improve working memory in children with CP. Methods/Designs The study is an investigator-blinded, randomized controlled trial with a stepped-wedge design that will include 115 schoolchildren with CP. Eligible for participation are children with CP, aged 7 to 15 years, who are able to follow instructions and handle a computer mouse. Exclusion criteria are the presence of photosensitive epilepsy, Gross Motor Function Classification System (GMFCS) level V (most severe CP) (Phys Ther 80: 974-985, 2000) and severe visual or hearing impairments. Following assessment of eligibility and baseline cognitive assessment the participants will be randomized to either cognitive working memory training or treatment-as-usual (‘control group’). The intervention is a computer-based working memory training program consisting of 25 daily sessions to be performed over a 5 to 6-week period at home. A neuropsychological assessment will be performed before and 4 to 6 weeks after completed training. When the latter assessment has been completed in the intervention group, the ‘control group’ will start on the same training program. Both groups will meet for a final neuropsychological assessment six months after completed training by an examiner unaware of group adherence. Discussion There is limited evidence for the effect of most interventions in children with CP, and evidence is completely lacking for interventions aiming to improve deficits in cognition, learning and behaviour. The proposed multicenter study, will bring forth comprehensive information about cognitive, neuropsychological, and daily-life functioning in children with CP aged between 7 and 15 years. In addition, the study will be the first to evaluate the effects of an intervention method to improve working memory in children with CP. If successful, computer-based working memory training may represent an efficient and cost-effective intervention for this group of children. Trial registration ClinicalTrials.gov Identifier: NCT02119364
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Affiliation(s)
- Gro C C Løhaugen
- Department of Pediatrics, Sørlandet Hospital, Sykehusveien 1, 4809 Arendal, Norway.
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Hakkarainen E, Pirilä S, Kaartinen J, van der Meere JJ. Error detection and response adjustment in youth with mild spastic cerebral palsy: an event-related brain potential study. J Child Neurol 2013; 28:752-7. [PMID: 22899795 DOI: 10.1177/0883073812452786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluated the brain activation state during error making in youth with mild spastic cerebral palsy and a peer control group while carrying out a stimulus recognition task. The key question was whether patients were detecting their own errors and subsequently improving their performance in a future trial. Findings indicated that error responses of the group with cerebral palsy were associated with weak motor preparation, as indexed by the amplitude of the late contingent negative variation. However, patients were detecting their errors as indexed by the amplitude of the response-locked negativity and thus improved their performance in a future trial. Findings suggest that the consequence of error making on future performance is intact in a sample of youth with mild spastic cerebral palsy. Because the study group is small, the present findings need replication using a larger sample.
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Affiliation(s)
- Elina Hakkarainen
- Finnish Cerebral Palsy Association, Malmin kauppatie 26, Helsinki, Finland.
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Weierink L, Vermeulen RJ, Boyd RN. Brain structure and executive functions in children with cerebral palsy: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1678-1688. [PMID: 23500162 DOI: 10.1016/j.ridd.2013.01.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/30/2013] [Accepted: 01/30/2013] [Indexed: 06/01/2023]
Abstract
This systematic review aimed to establish the current knowledge about brain structure and executive function (EF) in children with cerebral palsy (CP). Five databases were searched (up till July 2012). Six articles met the inclusion criteria, all included structural brain imaging though no functional brain imaging. Study quality was assessed using the STROBE checklist. All articles scored between 58.7% and 70.5% for quality (100% is the maximum score). The included studies all reported poorer performance on EF tasks for children with CP compared to children without CP. For the selected EF measures non-significant effect sizes were found for the CP group compared to a semi-control group (children without cognitive deficits but not included in a control group). This could be due to the small sample sizes, group heterogeneity and lack of comparison of the CP group to typically developing children. The included studies did not consider specific brain areas associated with EF performance. To conclude, there is a paucity of brain imaging studies focused on EF in children with CP, especially of studies that include functional brain imaging. Outcomes of the present studies are difficult to compare as each study included different EF measures and cortical abnormality measures.
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Affiliation(s)
- Lonneke Weierink
- Department of Child Neurology, VU University Medical Center, Neuroscience Campus Amsterdam, The Netherlands
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DTI correlates of cognition in term children with spastic diplegic cerebral palsy. Eur J Paediatr Neurol 2013; 17:294-301. [PMID: 23246381 DOI: 10.1016/j.ejpn.2012.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 10/27/2012] [Accepted: 11/17/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Presently, there is no published study that shows association between cognition and white matter injury in spastic cerebral palsy. We aimed to correlate cognitive functions with diffusion tensor imaging derived metrics in spastic diplegic children. METHODS Twenty-two term children with spastic diplegia and 22 healthy controls were recruited. All patients were graded on the basis of gross motor function. The Indian children intelligence Test was used to quantify cognition and diffusion tensor imaging was used to quantify microstructural changes in various white matter regions. Diffusion tensor imaging metrics were quantified by placing regions of interests in different white matter regions like corona radiata, anterior limb of internal capsule, posterior limb of internal capsule, mid brain, pons, medulla, genu, splenium, temporal white matter, parietal white matter, frontal white matter and occipital white matter. RESULTS Spastic diplegic children showed significantly lower neuropsychological test scores as compared to controls. A significantly decreased fractional anisotropy values were observed in corona radiata, anterior limb of internal capsule, posterior limb of internal capsule, mid brain, pons, medulla, genu, splenium and occipital white matter; however significantly increased mean diffusivity values were observed in corona radiata, anterior limb of internal capsule, posterior limb of internal capsule, mid brain, pons and genu in spastic diplegic as compared to controls. A significant positive correlation in fractional anisotropy and negative correlation in mean diffusivity was observed with neuropsychological test scores. CONCLUSION These results suggest that these imaging metrics may be used as a biomarker of cognitive functions in term children with spastic diplegia.
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Gagliardi C, Tavano A, Turconi AC, Borgatti R. Sequence memory skills in Spastic Bilateral Cerebral Palsy are age independent as in normally developing children. Disabil Rehabil 2012; 35:506-12. [DOI: 10.3109/09638288.2012.704124] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Toomela A. Short-Term Memory in Young Adults With Spastic Diplegic Cerebral Palsy. Dev Neuropsychol 2012; 37:317-32. [DOI: 10.1080/87565641.2011.632461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
We investigated sequence-learning skills in 64 children with cerebral palsy (aged 4.01-14.7 years; 49 with bilateral, two with dystonic, and 13 with unilateral cerebral palsy), compared with a matched control group of typically developing children. Participants' motor and handling abilities were classified according to the Gross Motor Function Classification System and the Manual Ability Classification System. General cognitive, visuoperceptual, and constructive abilities were assessed. Participants performed an experimental computerized version of Corsi Span, followed by a normalized Supraspan sequence. Controls outperformed cerebral palsy participants in visual memory and accuracy. Participants with cerebral palsy were likelier to fail the test (cerebral palsy, 37.5%; control subjects, 5%) and obtain overall lower scores. Sequence learning skills were not related to motor and handling impairments. Failure to learn sequences resulted in an overall lower functioning profile regarding visuoperceptual, verbal, and performance abilities. The ability to fix sequences seemed to split the cerebral palsy group into an overall high-functioning group (successful in sequence learning) and low-functioning (failing) group. Results are discussed in light of a specific implicit memory impairment and the abnormal development of white matter frontostriatal and parietal connections.
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Shank LK, Kaufman J, Leffard S, Warschausky S. Inspection time and attention-deficit/hyperactivity disorder symptoms in children with cerebral palsy. Rehabil Psychol 2010; 55:188-93. [PMID: 20496973 DOI: 10.1037/a0019601] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine between-groups differences in the associations between aspects of processing speed assessed with an inspection time task and attention-deficit/hyperactivity disorder (ADHD) symptoms. RESEARCH DESIGN Two groups comprising 34 children with cerebral palsy (CP) and 70 nonaffected peers (control), ages 8-16 years, participated in a prospective correlational study. Measures included a visual inspection time task and the Conners' Parent Rating Scale-Revised: Long Version. RESULTS Children with CP exhibited significantly slower processing speed and more symptoms of inattention and hyperactivity than controls. Significant associations between inspection time and ADHD symptoms were found only in the control group. CONCLUSIONS Findings have implications for clinical assessment and understanding of attentional risks associated with CP.
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Affiliation(s)
- Laura K Shank
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 East Eisenhower Parkway, AnnArbor, MI 48108-5744, USA
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Bottcher L. Children with Spastic Cerebral Palsy, Their Cognitive Functioning, and Social Participation: A Review. Child Neuropsychol 2010; 16:209-28. [DOI: 10.1080/09297040903559630] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bottcher L, Flachs EM, Uldall P. Attentional and executive impairments in children with spastic cerebral palsy. Dev Med Child Neurol 2010; 52:e42-7. [PMID: 20002117 DOI: 10.1111/j.1469-8749.2009.03533.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Children with cerebral palsy (CP) are reported to have learning and social problems. The aim of the present study was to examine whether children with CP have impairments in attention or executive function. METHOD We examined attention and executive function with standardized neuropsychological measures in a group of children with unilateral (n=15) or bilateral (n=18) spastic CP (14 females, 19 males, mean age 11y 4mo, SD 1y 1mo, range 9y 1mo-13y 7mo; Gross Motor Function Classification System level I n=22, II n=3, III n=6, and IV n=2). Performance was compared with test norms. RESULTS Verbal cognitive functioning fell within the normal range, whereas sustained (p=0.001) and divided attention (p<0.001) were found to be impaired. Greater impairment was observed in executive function in general (p<0.001) and in inhibition (p=0.038) and shifting (p<0.001) in particular. No significant difference was found between types of CP (unilateral and bilateral). Performance of all timed tasks was slower than the test norm (p<0.00). INTERPRETATION The finding of slower performances across tasks may indicate a general impairment in efficiency of information processing in relation to white-matter lesions. Impairments in attention and executive functions are present in children with CP and may help to explain why these children have increased social and learning problems.
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Affiliation(s)
- Louise Bottcher
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
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Pueyo R, Junqué C, Vendrell P, Narberhaus A, Segarra D. Neuropsychologic impairment in bilateral cerebral palsy. Pediatr Neurol 2009; 40:19-26. [PMID: 19068249 DOI: 10.1016/j.pediatrneurol.2008.08.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 04/02/2008] [Accepted: 08/22/2008] [Indexed: 11/29/2022]
Abstract
The lower-than-average cognitive performance of individuals with bilateral cerebral palsy found in previous studies does not always refer to an abnormal performance or clinically significant impairment. We aimed to establish the percentage of persons with bilateral cerebral palsy who present neuropsychologic impairment, and its relationship to perinatal data and motor signs. Forty children, adolescents, and adults (age range, 6-38 years; 15 females and 25 males) with bilateral cerebral palsy were neuropsychologically assessed. Vocabulary was impaired in 85% of participants, language comprehension in 13-48%, visuoperceptual abilities in 60%, visuospatial abilities in 90%, short-term memory in 21-58%, declarative memory in 47-67%, and praxis comprehension in 20%, with executive deficits in 58-74%. Perinatal data (intrauterine growth and birth weight) contributed to explaining memory impairment. Among cerebral palsy subtypes (spastic, mixed, and dyskinetic), forms of impairment differed only in short-term verbal memory. No persons with dyskinetic cerebral palsy experienced impairment in immediate memory or working visual memory. We conclude that visuospatial deficit is the most frequent impairment in people with bilateral cerebral palsy. Moreover, short-term memory impairment seems sensitive to perinatal complications, and differs among bilateral cerebral palsy subtypes.
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Affiliation(s)
- Roser Pueyo
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.
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