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Micheletti S, Galli J, Vezzoli M, Scaglioni V, Agostini S, Calza S, Merabet LB, Fazzi E. Academic skills in children with cerebral palsy and specific learning disorders. Dev Med Child Neurol 2024; 66:778-792. [PMID: 37990438 DOI: 10.1111/dmcn.15808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 09/02/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Abstract
AIM To investigate the prevalence and clinical manifestations of reading, writing, and mathematics disorders in children with cerebral palsy (CP). We explored how the clinical profile of these children differed from those with specific learning disorders (SLDs), taking into account several factors, particularly IQ scores, neuropsychological aspects, and the presence of a visual impairment. METHOD A prospective cross-sectional study was conducted in 42 children with CP (mean age 9 years 8 months; SD = 2 years 2 months) and 60 children with SLDs (mean age 10 years; SD = 1 year 7 months). Clinical characteristics, neuromotor and cognitive profiles, neuropsychological aspects (speech performance, academic skills, visual attention, phonological awareness, working memory), and signs of visual impairment (visual acuity, contrast sensitivity, visual field, oculomotor functions) were assessed. A machine learning approach consisting of a random forest algorithm, where the outcome was the diagnosis and the covariates were the clinical variables collected in the sample, was used for the analyses. RESULTS About 59% of the children with CP had reading, writing, or mathematics disorders. Children with CP with learning disorders had a low performance IQ, normal phonological awareness, and working memory difficulties, whereas children with SLDs had normal performance IQ, impaired phonological awareness, and mild working memory difficulties. There were no differences in verbal IQ between the two groups. INTERPRETATION Learning disorders are frequently associated with CP, with different clinical characteristics, compared with SLDs. Assessment of academic skills is mandatory in these children, even if the IQ is normal. At school age, specific interventions to promote academic skills in children with CP could be a major rehabilitative goal. WHAT THIS PAPER ADDS Reading, writing, and mathematics disorders in cerebral palsy have specific clinical characteristics. Their underlying mechanisms differ from those described in specific learning disorders. Working memory impairment can be considered a hallmark of learning disorders in children with cerebral palsy.
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Affiliation(s)
- Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Jessica Galli
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marika Vezzoli
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Vera Scaglioni
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stefania Agostini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Lotfi B Merabet
- Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Elisa Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Karlsson P, Shepherd M, Honan I. Accommodations to cognitive assessment for a child with dyskinetic cerebral palsy: case study. Disabil Rehabil Assist Technol 2024; 19:360-366. [PMID: 35730760 DOI: 10.1080/17483107.2022.2089244] [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: 06/22/2021] [Accepted: 05/23/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Despite the importance of having knowledge about a child's cognitive functioning, less than one-third of children with cerebral palsy (CP) are formally assessed. Consequently, the cognitive strengths of many children with severe CP may be underestimated or go overlooked. This case study aimed to test accommodations to cognitive assessment administration procedures to enable switch access. METHODS A 9-year-old boy with dyskinetic CP tested a suite of cognitive assessments with accommodations for single switch access and measures of user experience. The cognitive assessment included: receptive vocabulary; non-verbal reasoning; sustained attention; executive functions of problem solving and shifting; and visual perception skills. RESULTS The participant's ability to independently undertake assessment on the receptive vocabulary, non-verbal reasoning and the sustained attention measures indicates that accommodations made for single switch access were appropriate. Assessment took 1-2 h longer than expected for a typically developing child via standardised administration procedures, but was considerably faster than expected if undertaken via low-tech partner assisted scanning. Accessibility barriers continued to be present for the executive function and visual perception measures. Overall, the user experience was positive, both in regards to usability and cognitive load. CONCLUSIONS This case study provides emerging data for usability and accessibility of accommodations to a battery of cognitive assessment tasks. Further research is needed to devise appropriate accommodations for executive function and visual perception measures and to determine whether the accommodations are accessible more generally for children with motor and/or speech impairments. Implications for rehabilitationAccommodations can be successfully made to receptive vocabulary, non-verbal reasoning and sustained attention assessment administration procedures for switch technologies.Cognitive assessment with switch accommodations takes considerably longer to complete than standardised administration estimates for a typically developing child. Assessment may need to be scheduled over more than one session.User experience, including usability and cognitive load, of accommodations was positive.
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Affiliation(s)
- Petra Karlsson
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | | | - Ingrid Honan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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Sand K, Starrfelt R, Robotham RJ. Cognitive Functioning and Assessment in Adults with Cerebral Palsy: A Scoping Review. Dev Neurorehabil 2024; 27:57-67. [PMID: 38702978 DOI: 10.1080/17518423.2024.2347991] [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: 10/24/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
In this scoping review, we summarize the current knowledge of cognitive functioning in adults with cerebral palsy (CP), and identify the neuropsychological tests typically used in this population. 39 studies from the period January 1990 - August 2023 were included in the review, and they differ widely in their aims and approach to studying cognition. Very few studies have cognitive assessment as their core aim and use a neuropsychological test battery. The included studies show great variability in reported intelligence and cognitive functioning in adults with CP, and cognitive deficits have been reported in all cognitive domains. Most of the studies suffer from methodological limitations, and there is ample room for improvement within the field. We conclude by suggesting a number of recommendations that may contribute to increasing our understanding of cognitive impairments in adults with CP.
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Lopes-Santos LE, de Angelis G, Nakano FN, Thome U, Velasco TR, Santos MV, Machado HR, Hamad APA, Sakamoto AC, Wichert-Ana L. Executive functioning in children with posterior cortex epilepsy compared to temporal and frontal lobe epilepsies. Epilepsy Res 2023; 192:107141. [PMID: 37062183 DOI: 10.1016/j.eplepsyres.2023.107141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE People with epilepsy are at an increased risk of experiencing executive dysfunction, particularly those with frontal lobe epilepsy (FLE). The literature has also demonstrated alterations in executive functioning (EF) in patients with temporal lobe epilepsy (TLE). However, few studies have examined the neuropsychological profile of posterior cortex epilepsy (PCE), and little attention has been given to cognitive impairments in the pediatric population with PCE. This study aims to investigate EF performance in children with drug-resistant PCE compared to patients with FLE and TLE. METHODS We analyzed neuropsychological data from 217 patients aged 6-18 years who underwent preoperative evaluation for epilepsy surgery. The EF of patients with PCE was compared to patients with FLE and TLE. RESULTS There was no significant difference in Full-Scale Intelligence Quotient (FSIQ) means between groups. However, we found a significant effect of brain region on the Coding task, in which patients with PCE and FLE performed worse than those with TLE (p = 0.034). We also observed performance differences between groups on the Stroop test (p = 0.005), with patients with PCE and FLE performing worse than the TLE group. SIGNIFICANCE These findings suggest that children with PCE have alterations in their EF that are similar to the deficits found in FLE compared to patients with TLE. This emphasizes the importance of understanding the neuroanatomy of executive functions and the model of neural networks extending beyond the prefrontal cortex.
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Affiliation(s)
- Lucas Emmanuel Lopes-Santos
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Geisa de Angelis
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Frederico Nakane Nakano
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ursula Thome
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Tonicarlo Rodrigues Velasco
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcelo Volpon Santos
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Hélio Rubens Machado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Paula Andrade Hamad
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Américo Ceiki Sakamoto
- Epilepsy Surgery Center (CIREP), Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lauro Wichert-Ana
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Karlsson P, Honan I, Warschausky S, Kaufman JN, Henry G, Stephenson C, Webb A, McEwan A, Badawi N. A validation and acceptability study of cognitive testing using switch and eye-gaze control technologies for children with motor and speech impairments: A protocol paper. Front Psychol 2022; 13:991000. [PMID: 36225713 PMCID: PMC9549908 DOI: 10.3389/fpsyg.2022.991000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the importance of knowing the cognitive capabilities of children with neurodevelopmental conditions, less than one-third of children with cerebral palsy participate in standardized assessments. Globally, approximately 50% of people with cerebral palsy have an intellectual disability and there is significant risk for domain-specific cognitive impairments for the majority of people with cerebral palsy. However, standardized cognitive assessment tools are not accessible to many children with cerebral palsy, as they require manual manipulation of objects, verbal response and/or speeded response. As such, standardised assessment may result in an underestimation of abilities for children with significant motor and/or speech impairment. The overall aim of the project is to examine and compare the psychometric properties of standardised cognitive assessment tools that have been accommodated for use with either a switch device or eye-gaze control technologies, with the specific aims to: (1) Examine the psychometric properties (measurement agreement and validity) of accommodated assessment tools by comparing the performance of typically developing children on six cognitive assessment tools administered via standardised versus accommodated (switch or eye-gaze control) administration; (2) Describe and compare the performance and user experience of children with cerebral palsy on six accommodated cognitive assessments administered via switch or eye-gaze control technologies. Secondary aims are to: (1) Describe the completion rates and time to complete assessments of participants in each group; (2) Within the group with cerebral palsy, examine the effects of condition-specific characteristics (type of cerebral palsy, functional levels, and pain) and demographics (age, socio-demographic) on participation. This protocol paper describes a two-phase validation and acceptability study that utilizes a mixed-model design. This study will collect concurrent data from 80 typically developing children and 40 children with cerebral palsy, who use switch or eye-gaze control technology as alternate access communication methods. The set of instruments will measure receptive vocabulary, fluid reasoning, sustained attention, vision perception, visuospatial working memory and executive functions. Data analyses will be conducted using SPSS v. 25 and R v 4.1.0. SPSS Sample Power 3 was used for power computation and allows for a 10% drop out rate. Quantitative descriptive statistics, measurement agreement data plotting, bivariate and multiple regressions analysis will be conducted using appropriate methods.
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Affiliation(s)
- Petra Karlsson
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Petra Karlsson,
| | - Ingrid Honan
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Seth Warschausky
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Jacqueline N. Kaufman
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Georgina Henry
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Candice Stephenson
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Annabel Webb
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Alistair McEwan
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
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Coceski M, Stargatt R, Sherwell S, Abu-Rayya HM, Reid SM, Reddihough DS, Wrennall J, Hocking DR. 10-year follow-up study found that motor-free intelligence quotient declined in children with mild to moderate cerebral palsy. Acta Paediatr 2022; 111:1899-1906. [PMID: 35735126 PMCID: PMC9543839 DOI: 10.1111/apa.16463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Aim This 10‐year follow‐up study examined cognitive change in a cohort of children with cerebral palsy from preschool to adolescence at the group and individual levels. Methods The Wechsler Preschool and Primary Scale of Intelligence was administered to 80 children with cerebral palsy (mean = 4 years 6 months, standard deviation = 7 months) at baseline (Time 1). At 10‐year follow‐up (Time 2), 28 adolescents (mean = 14 years 6 months, standard deviation = 9 months) returned for assessment with the Wechsler Intelligence Scale for Children. Motor‐free intelligence quotient (IQ) scores were calculated and paired‐samples t‐tests and the Reliable Change Index (RCI) were used to investigate change in IQ over time. Results At the group level, nonverbal IQ scores declined significantly. At the individual level, RCI indicated nine and 11 children showed a clinically significant decline in Full Scale IQ (FSIQ) and nonverbal IQ scores, respectively. Decline in FSIQ was related to a history of seizures whereas decline in nonverbal IQ was associated with higher initial IQ. Conclusion Cognitive abilities in children with cerebral palsy evolve over time and selective deficits may not be observable until a later age, highlighting the importance of repeated cognitive assessment throughout childhood and adolescence.
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Affiliation(s)
- Monika Coceski
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Robyn Stargatt
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sarah Sherwell
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hisham M Abu-Rayya
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,School of Social Work, University of Haifa, Haifa, Israel
| | - Susan M Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Neurodevelopmental & Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jacquie Wrennall
- Mental Health, Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Darren R Hocking
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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