Early Brain Damage Affects Body Schema and Person Perception Abilities in Children and Adolescents with Spastic Diplegia

Understanding social cognition in children with cerebral palsy: exploring the relationship with executive functions and the intervention outcomes in a randomized controlled trial

Children with Cerebral Palsy (CP) experience Social Cognition (SC) difficulties, which could be related to executive functioning. While motor interventions are common, there is limited knowledge about the impact of cognitive interventions on SC in this population. This study examined the relationship between SC and Executive Function (EF) skills and the effectiveness of an EF intervention that included some SC tasks for improving SC in children with CP. SC and EF domains were assessed in 60 participants with CP (30 females; 8-12 years). The relationship between SC and EF baseline scores was analyzed by bivariate correlations and contingency tables. Participants were matched by age, sex, motor ability, and intelligence quotient and randomized into intervention or control groups. The intervention group underwent a 12-week home-based computerized EF intervention. Analysis of covariance was used to examine differences in SC components between groups at post-intervention and 9 months after. Significant positive correlations were found between the SC and EF scores. The frequencies of impaired and average scores in SC were distributed similarly to the impaired and average scores in EFs. The intervention group showed significant improvements in Affect Recognition performance post-intervention, which were maintained at the follow-up assessment, with a moderate effect size. Long-term improvements in Theory of Mind were observed 9 months after.

CONCLUSIONS

This study highlights the association between SC and EFs. A home-based computerized cognitive intervention program improves SC in children with CP. Including SC tasks in EF interventions may lead to positive short- and long-term effects for children with CP.

CLINICAL TRIAL REGISTRATION

NCT04025749 retrospectively registered on 19 July 2019.

WHAT IS KNOWN

• Executive functions and social cognition are associated with social and community participation in people with cerebral palsy. • A home-based computerized cognitive intervention can improve the executive functioning of children with cerebral palsy.

WHAT IS NEW

• Social cognition performance is related to core and higher-order executive functions. • A home-based computerized executive function intervention, including social cognition tasks, has positive short- and long-term effects on social cognition skills in children with cerebral palsy.

Synergistic effect of functional strength training and cognitive intervention on gross motor function in children with cerebral palsy

BACKGROUND

Cerebral palsy (CP) is a posture and movement disorder, however; it often includes disturbance of different aspects of cognitive function. This study aimed to investigate if combined functional strength training (FST) and cognitive intervention are more effective than either of them alone on gross motor function in children with spastic diplegic CP.

METHODS

Sixty-four children with spastic diplegic CP, with ages ranging from 8 to 12 years, were assigned randomly into four treatment groups; Group I; FST, group II; cognitive training, group III; combined FST and cognitive training, group IV; conventional physical therapy. The Gross Motor Function Measure (GMFM-88) was used to assess gross motor function at baseline, post-treatment, and 6 months follow-up.

RESULTS

Group III achieved a significant improvement in GMFM-88 when compared to other groups post-treatment and at follow-up.

CONCLUSION

This study suggests that combined lower limb FST and cognitive intervention had the potential to produce significantly more favorable effects than the single use of either of them on gross motor function in children with spastic diplegia.

Motor imagery ability in children and adolescents with cerebral palsy: a systematic review and evidence map

Background

Cerebral palsy (CP) refers to a group of permanent movement and posture disorders. Motor imagery (MI) therapy is known to provide potential benefits, but data on MI ability in children and adolescents with CP is lacking.

Objective

A systematic review was performed to explore MI abilities in children and adolescents with CP compared to typically developed (TD) subjects.

Methods

We searched on PubMed, Web of Science (WOS), EBSCO, Google Scholar, and PEDro including observational studies. Methodological quality was assessed with the modified Newcastle-Ottawa Scale and evidence map was created to synthesize the evidence qualitatively and quantitatively.

Results

Seven cross-sectional studies were selected, which included 174 patients with CP and 321 TD subjects. Three studies explored explicit MI, two MI-execution synchrony, and four implicit MI domains. Methodological quality ranged from 6 to 8 stars. Moderate evidence supported the absence of differences in vividness between the groups. As there was only limited evidence, establishing a clear direction for the results was not possible, especially for the capacity to generate MI, mental chronometry features, and MI-execution synchrony domains. Moderate evidence supported a lower efficiency in cases for hand recognition, derived from a lower accuracy rate, while reaction time remained similar between the two groups. Moderate evidence indicated that patients with CP and TD controls showed similar features on whole-body recognition.

Conclusion

Moderate evidence suggests that patients with CP present a reduced ability in hand recognition, which is not observed for whole-body recognition compared to healthy controls. Severe limitations concerning sample size calculations and validity of assessment tools clearly limits establishing a direction of results, especially for explicit MI and MI-Execution synchrony domains. Further research is needed to address these limitations to enhance our comprehension of MI abilities in children, which is crucial for prescribing suitable MI-based therapies in this child population.

Body experience influences lexical-semantic knowledge of body parts in children with hemiplegic cerebral palsy

Background

Disorders in different levels of body representation (i.e., body schema, body structural description, and body image) are present in hemiplegic cerebral palsy (HCP). However, it remains unclear whether the body image develops from aspects of body schema and body structural description, and how this occurs in children with HCP.

Objective and methods

In a cross-sectional study, we investigated 53 children with HCP (mean age about 10 years) and 204 typically developing (TD) control children to qualitatively evaluate whether and how body schema (related sensorimotor experiences) and body structural description (related visuospatial experiences) affect the development of children’s body image and whether this development is delayed through HCP. Graph analysis was used to create a lexical-semantic map of body representation from data of a semantic word fluency task.

Results

Results indicated a similar qualitative pattern of influences of sensorimotor and visuospatial experiences on lexical-semantic knowledge of body parts, with a delayed developmental course in children with HCP compared to TD children.

Conclusion

These findings suggest that children’s body image seemed to be influenced by body schema and body structural descriptions as indicated by poorer lexical-semantic knowledge of body parts in children with HCP due to missing physical experiences of the affected body parts. This might imply that “body talk” may beneficially complement physical therapy for children with HCP to promote body image development.

Body Processing in Children and Adolescents with Traumatic Brain Injury: An Exploratory Study

Dysfunctions in body processing have been documented in adults with brain damage, while limited information is available for children. This study aimed to investigate body processing in children and adolescents with traumatic brain injury (TBI) (N = 33), compared to peers with typical development. Two well-known computerized body-representation paradigms, namely Visual Body Recognition and Visuo-spatial Imagery, were administered. Through the first paradigm, the body inversion and composite illusion effects were tested with a matching to sample task as measures of configural and holistic processing of others’ bodies, respectively. The second paradigm investigated with a laterality judgement task the ability to perform first-person and object-based mental spatial transformations of own body and external objects, respectively. Body stimuli did not convey any emotional contents or symbolic meanings. Patients with TBI had difficulties with mental transformations of both body and object stimuli, displaying deficits in motor and visual imagery abilities, not limited to body processing. Therefore, cognitive rehabilitation of body processing in TBI might benefit from the inclusion of both general training on visuo-spatial abilities and specific exercises aimed at boosting visual body perception and motor imagery.

A multilevel Bayesian meta-analysis of the body inversion effect: Evaluating controversies over headless and sexualized bodies

Face and body perception rely on specialized processing mechanisms to interpret social information efficiently. The body inversion effect (BIE), refers to an inversion effect for bodies, such that recognition of bodies is impaired by inversion. The BIE, like the face inversion effect (FIE), is particularly important because a disproportionate BIE relative to inversion effects for objects could be interpreted in much the same way as the disproportionate FIE has often been characterized; that is, as evidence of specialized, configural processing. However, research supporting the BIE is marked by methodological heterogeneity and mixed findings. Our multilevel Bayesian meta-analysis addresses inconsistencies in the literature by pooling data from numerous studies to estimate the magnitude of the BIE across various methodological and stimulus properties. We included 180 effect sizes from 41 empirical articles representing data from 2,274 participants. Overall, we found that the BIE was moderate-large in magnitude (Hedges' g = 0.75). Importantly, the inversion effect was larger for bodies than objects (b = 0.42); however, the inversion effect for faces was larger than for bodies (b = 0.34). We tested the role of discrimination dimension, stimulus type, face/head inclusion, stimulus sexualization, and sexualized stimulus sex as moderators of the BIE. We found that the BIE was moderated by discrimination dimension, stimulus type, stimulus sexualization, and sexualized stimulus sex. By synthesizing the existing literature, we provide a better theoretical understanding of how underlying visual processing mechanisms may differ for different types of social information (i.e., bodies vs. faces).

Parietal Gamma Band Oscillation Induced by Self-Hand Recognition

Physiological studies have shown that self-body images receive unique recognition processing in a wide range of brain areas, from the frontal lobe to the parietal-occipital cortex. Event-related potential (ERP) studies have shown that the self-referential effect on the image of a hand increases P300 components, but such studies do not evaluate brain oscillatory activity. In this study, we aimed to discover the self-specific brain electrophysiological activity in relation to hand images. ERPs on the fronto-parietal midline were elicited by a three-stimulus visual oddball task using hand images: the self-hand, another hand (most similar to the self-hand), and another hand (similar to the self-hand). We analyzed ERP waveform and brain oscillatory activity by simple averaging and time-frequency analysis. The simple averaging analysis found no significant differences between the responses for the three stimulus tasks in all time windows. However, time-frequency analysis showed that self-hand stimuli elicited high gamma ERS in 650–900 ms at the Cz electrode compared to other hand stimuli. Our results show that brain activity specific to the self-referential process to the self-hand image was reflected in the long latency gamma band activity in the mid-central region. This high gamma-band activity at the Cz electrode may be similar to the activity of the mirror neuron system, which is involved in hand motion.

Somatosensory deficits and neural correlates in cerebral palsy: a scoping review

AIM

To synthetize studies assessing somatosensory deficits and alterations in cerebral responses evoked by somatosensory stimulation in individuals with cerebral palsy (CP) compared to typically developing individuals.

METHOD

A scoping review of the literature was performed in the MEDLINE, Embase, PsycInfo, CINAHL, Evidence-Based Medicine Reviews, and Web of Science databases (last search carried out on 6th and 7th August 2020) with a combination of keywords related to CP and somatosensory functions. Somatosensory deficits were measured with clinical tests and alterations in cerebral responses were measured with functional magnetic resonance imaging, electroencephalography, and magnetoencephalography.

RESULTS

Forty-eight articles were included. Overall, 1463 participants with CP (mean [SD] age 13y 1mo [4y 11mo], range 1-55y; 416 males, 319 females, sex not identified for the remaining participants) and 1478 controls (mean [SD] age 13y 1mo [5y 8mo], range 1-42y; 362 males, 334 females, sex not identified for the remaining participants) were included in the scoping review. For tactile function, most studies reported registration (8 out of 13) or perception (21 out of 21) deficits in participants with CP. For proprioception, most studies also reported registration (6 out of 8) or perception (10 out of 15) deficits. Pain function has not been studied as much, but most studies reported registration (2 out of 3) or perception (3 out of 3) alterations. Neuroimaging findings (18 studies) showed alterations in the somatotopy, morphology, latency, or amplitude of cortical responses evoked by somatosensory stimuli.

INTERPRETATION

Despite the heterogeneity in the methods employed, most studies reported somatosensory deficits. The focus has been mainly on tactile and proprioceptive function, whereas pain has received little attention. Future research should rigorously define the methods employed and include a sample that is more representative of the population with CP. What this paper adds Most of the papers reviewed found tactile registration and perception deficits in the upper limbs. Proprioceptive deficits were generally observed in cerebral palsy but results were heterogeneous. Pain has received little attention compared to tactile and proprioceptive functions. Neuroimaging studies supported behavioral observations. Alterations were observed for both the most and least affected limb.

The effects of visual impairment on motor imagery in children and adolescents

BACKGROUND

While the development of motor imagery (MI) has been extensively studied in sighted children, it is not clear how children with different severities of visual impairment (VI) represent motor actions by using the motor representations constructed through the remaining intact senses, especially touch.

AIMS

Mental chronometry and generation/manipulation of MI were examined in children with and without VI.

METHODS AND PROCEDURES

Participants included 64 youth with and without VI (33 without visual impairments, 14 moderate-to-severe, and 17 blind). Mental chronometry was assessed with the imagined Timed-Up-and-Go-Test (iTUG), and generation/manipulation of MI with the Controllability-of-Motor-Imagery-Test (CMI). In addition, the effect of working memory performance (Letter-Number-Sequencing) and physical activity upon MI were evaluated.

RESULTS

Mental duration for the iTUG was significantly shorter than the active durations. Results also provided evidence of better haptic representation than motor representation in all participants; however, only for the CMI-regeneration condition controls outperformed children with visual impairments and blindness (CVIB). Exercise and working memory performance showed a significant contribution only on a few MI tests.

CONCLUSION AND IMPLICATIONS

Our results suggest a possible relationship between motor performance, body representation deficits and visual impairment which needs to be addressed in the evaluation and treatment of CVIB. The design of new rehabilitation interventions that focus on strengthening adequate body perception and representation should be proposed and tested to promote motor development in CVIB.

Premature birth affects visual body representation and body schema in preterm children

Research has demonstrated that from the first six months of life infants show early sensitivity to body visual features and rely on sensorimotor and proprioceptive inputs in forming representations of their own bodies. Premature birth interferes with typical exposition to visual, sensorimotor and proprioceptive stimulation, thus presumably affecting the development of body representations. Here, we tested this hypothesis by comparing the performance of preterm children with that of age-matched full-termchildren in two tasks assessing, respectively, visual body processing and body schema. We found that preterm children had spared configural processing but altered holistic processing of others' bodies and showed a general difficulty in expressing visuospatial judgements on body stimuli. Furthermore, body-centered visuospatial abilities were associated with specific impairments in operating object-based visuospatial transformations. The findings of this study indicate that preterm birth might interfere with the development of body representations at the levels of body visual perceptual processing and of body schema, with effects even on visuo-spatial abilities for non-bodily stimuli. Body-centered rehabilitative interventions should be proposed to preterm children in order to enhance visuo-spatial abilities and higher-level cognitive functions.

Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy

BACKGROUND

Children with spastic hemiplegic cerebral palsy have deficits in eye-hand coordination. This limits manual actions performed with the affected hand, especially fine motor skills such as grasping and manipulation. Visual-motor integration, grasping skills, and visual perception are collectively involved in eye-hand coordination.

AIMS

We investigated the effects of augmented biofeedback training on eye-hand coordination in children with spastic hemiplegic cerebral palsy.

METHODS AND PROCEDURES

Forty-five spastic hemiplegic cerebral palsy children (5-8 years old) were included. Children were assigned randomly into three equal groups. One group received traditional physical therapy to facilitate visual-motor integration and grasping skills for 3 months. The second group received augmented biofeedback training. The third group received a combination of augmented biofeedback training and traditional physical therapy. Children were evaluated with the Peabody Developmental Motor Scale (2nd edition) (PDMS-2). Treatment sessions were conducted for 60 min, three times a week, for 3 consecutive months.

OUTCOMES AND RESULTS

Children that received augmented biofeedback training alongside traditional physical therapy had significantly improved scores in the Visual-Motor Integration and grasping subtests compared to children that received only one intervention.

CONCLUSIONS AND IMPLICATIONS

Augmented biofeedback training alongside physical therapy improved eye-hand coordination in children with spastic hemiplegic cerebral palsy.