Basic visual perceptual processes in children with typical development and cerebral palsy: The processing of surface,length, orientation,and position

The present study aims to assess how the processing of basic visual perceptual (VP) components (length, surface, orientation, and position) develops in typically developing (TD) children (n = 215, 4–14 years old) and adults (n = 20, 20–25 years old), and in children with cerebral palsy (CP) (n = 86, 5–14 years old) using the first four subtests of the Battery for the Evaluation of Visual Perceptual and Spatial processing in children. Experiment 1 showed that these four basic VP processes follow distinct developmental trajectories in typical development. Experiment 2 revealed that children with CP present global and persistent deficits for the processing of basic VP components when compared with TD children matched on chronological age and nonverbal reasoning abilities.     

Effects of utterance length on lip kinematics in aphasia

Most existing models of language production and speech motor control do not explicitly address how language requirements affect speech motor functions, as these domains are usually treated as separate and independent from one another. This investigation compared lip movements during bilabial closure between five individuals with mild aphasia and five age and gender-matched control speakers when the linguistic characteristics of the stimuli were varied by increasing the number of syllables. Upper and lower lip movement data were collected for mono-, bi- and tri-syllabic nonword sequences using an AG 100 EMMA system. Each task was performed under both normal and fast rate conditions. Single articulator kinematic parameters (peak velocity, amplitude, duration, and cyclic spatio-temporal index) were measured to characterize lip movements. Results revealed that compared to control speakers, individuals with aphasia showed significantly longer movement duration and lower movement stability for longer items (bi- and tri-syllables). Moreover, utterance length affected the lip kinematics, in that the monosyllables had smaller peak velocities, smaller amplitudes and shorter durations compared to bi- and trisyllables, and movement stability was lowest for the trisyllables. In addition, the rate-induced changes (smaller amplitude and shorter duration with increased rate) were most prominent for the short items (i.e., monosyllables). These findings provide further support for the notion that linguistic changes have an impact on the characteristics of speech movements, and that individuals with aphasia are more affected by such changes than control speakers.     

Speech timing subsequent to brain damage: effects of utterance length and complexity

Acoustic analyses of syllable durations were conducted in order to address several hypotheses concerning deficits in the control of speech timing subsequent to focal brain damage. Groups of nonfluent and fluent aphasics, right-hemisphere-damaged patients, and normal controls produced monosyllabic root syllables in medial and final position in the context of short and long sentences and syntactically simple and complex sentences. Durations of the target syllable as a proportion of the utterance were compared across contexts and groups. Somewhat surprisingly, the results revealed relatively normal temporal patterns in all subject groups, with the main exception emerging for the nonfluent aphasic patients who failed to demonstrate normal phrase-final lengthening effects. Implications of the findings for theories of temporal control in brain-damaged patients are considered.     

Sensory processing disorders in children with cerebral palsy

ObjectiveTo evaluate sensory processing in children with CP using the Sensory Profile questionnaire and to compare results with the ones of children with typical development (TD).MethodsWe assessed sensory processing of 59 TD children and 43 CP children using the Sensory Profile, a standardized parent reporting measure that records children's responses to sensory events in daily life. Mann-Whitney test was used to compare the results of sensory processing evaluation among the groups. Bonferroni correction was applied.ResultsWe found differences in sensory processing between groups in 16 out of the 23 categories evaluated in the Sensory Profile.ConclusionOur results pointed out to the existence of disturbances in the processing of sensory information in CP. Based on the importance of the sensory integration process for motor function, the presence of such important disturbances draw the attention to the implementation of sensory therapies which improve function in these children.     

Frequency and duration of therapeutic intervention with young children with cerebral palsy

Though the terms 'frequency' and 'duration' of physical and occupational therapy strategies for young children with cerebral palsy are inextricably woven, little research has been done to support the provision of these therapies. More recent studies have implied the expanded role of therapists in providing and participating in nontraditional types of intervention. An argument is presented for this position.     

Systematic review of chorioamnionitis and cerebral palsy

In a recent meta-analysis evaluating the relationship between chorioamnionitis and cerebral palsy, we found that chorioamnionitis is a risk factor for both cerebral palsy and cystic periventricular leukomalacia (cPVL). The current paper extends the meta-analysis by including studies published in the year 2000, and by further evaluating the causes of heterogeneity among individual study results. Using a random effects model, clinical chorioamnionitis was significantly associated with both cerebral palsy (RR 1.9, 95% CI 1.5-2.5) and cPVL (RR 2.6, 95% CI 1.7-3.9). Sources of heterogeneity included widely varying practices in the diagnosis of clinical chorioamnionitis, different gestational age characteristics, and varying study year. We conclude that based on the available literature, chorioamnionitis is a risk factor for both cerebral palsy and cPVL.     

Dynamic touch is affected in children with cerebral palsy

Children with developmental disorders such as cerebral palsy have limited opportunities for effortful interactions with objects and tools. The goal of the study was to investigate whether children with cerebral palsy have deficits in their ability to perceive object length by dynamic touch when compared to typically developing children. Fourteen children with typical development and 12 children with cerebral palsy were asked to report the length of hand-held rods after wielding them out of sight. Multilevel regression models indicated that I₁ (maximum principal moment of inertia) was a significant predictor of perceived length – L_P (p < .0001). The effect of I₁ on L_P was significantly different among children (p = .001) and the presence of cerebral palsy (group factor) partially explained such variance (p = .002). In addition, accuracy and reliability of the length judgments made by children with cerebral palsy were significantly lower than the typically developing children (p < .05). Theoretical and clinical implications of these results were identified and discussed.     

Childhood stuttering and speech disfluencies in relation to children's mean length of utterance: a preliminary study

The purpose of this study was to examine the influence of utterance length and complexity relative to the children's mean length of utterance (MLU) on stuttering-like disfluencies (SLDs) for children who stutter (CWS) and nonstuttering-like disfluencies (nonSLDs) for children who do not stutter (CWNS). Participants were 12 (3;1-5;11, years;months) children: 6 CWS and 6 age-matched (+/-5 months) CWNS, with equal numbers in each talker group (CWS and CWNS) exhibiting MLU from the lower to the upper end of normal limits. Data were based on audio-video recordings of each child in two separate settings (i.e., home and laboratory) during loosely structured, 30-min parent-child conversational interactions and analyzed in terms of each participant's utterance length, MLU, frequency and type of speech disfluency. Results indicate that utterances above children's MLU are more apt to be stuttered or disfluent and that both stuttering-like as well as nonstuttering-like disfluencies are most apt to occur on utterances that are both long and complex. Findings were taken to support the hypothesis that the relative "match" or "mismatch" between linguistic components of an utterance (i.e., utterance length and complexity) and a child's language proficiency (i.e., MLU) influences the frequency of the child's stuttering/speech disfluency. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to: (1) compare different procedures for assessing the relationship among stuttering, length and complexity of utterance, (2) describe the difference between relative and absolute measures of utterance length, (3) discuss the measurement and value of mean length of utterance and its possible contributions to childhood stuttering, and (4) describe how length and complexity influence nonstuttering-like disfluencies of children who stutter as well as the stuttering-like disfluencies of children who do not stutter.     

Complementary and alternative therapies for cerebral palsy

The optimal practice of medicine includes integrating individual clinical expertise with the best available clinical evidence from systematic research. This article reviews nine treatment modalities used for children who have cerebral palsy (CP), including hyperbaric oxygen, the Adeli Suit, patterning, electrical stimulation, conductive education, equine-assisted therapy, craniosacral therapy, Feldenkrais therapy, and acupuncture. Unfortunately, these modalities have different degrees of published evidence to support or refute their effectiveness. Uncontrolled and controlled trials of hippotherapy have shown beneficial effects on body structures and functioning. Studies of acupuncture are promising, but more studies are required before specific recommendations can be made. Most studies of patterning have been negative and its use cannot be recommended. However, for the other interventions, such as hyperbaric oxygen, more evidence is required before recommendations can be made. The individual with CP and his or her family have a right to full disclosure of all possible treatment options and whatever knowledge currently is available regarding these therapies.     

Memory for words and drawings in children with hemiplegic cerebral palsy

A list-learning paradigm was used to study learning and memory of verbal and figurative material in children with right versus left-sided hemiplegic cerebral palsy. Thirty-one children with right (n=18), or left (n=13) congenital hemiplegia were compared with normal controls (n=19). All children had normal intelligence (IQ>80), and were attending standard schools. The inclusion criteria for the two hemiplegic groups were; no epilepsy, no hearing or visual impairments, and a mild to moderate hemiparesis. The aim of this study was to explore material-specific (words and drawings) differences in the acquisition, recall and serial position effects in children with an early unilateral brain lesion. The left-hemisphere impaired (i.e. right hemiplegia) group showed impaired acquisition for drawings, as compared with the normal controls. There was also a material-specific difference in the serial position effect for all three groups. Learning of words followed the primacy principle, whereas the learning of drawings followed the recency principle. There were no group-differences in delayed-recall (i.e. long-term memory) for either words or drawings. The results are discussed in terms of acquisition and retention of verbal and figurative materials in relation to lesion side and size.     

Correlates of therapeutic progress by infants with cerebral palsy and motor delay

A group of 10 infants diagnosed as having cerebral palsy or severe motor delays was administered pre/posttest assessments of both standardized and nonstandardized motor-evaluation instruments. Following 6 mo. of therapeutic intervention provided through neurodevelopmental treatment, the motoric gains of these infants were correlated with age, IQ, infant hours in treatment, hours of parental participation, and degree of involvement. Kendall's tau correlations showed a significant relationship between motoric progress and age, parental participation, and degree of involvement. The dilemma faced by habilitation professionals regarding whether or not to encourage parents to participate in therapeutic intervention programs is noted.     

Advances in prevention and treatment of cerebral palsy

In recent years there have been a number of advances in understanding of predisposing and protective factors in the development of cerebral palsy in infants. Multiple gestation births, maternal infection, and maternal and fetal thrombophilic conditions all predispose to the development of CP in the infant. Opportunities for prevention of CP may develop from an improved understanding of these factors and their mechanisms of operation. Similar progress has been made in the evaluation of treatments for CP and the effects of these treatments on the individual's impairment, function, and disability. Selective posterior rhizotomy and Botulinum toxin A are now widely used in the treatment of spasticity. The challenge remains to determine how effectively these promising interventions can alter long-term function and quality of life outcomes in children and adults with CP.     

Sentence repetition in preschoolers: Effects of length,complexity, and word familiarity

Seventy-two sentences presented to ten preschool children for repetition were designed so that three sentence construction factors varied independently. The factors were (1) length in number of words, (2) complexity of personal pronouns and main verbs as scaled by Lee (1974), and (3) word familiarity, defined as common vocabulary or the substitution of a nonsense word in place of a typical noun or verb in the model sentence. Three methods were employed for scoring the children's responses: (1) number of retained words, (2) Developmental Sentence Scoring (Lee, 1974), and (3) Stephens's Categories (Stephens, 1974). Eighteen sentences were re-presented for the assessment of reliability. The results of multiple regression analyses indicated that length was the important contributing factor in the children's responses to the model sentences and that Stephens's Category Scale of response scoring was the most sensitive method for detecting the influence of the three sentence factors on the children's responses.     

Anticipatory and compensatory postural adjustments in sitting in children with cerebral palsy

The aim of this study was to examine postural control in children with cerebral palsy performing a bilateral shoulder flexion to grasp a ball from a sitting posture. The participants were 12 typically developing children (control) without cerebral palsy and 12 children with cerebral palsy (CP). We analyzed the effect of ball mass (1 kg and 0.18 kg), postural adjustment (anticipatory, APA, and compensatory, CPA), and groups (control and CP) on the electrical activity of shoulder and trunk muscles with surface electromyography (EMG). Greater mean iEMG was seen in CPA, with heavy ball, and for posterior trunk muscles (p < .05). The children with CP presented the highest EMG and level of co-activation (p < .05). Linear regression indicated a positive relationship between EMG and aging for the control group, whereas that relationship was negative for participants with CP. We suggest that the main postural control strategy in children is based on corrections after the beginning of the movement. The linear relationship between EMG and aging suggests that postural control development is affected by central nervous disease which may lead to an increase in muscle co-activation.     

Lower extremity kinetics for balance control in children with cerebral palsy

The authors examined and compared the effect of support-surface perturbations of various magnitudes on lower extremity kinetics of 7 children with cerebral palsy (CP) and 8 typically developing (TD) children. Results showed that the highest velocity tolerated without stepping was slower in children with CP than in either age-matched TD or younger TD children. Multimodal torque profiles were more frequent in children with CP than in TD controls. TD groups temporally and spatially organized torque activation, whereas children with CP activated all joints simultaneously and showed altered torque contribution patterns among joints. Those results suggest that impairments in reactive postural control in children with CP result not only from developmental delay but also from pathology. Evidence for pathology included increased numbers of torque bursts required to regain stability and less efficient temporal and spatial organization of torque activation patterns.     

Improving dynamic balance by self-controlled feedback in children with cerebral palsy

AimsMaintaining balance is an important topic for participation of children with Cerebral Palsy (CP) in their own activities. Purpose of the present study was to investigate the effect of self-controlled and yoked-group feedback on dynamic balance of children with Spastic Hemiplegic Cerebral Palsy (SHCP).MethodsUsing Convenience Sampling Method, twenty students with Cerebral Palsy, aged 8–10 years old, were selected from special schools and divided into the Self-Controlled (SC) and Yoked feedback groups. Children in SC group requested feedback when necessary during the acquisition phase; in contrast, participants in yoked group replicated the feedback schedule of their counterparts in SC group without any choice. Modified Star Excursion Balance Test (SEBT) was used for both dynamic balance intervention and assessment. To analyze the data, Multivariate Analysis of Covariance (MANCOVA) and Analysis of Covariance (ANCOVA) Tests were performed at p < 0.05.ResultsBased on MANCOVA test results, a significant difference were found between SC and Yoked groups after controlling for pretest at least in one balance variables (anterior, posterolateral, and posteromedial). Results of ANCOVA test showed a significant difference between the balance variables in the anterior, Posterolateral, and posteromedial directions in children with cerebral palsy.ConclusionsFindings of our study support the idea that requested feedback in SC conditions could have more benefits for motor learning since it is adjusted with the needs and preferences of children.