Effects of sensory manipulations on the dynamical structure of center-of-pressure trajectories of children with cerebral palsy during sitting

Aim: To investigate the effects of manipulating visual information and the compliance of the support surface on the area of sway and dynamical trajectories of center-of-pressure (CoP) in children with CP and children with typical development during static sitting. Methods: 32 typical children, 14 children with mild CP and 12 with moderate-to-severe CP were tested for CoP sway during static sitting under four sensory conditions: (1) eyes open on a rigid surface; (2) eyes closed on a rigid surface; (3) eyes open on foam; (4) eyes closed on foam. Results: Children with moderate-to-severe CP showed greater regularity and local stability of dynamical CoP trajectories and lower complexity in their motor patterns than typical children and children with mild CP. Moreover, removing vision and sitting on a compliant surface reduced the regularity of CoP trajectories. Conclusion: Children with CP were able to adjust the structure and complexity of their postural control responses to sensory challenges, although the structure of their postural responses was poorer than in typical children.     

Gradual increase of perturbation load induces a longer retention of locomotor adaptation in children with cerebral palsy

The goal of this study is to determine whether the size and the variability of error have an impact on the retention of locomotor adaptation in children with cerebral palsy (CP). Eleven children with CP, aged 7–16 years old, were recruited to participate in this study. Three types of force perturbations (i.e., abrupt, gradual and noisy loads) were applied to the right leg above the ankle starting from late stance to mid-swing in three test sessions while the subject walked on a treadmill. Spatial-temporal gait parameters were recorded using a custom designed 3D position sensor during treadmill walking. We observed that children with CP adapted to the resistance force perturbation and showed an aftereffect consisting of increased step length after load release. Further, we observed a longer retention of the aftereffect for the condition with a gradual load than that with an abrupt load. Results from this study suggested that the size of error might have an impact on the retention of motor adaptation in children with CP with a longer retention of motor adaptation for the condition with a small size of error than that with a large error. In addition, enhanced variability of error seems facilitate motor learning during treadmill training. Results from this study may be used for the development of force perturbation based training paradigms for improving walking function in children with CP.     

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.     

Effects of whole body vibration on spasticity and lower extremity function in children with cerebral palsy

AimThe aim of this study was to evaluate the effect of whole body vibration (WBV) on lower extremity spasticity and ambulatory function in children with cerebral palsy (CP) with a complete crossover design.MethodSixteen participants aged 9.8(2.3) years received a 20-min WBV and a control condition in a counterbalanced order on two separate days. Change scores of each outcome variable were used to show the improvement.ResultsRepeated-measures analyses revealed significant differences in condition scores among variables including active range-of-motion (active ROM, increased), relaxation index (RI, increased), Modified Ashworth Scale (MAS, decreased), timed up-and-go (TUG, decreased), and Six Minute Walk Test (6MWT, increased). Significant differences were also found in time change scores for MAS and 6MWT. Correlation results revealed that TUG was significantly correlated with RI (r = −.512, p = .042), and 6MWT (r = −.700, p = .003).InterpretationThis study suggested that WBV intervention can control the spasticity, enhance ambulatory performance and increase active ROM. Along with previous results, data from this study revealed the potential use of WBV in clinical rehabilitation in children with CP. Future investigations should focus on finding the combination of treatment frequency and duration to achieve an ideal result.     

Auditory processing and sensory behaviours in children with autism spectrum disorders as revealed by mismatch negativity

Sensory dysfunctions may underlie key characteristics in children with Autism Spectrum Disorders (ASD). The current study aimed to investigate auditory change detection in children with ASD in order to determine event-related potentials to meaningless and meaningful speech stimuli. 11 high functioning boys with a diagnosis of autism spectrum disorders (mean age = 13.0; SD = 1.08) and 11 typically developing boys (mean age = 13.7; SD = 1.5) participated in a mismatch negativity (MMN) paradigm. Results revealed that compared to TD controls, the children with ASD showed significantly reduced MMN responses to both words and pseudowords in the frontal regions of the brain and also a significant reduction in their activation for words in the Central Parietal regions. In order to test the relationship between sensory processing and auditory processing, children completed the Adult and Adolescent Sensory Profile. As predicted, the children with ASD showed more extreme sensory behaviours and were significantly higher than their typically developing controls across three of the sensory quadrants (sensory sensitivity, low registration and sensory avoidance). Importantly, only auditory sensory sensitivity was able to account for the differences displayed for words in the frontal and central parietal regions when controlling for the effect of group, revealing an inverse relationship of the higher sensory sensitivity scores the less activation in response for words. We discuss how the expression of sensory behaviours in ASD may result in deficient neurophysiological mechanisms underlying automatic language processing.     

Visuo-haptic transfer for object recognition in children with periventricular leukomalacia and bilateral cerebral palsy

Object recognition is a complex adaptive process that can be impaired in children with neurodevelopmental disabilities. Recently, we found a significant effect of time on the development of unimodal and crossmodal recognition skills for common objects in typical children and this was a starting point for the study of visuo-haptic object recognition skills in impaired populations. In this study, we investigated unimodal visual information, unimodal haptic information and visuo-haptic information transfer in 30 children, from 4.0 to 10.11 years of age, with bilateral Periventricular Leukomalacia (PVL) and bilateral cerebral palsy. Results were matched with those of 116 controls. Participants were tested using a clinical protocol, adopted in the previous study, involving visual exploration of black-and-white photographs of common objects, haptic exploration of real objects and visuo-haptic transfer of these two types of information. Results show that in the PVL group as in controls, there is an age-dependent development of object recognition abilities for visual, haptic and visuo-haptic modalities, even if PVL children perform worse in all the three conditions, in comparison with the typical group. Furthermore, PVL children have a specific deficit both in visual and haptic information processing, that improves with age, probably thanks to everyday experience, but the visual modality shows a better and more rapid maturation, remaining more salient compared to the haptic one. However, multisensory processes partially facilitate recognition of common objects also in PVL children and this finding could be useful for planning early intervention in children with brain lesion.     

Dynamical structure of center-of-pressure trajectories with and without functional taping in children with cerebral palsy level I and II of GMFCS

Postural control during quiet standing was examined in typical children (TD) and children with cerebral palsy (CP) level I and II of GMFCS. The immediate effect on postural control of functional taping on the thighs was analyzed. We evaluated 43 TD, 17 CP children level I, and 10 CP children level II. Participants were evaluated in two conditions (with and without taping). The trajectories of the center of pressure (COP) were analyzed by means of conventional posturography (sway amplitude, sway-path-length) and dynamic posturography (degree of twisting-and-turning, sway regularity). Both CP groups showed larger sway amplitude than the TD while only the CP level II showed more regular COP trajectories with less twisting-and-turning. Functional taping didn’t affect sway amplitude or sway-path-length. TD children exhibited more twisting-and-turning with functional taping, whereas no effects on postural sway dynamics were observed in CP children. Functional taping doesn’t result in immediate changes in quiet stance in CP children, whereas in TD it resulted in faster sway corrections. Children level II invest more attention in postural control than level I, and TD. While quiet standing was more automatized in children level I than in level II, both CP groups showed a less stable balance than TD.     

Working memory and fine motor skills predict early numeracy performance of children with cerebral palsy

Early numeracy is an important precursor for arithmetic performance, academic proficiency, and work success. Besides their apparent motor difficulties, children with cerebral palsy (CP) often show additional cognitive disturbances. In this study, we examine whether working memory, non-verbal intelligence, linguistic skills, counting and fine motor skills are positively related to the early numeracy performance of 6-year-old children with CP. A total of 56 children (M = 6.0, SD = 0.61, 37 boys) from Dutch special education schools participated in this cross-sectional study. Of the total group, 81% of the children have the spastic type of CP (33% unilateral and 66% bilateral), 9% have been diagnosed as having diskinetic CP, 8% have been diagnosed as having spastic and diskinetic CP and 2% have been diagnosed as having a combination of diskinetic and atactic CP. The children completed standardized tests assessing early numeracy performance, working memory, non-verbal intelligence, sentence understanding and fine motor skills. In addition, an experimental task was administered to examine their basic counting performance. Structural equation modeling showed that working memory and fine motor skills were significantly related to the early numeracy performance of the children (β = .79 and p < .001, β = .41 and p < .001, respectively). Furthermore, counting was a mediating variable between working memory and early numeracy (β = .57, p < .001). Together, these findings highlight the importance of working memory for early numeracy performance in children with CP and they warrant further research into the efficacy of intervention programs aimed at working memory training.     

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.     

Sensory processing sensitivity and its relation to parental bonding, anxiety, and depression

Sensory processing sensitivity is a recently proposed construct referring to a tendency to process a variety of information more strongly and deeply than others. Although some research has found links between sensory processing sensitivity and psychological difficulties, highly sensitive people may not necessarily be predisposed to negative affect, but may be more sensitive to poor parenting. Two hundred thirteen college students were given a measure of sensory processing sensitivity (the HSPS), the parental bonding scale (measuring parental care and over-protection), the trait anxiety scale, and the Beck depression inventory. Sensory processing sensitivity predicted both anxiety and depression above and beyond parental factors, indicating that it may be an independent risk factor. An interaction was found between sensory processing sensitivity and parental care when measuring depression. Highly sensitive people may be particularly sensitive to uncaring parents. Results indicate that sensory processing sensitivity may be a temperamental disposition that interacts meaningfully with environmental factors.     

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.     

Hierarchical forms processing in adults and children

Two experiments examined child and adult processing of hierarchical stimuli composed of geometric forms. Adults (ages 18-23 years) and children (ages 7-10 years) performed a forced-choice task gauging similarity between visual stimuli consisting of large geometric objects (global level) composed of small geometric objects (local level). The stimuli spatial arrangement was manipulated to assess child and adult reaction times and predisposition toward local or global form categorization under two distinct trial conditions, with varied density of the local forms comprising the global forms. In Experiment 1, children and adults were presented with common, simple geometric shape hierarchical forms composed of ovals and rectangles. In Experiment 2, adults were presented with hierarchical forms composed of the simple geometric shapes, ovals and rectangles, and additional novel complex geometric shapes, “posts” and “arches.” Results show a clear increase of global processing bias across the age ranges of the individuals in the study, with children at 10 years performing similarly to adults on the simple stimuli. In addition, adults presented with the novel complex geometric shapes showed a significant reduction in global processing bias, indicating that form novelty and complexity lead to additional attention to local features in categorization tasks.     

Verbal fluency over time as a measure of automatic and controlled processing in children with ADHD

The performance of ADHD children on semantic category fluency (SCF) versus initial letter fluency (ILF) tasks was examined. For each participant, word production was recorded for each 15-s time slice on each task. Performance on both fluency tasks was compared to test the hypothesis that children with ADHD are characterized by a performance deficit on the ILF task because performance on this task is less automated than performance on the SCF. Children classified with ADHD (N = 20) were compared to children with other psychopathology (N = 118) and healthy controls (N = 130). Results indicated that the groups could not be differentiated by the total number of words produced in 60 s in either fluency task. As hypothesized, a significant interaction of group by productivity over time by type of fluency task was found: ADHD children had more problems finding words in the first 15 s of the IFL than did children in the other two groups, and as compared with their performance on the SCF. Results were taken to indicate that children with ADHD symptoms show a delay in the development of automating skills for processing abstract verbal information.     

Predictors of Reading Comprehension in Children with Cerebral Palsy and Typically Developing Children

Predictors of reading comprehension were evaluated in 41 children with cerebral palsy and 74 typically developing children between the ages of 6 and 12 years. Regression analyses were conducted to determine the relative contributions of measures of phonemic awareness, receptive vocabulary, and general reasoning to variance in reading comprehension. All three independent variables were statistically significant predictors of reading comprehension in both groups of participants. The impact of phonemic awareness on reading comprehension was moderated by age, but only in the typically developing group. Within the group with cerebral palsy, there was an indirect effect of functional expressive ability on reading comprehension, mediated by phonemic awareness. It is concluded that largely the same variables predict reading comprehension in children with cerebral palsy as in typically developing children, but that children with cerebral palsy continue to rely on phonological processing for a more protracted period of time.     

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.     

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.     

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.     

Cognitive correlates of mathematical achievement in children with cerebral palsy and typically developing children

Background . Remarkably few studies have investigated the nature and origin of learning difficulties in children with cerebral palsy (CP). Aims . To investigate math achievement in terms of word‐problem solving ability in children with CP and controls. Because of the potential importance of reading for word‐problem solving, we investigated reading as well. Sample . Children with CP attending either special (n= 41) or mainstream schools (n= 16) and a control group of typically developing children in mainstream schools (n= 16). Method . Group differences in third grade math and reading, controlled for IQ, were tested with analyses of co‐variance (ANCOVAs). Hierarchical regression was used to investigate cognitive correlates of third grade math and reading. Predictors included verbal and non‐verbal IQ measured in first grade, components of working memory (WM) and executive function (EF) measured in second grade, and arithmetic fact fluency and reading measured in third grade. Results . Children with CP in special schools performed significantly worse than their peers on word‐problem solving and reading. There was a trend towards worse performance in children with CP in mainstream schools compared to typically developing children. Conclusions . Impairments of non‐verbal IQ and WM updating predicted future difficulties in both word‐problem solving and reading. Impairments of visuospatial sketchpad and inhibition predicted future word‐problem, but not reading difficulty. Conversely, deficits of phonological loop predicted reading but not word‐problem difficulty. Concurrent arithmetic fact fluency and reading ability were both important for word‐problem solving ability. These results could potentially help to predict which children are likely to develop specific learning difficulties, facilitating early intervention.     

The influence of data-driven processing on perceptions of memory quality and intrusive symptoms in children following traumatic events

Ehlers and Clark [(2000). A cognitive model of post-traumatic stress disorder. Behaviour Research and Therapy, 38, 319-345] cognitive model of post-traumatic stress disorder (PTSD) has been relatively untested with children. Seventy-five children (7-16 years) were interviewed within 4 weeks of an injury that led to hospital treatment to examine whether peri-traumatic processing strategies (data-driven processing and fear) were associated with perceptions of memory quality and intrusive memories. Perceptions of memory quality mediated the relationship between data-driven processing and intrusive reactions but not avoidance, arousal or depressive reactions. Finally, the relationship between peri-event fear and intrusion reactions was mediated by perceptions of memory quality even after data-driven processing was controlled. The implications of these findings are discussed in the context of a cognitive developmental model of PTSD in children.