White matter lesions are often seen in children with spastic cerebral palsy (CP). Evidence points to specific impairment of attentional, visuospatial, and executive functions; although both attention and executive functions are relatively unexplored in spastic CP. The few recent studies on language functions in mild or moderate CP point to well-functioning language. The presence of specific cognitive impairments may, in part, explain why children with spastic CP have a higher risk of learning disabilities and problems in peer relations. However, to understand the development of cognitive impairments, it is necessary to include how social participation feeds back on cognitive processes.
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.
RESULTSVerbal 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).
INTERPRETATIONThe 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.Cerebral palsy (CP) designates a group of neurodevelopmental conditions beginning in early childhood and persisting into adulthood. CP is due to a pre-or perinatal non-progressive brain disorder that often affects the periventricular white matter, either unilaterally or bilaterally.1 Although CP is primarily a disorder of movement and posture, it often involves other developing functions, such as perception and cognition. CP varies substantially in type and severity of symptoms. Seizure disorders are a common complication and are associated with a decreased level of cognitive functioning.
2CP is associated with restrictions in participation in day-today activities in childhood 3 and a higher prevalence of specific learning disabilities, 4 which affect academic achievement, school acceptance, and social participation. Children with CP are two to three times more likely than unaffected children to experience problems in their relations with peers.5 Later in life, CP is associated with limited educational and vocational possibilities.6 To obtain a better understanding of both learning difficulties and restrictions on participation in general, studies of the specific cognitive impairments associated with CP are highly relevant.A large proportion of spastic bilateral CP is caused by periventricular leukomalacia, particularly in children born preterm. Anterior lesions to white-matter tracts are associated with attentional and executive dysfunctions.7 Lesions of the basal ganglia and thalamic functional systems may affect both focused attention 8 and executive functions. Another type of lesion associated especially with unilateral CP is infarction of the middle cerebr...
The legacy of defectology, Vygotsky's theoretical work on children with disabilities, still offers a useful approach in disability research. Vygotsky understood disability as an incongruence between the individual's psychological structure and the structure of cultural forms. The incongruence describes a dialectical relation between the person with a disability and the surrounding society. The aim of this study is to explore Vygotsky's concept of incongruence. A case example is presented. Through video observation of a child with severe cerebral palsy (CP) and cognitive visual impairment, the incongruence is analysed in two settings: in school together with a teacher and at home together with his mother. Use of vision, arm movement and a Rolltalk (a computer for communication) were the categories selected for analysis. The results demonstrate how the impact of the boy's cognitive visual impairment and CP differed depending on the interaction with the environment and on how his teacher and mother interacted with him. The dialectical dynamics of incongruence in each of the two settings created different levels of abilities/disabilities. It is argued that the dialectical psychological understanding of disability offers a useful approach to overcome dualistic understandings of the person with a disability and the surrounding society.
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