Topographical working memory in children with cerebral palsy

Forty children with cerebral palsy (CP) and 120 typical developing children (TD) performed a topographic working memory (WalCT) test requiring to move their body in a walked vista-space and a visuo-spatial test (CBT) requiring just reaching movements. WalCT score was significantly higher in GMFCS II/III than in TD. CBT score was significantly lower in GMFCS I than in III/IV but lower than TD in all CP groups. Similar results in WalCT between GMFCS I and TD and GMFCS II and III/IV respectively indicate that mobility is associated with topographic working memory. Differently in CBT, the absence of bodily movement allows using different cognitive strategies. Children should be provided with opportunities and active participation to enhancing spatial awareness and navigational skills

Ambulation in persons with myelomeningocele

The aim was to study ambulatory function in persons with myelomeningocele. Different systems used to classify the extent of motor paresis were compared. The classification according to five commonly used systems showed a lack of congruence in classes L3 level and downward. In relation to functional ambulation groups of Hoffer, none of the patients could be classified in the same categories by all classification systems. The patient's orthopedic and neurologic status with respect to ambulation was investigated and possible causative factors influencing ambulatory function were discriminated from the influence of the motor paresis. It was found that children with similar muscle paresis exhibit different ambulatory function due to other factors involved than the mere neurological lesion level. Change in ambulatory status studied over a 12- year observation time showed downward transitions in ambulatory level explained by deterioration of the neurological level of lesion, spasticity, knee and hip flexion contractures, as well as by those of major medical events. Upper body movements in children with lumbo-sacral neurological level were quantified with motion analysis indicating that independent walking with orthoses show well defined and consistent upper body movements with the amplitudes of the upper body segments significantly correlated to the degree of muscle weakness of the lower limbs. No differences were seen in upper body segment displacements during walking with a knee-ankle-foot orthoses versus foot-ankle orthosis. This result is considered to be influenced by the achieved orthosis gait pattern and the material of the orthosis. Examination of energy expenditure in children with lumbo-sacral neurological level indicated that children with weaker hip muscles had higher energy effort as compared to children with better hip extension and abduction strength, although the difference was not statistically significant. Since energy expenditure while walking with the knee-ankle-foot orthosis was not found to be higher as compared to an ankle-foot orthosis we advise the former during childhood to vertically align the knee with shank and foot, particularly relevant in children with reduced hip abductor strengt

Topographical working memory in children and adolescents with motor disabilities

Aim: The aim of the present study was to investigate topographical working memory in individuals with motor disabilities. Methods: Topographical working memory was investigated using the Walking Corsi Test in 89 participants with motor disability, mean age 11.5 years, of which 40 with cerebral palsy, 31 with spina bifida, and 18 with orthopaedic or peripheral symptoms. The participants were grouped according to everyday mobility, i.e. walking outdoors, walking indoors, and using wheelchair. A control group constituted 120 typically developing participants, mean age 9.9 years. Results: Individuals with spina bifida, orthopaedic or peripheral symptoms as well as typically developing participants performed significantly larger walking spans than the cerebral palsy group. With respect to mobility, those walking outdoors had significantly larger span than those walking indoors and those using wheelchair for mobility. Conclusions: Participants with outdoor walking in the community, apart from type of motor disability, seem to have improved topographic memory compared to individuals who don’t walk outside and individuals who are mobile through wheelchair. The results highlight the question of development of spatial cognition to enhance participation in social environments. Future research should focus on prematurity in the cerebral palsy group, and on hydrocephalus in the spina bifida group

Working Memory in Navigational and Reaching Spaces in Typically Developing Children at Increasing School Stages

Background: Based on studies of children with motor disabilities on topographic working memory (TWM), no influence of age was reported. The only differences were in the degree of mobility and exploration of the environment. The more active a child was in exploring the environment, the less his/her TWM was poor. However, in typically developing children (TD), exploration of the environment increases with increasing age, and age-related effects have been described. Here, we aim at investigating TWM considering age in TD with the additional question of whether WM in the reaching space differed from that in the navigational space requiring body movements. We hypothesized that WM in both spaces would improve correspondingly with increasing age, assuming that the greater the autonomy in exploring the environment, the better TWM becomes. Method: 120 children (5–16 years old) performed the Corsi Block-Tapping test (CBT) and the Walking Corsi test (WalCT). Results: Statistical analyses evidenced significantly increasing WalCT and CBT spans between each school stage, except in the CBT span between middle stage (MS) and upper stage (US). CBT spans were significantly higher than in the WalCT in the pre-school, lower stage, and MS, with the CBT span increasing until MS, which is sufficient for using spatial orientation strategies effectively. Conclusions: When navigation is gradually controlled, a child may be able to pay increasingly more attention to wayfinding and behavior in traffic. Since the US group even presented as good in the WalCT as young adults living in metropolitan environments, assuming that children may gain spatial orientation from having opportunities to move in their surroundings, this is also relevant for children with motor disabilities

Evaluation of Knee Position Sense in Children with Motor Disabilities and Children with Typical Development: A Cross-Sectional Study

Background: In children with motor disabilities, knee position during walking is often of concern in rehabilitation. This study aimed to investigate knee joint position sense. Thirty-seven children with Cerebral Palsy (CP), 21 with Myelomeningocele (MMC), 19 with Arthrogryposis (AMC), and 42 TD children participated in the study. Knee joint position sense, i.e., the difference between the criterion angle and the reproduced angle (JPS-error), was assessed in sitting while 3D motion capture was recorded at flexed knee 70 (Knee70), 45 (Knee45), and 20 (Knee20) degrees, and after three seconds at maintained criterion angle (CAM) and maintained reproduced angle (RAM). No differences were found between the groups in JPS-error, CAM, and RAM. At Knee70, CAM differed between the right and left legs in the TD group (p = 0.014) and RAM in the MMC group (p = 0.021). In the CP group, CAM was greater than RAM at Knee70 in the left leg (p = 0.002), at Knee45 in both legs (p = 0.004, p = 0.025), and at Knee20 in the right leg (p = 0.038). Difficulties in maintaining the knee position at CAM in the CP group sheds light on the need for complementary judgments of limb proprioception in space to explore the potential influence on knee position during walking

Topographical working memory: differences in pointing versus performing a pathway in 4-5 year old children

Recently, several studies have highlighted the importance of topographical working memory in navigation. This was also supported by clinical evidence showing the presence of specific topographical working memory deficits in different types of pathologies that disrupt navigational skills (i.e., individuals affected by developmental topographical disorientation; patients treated surgically for a drug-resistant temporal lobe epilepsy; stroke patients; patients affected by Alzheimer Dementia). In the present study, we take into account the contribution of motor action to spatial representation during navigation by comparing two tasks (WalCT: Piccardi et al., 2008; 2014 and Laser-WalCT: De Nigris et al., 2013) of topographical working memory, one in which the child has to perform by walking the path previously demonstrated by the examiner and another one, in which the child has to manually point the path previously observed. A total of 51 (19 females) typically developing children aged 4–5 years performed WalCT, Laser-WalCT and Corsi Block-Tapping Test (CBT; Corsi, 1972), the latter a well-known visuo-spatial memory test. Cognitive non-verbal test (Raven’s Coloured Progressive Matrices, CPM; Raven, 1986) was performed to assess cognitive development. WalCT, Laser-WalCT and CBT were performed in randomized order and analyzed according to the longest list of items that the children were be able to repeat. Our results showed no gender differences supporting previous findings, suggesting that sex differences on spatial tasks emerge in adolescence. We also found that a greater effort was needed to reproduce a sequence of steps in a large-scale context than to reproduce a sequence of reaching movements in a small-scale context. In general, working memory measured on large-scale context, with or without motor activity, develops later than working memory measured on small-scale context. Specifically, 4 years old children demonstrated more difficulty in performing Laser-WalCT than WalCT with respect to 5 years children. The difference between WalCT and Laser-WalCT in 4 years old children is an interesting finding, since older children as well as young adults and adults did not differ in their performance when they had to act on a pathway or to point it. This data suggests the presence of a specific time period in which motor action has to be integrated with navigational information