Visual-motor Performance Research Articles

Cognitive development in low risk preterm infants at 3–4 years of life

Background: Major neurological handicaps and neuropsychological disturbances are more common in ex-preterm children than their counterparts born at term. Objective: To establish in a prospective study whether a characteristic neuropsychological...

NEUROPSYCHOLOGICAL CHARACTERISTICS OF CHILDREN WITH THE 22Q11 DELETION SYNDROME: A DESCRIPTIVE ANALYSIS

Previous reports of cognitive functioning in children with the 22q11 Deletion Syndrome have reported marked variability in IQ and achievement subtest scores. Studies have begun to explore neuropsychological function in 22q11 DS however results are inconsistent and the profile incomplete. We assessed 40 children ages 5–12 with 22q11 DS. Consistent with past results, visual-spatial memory was significantly lower than verbal memory. Differentially lowered scores were found only in visual attention, working memory and motor function. Contrary with some past results quantitative, verbal ability, and visual spatial memory scores were within 1 SD from the standardization sample mean. Motor behavior, not typically discussed with regard to 22q11 DS school-age children, may be critical to incorporate in neurocognitive studies of children with 22q11 DS. Implications of these findings are considered with regard to past results.

Neuropsychological outcome of infant heart transplant recipients

To assess long-term neuropsychological outcomes of infant heart transplant recipients. Fifty-five children (mean age, 6.4 years) with a primary diagnosis of hypoplastic left heart syndrome or other cardiac disorders participated in the study. Six areas of risk were assessed (birth; preoperative, intraoperative, and postoperative status; long-term medical complications; and socioeconomic factors). Neuropsychological evaluations included the following: Wechsler Scales of Intelligence, Wechsler Individual Achievement Test, Berry Visual Motor Integration Scale, Comprehensive Evaluation of Language Function, and Achenbach Child Behavioral Checklist. Intellectual functioning scores revealed a mean full-scale IQ of 81 +/- 19. Intraoperative and postoperative variables (bypass time, hospital course, and lowest posttransplant pH), long-term medical complications (serious infections and posttransplant surgical procedures), and socioeconomic factors were associated with cognitive functioning. Visual-motor functioning was also related to bypass and total support time. Long-term outcomes reveal low-average neuropsychological functioning and are related to intrasurgical-postsurgical, long-term medical, and socioeconomic factors. The neuropsychological and psychosocial functioning of infant heart transplant recipients will be important to address as they mature during adolescence and adulthood.

Cognitive functioning before chemotherapy treatment in women with breast cancer

548 Background: Many women with breast cancer (BC) undergoing chemotherapy report trouble with attention, concentration and memory. A small body of research suggests that attention, processing speed,and memory tend to be the areas most affected. However,most of the studies have looked at women only after treatment,with no pre-treatment assessment. As part of a longitudinal study, we report here pre-chemotherapy assessments of postmenopausal BC patients. Methods: Thirty-two pre-chemo BC patients (DCIS, Stage I and Stage II) were assessed with a battery of neuro-psychological tests and self-report forms measuring: intelligence, memory, attention, language, visuo-spatial and motor functioning, and mood. Results: Thirteen (40%) women were rated as cognitively impaired based on scoring >1 standard deviation below the mean on two or more tests. When we compared this group to the non-impaired patients, significant differences were seen on a number of tests assessing visual-motor function (Pegboard {P=.001 and .0...

Cognitive functioning before chemotherapy treatment in women with breast cancer

548 Background: Many women with breast cancer (BC) undergoing chemotherapy report trouble with attention, concentration and memory. A small body of research suggests that attention, processing speed,and memory tend to be the areas most affected. However,most of the studies have looked at women only after treatment,with no pre-treatment assessment. As part of a longitudinal study, we report here pre-chemotherapy assessments of postmenopausal BC patients. Methods: Thirty-two pre-chemo BC patients (DCIS, Stage I and Stage II) were assessed with a battery of neuro-psychological tests and self-report forms measuring: intelligence, memory, attention, language, visuo-spatial and motor functioning, and mood. Results: Thirteen (40%) women were rated as cognitively impaired based on scoring >1 standard deviation below the mean on two or more tests. When we compared this group to the non-impaired patients, significant differences were seen on a number of tests assessing visual-motor function (Pegboard {P=.001 and .004}, Trailmaking A and B {P=.031, 006},Digit Symbol (P=.015) and Rey {P=.038}), visual memory (BVRT; P=.002)and visual attention(Conner's Continuous Performance Test {Commissions, P=.010; Detectability,P=.022}) independent of age, ethnicity, educational level, and stage of cancer. Conclusions: The results of this study indicate that a significant number of postmenopausal women with BC exhibit objective cognitive deficits pre-treatment in many of the same areas as seen in women after chemotherapy. Thus, to truly understand the cognitive effects of chemotherapy it is necessary to measure pre-treatment functioning in this population to compare with post-treatment changes. In addition,these results may suggest that women with cognitive deficits before chemotherapy may be more vulnerable to the possible effects of chemotherapy and thus be more prone to notice more pronounced changes in their cognitive abilities. No significant financial relationships to disclose.

The short term results of selective nerve root block in herniated lumbar disc patients

Study Design: A prospective study Objectives: To analyze the serial results of selective nerve root blocks in herniated lumbar disc patients. Literature Review Summary: To our knowledge there has been no study demonstrating the serial efficacy of root blocks for patients with a herniated lumbar disc only. Materials and Methods: Selective nerve root blocks were performed in 36 patients who had a lumbar disc herniation only, with radiculopathy, between November 2002 and April 2003. The diagnoses were made by CT or MRI, which agreed with the symptoms and physical examinations. There were 31 men and 5 women, with a mean age of 28.2 years. The mean interval between the onset and procedure was 7.6 weeks, ranging from 1 to 26 weeks. Monoand double-segment injections were used in 18 cases, respectwely. The straight leg raising angle, visual analogue pain scale, and motor and sensory functions were investigated before, immediately, 2 days, and 1 and 3 months after the procedure. Results: The mean straight leg raising angle improved significantly, from 28±9°to 53±18°, immediately, and was maintained until 3 months after the procedure (P<0.001). The visual analogue pain scale was also improved, from 4.6±0.9 to 2.0±1 . 5 , immediately, and was maintained until 3 months after the procedure (P<0.001). Two of ten patients with motor weakness, and six of eighteen with sensory deficit were improved. There was no procedure related complication; however, surgical treatment was performed in two patients who showed no improvement until 3 months. Conclusions: Selective nerve root block is a safe and effective treatment method to obtain a rapid and remarkable improvement of radiculopathy in herniated lumbar disc patients.

Early Neuropsychological Correlates of Later Clock Drawing and Clock Copying Abilities Among School Aged Children

Although widely used in empirical study and bedside neuropsychological evaluation of geriatric populations, there is little literature on clock copying and drawing among children. However, existing research suggests that clock drawing tests (CDTs) may be effective and efficient tools for assessing neurocognitive development in children. This paper reports data on clock drawing on demand (CDT-D) and clock drawing to copy (CDT-C) among a non-clinical sample of elementary school aged children and identifies predictive relationships between earlier measures of executive function, visuo-construction, and visual-motor coordination and CDT performance 3 years later. Similar to findings with adult samples, analyses revealed better performance on copying than on drawing. Longitudinal analyses indicate that general intelligence significantly predicted performance on both tasks. Visual-motor coordination only predicted performance on the drawing on demand subtest of the CDT.

Cognitive development at 5.5 years of children with chronic lung disease of prematurity

Background: Preterm infants with chronic lung disease (CLD) had impaired cognitive development and poorer eye-hand coordination at 10 months of age. Aims: To study whether this effect of CLD persisted...

Glare Disability and Driving Safety

Purpose: Increasing investigation of the visual elements of safe driving environments may be of great benefit to society. Visual disability appears to be only one of many visual factors related to traffic accidents. The purpose of this article was to examine the type of visual impairment mediated by the increased glare sensitivity in adult drivers using the original halometer glare test. Methods: In this article, the visual sensory, cognitive and motor functions relevant to driving, their measurement, the epidemiology and prevention of age-associated functional impairments and the relationship of functional impairments to both self-reported driving and the imposition of legal restrictions are reviewed. Results: The problem of night and tunnel driving is the most urgent in relation to the effects of glare from vehicle headlights on motion perception of drivers. The reduced mesopic vision and increased sensitivity to glare are accompanied by an increased risk of nighttime accidents. Elderly drivers and patients with beginning cataract cannot sufficiently fulfill the criteria for night driving ability because of contrast and glare sensitivity. It is indispensable for the parameters mentioned to be carefully measured and for drivers to be informed that night driving ability may be impaired, even if visual acuity is sufficient. Conclusions: It would be advisable for traffic safety if simple tests for contrast and glare sensitivity were implemented for vehicles and/or were regularly added to the requirements for a driver’s licence, at least for older drivers. The age, functional status and test result limits should be defined to avoid a risk factor in traffic.

Perception of happy and sad facial expressions in chronic schizophrenia: Evidence for two evaluative systems

Background: Persons suffering from schizophrenia have impaired perception of emotional expressions, but it is not clear whether this is part of a generalized deficit in cognitive function. Aim: To test for existence of emotion-specific deficits by studying the effects of valence on recognition of facial emotional expressions. Methods: 24 male subjects suffering from chronic schizophrenia were examined with two tests of perception of emotion: the Penn Emotion Acuity Test (PEAT 40) and the Emotion Differentiation Task (EMODIFF). Clinical state was assessed with the Scale for the Assessment of Negative Symptoms (SANS) and Scale for the Assessment of Positive Symptoms (SAPS), visual memory with the Benton Visual Retention Test (BVRT) and motor function with the finger tapping test. Results: Identification of happy facial expressions showed significant negative correlation with age, cumulated time in hospital and length of current hospitalization; positive correlations were found with visual retention and finger tapping scores. Identification of sad facial expressions showed significant correlation only with cumulated time in hospital while identification of neutral facial expressions showed no significant correlations. Discrimination between degrees of happy but not sad facial expression showed a positive correlation with negative symptoms. Conclusion: Perception of happy and sad emotion relates differently to significant illness parameters. This differentiability supports the existence of an emotion-specific deficit in perception of emotions in schizophrenia and of separate channels for processing positive and negative emotions.

Onset of oscillopsia after visual maturation in patients with congenital nystagmus

Purpose To describe the clinical and oculographic characteristics of a cohort of five patients with congenital nystagmus (CN) and late-onset oscillopsia caused by a coincidental decline in other visual and/or ocular motor functions. Design Retrospective, observational, case series. Participants Five visually mature patients with CN and recent-onset oscillopsia were evaluated clinically and with motility recordings. Intervention Eye movement analysis was performed off-line by computer analysis of digitized data. Nystagmus was analyzed for null-zone characteristics, waveforms, frequency, amplitudes, and slow-phase drift velocity during foveation. Surgical and medical treatment of associated ocular conditions in four of five patients. Main outcome measures Presence of symptomatic oscillopsia and average time during foveation periods of slow-phase drift velocity less than 10°/second. Results One of the five patients had associated rod-cone dystrophy, and another had recurrence of childhood head posturing with return of an eccentric null zone. The remaining three patients had decompensated strabismus associated with their oscillopsia. All five patients complained of oscillopsia in primary position that was relieved in the four who received treatment. Treatment included prismatic correction in one patient and surgery in three. Recordings in primary position after treatment showed increased duration during foveation periods of slow-phase drift velocity less than 10°/second and an overall decreased intensity (amplitude/frequency) of the nystagmus. Conclusions Symptomatic oscillopsia in patients with CN is unusual. This visually disturbing symptom can be precipitated by new or changing associated visual sensory conditions (e.g., decompensating strabismus, retinal degeneration). If the associated conditions can be treated, then accompanying oscillopsia may be relieved.

Influence of operator orientation on relative organizational mapping and spatial compatibility

Following up on a study by Worringham and Beringer (1989) that examined the influence of operator orientation on visual-motor performance, Experiment 1 employed a choice reaction time paradigm in which participants had to make rapid, discrete movements with a lever in response to a discrete stimulus. In Experiment 2, participants had to synchronize rhythmic movements with an oscillating visual display. Operator orientation with respect to stimulus display and response array locations was varied to examine the influence of global spatial relations. Display orientation was varied to examine the influence of spatial configuration. Mapping rules were varied to examine the effects of spatial mapping. In Experiment 1, the spatial mapping that yielded faster responses was dependent upon the stimulus display-response array configuration and the global relation. Under a parallel configuration, participants appeared to code the spatial aspects of the stimulus display and response in a manner that was unaffected by the global spatial relation. Under an orthogonal configuration, spatial mapping effects were dependent upon the global relation. In Experiment 2, the global spatial relation did not have an impact on the uniformity of co-ordination under different configuration or mapping conditions. Spatial configuration influenced whether or not differences between spatial mapping rules emerged. Together, the results speak to the relative nature of stimulus-response coding that underlie compatibility phenomena. In addition, the results have potential importance for the design of human-machine systems that allow flexibility in operator orientation.

Influence of operator orientation on relative organizational mapping and spatial compatibility

Following up on a study by Worringham and Beringer (1989) that examined the influence of operator orientation on visual-motor performance, Experiment 1 employed a choice reaction time paradigm in which participants had to make rapid, discrete movements with a lever in response to a discrete stimulus. In Experiment 2, participants had to synchronize rhythmic movements with an oscillating visual display. Operator orientation with respect to stimulus display and response array locations was varied to examine the influence of global spatial relations. Display orientation was varied to examine the influence of spatial configuration. Mapping rules were varied to examine the effects of spatial mapping. In Experiment 1, the spatial mapping that yielded faster responses was dependent upon the stimulus display-response array configuration and the global relation. Under a parallel configuration, participants appeared to code the spatial aspects of the stimulus display and response in a manner that was unaffected by the global spatial relation. Under an orthogonal configuration, spatial mapping effects were dependent upon the global relation. In Experiment 2, the global spatial relation did not have an impact on the uniformity of co-ordination under different configuration or mapping conditions. Spatial configuration influenced whether or not differences between spatial mapping rules emerged. Together, the results speak to the relative nature of stimulus-response coding that underlie compatibility phenomena. In addition, the results have potential importance for the design of human-machine systems that allow flexibility in operator orientation.

A Neuropsychological Outcome Study of a Child’s Left Pericallosal Arteriovenous Malformation with Occult Fornix Lesion

Pericallosal arteriovenous malformations are rarely reported, particularly in children. Moreover, few arteriovenous malformation studies report through neuropsychological outcome data for assessing post-surgical functioning. This case report provides a longitudinal study of a boy who initially presented for neuropsychological testing at the age of 8 years and 1 month, following polyvinyl alcohol embolization, two craniotomies and resections and stereotactic radiosurgery for a pericallosal arteriovenous malformation involving nearly all of the corpus cailosum. Follow-up magnetic resonance imaging also indicated absence of the left fornix. Functioning has been assessed over 7 years. Neuropsychological measures identified a consistent pattern of verbally mediated cognitive and memory deficits, with relatively spared visual perceptual and visual motor functioning. No evidence of a split-brain syndrome was found. The findings are consistent with insult to dominant hemisphere language and memory systems, provide an interesting example of neurodevelopmental compensation for significant early brain insult, and may provide insight into functions subserved by the fornix.

Lead exposure and motor functioning in 4½ -year-old children: The Yugoslavia Prospective Study

Objective: To investigate associations between lead exposure and early motor development. Study design: We conducted standardized assessments of motor function (Bruininks-Oseretsky Test of Motor Proficiency and Beery Developmental Test of Visual-Motor Integration) at age 54 months in 283 children whose mothers were recruited in pregnancy from a smelter town and a non-lead-exposed town in Yugoslavia and who have been monitored twice yearly since birth. Blood lead concentration (BPb) was summarized in a measure reflecting the average of the child’s semiannual serial log BPbs through 54 months. Results: Multiple regression showed that taken together, anthropometric measures (birth weight, body mass index) and markers of a stimulating and organized home life (HOME scale, parental education and intelligence, availability of siblings) explained a significant 10% to 18% of the variance in motor functioning. Beyond these contributions, BPb was significantly associated with poorer fine motor and visual motor function but was unrelated to gross motor coordination. Conclusions: Modest associations between early lead exposure and fine motor and visual motor functioning appear even after statistical adjustment is done for other contributors to motor development. Associations with BPb are specific to these areas of motor skill; gross motor development was unaffected. (J Pediatr 2000;137:555-61)

Effects of occupational therapy services on fine motor and functional performance in preschool children.

This study examined how performance components and variables in intervention influenced fine motor and functional outcomes in preschool children. In a sample of 44 preschool-aged children with fine motor delays who received occupational therapy services, eight fine motor and functional performance assessments were administered at the beginning and end of the academic year. Data on the format and intervention activities of each occupational therapy session were recorded for 8 months. The children received a mean of 23 sessions, in both individual and group format. Most of the sessions (81%) used fine motor activities; 29% addressed peer interaction, and 16% addressed play skills. Visual motor outcomes were influenced by the number of intervention sessions and percent of sessions with play goals. Fine motor outcomes were most influenced by the therapists' emphasis on play and peer interaction goals; functional outcomes were influenced by number of sessions and percent of sessions that specifically addressed self-care goals. The influence of play on therapy outcomes suggests that a focus on play in intervention activities can enhance fine motor and visual motor performance.

The ‘pusher’ syndrome in elderly stroke patients

Reports on the ‘pusher’ syndrome have been conflicting. A small survey was undertaken to examine the relationships between ipsilateral pushing, unilateral visual neglect and motor performance in stroke patients, and an association was found. Therapists should identify perceptual as well as physical deficits in such patients to enable appropriate management.

Visual-motor function of very low birth weight and full-term children at 3 1/2 to 4 years of age.

Improvements in perinatal and neonatal management have not only led to a higher survival rate of very low birth weight infants (VLBW; < or = 1,500 g or < 32 weeks gestational age), but also to a better outcome of these children. However the percentage of VLBW children who need special education because of later school problems remains high even in children considered neurologically normal during infancy. We assessed 40 VLBW children and 83 healthy full-term children at age 3 to 4 years by means of a simple and short test for visual-motor deficits. The test included the copying and cutting-out of geometric shapes, the building of models, the recognition of colours and the observation of the concentration and cooperation during the test. All VLBW children had had a good perinatal outcome and had been considered neurologically normal at one year of age. Most VLBW children scored within 1 standard deviation (S.D.) of the test mean, but on average the VLBW children scored significantly lower than the full-term infants in the copying of figures, the cutting-out of geometric forms, the building of models and in the overall concentration and cooperation during the test. Children who attended a nursery school achieved significantly better test results. Girls tended to have better results, but this was not statistically significant. Social factors and age had a significantly greater impact on results than perinatal factors. In summary, VLBW children scored significantly less in almost every test item compared to their term peers. Our test battery could serve as a short introductory test to screen for deficits in visual-motor skills, especially in VLBW children.

Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child.

When thyroid deficiency occurs simultaneously in a pregnant woman and her fetus, the child's neuropsychological development is adversely affected. Whether developmental problems occur when only the mother has hypothyroidism during pregnancy is not known. In 1996 and 1997, we measured thyrotropin in stored serum samples collected from 25,216 pregnant women between January 1987 and March 1990. We then located 47 women with serum thyrotropin concentrations at or above the 99.7th percentile of the values for all the pregnant women, 15 women with values between the 98th and 99.6th percentiles, inclusive, in combination with low thyroxine levels, and 124 matched women with normal values. Their seven-to-nine-year-old children, none of whom had hypothyroidism as newborns, underwent 15 tests relating to intelligence, attention, language, reading ability, school performance, and visual-motor performance. The children of the 62 women with high serum thyrotropin concentrations performed slightly less well on all 15 tests. Their full-scale IQ scores on the Wechsler Intelligence Scale for Children, third edition, averaged 4 points lower than those of the children of the 124 matched control women (P= 0.06); 15 percent had scores of 85 or less, as compared with 5 percent of the matched control children. Of the 62 women with thyroid deficiency, 48 were not treated for the condition during the pregnancy under study. The full-scale IQ scores of their children averaged 7 points lower than those of the 124 matched control children (P=0.005); 19 percent had scores of 85 or less. Eleven years after the pregnancy under study, 64 percent of the untreated women and 4 percent of the matched control women had confirmed hypothyroidism. Undiagnosed hypothyroidism in pregnant women may adversely affect their fetuses; therefore, screening for thyroid deficiency during pregnancy may be warranted.

TRAUMATIC BRAIN INJURY

Very severe traumatic brain injury (TBI) can cause persistent functional limitations in visual-motor and cognitive functions which may have consequences for fitness to drive. On-road driving performance in this population is significantly related to performance on neuropsychological tests of attention and information processing. This particularly concerns basic “operational” driving tasks like brake reaction time, visual search time, and lateral position control. Many drivers in this population, however, succeed in compensating effectively for these functional limitations, presumably because higher-order “tactical” aspects of driving allow them to anticipate and avoid driving situations which would be too demanding. To be able to assess compensatory potential, two test drives in an advanced driving simulator are included in the neuropsychological assessment of fitness to drive. The tests and the context in which they are used are described. By means of three case studies with very severe TBI the additional value of the driving simulator tests is illustrated and discussed. Test drives in a driving simulator for the assessment of brain-damaged drivers have not yet been properly validated and standardized. As an addition to a neuropsychological examination, a driving test in a realistic driving simulator can be a useful tool to assess (lacking) compensatory driving skill in brain-damaged drivers. In the Swing Drive the authors assess the operational skill of lateral position control and the tactical skill of controlling speed in response to changing motivation and operator capacities. The test requires steering at various speeds on a winding country road with alternating left-right curves and a continuous stream of traffic from the opposing direction. In various conditions the average lateral position, the standard deviation of lateral position, lane crossings left and right, and collisions with other traffic are computed. In the City Drive the authors use a city and route developed in research on intersection complexity and advanced driver assistance systems (ADAS) in older drivers. The authors assess practical fitness to drive based on observation of speed choice, lateral and longitudinal position control, viewing behavior, gap acceptance, application of priority rules, etc. in a variety of road and traffic situations as they develop during the drive. The simulator system of ST Software B.V. is used. It contains the design tools to create simulated road environments and the runtime modules required for real-time simulation. Simulation of traffic is based on ‘autonomous agents’ technology which models the simulated participants (i.e., all traffic surrounding the simulator driver) as self-governing intelligent objects that show natural and normative driver behavior.