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. 2014 Nov 30:14:221.
doi: 10.1186/s12883-014-0221-0.

Neglect-like characteristics of developmental disregard in children with cerebral palsy revealed by event related potentials

Ingar M Zielinski  1 , Bert Steenbergen  2   3 , C Marjolein Baas  4 , Pauline Bm Aarts  5 , Marijtje L A Jongsma  6
Affiliations

Neglect-like characteristics of developmental disregard in children with cerebral palsy revealed by event related potentials

Ingar M Zielinski et al. BMC Neurol. .

Abstract

Background: Children with unilateral Cerebral Palsy (CP) often show diminished awareness of the remaining capacity of their affected upper limb. This phenomenon is known as Developmental Disregard (DD). DD has been explained by operant conditioning. Alternatively, DD can be described as a developmental delay resulting from a lack of use of the affected hand during crucial developmental periods. We hypothesize that this delay is associated with a general delay in executive functions (EF) related to motor behavior, also known as motor EFs.

Methods: Twenty-four children with unilateral CP participated in this cross-sectional study, twelve of them diagnosed with DD. To test motor EFs, a modified go/nogo task was presented in which cues followed by go- or nogo-stimuli appeared at either the left or right side of a screen. Children had to press a button with the hand corresponding to the side of stimulus presentation. Apart from response accuracy, Event-Related Potentials (ERPs) extracted from the ongoing EEG were used to register covert cognitive processes. ERP N1, P2, N2, and P3 components elicited by cue-, go-, and nogo-stimuli were further analyzed to differentiate between different covert cognitive processes.

Results: Children with DD made more errors. With respect to the ERPs, the P3 component to go-stimuli was enhanced in children with DD. This enhancement was related to age, such that younger children with DD showed stronger enhancements. In addition, in DD the N1 component to cue- and go-stimuli was decreased.

Conclusions: The behavioral results show that children with DD experience difficulties when performing the task. The finding of an enhanced P3 component to go-stimuli suggests that these difficulties are due to increased mental effort preceding movement. As age in DD mediated this enhancement, it seems that this increased mental effort is related to a developmental delay. The additional finding of a decreased N1 component in DD furthermore suggests a general diminished visuo-spatial attention. This effect reveals that DD might be a neuropsychological phenomenon similar to post-stroke neglect syndrome that does not resolve during development. These findings suggest that therapies aimed at reducing neglect could be a promising addition to existing therapies for DD.

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Figures

Figure 1
Figure 1
Trials of go/nogo paradigm. The four different trials of the modified go/nogo paradigm with a left hand go (A) and nogo (C) trial and a right hand go (B) and nogo (D) trial.
Figure 2
Figure 2
Errors (A), and RTs (B). Depicted are means ± SEMs. Blue bars show the results of the CP children without DD (noDD); green bars show the results of children with DD (DD). Clear bars depict the results of the non-affected hand; striped bars depict the results of the affected hand.
Figure 3
Figure 3
Grand averaged waveforms. Grand average ERPs following cue- (A), go- (B), and nogo-stimuli (C). ERPs of children with unilateral CP without DD (noDD) are depicted in blue and for children with DD (DD) in green. ERPs for the non-affected hand are depicted in solid lines (NA) and for the affected hand in dotted lines (AH).
Figure 4
Figure 4
N1 amplitudes (mean ± SEM; Fz, FCz, Cz) to cue-, go-, and nogo-stimuli. Children without DD are depicted in blue bars (noDD) and children with DD in green bars (DD). Clear bars depict the results of the non-affected hand; striped bars depict the results of the affected hand.
Figure 5
Figure 5
P3 amplitudes (mean ± SEM; Fz, FCz, Cz) to cue-, go-, and nogo-stimuli. Children without DD are depicted in blue bars and children with DD in green bars. Clear bars depict the results of the non-affected hand; striped bars depict the results of the affected hand.
Figure 6
Figure 6
Mean P3 amplitudes with age (mean ± SEM of Fz, FCz, Cz per participant) to go-stimuli. Children without DD are depicted on the left (noDD) and children with DD on the right (DD). Data of the non-affected hand (NA) are depicted as dots and for the affected hand (AH) as circles. The regression line for children without DD is depicted in blue and for children with DD in green.
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