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Clock drawing in children with perinatal stroke
Omid Yousefian1, Angela O Ballantyne1, Alex Doo1
1Department of Neurosciences, University of California, San Diego School of Medicine, La Jolla, California.
Insights
The Clock Drawing Test can detect spatial neglect in children with perinatal stroke, but this deficit may resolve with age. Early neurocognitive data has limitations in predicting long-term outcomes.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatric Neurology
Background:
- Children with perinatal stroke often exhibit contralateral spatial neglect.
- Spatial neglect is a neurological condition affecting awareness of one side of space.
Purpose of the Study:
- To evaluate the efficacy of the Clock Drawing Test (CDT) in identifying spatial neglect in children with perinatal stroke.
- To adapt the CDT for pediatric use by analyzing right- and left-sided drawing errors.
Main Methods:
- A cross-sectional study involved 38 children (6-21 years) with perinatal unilateral brain lesions and 179 age-matched controls.
- Participants completed a free-drawn Clock Drawing Test.
- An adapted scoring system was developed to differentiate left- and right-sided errors.
Main Results:
- Children with right hemisphere lesions showed more errors on both sides of the clock compared to controls across all age groups.
- Younger children (6-8 years) with right hemisphere lesions demonstrated significant left-sided neglect.
- By adolescence (15-21 years), right hemisphere lesion subjects performed similarly to controls, indicating resolution of neglect.
Conclusions:
- The Clock Drawing Test is effective in identifying spatial neglect in children with early-onset unilateral brain damage.
- Spatial neglect in children with perinatal stroke may improve or resolve over time due to brain plasticity.
- Early neurocognitive assessments have limitations in predicting long-term functional outcomes in this population.
Background:
Children with perinatal stroke may show evidence of contralateral spatial neglect. The goal of this study was to determine whether the Clock Drawing Test commonly used in adults to identify neglect would be effective in detecting neglect in children with perinatal stroke.
Methods:
Thirty-eight individuals (age range 6-21 years) with left hemisphere or right hemisphere perinatal onset unilateral lesions and 179 age-matched controls were given a free-drawn Clock Drawing Test in a cross-sectional design. An adapted scoring system that evaluated right- and left-sided errors separately was developed as part of the investigation.
Results:
Children with right hemisphere lesions made a greater number of errors on both the right and left sides of the clock drawings in all age subgroups (6-8 years, 9-14 years, and 15-21 years) compared with controls. Children with right hemisphere lesions showed greater left and right errors in the younger groups compared with controls, with significantly poorer performance on the left at 6-8 years, suggestive of contralateral neglect. However, by ages 15-21 years, the right hemisphere lesion subjects no longer differed from controls.
Conclusions:
Clock drawing can identify spatial neglect in children with early hemispheric damage. However, brain development is a dynamic process, and as children age, spatial neglect may no longer be evident. These findings demonstrate the limitations of predicting long-term outcome after perinatal stroke from early neurocognitive data. Children with perinatal stroke may require different neural pathways to accomplish specific skills or to overcome deficits, but ultimately they may have "typical" outcomes.
