Investigating the extent of neuroplasticity: Writing in children with perinatal stroke

The developing brain is remarkably plastic, as evidenced by language studies of children with perinatal stroke (PS). Despite initial delays and in contrast to adults with comparable lesions, children with PS perform comparably to their age-matched peers in free conversation by school age. Recent studies of spoken language in older children with PS have indicated limits to neural plasticity. Writing, a cognitively demanding and language dependent domain, is understudied in children with PS. Investigating writing development will provide another perspective on the continuing linguistic development in this population. Written language performance in 43 children with PS and 60 of their typically-developing (TD) peers was evaluated to further investigate the breadth and limits to neural plasticity. Two tasks of varying difficulty were administered: a picture description, which provided a referent to facilitate writing for the children, and a more challenging autobiographical narrative. Texts were analyzed across three broad writing dimensions - productivity, complexity, and linguistic accuracy. Group differences were primarily found on accuracy indices. Morphological accuracy was most impacted by early brain injury and older children with PS did not have higher morphological accuracy than their younger counterparts, suggesting limited development with age. There were no differences in performance based on hemisphere of lesion. In addition to enhancing our understanding of long-term language outcomes in children with PS, the results further illuminate the extent and limitations of early neural plasticity for language.