Motor-free visual perception and visuomotor integration in pediatric arterial ischemic stroke

Pediatric arterial ischemic stroke can have a significant impact on visuospatial processing, with patients exhibiting deficits in tasks such as copying and drawing, block construction, and spatial localization. However, given that these visuospatial tasks often also involve motor skills, it remains unclear to what extent patients' motor impairments may affect their performance. Therefore, this cross-sectional study aimed to examine the relationship between patients' motor-free visual perception and visuomotor integration, and to explore the impact of demographic and clinical characteristics on these skills. We investigated the visuospatial processing abilities of 16 pediatric stroke patients (M = 9.5 years, SD = 2.6 years) using the Rey-Osterrieth Complex Figure (ROCF) and Developmental Test of Visual Perception-3 (DTVP-3). Correlational analyses were conducted to examine associations between cognitive tests, as well as between age at stroke, socioeconomic status, modASPECTS, and test performance. The motor-free visual perception composite score of the DTVP-3 significantly correlated with the copy (r_s = .65) and delayed recall condition of the ROCF (r_s = .71). In contrast, the visuomotor integration composite score of the DTVP-3 did not correlate with any of the ROCF conditions (all p > .05). The modASPECTS was significantly related to the global visual perception (r = -.83), visuomotor integration (r = -.72), and motor-free visual perception (r = -.72) composite scores of the DTVP-3. These results suggest that the visuospatial processing deficits seen in pediatric stroke patients are independent of their visuomotor integration and that a larger initial lesion size negatively impacts their visuospatial abilities. Taken together, these findings contribute to our current understanding of the cognitive profile post stroke and to clinical predictors of visuospatial processing in pediatric stroke patients.