Cognitive correlates of mathematical achievement in children with cerebral palsy and typically developing children.

BACKGROUND: Remarkably few studies have investigated the nature and origin of learning difficulties in children with cerebral palsy (CP). AIMS: To investigate math achievement in terms of word-problem solving ability in children with CP and controls. Because of the potential importance of reading for word-problem solving, we investigated reading as well. SAMPLE: Children with CP attending either special (n= 41) or mainstream schools (n= 16) and a control group of typically developing children in mainstream schools (n= 16). METHOD: Group differences in third grade math and reading, controlled for IQ, were tested with analyses of co-variance (ANCOVAs). Hierarchical regression was used to investigate cognitive correlates of third grade math and reading. Predictors included verbal and non-verbal IQ measured in first grade, components of working memory (WM) and executive function (EF) measured in second grade, and arithmetic fact fluency and reading measured in third grade. RESULTS: Children with CP in special schools performed significantly worse than their peers on word-problem solving and reading. There was a trend towards worse performance in children with CP in mainstream schools compared to typically developing children. CONCLUSIONS: Impairments of non-verbal IQ and WM updating predicted future difficulties in both word-problem solving and reading. Impairments of visuospatial sketchpad and inhibition predicted future word-problem, but not reading difficulty. Conversely, deficits of phonological loop predicted reading but not word-problem difficulty. Concurrent arithmetic fact fluency and reading ability were both important for word-problem solving ability. These results could potentially help to predict which children are likely to develop specific learning difficulties, facilitating early intervention.

High disease impact of myotonic dystrophy type 2 on physical and mental functioning.

The aim of the study was to investigate health status in patients with myotonic dystrophy type 2 (DM2) and determine its relationship to pain and fatigue. Data on health status (SF-36), pain (MPQ) and fatigue (CIS-fatigue) were collected for the Dutch DM2 population (n = 32). Results were compared with those of sex- and age-matched adult-onset myotonic dystrophy type 1 (DM1) patients. In addition, we compared the obtained scores on health status of the DM2 group with normative data of the Dutch general population (n = 1742). Compared to DM1, the SF-36 score for bodily pain was significantly (p = 0.04) lower in DM2, indicating more body pain in DM2. DM2 did not differ from DM1 on any other SF-36 scales. In comparison to the Dutch population, DM2 patients reported lower scores (indicating worse clinical condition) on the physical functioning, role functioning-physical, bodily pain, general health, vitality, social functioning, and role functioning-emotional scales (p < 0.01 on all scales). The difference was most profound for the physical functioning scale. In the DM2 group the severity of pain was significantly correlated with SF-36 scores for bodily pain (p = 0.003). Fatigue was significantly correlated with the SF-36 scores for role functioning-physical (p = 0.001), general health (p = 0.02), and vitality (p = 0.02). The impact of DM2 on a patients' physical, psychological and social functioning is significant and as high as in adult-onset DM1 patients. From the perspective of health-related quality of life, DM2 should not be considered a benign disease. Management of DM2 patients should include screening for pain and fatigue. Symptomatic treatment of pain and fatigue may decrease disease impact and help improve health status in DM2, even if the disease itself cannot be treated.

Quality of arithmetic education for children with cerebral palsy.

The aim of this exploratory study was to investigate the quality of arithmetic education for children with cerebral palsy. The use of individual educational plans, amount of arithmetic instruction time, arithmetic instructional grouping, and type of arithmetic teaching method were explored in three groups: children with cerebral palsy (CP) in special (CP-special; n = 41) and mainstream schools (CP-mainstream; n = 16) and a control group in mainstream schools (n = 16). The majority of individual educational plans did not include well-formulated arithmetic goals and many were not based on optimal assessment. Special schools scheduled much less arithmetic instruction time. Many CP-mainstream children received individualized instruction, which may help to explain why their arithmetic performance did not differ from controls. Remedial arithmetic teaching methods used in special schools did not seem to be optimal, but more research is required. Suggestions to improve arithmetic education to children with CP were discussed.

Arithmetic difficulties in children with cerebral palsy are related to executive function and working memory.

BACKGROUND: Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue. METHODS: Arithmetic ability was longitudinally assessed in children with cerebral palsy in special (n = 41) and mainstream education (n = 16) and controls in mainstream education (n = 16). Second grade executive function and working memory scores were used to predict third grade arithmetic accuracy and response time. RESULTS: Children with cerebral palsy in special education were less accurate and slower than their peers on all arithmetic tests, even after controlling for IQ, whereas children with cerebral palsy in mainstream education performed as well as controls. Although the performance gap became smaller over time, it did not disappear. Children with cerebral palsy in special education showed evidence of executive function and working memory deficits in shifting, updating, visuospatial sketchpad and phonological loop (for digits, not words) whereas children with cerebral palsy in mainstream education only had a deficit in visuospatial sketchpad. Hierarchical regression revealed that, after controlling for intelligence, components of executive function and working memory explained large proportions of unique variance in arithmetic accuracy and response time and these variables were sufficient to explain group differences in simple, but not complex, arithmetic. CONCLUSIONS: Children with cerebral palsy are at risk for specific executive function and working memory deficits that, when present, increase the risk for arithmetic difficulties in these children.

The relationship between medical impairments and arithmetic development in children with cerebral palsy.

Arithmetic ability was tested in children with cerebral palsy without severe intellectual impairment (verbal IQ >or= 70) attending special (n = 41) or mainstream education (n = 16) as well as control children in mainstream education (n = 16) throughout first and second grade. Children with cerebral palsy in special education did not appear to have fully automatized arithmetic facts by the end of second grade. Their lower accuracy and consistently slower (verbal) response times raise important concerns for their future arithmetic development. Differences in arithmetic performance between children with cerebral palsy in special or mainstream education were not related to localization of cerebral palsy or to gross motor impairment. Rather, lower accuracy and slower verbal responses were related to differences in nonverbal intelligence and the presence of epilepsy. Left-hand impairment was related to slower verbal responses but not to lower accuracy.

The effect of cerebral palsy on arithmetic accuracy is mediated by working memory, intelligence, early numeracy, and instruction time.

The development of addition and subtraction accuracy was assessed in first graders with cerebral palsy (CP) in both mainstream (16) and special education (41) and a control group of first graders in mainstream education (16). The control group out-performed the CP groups in addition and subtraction accuracy and this difference could not be fully explained by differences in intelligence. Both CP groups showed evidence of working memory deficits. The three groups exhibited different developmental patterns in the area of early numeracy skills. Children with CP in special education were found to receive less arithmetic instruction and instruction time was positively related to arithmetic accuracy. Structural equation modeling revealed that the effect of CP on arithmetic accuracy is mediated by intelligence, working memory, early numeracy, and instruction time.

Expectancy effects on omission evoked potentials in musicians and non-musicians.

Abstract An expanded omitted stimulus paradigm was investigated to determine whether expectancy would modulate the amplitude of the omission evoked potentials (OEPs). In addition, we examined the effects of musical expertise on OEPs. Trials started with 3-7 beats randomly and contained 5 omitted beats. Three types of trials (n = 90) were presented with 1, 2, or 3 beats occurring between omissions. A tap response at the end of each trial was used to determine timing accuracy. Clear OEPs were observed over midline sites. We found main omission effects with respect to an N150 and a P400 OEPs component, such that peak amplitudes diminished whenever the occurrence of an omitted stimulus could be expected. In addition, an N600 OEPs component emerged in response to expectedly omitted stimuli toward the end of each trial within the group of musicians. Thus, musical training seems to lead to more efficient and more refined processing of auditory temporal patterns.

Perceptions of cardiovascular risk among patients with hypertension or diabetes.

We aimed to examine risk perceptions among patients at moderate to high cardiovascular risk. A questionnaire about perceived absolute risk of myocardial infarction and stroke was sent to 2424 patients with hypertension or diabetes. Response rate was 86.3% and 1557 patients without atherosclerotic disease were included. Actual cardiovascular risk was calculated by using Framingham risk functions. A total of 363 (23.3%) of the 1557 patients did not provide any risk estimates and these were particularly older patients, patients with a lower educational level, and patients reporting no alcohol consumption. The remaining 1194 patients tended to overestimate their risk. In 42.3% (497/1174) and 46.8% (541/1155) of the cases, patients overestimated their actual 10-year risk for myocardial infarction and stroke, respectively, by more than 20%. Older age, smoking, familial history of cardiovascular disease (CVD), and actual absolute risk predicted higher levels of perceived absolute risk. Male sex, higher scores for an internal health locus of control, lower scores for a physician locus of control, and self-rated excellent or (very) good health were positively related to higher accuracy. In conclusion, patients showed inadequate perceptions of their absolute risk of cardiovascular events and physicians should thus provide greater information about absolute risk when offering preventive therapy.