Horticultural Therapy May Reduce Psychological and Physiological Stress in Adolescents with Anorexia Nervosa: A Pilot Study.

Studies in psychiatric populations have found a positive effect of Horticultural therapy (HCT) on reductions in stress levels. The main objective of the present pilot study was to evaluate the impact of the addition of HCT to conventional clinical treatment (Treatment as Usual, TaU) in a sample of six female adolescents with anorexia nervosa restricting type (AN-R), as compared to six AN-R patients, matched for sex and age, under TaU only. This is a prospective, non-profit, pilot study on patients with a previous diagnosis of AN-R and BMI < 16, recruited in 2020 in clinical settings. At enrolment (T0) and after treatment completion (TF), psychiatric assessment was performed. At T0, all the patients underwent: baseline electrocardiogram acquisition with a wearable chest strap for recording heart rate and its variability; skin conductance registration and thermal mapping of the individual's face. An olfactory identification test was administered both to evaluate the olfactory sensoriality and to assess the induced stress. One-way analyses of variance (ANOVAs) were performed to analyze modifications in clinical and physiological variables, considering time (T0, TF) as a within-subjects factor and group (experimental vs. control) as between-subjects factors. When the ANOVA was significant, post hoc analysis was performed by Paired Sample T-tests. Only in the HCT group, stress response levels, as measured by the biological parameters, improved over time. The body uneasiness level and the affective problem measures displayed a significant improvement in the HCT subjects. HCT seems to have a positive influence on stress levels in AN-R.

Goal-oriented locomotion in children with spastic diplegia: Anticipatory orienting strategies and trajectory formation.

Goal-oriented locomotion (GOL) is a complex task integrating navigation and gait control. To our knowledge, this is the first study of GOL in subjects with Cerebral Palsy (CP). Thirteen subjects with spastic diplegia and 26 with typical development were enrolled in the study. Subjects performed a GOL task to reach luminous targets. Within-subject trajectory variability, maximal head deviation from trajectory and mean head anticipation over trajectory were analyzed. While all subjects showed gait impairment, only 8 of 13 subjects also showed navigation abnormalities as revealed by either: a) abnormal head orientation and trajectory formation, or b) abnormal head orientation with normal trajectory formation. Abnormal gait patterns do not account for and can be distinguished from navigation disorders in spastic diplegic CP. This distinction has important implications for novel rehabilitation methods that should specifically address navigation, not only gait.

The Virtual City ParadigmTM for Testing Visuo-Spatial Memory, Executive Functions and Cognitive Strategies in Children With ADHD: A Feasibility Study.

Navigation is a complex process, requiring target localization, route planning or retrieval, and physical displacement. Executive functions (EFs) such as working memory, inhibition and planning are fundamental for succeeding in this complex activity and are often impaired in Attention Deficit and Hyperactivity Disorder (ADHD). Our aim was to analyze the feasibility of a new ecological navigation task, the Virtual City paradigm™ (VC™) to test visuo-spatial memory and EFs in children with ADHD. Visuo-spatial short and working memory, inhibition and planning skills were tested with standardized tasks. The VC™, a new paradigm developed by our group, used the Virtual CarpetTM technology, consisting of a virtual town with houses, streets and crossroads projected on the ground. It includes a motion capture system, tracking body movement in 3D in real time. In one condition, children were required to walk through the city and reach a sequence of houses. In the other, before walking, they had to plan the shortest path to reach the houses, inhibiting the prepotent response to start walking. The results show a good feasibility of the paradigm (feasibility checklist and ad hoc questionnaire), being ecological and motivating. VC™ measures of span positively correlated with visuo-spatial short and working memory measures, suggesting that VC™ heavily relies on efficient spatial memory. Individual subject analyses suggested that children with ADHD may approach this task differently from typically developing children. Larger samples of ADHD and healthy children may further explore the specific role of EFs and memory, potentially opening new avenues for intervention.

Spastic diplegia in preterm-born children: Executive function impairment and neuroanatomical correlates.

BACKGROUND: The neuropsychological literature on preterm-born children with spastic diplegia due to periventricular leukomalacia is convergent in reporting deficits in non-verbal intelligence and in visuo-spatial abilities. Nevertheless, other cognitive functions have found to be impaired, but data are scant and not correlated with neuroimaging findings. AIMS: This study analyzes the neuropsychological strengths and weaknesses in preterm-born children with spastic diplegia (pSD) and their relationships with neuroanatomical findings, investigated by a novel scale for MRI classification. METHODS AND PROCEDURES: Nineteen children with pSD, mild to moderate upper limb impairment and Verbal IQ>80, and 38 normal controls were evaluated with a comprehensive neuropsychological battery (NEPSY-II), assessing Attention/Executive Functioning, Language, Memory, Sensorimotor, Social Perception and Visuospatial Processing domains. The MRIs were quantitatively scored for lesion severity. OUTCOMES AND RESULTS: The results showed that, beyond core visuo-spatial and sensory-motor deficits, impairments in attention and executive functions were present in more than half of the sample, particularly in children with damage to the anterior corpus callosum. CONCLUSIONS AND IMPLICATIONS: The findings are discussed in terms of clinical and rehabilitative implications tailored for pSD subgroups diversified for neuropsychological and neuroanatomical characteristics.

Anticipatory control and spatial cognition in locomotion and navigation through typical development and in cerebral palsy.

Behavioural evidence, summarized in this narrative review, supports a developmental model of locomotor control based on increasing neural integration of spatial reference frames. Two consistent adult locomotor behaviours are head stabilization and head anticipation: the head is stabilized to gravity and leads walking direction. This cephalocaudal orienting organization aligns gaze and vestibula with a reference frame centred on the upcoming walking direction, allowing anticipatory control on body kinematics, but is not fully developed until adolescence. Walking trajectories and those of hand movements share many aspects, including power laws coupling velocity to curvature, and minimized spatial variability. In fact, the adult brain can code trajectory geometry in an allocentric reference frame, irrespective of the end effector, regulating body kinematics thereafter. Locomotor trajectory formation, like head anticipation, matures in early adolescence, indicating common neurocomputational substrates. These late-developing control mechanisms can be distinguished from biomechanical problems in children with cerebral palsy (CP). Children's performance on a novel navigation test, the Magic Carpet, indicates that typical navigation development consists of the increasing integration of egocentric and allocentric reference frames. In CP, right-brain impairment seems to reduce navigation performance due to a maladaptive left-brain sequential egocentric strategy. Spatial integration should be considered more in rehabilitation.

Navigation strategies as revealed by error patterns on the Magic Carpet test in children with cerebral palsy.

INTRODUCTION: Short-term memory develops differently in navigation vs. manual space. The Magic Carpet (MC) is a novel navigation test derived from the Walking Corsi Test and the manual Corsi Block-tapping Task (CBT). The MC requires mental rotations and executive function. In Cerebral Palsy (CP), CBT, and MC scores relate differently to clinical and lesional factors. Hypotheses of this study are: that frontal lesion specifically affect navigation in CP; that brain lesions affect MC cognitive strategies. MATERIALS AND METHODS: Twenty-two children with spastic CP, aged 5 to 14 years, 14 with a unilateral and 8 with a bilateral form, underwent the CBT and the MC. Errors were classified into seven patterns by a recently described algorithm. Brain lesions were quantified according to a novel semi-quantitative MRI scale. Control data were partially drawn from a previous study on 91 typically developing children. RESULTS: Children with CP performed worse than controls on both tests. Right hemispheric impairment correlated with spatial memory. MC span was reduced less than CBT span and was more selectively related to right middle white-matter and frontal lesions. Error patterns were differently distributed in CP and in typical development, and depended on right brain impairment: children with more extensive right lesions made more positional than sequential errors. DISCUSSION: In CP, navigation is affected especially by extensive lesions involving the right frontal lobe. In addition, these are associated with abnormal cognitive strategies. Whereas in typical development positional errors, preserving serial order, increase with age and performance, in CP they are associated with poorer performance and more extensive right-brain lesions. The explanation may lie in lesion side: right brain is crucial for mental rotations, necessary for spatial updating. Left-lateralized spatial memory strategies, relying on serial order, are not efficient if not accompanied by right-brain spatial functions.

Cognitive strategies for locomotor navigation in normal development and cerebral palsy.

Visual-spatial impairment is a fundamental disorder in cerebral palsy (CP). However, current spatial testing is restricted to reaching space, whereas navigational space is seldom assessed. The Magic Carpet test, derived from the Corsi Block-tapping Task (CBT) for visual-spatial memory, is a new developmental test for navigation. The performances of the Magic Carpet test and CBT were assessed in 17 children with unilateral and bilateral spastic CP. The results were compared with an equal number of typically developing children, matched for age and sex. Magnetic resonance imaging scans of children with CP were scored according to a newly validated semi-quantitative classification. CBT span was significantly lower in CP, especially in bilateral forms, than in the comparison group, whereas the Magic Carpet test span did not significantly differ between the groups. CBT span, but not the Magic Carpet span, was related to gestational age at birth and to basic visual function. Both the CBT span and the Magic Carpet test were related to overall right-hemispheric impairment. In addition, CBT correlated with right periventricular impairment. In CP, navigation is differently impaired than visual spatial memory, and less tightly related to preterm birth, basic visual function, and deep white matter injury. The exploration of navigational space could prove useful in enhancing spatial representation and reference-frame manipulation in CP.

Visual-perceptual impairment in children with cerebral palsy: a systematic review.

AIM: Visual perception is one of the cognitive functions often impaired in children with cerebral palsy (CP). The aim of this systematic literature review was to assess the frequency of visual-perceptual impairment (VPI) and its relationship with patient characteristics. METHOD: Eligible studies were relevant papers assessing visual perception with five common standardized assessment instruments in children with CP published from January 1990 to August 2011. RESULTS: Of the 84 studies selected, 15 were retained. In children with CP, the proportion of VPI ranged from 40% to 50% and the mean visual perception quotient from 70 to 90. None of the studies reported a significant influence of CP subtype, IQ level, side of motor impairment, neuro-ophthalmological outcomes, or seizures. The severity of neuroradiological lesions seemed associated with VPI. The influence of prematurity was controversial, but a lower gestational age was more often associated with lower visual motor skills than with decreased visual-perceptual abilities. INTERPRETATION: The impairment of visual perception in children with CP should be considered a core disorder within the CP syndrome. Further research, including a more systematic approach to neuropsychological testing, is needed to explore the specific impact of CP subgroups and of neuroradiological features on visual-perceptual development.

Switching from reaching to navigation: differential cognitive strategies for spatial memory in children and adults.

Navigational and reaching spaces are known to involve different cognitive strategies and brain networks, whose development in humans is still debated. In fact, high-level spatial processing, including allocentric location encoding, is already available to very young children, but navigational strategies are not mature until late childhood. The Magic Carpet (MC) is a new electronic device translating the traditional Corsi Block-tapping Test (CBT) to navigational space. In this study, the MC and the CBT were used to assess spatial memory for navigation and for reaching, respectively. Our hypothesis was that school-age children would not treat MC stimuli as navigational paths, assimilating them to reaching sequences. Ninety-one healthy children aged 6 to 11 years and 18 adults were enrolled. Overall short-term memory performance (span) on both tests, effects of sequence geometry, and error patterns according to a new classification were studied. Span increased with age on both tests, but relatively more in navigational than in reaching space, particularly in males. Sequence geometry specifically influenced navigation, not reaching. The number of body rotations along the path affected MC performance in children more than in adults, and in women more than in men. Error patterns indicated that navigational sequences were increasingly retained as global paths across development, in contrast to separately stored reaching locations. A sequence of spatial locations can be coded as a navigational path only if a cognitive switch from a reaching mode to a navigation mode occurs. This implies the integration of egocentric and allocentric reference frames, of visual and idiothetic cues, and access to long-term memory. This switch is not yet fulfilled at school age due to immature executive functions.

Development of anticipatory orienting strategies and trajectory formation in goal-oriented locomotion.

In goal-oriented locomotion, healthy adults generate highly stereotyped trajectories and a consistent anticipatory head orienting behaviour, both evidence of top-down, open-loop control. The aim of this study is to describe the typical development of anticipatory orienting strategies and trajectory formation. Our hypothesis is that full-blown anticipatory control requires advanced navigational skills. Twenty-six healthy subjects (14 children: 4-11 years; 6 adolescents: 13-17 years; 6 adults) were asked to walk freely towards one of the three visual targets, in a randomised order. Movement was captured via an optoelectronic system, with 15 body markers. The whole-body displacement, yaw orientation of head, trunk and pelvis, heading direction and foot placements were extracted. Head-heading anticipation, trajectory curvature, indexes of variability of trajectories, foot placements and kinematic profiles were studied. The mean head-heading anticipation time and trajectory curvature did not significantly differ among age groups. In children, however, head anticipation was more often lacking (χ2 = 9.55, p < 0.01), and there were significant intra- and inter-subject variations. Trajectory curvature was often very high in children, while it became consistently lower in adolescence (χ2 = 78.59, p < 10(-17)). The indexes of spatial and kinematic variability all followed a decreasing developmental trend (R (2) > 0.5, p < 0.0001). In conclusion, children under 11 do not perform curvilinear locomotor trajectories as adolescents and adults do. Anticipatory head orientation and trajectory formation develop in late childhood, well after gait maturation. Navigational skills, such as path planning and shifting from ego- to allocentric spatial reference frames, are proposed as necessary requisites for mature locomotor control.

Hand movements at 3 months predict later hemiplegia in term infants with neonatal cerebral infarction.

AIM: The aim of this study was to explore the predictive value of quantitative assessment of hand movements in 3-month-old infants after neonatal stroke. METHOD: Thirteen infants born at term (five females, eight males; mean gestational age 39.4wks, SD 1.19, range 37-41wks; mean birthweight 3240g, SD 203, range 2900-3570g) with neonatal arterial ischaemic cerebral infarction, and 13 healthy infants (mean gestational age 39.1wks, range 37-41wks, SD 1.26; mean birthweight 3190g, SD 259, range 2680-3490g) were enrolled in the study. The absolute frequency and the asymmetry of global hand opening and closing, wrist segmental movements, and independent digit movements were assessed from videotapes recorded at around 12 weeks. Neurological outcome was assessed when the infants were at least 18 months old using Touwen's neurological examination. RESULTS: Five of the 13 infants with neonatal stroke had normal neurological development, and eight had hemiplegia. Asymmetry of wrist segmental movements and the absolute frequency of independent digit movements were significantly different between infants with and without hemiplegia (p=0.006 and p=0.008, respectively). No differences were found in global hand movements. INTERPRETATION: We propose that the observed abnormalities of hand movements are the result of two different mechanisms: direct disruption of the corticospinal projection to the spinal cord, and altered modulation of the central pattern generators of general movements.

Does the assessment of general movements without video observation reliably predict neurological outcome?

OBJECTIVE: To assess the clinical value of a modified version, not employing video recording, of Precthl's method on the qualitative assessment of general movements (GMs) in preterm, term and young infants at neurological risk. MATERIALS AND METHODS: One-hundred and fifteen infants consecutively enrolled in our follow-up program were selected for the study (103 preterm and 12 term infants). While being video recorded, each infant's spontaneous motor activity was directly observed and documented using a written proforma. An evaluation of the video was later performed by a different assessor blind to the infant's clinical history. RESULTS: The correlation between the two techniques was significant both at writhing age (birth to 6 weeks post-term age) and at fidgety age (9-15 weeks post-term age). Both methods showed a very high sensitivity for the prediction of cerebral palsy, as no false negatives were observed. The direct assessment showed a lower specificity, particularly during the writhing period. CONCLUSIONS: These results support the use of the direct assessment of GMs when the full application of the standard video observation cannot be routinely applied, restraining the use of video recordings to the abnormal or doubtful cases. This may facilitate the wished integration of the assessment of spontaneous motility into more general protocols of neurological examination and into clinical follow-up programs.