Executive functioning in children with unilateral cerebral palsy: protocol for a cross-sectional study

Abstract

IntroductionEarly brain injury, as found in children with unilateral cerebral palsy (CP), may cause deficits in higher-order cognitive tasks known as executive functions (EF). EF has been conceptualised as comprised of four distinct yet inter-related components: (1) attentional control, (2) cognitive flexibility, (3) goal setting and (4) information processing. The aim of this study was to examine EF in children with unilateral CP and compare their performance with a typically developing reference group (TDC). The potential laterality effects of unilateral CP on EF will be explored, as will the relationship between the cognitive measures of EF, behavioural manifestations of EF, psychological functioning and clinical features of unilateral CP.Methods and analysisThis cross-sectional study aims to recruit a total of 42 children with unilateral CP (21 right unilateral CP and 21 left unilateral CP) and 21 TDC aged between 8 and 16 years. Clinical severity will be described for gross motor function and manual ability. Outcomes for cognitive EF measureswill include subtests from the Wechsler Intelligence Scale for Children—Fourth Edition, Delis-Kaplan Executive Function System, Rey Complex Figure Test and the Test of Everyday Attention for Children. Behavioural manifestations of EF will be assessed using the Behaviour Rating Inventory of Executive Function, Parent and Teacher versions. Psychological functioning will be examined using the Strengths and Difficulties Questionnaire. Between-groups differences will be examined in a series of one-way analyses of covariance and followed up using linear comparisons. An overall composite of cognitive EF measures will be created. Bivariate correlations between the EF composite and psychological measures will be calculated.Ethics and disseminationThis protocol describes a study that, to our knowledge, is the first to examine multiple components of EF using a cohort of children with unilateral CP. Exploration of potential laterality effects of EF among children with a congenital, unilateral brain injury is also novel. Possible relationships between EF and psychological functioning will also be investigated. Ethics have been obtained through the University of Queensland School of Psychology Ethics Committee and the Queensland Children's Health Services Human Research Ethics Committee. Results will be disseminated in peer reviewed publications and presentations at national and international conferences. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000263998).

Everyday psychological functioning in children with unilateral cerebral palsy: does executive functioning play a role?

“…21 The study forms part of a larger study examining executive functioning in children with unilateral CP, with a previous paper identifying a global executive functioning deficit. 10 Institutional ethics approval was obtained from the School of Psychology Ethics Committee at the University of Queensland, Brisbane, (10-PSYCH-DCP-32-JM) and from the Queensland Children's Health Services Human Research Ethics Committee, Brisbane, Australia (HREC/ 10/QRCH/31).…”

“…27 Cognitive executive functioning measures A neuropsychological battery was developed that included the Rey Complex Figure Test 28 and subtests from the Delis-Kaplan Executive Function System, 29 Test of Everyday Attention for Children, 30 and the Wechsler Intelligence Scale for Children (4th edition). 31 A full description of the battery has been published in the study protocol, 21 and detailed comparisons between children with unilateral CP and CTD on each component of executive functioning have been published. 10 In this paper, a composite executive functioning measure was used, created by standardizing and averaging all measures.…”

“…19 A full description of each measure for this study, including psychometrics, has previously been published. 21 For this paper, the BRIEF index scores and the SDQ subscales were used. The BRIEF produces two index scores: the Behavioral Regulation Index (including initiate, working memory, plan/organize, organization of materials, and monitor) and the Metacognition Index (including inhibit, shift, and emotional control).…”

“…They were identified from a research database of children born in Queensland attending state-wide CP health services as described in the Australian CP Child Study protocol 23 and in the protocol for this study. 21 Identification of children for inclusion in the research database followed the guidelines of the Surveillance of Cerebral Palsy in Europe 24 and used a working definition of CP as a motor impairment stemming from an early, non-progressive brain lesion. 25 …”

School readiness of children with cerebral palsy

“…Measurement of cognition and general knowledge are less reliable under the age of 5 years. 36 The magnitude of deficits found in the measured domains suggests reduced school readiness compared with CTD despite failure to assess some areas. Another limitation is the ceiling effect of the CSBS-DP owing to standardized data only being available for CTD up to 24 months of age.…”