AIM The aim of this study was to compare executive function in children with left-and rightsided unilateral cerebral palsy (CP) and typically developing children.METHOD There was a cross-sectional cohort of 46 children with unilateral CP (24 right-side, 22 left-side; 25 males, 21 females; mean age 11y 1mo, SD 2y 5mo) and 20 typically developing children (nine males, 11 females; mean age 10y 10mo, SD 2y 4mo). Four cognitive domains of executive function were assessed: attentional control, cognitive flexibility, goal setting, and information processing. Subtests from the Delis-Kaplan Executive Function System, the Test of Everyday Attention for Children, the Rey-Osterrieth Complex figure, and the Wechsler Intelligence Scale for Children -Fourth Edition were utilized. Between-group differences (right unilateral CP, left unilateral CP, and typically developing children) were examined using analyses of covariance.
RESULTSChildren with CP performed significantly more poorly than typically developing children on all executive function measures (aggregate executive function: F(1,63)=31.16; p<0.001; g 2 =0.33). There were no significant differences between children with left and right unilateral CP, except in the case of inhibition/switching total errors, with children with left unilateral CP making fewer errors than children with right unilateral CP (F(1,39)=4.14; p=0.049; g 2 =0.1).INTERPRETATION Children and adolescents with unilateral CP experience difficulties across multiple executive function domains compared with typically developing children, irrespective of the side of hemiplegia. This finding supports an early vulnerability model of early brain injury and has implications for intervention for children with CP.Cerebral palsy (CP) is the leading cause of childhood physical disability worldwide, with financial expenditure in Australia totalling Aus$ 1.47 billion in 2007.1,2 Unilateral CP is the most common type of CP among children born at term and the second most common type in children born preterm, with an incidence of 1 in 1300 live births. 1,3 Children with unilateral CP experience one-sided motor and postural deficits and many experience difficulties with emotional and behavioural skills 4 and cognitive functions.
5Despite this, there is a paucity of research examining the neuropsychological outcomes of these children. Executive function is necessary for the successful completion of everyday activities and is an umbrella term that encompasses skills necessary for novel, goal-directed, and complex activity including self-regulation, problem solving, and organization.6 Deficits may manifest as an inability to focus and attend to tasks, perseveration, increased errors without subsequent self-correction, and taking longer to complete tasks. 6 There is no one way to define or conceptualize executive function as, by its very nature, it comprises a multitude of higher-order cognitive skills. A conceptual executive function framework in children and adolescents was proposed by Anderson, 7 and operationalizes execut...