The variety of visual perceptual impairments in pre-school children with perinatal brain damage


      To study the selectivity of visual perceptual impairment in children with early brain injury, eight visual perceptual tasks (L94), were administered to congenitally disabled children both with and without risk for cerebral visual impairment (CVI). The battery comprised six object-recognition and two visuoconstructive tasks. Seven tasks were newly designed. For these normative data are presented (age 2.75–6.50 years). Because the recognition tasks required object naming, each item included a canonical control drawing and visual perceptual ability was evaluated relative to the non-verbal intelligence level, instead of chronological age. In 22 multiple disabled children with no indications of CVI, the frequency of impairment did not exceed that in the reference sample for any L94 task. In contrast, in 57 5-year-old children who were at risk for CVI due to pre-maturity or birth asphyxia, a significant increase in the frequency of impairment was seen on six L94 tasks (range 12–38%). However, only five children had more than two impairments, indicating that the deficits were selective, not pervasive. We conclude that early brain lesions interfere with the functioning of particular visual subsystems, yet leave other subsystems intact and functioning within the normal range.



      BLOCKC, constructing block designs (), BLOCKM, matching block designs (), CVI, cerebral visual impairment (), DE VOS, De Vos task (), DE VOS*, alternative De Vos score in which viewpoint items were excluded (), GA, gestational age (), IC, inconclusive (score) (), LGN, lateral geniculate nucleus (), NOISE, line drawings occluded by noise (), OVERL, overlapping line drawings (), ROP, retinopathy of pre-maturity (), VGA, video graphics adapter (), VIEW, unconventional object views (), VISM, visual matching (), VMI, developmental test of visual motor integration (), WISC-R, Wechsler Intelligence Scale for Children – Revised (), WPPSI, Wechsler Pre-school and Primary Scale of Intelligence. ()
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        • Abercrombie M.L.J
        • Gardiner P.A
        • Hansen E
        • Jonckheere J
        • Lindon R.L
        • Solomon G
        • et al.
        Visual perceptual and visuomotor impairment in physically handicapped children.
        Percept Motor Skills. 1964; 18: 561-625
        • Ariel R
        • Sadeh M
        Congenital visual agnosia and prosopagnosia in a child: a case report.
        Cortex. 1996; 32: 221-240
        • Ballantyne A.O
        • Scarvie K.M
        • Trauner D.A
        Verbal and Performance IQ patterns in children after perinatal stroke.
        Dev Neuropsychol. 1994; 10: 39-50
        • Beery K.E
        The VMI. Developmental test of visual-motor integration. Administration, scoring and teaching manual. 3rd rev. ed. Modern Curriculum Press, Cleveland1989
        • Benton A
        • Tranel D
        Visuoperceptual, visuospatial, and visuoconstructive disorders.
        in: Heilman K.M Valenstein E Clinical neuropsychology. 3rd ed. Oxford University Press, New York1993: 165-213
        • Billard C
        • Santini J.J
        • Nargeot M.C
        • Gillet P
        • Adrien J
        • Dudin A
        Quel avenir pour les enfants hydrocéphales? Pronostic neurologique visuel et intellectuel d'une série de 77 hydrocéphalies non tumorales.
        Arch Fr Pediatr. 1987; 44: 849-854
        • Brigham E.O
        The Fast Fourier Transform. Prentice-Hall, Englewood Cliffs1974
        • Brookshire B.L
        • Fletcher J.M
        • Bohan T.P
        • Landry S.H
        • Davidson K.C
        • Francis D.J
        Verbal and nonverbal skill discrepancies in children with hydrocephalus: a five-year longitudinal follow-up.
        J Pediatr Psychol. 1995; 20: 785-800
        • Caplan B
        • Caffery D
        Fractionating block design: Development of a test of visuospatial analysis.
        Neuropsychology. 1992; 6: 385-394
        • Cioni G
        • Fazzi B
        • Coluccini M
        • Bartalena L
        • Boldrini A
        • van Hof-van Duin J
        Cerebral visual impairment in preterm infants with periventricular leukomalacia.
        Pediatr Neurol. 1997; 17: 331-338
        • Cioni G
        • Fazzi B
        • Ipata A.E
        • Canapicchi R
        • van Hof-van Duin J
        Correlation between cerebral visual impairment and magnetic resonance imaging in children with neonatal encephalopathy.
        Dev Med Child Neurol. 1996; 38: 120-132
        • De Renzi E
        • Lucchelli F
        The fuzzy boundaries of apperceptive agnosia.
        Cortex. 1993; 29: 187-215
        • De Renzi E
        • Spinnler H
        Visual recognition in patients with unilateral cerebral disease.
        J Nerv Ment Dis. 1966; 142: 515-525
        • de Vries L.S
        • Dubowitz L.M.S
        • Dubowitz V
        • Kaiser A
        • Lary S
        • Silverman M
        • et al.
        Predictive value of cranial ultrasound: a reappraisal.
        Lancet. 1985; ii: 137-140
        • de Vries L.S
        • Eken P
        • Dubowitz L.M
        The spectrum of leukomalacia using cranial ultrasound.
        Behav Brain Res. 1992; 49: 1-6
        • Eken P
        • de Vries L.S
        • van der Graaf Y
        • Meiners L.C
        • van Nieuwenhuizen O
        Haemorrhagic-ischaemic lesions of the neonatal brain: correlation between cerebral visual impairment, neurodevelopmental outcome and MRI in infancy.
        Dev Med Child Neurol. 1995; 37: 41-55
        • Eken P
        • van Nieuwenhuizen O
        • van der Graaf Y
        • Schalij-Delfos N.E
        • de Vries L.S
        Relation between neonatal cranial ultrasound abnormalities and cerebral visual impairment in infancy.
        Dev Med Child Neurol. 1994; 36: 3-15
        • Elman J.L
        • Bates E.A
        • Johnson M.H
        • Karmiloff-Smith A
        • Parisi D
        • Plunkett K
        Rethinking innateness. A connectionist perspective on development. MIT Press, Cambridge1996
        • Farah M.J
        • Aguirre G.K
        Imaging visual recognition: PET and fMRI studies of the functional anatomy of human visual recognition.
        Trends Cogn Sci. 1999; 3: 179-186
        • Farah M.J
        Visual agnosia: Disorders of object vision and what they tell us about normal vision. MIT Press/Bradford, Cambridge1990
        • Fazzi E
        • Orcesi S
        • Caffi L
        • Ometto A
        • Rondini G
        • Telesca C
        • et al.
        Neurodevelopmental outcome at 5–7 years in preterm infants with periventricular leukomalacia.
        Neuropediatrics. 1994; 25: 134-139
        • Fedrizzi E
        • Inverno M
        • Botteon G
        • Anderloni A
        • Filippini G
        • Farinotti M
        The cognitive development of children born preterm and affected by spastic diplegia.
        Brain Dev. 1993; 15: 428-432
        • Fletcher J.M
        • Francis D.J
        • Thompson N.M
        • Brookshire B.L
        • Bohan T.P
        • Landry S.H
        • et al.
        Verbal and nonverbal skill discrepancies in hydrocephalic children.
        J Clin Exp Neuropsychol. 1992; 14: 593-609
        • Flodmark O
        • Jan J.E
        • Wong P.K.H
        Computed tomography of the brains of children with cortical visual impairment.
        Dev Med Child Neurol. 1990; 32: 611-620
        • Fujimori M
        • Imamura T
        • Hirono N
        • Ishii K
        • Sasaki M
        • Mori E
        Disturbances of spatial vision and object vision correlate differently with regional cerebral glucose metabolism in Alzheimer's disease.
        Neuropsychologia. 2000; 38: 1356-1361
        • Gonzalez R.C
        • Woods R.E
        Image enhancement.
        in: Gonzalez R.C Woods R.E Digital image processing. Addison-Wesley, Reading1992: 161-244
        • Good W.V
        • Jan J.E
        • DeSa L
        • Barkovich A.J
        • Groenveld M
        • Hoyt C.S
        Cortical visual impairment in children.
        Surv Ophthalmol. 1994; 38: 351-364
        • Goodman R
        • Yude C
        IQ and its predictors in childhood hemiplegia.
        Dev Med Child Neurol. 1996; 38: 881-890
        • Grill-Spector K
        • Kushnir T
        • Edelman S
        • Itzchak Y
        • Malach R
        Cue-invariant activation in object-related areas of the human occipital lobe.
        Neuron. 1998; 21: 191-202
        • Happé F
        Autism: cognitive deficit or cognitive style?.
        Trends Cogn Sci. 1999; 3: 216-222
        • Humphreys G.W
        • Riddoch M.J
        Routes to object constancy: Implications from neurological impairments of object constancy.
        Q J Exp Psychol - A. 1984; 36: 385-415
        • Ito J-U
        • Saijo H
        • Araki A
        • Tanaka H
        • Tasaki T
        • Cho K
        • et al.
        Assessment of visuoperceptual disturbance in children with spastic diplegia using measurements of the lateral ventricles on cerebral MRI.
        Dev Med Child Neurol. 1996; 38: 496-502
        • Ito J-U
        • Saijo H
        • Araki A
        • Tanaka H
        • Tasaki T
        • Cho K
        • et al.
        Neuroradiological assessment of visuoperceptual disturbance in children with spina bifida and hydrocephalus.
        Dev Med Child Neurol. 1997; 39: 385-392
        • Jacobson L
        • Ek U
        • Fernell E
        • Flodmark O
        • Broberger U
        Visual impairment in preterm children with periventricular leukomalacia – visual, cognitive and neuropaediatric characteristics related to cerebral imaging.
        Dev Med Child Neurol. 1996; 38: 724-735
        • Jan J.E
        • Groenveld M
        • Sykanda A.M
        • Hoyt C.S
        Behavioural characteristics of children with permanent cortical visual impairment.
        Dev Med Child Neurol. 1987; 29: 571-576
        • Kanwisher N
        • Chun M.M
        • McDermott J
        • Ledden P.J
        Functional imaging of human visual recognition.
        Brain Res Cogn Brain Res. 1996; 5: 55-67
        • Kirk A
        • Kertesz A
        Localization of lesions in constructional impairment.
        in: Kertesz A Localization and neuroimaging in neuropsychology. Foundations of neuropsychology. Academic Press, San Diego, CA1994: 525-544
        • Koeda T
        • Takeshita K
        Visuo-perceptual impairment and cerebral lesions in spastic diplegia with preterm birth.
        Brain Dev. 1992; 14: 239-244
        • Kolbe B
        Brain plasticity and behavior. Lawrence Erlbaum, Mahwah1995
        • Kosslyn S.M
        • Alpert N.M
        • Thompson W.L
        • Chabris C.F
        • Rauch S.L
        • Anderson A.K
        Identifying objects seen from different viewpoints: A PET investigation.
        Brain. 1994; 117: 1055-1071
        • Kourtzi Z
        • Kanwisher N
        Cortical regions involved in perceiving object shape.
        J Neurosci. 2000; 20: 3310-3318
        • Kovács G
        • Vogels R
        • Orban G
        Selectivity of Macaque inferior temporal neurons for partially occluded shapes.
        J Neurosci. 1995; 15: 1984-1997
        • Krägeloh-Mann I
        • Petersen D
        • Hagberg G
        • Vollmer B
        • Hagberg B
        • Michaelis R
        Bilateral spastic cerebral palsy – MRI pathology and origin. Analysis from a representative series of 56 cases.
        Dev Med Child Neurol. 1995; 37: 379-397
        • Lambert S.R
        • Hoyt C.S
        • Jan J.E
        • Barkovich J
        • Flodmark O
        Visual recovery from hypoxic cortical blindness during childhood. Computed tomographic and magnetic resonance imaging predictors.
        Arch Ophthalmol. 1987; 105: 1371-1377
        • Leiter R.G
        General instructions for the Leiter International Performance Scale. Stoeling Company, Chicago1969
        • Levene M.I
        • Fawer C.L
        • Lamont R.F
        Risk factors in the development of intraventricular haemorrhage in the preterm and the newborn.
        Arch Dis Child. 1982; 57: 410-417
        • Marozas D.S
        • May D.C
        Research on effects of color reversal on the visual perceptual and visuomotor performances of spastic cerebral palsied and other exceptional individuals.
        Percept Motor Skills. 1986; 62: 595-607
        • McCarthy D
        McCarthy scales of children's abilities, Manual. The Psychological Corporation, New York1972
        • McCarthy R.A
        • Warrington E.K
        Cognitive neuropsychology: a clinical introduction. Academic Press, San Diego, CA1990
        • McDonald M.A
        • Dobson V
        • Sebris S.L
        • Baitch L
        • Varner D
        • Teller D.Y
        The acuity card procedure: A rapid test of infant acuity.
        Invest Ophthalmol Vis Sci. 1985; 26: 1158-1162
        • Menken C
        • Cermak S.A
        • Fisher A
        Evaluating the visual-perceptual skills of children with cerebral palsy.
        Am J Occup Therapy. 1987; 41: 646-651
        • Okumara A
        • Hayakawa F
        • Kato T
        • Kuno K
        • Watanabe K
        MRI findings in patients with spastic cerebral palsy. I: Correlation with gestational age at birth.
        Dev Med Child Neurol. 1997; 39: 363-368
        • Paneth N
        • Rudelli R
        • Kazam E
        • Monte W
        Brain damage in the preterm infant. Clinics in Developmental Medicine No. 131. Mac Keith Press, London1994
        • Payne B.R
        • Lomber S.G
        • MacNeil M.A
        • Cornwell P
        Evidence for greater sight in blindsight following damage of primary visual cortex early in life.
        Neuropsychologia. 1996; 34: 741-774
        • Riddoch M.J
        • Humphreys G.W
        A case of integrative visual agnosia.
        Brain. 1987; 110: 1431-1462
        • Roland E.H
        • Hill A
        How important is perinatal asphyxia in the causation of brain injury?.
        Ment Retard Dev Disabil Res Rev. 1997; 3: 22-27
        • Sarnat H.B
        • Sarnat M.S
        Neonatal encephalopathy following neonatal distress. A clinical and electroencephalographic study.
        Arch Neurol. 1976; 33: 696-705
        • Schenk-Rootlieb A.J.F
        • van Nieuwenhuizen O
        • van Zoggel J
        • van der Graaf Y
        • Willemse J
        Normal values of visual acuity in children up to 13 years as assessed by the acuity card procedure.
        Ophthalmic Paediatr Genet. 1992; 3: 155-163
        • Schroots J.J.F
        • van Alphen de Veer R.J
        Leidse Diagnostische Test. Deel 1: Handleiding. Swets & Zeitlinger, Lisse1976
        • Siegel S
        • Castellan Jr, N.J
        Nonparametric statistics for the behavioral sciences. 2nd ed. McGraw-Hill, New York1988
        • Snijders J.T
        • Snijders-Oomen N
        Handleiding van de SON 21/2–7. Wolters-Noordhof, Groningen1975
        • Stiers P
        • De Cock P
        • Vandenbussche E
        Impaired visual perceptual performance on an object recognition task in children with cerebral visual impairment.
        Neuropediatrics. 1998; 29: 80-88
        • Stiers P
        • De Cock P
        • Vandenbussche E
        Separating visual perception and non-verbal intelligence in children with early brain injury.
        Brain Dev. 1999; 21: 397-406
        • Stinissen J
        • Vandersteene G
        WPPSI Wechsler Preschool and Primary Scale of Intelligence. Handleiding bij de Vlaamse aanpassing. Swets & Zeitlinger, Lisse1981
        • Teller D.Y
        • McDonald M.A
        • Preston K
        • Sebris S.L
        • Dobson V
        Assessment of visual acuity in infants and children: The acuity card procedure.
        Dev Med Child Neurol. 1986; 28: 779-789
        • Turnbull O.H
        • Carey D.P
        • McCarthy R.A
        The neuropsychology of object constancy.
        J Int Neuropsychol Soc. 1997; 3: 288-298
        • Uggetti C
        • Egitto M.G
        • Fazzi E
        • Bianchi P.E
        • Bergamaschi R
        • Zappoli F
        • et al.
        Cerebral visual impairment in periventricular leukomalacia: MR correlation.
        Am J Neuroradiol. 1996; 17: 979-985
        • van den Hout B.M
        • Eken P
        • Van der Linden D
        • Wittebol-Post D
        • Aleman S
        • Jennekens-Schinkel A
        • et al.
        Visual, cognitive, and neurodevelopmental outcome at 51/2 years in children with perinatal haemorrhagic-ischaemic brain lesions.
        Dev Med Child Neurol. 1998; 40: 820-828
        • van den Hout B.M
        • Stiers P
        • Haers M
        • Van der Schouw Y.T
        • Vandenbussche E
        • van Nieuwenhuizen O
        • et al.
        Relation between visual perceptual impairment and neonatal ultrasound diagnosis of haemorrhagic-ischaemic brain lesions in 5-year-old children.
        Dev Med Child Neurol. 2000; 42: 376-386
        • van der Meulen B.F
        • Smrkovsky M
        McCarthy Ontwikkelingsschalen 21/2–81/2: handleiding. Swets & Zeitlinger, Lisse1986
        • Vanderkelen R
        • Vandenbussche E
        GARA, De Ganspoel rastertest. Handleiding. Ganspoel Instituut, Huldenberg, Belgium1995
        • Vargha-Khadem F
        • Isaacs E
        • Van Der Werf S
        • Robb S
        • Wilson J
        Development of intelligence and memory in children with hemiplegic cerebral palsy.
        Brain. 1992; 115: 315-329
        • Volpe J.J
        Neurology of the newborn. 3rd ed. Saunders, Philadelphia, PA1995
        • Volpe J.J
        Brain injury in the premature infant: Neuropathology, clinical aspects, and pathogenesis.
        Ment Retard Dev Disabil Res Rev. 1997; 3: 3-12
        • Wang P.P
        • Doherty S
        • Rourke S.B
        • Bellugi U
        Unique profile of visuo-perceptual skills in a genetic syndrome.
        Brain Cogn. 1995; 29: 54-65
        • Warrington E.K
        • James M
        Visual apperceptive agnosia: A clinico-anatomical study of three cases.
        Cortex. 1988; 24: 13-32
        • Warrington E.K
        • Taylor A.M
        Contribution of the right parietal lobe to object recognition.
        Cortex. 1973; 9: 152-164
        • Warrington E.K
        • Taylor A.M
        Two categorical stages of object recognition.
        Perception. 1978; 7: 695-705
        • Wechsler D
        Manual for the Wechsler Preschool and Primary Scale of Intelligence. The Psychological Corporation, New York1967
        • Weller R.E
        • Kaas J.H
        Parameters affecting the loss of ganglion cells in the retina following ablations of striate cortex in primates.
        Vis Neurosci. 1989; 3: 327-349
        • Whiting S
        • Jan J.E
        • Wong P.K.H
        • Flodmark O
        • Farrell K
        • McCormick A.Q
        Permanent cortical visual impairment in children.
        Dev Med Child Neurol. 1985; 27: 730-739
        • World Health Organization
        International Classification of Diseases. World Health Organization, Geneva1977
        • Young A.W
        • Ellis H.D
        Childhood prosopagnosia.
        Brain Cogn. 1989; 9: 16-47