Two groups of children were used for the comparative study. The first was drawn from a parent population of 43 children who had been diagnosed as having minimal cerebral dysfunction and as being hyperactive and who had been referred to the Department of Physiotherapy, University of Queensland, for assessment and treatment. Of these, 20 children who had demonstrated abnormalities in awareness of body space and who had received only minimal treatment for their condition were selected to form the experimental subject sample. Their ages ranged from four years two months, to nine years eleven months. Sixteen of the twenty subjects were boys.
By the process of stratified random sampling, a control group, matched exactly for age and sex, was selected from large parent populations at several local schools and pre-schools. Confirmed inclusion in the control group depended on the results of a screening neurological examination and on the medical history. Any significant abnormality in one or more of the ten tested areas, or any reported signs of nervous system dysfunction resulted in exclusion of the child.
In order to obtain quantitative results and to decrease the number of variables, a mechanically driven rotating chair was incorporated in this experiment to provide the acceleration and deceleration stimuli needed to elicit nystamus. A basic neurological assessment was carried out prior to a series of twelve tests for post-rotatory nystagmus. The horizontal eye movements occurring on completion of rotation were traced on the recording paper of the ENG to give an accurate permanent record of each trial for later analysis.
What this comparative study of 'normally active' and 'hyperactive children' with observed vestibular and spatial problems showed that the latter group have a reduced duration of post-rotatory nystagmus following spinning, under specific experimental conditions where they are not able to fixate visually. However, it must be noted that some children in the control group had a nystagmus of less duration than some subjects in the experimental group. For this reason, a test of nystagmus duration alone would be insufficient to discriminate between a 'hyperactive' and a 'normally active' child. Nevertheless, the study did demonstrate that children with some apparent neurological impairment have a tendency to exhibit depressed vestibular reactions. Such results stress the importance of considering individual responses in conjunction with other neurological symptoms. Although a child with mild neurological impairment may not exhibit a marked abnormal response to particular sections of the neurological assessment, the results of a total assessment provide a complete and accurate picture of his sensory motor abilities.
While carried out on a small sample of subjects, the results of this trial suggest that further study of the vestibular system and more extensive observation of the nature of post-rotatory nystagmus could be useful int he assessment and treatment of children with sensory motor dysfunction.
Written by Emily Haylock-Jordan, Chiropractor.
Harrison, J.A., & Bullock, M.L. (1978). Post rotary nystagmus in hyperactive children with spatial awareness problems. The Australian Journal of Physiotherapy, 24(4), 173-80. doi: 10.1016/S0004-9514(14)60878-3.
Spatial Awareness in 7 to 11-year-old Physically Handicapped Children in Mainstream Schools
This study involved ten mainstream-educated children with physical handicaps that restrict their independent mobility, aged between 7 and 11 years, that were compared with matched classmates on measures of spatial awareness and cognitive mapping skills. Ten children, of whom six were female, were carefully selected from among the integrated handicapped school population in two midland counties of the UK as having a physical handicap that limited their mobility, but who otherwise fell within the normal range of intellectual attainment. Six had forms of brain damage (four cerebral palsy and two birth strokes), two muscular dystrophy, one an arthritic condition and another malformation of the limbs. For each, a comparison (control) child was selected in the same class, of the same age and sex, judged by the class teacher as being of similar disposition. Children were made to feel that they had been randomly selected for participation in the study, following a call for volunteers. All children were tested in classrooms in which they had been based for at least two months.
The handicapped children were significantly worse on all three spatial measures than their age-matched controls. The Wilcoxon Matched Pairs Signed Rank test showed that they drew less accurate classroom maps, placed classroom objects less accurately, and pointed to external landmarks less accurately. The authors said it was worth noting that (in absolute terms) all non-brain- damaged handicapped subjects reported greater numbers of landmarks than their controls, while the reverse was true for all brain-damaged handicapped subjects. From this study they were unsure whether the difficulty arises because of a history of poor mobility in earlier developmental stages (resulting in poor general spatial development) or poor mobility within the junior school environment specifically. It is possible that remedial spatial training of handicapped children at a younger age might develop their spatial competence such that passive experience at 7—11 years is as effective as it seems to be for able-bodied children at this age. Further studies are needed to address this issue.
Although spatial appreciation, map drawing skills and scale-reduction were confounded in the map drawing task, the uniformly poor performance of handicapped pupils on all the main spatial measures (tested variously by drawing or pointing) suggests that the deficit is one of spatial awareness and not of poor praxic skill. What the study found was that compared with their classmates, the handicapped children were significantly worse at drawing plan maps of their classrooms, placing missing objects on accurate classroom maps, and pointing in the direction of distant landmarks on the school campus. All motorically impaired children were deficient on one or more measures (whether brain damaged or not). Awareness of spatial relations is likely to be important for the development of several intellectual skills, and since physically handicapped children may be disadvantaged in this area, it is worthy of special attention from teachers and support staff.
Written by Emily Haylock-Jordan, Chiropractor
Forman, N., Orencas, C., Nicholas, E., Morton, P., & Gell, M. (2003). Spatial awareness in 7 to 11-year-old physically handicapped children in mainstream schools. Journal of Experimental Psychology, 9(2), 67–74. DOI: 10.1037/1076-898X.9.2.67.