Assessment of Unilateral Spatial Neglect in Children
Objective : In a previous study, we demonstrated that unilateral spatial neglect (USN) exists in children, and described an original task to evaluate USN : the Teddy Bear Cancellation Test. We showed it was sensitive on a population of children presenting with USN after acquired brain injury. The objectives of this study were (1) to standardise the Teddy Bear Cancellation test and (2) to evaluate prospectively the frequency of USN in children with acquired brain lesions.
Method : We studied two groups. The first group consisted of 419 control children aged 3 to 8 years coming from different classes in public schools. The second group consisted of 41 children aged 3 to 8 years admitted in a department of physical medicine after acquired brain injury. They were studied prospectively. All children underwent the Teddy Bear Cancellation Test. For each child, we noted the number of omissions and the location of the three first teddy bears cancelled.
Results : In the control population, the omissions were rare and decreased with age and a left displacement of the first three teddy bears cancelled was observed as age increased. This preferential strategy of left-to-right cancelling can be interpreted as learned, depending on environmental influences, like reading habits.
In the brain injured population, USN was observed in 19,5% of patients. Right neglect was more frequent (12,2%) than left neglect (7,3%). Nevertheless it must be underlined that left USN was observed in 30% of the right brain injured children; and right USN occurred in 13% of the left and 13% of the non lateralised lesions. The high incidence of right USN in younger children is discussed in relation to the development of hemispheric specialisation.
Conclusion: We propose a cancellation test specific of children, and we normalised this test on a large control group. In a prospective study, we showed that USN is relatively frequent in children after acquired brain injury and it must be detected.