Impaired Motor Learning in Children with Hydrocephalus

Pediatric Neurosurgery 2001. Adapted by a paper by Yuchuan Ding, Qin Lai, James McAllister and Alexa Canady

    Children with hydrocephalus have been observed to have a range of motor and cognitive deficits. Few studies, however, have addressed motor-learning deficits in children with hydrocephalus, although neurobehavioral performance, deficits in cognitive function and motor activity have been widely studied.

    Motor learning is a process associated with acquiring new motor skills. Many complex motor skills are acquired through a process of segmental motor learning, in which movement segments are formed and then retrieved for the execution of the learned skill. Timing rhythm is one of the most important motor skills. It affects the acquisition of any sequential movements, such as playing the piano, handwriting and drawing, as well as walking, running and speaking. Learning and memory formation of rhythmic motor skills have been well studied in general child populations, but not among children with hydrocephalus.

    The study group consisted of 19 children with hydrocephalus between the ages of 9 and 15, with congenital (9) and noncongenital (10) hydrocephalus. Twenty "normal" children of the same age range participated in the study as a control group. The children were assigned to four groups: two groups for children with hydrocephalus, age 9-12 and 13-15, and two groups for the control, ages 9-11 and 13-15.

The Task

    Participants were asked to use the index finger of each hand to sequentially press the J and F keys in a standard computer keyboard to match specific timing requirements. The goal timing intervals were shown on the monitor before performing the task. In addition to verbal instruction for the tasks, auditory information for the timing intervals (beeping sounds) and visual feedback (lines shown in different colors on the monitor) were provided before and after each trial. Subjects repeated the tests on the second day, but without the auditory and visual feedback information.

The Results

    Children with hydrocephalus made significantly more errors than the control group. Results also suggested that, unlike the control group, the children with hydrocephalus were not able to improve their performance with practice. There was no different in performance between the group of 10 year olds and the group of 14 year olds (in direct contrast to the control group, in which the 14 year olds produced fewer errors than the 10 year olds). There was no significant difference in performance between children with congenital and noncongenital hydrocephalus.

Discussion

    The children with hydrocephalus were not able to improve their relative-timing learning with practice or age progression. They were, however better able to learn less complicated motor skills, having no problems in learning absolute timing and the first segment of relative timing.

    Both motor and cognitive deficits in children with hydrocephalus have been well documented. It has been shown that nonverbal IQ-but not verbal IQ-is significantly lower in children with hydrocephalus than in control groups. It has also been shown that they have significantly poorer development of nonverbal skills to verbal cognitive abilities.

    Poor performance IQ may indicate an impaired cognitive-motor functioning that largely relates to motor learning and memory formation in children with hydrocephalus.

    There is a concern as to whether motor activity deficits, such as disorders of gross and fine motor movements that are commonly observed in hydrocephalus, could contribute to poor performance in learning the motor skills in this study.

    Evidence from this study showed that children with hydrocephalus had no difficulty performing less complex movements, such as the first segment using relative-timing-sequence learning, as well as in absolute timing learning. However, they did have difficulties performing more complicated and sequential movements that are involved largely in learning, programming and processing information. These results suggest that the children with hydrocephalus were physically able to perform the tasks.

    In the study, no significant differences in performance were found between children with congenital and noncongenital hydrocephalus. Because of the small sample size, however, it is still difficult to conclude that different etiologies have little effect on motor learning in children with hydrocephalus.

    The findings of this study suggest that children with hydrocephalus are better able to acquire a single or less complex movement. Proper practice and training procedures with simplified movements may help them in motor-skill learning. Further studies utilizing a proper training procedure with simplified tasks are encouraged in order to improve motor-skill learning. 

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