Visual Search Strategy and Balance in Children After Unilateral Brain Damage

Research Objectives To evaluate visual search strategy (VSS) and balance deficits in children with and without unilateral brain damage (UBD). Design Cross-sectional assessment study. Setting Academic medical research center. Participants Five children with and five without UBD were included. Those with UBD met inclusion criteria: 1) 3 - 12 years old; 2) UBD as documented in medical record; 3) can stand for 10 minutes; 4) can follow 2-3 step directions. Controls were matched by age and sex. Interventions None. Main Outcome Measures The Teddy Bear Cancellation Test (TBCT) requires children to identify 15 teddy bear pictures on a page of distractors. TBCT was used to describe VSS by video recording the completion of the test and tracking the order of identifications. The Sensory Organization Test (SOT) measures the effectiveness of the sensory systems in maintaining balance. The Bruininks-Oseretsky Test of Motor Proficiency Ed.2 (BOT-2) balance subtest assesses motor skills for children relative to age-norms. Results Children with UBD demonstrated a different VSS than controls. They were more likely to begin in the middle of the page then find the bears on the edges of the page. Children without UBD were more likely to start on one side and visually-search across the full page. Two of five children with UBD missed at least one bear, while children without injury found all 15. Children with UBD all scored below average on the BOT-2 balance subtest, while those without UBD scored at least average. All ten children scored above their age-norm on the SOT. Conclusions The SOT was unable to identify functional balance deficits in children with UBD, while the BOT-2 highlighted areas of deficits for these children. This suggests that the SOT may not be sensitive enough to detect functional balance deficits. Balance deficits were evident when asked to complete motorically challenging tasks such as the BOT-2. Given the differences observed in VSS, there may be some connection between visual search strategy and complex balance impairments that should be investigated in future, larger studies. Author(s) Disclosures None. To evaluate visual search strategy (VSS) and balance deficits in children with and without unilateral brain damage (UBD). Cross-sectional assessment study. Academic medical research center. Five children with and five without UBD were included. Those with UBD met inclusion criteria: 1) 3 - 12 years old; 2) UBD as documented in medical record; 3) can stand for 10 minutes; 4) can follow 2-3 step directions. Controls were matched by age and sex. None. The Teddy Bear Cancellation Test (TBCT) requires children to identify 15 teddy bear pictures on a page of distractors. TBCT was used to describe VSS by video recording the completion of the test and tracking the order of identifications. The Sensory Organization Test (SOT) measures the effectiveness of the sensory systems in maintaining balance. The Bruininks-Oseretsky Test of Motor Proficiency Ed.2 (BOT-2) balance subtest assesses motor skills for children relative to age-norms. Children with UBD demonstrated a different VSS than controls. They were more likely to begin in the middle of the page then find the bears on the edges of the page. Children without UBD were more likely to start on one side and visually-search across the full page. Two of five children with UBD missed at least one bear, while children without injury found all 15. Children with UBD all scored below average on the BOT-2 balance subtest, while those without UBD scored at least average. All ten children scored above their age-norm on the SOT. The SOT was unable to identify functional balance deficits in children with UBD, while the BOT-2 highlighted areas of deficits for these children. This suggests that the SOT may not be sensitive enough to detect functional balance deficits. Balance deficits were evident when asked to complete motorically challenging tasks such as the BOT-2. Given the differences observed in VSS, there may be some connection between visual search strategy and complex balance impairments that should be investigated in future, larger studies.