I can understand even if I can't play: motor impairment does not inevitably mean intellectual impairment

Abstract

This study investigates the cerebral palsied children's understanding of conceptual and strategic knowledge in terms of spatial and temporal prepositions. Intelligence tests have shown children with cerebral palsy often have an intellectual impairment. However, intelligence tests use items requiring motor facility which cerebral palsied children have difficulty with. Despite the low scores obtained in intelligence tests, cerebral palsied individuals may often attain remarkable intellectual achievements. Studies with language have shown that these children are not delayed in their understanding of declarative terms, though they are delayed in their understanding of procedural terms, and that they achieve high scores on language tests. These results indicate that the physical impairment suffered by the cerebral palsied children may not necessarily lead to intellectual impairment. This hypothesis is further strengthened by the research findings that children with similar congenital physical impairments, like thalidomide poisoning, are not intellectually impaired despite their lack of adequate motor experience. This study aims at investigating the long-standing argument as to whether cerebral palsy will necessarily lead to intellectual impairment by comparing cerebral palsied and unimpaired children's understanding of conceptual and strategic knowledge at different developmental stages. In this study 8 and 10 year old cerebral palsied children were compared with unimpaired children of the same ages using a picture matching test. The test instrument required the children to match a picture to a preposition (conceptual knowledge) or sequence of four pictures to a preposition (strategic knowledge). Results from this study show that cerebral palsied children develop a conceptual understanding of spatial and temporal prepositions similar to unimpaired children. However, they are delayed in their development of strategic knowledge of the spatial and temporal prepositions. Furthermore, there was no apparent link between levels of cerebral palsied children's physical impairment and their test scores. These results suggest that children's direct manipulation of the physical world through motor actions may not be the only crucial pathway in children's cognitive development, as suggested by Piaget. The results support Gibson's (1987) perceptual learning theory and Goodale and Milner's (1992) hypothesis for a ventral or visual perception input stream. A correlation between early opportunities for cerebral palsied children to be mixed with unimpaired children and their test scores was indicated, suggesting that cerebral palsied children may learn knowledge from interacting with and observing their age peers, and that development of knowledge is mediated through a rich and changing visual environment with appropriate correctional feedback. The findings of this study strongly advocate the view that cerebral palsy does not necessarily lead to intellectual impairment, though the physical impairment resulting from cerebral palsy may restrict and delay certain aspects of cognitive development. Normal expectations from the caregivers and adequate interactions with and observations of age peers may lead to normal intellectual development of cerebral palsied children.