=Paper=
{{Paper
|id=Vol-1419/paper0064
|storemode=property
|title=Body Representation and Spatial Abilities of Preterm Low Birth Weight Preschool Children
|pdfUrl=https://ceur-ws.org/Vol-1419/paper0064.pdf
|volume=Vol-1419
|dblpUrl=https://dblp.org/rec/conf/eapcogsci/LabadiGB15
}}
==Body Representation and Spatial Abilities of Preterm Low Birth Weight Preschool Children==
https://ceur-ws.org/Vol-1419/paper0064.pdf
Body representation and spatial abilities of preterm low birth weight preschool
children
Beatrix Lábadi (labadi.beatrix@pte.hu)
Institute of Psychology, University of Pécs, Ifjúság u. 6. Pécs, 7627 Hungary
Enikő Györkő
Institute of Psychology, University of Pécs, Hungary
Anna Beke
Obstetrics and Gynaecology Clinic No.1, Semmelweis University, Budapest, Hungary
Abstract Recently an extensive interest has been shown about the role
of bodily experience in cognitive processes. However, there
The goal of the present study was to investigate the
relationship between spatial ability and development of body has been a widespread confusion about the nature of the
representation in preterm low birth weight preschool four- mental representation of body (Gallagher, 1986) mostly due
year-old children without neurological deficit and typically to the variability of existing taxonomies and models.
developing children who were matched by IQ and According to the growing consensus in the field of
chronological age. Our findings indicate that children born neuropsychology (Sirigu, Grafman, Bressler, &
prematurely with a normal cognitive level may have specific Sunderland, 1991) as well as in developmental psychology
difficulties in all levels of body representation which may be
associated with the spatial language production. These finding
(Slaughter & Heron, 2004) the three-level model is
are relevant for understanding the qualitative aspects of body supported which distinguishes (a) a sensori-motor
representation and provide practical consequences for early representation of the body; (b) a visual-spatial body
intervention of children born prematurely. representation; and (c) a lexical-semantic representation of
Keywords: body representation, spatial memory, spatial
the body. The sensori-motor level consists of a short-term
language, preterm born online representation of the body which is responsible for
body movement and not accessible to consciousness. The
Introduction visual-spatial representation consists of long-term and
general knowledge about the body topography including the
Over the past decades, rapid development in the perinatal
spatial localization of body parts. The lexical-semantic
and neonatal care has increased the survival rate of children
representation involves the general knowledge of the body
who are born very premature, however, there are potential
and its functions involving the naming of body parts or
risks for long-term morbidity. Indeed, children born preterm
semantic knowledge about the body functions e.g. biological
with low birth weight often have neuromotor problems and
background. The latter two levels of body representation are
are at risk for deficit in cognitive abilities in such
accessible to consciousness.
neuropsychological domains as memory, attention,
The available studies suggest that infants begin learning
executive function and language (Mikkola et al. 2005;
about their bodies as newborns, but at that time they create
Marlow, Henessy, Bracewell & Wolke, 2007). The
only a highly schematic representation of human body
longitudinal studies emphasize that preterm birth with low
(Quinn & Eimas, 1998). The detailed visual-spatial
birth weight have long-lasting negative impact on the
representations of human body emerge around 15- to 18
cognitive abilities and academic skills in school-aged
months when they are capable to discriminate scrambled
children (Conley & Bennet, 2000). However, cognitive
human body image from non-scrambled body image
impairments often cannot be detected clearly until these
(Slaughter & Heron, 2004). Interestingly, visual-spatial
children begin school.
representation of faces emerges earlier than body
Most psychological studies of cognitive functioning of
representation; even newborns are able to discriminate
preterm children investigated the deficit in general domains
human faces from scrambled faces (Johnson & Morton,
such as global intelligence, attention, perceptual-motor
1991), infants are likely to be born with an innate schema of
functioning, executing functioning and memory. These
human faces rather than a human body. The detailed visual-
assessments demonstrated that children born preterm have
spatial representation becomes available from the second or
worse neuropsychological outcomes relative to typically
third year of life when children begin to develop an explicit
developed children. Relatively small number of studies
representation of the body and recognize the human shape
focused on the specific patterns of the cognitive abilities of
with its distinctive configuration and spatial topography
preterm children such as spatial abilities, and none of these
(Brownell, Nichols, Svetlova, Zerwas & Ramini, 2010).
studies investigated the specific impairment in body
Based on the previous studies the visual-spatial
representation. Some studies reported that being born
representation of the body is likely to derive from sensori-
prematurely with low birth weight is a risk for deficit in
motor representation. This early bodily experience is the
spatial memory span and spatial working memory, as well
root of the developing body representation, cognitive
as recognition memory (e.g., Georgieff & Nelson, 2002).
401
abilities as well as the self. The body awareness is not a sort The control group included children born at term having
of separated entity in the world; rather it is a relational no history of perinatal problems. The full-term children with
between the body and either the physical and social typical developing characteristics (N=26) were born after 38
environment (Rochat, 2010). Even newborns begin to gestational weeks and individually matched with the
develop the implicit bodily self which is embedded in their preterm sample for age, parents education and IQ
environment. Shortly after the birth neonates begin to learn (Hungarian version of Brunet-Lezine Test). Full-term
the relation between their current capacities (e.g. motor children were recruited from the local preschool selected by
skills, bodily constraints) and the environmental conditions. teachers on the average level of the class.
But an important question is raised whether children who
are born very prematurely before 30 gestational weeks and Materials and Procedure
spend their first month(s) in a sensory deprived environment General procedures took place in a quiet lab. Each child
are able to develop a typical body representation. was tested individually. Three tasks were conducted to
assess body representation of children and additional two
Present study tasks evaluated children’s spatial abilities.
Children who were born prematurely and spent their first
weeks in incubator as a part of the intensive care have been Tasks for body representation
frequently reported deficit in sensori-motor domain. The Sensori-motor body representation - Fitting hands task.
lack of early physical contact with the world prevents them Here, we investigated children’s ability to reason about their
from collecting experience from their own bodies which body size, and shape relative to the objective physical
might specifically impact on the later body knowledge and world. In this task children were required to use their own
related cognitive abilities. sensori-motor body representation while fitting their actions
This study was designed to answer specific questions about to the visual-spatial patterns of the world. Nevertheless, our
different aspect of body representation in prematurely born task included only the hands and it did not extend to the
children aged between 4 to 5 years. There are both practical whole body. This task required the child to insert their hand
and theoretical reasons for addressing the questions of body into one of two apertures to take out a toy from a box. The
representation. From a theoretical point of view, the apertures were placed on the top of a box and varied due to
research attempts to provide further evidence for the different visual-spatial patterns. To be able to solve the task,
childhood development of body representation and its the child required to recognize the spatial relationship of a
relation to spatial cognition. The practical aspect of the visual pattern of the aperture and his/her own body
research is to provide deeper insights into the possible properties and the bodily action. First, the child had to
deficit of body representation in preterm children for early analyze the perceptual constraints of the apertures then
educational and rehabilitative intervention to improve the compare them with their own hands properties. Finally, they
preterm children’s cognitive and behavioral outcome. were required to choose the correct aperture, orient and
adjust their hands to the size, orientation and the shape of
Method the aperture in order to insert one hand into the box.
In this task we used a box (20 x 30 x 15 cm) with different
Participants interchangeable lids. The size of the apertures was adjusted
to a typical 5-year-old child’s hand size. Each lid had two
We studied 31 preterm children aged between 4 and 5 years, apertures which varied within three dimensions: size, shape
who were born before 30 gestational weeks (Mean: 27.93 and orientation. The apertures were presented side by side
weeks, SD: 1.63; ranging from 25 to 30 gestational weeks) on the lid and one of two apertures violated the physical
and their birth weight ranged from 600 g to 1680 g (Mean: constraints, therefore children were prevented from inserting
1040g, SD: 241 g). Additional 12 children were discarded their hands into this aperture, for example the aperture was
because of fussiness (N =4) or incomplete task performance smaller than the child’s hand. Each child performed 9 trials
on more than 3 tasks (N=8). Preterm children were enrolled (three per dimension) and the order of the stimuli was
via the Department of Pediatric Neurology at the Obstetrics randomized.
and Gynaecology Clinic No.1 of Semmelweis University in The experiment was recorded and the tapes were time-
Budapest. Prior to the study children were assessed by a coded by digital clock. The hand actions were also coded
clinical neuropsychologist and a pediatric neurologist who and analyzed by two independent raters for the purpose of
ensured that children are within the normal range of assessing successful choice, reaction time and qualitative
intellectual abilities without neurological symptoms, analysis of hand laterality.
however they are in the lower part of the normal range as Visual-spatial body representation - Scrambled body task
the most of the very preterm children (< 30 gestational To investigate the visual-spatial body representation we
week). The inclusion criteria for preterm children were the reproduced scrambled body images used by Slaughter,
following: (1) birth at a gestational age of 30 weeks or Heron & Sim (2002). However, we modified them by using
younger; (2) no congenital abnormalities; (3) no measurable friendlier children figures instead of adult pictures, and we
neurological deficit; (4) no retinopathy or prematurity; (5) also changed the presentation method. We used a pairwise
no mental, intellectual disabilities.
402
comparison method with two sets of human body pictures, but the same complexity provides good grounds for testing
one for typical body and another for scrambled body. Each path type effects on spatial language use, which is not
set consisted of 6 six images, these were black and white available in all languages - for example, English often uses
line drawings. The scrambled body set violated the typical the same postpositions for static and goal relations.
canonical human body shape, for example legs attached to
the shoulders or arms attached to the hip. The pairings of
typical and scrambled figure pictures and the side of
presentations were randomized across children. The children
were asked to decide which picture showed a typical body.
We measured the correct responses and analyzed the typical
errors.
Lexical- semantic body representation - Body part
localization task
This task investigated children’s ability to locate their
body parts on themselves. The task was adopted from adult
studies examining the body representation deficits in adults
with focal brain damages. Children were asked to point to
their own body parts as the examiner named them. This task
was divided into two parts, one of which referred to the Fig. 1. Spatial layout in the spatial language task
naming of the head parts and the other requested naming the
other body parts (we determined 7 standard locations on the In our study the spatial terms were elicited in an
head and 24 locations on the body). The whole procedure experimental space consisting of a 1.5 x 1.5 m matrix
was recorded and two independent trained raters coded the involving a white mug divided into 16 identical squares
performance (within these categories: correct location, with black lines (Fig. 1). We also used five little wooden
different body part, refuse). Interraters reliability was .93. chairs made for children with different tops representing
animals (e.g. monkey) and fruits (e.g. pumpkin) as reference
Tasks for spatial abilities objects. During the experiment these chairs were placed into
the matrix, while children were requested to answer 3 types
Spatial memory. The spatial memory task was adopted of questions encoding the path e.g. ’Where is the monkey?’
from the Hungarian Version of Snijders – Oomen (static); ’Where do I put the melon?’ (goal); ’Where do I
Nonverbal Intelligence Scale for Young Children. This take the apple from?’ (source). We tested the spatial term
subtest assesses the spatial location memory in young production within either egocentric or allocentric frame of
children. The participant is presented with a little house reference. The experimenter was standing outside of the
shape made of paper with six or ten windows depending on matrix and put the target object (chair) to different positions
the trials. The windows represent the hiding locations, related to either one or two other objects (chairs) or the child
which are displayed in three horizontal rows with 6 depending on the spatial frame of reference. In the
windows, and L-shaped configuration with ten windows, allocentric situation the child stood outside of the matrix
where these extra four windows are added to one side of the and he/she was required to respond to the experimenter’s
house. In each trial, the experimenter places a black kitten questions referring to the relations among the objects (e.g.
made of paper into one of the windows then quickly closes ‘The apple is next to the melon’). While in the egocentric
all windows and covered the place with a screen for 6 s. situation child sat in the centre of the matrix on a chair and
When the screen is removed the children are immediately requested to answer the question from his/her egocentric
being requested to point the window where the kitten was viewpoint (e.g. ‘The apple is next to me’). Altogether 12
hid. The number of the correct responses was computed for postpositions were tested in each situation. Children’s
the analysis. scores were computed according to the number of correct
Spatial language production ‘spatial postposition’ productions.
Hungarian language has many possibilities to encode
spatial relations: suffixes, postpositions, verbal prefixes and Results
adverbs (Lukács, Pléh, & Racsmány, 2007). In this study we Sensori-motor body representation - Fitting hands to a
focus on postpositions that are used to encode cognitively visual form task. The hand actions were analyzed due to the
complex relations and postpositions providing cue to encode number of correct choices and action duration.
the path type in three different forms according to the Correct insertion: For each trial, the correct attempts to
dynamic aspect of coding the location and the path. For insert the hand into the aperture were coded and calculated
each spatial relation, Hungarian has a static locative term, as a correct choice, but it was only the first attempt that was
and two dynamic forms, one encoding the goal or end of the counted. A repeated measures of ANOVA with visual-
path; and the other relates to the source or starting point of spatial features (form, size and orientation) as the within
the path. All three types can be distinguished linguistically subjects factor and groups (preterm and full-term) as the
403
between subject factor was conducted on the scores of the groups (F (1, 54) = 28.635 p <.000). Children born full-term
correct responses. No significant difference was found achieved more than twice as many scores as prematurely
between the groups (F (1, 50) = 1.198 p =ns.). But a born children did. We also found differences between the
significant effect emerged for visual-spatial feature (F (1, conditions (allocentric and egocentric; F(1, 54) = 11.916
50) = 26.162, p < .000), namely, children tended to perform p<.001). In both groups children performed poorer in the
better in trials of orientation than form or size trials. No egocentric condition, they could use more postpositions
significant interaction between the group and visual-spatial viewed from outside of the matrix.
features was found. Relationship between body representation and spatial
Time: we registered the overall duration of action, the time abilities in preterm children. To determine whether preterm
from the appearance of the novel lid until the child took out children’s body representations were related to spatial
the toy from the box. The incorrect choices were excluded abilities Pearson correlations were calculated among these
from the analysis. Repeated measures of ANOVA (2 x 3 x variables with age partialled out from the calculation
3) were used to compare preterm and full-term children as (Table1). Surprisingly, we have not found association
between subject variable (preterm vs. full-term) and trials as between the performance in scrambled body task and the
well as visual-spatial features (shape, orientation and size) spatial variables. However, positive association was found
as within subject variables. We found significant differences between the performance in allocentric spatial language and
between the groups for the overall reaction time (F (1, 50) = body localization test (r = .680, p <.21); whereas the
7.609, p <.009). Preterm children (M= 3.93, SE =.198) spent egocentric spatial language showed negative correlation
more time to solve this problem than full-term children with the meantime of hand action (r = -.606, p<.048).
(M=3.02, SE = .193). We also found differences between Furthermore, the egocentric spatial language showed
the visual-spatial categories (F (2,50) = 24.433, p<.000), positive association with the mean correct choices in the
where the pairwise comparison showed that the orientation hand task (r = .692, p<.018). In contrast, no significant
category (M=2.409, SE =.094) of the visual-spatial pattern association was found between the performance in spatial
of the aperture differed either from the shape (M = 4.005, memory and different levels of body representation.
SE = .205) or the size (M= 3.787, SE = .236) category.
Significant interaction was found among group, trial and Table 1 Intercorrelation among body representation
visual-spatial features (F (4, 50) =3.409, p <.011). and spatial ability measures in preterm children
Visual-spatial body representation - Scrambled body task
We compared the performance between the preterm and Spatial Spatial Spatial
full-term group based on the total scores. The analysis language language memory
Allocentric Egocentric
revealed significant differences (F (1, 60) = 4.901; p< .031).
Scrambled body .404 .369 .197
The premature children’s performances were poorer (M=
5.04, SD= .79) than those of the control peers (M= 5.92, Body part .680* .103 .394
SD= .37). These differences can be described by the localization
difficulties in the discrimination of the limbs. Whole body
Body part localization. One-way analysis of variance Hand fitting .027 .692* .119
Correct choices
(ANOVA) was conducted as appropriate on the measures of
both dimensions of body representation such as the head and Hand fitting .191 -.606* -.226
the whole body. Significant effect for both dimensions task
emerged, and full-term children showed better performance Note df varied from 24-29 depending on the number of children completing
either for head dimension (F (1, 47) = 11.609; p<.001) and a given task of overall sample
*p < .05
for the whole body dimension (F(1, 47) = 28.975; p<.000).
Though, the scores of head were near the ceiling in both
To determine to what body representation levels are related,
groups (preterm: M =6.32, SD=.72; full-term: M= 6.94,
Pearson correlation were computed controlling for age (in
SD=.24). Children in the full-term group (M=19.17,
months) in the whole sample. The correlations were
SD=2.40) exhibited higher performance than their preterm
calculated among each score of performance in each body
peers (M=14.22, SD = 3.27).
representation tasks: scrambled body, body part
Spatial memory. Delayed recall score of the two groups
localization, fitting hands. Significant correlation (see Table
were analyzed by a one-way analysis of variance
5) were observed between the performance of scrambled
(ANOVA). The preterm children obtained a lower score (M
body task and performance in both body localization tasks
= 6.70 SD = 2.57) than did the control group (M=7.84, SD =
(for head r =.427, p <.04; r =.471, p<.04; for whole body r
2.22), but no significant difference was found (F (1, 56) =
=.471 p<.02) as well as the scores of correct choices in hand
3.122, p= .08).
fitting task (r=.427, p <.04). None of the variables of hand
Spatial language. A repeated measures of ANOVA (Type
fitting task related to the outcome of other body knowledge
III) for spatial language (egocentric, allocentric) as within
variables. The variables of hand fitting task was associated
subjects factor and for groups as between subjects factor
only with each other, namely, the means of the correct
was conducted. Significant effects were revealed for the
404
responses negatively correlated with the mean time of because even toddlers are capable to discriminate the
preadjustment (r= -.545, p<.007). scrambled body from the typical body (Slaughter et al.,
2003). In the other body topography (body part localization)
Discussion task children were asked to point body parts by name. The
Early development of body representation comparing findings showed that full-term children are superior. The
preterm and full-term children was investigated in the preterm children’s poor performances remind us of the
current study. We reported evidence that children born very neuropsychological deficit at the level of lexical-semantic
prematurely, without major neurological deficits and with a body representation, patients (autotopagnosia) with damage
normal cognitive level, have specific difficulties in most of to the left parietal area have difficulties to localize their own
the body related tasks evaluated at 4 years of age. We body parts when the examiner names them, but they can
further found that the reduced performance in body identify parts of inanimate objects (Guariglia et al., 2002).
representation is related to spatial language, but not to the These results suggest dissociation between the topographic
spatial memory within the preterm group. representation and semantic representation of their own
Relative to full-term controls, preterm children in the body. Nevertheless, in our preterm sample we did not find
present study showed reduced performance at all levels of that the semantic representation is dissociated from the
body knowledge. However, in the task of fitting hand, visuospatial representation, because the children’s
where the children are requested to rely on their sensori- performance of body part localization correlated with the
motor body representation, both groups are equally good at performance score in scrambled body task (for whole body r
scaling their reaching action to size, form and orientation of =.405 p < .04). Notably, the impairments in movement-
the aperture. By contrast, previous findings of younger related representations (hand fitting) of one’s body did not
children (1.5 - 2 years) showed a poor performance in a correlate with the two other representational levels either in
similar scaling task (Ishak and Adolph, 2008), where the preterm sample or in the whole sample. Such findings
toddlers frequently attempted to fit their hands into the suggest that sensori-motor body representation might be a
impossibly small holes. As Brownell et al (2010) suggested distinct aspect of the body representation.
the awareness of body to one’s own body size begins to The last question we addressed refers to the possible
emerge in the second year of life but in very limited ways relationship between the body-related representations and
and continues developing over the childhood. spatial abilities in preterm children. Our data suggested that
In contrast to our prediction, significant differences were not the production of spatial language from two different spatial
found between the preterm and full-term groups regarding viewpoints, using allocentric vs. egocentric frame of
their performance scores. But they differed in reaction time; reference, was associated with the body representations,
preterm children solve this task slower than the control. As namely the preterm children who showed better
Milner and Goodale (1995) noted the reaction time of a performance in the body location tasks obtained better
particular hand action refers to the transformation speed of outcomes of spatial language production (within the
the visuospatial information into motor execution. This allocentric reference). Moreover, the performance of hand
process is the function of the dorsal stream, and the longer fitting task also correlated with the spatial language
reaction time in preterm children suggests an impairment of productions. It seems that the body might play an important
dorsal system functioning. This finding is consistent with role in the spatial representation as the popular theory of
other studies (Braddick, Atkinson and Wattam-Bell, 2003, embodiment suggested. The body is used as a sort of
Taylor, Jakobson, Maurer and Lewis, 2009) suggesting the reference frame (head-feet, front-back, left-right) which is
increased vulnerability of the dorsal stream in children born mapped onto the embodied objects, for example ‘I am
prematurely. The different amount of time in transforming behind the melon’ (Lakoff and Johnson, 1999). However,
the visuospatial information into execution is likely to the speaker can use a viewer-centered (egocentric or deictic)
account for the group differences. As we observed, preterm or object-centered (allocentric or intrinsic) frame of
children needed more time to take out the toy from the box reference, and using the allocentric rather than egocentric
through the aperture hole because they had not adjusted spatial reference frame to describe the spatial relations can
their hand to the visuospatial patterns in advance. refer to the objective and viewpoint independent approach
To study children’s knowledge of body topography we of the world. In fact, preterm children’s production of
created two age-appropriate modifications of previously egocentric spatial language correlated with the movement-
used tasks, we investigated the children’s topographic body related body representation. We propose children who use
knowledge using typical human bodies versus scrambled an egocentric view to describe the scene are involved
bodies portrayed in various postures. Preterm children bodily. An impaired sensori-motor body representation is
tended more frequently to fail to discriminate the canonical not allowed to provide a stable egocentric reference point to
body posture from the scrambled body, especially in that determine the locations.
case when the arms and legs were interchanged. Our
findings suggest that children aged 4 years are able to Conclusion
discriminate the canonical human body confidently This study is the first to examine the different levels of body
regardless of the body posture. This result is not surprising, knowledge associated with some spatial abilities in children
405
born very prematurely. Relative to full-term sample, preterm Brownell, C., Zerwas, S., Ramini, G. (2007). “So big”: The
children showed reduced performance in all levels of body development of body self-awareness in toddlers. Child
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the early body experience is very important for the later Mikkola, K., Ritari, N, Tommiska, V., Salokorpi, T.,
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some reasons. First, we did not control the birth weight category representation during infancy: Are separated and
relative to gestational weeks, our preterm sample involved conceptual process required? Journal of Cognition and
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Acknowledgments comparison with full-terms. Child Development, 67,
This research was supported by OTKA (PD – 109597) 2005–2021.
research grant. Sirigu, A., Grafman, J., Bressler, K., Sunderland, T. (1991).
Multiple representations contribute to body knowledge
processing. Brain, 114, 629-642.
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