There are so many facets to this out-of-print 50 year-old gem that each of its 22 chapters lends itself to a blog, but I’ll bring this mini-series to a close with the opening chapter of this volume titled: “The Examination of Higher Cerebral Functions in Children”. Its author was Robert P. Sedgwick, M.D., Associate Clinical Professor of Neurology at the University of Southern California School of Medicine and Head, Division of Neurology, Children’s Hospital of Los Angeles (the academically affiliated hospital of USC).
Whenever I give presentations that includes material about cerebral function, I point out only half-jokingly that anything innovative in our field seems to emanate from Southern California, and slowly migrates across the country. That’s because on the East Coast when we present new ideas, colleagues tend to sit with arms folded thinking: “Oh yeh? Prove it to me.”
In Southern California they say: “Really? That sounds interesting. Let’s try it! And it seems like in the 1960s, USC in particular was the hotbed for ideas that touched upon pediatric neurology. A. Jean Ayres, the godmother of sensory integration therapy for OTs, was at USC. Paul Denison, the originator of Brain Gym, was at USC. Elena Boder, who sub-classifed dyslexia, was at USC. You get the idea, and Dr. Sedgwick (an individual I hadn’t previously been aware of) was definitely in that milieu. Here are some key excerpts from Dr. Sedgwick’s chapter and again, bear in mind how timely these points remain despite having been written 50 years ago. They are all direct quotes:
- It is important for the physician to sharpen his clinical tools for examination of higher cerebral functions since his ordinary tools of examination, including the classical neurological examination (and even the EEG) will be largely unrewarding in enabling him to understand and help the child with a learning disorder.
- Part-functions of the CNS are, of course, operationally defined by our own concepts and testing. Thus they can only be considered as approximations of what actually occurs in nature.
- Discussion of body perception leads naturally to consideration of spatial perception. The development of the latter undoubtedly utilizes the body as central reference. From this reference a three-dimensional frame is constructed with coordinates near/far, front/back, right/left and up/down.
- Perceptual deficit of things seen may include unilateral neglect, metamorphopsias, loss of stereoscopic vision, illusory deceptions, and inability to judge dimensions, distances, and directions correctly.
- Differentiation between screening tests and specific testing in depth should be made. Screening tests are valuable in the survey of large populations to attempt to find those children who are “at learning risk”. But the screening test will often not define the problem of a specific child in sufficient depth to be therapeutically relevant.