Body representation in children with unilateral cerebral palsy

Drawings produced by children provide insights about their physical and psychological status. In children suffering from unilateral cerebral palsy (UCP), self-portraits constitute a unique opportunity to study whether and how their disease affects self-body representation. The aim of the present study is to evaluate self-body representation in UCP children, comparing it to the way they portray both healthy and hemiparetic peers. Ten UCP children were asked to perform 3 drawings: a self-portrait, a portrait of their best classmate, and finally a portrait of a hemiparetic peer who had joint them in a child-to-child rehabilitation protocol. As controls, 16 typically developing children were asked to perform a self-portrait, and their best-classmate portrait. The asymmetry index (AI), consisting of the difference between the upper limbs length expressed as percentage of their average, resulted greater in UCP than in controls' self-portrait. More interestingly, UCP children portrayed themselves more asymmetrically relative to their classmates and hemiparetic peers. No difference in terms of AI was found between self- vs. classmate-portrait in the control group. This study provides evidence that UCP affects body self-representation, but not body-representation in general. In fact, the asymmetry in upper limb representation observed in children with UCP does not constitute a mere picturing of the hemiparesis, but rather reflects the experienced status of functioning, that is valid only for one's own. The inclusion of portraits in pediatric neurorehabilitation programs might enable clinicians to collect additional evidence about the children self-perceived functioning, i.e., an information not easily obtainable in pediatric patients.