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It’s easier to relearn gross motor skills than learn them for the first time after injury: empirical evidence informing the age at injury debate

Lookup NU author(s): Dr Rob ForsythORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


The effect of age at injury on outcomes after brain injury has long been debated. Many have argued that the greater plasticity of the immature brain aids in its recovery from trauma, but others (notably Donald Hebb) have argued that early injury can impair the future ability of the brain to acquire new capabilities. This is difficult to assess empirically due to the presence of many age-dependent confounders. We performed Item Response Theory (IRT) analyses of two datasets of Gross Motor Function Measure (GMFM) observations, one in children with cerebral palsy (CP) and one in children with acquired brain injury (ABI) sustained at later ages. We used IRT to derive independent estimates of test item difficulty in the two populations. Additionally, where comparison between GMFM items and items in the Denver II Developmental Screening Test battery was possible we used the latter to obtain the ages at which these abilities are acquired in typically developing children. Item difficulty estimates for the two populations are highly correlated (adjusted r2 = 0.89, p < 0.0005), but demonstrate significant bias with harder items (typically acquired at later ages) being more readily achieved by children with ABI compared to CP. These results support the Hebbian perspective that (when considering gross motor function) it is easier to maintain or recover previously established functions than to learn them for the first time in an injured brain. This argues for a more cautious outcome prognosis in injury at very young ages

Publication metadata

Author(s): Atkinson TB, Forsyth RJ

Publication type: Article

Publication status: Published

Journal: European Journal of Paediatric Neurology

Year: 2023

Volume: 47

Pages: 67-71

Print publication date: 01/11/2023

Online publication date: 12/09/2023

Acceptance date: 01/09/2023

Date deposited: 05/09/2023

ISSN (electronic): 1090-3798

Publisher: Elsevier


DOI: 10.1016/j.ejpn.2023.09.001

ePrints DOI: 10.57711/kaem-hw03


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