A brain lesion is an abnormality in a certain part of the brain that can be of different size and severity. Brain lesions can be seen using brain-imaging tests like a magnetic resonance imaging (MRI) or a computerized tomography (CT). Lesions show up in these images as either lighter or darker spots on the brain than what a normal parts of the brain look like (Mayo Clinic Staff, 2017). Brain lesions can affect different aspect of a person’s language, personality, and development depending on the cause of the lesion as well as when the lesion appeared.

Pre- or perinatal brain lesions (PL) are those that are present before birth or immediately after birth. Damage to the brain can be due to lack of oxygen to the baby while in the womb or during birth. This can occur when an umbilical chord is knotted and cuts off oxygen from mother to child, or when a baby get stuck in the birth canal; when they are stuck they can lose oxygen. Another cause of brain damage in infants could be infections of the mother such as preeclampsia. Preeclampsia is shown by elevated blood pressure and extra protein in a mother’s urine. It can lead to restricted blood flow to both the mother and the baby. Preeclampsia can cause brain damage in the baby. A third cause of brain damage can occur if there is physical trauma to the baby during labor. Excessive pulling by the doctor or during a long difficult labor can result in the babies head knocking against the mother’s pelvis. This can also cause brain injury for the baby (Infant Brain Damage Guide, n.d).

Children with PL are affected by a delay in language during early development. Children with PL do not show the same symptoms as adults with aphasia who have the same lesions present during adulthood. Although there are delays in language acquisition in children with PL, they are mild. These children use the regions of their brains that are intact to acquire language that they normally would have gotten from the area of the brain that is damaged (Özçalişkan et al., 2012). For some children these delays can be transient while for others the delays may persist throughout their lifetime (Sauer et al., 2010).

Location of the lesions affects the type of language delay that is present in children with PL. Children with focal brain lesions in general produce less speech, they produce shorter propositions and fewer word types and word tokens. Word types are the number of different words while word tokens are the number of examples for each word type (Reilly et al., 1998). Children that have unilateral brain injuries have deficits in language production and comprehension due to the location of the lesion. Injuries to the left hemisphere show the largest impairments in initial vocabulary production, while the injuries to the right hemisphere show the strongest impairments in initial comprehension and gesture (Beharelle et al., 2010).

Many studies have looked into the effects of these pre- or perinatal brain lesions on communicative gesture in children at a young age. Gesture is an important part of language development. It is known that for typically developing children (TD), gesture is used as a form of communication before they gain the ability to speak. As they start to develop speech, they use gesture and speech to communicate more effectively. This combination of gesture and language is the basis for children to start sentence production (Özçalişkan et al., 2012). Three types of gesture are used: deictic, iconic, and conventional. Deictic gestures are those that indicate a certain person, place, or thing. An example of a deictic gesture would be if a child were to point to a bottle to indicate “bottle.” Iconic gestures or those that show the attributes or actions of an object in which the participant uses hand or body movements to communicate. An example of an iconic gesture would be if a child spread his arms our wide to convey how big something was. Conventional gestures are gestures in which the forms and meanings are present due to culture. An example of a conventional gesture would be a wave of the hand and arm to mean hello (Sauer et al., 2010).

Gesture use in children with PL between the ages of 18 and 26 months is most commonly deictic gesture. At 26 months you start to see a difference between children with PL and TD children. Kids with PL are only producing 75 gestures while TD children are producing 113 gestures. Differences in gesture production in children with PL can predict differences in productive vocabulary and receptive vocabulary later in life. For children with PL those that produce fewer gesture types at 18 months exhibit lower scores on productive and receptive vocabulary later in life (Sauer et al., 2010).

Gesture can also be affected by the size of the lesion in a child with pre- or perinatal brain lesions. Kids with smaller lesion produce and comprehend speech and gesture closer in relation to TD kids than they do with children who exhibit large lesions. Children with smaller lesions have increased production of gesture, speech, and the gesture speech combination just as TD kids do. But on the other hand, children with larger brain lesions have a much more delayed production of speech and gesture combinations, gesture alone, and speech alone. These children need a longer amount of time to catch up developmentally to TD children and children with small lesions (Özçalişkan et al., 2012).

However, there is a possibility that the motor deficits brought on by the pre- or perinatal brain lesions might also play a role in gesture use. These deficits could affect a minimal amount or range of iconic and conventional gestures. This could explain why children with PL do not begin using gesture and speech together to help produce what they are trying to convey. This could also explain why they may be slower at learning tasks due to their lack of full motion of their hands (Özçalişkan et al., 2012).

Using early gesture is a more valuable predictor for children with PL than it is for TD children because it can help determine whether or not these gesture and language delays will be transient or persistent throughout the child’s lifetime. Most children with PL will eventually catch up to TD children in language acquisition, it just make take them a few more years to get to the same level as TD children are at. In order to help PL children will their developmental delays parents and teacher can encouraging these children to gesture at an early age because gesture itself facilitates learning language (Sauer et al., 2010). They can also give these children support and the ability to take the extra time they need to learn gesture and language acquisition.

References

Beharelle, A.., Dick, A. S., Jossee, G., Solodokin, A., Huttenlocher, P. R., Levine, S. C., & Small, S. L. (2010). Left hemisphere regions are critical for language in the face of early left focal brain injury . Brain: A Journal of Neurology, 133(6). Retrieved December 12, 2017, from https://academic-oup-com.libproxy.unh.edu/brain/article/133/6/1707/355904.

Infant Brain Damage Causes. (n.d.). Retrieved December 13, 2017, from http://www.birthinjuryguide.org/brain-damage/causes/

Mayo Clinic Staff. (2017, November 10). Brain lesions. Retrieved December 13, 2017, from https://www.mayoclinic.org/symptoms/brain-lesions/basics/definition/sym-20050692

Özçalişkan,., Levine, S. C., & Goldin-Meadow, S. (2012). Gesturing with an injured brain: How gesture helps children with early brain injury learn linguistic constructions. Journal of Child Language, 40(01), 69-105. doi:10.1017/s0305000912000220

Reilly, J. S., Bates, E. A., & Marchman, V. A. (1998). Narrative Discourse in Children with Early Focal Brain Injury. Brain and Language, 335-375. Retrieved December 12, 2017, from https://ac-els-cdn-com.libproxy.unh.edu/S0093934X97918824/1-s2.0-S0093934X97918824-main.pdf?_tid=a75a0ef4-df50-11e7-962f-00000aab0f02&acdnat=1513092496_8f7938f6061a8a29c782fe8ae5126792.

Sauer, E., Levine, S. C., & Goldin-Meadow, S. (2010). Early Gesture Predicts Language Delay in Children With Pre- or Perinatal Brain Lesions. Child Development, 81(2), 528-539. doi:10.1111/j.1467-8624.2009.01413.x