Vancomycin levels: to draw or not to draw.
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Relations between drawing cubes and copying line diagrams of cubes in 7- to 10-year-old children.
Previous research has suggested both links and differences between children's copying of line diagrams and their drawings of solid objects. If the diagram represents a familiar object, children make more errors than when copying a diagram of a nonobject or unfamiliar object, as if they are drawing from their representation of the object rather than copying the surface features of the diagram. However, copying a diagram yields fewer and different types of errors than drawing the equivalent solid, which suggests a different process. In Experiment 1 (n = 72), possible relations between copying and drawing are investigated by asking children to draw a solid cube, then to copy or trace a line diagram of the cube in oblique projection, and finally to draw the solid again. Copying was better than drawing, and there was positive transfer to a subsequent drawing. Tracing was very accurate, but transfer to drawing did not occur, possibly because of the automatic nature of tracing. In Experiment 2 (n = 120) different groups received versions of the copying task that differed in the extent to which temporal order of line copying was structured. Asking children to copy the lines in a systematic order led to improved copies, but this performance did not carry over to a subsequent drawing of the solid. In contrast, when temporal ordering of line copying was not manipulated, there was positive transfer from copying to the subsequent drawing. In Experiment 3 (n = 80), provision of structure that emphasized faces by color-groupings of lines or coloring faces led to improved copies and did not hinder transfer to drawing the solid. Experiment 4 (n = 90) showed that in a solid drawing task emphasis on faces but not edges produced a positive effect, both on the immediate drawing and on a subsequent drawing of a plain cube. We conclude that emphasis on order of line copying improves performance in a copying task because in that case line-to-line matching is an important element of the skill, whereas this does not aid drawing of the solid object, in which the focus is primarily on representation of faces and their interrelations.
Child↗
The effect of three different educational approaches on children's drawing ability: Steiner, Montessori and traditional.
BACKGROUND: Although there is a national curriculum for art education in the UK there are also alternative approaches in the private sector. This paper addresses the issue of the effect of these approaches on children's drawing ability. AIM: To compare the drawing ability in three drawing tasks of children in Steiner, Montessori and traditional schools. SAMPLE: The participants were 60 school children between the ages of 5;11 and 7;2. Twenty children were tested in each type of school. METHOD: Each child completed three drawings: a free drawing, a scene and an observational drawing. RESULTS: As predicted, the free and scene drawings of children in the Steiner school were rated more highly than those of children in Montessori and traditional schools. Steiner children's use of colour was also rated more highly, although they did not use more colours than the other children. Steiner children used significantly more fantasy topics in their free drawings. Further observation indicated that the Steiner children were better at using the whole page and organising their drawings into a scene; their drawings were also more detailed. Contrary to previous research Montessori children did not draw more inanimate objects and geometrical shapes or fewer people than other children. Also, contrary to the prediction, Steiner children were significantly better rather than worse than other children at observational drawing. CONCLUSION: The results suggest that the approach to art education in Steiner schools is conducive not only to more highly rated imaginative drawings in terms of general drawing ability and use of colour but also to more accurate and detailed observational drawings.
Aptitude↗
Drawing with the non-dominant hand: implications for the study of construction.
BACKGROUND: Constructional impairment following left vs. right hemisphere damage has been extensively studied drawing tasks. A confounding factor in these studies is that right-handed patients with left hemisphere damage (LHD) are often forced by weakness to use their non-dominant (left) hand or hemiparetic dominant hand. Qualitative differences in the drawing characteristics of left and right hand drawings by normal subjects have not previously been characterized. The present study was undertaken to determine the qualitative differences between left and right hand drawings of normal subjects. METHODS: Thirty right-handed, elderly subjects without a history of neurological disease were asked to draw, from memory, seven objects using the right and left hand. Half of the subjects were randomly assigned to draw with the left hand first, and half the right hand first. Right and left hand drawings were compared using a standardized scoring system utilized in several previous studies of drawing in focal and diffuse neurological disease. Each drawing was scored on eighteen criteria. Right and left hand drawing scores were then compared using the t-test for paired samples or the Wilcoxon matched-pairs test. RESULTS: Drawings made using the left hand were found to be significantly simpler, more tremulous and of poorer overall quality than drawings made by the same subjects using the right hand. CONCLUSIONS: The deficits found in left versus right hand drawings of normals are similar to those found in patients with LHD, suggesting that much of the drawing impairment seen following LDH is due to an elementary motor disturbance related to use of the non-dominant hand.
Aged↗
Serial headache drawings by children with migraine: correlation with clinical headache status.
Children's artistic self-depictions of headache provide valuable insights into their experience of pain and aid in the diagnostic differentiation of headache types. In a previous study, we compared the clinical diagnosis (gold standard) and artistic diagnosis of headaches in 226 children. In approximately 90% of cases, the drawing predicted the clinical diagnosis of migraine versus nonmigraine headache correctly. In the present study, we explored whether headache drawings correlate with clinical improvement after treatment in children with migraine headaches followed longitudinally. Children seen in the Pediatric Neurology Clinic with the chief complaint of headache were asked to draw a picture of what their headache feels like. On subsequent clinic visits, children with the clinical diagnosis of migraine were asked to draw another picture depicting their current headache. The two drawings were compared to assess whether there was improvement; this "artistic response" was then correlated with the child's clinical status (ie, whether the headaches were improved clinically). One hundred eleven children (66 girls, 45 boys) participated in the study, with a mean interval of 5.3 +/- 2.3 (standard error of the mean) months between the first and second visits. The mean age at the first visit was 11.6 +/- 3.1 years. The raters agreed that serial drawings were both improved or both not improved in 99 of the 111 cases (89%; interrater reliability kappa score of 0.767). Fifty-three children had improvements in their headaches and drawings, 3 children had an improved drawing but no clinical headache improvement, 32 children had no improvement in either their drawing or clinical headaches, and 11 children had improved headaches but no improvement in their drawing. The sensitivity of the drawings for clinical improvement was 0.83, and the specificity was 0.91. The predictive value of an improved headache drawing for an improved clinical response was 0.946. There was no correlation between specific treatment modality and artistic response. We concluded that children's headache drawings are a useful adjunct for the diagnosis of headache type and provide valuable insights into their experience of pain. The present data show that headache drawings can be used longitudinally to provide additional information about the clinical course. The technique is simple, inexpensive, and enjoyable for children and can be applied in a variety of clinical settings.
Adolescent↗
Spatial limitation of eye movements during ocular exploration of simple line drawings in neglect syndrome.
The eye movement behaviour of a patient suffering from a right basal ganglia infarction with left-sided neglect but without any visual field defects was investigated during the ocular exploration of simple line drawings. The eye movements were registered by means of an i.r. light technique. Each line drawing consisted of different figural elements located in the centre and both the left and the right half of the picture. In each case, only the contextual connection of the left and right elements in a drawing allowed the spectator to describe the whole scene consistently and to perceive the correct theme of the drawing. The drawings fell into two categories. The cognitive impact of the elements in the drawings' centre was varied by "pointing" to the elements located in the left and right halves with a different strength of connection. When exploring the two types of drawings (weak vs. strong connective elements in the centre) the patient showed a similar eye movement pattern, exploring exclusively the right halves of the drawings. Irrespective of the cognitive impact of the drawing's central elements in "pointing" towards supplementary information in the picture's left half, exploration of this half took place in neither case. A striking difference between the two categories was, however, found concerning the patient's ability to recognize the general context, i.e. to describe the correct theme of the whole drawing. While the patient could not correctly depict any of the scenes from the drawings with weak connective elements in the centre, he was easily capable of properly describing the themes from the group of drawings with strong connective elements, which implies that he must have analysed and perceived the figural elements of both halves of the picture. Different possibilities are discussed to explain the similarity of the patient's exploratory eye movements but discrepancy in his verbal responses when dealing with the two different types of drawings.
Attention↗
Weber (slope) analyses of timing variability in tapping and drawing tasks.
Timing variability in continuous drawing tasks has not been found to be correlated with timing variability in repetitive finger tapping in recent studies (S. D. Robertson et al., 1999; H. N. Zelaznik, R. M. C. Spencer, & R. B. Ivry, 2002). Furthermore, the central component of timing variability, as measured by the slope of the timing variance versus the square of the timed interval, differed for tapping and drawing tasks. On the basis of those results, the authors posited that timing in tapping is explicit and as such uses a central representation of the interval to be timed, whereas timing in drawing tasks is implicit, that is, the temporal component is an emergent property of the trajectory produced. The authors examined that hypothesis in the present study by determining the linear relationship between timing variance and squared duration for tapping, circle-drawing, and line-drawing tasks. Participants (N = 50) performed 1 of 5 tasks: finger tapping, line drawing in the x dimension, line drawing in the y dimension, continuous circle drawing timed in the x dimension, or continuous circle drawing timed in the y dimension. The slopes differed significantly between finger tapping, line drawing, and circle drawing, suggesting separable sources of timing variability. The slopes of the 2 circle-drawing tasks did not differ from one another, nor did the slopes of the 2 line-drawing tasks differ significantly, suggesting a shared timing process within those tasks. Those results are evidence of a high degree of specificity in timing processes.
Adult↗
Evaluating young children's cognitive capacities through computer versus hand drawings.
Young normal and handicapped children, aged 3 to 6 years, were taught to draw a scene of a house, garden and a sky with a computer drawing program that uses icons and is operated by a mouse. The drawings were rated by a team of experts on a 7-category scale. The children's computer- and hand-produced drawings were compared with one another and with results on cognitive, visual and fine motor tests. The computer drawing program made it possible for the children to accurately draw closed shapes, to get instant feedback on the adequacy of the drawing, and to make corrections with ease. It was hypothesized that these features would compensate for the young children's limitations in such cognitive skills, as memory, concentration, planning and accomplishment, as well as their weak motor skills. In addition, it was hypothesized that traditional cognitive ratings of hand drawings may underestimate young children's intellectual ability, because drawing by hand demands motor skills and memory, concentration and planning skills that are more developed than that actually shown by young children. To test the latter hypothesis, the children completed a training program in using a computer to make drawings. The results show that cognitive processes such as planning, analysis and synthesis can be investigated by means of a computer drawing program in a way not possible using traditional pencil and paper drawings. It can be said that the method used here made it possible to measure cognitive abilities "under the floor" of what is ordinarily possible by means of traditionally hand drawings.
Art↗
How is emergent writing based on drawing? Analyses of children's products and their sorting by children and mothers.
Writing and drawing produced by children 28-53 months old were compared. Israeli and Dutch preschoolers were asked to draw and write, to classify their products as drawing and writing, and to decide what they had drawn or written. Israeli and Dutch mothers classified the products. Scores on a scale for writing composed of graphic, "writing-like," and symbolic schemes showed improvement with age. Recognition of drawings as drawings preceded recognition of writings as writings. Scores on writing and drawing were substantially correlated, even with age partialed out, suggesting (a) that when children start drawing objects referentially, they write by drawing "print" and (b) that progress in object drawing involves progress in drawing print, so that their writing becomes more writing-like. Children unable to communicate meaning by writing spontaneously resort to drawing-like devices, indicating the primacy of drawing as a representational-communicative system.
Art↗
Comparison of the neural basis for imagined writing and drawing.
Drawing and writing are complex processes that require the synchronization of cognition, language, and perceptual-motor skills. Drawing and writing have both been utilized in the treatment of aphasia to improve communication. Recent research suggests that the act of drawing an object facilitated naming, whereas writing the word diminished accurate naming in individuals with aphasia. However, the relationship between object drawing and subsequent phonological output is unclear. Although the right hemisphere is characteristically mute, there is evidence from split-brain research that the right hemisphere can integrate pictures and words, likely via a semantic network. We hypothesized that drawing activates right hemispheric and left perilesional regions that are spared in aphasic individuals and may contribute to semantic activation that supports naming. Eleven right-handed subjects participated in a functional MRI (fMRI) experiment involving imagined drawing and writing and 6 of the 11 subjects participated in a second fMRI experiment involving actual writing and drawing. Drawing and writing produced very similar group activation maps including activation bilaterally in the premotor, inferior frontal, posterior inferior temporal, and parietal areas. The comparison of drawing vs. writing revealed significant differences between the conditions in areas of the brain known for language processing. The direct comparison between drawing and writing revealed greater right hemisphere activation for drawing in language areas such as Brodmann area (BA) 46 and BA 37.
Adult↗
Colored pain drawings: preliminary observations in a neurosurgical practice.
BACKGROUND: Black and white pain drawings were introduced as a proposed means to identify patients, presenting with low back pain, who demonstrated functional overlay upon neurological testing. The use of color may enhance the usefulness of such pain drawings, but has not been described for adult patients. AIMS: To retrospectively explore the use of colored pain drawings in patients with neck, low back, or radicular pain. METHODS: Patients with neck, low back, or radicular pain referred to a community-based neurosurgical practice for evaluation during 1 year (n=359) depicted their pain on anatomical drawings using colored pencils representing different pain characteristics. Patients with abnormal (n=55) and normal (n=54) pain drawings were selected for this study. Use of medications, findings on physical examination, radiographic findings, activity levels, Waddell signs, and pending litigation were recorded and compared between patients with normal and abnormal pain drawings, as assessed according to the Ransford penalty point system. RESULTS: Patients whose colored pain drawings were abnormal, demonstrated a greater use of medications, more non-focal clinical findings, Waddell signs, impaired activity levels, involvement in pending litigation, and significantly fewer pathological radiographic findings than patients with normal pain drawings. CONCLUSIONS: Our findings agree with previous observations using black and white pain drawings, indicating that colored pain drawings are no less useful than the black and white approach. Further research is necessary to examine the psychometric properties and clinical usefulness of colored pain drawings to predict outcomes and/or determine treatment.
Adult↗
The association between pain drawings and computed tomographic/discographic pain responses.
STUDY DESIGN: Pain drawings were scored and their relationship to discographic pain responses was investigated. OBJECTIVES: The purpose of this study was to determine if there was a relationship between patients indicating pain in nonanatomic patterns on pain drawings (possibly suggestive of a tendency to overreport pain) and discographic pain responses, and in particular, if patients with abnormal drawings were more likely to provide false-positive discographic pain reports. SUMMARY OF BACKGROUND DATA: Patients with abnormal pain drawings have been found to have elevated scores on the hysteria and hypochondriasis scales of the Minnesota Multiphasic Personality Inventory. Elevations on these same two scales have been related to discordant discographic pain reports. METHODS: Pain drawings were completed by 170 patients the day of, but before computed tomography/discography. The drawings were scored as described by Ransford et al and classified as normal or abnormal. The number of levels at which a patient reported pain and the incidence of false-positive computed tomographic/discographic pain reports were compared for the two pain drawing groups. RESULTS: Patients with abnormal drawings reported pain at more levels than patients with normal ones. When dealing specifically with false-positive pain reports (pain reproduction on the injection of a nondisrupted disc), among the 105 patients in the normal group, only 13 (12.3%) reported false-positive pain. This was significantly less than the 50.0% (18 of 36) reporting false-positive pain in the abnormal group. The overall accuracy of pain drawings in differentiating patients with false-positive pain reports was 78.0% (110 of 141). CONCLUSIONS: There is a relationship between pain drawings and discographic pain responses. Pain drawings can help identify patients who may be likely to report pain on injection of a nondisrupted disc. While it was not totally sensitive to this occurrence, it can help identify at least some of the patients in whom pain responses should be interpreted cautiously.
Adult↗
Repeatability of pain drawings in a low back pain population.
STUDY DESIGN: This is a prospective test-retest repeatability study. OBJECTIVE: The primary purpose of this study was to determine the test-retest repeatability, using a variety of scoring methods, of pain drawings in a group of chronic low back pain patients. The intraevaluator repeatability for the methods requiring subjective interpretation was also evaluated. SUMMARY OF BACKGROUND DATA: Pain drawings have been used in a variety of applications, including documentation of symptom location, as a tool for diagnosis and as a psychological screening tool. Accordingly, there have been several methods described for interpreting the drawings and several groups have investigated evaluators' abilities to replicate their interpretation. However, there has been less investigation of patients' consistency in completing the drawings. METHODS: The intraevaluator repeatability was determined for the two scoring methods requiring subjective interpretation by the evaluator rescoring the drawings 2 weeks after the initial scoring. To determine repeatability, drawings were completed on two occasions by 75 patients. Patients who indicated on a questionnaire that there had been no change in their pain location since their first clinic visit (the day the first drawing was completed) were included in the study. This subgroup consisted of 45 patients who completed pain drawings on two occasions separated by a mean of 244.2 days (range, 26-1197 days). Repeatability was assessed for several scoring methods described in the literature: penalty point system, overall visual inspection, body regions, and a grid method. RESULTS: Patients were consistent in completing the drawings, assessed by the various scoring methods. The worst repeatability values were for some of the sensation types. DISCUSSION: As reported by others, the intraevaluator repeatability was high. The results of this study, finding acceptable repeatability for most scoring methods for pain drawing completed on occasions separated by a relatively long period of time, support that the pain drawing is a stable instrument for use in chronic back pain patients.
Adult↗
Human figure drawing size and body image in preschool children from a self-physique perspective.
To learn about the relationship between size of human figure drawings and the physiques of children, we investigated body image characteristics in childhood by using the Human Figure Drawing test. Height, weight, Kaup Index (a body mass index for children) and Human Figure Drawing traits (vertical height, horizontal width, waist size, surface area of head, surface area of the self-drawing) were measured for drawings of 122 4- to 6-yr.-old children (62 boys, 60 girls). Analysis showed that boys, who are physically larger than girls, produced self-drawings with somewhat larger surface areas. For vertical height of self-drawings of boys, 4-yr.-olds characteristically made taller self-drawings than 5-yr.-olds. While we hypothesized that taller children would make vertically taller self-drawings, we observed a negative relationship between children's physical height and the vertical height of the self-drawings. 4-yr.-old boys showed the most interest in their own physical height, making taller drawings and in doing so gave a clue to an early childhood feature of body image.
Body Image↗
Subcortical contributions to drawing.
Constructional impairment is often considered a sign of cortical damage. However, aphasia, agraphia, and apraxia, disorders traditionally deemed cortical, have been well described following subcortical lesions, suggesting an important role for subcortical structures in cognition. Drawing impairment following subcortical lesions has not been systematically explored or compared with that following cortical damage. We examined relative incidence and severity of drawing impairment after cortical and subcortical strokes and whether there were qualitative differences between these two groups' drawings. Drawings by 125 patients with single hemispheric strokes of similar volume (42 left cortical, 36 left subcortical, 20 right cortical, 27 right subcortical) were compared using a standardized scoring system. Although previously noted right/left differences were confirmed, "subcortical drawings" did not differ from "cortical drawings" on any measures, including overall impairment. Compared with cortical patients, drawing impairment in those with subcortical lesions (especially left) was more strongly associated with impairment of other cognitive abilities. Thus, although a subcortical lesion does not cause more severe drawing impairment, subcortical lesions affecting drawing lead to more widespread cognitive dysfunction than do similarly sized cortical lesions. Drawing impairment often follows subcortical strokes and is by no means an indicator of cortical lesion localization.
Aged↗
Hemispheric contributions to drawing.
The drawings of 69 consecutive stroke patients with single cerebral lesions on CT and of 33 normal controls, were analyzed by two independent observers using a standardized scoring system. The drawings of left brain damaged subjects (LBD) were more impaired overall than those of right brain damaged subjects (RBD). RBD drawings displayed hemispatial neglect and impaired spatial relationships. LBD drawings were simplified and exhibited low level errors of execution. Lesion size correlated significantly with drawing impairment in RBD but not in LBD. No relationship between intrahemispheric lesion location and drawing quality was found. However, severity of hemiparesis correlated significantly with drawing impairment in LBD. Performance on a visuospatial perceptual task correlated better with overall drawing quality for RBD than for LBD. Our data suggest that neglect and a visuospatial deficit impair drawing in RBD while dominant hand paresis and a conceptual impairment which parallels comprehension impairment contribute to LBD drawing disability.
Aged↗
Both parietal lobes are involved in drawing: a functional MRI study and implications for constructional apraxia.
In clinical studies, many researchers have reported that drawing can be disturbed by left or right unilateral parietal lobe damage (constructional apraxia). There seem to be two possible predictions about the cerebral laterality for drawing. The first is that drawing requires both parietal lobes, therefore, a lesion to either side can disrupt drawing. The second is that individuals can differ in laterality: some have only right or left activations, and some have bilateral. To test these predictions, we investigated with functional magnetic resonance imaging (fMRI) the cerebral activation whilst 17 right-handed healthy subjects performed a drawing task. The experiment consisted of two conditions: (1). naming an object in a presented picture and drawing it by using right index finger (DRAWING & NAMING); (2). naming an object in a presented picture (NAMING). We considered the brain regions that had greater activity in the DRAWING&NAMING condition than in the NAMING condition were the neural substrates of drawing. Individual analysis revealed that all subjects showed parietal activation bilaterally. We interpret that the results support the first prediction that both parietal lobes are required for drawing. By calculating the laterality indices of the individual parietal activations, it was found that there were more left dominant subjects than right dominant subjects (left, 12; right, 5). The results are inconsistent with previous studies on the incidence of constructional apraxia. In addition, we found activation in regions that were not previously reported in the literature of constructional apraxia: they are the ventral premotor area and posterior part of inferior temporal sulcus.
Adult↗
Pain drawings in the assessment of nerve root compression: a comparative study with lumbar spine magnetic resonance imaging.
STUDY DESIGN: Prospective comparative study of pain drawings with findings on lumbar spine magnetic resonance imaging. OBJECTIVES: To assess the ability of the pain drawing to predict the presence of nerve root compression. SUMMARY OF BACKGROUND DATA: Most research work has concentrated on the ability of the pain drawing to act as a screening method for psychological distress with less work directed at the influence the anatomic abnormality has on the pain drawing. METHODS: One hundred thirty-four consecutive outpatients attending for lumbar magnetic resonance imaging in the investigation of back and leg pain completed pain drawings and psychological testing immediately before the examination. The pain drawing was analyzed by previously reported criteria, and the magnetic resonance imaging was assessed independently for the presence of nerve compression by three radiologists. Multivariate stepwise discriminant analysis was used to identify patients with nerve compression on the basis of their pain drawing. RESULTS: Nerve compression was predicted by numbness in the anterolateral aspect of the foot. There was considerable overlap in the appearances of the pain drawings between patients with and without nerve compression, and the pain drawing correctly classified only 58% of patients with nerve compression. CONCLUSIONS: The pain drawing is not a good predictor of nerve compression on magnetic resonance imaging in a group of patients investigated for back and leg pain. It should be interpreted with caution and in light of the full clinical picture.
Adult↗