Visual function and visual perception in cerebral palsied children (original) (raw)
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Measurement of visual ability in children with cerebral palsy: a systematic review
Developmental Medicine & Child Neurology, 2016
This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions INTRODUCTION Cerebral palsy (CP) is a very prevalent physical disability in childhood 1. Its definition has been revised to identify the possibility of secondary impairments including vision: "Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems" (Rosenbaum et al., 2007, p.9) 2. Impairments additional to the motor disorder contribute to the developmental and performance challenges faced by children with CP 3 , and evidence suggests that disturbances to vision can be especially challenging for children 4. There is a growing body of literature reporting the relationship between vision impairments and various aspects of functioning for children with CP, including gross motor, communication, cognition, self-care and daily functioning skills 5-11. Being able to describe the visual abilities of children with CP, and targeting interventions to promote visual abilities, are important areas for practice and research, and in order to establish efficacy for interventions targeting visual abilities or 'useful vision', valid and reliable measurement is required. The 'Classification of Cerebral Palsy' 2 specifies that accompanying impairments, including vision, should be classified as either present or absent, and that if present, the extent to which they interfere with the individual's ability to function or participate in desired activities and roles should be described, but no specific guidelines are provided for this. It is recommended that vision be assessed, and that the standardized instruments for measuring vision function and impairment are accepted. The challenge of terminology when measuring 'vision' The definition of visual impairment in the World Health Organisation's (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD-10) 12 is based on "best corrected" vision. A level of vision impairment is obtained by measuring visual acuity with best possible refractive correction, and results are categories from 'mild or no visual impairment' (visual acuity equal to or better than 6/18) to 'blindness' (no light perception, light perception, or visual acuity worse that 3/60). A recent systematic review and metaanalysis on the rates of co-occurring impairments and functional limitations in children with CP utilised this definition in its finding that 1 in 10 children with CP has a severe visual impairment or is blind 3. These findings suggest that impaired vision is a significant problem for some children with CP, however the authors of that review identified a lack of consistency among studies in the recording of information on vision impairments, and were consequently not able to include all vision impairment data in their analysis. Other 'visual impairments' included refractive errors, myopia, hypermetropia, astigmatism and strabismus, in addition to the reporting of children with 'some impairment' or 'functional blindness'. A definition or measurement of 'visual impairment' only describes the eye or visual functions being assessed, and these results, although valuable, do not specifically tell us how a child with CP functions in vision-related activities (their 'visual ability'), particularly in the presence of other comorbidities such as gross motor limitations or cognitive impairments. Children with CP may be diagnosed with visual deficits that are of ocular (eye) or cerebral (brain) origin, or a combination of both, and recognition of vision impairment resulting from
Visual-perceptual impairment in a random sample of children with cerebral palsy
Developmental Medicine & Child Neurology, 2007
Several studies have tried to establish the prevalence of visual-perceptual impairment in children with physical disabilities, particularly in those with cerebral palsy (CP), but failed to take into account the selective impairment of nonverbal intelligence that is frequent in these children. This has resulted in the confounding of visual-perceptual and non-verbal intelligence impairment. In the present study we aimed to determine how widespread visual-perceptual impairment is in children with CP by evaluating perceptual ability together with the performance level on non-verbal intelligence subtests. All children (n=96; 44 females, 52 males) who attended an institute for children with physical disabilities were included (age ranged from 4 years 11 months to 21 years 5 months) who had a nonverbal mental age between 3 and 7 years; Total IQ was <85 in 91% of participants. They were given a grating acuity task and the visual-perceptual battery L94, comprising six visual object recognition and two visuoconstruction tasks. Relative to their performance level on non-verbal intelligence subtests, 37.5% of the children were impaired on at least one task, and 18.7% on two or more tasks. No child was impaired on the visuoconstruction tasks. Visual-perceptual impairment was highest among six children with brain malformation (67%), followed by spastic CP (40%), and brain damage acquired after the first year of life (38%). There was no difference in visual-perceptual impairment between the subtypes of spastic CP. Results are not secondary to visual acuity deficits, as only one L94 task was significantly correlated with acuity impairment. We conclude that visual-perceptual impairment is frequent in children with physical disabilities, and not restricted to children with CP of hypoxic-ischaemic origin.
Visual Impairments in Children with Cerebral Palsy
Indian Journal of Child Health, 2019
Background: Visual impairments are associated with cerebral palsy (CP). They enhance functional limitations in children with CP. Objective: The objective of the study was to determine the types of visual impairments in children with CP, and thus the importance of early evaluation and intervention to improve the quality of life. Materials and Methods: Children with CP (n=775) attending the child development clinic from 2012 to 2017 were included in the study. Thorough antenatal, natal, postnatal, and developmental history were recorded. Complete demographic data, anthropometry and general physical, and neurological examination findings were recorded. All patients were advised neuroimaging (computed tomography/magnetic resonance imaging) and hearing and ophthalmological assessment. Results: Of the 775 patients, 270 (34.8%) patients had squint (including convergent and divergent). Detailed fundoscopic and visual evoked potentials (VEP) examination was done in 382 patients. Non-apparent abnormalities (VEP and fundus changes) were seen in 121 patients (31.7%) among 382 tested. Of those 121 patients, VEP changes and fundus changes were seen in 62 and 41 patients, respectively. Refractive errors were detected in 25 patients. Of the total patients assessed for ophthalmological ailments, 129 (33.7%) patients were completely normal. Conclusion: Visual impairments are associated in large percentage of CP patients. Early evaluation and intervention are emphasized to improve the quality of life in these patients.
A Comparison of the Visual Perceptual Skills in Typical and Cerebral Palsy Children
Pakistan journal of rehabilitation, 2023
Objective: The purpose of this study is to evaluate the difference at occupational performance skills related to visual perception among typical developing children and cerebral palsy children by using measuring test of MVPT-R. Design And Sampling Technique: Quantitative cross-sectional study, convenience sampling method. Study Setting And Participants: A total of 400 Cerebral palsy children (all types) and typical children each from different mainstream schools, rehab centers, pediatric occupational therapy departments, and special education centers located in Karachi. Interventions / Data Collection: Test of visual perception that is Motor Free visual perceptual test-Revised MVPT-R. Result: Result shows difference in perceptual ages (PA) between typical and cerebral palsy children. Perceptual age (PA) was greater than the chronological age (CA) in the typical group. Conversely, in the CP group the perceptual age (PA) was lesser than the chronological age (CA). Conclusion: Visual perception skills play a key role in a child's achievement at school and at home. Children require intact visual perception for the successful performance of their daily living as well as academic tasks like good eye-hand coordination, handwriting, reading, shape perception, play skills, and copying patterns, etc. This study is helpful to identify those children who have visual perception issues and sorting this problem will form the baseline for better evaluating and planning of useful visual perception activities for typical and cerebral palsy children.
Background: Most aspects of development are dependent or guided by visual system. Defect of visual perception can cause secondary mental retardation in cerebral palsy children with normal intelligence. So, identifying the effective factors on visual perceptual skills and early treatment of them in these children can prevent learning disorders, slowing the treatment process and secondary problems. This study was designed to compare the effect of chronological age, strabismus and sex factors on visual perceptual quotient. Materials and Methods: In this cross-sectional study, 120 spastic cerebral palsy children with equal numbers of strabismal/non-strabismal disorder (age 8-10 years) were randomly selected from exceptional schools of educational departments and rehabilitation clinics of Tehran and were evaluated with the test of visual perceptual skill-revised (TVPS-R). Results: The results showed that the scores of visual perceptual quotient (P<0.0001) and visual perceptual age were significantly different among 8 to 10 years old children (P<0.0001). There was no significant difference in visual perceptual quotient between two sexes (P=0.76) and that non-strabismal children had greater visual perceptual quotient compared to strabismal one (P<0.0001). Conclusion: It can be concluded that age and strabismus have a significant effect on visual perceptual quotient, while this is not the case on sex.
Age-Related Effects on the Spectrum of Cerebral Visual Impairment in Children With Cerebral Palsy
Frontiers in Human Neuroscience, 2022
Background: Cerebral Visual Impairment (CVI) is a very common finding in children affected by Cerebral Palsy (CP). In this paper we studied the characteristics of CVI of a large group of children with CP and CVI, describing their neurovisual profiles according to three different age subgroups (subgroup 1: infants 6 months-2 years; subgroup 2: preschool age 3-5 years; subgroup 3: school age ≥ 6 years). Methods: We enrolled 180 subjects (104 males, mean age 66 ± 42.6 months; range 6-192 months) with CP and CVI for the study. We carried out a demographic and clinical data collection, neurological examination, developmental or cognitive assessment, and a video-recorded visual function assessment including an evaluation of ophthalmological characteristics, oculomotor functions, and basic visual functions. In school-aged children, we also performed an evaluation of their cognitive-visual profiles. Results: There were signs of CVI in all the three subgroups. Subgroup 1 (62 children) and subgroup 2 (50 children) were different for fixation (p = 0.02), visual acuity (p = 0.03) and contrast sensitivity (p < 0.01), being more frequently impaired in younger children. Comparing subgroup 2 with subgroup 3 (68 children), the older children presented more frequently myopia (p = 0.02) while the younger ones esotropia (p = 0.02) and alteration in smooth pursuit (p = 0.03) and saccades (p < 0.01). Furthermore, fixation, smooth pursuit, visual acuity, contrast sensitivity and visual filed (p < 0.01) were more frequently impaired in younger children (subgroup 1) compared to the older ones. Multiple correspondence analysis (MCA) confirmed the different neurovisual profiles according to age: younger children with CP showed more signs of CVI compared to the older ones. 34 out of 68 children belonging to subgroup 3 underwent the cognitive visual evaluation; an impairment of cognitive visual skills was detected in 21 subjects. Conclusion: Younger children with CP showed more signs of CVI compared to the older ones, likely for the physiological maturation of visual system and mechanisms of neuroplasticity. In this direction, we suggest an early neurovisual evaluation to detect any weak visual functions.
Visual assessment in delayed development and cerebral palsy children in tertiary care center
IP Innovative Publication Pvt. Ltd., 2018
Aim: To assess vision in children with delayed development or cerebral palsy attending OPD at tertiary care hospital, for early assessment and accurate detection of visual disorder, which in turn helps their rehabilitation, locomotor and cognitive functions. Materials and Methods: Total of 24 (18 males and 6 females) children with delayed development and 12 (6 males and 6 females) with cerebral palsy were examined. Central steady maintenance method (CSM) was used for visual assessment as children were not co-operative for Teller’s acuity card. Thorough examination was done in children including dilated refraction & fundus examination. Clinical findings like nystagmus, squint, roving eye movements were noted and photographed. Selected children were given glasses and few were advised visual stimulation exercises. Results: Out of 36 children, about 24 were males and 12 were females. It was noted that about 16% in developmental delay children and about 17% in cerebral palsy children had abnormal birth history Among 24 children with developmental delay, 16% had squint,12.5% had horizontal nystagmus, among 12 children with cerebral palsy, 66% had fundus abnormalities, 50% had squint,16% had horizontal nystagmus, Central steady maintenance was good in 8% of developmental delayed children and 15% of cerebral palsy children. Conclusion: Above study showed that visual assessment in children with delayed development and cerebral Palsy provided relevant information for creating a rehabilitation program aimed at the individual as a whole. Visual impairment plays key role in locomotor and cognitive performance in CP and visual exploration seems to be crucial in rehabilitation of affected children, contributing to their motor improvement and to a better visual prognosis. Keywords: Cerebral palsy, Delayed development, Visual assessment, Tertiary care center
Visual Assessment in Children with Cerebral Palsy: Implementation of a Functional Questionnaire.
AIM: The aim of this study was to evaluate an interdisciplinary visual assessment for multiply challenged children diagnosed with cerebral palsy (CP). METHOD: A comprehensive ophthalmological assessment together with a visual classification scale (VCS) and a questionnaire evaluating daily visual function were completed regarding 77 children (41 females, 36 males; age range 3-20y; mean age 8 y 3 mo [SD 4 y 3 mo]; Gross Motor Function Classification System [GMFCS] level V; Manual Ability Classification System level V) who were diagnosed with CP (79.2% spastic quadriplegia, 6.5% athetoid quadriplegia, 10.4% mixed type, 3.9% hemiplegia). All participants had severe to profound motor and intellectual disability and an inability to communicate consistently through either verbal or assisted communication. The interrater and test-retest reliability of the questionnaire and its validity in comparison with the VCS were examined. In addition, the contribution of ophthalmological testing in predicting daily visual function was assessed. RESULTS: The ophthalmological examination revealed three diagnostic subgroups: a group with cerebral visual impairment (CVI), a group with optic atrophy, and a group without visual impairment. The questionnaire was found to have high values of interrater reliability (interclass correlation coefficient [ICC]=0.873; 95% confidence interval [CI] 0.762-0.935) and test-retest reliability (ICC=0.988; 95% CI 0.964-0.996). Validity was established for the questionnaire factors: task-orientated visual function (r=0.802; 95% CI 0.669-0.885) and basic visual skills (r=0.691; 95% CI 0.504-0.816). The questionnaire provided information about daily visual performance not available from one-time ophthalmological testing, particularly for participants diagnosed with CVI. The visual performance scale significantly predicted daily visual function for all groups. INTERPRETATION: This study highlights the benefits of implementing a diagnostic performance scale as well as a reliable functional questionnaire to achieve a precise visual assessment of children with severe neurological impairment.
Visual disorders associated with cerebral palsy.
British Journal of Ophthalmology, 1982
School children severely afflicted with cerebral palsy, but unselected in regard to their visual status, have been studied. Of 120 children examined only 24 (20%) had normal eyes or ocular adnexae. Squint was found in 52*5% of the children and significant refractive errors in 50%. There was also a high incidence of strabismic and anisometropic amblyopia (15%) and visual field defects (11%). A number of other ocular abnormalities were found, the majority of which were not amenable to any form of treatment. Early identification of treatable ocular defects and their treatment along conventional lines is emphasised. It is also important to identify untreatable defects that may have a bearing on the child's education. These children need all the help available, and visual function should be at its best. A diagnosis of cerebral palsy has usually been made by the time such a child reaches 18 months of age. In view of the high incidence of ocular defects a full ophthalmological assessment should be part of the routine assessment of the child.