Vision Impairment in children with Cerebral Palsy: Difference between revisions

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=== Introduction ===
=== I ===
=== roduction ===
   
   
One in every ten children with Cerebral Palsy (CP) presents with severe visual impairment and 75-90% present with some degree of visual impairment.<ref>Physio-pedia, Cerebral Palsy Association Conditions. [/www.physio-pedia.com/Cerebral%20Palsy%20Association%20Conditions http://www.physio-pedia.com/Cerebral_Palsy_Association_Conditions] (last accessed 26/10/2016)</ref> Associated conditions should always be considered when treating a child with CP to ensure a holistic approach is taken. Read more about some of these conditions on the Physiopedia page [/www.physio-pedia.com/Cerebral%20Palsy%20Association%20Conditions http://www.physio-pedia.com/Cerebral_Palsy_Association_Conditions].  
One in every ten children with Cerebral Palsy (CP) presents with severe visual impairment and 75-90% present with some degree of visual impairment.<ref>Physio-pedia, Cerebral Palsy Association Conditions. [/www.physio-pedia.com/Cerebral%20Palsy%20Association%20Conditions http://www.physio-pedia.com/Cerebral_Palsy_Association_Conditions] (last accessed 26/10/2016)</ref> Associated conditions should always be considered when treating a child with CP to ensure a holistic approach is taken. Read more about some of these conditions on the Physiopedia page [/www.physio-pedia.com/Cerebral%20Palsy%20Association%20Conditions http://www.physio-pedia.com/Cerebral_Palsy_Association_Conditions].  
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Attention should be given to the caregivers’ observation. They will often note that children tend to stare at lights (as observed in 60% of children with CVI <ref name=":0" />), respond to high contrast colours or objects illuminated by light in a darkroom and they will often be aware in which area of the visual field the child responds best to.
Attention should be given to the caregivers’ observation. They will often note that children tend to stare at lights (as observed in 60% of children with CVI <ref name=":0" />), respond to high contrast colours or objects illuminated by light in a darkroom and they will often be aware in which area of the visual field the child responds best to.
The following low cost objects can be used during treatment:
The following low cost objects can be used during treatment:
'''contrast'''
[[File:Contrast.jpg|right|frameless|195x195px]]

Revision as of 19:00, 25 June 2017

I[edit | edit source]

roduction[edit | edit source]

One in every ten children with Cerebral Palsy (CP) presents with severe visual impairment and 75-90% present with some degree of visual impairment.[1] Associated conditions should always be considered when treating a child with CP to ensure a holistic approach is taken. Read more about some of these conditions on the Physiopedia page [/www.physio-pedia.com/Cerebral%20Palsy%20Association%20Conditions http://www.physio-pedia.com/Cerebral_Palsy_Association_Conditions]. Cortical visual impairment is an associated condition of CP and has been identified as one of the primary causes of visual impairment in children. [2][3]

Cortical Visual Impairment (CVI)[edit | edit source]

CVI is defined as visual loss due to damage caused to the central nervous system, more specifically the occipital lobe of the brain.[2][3] It is therefore understandable that it is commonly associated with CP, which shares similar etiology (i.e. hypoxia, increased intracranial pressure, head injury etc.) [2] As with any injury to the brain CVI may gradually improve due to neural plasticity, especially in the first year of life. Aspects of visual stimulation should form an integral part of the assessment and treatment done by the multidisciplinary team (MDT). [2] A formal vision assessment should always be performed by a specialist to confirm the diagnosis and prescribe appropriate treatment.[2]

Vision and normal development[edit | edit source]

Children with visual impairments are at risk for developing delays in many different aspects (including, but not limited to): [2][4] [5][6]

  • Gross motor development
  • Fine motor development
  • Cognitive development
  • Communication and language development
  • Social interaction Self-help skills
  • Play skills

Visual impairment consequently affects patients on all the levels of the International Classification of Functioning, Disability and Health (ICF)[7]. A MDT approach is essential to maximise the patient’s potential.[2] For more information on the ICF refer to http://www.physio-pedia.com/ICF_and_RPS_within_Cerebral_Palsy. Motor development relies greatly on vision to encourage children to move. Curiosity and motivation to explore a visual stimulus assist with the development of head control, crawling, walking and learning to manipulate objects. [2][4]

CVI and physiotherapy[edit | edit source]

As previously mentioned a formal diagnosis should always be made by a specialist. Unfortunately in many developing countries it often takes months to years for a patient to get an appointment. In the meantime it is important to start stimulating the child’s residual vision or use non-visual stimulation during treatment. The goal is to allow the child to fixate/locate an object, track it, reach for it and ultimately take it to the mouth for exploration.[2][4]

Treatment[edit | edit source]

The following guidelines can be used during treatment: [2,4,5,6]

Preparation[edit | edit source]

  • Confirm with the caregivers if a specialist has been consulted. If not refer them to the appropriate person.
  • Treatment should take place in a quiet area in order to minimise distractions.
  • Ensure suitable lighting, preferably adjustable lights.
  • Perform a comprehensive subjective and objective assessment with the caregivers.
  • Involve the caregivers as much as possible during the session. Children often respond best to their caregivers’ faces as part of normal development.

Positioning[2][4][5][6][edit | edit source]

A child with CP has to overcome multiple factors to maintain a stable position. The child should be supported in order to focus on visual input only. Supported sitting is therefore a good position to start visual stimulation. [2][4] Different positions can be implemented as the child progresses.

Introduction of visual stimulus[edit | edit source]

Attention should be given to the caregivers’ observation. They will often note that children tend to stare at lights (as observed in 60% of children with CVI [2]), respond to high contrast colours or objects illuminated by light in a darkroom and they will often be aware in which area of the visual field the child responds best to. The following low cost objects can be used during treatment: contrast

Contrast.jpg
  1. Physio-pedia, Cerebral Palsy Association Conditions. [/www.physio-pedia.com/Cerebral%20Palsy%20Association%20Conditions http://www.physio-pedia.com/Cerebral_Palsy_Association_Conditions] (last accessed 26/10/2016)
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 Swift SH, Davidson RC, Weems LJ. Cortical Visual Impairment in Children: Presentation Intervention, and Prognosis in Educational Settings. Teaching Exceptional Children Plus. 2008;4:2-14.
  3. 3.0 3.1 Carden SM, Good WV. Cortical Visual Impairment. Handbook of pediatric neuro-ophthalmology. P247-254
  4. 4.0 4.1 4.2 4.3 4.4 RNIB. Southwell, C. Haigh, K. Visual Impairment and Physiotherapy. November 2010:
  5. 5.0 5.1 RNIB. Visual Impairment and Occupational Therapy. March 2011
  6. 6.0 6.1 RNIB. Bell, I. & Bell, J. Visual Impairment and Speech and Language Therapy. July 2011
  7. Physio-pedia, ICF and RPS within CP. [/www.physio-pedia.com/ICF%20and%20RPS%20within%20Cerebral%20Palsy http://www.physio-pedia.com/ICF_and_RPS_within_Cerebral_Palsy] (last accessed 27/10/2106)