Vision Impairment in children with Cerebral Palsy

Introduction

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 [1]. 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)

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

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 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]