“I See Something You Don’t See...”: Cerebral Visual Impairment in Children with Cerebral Palsy

Background/Purpose: Cerebral visual impairments (CVI) in childhood are caused by pre-, peri-, or postnatal structural brain lesions or changes in the communication of neural networks, associated with forwarding, coding, and intercommunication of special visual qualities. The number of publications concerning CVI has increased enormously in the last years. A relevant health care gap in the assessment of the visual function can be described: ophthalmologists and orthoptists usually asses the oculomotor function (e.g., fixation, saccades, pursuit eye movements, accommodation) and the sensory function (e.g., near and far acuity, grating acuity, contrast sensitivity). An assessment of the functions of early visual processing (e.g., line length, line direction, figure-ground recognition, visual short-term memory), temporal processing (e.g., letter recognition, crowding, face recognition, and image recognition), and parietal processing (e.g., spatial direction, spatial memory, eye–hand coordination) networks is rare, even though they are well known in neuropsychology. In a neuropediatric perspective, there is a gap of knowledge about the functions, the applicable diagnostic approach and the therapy. A specialized subdiscipline, pediatric visuolgist, like a pediatric audiologist, does not exist. The specific therapy for children with CVI is an assignment of institutions for special education. Disorders of peripheral and central visual functions are common in children with cerebral palsy.

Methods: Due to our focus on children with (unilateral) cerebral palsy, we developed a cooperation with the project provision (PROcessing VISual InformatiOn in childreN), Faculty of Rehabilitation Science, Technical University of Dortmund.

Results: Together we developed a diagnostic system with focus on function and activities of daily living. A screening investigates some parts of visual function, followed by a larger diagnostic tool, if there are abnormalities in the screening. An ophthalmologic and orthoptic examination is also part of the diagnostics. We are working on a cooperation with the institutes for special education to support and coach the children and their parents.

Conclusion: We report about the anamnesis of visual problems relevant to everyday life and the diagnostic tool, illustrated by video captures. Consequences for the therapy will be shown, and necessary cooperation will be described.