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Weisser-Pike O, Mitchell AW, Cordova L. Occupational Therapy Assessments of Cortical or Cerebral Visual Impairment: A Systematic Review. Am J Occup Ther 2023; 77:7706205160. [PMID: 37971385 DOI: 10.5014/ajot.2023.050313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
IMPORTANCE Cortical or cerebral visual impairment (CVI), a leading cause of visual dysfunction in children across the globe, can result in delayed development of fine and gross motor skills, functional mobility, and socialization, which affects all areas of occupation. No assessments are recommended for occupational therapy practitioners working with children with CVI. OBJECTIVE To appraise the measurement properties and clinical utility of CVI assessments appropriate for use by occupational therapy practitioners. DATA SOURCES MEDLINE via PubMed, Scopus, and Web of Science. STUDY SELECTION AND DATA COLLECTION We followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines for systematic reviews of patient-reported outcome measures for relevant studies. FINDINGS A total of 590 records yielded 15 studies of the measurement properties of 12 assessment tools, 8 patient-reported outcome measures and 4 clinician-reported or performance-based outcome measures. We report on the quality of measurement properties of 10 of the 12 outcome measures. None had high-quality evidence of content validity, structural validity, or test-retest reliability. Most had indeterminate internal consistency as a result of a lack of confirmatory factor analysis. Three instruments demonstrated high quality and sufficient construct validity. CONCLUSIONS AND RELEVANCE On the basis of the COSMIN guidelines, all 12 outcome measures have the potential to be recommended but require further study before definitive recommendations can be made. What This Article Adds: This is the first systematic review of assessments of CVI feasible for use by occupational therapy practitioners. High-quality studies of measurement properties are lacking. Further examination of the measurement properties of outcome measures is required.
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Affiliation(s)
- Orli Weisser-Pike
- Orli Weisser-Pike, OTD, OTR/L, CLVT, SCLV, FAOTA, is Associate Professor, University of Tennessee Health Science Center, College of Health Professions, University of Tennessee, Memphis;
| | - Anita Witt Mitchell
- Anita Witt Mitchell, PhD, OTR, FAOTA, is retired. At the time of the study, Mitchell was Professor, College of Health Professions, University of Tennessee Health Science Center, University of Tennessee, Memphis
| | - Leah Cordova
- Leah Cordova, MLIS, is Health Librarian, Chamberlain University, Chicago, IL. At the time of the study, she was Health Librarian, University of Tennessee Health Science Center, Memphis
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Sumalini R, Errolla P, Lingappa L, Conway M, Subramanian A, Satgunam P. Parent-Reported Visual Concerns in Children with Cerebral Visual Impairment Presenting to a Pediatric Neurology Clinic. CLINICAL OPTOMETRY 2023; 15:147-158. [PMID: 37497463 PMCID: PMC10368111 DOI: 10.2147/opto.s410903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
Purpose Children with cerebral visual impairment (CVI) present with delayed developmental milestones. Pediatricians and pediatric neurologists are usually the first point of contact, and eye exam largely remains referral based. This study documented the visual concerns reported by parents of children with CVI visiting a pediatric neurology clinic. Additionally, we investigated the association between visual concerns, functional vision measures and visual functions. Patients and Methods A cross-sectional study was undertaken in children with CVI (chronological age range: 7 months-7 years). Visual concerns reported by the parents/caregivers were documented as open-ended statements. Additionally, a functional vision assessment was conducted using the CVI Range instrument with phase 1, 2 and 3 indicating low, moderate and high visual functioning, respectively. Grating acuity and contrast sensitivity were measured using Teller acuity cards-II and Ohio contrast cards respectively. Results A total of 73 children (mean age of 2.84 ± 1.87 years) were recruited. Sixty-eight parents reported visual concerns that were broadly grouped into 14 unique concerns. Nineteen parents (27.9%) reported more than one visual concern. Difficulty maintaining eye contact and recognizing faces were the top two visual concerns in phases 1 and 2. Missing objects in the lower visual field was the top concern in phase 3. A larger number of visual concerns were reported in phase 1 (43%) than phase 2 (40.6%) and phase 3 (16.2%). Multiple regression analysis revealed that grating acuity, contrast sensitivity and chronological age were able to predict the functional vision, F (3, 55) = 63.0, p < 0.001, r2 = 0.77. Conclusion Targeted questions enquiring about eye contact and face recognition can be included in history elicitation in children with CVI in pediatric neurology clinics. In the presence of visual concerns, it will be important to assess grating acuity and contrast sensitivity. A poor functional vision score requires referral for eye examination and vision rehabilitation services.
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Affiliation(s)
- Rebecca Sumalini
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
- Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India
- Division of Optometry and Vision Sciences, City, University of London, London, United Kingdom
| | - Premalatha Errolla
- Department of Pediatric Neurology, Rainbow Children’s Hospitals, Hyderabad, India
| | - Lokesh Lingappa
- Department of Pediatric Neurology, Rainbow Children’s Hospitals, Hyderabad, India
| | - Miriam Conway
- Division of Optometry and Vision Sciences, City, University of London, London, United Kingdom
| | - Ahalya Subramanian
- Division of Optometry and Vision Sciences, City, University of London, London, United Kingdom
| | - PremNandhini Satgunam
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
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3
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Pilling RF, Allen L, Bowman R, Ravenscroft J, Saunders KJ, Williams C. Clinical assessment, investigation, diagnosis and initial management of cerebral visual impairment: a consensus practice guide. Eye (Lond) 2023; 37:1958-1965. [PMID: 36258009 PMCID: PMC10333179 DOI: 10.1038/s41433-022-02261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022] Open
Abstract
Cerebral Visual Impairment (CVI) is a common condition in the UK. Patients with conditions associated with CVI are frequently seen in paediatric ophthalmology clinics offering eye care professionals an opportunity to identify children proactively. In most cases CVI occurs as part of a neurodevelopmental condition or as a feature of multiple and complex disabilities. However, CVI can also be seen in children with apparently typical development. In some cases, high contrast visual acuity is normal and in other cases severely impaired. As such, identification of CVI requires evaluation of aspects of visual performance beyond high contrast acuity and consideration that visual function of those with CVI may fluctuate. Few paediatric ophthalmologists have received formal training in CVI. The detection and diagnosis of CVI varies across the UK and patients report hugely different experiences. A diagnosis of CVI is made based on professional clinical judgement and it is recognised that individual perspectives and local practice in the specific methodologies of assessment will vary. A systematic review and survey of professionals is underway to attempt to reach agreement on diagnostic criteria. Nonetheless, established pathways and published protocols can offer guidance on how a paediatric ophthalmology service can approach assessment of the child with suspected CVI. The purpose of this paper is to present a summary of research and clinical practice methods for detecting and diagnosing CVI in a paediatric ophthalmology outpatient setting. It represents current understanding of the topic and acknowledges the evolving nature of both practice and the evidence-base. A rapid literature review was undertaken to identify articles relating to clinical investigation of children with CVI. A focus group of QTVI and subject matter experts from sight loss charities was undertaken to address areas which were not covered by the literature review.
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Affiliation(s)
- Rachel Fiona Pilling
- University of Bradford, Bradford, England.
- Department of Ophthalmology, Bradford Teaching Hospitals, Bradford, UK.
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Pilling RF, Allen L, Anketell P, Bullaj R, Harwood J, Little S. Visual Behaviours (ViBes) in Cerebral Visual Impairment: Validating a Descriptive Tool to Support Diagnosis and Monitoring. Br Ir Orthopt J 2023; 19:44-51. [PMID: 37332843 PMCID: PMC10275135 DOI: 10.22599/bioj.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Cerebral visual impairment (CVI) is the most common cause of visual impairment in children in the UK. Diagnosis is based on identification of visual behaviours (ViBes) relating to visual dysfunction. Examination techniques and inventories have been developed to elicit these in children with a developmental age of two years or more. The absence of a structured approach to recording visual behaviours in children with complex needs is a barrier to diagnosis. The aim of the study was to develop a matrix of visual behaviours seen in pre-verbal and pre-motor children with visual impairment and establish its content validity and inter-rater reliability. Methods ViBe content validation:: Visual behaviour descriptors relating to visual function were collated and categorised by expert consensus of vision professionals into a matrix composed of three functions (attention, field/fixation, motor response) and five levels (0 = no awareness; 1 = visual awareness; 2 = visual attention; 3 = visual detection; 4 = visual understanding).ViBe inter-rater reliability:: The participants (two orthoptists, an optometrist, an ophthalmologist and two qualified teachers of the visually impaired) used the ViBe matrix to independently score each of 17 short video clips of children demonstrating visual behaviours seen in CVI. Results The ViBe matrix will be presented. Cohen's kappa for the matrix was 0.67, demonstrating moderate-to-strong inter-rater reliability. Conclusion The development of standardised descriptors can support clinicians and teachers in identifying areas of concern for children with complex needs. In addition, the ViBe matrix could be utilised in research, clinical and diagnostic reports to clearly communicate the areas of visual dysfunction and track progress resulting from interventions. Key Points The absence of a structured approach to recording visual behaviours in children with complex needs is a barrier to diagnosis.The ViBe matrix offers descriptors relating to visual behaviours and has demonstrated acceptable inter-rater reliability.The tool may support the identification and diagnosis of cerebral visual impairment in a population of children who cannot access standard testing.
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Weden K, DeCarlo DK, Barstow E. A Scoping Review of Intervention for Pediatric Cerebral Visual Impairment: Calling All Pediatric Occupational Therapists. Occup Ther Health Care 2023; 37:326-356. [PMID: 37139689 PMCID: PMC10950195 DOI: 10.1080/07380577.2023.2172761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/22/2023] [Indexed: 05/05/2023]
Abstract
Cerebral visual impairment is the leading cause of low vision in children, and functional gains can be achieved with intervention. To date there exists no evidence-based intervention protocol to guide rehabilitation therapists. This scoping review was conducted to synthesize the evidence currently available and explore current interventions in order to guide future research. This review identified five types of interventions for cerebral visual impairment; habilitation, visual stimulation, video game, color tent, and medical and also evidenced the need for standardized, objective measures of function for this population.
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Affiliation(s)
- Kathleen Weden
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, USA
| | - Dawn K. DeCarlo
- Department of Ophthalmology & Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Elizabeth Barstow
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, USA
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6
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Philip J, Sethuraman S, Hussaindeen JR, Jacob N, Swaminathan M. Development of an integrated telerehabilitation model in children with cerebral visual impairment in South India during the COVID-19 pandemic - A pilot study. Indian J Ophthalmol 2023; 71:2181-2187. [PMID: 37202945 PMCID: PMC10391408 DOI: 10.4103/ijo.ijo_1764_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose Coronavirus disease 2019 (COVID-19) pandemic affected the in-person rehabilitation/habilitation services in families with children with cerebral visual impairment (CVI) in India. This study aimed to develop a structured and family-centered telerehabilitation model alongside conventional in-person intervention in children with CVI to observe its feasibility in the Indian population. Methods This pilot study included 22 participants with a median age of 2.5 years (range: 1-6) who underwent a detailed comprehensive eye examination followed by functional vision assessment. The visual function classification system (VFCS) was administered to the children and the structured clinical question inventory (SCQI) to the parents. Every participant underwent 3 months of telerehabilitation including planning, training, and monitoring by experts. At 1 month, the parental care and ability (PCA) rubric was administered to the parents. After 3 months, in an in-person follow-up, all the measures were reassessed for 15 children. Results After 3 months of Tele-rehabilitation there were significant improvements noted in PCA rubric scores (P<0.05). Also, statistically significant improvements were noted in functional vision measured using SCQI and VFCS scores (P<0.05) compared to baseline. Conclusion The outcomes of the study provide the first steps towards understanding the use of a novel tele-rehabilitation model in childhood CVI along-side conventional face-to-face intervention. The added role of parental involvement in such a model is highly essential.
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Affiliation(s)
- Jannet Philip
- Graduate Research Scholar, Elite School of Optometry Affiliated to SASTRA Deemed to be University, Thanjavur and Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Saranya Sethuraman
- Vision Enhancement Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Jameel R Hussaindeen
- Binocular Vision and Vision Therapy Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Namita Jacob
- Director-Chetana Charitable Trust, Chennai, Tamil Nadu, India
| | - Meenakshi Swaminathan
- Senior Pediatric Ophthalmologist, Department of Pediatric Ophthalmology, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India
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Ben Itzhak N, Kooiker MJG, Pel JJM, Ortibus E. Including visual orienting functions into cerebral visual impairment screening: Reliability, variability, and ecological validity. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 132:104391. [PMID: 36493737 DOI: 10.1016/j.ridd.2022.104391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cerebral visual impairment (CVI) is a heterogeneous brain-based visual processing disorder in which basic visual orienting functions (VOF) and higher-order perception can be impaired. AIMS To evaluate (1) the test-retest reliability and variability of an eye tracking-based VOF paradigm, and related clinical characteristics, and (2) the relations between VOF (variability) and daily visual functioning and visuoperceptual dimensions. METHODS AND PROCEDURES Thirty-three children with CVI (Males=14; mean age=9 years 10 months) underwent eye tracking thrice, completed a visuoperceptual battery, and parents completed the Flemish CVI questionnaire. VOF reliability and variability of reaction time (RTF), fixation duration and accuracy were assessed with intraclass correlation coefficient (ICC), Bland-Altman plots, and coefficient of variation. Relations were analysed with linear mixed models. OUTCOMES AND RESULTS Highly salient visual stimuli had good RTF reliability (ICCs=0.75) and triggered less variable VOF. Intermediate and low salience stimuli had poor-to-moderate reliability and triggered more variable VOF. Younger performance age related to more VOF variability. Greater visual (dis)interest, clutter and distance viewing impairments, and a weaker visuoperceptual profile related to slower RTF. CONCLUSIONS AND IMPLICATIONS Highly salient stimuli reveal a child's 'optimal' visual performance, whereas intermediate and low salience stimuli uncover VOF variability, which is a key CVI hallmark to detect.
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Affiliation(s)
- N Ben Itzhak
- Department of Development and Regeneration, University of Leuven (KU Leuven), Leuven, Belgium; Child Youth Institute (L-C&Y), Leuven, Belgium.
| | - M J G Kooiker
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, the Netherlands; Royal Dutch Visio, Amsterdam, the Netherlands
| | - J J M Pel
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, the Netherlands
| | - E Ortibus
- Department of Development and Regeneration, University of Leuven (KU Leuven), Leuven, Belgium; Child Youth Institute (L-C&Y), Leuven, Belgium
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Signorini S, Luparia A, Cappagli G, Perotto E, Antonini M, Morelli F, Aprile G, Ballante E, Figini S, Borgatti R. Visual Function Score: A New Clinical Tool to Assess Visual Function and Detect Visual Disorders in Children. Front Pediatr 2022; 10:868974. [PMID: 35558364 PMCID: PMC9087345 DOI: 10.3389/fped.2022.868974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A comprehensive assessment of visual functioning at an early age is important not only for identifying and defining visual impairment but also for planning personalized rehabilitation programs based on the visual diagnosis. Since existing tools to evaluate visual functioning present some important limitations (e.g., they are based on qualitative reports, they do not take into account environmental adaptations of visual testing or they have not been formally validated as clinical instruments), the present work has the main aim to propose a new clinical tool (Visual Function Score, VFS) to detect and define visual disorders at an early age. METHODS The Visual Function Score was administered to one hundred visually impaired children (age range 4 months to 17.75 years old) in the form of a professional-reported protocol for a total of 51 items, each of which is assigned a score from 1 to 9 (or from 0 to 9 in some specific cases). The VFS produces three sub-scores and a global score (from 0 to 100), resulting in a quantitative evaluation of visual functioning. RESULTS The VFS can detect the well-known differences between different types of visual impairment (cerebral, oculomotor, and peripheral or grouped as central and peripheral) and takes into account different environments in the definition of a quantitative score of visual functioning. DISCUSSION Overall, the use of a quantitative tool to evaluate visual functions and functional vision such as the VFS would be fundamental to monitor the progresses of patients over time in response to rehabilitation interventions.
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Affiliation(s)
- Sabrina Signorini
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonella Luparia
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Cappagli
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Eleonora Perotto
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mauro Antonini
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Federica Morelli
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Giorgia Aprile
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Ballante
- BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Silvia Figini
- BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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9
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Duke RE, Chimaeze T, Kim MJ, Ameh S, Burton K, Bowman R. The Effect of Insight Questions Inventory and Visual Support Strategies on Carer-Reported Quality of Life for Children With Cerebral Palsy and Perceptual Visual Dysfunction in Nigeria: A Randomized Controlled Trial. Front Hum Neurosci 2021; 15:706550. [PMID: 34867233 PMCID: PMC8636698 DOI: 10.3389/fnhum.2021.706550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Structured clinical history question inventories have previously been used to try and elicit symptoms of perceptual visual dysfunction (PVD) in children with cerebral palsy (CP) in different settings. Earlier studies have suggested that PVD may affect quality of life and specific habilitational strategies, linked to inventory responses, may improve quality of life. Through an RCT, based on a community based sample of children with CP in Cross River State, Nigeria, we aimed to determine if a structured history inventory such as the Insight question inventory (IQI) and associated tailored visual support strategies (IQI VSS) for the management of those children who have PVD, can improve quality of life and is superior to standard therapy. Children with CP were recruited by the key informant method and confirmed by clinical examination. The parent reported IQI was used to identify children with PVD. Primary outcome measures were both Pediatric Quality of Life 4.0 Generic (PedsQL 4.0 Generic) and Pediatric Quality of Life 3.0 Cerebral Palsy (PedsQL 3.0 CP) scale scores. Children were enrolled with a parallel arm allocation to either IQI and IQI VSS or to standard therapy for CP. Children were followed up for 6 weeks with weekly phone call session and the questionnaires repeated at the end of the 6 weeks’ period. Results show that the children in the treatment group (n = 191) showed no significantly different change between baseline and follow up in quality of life (PedsQL 4.0 Generic p = 0.943: and PedsQL-CP 3.0 p = 0.287), compared to the control group. There was suggestion of a better improvement (p = 0.035) in the PedsQL 3.0 CP subscale of speech and communication for the intervention group. The use of IQI VSS for the treatment of PVD in children with CP in this population does not show any superiority over current standard CP management in terms of overall quality of life. However, there was some evidence of improvement in quality of life in the area of speech and communication. Further research and refinement of these management method is required. Clinical Trial Registration:www.ClinicalTrials.gov, identifier [PACTR20161200188] 6396.
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Affiliation(s)
- Roseline E Duke
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom.,Children's Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Torty Chimaeze
- Department of Pediatrics, Pediatric Neurology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Min J Kim
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom
| | - Soter Ameh
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Kathryn Burton
- Cambridgeshire Community Services, Oxfordshire, United Kingdom
| | - Richard Bowman
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom
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Chandna A, Ghahghaei S, Foster S, Kumar R. Higher Visual Function Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity. Front Hum Neurosci 2021; 15:711873. [PMID: 34867236 PMCID: PMC8636735 DOI: 10.3389/fnhum.2021.711873] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/07/2021] [Indexed: 01/25/2023] Open
Abstract
In clinical practice Cerebral Visual Impairment (CVI) is typically diagnosed by observation of abnormal visually guided behaviors which indicate higher visual function deficits (HVFDs) suggesting abnormal brain development or brain damage in a child with a suitable clinical history. HVFDs can occur even in the presence of good visual acuity and may remain undiagnosed because the good visual acuity does not prompt further investigation. This leads to a lack of understanding of the child's visual perceptual difficulties. In a prospective study, we determined the spectrum of HVFDs in a group of children with history suggestive of brain damage or disruption of brain development and an independent diagnosis of CVI in comparison with typically developing children with a structured 51 question inventory, the Higher Visual Function Question Inventory (HVFQI-51) adapted from the Cerebral Vision Impairment Inventory, CVI-I. Here, we show that the HVFQI-51 can detect a range of HVFDs in children with CVI with good visual acuity and clearly distinguishes these children from typically developing children. HVFDs in our study group could mostly be attributed to dorsal stream visual processing dysfunction though the spectrum varied between children. We report on the inclusion of the "not applicable" response option in analysis providing a picture of HVFDs more in tune with the overall disability of each child. We also propose a subset of 11 questions (Top-11) which discriminate between children with CVI vs. behaviors seen in typical children: this provides both a potential screening tool for initial assessment of HVFDs and a measure of CVI-related impairment, and needs further validation in a secondary independent sample.
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Affiliation(s)
- Arvind Chandna
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, United States
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Saeideh Ghahghaei
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, United States
| | - Susan Foster
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Ram Kumar
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
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11
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Pehere NK, Dutton GN. Perceptual visual dysfunction in children - An Indian perspective. Indian J Ophthalmol 2021; 69:2004-2011. [PMID: 34304166 PMCID: PMC8482924 DOI: 10.4103/ijo.ijo_1996_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/04/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022] Open
Abstract
Perceptual visual dysfunction (PVD) comprises a group of vision disorders resulting from dysfunction of the posterior parietal and/or temporal lobes. Often, affected children have normal/near normal visual acuities and/or visual fields, but have difficulties in activities of daily living involving the use of vision. PVDs are known to be common among children with risk factors such as a history of prematurity and/or neurodevelopmental disorders. The inferior temporal lobes and ventral stream transform visual signals into perception, while the posterior parietal lobes and dorsal stream transform visual signals to non-consciously map the scene to guide action and facilitate attention. Dysfunction of these can lead to specific visual impairments that need to be identified during history taking, triggering ascertainment of further details by a structured inventory approach. Clinical tests to elicit dorsal and ventral stream visual dysfunctions have good specificity but low sensitivity. Neuropsychologists are rarely available in the developing world to perform detailed assessments, but there are a few tests that can be used by eye care professionals with some training. Optical coherence tomography (OCT) showing thinning of the ganglion cell layer and retinal nerve fiber layer is being explored as a potential tool for rapid assessment in the clinic. The behavioral outcomes of PVD can mimic psychological conditions including autism spectrum disorder, attention deficit hyperactivity disorder, specific learning disability, and intellectual impairment, and one needs to be aware of overlap among these differential diagnoses. A practical functional approach providing working solutions for each child's set of difficulties in day-to-day activities is needed.
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Affiliation(s)
- Niranjan K Pehere
- Liberia Eye Center (L V Prasad Eye Institute Liberia Inc), John F Kennedy Memorial Medical Center, Monrovia, Liberia
| | - Gordon N Dutton
- Department of Vision Science, Glasgow Caledonian University, Glasgow, United Kingdom
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12
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Wilton GJ, Woodhouse R, Vinuela-Navarro V, England R, Woodhouse JM. Behavioural Features of Cerebral Visual Impairment Are Common in Children With Down Syndrome. Front Hum Neurosci 2021; 15:673342. [PMID: 34194306 PMCID: PMC8236883 DOI: 10.3389/fnhum.2021.673342] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/17/2021] [Indexed: 01/29/2023] Open
Abstract
It is widely recognised that children with Down syndrome have a broad range and a high prevalence of visual deficits and it has been suggested that those with Down syndrome are more likely to exhibit visual perception deficits indicative of cerebral visual impairment. This exploratory study aims to determine the prevalence of behavioural features suggestive of cerebral visual impairment (CVI) occurring with Down syndrome and whether the visual problems can be ascribed to optometric factors. A cohort of 226 families of children with Down syndrome (trisomy 21), aged 4–17, were invited to participate in a validated question inventory, to recognise visual perception issues. The clinical records of the participants were then reviewed retrospectively. A five-question screening instrument was used to indicate suspected CVI. The majority of the 81 families who responded to the questionnaire reported some level of visual perceptual difficulty in their child. Among this cohort, the prevalence of suspected CVI as indicated by the screening questionnaire was 38%. Only ametropia was found to have a significant association with suspected CVI, although this increased the correct prediction of suspected CVI outcome by only a small amount. Results suggest that children with Down syndrome are more likely to experience problems consistent with cerebral visual impairment, and that these may originate from a similar brain dysfunction to that which contributes to high levels of ametropia and failure to emmetropise. It is important that behavioural features of CVI are recognised in children with Down syndrome, further investigations initiated and appropriate management applied.
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Affiliation(s)
- Gemma J Wilton
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Rhodri Woodhouse
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Valldeflors Vinuela-Navarro
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom.,Optometry and Vision Science Research Group, Optometry School, Aston University, Birmingham, United Kingdom
| | - Rachel England
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - J Margaret Woodhouse
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
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Deramore Denver B, Froude E, Rosenbaum P, Imms C. Measure of Early Vision Use: development of a new assessment tool for children with cerebral palsy. Disabil Rehabil 2021; 44:4055-4065. [PMID: 33689557 DOI: 10.1080/09638288.2021.1890241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the development of an assessment tool to describe "how vision is used" for children with cerebral palsy. METHOD Measurement development consisted of three steps: (i) an online survey to explore the relevance and comprehensiveness of visual behaviours identified in a previous conceptualisation study; (ii) construction of items and a rating scale for the new measure; and (iii) cognitive interviews to explore comprehensibility and refine the measure in preparation for field testing. Survey respondents were 130 parents of children with cerebral palsy, eight adults with cerebral palsy, and 108 clinicians (n = 246). Nine parents participated in the interviews. RESULTS The new tool, the Measure of Early Vision Use, is a 14-item descriptive measure of typical performance of visual behaviours observable in everyday activities, as rated by parent/caregiver observation. Each item is rated on a 4-point ordinal scale. CONCLUSIONS This new measure is conceptually grounded within the Activity level domain of the International Classification of Functioning, Disability and Health as a measure of a single visual ability construct. The target population is children with cerebral palsy, and using parent report the Measure of Early Vision Use describes both strengths and limitations in using vision. This study addressed the selection of items and response options for the new scale, and provides evidence to support content relevance, comprehensiveness and comprehensibility from key stakeholders. Further research will explore psychometric properties and clinical utility.Implications for rehabilitationThe ability to use vision in daily activities is relevant to the development and learning of all children, so the availability of a method for describing visual abilities has potential for diverse research and clinical purposes.The Measure of Early Vision Use is a parent-report tool that provides a criterion-referenced method for quantifying and describing how children use vision in typical daily activities to support intervention planning.Clinicians and parents wishing to measure vision use in children with cerebral palsy can be confident about the rigorous methods used to develop this tool, including consultation with key stakeholders.
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Affiliation(s)
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Peter Rosenbaum
- Department of Paediatrics, McMaster University, Hamilton, Canada
| | - Christine Imms
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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14
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Duke RE, Nwachukuw J, Torty C, Okorie U, Kim MJ, Burton K, Gilbert C, Bowman R. Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria. Br J Ophthalmol 2020; 106:427-434. [PMID: 33268343 DOI: 10.1136/bjophthalmol-2020-317768] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria. METHODS A paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD). RESULTS 388 children aged 4-15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included. CONCLUSION Children with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.
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Affiliation(s)
- Roseline Ekanem Duke
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria .,Clinical Research Unit, ITD, International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
| | - Justin Nwachukuw
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Chima Torty
- Pediatric Neurology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Uche Okorie
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Min J Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Kathryn Burton
- Community Paediatrics, Cambridgeshire Community Services NHS Trust, Saint Ives, Cambridgeshire, UK
| | - Clare Gilbert
- Clinical Research Unit, ITD, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
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