Skip to main content

Testing Visual Function and Visual Evaluation Outcomes in the Child with Cerebral Palsy

  • Living reference work entry
  • First Online:
  • 295 Accesses

Abstract

Vision is an important area to evaluate in children with cerebral palsy, playing a key role in learning and development throughout a child’s lifetime. Understanding the role of vision in the daily lives of children with cerebral palsy (CP) and having knowledge of the high prevalence of ocular and vision disorders associated with CP are essential in the medical, rehabilitation, and education profile for each child. Vision disorders affecting a child’s performance of vision-dependent tasks are often overlooked, undiagnosed, or unrecognized. Evaluating the visual function of children with cerebral palsy (CP) can, however, present challenges for eye care practitioners as children with CP may not be responsive to standard testing procedures for a wide range of reasons. As a result, erroneous labels such as severe visual impairment, “untestable,” or “blind” have been applied, despite reports by parents, teachers, therapists, and caregivers that these children appear to show visual responses. This chapter discusses the common ocular and vision disorders in children with CP and the components of a clinical vision evaluation for children with CP who may have widely disparate levels of communication, cognitive, and motor skills. This is followed by management of vision disorders and implications of assessment outcomes on overall function for the child with CP. The eye care provider can contribute important information regarding how a child sees, the potential for improvements in vision, and recommendations to allow educators and rehabilitation specialists to integrate vision into the child’s comprehensive education and rehabilitation programs.

This is a preview of subscription content, log in via an institution.

References

  • Adoh TO, Woodhouse JM, Oduwaiye KA (1992) The Cardiff Test: a new visual acuity test for toddlers and children with intellectual impairment. A preliminary report. Optom Vis Sci 69(6):427–32

    Article  CAS  Google Scholar 

  • Altman HE, Hiatt RL, Deweese MW (1966) Ocular findings in cerebral palsy. South Med J 59:1015–1018

    Article  CAS  Google Scholar 

  • Appel S, Ciner EB (2011) Vision problems in the developmentally disabled. In: Scheiman M (ed) Understanding and managing vision deficits: a guide for occupational therapists. Slack Inc, Thorofare

    Google Scholar 

  • Appel S, Ciner E, Graboyes M (1997) Developing comprehensive vision care for multiply impaired children. Pract Optomet 8:225–234

    Google Scholar 

  • Arnold RW (2004) Pseudo-false positive eye/vision photoscreening due to accommodative insufficiency. A serendipitous benefit for poor readers? Binocul Vis Strabismus Q 19(2):75–80

    PubMed  Google Scholar 

  • Arnoldi KA, Pendarvis L, Jackson J, Batra NN (2006) Cerebral palsy for the pediatric eye care team part III: diagnosis and management of associated visual and sensory disorders. Am Orthopt J 56:97–107. https://doi.org/10.3368/aoj.56.1.97

    Article  PubMed  Google Scholar 

  • Arroyo-Yllanes ME, Ramirez-Sánchez EV, Pérez-Pérez JF, Magaña-García M (2005) Refractive errors in normal children and children with down syndrome or cerebral palsy. Am Orthopt J 55:122–127. https://doi.org/10.3368/aoj.55.1.122

    Article  PubMed  Google Scholar 

  • Atkinson J, Anker S, Nardini M et al (2002) Infant vision screening predicts failures on motor and cognitive tests up to school age. Strabismus 10(3):187–198

    Article  Google Scholar 

  • Atkinson J, Anker S, Braddick O, Rutherford O, Edwards D, Cowan F (2004) Deficits in selective visual attention and dorsal stream function: children with hyperopic refractive errors in infancy and children born prematurely. Invest Ophthalmol Vis Sci 45:U158–U158

    Google Scholar 

  • Beasley I, Davies L (2012) Susceptibility to pattern glare following stroke. J Neurol 259(9):1832–1839. https://doi.org/10.1007/s00415-012-6418-5

    Article  PubMed  PubMed Central  Google Scholar 

  • Black P (1982) Visual disorders associated with cerebral palsy. Br J Ophthalmol 66:46–52

    Article  CAS  Google Scholar 

  • Boyaci A, Akal A, Tutoglu A et al (2014) Relationship among ocular diseases, developmental levels, and clinical characteristics of children with diplegic cerebral palsy. J Phys Ther Sci 26(11):1679–1684. https://doi.org/10.1589/jpts.26.1679

    Article  PubMed  PubMed Central  Google Scholar 

  • Breakey AS (1955) Ocular findings in cerebral palsy. AMA Arch Ophthalmol 53(6):852–856

    Article  CAS  Google Scholar 

  • British National Formulary (2017) British Medical Association and Royal Pharmaceutical Society of Great Britain, London, March 2017

    Google Scholar 

  • Chan-Ling T, Gole GA, Quinn GE, Adamson SJ, Darlow BA (2017) Pathophysiology, screening and treatment of ROP: a multi-disciplinary perspective. Prog Retin Eye Res 62:77–119. https://doi.org/10.1016/j.preteyeres.2017.09.002. Review

    Article  CAS  PubMed  Google Scholar 

  • Chorna OD, Guzzetta A, Maitre NL (2017) Vision assessments and interventions for infants 0–2 years at high risk for cerebral palsy: a systematic review. Pediatr Neurol 76:3–13. https://doi.org/10.1016/j.pediatrneurol.2017.07.011. Review

    Article  PubMed  Google Scholar 

  • Ciner EB, Graboyes M, Appel S, Zambone A (1996) Assessment and rehabilitation of children with special needs. Optom Clin 5(2):187–226

    CAS  PubMed  Google Scholar 

  • Ciner EB, Graboyes M, Appel S, Klitsch E (1999) Low vision special populations I: the multiply impaired patient. In: Brilliant RL (ed) Essentials of low vision practice, Woburn, Butterworth-Heinemann Press, pp 313–334

    Google Scholar 

  • Ciner EB, Appel S, Graboyes M (2011) Management of vision problems for the developmentally disabled. In: Scheiman M (ed) Understanding and managing vision deficits: a guide for occupational therapists. Slack Inc, Thorofare

    Google Scholar 

  • Ciner EB, Kulp MT, Maguire MG, Pistilli M, Candy TR, Moore B, Ying GS, Quinn G, Orlansky G, Cyert L (2016) Vision in preschoolers – hyperopia in preschoolers (VIP-HIP) study group writing committee. Visual function of moderately hyperopic 4- and 5-year-old children in the vision in preschoolers – hyperopia in preschoolers study. Am J Ophthalmol 170:143–152. https://doi.org/10.1016/j.ajo.2016.07.017

    Article  PubMed  PubMed Central  Google Scholar 

  • Collins ML (2014) Strabismus in cerebral palsy: when and why to operate. Am Orthopt J 64:17–20. https://doi.org/10.3368/aoj.64.1.17. Review

    Article  PubMed  Google Scholar 

  • Costa MF, Pereira JC (2014) Correlations between color perception and motor function impairment in children with spastic cerebral palsy. Behavior Brain Funct 10:22. https://doi.org/10.1186/1744-9081-10-22

    Article  Google Scholar 

  • da Cunha Matta AP, Nunes G, Rossi L, Lawisch V, Dellatolas G, Braga L (2008) Outpatient evaluation of vision and ocular motricity in 123 children with cerebral palsy. Dev Neurorehabil 11(2):159–165. https://doi.org/10.1080/17518420701783622

    Article  PubMed  Google Scholar 

  • Denver BD, Froude E, Rosenbaum P, Wilkes-Gilan S, Imms C (2016) Measurement of visual ability in children with cerebral palsy: a systematic review. Dev Med Child Neurol 58:1016–1029

    Article  Google Scholar 

  • Dobson V, Quinn GE, Tung B, Palmer EA, Reynolds JD (1995) Comparison of recognition and grating acuities in very-low-birth-weight children with and without retinal residua of retinopathy of prematurity. Cryotherapy for retinopathy of prematurity cooperative group. Invest Ophthalmol Vis Sci 36(3):692–702

    CAS  PubMed  Google Scholar 

  • Duckman R (1979) The incidence of visual anomalies in a population of cerebral palsied children. J Am Optom Assoc 50(9):1013–1016

    CAS  PubMed  Google Scholar 

  • Duckman RH (1984) Accommodation in cerebral palsy: function and remediation. J Am Optom Assoc 55:281–283

    CAS  PubMed  Google Scholar 

  • Dufresne D, Dagenais L, Shevell MI, REPACQ Consortium (2014) Spectrum of visual disorders in a population-based cerebral palsy cohort. Pediatr Neurol 50(4):324–328. https://doi.org/10.1016/j.pediatrneurol.2013.11.022

    Article  PubMed  Google Scholar 

  • Dwyer P, Wick B (1995) The influence of refractive correction upon disorders of vergence and accommodation. Optom Vis Sci 72(4):224–232

    Article  CAS  Google Scholar 

  • Ego C, Orban de Xivry JJ, Nassogne MC, Yüksel D, Lefèvre P (2014) Spontaneous improvement in oculomotor function of children with cerebral palsy. Res Dev Disabil 36C:630–644. https://doi.org/10.1016/j.ridd.2014.10.025

    Article  PubMed  Google Scholar 

  • Ego A, Lidzba K, Brovedani P, Belmonti V, Gonzalez-Monge S, Boudia B, Ritz A, Cans C (2015) Visual-perceptual impairment in children with cerebral palsy: a systematic review. Dev Med Child Neurol 57(Suppl 2):46–51. https://doi.org/10.1111/dmcn.12687. Review

    Article  PubMed  Google Scholar 

  • Fazzi E, Bova SM, Uggetti C, Signorini SG, Bianchi PE, Maraucci I, Zoppello M, Lanzi G (2004) Visual-perceptual impairment in children with periventricular leukomalacia. Brain and Development 26(8):506–512

    Article  Google Scholar 

  • Fazzi E, Signorini SG, Bova SM, La Piana R, Ondei P, Bertone C, Misefari W, Bianchi PE (2007) Spectrum of visual disorders in children with cerebral visual impairment. J Child Neurol 22(3):294–301

    Article  Google Scholar 

  • Fazzi E, Signorini SG, LA Piana R, Bertone C, Misefari W, Galli J, Balottin U (2012) Bianchi PE (2012) neuro-ophthalmological disorders in cerebral palsy: ophthalmological, oculomotor, and visual aspects. Dev Med Child Neurol 54(8):730–736. https://doi.org/10.1111/j.1469-8749.2012.04324.x

    Article  PubMed  Google Scholar 

  • Ferziger NB, Nemet P, Brezner A, Feldman R, Galili G, Zivotofsky AZ (2011) Visual assessment in children with cerebral palsy: implementation of a functional questionnaire. Dev Med Child Neurol 53(5):422–428. https://doi.org/10.1111/j.1469-8749.2010.03905.x

    Article  PubMed  Google Scholar 

  • Fielder A, Blencowe H, O'Connor A, Gilbert C (2015) Impact of retinopathy of prematurity on ocular structures and visual functions. Arch Dis Child Fetal Neonatal Ed 100(2):F179–F184. https://doi.org/10.1136/archdischild-2014-306207. Review

    Article  PubMed  Google Scholar 

  • Fulton AB, Hansen RM, Moskowitz A, Akula JD (2009) The neurovascular retina in retinopathy of prematurity. Prog Retin Eye Res 28(6):452–482. https://doi.org/10.1016/j.preteyeres.2009.06.003. Epub 2009 Jun 27. Review. Erratum in: Prog Retin Eye Res 29(1):94

    Article  PubMed  PubMed Central  Google Scholar 

  • Ghasia F, Brunstrom J, Gordon M, Tychsen L (2008) Frequency and severity of visual sensory and motor deficits in children with cerebral palsy: gross motor function classification scale. Invest Ophthalmol Vis Sci 49(2):572–580. https://doi.org/10.1167/iovs.07-0525. PubMed PMID: 18235001

    Article  PubMed  Google Scholar 

  • Ghasia F, Brunstom J, Tychsen L (2009) Visual acuity and visually evoked responses in children with cerebral palsy: Gross Motor Function Classification Scale. Br J Ophthalmol 93(8):1068–1072. https://doi.org/10.1136/bjo.2008.156372. Epub 2009 May 7. PubMed PMID: 19429585

    Article  CAS  Google Scholar 

  • Ghate D, Vedanarayanan V, Kamour A et al (2016) Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin. J Neurol Sci 368:25–31. https://doi.org/10.1016/j.jns.2016.06.029

    Article  PubMed  Google Scholar 

  • Guzzetta A, Fazzi B, Mercuri E, Bertuccelli B, Canapicchi R, van Hof-van Duin J, Cioni G (2001) Visual function in children with hemiplegia in the first years of life. Dev Med Child Neurol 43(5):321–329

    Article  CAS  Google Scholar 

  • Hansen RM, Moskowitz A, Akula JD, Fulton AB (2017) The neural retina in retinopathy of prematurity. Prog Retin Eye Res 56:32–57. https://doi.org/10.1016/j.preteyeres.2016.09.004. Review

    Article  CAS  PubMed  Google Scholar 

  • Hellstrom A, Smith L, Dammann O (2013) Retinopathy of prematurity. Lancet 382(9902):1445–1457. https://doi.org/10.1016/S0140-6736(13)60178-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hilton EJ, Hosking SL, Betts T (2004) The effect of antiepileptic drugs on visual performance. Seizure 13(2):113–128. Review

    Article  Google Scholar 

  • Hopkins G, Pearson R (1998) Adverse ocular reactions to systemic drug treatment. In: O’Connor Davies PH (ed) OConnor Davies’s ophthalmic drugs: diagnostic and therapeutic uses, 4th edn. Butterworth Heinemann, London, pp 217–235

    Google Scholar 

  • Jacobson LK, Dutton GN (2000) Periventricular leukomalacia: an important cause of visual and ocular motility dysfunction in children. Surv Ophthalmol 45(1):1–13. Review

    Article  CAS  Google Scholar 

  • Jacobson L, Rydberg A, Eliasson AC, Kits A, Flodmark O (2010) Visual field function in school-aged children with spastic unilateral cerebral palsy related to different patterns of brain damage. Dev Med Child Neurol 52(8):e184–e187. https://doi.org/10.1111/j.1469-8749.2010.03650.x

    Article  PubMed  Google Scholar 

  • Kaur S, Jain S, Sodhi HB et al (2013) Optic nerve hypoplasia. Oman J Ophthalmol 6:77–82. https://doi.org/10.4103/0974-620X.116622

    Article  PubMed  PubMed Central  Google Scholar 

  • Kozeis N, Anogeianaki A, Mitova DT, Anogianakis G, Mitov T, Klisarova A (2007) Visual function and visual perception in cerebral palsied children. Ophthalmic Physiol Opt 27(1):44–53

    Article  Google Scholar 

  • Kozeis N, Panos GD, Zafeiriou DI, de Gottrau P, Gatzioufas Z (2015) Comparative study of refractive errors, strabismus, microsaccades, and visual perception between preterm and full-term children with infantile cerebral palsy. J Child Neurol 30(8):972–975. https://doi.org/10.1177/0883073814549248

    Article  PubMed  Google Scholar 

  • Kulp MT, Ciner E, Maguire M, Pistilli M, Candy TR, Ying GS, Quinn G, Cyert L, Moore B (2017) Vision in preschoolers-hyperopia in preschoolers study group. Attention and visual motor integration in young children with uncorrected hyperopia. Optomet Vis Sci 94(10):965–970. https://doi.org/10.1097/OPX.0000000000001123

    Article  Google Scholar 

  • Lagunji IA, Oluleye TS (2007) Ocular abnormalities in children with cerebral palsy. Afr J Med Med Sci 36(1):71–75

    Google Scholar 

  • Leat SJ (1996) Reduced accommodation in children with cerebral palsy. Ophthalmic Physiol Opt 16(5):385–390

    Article  CAS  Google Scholar 

  • Leat SJ (2011) To prescribe or not to prescribe? Guidelines for spectacle prescribing in infants and children. Clin Exp Optom 94(6):514–527. https://doi.org/10.1111/j.1444-0938.2011.00600.x. Review

    Article  PubMed  Google Scholar 

  • Luisa Mayer D (2011) PhD thesis. http://www.perkins.org/assets/downloads/low-vision-clinic/handout-visual-field-loss-in-infants-rev-1-31-11.pdf

  • Ma DJ, Yang HK, Hwang JM (2013) Surgical outcomes of medial rectus recession in esotropia with cerebral palsy. Ophthalmology 120(4):663–667. https://doi.org/10.1016/j.ophtha.2012.09.018

    Article  PubMed  Google Scholar 

  • Ma DJ, Yang HK, Hwang JM (2017) Surgical responses and outcomes of bilateral lateral rectus recession in exotropia with cerebral palsy. Acta Ophthalmol 95(3):e179–e184. https://doi.org/10.1111/aos.13158

    Article  PubMed  Google Scholar 

  • McClelland JF, Parkes J, Hill N, Jackson AJ, Saunders KJ (2006) Accommodative dysfunction in children with cerebral palsy: a population-based study. Invest Ophthalmol Vis Sci 47(5):1824–1830

    Article  Google Scholar 

  • McDonald MA, Dobson V, Sebris SL, Baitch L, Varner D, Teller DY (1985) The acuity card procedure: a rapid test of infant acuity. Invest Ophthalmol Vis Sci 26(8):1158–62

    Google Scholar 

  • Morale SE, Hughbanks-Wheaton DK, Cheng C, Subramanian V, O’Connor AR, Birch EE (2012) Visual acuity assessment of children with special needs. Am Orthopt J 62:90–8

    Article  Google Scholar 

  • Mudgil AV, Repka MX (2000) Childhood optic atrophy. Clin Exp Ophthalmol 28(1):34–37

    Article  CAS  Google Scholar 

  • Novak I, Hines M, Goldsmith S, Barclay R (2012) Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 130:e1–e28

    Article  Google Scholar 

  • Ozturk AT, Berk AT, Yaman A (2013) Ocular disorders in children with spastic subtype of cerebral palsy. Int J Ophthalmol 6(2):204–210. https://doi.org/10.3980/j.issn.2222-3959.2013.02.19.Print2013

    Article  PubMed  PubMed Central  Google Scholar 

  • Pagliano E, Fedrizzi E, Erbetta A, Bulgheroni S, Solari A, Bono R, Fazzi E, Andreucci E, Riva D (2007) Cognitive profiles and visuoperceptual abilities in preterm and term spastic diplegic children with periventricular leukomalacia. J Child Neurol 22(3):282–288

    Article  Google Scholar 

  • Pansell T, Hellgren K, Jacobson L, Brautaset R, Tedroff K (2014) The accommodative process in children with cerebral palsy: different strategies to obtain clear vision at short distance. Dev Med Child Neurol 56(2):171–177. https://doi.org/10.1111/dmcn.12266

    Article  PubMed  Google Scholar 

  • Park MJ, Yoo YJ, Chung CY, Hwang JM (2016) Ocular findings in patients with spastic type cerebral palsy. BMC Ophthalmol 16(1):195

    Article  Google Scholar 

  • Pennefather PM, Tin W (2000) Ocular abnormalities associated with cerebral palsy after preterm birth. Eye (Lond) 14(Pt 1):78–81

    Article  Google Scholar 

  • Philip SS, Dutton GN (2014) Identifying and characterizing cerebral visual impairment in children: a review. Clin Exp Optom 97(3):196–208. https://doi.org/10.1111/cxo.12155

    Article  PubMed  Google Scholar 

  • Poltavski DV, Biberdorf D, Petros TV (2012) Accommodative response and cortical activity during sustained attention. Vis Res 63:1–8

    Article  Google Scholar 

  • Press LJ (1982) STYCAR ball acuity in relation to contrast and blur. Am J Optom Physiol Optic 59(2):128–134

    Article  CAS  Google Scholar 

  • Preston KL, McDonald M, Sebris SL, Dobson V, Teller DY (1987) Validation of the acuity card procedure for assessment of infants with ocular disorders. Ophthalmology 94(6):644–653

    Article  CAS  Google Scholar 

  • Roch-Levecq AC, Brody BL, Thomas RG, Brown SI (2008) Ametropia, preschoolers’ cognitive abilities, and effects of spectacle correction. Arch Ophthalmol 126(2):252–258

    Article  Google Scholar 

  • Salati R, Borgatti R, Giammari G, Jacobson L (2002) Oculomotor dysfunction in cerebral visual impairment following perinatal hypoxia. Dev Med Child Neurol 44(8):542–550

    Article  Google Scholar 

  • Sasmal NK, Maiti P, Mandal R, Das D, Sarkar S, Sarkar P, Biswas MC, Dey AK, Chatterjee S (2011) Ocular manifestations in children with cerebral palsy. J Indian Med Assoc 109(5):318 323

    PubMed  Google Scholar 

  • Saunders KJ, Little JA, McClelland JF, Jackson AJ (2010) Profile of refractive errors in cerebral palsy: impact of severity of motor impairment (GMFCS) and CP subtype on refractive outcome. Invest Ophthalmol Vis Sci 51(6):2885–2890. https://doi.org/10.1167/iovs.09-4670

    Article  PubMed  Google Scholar 

  • Scheiman MM (1984) Optometric findings in children with cerebral palsy. Am J Optom Physiol Optic 61(5):321–323

    Article  CAS  Google Scholar 

  • Simons K (2004) Hyperopia, accommodative dysfunction and reading. Binocul Vis Strabismus Q 19(2):69–70

    PubMed  Google Scholar 

  • Sobrado P, Suárez J, García-Sánchez FA, Usón E (1999) Refractive errors in children with cerebral palsy, psychomotor retardation, and other non-cerebral palsy neuromotor disabilities. Dev Med Child Neurol 41(6):396–403

    Article  CAS  Google Scholar 

  • Stiers P, Vanderkelen R, Vanneste G, Coene S, De Rammelaere M, Vandenbussche E (2002) Visual-perceptual impairment in a random sample of children with cerebral palsy. Dev Med Child Neurol 44(6):370–382

    Article  Google Scholar 

  • VIP-HIP Study Group, Kulp MT, Ciner E, Maguire M, Moore B, Pentimonti J, Pistilli M, Cyert L, Candy TR, Quinn G, Ying GS (2016) Uncorrected hyperopia and preschool early literacy: results of the vision in preschoolers-hyperopia in preschoolers (VIP-HIP) study. Ophthalmology 123(4):681–689. https://doi.org/10.1016/j.ophtha.2015.11.023

    Article  Google Scholar 

  • Westall CA, Ainsworth JR, Buncic JR (2000) Which ocular and neurologic conditions cause disparate results in visual acuity scores recorded with visually evoked potential and teller acuity cards? J AAPOS 4(5):295–301

    Article  CAS  Google Scholar 

  • Woo SJ, Ahn J, Park MS, Lee KM, Gwon DK, Hwang JM, Chung CY (2011) Ocular findings in cerebral palsy patients undergoing orthopedic surgery. Optom Vis Sci 88(12):1520–1523. https://doi.org/10.1097/OPX.0b013e3182346711

    Article  PubMed  Google Scholar 

  • Zambone A, Ciner EB, Appel GM (2000) Children with multiple impairments. In: Silverstone B, Llang M, Rosenthal B, Faye E (eds) Interaction of vision impairments with other disabilities and sensory impairments. The lighthouse handbook on vision impairment & rehabilitation. Oxford University Press, New York, pp 451–468

    Google Scholar 

Further Readings

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elise Ciner .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Ciner, E., Appel, S., Graboyes, M., Kenny, E. (2018). Testing Visual Function and Visual Evaluation Outcomes in the Child with Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-50592-3_76-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-50592-3_76-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50592-3

  • Online ISBN: 978-3-319-50592-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics