Visual, perceptual functions, and functional vision in children with unilateral cerebral palsy compared to children with neurotypical development

Abstract

AimTo investigate visual (perceptual) function and functional vision in children with unilateral cerebral palsy (CP) and children with neurotypical development (NTD).MethodFifty children with unilateral CP (mean age 11 years 11 months, SD 2 years 10 months, range 7–15 years; 27 males; 26 left‐sided unilateral CP; Manual Ability Classification System [MACS] levels: I, 27; II, 16; III, 7) and 50 age‐ and sex‐matched children with NTD participated in a cross‐sectional study. Visual acuity, stereoacuity, and visual–perceptual functions were measured with standardized clinical tests. Functional vision was assessed in children with unilateral CP with the Flemish cerebral visual impairment questionnaire (FCVIQ). Group differences were investigated with Mann–Whitney U tests, Kruskal–Wallis tests, and the relative effect sizes r, η2 respectively. Correlations between visual assessments and the FCVIQ were investigated with Spearman's rank correlations.ResultsThe total group of children with unilateral CP showed reduced visual acuity compared with children with NTD (p = 0.02, r = 0.23). Only children with left‐sided unilateral CP scored lower than those with NTD on stereoacuity (p < 0.01, r = 0.36). Children with right/left‐sided unilateral CP scored significantly lower than those with NTD on visual–perceptual functions (p = 0.001–0.02), with large effect sizes on visuomotor integration and visual closure (both r = 0.57). Children with unilateral CP classified in MACS level III showed significantly lower scores on visual–perceptual assessments than children classified in MACS level I. Stereoacuity and visual–perceptual functions negatively correlated with the FCVIQ, with the highest association with visual (dis)interest and anxiety‐related behaviours.InterpretationMulti‐level visual profiling is warranted in the clinical intake of children with unilateral CP to detect visual impairments that further compromise their level of functioning.

The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy

“…We could hypothesize that parents of children with uCP have the tendency to underestimate the presence of VI of their children due to the diagnosis of the motor impairments which are more prominent and visible in daily life. Nevertheless, no information on the direction (worse or better visual function reported by parents) can be inferred from our analysis and further research is warranted to further understand the speci city of the FCVIQ in detecting VI in children with uCP(Crotti et al, 2024).Overall regression models did not show a strong performance of visual functions and functional vision in predicting bimanual function. The Kinarm circuit task was the only model showing a large predictive performance.…”

“…Functional vision was assessed using the Flemish cerebral visual impairment questionnaire (FCVIQ) (Ortibus et al, 2011), a 46-item binary-response screening tool lled by the caregivers. Our previous ndings (Crotti et al, 2024) showed that children with uCP do not show large variability on the FCVIQ data when grouped into the ve factors described in the literature (Ben Itzhak et al, 2020). Furthermore, no signi cant difference was found between the ve FCVIQ factors between children with uCP with MACS-level I, II and III.…”

“…Stereoacuity was scored as the last correctly identi ed circle, with ordinal values ranging between 1 and 9. Information from the y subtest was retrieved if the child failed to identify the rst circle and scored as 0 if failed and 0.5 if successful (Crotti et al, 2024).…”

“…Motor-free visual-perceptual skills were assessed using ve subtests of the Test of Visual Perceptual Skills, Fourth Edition (TVPS-4) (Martin, 2017), namely visual discrimination, spatial relationships, form constancy, visual gureground, and visual closure. The visual memory and sequential memory subtests were not administered in our study since our aim was not to assess memory-related impairments (Crotti et al, 2024). According to the manual, TVPS-4 raw scores were translated into the age-equivalent scaled scores (mean = 10, SD = 3).…”

“…In children with uCP, motor di culties are mainly present in the upper limb, resulting in impairments in bimanual dexterity (Basu et al, 2018;Decraene et al, 2021) and coordination (Decraene et al, 2023;Mailleux et al, 2023;Rudisch et al, 2016). Besides motor problems, up to 62% of children with uCP show some degree of VI in the geniculostriate and/or visual-perceptual functions (Crotti et al, 2024). Impairments in visual functions may further compromise their motor performances (Bakke et al, 2019), especially those involving complex movements, such as bimanual dexterity (Wiesendanger & Serrien, 2001) and coordination (Swinnen & Gooijers, 2015).…”