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Frequency and severity of visual sensory and motor deficits in children with cerebral palsy: gross motor function
Fatema Ghasia1, Janice Brunstrom, Mae Gordon
1Department of Ophthalmology and Visual Sciences, St Louis Children's Hospital at Washington University Medical Center, St Louis, MO, USA.
Insights
Visual deficits in children with cerebral palsy (CP) correlate with severity. Higher Gross Motor Function Classification System (GMFCS) scores indicate greater risk of vision impairment, including myopia and optic neuropathy.
Area of Science:
- Neurology
- Ophthalmology
- Pediatrics
Background:
- Cerebral palsy (CP) is a nonprogressive brain disorder affecting movement and posture.
- Visual dysfunction is a common comorbidity in children with CP.
- The Gross Motor Function Classification System (GMFCS) stratifies CP severity.
Purpose of the Study:
- To investigate the relationship between CP severity (GMFCS levels) and the type/degree of visual dysfunction.
- To identify specific visual deficits associated with different GMFCS levels and CP subtypes.
Main Methods:
- Observational, cross-sectional study of 50 children with CP.
- Neurologic and masked ophthalmic examinations were performed.
- Participants' ages ranged from 2 to 19.5 years, with a mean gestational age of 31 weeks.
Main Results:
- Higher GMFCS scores correlated with increased likelihood of severe visual deficits.
- Children with GMFCS level 5 exhibited high myopia, absent binocular fusion, dyskinetic strabismus, gaze dysfunction, and optic neuropathy/cerebral visual impairment (CVI).
- Diplegic/spastic CP subtypes showed hyperopia and esotropia, while quadriplegic/mixed CP subtypes had higher rates of myopia and CVI.
Conclusions:
- Visual deficits vary significantly between mild and severe CP cases.
- GMFCS levels 1-2 present deficits similar to typical strabismus/amblyopia.
- GMFCS levels 3-5 are associated with more severe, atypical visual impairments.
Purpose:
Cerebral palsy (CP) is a permanent, nonprogressive disorder of movement and posture due to a lesion of the fetal or infant brain. The goal was to determine whether children with different severities of CP, as defined using the Gross Motor Function Classification System (GMFCS), had different degrees or types of visual dysfunction.
Methods:
An observational, cross-sectional-design study was conducted by using neurologic and masked ophthalmic measurements on a representative cohort of 50 children with CP. Mean age was 5.6 years (range, 2-19.5 years); mean gestational age was 31 weeks.
Results:
The likelihood of debilitating visual deficits was greater in children with higher GMFCS scores, independent of gestational age. Children with level 5 disease (most severe) were at greatest risk for high myopia, absence of binocular fusion, dyskinetic strabismus, severe gaze dysfunction, and optic neuropathy or cerebral visual impairment (CVI). These deficits were rare or absent in children with the mildest disease, level 1. When categorized by anatomic or physiologic CP subtype, diplegic and spastic children were more often hyperopic and esotropic, but had the highest prevalence of fusion and stereopsis. In contrast, children with quadriplegic and mixed CP (dyskinetic, athetoid, hypotonic, and ataxic) more often had high myopia, CVI, dyskinetic strabismus, and gaze dysfunction.
Conclusions:
Visual deficits differ in children who have mild versus severe CP. Children with GMFCS level 1 to 2 have sensorimotor deficits resembling those of neurologically normal children with strabismus and amblyopia; children at level 3 to 5 have more severe deficits, not observed in neurologically normal children.
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