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Visual assessment in children with cerebral palsy: implementation of a functional questionnaire
Naomi B Ferziger1, Pinhas Nemet, Amichai Brezner
1The Gonda Multidisciplinary Brain Research Centre, Bar Ilan University, Ramat Gan, Israel. naomiferziger@gmail.com
Insights
A reliable functional questionnaire and diagnostic scale precisely assess visual function in children with cerebral palsy (CP). This interdisciplinary approach improves understanding of daily visual performance, especially for those with cerebral visual impairment (CVI).
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Children with cerebral palsy (CP) often have complex visual impairments.
- Accurate visual assessment is crucial for these multiply challenged children.
- Existing assessment methods may not fully capture daily visual function.
Purpose of the Study:
- To evaluate an interdisciplinary visual assessment for children with CP.
- To assess the reliability and validity of a functional questionnaire for daily visual function.
- To determine the contribution of ophthalmological testing in predicting visual performance.
Main Methods:
- A cohort of 77 children with CP (GMFCS V, MACS V) underwent comprehensive ophthalmological assessment.
- A visual classification scale (VCS) and a daily visual function questionnaire were utilized.
- Interrater and test-retest reliability, and validity of the questionnaire were examined.
Main Results:
- Ophthalmological examination identified subgroups with cerebral visual impairment (CVI), optic atrophy, or no visual impairment.
- The questionnaire demonstrated high interrater (ICC=0.873) and test-retest (ICC=0.988) reliability.
- Questionnaire validity was confirmed (task-orientated r=0.802, basic skills r=0.691), providing unique insights into daily visual performance, especially for CVI cases.
Conclusions:
- An interdisciplinary approach combining a diagnostic scale and a functional questionnaire is beneficial for precise visual assessment in neurologically impaired children.
- This integrated method enhances the understanding of daily visual function beyond standard ophthalmological testing.
- The findings support the implementation of such tools for improved visual care in children with severe neurological impairment.
Aim:
The aim of this study was to evaluate an interdisciplinary visual assessment for multiply challenged children diagnosed with cerebral palsy (CP).
Method:
A comprehensive ophthalmological assessment together with a visual classification scale (VCS) and a questionnaire evaluating daily visual function were completed regarding 77 children (41 females, 36 males; age range 3-20y; mean age 8 y 3 mo [SD 4 y 3 mo]; Gross Motor Function Classification System [GMFCS] level V; Manual Ability Classification System level V) who were diagnosed with CP (79.2% spastic quadriplegia, 6.5% athetoid quadriplegia, 10.4% mixed type, 3.9% hemiplegia). All participants had severe to profound motor and intellectual disability and an inability to communicate consistently through either verbal or assisted communication. The interrater and test-retest reliability of the questionnaire and its validity in comparison with the VCS were examined. In addition, the contribution of ophthalmological testing in predicting daily visual function was assessed.
Results:
The ophthalmological examination revealed three diagnostic subgroups: a group with cerebral visual impairment (CVI), a group with optic atrophy, and a group without visual impairment. The questionnaire was found to have high values of interrater reliability (interclass correlation coefficient [ICC]=0.873; 95% confidence interval [CI] 0.762-0.935) and test-retest reliability (ICC=0.988; 95% CI 0.964-0.996). Validity was established for the questionnaire factors: task-orientated visual function (r=0.802; 95% CI 0.669-0.885) and basic visual skills (r=0.691; 95% CI 0.504-0.816). The questionnaire provided information about daily visual performance not available from one-time ophthalmological testing, particularly for participants diagnosed with CVI. The visual performance scale significantly predicted daily visual function for all groups.
Interpretation:
This study highlights the benefits of implementing a diagnostic performance scale as well as a reliable functional questionnaire to achieve a precise visual assessment of children with severe neurological impairment.
