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Use of eye-pointing by children with cerebral palsy: what are we looking at?
Jenefer Sargent1, Michael Clarke, Katie Price
1Wolfson Neurodisability Service, Great Ormond St Hospital NHS Foundation Trust, London, UK.
Insights
Children with cerebral palsy can use eye-pointing as an alternative communication method. This study defines eye-pointing for non-speaking children with cerebral palsy, aiding communication development.
Area of Science:
- Pediatric communication disorders
- Augmentative and Alternative Communication (AAC)
- Child neurology and developmental disabilities
Background:
- Children with cerebral palsy often experience severe speech and motor impairments, limiting traditional communication methods.
- Controlled gaze, or 'eye-pointing,' offers a vital communication channel for these children, enabling requests and interaction.
- Clinical understanding and standardized recognition of 'eye-pointing' remain unclear, impacting its effective use.
Purpose of the Study:
- To establish a clear clinical definition of 'eye-pointing' for children with severe cerebral palsy who have limited speech and motor control.
- To contextualize 'eye-pointing' within the broader framework of communication development and the significance of gaze.
- To address the lack of established clinical guidance for recognizing and utilizing eye-pointing in this population.
Main Methods:
- Analysis of cumulative clinical observations from a specialist multidisciplinary communication clinic.
- Discussion among authors regarding the appropriate use and recognition of 'eye-pointing' in young children with severe cerebral palsy.
- Literature search to determine the established use and meaning of 'eye-pointing' in scientific literature.
Main Results:
- The term 'eye-pointing' is inconsistently defined and applied in the literature, particularly for individuals using augmentative and alternative communication (AAC).
- No universally applicable clinical description for 'eye-pointing' exists for children with severe motor impairments.
- Guidance is lacking on distinguishing intentional eye-pointing from other forms of directed gaze in developing communicators.
Conclusions:
- Effective use of eye-gaze for communication requires careful observation and interpretation of multiple factors, informed by the child's overall communication skills.
- A proposed clinical description of eye-pointing for children with severe cerebral palsy is offered to support communication development.
- This work aims to provide practical benefits for clinicians and caregivers supporting non-speaking children with cerebral palsy.
Background:
Children with cerebral palsy often show significant communication impairment due to limited or absent speech. Further, motor impairment can restrict the use of movement, including pointing, to signal interest and intent. For some children, controlled gaze can be an effective 'point-substitute': such 'eye-pointing' can be used to request items, establish mutual interest in an event, or select vocabulary within an alternative or augmentative communication (ACC) system. However, in clinical practice there is a lack of clarity about how the term 'eye-pointing' is used, how 'eye-pointing' is recognized or how it relates to social development.
Aims:
To present a clinical description of the term 'eye-pointing' with reference to children with severe cerebral palsy who cannot speak or finger-point. To consider this description within a wider discussion of the importance of gaze in communication development.
Methods & Procedures:
Cumulative clinical observations during assessment of children referred to a specialist multidisciplinary communication clinic have provoked discussion between the authors on what factors precipitate use of the term 'eye-pointing' in young children with severe cerebral palsy. In particular, discussion has centred on whether use of the term is appropriate in individual cases and whether guidance is available about how gaze should be observed in this developmentally vulnerable group of children. A literature search was also conducted in order to explore whether the use and meaning of the term is established.
Conclusions & Implications:
In interactions with non-speaking children, determining whether a child is using eye-gaze communicatively requires observation and interpretation of several factors. These processes will be informed by reflection on what is known about other aspects of the child's communication and interaction skills. Within the literature, the term 'eye-pointing' is sometimes used when describing the communication functions of individuals using augmentative and alternative communication (AAC) systems, and is occasionally qualified by a definition. No papers have been found that set out a clinical description universally applicable to children with severe motor impairment. Moreover, guidance is lacking on how possible episodes of 'eye-pointing' might be confidently distinguished from other episodes of directed gaze in young, developing communicators. The discussion of the term makes reference to the importance of gaze in early communication development, and explores factors that might influence gaze and its interpretation in young children with cerebral palsy. A description of eye-pointing for this group is offered. The authors suggest that this will bring practical benefits to those supporting the communication development of children with severe cerebral palsy.
