Age-Related Effects on the Spectrum of Cerebral Visual Impairment in Children With Cerebral Palsy
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Jessica Galli1,2, Erika Loi2,3, Anna Molinaro2
1Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Insights
Younger children with Cerebral Palsy (CP) exhibit more signs of Cerebral Visual Impairment (CVI) due to visual system maturation. Early neurovisual evaluation is recommended to detect visual function deficits in children with CP.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Developmental Neuroscience
Background:
- Cerebral Visual Impairment (CVI) is a common comorbidity in children with Cerebral Palsy (CP).
- Understanding the age-specific characteristics of CVI in children with CP is crucial for targeted interventions.
- This study investigates the neurovisual profiles of children with CP across different age groups.
Purpose of the Study:
- To characterize the neurovisual profiles of children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI).
- To analyze differences in CVI characteristics across three distinct age subgroups: infants (6 months-2 years), pre-schoolers (3-5 years), and school-aged children (≥6 years).
- To identify age-related patterns in visual function impairments in children with CP and CVI.
Main Methods:
- 180 children with CP and CVI were enrolled, categorized into three age subgroups.
- Evaluations included demographic and clinical data, neurological examination, cognitive assessment, and video-recorded visual function assessment.
- Specific assessments covered ophthalmological characteristics, oculomotor functions, basic visual functions, and cognitive-visual profiles in older children.
Main Results:
- CVI signs were present in all age groups, with younger children showing more frequent impairments in fixation, visual acuity, and contrast sensitivity.
- Older children had higher rates of myopia, while younger children exhibited more esotropia and saccade/smooth pursuit alterations.
- Multiple correspondence analysis confirmed distinct neurovisual profiles by age, with younger children displaying more CVI signs.
Conclusions:
- Younger children with CP demonstrate a higher prevalence of CVI signs, attributed to ongoing visual system maturation and neuroplasticity.
- These findings underscore the importance of early neurovisual assessments in children with CP to identify and address visual deficits promptly.
- Tailored interventions based on age-specific neurovisual profiles can potentially improve outcomes for children with CP and CVI.
Background:
Cerebral Visual Impairment (CVI) is a very common finding in children affected by Cerebral Palsy (CP). In this paper we studied the characteristics of CVI of a large group of children with CP and CVI, describing their neurovisual profiles according to three different age subgroups (subgroup 1: infants 6 months-2 years; subgroup 2: pre-school age 3-5 years; subgroup 3: school age ≥ 6 years).
Methods:
We enrolled 180 subjects (104 males, mean age 66 ± 42.6 months; range 6-192 months) with CP and CVI for the study. We carried out a demographic and clinical data collection, neurological examination, developmental or cognitive assessment, and a video-recorded visual function assessment including an evaluation of ophthalmological characteristics, oculomotor functions, and basic visual functions. In school-aged children, we also performed an evaluation of their cognitive-visual profiles.
Results:
There were signs of CVI in all the three subgroups. Subgroup 1 (62 children) and subgroup 2 (50 children) were different for fixation (p = 0.02), visual acuity (p = 0.03) and contrast sensitivity (p < 0.01), being more frequently impaired in younger children. Comparing subgroup 2 with subgroup 3 (68 children), the older children presented more frequently myopia (p = 0.02) while the younger ones esotropia (p = 0.02) and alteration in smooth pursuit (p = 0.03) and saccades (p < 0.01). Furthermore, fixation, smooth pursuit, visual acuity, contrast sensitivity and visual filed (p < 0.01) were more frequently impaired in younger children (subgroup 1) compared to the older ones. Multiple correspondence analysis (MCA) confirmed the different neurovisual profiles according to age: younger children with CP showed more signs of CVI compared to the older ones. 34 out of 68 children belonging to subgroup 3 underwent the cognitive visual evaluation; an impairment of cognitive visual skills was detected in 21 subjects.
Conclusion:
Younger children with CP showed more signs of CVI compared to the older ones, likely for the physiological maturation of visual system and mechanisms of neuroplasticity. In this direction, we suggest an early neurovisual evaluation to detect any weak visual functions.
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