Seeing the Unseen: The Neurodevelopmental Factors Related to Visual Impairments in Children With Unilateral Cerebral
Monica Crotti1, Nofar Ben Itzhak1, Lisa Mailleux2
1Department of Development and Regeneration, Locomotor and Neurological Disorders Group, KU Leuven, Leuven, Belgium; Child and Youth Institute, KU Leuven, Leuven, Belgium.
Insights
Brain damage and prematurity in children with unilateral cerebral palsy (uCP) are linked to specific visual impairments. Understanding these connections aids in targeted visual assessments and interventions for affected children.
Area of Science:
- Neuroscience
- Ophthalmology
- Developmental Pediatrics
Background:
- Visual impairments are common in children with unilateral cerebral palsy (uCP) but often overlooked.
- The relationship between brain damage, prematurity, cerebral palsy side, and visual deficits in uCP remains unclear.
Purpose of the Study:
- To investigate the association between brain damage characteristics and visual impairments in children with uCP.
- To explore the impact of prematurity and the side of cerebral palsy on visual function outcomes.
Main Methods:
- Assessed visual functions and functional vision in 41 children (7-15 years) with uCP.
- Utilized structural MRI to score brain damage (lesion timing, location, severity) and corpus callosum (CC) metrics.
- Employed nonparametric statistics and elastic-net regression models to analyze relationships and predictive factors.
Main Results:
- Damage to cerebral lobes and CC correlated with reduced visual functions (rs = -0.402 to -0.611).
- Preterm children exhibited reduced geniculostriate functions and parietal lobe damage compared to term-born peers.
- Shorter CC length and parietal lesions predicted impaired stereoacuity (AUC = 0.77); occipital lesions predicted impaired visuomotor integration (AUC = 0.81).
Conclusions:
- Specific brain damage patterns and prematurity are associated with distinct visual impairments in children with uCP.
- Findings can inform targeted visual assessments and interventions for children with uCP.
Background:
In children with unilateral cerebral palsy (uCP), the relation between different factors (brain damage, prematurity, and cerebral palsy side) and visual impairments, which are common but often 'unseen,' is not fully understood.
Methods:
Visual functions and functional vision were assessed in 41 children with uCP (7-15 years, 21 left-sided, 19 preterm). Brain damage was scored on structural magnetic resonance imaging regarding lesion timing, location, and severity, and corpus callosum (CC) length and splenium thickness. With nonparametric statistics, we investigated the relation between visual outcomes and brain damage (rs) and differences in visual outcomes and brain damage based on prematurity and uCP side (r). With elastic-net regularized regression models (area under the receiver operating characteristic curve [AUC]; d), we explored if gestational age and brain damage could predict impairments in visual functions.
Results:
Damage to the lobes and CC was associated with reduced visual functions and functional vision (rs = -0.402 to -0.611). Compared to children born at term, preterm children mainly showed reduced geniculostriate functions (r = 0.343-0.443) and damage to the parietal lobe (r = 0.353). No differences in brain damage were found between children with left- and right-sided uCP. In regression models, shorter CC length and parietal lobe lesion (d = -0.526 to 0.564) were the main predictors for impaired stereoacuity (AUC = 0.77), and occipital lobe lesion (d = 0.349) for impaired visuomotor integration (AUC = 0.81). Prediction models of visual perception showed poor predictive performance (AUC<0.70).
Conclusions:
Specific brain damage and prematurity are related to different visual impairments in children with uCP. Our results could guide clinicians in directing their attention to specific visual assessments and subsequent intervention in children with uCP.
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