Visual disorders in children with cerebral palsy: the implications for rehabilitation programs and school work

Damage to the brain is the most common cause of visual impairment in children in the developed world, and many children with cerebral palsy are affected. The severity varies. Profound visual impairment results from bilateral occipital lobe damage. Visual acuities are frequently impaired but may be within the normal range. Accommodation is commonly impaired and requires appropriate correction. Limitation of the visual fields includes hemianopia due to unilateral damage, and lower visual field impairment due to periventricular white matter pathology. Perceptual visual dysfunction includes impaired visual guidance of movement (optic ataxia), associated with impaired visual search and attention, (due to posterior parietal / dorsal stream dysfunction) and impaired recognition and orientation (due to temporal lobe / ventral stream dysfunction). Impairment of eye movements may also contribute to the clinical picture. Structured evaluation of all aspects of visual function, matched to each child’s condition and construction of an optimal management plan, (which can be understood and implemented by everyone looking after and teaching the child), is needed to ensure that no child with cerebral palsy is inappropriately disadvantaged on account of their additional cerebral visual impairment.