A multidisciplinary program for visually impaired children and youths

Observations on the Habilitation of Children with Cortical Visual Impairment

There is a radical difference between the visual habilitation of children with cortical visual impairment (CVI) and those with ocular visual loss. This article presents the experiences of a developmental psychologist, a child neurologist, and a teacher of the visually impaired who worked with CVI children for a number of years.

Intelligence Profiles of Low Vision and Blind Children

This article reports on an analysis of the WISC-R and WPPSI profiles of 118 visually impaired children without additional neurological problems. A consistent response pattern on the Wechsler batteries emerged, suggesting that the verbal as well as the performance tests can provide useful assessment information.

Neurodevelopmental Criteria in the Classification of Congenital Motor Nystagmus

Congenital motor nystagmus (CMN) can be familial or non-familial. The expressivity of CMN is so variable that in one affected member of the family the oscillations are obvious, while in the others the nystagmus could be overlooked even by the patients themselves. In spontaneous cases the proof of heredity might be discovered by an ophthalmological examination or eye movement recordings of other family members. Our multidisciplinary studies of 27 children with CMN suggests that a neurodevelopmental assessment can also be valuable in establishing a diagnosis of heredity. Our studies suggest that the hereditary form of CMN is free from neurodevelopmental problems, while the non-familial form is not. Therefore, children with spontaneous CMN could be referred for neurodevelopmental evaluation in order to establish a more accurate diagnosis.

Characteristics of a pediatric low-vision population

BACKGROUND

Assessment of the causes of childhood blindness is important to develop preventive and therapeutic strategies that can reduce the incidence of visual impairment.

METHODS

A retrospective survey of the clinical records of 395 consecutive children younger than 14 years of age who were attended by the Low Vision Service of State University of Campinas (UNICAMP) was conducted. Data on the age distribution, the causes of low vision, the types of low vision aids prescribed, the follow up of their use, and improvement in visual acuity were obtained.

RESULTS

Congenital bilateral toxoplasmic macular scars, optic atrophy, and congenital cataracts were the major causes of low vision in this population. The optical aid most frequently prescribed was a telescope. The improvement of visual acuity with the use of aids was highly significant.

Multidisciplinary teams and childhood visual impairment: a study of two teams

Multidisciplinary teams are generally viewed as beneficial in the management of the visually impaired child, yet little is known about them. Two teams were studied. Team A had well-defined functions relating to identification of visually impaired children, co-ordination of services and liaison. Team B had a more general aim of sharing information on a range of ophthalmic issues other than visual impairment. By comparing the two teams, we conclude that a multidisciplinary team is more likely to be effective if it draws its membership from a range of appropriate professions and its functions are focused. Benefits of teams include increased and earlier referral, improved interdisciplinary liaison and collaboration, and speedier and more appropriate implementation of services. Lack of time to participate, particularly by medical personnel, is a problem.

Eye-poking

Eye-poking, -rubbing and -pressing are often incorrectly grouped together because of the assumption that they represent variations of the same self-stimulating behaviour. This prospective study of 21 children shows that eye-poking is a distinct, chronic, stereotyped, self-injurious act seen mainly among severely mentally disabled individuals, who may or may not be visually impaired. Eye-poking, which leads to intense, self-induced pain, is a harmful behaviour because it can result in permanent visual loss and even in total blindness. The cause is unclear, although it is probably multifactorial. The treatment is exceedingly difficult. Further studies are needed to develop specific management techniques to prevent eye-poking, which adds to the physical and emotional burden on the caregivers.

Impact of cerebral visual impairment on the everyday life of cerebral palsied children

A group of 43 patients suffering from cerebral palsy and cerebral visual impairment was compared with a group of 24 cerebral palsy patients with normal visual acuity, with regard to a functional level in daily life. Four categories were considered: communication, emotional contact, self-care and intelligence. Cerebral visual impairment-cerebral palsy patients scored significantly lower in all categories than cerebral palsy patients with normal visual acuity. In the cerebral visual impairment-cerebral palsy group, there was a higher frequency of tetraplegia compared with the group with normal acuity, but even after this predominance had been excluded, a significant difference remained. When dealing with cerebral palsy patients, occurrence of cerebral visual impairment must be taken into account. By initiating intervention programmes, one can prevent extra handicaps due to the consequences of diminished visual acuity.

Photophobia and cortical visual impairment

Photophobia, or intolerance of light, is not completely understood as a symptom. It has been divided into ocular and central types. This study shows that persistent, usually mild, photophobia occurs in about one-third of children with cortical visual impairment (CVI). When the CVI is congenital the photophobia is present from birth, and when it is acquired the sensitivity to light appears immediately after the brain insult. The intensity of photophobia tends to diminish with time and occasionally it may even disappear. The pathophysiology is unclear, as in all other neurological disorders associated with photophobia.

Light-gazing by visually impaired children

This study assessed the prevalence and characteristics of light-gazing by all visually impaired children referred during a 2 1/2-year period. Light-gazing (compulsive staring into lights) is one of the many clinical signs of cortical visual impairment (CVI), and in the present study it occurred in 60 per cent of children with CVI. The authors believe that light-gazing by any child with ocular lesions indicates some degree of CNS involvement. Visually impaired children who flicker their fingers in front of their eyes against a light source demonstrate an extension of this compulsive behaviour. This and other studies suggest that blind mannerisms have specific neuropathological substrata and therefore are useful clinical signs.