Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Procedure
Parameter | Category | N (%) |
Sex | Male | 25 (49) |
Female | 26 (51) | |
Mean age (months) | 113.07 (range 62–213) ± 35.7 | |
Gestational age | Term | 4 (8) |
Late preterm (34–36 weeks) | 15 (29) | |
Moderate preterm (32–34 weeks) | 3 (6) | |
Very preterm (28–32 weeks) | 8 (16) | |
Extremely preterm (<28 weeks) | 17 (33) | |
Unknown | 4 (8) | |
GMFCS | Level I | 14 (27) |
Level II | 18 (35) | |
Level III | 15 (29) | |
Level IV | 3 (6) | |
Level V | 1 (2) | |
Neuroradiological findings ** | PVL (mild/severe) | 33 (65) |
Sequelae of IVH or periventricular haemorrhagic Infarction | 5 (10) | |
Combination of PVL and IVH sequelae | 1 (2) | |
Basal ganglia/thalamus lesions (mild/moderate/severe) | 1 (2) | |
Cortico-subcortical lesions only (watershed lesions in parasagittal distribution/multicystic encephalomalacia) not covered under C3 | 1 (2) | |
Arterial infarctions (middle cerebral artery/other) | 2 (4) | |
Miscellaneous | 2 (4) | |
Normal | 1 (2) | |
Unknown | 5 (10) | |
Neurological Picture | Unilateral cerebral palsy | 14 (27) * |
Bilateral cerebral palsy | 30 (59) * | |
Early CNS injury w/out neuromotor deficit | 7 (14) | |
Neurologic comorbidity (epileptic abnormalities) | Not reported | 44 (86) |
Reported | 7 (14) | |
Psychiatric comorbidity (anxiety, hyperactivity) | Not reported | 43 (84) |
Reported | 8 (16) | |
Neurological signs | Diplegia | 21 (41) |
Hemiplegia | 15 (29) | |
Tetraplegia | 8 (16) | |
Motor incoordination | 4 (8) | |
None | 3 (6) | |
Motor delay | Unknown | 6 (12) |
Not reported | 14 (27) | |
Reported | 31 (61) | |
Language delay | Unknown | 3 (6) |
Not reported | 36 (71) | |
Reported | 12 (24) | |
Type of therapy | No habilitation | 5 (10) |
Only physical therapy | 24 (52) | |
Physical and psychomotor | 7 (15) | |
Physical and speech therapy | 3 (7) | |
Physical, psychomotor, and speech therapy | 2 (4) | |
Psychomotor only | 7 (15) | |
Speech only | 2 (4) | |
Psychomotor and speech | 1 (2) |
- Best Corrected Visual Acuity (BCVA). All children in the sample were above 4 years of age (mean age: 113.07 months, SD: ±35.7; age range: 62–213 months), and their visual acuity was assessed using line tests (symbolic or literal optotypes, according to their age), both for near (40 cm) and far (3 m) distances. Recognition acuity was measured with the Snellen chart [33] or LEA vision test [34].
- Contrast Sensitivity (CS): the ability to detect an image’s photometric contrast and spatial frequency, evaluated with the LEA low contrast symbols test or Hiding Heidi [35], based on the age and level of cooperation of the patient.
- Fixation (F), indicated as the ability to maintain fixation on a target.
- Smooth Pursuit (SP), indicated as the ability to follow the trajectory of a slow-moving object both on a horizontal and vertical arc.
- Saccades (SC), indicated as rapid re-fixation eye movements.
- Extrinsic Ocular Motility (OM) indicated as extraocular movements.
- Cognitive assessment, with the following tests:
- ▪
- The Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) [36] or Wechsler Intelligence Scale for Children (WISC-IV) [37] were performed according to the age of the child. For the WISC-IV scale, we collected the following scores: (i) Verbal Comprehension Index (VCI); (ii) Perceptual Reasoning Index (PRI); (iii) Working Memory Index (WMI); (iv) Processing Speed Index (PSI); (v) (TIQ). For WPPSI-III scale, we collected the following scores: (i) Verbal Comprehension Index (VCI); (ii) Performance Index (PI); (iii) Processing Speed Index (PSI); (iv) Total Intelligence Quotient (TIQ); (v) General Language Index (GLI). Additionally, we included the weighted scores derived from each subtest.
- Cognitive visual assessment, with the following parameters:
- ▪
- The Developmental Test of Visual-Motor Integration (VMI) [38], performed along with its subtests, i.e., Visual Perception (VMI-V) and Motor Coordination (VMI-M), expressed in terms of percentile scores and categorized into normal (>16°P), frailty (5°–16°P), and deficient (<5°P);
- ▪
- The Developmental Test for Visual Perception (DTVP) [39]: General Visual-Perceptual (DTVP-GVP), Non-Motor Visual-Perceptual (DTVP-NMVP), and Visual-Motor Integration (DTVP-VMI) quotients were collected and categorized as normal (>16°P), frail (5°–16°P) and deficient (<5°P).
- Learning abilities, with the following parameters, categorized as normal or deficient based on the Z-score:
- ▪
- The Battery for Dyslexia and Developmental Dysorthography (DDE-2) [40], which is a commonly used Italian battery for the assessment of dyslexia and dysorthography. Specifically, the battery evaluates the ability to read and write both meaningful (DDE-MF) and non-meaningful (DDE-NMF) words by taking into account speed (VEL) and accuracy (ERR);
- ▪
- The MT-3 test [41], which is a currently used Italian instrument aimed to evaluate comprehension (MT-COMP), reading accuracy (MT-RCOR), and reading speed (MT-RVEL) by proposing tests appropriate to the patient’s level of education.
2.3. Data Analysis and Statistics
- −
- Effect size dz: 1.20;
- −
- α err. prob. = 0.05;
- −
- Power (1-β err. prob.) = 0.95.
3. Results
4. Discussion
4.1. Clinical, Visual Function and Neuropsychological Profiles
4.2. Relation between Visual Functions and Neuropsychological Profile
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Parameter | Category | N (%) |
---|---|---|
Near visual acuity | Normal (>7/10) | 32 (63) |
Near-normal (3–7/10) | 12 (32) | |
Mild low vision (2–3/10) | 2 (4) | |
Moderate low vision (1–2/10) | 1 (2) | |
Severe low vision (0.05–1/10) | 0 (0) | |
Partial blindness (<0.05/10) | 0 (0) | |
Blindness | 0 (0) | |
Missing data | 4 (8) | |
Far visual acuity | Normal (>7/10) | 29 (57) |
Near-normal (3–7/10) | 12 (33) | |
Mild low vision (2–3/10) | 3 (6) | |
Moderate low vision (1–2/10) | 2 (4) | |
Severe low vision (0.05–1/10) | 0 (0) | |
Partial blindness (<0.05/10) | 0 (0) | |
Blindness | 0 (0) | |
Missing data | 5 (10) | |
Contrast sensitivity | Normal | 33 (65) |
Altered | 15 (29) | |
Missing data | 3 (6) | |
Fixation | Normal (stable, durable, binocular) | 23 (45) |
Mildly altered (durable, but alternating or slight difference between the two eyes) | 21 (41) | |
Slightly instable and/or discontinuous | 6 (12) | |
Instable and/or discontinuous | 0 (0) | |
Fluctuating/eccentric | 0 (0) | |
Occasionally erratic | 0 (0) | |
Absent response | 0 (0) | |
Missing data | 1 (2) | |
Smooth Pursuit | Durable, complete, and binocular | 0 (0) |
Durable but incomplete/asymmetric/non binocular | 6 (12) | |
Slightly discontinuous in all or great parts of directions | 19 (37) | |
Clearly discontinuous/augmented latency | 22 (43) | |
Inconstant/eccentric/fragmented | 3 (6) | |
Only for small angle | 0 (0) | |
Absent/no response | 0 (0) | |
Missing information | 1 (2) | |
Saccades | Fluid, complete, normal latency, conjugacy and precision, no evident hypo- or hypermetria | 0 (0) |
Fluid but incomplete and/or asymmetric and/or not binocular | 4 (8) | |
Slight alteration (metria, fluidity, latency) | 15 (29) | |
Moderate alteration (metria, fluidity, latency) | 27 (53) | |
Severe alteration/difficult to elicit (metria, fluidity, latency) | 4 (8) | |
Absent/no response | 0 (0) | |
Missing information | 1 (2) | |
Extrinsic ocular motility | Normal | 24 (47) |
Hyperfunction/limitation | 19 (37) | |
Paralytic limitation | 6 (12) | |
Missing data | 2 (4) |
Cognitive Assessment | N (%) | |
---|---|---|
WPPSI-III | VCI | 9 (90) |
PI | 9 (90) | |
PSI | 4 (40) | |
TIQ | 8 (80) | |
GLI | 3 (30) | |
WISC-IV | VCI | 36 (87) |
PRI | 32 (78) | |
WMI | 37 (90) | |
PSI | 35 (85) | |
TIQ | 29 (71) |
Visuo-Cognitive Assessment | Category | N | |
---|---|---|---|
VMI 1 | VMI a | normal (>16°p) | 18 |
frailty (5°–16°p) | 4 | ||
deficit (<5°p) | 20 | ||
total | 42 | ||
VMI-V b | normal (>16°p) | 20 | |
frailty (5°–16°p) | 10 | ||
deficit (<5°p) | 11 | ||
total | 41 | ||
VMI-M c | normal (>16°p) | 10 | |
frailty (5°–16°p) | 9 | ||
deficit (<5°p) | 21 | ||
total | 40 | ||
DTVP 2 | DTVP-GVP a | normal (>16°p) | 14 |
frailty (5–16°p) | 6 | ||
deficit (<5°p) | 14 | ||
total | 34 | ||
DTVP-NMVP b | normal (>16°p) | 15 | |
frailty (5°–16°p) | 14 | ||
deficit (<5°p) | 12 | ||
total | 41 | ||
DTVP-VMI c | normal (>16°p) | 8 | |
frailty (5°–16°p) | 13 | ||
deficit (<5°p) | 13 | ||
total | 34 |
Leaning Abilities Assessment | Category | N | ||
---|---|---|---|---|
DDE-2 1 | MF a | VEL | normal | 18 |
deficit | 14 | |||
total | 32 | |||
ERR | normal | 26 | ||
deficit | 5 | |||
total | 31 | |||
NMF b | VEL | normal | 12 | |
deficit | 14 | |||
total | 26 | |||
ERR | normal | 22 | ||
deficit | 6 | |||
total | 28 | |||
MT-3 2 | COMP a | normal | 22 | |
deficit | 13 | |||
total | 35 | |||
RCOR b | normal | 21 | ||
deficit | 5 | |||
total | 26 | |||
RVEL c | normal | 16 | ||
deficit | 12 | |||
total | 28 |
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Morelli, F.; Aprile, G.; Martolini, C.; Ballante, E.; Olivier, L.; Ercolino, E.; Perotto, E.; Signorini, S. Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment. Children 2022, 9, 921. https://doi.org/10.3390/children9060921
Morelli F, Aprile G, Martolini C, Ballante E, Olivier L, Ercolino E, Perotto E, Signorini S. Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment. Children. 2022; 9(6):921. https://doi.org/10.3390/children9060921
Chicago/Turabian StyleMorelli, Federica, Giorgia Aprile, Chiara Martolini, Elena Ballante, Lucrezia Olivier, Elisa Ercolino, Eleonora Perotto, and Sabrina Signorini. 2022. "Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment" Children 9, no. 6: 921. https://doi.org/10.3390/children9060921