Visuoperceptual profiles of children using the Flemish cerebral visual impairment questionnaire.

AIM: To investigate the underlying factor structure of the 46-item Flemish cerebral visual impairment (CVI) questionnaire, differentiate the factor scores of children with and without CVI, and examine the impact of comorbidities on factor scores. METHOD: The records of 630 children (386 males, 244 females; median age 77mo; interquartile range 63-98mo) who visited the CVI clinic and the Centre for Developmental Disabilities at the University Hospitals of Leuven from 2001 to 2018 were reviewed systematically. Inclusion criteria included an up-to-date questionnaire, a definitive diagnosis, and clinical assessment. RESULTS: Three hundred and forty-five children (179 with CVI [108 males, 71 females; median age 74mo; interquartile range 61-93mo] and 166 without CVI [110 males, 56 females; median age 88mo; interquartile range 70-107mo]) were included. An exploratory factor analysis resulted in a 5-factor (object and face processing impairments; visual (dis)interest; clutter and distance viewing impairments; moving in space impairments; and anxiety-related behaviours) biologically and clinically plausible model, which retained 35 items and explained 56% of the total variance. Mann-Whitney U tests indicated that factors 1 to 4 were significantly higher in children with CVI compared to children without CVI (p-values ranged from p<0.001 to p<0.05; effect sizes ranged from 0.11 to 0.33); factor 5 showed no differences. Autism, developmental coordination disorder, epilepsy, and cerebral palsy impacted factor scores. INTERPRETATION: A 5-factor structure of the Flemish CVI questionnaire differentiates children with and without CVI. Comorbidities should be accounted for when researching CVI. WHAT THIS PAPER ADDS: Cerebral visual impairment (CVI) is characterized by impaired object and face processing and impaired visual interest. CVI is also characterized by impaired clutter and distance viewing, and impaired moving in space. All children (with or without CVI) demonstrated anxiety-related behaviours. Autism affected object/face processing, whereas developmental coordination disorder, epilepsy, and cerebral palsy affected visual interest.

Perfis visuoperceptuais de crianças usando o questionário Flemish de deficiência visual cerebral OBJETIVOS: Investigar a estrutura de fator do questionário Flemish de deficiência visual cerebral (DVC) com 46 itens, diferenciar os escores de fator de crianças com e sem DVC, e examinar o impacto de comorbidades nos escores de fator. MÉTODO: Os prontuários de 630 crianças (386 do sexo masculino, 244 do sexo feminino; idade mediana 77m; intervalo interquartil 63-98m;) que visitaram a clínica de DVC e o Centro para Desordens do Desenvolvimento nos Hospitais Universitários de Leuven de 2001 a 2018 foram sistematicamente revisados. Os critérios de inclusão foram um questionário atualizado, um diagnóstico definitivo, e uma avaliação clínica. RESULTADOS: Trezentas e quarenta e cinco crianças (179 com DVC [108 do sexo masculino, 71 do sexo feminino; idade mediana 74m; intervalo interquartil 61-93m] e 166 sem DVC [110 do sexo masculino, 56 do sexo feminino; idade mediana 88m; intervalo interquartil 70-107m]) foram incluídas. Uma análise exploratória de fator resultou em um modelo com 5 fatores (deficiências no processamento de objeto e face; (des)interesse visual; deficiências na visão de espaços abarrotados e distância; deficiências na movimentação no espaço; e comportamentos relacionados a ansiedade) biológica e clinicamente plausível, que reteve 35 itens e explicou 56% da variância total. Os testes U de Mann-Whitney indicaram que fatores de 1 a 4 foram significativamente mais altos nas crianças com DVC comparadas com aquelas sem (valores de p variaram de p<0,001 a p<0,05; os tamanhos de efeito variaram de 0,11 a 0,33); o fator 5 não mostrou diferenças. Autismo, transtorno do desenvolvimento da coordenação, epilepsia e paralisia cerebral impactaram os escores de fator. INTERPRETAÇÃO: Uma estrutura com 5 fatores do questionário Flemish para DVC diferencia crianças com e sem DVC. Comorbidades devem ser consideradas quando se pesquisar a DVC.

Perfis visuoperceptuais de crianças usando o questionário Flemish de deficiência visual cerebral OBJETIVOS: Investigar a estrutura de fator do questionário Flemish de deficiência visual cerebral (DVC) com 46 itens, diferenciar os escores de fator de crianças com e sem DVC, e examinar o impacto de comorbidades nos escores de fator. MÉTODO: Os prontuários de 630 crianças (386 do sexo masculino, 244 do sexo feminino; idade mediana 77m; intervalo interquartil 63-98m;) que visitaram a clínica de DVC e o Centro para Desordens do Desenvolvimento nos Hospitais Universitários de Leuven de 2001 a 2018 foram sistematicamente revisados. Os critérios de inclusão foram um questionário atualizado, um diagnóstico definitivo, e uma avaliação clínica. RESULTADOS: Trezentas e quarenta e cinco crianças (179 com DVC [108 do sexo masculino, 71 do sexo feminino; idade mediana 74m; intervalo interquartil 61-93m] e 166 sem DVC [110 do sexo masculino, 56 do sexo feminino; idade mediana 88m; intervalo interquartil 70-107m]) foram incluídas. Uma análise exploratória de fator resultou em um modelo com 5 fatores (deficiências no processamento de objeto e face; (des)interesse visual; deficiências na visão de espaços abarrotados e distância; deficiências na movimentação no espaço; e comportamentos relacionados a ansiedade) biológica e clinicamente plausível, que reteve 35 itens e explicou 56% da variância total. Os testes U de Mann-Whitney indicaram que fatores de 1 a 4 foram significativamente mais altos nas crianças com DVC comparadas com aquelas sem (valores de p variaram de p<0,001 a p<0,05; os tamanhos de efeito variaram de 0,11 a 0,33); o fator 5 não mostrou diferenças. Autismo, transtorno do desenvolvimento da coordenação, epilepsia e paralisia cerebral impactaram os escores de fator. INTERPRETAÇÃO: Uma estrutura com 5 fatores do questionário Flemish para DVC diferencia crianças com e sem DVC. Comorbidades devem ser consideradas quando se pesquisar a DVC.

The relation between neuroimaging and visual impairment in children and adolescents with cerebral palsy: A systematic review.

OBJECTIVE: The structure-function relation between magnetic resonance imaging (MRI) and visual impairment (VI) in children with cerebral palsy (CP) has not been fully unravelled. The present systematic review aims to summarize the relation between brain lesions on MRI and VI in children and adolescents with CP. METHODS: PubMed, Embase, Web of Science Core Collection, and Cochrane Database were systematically searched according to the PRISMA checklist. A total of 45 articles met the inclusion criteria. RESULTS: White matter lesions were most frequently associated with VI. Only 25 studies described lesions within specific structures, mainly in the optic radiations. Only four studies reported on the thalamus. 8.4% of children with CP showed no brain abnormalities on MRI. Diffusion-weighted MRI studies showed that decreased structural connectivity in the optic radiations, superior longitudinal fasciculus, posterior limb of the internal capsule, and occipital lobe is associated with more severe VI. CONCLUSIONS: All types of brain lesions lead to visual dysfunctions, arguing for a comprehensive visual assessment in all children with CP. Whereas white matter damage is a well-known contributor, the exact contribution of specific visual structures requires further investigation, to enable early prediction, detection, and intervention.

The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy.

BACKGROUND: Accurate visual information is needed to guide and perform efficient movements in daily life. AIMS: To investigate the relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy (uCP). METHODS AND PROCEDURES: In 49 children with uCP (7-15 y), we investigated the relation between stereoacuity (Titmus Stereo Fly test), visual perception (Test of Visual Perceptual Skills), visuomotor integration (Beery Buktenica Test of Visual-Motor Integration) and functional vision (Flemish cerebral visual impairment questionnaire) with bimanual dexterity (Tyneside Pegboard Test), bimanual coordination (Kinarm exoskeleton robot, Box opening task), and functional hand use (Children's Hand-use Experience Questionnaire; Assisting Hand Assessment) using correlations (rs) and elastic-net regularized regressions (d). OUTCOMES AND RESULTS: Visual perception correlated with bimanual coordination (rs=0.407-0.436) and functional hand use (rs=0.380-0.533). Stereoacuity (rs=-0.404), visual perception (rs=-0.391 to -0.620), and visuomotor integration (rs=-0.377) correlated with bimanual dexterity. Functional vision correlated with functional hand use (rs=-0.441 to -0.458). Visual perception predicted bimanual dexterity (d=0.001-0.315), bimanual coordination (d=0.004-0.176), and functional hand use (d=0.001-0.345), whereas functional vision mainly predicted functional hand use (d=0.001-0.201). CONCLUSIONS AND IMPLICATIONS: Visual functions and functional vision are related to bimanual function in children with uCP highlighting the importance of performing extensive visual assessment to better understand children's difficulties in performing bimanual tasks. WHAT THIS PAPER ADDS: Previous findings showed that up to 62 % of children with unilateral cerebral palsy (uCP) present with visual impairment, which can further compromise their motor performance. However, the relation between visual and motor function has hardly been investigated in this population. This study makes a significant contribution to the literature by comprehensively investigating the multi-level relation between the heterogenous spectrum of visual abilities and bimanual function in children with uCP. We found that mainly decreased visual perception was related to decreased bimanual dexterity, bimanual coordination, and functional hand use while impairments in functional vision were only related to decreased functional hand use. Additionally, elastic-net regression models showed that visual assessments can predict bimanual function in children with uCP, however, effect sizes were only tiny to small. With our study, we demonstrated a relation between visual functions and bimanual function in children with uCP. These findings suggest the relevance of thoroughly examining visual functions in children with uCP to identify the presence of visual impairments that may further compromise their bimanual function.

[Formula: see text] Quantifying visuoperceptual profiles of children with cerebral visual impairment.

The aim was to develop a visuoperceptual profile schema reflecting visuoperceptual strengths and weaknesses, using neuropsychological tests. Secondly, this schema was used to quantify individual visuoperceptual profiles of children with and without cerebral visual impairment (CVI), and to identify differences in their profiles. Clinical records (2001-2018) of 630 children (386 males, 244 females; median age 77 months; interquartile range 63-98 months) suspected for CVI were reviewed. Neurological history, visuoperceptual results, ophthalmological, and neuroimaging data were retrieved. To develop the visuoperceptual schema, exploratory factor analyses (EFAs) were performed, followed by a Delphi study. In individual interviews, six experts were asked to "name the different visuoperceptual dimensions" and "what visuoperceptual dimensions are targeted by each of the 24 visuoperceptual subtests." To reach consensus, two questionnaire rounds (44 statements and 20 statements, respectively, five experts) followed. EFAs showed clinically uninterpretable results. The Delphi study revealed seven visuoperceptual dimensions; (1) visual discrimination and matching, (2) object or picture recognition, (3) visual spatial perception, (4) figure-ground perception, (5) motion perception, (6) visual short-term memory, and (7) scene perception. The most discriminating dimensions between CVI and no CVI were object/picture recognition (r = 0.56), visual spatial perception (r = 0.52), visual discrimination and matching (r = 0.47), and figure-ground perception (r = 0.39). Motion perception and visual short-term memory (both r = 0.22) were less discriminating. Two case studies illustrate how to apply the visuoperceptual schema to characterize dysfunction and intact functions. Visuoperceptual profiling can serve as a basis for individualized therapies in heterogeneous disorders.