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Visual Acuity and Visually-evoked Responses in Children with Cerebral Palsy: Gross Motor Function Classification Scale
  1. Fatema Ghasia (ghasiaf{at}vision.wustl.edu),
  2. Janice Brunstrom (brunstromj{at}neuro.wustl.edu),
  3. Lawrence Tychsen (tychsen{at}vision.wustl.edu)
  1. St. Louis Children's Hospital at Washington University Medical Center, United States
  2. St. Louis Children's Hospital at Washington University Medical Center, United States
  3. St. Louis Children's Hospital at Washington University Medical Center, United States

    Abstract

    Background/Aims: Measurement of visual acuity can be difficult in children with cerebral palsy (CP). The purpose of this study was to determine the probability of obtaining quantitative (logMAR) visual acuities in CP children with different severities of motor dysfunction.

    Methods: An observational, cross-sectional design study was conducted in 76 children (mean age 5.9 years) who had CP severity graded using the Gross Motor Function Classification Scale (GMFCS). Visual testing was performed using optotypes, spatial-sweep (SSVEP) or flash (FVEP) visually-evoked potentials.

    Results: LogMAR acuity was obtainable in 88% of CP children, using either optotypes or SSVEPs. The success rate decreased with increasing severity of GMFCS Levels 1-5; nevertheless, logMAR acuities were obtainable in more than one-half (56%) of children with the most severe disease: Level 5. Similar results were obtained for CP severity assessed using physiologic-anatomic subtype (hemiplegic; diplegic; quadriplegic) rather than GMFCS. Average logMAR acuity (0.37; 20/48) in the CP cohort as a whole was ~ 2 Snellen-equivalent lines worse than that recorded in age-matched, normal children (0.22; 20/33).

    Conclusion: Quantitative visual acuities can be obtained in the majority of CP children, including those with severe motor dysfunction. Difficulties in testing CP children lead often to the misconception that the children have immeasurably low vision.

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