Multidisciplinary assessment of vision in children with neurological disability.

INTRODUCTION: There is no consensus as to the best method of assessing vision in children with neurological disability. There are a variety of tests and approaches that can be used. It is important to look at models of assessment that identify the visual diagnosis and provide appropriate feedback and explanation to parents, carers and educational professionals. METHODS: This study reports on the results of comprehensive visual assessments of fifty children with neurological disability over a three year period. It focuses on the feedback from families and professionals after the assessment report was disseminated. RESULTS: The majority of families and professionals strongly agreed that a specialist assessment was needed in this population. Parents and professionals particularly valued the written report which provided guidance on appropriate visual material including advice relevant to education. CONCLUSION: This study highlights the importance of specialist teams engaging with local child development services and indicates how partnership working can potentially be emotionally supportive as well as developmentally beneficial.

Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study.

AIM: to report the prevalence, clinical associations, and trends over time of oromotor dysfunction and communication impairments in children with cerebral palsy (CP). METHOD: multiple sources of ascertainment were used and children followed up with a standardized assessment including motor speech problems, swallowing/chewing difficulties, excessive drooling, and communication impairments at age 5 years. RESULTS: a total of 1357 children born between 1980 and 2001 were studied (781 males, 576 females; median age 5y 11mo, interquartile range 3-9y; unilateral spastic CP, n=447; bilateral spastic CP, n=496; other, n=112; Gross Motor Function Classification System [GMFCS] level: I, 181; II, 563; III, 123; IV, 82; IV, 276). Of those with 'early-onset' CP (n=1268), 36% had motor speech problems, 21% had swallowing/chewing difficulties, 22% had excessive drooling, and 42% had communication impairments (excluding articulation defects). All impairments were significantly related to poorer gross motor function and intellectual impairment. In addition, motor speech problems were related to clinical subtype; swallowing/chewing problems and communication impairments to early mortality; and communication impairments to the presence of seizures. Of those with CP in GMFCS levels IV to V, a significant proportion showed a decline in the rate of motor speech impairment (p=0.008) and excessive drooling (p=0.009) over time. INTERPRETATION: these impairments are common in children with CP and are associated with poorer gross motor function and intellectual impairment.

The needs of children and young people with cerebral palsy.

Because cerebral palsy (CP) is a sufficiently common condition of childhood and adolescence, the number and needs of these children and young people with cerebral palsy are monitored by centres across the UK (Surman et al 2006) and Europe (Surveillance of Cerebral Palsy in Europe 2000). This article describes the epidemiology of CP in childhood using data derived from the Northern Ireland Cerebral Palsy Register, which is one of the longest running CP registers in Europe. The findings presented here are similar to, and representative of, the epidemiology of CP in the western world (Dolk et al 2006).

The changing visual profile of children attending a regional specialist school for the visually impaired in Northern Ireland.

AIM: To investigate the changing profile of children attending a special school for visually impaired children over a 30-year period. METHODS: Between 1975 and 2004, 266 children were identified as having been students in the introductory years to secondary education at Jordanstown School. School records and records from the Regional Paediatric Low Vision Clinic at the Royal Victoria Hospital, Belfast were examined to obtain data regarding age, primary ophthalmic diagnosis, visual acuity and any additional impairment. RESULTS: There was no statistically significant change in mean visual acuity of the children entering the secondary school over this period (p > 0.1). Albinism was the most common single condition (20.3%). Notable also was the reduction in incidence of visual impairment following congenital glaucoma and cataract and the corresponding increase in cortical visual impairment (CVI) during this period. CONCLUSION: During the last 30 years medical/surgical treatment has reduced the impact of treatable conditions (e.g. cataract) on visual impairment to the extent that their prevalence within this school has decreased. Consequently, children with non-treatable conditions (e.g. albinism) constitute a larger proportion of the school population. An increase in the proportion of children with CVI and learning disability in the school was noted.

Trends in the prevalence of cerebral palsy in Northern Ireland, 1981-1997.

We describe trends in the prevalence of cerebral palsy (CP) by birthweight group, and in the severity of motor impairments and presence of associated intellectual impairment, in Northern Ireland from 1981 to 1997 (n=909; 510 males, 399 females; total population 415,936 live births) using data from a population-based register of CP. Children with suspected CP or who died before 1 year of age and those with CP of postneonatal origin were excluded. Prevalence of CP was 2.2 per 1,000 live births without significant change over time. Among very-low-birthweight (<1,500 g) live births, prevalence was 44.5 per 1,000 (95% confidence interval 32.3-59.8) from 1994 to 1997, with evidence of a statistically significant decline in prevalence since the mid- to late 1980s accompanied by a decrease in the severity of motor impairment and likelihood of intellectual impairment. Among moderately-low-birthweight (1,500-2,499 g) children there was weaker evidence of a peak prevalence in the late 1980s. Prevalence among normal-birthweight infants did not change significantly, but outcome in terms of severity of motor impairment and intellectual impairment improved in the 1990s. Occurrence of bilateral spasticity from 1994 to 1997 was associated with greater severity and likelihood of intellectual impairment for normal-birthweight individuals than for low- or very-low-birthweight individuals.

Accommodative dysfunction in children with cerebral palsy: a population-based study.

PURPOSE: To determine the prevalence, nature, and degree of accommodative dysfunction among children with different types and severities of cerebral palsy (CP) in Northern Ireland. METHODS: Ninety subjects with CP (aged 4-15 years) were recruited through the Northern Ireland CP Register (NICPR). Modified Nott dynamic retinoscopy was used to measure lag and lead of accommodation at three test distances: 25 cm (4 D), 16.7 cm (6 D), and 10 cm (10 D) with the distance correction in place. Accommodative function was also assessed in an age-matched control group (n = 125) for comparison. Each subject's neurologic status was derived from the NICPR. RESULTS: Children with CP demonstrate significantly reduced accommodative responses compared with their neurologically normal peers. Of the subjects with CP, 57.6% demonstrated an accommodative lag outside normal limits at one or more distances. Reduced accommodative responses were significantly associated with more severe motor and intellectual impairments (ANOVA P = 0.001, P < 0.01, respectively). CONCLUSIONS: Brain injury such as that present in CP has a significant impact on accommodative function. These findings have implications for the optometric care of children with CP and inform our understanding of the impact of early brain injury on visual development.