The Gonda Multidisciplinary Brain Research Centre, Bar Ilan University, Ramat Gan, Israel.
Dev Med Child Neurol. 2011 May;53(5):422-8. doi: 10.1111/j.1469-8749.2010.03905.x. Epub 2011 Feb 11.
The aim of this study was to evaluate an interdisciplinary visual assessment for multiply challenged children diagnosed with cerebral palsy (CP).
A comprehensive ophthalmological assessment together with a visual classification scale (VCS) and a questionnaire evaluating daily visual function were completed regarding 77 children (41 females, 36 males; age range 3-20y; mean age 8 y 3 mo [SD 4 y 3 mo]; Gross Motor Function Classification System [GMFCS] level V; Manual Ability Classification System level V) who were diagnosed with CP (79.2% spastic quadriplegia, 6.5% athetoid quadriplegia, 10.4% mixed type, 3.9% hemiplegia). All participants had severe to profound motor and intellectual disability and an inability to communicate consistently through either verbal or assisted communication. The interrater and test-retest reliability of the questionnaire and its validity in comparison with the VCS were examined. In addition, the contribution of ophthalmological testing in predicting daily visual function was assessed.
The ophthalmological examination revealed three diagnostic subgroups: a group with cerebral visual impairment (CVI), a group with optic atrophy, and a group without visual impairment. The questionnaire was found to have high values of interrater reliability (interclass correlation coefficient [ICC]=0.873; 95% confidence interval [CI] 0.762-0.935) and test-retest reliability (ICC=0.988; 95% CI 0.964-0.996). Validity was established for the questionnaire factors: task-orientated visual function (r=0.802; 95% CI 0.669-0.885) and basic visual skills (r=0.691; 95% CI 0.504-0.816). The questionnaire provided information about daily visual performance not available from one-time ophthalmological testing, particularly for participants diagnosed with CVI. The visual performance scale significantly predicted daily visual function for all groups.
This study highlights the benefits of implementing a diagnostic performance scale as well as a reliable functional questionnaire to achieve a precise visual assessment of children with severe neurological impairment.
本研究旨在评估一种针对被诊断为脑瘫（CP）的多重障碍儿童的跨学科视觉评估方法。
对 77 名儿童（41 名女性，36 名男性；年龄 3-20 岁；平均年龄 8 岁 3 个月[SD 4 岁 3 个月]；粗大运动功能分类系统[GMFCS]水平 V；手动能力分类系统水平 V）进行了全面的眼科评估，包括视觉分类量表（VCS）和评估日常视觉功能的问卷，这些儿童均被诊断为 CP（79.2%痉挛性四肢瘫，6.5%手足徐动性四肢瘫，10.4%混合型，3.9%偏瘫）。所有参与者均存在严重至重度的运动和智力障碍，无法通过言语或辅助交流持续进行沟通。评估了问卷的组内和重测信度及其与 VCS 的有效性，并评估了眼科检查在预测日常视觉功能方面的作用。
眼科检查显示存在三个诊断亚组：一组存在脑瘫性视觉障碍（CVI），一组存在视神经萎缩，一组不存在视觉障碍。问卷具有很高的组内信度（组间相关系数[ICC]=0.873；95%置信区间[CI] 0.762-0.935）和重测信度（ICC=0.988；95% CI 0.964-0.996）。确定了问卷因素的有效性：任务导向的视觉功能（r=0.802；95% CI 0.669-0.885）和基本视觉技能（r=0.691；95% CI 0.504-0.816）。问卷提供了单次眼科检查无法获得的有关日常视觉表现的信息，尤其是对被诊断为 CVI 的参与者。视觉表现量表对所有组均能显著预测日常视觉功能。
本研究强调了实施诊断表现量表和可靠的功能问卷的好处，这有助于对严重神经功能障碍儿童进行精确的视觉评估。
