Pilling Rachel F, Allen Louise, Anketell Pamela, Bullaj Raimonda, Harwood Janet, Little Suzanne
University of Bradford, UK.
University of Liverpool, UK.
Br Ir Orthopt J. 2023 Jun 14;19(1):44-51. doi: 10.22599/bioj.290. eCollection 2023.
Cerebral visual impairment (CVI) is the most common cause of visual impairment in children in the UK. Diagnosis is based on identification of visual behaviours (ViBes) relating to visual dysfunction. Examination techniques and inventories have been developed to elicit these in children with a developmental age of two years or more. The absence of a structured approach to recording visual behaviours in children with complex needs is a barrier to diagnosis. The aim of the study was to develop a matrix of visual behaviours seen in pre-verbal and pre-motor children with visual impairment and establish its content validity and inter-rater reliability.
Visual behaviour descriptors relating to visual function were collated and categorised by expert consensus of vision professionals into a matrix composed of three functions (attention, field/fixation, motor response) and five levels (0 = no awareness; 1 = visual awareness; 2 = visual attention; 3 = visual detection; 4 = visual understanding). The participants (two orthoptists, an optometrist, an ophthalmologist and two qualified teachers of the visually impaired) used the ViBe matrix to independently score each of 17 short video clips of children demonstrating visual behaviours seen in CVI.
The ViBe matrix will be presented. Cohen's kappa for the matrix was 0.67, demonstrating moderate-to-strong inter-rater reliability.
The development of standardised descriptors can support clinicians and teachers in identifying areas of concern for children with complex needs. In addition, the ViBe matrix could be utilised in research, clinical and diagnostic reports to clearly communicate the areas of visual dysfunction and track progress resulting from interventions.
The absence of a structured approach to recording visual behaviours in children with complex needs is a barrier to diagnosis.The ViBe matrix offers descriptors relating to visual behaviours and has demonstrated acceptable inter-rater reliability.The tool may support the identification and diagnosis of cerebral visual impairment in a population of children who cannot access standard testing.
脑性视觉障碍（CVI）是英国儿童视力障碍最常见的原因。诊断基于对与视觉功能障碍相关的视觉行为（ViBes）的识别。已经开发了检查技术和清单来在发育年龄两岁或以上的儿童中引出这些行为。对于有复杂需求的儿童，缺乏记录视觉行为的结构化方法是诊断的一个障碍。本研究的目的是开发一个在有视力障碍的语言前和运动前儿童中观察到的视觉行为矩阵，并确定其内容效度和评分者间信度。
与视觉功能相关的视觉行为描述符由视力专业人员的专家共识整理和分类成一个由三个功能（注意力、视野/注视、运动反应）和五个水平（0 = 无意识；1 = 视觉意识；2 = 视觉注意力；3 = 视觉检测；4 = 视觉理解）组成的矩阵。参与者（两名斜视矫正师、一名验光师、一名眼科医生和两名合格的视障教师）使用ViBe矩阵独立地对17个展示CVI中观察到的视觉行为的儿童短视频片段进行评分。
将展示ViBe矩阵。该矩阵的科恩kappa系数为0.67，表明评分者间信度为中度到高度。
标准化描述符的开发可以支持临床医生和教师识别有复杂需求儿童的关注领域。此外，ViBe矩阵可用于研究、临床和诊断报告，以清楚地传达视觉功能障碍的领域并跟踪干预产生的进展。
对于有复杂需求的儿童，缺乏记录视觉行为的结构化方法是诊断的一个障碍。ViBe矩阵提供了与视觉行为相关的描述符，并已证明具有可接受的评分者间信度。该工具可能有助于在无法进行标准测试的儿童群体中识别和诊断脑性视觉障碍。
