|Year : 2022 | Volume
| Issue : 2 | Page : 528-530
Effects of early intervention in a child with cerebral palsy and cerebral/cortical visual impairment: A case study
Karthik Bhushan1, Beula Christy1, Vivian Manohar2
1 Institute for Vision Rehabilitation, LV Prasad Eye Institute, Hyderabad, Telangana, India
2 Social Innovation Fellow, BIRAC-SPARSH Program, IKP Knowledge Park, Hyderabad, Telangana, India
|Date of Submission||17-Aug-2021|
|Date of Acceptance||24-Sep-2021|
|Date of Web Publication||13-Apr-2022|
Head of the Department, Institute for Vision Rehabilitation, L. V. Prasad Eye Institute, Hyderabad - 500 034, Telangana
Source of Support: None, Conflict of Interest: None
Cerebral (CVI)/cortical visual impairment is a decrease in the visual response due to damage or malfunction of the visual processing centers in the brain. While on the other hand, cerebral palsy (CP) is a permanent, nonprogressive disorder of movement and posture due to lesion of the infant's brain. This article presents a case study of a child with CP and CVI, and the strategies adopted in the Early Intervention program to that would work on the neuroplasticity. This in turn has demonstrated the improvement in the functional mobility, and the overall independence of the child.
Keywords: Cerebral palsy, cerebral/cortical visual impairment, early intervention, neuroplasticity
|How to cite this article:|
Bhushan K, Christy B, Manohar V. Effects of early intervention in a child with cerebral palsy and cerebral/cortical visual impairment: A case study. Indian J Ophthalmol Case Rep 2022;2:528-30
|How to cite this URL:|
Bhushan K, Christy B, Manohar V. Effects of early intervention in a child with cerebral palsy and cerebral/cortical visual impairment: A case study. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 19];2:528-30. Available from: https://www.ijoreports.in/text.asp?2022/2/2/528/342917
Cerebral visual impairment (CVI) is a decrease in the visual response due to damage or malfunction of the visual pathways and visual processing centers in the brain. Cerebral palsy (CP) is a permanent, nonprogressive disorder of movement and posture, and a range of cognitive and sensory dysfunctions due to a lesion of the fetal brain., CVI is a commonly associated condition of CP, about 60–70% of children have both with other associated conditions that needs intervention. Vision impairment causes delay in development which can be prevented through cross-modal plasticity of the brain if intervened in early years.
| Case Report|| |
One-year-old male child having an inward deviation of both the eyes since birth and delay in developmental areas was identified through a community screening program and provided rehabilitation intervention in a center of excellence.
The patient was born at full-term through Caesarean section. Presented immediate birth cry, but developed jaundice on the third day. On the fifth day, seizure was noticed along with dengue encephalopathy; hence, it was in NICU with ventilation for 25 days. On the first visit at the age of 1 year, the child's visual acuity was limited to fixing and following objects, recognize familiar faces at a 0.5-m distance. The clinical diagnosis was compound hypermetropic astigmatism and partial optic atrophy in both the eyes, along with esotropia. Magnetic resonance imaging of the brain was suggestive of hypoxic ischemic encephalopathy (HIE) – severe cerebral atrophy, pons and midbrain atrophy with ventriculomegaly, and dengue encephalopathy with status epilepticus with a component of HIE, resulting in CVI and diplegic spastic CP.
The initial assessment and observation made by the rehabilitation professionals confirmed the presence of developmental delay in the areas of vision, motor, speech and cognition [Table 1]. Between 2013 and 2020, the child was intervened at the center by the interdisciplinary team. The individualized rehabilitation plan was reviewed every quarter, and assessments and goal settings were followed-up regularly [Table 2].
|Table 1: Summary of the observations made of the child during pre- and postassessment|
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Through a period of 7 years, the child demonstrated improvements in all areas of development, including visual tracking and postural stability. The child had developed a crouch posture, which required him to undergo the selective dorsal rhizotomy procedure to improve his crouch gait. With regular physiotherapy and with assistance on knee ankle–foot orthotics, now the child is able to walk with occasional physical support.
| Discussion|| |
CP and CVI are comorbid conditions occurring due to neurological damage. Currently, either of the conditions does not have any medication or well-established surgeries. This case study demonstrated the potential of a well-structured intervention program addressing the progress in development. The detailed follow-up indicates the progress achieved over a period of time. This study highlights the importance of appropriate and timely intervention through a comprehensive approach that includes early identification, assessment, planning, provision of services, and monitoring and evaluation in helping these children achieve their full potential.
| Conclusion|| |
This case study provides evidence for gains from EIP in a wide range of skills. Besides enhancing children's developmental competencies and minimizing secondary complications, EIPs can also promote confidence and competence among parents of such children.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]