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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 528-530

Effects of early intervention in a child with cerebral palsy and cerebral/cortical visual impairment: A case study


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 Submission17-Aug-2021
Date of Acceptance24-Sep-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Beula Christy
Head of the Department, Institute for Vision Rehabilitation, L. V. Prasad Eye Institute, Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1976_21

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  Abstract 


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.[1] 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.[2],[3] CVI is a commonly associated condition of CP, about 60–70% of children have both[4] with other associated conditions that needs intervention.[5] Vision impairment causes delay in development which can be prevented through cross-modal plasticity of the brain if intervened in early years.[6]


  Case Report Top


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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Table 2: Summary of intervention provided and milestones achieved

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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 Top


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 Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.[11]



 
  References Top

1.
Dutton G. Impairment of vision due to damage to the brain. In: Lueck AH, Dutton GN, editors. Vision and the Brain: Understanding Cerebral Visual Impairment in Children. New York: AFB Press–American Foundation for the Blind; 2015.  Back to cited text no. 1
    
2.
Ospina LH. Cortical visual impairment. Pediatr Rev 2009;30:e81.  Back to cited text no. 2
    
3.
Katoch S, Devi A, Kulkarni P. Ocular defects in cerebral palsy. Indian J Ophthalmol 2007;55:154-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Fazzi E, Signorini SG, LA Piana R, Bertone C, Misefari W, Galli J, et al. Neuro-ophthalmological disorders in cerebral palsy: Ophthalmological, oculomotor, and visual aspects. Dev Med Child Neurol 2012;54:730-6.  Back to cited text no. 4
    
5.
Schenk-Rootlieb AJ, van Nieuwenhuizen O, van Waes PF, van der Graaf Y. Cerebral visual impairment in cerebral palsy: Relation to structural abnormalities of the cerebrum. Neuropediatrics 1994;25:68-72.  Back to cited text no. 5
    
6.
Collignon O, Voss P, Lassonde M, Lepore F. Cross-modal plasticity for the spatial processing of sounds in visually deprived subjects. Exp Brain Res 2009;192:343-58.  Back to cited text no. 6
    
7.
Baranello G, Signorini S, Tinelli F, Guzzetta A, Pagliano E, Rossi A, et al. Visual function classification system for children with cerebral palsy: Development and validation. Dev Med Child Neurol 2020;62:104-10.  Back to cited text no. 7
    
8.
Roman Lantzy C. Cortical Visual Impairment: An Approach to Assessment and Intervention. American Foundation for the Blind; 2007.  Back to cited text no. 8
    
9.
Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol 2008;50:744-50.  Back to cited text no. 9
    
10.
Bzoch KR, League R. Assessing Language Skills in Infancy: A Handbook for the Multidimensional Analysis of Emergent Language. Tree of Life Press; 1971.  Back to cited text no. 10
    
11.
Myreddi V, Narayan J, Saleem S, Sumalini K, Padma V. Functional Assessment Checklist for Programming of Students with Profound Mental Retardation (FACP-PMR). National Institute for the Mentally Handicapped; 2004.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2]



 

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