Visual Perceptual Skills and Related School Functions in Children with Hemiplegic Cerebal Palsy

Article excerpt

Abstract

This study investigated differences in visual perception and visual-motor based school functions in children with and without congenital hemiplegia. Twenty children with hemiplegia (9 right; 11 left) and 37 control children ages 4-10 years were compared using the Developmental Test of Visual Perception, Motor-Free Visual Perceptual Test-Revised and School Function Assessment subtests (Using Materials, Written Work). Children with hemiplegia attained significantly lower scores than controls on all measures by one-way ANOVAs. Children with left hemiplegia scored significantly lower on motor-free visual tests. Regression analyses identified visual measures predictive of school performance. Results will assist school-based therapists working with this population.

Key words

Visual Perception, Cerebral Palsy, Occupational Therapy, School, Functional Skills.

Burtner, P.A., Dukeminier, A., Ben, L., Qualls, C., & Scott, K. Visual perceptual skills and related school functions in children with hemiplegic cerebral palsy. New Zealand Journal of Occupational Therapy 53(1), 24-29

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Occupational therapists are often the team members responsible for assessing the functional skills of children in the school setting. While therapists have long recognised the contributions of multiple systems (motor, cognitive, sensory, environmental) to daily occupations mastered by children, only recently have models of practice emphasised this functional approach (Law et. al, 1998). Likewise, researchers in movement sciences (Newell, 1991; Shumway-Cook & Woollacott, 2001) emphasise the study of development of perception, action and cognition less in isolation and more in the context of functional outcomes in the child's natural environment. In response to this contemporary view of disabilities, the World Health Organisation (2001) recently revised their guidelines in the International Classification of Functioning, Disability and Health (ICF) to highlight the activities and participation of individuals with disabilities in addition to levels of impairment. The ICF guidelines are also congruent with the inclusion of special populations of children in regular classrooms. Children with spastic hemiplegic cerebral palsy, one group qualifying for school therapy services, often demonstrate neurological differences in motor skills and visual perceptual skills that affect school performance not observed in typically developing peers. The aim of this research study was to identify visual perceptual and school functional differences in children with hemiplegic cerebral palsy as compared with typically developing children.

Review of literature

Cerebral palsy (CP) is a neurodevelopmental disorder caused by non-progressive lesions in single or multiple locations in the immature brain in utero, during or shortly after birth, resulting in motor impairment and often sensory deficits evident in early infancy (Scherzer & Tscharnuter, 1990). Within the diagnostic category of CP, an estimated 36.4% are children with spastic hemiplegia (Hagberg, Hagberg, Olow & von Wendt, 1989) and an estimated 40% of these children have accompanying cognitive and learning disabilities. A variety of vision abnormalities have also been identified in children with hemiplegia and the overall population of children with CP (Pellegrino, 2002).

Visual perceptual differences of children with spastic hemiplegia are of interest to researchers due to differences in hemisphere functions (left hemisphere typically processing verbal-language functions vs. right hemisphere processing non-verbal visual spatial functions). In children with congenital spastic hemiplegia, hemisphere processing has not been clear. Carlsson, Uvebrandt, Hugdahl, Arvidsson, Wiklund & von Wendt (1994) reported lower scores on tests of intellectual functioning in children with right or left hemiplegia, with performance scores (visual spatial functions) lower than verbal scores in both groups of children. …