Role of visual therapy in children with cerebral visual impairment

Completed

• Conditions: Newborn affected by complication of labor and delivery, unspecified,

• Registration Number: CTRI/2022/12/048114
• Lead Sponsor: No sponsor

Brief Summary

This study aims to study rehabilitative effectiveness of vision therapy in improving visual attention, visuo-perceptual, visuo-motor and visuo-cogntive behaviour in children with cerebral visual impairment by conducting a randomised controversy study where patients will be divided into two arms: one arm shall receive standard therapy and other would receive vision  therapy apart from standard management. Vision therapy will include home based tailored visual stimulation, visuo-motor, visuo-perceptual and cognitive tasks depending on child’s functional vision. Children with suspected CVI will be observed and proforma will be filled up with regard to their neuro-visual behaviours, characteristic findings, visual grade, oculomotility pattern, electrophysiological tests, fundus findings, imaging findings etc. All children will undergo detailed paediatric neurological evaluation. Imaging will be analysed by radiologists and scored. The rationale of the study is that home-based visual stimulation and rehabilitative strategies (tailored to the CVI inventory responses and examination findings) if explained to carers and carefully applied, can improve visual skills and neuro-visual behavior in children with cerebral visual impairment, thereby improving everyday visual functioning, participation, and quality of life as an ultimate goal.

Detailed Description

Not available

Study Timeline

• Study Start: 2022-12-18
• Last Update Posted: 2023-11-02

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• Inclusion criteria includes 1.
• patients with history and documentation of perinatal asphyxia, periventricular leukomalacia, hypoglycemia, perinatal infections, genetic, metabolic, hydrocephalus, or structural causes or 2.
• documented perinatal brain damage confirmed by a pediatric neurologist along with 3.
• MRI evidence of brain injury in a pattern typical of hypoxic-ischemic encephalopathy (HIE) including peri-ventricular leukomalacia (PVL) 4.
• problems in visual functioning (corroborated by results of functional vision assessment) or atypical neuro-visuo-behavior or visual perceptual or cognitive dysfunction on CVI inventory questionnaire and 5.
• confirmed on examination with at least 2 or more of the following: a) Deficit or impaired visual inattention, fixation, or inability to follow objects; b)Deficit visual guided reach or visual guidance of upper limbs (inability to reach out or hold a toy or difficulty in picking up a toy); c) Deficit visual communication/search/curiosity/ spatial orientation; d)Deficit visual processing like recognition of face/objects/facial expression or Difficulty with clutter.

Exclusion Criteria

•Children with pediatric cataracts, corneal pathologies, retinal pathologies, or dense amblyopia responsible for low vision •Retinopathy of prematurity of grade 4 or 5, and major ROP sequelae like falciform fold involving disc or macula nonresolving macular bleed, vitreous hemorrhage assessed by a paediatric ophthalmologist •Children with epileptic spasms, electroclinical epileptic encephalopathy, seizure frequency of more than one/month in the past 3 months or patients using anti-epileptic vigabatrin •Children with debilitating illnesses requiring immediate attention •Children whose caregivers refuse to participate in the study •Autistic children.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
6. improvement in visual perception including cognition, recognition	outcome will be assessed at the end of 1 year
Primary outcome is improvement in FUNCTIONAL VISION in terms of	outcome will be assessed at the end of 1 year
1. improvement in visual acuity,	outcome will be assessed at the end of 1 year
2. visual attention (attention span, reaction time and number of orienting responses),	outcome will be assessed at the end of 1 year
3. achieving steadiness of visual fixation,	outcome will be assessed at the end of 1 year
4. improvement in visual communication,	outcome will be assessed at the end of 1 year
5. improvement in visual guidance of limbs or visuomotor tasks	outcome will be assessed at the end of 1 year

Secondary Outcome Measures

Name	Time	Method
•Imaging findings and correlation of imaging findings with clinical findings	•pre and post electrophysiologic findings (Improvement in P100 latency)

Trial Locations

Locations (1)

Post Graduatye Institute of Medical Education and Research, Chandigarh; 🇮🇳 Chandigarh, CHANDIGARH, India

Post Graduatye Institute of Medical Education and Research, Chandigarh

🇮🇳Chandigarh, CHANDIGARH, India

Shweta Chaurasia

Principal investigator

01722756111

shweta84omns@yahoo.com