Visual assessment in children with cerebral palsy: implementation of a functional questionnaire


  • This article is commented on by Dutton on page 390 of this issue.

Naomi Ferziger at the Gonda Multidisciplinary Brain Research Centre Bar Ilan University, Ramat Gan, Israel. E-mail:


Aim  The aim of this study was to evaluate an interdisciplinary visual assessment for multiply challenged children diagnosed with cerebral palsy (CP).

Method  A comprehensive ophthalmological assessment together with a visual classification scale (VCS) and a questionnaire evaluating daily visual function were completed regarding 77 children (41 females, 36 males; age range 3–20y; mean age 8y 3mo [SD 4y 3mo]; Gross Motor Function Classification System [GMFCS] level V; Manual Ability Classification System level V) who were diagnosed with CP (79.2% spastic quadriplegia, 6.5% athetoid quadriplegia, 10.4% mixed type, 3.9% hemiplegia). All participants had severe to profound motor and intellectual disability and an inability to communicate consistently through either verbal or assisted communication. The interrater and test–retest reliability of the questionnaire and its validity in comparison with the VCS were examined. In addition, the contribution of ophthalmological testing in predicting daily visual function was assessed.

Results  The ophthalmological examination revealed three diagnostic subgroups: a group with cerebral visual impairment (CVI), a group with optic atrophy, and a group without visual impairment. The questionnaire was found to have high values of interrater reliability (interclass correlation coefficient [ICC]=0.873; 95% confidence interval [CI] 0.762–0.935) and test–retest reliability (ICC=0.988; 95% CI 0.964–0.996). Validity was established for the questionnaire factors: task-orientated visual function (r=0.802; 95% CI 0.669–0.885) and basic visual skills (r=0.691; 95% CI 0.504–0.816). The questionnaire provided information about daily visual performance not available from one-time ophthalmological testing, particularly for participants diagnosed with CVI. The visual performance scale significantly predicted daily visual function for all groups.

Interpretation  This study highlights the benefits of implementing a diagnostic performance scale as well as a reliable functional questionnaire to achieve a precise visual assessment of children with severe neurological impairment.