Assessing functional vision skills for communication in children with severe cerebral palsy: findings from a practical structured history taking and assessment approach

Introduction: Children whose movements are restricted due to cerebral palsy experience activity limitations which reduce opportunities to learn through direct experience. Poor hand skills and bulbar involvement limit gesture and vocalisation, creating expressive communication difficulties. For such children, the use of vision is critical for sensory input (watching others’ actions partially compensates for limited experience), and for communication output (controlled gaze can act as a selection method [sometimes called eye-pointing] within augmentative communication systems.)

Patients and method: Our previous work has demonstrated that children’s use of gaze may be poorly described by parents and therapists, despite these observations being key to assessing communication. A structured history taking approach was therefore devised in order to elicit basic descriptions of the child’s looking skills, including fixation quality, fixation shifts ,and confidence in determining fixation target during choice-making. Functional visual assessment then followed. Of 124 children referred in a 2-year period to a specialist communication clinic, the 33 children reported as using eye-pointing, or referred with explicit questions about functional visual skills or the use of eye-gaze access technology, were assessed.

Results: Parents provided descriptive information about their child’s patterns of fixation. In 22/33 children assessment findings largely matched parental descriptions. However, in a notable proportion of these cases, clinical findings conflicted with skills reported by referring therapists.

Conclusion: In children with limited movement, a structured history yields descriptions of functional visual skills for communication which assessment can investigate. Such history taking could be a useful tool for the therapist.