Physical Therapy Management of a Patient with Cortical Visual Impairment to Improve Functional Mobility: A Case Report

Background: Cortical visual impairment (CVI) is the leading cause of visual impairment in developed countries. CVI is caused by any process that damages the central visual pathways in the brain, including stroke, seizure, hypoxia, hydrocephalus and other neurologic disorders. Individuals with CVI oftentimes have a normal eye exam, making early detection difficult. Purpose: The purpose of this case report is to present the multi-dimensional treatment approach to a patient with cortical visual impairment and abnormal gross motor development, as well as the challenges associated with evaluating progress. Case Description: The patient was a 5-year-old female with a medical diagnosis of paraventricular leukocytosis, resulting in cerebral palsy. During the case report period, the patient scored at level 4 on the Cortical Visual Impairment scale, meaning that she consistently responded to visual stimuli. The patient required hand-hold assist for ambulation, and maintained a crouched posture in standing. Interventions: Both visual tracking and ambulation training were utilized to improve the patient’s functional mobility and independence. Discussion: During the case reporting period, the patient demonstrated improvements in visual tracking, as well as postural stability in static stance and during ambulation. Multiple outcome measures were utilized, including the GMFM-88, PDMS-2, and a Functional Visual Evaluation. Due to the numerous confounding factors that play into a pediatric patient’s progress, it is difficult to produce a cause and effect relationship between outcome and intervention