Manifestations of cerebral visual impairment in children with multiple disabilities

Uvod: Cerebralno oštećenje vida je neurološki poremećaj koji nastaje kao po- sledica lezije u beloj moždanoj masi. Smatra se najčešćim uzrokom oštećenja vida kod prevremeno rođene dece i dece s cerebralnom paralizom. Osim toga, medicinska stanja kod kojih se javlja ovaj tip oštećenja vida uključuju i periven- trikularnu leukomalaciju, hipoksičnu ishemičnu encefalopatiju, moždani udar, različite infekcije, strukturalne abnormalnosti, traume (npr. povrede glave), metaboličke poremećaje. Zbog kompleksne neurološke i neurooftalmološke etiologije, ovo stanje se često ne dijagnostikuje ili se dijagnostikuje pogrešno. Cilj: Na osnovu pregleda literature opisati karakteristike vizuelnog ponašanja koje se javlja kod višestruko ometene dece i koje može ukazati na prisustvo oštećenja vida usled neuroloških smetnji. Metod: Prikupljanje podataka je izvršeno pregledom dostupnih štampanih izvora, kao i elektronskih baza ERIC, JSTOR, Google Scholar, sa odgovrajućim ključnim rečima. Rezultati: Cerebralno oštećenje vida najčešće se manifestuje kao neuobičaje- no zurenje u izvor svetla i nedostatak vizuelnih refleksnih odgovora. Uočena je pojava preferencije posmatranja jednobojnih i/ili poznatih predmeta, pred- meta koji se kreću ili koji reflektuju svetlo, kao i nemogućnost prepoznavanja udaljenih predmeta. Latencija u davanju adekvatnog vizuomotornog odgovo- ra i ispadi u vidnom polju takođe mogu ukazati na prisutnost promena na nivou mozga. Složenost vizuelnog okruženja (zasićenost predmetima, bojama, šarama i sl.) ima upadljivo negativan uticaj na vizuelnu percepciju dece s više- strukim smetnjama. Vizuelna disfunkcija može biti različitog stepena – teška, umerena ili laka, ali je začajno istaći da ona ne predstavlja indikaciju detetovih kognitivnih sposobnosti. Zaključak: Bez obzira na stepen vizuelne disfunkcije, karakteristično je da vi- zuelno funkcionisanje fluktuira tokom dana u zavisnosti od sredinskih fakto- ra, doba dana, detetovog zdravstvenog stanja, terapije lekovima, što znatno otežava procenu. Iako vrlo složena, procena vizuelnog funkcionisanja dece s višestrukom ometenošću predstavlja temelj za kreiranje individualnih progra- ma intervencije. Stoga je izuzetno značajno poznavati karakteristike vizuelnog ponašanja koje koja ukazuju na ovo neurološko stanje.Introduction: Cerebral visual impairment is a neurological disorder that occurs as a consequence of a lesion in the white matter of the brain. It is considered to be the most common cause of visual impairment in premature babies and children with cerebral palsy. In addition to brain damage, medical conditions in which this type of impairment occurs include periventricular leukomalacia, hypoxic-ischemic encephalopathy, stroke, various infections, structural abnormalities, trauma (e.g. head injuries), and metabolic disorders. Due to the complex neurological and neuroophthalmological etiology, this condition is often undiagnosed or misdiagnosed. Aim: Based on the literature review, to describe characteristics of visual behavior which occur in children with multiple disabilities and which could indicate the presence of visual impairment due to neurological disorders. Method: Data was collected by reviewing available printed sources, as well as electronic databases ERIC, JSTOR, Google Scholar, with appropriate keywords. Results: Cerebral visual impairment is most often manifested as unusual staring at a light source and lack of visual reflex responses. The preference for observing monochromatic and/or known objects, moving or reflecting objects, as well as the inability of recognizing distant objects were noted. Latency in giving an adequate visuomotor response and visual field deficits may also indicate the presence of changes at the brain level. The complexity of the visual environment (saturation with objects, colors, patterns, etc.) has a noticeable negative impact on the visual perception of children with multiple disabilities. Visual dysfunction can be of varying degrees – severe, moderate or mild, but it is important to point out that it is not an indication of the child’s cognitive abilities. Conclusion: Regardless of the visual dysfunction degree, it is characteristic that visual functioning fluctuates during the day depending on environmental factors, part of the day child’s health condition, drug therapy, which significantly complicates the assessment. Although very complex, the assessment of the visual functioning of children with multiple disabilities is the foundation for creating individual intervention programs. Therefore, it is extremely important to know the characteristic of visual behavior that indicate this neurological condition