CVI and Cerebral Palsy Explained

WhaT is CVI

Cerebral Visual Impairment (CVI) also known as Cortical or Central Visual Impairment is a neurological, brain-based vision condition. It occurs when the visual pathways or processing areas in the brain are damaged or not functioning properly. As a result, even if the eyes are healthy, the brain has difficulty interpreting visual information.  

CVI can be present at birth or develop after an illness, injury, or medical event that affects the brain, such as a lack of oxygen, infection or trauma. It may also occur along with other eye conditions. CVI is now recognized as the leading cause of childhood blindness and low vision in industrialized countries.  

Individuals with CVI may experience difficulties with visual attention (focusing on what they want to look at) and visual recognition (understanding what they see). Some people describe the visual world as confusing, cluttered, or hard to interpret. Vision can also fluctuate—lighting, noise, fatigue, or crowded environments can significantly impact how well a person can use their vision at any given time.
 

Statistics and research about CVI and Cerebral Palsy

Many people with CVI also have cerebral palsy (CP). In fact, 65 percent of kids with CVI also have CP. 

CP is the most common lifelong motor disability. It affects muscle tone, posture, and movement as a result of damage to an infant's developing brain, though it can also be congenital. Symptoms can change with growth and development; CP doesn’t get worse over time.

Overall, children with CP have higher rates of vision impairment than children without it. One recent study examined 419 children with CP; in that group, 66.5 percent had some degree of vision impairment, and 11 percent had severe visual impairment. Multiple research studies show that 60-70% of kids with CP also have CVI. 

How CVI and Cerebral Palsy overlap

CP is a movement disorder, and vision is a crucial part of movement. Visual impairment can have a significant effect on motor development and skills, such as sitting, crawling, and walking. Many people with CVI have difficulty with visual-motor skills, such as reaching while maintaining visual fixation on an item or navigating changes in depth. 

Kids with both CP and CVI develop self-care, mobility, and social function skills more slowly than children with CP without CVI. Kids with more severe CP may also have a greater reduction in visual acuity (sharpness or clarity).

Does My Child With CP also have CVI?

Because young children with CP show more signs of CVI compared with older ones, early detection is essential.

Here are specific signs to look for with respect to visual skills if you suspect CVI:

Your child might:

• Have trouble looking at and orienting to something pointed out at a distance
• Notice something only when it moves or only seems interested in objects that move
• Be overly attentive to light sources (lamps, overhead lights, windows)
• Get close to objects, TV, or an item in their environment in order to see it
• Tilt their head or move their body in a certain position when looking at something
• Only notice or pay attention to objects close by or in front of them
• Not seem interested in new toys or objects
• Rely on their touch or hearing to find an object
• Have difficulty reaching while maintaining visual fixation on an object
• Have more trouble with visual motor skills when there’s more visual clutter, noise, or in an unfamiliar environment
• Have difficulty using vision when in an unsupported position
• Have trouble finding things that aren’t in a predictable place
• Have trouble finding an item on a cluttered surface or in a bin with other items
• Miss things in certain visual fields (right, left, lower, upper)
• Need verbal directions and cues to find something
• Have a hard time recognizing pictures and images
• Mistake people who have similar attributes (hair, glasses, gait)
• Only recognize someone when they speak
• Have trouble recognizing themselves or familiar people in photos
• Get overwhelmed, upset, or have meltdowns in new, loud, or busy places
• Get easily overwhelmed when there are too many things to look at\
• Choose to hold their head down, not looking as a result
• Appear to have a short attention span or be disinterested in learning tasks

Learn more about how CVI affects skill development beyond vision. 

If your child with CP displays these behaviors, it’s important to consider CVI. Often, a CP diagnosis can mask a CVI diagnosis, but they frequently co-exist. CVI remains poorly understood, but we’re working hard to change that through education and advocacy.

Learn more about When to Suspect CVI.

Educational tools and access for kids with CVI and CP

Children with CVI and CP can learn in the right environment. Access is everything! Kids with CVI and CP need:

1. Thorough CVI assessments to be understood as a learner with a dual-diagnosis. Learn more about CVI assessments.
2. A team approach to ensure the best learning environment possible, with educators who understand your child’s unique profile and needs. Learn more about how to advocate for a team approach to CVI.
3. Access to multisensory learning, emphasizing autonomy and choice. A multisensory approach incorporates different sensory channels into the learning process—auditory, tactile, visual, kinesthetic (movement), olfactory (smell), and taste. Learn more about how to incorporate this into your child’s classroom.
4. Special attention to Orientation and Mobility. O&M provides people who have visual and motor impairments with the mental and physical skills they need to navigate from point A to point B and to maneuver in familiar and unfamiliar spaces efficiently, safely, and independently.

In particular, understanding visual guidance of the upper and lower limbs can help caregivers better understand both the motoric challenges of CP and the visual challenges related to CVI. 

O&M can help kids with CVI and CP:

• Understand position in relation to other people, objects, or landmarks
• Identify body parts of themselves and others, and learn how they move
• Evaluate elements of an environment, like doors, stairs, and hallways
• Practice self-advocacy in social situations
• Learn more about the importance of O&M for incidental learning, advocacy, and independence.