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Background of the problem
Children with Cerebral Palsy and Hemiplegia or Spastic Diplegia have a very high incidence of visual and visual perceptive problems (Ego et al., 2015, Fazzi et al., 2012; Poggi et al., 2000). Children with these diagnoses who are ambulatory often have problems of postural control and balance. Multiple body systems influence balance abilities. Oculomotor and visual perceptive characteristics have not been studied clinically in conjunction with multidimensional balance testing as found on the Kids BESTest (Dewar et al., 2019; Dewar, et al., 2021b).
Methods
The primary purpose of the research was to describe the oculomotor and visual perceptual skills in children with ambulatory CP compared to typically developing children and the relationship of these constructs with balance. The study design was an observational cohort design. Testing occurred for the following measures: NSUCO test of pursuits and saccades (Maples & Ficklin, 1988) , Subjective Visual Vertical (Zwergal et al., 2009) , MVPT-4 (Tsai, Lin, Liao, & Hsieh, 2018) , Kids BESTest Verticality and Stability Limits, and the Kids Mini BESTest (Dewar et al., 2019; Dewar, et al., 2021b). Similarities and differences between children with hemiplegic and spastic diplegic CP for these characteristics were also documented. The data was expected to be variable due to the nature of the diagnosis of cerebral palsy and a relatively small sample size. When normality criteria were not met, nonparametric analyses were utilized.
Results
Children with CP with hemiplegia or spastic diplegia had lower scores than typically developing children for oculomotor, visual perceptual and balance testing. The sample size was not sufficient to determine a difference between the CP types for these tests. Additionally, a Spearman Correlation was performed to analyze the relationship between oculomotor and visual perception scores with balance scores for the full sample with CP, as well as between children with hemiplegia and spastic diplegia.
Children with hemiplegic CP had a moderate positive direct relationship between scores on the balance tests for both pursuits and saccades. Children with spastic diplegia had a moderate relationship with accuracy of eye movement with pursuits and scores on the two balance tests.
Conclusions
These preliminary findings suggest that addressing balance deficits might be personalized by adding oculomotor and visual perception assessments, as well as interventions to complement balance training.
