Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Brain Injury
Objective : To set therapeutic goals for a girl with cerebral visual impairment.
Design : Case study.
Setting : Changhua Christian Hospital (CCH)
Participants (or Animals, Specimens, Cadavers) : This is a 7-year-old girl with a history of encephalitis. She suffered from encephalitis at the age of 5 years. MRI finding showed encephalomalacia with focal cerebral atrophy in bilateral occipitoparietal lobes more on the left with areas of demyelination as a sequel of encephalitis. The Wechsler Pre-School & Primary Scale of Intelligence (WPPSI) was administered when she was 65 months old and the Full Scale IQ score was 44. After pediatric intensive care unit discharge, she received occupational therapy weekly for cognitive and fine-motor training at a local rehabilitation clinic. Because of persistent difficulties encountered at school, she came to the CCH for a comprehensive assessment at the age of 80 months.
Interventions : Not applicable.
Main Outcome Measure(s) : The Peabody Developmental Motor Scale (PDMS), Wechsler Pre-School & Primary Scale of Intelligence (WPPSI), Test of visual perceptual skills (TVPS), and a self-developed face memory test.
Results : Motor skills were tested using the PDMS and the results revealed that all scores were above the 16th percentile, the suggested cut-off on the PDMS. The WPPSI was administered at the age of 81 months and the Full Scale IQ score was 69. The percentile rank of TVPS overall score was 5. This result revealed that most aspects of visual perception were not well developed. In order to measure face recognition skills, a self-development tool was performed. She scored only 57 percent of questions correct. Eighteen Children with moderate mental retardation did the same test and scored an average of 94 percent of questions correct. This results revealed that she had great difficulties in recognizing face.
Conclusions : According to the MRI findings and results of tests, the diagnosis of cerebral visual impairment was strongly suspected in this 7-year-old girl. The therapeutic goals of occupational therapy and home programs should focus on compensatory strategies of face recognition and problems of orientation instead of strategies for mental retardation. The therapeutic goals and home programs with a strong emphasis on moving accurately through visual space, difficulties handling complex visual scenes, and problems recognizing certain aspects of the world around her. All of these will help her to participate in daily lives.