title: Visual assessment in children with cerebral palsy: implementation of a functional questionnaire.
abstract: OBJECTIVE
  The aim of this study was to evaluate an interdisciplinary visual assessment for multiply challenged children diagnosed with cerebral palsy (CP).
  
  
  METHODS
  A comprehensive ophthalmological assessment together with a visual classification scale (VCS) and a questionnaire evaluating daily visual function were completed regarding 77 children (41 females, 36 males; age range 3-20y; mean age 8 y 3 mo [SD 4 y 3 mo]; Gross Motor Function Classification System [GMFCS] level V; Manual Ability Classification System level V) who were diagnosed with CP (79.2% spastic quadriplegia, 6.5% athetoid quadriplegia, 10.4% mixed type, 3.9% hemiplegia). All participants had severe to profound motor and intellectual disability and an inability to communicate consistently through either verbal or assisted communication. The interrater and test-retest reliability of the questionnaire and its validity in comparison with the VCS were examined. In addition, the contribution of ophthalmological testing in predicting daily visual function was assessed.
  
  
  RESULTS
  The ophthalmological examination revealed three diagnostic subgroups: a group with cerebral visual impairment (CVI), a group with optic atrophy, and a group without visual impairment. The questionnaire was found to have high values of interrater reliability (interclass correlation coefficient [ICC]=0.873; 95% confidence interval [CI] 0.762-0.935) and test-retest reliability (ICC=0.988; 95% CI 0.964-0.996). Validity was established for the questionnaire factors: task-orientated visual function (r=0.802; 95% CI 0.669-0.885) and basic visual skills (r=0.691; 95% CI 0.504-0.816). The questionnaire provided information about daily visual performance not available from one-time ophthalmological testing, particularly for participants diagnosed with CVI. The visual performance scale significantly predicted daily visual function for all groups.
  
  
  CONCLUSIONS
  This study highlights the benefits of implementing a diagnostic performance scale as well as a reliable functional questionnaire to achieve a precise visual assessment of children with severe neurological impairment.
authors.affiliation: The Gonda Multidisciplinary Brain Research Centre, Bar Ilan University, Ramat Gan, Israel. naomiferziger@gmail.com 
authors.forename: Naomi B
authors.initials: NB
authors.lastname: Ferziger
authors.forename: Pinhas
authors.initials: P
authors.lastname: Nemet
authors.forename: Amichai
authors.initials: A
authors.lastname: Brezner
authors.forename: Ruth
authors.initials: R
authors.lastname: Feldman
authors.forename: Giora
authors.initials: G
authors.lastname: Galili
authors.forename: Ari Z
authors.initials: AZ
authors.lastname: Zivotofsky
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009885:Ophthalmology / Q000379:methods; D011680:Pupil / Q000502:physiology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology*; D014796:Visual Perception / Q000502:physiology; D055815:Young Adult