title: Perceptual visual dysfunction, physical impairment and quality of life in Bangladeshi children with cerebral palsy.
abstract: Cerebral palsy (CP) is the most common cause of motor disability in children and is often accompanied by sensory and/or cognitive impairment. The aim of this study was to characterise visual acuity impairment, perceptual visual dysfunction (PVD) and physical disability in a community-based sample of Bangladeshi children with CP and to assess the impact of these factors on the quality of life of the children.
  
  
  
  A key informant study was used to recruit children with CP from Sirajganj district. Gross Motor Function Classification System (GMFCS) levels and visual impairment were assessed by a physiotherapist and an optometrist, respectively. Assessments of visual perception were performed and standardised questionnaires were administered to each child's main carer to elicit indicators of PVD and parent-reported health-related quality of life. A generalised linear regression analysis was conducted to assess the determinants of the quality of life scores.
  
  
  
  180 children were recruited. The median age was 8 years (IQR: 6-11 years); 112 (62%) were male; 57 (32%) had visual acuity impairment and 95 (53%) had some parent-reported PVD. In analyses adjusted for age, sex, GMFCS and acuity impairment, visual attention (p<0.001) and recognition/navigation (p<0.001) were associated with total health-related quality of life, and there were similar trends for total PVD score (p=0.006) and visual search (p=0.020).
  
  
  
  PVD is an important contributor in reducing quality of life in children with CP, independent of motor disability and acuity impairment. Better characterisation of PVD is important to help design interventions for affected children, which may improve their quality of life.
authors.affiliation: Research Centre for Ophthalmology, NIHR Biomedical Research Centre at Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Mitry
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK Department of Paediatric Ophthalmology, Bristol Eye Hospital, Bristol, UK.
authors.forename: C
authors.initials: C
authors.lastname: Williams
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: K
authors.initials: K
authors.lastname: Northstone
authors.affiliation: Child Sight Foundation, Dhaka, Bangladesh.
authors.forename: A
authors.initials: A
authors.lastname: Akter
authors.affiliation: Child Sight Foundation, Dhaka, Bangladesh.
authors.forename: J
authors.initials: J
authors.lastname: Jewel
authors.affiliation: Child Neurology and Development, Bangladesh Institute of Child Health, Dhaka Shishu Hospital Dhaka, Bangladesh.
authors.forename: N
authors.initials: N
authors.lastname: Khan
authors.affiliation: Child Sight Foundation, Dhaka, Bangladesh.
authors.forename: M
authors.initials: M
authors.lastname: Muhit
authors.affiliation: Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Gilbert
authors.affiliation: Research Centre for Ophthalmology, NIHR Biomedical Research Centre at Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, UK Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK Department of Clinical Research, Institute of Child Health, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Bowman
mesh_terms: D000293:Adolescent; D001459:Bangladesh / Q000453:epidemiology; D002547:Cerebral Palsy / Q000150:complications / Q000453:epidemiology* / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010865:Pilot Projects; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation*; D014792:Visual Acuity
keywords: Child health (paediatrics); Public health; Vision; Visual pathway; Visual perception