Cerebral Visual Impairment: which perceptive visual dysfunctions can be expected in children with brain damage? A systematic review.
CVI diagnosis should move from brain scans to real-life visual behavior, but we still lack clear links between injury site and visual loss.
01Research in Context
What this study did
Doughty et al. (2010) hunted for every paper on visual problems caused by brain damage in children.
They wanted to know which eye-brain disconnects show up most and where in the brain they start.
After reading piles of studies they still could not link one injury spot to one visual problem.
What they found
No clear map exists. A child with back-brain injury and a child with front-brain injury can show the same visual trouble.
Because of this mess the authors say we should stop naming CVI by brain scan and start naming it by what the child actually does with vision.
How this fits with other research
Lanza et al. (2024) backs this up. Their big 2024 scoping review shows vision loss drags down quality of life and participation, so we need tools that capture daily visual function, not MRI pictures.
Reus et al. (2013) already built one fix. They proved the Bayley-III Low Motor/Vision version gives fairer cognitive scores for toddlers who see poorly, matching the call to test function, not anatomy.
Levin et al. (2014) adds a warning. They found totally blind kids score far worse on gross-motor tests than partly-sighted peers, showing that once vision drops to zero, new assessments must also target motor fallout.
Why it matters
For BCBAs this means: stop waiting for the neurologist’s report. Watch how the child uses vision during table work, play, and transitions. Pick tools like the Bayley-III Low Motor/Vision or participation checklists that score what the child does, not what the scan says. If the child is totally blind, add motor and spatial lessons early. Shift your goals from “fix the brain spot” to “teach the usable vision and build participation skills.”
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02At a glance
03Original abstract
The current definition of Cerebral Visual Impairment (CVI) includes all visual dysfunctions caused by damage to, or malfunctioning of, the retrochiasmatic visual pathways in the absence of damage to the anterior visual pathways or any major ocular disease. CVI is diagnosed by exclusion and the existence of many different causes and symptoms make it an overall non-categorized group. To date, no discrimination is made within CVI based on types of perceptive visual dysfunctions. The aim of this review was to outline which perceptive visual dysfunctions are to be expected based on a number of etiologies of brain damage and brain development disorders with their onset in the pre-, peri- or postnatal period. For each period two etiologies were chosen as the main characteristic brain damage. For each etiology a main search was performed. The selection of the articles was based on the following criteria: age, etiology, imaging, central pathology and perceptive visual function test. The perceptive visual functions included for this review were object recognition, face recognition, visual memory, orientation, visual spatial perception, motion perception and simultaneous perception. Our search resulted in 11 key articles. A diversity of research history is performed for the selected etiologies and their relation to perceptive visual dysfunctions. Periventricular Leukomalacia (PVL) was most studied, whereas the main tested perceptive visual function was visual spatial perception. As a conclusion, the present status of research in the field of CVI does not allow to correlate between etiology, location and perceptive visual dysfunctions in children with brain damage or a brain development disorder. A limiting factor could be the small number of objective tests performed in children experiencing problems in visual processing. Based on recent insights in central visual information processing, we recommend an alternative approach for the definition of CVI that is based on functional visual processing, rather than anatomical landmarks. This could be of benefit in daily practice to diagnose CVI.
Research in developmental disabilities, 2010 · doi:10.1016/j.ridd.2010.08.001