BACKGROUND: Cerebral Palsy (CP) is a systemic condition that involves muscle weakness and coordination difficulties. These patients often exhibit optic nerve atrophy, strabismus, poor oculomotility skills, and accommodative insufficiency. In addition to spectacle correction, vision therapy (VT) is usually the preferred method of treatment for remediating visual skill deficiencies in most patients; however, VT is not considered as often for patients with CP. This case report will document improvement of visual skills and academic performance after VT in a young patient with CP.
CASE REPORT(S): A 9-year-old male with CP presented to the Illinois Eye Institute for a comprehensive eye examination. CC is a quadriplegic and has limited use of his limbs. The exam revealed a constant alternating exotropia, severe accommodative insufficiency, saccadic disorder, fixation instability, and no refractive error. His mother reported that school performance was lagging, specifically in the area of reading, in spite of normal cognitive ability. Low plus lenses were prescribed for computer use, since this is his primary method of demonstrating academic ability. VT was initiated to remediate his visual skill deficits, concentrating on fixation, saccades, and accommodation. CC achieved improved fixation, saccadic ability, and, most notably, accommodative amplitudes along with parental report of improved academic performance. One problem encountered was regression in visual skills immediately following episodes of illness or fatigue; these regressions took several weeks to recoup. A recommendation for books on tape was suggested for extended reading due to fatigue. After several years of VT, CC’s progress has stabilized, prompting a potential end to formal VT. However, the mother feels that continued VT is supportive for the patient’s move to regular high school classes.
CONCLUSIONS: Patients with CP are often found to have visual skill problems. Vision therapy may be an appropriate treatment option for select patients who have a diagnosis of CP.