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Europa Medicophysica 2002 December;38(4):219-235

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

Visual and motor control disorders in children with cerebral palsy: a proposed guide to evaluate the oculomotor system

Cazzagon M. ¹, Olimpi I. ¹, Cordaro C. ¹, Giammari Aldè G. ², Pierro M. M. ³

¹ IRCCS “Eugenio Medea”, Polo Friuli, Pasian di Prato (Udine) 2 IRCCS “Eugenio Medea”, Bosisio Carini (Lecco) 3 IRCCS “Bambino Gesù” Children Hospital, Roma

The def­i­ni­tion giv­en by ­the Little Club (1959) ­and ­still accept­ed by ­most ­experts of infan­tile cere­bral pal­sy (ICP) stress­es ­the pres­ence of “­non-­motor” dis­or­ders along­side ­motor dis­or­ders in ­this com­plex ­group of syn­dromes. The inter­est of numer­ous research­ers ­and schol­ars ­has ­long ­been con­cen­trat­ed on ­the ­non-­motor dis­or­ders. This ­has ­been moti­vat­ed by ­the evi­dence ­that, fre­quent­ly, ­the “­non-­motor” dis­or­ders (sen­so­ry, per­cep­tive, per­cep­tive-­motor, prax­o­log­i­cal, gnos­tic or con­cep­tu­al dis­or­ders) con­di­tion ­the prog­no­sis of ­the ­motor func­tion dis­or­der. The ­most ­recent the­o­ries on ­motor con­trol ­have pro­vid­ed increas­ing­ly sol­id sup­port ­for ­this clin­i­cal evi­dence. Among sen­so­ry dis­or­ders, inter­est ­has in par­tic­u­lar ­been con­cen­trat­ed on dis­or­ders of ­the vis­u­al func­tion, ­which ­are ­very fre­quent in ­ICP. Vision is ­the ­most syn­thet­ic ­and ­the ­most pre­dic­tive ­among ­the impor­tant sourc­es of infor­ma­tion con­cern­ing ­the rela­tion­ship ­between ­the ­body ­and ­objects in ­the envi­ron­ment, ­and it ­plays a lead­ing ­role in ­the acqui­si­tion of ­motor beha­vi­our ­that is adap­tive to chang­es of ­goal ­and of envi­ron­ment. However, it is ­not auton­o­mous in ­this ­task, ­and ­requires inte­gra­tion ­with ves­tib­u­lar ­and exte­ro-pro­pri­o­cep­tive infor­ma­tion to ­enable ­the indi­vid­u­al to ­define per­cep­tive invar­i­ants or con­stants ­that ­enable ­him or ­her to mod­ulate ­the pro­cess of adap­tive mod­ifi­ca­tion of ­motor beha­vi­our. The influ­ence of ­vision on ­motor con­trol is par­tic­u­lar­ly impor­tant dur­ing infan­cy. The ocu­lo­mo­tor ­system, ­through ­the inter­ac­tion of ­its 5 prin­ci­pal ­sub-­systems, pro­vides dynam­ic sta­bil­isa­tion of ­the ­fovea on ­the tar­get ­and ­plays a fun­da­men­tal ­role in gath­er­ing ­and inte­grat­ing vis­u­al infor­ma­tion. Many ­infants ­with ­ICP ­present alter­a­tions of ­the ocu­lo­mo­tor func­tion ­and of com­bined ­eye ­and ­head move­ments. A Guide is pre­sent­ed ­for ­the clin­i­cal-func­tion­al obser­va­tion of ­the mul­ti-mod­ular ocu­lo­mo­tor-­vision ­system.