Background: A typically developing child has an overall feedback from somatosensory, visual, auditory and vestibular systems which affects development of physical and emotional growth. Although the normal visual system is not mature at birth and needs much of the first 6months to become useful, enough visual stimuli reach the developing brain to make vision a motivator for bonding and head control.  A child with cerebral palsy may have impairments in any of these systems thus leading to delayed achievement of milestones, being more or less dependent for activities of daily living on parents and thereby lesser opportunities for overall development. A physiotherapist treats a child with cerebral palsy with a broad goal of improving independence and increasing quality of life both for them and their parents.

Impaired vision can interfere in the growth emotionally as well as physically. The first motor milestone of head control may be delayed or unachieved. A child will be tempted to raise, move head and body in direction of visual and auditory stimuli. Various factors like level of spasticity, tightness, voluntary control, cognition can affect motor development along with vision. The motor recruitment, firing, strength of muscle contraction will impair balance and posture development. The correlation between visual deficits and functional balance can help early identification and correction to help achievement of milestones .Hence the need for the study is to correlate visual impairment and  balance scales PBS & ECAB and GMFCS.

Aim: To find the correlation between visual impairments and functional balance in children with cerebral palsy.

Objectives: To find correlation of  PBS, ECAB and GMFCS

1)    With VCS

2)    With Visual Acuity

3)    With  Refraction

4)    With Binocular Vision and Ocular Motility

Methodology :

An observational study will done in children with cerebral palsy  of 1.5  – 10 years of age, who will be screened for inclusion and exclusion criteria selected through convenient sampling between November 2018 – August 2019 in the physiotherapy department of a tertiary hospital. A detailed explanation of the purpose and the procedure of the study will be given to the parents of eligible children and will be requested to participate in the study by signing the Inform Consent Document. Also, wherever applicable, for children above 7 years of age - the child’s assent will be taken separately after the study procedure has been explained.  Physiotherapeutic assessments will be performed including scales for balance assessments like PBS & ECAB and GMFCS  on all the children in the physiotherapy department of a tertiary hospital. These children will undergo routine ophthalmologic examination carried out by the ophthalmology department within the same tertiary hospital which includes tests for visual functions and a visual classification scale(VCS). The VCS levels will be correlated with PBS & ECAB and GMFCS . Also, visual acuity, refractive errors, the various components of binocular vision and ocular motility will each be correlated with PBS & ECAB and GMFCS .

The statistical analysis will be performed using IBM SPSS Statistics 23. Quantitative variables like age, height, weight, range of motion, etc. will be expressed as mean, median and standard deviation. All quantitative data would be tested for normality using the Kolmogorov Smoimov test or the Shapiro Wilk test. Qualitative data like gender, presence for visual acuity, binocular single vision, ocular motility, refraction and levels of Visual Classification Scale will be expressed as frequency and percentages.

The correlation of PBS, ECAB and GMFCS with VCS will be done by Chi Square test. The relationship between PBS and ECAB with Visual Acuity will be done using Pearson correlation test or Spearman’s correlation test. The correlation of PBS with Refraction and Binocular single vision ,ocular motility will be analyzed using Mann-Whitney U test or Kruskal Wallis H test. The correlation of ECAB with Refraction and Binocular single vision ,ocular motility will be done by using Mann-Whitney U test. The relationship between GMFCS and Visual Acuity, Refraction and Binocular single vision ,ocular motility will be analyzed using Chi Square test. p value less than 0.05 will be considered significant.