Purpose:
Children with multiple disabilities are more likely to have a visual impairment, which severely limits their capacity to operate in everyday life. A comprehensive examination of vision and functional vision is required to determine early intervention for children with multiple disabilities. This case study illustrates the functional vision assessment of a child with multiple disabilities.

Case:
This case involves a four-year-old child who, accompanied by her parents, visited the low vision center at An-Najah University for an evaluation of her eyesight. This child was born with isovaleric acidemia, a rare, inherited metabolic condition in which the body is unable to process the building blocks of the proteins, “amino acids,” and she also has seizures. Additionally, the child has a moderate delay in cognitive, motor, and speech development. 

A comprehensive visual impairment assessment was conducted to assess her visual functions, using toys that make sound or have light, as the child was more attentive to such toys. The visual assessment results indicate that the pupil's reaction to light was normal, but it was difficult to estimate her visual acuity. However, she became excited when presented with shiny objects measuring 20-30 cm. Her fixation, target tracking, saccades, eye contact, and contrast sensitivity are all poor. The eye-hand coordination was variable, and there was a delay in responding to the visual field. Her refraction revealed significant compound hyperopic astigmatism along with significant esotropia. The child was diagnosed with severe visual impairment and prescribed a pair of spectacles. 

She was referred to the national center for children for occupational and physical rehabilitation for assessment. They reported that the child responds strongly to sounds compared to other senses, and she loses concentration when combining a tactile or sound stimulus with a vision stimulus. They recommended that rehabilitation for this child focus on the integration of sensory inputs. Since the child was found to be more attentive to toys that have light or make sound, such toys can be used during the rehabilitation sessions to improve her sensory integration in the clinic or at home with parents. Because of her blurry vision at both a distance and up close, the therapist must perform the activities at a very close distance to the child (approximately within 30-40 cm). 

Discussion:
In such cases, multi-disciplinary rehabilitation is essential as it can enhance the educational and other training provided to children with multiple disabilities, potentially improving their overall quality of life and helping some achieve functional independence or reduce functional dependency.

Conference Title

22nd Emirates Society of Ophthalmology Conference

Conference Country

United Arab Emirates

Conference Date

Feb. 9, 2025 - Feb. 11, 2025

Conference Sponsor

none