EACD Consensus Project: 

Towards new clinical practice guidelines for cerebral visual impairment

EACD is funding a new clinical consensus project: Development of Evidence-based Clinical Practice Guidelines for Cerebral Visual Impairment (CPG-CVI), which commenced in spring 2021. The outcomes are anticipated to be presented in May 2022 at the EACD Barcelona 2022 meeting.

There are currently no international clinical guidelines in screening, assessment, diagnostics and classification of paediatric cerebral visual impairment (CVI). Unlike other neurodisabilities, cerebral-based vision disorders are not precisely defined or operationalised in practice (Sakki et al. 2017). This brings with it potential clinical risk as children may fail to receive reliable valid clinical assessments and diagnoses and the follow-up and habilitation may be inappropriate for their needs. However the understanding and assessment of CVI is challenging as it is a complex, multi-dimensional phenomenon. Visual acuity varies from severe loss to near normal performance. There are diverse basic and higher vision disorders, of differing patterns and severity, such as strabismus, field deficit, stereopsis or depth perception problems, and complex visual perceptual and visuo-motor disorders. It frequently co-exists with other neurodevelopmental disorders, such as cerebral p alsy or autism or ADHD or intellectual disability, and assessment approaches must take into account other cognitive and motor disorders.

Nevertheless, research programmes and clinical practice in the field have been advancing in recent years. Multidisciplinary colleagues in leading paediatric neurodisability and neuro-ophthalmology centres in Belgium, Italy and UK, with colleagues from USA and Australia, have been sharing ideas and communicating together (Ortibus et al. 2017).  New diagnostic frameworks, assessment tools and methods have been scientifically trialled leading to new possibilities for consensus. Symposia have been presented in various EACD conferences, leading to emergence of the 'CVI Consensus working group'. A number of stakeholders (parents, young adult user) will also assist. Through joint meetings this year and a systematic review of the most effective quality evidence, we aim to reach evidence-based clinical practice guidelines on CVI (CPG-CVI). These will be published in a scientific journal and presented to the members of EACD in the Barcelona conference 2022. We look forward to taking these ideas forward with our EACD colleagues for improved practice and research possibilities to optimise outcomes for children with CVI in the future.

Prof. Naomi Dale, Great Ormond Street Hospital, UCL Great Ormond Street Institute of Child Health, UK

Prof. Els Ortibus, KU Leuven, Belgium

(Co-chairs on behalf of the CVI Consensus Working Group Europe)

Previous EACD Consensus Projects: 

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder

These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice. Thirty‐five recommendations were made. Eight were based on the evidence from literature reviews (three on ‘assessment’, five on ‘intervention’). Twenty‐two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity‐oriented and participation‐oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD.

The CPR–DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR–DCD may serve as a basis for national guidelines.

This work has been published open-access in Developmental Medicine & Child Neurology in 2019:

https://doi.org/10.1111/dmcn.14132