CP and visual challenges

Many people with Cerebral Palsy experience visual challenges, which can appear in very different ways. However, several strategies can reduce the impact of these difficulties and make everyday life easier.

Vision plays a bigger role in our daily lives than we often realise. In fact, it is our most dominant sense, and it matters in every part of daily life, whether it’s playing, reading, cooking or navigating traffic.

A significant number of people with Cerebral Palsy (CP) experience visual challenges. These often stem from the same effects on the brain that led to the CP. When vision is affected, it can influence well-being, development, and participation in everyday activities. That’s why it is important to be aware of visual challenges in both children and adults with CP, even though they are not always easy to spot.

Typical visual challenges in CP

It is estimated that just over 3 out of 5 people with CP have some form of visual challenge. These can range from mild to severe and may manifest in many ways. The challenges can be due to physical conditions related to the eyes, but also to the way the brain processes visual input.

They are typically divided into three main types:

Eye-related difficulties: Changes in the eye’s structure or function. For example, damage to the retina or optic nerve, which can lead to blurred vision and, in some cases, affects the visual field.
Visuo-motor difficulties: The eye’s movements are affected, for example in the form of strabismus or involuntary rhythmic eye movements, which make it difficult to maintain focus.
Cognitive visual difficulties: The brain has difficulty interpreting what the eye perceives. This may appear in many ways, for example, difficulty judging distance, recognising things in cluttered environments, or directing attention.

Facts about vision

Vision depends on both the eye’s ability to capture light from the surroundings and the brain’s ability to process and understand visual input.
Vision is the most dominant human sense and plays a central role in everything from orientation and communication to learning and social relationships.
Around 30-40% of the brain is involved in visual processing, including areas that control eye movements, as well as those responsible for recognition, spatial understanding, and attention.

Why is vision often affected in people with CP?

Visual challenges in CP are typically linked to the brain development differences that cause the condition. A large part of the brain is involved in processing vision, meaning the areas that control the eyes and interpret visual input are often impacted in CP.

Visual challenges in CP can be difficult to detect, and they may change over time. In young children, these difficulties may appear as a lack of interest in visual exploration of toys, or difficulty following moving objects, such as a ball or a car. As children get older, these difficulties may become more noticeable and can affect learning, spatial awareness, and social interactions.

Cognitive visual challenges are sometimes detected later, often only becoming apparent when demands increase, for example at school or work.

Recognizing visual difficulties

It is not always easy to recognize visual difficulties. Children and adults with CP have usually lived with them their whole lives and are often unaware that their vision works differently.

Cognitive visual challenges can be especially hard to detect, particularly if the eyes themselves function normally and visual acuity is good. When the difficulty is in how the brain processes visual input, the challenges are often less obvious and hard to describe for both children and adults.

In children, these difficulties can affect play, learning, and social interactions because visual information is processed differently or not fully understood. Later it may affect education, work, and daily independence, for example, managing a busy workspace, navigating unfamiliar places, or processing complex visual information.

CVI: brain-based visual impairment

A particular type of visual difficulty often seen in people with CP is called brain-based visual impairment or CVI (Cerebral Visual Impairment).

CVI is an umbrella term for visual challenges caused by damage in the brain. This means the brain has difficulty processing visual input, which can lead to various types of visual challenges, for example reduced visual acuity, visual field loss, or problems with visual orientation.

Many people with CP have CVI to some degree. Several of the examples described here also fall under the concept of CVI.

Currently, there is no consensus on the exact meaning of the term, so different professional groups may interpret it in different ways. For CVI to be diagnosed, the visual difficulties cannot be explained by an eye condition alone. A person can have CVI without having CP.

Information on CVI from other sources:

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How can relatives provide help and support?

As a parent, partner, or close relative of a child or adult with CP, there are many ways you can help. You might be the one to notice visual difficulties, support the person in getting an assessment, or provide help in daily life when adaptations are needed.

Visual challenges are not always obvious, especially if visual acuity is normal. However, there are several signs you can look out for. If you suspect that your child or relative with CP has visual challenges, it’s a good idea to seek a professional assessment.

Signs to look for in yourself or a relative

Uncertainty in new environments, for example difficulty navigating demanding surroundings such as traffic.
Tendency to avoid eye contact.
Trouble judging distance or speed.
Trouble finding things, even when they are visible.
Trouble recognising faces or seeing objects in motion.
Avoiding activities that rely on vision, such as reading, playing with small objects, or screen work.
Feeling tired or frustrated in visually busy environments such as supermarkets, school, or work.

If you notice some of these signs, a vision assessment may be helpful. It can provide clarity and suggest ways to support daily life.

Where can you get professional help?

You can start by contacting an ophthalmologist, who can examine the eyes, optic nerve, and visual fields and provide guidance or recommend treatment if needed.

You can also contact a local vision consultant, often linked to municipal or specialised services. Vision consultants can help clarify visual difficulties in daily life and help with using assistive devices and compensatory strategies.

Assessment of cognitive visual challenges requires specialists with expertise in cognitive visual processing - that is, how the brain interprets and makes sense of visual information.

If you are unsure where to begin, consider contacting your GP.

What can help in everyday life?

There are many simple, practical steps that can ease visual difficulties in daily life. Small adjustments to the environment and daily routines can make a big difference:

Create calm and clarity: Avoid visual noise and clutter. Create a simple, tidy environment, for example, pencils neatly arranged in a pencil case, or jewellery organised in a box. Use contrasting colours to make important items stand out, such as a solid-coloured mat under toys or a coloured placemat under a plate.
Structure and repetition: Keep items in fixed places and repeat routines, making it easier for the brain to recognize and understand what it sees.
Lighting and magnification: Ensure good lighting to make things easier to see. In some cases, enlarging objects, for example using a magnifying glass or zooming on a computer screen, can help.
Use multiple senses: Combine vision with sound and touch, for example, by having someone describe what is happening or by exploring objects by touch.
Adjust the pace: Allow time to get oriented and process visual information, especially in new or complex situations.

Talking about visual challenges can be a relief. With the right knowledge, support, and adaptations, many people can have more energy, participate more fully, and enjoy a better quality of life.

The goal is not to fix everything, but to find the best ways to support a person’s existing vision.

Sources:

Chang et al. (2024). Special Commentary: Cerebral/Cortical Visual Impairment Working Definition: A Report from the National Institutes of Health CVI Workshop. Ophthalmology.
Ego et al. (2015). Visual-perceptual impairment in children with cerebral palsy: A systematic review. Developmental Medicine and Child Neurology.
Ortibus et al. (2019). Cerebral Visual Impairment and Clinical Assessment: The European Perspective. Seminars in Pediatric Neurology.
Sakki et al. (2018). Is there consensus in defining childhood cerebral visual impairment? A systematic review of terminology and definitions. British Journal of Ophthalmology, 102(4), 424–432.
Zihl & Dutton (2015). Cerebral Visual Impairment in Children. Springer Vienna.