Gaze responses in children with cerebral palsy, cerebral visual impairment, and severe intellectual and developmental disabilities

Aim: To identify gaze responses of children with cerebral palsy (CP), cerebral visual impairment (CVI), and severe intellectual and developmental disabilities (IDD) to unimodal and bimodal sensory stimuli. Method: Forty children (27 female; mean age 8 years 3 months [range: 3–21 years] with two participants [ages 20 years and 21 years] representing outliers; Gross Motor Function Classification System [GMFCS] level V, Manual Ability Classification System level V, Communication Function Classification System level V) with spastic and dyskinetic CP and severe IDD (20 CVI, 20 no visual impairment) participated in an experimental-observational study. Unimodal (light, auditory, tactile) and bimodal (visual–auditory, visual-tactile) stimuli were presented in a darkened room. Standardized and validated microanalysis of video recordings assessed gaze frequency, duration, and latency. Results: Compared to children with no visual impairment, children with CVI had significantly longer gaze latency to static visual and visual-tactile stimuli (p <0.05) and shorter overall gaze duration (p = 0.005). The CVI group showed sensory enhancement, responding more frequently to bimodal stimuli than unimodal non-visual stimuli (p = 0.014) and with significantly longer gaze duration to bimodal visual–auditory stimuli than unimodal auditory stimuli (p = 0.005). Interpretation: This study provides evidence that bimodal sensory stimulation can enhance visual engagement in children with CP, CVI, and severe IDD. Gaze frequency, duration, and latency are important considerations for interventions and adapting sensory environments.