Neuro Visual Rehabilitation Unit
It has been seen from experience in Adarsh special school that there are some children who are affected by Cerebral Palsy and in whose case visual impairment (low vision or near total blindness) is very significant. The brain damage that causes cerebral palsy often affects the muscles of the eye, leading to this problem.In these cases, even when other problems are overcome and consequently mobility level and the quality of sensory perceptions and abilities improve, the visual impairment remains unattended. In fact, about three out of four such children have a problem with squint and/or myopia( nearsightedness). Unless the problem is detected and attended to early, it could result in complete loss of vision in the affected eye.

Normally, children with visual challenges are sent to "blind schools" where Braille method is adopted to teach them. There are two major lacunae in this arrangement
I. Many children suffer not only from visual problems and unless all these problems are attended to simultaneously, the rehabilitation process does not become effective. In normal "blind schools", facilities for such comprehensive therapy do not exist.
II. In other special schools, facilities for attending to visual problems, Orientation& Mobility and Braille training are not available
We started such a centre at Adarsh on 3rd December 2009 (World Disability Day)where, apart from Physiotherapy and Sensory Integration therapy, facilities for Orientation and Mobility training will also be made available for children needing that, particularly in the Early Intervention group. As the children grow, some amount of Braille training also will be imparted which will be useful for the children who can ultimately get absorbed into a "blind school." In addition, we have come across a few cases of "Retinopathy of Prematurity" in our Risk Baby Unit. These children, need Early intensive visual stimulation programmes, Orientation & Mobility, as well as Braille training. In the centre, the intention is to provide all these facilities under one roof.

OCULAR PROBLEMS: General Incidence:
A large proportion of the population suffers from some amount of abnormality of vision or oculomotor control. If there is damage to the visual cortex, a child will be functionally blind because he/she will be unable to interpret impulses from the retina. In severe cases, the optic nerves are also found damaged. Lack of coordination of the muscles controlling eye movements is very common. The child cannot fix his/her gaze on an object. In half the cases, binocular vision does not develop. Myopia is a concomitant problem. Therefore, screening for detecting visual deficits is very important as some of these deficits are preventable and if not prevented, they lead to movement problems.

OCULAR PROBLEMS IN Cerebral Palsy and Neuro Developmental disorders
An individual with CP may also experience conditions with their eye that can affect depth perception and smooth movements of the eye. These are called oculomotor problems and include: • eye turns in towards the nose (esotropia or esophoria),• eye turns out towards the ears (exotropia or exophoria),
• eye turns up (hypertropia or hyperphoria),
• eye turns down (hypotropia or hypophoria),
• eye misalignment due to muscle imbalance (strabismus),
• lazy eye (amblyopia)

Processing problems:
Many children have problems making sense of visual information. Cortical visual impairment or CVI causes processing problems. CVI can cause the vision to fluctuate from day to day and even from minute to minute. It can also impact depth perception and cause a field loss.
Visual concentration and eye-hand coordination
Children with CP may also have problems with visual concentration and/or eye-hand skills. Many of the children expend so much energy and concentration on keeping their body upright, controlling an accurate reach, etc. that they have little left over to use for visual tasks. Asking a child with CP to hold their body in alignment, look at a toy and then reach for it, might be like
attempting to read *War and Peace* and put a bicycle together , while serving some one high tea. We are asking the child to do too much at one time. If we can support and stabilize his body, he will be able to concentrate on looking and reaching. If trunk and head control is the skill we want to work on, we may not want to use a visual toy as a motivator. Therefore, while working on a child with all these problems, the whole team has to work together, attending to all the problems and not placing more demands on the child than it can handle.The incidence of ocular defects like refractive errors (50%), squint (52%), squint with amblyopia (15%) and visual field defects (11%) has been found to be high ,as the figures in brackets above bring out. Other ocular defects reported include nystagmus, amblyopia, gaze palsies, optic atrophy and ptosis.

Retinopathy of prematurity (ROP), is an eye disease that affects prematurely born babies. It is thought to be caused by disorganized growth of retinal blood vessels which may result in scarring to retinal detachment. ROP can be mild and may resolve spontaneously, but in serious cases may lead to blindness. As such, all preterm babies are at risk for ROP, and very low birth weight is an additional risk factor. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP.
Facilities that are proposed to be made available at the Neuro visual centre of Adarsh: I. Early Neuro Visual Assessment, both Medical & Therapeutic
II. Early Sensory Integration Therapy and Neuro Developmental Therapy
III. Early visual stimulation
IV. Orientation & Mobility Training
V. Braille Training

Consultants:

I. Pediatrician
II. Ophthalmologist
III. Physiotherapist
IV. Special Educator
V. Mobility or Braille trainer

Working hours: Monday to Friday-10 am to 3 pm
Location: CDEIRC of Adarsh at CDEIRC, Near Skyline Villa, Shijne Road, Vyttila Ernakulam Contact Nos. Ms.Mithun Raj- Co-ordinator
Telephone Nos:0484 3112636, 2389448