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Gordon Dutton’s Blog (11)

Could cerebral visual impairment be associated with cerebral auditory impairment too?

The parents of many children with cerebral visual impairment have explained to me that their child has no idea where they are calling from and will look around all over the place to find them, unlike their unaffected brothers and sisters, who turn instantly to look in the right direction.

In my experience these children fall into two groups:

  • Those with difficulty finding things, often associated with a tendency to bump into low obstacles, to walk off pavements and have difficulty going down slopes and stairs. These features are typical of those with dorsal stream dysfunction associated with lower visual field impairment due to dysfunction or injury to the posterior parietal area of the brain on both sides.
  • A smaller group who have weakness down their left side, who are unaware of their surroundings to the left of the midline of their bodies, yet are able and willing to cooperate. This is due to dysfunction or injury to the posterior parietal area of the brain on the right side. If one asks such a person to close their eyes and point to your finger clicks as you move your hand from their left to their right, they may only start to point to the hand when it reaches the imaginary line extending straight forward from the midline of their body. Rotating the head and eyes to the left does not compensate, but turning the body to the left does.

The explanation must relate to the internal unconscious map of our surroundings that is created in the posterior parietal lobes (more so on the right side of the brain than the left) that maps sound as well as sight, and when the map has bigger mental voxels, lack of being able to map sound accompanies lack of being able to map sight. So in some children, when the right side of the posterior parietal lobes of the brain is mainly affected, in some, neither sight nor sound can be detected to the left of the midline of the body. Only turning the body to the left compensates, but not turning the head and eyes, because the map in the mind relates to our bodies, not our head and eyes.

Another anomaly is the possibility of slow sound processing, which in our experience can accompany cerebral visual impairment. The affected child may not see fast moving objects and much prefers to watch slow TV, or You Tube in the slowed down mode. In addition the child has yet to understand language or speak. If the brain is processing information more slowly for vision, will slowed down single words, matched to and just after the child's experience register better in the mind? The brain processes information relating to the 3 dimensions of space, and the dimension of time. What happens if processing is slower for some?Throughout my career I have slowed my voice for the children with cerebral visual impairment who have yet to learn language. I prolong each element of each word, vowels and consonants alike. It is remarkable how many turn their heads to listen to slowed speech, but turn away again when the speech speeds up once more. This, for me is a consistent observation. Suggesting that it can be fun to experiment with slowing down in this way proved very rewarding.Connor never spoke nor understood language until he was 7 years old. The description of how his life has been turned round when language was made meaningful by enhancing his experiences and accessible by slowing down has just been added to the website.

Children can only learn from what they can perceive. Acoustic damping of working environments as well as decluttering them for children with CVI makes a very big difference. While always communicating with children with left hemiplegic cerebral palsy, from their better right side, may well make what you are saying (sound) and doing (sight) much more accessible to them, particularly if you only refer to what they are experiencing, not what you are.

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At CVI Scotland we are devoted to helping people understand cerebral visual impairments, and together working towards developing the understanding of this complex condition.