The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy

Background: Visual information is crucial for performing goal-directed movements in daily life. Aims: To investigate the relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy (uCP). Methods and procedures: In 49 children with uCP (7-15y), we investigated the relation between stereoacuity (Titmus Stereo Fly test), visual perception (Test of Visual Perceptual Skills), visuomotor integration (Beery Buktenica Test of Visual-Motor Integration) and functional vision (Flemish cerebral visual impairment questionnaire) with bimanual dexterity (Tyneside Pegboard Test), bimanual coordination (Kinarm exoskeleton robot, Box opening task), and functional hand use (Children’s Hand-use Experience Questionnaire; Assisting Hand Assessment) using correlations ( r _s ) and elastic-net regularized regressions ( d ). Outcomes and results: Visual perception correlated with bimanual coordination ( r _s =0.407-0.436) and functional hand use ( r _s =0.380-0.533). Stereoacuity ( r _s =-0.404), visual perception ( r _s =-0.391-(-0.620)), and visuomotor integration ( r _s =-0.377) correlated with bimanual dexterity. Functional vision correlated with functional hand use ( r _s =-0.441-(-0.458)). Visual perception predicted bimanual dexterity ( d =0.001-0.315), bimanual coordination ( d =0.004-0.176), and functional hand use ( d =0.001-0.345), whereas functional vision mainly predicted functional hand use ( d =0.001-0.201). Conclusions and implications: Visual functions and functional vision are related to bimanual function in children with uCP highlighting the importance of performing extensive visual assessment to better understand children's difficulties in performing bimanual tasks.