The associations between vision level and early hand use in children aged 6-36 months with visual impairment: A cross-sectional, historical case note review

Vision level varies within the population of children born with visual impairment (VI). Children with profound visual impairment (PVI - with light awareness at best) are more developmentally vulnerable than peers born with typical sight or those with severe visual impairment (SVI basic form vision). Many children with VI are dependent on their hand skills to support their development. However, the impact of vision level on the development of hand use is poorly understood. The aim of the study was to describe the associations between vision level and early hand use in children between 6 and 36 months of age with SVI and PVI. A historical case note review, including video footage of 19 children with SVI ((x) over bar = 19 months) and 12 children with PVI ((x) over bar = 16 months), was completed. Hand use was observed while the children completed the Reynell-Zinkin Scales. Observations were recorded using a data collection tool designed for the study. The tool included a checklist of developmentally appropriate hand skills expected to emerge in the first 3 years of life. The observer marked each skill as present, absent or emerging in the video clips. Children with SVI used 80.2% (95% confidence interval [CI] = [75.0, 87.5]) of the hand skills under observation. Those with PVI used 57.1% (95% CI = [46.4, 67.9]) of these skills. Vision level and hand use were positively correlated: r(s) =.564 (95% CI = [.263,.765]), p <.01. This correlation was stronger than the association between developmental level and hand use: r =.364 (95% CI = [.012,.636]), p <.05. Furthermore, 15.8% (95% CI = [0.0, 31.6]) of the children with SVI and 66.7% (95% CI = [41.7, 91.7]) with PVI showed some reluctance to touch objects (p <.05) by withdrawing their hands actively from items offered to them. Vision level and developmental level influenced hand use; however, vision level appeared to have the greater impact. Interventions that are tailored to promote hand use according to vision level have the potential to improve functional participation.