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CVI
and tends to be identified with ones phenomenological experience of the world. It is fair to say, however, that the line of
demarcation between cognition and perception, and the role of
consciousness in both these processes, are matters of some debate
and can vary depending on the task. Nevertheless, it is perception that allows us to model the world beyond our bodies, to
share that experience with other members of our species, and to
plan a vast range of different actions with respect to objects and
events that we have identified. However, even though perception
allows us to choose a goal, the actual programming and control
of the execution of an action that is performed to fulfil that goal
is mediated by dedicated visuomotor modules that are not
dissimilar in principle from those found in lower vertebrates. In
other words, vision in humans and other primates (and perhaps
other animals) has two distinct but interacting functions: (1) the
perception of objects and their relations, which provides a
foundation for the organisms cognitive life, and (2) the control of
actions directed at (or with respect to) those objects. As we
shall see, the organization of the cerebral visual pathways in
higher primates reflects this fundamental distinction in visual
processing.3
The distinction between vision-for-perception and vision-foraction provides a useful framework for unpacking the myriad of
visual deficits that can be observed in children who have been
diagnosed with cortical visual impairment (CVI).57 Moreover, it
can help to explain why some visual abilities are more likely to be
affected by preterm birth than others.
The Author. Developmental Medicine & Child Neurology 2013 Mac Keith Press, 55 (Suppl. 4): 912
DOI: 10.1111/dmcn.12299 9
NEUROPSYCHOLOGICAL EVIDENCE
It has been known for a long time that patients with lesions in
the dorsal stream, particularly in the intraparietal sulcus and the
superior occipito-parietal area, can have problems using vision to
direct a grasp or aiming movement towards the correct location
of a visual target placed in different positions in the contralesional
visual field, especially in the periphery.14,15 This deficit is often
called optic ataxia. But the failure to locate an object with the
hand should not be construed as a problem in spatial vision; many
of these patients, for example, can describe the relative position of
the object in space quite accurately, even though they cannot
direct their hand towards it.16 Moreover, sometimes the deficit
will be seen in one hand but not the other.14,15,17 It should be
pointed out, of course, that these patients typically have no difficulty using input from other sensory systems, such as proprioception or audition, to guide their movements. Some of these
patients are unable to use visual information to rotate their hand,
scale their grip, or configure their fingers properly when reaching
out to pick up an object, even though they have no difficulty
describing the orientation, size, or shape of objects in that part of
the visual field.1719 Clearly, a disorder of spatial vision fails to
capture this range of visuomotor impairments.10 Instead, this pattern of deficits is consistent with our proposal that the posterior
parietal cortex plays a critical role in the visual control of skilled
actions.4
10 Developmental Medicine & Child Neurology 2013, 55 (Suppl. 4): 912
visuomotor and perceptual deficits are often dissociated in periventricular leukomalacia, it has been difficult to correlate the observed
pattern of deficits with morphometric data from MRI, probably
because damage to the periventricular white matter leads to abnormal functional development of visual areas in the dorsal and/or
ventral streams, changes that are difficult to track with structural
MRI.33 For this reason, techniques such as functional MRI, functional connectivity analyses, and tractography that can detect these
changes are much more likely to uncover the relation between
abnormal brain organization and behavioural dysfunction.6,3436
It is also worth noting that CVI is observed in children with
genetic developmental disorders, such as Williams and fragile X
syndromes. In both these syndromes, the visual and attentional
deficits would appear to be associated with dorsal-stream damage.37,38 The MRI morphometric studies certainly support this
conclusion,39,40 but, as is the case with children with periventricular leukomalacia, there have been few functional MRI or connectivity studies of these genetic disorders.38
CONCLUSION
In this brief review, I have tried to show how the distinction
between vision-for-perception and vision-for-action and the differences in their underlying neural substrates can help to unpack
the complex array of visual deficits that characterize CVI. Vision
is not a monolithic entity and quite different visual deficits can
arise depending on the locus and nature of the abnormalities in
brain development that can arise from preterm birth and various
genetic disorders. Understanding this point is a critical first step
in the construction of useful diagnostic criteria and effective pediatric rehabilitation.
CONFLICTS OF INTEREST
The author has no conflicts of interest.
REFERENCES
1. Goodale MA. Vision as a sensorimotor system. In: Robinson TE, editor. Behavioral Approaches to Brain Research.
New York, NY: Oxford University Press, 1983: 4161.
25. Patla AE, Goodale MA. Obstacle avoidance during locomotion is unaffected in a patient with visual form agnosia. NeuroReport 1996; 8: 1658.
26. Kravitz DJ, Saleem KS, Baker CI, Mishkin M. A new
neural framework for visuospatial processing. Nat Rev
Neurosci 2011; 12: 21730.
29. Atkinson J, Braddick O. Visual and visuocognitive development in children born very prematurely. Prog Brain
Res 2007; 164: 12349.
30. Jakobson LS, Frisk V, Knight RM, Downie ALS, Whyte
H. The relationship between periventricular brain injury
and deficits in visual processing among extremely-low-
Latal Hajnal B. Correlations between motor performance and cognitive functions in children born <1250 g
at school age. Neuropediatrics 2006; 37: 612.
33. Fazzi E, Bova S, Giovenzana A, Signorini S, Uggetti C,
Bianchi P. Cognitive visual dysfunctions in preterm