Assessment of Sensory Impairments in Cerebral Palsy Following Perinatal Hypoxic-Ischaemic Brain Injury: A Critical Narrative Review

Abstract

Sensory impairment is clinically consequential in cerebral palsy (CP), yet it is often assessed less systematically than motor function. The problem is particularly complex when CP follows neonatal hypoxic-ischaemic encephalopathy (HIE), because a single hypoxic-ischaemic insult can affect ocular, auditory, somatosensory and associative networks, while motor, cognitive and communication impairments can obscure the child's true sensory capacity. This critical narrative review evaluates how visual, auditory and somatosensory impairments should be assessed in children and adolescents with CP after documented or strongly supported perinatal HIE. It also examines the evidential limits of attributing CP and later sensory findings to hypoxia-ischaemia. The literature was identified through live searches of biomedical and scholarly sources for publications from 1 January 1990 to 31 May 2026, supplemented by citation searching and targeted inclusion of foundational sources. The synthesis shows that evidence is strongest for visual and hearing outcomes but remains methodologically heterogeneous. Visual assessment requires separation of ocular health, refraction, acuity, contrast, fields and eye movements from cerebral visual processing and real-world functional vision. Hearing assessment requires a cross-check approach that combines cochlear and neural measures, because otoacoustic emissions alone may not detect auditory neuropathy or brainstem dysfunction and early auditory brainstem abnormalities may be transient. Somatosensory assessment is the least standardised domain; tactile registration, localisation, discrimination, stereognosis, joint-position sense and kinesthesia must be tested separately while minimising motor, visual, language and attention demands. Neuroimaging and neurophysiology can clarify mechanisms and resolve discordant findings, but neither substitutes for direct, developmentally appropriate functional assessment. An integrated stepped pathway is proposed, linking perinatal records and lesion pattern to repeated domain-specific testing, response adaptations, activity-level observation and participation consequences. The central conclusion is that no single test or lesion pattern can characterise sensory function after HIE-related CP. Reliable assessment depends on triangulation across modalities, methods, developmental stages and everyday contexts.