INFORM CONSENT

TITLE OF RESEARCH STUDY

A COMPARATIVE STUDY OF VISUAL PERCEPTUAL SKILLS IN NORMAL AND CEREBRAL PALSY

CHILDREN.

INVESTIGATORS

Rufaiza Shoukat Kashaf

Ramsha Mansoor Shahabuddin

PURPOSE OF STUDY:

The aim of this study is to evaluate and to compare the visual perception skills in normal children and children with
cerebral palsy.

Time Declaration:

10-15 minutes

Potential Benefit Of Being In Study:

Visual perception is the ability to identify, organize, interpret and comprehend visual information received by a person
through his or her eyes. It provides connection to our environment. Perception is increased by experience and application
over time, with the stimuli coming from the environment. These skills play an important role to continue our daily lives.
Visual perceptual dysfunctions affect the children to perform their activities of daily living (ADL) like eating, dressing,
tying shoe laces, play activities involving building blocks, solving puzzles, reading and writing. They seem to be
uncoordinated, have trouble seeing the difference between similar letters or shapes and have a hard time remembering
what they’ve seen.
OT focuses on functional independence in performing ADL, improving play skills, involving in leisure activities. It is
important to focus on performance component of visual perception. So this study will help to assess child’s visual
perceptual skills by using standardized test, Motor Free Visual Perception Test (MVPT). Using this test, will allow us to
diagnose visual perceptual dysfunction appropriately and measure effectively any change in a client’s occupational
performance.

Confidentiality: The records of this study and all information will be kept confidential. None of your information lead to
your identification. The information about you will be sealed; only the researchers of this study will have access to the
records.
Child Name: ________________

Age: ____

Gender: ________

Institution Name: _________________________

DECLARATION OF CONSENT

I understand that relevant sections of my child medical notes and data collected during the study may be looked by
individuals from regulatory authorities, where it is relevant to my child taking part in this research. I give permission for
these investigators to have access to my records.

I confirmed that I am fully aware that this research will not affect clinical care by my doctor.

Having been assured of total anonymity, I consent to the collected data being used for analysis, presentation and
publication.

I have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it and
any questions that I have asked have been answered to my satisfaction I consent voluntarily for my child to participate as
a participant in this study.

Name/Signature of Guardian: _____________________

Date:____________

For Investigator/ Researcher

I have witnessed the accurate reading of the consent form to the parent of the potential participant, and the individual has
had the opportunity to ask questions. I confirm that the individual has given consent freely.

Name/Signature of Researcher: ___________________

Date: ____________