Visual Mirror Therapy: An Exploratory Framework for Vision Rehabilitation in Children with Cerebral Visual Impairment and an Atelic Profile, Registered Report Stage 1

Children with cerebral visual impairment (CVI) presenting an atelic profile constitute a population that is largely excluded from neurovisual research, primarily due to the absence of reliable behavioural responses to standard assessment or intervention paradigms. This exclusion often leads to the assumption that a lack of observable response reflects an absence of visual processing, despite converging evidence from neuroscience indicating that neural processing may persist in the absence of overt behavioural expression. This protocol describes a clinical feasibility study designed to evaluate the feasibility, tolerability, and measurement reliability of a passive visual mirror exposure paradigm in children with CVI and an atelic profile. The visual mirror is defined as the repeated presentation of a highly predictable, coherent visual experience, intended to reduce perceptual instability and cognitive load associated with typical visual environments, without aiming to restore or train visual function. The paradigm relies on passive visual exposure delivered via a large screen, or, where appropriate and tolerated, a virtual reality headset configured in a strictly non-interactive mode, without requiring effort, task engagement, or voluntary responses from the child. The study is embedded within a precautionary ethical framework specifically adapted to behaviourally non-responsive paediatric populations, defined here as children presenting absent voluntary behavioural responses to sensory or task-based instructions. Feasibility and tolerability are assessed using predefined safety criteria and non-verbal physiological indicators, including heart rate and autonomic markers, rather than behavioural performance. This feasibility study is designed to characterise the ethical acceptability, implementability, and physiological tolerability of the protocol in this vulnerable population, and to inform future research considerations without implying any obligation or commitment to subsequent studies.