A Methodological Framework for Passive Visual Mirror Exposure in Children with CVI and an Atelic Profile

Abstract 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 article proposes a pre-empirical methodological framework describing a passive visual mirror exposure paradigm intended to inform the design of future feasibility studies 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 proposed framework is grounded in a precautionary ethical rationale specifically adapted to behaviourally non-responsive paediatric populations, defined here as children presenting absent voluntary behavioural responses to sensory or task-based instructions. The framework outlines predefined safety criteria and non-verbal physiological indicators, including heart rate and autonomic markers, as illustrative examples of feasibility and tolerability monitoring, rather than behavioural performance. This manuscript does not report or initiate research involving human participants. It is intended to characterise the ethical acceptability, conceptual implementability, and methodological considerations of a passive visual mirror paradigm in this vulnerable population, and to inform future research considerations contingent upon formal ethical approval, without implying any obligation or commitment to subsequent studies.