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Xavier JS, Orsati FT, Laurence PG, Barbosa LK, Gouveia AS, D'Antino MEF, Lukasova K, Macedo EC, Schwartzman JS. Insights into Rett Syndrome girls' receptive vocabulary through eye movements and parental perception. Eur J Paediatr Neurol 2024; 51:1-8. [PMID: 38729045 DOI: 10.1016/j.ejpn.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study evaluated the receptive vocabulary of girls diagnosed with Rett Syndrome (RS) by employing eye-tracking technology and examined how these objective measures compared with parents' perceptions of their daughters' language abilities. METHOD Fourteen girls with RS and eleven typically developing peers participated. Instruments included the Kerr Scale, a parental questionnaire on communication skills, the Peabody Picture Vocabulary Test - PPVT-4, and eye-tracking equipment. The PPVT-4's initial 12 cards, each displaying four images, were presented on screen for 5 s for the child's initial inspection. Subsequently, the same card was shown for 5 s with instructions to identify the picture matching the word, repeated three times in a randomized order. RESULTS Eye-tracking assessments revealed that girls with RS with less severe symptoms, performed below typically developing peers with aged 3-4 years. The number of eye fixations emerged as a reliable metric for assessing their performance. A positive correlation was found between parental reports of their daughters' vocabulary knowledge and their ability to identify the correct stimulus, suggesting comprehension and active engagement in the testing process. CONCLUSION This study presents a pioneering approach by combining parental perceptions with eye-tracking measures to assess receptive vocabulary in girls diagnosed with Rett Syndrome. Despite showing lower performance levels compared to significantly younger peers, the findings suggest that these individuals use less effectively eye contact as a mode of communication.
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Affiliation(s)
- Jucineide S Xavier
- Social and Cognitive Neuroscience Laboratory and Human Developmental Sciences Graduate Program, Mackenzie Presbyterian University, Brazil.
| | | | - Paulo G Laurence
- Social and Cognitive Neuroscience Laboratory and Human Developmental Sciences Graduate Program, Mackenzie Presbyterian University, Brazil
| | | | | | | | - Katerina Lukasova
- Center of Mathematics, Computing and Cognition, Federal University of ABC, Brazil
| | - Elizeu C Macedo
- Social and Cognitive Neuroscience Laboratory and Human Developmental Sciences Graduate Program, Mackenzie Presbyterian University, Brazil
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2
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Xu Y, Zheng P, Feng W, Chen L, Sun S, Liu J, Tang W, Bao C, Xu L, Xu D, Zhao K. Patterns of attentional bias in antenatal depression: an eye-tracking study. Front Behav Neurosci 2023; 17:1288616. [PMID: 38192488 PMCID: PMC10773570 DOI: 10.3389/fnbeh.2023.1288616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction One of the most common mental disorders in the perinatal period is depression, which is associated with impaired emotional functioning due to alterations in different cognitive aspects including thought and facial emotion recognition. These functional impairment may affect emerging maternal sensitivity and have lasting consequences for the dyadic relationship. The current study aimed to investigate the impact of depressive symptoms on the attention bias of infant stimuli during pregnancy. Methods Eighty-six pregnant women completed the Edinburgh Postnatal Depression Scale and an eye-tracking task comprising infant-related emotion images. All participants showed biased attention to infant-related images. Results First, compared to healthy pregnant women, pregnant women with depression symptoms initially directed their attention to infant-related stimuli more quickly (F (1, 84) = 6.175, p = 0.015, η2 = 0.068). Second, the two groups of pregnant women paid attention to the positive infant stimuli faster than the neutral infant stimuli, and the first fixation latency bias score was significantly smaller than that of the infant-related negative stimulus (p = 0.007). Third, compared with the neutral stimulus, the non-depression group showed a longer first gaze duration to the negative stimulus of infants (p = 0.019), while the depressive symptoms group did not show this difference. Conclusion We speculate that structural and functional changes in affective motivation and cognitive-attention brain areas may induce these attentional bias patterns. These results provide suggestions for the implementation of clinical intervention programs to correct the attention bias of antenatal depressed women.
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Affiliation(s)
- Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Peiwen Zheng
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wenqian Feng
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, China
| | - Lipeng Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Shiyu Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jie Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Weina Tang
- Shaoxing 7th People’s Hospital, Shaoxing, China
| | - Ciqing Bao
- Wenzhou Seventh People’s Hospital, Wenzhou, China
| | - Ling Xu
- Wenzhou Seventh People’s Hospital, Wenzhou, China
| | - Dongwu Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- Lishui Second People’s Hospital Affiliated to Wenzhou Medical University, Lishui, China
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China
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Elvidge KL, Christodoulou J, Farrar MA, Tilden D, Maack M, Valeri M, Ellis M, Smith NJC. The collective burden of childhood dementia: a scoping review. Brain 2023; 146:4446-4455. [PMID: 37471493 PMCID: PMC10629766 DOI: 10.1093/brain/awad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023] Open
Abstract
Childhood dementia is a devastating and under-recognized group of disorders with a high level of unmet need. Typically monogenic in origin, this collective of individual neurodegenerative conditions are defined by a progressive impairment of neurocognitive function, presenting in childhood and adolescence. This scoping review aims to clarify definitions and conceptual boundaries of childhood dementia and quantify the collective disease burden. A literature review identified conditions that met the case definition. An expert clinical working group reviewed and ratified inclusion. Epidemiological data were extracted from published literature and collective burden modelled. One hundred and seventy genetic childhood dementia disorders were identified. Of these, 25 were analysed separately as treatable conditions. Collectively, currently untreatable childhood dementia was estimated to have an incidence of 34.5 per 100 000 (1 in 2900 births), median life expectancy of 9 years and prevalence of 5.3 per 100 000 persons. The estimated number of premature deaths per year is similar to childhood cancer (0-14 years) and approximately 70% of those deaths will be prior to adulthood. An additional 49.8 per 100 000 births are attributable to treatable conditions that would cause childhood dementia if not diagnosed early and stringently treated. A relational database of the childhood dementia disorders has been created and will be continually updated as new disorders are identified (https://knowledgebase.childhooddementia.org/). We present the first comprehensive overview of monogenic childhood dementia conditions and their collective epidemiology. Unifying these conditions, with consistent language and definitions, reinforces motivation to advance therapeutic development and health service supports for this significantly disadvantaged group of children and their families.
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Affiliation(s)
| | - John Christodoulou
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children's Hospital, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital Network, Randwick, NSW 2031, Australia
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW 2052, Australia
| | | | - Megan Maack
- Childhood Dementia Initiative, Brookvale, NSW 2100, Australia
| | | | - Magda Ellis
- THEMA Consulting Pty Ltd, Pyrmont, NSW 2009, Australia
| | - Nicholas J C Smith
- Discipline of Paediatrics, University of Adelaide, Women's and Children's Hospital, North Adelaide, South Australia 5006, Australia
- Department of Neurology and Clinical Neurophysiology, Women’s and Children’s Health Network, North Adelaide, South Australia 5006, Australia
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McComas JJ, Kolb R, Girtler S. The Effect of Caregiver-Implemented Training on Augmentative Alternative Communication Use by Individuals with Rett Syndrome: Remote Coaching via Telehealth. Dev Neurorehabil 2023; 26:436-449. [PMID: 38183414 DOI: 10.1080/17518423.2023.2301617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
Limited published literature exists demonstrating functional relations between idiosyncratic responses or augmentative alternative communication (AAC) and social reinforcement for individuals with Rett syndrome. In this study, six females with Rett syndrome ages 2-25 demonstrated requesting for preferred items using both idiosyncratic responses (e.g, looking, reaching) and AAC (e.g. single response microswitches). Researchers connected remotely via telehealth to coach caregivers to implement all sessions in home environments. Researchers individualized response prompt delays during AAC sessions (request/mand training) based on each participants' latency to respond during baseline. Implications for practice and directions for future research are discussed.
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Affiliation(s)
| | - Rebecca Kolb
- The University of Minnesota, Minneapolis, MN, USA
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St John M, Tripathi T, Morgan AT, Amor DJ. To speak may draw on epigenetic writing and reading: Unravelling the complexity of speech and language outcomes across chromatin-related neurodevelopmental disorders. Neurosci Biobehav Rev 2023; 152:105293. [PMID: 37353048 DOI: 10.1016/j.neubiorev.2023.105293] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/11/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
Speech and language development are complex neurodevelopmental processes that are incompletely understood, yet current evidence suggests that speech and language disorders are prominent in those with disorders of chromatin regulation. This review aimed to unravel what is known about speech and language outcomes for individuals with chromatin-related neurodevelopmental disorders. A systematic literature search following PRISMA guidelines was conducted on 70 chromatin genes, to identify reports of speech/language outcomes across studies, including clinical reports, formal subjective measures, and standardised/objective measures. 3932 studies were identified and screened and 112 were systematically reviewed. Communication impairment was core across chromatin disorders, and specifically, chromatin writers and readers appear to play an important role in motor speech development. Identification of these relationships is important because chromatin disorders show promise as therapeutic targets due to the capacity for epigenetic modification. Further research is required using standardised and formal assessments to understand the nuanced speech/language profiles associated with variants in each gene, and the influence of chromatin dysregulation on the neurobiology of speech and language development.
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Affiliation(s)
- Miya St John
- Speech and Language, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Audiology and Speech Pathology, University of Melbourne, VIC, Australia.
| | - Tanya Tripathi
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Angela T Morgan
- Speech and Language, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Audiology and Speech Pathology, University of Melbourne, VIC, Australia; Speech Genomics Clinic, Royal Children's Hospital, Parkville, VIC, Australia.
| | - David J Amor
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, VIC, Australia; Speech Genomics Clinic, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, VIC, Australia.
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Rocco K, Drobnyk W, Bruce S, Soumerai SB. Ayres Sensory Integration Therapy for a Child With Rett Syndrome: A Case Report. Clin Med Insights Pediatr 2023; 17:11795565231188939. [PMID: 37529622 PMCID: PMC10387803 DOI: 10.1177/11795565231188939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Rett syndrome (RTT) is a neurodevelopmental disorder characterized by severe dyspraxia, hand stereotypies, and sensory processing issues for which there is no known treatment. This case describes a child with classic RTT and the child's responses to an Ayres Sensory Integration (ASI) treatment intervention (36 one-hour sessions, 3 per week). We coded and analyzed 36 detailed treatment notes to answer the following questions: What strategies and factors facilitated or interfered with participation in the intervention? What critical elements of treatment documentation might detect small changes in praxis and participation? How do patterns of motor or praxis milestones that emerge over time relate to this child's level of participation? We observed an increase in participation when the therapist incorporated elements of neurodevelopmental treatment (NDT) and motor learning theory- treatment strategies commonly used with children who have neuromotor conditions. This increase in participation in the ASI intervention emerged at approximately the same time that the therapist documented acquisition of new motor and praxis skills. We observed the importance of using: lateral movement activities to develop weight-shifting and bilateral coordination, rotary play to increase trunk rotation and improve postural transitions, and rhythm to promote continuing or initiating actions. The documentation of the specific amounts of assistance and prompting needed during treatment sessions was an important tool for tracking small yet meaningful responses to treatment. This case illustrates a novel use of ASI intervention supplemented with strategies that developed foundational skills, and the emergence of praxis and participation in the therapeutic intervention. We suggest further research is needed to determine efficacy of ASI for other children with this rare disorder.
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Affiliation(s)
| | | | - Susan Bruce
- Special Education, Curriculum & Instruction, Boston College, Chestnut Hill, MA, USA
| | - Stephen B Soumerai
- Department of Population Medicine and Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, MA, USA
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Tost A, Bachiller A, Garcia-Cazorla A, Medina-Rivera I, Romero S, Mananas MA. Electroencephalographic assessment in patients with Rett syndrome during cognitive stimulation by means of eye tracking technology and alternative and augmentative communication systems. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082932 DOI: 10.1109/embc40787.2023.10340249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Rett syndrome (RTT) is considered a rare disease despite being the leading genetic disorder to cause severe intellectual disability in women. There is no cure for RTT, so the treatment is symptomatic and supporting, requiring a multidisciplinary approach. Occupational therapy can help girls and their families to improve communication, being one of the main concerns when verbal language and intentional hand movement are impaired or lost. This paper presents a pilot study of cognitive training through the combined use of eye-tracking technology (ETT) and augmentative and alternative communication (AAC) using the Peabody Picture Vocabulary Test (PPVT-IV). The objective was to evaluate brain activation by means of electroencephalography (EEG) during the stimulation of non-verbal communication. EEG data were recorded during an eyes-open resting state (EO-RS) period and during cognitive stimulation via AAC activity. To assess their effect, both signals were compared at the spectral level, focusing on frequency, brain symmetry and connectivity. During the task, a redistribution of power towards fast frequency bands was observed, as well as an improvement in the brain symmetry index (BSI) and functional synchronicity through increased coherence. Therefore, the results of the spectral analysis showed a possible deviation from the pathological pattern, manifesting a positive effect in the use of non-verbal cognitive stimulation activities. In conclusion, it was observed that it is possible to establish a cognitive training system that produces brain activation and favors communication and learning despite intentional language loss.Clinical Relevance- This manifests a method of cognitive training that would induce brain activation in RTT patients with absence of intentional communication. The evaluation system through spectral analysis could complement the standardized protocols to asses communication that are based on verbal and motor production.
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Characterizing eye-gaze positions of people with severe motor dysfunction: Novel scoring metrics using eye-tracking and video analysis. PLoS One 2022; 17:e0265623. [PMID: 36044416 PMCID: PMC9432701 DOI: 10.1371/journal.pone.0265623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/06/2022] [Indexed: 11/19/2022] Open
Abstract
Nonverbal communication with people who have physical disabilities is difficult. Eye-tracking technologies have recently been developed and applied to help people with physical disabilities in their communication. However, the eye-gaze patterns of people with severe motor dysfunction (SMD) have not been analyzed in detail. To clarify characterization of people with SMD, we aimed to develop gaze position-based evaluation metrics and analyze detailed eye-gaze patterns of people with SMD. We developed two new scoring metrics: (1) saliency score based on three saliency maps—spectral residual (SR), fine grained (FG), and motion (Mo); and (2) the distance score, which represents to what extent people can chase an object in a video. The evaluation was performed on 102 participants, consisting of 35 subjects with profound intellectual and multiple disabilities (PIMD; SMD with IQ < 20), 19 with severe physical disabilities (SPD; SMD with IQ ≥ 20), and 48 healthy individuals. We observed that two saliency scores (SR and FG) and the distance score showed significant differences between the PIMD/SPD and healthy groups for the entire video, whereas Mo scores did not. Moreover, the distance score was analyzed separately for each scene, where scenes were categorized into three patterns—running, explanation, and hiding—according to the behavior of the moving objects. In the SPD and healthy groups, the explanation scenes accounted for the highest percentage of all scenes with the best distance score (63.6% and 61.9%, respectively), whereas in the PIMD group, the running scenes accounted for the highest percentage (54.5%). In conclusion, the new metrics were successful in quantitatively assessing the gaze responsiveness of people with SMD, which could not be assessed using a conventional metric, gaze-acquisition time. This study is expected to expand the possibilities of nonverbal communication using eye-tracking devices for people with SMD.
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Gómez Taibo ML, Paramos Alonso S. Documentación de habilidades comunicativas y de lenguaje receptivo en un caso de Síndrome de Rett. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2022. [DOI: 10.5209/rlog.77431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Las dificultades de las personas con síndrome de Rett (SR) para hablar y producir respuestas motoras hace de la valoración un proceso difícil, resultando necesario combinar métodos informales y adaptaciones en los instrumentos formales para obtener información sobre los niveles de competencia. El objetivo de este estudio es documentar el proceso de valoración de las habilidades comunicativo-lingüísticas seguido con una niña con SR combinando métodos de evaluación y realizando adaptaciones en los tests estandarizados. Se llevaron a cabo observaciones informales en entornos naturales, los compañeros de comunicación cubrieron la Matriz de Comunicación, y se realizaron adaptaciones en los tests Vocabulario en Imágenes Peabody y TSA de desarrollo de la morfosintaxis, y en el Test of Aided Communication Performance, consistentes en reducir el número de alternativas, presentarlas en una disposición accesible a la señalización con la mirada, y en dar tiempo de espera para la respuesta de la participante con SR. Los resultados obtenidos mediante las adaptaciones utilizando la mirada como método de acceso mostraron niveles de dominio de comunicación preintencional y de comunicación no convencional, junto con destrezas emergentes en comunicación convencional y simbólica para funciones de petición e interacción social y una comprensión de estructuras gramaticales sencillas. La conclusión que se desprende es que es imperativo que las evaluaciones se adapten a las limitaciones físicas y orales de las personas con SR, de modo que puedan descubrirse capacidades ocultas, se establezcan objetivos para la intervención basados en sus niveles reales de competencia para apoyar al máximo la comunicación.
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Kujawa K, Żurek A, Gorączko A, Zurek G. Application of High-Tech Solution for Memory Assessment in Patients With Disorders of Consciousness. Front Neurol 2022; 13:841095. [PMID: 35432173 PMCID: PMC9008141 DOI: 10.3389/fneur.2022.841095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Testing cognitive function in patients after severe brain damage is a major clinical challenge. In the absence of both verbal and motor communication, tests commonly used to assess cognitive function are completely or partially undoable for disorders of consciousness patients. The study involved 12 patients with varying degrees of impaired consciousness due to brain damage, with no verbal and motor communication. Memory was assessed in study participants using oculography. Memory tasks were presented in four categories. The total percentage of correctly completed tasks obtained across the group was 39.58%. The most difficult tasks included category C.4 with tasks involving working memory. Regardless of the subjects' level of consciousness, there was no statistically significant difference in the percentage of correct responses obtained in subgroups distinguished by CRS-R score. Eye tracking technology can be successfully used in the assessment of cognitive function, particularly when eye movements are the only channel of communication in individuals after brain damage. We suggest that the cognitive functions of people after brain damage should be further analyzed using eye tracking.
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Affiliation(s)
- Katarzyna Kujawa
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- Neurorehabilitation Clinic, Wrocław, Poland
| | - Alina Żurek
- Institute of Psychology, University of Wroclaw, Wrocław, Poland
| | - Agata Gorączko
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- Neurorehabilitation Clinic, Wrocław, Poland
| | - Grzegorz Zurek
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- *Correspondence: Grzegorz Zurek
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Migliorelli C, Medina-Rivera I, Bachiller A, Tost A, Alonso JF, López-Sala A, Armstrong J, O'Callahan MDM, Pineda M, Mañanas MA, Romero S, García-Cazorla Á. Cognitive stimulation has potential for brain activation in individuals with Rett syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:213-224. [PMID: 34796573 DOI: 10.1111/jir.12902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Knowledge regarding neuropsychological training in Rett syndrome (RS) is scarce. The aim of this study was to assess the outcome and the duration of the effect of cognitive stimulation on topographic electroencephalography (EEG) data in RS. METHODS Twenty female children diagnosed with RS were included in the analysis. Girls with RS conducted a cognitive task using an eye-tracker designed to evaluate access and choice skills. EEG data were acquired during the experimental procedure including two 10-min baseline stages before and after the task. Topographical changes of several EEG spectral markers including absolute and relative powers, Brain Symmetry Index and entropy were assessed. RESULTS Topographic significance probability maps suggested statistical decreases on delta activity and increases on beta rhythm associated with the cognitive task. Entropy increased during and after the task, likely related to more complex brain activity. A significant positive interaction was obtained between Brain Symmetry Index and age showing that the improvement of interhemispheric symmetry was higher in younger girls (5-10 years). CONCLUSIONS According to our findings, significant alterations of brain rhythms were observed during and after cognitive stimulation, suggesting that cognitive stimulation may have effects on brain activity beyond the stimulation period. Finally, our promising results also showed an increase brain symmetry that was especially relevant for the younger group. This could suggest an interaction of the eye-tracking cognitive task; however, further studies in this field are needed to assess the relation between brain asymmetries and age.
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Affiliation(s)
- C Migliorelli
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - I Medina-Rivera
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Neurology Department, Neurometabolic Unit and Synaptic Metabolism Lab, Institut Pediàtric de Recerca, Hospital Sant Joan de Déu, metabERN and CIBERER-ISCIII, Barcelona, Spain
| | - A Bachiller
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - A Tost
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - J F Alonso
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - A López-Sala
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Neurology Department, Neurometabolic Unit and Synaptic Metabolism Lab, Institut Pediàtric de Recerca, Hospital Sant Joan de Déu, metabERN and CIBERER-ISCIII, Barcelona, Spain
| | - J Armstrong
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Molecular Genetics Medicine Section, Hospital Sant Joan de Déu, Barcelona, Spain
| | - M D M O'Callahan
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Neurology Department, Neurometabolic Unit and Synaptic Metabolism Lab, Institut Pediàtric de Recerca, Hospital Sant Joan de Déu, metabERN and CIBERER-ISCIII, Barcelona, Spain
| | - M Pineda
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - M A Mañanas
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - S Romero
- Department of Automatic Control (ESAII), Biomedical Engineering Research Centre (CREB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Á García-Cazorla
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Neurology Department, Neurometabolic Unit and Synaptic Metabolism Lab, Institut Pediàtric de Recerca, Hospital Sant Joan de Déu, metabERN and CIBERER-ISCIII, Barcelona, Spain
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Zhu L, Cui G, Li Y, Zhang J, Kong W, Cichocki A, Li J. Attention allocation on mobile app interfaces when human interacts with them. Cogn Neurodyn 2021; 16:859-870. [PMID: 35847542 PMCID: PMC9279534 DOI: 10.1007/s11571-021-09760-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022] Open
Abstract
AbstractWith the popularity of smartphones and the pervasion of mobile apps, people spend more and more time to interact with a diversity of apps on their smartphones, especially for young population. This raises a question: how people allocate attention to interfaces of apps during using them. To address this question, we, in this study, designed an experiment with two sessions (i.e., Session1: browsing original interfaces; Session 2: browsing interfaces after removal of colors and background) integrating with an eyetracking system. Attention fixation durations were recorded by an eye-tracker while participants browsed app interfaces. The whole screen of smartphone was divided into four even regions to explore fixation durations. The results revealed that participants gave significantly longer total fixation duration on the bottom left region compared to other regions in the session (1) Longer total fixation duration on the bottom was preserved, but there is no significant difference between left side and right side in the session2. Similar to the finding of total fixation duration, first fixation duration is also predominantly paid on the bottom area of the interface. Moreover, the skill in the use of mobile phone was quantified by assessing familiarity and accuracy of phone operation and was investigated in the association with the fixation durations. We found that first fixation duration of the bottom left region is significantly negatively correlated with the smartphone operation level in the session 1, but there is no significant correlation between them in the session (2) According to the results of ratio exploration, the ratio of the first fixation duration to the total fixation duration is not significantly different between areas of interest for both sessions. The findings of this study provide insights into the attention allocation during browsing app interfaces and are of implications on the design of app interfaces and advertisements as layout can be optimized according to the attention allocation to maximally deliver information.
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Affiliation(s)
- Li Zhu
- Computer & Software School, Hangzhou Dianzi University, Hangzhou, Zhejiang Province 310018 China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou Dianzi University, 310018 Hangzhou, China
| | - Gaochao Cui
- Department of Information System, Saitama Institute of Technology, Fukaya, Saitama 369-0293 Japan
| | - Yan Li
- School of Art and Textile and Clothing Engineering, Changshu Institute of Techonology, Changshu, 215500 China
- Graduate School of Advanced Imaging Science, Multimedia and Film, Chung-Ang University, Seoul, 06974 Korea
| | - Jianhai Zhang
- Computer & Software School, Hangzhou Dianzi University, Hangzhou, Zhejiang Province 310018 China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou Dianzi University, 310018 Hangzhou, China
| | - Wanzeng Kong
- Computer & Software School, Hangzhou Dianzi University, Hangzhou, Zhejiang Province 310018 China
- Key Laboratory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou Dianzi University, 310018 Hangzhou, China
| | - Andrzej Cichocki
- Computer & Software School, Hangzhou Dianzi University, Hangzhou, Zhejiang Province 310018 China
- Skolkovo Institute of Science and Technology (Skoltech), Moscow, Russia 143026
| | - Junhua Li
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, CO4 3SQ UK
- Laboratory for Brain-Bionic Intelligence and Computational Neuraoscience, Wuyi University, Jiangmen, 529020 China
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13
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Graziola F, Garone G, Grasso M, Capuano A. Cognitive Assessment in GNAO1 Neurodevelopmental Disorder Using an Eye Tracking System. J Clin Med 2021; 10:jcm10163541. [PMID: 34441836 PMCID: PMC8397136 DOI: 10.3390/jcm10163541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
GNAO1 gene mutations are associated with a neurodevelopmental disorder characterized by developmental delay, epilepsy, and movement disorder. Eye tracking and eye movement analysis are an intriguing method to assess cognitive and language function and, to the best of our knowledge, it has never been tested in a standardized way in GNAO1. GNAO1 children are usually wheelchair-bound and with numerous motor constrains, including dystonic movements and postures, heterotropia, and hypotonia, making the cognitive assessment arduous. These contribute to the burden and disability, with a high level of frustration of caregivers and patients. We have herein demonstrated that, through an eye tracking system, six GNAO1 patients evaluated showed variable degrees of communicative intent through intentionally directed gaze. Moreover, three of these were able to complete a cognitive evaluation, and showed normal fluid intelligence and lexical comprehension. In conclusion, in GNAO1-related disorders, the degree of cognitive development is underestimated; eye tracking technologies may help in overcome these boundaries.
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Affiliation(s)
- Federica Graziola
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, 00146 Rome, Italy; (G.G.); (M.G.); (A.C.)
- Department of System Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence:
| | - Giacomo Garone
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, 00146 Rome, Italy; (G.G.); (M.G.); (A.C.)
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Melissa Grasso
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, 00146 Rome, Italy; (G.G.); (M.G.); (A.C.)
| | - Alessandro Capuano
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, 00146 Rome, Italy; (G.G.); (M.G.); (A.C.)
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14
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Tost A, Migliorelli C, Bachiller A, Medina-Rivera I, Romero S, García-Cazorla Á, Mañanas MA. Choosing Strategies to Deal with Artifactual EEG Data in Children with Cognitive Impairment. ENTROPY (BASEL, SWITZERLAND) 2021; 23:1030. [PMID: 34441170 PMCID: PMC8392530 DOI: 10.3390/e23081030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/23/2021] [Accepted: 08/05/2021] [Indexed: 12/21/2022]
Abstract
Rett syndrome is a disease that involves acute cognitive impairment and, consequently, a complex and varied symptomatology. This study evaluates the EEG signals of twenty-nine patients and classify them according to the level of movement artifact. The main goal is to achieve an artifact rejection strategy that performs well in all signals, regardless of the artifact level. Two different methods have been studied: one based on the data distribution and the other based on the energy function, with entropy as its main component. The method based on the data distribution shows poor performance with signals containing high amplitude outliers. On the contrary, the method based on the energy function is more robust to outliers. As it does not depend on the data distribution, it is not affected by artifactual events. A double rejection strategy has been chosen, first on a motion signal (accelerometer or EEG low-pass filtered between 1 and 10 Hz) and then on the EEG signal. The results showed a higher performance when working combining both artifact rejection methods. The energy-based method, to isolate motion artifacts, and the data-distribution-based method, to eliminate the remaining lower amplitude artifacts were used. In conclusion, a new method that proves to be robust for all types of signals is designed.
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Affiliation(s)
- Ana Tost
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC), 08028 Barcelona, Spain; (C.M.); (A.B.); (S.R.); (M.A.M.)
| | - Carolina Migliorelli
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC), 08028 Barcelona, Spain; (C.M.); (A.B.); (S.R.); (M.A.M.)
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain; (I.M.-R.); (Á.G.-C.)
| | - Alejandro Bachiller
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC), 08028 Barcelona, Spain; (C.M.); (A.B.); (S.R.); (M.A.M.)
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain; (I.M.-R.); (Á.G.-C.)
| | - Inés Medina-Rivera
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain; (I.M.-R.); (Á.G.-C.)
| | - Sergio Romero
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC), 08028 Barcelona, Spain; (C.M.); (A.B.); (S.R.); (M.A.M.)
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain; (I.M.-R.); (Á.G.-C.)
| | - Ángeles García-Cazorla
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain; (I.M.-R.); (Á.G.-C.)
- Neurometabolic Unit and Synaptic Metabolism Lab, Neurology Department, Institut Pediàtric de Recerca, Hospital Sant Joan de Déu, metabERN and CIBERER-ISCIII, 08950 Barcelona, Spain
| | - Miguel A. Mañanas
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC), 08028 Barcelona, Spain; (C.M.); (A.B.); (S.R.); (M.A.M.)
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain; (I.M.-R.); (Á.G.-C.)
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15
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Liu Z, Yang Z, Gu Y, Liu H, Wang P. The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis. PLoS One 2021; 16:e0254059. [PMID: 34252113 PMCID: PMC8274929 DOI: 10.1371/journal.pone.0254059] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
Background Eye tracking (ET) is a viable marker for the recognition of cognitive disorders. We assessed the accuracy and clinical value of ET for the diagnosis of cognitive disorders in patients. Methods We searched the Medline, Embase, Web of Science, Cochrane Library, and Pubmed databases from inception to March 2, 2021, as well as the reference lists of identified primary studies. We included articles written in English that investigated ET for cognitive disorder patients—Mild cognitive impairment (MCI), Alzheimer’s disease (AD), Amyotrophic lateral sclerosis (ALS), and dementia. Two independent researchers extracted the data and the characteristics of each study; We calculated pooled sensitivities and specificities. A hierarchical summary of receiver performance characteristics (HSROC) model was used to test the diagnostic accuracy of ET for cognitive impairment (CI). Findings 11 studies met the inclusion criteria and were included in qualitative comprehensive analysis. Meta-analysis was performed on 9 trials using Neuropsychological Cognitive Testing (NCT) as the reference standard. The comprehensive sensitivity and specificity of ET for detecting cognitive disorders were 0.75 (95% CI 0.72–0.79) and 0.73 (95% CI 0.70 to 0.76), respectively. The combined positive likelihood ratio (LR+) was 2.74 (95%CI 2.32–3.24) and the negative likelihood ratio (LR−) was 0.27 (95%CI 0.18–0.42). Conclusions This review showed that ET technology could be used to detect the decline in CI, clinical use of ET techniques in combination with other tools to assess CI can be encouraged.
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Affiliation(s)
- Zicai Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Zhen Yang
- Histology and Imaging platform, Core Facilities of West China Hospital, Sichuan University, China
| | - Yueming Gu
- Rehabilitation College of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The 7th Affiliated Hospital of Sun Yat-Sen University (Shenzhen), Shenzhen, Guangdong, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
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16
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Ward C, Chiat S, Townend GS. A comparison of formal and informal methods for assessing language and cognition in children with Rett syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 114:103961. [PMID: 33915382 DOI: 10.1016/j.ridd.2021.103961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Opinions about the cognitive and receptive language skills of people with Rett syndrome (RTT) range from severe intellectual impairment to near-normal development. Assessment is challenging because most are non-verbal, with no purposeful hand use. Clarkson et al. (2017) adapted the Mullen Scales of Early Learning for use with eye gaze technology (MSEL-A/ET) for people with RTT. AIMS To investigate and compare the performance of children with RTT on formal and newly-designed informal assessments of language and cognition using eye gaze/tracking technology. METHODS AND PROCEDURES Ten children with RTT aged 4:0-6:8 were assessed on the MSEL-A/ET for Visual Reception (VR) and Receptive Language (RL), and standard MSEL for Expressive Language (EL). Informal assessments of the same skills were embedded in activities such as reading and cake-decorating. OUTCOMES AND RESULTS Standard scores on MSEL-A/ET VR and RL subtests ranged from 'very low' to 'above average'. All children scored 'very low' on standard EL assessment. Informal assessments added information about EL, with children producing 1-3 word utterances and a range of communicative functions through an eye gaze device. CONCLUSIONS AND IMPLICATIONS Combining low-tech augmentative and alternative communication, eye gaze technology, informal activities and formal assessment, yields greater insight into children's abilities. This is important in informing suitable support and education for the individual.
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Affiliation(s)
- Callie Ward
- School of Health Sciences, Language and Communication Science, City, University of London, Northampton Square, London, EC1V 0HB, UK; Rett UK, Victory House, Chobham Street, Luton, LU1 3BS, UK
| | - Shula Chiat
- School of Health Sciences, Language and Communication Science, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Gillian S Townend
- Rett UK, Victory House, Chobham Street, Luton, LU1 3BS, UK; Rett Expertise Centre Netherlands-GKC, Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands.
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17
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Dovigo L, Caprì T, Iannizzotto G, Nucita A, Semino M, Giannatiempo S, Zocca L, Fabio RA. Social and Cognitive Interactions Through an Interactive School Service for RTT Patients at the COVID-19 Time. Front Psychol 2021; 12:676238. [PMID: 34248774 PMCID: PMC8265204 DOI: 10.3389/fpsyg.2021.676238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The closure of all educational institutions and most rehabilitation centres represents a precautionary measure to face the COVID-19 pandemic, but the isolation and social distancing may be particularly challenging for children with special needs and disabilities (SEND), such as Rett Syndrome (RTT). The main aim of this study was to promote cognitive and social interactions among children with RTT through an interactive school program. Methods: The Interactive School palimpsest was composed of moments in which a teacher spoke directly to children with RTT and expected a response through eye gaze, and moments in which storeys-cartoon were presented while tracking the eye gaze of children. We investigated behavioural, social and cognitive parameters. Results: Children participated in both social and cognitive tasks with the spontaneous reduction of stereotypies and with increase in attention. They recalled more significant indexes when music or a song was presented together with a cartoon or a cognitive task. Conclusions: This study provides initial insights in promoting cognitive and social interactions and in the support needs of families with a child with RTT during the COVID-19 pandemic.
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Affiliation(s)
- Lucia Dovigo
- Airett Innovation and Research Center, Verona, Italy
| | - Tindara Caprì
- Airett Innovation and Research Center, Verona, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giancarlo Iannizzotto
- Airett Innovation and Research Center, Verona, Italy
- Department of Cognitive Sciences, Psychological, Educational and Cultural Studies, University of Messina, Messina, Italy
| | - Andrea Nucita
- Airett Innovation and Research Center, Verona, Italy
- Department of Cognitive Sciences, Psychological, Educational and Cultural Studies, University of Messina, Messina, Italy
| | - Martina Semino
- Airett Innovation and Research Center, Verona, Italy
- Tice Learning Center, Piacenza, Italy
| | - Samantha Giannatiempo
- Airett Innovation and Research Center, Verona, Italy
- Tice Learning Center, Piacenza, Italy
| | - Lia Zocca
- Airett Innovation and Research Center, Verona, Italy
| | - Rosa Angela Fabio
- Airett Innovation and Research Center, Verona, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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18
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Dovigo L, Caprì T, Iannizzotto G, Nucita A, Semino M, Giannatiempo S, Zocca L, Fabio RA. Social and Cognitive Interactions Through an Interactive School Service for RTT Patients at the COVID-19 Time. Front Psychol 2021; 12:676238. [PMID: 34248774 PMCID: PMC8265204 DOI: 10.3389/fpsyg.2021.676238 10.3389/fpsyg.2021.676238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The closure of all educational institutions and most rehabilitation centres represents a precautionary measure to face the COVID-19 pandemic, but the isolation and social distancing may be particularly challenging for children with special needs and disabilities (SEND), such as Rett Syndrome (RTT). The main aim of this study was to promote cognitive and social interactions among children with RTT through an interactive school program. Methods: The Interactive School palimpsest was composed of moments in which a teacher spoke directly to children with RTT and expected a response through eye gaze, and moments in which storeys-cartoon were presented while tracking the eye gaze of children. We investigated behavioural, social and cognitive parameters. Results: Children participated in both social and cognitive tasks with the spontaneous reduction of stereotypies and with increase in attention. They recalled more significant indexes when music or a song was presented together with a cartoon or a cognitive task. Conclusions: This study provides initial insights in promoting cognitive and social interactions and in the support needs of families with a child with RTT during the COVID-19 pandemic.
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Affiliation(s)
- Lucia Dovigo
- Airett Innovation and Research Center, Verona, Italy
| | - Tindara Caprì
- Airett Innovation and Research Center, Verona, Italy,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy,*Correspondence: Tindara Caprì
| | - Giancarlo Iannizzotto
- Airett Innovation and Research Center, Verona, Italy,Department of Cognitive Sciences, Psychological, Educational and Cultural Studies, University of Messina, Messina, Italy
| | - Andrea Nucita
- Airett Innovation and Research Center, Verona, Italy,Department of Cognitive Sciences, Psychological, Educational and Cultural Studies, University of Messina, Messina, Italy
| | - Martina Semino
- Airett Innovation and Research Center, Verona, Italy,Tice Learning Center, Piacenza, Italy
| | - Samantha Giannatiempo
- Airett Innovation and Research Center, Verona, Italy,Tice Learning Center, Piacenza, Italy
| | - Lia Zocca
- Airett Innovation and Research Center, Verona, Italy
| | - Rosa Angela Fabio
- Airett Innovation and Research Center, Verona, Italy,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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19
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Benson-Goldberg S, Erickson K. Eye-trackers, digital-libraries, and print-referencing: A single case study in CDKL5. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 112:103913. [PMID: 33626486 DOI: 10.1016/j.ridd.2021.103913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Providing emergent literacy intervention and assessing outcomes for children with low-incidence, complex disabilities with concomitant physical, cognitive, sensory, and communication impairments presents a significant challenge to researchers, educators, clinicians, and families alike. AIMS This study aimed to leverage advancements in commercially available eyetracking technologies to measure visual attention to print before and after a parentmediated print referencing intervention with a child with a severe, low incidence, congenital disability. Print referencing means drawing attention to the print on the page while reading. METHODS AND PROCEDURES The single case study investigated a mother-daughter dyad who completed the protocol using eye-gaze technology, digital children's books, and a computer configured with software for observing and recording interactions that were shipped to the family's home and set up by the mother with remote support from a researcher. OUTCOMES AND RESULTS Results demonstrate that the eye-tracker successfully captured the participant's eye-gaze. Furthermore, mean-level shifts in frequency of fixations demonstrates changes in visual attention to print after the parent introduced the print referencing strategy during reading. CONCLUSIONS AND IMPLICATIONS Commercially available eye-trackers and digital libraries were successfully used by the parent-child dyad to record visual attention. Furthermore, remote support from a trained researcher was sufficient to support the parent through set-up, calibration, intervention, and implementation.
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Affiliation(s)
- Sofia Benson-Goldberg
- Center for Literacy and Disability Studies, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, United States.
| | - Karen Erickson
- Center for Literacy and Disability Studies, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, United States
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20
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Fabio RA, Giannatiempo S, Semino M, Caprì T. Longitudinal cognitive rehabilitation applied with eye-tracker for patients with Rett Syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 111:103891. [PMID: 33581477 DOI: 10.1016/j.ridd.2021.103891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND longitudinal effects of cognitive rehabilitation in Rett Syndrome (RTT) have been poorly investigated and the mechanisms do not appear to have been described in detail. AIMS the aim of this study was to examine the effects of cognitive rehabilitation with eye-tracker technology on attention, choice behaviours and language over a 2-year period in patients with RTT. METHODS AND PROCEDURES 28 participants with RTT, ranging from age 4-22 years old (M = 13.85 years, SD = 5.89), received 30 min of cognitive rehabilitation with eye-tracker for 3 days a week over a 1-month for 2 years. They then underwent cognitive assessment to evaluate attention, choice, language and global functioning in four specific times: before cognitive rehabilitation (T1), after six months of cognitive rehabilitation (T2), six months after the second cognitive rehabilitation phase (T3) and at the end of the third cognitive rehabilitation phase (T4). OUTCOME AND RESULTS patients with RTT show long-term improvements in seconds of attention and number of choice behaviours, with barely any improvement in global functioning. No improvement in language was found. CONCLUSIONS AND IMPLICATIONS this is the first study aimed at examining longitudinal effects of cognitive rehabilitation in patients with RTT, demonstrating a linear improvement across time in attention and choice.
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Affiliation(s)
- Rosa Angela Fabio
- Department of Clinical and Experimental Medicine, University of Messina, Via Bivona, 98100, Messina, Italy
| | - Samantha Giannatiempo
- Centro AIRETT Ricerca e Innovazione (CARI), Research and Innovation Airett Center, Verona, Italy
| | - Martina Semino
- Centro AIRETT Ricerca e Innovazione (CARI), Research and Innovation Airett Center, Verona, Italy
| | - Tindara Caprì
- Department of Clinical and Experimental Medicine, University of Messina, Via Bivona, 98100, Messina, Italy.
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21
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Yang D, Robertson HL, Condliffe EG, Carter MT, Dewan T, Gnanakumar V. Rehabilitation therapies in Rett syndrome across the lifespan: A scoping review of human and animal studies. J Pediatr Rehabil Med 2021; 14:69-96. [PMID: 32894256 DOI: 10.3233/prm-200683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To perform a scoping review of the evidence for therapeutic interventions to manage functional impairments associated with Rett syndrome (RTT) throughout the lifespan. METHODS MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, Scopus and Index to Chiropractic Literature were searched systematically up to December 2019. Two investigators independently reviewed all search results and extracted those that met the inclusion criteria. Human and animal model studies pertaining to therapies that increase functional ability or treat RTT-associated symptoms in all age groups were included. Relevant studies were grouped into intervention categories and rated using the Oxford Centre of Evidence Based Medicine Levels of Evidence. Demographics of participants, interventions, and outcomes were summarized. RESULTS Ninety-one articles representing 88 studies met the inclusion criteria, of which 80 were human clinical studies and eight were studies using animal models. Study designs were primarily case series and only six studies involved participants above the age of 40. CONCLUSION A small number of rigorously studied rehabilitation interventions have been published. Published studies aim to address a wide variety of functional impairments. Research regarding implementation of therapies for older patients with RTT is lacking and requires further exploration.
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Affiliation(s)
- David Yang
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Helen Lee Robertson
- Liaison Librarian, Clinical Medicine, Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Elizabeth G Condliffe
- Departments of Clinical Neurosciences and Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Melissa T Carter
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Vithya Gnanakumar
- Departments of Clinical Neurosciences and Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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22
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Raspa M, Bann CM, Gwaltney A, Benke TA, Fu C, Glaze DG, Haas R, Heydemann P, Jones M, Kaufmann WE, Lieberman D, Marsh E, Peters S, Ryther R, Standridge S, Skinner SA, Percy AK, Neul JL. A Psychometric Evaluation of the Motor-Behavioral Assessment Scale for Use as an Outcome Measure in Rett Syndrome Clinical Trials. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:493-509. [PMID: 33211820 PMCID: PMC7778880 DOI: 10.1352/1944-7558-125.6.493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 07/23/2020] [Indexed: 05/13/2023]
Abstract
Rett syndrome (RTT) is a neurodevelopmental disorder that primarily affects females. Recent work indicates the potential for disease modifying therapies. However, there remains a need to develop outcome measures for use in clinical trials. Using data from a natural history study (n = 1,075), we examined the factor structure, internal consistency, and validity of the clinician-reported Motor Behavior Assessment scale (MBA). The analysis resulted in a five-factor model: (1) motor dysfunction, (2) functional skills, (3) social skills, (4) aberrant behavior, and (5) respiratory behaviors. Item Response Theory (IRT) analyses demonstrated that all items had acceptable discrimination. The revised MBA subscales showed a positive relationship with parent reported items, age, and a commonly used measure of clinical severity in RTT, and mutation type. Further work is needed to evaluate this measure longitudinally and to add items related to the RTT phenotype.
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Affiliation(s)
- Melissa Raspa
- Melissa Raspa, Carla M. Bann, and Angela Gwaltney, RTI International
| | - Carla M Bann
- Melissa Raspa, Carla M. Bann, and Angela Gwaltney, RTI International
| | - Angela Gwaltney
- Melissa Raspa, Carla M. Bann, and Angela Gwaltney, RTI International
| | | | - Cary Fu
- Cary Fu, Vanderbilt Kennedy Center
| | | | - Richard Haas
- Richard Haas, University of California San Diego
| | | | | | | | | | - Eric Marsh
- David Lieberman and Eric Marsh, Children's Hospital Boston
| | | | - Robin Ryther
- Robin Ryther, Washington University School of Medicine
| | | | | | - Alan K Percy
- Alan K. Percy, University of Alabama at Birmingham
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23
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Lim J, Greenspoon D, Hunt A, McAdam L. Rehabilitation interventions in Rett syndrome: a scoping review. Dev Med Child Neurol 2020; 62:906-916. [PMID: 32472972 DOI: 10.1111/dmcn.14565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/06/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022]
Abstract
AIM To summarize existing interventions and their outcomes in Rett syndrome (RTT) rehabilitation and identify gaps in the literature. METHOD Five databases (Ovid MEDLINE, Ovid Embase Classic, Ovid PsycINFO, EBSCO CINAHL Plus, and ProQuest ERIC) were systematically searched up to 23rd July 2018 for studies describing rehabilitation interventions. Data on study participants, design, and outcomes were extracted. RESULTS Sixty-two articles were included in the final review. Evidence consistently demonstrated that females with RTT can improve their gross motor, fine motor, and communicative skills with rehabilitation. All 11 interventions targeting gross motor function, namely ambulation, achieved functional improvements. Twenty of 24 articles describing fine motor rehabilitation studies succeeded in decreasing stereotypies, improving functional hand use, and/or reducing self-injurious behaviors. Twenty-one of 22 studies describing communication interventions succeeded in training choice-making, communicative language, or socialization behavior. Other key findings include the positive interplay between physical and communicative rehabilitation outcomes, and the ability of females with RTT to improve their cognitive abilities during intervention. INTERPRETATION Rehabilitation can impact the daily lives of females with RTT and their caregivers in clinically meaningful ways.
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Affiliation(s)
- Jan Lim
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Dayna Greenspoon
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Anne Hunt
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Laura McAdam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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24
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Schwartzman JS, Xavier JS, Arvigo MC, Barbosa LK. Use of eye tracking in girls with Rett syndrome. Eur J Paediatr Neurol 2020; 25:191. [PMID: 31959554 DOI: 10.1016/j.ejpn.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Maria Claudia Arvigo
- Mackenzie Presbyterian University (UPM), Piaui Street, 181, 6th Floor, 01241-001.
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25
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Moseley M, Howat L, McLoughlin L, Gilling S, Lewis D. Accessible digital assessments of temporal, spatial, or movement concepts for profoundly motor impaired and non-verbal individuals: a pilot study. Disabil Rehabil Assist Technol 2019; 16:350-360. [PMID: 31729265 DOI: 10.1080/17483107.2019.1683240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Here we present a study of two new Assistive Technology (AT) accessible digital assessments which were developed to address the current paucity of (English) spoken language comprehension assessments accessible to individuals who are both non-verbal and have profound motor impairments. Such individuals may rely heavily upon AT for communication and control. However, many assessments require that responses are given either verbally, by physical pointing or manipulating physical objects. A further problem with many assessments is their reliance upon static images to represent language components involving temporal, spatial or movement concepts. These new assessments aim to address some of these issues. MATERIALS AND METHODS The assessments were used with 2 young people who are non-verbal and have profound motor impairments (GMFCS level IV/V) and who use eye gaze as their primary method of communication and access. One assessment uses static images and the other short video clips to represent concepts containing temporal, spatial or movement elements. The assessments were carried out with each participant, both before and after an intervention, as part of a larger study. RESULTS The assessments were accessible using AT (eye gaze) for both participants, although assessment scores varied. The design of the assessments particularly suited one participant who scored near maximum, but they appeared less suitable for the other participant. CONCLUSIONS Making assessments AT accessible removes a barrier to assessing aspects of the spoken language comprehension abilities of some. Video may be a better medium for representing certain concepts within assessments compared with static images.IMPLICATIONS FOR REHABILITATIONThe new assessments provided a deeper understanding of two members of a group who are traditionally difficult to assess, using two alternative physically accessible methods of assessing the spoken language comprehension of the target group;Accessible assessments are important for assessing complex individuals in order to identify knowledge limitations and set therapy (and education) goals;The alternative access features of communication software can provide a "wrapper" for providing accessibility features to assessments;Video clips may be a better means of representing certain concepts in assessments compared to their static equivalents;Ensuring that assessments are physically accessible is sufficient for the assessment of some individuals, but for some "cognitive" accessibility also needs to be considered.
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Affiliation(s)
- Mark Moseley
- Faculty of Media and Communication, Bournemouth University, Poole, UK.,Livability Victoria Education Centre, Poole, UK
| | - Lindsey Howat
- Dorset Healthcare University NHS Foundation Trust, Adult Community Speech and Language Therapy Service, Blandford Forum, UK
| | - Leigh McLoughlin
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | | | - Diane Lewis
- Livability Victoria Education Centre, Poole, UK
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Drobnyk W, Rocco K, Davidson S, Bruce S, Zhang F, Soumerai SB. Sensory Integration and Functional Reaching in Children With Rett Syndrome/Rett-Related Disorders. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519871952. [PMID: 31488957 PMCID: PMC6710672 DOI: 10.1177/1179556519871952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
Background The loss of functional hand skills is a primary characteristic of Rett syndrome. Stereotypies, dyspraxia, and other sensory processing issues severely limit the individual's ability to reach toward and sustain grasp on objects. This loss of functional reach and grasp severely limits their ability to participate in self-help, play, and school-related activities. We proposed that Ayres Sensory Integration (ASI) treatment would improve sensory processing and motor planning, which would lay the sensory-motor groundwork for improving grasp of objects, an important first step in developing functional hand use. Objective We examined effects of ASI treatment on rate of reaching and grasping for children with Rett syndrome/Rett-related disorders. Methods We used an interrupted time series design to measure changes in outcome variables occurring after intervention initiation and cessation. We analyzed daily video observations during baseline, intervention, and post-intervention periods, over a span of 7 months. Results During baseline, rate of grasping declined moderately. There was a 15% increase in grasping from the end of baseline to end of the post-intervention period. There was no significant change in rate of reaching. Conclusions This study provides preliminary data showing very small improvements in hand grasp of children with Rett syndrome following ASI treatment; larger studies in diverse settings are needed to establish the effectiveness of this approach. This study shows that an interrupted time series research design provides a valid template for evaluating interventions for children with rare disorders.
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Affiliation(s)
- Wendy Drobnyk
- Lynch School of Education, Boston College, Chestnut Hill, MA, USA
| | - Karen Rocco
- Lynch School of Education, Boston College, Chestnut Hill, MA, USA
| | - Sara Davidson
- Lynch School of Education, Boston College, Chestnut Hill, MA, USA
| | - Susan Bruce
- Lynch School of Education, Boston College, Chestnut Hill, MA, USA
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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27
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Townend GS, van de Berg R, de Breet LHM, Hiemstra M, Wagter L, Smeets E, Widdershoven J, Kingma H, Curfs LMG. Oculomotor Function in Individuals With Rett Syndrome. Pediatr Neurol 2018; 88:48-58. [PMID: 30340908 DOI: 10.1016/j.pediatrneurol.2018.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Individuals with Rett syndrome (RTT) are notoriously reliant on the use of eye gaze as a primary means of communication. Underlying an ability to communicate successfully via eye gaze is a complex matrix of requirements, with an intact oculomotor system being just one element. To date, the underlying neural and motor pathways associated with eye gaze are relatively under-researched in RTT. PURPOSE This study was undertaken to plug this gap in knowledge and to further the understanding of RTT in one specific area of development and function, namely oculomotor function. MATERIAL AND METHODS The eye movements of 18 girls and young women with RTT were assessed by electronystagmography (ENG). This tested their horizontal saccadic and smooth pursuit eye movements as well as optokinetic nystagmus and vestibulo-ocular reflex. Their results were compared with normative data collected from 16 typically developing children and teenagers. RESULTS Overall, the individuals with RTT demonstrated a range of eye movements on a par with their typically developing peers. However, there were a number of difficulties in executing the ENG testing with the RTT cohort which made quantitative analysis tricky, such as reduced motivation and attention to test materials and low-quality electrode signals. CONCLUSIONS This study suggests that individuals with RTT have an intact oculomotor system. However, modifications should be made to the ENG assessment procedure to combat problems in testing and add strength to the results. Further investigation into these testing difficulties is warranted in order to inform such modifications.
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Affiliation(s)
- Gillian S Townend
- Rett Expertise Centre Netherlands - GKC, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Raymond van de Berg
- Rett Expertise Centre Netherlands - GKC, Maastricht University Medical Center, Maastricht, The Netherlands; Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Faculty of Physics, Tomsk State University, Tomsk, Russia
| | | | - Monique Hiemstra
- Faculty of Medicine, Maastricht University, Maastricht, The Netherlands
| | - Laura Wagter
- Faculty of Medicine, Maastricht University, Maastricht, The Netherlands
| | - Eric Smeets
- Rett Expertise Centre Netherlands - GKC, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Josine Widdershoven
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Leopold M G Curfs
- Rett Expertise Centre Netherlands - GKC, Maastricht University Medical Center, Maastricht, The Netherlands
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28
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Loffler G, Gordon GE. Cognitive function in Rett syndrome: Profoundly impaired or near normal? Eur J Paediatr Neurol 2018; 22:2-3. [PMID: 29332766 DOI: 10.1016/j.ejpn.2017.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022]
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