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Walter K, Manley CE, Bex PJ, Merabet LB. Visual search patterns during exploration of naturalistic scenes are driven by saliency cues in individuals with cerebral visual impairment. Sci Rep 2024; 14:3074. [PMID: 38321069 PMCID: PMC10847433 DOI: 10.1038/s41598-024-53642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/03/2024] [Indexed: 02/08/2024] Open
Abstract
We investigated the relative influence of image salience and image semantics during the visual search of naturalistic scenes, comparing performance in individuals with cerebral visual impairment (CVI) and controls with neurotypical development. Participants searched for a prompted target presented as either an image or text cue. Success rate and reaction time were collected, and gaze behavior was recorded with an eye tracker. A receiver operating characteristic (ROC) analysis compared the distribution of individual gaze landings based on predictions of image salience (using Graph-Based Visual Saliency) and image semantics (using Global Vectors for Word Representations combined with Linguistic Analysis of Semantic Salience) models. CVI participants were less likely and were slower in finding the target. Their visual search behavior was also associated with a larger visual search area and greater number of fixations. ROC scores were also lower in CVI compared to controls for both model predictions. Furthermore, search strategies in the CVI group were not affected by cue type, although search times and accuracy showed a significant correlation with verbal IQ scores for text-cued searches. These results suggest that visual search patterns in CVI are driven mainly by image salience and provide further characterization of higher-order processing deficits observed in this population.
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Affiliation(s)
- Kerri Walter
- Translational Vision Lab, Department of Psychology, Northeastern University, Boston, MA, USA
| | - Claire E Manley
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Peter J Bex
- Translational Vision Lab, Department of Psychology, Northeastern University, Boston, MA, USA
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA.
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Crotti M, Genoe S, Ben Itzhak N, Mailleux L, Ortibus E. The relation between neuroimaging and visual impairment in children and adolescents with cerebral palsy: A systematic review. Brain Dev 2024; 46:75-92. [PMID: 38016876 DOI: 10.1016/j.braindev.2023.11.002] [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: 05/12/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The structure-function relation between magnetic resonance imaging (MRI) and visual impairment (VI) in children with cerebral palsy (CP) has not been fully unravelled. The present systematic review aims to summarize the relation between brain lesions on MRI and VI in children and adolescents with CP. METHODS PubMed, Embase, Web of Science Core Collection, and Cochrane Database were systematically searched according to the PRISMA checklist. A total of 45 articles met the inclusion criteria. RESULTS White matter lesions were most frequently associated with VI. Only 25 studies described lesions within specific structures, mainly in the optic radiations. Only four studies reported on the thalamus. 8.4% of children with CP showed no brain abnormalities on MRI. Diffusion-weighted MRI studies showed that decreased structural connectivity in the optic radiations, superior longitudinal fasciculus, posterior limb of the internal capsule, and occipital lobe is associated with more severe VI. CONCLUSIONS All types of brain lesions lead to visual dysfunctions, arguing for a comprehensive visual assessment in all children with CP. Whereas white matter damage is a well-known contributor, the exact contribution of specific visual structures requires further investigation, to enable early prediction, detection, and intervention.
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Affiliation(s)
- Monica Crotti
- KU Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium; KU Leuven, Child and Youth Institute, B-3000 Leuven, Belgium.
| | - Sarah Genoe
- KU Leuven, Faculty of Medicine, B-3000 Leuven, Belgium.
| | - Nofar Ben Itzhak
- KU Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium; KU Leuven, Child and Youth Institute, B-3000 Leuven, Belgium.
| | - Lisa Mailleux
- KU Leuven, Child and Youth Institute, B-3000 Leuven, Belgium; KU Leuven, Department of Rehabilitation Sciences, Research group for Neurorehabilitation, B-3000 Leuven, Belgium.
| | - Els Ortibus
- KU Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium; KU Leuven, Child and Youth Institute, B-3000 Leuven, Belgium.
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Boonstra FN, Bosch DGM, Geldof CJA, Stellingwerf C, Porro G. The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment. Front Hum Neurosci 2022; 16:727565. [PMID: 35845239 PMCID: PMC9280621 DOI: 10.3389/fnhum.2022.727565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method. Patients and Methods We developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic. Results Based on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458). Conclusion In medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.
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Affiliation(s)
- Frouke N. Boonstra
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
- *Correspondence: Frouke N. Boonstra,
| | | | - Christiaan J. A. Geldof
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
| | - Catharina Stellingwerf
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
| | - Giorgio Porro
- Department of Ophthalmology, UMC Utrecht and Amphia Hospital Breda, Breda, Netherlands
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Fonteyn-Vinke A, Huurneman B, Boonstra FN. Viewing Strategies in Children With Visual Impairment and Children With Normal Vision: A Systematic Scoping Review. Front Psychol 2022; 13:898719. [PMID: 35783772 PMCID: PMC9248372 DOI: 10.3389/fpsyg.2022.898719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/19/2022] [Indexed: 11/25/2022] Open
Abstract
Viewing strategies are strategies used to support visual information processing. These strategies may differ between children with cerebral visual impairment (CVI), children with ocular visual impairment, and children with normal vision since visual impairment might have an impact on viewing behavior. In current visual rehabilitation practice a variety of strategies is used without consideration of the differences in etiology of the visual impairment or in the spontaneous viewing strategies used. This systematic scoping review focuses on viewing strategies used during near school-based tasks like reading and on possible interventions aimed at viewing strategies. The goal is threefold: (1) creating a clear concept of viewing strategies, (2) mapping differences in viewing strategies between children with ocular visual impairment, children with CVI and children with normal vision, and (3) identifying interventions that can improve visual processing by targeting viewing strategies. Four databases were used to conduct the literature search: PubMed, Embase, PsycINFO and Cochrane. Seven hundred and ninety-nine articles were screened by two independent reviewers using PRISMA reporting guidelines of which 30 were included for qualitative analysis. Only five studies explicitly mentioned strategies used during visual processing, namely gaze strategies, reading strategies and search strategies. We define a viewing strategy as a conscious and systematic way of viewing during task performance. The results of this review are integrated with different attention network systems, which provide direction on how to design future interventions targeting the use of viewing strategies to improve different aspects of visual processing.
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Affiliation(s)
- Anke Fonteyn-Vinke
- Royal Dutch Visio, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Bianca Huurneman
- Royal Dutch Visio, Nijmegen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
- *Correspondence: Bianca Huurneman
| | - Frouke N. Boonstra
- Royal Dutch Visio, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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Galli J, Loi E, Molinaro A, Calza S, Franzoni A, Micheletti S, Rossi A, Semeraro F, Fazzi E. Age-Related Effects on the Spectrum of Cerebral Visual Impairment in Children With Cerebral Palsy. Front Hum Neurosci 2022; 16:750464. [PMID: 35308614 PMCID: PMC8924515 DOI: 10.3389/fnhum.2022.750464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cerebral Visual Impairment (CVI) is a very common finding in children affected by Cerebral Palsy (CP). In this paper we studied the characteristics of CVI of a large group of children with CP and CVI, describing their neurovisual profiles according to three different age subgroups (subgroup 1: infants 6 months–2 years; subgroup 2: pre-school age 3–5 years; subgroup 3: school age ≥ 6 years). Methods We enrolled 180 subjects (104 males, mean age 66 ± 42.6 months; range 6–192 months) with CP and CVI for the study. We carried out a demographic and clinical data collection, neurological examination, developmental or cognitive assessment, and a video-recorded visual function assessment including an evaluation of ophthalmological characteristics, oculomotor functions, and basic visual functions. In school-aged children, we also performed an evaluation of their cognitive-visual profiles. Results There were signs of CVI in all the three subgroups. Subgroup 1 (62 children) and subgroup 2 (50 children) were different for fixation (p = 0.02), visual acuity (p = 0.03) and contrast sensitivity (p < 0.01), being more frequently impaired in younger children. Comparing subgroup 2 with subgroup 3 (68 children), the older children presented more frequently myopia (p = 0.02) while the younger ones esotropia (p = 0.02) and alteration in smooth pursuit (p = 0.03) and saccades (p < 0.01). Furthermore, fixation, smooth pursuit, visual acuity, contrast sensitivity and visual filed (p < 0.01) were more frequently impaired in younger children (subgroup 1) compared to the older ones. Multiple correspondence analysis (MCA) confirmed the different neurovisual profiles according to age: younger children with CP showed more signs of CVI compared to the older ones. 34 out of 68 children belonging to subgroup 3 underwent the cognitive visual evaluation; an impairment of cognitive visual skills was detected in 21 subjects. Conclusion Younger children with CP showed more signs of CVI compared to the older ones, likely for the physiological maturation of visual system and mechanisms of neuroplasticity. In this direction, we suggest an early neurovisual evaluation to detect any weak visual functions.
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Affiliation(s)
- Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- *Correspondence: Jessica Galli,
| | - Erika Loi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Anna Molinaro
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Calza
- BDbiomed, BODaI Lab, University of Brescia, Brescia, Italy
| | - Alessandra Franzoni
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Andrea Rossi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesco Semeraro
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Brescia, Italy
- Eye Clinic, University of Brescia, Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
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Sakki H, Dale NJ, Mankad K, Sargent J, Talenti G, Bowman R. Exploratory Investigation of Brain MRI Lesions According to Whole Sample and Visual Function Subtyping in Children With Cerebral Visual Impairment. Front Hum Neurosci 2022; 15:765371. [PMID: 35069150 PMCID: PMC8770951 DOI: 10.3389/fnhum.2021.765371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background: There is limited research on brain lesions in children with cerebral visual impairment (CVI) of heterogeneous etiologies and according to associated subtyping and vision dysfunctions. This study was part of a larger project establishing data-driven subtypes of childhood CVI according to visual dysfunctions. Currently there is no consensus in relation to assessment, diagnosis and classification of CVI and more information about brain lesions may be of potential diagnostic value. Aim: This study aimed to investigate overall patterns of brain lesions and associations with level of visual dysfunction and to compare the patterns between the classification subgroups in children with CVI. Methods: School-aged children with CVI received ophthalmological and neuro-psychological/developmental assessments to establish CVI-related subtyping. Other pediatric information was collected from medical records. MRI scans were coded according to a semi-quantitative template including brain regions (right hemisphere, left hemisphere, visual pathways) and summed for total scores. Non-parametric analyses were conducted. Results: 28 children had clinical brain MRI scans available [44% of total sample, Group A (lower severity of visual dysfunctions) n = 16, Group B (higher severity) n = 12]. Total brain scores ranged between 0 and 18 (Group A mdn = 7, IQR = 0.8–10.0, Group B mdn = 10, IQR = 6.5–11.8) and were widespread across regions. 71 per cent had post-geniculate visual pathway damage. The median total brain and hemisphere scores of Group B were higher than subgroup A but differences did not reach statistical significance. No statistically significant associations were found between brain scores and vision variables (acuity, contrast sensitivity). Conclusion: This study found a spread of lesions across all regions on the brain scans in children with congenital CVI. The majority had damage in the postgeniculate visual pathways and visual cortex region suggesting this is an area of interest and potentially informative for diagnosis. However the subtyping classification did not show differences in number or region of lesions though the trend was higher toward Group B. This study confirms the complex diffuse and variable nature of brain lesions in children with congenital CVI, many of whom have other neurological impairments.
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Affiliation(s)
- Hanna Sakki
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Naomi J. Dale
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Neurodisability Service, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- *Correspondence: Naomi J. Dale,
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Jenefer Sargent
- Neurodisability Service, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Giacomo Talenti
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Bowman
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Ophthalmology Department, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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Ben Itzhak N, Kooiker MJG, van der Steen J, Pel JJM, Wagemans J, Ortibus E. The relation between visual orienting functions, daily visual behaviour and visuoperceptual performance in children with (suspected) cerebral visual impairment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104092. [PMID: 34619456 DOI: 10.1016/j.ridd.2021.104092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children with cerebral visual impairment (CVI) present heterogeneous visual orienting functions (VOF) and higher-order perception. Multiple assessment methods evaluate CVI, but the relations between them remain unclear. AIM To investigate the relations between VOF and (1) daily life behaviour and (2) visuoperceptual tests in children with (suspected) CVI. METHODS AND PROCEDURES VOF were tested with a validated eye tracking-based paradigm. Visual perception was assessed using the children's visual impairment test for 3- to 6-year olds (CVIT 3-6) and (retrospective) visuoperceptual dimension results. Caregivers completed the Flemish cerebral visual impairment questionnaire (FCVIQ) and an expert panel scored relations between VOF and the other methods. We compared experts' survey responses with data-based results (linear mixed models and correlations). OUTCOMES AND RESULTS Fourty-four children (23 boys, 21 girls; median age = 7y11mo, SD = 2y7mo) participated. Twenty-one experts completed the survey. Slower VOF was significantly associated with (1) object and face processing impairments, (2) visual (dis)interest, (3) worse visual spatial perception (to local motion and form stimuli), and (4) worse CVIT 3-6 object and scene recognition (to cartoon stimuli). CONCLUSIONS AND IMPLICATIONS Integration of VOF with existing visual assessments provides a better clinical picture of CVI and can prevent misdiagnosing children as inattentive, incapable, or unmotivated.
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Affiliation(s)
- N Ben Itzhak
- Department of Development and Regeneration, University of Leuven (KU Leuven), O&N IV Herestraat 49, Box 805, 3000 Leuven, Belgium.
| | - M J G Kooiker
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Royal Dutch Visio, Amsterdam, the Netherlands
| | - J van der Steen
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - J J M Pel
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - J Wagemans
- Department of Brain & Cognition, University of Leuven (KU Leuven), Leuven, Belgium; Leuven Brain Institute (LBI), Leuven, Belgium
| | - E Ortibus
- Department of Development and Regeneration, University of Leuven (KU Leuven), O&N IV Herestraat 49, Box 805, 3000 Leuven, Belgium; Child Youth Institute (L-C&Y), Leuven, Belgium
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Chandna A, Nichiporuk N, Nicholas S, Kumar R, Norcia AM. Motion Processing Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 34779820 PMCID: PMC8606874 DOI: 10.1167/iovs.62.14.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose We sought to characterize neural motion processing deficits in children with cerebral visual impairment (CVI) who have good visual acuity using an objective, quantifiable method (steady-state visual evoked potentials [SSVEPs]). Methods We recorded SSVEPs in response to three types of visual motion – absolute motion and more complex relative and rotary motion, comparing them to form-related vernier and contour responses. We studied a group of 31 children with CVI diagnosed via detailed clinical examinations and 28 age-matched healthy controls. Results Using measurements made at the appropriate response harmonics of the stimulation frequency, we found significant deficits in cerebral processing of relative and rotary motion but not of absolute motion in children with CVI compared with healthy controls. Vernier acuity, in keeping with good recognition acuity in both groups, was not different, nor were contour-related form responses. Conclusions Deficits for complex motion but relative sparing of elementary motion and form-related signals suggests preferential damage to extra-striate visual motion areas in children with CVI. The fact that these preferential losses occur in the absence of significant acuity loss indicates that they are not secondary to reduced visual acuity, but rather are an independent vulnerability in CVI. These results corroborate parental and caregivers’ reports of difficulties with tasks that involve motion perception in children with CVI.
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Affiliation(s)
- Arvind Chandna
- Smith-Kettlewell Eye Research Institute, San Francisco, California, United States.,Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Nikolay Nichiporuk
- Smith-Kettlewell Eye Research Institute, San Francisco, California, United States
| | - Spero Nicholas
- Smith-Kettlewell Eye Research Institute, San Francisco, California, United States
| | - Ram Kumar
- Alder Hey Children's Hospital, Liverpool, United Kingdom
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Fazzi E, Micheletti S, Calza S, Merabet L, Rossi A, Galli J. Early visual training and environmental adaptation for infants with visual impairment. Dev Med Child Neurol 2021; 63:1180-1193. [PMID: 34813110 PMCID: PMC8518055 DOI: 10.1111/dmcn.14865] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/04/2022]
Abstract
AIM To evaluate the effectiveness of early visual training and environmental adaptation on visual function and neurological development in infants with visual impairment. METHOD This was a pilot intervention clinical trial study. Thirty infants (mean age 5.9mo, SD 2.1mo, range 4-11mo; 16 males, 14 females) with peripheral visual impairment (PVI, n=15) or cerebral visual impairment (CVI, n=15) participated in a 6-month visual intervention programme. Thirty matched infants (mean age 6mo, SD 1.4mo, range 4-9mo; 18 males, 12 females) served as a comparison group. Primary outcome measures were visual acuity, contrast sensitivity, and qualitative ocular motor functions. Secondary outcomes were scores on the Griffiths Mental Developmental Scales (GMDS). RESULTS The treatment group showed a significant improvement in all the primary outcomes (p<0.01). The comparison group improved only in visual acuity and contrast sensitivity (p<0.01). The treatment group showed greater improvement than the comparison group in visual fixation (p=0.033) and smooth pursuit (p<0.01). The CVI subgroup showed greater improvement in visual acuity than the PVI subgroup (p<0.01). GMDS subscales of hand-eye coordination (p=0.01) and performance (p<0.01) increased in the treatment group, while the total score of the comparison group decreased, driven by language (p=0.039) and hand-eye coordination (p=0.025) subscales. INTERPRETATION Results suggest that, in infants with visual impairment, visual function and certain developmental outcomes improve in response to early visual training and environmental adaptation, in an interactive context. What this paper adds Early visual training and environmental adaptation are associated with enhanced visual acuity and smooth pursuit. Early visual training and environmental adaptation are associated with an improvement of neurological developmental outcome. Performance, hand-eye coordination, and language scores in Griffiths Mental Developmental Scales increase after visual training. After training, visual acuity improves more in infants with cerebral rather than anterior visual impairment. Type and complexity of visual impairment contribute to determine infants' response to training.
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Affiliation(s)
- Elisa Fazzi
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly,Unit of Child Neurology and PsychiatryASST Spedali Civili of BresciaBresciaItaly
| | - Serena Micheletti
- Unit of Child Neurology and PsychiatryASST Spedali Civili of BresciaBresciaItaly
| | - Stefano Calza
- Unit of Biostatistics and BioinformaticsDepartment of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Lotfi Merabet
- The Laboratory for Visual NeuroplasticityDepartment of OphthalmologyMassachusetts Eye and EarHarvard Medical SchoolBostonMAUSA
| | - Andrea Rossi
- Unit of Child Neurology and PsychiatryASST Spedali Civili of BresciaBresciaItaly
| | - Jessica Galli
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly,Unit of Child Neurology and PsychiatryASST Spedali Civili of BresciaBresciaItaly
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Rice ML, Sandoval MA, Castleberry KM, Schwartz TL. Physician Prescribing and Referral Patterns in Children with Cerebral Visual Impairment. Optom Vis Sci 2021; 98:1078-1084. [PMID: 34524214 DOI: 10.1097/opx.0000000000001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Cerebral visual impairment (CVI) is the leading cause of visual impairment in the developed world. Providing children with CVI with the appropriate treatment ensures the best possible visual outcome and potentially improves quality of life. PURPOSE The purpose of this study was to determine physician prescribing and visual rehabilitation referral patterns in children with CVI. METHODS A retrospective chart review was completed on children with CVI examined at Cincinnati Children's Hospital Medical Center from January 1, 2008, to March 1, 2018. Significant refractive error warranting correction was determined using the American Academy of Ophthalmology Preferred Guidelines and the American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee Guidelines. The CVI Range was used as a surrogate to categorize CVI severity. RESULTS A total of 194 children were included. Sixty-eight (35%) had refractive error warranting correction and were prescribed glasses (group RC), 99 (51%) did not have refractive error warranting correction and were not prescribed glasses (group NRNC), 20 (10%) had refractive error warranting correction but were not prescribed glasses (group RNC), and 7 (4%) did not have refractive error warranting correction but were prescribed glasses (group NRC). There was greater than one-line Snellen equivalent difference between group RC (20/156) and group RNC (20/221). There was greater than six-line Snellen equivalent difference between group NRNC (20/149) and group NRC (20/35). Mean CVI Range score 2 values for each group were 5.9, 4.6, 4.8, and 7.1. CONCLUSIONS Children with less severe CVI were less likely to have significant refractive error but given glasses. Despite significant refractive error, children with more severe CVI were not prescribed glasses. Children with very low visual function were not prescribed glasses as frequently, possibly limiting their visual rehabilitation. Providers should ensure that all children with CVI are correctly prescribed glasses to provide the best possible visual outcome.
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Affiliation(s)
| | - Monica A Sandoval
- Division of Pediatric Ophthalmology/Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katherine M Castleberry
- Division of Pediatric Ophthalmology/Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Abstract
PURPOSE OF REVIEW Cortical visual impairment (CVI) is the leading cause of pediatric visual impairment in developed countries. Currently, there is no standardized method of visual assessment in these children, who usually cannot participate in tests designed for typically developing children. A reproducible method of visual assessment that accurately reflects the multitude of visual deficits in CVI is critical to evaluate proposed therapies for this disorder. This review analyzes current research on methods of visual assessment in children with CVI. RECENT FINDINGS Earlier studies focused on measuring visual acuity in children with CVI. More recent studies have emphasized other aspects of visual function, such as contrast sensitivity, motion detection, and visual search. Current research topics include questionnaires, functional vision assessment (CVI Range), neuropsychological tests of visual perception, and eye tracking. Eye tracking shows promise for visual assessment in both clinical and research settings because it is objective and quantitative, with the ability to assess diverse visual parameters. SUMMARY Current research on visual assessment in children with CVI focuses on measuring deficits of visual function beyond visual acuity. This research represents an important step toward designing clinical trials to identify effective therapeutics for this increasingly prevalent disorder with heterogeneous manifestations.
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12
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Ionta S. Visual Neuropsychology in Development: Anatomo-Functional Brain Mechanisms of Action/Perception Binding in Health and Disease. Front Hum Neurosci 2021; 15:689912. [PMID: 34135745 PMCID: PMC8203289 DOI: 10.3389/fnhum.2021.689912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
Vision is the main entrance for environmental input to the human brain. Even if vision is our most used sensory modality, its importance is not limited to environmental exploration. Rather it has strong links to motor competences, further extending to cognitive and social aspects of human life. These multifaceted relationships are particularly important in developmental age and become dramatically evident in presence of complex deficits originating from visual aberrancies. The present review summarizes the available neuropsychological evidence on the development of visual competences, with a particular focus on the associated visuo-motor integration skills in health and disease. With the aim of supporting future research and interventional settings, the goal of the present review is to constitute a solid base to help the translation of neuropsychological hypotheses into straightforward empirical investigations and rehabilitation/training protocols. This approach will further increase the impact, ameliorate the acceptance, and ease the use and implementation of lab-derived intervention protocols in real-life situations.
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Affiliation(s)
- Silvio Ionta
- Sensory-Motor Lab (SeMoLa), Department of Ophthalmology-University of Lausanne, Jules Gonin Eye Hospital-Fondation Asile des Aveugles, Lausanne, Switzerland
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Deramore Denver B, Froude E, Rosenbaum P, Imms C. Measure of Early Vision Use: development of a new assessment tool for children with cerebral palsy. Disabil Rehabil 2021; 44:4055-4065. [PMID: 33689557 DOI: 10.1080/09638288.2021.1890241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To report the development of an assessment tool to describe "how vision is used" for children with cerebral palsy. METHOD Measurement development consisted of three steps: (i) an online survey to explore the relevance and comprehensiveness of visual behaviours identified in a previous conceptualisation study; (ii) construction of items and a rating scale for the new measure; and (iii) cognitive interviews to explore comprehensibility and refine the measure in preparation for field testing. Survey respondents were 130 parents of children with cerebral palsy, eight adults with cerebral palsy, and 108 clinicians (n = 246). Nine parents participated in the interviews. RESULTS The new tool, the Measure of Early Vision Use, is a 14-item descriptive measure of typical performance of visual behaviours observable in everyday activities, as rated by parent/caregiver observation. Each item is rated on a 4-point ordinal scale. CONCLUSIONS This new measure is conceptually grounded within the Activity level domain of the International Classification of Functioning, Disability and Health as a measure of a single visual ability construct. The target population is children with cerebral palsy, and using parent report the Measure of Early Vision Use describes both strengths and limitations in using vision. This study addressed the selection of items and response options for the new scale, and provides evidence to support content relevance, comprehensiveness and comprehensibility from key stakeholders. Further research will explore psychometric properties and clinical utility.Implications for rehabilitationThe ability to use vision in daily activities is relevant to the development and learning of all children, so the availability of a method for describing visual abilities has potential for diverse research and clinical purposes.The Measure of Early Vision Use is a parent-report tool that provides a criterion-referenced method for quantifying and describing how children use vision in typical daily activities to support intervention planning.Clinicians and parents wishing to measure vision use in children with cerebral palsy can be confident about the rigorous methods used to develop this tool, including consultation with key stakeholders.
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Affiliation(s)
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Peter Rosenbaum
- Department of Paediatrics, McMaster University, Hamilton, Canada
| | - Christine Imms
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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Kamali AM, Gholamzadeh MJ, Mousavi SZ, Gharamaleki MV, Nami M. Improved Visual Function in a Case of Ultra-low Vision following Ischemic Encephalopathy Using Transcranial Electrical Stimulation; A Brief Report. Dev Neurorehabil 2021; 24:68-72. [PMID: 33161826 DOI: 10.1080/17518423.2020.1839978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Cerebral visual impairment is amongst the key pathological causes of pediatric visual abnormalities often resulted from hypoxic-ischemic brain injury. Such an injury results in profound visual impairments which severely impairs patients' quality of life. Given the nature of the pathology, treatments are currently limited to rehabilitation strategies such as transcranial electrical stimulation and visual rehabilitation therapy. CASE DESCRIPTION Here, we discussed an 11-year-old girl with cerebral visual impairment who underwent concurrent visual rehabilitation therapy, transcranial electrical stimulation, and pharmacological therapy resulting in her improved visual function. CONCLUSION Given its beneficial effects, transcranial electrical stimulation may be sought as a potential add-on modality when strategizing visual rehabilitation therapy.
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Affiliation(s)
- Ali-Mohammad Kamali
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences , Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter , Shiraz, Iran
| | | | - Seyedeh Zahra Mousavi
- Students' Research Committee, School of Medicine, Shiraz University of Medical Sciences , Shiraz, Iran
| | | | - Mohammad Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences , Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter , Shiraz, Iran.,Academy of Health, Senses Cultural Foundation , Sacramento, CA, USA.,Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge , Panama City, Republic of Panama.,Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS) , Pardis, Tehran, Iran
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15
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Advances in the evaluation and management of cortical/cerebral visual impairment in children. Surv Ophthalmol 2020; 65:708-724. [DOI: 10.1016/j.survophthal.2020.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
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