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Herron MS, Wang L, von Bartheld CS. Prevalence and Types of Strabismus in Cerebral Palsy: A Global and Historical Perspective Based on a Systematic Review and Meta-Analysis. Ophthalmic Epidemiol 2024:1-18. [PMID: 38635869 DOI: 10.1080/09286586.2024.2331537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Strabismus is more frequent in cerebral palsy (CP) than in the normal population, but reports differ how much it is increased. We here examined the global prevalence and types of strabismus in CP, whether esotropia or exotropia is more frequent, and whether the prevalence differs between ethnicities and/or country income levels, and between generations. METHODS We compiled in a systematic review and meta-analysis the results of 147 CP studies that report the prevalence of strabismus or the ratio of esotropia to exotropia, and we conducted subgroup analyses for region (income level) and ethnicity. We performed a pooled analysis for the CP strabismus prevalence, and estimated the global number of CP cases with strabismus. RESULTS The pooled prevalence of strabismus in CP is 49.8% in high-income countries and 39.8% in lower-income countries. We estimate the global number of strabismus cases in CP as 12.2 million, with 7.6 million males and 4.6 million females, based on current estimates of 29.6 million global CP cases. Esotropia is more frequent than exotropia in Caucasians, while exotropia is more frequent than esotropia in Hispanic and in some Asian and African populations. The strabismus prevalence in CP increases with increasing country income levels. CONCLUSION Generational changes in strabismus prevalence appear to reflect a transition of CP types and an increase in prevalence as countries attain higher income and more effective maternal health care. The distribution of esotropia and exotropia in CP patients largely reflects the horizontal strabismus type that is predominant in the subject's ethnicity.
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Affiliation(s)
- Michael S Herron
- Center of Biomedical Research Excellence in Cell Biology, School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Lingchen Wang
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Christopher S von Bartheld
- Center of Biomedical Research Excellence in Cell Biology, School of Medicine, University of Nevada, Reno, Nevada, USA
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, Nevada, USA
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Herron MS, Wang L, von Bartheld CS. Prevalence and types of strabismus in cerebral palsy: A global and historical perspective based on a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.23.24301684. [PMID: 38343841 PMCID: PMC10854329 DOI: 10.1101/2024.01.23.24301684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Purpose Strabismus is more frequent in cerebral palsy (CP) than in the normal population, but reports differ how much it is increased. We here examined the global prevalence and types of strabismus in CP, whether esotropia or exotropia is more frequent, and whether the prevalence differs between ethnicities and/or country income levels, and between generations. Methods We compiled in a systematic review and meta-analysis the results of 147 CP studies that report the prevalence of strabismus or the ratio of esotropia to exotropia, and we conducted subgroup analyses for region (income level) and ethnicity. We performed a pooled analysis for the CP strabismus prevalence, and estimated the global number of CP cases with strabismus. Results The pooled prevalence of strabismus in CP is 49.8% in high-income countries and 39.8% in lower-income countries. We estimate the global number of strabismus cases in CP as 12.2 million, with 7.6 million males and 4.6 million females, based on current estimates of 29.6 million global CP cases. Esotropia is more frequent than exotropia in Caucasians, while exotropia is more frequent than esotropia in Hispanic and in some Asian and African populations. The strabismus prevalence in CP increases with increasing country income levels. Conclusion Generational changes in strabismus prevalence appear to reflect a transition of CP types and an increase in prevalence as countries attain higher income and more effective maternal health care. The distribution of esotropia and exotropia in CP patients largely reflects the horizontal strabismus type that is predominant in the subject's ethnicity.
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Affiliation(s)
- Michael S. Herron
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Lingchen Wang
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Christopher S. von Bartheld
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
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Abid M, Cherni Y, Batcho CS, Traverse E, Lavoie MD, Mercier C. Facilitators and barriers to participation in physical activities in children and adolescents living with cerebral palsy: a scoping review. Disabil Rehabil 2023; 45:4322-4337. [PMID: 36447398 DOI: 10.1080/09638288.2022.2150327] [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: 05/27/2022] [Accepted: 11/05/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE This scoping review aimed to synthetize personal and environmental facilitators and barriers to participation in physical activities among youths living with cerebral palsy. METHODS A systematic literature search was performed in five databases: CINAHL, EMBASE, MEDLINE, PsycINFO, Cochrane, WEB OF SCIENCE. The studies were selected by two independent researchers based on inclusion and exclusion criteria. A semi-quantitative evaluation assessed the consistency of results for a given variable. Variables displaying consistent associations were classified based on the Physical Activity for people with Disability Model. RESULTS The electronic search yielded 10 795 articles, of which 57 were included. The main barriers to physical activity identified were motor impairments (30 studies), older age (15 studies), pain (6 studies), attendance in regular school (6 studies), and communication problems (4 studies). Barriers such as upper limb impairment and visual deficit were less frequently studied, while cognitive attributes, adapted physical environments and positive attitude, and family support were identified as facilitators. CONCLUSION Personal and environmental factors influencing physical activities behaviors among youths living with cerebral palsy are multiple and complex since they interact with each other. Rehabilitation interventions need to adopt a person-based approach to address barriers and reinforce facilitators.IMPLICATIONS FOR REHABILITATION:Physical activity participation among youths with cerebral palsy is a multidimensional phenomenon, dependent on different personal and environmental factors.Gross motor impairments, communication problems, and pain were the most common personal factors limiting physical activity participation.Environmental factors consistently associated with physical activity participation were school settings, physical environment such as transportation, and social and family support and attitude.Rehabilitation interventions to promote an active lifestyle should consider not only personal factors but their interaction with the child's environment.
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Affiliation(s)
- Manel Abid
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Yosra Cherni
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Charles Sèbiyo Batcho
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Elodie Traverse
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
| | | | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, Quebec City, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
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4
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Chokron S, Dutton GN. From vision to cognition: potential contributions of cerebral visual impairment to neurodevelopmental disorders. J Neural Transm (Vienna) 2023; 130:409-424. [PMID: 36547695 DOI: 10.1007/s00702-022-02572-8] [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: 08/16/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
Vision has a crucial role to play in human development and functioning. It is, therefore, not surprising that vision plays a fundamental role in the development of the child. As a consequence, an alteration in visual function is, therefore, likely to hinder the child's development. Although ocular disorders are well known, diagnosed and taken into account, cerebral visual impairments (CVI) resulting from post-chiasmatic damage are largely underdiagnosed. However, among the disorders resulting from an episode of perinatal asphyxia and/or associated with prematurity, or neonatal hypoglycaemia, CVIs are prominent. In this article, we focus on the role of the possible effects of CVI on a child's learning abilities, leading to major difficulty in disentangling the consequences of CVI from other neurodevelopmental disorders (NDD) such as dyslexia, dyscalculia, dysgraphia, attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD) and autism spectrum disorders (ASD). Although we focus here on the possible overlap between children with CVI and children with other NDD, De Witt et al. (Wit et al. Ear Hear 39:1-19, 2018) have raised exactly the same question regarding children with auditory processing disorders (the equivalent of CVI in the auditory modality). We underline how motor, social and cognitive development as well as academic success can be impaired by CVI and raise the question of the need for systematic evaluation for disorders of vision, visual perception and cognition in all children presenting with a NDD and/or previously born under adverse neurological conditions.
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Affiliation(s)
- Sylvie Chokron
- INCC, CNRS, UMR8002, Université de Paris-Cité, Paris, France.
- Institut de Neuropsychologie, Neurovision et Neurocognition, Hôpital-Fondation A. de Rothschild, Paris, France.
| | - Gordon N Dutton
- Department of Vision Science, Glasgow Caledonian University, Glasgow, UK
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Araneda R, Ebner-Karestinos D, Dricot L, Herman E, Hatem SM, Friel KM, Gordon AM, Bleyenheuft Y. Impact of early brain lesions on the optic radiations in children with cerebral palsy. Front Neurosci 2022; 16:924938. [PMID: 36278011 PMCID: PMC9583910 DOI: 10.3389/fnins.2022.924938] [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: 04/20/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Due to their early brain lesion, children with unilateral spastic cerebral palsy (USCP) present important changes in brain gray and white matter, often manifested by perturbed sensorimotor functions. We predicted that type and side of the lesion could influence the microstructure of white matter tracts. Using diffusion tensor imaging in 40 children with USCP, we investigated optic radiation (OR) characteristics: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). First, we compared the OR of the lesional and non-lesional hemisphere. Then we evaluated the impact of the brain lesion type (periventricular or cortico-subcortical) and side in the differences observed in the lesional and non-lesional OR. Additionally, we examined the relationship between OR characteristics and performance of a visuospatial attention task. We observed alterations in the OR of children with USCP on the lesional hemisphere compared with the non-lesional hemisphere in the FA, MD and RD. These differences were influenced by the type of lesion and by the side of the lesion. A correlation was also observed between FA, MD and RD and the visuospatial assessment mainly in children with periventricular and right lesions. Our results indicate an important role of the timing and side of the lesion in the resulting features of these children’s OR and probably in the compensation resulting from neuroplastic changes.
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Affiliation(s)
- Rodrigo Araneda
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andrés Bello, Santiago, Chile
| | - Daniela Ebner-Karestinos
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andrés Bello, Santiago, Chile
| | - Laurance Dricot
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Enimie Herman
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Samar M. Hatem
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
- Physical and Rehabilitation Medicine, Brugmann University Hospital, Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kathleen M. Friel
- Burke-Cornell Medical Research Institute, White Plains, NY, United States
| | - Andrew M. Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
- *Correspondence: Yannick Bleyenheuft,
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Ana K, Iris ŽI, Nina P, Marina R, Tomislav Ć, Snježana S, Andrea B, Milan R, Ivica K. Linking integrity of visual pathways trajectories to visual behavior deficit in very preterm infants. Infant Behav Dev 2022; 67:101697. [DOI: 10.1016/j.infbeh.2022.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/05/2022]
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Muhit M, Karim T, Jahan I, Al Imam MH, Das MC, Khandaker G. Epidemiology of eye diseases among children with disability in rural Bangladesh: a population-based cohort study. Dev Med Child Neurol 2022; 64:209-219. [PMID: 34468025 DOI: 10.1111/dmcn.15041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
AIM To describe the epidemiology of eye diseases among children with disability in rural Bangladesh. METHOD We established a population-based cohort of children with disability using the key informant method. Children younger than 18 years with disability (i.e. physical, visual, hearing, speech, epilepsy) were included. We used detailed ophthalmological assessments following World Health Organization (WHO) protocols by a multidisciplinary team including an ophthalmologist, optometrist, physician, and physiotherapist. Visual impairment, blindness, and severe visual impairment (SVI) were defined by following WHO categories. RESULTS Between October 2017 and February 2018, 1274 children were assessed (43.6% female; median [interquartile range] age 9y 10mo [6y -13y 7mo]). Overall, 6.5% (n=83) had blindness/SVI, and 5.6% (n=71) had visual impairment. In the group with blindness/SVI, 47% (n=39) had cortical blindness; of those, 79.5% (n=31) had cerebral palsy (CP). The other main anatomical sites of abnormalities in this group included lens (13.3%, n=11), cornea (10.8%, n=9), and optic nerve (9.6%, n=8). In the group with visual impairment, 90.1% (n=64) had refractive error. Overall, 83.1% (n=69) and 78.8% (n=56) of those with blindness/SVI and visual impairment had avoidable causes. Most children with blindness/SVI and visual impairment lacked access to education. INTERPRETATION The burden of blindness/SVI/visual impairment is high among children with disability in rural Bangladesh, mostly due to avoidable causes. Overrepresentation of CP and cortical blindness in the group with blindness/SVI and refractive error in the group with visual impairment highlights the need for integration of ophthalmology assessment, eye care, and refraction services in comprehensive health care for children with disability including CP in rural Bangladesh.
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Affiliation(s)
- Mohammad Muhit
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Tasneem Karim
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
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8
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Heydarian S, Abbasabadi MM, Khabazkhoob M, Hoseini-Yazdi H, Gharib M. Vision Abnormalities in Children and Young Adults With Cerebral Palsy; A Systematic Review. Semin Ophthalmol 2022; 37:471-479. [PMID: 34978933 DOI: 10.1080/08820538.2021.2021248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The current study was designed to provide detailed information on the prevalence of ocular abnormalities in patients with cerebral palsy (CP). METHODS Four international online scientific databases, including Web of Science, PubMed, Scopus, and Google Scholar were systemically searched. First, the titles of the articles were evaluated, and if relevant, their abstracts and full texts were reviewed. The quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS A total of 147 articles were found in the initial search. After applying the exclusion criteria, 65 articles were chosen for further review, from which 17 articles, comprising a total of 1734 patients with CP ranging in age from birth to 22 years, passed the STROBE quality check and were included in this review. The prevalence of ocular abnormalities in the CP patients reported in the evaluated studies ranged between 34% to 100%, with refractive error, strabismus, and nystagmus exhibiting the greatest overall prevalence at 52%, 48%, and 11%, respectively in this population. CONCLUSION Early ocular assessment of children with CP is essential for an accurate diagnosis, personalized rehabilitation and performing early interventions to improve their visual function.
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Affiliation(s)
- Samira Heydarian
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marziye Moradi Abbasabadi
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Hoseini-Yazdi
- Contact Lens and Visual Optics Laboratory Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Masoud Gharib
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
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Chokron S, Kovarski K, Dutton GN. Cortical Visual Impairments and Learning Disabilities. Front Hum Neurosci 2021; 15:713316. [PMID: 34720906 PMCID: PMC8548846 DOI: 10.3389/fnhum.2021.713316] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Medical advances in neonatology have improved the survival rate of premature infants, as well as children who are born under difficult neurological conditions. As a result, the prevalence of cerebral dysfunctions, whether minimal or more severe, is increasing in all industrialized countries and in some developing nations. Whereas in the past, ophthalmological diseases were considered principally responsible for severe visual impairment, today, all recent epidemiological studies show that the primary cause of blindness and severe visual impairment in children in industrialized countries is now neurological, with lesions acquired around the time of birth currently comprising the commonest contributor. The resulting cortical or cerebral visual impairments (CVIs) have long been ignored, or have been confused either with other ophthalmological disorders causing low vision, or with a range of learning disabilities. We present here the deleterious consequences that CVI can have upon learning and social interaction, and how these can be given behavioral labels without the underlying visual causes being considered. We discuss the need to train and inform clinicians in the identification and diagnosis of CVI, and how to distinguish the diagnosis of CVI from amongst other visual disorders, including the specific learning disorders. This is important because the range of approaches needed to enhance the development of children with CVI is specific to each child's unique visual needs, making incorrect labeling or diagnosis potentially detrimental to affected children because these needs are not met.
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Affiliation(s)
- Sylvie Chokron
- Hôpital Fondation Adolphe de Rothschild, Paris, France
- INCC UMR 8002, CNRS, Université de Paris, Paris, France
| | - Klara Kovarski
- Hôpital Fondation Adolphe de Rothschild, Paris, France
- INCC UMR 8002, CNRS, Université de Paris, Paris, France
| | - Gordon N. Dutton
- Department of Vision Science, Glasgow Caledonian University, Glasgow, United Kingdom
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Upper Limb Motor Planning in Individuals with Cerebral Palsy Aged between 3 and 21 Years Old: A Systematic Review. Brain Sci 2021; 11:brainsci11070920. [PMID: 34356154 PMCID: PMC8306670 DOI: 10.3390/brainsci11070920] [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: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022] Open
Abstract
Individuals with cerebral palsy have difficulties performing activities of daily living. Beyond motor execution impairments, they exhibit motor planning deficits contributing to their difficulties. The objective of this review is to synthesize the behavioral evidence of motor planning deficits during an upper limb motor task in children, adolescents and young adults with cerebral palsy aged between 3 and 21 years. Methods: The inclusion criteria were: (1) including individuals with cerebral palsy from 3 to 21 years old; (2) assessing upper limb motor planning. Six databases were screened. The quality assessment of the studies was performed. Results: Forty-six studies and 686 participants were included. Five articles have been identified as very high quality, 12 as high, 20 as moderate, six as low, three as very low. Force planning studies reported a deficit for the more affected hand but adequate performances for the less affected hand. Object-manipulation studies reported hand posture planning deficits irrespectively of the hand assessed. Conclusions: Motor planning deficits has been shown in the more affected hand for force scaling, while the results for other variables showed overall deficits. Hence, variables affected by motor planning deficits in both hands should be considered in children with cerebral palsy to optimize intervention.
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11
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Poitras I, Martinie O, Robert MT, Campeau-Lecours A, Mercier C. Impact of Sensory Deficits on Upper Limb Motor Performance in Individuals with Cerebral Palsy: A Systematic Review. Brain Sci 2021; 11:brainsci11060744. [PMID: 34205153 PMCID: PMC8227331 DOI: 10.3390/brainsci11060744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/28/2022] Open
Abstract
People living with cerebral palsy (CP) exhibit motor and sensory impairments that affect unimanual and bimanual functions. The importance of sensory functions for motor control is well known, but the association between motor and sensory functions remains unclear in people living with CP. The objective of this systematic review was to characterize the relationship between sensory deficits and upper limb motor function in individuals living with CP. METHODS Five databases were screened. The inclusion criteria were: (1) including people living with CP, (2) reporting measurements of upper limb motor and sensory functions. A qualitative analysis of the studies' level of evidence was done. RESULTS Thirty-three articles were included. Twenty-five articles evaluated tactile functions, 10 proprioceptive functions and 7 visual functions; 31 of the articles reported on unimanual functions and 17 of them reported on bimanual functions. Tactile functions showed a moderate to high association; it was not possible to reach definitive conclusions for proprioceptive and visual functions. CONCLUSIONS The heterogeneity of the results limits the ability to draw definitive conclusions. Further studies should aim to perform more comprehensive assessments of motor and sensory functions, to determine the relative contribution of various sensory modalities to simple and more complex motor functions.
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Affiliation(s)
- Isabelle Poitras
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Ophélie Martinie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Maxime T. Robert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Alexandre Campeau-Lecours
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
- Correspondence:
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12
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Hoffman RM, Embury CM, Lew BJ, Heinrichs-Graham E, Wilson TW, Kurz MJ. Cortical oscillations that underlie visual selective attention are abnormal in adolescents with cerebral palsy. Sci Rep 2021; 11:4661. [PMID: 33633169 PMCID: PMC7907343 DOI: 10.1038/s41598-021-83898-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/04/2021] [Indexed: 01/13/2023] Open
Abstract
Adolescence is a critical period for the development and refinement of several higher-level cognitive functions, including visual selective attention. Clinically, it has been noted that adolescents with cerebral palsy (CP) may have deficits in selectively attending to objects within their visual field. This study aimed to evaluate the neural oscillatory activity in the ventral attention network while adolescents with CP performed a visual selective attention task. Adolescents with CP (N = 14; Age = 15.7 ± 4 years; MACS I-III; GMFCS I-IV) and neurotypical (NT) adolescents (N = 21; Age = 14.3 ± 2 years) performed the Eriksen flanker task while undergoing magnetoencephalographic (MEG) brain imaging. The participants reported the direction of a target arrow that was surrounded by congruent or incongruent flanking arrows. Compared with NT adolescents, adolescents with CP had slower responses and made more errors regarding the direction of the target arrow. The MEG results revealed that adolescents with CP had stronger alpha oscillations in the left insula when the flanking arrows were incongruent. Furthermore, participants that had more errors also tended to have stronger alpha oscillatory activity in this brain region. Altogether these results indicate that the aberrant activity seen in the left insula is associated with diminished visual selective attention function in adolescents with CP.
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Affiliation(s)
- Rashelle M Hoffman
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14000 Boys Town Hospital Road, Boys Town, NE, 68010, USA.,Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christine M Embury
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14000 Boys Town Hospital Road, Boys Town, NE, 68010, USA
| | - Brandon J Lew
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14000 Boys Town Hospital Road, Boys Town, NE, 68010, USA
| | - Elizabeth Heinrichs-Graham
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14000 Boys Town Hospital Road, Boys Town, NE, 68010, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14000 Boys Town Hospital Road, Boys Town, NE, 68010, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14000 Boys Town Hospital Road, Boys Town, NE, 68010, USA.
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13
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VerMaas JR, Lew BJ, Trevarrow MP, Wilson TW, Kurz MJ. Children with Cerebral Palsy Have Altered Occipital Cortical Oscillations during a Visuospatial Attention Task. Cereb Cortex 2021; 31:3353-3362. [PMID: 33611348 DOI: 10.1093/cercor/bhab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Dynamically allocating neural resources to salient features or objects within our visual space is fundamental to making rapid and accurate decisions. Impairments in such visuospatial abilities have been consistently documented in the clinical literature on individuals with cerebral palsy (CP), although the underlying neural mechanisms are poorly understood. In this study, we used magnetoencephalography (MEG) and oscillatory analysis methods to examine visuospatial processing in children with CP and demographically matched typically developing (TD) children. Our results indicated robust oscillations in the theta (4-8 Hz), alpha (8-14 Hz), and gamma (64-80 Hz) frequency bands in the occipital cortex of both groups during visuospatial processing. Importantly, the group with CP exhibited weaker cortical oscillations in the theta and gamma frequency bands, as well as slower response times and worse accuracy during task performance compared to the TD children. Furthermore, we found that weaker theta and gamma oscillations were related to greater visuospatial performance deficits across both groups. We propose that the weaker occipital oscillations seen in children with CP may reflect poor bottom-up processing of incoming visual information, which subsequently affects the higher-order visual computations essential for accurate visual perception and integration for decision-making.
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Affiliation(s)
- Jacy R VerMaas
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA.,Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Brandon J Lew
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
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14
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Moon JH, Kim GH, Kim SK, Kim S, Kim YH, Kim J, Kim JK, Noh BH, Byeon JH, Yeom JS, Eun BL, Eun SH, Choi J, Chung HJ. Development of the Parental Questionnaire for Cerebral Visual Impairment in Children Younger than 72 Months. J Clin Neurol 2021; 17:354-362. [PMID: 34184442 PMCID: PMC8242312 DOI: 10.3988/jcn.2021.17.3.354] [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: 09/29/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Cerebral visual impairment (CVI) is an underdiagnosed condition in children, and its assessment tools have focused on older children. We aimed to develop a parental questionnaire for cerebral visual impairment (PQCVI) for screening CVI in young children. Methods The PQCVI comprised 23 questions based on a modified version of Houliston and Dutton's questionnaire for older children. The PQCVI with neurocognitive function tests was applied to 201 child-parent pairs with typically developing children younger than 72 months (age 32.4±20.1 months, mean±standard deviation). The children were classified into six age groups. The normative data, cutoff scores, and internal reliability were assessed and item analysis was performed. We referred to the total score for all questions as the cerebral visual function (CVF) score. Results The normative data showed that the CVF score and the scores corresponding to ventral-stream and dorsal-stream visual functions plausibly increased with age. The scores rapidly reached 90% of their maximum values up to the age of 36 months, after which they increased slowly. Cronbach's alpha for all questions across all age groups was 0.97, showing excellent consistency. The item difficulty and item discrimination coefficients showed that the questions were generally adequate for this age stage. Conclusions The PQCVI items produced reliable responses in children younger than 72 months. The rapid increase in scores before the age of 3 years supports the importance of early identification of CVI. Following additional clinical verification, the PQCVI may be useful for CVI screening.
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Affiliation(s)
- Jin Hwa Moon
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Gun Ha Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Sung Koo Kim
- Department of Pediatrics, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Seunghyo Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Young Hoon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - JoonSik Kim
- Department of Pediatrics, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jin Kyung Kim
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Byoungho H Noh
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Jung Hye Byeon
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Baik Lin Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - So Hee Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jieun Choi
- Department of Pediatrics, Seoul National University College of Medicine, SMC-SNU Boramae Medical Center, Seoul, Korea
| | - Hee Jung Chung
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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15
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Jacobson L, Lennartsson F, Nilsson M. Retinal ganglion cell topography predicts visual field function in spastic cerebral palsy. Dev Med Child Neurol 2020; 62:1100-1106. [PMID: 32314356 DOI: 10.1111/dmcn.14545] [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] [Accepted: 03/11/2020] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the use of optical coherence tomography (OCT) to identify and assess visual field defects caused by primary damage to the optic radiation in individuals with spastic cerebral palsy (CP). Ten individuals with spastic CP (six females, four males, with a median age of 21 years [range 17-38y]) had their brain lesions documented with conventional magnetic resonance imaging (MRI) and diffusion-weighted MRI fibre tractography. Their macular ganglion cell layer (GCL) and inner plexiform layer (IPL) were examined with OCT and their visual fields were plotted. All participants had good visual acuity and were able to cooperate with the MRI and OCT examinations, as well as undergoing reliable perimetry. We found focal thinning of the GCL+IPL and corresponding homonymous visual field defects in individuals with brain damage affecting the optic radiation. We used GCL+IPL sector asymmetry as a sensitive OCT parameter to identify focal visual field defects. We observed no such sector asymmetry in GCL+IPL, or focal visual field defects, in individuals with normal MRI optic radiation imaging. Lesions affecting the optic radiation cause retrograde trans-synaptic degeneration of retinal ganglion cells. OCT examination of the GCL in the macula identified corresponding focal damage to the optic radiation in individuals with spastic CP and can be used to predict focal visual field defects. WHAT THIS PAPER ADDS: Spastic cerebral palsy (CP) may be associated with damage to the optic radiation. Damage to the optic radiation causes retrograde trans-synaptic degeneration (RTSD). RTSD can be mapped using optical coherence tomography. Ganglion cell topography can predict visual field defects in individuals with spastic CP.
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Affiliation(s)
- Lena Jacobson
- Section for Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Finn Lennartsson
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Maria Nilsson
- Unit of Optometry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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16
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Fried-Oken M, Kinsella M, Peters B, Eddy B, Wojciechowski B. Human visual skills for brain-computer interface use: a tutorial. Disabil Rehabil Assist Technol 2020; 15:799-809. [PMID: 32476516 DOI: 10.1080/17483107.2020.1754929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background and objectives: Many brain-computer interfaces (BCIs) for people with severe disabilities present stimuli in the visual modality with little consideration of the visual skills required for successful use. The primary objective of this tutorial is to present researchers and clinical professionals with basic information about the visual skills needed for functional use of visual BCIs, and to offer modifications that would render BCI technology more accessible for persons with vision impairments.Methods: First, we provide a background on BCIs that rely on a visual interface. We then describe the visual skills required for BCI technologies that are used for augmentative and alternative communication (AAC), as well as common eye conditions or impairments that can impact the user's performance. We summarize screening tools that can be administered by the non-eye care professional in a research or clinical setting, as well as the role of the eye care professional. Finally, we explore potential BCI design modifications to compensate for identified functional impairments. Information was generated from literature review and the clinical experience of vision experts.Results and conclusions: This in-depth description culminates in foundational information about visual skills and functional visual impairments that affect the design and use of visual interfaces for BCI technologies. The visual interface is a critical component of successful BCI systems. We can determine a BCI system for potential users with visual impairments and design BCI visual interfaces based on sound anatomical and physiological visual clinical science.Implications for RehabilitationAs brain-computer interfaces (BCIs) become possible access methods for people with severe motor impairments, it is critical that clinicians have a basic knowledge of the visual skills necessary for use of visual BCI interfaces.Rehabilitation providers must have a knowledge of objectively gathering information regarding a potential BCI user's functional visual skills.Rehabilitation providers must understand how to modify BCI visual interfaces for the potential user with visual impairments.Rehabilitation scientists should understand the visual demands of BCIs as they develop and evaluate these new access methods.
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Affiliation(s)
- Melanie Fried-Oken
- Departments of Neurology, Pediatrics, Biomedical Engineering, and Otolaryngology, Oregon Health & Science University, Portland, OR, USA.,Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | - Michelle Kinsella
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | - Betts Peters
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | - Brandon Eddy
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA.,Department of Speech and Hearing Sciences, Portland State University, Portland, OR, USA
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17
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Jeon H, Jung JH, Yoon JA, Choi H. Strabismus Is Correlated with Gross Motor Function in Children with Spastic Cerebral Palsy. Curr Eye Res 2019; 44:1258-1263. [PMID: 31189336 DOI: 10.1080/02713683.2019.1631851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To investigate the correlation between clinical features of strabismus and motor dysfunction classified according to the Gross Motor Function Classification System (GMFCS) in patients with spastic cerebral palsy (CP).Methods: In this retrospective, cross-sectional study in single tertiary medical center, 62 patients who are diagnosed with spastic CP who had an ophthalmic examination between 2006 and 2014 were included. Only patients with vision sufficient to fixate were included and patients with restrictive or paralytic strabismus were excluded. The types of CP were classified as diplegia, hemiplegia, or quadriplegia for distribution of motor impairment. The GMFCS was used to grade gross motor dysfunction, which was then classified as mild (grade 1, 2 and 3) or severe (grade 4 and 5) motor impairment. Strabismus was investigated in terms of direction, constancy, and deviation angle. The relationship between strabismus characteristics and the level of GMFCS and type of CP were assessed.Results: Thirty-eight and 24 patients had mild or severe motor deficit, respectively. Forty patients had strabismus, which was more frequent in patients with severe motor impairment.(P = .014) Exotropia and esotropia occurred with similar frequency. Constant and large-angle strabismus was frequently observed in patients with severe motor impairment.(P < .005, 0.027) The topographical subtype of CP was not related to clinical features of strabismus.Conclusions: The prevalence of strabismus is higher in severe motor impairment. The constancy and angle of strabismus was related to the severity of motor impairment while the topographical subtype of CP has no significant relationship.
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Affiliation(s)
- Hyeshin Jeon
- Department of Ophthalmology, Pusan National University Hospital, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin A Yoon
- Department of Rehabilitation medicine, Pusan National University Hospital, Busan, South Korea
| | - Heeyoung Choi
- Department of Ophthalmology, Pusan National University Hospital, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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18
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VerMaas JR, Gehringer JE, Wilson TW, Kurz MJ. Children with cerebral palsy display altered neural oscillations within the visual MT/V5 cortices. NEUROIMAGE-CLINICAL 2019; 23:101876. [PMID: 31176292 PMCID: PMC6555897 DOI: 10.1016/j.nicl.2019.101876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/12/2019] [Accepted: 05/25/2019] [Indexed: 11/19/2022]
Abstract
Cortical visual processing in visual MT/V5 is necessary for tracking movement and performing reliable visuomotor transformations. Although the role of this cortical area is well recognized, the activity of the visual MT/V5 cortical area in children with cerebral palsy (CP) has not been examined nor has its potential role in the atypical motor actions of these children been considered. This study used magnetoencephalography to image the neural activity in the motion-sensitive MT/V5 cortices of typically developing (TD) children (n = 21; mean age 14 yrs. ± 2, 12 males) and children with CP (n = 21; mean age 16 yrs. ± 4, 13 males) as they viewed a horizontally moving stimulus. Behavioral measures of visual perception were additionally assessed by having the participants press a button when the visual stimulus changed to moving in vertical direction. Our results showed that the horizontal movement of the visual stimulus evoked changes in the strength of the theta-alpha (5-10 Hz) and alpha-beta (8-20 Hz) oscillations in the visual MT/V5 area of all participants. Compared with the TD children, the children with CP had weaker alpha-beta oscillations in the visual MT/V5 cortices. In addition, the children with CP took longer to perceive a directional change of the visual stimulus and made more errors in detecting the change. Lastly, weaker alpha-beta oscillations were correlated with slower detection of the change in motion direction and less accuracy in identifying the change. This study shows that the uncharacteristic neural oscillations in the visual MT/V5 cortical area may partially account for the abnormal perceptions and motor decisions seen in children with CP.
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Affiliation(s)
- Jacy R VerMaas
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States of America; Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - James E Gehringer
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States of America; Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Tony W Wilson
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States of America; Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States of America; Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, United States of America.
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19
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Christy JB. Considerations for Testing and Treating Children with Central Vestibular Impairments. Semin Hear 2018; 39:321-333. [PMID: 30038458 DOI: 10.1055/s-0038-1666821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This perspective explores common pediatric diagnoses that could present with central vestibular pathway dysfunction, leading to delays in motor development and postural control, and gaze instability. Specifically, the following diagnoses are considered: cerebral palsy, myelomeningocele, vestibular migraine, attention-deficit hyperactivity disorder, developmental coordination disorder, concussion, childhood cancer, congenital muscular torticollis, adolescent idiopathic scoliosis, and autism. Suggestions for clinical screening, vestibular function testing, and vestibular rehabilitation for children with these diagnoses are based on evidence for the efficacy of testing and interventions for children with peripheral vestibular hypofunction. More research is needed to explore peripheral and central vestibular function in children with these diagnoses. Testing and intervention methods may need to be modified to accommodate for the specific behavior and motor challenges that some children might present. Researchers should develop technology so that gaze stabilization exercises can be delivered in a fun, functional, and effective way.
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Affiliation(s)
- Jennifer B Christy
- Department of Physical Therapy, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama
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20
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Salavati M, Rameckers E, Waninge A, Krijnen W, van der Schans C, Steenbergen B. Evaluating the outcome of an individual functional therapy program focused on children with cerebral palsy and cerebral visual impairment: a multiple case study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2017.1374455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Masoud Salavati
- Royal Dutch Visio, Center of Expertise for Blind and Visually Impaired People, Haren, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Eugene Rameckers
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands
- AVANSplus, University for Professionals for Paediatric Physical Therapy, Breda, The Netherlands
| | - Aly Waninge
- Royal Dutch Visio, Center of Expertise for Blind and Visually Impaired People, Haren, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Wim Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Cees van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
- School of Psychology, Australian Catholic University, Melbourne, Australia
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21
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Abstract
PURPOSE To identify the anatomic sites and the etiology of childhood blindness and to discern treatable and preventable causes. METHODS The records of 998 patients seen in the authors' pediatric ophthalmology unit between June 1998 and May 2002 were examined retrospectively. A total of 148 patients who had visual impairment and blindness according to World Health Organization criteria were included in the study. They are classified according to the etiology based on time of insult and the anatomic site of visual loss. RESULTS The most common anatomic site of visual loss was retina, with a rate of 25.0%. The etiology according to the time of insult was unknown in 45.2% of the patients, of whom 20.2% had cataract. Genetic disorders were responsible in 25.0% of the patients. In 69.6% of the patients, the causes of visual impairment were considered either preventable or treatable, including cataract, retinopathy of prematurity, genetic disorders, and refractive errors. CONCLUSIONS A high percentage of our patients had avoidable causes of childhood blindness. Genetic counseling services, as well as national screening programs for amblyopia, red fundus reflex, and retinopathy of prematurity, should be established.
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Affiliation(s)
- E Cetin
- Department of Ophthalmology, Dokuz Eylul University Hospital, Izmir - Turkey
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22
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Abstract
Much remains to be understood about visual system malfunction following injury. The resulting deficits range from dense, visual field scotomas to mild dysfunction of visual perception. Despite the predictive value of anatomical localization studies, much patient-to-patient variability remains regarding (a) perceptual abilities following injury and (b) the capacity of individual patients for visual rehabilitation. Visual field perimetry is used to characterize the visual field deficits that result from visual system injury. However, standard perimetry mapping does not always precisely correspond to underlying anatomical or functional deficits. Functional magnetic resonance imaging can be used to probe the function of surviving visual circuits, allowing us to classify better how the pattern of injury relates to residual visual perception. Identifying pathways that are potentially modifiable by training may guide the development of improved strategies for visual rehabilitation. This review discusses primary visual cortex lesions, which cause dense contralateral scotomas.
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Affiliation(s)
- Stelios M Smirnakis
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts 02115.,Department of Neurology, Jamaica Plain Campus, Veterans Administration Boston Healthcare System, Boston, Massachusetts 02130.,Harvard Medical School, Boston, Massachusetts 02115;
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24
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Response to correction of refractive errors and hypoaccommodation in children with congenital Zika syndrome. J AAPOS 2017; 21:480-484.e1. [PMID: 29066355 DOI: 10.1016/j.jaapos.2017.07.206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/17/2017] [Accepted: 07/29/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe the immediate response to correction of refractive errors and hypoaccommodation in children with congenital Zika syndrome (CZS). METHODS Children born between May and December 2015 with a confirmed diagnosis of CZS and enrolled in a multidisciplinary early intervention program were included in this study. All children received a comprehensive ophthalmic examination, including dynamic retinoscopy and cycloplegic refraction. Children were prescribed their full correction if they met the criteria for refractive error, and additional plus 3.00 overcorrection for strabismus, accommodative dysfunction, and/or low vision. Monocular and binocular visual responses to Lea Grating Test at 30 cm, with and without eyeglasses, were measured on day 1 of glasses wear. RESULTS A total of 60 children were evaluated (mean age at evaluation, 11.5 ± 1.1 months; range, 9.0-16.0 months). Lea Grating Test responses were abnormal in all children prior to spectacle correction. Hypoaccommodation was present in 17 of 21 children (81%). Overcorrection was prescribed for all children. Visual responses were subnormal even with glasses use; however, immediate improvement in binocular vision was found in 37 children (62%) and in 74 of 119 eyes (62.2%). For the monocular visual improvement, 27 of 115 eyes (23.5%) had structural abnormalities, and 44 of 115 eyes (38.3%) were structurally normal. There was a statistical difference between the cycloplegic refraction of the children in August and in November, including emmetropia (P = 0.001), hyperopia (P = 0.000), myopia (P = 0.007), and astigmatism (P = 0.004). CONCLUSIONS Eyeglasses can improve visual acuity in children with CZS. Significant changes in their refractive status over time requires periodic updates.
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25
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Salt A, Sargent J. Fifteen-minute consultation-the child with a developmental disability: is there an ocular or visual abnormality? Arch Dis Child Educ Pract Ed 2017; 102:304-309. [PMID: 28667047 DOI: 10.1136/archdischild-2016-311252] [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: 10/11/2016] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To present a structured approach for an outpatient consultation for a child with developmental disability who may have an ocular or visual disorder. METHOD Review of relevant literature and description of the approach to ocular and visual assessment which could be used by any paediatrician. CONCLUSION A systematic approach to history, observation and examination of a child with a developmental disability will assist in identifying a possible visual problem. A structured referral letter will ensure that the child will receive the most appropriate assessment to clarify the problem and appropriate management in the eye clinic.
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Affiliation(s)
- Alison Salt
- Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Clinical Neurosciences, UCL Institute of Child Health, London, UK
| | - Jenefer Sargent
- Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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26
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Chokron S, Dutton GN. Impact of Cerebral Visual Impairments on Motor Skills: Implications for Developmental Coordination Disorders. Front Psychol 2016; 7:1471. [PMID: 27757087 PMCID: PMC5048540 DOI: 10.3389/fpsyg.2016.01471] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/13/2016] [Indexed: 12/16/2022] Open
Abstract
Cerebral visual impairment (CVI) has become the primary cause of visual impairment and blindness in children in industrialized countries. Its prevalence has increased sharply, due to increased survival rates of children who sustain severe neurological conditions during the perinatal period. Improved diagnosis has probably contributed to this increase. As in adults, the nature and severity of CVI in children relate to the cause, location and extent of damage to the brain. In the present paper, we define CVI and how this impacts on visual function. We then define developmental coordination disorder (DCD) and discuss the link between CVI and DCD. The neuroanatomical correlates and aetiologies of DCD are also presented in relationship with CVI as well as the consequences of perinatal asphyxia (PA) and preterm birth on the occurrence and nature of DCD and CVI. This paper underlines why there are both clinical and theoretical reasons to disentangle CVI and DCD, and to categorize the features with more precision. In order to offer the most appropriate rehabilitation, we propose a systematic and rapid evaluation of visual function in at-risk children who have survived preterm birth or PA whether or not they have been diagnosed with cerebral palsy or DCD.
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Affiliation(s)
- Sylvie Chokron
- Unité Fonctionnelle Vision and Cognition, Fondation Ophtalmologique RothschildParis, France; Laboratoire de Psychologie de la Perception, UMR 8242, Centre National de la Recherche Scientifique - Université Paris-DescartesParis, France
| | - Gordon N Dutton
- Department of Vision Science, Glasgow Caledonian University Glasgow, UK
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27
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Piovesana AM, Ross S, Whittingham K, Ware RS, Boyd RN. Stability of executive functioning measures in 8-17-year-old children with unilateral cerebral palsy. Clin Neuropsychol 2015; 29:133-49. [PMID: 25599107 DOI: 10.1080/13854046.2014.999125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The study investigated the stability of executive functioning (EF) measures in children and adolescents aged 8-17 years with unilateral cerebral palsy (CP). Here 44 participants with unilateral CP (mean age = 11 years, 11 months; Manual Abilities Classification Scale Level I = 6 and Level II = 37; Gross Motor Function Classification Scale Level I = 22 and Level II = 22) were randomized into the wait-list control group of a large randomized controlled trial. Participants had baseline testing with Wechsler Intelligence Scale for Children--Fourth Edition Short Form (WISC-IV-SF) and Delis-Kaplan Executive Function System (D-KEFS) subtests. Parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF). Participants were re-assessed 20 ±2 weeks later with a shortened test battery including the D-KEFS subtests; Digit Span, Coding and Symbol Search (WISC-IV); and BRIEF. Pearson's test-retest reliabilities and Reliable change scores were calculated. Results indicated excellent to fair test-retest reliabilities (r = 0.91-0.74) for all measures except Digit Span Backwards (r = 0.62), Inhibition (r = 0.69), and Initiate (r = 0.68). Reliable change scores applying 90% confidence intervals for estimating reliable change while accounting for practice effects were provided for all measures. The data support the stability of EF measures in this population.
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Affiliation(s)
- Adina M Piovesana
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine , The University of Queensland , Brisbane , QLD 4029 , Australia
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Salt A, Sargent J. Common visual problems in children with disability. Arch Dis Child 2014; 99:1163-8. [PMID: 25165073 PMCID: PMC4251159 DOI: 10.1136/archdischild-2013-305267] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 11/12/2022]
Abstract
Children with disability are at a substantially higher risk of visual impairment (VI) (10.5% compared with 0.16%) but also of ocular disorders of all types, including refractive errors and strabismus. The aetiology of VI in children with disability reflects that of the general population and includes cerebral VI, optic atrophy, as well as primary visual disorders such as retinal dystrophies and structural eye anomalies. VI and other potentially correctable ocular disorders may not be recognised without careful assessment and are frequently unidentified in children with complex needs. Although assessment may be more challenging than in other children, identifying these potential additional barriers to learning and development may be critical. There is a need to develop clearer guidelines, referral pathways and closer working between all professionals involved in the care of children with disability and visual disorders to improve our focus on the assessment of vision and outcomes for children with disability.
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Affiliation(s)
- Alison Salt
- Neurodisability Service, Great Ormond, Street Hospital for Children, London, UK
| | - Jenefer Sargent
- Neurodisability Service, Great Ormond, Street Hospital for Children, London, UK
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Bosch DGM, Boonstra FN, Reijnders MRF, Pfundt R, Cremers FPM, de Vries BBA. Chromosomal aberrations in cerebral visual impairment. Eur J Paediatr Neurol 2014; 18:677-84. [PMID: 24912731 DOI: 10.1016/j.ejpn.2014.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/06/2014] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebral visual impairment (CVI) is a disorder in projection and/or interpretation of the visual input in the brain and accounts for 27% of the visually impaired children. AIM A large cohort of patients with CVI was investigated in order to ascertain the relevance of chromosomal aberrations in the etiology of this disorder. METHODS 607 patients with CVI and a visual acuity ≤0.3 were assessed for the presence of a chromosomal aberration retrospectively. The observed aberrations were classified for pathogenicity. RESULTS A total of 98 chromosomal aberrations were found in 79 persons (13%) of the cohort. In nine persons it was not possible to classify the clinical implication of the aberration, due to lack of detailed information. In 70 persons it was possible to classify the aberration for causality: in 41 patients the aberration was associated with CVI, in 16 it was unknown and in 13 the aberration was unlikely to be associated with CVI. For four aberrations, present in 26 patients, the association with CVI has been reported before: trisomy 21, 1p36 deletion syndrome, 17p13.3 deletion syndrome (Miller-Dieker syndrome) and 22q13.3 deletion syndrome (Phelan-McDermid syndrome). The chromosomal aberrations in another 15 patients were for the first time associated with CVI. CONCLUSIONS Chromosomal aberrations associated with CVI were found in 7% (41/607) of patients, of which 37% (15/41) have not been reported before in association with CVI. Therefore, in patients with CVI chromosomal investigations should be routinely performed to warrant a good clinical diagnosis and counseling.
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Affiliation(s)
- Daniëlle G M Bosch
- Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands; Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands
| | - F Nienke Boonstra
- Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands
| | - Margot R F Reijnders
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Frans P M Cremers
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Bert B A de Vries
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
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Lampe R, Turova V, Blumenstein T, Alves-Pinto A. Eye movement during reading in young adults with cerebral palsy measured with eye tracking. Postgrad Med 2014; 126:146-58. [PMID: 25295659 DOI: 10.3810/pgm.2014.09.2809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cerebral palsy is a nonprogressive brain disorder associated with lifelong motor impairments and often with cognitive deficits, impaired communication, and impaired sensory perception. Vision deficits, in particular, occur frequently in cerebral palsy and can lead to reading difficulties. OBJECTIVE Investigate the extent to which the motor impairments in this clinical group affect patients' ability to read. METHODS An eye-tracking system was used to record the eye movements during a reading task in 31 adults diagnosed with cerebral palsy and in 10 healthy controls. Participants were asked to read out loud 1 to 5 excerpts from children's books. RESULTS In comparison to the healthy readers, cerebral palsy patients took longer to read the excerpts; made more saccades, fixations, and regressions; and made shorter saccades. Average fixation times were similar between the 2 groups, but the average saccade duration was significantly longer for the cerebral palsy group, as a function of the degree of severity of motor impairment. The latter was not a determinant of the level of text comprehension achieved by these patients. CONCLUSIONS OBJECTIVE measures of eye movement during a reading task can be obtained in cerebral palsy patients using eye-tracking techniques. RESULTS suggest that cerebral palsied patients may experience difficulties in searching for words during reading.
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Affiliation(s)
- Renée Lampe
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Salavati M, Rameckers EA, Steenbergen B, van der Schans C. Gross motor function, functional skills and caregiver assistance in children with spastic cerebral palsy (CP) with and without cerebral visual impairment (CVI). EUROPEAN JOURNAL OF PHYSIOTHERAPY 2014. [DOI: 10.3109/21679169.2014.899392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Masoud Salavati
- Royal Visio, Center of Expertise for Blind and Partially Sighted People, Haren, The Netherlands
| | - Eugene A.A. Rameckers
- Maastricht University, Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
- Adelante Center of Expertise in Rehabilitation and Audiology, Valkenburg and Hoensbroek, The Netherlands
- AVANSplus, University for Professionals for Pediatric Physical Therapy, Breda, The Netherlands
| | - Bert Steenbergen
- Radboud University Nijmegen, Behavioural Science Institute, Nijmegen, The Netherlands
- Australian Catholic University, School of Psychology, Melbourne, Australia
| | - Cees van der Schans
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Research Group in Health Care and in Nursing, Hanze University Applied Sciences Groningen, Groningen, The Netherlands
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Dufresne D, Dagenais L, Shevell MI. Spectrum of visual disorders in a population-based cerebral palsy cohort. Pediatr Neurol 2014; 50:324-8. [PMID: 24468636 DOI: 10.1016/j.pediatrneurol.2013.11.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/19/2013] [Accepted: 11/23/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Children with cerebral palsy are known to be at increased risk for visual impairment. METHODS In a population-based sample drawn from a geographically defined registry, the profile of visual impairment in children with cerebral palsy was investigated. RESULTS Close to half (49.8%; 106/213) had a visual impairment. The majority of these individuals had strabismus (55.7%; 59/106) and a slightly lesser fraction had refractive errors (20.7%; 22/106) or severe visual loss (18.9%; 20/106). The vast majority of children with severe visual loss had spastic quadriplegia (83%; 17/20) or were nonambulatory (i.e., Gross Motor Function Classification Scale IV/V, 80%; 16/20). CONCLUSIONS Knowledge of this profile will assist practitioners to heighten their appreciation of potential visual disturbances in certain subsets of children with cerebral palsy.
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Affiliation(s)
- David Dufresne
- Departments of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Lynn Dagenais
- Departments of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Michael I Shevell
- Departments of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
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Guzzetta A. Visual disorders in children with cerebral palsy: is the picture still 'blurred'? Dev Med Child Neurol 2014; 56:103-4. [PMID: 24127758 DOI: 10.1111/dmcn.12314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Guzzetta
- SMILE Lab, Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
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Alimović S, Jurić N, Bošnjak VM. Functional vision in children with perinatal brain damage. J Matern Fetal Neonatal Med 2013; 27:1491-4. [DOI: 10.3109/14767058.2013.863863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Leonhardt M, Forns M, Calderón C, Reinoso M, Gargallo E. Visual performance in preterm infants with brain injuries compared with low-risk preterm infants. Early Hum Dev 2012; 88:669-75. [PMID: 22381046 DOI: 10.1016/j.earlhumdev.2012.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 11/04/2011] [Accepted: 02/06/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neonatal brain injuries are the main cause of visual deficit produced by damage to posterior visual pathways. While there are several studies of visual function in low-risk preterm infants or older children with brain injuries, research in children of early age is lacking. AIM To assess several aspects of visual function in preterm infants with brain injuries and to compare them with another group of low-risk preterm infants of the same age. STUDY DESIGN AND SUBJECTS Forty-eight preterm infants with brain injuries and 56 low-risk preterm infants. OUTCOME MEASURES The ML Leonhardt Battery of Optotypes was used to assess visual functions. This test was previously validated at a post-menstrual age of 40 weeks in newborns and at 30-plus weeks in preterm infants. RESULTS The group of preterm infants with brain lesions showed a delayed pattern of visual functions in alertness, fixation, visual attention and tracking behavior compared to infants in the healthy preterm group. The differences between both groups, in the visual behaviors analyzed were around 30%. These visual functions could be identified from the first weeks of life. CONCLUSION Our results confirm the importance of using a straightforward screening test with preterm infants in order to assess altered visual function, especially in infants with brain injuries. The findings also highlight the need to provide visual stimulation very early on in life.
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Affiliation(s)
- Merçè Leonhardt
- NICU, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues, Barcelona, Spain.
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Abstract
This chapter deals with neuro-ophthalmological diseases at different levels of the afferent visual pathways with special regard to visual field defects, their functional impact, and their rehabilitation. The nature of these impairments and their significance for activities of daily living can be quite varied; an exact assessment of the residual function is required to determine specific rehabilitation approaches. Rehabilitation aims to compensate for the visual deficits by means of specific training and visual aids. Visual field defects in the center cause reading disability. Preconditions for reading are a sufficient size of the reading visual field or perceptual span and sufficient resolution of the retinal area used for reading. In central scotoma, as in macular or optic nerve disease, reading ability can be regained by eccentric fixation plus text magnification. In hemianopia, reading depends on the amount of sparing in the center, the side of the defect, and adaptive strategies. Field defects in the periphery cause orientation and mobility problems. In constricted fields, tactile training with a cane is indicated; in hemianopia, explorative saccadic training is effective. With the appropriate technique, rehabilitation can be very successful, and quality of life can be regained in most patients.
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Masia L, Frascarelli F, Morasso P, Di Rosa G, Petrarca M, Castelli E, Cappa P. Reduced short term adaptation to robot generated dynamic environment in children affected by Cerebral Palsy. J Neuroeng Rehabil 2011; 8:28. [PMID: 21600031 PMCID: PMC3117777 DOI: 10.1186/1743-0003-8-28] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 05/21/2011] [Indexed: 11/20/2022] Open
Abstract
Background It is known that healthy adults can quickly adapt to a novel dynamic environment, generated by a robotic manipulandum as a structured disturbing force field. We suggest that it may be of clinical interest to evaluate to which extent this kind of motor learning capability is impaired in children affected by cerebal palsy. Methods We adapted the protocol already used with adults, which employs a velocity dependant viscous field, and compared the performance of a group of subjects affected by Cerebral Palsy (CP group, 7 subjects) with a Control group of unimpaired age-matched children. The protocol included a familiarization phase (FA), during which no force was applied, a force field adaptation phase (CF), and a wash-out phase (WO) in which the field was removed. During the CF phase the field was shut down in a number of randomly selected "catch" trials, which were used in order to evaluate the "learning index" for each single subject and the two groups. Lateral deviation, speed and acceleration peaks and average speed were evaluated for each trajectory; a directional analysis was performed in order to inspect the role of the limb's inertial anisotropy in the different experimental phases. Results During the FA phase the movements of the CP subjects were more curved, displaying greater and variable directional error; over the course of the CF phase both groups showed a decreasing trend in the lateral error and an after-effect at the beginning of the wash-out, but the CP group had a non significant adaptation rate and a lower learning index, suggesting that CP subjects have reduced ability to learn to compensate external force. Moreover, a directional analysis of trajectories confirms that the control group is able to better predict the force field by tuning the kinematic features of the movements along different directions in order to account for the inertial anisotropy of arm. Conclusions Spatial abnormalities in children affected by cerebral palsy may be related not only to disturbance in motor control signals generating weakness and spasticity, but also to an inefficient control strategy which is not based on a robust knowledge of the dynamical features of their upper limb. This lack of information could be related to the congenital nature of the brain damage and may contribute to a better delineation of therapeutic intervention.
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Affiliation(s)
- Lorenzo Masia
- Robotics Brain and Cognitive Sciences Dept,, Italian Institute of Technology, Genoa, Italy.
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Abstract
This article reviews developmental processes in the human brain and basic principles underlying typical and atypical motor development. The Neuronal Group Selection Theory is used as theoretical frame of reference. Evidence is accumulating that abundance in cerebral connectivity is the neural basis of human behavioral variability (ie, the ability to select, from a large repertoire of behavioral solutions, the one most appropriate for a specific situation). Indeed, typical human motor development is characterized by variation and the development of adaptive variability. Atypical motor development is characterized by a limited variation (a limited repertoire of motor strategies) and a limited ability to vary motor behavior according to the specifics of the situation (ie, limited variability). Limitations in variation are related to structural anomalies in which disturbances of cortical connectivity may play a prominent role, whereas limitations in variability are present in virtually all children with atypical motor development. The possible applications of variation and variability in diagnostics in children with or at risk for a developmental motor disorder are discussed.
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Martinez-Biarge M, Diez-Sebastian J, Rutherford MA, Cowan FM. Outcomes after central grey matter injury in term perinatal hypoxic-ischaemic encephalopathy. Early Hum Dev 2010; 86:675-82. [PMID: 20864278 DOI: 10.1016/j.earlhumdev.2010.08.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Central grey matter damage following perinatal hypoxia-ischaemia frequently leads to death or motor abnormality often with deficits in other developmental domains. Predicting these different outcomes is difficult yet very important for early management, planning and providing for needs on discharge and later and not least for parents to know how their children will be affected. The best single predictor of the pattern of outcomes for an individual infant is an early MRI scan. We present a guide for predicting outcome at 2 years in different developmental domains based on the severity of injury seen in the basal ganglia and thalami (BGT) on neonatal MRI.
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Guzzetta A, D'Acunto G, Rose S, Tinelli F, Boyd R, Cioni G. Plasticity of the visual system after early brain damage. Dev Med Child Neurol 2010; 52:891-900. [PMID: 20561008 DOI: 10.1111/j.1469-8749.2010.03710.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this review is to discuss the existing evidence supporting different processes of visual brain plasticity after early damage, as opposed to damage that occurs during adulthood. There is initial evidence that some of the neuroplastic mechanisms adopted by the brain after early damage to the visual system are unavailable at a later stage. These are, for example, the ability to differentiate functional tissue within a larger dysplastic cortex during its formation, or to develop new thalamo-cortical connections able to bypass the lesion and reach their cortical destination in the occipital cortex. The young brain also uses the same mechanisms available at later stages of development but in a more efficient way. For example, in people with visual field defects of central origin, the anatomical expansion of the extrastriatal visual network is greater after an early lesion than after a later one, which results in more efficient mechanisms of visual exploration of the blind field. A similar mechanism is likely to support some of the differences found in people with blindsight, the phenomenon of unconscious visual perception in the blind field. In particular, compared with people with late lesions, those with early brain damage appear to have stronger subjective awareness of stimuli hitting the blind visual field, reported as a conscious feeling that something is present in the visual field. Expanding our knowledge of these mechanisms could help the development of early therapeutic interventions aimed at supporting and enhancing visual reorganization at a time of greatest potential brain plasticity.
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Affiliation(s)
- Andrea Guzzetta
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy.
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Arpino C, Compagnone E, Montanaro ML, Cacciatore D, De Luca A, Cerulli A, Di Girolamo S, Curatolo P. Preterm birth and neurodevelopmental outcome: a review. Childs Nerv Syst 2010; 26:1139-49. [PMID: 20349187 DOI: 10.1007/s00381-010-1125-y] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Accepted: 03/03/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of preterm delivery and the survival rate of preterm newborns are rising, due to the increased use of assisted reproductive technology associated with multiple gestations and improved technology in obstetrics and neonatology, which allow saving preterm infants at earlier gestational ages. As a consequence, the risk of developmental disabilities in preterm children is high, and clinical pictures need to be fully defined. METHODS Narrative review including articles regarding neurodevelopmental disorders published in the international medical literature and reported in PubMed between the years 2000 and January 2010. RESULTS Although survival rates of extremely low birth weight infants (ELBW) significantly increased during the last decade, the substantial stability of disability trends in this population was disappointing. Late-preterm infants, who account for about 75% of all preterm births and had not been considered at risk for adverse long-term neurodevelopmental outcomes in the past, are now reconsidered as more likely to develop such events, though their risk remains lower than in ELBW. CONCLUSIONS The findings of the studies discussed in our article support the importance of early diagnosis in order to make decision about appropriate treatment of preterm infants.
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Affiliation(s)
- Carla Arpino
- Department of Neurosciences, Pediatric Neurology Unit, Tor Vergata University of Rome, Via Montpellier 1, Rome, Italy.
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Tüzün EH, Guven DK, Eker L. Pain prevalence and its impact on the quality of life in a sample of Turkish children with cerebral palsy. Disabil Rehabil 2010; 32:723-8. [PMID: 20302440 DOI: 10.3109/09638280903295433] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the measurement properties of the Pain Evaluation Scale (PES), to estimate the prevalence of pain based on the PES data, and to evaluate the impact of pain on the quality of life (QoL) in a sample of Turkish children with CP. METHOD A total of 346 children with CP participated in a cross-sectional study. The Gross Motor Function Classification System (GMFCS), PES, Wong-Baker FACES Pain Rating Scale, and the Child Health Questionnaire (CHQ-PF50) were used as the assessment tools. RESULTS The Cronbach's alpha coefficient was 0.90 for the PES. The PES score was moderately correlated with the bodily pain subscale score, and very weekly with the mental health subscale score of the CHQ-PF50. For the threshold value of 2 on the PES, sensitivity and specificity were 91.1% and 100%, respectively. Overall, apparent prevalence and true prevalence of pain were 69.1% and 75.9%, respectively. There was a significant negative effect of pain on the QoL of subjects. The pain also negatively affected parent's personal time and caused limitations in family activities. CONCLUSIONS The PES is valid and reliable pain assessment tool for children with CP. Pain is a frequent health problem and has severe consequences both on the cerebral palsied children's QoL and their family.
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Affiliation(s)
- Emine Handan Tüzün
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Başkent University, Baglica, Ankara, Turkey.
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Pruitt DW, Tsai T. Common medical comorbidities associated with cerebral palsy. Phys Med Rehabil Clin N Am 2009; 20:453-67. [PMID: 19643347 DOI: 10.1016/j.pmr.2009.06.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The medical issues associated with the diagnosis of cerebral palsy (CP) can have significant interplay with the neuromuscular issues that most physiatrists manage in the clinical setting. Identification and appropriate management of these common comorbidities by the primary care and subspecialist physicians can have significant impact on the quality of life of the patient and family. Some of these issues are prevalent across all gross motor function classification system (GMFCS) levels of severity, whereas others more commonly complicate the care of those children with the more severe GMFCS levels IV and V. Performance of a complete review of systems to address the potentially complex medical comorbidities and subsequent application of appropriate screening tools can assist in achieving optimal outcomes in children with CP and their families.
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Affiliation(s)
- David W Pruitt
- Division of Pediatric Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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Dammann O, Leviton A. Inflammation, brain damage and visual dysfunction in preterm infants. Semin Fetal Neonatal Med 2006; 11:363-8. [PMID: 16581321 DOI: 10.1016/j.siny.2006.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Antenatal intrauterine infection and the fetal inflammatory response appear to be important pathogenetic factors in preterm birth and subsequent neonatal disorders of the lung and brain. In this paper, we expand this concept to include visual dysfunction. Although present data tend to support our notion, we suggest that more experimental and epidemiological research is needed to elucidate mechanisms of infection/inflammation-induced damage to the eye and visual brain pathways of preterm infants.
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Affiliation(s)
- Olaf Dammann
- Perinatal Infectious Disease Epidemiology Unit, Department of Gynecology, Hannover Medical School, OE 6415, 30623 Hannover, Germany.
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