Postural control in dyslexic and non-dyslexic children

The effect of online visual games on visual perception, oculomotor, and balance skills of children with developmental dyslexia during the COVID-19 pandemic

PURPOSE

To evaluate the effect of online visual games on the balance, visual perception, and oculomotor skills of children with developmental dyslexia during the COVID-19 pandemic.

METHODS

In this single-blind randomized clinical trial, 50 children with developmental dyslexia, aged 7 to 11 years, were recruited from rehabilitation centers in Tehran, Iran, using a convenience sampling strategy. Participants were randomly divided into two groups: intervention (25) and control (25), with close matching based on sex, age, IQ, and type of disease. The interventions consisted of web-based online computer games focusing on visual perception and oculomotor skills. Outcome measures included the Test of Visual Perception Skills-Revised, the Pediatric Balance Scale, and videonystagmography. The Wechsler Intelligence Scale for Children-IV and the Reading and Dyslexia Test were used to evaluate IQ and reading skills, respectively.

RESULTS

The intervention group exhibited significant post-intervention improvements in the Test of Visual Perception Skills-Revised, tracking gain, saccade latency, and saccade velocity scores (all P < 0.001). In contrast, the control group showed no significant differences in these tests in pre- and post-intervention (all P > 0.05). Notably, post-intervention comparisons between the groups revealed significant differences in smooth pursuit eye movements (P < 0.001), saccade latency (P = 0.027), and saccade velocity (P < 0.001). The Pediatric Balance Scale scores remained unchanged in both groups post-intervention (intervention: P = 0.317; control: P = 0.999). Game face validity was affirmed with impact scores above 1.5 for all items, suggesting that the games were straightforward, clear, and relevant.

CONCLUSION

Online visual games enhanced oculomotor and visual perception skills in children with dyslexia but did not influence balance skills.

Disconjugate Eye Movements in Dyslexic Adolescents While Viewing Op Art: A Creative Handicap?

Op art was created, in part, to produce illusions of movement. Given that dyslexics have been shown to have impaired visuo-postural axis deficits, it may be possible that dyslexics see illusions different than their non-dyslexic peers. To test this theory, we measured eye movement and posture in 47 dyslexic (18 female, 29 male; mean age 15.4) and 44 non dyslexic (22 female, 22 male; mean age 14.8) adolescents while they viewed three works of art by Op artist Bridget Riley. They then responded to a questionnaire about how they felt while viewing the artworks. Dyslexics demonstrated significantly slower saccades in terms of average velocity that was particularly disturbed in paintings that manipulated depth. Subjectively, dyslexics felt much more destabilized compared to their peers; however, there was not a significant difference in objective postural measurements between the two groups. The sensation of destabilization was positively correlated with appreciation in non-dyslexic adolescents. These subjective results suggest that dyslexics may be more sensitive to movement in depth, which could be related to the instability in vergence movements. Whereas this instability represents a hinderance in relation to reading, it could be an advantage while viewing paintings such as these.

Specific Learning Disorder in Children and Adolescents, a Scoping Review on Motor Impairments and Their Potential Impacts

Mastering motor skills is important for children to achieve functional mobility and participate in daily activities. Some studies have identified that students with specific learning disorders (SLD) could have impaired motor skills; however, this postulate and the potential impacts remain unclear. The purpose of the scoping review was to evaluate if SLD children have motor impairments and examine the possible factors that could interfere with this assumption. The sub-objective was to investigate the state of knowledge on the lifestyle behavior and physical fitness of participants with SLD and to discuss possible links with their motor skills. Our scoping review included preregistration numbers and the redaction conformed with the PRISMA guidelines. A total of 34 studies published between 1990 and 2022 were identified. The results of our scoping review reflected that students with SLD have poorer motor skills than their peers. These motor impairments are exacerbated by the complexity of the motor activities and the presence of comorbidities. These results support our sub-objective and highlight the link between motor impairments and the sedentary lifestyle behavior of SLDs. This could lead to deteriorating health and motor skills due to a lack of motor experience, meaning that this is not necessarily a comorbidity. This evidence emphasizes the importance of systematic clinical motor assessments and physical activity adaptations.

Reliance on visual feedback from ocular accommodation on motor skills in children with developmental coordination disorder and typically developing controls

Children with developmental coordination disorder (DCD) present with marked impairments in motor skills, including visual-motor integration. Oculomotor anomalies are more prevalent in children with DCD than typically developing children. Children with DCD further demonstrate altered use of visual feedback compared to typically developing controls. We investigated whether the accommodation system, a key component of the oculomotor system, contributes to visual feedback during fine and gross motor skills performance; and whether children with DCD demonstrate differences in reliance on visual feedback from accommodation. Minus dioptre lenses were used to maximally induce accommodation and impede accommodation dynamics. Children with DCD and typically developing controls performed motor skills tests assessing balance, upper limb coordination, visual-motor performance, gross and fine dexterity. Motor skills performance in controls was significantly affected by impeded accommodation in all tasks. Children with DCD demonstrated reliance on accommodation feedback in upper limb and visual-motor tasks only. Children with DCD may be less reliant on visual feedback obtained from accommodation due to adaptive mechanisms to overcome faulty information in the presence of oculomotor anomalies. These results strengthen our previous findings that accommodation anomalies contribute to motor skills impairment, and suggest that performance on these motor tasks is heavily reliant on visual feedback from accommodation.

Test-retest of a phoria adaptation stimulus-induced functional MRI experiment

This study was designed to identify the neural substrates activated during a phoria adaptation task using functional magnetic resonance imaging (MRI) in young adults with normal binocular vision and to test the repeatability of the fMRI measurements for this protocol. The phoria adaptation task consisted of a block protocol of 90 seconds of near visual crossed fixation followed by 90 seconds of far visual uncrossed fixation, repeated three times; the data were collected during two different experimental sessions. Results showed that the oculomotor vermis, cuneus, and primary visual cortex had the greatest functional activity within the regions of interest studied when stimulated by the phoria adaptation task. The oculomotor vermis functional activity had an intraclass correlation coefficient (ICC) of 0.3, whereas the bilateral cuneus and primary visual cortex had good ICC results of greater than 0.6. These results suggest that the sustained visual fixation task described within this study reliably activates the neural substrates of phoria adaptation. This protocol establishes a methodology that can be used in future longitudinal studies investigating therapeutic interventions that may modify phoria adaptation.

Frequency of Visual Deficits in Children With Developmental Dyslexia

Importance

Developmental dyslexia (DD) is a specific learning disability of neurobiological origin whose core cognitive deficit is widely believed to involve language (phonological) processing. Although reading is also a visual task, the potential role of vision in DD has been controversial, and little is known about the integrity of visual function in individuals with DD.

Objective

To assess the frequency of visual deficits (specifically vergence, accommodation, and ocular motor tracking) in children with DD compared with a control group of typically developing readers.

Design, Setting, and Participants

A prospective, uncontrolled observational study was conducted from May 28 to October 17, 2016, in an outpatient ophthalmology ambulatory clinic among 29 children with DD and 33 typically developing (TD) children.

Main Outcomes and Measures

Primary outcomes were frequencies of deficits in vergence (amplitude, fusional ranges, and facility), accommodation (amplitude, facility, and accuracy), and ocular motor tracking (Developmental Eye Movement test and Visagraph eye tracker).

Results

Among the children with DD (10 girls and 19 boys; mean [SD] age, 10.3 [1.2] years) and the TD group (21 girls and 12 boys; mean [SD] age, 9.4 [1.4] years), accommodation deficits were more frequent in the DD group than the TD group (16 [55%] vs 3 [9%]; difference = 46%; 95% CI, 25%-67%; P < .001). For ocular motor tracking, 18 children in the DD group (62%) had scores in the impaired range (in the Developmental Eye Movement test, Visagraph, or both) vs 5 children in the TD group (15%) (difference, 47%; 95% CI, 25%-69%; P < .001). Vergence deficits occurred in 10 children in the DD group (34%) and 5 children in the TD group (15%) (difference, 19%; 95% CI, -2.2% to 41%; P = .08). In all, 23 children in the DD group (79%) and 11 children in the TD group (33%) had deficits in 1 or more domain of visual function (difference, 46%; 95% CI, 23%-69%; P < .001).

Conclusions and Relevance

These findings suggest that deficits in visual function are far more prevalent in school-aged children with DD than in TD readers, but the possible cause and clinical relevance of these deficits are uncertain. Further study is needed to determine the extent to which treating these deficits can improve visual symptoms and/or reading parameters.

Are changes in the stomatognatic system able to modify the eye balance in dyslexia?

Objectives

To clarify the link between eye muscle function and oral information by comparing 21 dyslexic readers (DR) and 14 normal readers (NR).

Methods

Changes in vertical heterophoria (VH) were measured using the Maddox Rod Test performed according to oral modifications and postural conditions. The Spearman correlation was used to assess whether reading delay was correlated with the lability index.

Results

Overall, 50% of NR children and 81% of DR experienced at least one variation in visual perception (p = 0.053). Among DR, the less reading delay they had, the higher their index of lability (p = 0.026), whereas there was no significant correlation among NR. Changes in the Maddox Test were more frequent in DR than in NR after the addition of sensory and postural stimuli, except for one specific posture. For sensory stimuli, the mean lability index was 1.35 in NR and 4.19 in DR, (p = 0.001). For postural stimuli, it was 0.71 and 2.61, (p = 0.003).

Conclusions

It is possible to modify visual perception by changing sensory or mechanical stimuli. Changes are more frequent in DR than in NR. Postural control can be improved with guided oral stimulations.

Significance

These results reinforce the importance of professional cooperation in the care of dyslexic readers.

Postural Patterns of the Subjects with Vergence Disorders: Impact of Orthoptic Re-education, a Pilot Study

Aim:

Vergence insufficiency is a common oculomotor disorder which causes visual but also general, and even postural symptoms. This study aimed to characterise postural control of subjects with isolated vergence disorder and assess whether orthoptic therapy affects it.

Method:

Vergence disorders were evaluated and treated by orthoptists. Postural control quality was measured before and after orthoptic therapy in different conditions to study the role of vision, fixating distance, binocular vision and ocular dominance.

Results:

Before orthoptic therapy, we recorded less body sway when subjects had their eyes closed than when they had their eyes open, and also less sway for the binocular condition when compared with monocular viewing conditions. This is opposite to well-known normal behaviour. Moreover, no distance or ocular dominance effect was found. After orthoptic therapy, our subject’s body sway was less when they had their eyes open than with their eyes closed and less when they looked at near fixation. No difference was found between monocular and binocular viewing conditions, but a small advantage of ocular dominance was found for one parameter.

Conclusion:

We conclude that subjects with vergence disorders show postural behaviour that is not characterized by the normal regularities observed in healthy subjects. Orthoptic re-education may have contributed to promoting such regularities. Further studies are needed to confirm these preliminary results.

Reeducation of vergence dynamics improves postural control

INTRODUCTION

The purpose was to investigate the effect of vergence reeducation on postural control, in subjects with isolated vergence disorders.

MATERIAL AND METHODS

We studied the dynamics of vergence in 19 subjects (20-44 years old) using video-oculography (Eye See Cam). On the basis of orthoptic and symptomatology assessments, ten of the subjects were diagnosed for vergence disorders then vergence eye movements were reeducated with the REMOBI method (US8851669, 5 weekly sessions lasting for 35min). Postural control was measured before and after reeducation, postural recording was done in upright stance (Dynaport), with both eyes closed or open and looking a visual target located at 2m distance.

RESULTS

After reeducation with REMOBI, the visual symptomatology faded away and the stereoacuity improved at least for some subjects; the vergence latency decreased significantly and the vergence accuracy increased significantly. In terms of posture, the Mean Power Frequency (MPF) of the body sway decreased significantly in both eyes open and eyes closed conditions. Considering all subjects together (i.e. healthy subjects and subjects with vergence disorders before the reeducation), the antero-posterior body sway (Root Mean Square A/P) was positively correlated with the visual symptomatology: the higher the visual symptomatology, the higher was the body sway.

CONCLUSION

The results bring evidence for synergy between the quality of vergence and the quality of postural control. They open a new research line that bridges the gap between neuroscience, ophthalmology-orthoptics and posturology.

Active ocular vergence improves postural control in elderly as close viewing distance with or without a single cognitive task

Performance of the vestibular, visual, and somatosensory systems decreases with age, reducing the capacity of postural control, and increasing the risk of falling. The purpose of this study is to measure the effects of vision, active vergence eye movements, viewing distance/vergence angle and a simple cognitive task on postural control during an upright stance, in completely autonomous elderly individuals. Participated in the study, 23 elderly subjects (73.4 ± 6.8 years) who were enrolled in a center dedicated to the prevention of falling. Their body oscillations were measured with the DynaPort(®) device, with three accelerometers, placed at the lumbosacral level, near the center of mass. The conditions were the following: eyes open fixating on LED at 20 cm or 150 cm (vergence angle 17.0° and 2.3° respectively) with or without additional cognitive tasks (counting down from one hundred), performing active vergence by alternating the fixation between the far and the near LED (convergence and divergence), eyes closed after having fixated the far LED. The results showed that the postural stability significantly decreased when fixating on the LED at a far distance (weak convergence angle) with or without cognitive tasks; active convergence-divergence between the LEDs improved the postural stability while eye closure decreased it. The privilege of proximity (with increased convergence at near), previously established with foot posturography, is shown here to be valid for accelerometry with the center of mass in elderly. Another major result is the beneficial contribution of active vergence eye movements to better postural stability. The results bring new perspectives for the role of eye movement training to preserve postural control and autonomy in elderly.

Controlling Posture and Vergence Eye Movements in Quiet Stance: Effects of Thin Plantar Inserts

The purpose of this study was to assess properties of vergence and saccade eye movements as well as posture in quiet stance, and the effects of thin plantar inserts upon postural and oculomotor control. The performances of 36 young healthy subjects were recorded by a force platform and an eye tracker in three testing conditions: without plantar stimulation, with a 3 millimetre-thick plantar insert, either a Medial or a Lateral Arch Support (MAS/LAS). The results showed a decrease of the Surface and Variance of Speed and a more posterior position of the CoP with either stimulation compared with the control condition. The fractal analysis showed a decrease with MAS. Wavelet analysis in the time-frequency domain revealed an increase in the Cancelling Time of the low frequency band with MAS. These results suggest a better stability for a lower energy cost. Concerning eye movements, the inserts influenced only vergence (not saccades): MAS caused an increase of the phasic amplitude of divergence, and conversely a decrease of the tonic amplitude. In contrast, LAS caused an increase of the tonic amplitude of convergence. Thus, MAS renders divergence less visually driven, while LAS renders convergence more visually driven. We conclude that the CNS uses the podal signal for both postural and vergence control via specific mechanisms. Plantar inserts have an influence upon posture and vergence movements in a different way according to the part of the foot sole being stimulated. These results can be useful to clinicians interested in foot or eye.

The distinctive vertical heterophoria of dyslexics

In this study, we looked for the presence of vertical heterophoria (VH) in 42 dyslexic children (22 males and 20 females) aged 118.5±12.9 months who were compared with a control group of 22 nondyslexic children (eleven males and eleven females) aged 112±9.8 months. Dyslexics presented a low-level (always <1 prism diopter) VH combined with torsion. This oculomotor feature clearly separates the dyslexic group from the normal readers group. It is independent of the type of dyslexia. The essential feature of this VH is a lability that appears during specific stimulation of sensory receptors involved in postural regulation. This lability is demonstrated using a vertical Maddox test conducted under very specific conditions in which postural sensors are successively stimulated in a predetermined order. A quantitative variation in this VH may be seen during the Bielchowsky Head Tilt Test, which reveals hypertonia of the lower or upper oblique muscles. Vertical orthophoria can be achieved by placing low-power prisms asymmetrically within the direction of action of the superior or inferior oblique muscles. The selection of power and axis is not only guided by elements of the eye examination but also from observation of postural muscle tone. All these elements suggest that the VH could be of postural origin and somehow related to the vertical action of the oblique muscles. VH and torsion are not harmful per se. There is no statistical relationship between their level and the various parameters used to assess the reading skills of dyslexic children. VH and torsion could be a clinical marker of global proprioceptive dysfunction responsible for high-level multisensory disturbances secondary to poor spatial localization of visual and auditory information. This dysfunction might also explain the motor disorders concomitant to dyslexia.

Visuomotor processing and hand force coordination in dyslexic children during a visually guided manipulation task

Developmental Dyslexia negatively affects children's reading and writing ability and, in most cases, performance in sensorimotor tasks. These deficits have been associated with structural and functional alterations in the cerebellum and the posterior parietal cortex (PPC). Both neural structures are active during visually guided force control and in the coordination of load force (LF) and grip force (GF) during manipulation tasks. Surprisingly, both phenomena have not been investigated in dyslexic children. Therefore, the aim of this study was to compare dyslexic and non-dyslexic children regarding their visuomotor processing ability and GF-LF coordination during a static manipulation task. Thirteen dyslexic (8-14 YO) and 13 age- and sex-matched non-dyslexic (control) children participated in the study. They were asked to grasp a fixed instrumented handle using the tip of all digits and pull the handle upward exerting isometric force to match a ramp-and-hold force profile displayed in a computer monitor. Task performance (i.e., visuomotor coordination) was assessed by RMSE calculated in both ramp and hold phases. GF-LF coordination was assessed by the ratio between GF and LF (GF/LF) calculated at both phases and the maximum value of a cross-correlation function (rmax) and its respective time lag calculated at ramp phase. The results revealed that the RMSE at both phases was larger in dyslexic than in control children. However, we found that GF/LF, rmax, and time lags were similar between groups. Those findings indicate that dyslexic children have a mild deficit in visuomotor processing but preserved GF-LF coordination. Altogether, these findings suggested that dyslexic children could present mild structural and functional alterations in specific PPC or cerebellum areas that are directly related to visuomotor processing.

Dyslexic children suffer from less informative visual cues to control posture

The goal of this study was to investigate the effects of manipulation of the characteristics of visual stimulus on postural control in dyslexic children. A total of 18 dyslexic and 18 non-dyslexic children stood upright inside a moving room, as still as possible, and looked at a target at different conditions of distance between the participant and a moving room frontal wall (25-150 cm) and vision (full and central). The first trial was performed without vision (baseline). Then four trials were performed in which the room remained stationary and eight trials with the room moving, lasting 60s each. Mean sway amplitude, coherence, relative phase, and angular deviation were calculated. The results revealed that dyslexic children swayed with larger magnitude in both stationary and moving conditions. When the room remained stationary, all children showed larger body sway magnitude at 150 cm distance. Dyslexic children showed larger body sway magnitude in central compared to full vision condition. In the moving condition, body sway magnitude was similar between dyslexic and non-dyslexic children but the coupling between visual information and body sway was weaker in dyslexic children. Moreover, in the absence of peripheral visual cues, induced body sway in dyslexic children was temporally delayed regarding visual stimulus. Taken together, these results indicate that poor postural control performance in dyslexic children is related to how sensory information is acquired from the environment and used to produce postural responses. In conditions in which sensory cues are less informative, dyslexic children take longer to process sensory stimuli in order to obtain precise information, which leads to performance deterioration.

Postural control in underachieving students

Postural balance is a sensory-motor function resulting from a learning process.

OBJECTIVE

To evaluate the postural control of underachieving students through static posturography together with virtual reality stimulation.

METHODS

This was a controlled cross-sectional study of a group of 51 underachieving students and a control group of 60 students with good school performance, with no history of vestibular disorders or neurotological complaints, volunteers from the community, age- and gender-matched. The students were submitted to Balance Rehabilitation Unit (BRU™) posturography.

RESULTS

A total of 111 students aged 7 to 12 years old were evaluated. At posturography evaluation, there was no significant difference between the limit of stability area (cm2) of the control group and the experimental group. The comparison between groups demonstrated a statistically significant difference (p < 0.05) in the values of sway velocity (cm/s) and center of pressure area (cm2) in the ten sensory conditions evaluated.

CONCLUSION

Posturography with virtual reality stimulation, allows for the identification of incapacity to maintain postural control, with or without visual deprivation, and the assessment of visual, somatosensory, and vestibular-visual interaction conflict in underachieving students.

Impaired body balance control in adults with strabismus

Previous studies revealed that people with binocular vision disorders have poor postural stability. However, most of the research was performed only on children and under binocular viewing condition, that could negatively affect the results. The aim of the current study was to investigate the influence of extra-ocular proprioceptive signals on postural stability in young adults with binocular vision disorders. Moreover, additional mental task was introduced to detect any postural compensation which could possibly hide the real influence of afferent extra-ocular signals. 21 Subjects, aged 18-45 yrs, with horizontal strabismus, were qualified to binocular vision disorders (BVD) group. 41 subjects, aged 19-45 yrs, with no strabismus formed the normal binocular vision (NBV) group. Posturography data were collected in 2 separate parts: (1) quiet standing (Single-Task), and (2) performance of a mental task while standing (Dual-Task). Each part consisted of three 60-s viewing conditions, with: (1) dominant/fellow eye (DE), (2) non-dominant/strabismic eye (NDE), and with (3) both eyes closed (EC). Subjects were looking at X located at the distance of 150 cm. Generally, BVD group showed elevated body balance during quiet stance compared to NBV group. Interestingly, better stabilization in BVD group occurred under NDE viewing. Surprisingly, additional mental task improved the postural stability in BVD group almost to the level of NBV group. These findings emphasize the role of the eye-muscle signals in postural control and suggest that suitable vision therapy can be the appropriate way to improve body balance/motor functions in people with binocular vision disorders.

Vergence and Standing Balance in Subjects with Idiopathic Bilateral Loss of Vestibular Function

There is a natural symbiosis between vergence and vestibular responses. Deficits in vergence can lead to vertigo, disequilibrium, and postural instability. This study examines both vergence eye movements in patients with idiopathic bilateral vestibular loss, and their standing balance in relation to vergence. Eleven patients participated in the study and 16 controls. Bilateral loss of vestibular function was objectified with many tests; only patients without significant response to caloric tests, to video head impulse tests and without vestibular evoked myogenic potentials were included in the study.

Developmental dyslexia and vision

Developmental dyslexia affects almost 10% of school-aged children and represents a significant public health problem. Its etiology is unknown. The consistent presence of phonological difficulties combined with an inability to manipulate language sounds and the grapheme-phoneme conversion is widely acknowledged. Numerous scientific studies have also documented the presence of eye movement anomalies and deficits of perception of low contrast, low spatial frequency, and high frequency temporal visual information in dyslexics. Anomalies of visual attention with short visual attention spans have also been demonstrated in a large number of cases. Spatial orientation is also affected in dyslexics who manifest a preference for spatial attention to the right. This asymmetry may be so pronounced that it leads to a veritable neglect of space on the left side. The evaluation of treatments proposed to dyslexics whether speech or oriented towards the visual anomalies remains fragmentary. The advent of new explanatory theories, notably cerebellar, magnocellular, or proprioceptive, is an incentive for ophthalmologists to enter the world of multimodal cognition given the importance of the eye's visual input.

Spherical lenses and prisms lead to postural instability in both dyslexic and non dyslexic adolescents

There is controversy as to whether dyslexic children present systematic postural deficiency. Clinicians use a combination of ophthalmic prisms and proprioceptive soles to improve postural performances. This study examines the effects of convergent prisms and spherical lenses on posture. Fourteen dyslexics (13-17 years-old) and 11 non dyslexics (13-16 years-old) participated in the study. Quiet stance posturography was performed with the TechnoConcept device while subjects fixated a target at eye-level from a distance of 1_m. Four conditions were run: normal viewing; viewing the target with spherical lenses of -1 diopter (ACCOM1) over each eye; viewing with -3 diopters over each eye (ACCOM3); viewing with a convergent prism of 8 diopters per eye. Relative to normal viewing, the -1 lenses increased the surface of body sway significantly whereas the -3 diopter lenses only resulted in a significant increase of antero-posterior body sway. Thus, adolescents would appear to cope more effectively with stronger conflicts rather than subtle ones. The prism condition resulted in a significant increase in both the surface and the antero-posterior body sway. Importantly, all of these effects were similar for the two groups. Wavelet analysis (time frequency domain) revealed high spectral power of antero-posterior sway for the prism condition in both groups. In the ACCOM3 condition, the spectral power of antero-posterior sway decreased for non dyslexics but increased for dyslexics suggesting that dyslexics encounter more difficulty with accommodation. The cancelling time for medium range frequency (believed to be controlled by the cerebellum), was shorter in dyslexics, suggesting fewer instances of optimal control. We conclude that dyslexics achieve similar postural performances albeit less efficiently. Prisms and lenses destabilize posture for all teenagers. Thus, contrary to adults, adolescents do not seem to use efferent, proprioceptive ocular motor signals to improve their posture, at least not immediately when confronted to convergence accommodation conflict.

Accommodation, pattern glare, and coloured overlays

We manipulated the accommodative response using positive and negative lenses to study any association between symptoms of pattern glare and accommodation. Two groups of eighteen young adults were selected from seventy-eight on the basis (i) that their rate of reading increased by 5% or more with an overlay compared to their rate without it, and (ii) that they reported more than 2 symptoms of pattern glare (group 1) or had no such increment in reading speed and reported fewer than 3 symptoms (group 2). Under double-masked conditions participants observed at 0.4 m a pattern of stripes while measurements of accommodation were made using an open field autorefractor with and without positive and negative trial lenses (0.75 D), and with and without a coloured overlay. Pattern glare was also assessed with and without the trial lenses. Without lenses, the mean accommodative response in group 1 was 1.55 D, a lag of 0.95 D +/- 0.24 D relative to the demand. The lag decreased by 0.43 D (p < 0.0001) when the chosen overlay was used, an effect that was not shown in group 2 even when lag increased with negative trial lenses (p = 0.13). In both groups, pattern glare scores were reduced by the trial lenses, but were unaffected by the sign of the lenses. This suggests that symptoms of pattern glare are not strongly associated with accommodative response.

Postural control during the Stroop test in dyslexic and non dyslexic teenagers

Postural control in quiet stance although simple still requires some cognitive resources; dual cognitive tasks influence further postural control. The present study examines whether or not dyslexic teenagers experience postural instability when performing a Stroop dual task for which their performances are known to be poor. Fifteen dyslexics and twelve non-dyslexics (14 to 17 years old) were recruited from the same school. They were asked to perform three tasks: (1) fixate a target, (2) perform an interference Stroop test (naming the colour or the word rather than reading the word), (3) performing flexibility Stroop task: the subject performed the interference task as in (2) except when the word was in a box, in which case he had to read the word. Postural performances were measured with a force platform. The results showed a main task effect on the variance of speed of body sway only: such variance was higher in the flexibility task than for the other two tasks. No group effect was found for any of the parameters of posture (surface, mediolateral and anteroposterior sway, variance of speed). Further wavelet analysis in the time-frequency domain revealed an increase in the spectral power of the medium frequency range believed to be related to cerebellum control; an accompanying increase in the cancellation time of the high frequency band related to reflexive loops occurred for non-dyslexics only. These effects occurred for the flexibility task and could be due to its high cognitive difficulty. Dyslexics displayed shorter cancellation time for the medium frequency band for all tasks, suggesting less efficient cerebellar control, perhaps of eye fixation and attention influencing body sway. We conclude that there is no evidence for a primary posture deficit in 15 year old teenagers who come from the general population and who were recruited in schools.

Integration of proprioceptive signals and attentional capacity during postural control are impaired but subject to improvement in dyslexic children

Children with developmental dyslexia suffer from delayed reading capabilities and may also exhibit attentional and sensori-motor deficits. The objective of this study was twofold. First, we aimed at investigating whether integration of proprioceptive signals in balance control was more impaired in dyslexic children when the attentional demand was varied. Secondly, we checked whether this effect was reduced significantly by using a specific treatment to improve eye control deficits and certain postural signs that are often linked to dyslexia (Quercia et al. in J Fr Ophtalmol 28:713-723, 2005, J Fr Ophtalmol 30:380-89, 2007). Thirty dyslexic and 51 treated dyslexic children (> 3 months of treatment) were compared with 42 non-dyslexic children in several conditions (mean age: 136.2 ± 23.6, 132.2 ± 18.7 and 140.2 ± 25 months, respectively). Co-vibration of ankle muscles was effected in order to alter proprioceptive information originating from the ankle. In two vibration conditions, ankle muscles were either not vibrated or vibrated at 85 Hz without illusion of any movement. These two vibration conditions were combined with two attentional conditions. In the first such condition, children maintained balance while merely fixing their gaze on a point in front of them. In the second condition, they had to look for smaller or larger stars in a panel showing forty of each kind. Balance was assessed by means of a force plate. Results indicated that the mean velocity (i.e. the total length) of the center of pressure (CoP) displacement in the 85-Hz vibration condition increased significantly more (compared with no vibration) in the dyslexic and the treated dyslexic groups than in the control group, irrespective of the attention task. Interestingly, in the condition without vibration, the attentional performance of treated children was similar to that of the control group, whereas the attentional performance of the untreated dyslexic children was significantly impaired. Altogether, these results suggest that integration of proprioceptive signals in balance control and attentional capacity are impaired in dyslexic children. However, attention capacity during the control of stance could be improved significantly.

Poor Stroop performances in 15-year-old dyslexic teenagers

The Stroop test enables interference between color naming and reading to be studied. Protopapas et al. (2007) reported more errors in an interference task and longer reaction times in 12.5-year-old dyslexics; also more Stroop interference with lower reading skills. The present study uses a version of the Stroop with four color cards and aims to test interference and flexibility in older dyslexic teenagers. The four cards are: color naming, reading, interference and flexibility. In the latter, subjects have to name the color of the word inhibiting reading except when the word is inside a box. This flexibility task enables the testing of the capacity for cognitive switching between tasks. Ten dyslexics (15.1 +/- 0.7 years old) and fourteen controls (14.3 +/- 1.6 years old) participated in the study. All performed the color naming, the reading, the interference and the flexibility tasks in the same order. Subsequently, they performed a sequence of 60 saccades left-right followed by the interference task. Generally, dyslexic teenagers behaved similarly to non-dyslexics as they showed fewer errors in reading and color than in the interference and flexibility tasks. However, they made more errors and needed more time to accomplish each task than non-dyslexics. The results suggest that the inhibitory and attention processes required by the Stroop test are dysfunctioning even in older dyslexics. In contrast, the study shows no evidence for particular difficulty in the flexibility task, which would constitute an argument against problems with mental switching. Following the execution of saccades, errors in the interference test were significantly reduced for dyslexics, while the time was reduced for both groups. The effects are attributed to visual attention training via saccades.

Cognitive demands impair postural control in developmental dyslexia: a negative effect that can be compensated

Children with developmental dyslexia exhibit delayed reading abilities and various sensori-motor deficits. The way these various symptoms interact remain poorly understood. The objective of this study was twofold. First, we aimed to investigate whether postural control was impaired in dyslexic children when cognitive demands are increased. Second, we checked whether this effect could be reduced significantly by a treatment aiming to recalibrate ocular proprioception. Twelve dyslexic and fifteen treated dyslexic children (>3 months of treatment) were compared with twelve non-dyslexic children in two conditions (mean age: 11.6+/-2.1, 12.5+/-1.5 and 10.6+/-1.7 years respectively). In a first condition they maintained balance while fixating a point in front of them. In the second condition the postural task was combined with a silently reading one. Balance was assessed by means of a force plate. Results demonstrated that the mean velocity (i.e. the total length) of the center of pressure (CoP) displacement was increased in the reading task only for the dyslexic group. Interestingly, for the treated children, an inverse tendency was observed: the mean velocity (i.e. the total length) and the surface of the 90% confidence ellipse of the CoP displacement decreased for 13/15 patients and for 12/15 patients respectively, while performing the reading task. Values remained similar to those observed for the control children. Altogether, these results strongly suggest that cognitive demands can impair postural control in developmental dyslexia but this interaction could be normalized. These results sustain the hypothesis of a cerebellar origin for dyslexia.