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

Proprioceptive intervention improves reading performance in developmental dyslexia: An eye-tracking study

Developmental dyslexia is characterized by difficulties in learning to read, affecting cognition and causing failure at school. Interventions for children with developmental dyslexia have focused on improving linguistic capabilities (phonics, orthographic and morphological instructions), but developmental dyslexia is accompanied by a wide variety of sensorimotor impairments. The goal of this study was to examine the effects of a proprioceptive intervention on reading performance and eye movement in children with developmental dyslexia. Nineteen children diagnosed with developmental dyslexia were randomly assigned to a regular Speech Therapy (ST) or to a Proprioceptive and Speech Intervention (PSI), in which they received both the usual speech therapy and a proprioceptive intervention aimed to correct their sensorimotor impairments (prism glasses, oral neurostimulation, insoles and breathing instructions). Silent reading performance and eye movements were measured pre- and post-intervention (after nine months). In the PSI group, reading performance improved and eye movements were smoother and faster, reaching values similar to those of children with typical reading performance. The recognition of written words also improved, indicating better lexical access. These results show that PSI might constitute a valuable tool for reading improvement children with developmental dyslexia.

Motor skills and capacities in developmental dyslexia: A systematic review and meta-analysis

In recent decades, the connections between academic skills, such as reading, writing, and calculation, and motor skills/capacities have received increasing attention. Many studies provided evidence for motor difficulties in children and adolescents with dyslexia, prompting the need for a meta-analysis to combine these multiple findings. Therefore, we conducted a meta-analysis using PsycINFO, Pubmed, and SportDiscus as scientific databases. A total of 572 studies were analyzed following several stringent inclusion criteria, resulting in the inclusion of 23 peer-reviewed studies in the final analysis. Our results showed that children and adolescents with dyslexia displayed significant different performances in multiple motor tasks and these differences persisted also when the type of motor task was considered as moderator in the analysis. The present findings are in accordance with the literature that supports a close connection between reading disabilities and difficulties in motor skills/capacities.

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.

Visual Occlusion Effects On Bipedal Stance Control In Chinese-Speaking Children With Dyslexia

Visual processing of complex character configurations is especially challenging for Chinese-speaking children with dyslexia (CSCD). The purpose of this study was to compare the effects of visual occlusion on postural control between dyslexic and non-dyslexic Chinese-speaking children by examining their visual-perceptual capacity and movement coordination with scale measures. Sixteen dyslexic children (10 males and, 6 females, 9.46 ± 1.26 yrs) and sixteen non-dyslexic children (10 males and 6 females, 9.91 ± 1.18 yrs) were recruited from the campus in Taiwan. Motor and visual perceptual performance were assessed with the Movement Assessment Battery for Children, 2nd Edition (MABC-2) and the Test of Visual-Perceptual Skills, 4th Edition (TVPS-4). Root mean square (RMS) and sample entropy (SampEn) of center of pressure (COP) were characterized during a bilateral upright stance with eyes open (EO) and eyes closed (EC). The results showed significant group differences in six of the seven TVPS-4 subscales (P < .001-.017) and one category of the MABC-2 (P = .006). In the EO condition, the children with dyslexia showed a greater RMS of COP specifically in the anterior-posterior (AP) direction than did the non-dyslexic children (P = .029). However, SampEn of COP in the two directions were not group dependent (P > .05). In the EC condition, RMS and SampEn of COP did not vary with group (P > .05). RMS of COP in the AP direction was negatively correlated with the sub-score of visual figure-ground in the TVPS-4 (r = - .381, P = .031). In summary, postural control of Chinese-speaking children with dyslexia is more affected with eyes open than with eyes closed, and the effect is related to visual disturbance of the foreground and background.

Dyslexic children need more robust information to resolve conflicting sensory situations

The study involved investigating dyslexic children's postural control responses when visual and somatosensory cues were separately manipulated. Twenty dyslexic and 19 nondyslexic children performed a trial by standing upright inside a moving room and another by lightly touching a moving bar. Both trials lasted 240 s with the following three different stimulus characteristics: low (pretransition), high (transition), and low amplitude (posttransition). Body sway magnitude and the relationship between the movement of the room/bar surface and body sway were examined. When compared to nondyslexic children, dyslexic children oscillated with higher magnitude in the transition and posttransition under visual and somatosensory manipulation; their sway was more influenced by visual manipulation in the transition and posttransition, and they used higher applied force levels in the somatosensory modality in all conditions. The results suggest that dyslexic children could not efficiently reweight visual cues when compared to nondyslexic children. The same was not observed in the somatosensory cues when dyslexic children reduced the influence of the somatosensory stimulus. The proper use of somatosensory information was related to stronger acquired cues and higher applied forces as observed for dyslexic children. Dyslexic children experience difficulties in dynamically reweighting sensory cues although these types of difficulties are overcome when more informative sensory cues are provided.

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.

Eye movement and postural sway in dyslexic children during sitting and standing

In this study, we investigated the eye movement and postural control performance in dyslexic children while reading text and performing Landolt reading when sitting and standing. Fifteen dyslexic and 15 non-dyslexic children were asked to sit in a chair while the eye movements were recorded, and were then asked to stand on an unstable platform while eye movements and postural sway were recorded simultaneously at the time of Landolt reading and text reading. Eye movements were recorded binocularly by Mobile EyeBrain Tracker (MobileT2^®, SuriCog) and center of pressure excursions were recorded by Multitest Equilibre (by Framiral^®). The dependent variables for visual performance in the reading tasks were: total reading time, mean duration of fixation, number of pro- and retro-saccades, and amplitude of pro-saccades. The dependent variable for postural performance was the center of pressure area. The results showed that dyslexic children spent more time reading the text compared to non-dyslexic children (p < 0.02). However, no difference was observed for the Landolt reading task (p > 0.05). Dyslexic children performed longer fixations in the sitting condition as compared to the standing (p < 0.03), namely, higher number of pro- (p < 0.001) and retro- saccades (p < 0.001), and smaller pro-saccades amplitude (p < 0.001). Therefore, when the linguistic and semantic requirements are not involved in the reading task, dyslexic children perform similar to non-dyslexic children even in different task requirements (p > 0.05). Finally, postural performance was poorer in dyslexic children than in non-dyslexic children in both the reading tasks (p < 0.02). However, postural control performance, which was poor in dyslexic children, is not related to lexical and semantic reading requirements.

Representational Bias in the Radial Axis in Children With Dyslexia: A Landmarks Alignment Study

To better identify the distinctive characteristics of space representation in the radial dimension, we have proposed a new paradigm: the landmarks alignment task where two parallel aluminum bars were radially presented. Children had to move a landmark along one bar and place it at the same location as the reference landmark placed by the examiner on the parallel bar. The major interest of this task was its capacity to assess space representation in the radial dimension when considering a spatial landmark that oriented the subject's attention toward the orthogonal dimension. The most important result showed that in the radial dimension children with dyslexia exhibited a forward bias on the left bar, meaning a mental underrepresentation of the leftward peripersonal space and/or a mental overrepresentation of the rightward peripersonal space. Furthermore, reading discrepancies were correlated with radial forward bias on the left bar. The experiment was also conducted in the lateral axis, showing a pseudoneglect behavior in children without dyslexia. Our landmarks alignment task had the advantage of being able to assess space representation in a complex environment. The forward radial representational bias in children with dyslexia could have implications for spatial orientation in peripersonal workspace in school situations.

Feedforward motor control in developmental dyslexia and developmental coordination disorder: Does comorbidity matter?

BACKGROUND AND AIM

Feedforward and online controls are two facets of predictive motor control from internal models, which is suspected to be impaired in learning disorders. We examined whether the feedforward component is affected in children (8-12 years) with developmental dyslexia (DD) and/or with developmental coordination disorder (DCD) compared to typically developing (TD) children.

METHODS

Children underwent a bimanual unloading paradigm during which a load supported to one arm, the postural arm, was either unexpectedly unloaded by a computer or voluntary unloaded by the subject with the other arm.

RESULTS

All children showed a better stabilization (lower flexion) of the postural arm and an earlier inhibition of the arm flexors during voluntary unloading, indicating anticipation of unloading. Between-group comparisons of kinematics and electromyographic activity of the postural arm revealed that the difference during voluntary unloading was between DD-DCD children and the other groups, with the former showing a delayed inhibition of the flexor muscles.

CONCLUSION

Deficit of the feedforward component of motor control may particularly apply to comorbid subtypes, here the DD-DCD subtype. The development of a comprehensive framework for motor performance deficits in children with learning disorders will be achieved only by dissociating key components of motor prediction and focusing on subtypes and comorbidities.

Accident ahead? Difficulties of drivers with and without reading impairment recognising words and pictograms in variable message signs

A timely and accurate acquisition of the information provided by variable message signs (VMS) can be crucial while driving. In the current study, we assess the difficulties of adults with dyslexia acquiring the information shown in VMS and provide evidence to discuss the controversial use of pictograms as potential countermeasures. Twenty-two adults with dyslexia and 22 matched controls completed a simulated driving session. The legibility of 12 VMS was assessed, including six text messages (e.g. "ACCIDENT") and six single pictograms (e.g. the icon for "accident ahead"). On average, participants with dyslexia started reading text messages when they were closer to the VMS. In addition, while approaching text VMS, they dedicated more gazes and manifested worse control of speed. Regarding pictogram VMS, we observed no differences in response distance, accuracy, response duration, or number of gazes. To sum up, the evidence provided reveals that adults with dyslexia, despite potential compensation effects, may still find difficulties reading text messages in VMS (shorter legibility distances, longer reading times, and increased cognitive effort), whereas we found no such differences in the recognition of pictograms (only some difficulties keeping a steady speed). Research on inclusive measures to improve reading in low-skilled or dyslexic drivers must be encouraged.

Postural Control in Children with Dyslexia: Effects of Emotional Stimuli in a Dual-Task Environment

The aim of this study was to compare the visual exploration strategies used during a postural control task across participants with and without dyslexia. We simultaneously recorded eye movements and postural control while children were viewing different types of emotional faces. Twenty-two children with dyslexia and twenty-two aged-matched children without dyslexia participated in the study. We analysed the surface area, the length and the mean velocity of the centre of pressure for balance in parallel with visual saccadic latency, the number of saccades and the time spent in regions of interest. Our results showed that postural stability in children with dyslexia was weaker and the surface area of their centre of pressure increased significantly when they viewed an unpleasant face. Moreover, children with dyslexia had different strategies to those used by children without dyslexia during visual exploration, and in particular when they viewed unpleasant emotional faces. We suggest that lower performance in emotional face processing in children with dyslexia could be due to a difference in their visual strategies, linked to their identification of unpleasant emotional faces. Copyright © 2017 John Wiley & Sons, Ltd.

Influence of both cutaneous input from the foot soles and visual information on the control of postural stability in dyslexic children

Dyslexic children show impaired in postural stability. The aim of our study was to test the influence of foot soles and visual information on the postural control of dyslexic children, compared to non-dyslexic children. Postural stability was evaluated with TechnoConcept^® platform in twenty-four dyslexic children (mean age: 9.3±0.29years) and in twenty-four non-dyslexic children, gender- and age-matched, in two postural conditions (with and without foam: a 4-mm foam was put under their feet or not) and in two visual conditions (eyes open and eyes closed). We measured the surface area, the length and the mean velocity of the center of pressure (CoP). Moreover, we calculated the Romberg Quotient (RQ). Our results showed that the surface area, length and mean velocity of the CoP were significantly greater in the dyslexic children compared to the non-dyslexic children, particularly with foam and eyes closed. Furthermore, the RQ was significantly smaller in the dyslexic children and significantly greater without foam than with foam. All these findings suggest that dyslexic children are not able to compensate with other available inputs when sensorial inputs are less informative (with foam, or eyes closed), which results in poor postural stability. We suggest that the impairment of the cerebellar integration of all the sensorial inputs is responsible for the postural deficits observed in dyslexic children.

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.

Procedural learning and automatization process in children with developmental coordination disorder and/or developmental dyslexia

OBJECTIVE

There is increasing evidence to suggest that developmental dyslexia (DD) and developmental coordination disorder (DCD) actually form part of a broader disorder. Their frequent association could be justified by a deficit of the procedural memory system, that subtends many of the cognitive, motor and linguistic abilities that are impaired in both DD and DCD. However, studies of procedural learning in these two disorders have yielded divergent results, and in any case no studies have so far addressed the issue of automatization (dual-task paradigm).

METHODS

We administered a finger tapping task to participants aged 8-12 years (19 DCD, 18 DD, and 22 with both DD and DCD) to explore procedural learning and automatic movements in these three groups of children, comparing motor performances at the prelearning stage, after 2 weeks of training, and in a post-training dual-task condition.

RESULTS

First, results indicated that all the children were able to learn a sequence of movements and even automatize their movements. Second, they revealed between-groups differences in procedural/automatization learning abilities, setting the DCD group apart from the other two. Third, contrary to our expectations concerning comorbidity, they suggested that the DD+DCD association does not have an additional impact on behavioral performances.

The Effect of Training on Postural Control in Dyslexic Children

The aim of this study was to explore whether a short postural training period could affect postural stability in dyslexic children. Postural performances were evaluated using Multitest Equilibre from Framiral. Posture was recorded in three different viewing conditions (eyes open fixating a target, eyes closed and eyes open with perturbed vision) and in two different postural conditions (on stable and unstable support). Two groups of dyslexic children participated in the study, i.e. G1: 16 dyslexic participants (mean age 9.9 ± 0.3 years) who performed short postural training and G2: 16 dyslexic participants of similar ages (mean age 9.1 ± 0.3 years) who did not perform any short postural training. Findings showed that short postural training improved postural stability on unstable support surfaces with perturbed vision: indeed the surface, the mean velocity of CoP and the spectral power indices in both directions decreased significantly, and the cancelling time in the antero-posterior direction improved significantly. Such improvement could be due to brain plasticity, which allows better performance in sensory process and cerebellar integration.

Multisensory integration and child neurodevelopment

A considerable number of cognitive processes depend on the integration of multisensory information. The brain integrates this information, providing a complete representation of our surrounding world and giving us the ability to react optimally to the environment. Infancy is a period of great changes in brain structure and function that are reflected by the increase of processing capacities of the developing child. However, it is unclear if the optimal use of multisensory information is present early in childhood or develops only later, with experience. The first part of this review has focused on the typical development of multisensory integration (MSI). We have described the two hypotheses on the developmental process of MSI in neurotypical infants and children, and have introduced MSI and its neuroanatomic correlates. The second section has discussed the neurodevelopmental trajectory of MSI in cognitively-challenged infants and children. A few studies have brought to light various difficulties to integrate sensory information in children with a neurodevelopmental disorder. Consequently, we have exposed certain possible neurophysiological relationships between MSI deficits and neurodevelopmental disorders, especially dyslexia and attention deficit disorder with/without hyperactivity.

The influence of oculomotor tasks on postural control in dyslexic children

Dual task is known to affect postural stability in children. We explored the effect of visual tasks on postural control in thirty dyslexic children. A selected group of thirty chronological age-matched non-dyslexic children (mean age: 9.92 ± 0.35 years) and a group of thirty reading age-matched non-dyslexic children (mean reading age: 7.90 ± 0.25 years) were chosen for comparison. All children underwent ophthalmologic and optometric evaluation. Eye movements were recorded by a video-oculography system (EyeBrain® T2) and postural sway was recorded simultaneously by a force platform (TechnoConept®). All children performed fixations, pursuits, pro- and anti-saccades tasks. Dyslexic children showed significantly poor near fusional vergence ranges (convergence and divergence) with respect to the non-dyslexic children groups. During the postural task, quality of fixation and anti-saccade performance in dyslexic children were significantly worse compared to the two non-dyslexic children groups. In contrast, the number of catch-up saccades during pursuits and the latency of pro- and anti-saccades were similar in the three groups of children examined. Concerning postural quality, dyslexic children were more unstable than chronological age-matched non-dyslexic children group. For all three groups of children tested we also observed that executing saccades (pro- and anti-saccades) reduced postural values significantly in comparison with fixation and pursuit tasks. The impairment in convergence and divergence fusional capabilities could be due to an immaturity in cortical structures controlling the vergence system. The poor oculomotor performance reported in dyslexic children suggested a deficit in allocating visual attention and their postural instability observed is in line with the cerebellar impairment previously reported in dyslexic children. Finally, pro- or anti-saccades reduce postural values compared to fixation and pursuit tasks in all groups of children tested, suggesting a different influence of visual tasks on postural control according to their attentional demand.

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 is not systematically related to reading skills: implications for the assessment of balance as a risk factor for developmental dyslexia

Impaired postural control has been associated with poor reading skills, as well as with lower performance on measures of attention and motor control variables that frequently co-occur with reading difficulties. Measures of balance and motor control have been incorporated into several screening batteries for developmental dyslexia, but it is unclear whether the relationship between such skills and reading manifests as a behavioural continuum across the range of abilities or is restricted to groups of individuals with specific disorder phenotypes. Here were obtained measures of postural control alongside measures of reading, attention and general cognitive skills in a large sample of young adults (n = 100). Postural control was assessed using centre of pressure (CoP) measurements, obtained over 5 different task conditions. Our results indicate an absence of strong statistical relationships between balance measures with either reading, cognitive or attention measures across the sample as a whole.

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.

Space representation in children with dyslexia and children without dyslexia: contribution of line bisection and circle centering tasks

Line bisection tasks (different space locations and different line lengths) and circle centering tasks (visuo-proprioceptive and proprioceptive explorations, with left or right starting positions) were used to investigate space representation in children with dyslexia and children without dyslexia. In line bisection, children with dyslexia showed a significant rightward bias for central and right-sided locations and a leftward bias for left-sided location. Furthermore, the spatial context processing was asymmetrically more efficient in the left space. In children without dyslexia, no significant bias was observed in central lines but the spatial context processing was symmetrical in both spaces. When the line length varied, no main effect was shown. These results strengthen the 'inverse pseudoneglect' hypothesis in dyslexia. In the lateral dimension of the circle centering tasks, children showed a response bias in the direction of the starting hand location for proprioceptive condition. For radial dimension, the children showed a forward bias in visuo-proprioceptive condition and more backward error in proprioceptive condition. Children with dyslexia showed a forward bias in clockwise exploration and more accurate performance in counterclockwise exploration for left starting position which may be in accordance with leftward asymmetrical spatial context processing in line bisection. These results underline the necessity to use the line bisection task with different locations as an appropriate experimental paradigm to study lateral representational bias in dyslexia. The contribution of the present results in the understanding of space representation in children with dyslexia and children without dyslexia is discussed in terms of attentional processes and neuroanatomical substrate.

The effect of a cognitive task on the postural control of dyslexic children

We explore the influence of a secondary cognitive task on concurrent postural control in dyslexic children. Seventeen children with dyslexia (DYS) were compared with thirteen non-dyslexic children (NDYS). Postural control was recorded in Standard Romberg (SR) and Tandem Romberg (TR) conditions while children, in separate sessions, have to fixate on a target and name simple objects appearing consecutively on a computer screen. The surface, the length and the mean speed of the center of pressure were analyzed; the percentage of correct responses to the cognitive task was also measured. DYS are significantly more unstable than NDYS. The secondary cognitive task significantly decreases the postural stability in DYS only. For both children postural performances in the TR condition is significantly worse than in the SR condition. The percentage of wrong responses to the cognitive task is significantly higher in DYS. Postural instability observed in DYS supports the hypothesis that there is a deficit of automatic integration of visual information and postural control in these children. This result is in line with the U-shaped non linear model showing that a secondary task performed during a postural task leads to an impaired postural stability probably due to focus attention on the cognitive task.

The effect of a Stroop-like task on postural control in dyslexic children

The influence of a secondary task on concurrent postural control was explored in twenty-one dyslexic children (mean age: 10.4 ± 0.3 years). Data were compared with twenty age-matched non-dyslexic children. As a secondary task, a modified Stroop test was used, in which words were replaced with pictures of fruits. The postural control of children was recorded in standard Romberg condition as the children were asked to name the colour of fruits appearing consecutively on a computer screen. Two conditions were tested: a congruent condition, in which the fruit was drawn in its natural ripe colour, and a non-congruent colour condition (NC), in which the fruit was drawn in three abnormal colours. A fixating condition was used as baseline. We analyzed the surface, length and mean speed of the center of pressure and measured the number of correct responses in the Stroop-like tasks. Dyslexic children were seen to be significantly more unstable than non-dyslexic ones. For both groups of children, the secondary task significantly increased postural instability in comparison with the fixating condition. The number of correct responses in the modified Stroop task was significantly higher in the non-dyslexic than in the dyslexic group. The postural instability observed in dyslexic children is in line with the cerebellar hypothesis and supports the idea of a deficit in automatic performance in such children. Furthermore, in accordance with cross domain competition model, our findings show that attentional resources are used to a greater extent by the secondary task than in controlling body stability.

Sensorimotor integration in dyslexic children under different sensory stimulations

Dyslexic children, besides difficulties in mastering literacy, also show poor postural control that might be related to how sensory cues coming from different sensory channels are integrated into proper motor activity. Therefore, the aim of this study was to examine the relationship between sensory information and body sway, with visual and somatosensory information manipulated independent and concurrently, in dyslexic children. Thirty dyslexic and 30 non-dyslexic children were asked to stand as still as possible inside of a moving room either with eyes closed or open and either lightly touching a moveable surface or not for 60 seconds under five experimental conditions: (1) no vision and no touch; (2) moving room; (3) moving bar; (4) moving room and stationary touch; and (5) stationary room and moving bar. Body sway magnitude and the relationship between room/bar movement and body sway were examined. Results showed that dyslexic children swayed more than non-dyslexic children in all sensory condition. Moreover, in those trials with conflicting vision and touch manipulation, dyslexic children swayed less coherent with the stimulus manipulation compared to non-dyslexic children. Finally, dyslexic children showed higher body sway variability and applied higher force while touching the bar compared to non-dyslexic children. Based upon these results, we can suggest that dyslexic children are able to use visual and somatosensory information to control their posture and use the same underlying neural control processes as non-dyslexic children. However, dyslexic children show poorer performance and more variability while relating visual and somatosensory information and motor action even during a task that does not require an active cognitive and motor involvement. Further, in sensory conflict conditions, dyslexic children showed less coherent and more variable body sway. These results suggest that dyslexic children have difficulties in multisensory integration because they may suffer from integrating sensory cues coming from multiple sources.

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.

Effect of a dual task on postural control in dyslexic children

Several studies have examined postural control in dyslexic children; however, their results were inconclusive. This study investigated the effect of a dual task on postural stability in dyslexic children. Eighteen dyslexic children (mean age 10.3±1.2 years) were compared with eighteen non-dyslexic children of similar age. Postural stability was recorded with a platform (TechnoConcept®) while the child, in separate sessions, made reflex horizontal and vertical saccades of 10° of amplitude, and read a text silently. We measured the surface and the mean speed of the center of pressure (CoP). Reading performance was assessed by counting the number of words read during postural measures. Both groups of children were more stable while performing saccades than while reading a text. Furthermore, dyslexic children were significantly more unstable than non-dyslexic children, especially during the reading task. Finally, the number of words read by dyslexic children was significantly lower than that of non-dyslexic children and, in contrast to the non-dyslexic children. In line with the U-shaped non-linear interaction model, we suggest that the attention consumed by the reading task could be responsible for the loss of postural control in both groups of children. The postural instability observed in dyslexic children supports the hypothesis that such children have a lack of integration of multiple sensorimotor inputs.

Postural control and automaticity in dyslexic children: the relationship between visual information and body sway

Difficulty with literacy acquisition is only one of the symptoms of developmental dyslexia. Dyslexic children also show poor motor coordination and postural control. Those problems could be associated with automaticity, i.e., difficulty in performing a task without dispending a fair amount of conscious efforts. If this is the case, dyslexic children would show difficulties in using "unperceived" sensory cues to control body sway. Therefore, the aim of the study was to examine postural control performance and the coupling between visual information and body sway in dyslexic children. Ten dyslexic children and 10 non-dyslexic children stood upright inside a moving room that remained stationary or oscillated back and forward at frequencies of 0.2 or 0.5 Hz. Body sway magnitude and the relationship between the room's movement and body sway were examined. The results indicated that dyslexic children oscillated more than non-dyslexic children in both stationary and oscillating conditions. Visual manipulation induced body sway in all children but the coupling between visual information and body sway was weaker and more variable in dyslexic children. Based upon these results, we can suggest that dyslexic children use visual information to postural control with the same underlying processes as non-dyslexic children; however, dyslexic children show poorer performance and more variability while relating visual information and motor action even in a task that does not require an active cognitive and conscious motor involvement, which may be a further evidence of automaticity problem.

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.