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Çapar SH, Karaman E, Kara E, Çapar O, Ahmet S, Cetin Kara H, Çakır A, Gökyiğit B, Ataş A. The effect of strabismus surgery on the dynamic balance in children with strabismus. Strabismus 2024:1-10. [PMID: 38889053 DOI: 10.1080/09273972.2024.2367070] [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] [Indexed: 06/20/2024]
Abstract
Purpose: To evaluate the effect of strabismus surgery on dynamic balance by using computerized dynamic posturography in children with strabismus. Methods: This study was designed as a prospective observational study. Hearing tests and complete ophthalmological examinations were performed for all subjects. Patients with moderate and severe amblyopia, hearing loss at any level, and/or any suspicion of balance impairment were excluded from the study. Postural stability evaluation was performed by computerized dynamic posturography including sensory organization test, adaptation test, and rhythmic weight shift test. All tests were applied preoperatively and in the postoperative 1st and 3rd months, respectively. Results: Fifteen female and twelve male pre-adolescents aged between 7 and 12 (9.67 ± 1.62 years) were included in the current study. In the sensory organization test, the preoperative visual ratio percentages (73.19 ± 14.95%) improved statistically significantly at the postoperative 1st and 3rd months (78.59 ± 16.21% and 81.44 ± 14.18; p = .026, p = .021, respectively). The preoperative toes up (110.66 ± 33,48) and toes down (81.46 ± 28.36) adaptation tests improved statistically significantly in the postoperative 3rd month (88.74 ± 20.94 and 63.36 ± 16.03; p < .001, p = .001, respectively). In the Rhythmic Weight Shift test, the postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the preoperative directional control (forward-backward) value (67.76 ± 11.38%) (p = .011). The postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the postoperative 1st-month directional control (forward-backward) value (68.43 ± 14.00%) (p = .028). Conclusion: Surgical treatment resulted in an improvement in the maintenance of dynamic balance in children with strabismus.
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Affiliation(s)
- Serpil Hülya Çapar
- Faculty of Health Sciences, Department of Audiology, Bahcesehir University, Istanbul, Turkey
| | - Emin Karaman
- Cerrahpaşa Medical Faculty Department of Otorhinolaryngology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Eyyup Kara
- Faculty of Health Sciences, Department of Audiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Olgu Çapar
- Department of Ophthalmology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Sibel Ahmet
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Halide Cetin Kara
- Cerrahpaşa Medical Faculty, Department of Audiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Akın Çakır
- Department of Ophthalmology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Birsen Gökyiğit
- Department of Ophthalmology, Yeni Yüzyıl University Medical Faculty, Istanbul, Turkey
| | - Ahmet Ataş
- Department of Otorhinolaryngology, Koç University Medical Faculty, Istanbul, Turkey
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Abstract
BACKGROUND Postural control is a complex skill based on the collaboration of dynamic sensory mechanisms, namely the visual, vestibular, and somatosensory systems. METHODS A literature survey regarding postural stability in strabismus and amblyopia was conducted using databases in order to collect data for a narrative review of published reports and available literature. RESULTS The results of the literature survey were analyzed to provide an overview of the current knowledge of postural stability in strabismus and amblyopia. The results revealed that although postural control depends on the fundamental integration of three essential components (the visual, vestibular, and somatosensory systems), the role of vision is critical in postural stability. Once normal binocular vision is undesirably disrupted in childhood by some reason, especially in strabismus and/or amblyopia, balance is also affected. Abnormal balance affects coordination in gross and fine motor controls in school-age children and results in weakened academic performance and delayed social progress. It also impacts a child's general health, self-esteem, and safety. CONCLUSIONS Binocular vision is imperative for the maturation and preservation of balance control in children, as balance performance is reduced in strabismus and/or amblyopia.
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Affiliation(s)
- Ali Nouraeinejad
- Department of Clinical Ophthalmology, University College London (UCL), London
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Birch EE, Kelly KR. Amblyopia and the whole child. Prog Retin Eye Res 2023; 93:101168. [PMID: 36736071 PMCID: PMC9998377 DOI: 10.1016/j.preteyeres.2023.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
Amblyopia is a disorder of neurodevelopment that occurs when there is discordant binocular visual experience during the first years of life. While treatments are effective in improving visual acuity, there are significant individual differences in response to treatment that cannot be attributed solely to difference in adherence. In this considerable variability in response to treatment, we argue that treatment outcomes might be optimized by utilizing deep phenotyping of amblyopic deficits to guide alternative treatment choices. In addition, an understanding of the broader knock-on effects of amblyopia on developing visually-guided skills, self-perception, and quality of life will facilitate a whole person healthcare approach to amblyopia.
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Affiliation(s)
- Eileen E Birch
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, 9600 North Central Expressway #200, Dallas, TX, 75225, USA; Department of Ophthalmology, University of Texas Southwestern Medical Center, 5303 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Krista R Kelly
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5303 Harry Hines Boulevard, Dallas, TX, 75390, USA; Vision and Neurodevelopment Laboratory, Retina Foundation of the Southwest, 9600 North Central Expressway #200, Dallas, TX, 75225, USA.
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Choi KY, Wong HY, Cheung HN, Tseng JK, Chen CC, Wu CL, Eng H, Woo GC, Cheong AMY. Impact of visual impairment on balance and visual processing functions in students with special educational needs. PLoS One 2022; 17:e0249052. [PMID: 35486663 PMCID: PMC9053808 DOI: 10.1371/journal.pone.0249052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vision is critical for children's development. However, prevalence of visual impairment (VI) is high in students with special educational needs (SEN). Other than VI, SEN students are prone to having functional deficits. Whether visual problems relate to these functional deficits is unclear. This study aimed to assess the impact of vision on visual processing functions and balance in SEN students through a community service. METHODS Visual acuity (VA) and contrast sensitivity were measured in a total of 104 (aged 14.3±4.3) SEN students as the visual outcomes, followed by retinoscopy. Visual processing function assessment included facial expression recognition by card matching examiner's facial expression matching, and visual orientation recognition. Dynamic balance, by Timed Up and Go test, and static standing balance (postural sway in double-legged standing with feet-together and tandem-stance for open-eye and closed-eye conditions) were assessed. Static balance was presented in terms of the maximal medial-lateral and antero-posterior sways. RESULTS Of the 104 students, 62 (59.6%) were classified as visually impaired according to WHO classification of visual impairment based on presenting distance acuity. Ocular problems (e.g. optic nerve anomaly, uncorrected/ under-corrected refractive errors) and neurological anomalies were the major causes of vision loss. VA was positively associated with visual processing functions (all p ≤ 0.01), as SEN students with better vision tended to perform better in visual orientation and facial expression recognition tasks, as well as dynamic balance function (p = 0.04). For the static balance, postural sway and VA showed a positive relationship under open-eye and tandem stance conditions. However, the relationship between postural sway and VA became negative under closed-eye and tandem stance conditions. CONCLUSION This study found a high prevalence of SEN students with visual impairment, in which many of them were undetected. Optometric examination is important to improve their visual function to minimize the effect of vision on functional performance. Vision is critical in visual processing as well as playing an important role in maintaining balance in SEN students.
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Affiliation(s)
- Kai Yip Choi
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ho Yin Wong
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Hoi Nga Cheung
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jung Kai Tseng
- Department of Optometry, Asia University, Taichung, Taiwan
| | | | - Chieh Lin Wu
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Helen Eng
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - George C. Woo
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Center for Eye and Vision Research (CEVR), Sha Tin, Hong Kong
| | - Allen Ming Yan Cheong
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Center for Eye and Vision Research (CEVR), Sha Tin, Hong Kong
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Strabismus Surgery Decreases the Risk of Injuries in Pediatric Patients in the OptumLabs Data Warehouse. Am J Ophthalmol 2022; 236:147-153. [PMID: 34283972 DOI: 10.1016/j.ajo.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Previous studies have shown an association between injury risk and strabismus in aged Medicare beneficiaries and children. The injury prevalence in strabismic children was 30% in a study of >10 million patients in the OptumLabs Data Warehouse. The purpose of this study was to determine whether strabismus surgery decreases the risk of injury. DESIGN Retrospective cohort study. METHODS The OptumLabs Data Warehouse is a deidentified, longitudinal health database that was queried for strabismic patients aged <19 years. The patients who underwent strabismus surgery were compared with those strabismic patients who did not undergo surgery for injury. Injury risk (fractures, musculoskeletal injuries, and head injuries) during their insurance enrollment was calculated in the nonsurgical patients after their first strabismus claim and compared with the risk in surgical patients postoperatively. RESULTS There were 344,794 patients with strabismus. Surgery was performed in 26,459 (7.7%). Esotropia was the most common diagnosis (n = 181,195, 52.6%) followed by exotropia (n = 161,712, 46.9%) and hypertropia (n = 43,831, 12.7%). Within these groups, patients with hypertropia were significantly more likely to undergo surgery (24.2%) compared with patients with esotropia and exotropia (10.2% and 9.6%, respectively). Injuries were diagnosed after the first strabismus claim in 94,960 (29.8%) nonsurgical patients vs 5790 (21.9%) postsurgical patients (P < .001) with a mean follow-up of 4.3 ± 3.1 vs 3.8 ± 3.1 years, respectively. The adjusted hazard ratio for injuries was 0.85 (95% confidence interval [CI]: 0.83-0.87) for the risk of any injury after strabismus surgery. The hazard ratio was significantly decreased after surgery for each type of strabismus: esotropia (0.91, 95% CI: 0.88-0.94), exotropia (0.82, 95% CI: 0.80-0.85), and hypertropia (0.89, 95% CI: 0.85-0.93). DISCUSSION Strabismus surgery was associated with a 15% decrease in the risk of physical injury over approximately 4 years of follow-up. Surgery may be a factor in decreasing injury risk in strabismic patients, particularly in exotropia. Given the large number of children with strabismus in the United States, further assessment of strategies such as strabismus surgery to reduce injuries in children with strabismus is needed.
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Papalia GF, Mangano G, Diaz Balzani LA, Cupo G, Giurazza G, Di Zazzo A, Coassin M, Papalia R. Strabismus and postural control: a systematic review. Musculoskelet Surg 2022; 106:345-356. [PMID: 35187611 DOI: 10.1007/s12306-022-00737-y] [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: 05/20/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
The primary aim of this systematic review is to evaluate how postural balance and visual system are related in cross-eyed patients. The secondary goal is to assess the benefits of eye realignment on motor skills and body balance. Analyzing two different approaches: surgical or conservative, a systematic literature search was conducted using PubMed-Medline, Google Scholar and Cochrane Central in order to identify randomized controlled trials, case series and case-control studies which contained clinical evaluation of balance in strabismic patients as well as re-evaluation after surgery or conservative treatments via posturography to evaluate surface, length and mean speed of the center of pressure (CoP). A total of 11 studies were included in this review. The MINORS score is used to assess the methodological quality of the included studies, and its mean value was 12.8 for non-comparative studies and 17.5 for comparative studies. The postural balance was lower in strabismic patients compared with the control group, with statically higher value (p < 0.05) of surface, length and mean speed of the CoP in the study group. All patients show improvement in stability after surgery, as surface, length and mean speed of the CoP decreased after surgery in all the studies with statistical significance (p < 0.05).
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Affiliation(s)
- G F Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Roma, Italy.
| | - G Mangano
- Ophthamology, University Campus Bio-Medico of Rome, Rome, Italy
| | - L A Diaz Balzani
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Roma, Italy
| | - G Cupo
- Ophthamology, University Campus Bio-Medico of Rome, Rome, Italy
| | - G Giurazza
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Roma, Italy
| | - A Di Zazzo
- Ophthamology, University Campus Bio-Medico of Rome, Rome, Italy
| | - M Coassin
- Ophthamology, University Campus Bio-Medico of Rome, Rome, Italy
| | - R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Roma, Italy
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Jayakaran P, Aman W, Fernando U, Hackfath K, McPherson A, Williams M, Mitchell L. Sensory organization for postural control in children with strabismus-A systematic review and meta-analysis. Gait Posture 2021; 88:94-104. [PMID: 34015547 DOI: 10.1016/j.gaitpost.2021.05.008] [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: 10/14/2020] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural control requires the interaction of somatosensory, vestibular and visual systems to prevent disequilibrium. Children with strabismus have an impaired visual input which can lead to postural control deficits. RESEARCH QUESTION Does strabismus affect sensory organization for postural control in children? METHODS A systematic comprehensive search of multiple electronic databases for relevant articles was performed using a predetermined search strategy. Peer-reviewed journal publications that assessed sensory organization and postural performance in children with strabismus were included in this review. Methodological quality of the articles was evaluated using the modified Downs and Black quality assessment tool. A total of 10 articles were included in this review. RESULTS Eight of the 10 articles reviewed were included in the meta-analysis. Meta-analysis for Centre of Pressure CoP velocity (n = 3) (eyes open, stable support), was statistically significant (P = 0.01) in favor of controls over children with strabismus (MD, 3.08; 95 % CI -0.66, 5.51). Meta-analysis for CoP surface area (n = 5) (eyes open, stable support) was also statistically significant (P < 0.001) in favor of the control group (MD, 130.14; 95 % CI 70.01, 190.260). Meta-analysis with standardized mean difference (n = 6) for eyes open vs closed, stable support was statistically significant (P = 0.02) in favor of eyes open (MD, -0.94; 95 % CI, -1.74, -0.15). Overall, there was a high level of heterogeneity throughout the studies. SIGNIFICANCE This is the first systematic review of its kind to collate and synthesize evidence on the effect of strabismus on postural control in children. This review suggests that postural control performance in children with strabismus is inferior to that of age-matched control children. Further investigation is needed to understand the influence of the three sensory systems.
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Affiliation(s)
| | - Wali Aman
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Udari Fernando
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kristen Hackfath
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | - Mike Williams
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Logan Mitchell
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Marinato Clinic (Ophthalmology), Dunedin, New Zealand
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Sá CDSCD, Luz C, Pombo A, Rodrigues LP, Cordovil R. Motor Competence in Children With and Without Ambliopia. Percept Mot Skills 2021; 128:746-765. [PMID: 33435851 DOI: 10.1177/0031512520987359] [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] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to assess the motor competence of children with and without amblyopia. Study participants were 165 primary school children, aged 6-9 years, divided into three groups based on their visual acuity with the Snellen chart: (a) non-amblyopia, (b) corrected amblyopia, and (c) non-corrected amblyopia. We assessed the children's motor competence with the Motor Competence Assessment battery (MCA) and their physical activity with the Physical Activity Questionnaire for Older Children (PAQ-C). The non-amblyopia group presented significantly better motor competence on the MCA than either the corrected amblyopia group or the non-corrected amblyopia group; there were no statistically significant motor differences between the two amblyopia subgroups. Amblyopia versus non-amblyopia differences on the MCA were mainly in stability and locomotor components, involving dynamic balance and the change of spatial position and direction of movement, but not in the manipulative component (ball throwing velocity and ball kicking velocity). Predictably, from within an integrated visual motor perspective of child development, our findings suggest that intact vision played an important role in children's motor competence. The development of fundamental motor skills, especially of stability and locomotor skills, may be affected by poor visual processing in that participants with uncorrected amblyopia showed poor movement accuracy, uncoordinated movement, and impaired balance.
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Affiliation(s)
| | - Carlos Luz
- Escola Superior de Educação, Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - André Pombo
- Escola Superior de Educação, Instituto Politécnico de Lisboa, Lisboa, Portugal.,Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Luis Paulo Rodrigues
- Escola Superior Desporto e Lazer de Melgaço, Instituto Politécnico de Viana do Castelo, Melgaço, Portugal.,Research Center in Sports Sciences Health Sciences and Human Development, Vila Real, Portugal
| | - Rita Cordovil
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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Reche-Sainz JA, Ruiz-Aimituma F, Toledano-Fernández N. Comparison of postural control between strabismic and non-strabismic children. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:10-18. [PMID: 32690373 DOI: 10.1016/j.oftal.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare the postural control of children with strabismus versus non-strabismus children. MATERIAL AND METHODS Cross-sectional cohort study with a total of 171 children, including 73 children with esotropia, 24 with exotropia, and 74 controls. Postural control was determined using a dynamometric platform in a standing position in various conditions: eyes open and eyes closed, near and gaze fixation, and with and without foam pad. The studied variables were the area, the mean speed, and the lengths in the X and Y axis of the centre of pressure displacement. RESULTS Children with esotropia and exotropia had significantly higher mean values (speed, lengths of X and Y) compared to controls. In the open-eye, far distance fixation, and on foam pad, as well as under exam conditions; with eyes open, without foam pad, and far distance fixation, the exotropia values were higher than those of endotropia and controls. With eyes closed, there were no differences between the 3 groups under the described examination conditions, but their values were worse compared to their respective ones with eyes open. CONCLUSIONS The children with strabismus had a worse postural control than the non-strabismus ones. All of the them appeared to be more unstable with eyes closed than with eyes open, which demonstrates that vision plays an important relevant role in postural stability in both strabismus and non-strabismus children.
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Affiliation(s)
- J A Reche-Sainz
- Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - F Ruiz-Aimituma
- Servicio de Oftalmología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - N Toledano-Fernández
- Servicio de Oftalmología, Hospital Universitario de Fuenlabrada, Fuenlabrada (Madrid), España
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Visual Binocular Disorders and Their Relationship with Baropodometric Parameters: A Cross-Association Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6834591. [PMID: 32802865 PMCID: PMC7426776 DOI: 10.1155/2020/6834591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/30/2020] [Accepted: 07/18/2020] [Indexed: 12/24/2022]
Abstract
The aim of this study was to establish a relationship between nonstrabismic binocular dysfunction and baropodometric parameters. A total of 106 participants underwent binocular vision assessment by evaluating horizontal heterophoria, horizontal and vertical fusional vergence ranges, and vergence facility. Posturography was measured using the FreeMED baropodometric platform. Among the variables that the software calculates are foot surface, foot load, and foot pressure. Our results showed that in the participants with positive fusional vergence (PFV) (near) blur and recovery values outside the norm, there are statistically significant differences between the total foot area (p < 0.05), forefoot area (p < 0.05), forefoot load (p < 0.05), and rearfoot load (p < 0.05), in all of the cases of left foot vs. right foot. In the group of subjects who did not meet Sheard's criterion (distance), that is, those with unstable binocular vision, there was a statistically significant difference (p < 0.01) between maximum left and right foot pressure. In conclusion, our results establish a relationship between nonstrabismic binocular dysfunctions and some baropodometric parameters.
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Micarelli A, Viziano A, Augimeri I, Micarelli B, Alessandrini M. Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents. J Mot Behav 2019; 52:418-426. [PMID: 31328659 DOI: 10.1080/00222895.2019.1643284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant (p < 0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4-13 and 4-7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.
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Affiliation(s)
- Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ivan Augimeri
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Zipori AB, Colpa L, Wong AMF, Cushing SL, Gordon KA. Postural stability and visual impairment: Assessing balance in children with strabismus and amblyopia. PLoS One 2018; 13:e0205857. [PMID: 30335817 PMCID: PMC6193669 DOI: 10.1371/journal.pone.0205857] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022] Open
Abstract
Background Vision plays an important role in controlling posture and balance in children. Reduced postural control has been reported in children with strabismus, but little has been reported specifically in amblyopia. Objective To investigate whether children with amblyopia have reduced balance compared to both children with strabismus without amblyopia and healthy controls. Study design and methods In this cross-sectional study, a total of 56 patients and healthy controls were recruited from the Ophthalmology and Otolaryngology Clinics at The Hospital for Sick Children, Toronto. Participants were divided into three groups: (1) 18 with unilateral amblyopia (strabismic amblyopia or mixed mechanism); (2) 16 with strabismus only without amblyopia; and (3) 22 visually-normal controls. The primary outcome was the balance performance as measured by the balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency 2 [BOT2]. Results The age and gender-adjusted BOT2 balance scores were significantly reduced in the amblyopia group (mean score 9.0 ± 3.1 SD) and the strabismus without amblyopia group (mean score 8.6 ± 2.4 SD) compared to visually normal controls (mean score 18.9 ± 4.2) (p<0.0001), but no statistical difference was demonstrated between the two patient groups (p = 0.907). Further subgroup analysis of the strabismus only group did not reveal a statistically significant difference in performance on BOT2 balance score between strabismus only patients with good stereopsis 60 sec or better (BOT2 mean score 9.8±3.0 SD) to patients with 3000 sec or no stereopsis (BOT2 mean score 7.9±1.7) (p = 0.144). Conclusion Our findings suggest that normal vision plays an important role in the development and maintenance of balance control. When normal binocular vision is disrupted in childhood in strabismus and/or amblyopia, not only is the vision affected, but balance is also reduced. Our results indicate that the presence of even mild binocular discordance/dysfunction (patients with intermittent strabismus and good stereopsis) may lead to postural instability.
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Affiliation(s)
- Anat Bachar Zipori
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Colpa
- Eye Movement and Vision Neuroscience Laboratory, The Hospital for Sick Children, Toronto, Canada
| | - Agnes M. F. Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada
- Eye Movement and Vision Neuroscience Laboratory, The Hospital for Sick Children, Toronto, Canada
| | - Sharon L. Cushing
- Department of Otolaryngology–Head and Neck Surgery, The Hospital for Sick Children, Toronto, Canada
- Archie's Cochlear Implant Laboratory, Cochlear Implant Program and Communication Disorders, The Hospital for Sick Children, Toronto, Canada
| | - Karen A. Gordon
- Archie's Cochlear Implant Laboratory, Cochlear Implant Program and Communication Disorders, The Hospital for Sick Children, Toronto, Canada
- * E-mail:
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Milleret C, Bui Quoc E. Beyond Rehabilitation of Acuity, Ocular Alignment, and Binocularity in Infantile Strabismus. Front Syst Neurosci 2018; 12:29. [PMID: 30072876 PMCID: PMC6058758 DOI: 10.3389/fnsys.2018.00029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/15/2018] [Indexed: 11/13/2022] Open
Abstract
Infantile strabismus impairs the perception of all attributes of the visual scene. High spatial frequency components are no longer visible, leading to amblyopia. Binocularity is altered, leading to the loss of stereopsis. Spatial perception is impaired as well as detection of vertical orientation, the fastest movements, directions of movement, the highest contrasts and colors. Infantile strabismus also affects other vision-dependent processes such as control of postural stability. But presently, rehabilitative therapies for infantile strabismus by ophthalmologists, orthoptists and optometrists are restricted to preventing or curing amblyopia of the deviated eye, aligning the eyes and, whenever possible, preserving or restoring binocular vision during the critical period of development, i.e., before ~10 years of age. All the other impairments are thus ignored; whether they may recover after strabismus treatment even remains unknown. We argue here that medical and paramedical professionals may extend their present treatments of the perceptual losses associated with infantile strabismus. This hypothesis is based on findings from fundamental research on visual system organization of higher mammals in particular at the cortical level. In strabismic subjects (as in normal-seeing ones), information about all of the visual attributes converge, interact and are thus inter-dependent at multiple levels of encoding ranging from the single neuron to neuronal assemblies in visual cortex. Thus if the perception of one attribute is restored this may help to rehabilitate the perception of other attributes. Concomitantly, vision-dependent processes may also improve. This could occur spontaneously, but still should be assessed and validated. If not, medical and paramedical staff, in collaboration with neuroscientists, will have to break new ground in the field of therapies to help reorganize brain circuitry and promote more comprehensive functional recovery. Findings from fundamental research studies in both young and adult patients already support our hypothesis and are reviewed here. For example, presenting different contrasts to each eye of a strabismic patient during training sessions facilitates recovery of acuity in the amblyopic eye as well as of 3D perception. Recent data also demonstrate that visual recoveries in strabismic subjects improve postural stability. These findings form the basis for a roadmap for future research and clinical development to extend presently applied rehabilitative therapies for infantile strabismus.
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Affiliation(s)
- Chantal Milleret
- Center for Interdisciplinary Research in Biology, Centre National de la Recherche Scientifique, College de France, INSERM, PSL Research University, Paris, France
| | - Emmanuel Bui Quoc
- Department of Ophthalmology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris Paris, France
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Zanini S, Cordaro C, Martucci L, Del Piero I, Geotti S, Makuc M, Csillaghy A, Godio M, Cazzagon M. Visual and vestibular functioning, and age and surgery effects on postural control in healthy children with vertical strabismus. Ther Adv Ophthalmol 2018; 10:2515841418788005. [PMID: 30046771 PMCID: PMC6055097 DOI: 10.1177/2515841418788005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 05/23/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose: To describe visual and vestibular functioning and the effects of age and surgery effects on postural control in healthy children with vertical strabismus. Design: This is a comparative case series. Methods: We evaluated participants at the Scientific Institute Eugenio Medea during routine clinical activities. We enrolled 30 consecutive children/adolescents (age range 4–13 years) with isolated vertical strabismus, with and without corrective surgery. Participants were split into four subgroups according to age (4–8 years versus 9–13 years) and ocular surgery (surgery versus no surgery). The clinical protocol included ophthalmological, orthoptic, neurological, physiatrical, otolaryngological, and vestibular evaluations, and the instrumental protocol included ocular cyclotorsions assessment, posturography, and vestibular myogenic-evoked potentials. Main outcome measures of the study were the prevalence of study-relevant orthopedic, ocular, vestibular, and posturographic abnormalities. Results: Among the overall largely variable findings across patients’ groups, we found some interesting trends: larger binocular vision and convergence disorders in younger children, smaller prevalence of asymmetric vestibular-evoked potentials in operated children, less posturographic abnormalities in younger children. No clear-cut beneficial effect of surgery was found on all clinical and instrumental parameters considered, despite good re-alignment of the eyes. Conclusion: The pathophysiology of postural control in vertical strabismus is extremely complex and above the potential of this study design and should be specifically addressed in deeper experimental studies.
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Affiliation(s)
- Sergio Zanini
- Scientific Institute, IRCCS Eugenio Medea, Udine, Italy
| | | | | | | | | | - Marta Makuc
- Scientific Institute, IRCCS Eugenio Medea, Udine, Italy
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15
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The impact of strabismus surgery on gait pattern in patients with congenital or starting within one year of age strabismus. Neurosci Lett 2018; 670:22-30. [DOI: 10.1016/j.neulet.2018.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/30/2022]
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Paduca A, Bruenech JR. Neuroanatomical Structures in Human Extraocular Muscles and Their Potential Implication in the Development of Oculomotor Disorders. J Pediatr Ophthalmol Strabismus 2018; 55:14-22. [PMID: 28991350 DOI: 10.3928/01913913-20170703-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/08/2017] [Indexed: 11/20/2022]
Abstract
The potential role of sensory feedback from human extraocular muscles has been subjected to considerable speculation in the ophthalmic literature. Extraocular muscles pull against a fairly even load and do not initiate a stretch reflex, even when the eyes are directed toward the boundaries of their respective field of action. These unique working conditions and physiological properties have led to the notion that the sensory signal arising from receptors in extraocular muscles differs from the conventional proprioceptive signal arising from their somatic counterparts. The interest in the receptors at the myotendinous junction of human extraocular muscles has been renewed due to their alleged role in the development of binocular vision and their potential implication in the etiology of binocular vision anomalies. The idea that extraocular muscles provide knowledge of eye position and whether this function can be affected by surgical intervention has initiated several clinical and neuroanatomical studies. Many of these studies support this concept and suggest that surgical procedures that impose only minimal interference with the proprioceptive signal will give a better postoperative result. However, other studies contradict this view because the afferent capacity of the receptors can be questioned and some uncertainties remain. The purpose of this study was to review the related literature and discuss the possible role of ocular proprioceptors in relation to binocular vision and the development of eye motility disorders. [J Pediatr Ophthalmol Strabismus. 2018;55(1):14-22.].
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Klavina A, Zusa-Rodke A, Galeja Z. The assessment of static balance in children with hearing, visual and intellectual disabilities. ACTA GYMNICA 2017. [DOI: 10.5507/ag.2017.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Affiliation(s)
- Wendy Hood
- Senior lecturer (Physiotherapy) Northumbria University, Newcastle Upon Tyne, UK
| | - Martin Hood
- Optometrist in private practice Senior Optometrist Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Bucci MP, Soufi H, Villeneuve P, Colleville L, Bui-Quoc E, Lions C. Importance of Proprioceptive Information for Postural Control in Children with Strabismus before and after Strabismus Surgery. Front Syst Neurosci 2016; 10:67. [PMID: 27656133 PMCID: PMC5012200 DOI: 10.3389/fnsys.2016.00067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 07/25/2016] [Indexed: 11/25/2022] Open
Abstract
The objective of this study is to examine the role of proprioception in postural balance in children with strabismus before and after realignment of their visual axes by eye surgery. Postural recordings were made with the TechnoConcept® force platform in 23 children. Several conditions were studied, whether the subjects had both eyes open, or either the dominant or the non-dominant eye open, without and with foam pads of 4 mm underfoot. Recordings were performed before and after strabismus surgery. The surface area, the length and the mean speed of the center of pressure (CoP) were analyzed. Before strabismus surgery, all children showed better stability with both eyes open with respect to the condition with the non-dominant eye open; furthermore postural stability improved in the presence of foam pads. After surgery, the surface area of CoP decreased significantly, especially in the non-dominant eye viewing condition. We suggest that strabismic children use mainly proprioceptive information in order to control their posture, but also visual inputs, which are important for obtaining a good postural stability. The alignment of the visual axes after surgery provides enhanced postural stability, suggesting, again the major role of visual inputs in the control of posture. Proprioceptive plasticity after strabismus surgery may allow better visual rehabilitation.
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Affiliation(s)
- Maria P Bucci
- Institut National de la Santé et de la Recherche Médicale- Université Paris 7, Robert Debré University HospitalUMR 1141, Paris, France; Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University HospitalParis, France
| | - Hayette Soufi
- Institut National de la Santé et de la Recherche Médicale- Université Paris 7, Robert Debré University HospitalUMR 1141, Paris, France; Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University HospitalParis, France
| | | | - Lucile Colleville
- Institut National de la Santé et de la Recherche Médicale- Université Paris 7, Robert Debré University HospitalUMR 1141, Paris, France; Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University HospitalParis, France
| | | | - Cynthia Lions
- Institut National de la Santé et de la Recherche Médicale- Université Paris 7, Robert Debré University HospitalUMR 1141, Paris, France; Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University HospitalParis, France
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Dickmann A, Di Sipio E, Simbolotti C, Agresta A, Germanotta M, Tredici C, Petroni S, Padua L, Aprile I. Balance in subjects with congenital or early onset strabismus: Influence of age. Neurosci Lett 2016; 623:28-35. [PMID: 27109787 DOI: 10.1016/j.neulet.2016.04.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/04/2016] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
Abstract
Few studies have investigated the relationship between strabismus and balance, and those that do exist focused on patients within a limited age range, while no studies on possible age-related changes have yet been conducted. Therefore, the aim of our study was to investigate whether the balance strategies adopted by patients with congenital or early onset strabismus change with age. Forty strabismic patients and 36 healthy subjects were enrolled in the study. Both patients and healthy subjects were divided into three subgroups according to age (children, adolescents, and adults) and underwent a stabilometric evaluation. When we compared the whole group of strabismic patients with the group of healthy subjects, we found that the center of pressure area and the trunk oscillations in the former were significantly different from those in the latter; when we considered the three age groups separately, only values in children with strabismus were different from those in the age-matched control group of healthy subjects. Strabismus was found to affect balance in children by inducing a postural strategy characterized by a reduction in physiological trunk oscillations. Gaining a better insight into postural control in strabismic subjects and its evolution with age may be crucial to improving rehabilitation in such patients and planning tailored rehabilitation treatment.
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Affiliation(s)
- Anna Dickmann
- Department of Surgical Sciences of Head and Neck, Institute of Ophtalmology, Catholic University, Largo F. Vito, 1 00168 Rome, Italy
| | - Enrica Di Sipio
- Don Carlo Gnocchi Onlus Foundation, Piazzale Morandi 6, 20121 Milan, Italy
| | - Chiara Simbolotti
- Don Carlo Gnocchi Onlus Foundation, Piazzale Morandi 6, 20121 Milan, Italy
| | - Antonio Agresta
- Department of Surgical Sciences of Head and Neck, Institute of Ophtalmology, Catholic University, Largo F. Vito, 1 00168 Rome, Italy
| | - Marco Germanotta
- Don Carlo Gnocchi Onlus Foundation, Piazzale Morandi 6, 20121 Milan, Italy
| | - Costanza Tredici
- Department of Surgical Sciences of Head and Neck, Institute of Ophtalmology, Catholic University, Largo F. Vito, 1 00168 Rome, Italy
| | - Sergio Petroni
- Ophthalmology Department, Bambino Gesù Children's Hospital, Via Torre di Palidoro snc, Passoscuro, 00050 Rome, Italy
| | - Luca Padua
- Don Carlo Gnocchi Onlus Foundation, Piazzale Morandi 6, 20121 Milan, Italy; Neuroscience Department of Catholic University, Largo F. Vito, 1 00168 Rome, Italy
| | - Irene Aprile
- Don Carlo Gnocchi Onlus Foundation, Piazzale Morandi 6, 20121 Milan, Italy.
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Lions C, Colleville L, Bui-Quoc E, Bucci MP. Importance of visual inputs quality for postural stability in strabismic children. Neurosci Lett 2016; 617:127-33. [PMID: 26876478 DOI: 10.1016/j.neulet.2016.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/22/2016] [Accepted: 02/02/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The first goal of the present study is to analyze the postural control in strabismic children in four different visual conditions (eyes open, eyes closed and monocular viewing with squint eye and non-squint eye). Secondly, we wish to explore the effect of strabismus surgery in postural control. METHOD Postural stability was recorded with a platform (TechnoConcept) in 23 strabismic children aged from 4.4 to 14.8 years old (mean age: 8.4 years); 12 of these children were also examined at least two months after strabismus surgery. We analyzed the surface, the length, and the mean speed of the Center of Pressure displacement (CdP), and we calculated the Romberg's Quotient (that is for each postural parameter the ratio between eyes closed relative to eyes open). RESULTS Strabismic children are significantly more stable when they can use their visual information to control their posture. Also, postural stability was better when the non-squint eye was viewing. For the first time, we observed the important role of vision (by calculating Romberg's Quotient) in strabismic children with binocular vision in comparison of strabismic children without binocular vision. Finally, we found that eye surgery improves postural stability. CONCLUSION Strabismic children use visual inputs to control their posture. Moreover, binocular vision plays an important role in postural control. Strabismus surgery improves postural stability. SIGNIFICANCE Visual inputs from the non-squint eye and binocular vision are important to control stability.
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Affiliation(s)
- Cynthia Lions
- UMR 1141, INSERM -Université Paris 7, Robert Debré University Hospital, 48 Boulevard Sérurier, Paris, France; Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University Hospital, 48 Boulevard Sérurier, 75019 Paris, France.
| | - Lucile Colleville
- UMR 1141, INSERM -Université Paris 7, Robert Debré University Hospital, 48 Boulevard Sérurier, Paris, France; Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University Hospital, 48 Boulevard Sérurier, 75019 Paris, France
| | - Emmanuel Bui-Quoc
- Ophthalmology Unit, Robert Debré University Hospital, 48 Boulevard Sérurier, 75019 Paris, France
| | - Maria Pia Bucci
- UMR 1141, INSERM -Université Paris 7, Robert Debré University Hospital, 48 Boulevard Sérurier, Paris, France; Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University Hospital, 48 Boulevard Sérurier, 75019 Paris, France
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Ezane MD, Lions C, Bui Quoc E, Milleret C, Bucci MP. Spatial and temporal analyses of posture in strabismic children. Graefes Arch Clin Exp Ophthalmol 2015; 253:1629-39. [PMID: 26287266 DOI: 10.1007/s00417-015-3134-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/14/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To analyse postural performances of strabismic children, both in the spatial and the temporal domains, by wavelet transformation, comparing both stable and unstable situations. METHODS Twenty-six strabismic children aged from 4 to 11 years old and 26 age-matched normal children participated in the study. Postural performances were evaluated using the Framiral® platform. Posture was recorded in the following conditions: eyes open fixating a target and eyes closed on stable and unstable platforms. RESULTS For both strabismic and non-strabismic children, the surface and the mean velocity of the center of pressure (CoP) were significantly larger in the eyes closed on unstable platform condition, but this was much more pronounced in case of strabismus. Spectral power index and cancelling time were also found to be altered in strabismic children compared to non-strabismic children. CONCLUSIONS This data demonstrates poor postural stability for both groups on an unstable platform with the eyes closed. However, strabismic children had significantly worse performance than non-strabismic children. Strabismic children also engage more energy to stabilize their posture by using visuo-vestibular sensory inputs to compensate their altered vision due to strabismus, in comparison to non-strabismic children.
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Affiliation(s)
- Marie-Désirée Ezane
- UMR 1141, INSERM - Université Paris 7, Hôpital Robert Debré, 48 boulevard Sérurier, Paris, France
| | - Cynthia Lions
- UMR 1141, INSERM - Université Paris 7, Hôpital Robert Debré, 48 boulevard Sérurier, Paris, France.
| | - Emmanuel Bui Quoc
- Service d'Ophtalmologie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019, Paris, France
| | - Chantal Milleret
- Collège de France, Center Interdisciplinary Research in Biology (CIRB), Spatial Memory and Navigation Team, 75005, Paris, France
| | - Maria Pia Bucci
- UMR 1141, INSERM - Université Paris 7, Hôpital Robert Debré, 48 boulevard Sérurier, Paris, France
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Aprile I, Ferrarin M, Padua L, Di Sipio E, Simbolotti C, Petroni S, Tredici C, Dickmann A. Walking strategies in subjects with congenital or early onset strabismus. Front Hum Neurosci 2014; 8:484. [PMID: 25071514 PMCID: PMC4090756 DOI: 10.3389/fnhum.2014.00484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/16/2014] [Indexed: 11/13/2022] Open
Abstract
Introduction: In congenital strabismus, sensory adaptations occur hampering the correct development of normal binocular vision. The aim of this study is to investigate if patients with congenital or early onset exotropic or esotropic strabismus adopt different walking strategies with respect to healthy subjects. Our hypothesis is that the abnormal binocular cooperation, occurring in patients with exotropic or esotropic strabismus, could influence neurosensorial adaptation of the gait pattern. Materials and Methods: Twenty-five patients were enrolled: 19 with esotropic (ESO) and 6 with exotropic strabismus (EXO). All patients underwent an ophthalmological and orthoptic evaluation. Biomechanical data were collected using a stereophotogrammetric system and a force platform. Twenty-seven age-matched healthy subjects (HS) were used as controls. Results: The comparison between patients with ESO and patients with EXO strabismus showed that the maximal power at the knee and at the ankle was lower in EXO group (p < 0.01 and p < 0.05, respectively). The step width was statistically different between ESO and EXO groups (p < 0.01), lower in patients with ESO and higher in patients with EXO strabismus when compared with HS (though not statistically significant). The deviation angle values showed a relationship with the step width (at the near fixation p < 0.05) and with the maximal power at the knee and at the ankle (at the far fixation for the knee p < 0.001 and for the ankle p < 0.05; at the near fixation for the knee p < 0.05): in the patients with EXO the increased angle deviation is related to larger step width and to lower power at the knee and at the ankle. In the patients with ESO strabismus this relationship is less robust. Discussion: Patients with EXO and ESO strabismus adopt different strategies to compensate their walking difficulties, and these strategies are likely due to an expanded binocular visual field in patients with EXO and to a reduced visual field in patients with ESO strabismus.
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Affiliation(s)
- Irene Aprile
- SM Provvidenza Movement Laboratory, Don Carlo Gnocchi Foundation, IRCCS Milan, Rome, Italy
| | - Maurizio Ferrarin
- Biomedical Technology Department, Don Carlo Gnocchi Foundation, IRCCS Milan, Italy
| | - Luca Padua
- SM Provvidenza Movement Laboratory, Don Carlo Gnocchi Foundation, IRCCS Milan, Rome, Italy ; Neuroscience Department of Catholic University Rome, Italy
| | - Enrica Di Sipio
- SM Provvidenza Movement Laboratory, Don Carlo Gnocchi Foundation, IRCCS Milan, Rome, Italy
| | - Chiara Simbolotti
- SM Provvidenza Movement Laboratory, Don Carlo Gnocchi Foundation, IRCCS Milan, Rome, Italy
| | - Sergio Petroni
- Ophthalmology Department, Bambino Gesù Children's Hospital Rome, Italy
| | - Costanza Tredici
- Department of Surgical Sciences of Head and Neck, Institute of Ophtalmology, Catholic University Rome, Italy
| | - Anna Dickmann
- Department of Surgical Sciences of Head and Neck, Institute of Ophtalmology, Catholic University Rome, Italy
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Lions C, Bui Quoc E, Wiener-Vacher S, Bucci MP. Postural control in strabismic children: importance of proprioceptive information. Front Physiol 2014; 5:156. [PMID: 24795651 PMCID: PMC4006047 DOI: 10.3389/fphys.2014.00156] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/02/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the effect of proprioceptive information during postural control in strabismic children. METHODS Postural stability was recorded with a platform (Techno Concept®) in 12 strabismic children aged from 4.9 to 10 years and data were compared to that of 12 control age-matched children. Two postural positions were performed: Romberg and Tandem. Two postural conditions: without and with foam pad. We analyzed the surface area, the length, the mean speed of the center of pressure (CoP) and the effect of proprioceptive information. RESULTS Strabismic children are more instable than control age-matched children. The surface, the length and the mean speed of CoP are significantly higher in strabismic children than in control age-matched children. Both groups are more instable in Tandem position than in Romberg position. Finally, strabismic children use more proprioceptive information than control age-matched children. CONCLUSION For both Romberg and Tandem position, strabismic children are more instable than control age-matched children. Strabismic children use proprioceptive information more than control age-matched children to control their posture. SIGNIFICANCE Proprioceptive inputs are important for control posture particularly for strabismic population.
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Affiliation(s)
- Cynthia Lions
- UMR 1141, INSERM-Université Paris Diderot, Hôpital Robert Debré Paris, France
| | | | | | - Maria P Bucci
- UMR 1141, INSERM-Université Paris Diderot, Hôpital Robert Debré Paris, France
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Przekoracka-Krawczyk A, Nawrot P, Czaińska M, Michalak KP. Impaired body balance control in adults with strabismus. Vision Res 2014; 98:35-45. [PMID: 24680877 DOI: 10.1016/j.visres.2014.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/03/2014] [Accepted: 03/11/2014] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Anna Przekoracka-Krawczyk
- Laboratory of Vision Science and Optometry, Faculty of Physics, Adam Mickiewicz University in Poznań, Umultowska 85, 61-614 Poznań, Poland.
| | - Paweł Nawrot
- Laboratory of Vision Science and Optometry, Faculty of Physics, Adam Mickiewicz University in Poznań, Umultowska 85, 61-614 Poznań, Poland.
| | - Monika Czaińska
- Laboratory of Vision Science and Optometry, Faculty of Physics, Adam Mickiewicz University in Poznań, Umultowska 85, 61-614 Poznań, Poland.
| | - Krzysztof Piotr Michalak
- Laboratory of Vision Science and Optometry, Faculty of Physics, Adam Mickiewicz University in Poznań, Umultowska 85, 61-614 Poznań, Poland.
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Ajrezo L, Wiener-Vacher S, Bucci MP. Saccades improve postural control: a developmental study in normal children. PLoS One 2013; 8:e81066. [PMID: 24278379 PMCID: PMC3836891 DOI: 10.1371/journal.pone.0081066] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/09/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Dual-task performance is known to affect postural stability in children. This study focused on the effect of oculomotor tasks like saccadic eye movements on postural stability, studied in a large population of children by recording simultaneously their eye movements and posture. MATERIALS AND METHODS Ninety-five healthy children from 5.8 to 17.6 years old were examined. All children were free of any vestibular, neurological, ophtalmologic and orthoptic abnormalities. Postural control was measured with a force platform TechnoConcept®, and eye movements with video oculography (MobilEBT®). Children performed two oculomotor tasks: fixation of a stable central target and horizontal saccades. We measured the saccade latency and the number of saccades during fixation as well as the surface, length and mean velocity of the center of pressure. RESULTS During postural measurement, we observed a correlation between the age on the one hand and a decrease in saccade latency as well as an improvement in the quality of fixation on the other. Postural sway decreases with age and is reduced in the dual task (saccades) in comparison with a simple task of fixation. DISCUSSION - CONCLUSION These results suggest a maturation of neural circuits controlling posture and eye movements during childhood. This study also shows the presence of an interaction between the oculomotor system and the postural system. Engaging in oculomotor tasks results in a reduction of postural sway.
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Affiliation(s)
- Layla Ajrezo
- Vestibular and Oculomotor Evaluation Unit, ORL Dept., 75019 Robert Debré Paediatric Hospital, Paris, France
- UMR 676, INSERM- Université Paris 7, Hôpital Robert Debré, Paris, France
| | - Sylvette Wiener-Vacher
- Vestibular and Oculomotor Evaluation Unit, ORL Dept., 75019 Robert Debré Paediatric Hospital, Paris, France
- UMR 676, INSERM- Université Paris 7, Hôpital Robert Debré, Paris, France
| | - Maria Pia Bucci
- UMR 676, INSERM- Université Paris 7, Hôpital Robert Debré, Paris, France
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Barozzi S, Soi D, Gagliardi C, Selicorni A, Bedeschi MF, Forti S, Di Berardino F, Cesarani A, Brambilla D. Balance function in patients with Williams syndrome. Gait Posture 2013; 38:221-5. [PMID: 23219788 DOI: 10.1016/j.gaitpost.2012.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 10/04/2012] [Accepted: 11/13/2012] [Indexed: 02/02/2023]
Abstract
Impaired control of balance has been described in Williams syndrome (WS). The aim of this study was to investigate balance function by means of clinical and instrumental tests in order to measure postural sway in people with WS in an objective way. 23 WS patients (11 males, 12 females, mean age 17.52 ± 8.33 years) and 23 healthy subjects (11 males, 12 females, mean age 17.74 ± 8.93 years) performed static posturography with eyes open and closed, on a firm surface and on foam pads. The WS patients had higher mean length, velocity and surface values than controls under all of the test conditions, and their length and surface values were significantly higher in the eyes open test. The cognitive abilities of the WS patients were not related to their stabilometric performance. The greatest differences between the WS patients and the controls were found mainly in the older subjects. WS patients are more unstable than healthy subjects of the same age, particularly when they use visual information to maintain their balance: i.e. under conditions of normal everyday life. Possible explanations may be the ophthalmologic problems and the visuospatial difficulties attributed to a neural processing abnormality involving the dorsal stream impairment model. The balance function of WS patients is different from that of normal developing subjects, especially after adolescence when postural control is generally complete. This suggests an atypical developmental trajectory.
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Affiliation(s)
- Stefania Barozzi
- Audiology Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Pace 9, I-20122 Milano, Italy.
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Postural control in strabismic children versus non strabismic age-matched children. Graefes Arch Clin Exp Ophthalmol 2013; 251:2219-25. [PMID: 23657730 DOI: 10.1007/s00417-013-2372-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Several studies have shown that achieving a dual task modifies postural control; however, their results are conflicting. The goal of the present study is to compare the effect of a simple task (eye fixation) to the effect of a dual task (saccadic eye movements) on postural balance in strabismic and in non strabismic children. METHODS Postural stability was recorded with a platform (Techno Concept©) in ten strabismic children aged from 5.4 to 13.8 years (mean age: 8.8 ± 2.5 years). Data were compared to that of ten age-matched non strabismic control children. We analyzed the surface area, the length and the mean speed of the center of pressure (CoP). RESULTS Strabismic children are more instable than control children. The surface (340 mm(2)), the length (402 mm) and the mean speed (16 mm/s) of the CoP are significantly higher in strabismic children than in control children (160 mm(2), 280 mm and 11 mm/s, respectively). In addition, both strabismic and control children have a better postural control during saccades than during a fixation task. Surface, length and mean speed of the CoP are significantly reduced during the saccade task (214 mm(2), 306 mm and 12.5 mm/s, respectively) than during the fixation task (285 mm(2), 376 mm and 14.8 mm/s, respectively). CONCLUSIONS Abnormal postural control in strabismic children could be due to their visual deficits. The postural improvement observed in a dual task (saccades) vs. a simple task (fixation) might be due to the fact that postural control becomes more automatic during saccadic eye movements.
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Gaertner C, Creux C, Espinasse-Berrod MA, Orssaud C, Dufier JL, Kapoula Z. Benefit of bi-ocular visual stimulation for postural control in children with strabismus. PLoS One 2013; 8:e60341. [PMID: 23565228 PMCID: PMC3614554 DOI: 10.1371/journal.pone.0060341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/25/2013] [Indexed: 11/19/2022] Open
Abstract
Vision is important for postural control as is shown by the Romberg quotient (RQ): with eyes closed, postural instability increases relative to eyes open (RQ = 2). Yet while fixating at far distance, postural stability is similar with eyes open and eyes closed (RQ = 1). Postural stability can be better with both eyes viewing than one eye, but such effect is not consistent among healthy subjects. The first goal of the study is to test the RQ as a function of distance for children with convergent versus divergent strabismus. The second goal is to test whether vision from two eyes relative to vision from one eye provides better postural stability. Thirteen children with divergent strabismus and eleven with convergent strabismus participated in this study. Posturtography was done with the Techno concept device. Experiment 1, four conditions: fixation at 40 cm and at 200 cm both with eyes open and eyes covered (evaluation of RQ). Experiment 2, six conditions: fixation at 40 cm and at 200 cm, with both eyes viewing or under monocular vision (dominant and non-dominant eye). For convergent strabismus, the groups mean value of RQ was 1.3 at near and 0.94 at far distance; for divergent, it was 1.06 at near and 1.68 at far. For all children, the surface of body sway was significantly smaller under both eyes viewing than monocular viewing (either eye). Increased RQ value at near for convergent and at far for divergent strabismus is attributed to the influence of the default strabismus angle and to better use of ocular motor signals. Vision with the two eyes improves postural control for both viewing distances and for both types of strabismus. Such benefit can be due to complementary mechanisms: larger visual field, better quality of fixation and vergence angle due to the use of visual inputs from both eyes.
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Affiliation(s)
- Chrystal Gaertner
- IRIS Group, Centre d’Etudes SensoriMotrices UMR8194, CNRS, Université Paris Descartes, Paris, France
| | - Charlotte Creux
- Service d’Ophtalmologie, Hôpital pour enfants Necker, Paris, France
| | | | | | | | - Zoï Kapoula
- IRIS Group, Centre d’Etudes SensoriMotrices UMR8194, CNRS, Université Paris Descartes, Paris, France
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Legrand A, Bui-Quoc E, Doré-Mazars K, Lemoine C, Gérard CL, Bucci MP. Effect of a dual task on postural control in dyslexic children. PLoS One 2012; 7:e35301. [PMID: 22523583 PMCID: PMC3327646 DOI: 10.1371/journal.pone.0035301] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/14/2012] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Agathe Legrand
- Laboratoire de Psychologie et Neuropsychologie Cognitives, IUPDP, Université Paris Descartes, Sorbonne Paris Cité, Institut de Psychologie, Boulogne Billancourt, France.
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Legrand A, Bui-Quoc E, Bucci MP. Re-alignment of the eyes, with prisms and with eye surgery, affects postural stability differently in children with strabismus. Graefes Arch Clin Exp Ophthalmol 2011; 250:849-55. [PMID: 22033625 DOI: 10.1007/s00417-011-1845-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 09/06/2011] [Accepted: 10/03/2011] [Indexed: 11/30/2022] Open
Affiliation(s)
- Agathe Legrand
- Laboratoire de Psychologie et Neuropsychologie Cognitives, FRE 3292 CNRS IUPDP Université Paris Descartes, 71 Avenue Edouard Vaillant, 92774 Boulogne Billancourt Cedex, France
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