Inference making skill in children with visual impairments

There is a scarcity of research examining the reading comprehension skills of partially-sighted children despite evidence indicating that they lag behind their typically-sighted (TS) peers in reading comprehension ability. We compare the performance of children with visual impairments (VIs) with that of chronological-age matched TS counterparts on a task that requires them to make emotional, temporal and spatial inferences from short texts. The findings indicate that children with VIs exhibit a specific deficit in drawing inferences about spatial information in narratives as opposed to emotional or temporal information. The results are discussed in relation to the role of visual acuity in imagery skills and how this affects the construction of a mental model of a text.

Randomized Trial of Tablet Computers for Education and Learning in Children and Young People with Low Vision

SIGNIFICANCE

Mobile devices such as tablet computers have become widely available as mainstream devices and are also used in some schools, but there is an absence of robust information regarding the efficacy of any optical/electronic low vision device or tablet computer in supporting education of young people with low vision.

PURPOSE

A randomized controlled trial (RCT) is needed to measure the impact of tablet computers on education, specifically on independent access to educational material, in children and young people with low vision. We conducted a pilot RCT to determine the feasibility of conducting a full-scale trial.

METHODS

This was a randomized multicenter pilot trial across two sites in the United Kingdom and one site in India. Forty children and young people aged 10 to 18 years with low vision (best-corrected visual acuity for distance between <20/60 [0.48 logMAR] and 20/400 [1.30 logMAR] in the better eye) in the United Kingdom (n = 20) and India (n = 20) were randomized to two parallel arms, with a 1:1 allocation ratio, to control (n = 20) or intervention (n = 20). Control group participants received standard low vision care. The intervention group received a tablet computer (iPad) with low vision applications and instruction in its use, including accessibility features. Four primary outcomes included (1) 6-month recruitment rate, (2) retention of participants for 3 months, (3) acceptance/usage of device, and (4) accessibility of device.

RESULTS

Nineteen participants (95%) enrolled within 6 months in the United Kingdom, and 20 participants (100%), in India. Retention at 3 months was 85% (n = 17) in the United Kingdom and 95% (n = 19) in India. More than one half of participants reported using a tablet computer at school at least once every day. The majority (90%) found it easily accessible.

CONCLUSIONS

This study demonstrated that it is feasible to recruit children and young people with low vision into an international multicenter RCT of electronic assistive technology. Regardless of geographical location, children and young people with low vision reported using tablet computers at least once a day at school and accessed them easily.

Saccade latencies during a preferential looking task and objective scoring of grating acuity in children with and without visual impairments

PURPOSE

We determined the latencies of orienting responses during a preferential looking task in children with normal vision and in children with visual impairments between 6 and 12 years old, and assessed the feasibility of scoring grating detection in these populations with video-based eye tracking.

METHODS

Children performed a computerized preferential looking test, while a remote eye tracker measured the children's eye movements. The stimuli consisted of a 2 × 2 grid, with three uniform grey fields and one target field consisting of a black-and-white square wave grating. The grating was presented randomly at one of the four locations. The spatial frequencies (1.05, 2.11 and 7.02 cyc/deg) were randomly interleaved, with 10 trials per spatial frequency. Three different methods were used to score the accuracy of the responses: (1) primary saccade ends on target, (1) gaze 50% of the presentation time on target, and (3) a combination of method 1 and 2 (i.e. primary saccade ends on target, and/or gaze 50% of the presentation time on target).

RESULTS

The combined scoring method was most reliable to determine whether children could resolve the gratings. Children with visual impairments had significantly lower accuracies than children with normal vision with all three scoring methods. In addition, saccade latencies decreased with age and were significantly longer (62 ± 15 ms) in children with visual impairments.

CONCLUSION

The use of eye tracking to assess grating detection with a preferential looking task in clinical populations provides valuable additional information, including objective detection measures and developmental delays in saccade latencies.

The effects of reading mode and braille reading patterns on braille reading speed and comprehension: A study of students with visual impairments in China

The purpose of this study was to examine the effects of reading mode (oral and silent reading) and braille reading patterns (one-handed pattern, mark pattern, parallel pattern, cooperative pattern) on the reading speed and comprehension of students with visual impairments in China. Seventy-three students with visual impairments aged 10-19 years participated in the study; 48 were students with congenital visual impairments and 25 were students with adventitious visual impairments. The participants' braille reading performance was assessed by the Chinese Reading Comprehension Test. Measurement indicators included reading speed (wpm) and reading comprehension. The results indicated that (1) Reading mode had a significant effect on both reading speed and reading comprehension. More specifically, although participants read faster in silent reading than in oral reading, they demonstrated better reading comprehension in oral reading than in silent reading. (2) There was a significant interaction effect between reading mode and braille reading patterns on reading speed. In particular, participants using cooperative and one-handed patterns read faster than other patterns in silent reading. This difference did not exist in the oral reading mode. (3) There was no difference between the measurement indicators of the students with congenital and adventitious visual impairments. Implications and recommendations are given based on the analyses.

Phonological Awareness of Young Children with Visual Impairments

The findings from a sample of 22 young children with visual impairments and no additional disabilities suggest that potential readers of braille or dual media had better syllable-segmentation, sound-isolation, and sound-segmentation skills than potential readers of print. Potential readers of print seemed to have slightly better letter-identification and letter-sound identification skills than potential readers of braille or dual media.

Tablet computers versus optical aids to support education and learning in children and young people with low vision: protocol for a pilot randomised controlled trial, CREATE (Children Reading with Electronic Assistance To Educate)

INTRODUCTION

Low vision and blindness adversely affect education and independence of children and young people. New 'assistive' technologies such as tablet computers can display text in enlarged font, read text out to the user, allow speech input and conversion into typed text, offer document and spreadsheet processing and give access to wide sources of information such as the internet. Research on these devices in low vision has been limited to case series.

METHODS AND ANALYSIS

We will carry out a pilot randomised controlled trial (RCT) to assess the feasibility of a full RCT of assistive technologies for children/young people with low vision. We will recruit 40 students age 10-18 years in India and the UK, whom we will randomise 1:1 into two parallel groups. The active intervention will be Apple iPads; the control arm will be the local standard low-vision aid care. Primary outcomes will be acceptance/usage, accessibility of the device and trial feasibility measures (time to recruit children, lost to follow-up). Exploratory outcomes will be validated measures of vision-related quality of life for children/young people as well as validated measures of reading and educational outcomes. In addition, we will carry out semistructured interviews with the participants and their teachers.

ETHICS AND DISSEMINATION

NRES reference 15/NS/0068; dissemination is planned via healthcare and education sector conferences and publications, as well as via patient support organisations.

TRIAL REGISTRATION NUMBER

NCT02798848; IRAS ID 179658, UCL reference 15/0570.

Assistive technology for children and young people with low vision

BACKGROUND

Recent technological developments, such as the near universal spread of mobile phones and portable computers and improvements in the accessibility features of these devices, give children and young people with low vision greater independent access to information. Some electronic technologies, such as closed circuit TV, are well established low vision aids and newer versions, such as electronic readers or off-the shelf tablet computers, may offer similar functionalities with easier portability and at lower cost.

OBJECTIVES

To assess the effect of electronic assistive technologies on reading, educational outcomes and quality of life in children and young people with low vision.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2014), EMBASE (January 1980 to October 2014), the Health Technology Assessment Programme (HTA) (www.hta.ac.uk/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 30 October 2014.

SELECTION CRITERIA

We intended to include randomised controlled trials (RCTs) and quasi-RCTs in this review. We planned to include trials involving children between the ages of 5 and 16 years with low vision as defined by, or equivalent to, the WHO 1992 definition of low vision. We planned to include studies that explore the use of assistive technologies (ATs). These could include all types of closed circuit television/electronic vision enhancement systems (CCTV/EVES), computer technology including tablet computers and adaptive technologies such as screen readers, screen magnification and optical character recognition (OCR). We intended to compare the use of ATs with standard optical aids, which include distance refractive correction (with appropriate near addition for aphakic (no lens)/pseudophakic (with lens implant) patients) and monocular/binoculars for distance and brightfield magnifiers for near. We also planned to include studies that compare different types of ATs with each other, without or in addition to conventional optical aids, and those that compare ATs given with or without instructions for use.

DATA COLLECTION AND ANALYSIS

Independently, two review authors reviewed titles and abstracts for eligibility. They divided studies into categories to 'definitely include', 'definitely exclude' and 'possibly include', and the same two authors made final judgements about inclusion/exclusion by obtaining full-text copies of the studies in the 'possibly include' category.

MAIN RESULTS

We did not identify any randomised controlled trials in this subject area.

AUTHORS' CONCLUSIONS

High-quality evidence about the usefulness of electronic AT for children and young people with visual impairment is needed to inform the choice healthcare and education providers and family have to make when selecting a technology. Randomised controlled trials are needed to assess the impact of AT. Research protocols should carefully select outcomes relevant not only to the scientific community, but more importantly to families and teachers. Functional outcomes such as reading accuracy, comprehension and speed should be recorded, as well as the impact of AT on independent learning and quality of life.

Optical reading aids for children and young people with low vision

BACKGROUND

Low vision in childhood is a significant barrier to learning and development, particularly for reading and education. Optical low vision aids may be used to maximise the child's functional vision. The World Health Organization (WHO) has previously highlighted the importance of the use of low vision aids in managing children with visual impairment across the world.

OBJECTIVES

To assess the effect of optical low vision aids on reading in children and young people with low vision.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2015), EMBASE (January 1980 to January 2015), the Health Technology Assessment Programme (HTA) (www.hta.ac.uk/), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 8 January 2015.We also used manual searching to check the references listed in retrieved articles. Manufacturers of low vision aids were contacted to request any information about studies or research regarding their products.

SELECTION CRITERIA

We planned to include randomised controlled trials (RCTs) and quasi-RCTs where any optical low vision aid was compared to standard refractive correction in children and young people aged between 5 and 16 years of age with low vision as defined by the WHO. We planned to include within-person design studies where the order of presentation of devices was randomised.

DATA COLLECTION AND ANALYSIS

Two authors independently reviewed the search results for eligibility .

MAIN RESULTS

No studies met the inclusion criteria for this review.

AUTHORS' CONCLUSIONS

There is a lack of good quality evidence regarding the use of optical low vision aids in children and young people. As such, no implications for practice can be drawn. We believe future research should include functional outcome measures such as reading speed, accuracy and comprehension, as well as the effect of low vision aids on quality of life, in order to truly assess and compare the effect of these devices on a child's life and development.

Crowded task performance in visually impaired children: magnifier versus large print

BACKGROUND

This study compares the influence of two different types of magnification (magnifier versus large print) on crowded near vision task performance.

METHODS

Fifty-eight visually impaired children aged 4-8 years participated. Participants were divided in two groups, matched on age and near visual acuity (NVA): [1] the magnifier group (4-6 year olds [n = 13] and 7-8 year olds [n = 19]), and [2] the large print group (4-6 year olds [n = 12] and 7-8 year olds [n = 14]). At baseline, single and crowded Landolt C acuity were measured at 40 cm without magnification. Crowded near vision was measured again with magnification. A 90 mm diameter dome magnifier was chosen to avoid measuring the confounding effect of navigational skills. The magnifier provided 1.7× magnification and the large print provided 1.8× magnification. Performance measures: [1] NVA without magnification at 40 cm, [2] near vision with magnification, and [3] response time. Working distance was monitored.

RESULTS

There was no difference in performance between the two types of magnification for the 4-6 year olds and the 7-8 year olds (p's = .291 and .246, respectively). Average NVA in the 4-6 year old group was 0.95 logMAR without and 0.42 logMAR with magnification (p < .001). Average NVA in the 7-8 year was 0.71 logMAR without and 0.01 logMAR with magnification (p < .001). Stronger crowding effects predicted larger improvements of near vision with magnification (p = .021).

CONCLUSIONS

A magnifier is equally effective as large print in improving the performance of young children with a range of visual acuities on a crowded near vision task. Visually impaired children with stronger crowding effects showed larger improvements when working with magnification.

Adaptive behavior of primary school students with visual impairments: the impact of educational settings

This study explored the adaptive behavior of primary school students with visual impairments, as well as the impact of educational setting on their adaptive behavior. Instrumentation included an informal questionnaire and the Vineland Adaptive Behavior Scales. Participants were 36 primary school students with visual impairments. The educational setting had an effect on Daily Living Skills and Socialization. Students with visual impairments visiting special schools present worse adaptive behavior (higher developmental delay) compared to students visiting mainstream schools. Moreover, the educational level of parents influences the developmental delay on the Communication and Socialization. The higher the educational level of parents the lower the developmental delay.

Comparison of reading performance between visually impaired and normally sighted students in Malaysia

The aim of this study is to compare reading performance between visually impaired and normally sighted school children. Participants ( n = 299) were divided into three groups: normal vision (NV, n = 193), visually impaired print reader (PR, n = 52), and Braille reader (BR, n = 54). Reading performance was determined by measuring reading rate and comprehension. ANOVA was used to compare the results. A statistically significant difference was found in reading rate between the three groups ( p < 0.0001). The BR had the lowest reading rate compared to other groups. Only a small percentage of the visually impaired children were able to achieve a reading rate within the normal values of normally sighted children. Results of the comprehension test showed no significant difference in the scores of the three groups ( p = 0.232). The findings of this study suggests that visually impaired students required a longer time to read and understand a text and this has implications on the time given to them, especially during examinations.

Adaptive behavior of children and adolescents with visual impairments

The present study explored the total adaptive behavior of children and adolescents with visual impairments, as well as their adaptive behavior in each of the domains of Communication, Daily Living Skills, and Socialization. Moreover, the predictors of the performance and developmental delay in adaptive behavior were investigated. Instrumentation included an informal questionnaire and the Vineland Adaptive Behavior Scales (Survey Form). Forty-six children and adolescents with visual impairments participated. The results reveal the effect of age on total adaptive behavior and on each of the domains of Communication, Daily Living Skills, and Socialization; the older individuals with visual impairments present better performance but also a higher rate of delay in comparison with younger individuals. Moreover, the ability of independent movement is a predictor of performance and developmental delay on the Daily Living Skills and Socialization. The more independent the mobility of individuals with visual impairments is the better the performance and the lower the level of developmental delay. Moreover, the educational level of parents is a predictor of performance and developmental delay on the Communication and Socialization. The higher the educational level of parents the better the performance and the lower the developmental delay.

Reading errors made by children with low vision*

Previous research has shown that, on average, children with low vision lag their sighted peers in general reading development (in terms of speed, accuracy and comprehension). This study sought to examine this apparent lag by comparing the reading profiles of 25 normally sighted readers (mean age 8 years 8 months) with 25 low vision readers. The children were tested using a reading test (the Neale Analysis of Reading Ability, NARA) and were matched on the reading accuracy score produced by the test. Therefore in terms of the reading accuracy scores (and reading ages) derived from the NARA both groups were the same. The low vision readers were on average older than the normally sighted children (mean = 10 years, 5 months). When the reading profile (i.e. accuracy, comprehension and speed) was examined in the same analysis no significant effect was revealed [d.f. = 1, 48; F = 0.05; p > 0.1], but a general lag for these children is suggested (in keeping with previous research). However, a closer analysis of the reading error profile revealed the most common reading errors made by all readers in the analysis were either mispronunciations or substitutions. The low vision readers were more prone to making substitution errors than mispronunciations and the reverse was true for normally sighted readers [d.f. = 1, 48; F = 7.1; p < 0.05]. This indicates that the reading strategies adopted by low vision readers may differ from those of normally sighted readers of the same apparent reading ability.