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Shimizu T, Miura Y. A screening method for visual attention disabilities in cerebral palsy with periventricular leukomalacia. Brain Dev 2023; 45:564-570. [PMID: 37516579 DOI: 10.1016/j.braindev.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Patients with periventricular leukomalacia (PVL) have been reported to have a variety of complications; however, whether these involve impaired visual attention disabilities remains unclear. Therefore, this study aimed to investigate the presence or absence and degree of visual attention disabilities in patients with PVL and propose a screening test that would allow anyone to check for visual attention disabilities easily. METHODS The study participants were 14 patients with PVL and seven controls with dyskinetic cerebral palsy. All participants performed three types of visual attention tasks: spatial attention tasks, feature-based attention tasks, and object-based attention tasks. The participants also performed counting tasks to determine how many squares of the same size and color could be counted (up to nine). Receiver operating characteristic analysis was used to calculate cutoff values, with disability as the objective variable and the value of the counting task as the explanatory variable. RESULTS The results revealed that patients with PVL often had visual attention disabilities, as indicated by a significant reduction in tasks requiring divided attention. Visual attention disabilities could be detected by a score of ≤8 in the square counting task. CONCLUSIONS These findings suggest that family members and teachers of patients with PVL can easily screen for visual attention disabilities at home and school to improve mobility precautions in patients with this disability.
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Affiliation(s)
- Toshiyuki Shimizu
- Department of Rehabilitation, Central Hospital, Hyogo Prefectural Rehabilitation Center, Japan; Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Japan.
| | - Yasushi Miura
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Japan
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Morelli F, Catalano G, Scognamillo I, Balzarotti N, Luparia A, Olivier L, Bertone C, Gori M, Signorini S. Visual Function and Neuropsychological Profiling of Idiopathic Infantile Nystagmus. Brain Sci 2023; 13:1348. [PMID: 37759948 PMCID: PMC10526276 DOI: 10.3390/brainsci13091348] [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: 08/10/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Though considered a benign condition, idiopathic infantile nystagmus (IIN) may be associated with decreased visual acuity and oculo-motor abnormalities, resulting in developmental delays and poor academic performance. Nevertheless, the specific visual function profile of IIN and its possible impact on neuropsychological development have been poorly investigated. To fill this gap, we retrospectively collected the clinical data of 60 children presenting with IIN over a 10-year period (43 male; mean age of 7 years, range of 2 months-17 years, 9 months). The majority of the subjects in our cohort presented with reduced visual acuity for far distances and normal visual acuity for near distances, associated with oculo-motor abnormalities. The overall scores of cognitive and visual-cognitive tests were in the normal range, but revealed peculiar cognitive and visual-cognitive profiles, defined by specific frailties in processing speed and visual-motor integration. The same neuropsychological profiles characterize many neurodevelopmental disorders and may express a transnosographic vulnerability of the dorsal stream. As the first study to explore the neuropsychologic competencies in children with IIN, our study unveils the presence of subclinical frailties that need to be addressed to sustain academic and social inclusion.
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Affiliation(s)
- Federica Morelli
- Department of Brain and Behavioral Sciences, University of Pavia, Via Agostino Bassi 21, 27100 Pavia, Italy; (F.M.); (I.S.)
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; (A.L.); (L.O.); (S.S.)
| | - Guido Catalano
- Department of Brain and Behavioral Sciences, University of Pavia, Via Agostino Bassi 21, 27100 Pavia, Italy; (F.M.); (I.S.)
| | - Ilaria Scognamillo
- Department of Brain and Behavioral Sciences, University of Pavia, Via Agostino Bassi 21, 27100 Pavia, Italy; (F.M.); (I.S.)
| | - Nicolò Balzarotti
- Unit for Visually Impaired People, Istituto Italiano di Tecnologia, Via Enrico Melen 82, 16100 Genova, Italy; (N.B.); (M.G.)
| | - Antonella Luparia
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; (A.L.); (L.O.); (S.S.)
| | - Lucrezia Olivier
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; (A.L.); (L.O.); (S.S.)
| | - Chiara Bertone
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Monica Gori
- Unit for Visually Impaired People, Istituto Italiano di Tecnologia, Via Enrico Melen 82, 16100 Genova, Italy; (N.B.); (M.G.)
| | - Sabrina Signorini
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; (A.L.); (L.O.); (S.S.)
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Castricum J, Tulen JHM, Taal W, Pel JJM, Elgersma Y. Visual-spatial and visuomotor functioning in adults with neurofibromatosis type 1. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:362-374. [PMID: 36625000 DOI: 10.1111/jir.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a neurodevelopmental genetic disorder associated with visual-spatial and visuomotor deficits, which have not been studied well in adults with NF1. METHODS In 22 adults with NF1 and 31 controls, visuomotor functioning was assessed by measuring eye latency, hand latency and hand accuracy during visuomotor tasks. Visual-spatial functioning was assessed by measuring eye movement responses during the Visual Threshold Task. RESULTS The NF1 group had a significantly shorter eye latency than the control group and was less accurate in their hand movements during specific visuomotor tasks. The groups showed no differences in eye movement responses during the Visual Threshold Task and in hand latency during the visuomotor tasks. CONCLUSIONS In contrast to studies in children with NF1, we found no alterations in visual-spatial information processing in adults. Impairments in eye latency and hand accuracy during specific visuomotor tasks may indicate deficits in visuomotor functioning in adults with NF1.
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Affiliation(s)
- J Castricum
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J H M Tulen
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W Taal
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Neurology/Neuro-oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - J J M Pel
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Y Elgersma
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Neurology/Neuro-oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
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Tanke N, Barsingerhorn AD, Goossens J, Boonstra FN. The Developmental Eye Movement Test Does Not Detect Oculomotor Problems: Evidence from Children with Nystagmus. Optom Vis Sci 2022; 99:711-717. [PMID: 35914094 PMCID: PMC9470044 DOI: 10.1097/opx.0000000000001930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The Developmental Eye Movement (DEM) test, a test purported to assess oculomotor skills, does not detect eye movement disorder in nystagmus syndromes. The test should not be used for the clinical evaluation of oculomotor disorders. PURPOSE The DEM test ratio compares a horizontal number naming subtest with a vertical one to identify oculomotor problems independent of a child's visual-verbal naming skills. Here, we tested the construct validity of this method by comparing scores of children with and without pathologic nystagmus. Such a nystagmus disturbs normal fixation and saccadic behavior because of the presence of involuntary rhythmic oscillations of the eyes. Therefore, if the ratio is indeed a comprehensive measure of oculomotor problems, children with nystagmus should show an increased ratio score. METHODS The DEM test performances of normally sighted children (n = 94), children with ocular visual impairments (VI o ; n = 33), and children with cerebral visual impairment (n = 30) were analyzed using linear regression. Part of the children with VI o and cerebral visual impairment had either fusion maldevelopment nystagmus syndrome (n = 8) or infantile nystagmus syndrome (n = 20), whereas the others showed no pathologic nystagmus. RESULTS The times needed for the horizontal and vertical subtests were significantly different between children with normal vision, VI o , and cerebral visual impairment ( P < .001). However, the presence of nystagmus did not add significantly to the horizontal and vertical times ( P > .20), nor did it have an effect on the ratio ( P > .10). CONCLUSIONS The DEM test ratio is not sensitive to fixation and saccade abnormalities associated with nystagmus, indicating that it does not have general construct validity to detect true eye movement disorders. Although not suitable for the evaluation of oculomotor disorders, the subtests do have clinical relevance in the diagnosis of cerebral visual impairment.
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Affiliation(s)
- Nouk Tanke
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Annemiek D. Barsingerhorn
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Biophysics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jeroen Goossens
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - F. Nienke Boonstra
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, the Netherlands
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Nijmegen, the Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands
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Kooiker MJG, van Gils MM, van der Zee YJ, Swarte RMC, Smit LS, Loudon S, van der Steen S, Reiss IKM, Pel JJM, van der Steen J. Early Screening of Visual Processing Dysfunctions in Children Born Very or Extremely Preterm. Front Hum Neurosci 2021; 15:729080. [PMID: 34790105 PMCID: PMC8591256 DOI: 10.3389/fnhum.2021.729080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Children with early brain damage or dysfunction are at risk of developing cerebral visual impairment (CVI), including visual processing dysfunctions (VPD), which currently remain largely undetected until school age. Our aim was to systematically screen for possible VPD in children born very or extremely preterm from 1 to 2 years corrected age (CA) and to evaluate the effectiveness of early referral. Method: We included N = 48 children born < 30 weeks from 1 year CA. They underwent a two-step VPD screening based on (1) neurological signs indicative of visual brain damage evaluated by neonatologists and/or pediatric neurologist and (2) a functional assessment of visual orienting functions (VOF) with an eye tracking-based test. If at least one of these assessments was abnormal for their age, the children were classified as a risk of VPD and referred to undergo conventional visual diagnostics: ophthalmic exam and visual function assessment (VFA). At 2 years CA, VOF screening was repeated and neurodevelopment was assessed. Results: 18 children (38%) were classified as at risk of VPD at 1 year CA. 7 children had abnormal neurological signs, 5 children had abnormal VOF, and 6 children had both. Subsequent ophthalmic exams (N = 14) showed severe hypermetropia in 21% and strabismus in 14%. VFA (N = 10) showed abnormal visual function and behavior in only 1 child. At 2 years CA, the total group showed an increase in abnormal VOF. Whereas the children at risk showed some normalization, the group without VPD risk at 1 year CA showed deterioration of VOF. Neurodevelopmental outcome did not clearly differ between risk groups. Conclusion: Our findings show a substantial risk of VPD during visual screening (in 38%) at 1 year CA, but relatively few deficits on subsequent conventional ophthalmic exams and VFA. The data suggest that most conventional visual diagnostic methods at this young age are not related to the established VPD risks. VOF assessment should be used complimentary to these methods. The fact that at 2 years CA the number of children with a VPD risk based on abnormal VOF increased argues for more extensive and continuous screening in risk groups, at least until school age.
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Affiliation(s)
- Marlou J G Kooiker
- Department Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Royal Dutch Visio, Heerhugowaard, Netherlands
| | - Maud M van Gils
- Department Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Department Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Renate M C Swarte
- Division of Neonatology, Department Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Liesbeth S Smit
- Division of Neonatology, Department Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Division of Pediatric Neurology, Department Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Sjoukje Loudon
- Department Pediatric Ophthalmology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Irwin K M Reiss
- Division of Neonatology, Department Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Johan J M Pel
- Department Neuroscience, Erasmus MC, Rotterdam, Netherlands
| | - Johannes van der Steen
- Department Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Royal Dutch Visio, Huizen, Netherlands
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Kooiker MJG, Pel JJM, van der Steen-Kant SP, van der Steen J. A Method to Quantify Visual Information Processing in Children Using Eye Tracking. J Vis Exp 2016:54031. [PMID: 27500922 PMCID: PMC4993407 DOI: 10.3791/54031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Visual problems that occur early in life can have major impact on a child's development. Without verbal communication and only based on observational methods, it is difficult to make a quantitative assessment of a child's visual problems. This limits accurate diagnostics in children under the age of 4 years and in children with intellectual disabilities. Here we describe a quantitative method that overcomes these problems. The method uses a remote eye tracker and a four choice preferential looking paradigm to measure eye movement responses to different visual stimuli. The child sits without head support in front of a monitor with integrated infrared cameras. In one of four monitor quadrants a visual stimulus is presented. Each stimulus has a specific visual modality with respect to the background, e.g., form, motion, contrast or color. From the reflexive eye movement responses to these specific visual modalities, output parameters such as reaction times, fixation accuracy and fixation duration are calculated to quantify a child's viewing behavior. With this approach, the quality of visual information processing can be assessed without the use of communication. By comparing results with reference values obtained in typically developing children from 0-12 years, the method provides a characterization of visual information processing in visually impaired children. The quantitative information provided by this method can be advantageous for the field of clinical visual assessment and rehabilitation in multiple ways. The parameter values provide a good basis to: (i) characterize early visual capacities and consequently to enable early interventions; (ii) compare risk groups and follow visual development over time; and (iii), construct an individual visual profile for each child.
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Kooiker MJG, Pel JJM, van der Steen J. Viewing behavior and related clinical characteristics in a population of children with visual impairments in the Netherlands. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1393-1401. [PMID: 24713519 DOI: 10.1016/j.ridd.2014.03.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 06/03/2023]
Abstract
Children with visual impairments are very heterogeneous in terms of the extent of visual and developmental etiology. The aim of the present study was to investigate a possible correlation between prevalence of clinical risk factors of visual processing impairments and characteristics of viewing behavior. We tested 149 children with visual information processing impairments (90 boys, 59 girls; mean age (SD)=7.3 (3.3)) and 127 children without visual impairments (63 boys and 64 girls, mean age (SD)=7.9 (2.8)). Visual processing impairments were classified based on the time it took to complete orienting responses to various visual stimuli (form, contrast, motion detection, motion coherence, color and a cartoon). Within the risk group, children were divided into a fast, medium or slow group based on the response times to a highly salient stimulus. The relationship between group specific response times and clinical risk factors was assessed. The fast responding children in the risk group were significantly slower than children in the control group. Within the risk group, the prevalence of cerebral visual impairment, brain damage and intellectual disabilities was significantly higher in slow responding children compared to faster responding children. The presence of nystagmus, perceptual dysfunctions, mean visual acuity and mean age did not significantly differ between the subgroups. Orienting responses are related to risk factors for visual processing impairments known to be prevalent in visual rehabilitation practice. The proposed method may contribute to assessing the effectiveness of visual information processing in children.
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Affiliation(s)
- M J G Kooiker
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - J J M Pel
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - J van der Steen
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Royal Dutch VISIO, Postbus 1180, 1270 BD Huizen, The Netherlands.
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