Assessment of Motor Skills in Children With Visual Impairment: A Systematic and Integrative Review

Comparing paediatric optometric vision care in Canada over a 14-year period

PURPOSE

In Canada, teaching in paediatric eye care has increased in the past decade both within the optometry curriculum and as continuing education to optometrists. Paediatric vision care guidelines have also been established by North American optometric associations. This study examined whether this exposure was associated with changes in paediatric eye care in Canada over a 14-year period.

METHODS

Canadian optometrists were invited to participate in an anonymous 35-item survey in 2007 and 2021. The surveys sought to investigate optometrist's recommendations for first eye examinations, the number of paediatric patients seen in a typical week and preparedness to provide eye examinations to children. Response frequencies were determined for each survey item.

RESULTS

Across Canada, 133/1000 (13.3%) and 261/~6419 (~4.1%) optometrists responded to the survey in 2007 and 2021, respectively. No significant difference was found in the number of years practicing, days per week in practice and total number of patients seen per week. The modal age optometrists recommended children be seen for their first eye examination changed from 3-4 years in 2007 (53%) to 6-12 months in 2021 (61%). In 2007, 87% of respondents provided eye examinations to children <2 years, increasing to 94% in 2021 (p = 0.02). Despite a reduction in the recommended age between the two survey years, the most frequent age children were seen for their first eye examination was 3-4 years (30% in both surveys) and the most common age seen in a typical week remained unchanged (4-6 years-56% 2007; 66% 2021).

CONCLUSION

Although optometrists' willingness to provide paediatric eye care increased over the past 14 years, the number of children seen in a typical week did not change. Barriers to determine why more children are not being seen at an earlier age need to be investigated.

Physical activity and sport practice to improve balance control of visually impaired individuals: a narrative review with future perspectives

Visual disability negatively impacts balance, everyday self-efficacy, and mobility and often leads affected subjects to perceive physical exercise as a burdensome challenge thus discouraging them from practicing. Despite the well-proven benefits of regular physical activity in visually impaired people, especially addressing postural control, there are no specific guidelines and most of the available literature seems to be flawed by critical issues. Given the wide heterogeneity and the multidimensional needs of this population, a more realistic and target-specific perspective is needed in order to properly investigate and promote exercise practice and adherence for balance improvement. On this basis, through a critical overview of the recent literature, the present article aimed to enrich the current knowledge about this topic by providing innovative suggestions, both practical and methodological, and specifically deepening the disability-related deficits and peculiarities of different age ranges. Moreover, since a multidisciplinary approach is advisable when designing and leading exercise protocols tailored to visually impaired individuals, such innovative hints also highlighted the central role of the adapted physical activity specialist, hence contributing to foster its official professional recognition and involvement in this field.

A review of the essential visual skills required for soccer: Beyond 20-20 optometry

In ball sports such as soccer, the visual system is critical in guiding a player's search for crucial information that underpins skillful behavior, which requires the incorporation of all of the relevant information in the environment in order to make successful decisions under pressure. However, vision in sport, and focusing on the specific visual skills required to be successful in a particular sport has largely been a practice ignored by experts and coaches as being an essential component of athletic performance. This is the first attempt to summarize and compile the necessary visual skills for soccer. This review's evidence suggests that, while current research still tends to focus on visual skills as a whole, there is a need to streamline this focus to the necessities of a particular sport. Furthermore, in identifying the visual skills essential for soccer, it allows for the effective training and testing of these skills, as well as for talent identification.

Sex differences on the relation among gross motor competence, cognition, and academic achievement in children

An association between gross motor competence (GMC) and academic achievement (AA) has been described, but the potential mechanisms behind this association are still unknown. It is not known either whether these mechanisms are similar for boys and girls. The aim of this study was to analyse whether the association between GMC and AA is mediated by executive functions (EFs), and to investigate whether this mediation differs by sex. This cross-sectional study involved 451 children aged 8 to 10 (234 girls; mean age 9.95 ± 0.59). The Movement Assessment Battery for Children-Second Edition (MABC-2), NIH Toolbox, and grades in language and mathematics were used to test GMC, EFs, and AA, respectively. Multifactorial structural equation model (SEM) was used to evaluate a possible relation between variables, controlling for confounders. The differences by sex were examined using a multi-group SEM approach. The results showed that EFs acted as a full mediator of the relationship between GMC and AA in boys (β = 0.14, p = 0.012) but not in girls (β = 0.10, p = 0.326). These results show that the benefit of GMC on AA is mediated by EFs in boys but not in girls. Nevertheless, these conclusions should be carefully considered due to the cross-sectional nature of the study.

A Study of Improving Independent Walking Outcomes in Children Who Are Blind or Have Low Vision Aged 5 Years and Younger

Walking alone (without assistance) is considered by the World Health Organization as the terminal independent walking milestone, typically achieved by 18 months. Children born with severe visual impairment and blindness (visual impairments) do not achieve independent walking milestones on time. This study examined independent walking in 35 children with visual impairments (VIs) aged 14–69 months. Before treatment, they had limited to no anticipatory control. Wearing the pediatric belt cane (PBC) provided them with consistent, tactile anticipatory control. Thirty-five participants with VIs’ independent walking milestones were analyzed using pre- and post-video recordings provided weekly 1 month before and the 3 months after obtaining the PBC. The PBC consisted of a rectangular frame that connects to a custom-made belt with magnets. The PBC provided no weight support. While none of the participants had motor impairments, 80% of them were receiving physical therapy services prior to obtaining a PBC. Fifty-four percent were receiving orientation and mobility services, and half were equipped with hand-held mobility tools (long canes, adaptive mobility devices, push toys, and reverse walkers). A paired samples t-test indicated a significant difference between the before and with PBC scores ( N = 35, t = −13.0, df = 34, p = .000). Participants demonstrated significantly improved independent walking after wearing their PBC regularly over 3 months. Before PBC, the participants demonstrated delayed independent walking milestones. Most participants walked only with assistance. Those who walked independently experienced unavoidable bodily collisions and used a slow pace with poor gait patterns. After being provided PBCs, these same participants’ independent walking milestones improved, all but three were walking independently and five were observed independently running. Wearing their PBCs allowed them to perform motor skills, like running, often described as needing to be specifically taught to learners with VIs due to their inability to learn incidentally through visual observation.

The Brief Form of the Test of Gross Motor Development-3 for Individuals with Visual Impairments

Children with visual impairments (VI) tend to struggle with their fundamental motor skills (FMS), and these difficulties often persist across the lifespan, requiring frequent assessment. The Test of Gross Motor Development (TGMD) shows robust psychometric properties for children with VI. The TGMD, which includes 13 skills, is time-consuming to administer and score, warranting the need to explore brief versions. Therefore, the purpose of this study was to explore the psychometric properties of three, six-skill versions of the TGMD-3 with children with VI. Children (n = 302; Boys = 58%, Girls = 42%; Mage = 13.00, SD = 2.50 years) with VI (B1 = 27%, B2 = 20%, B3 = 38%, B4 = 15%) participated in this study. We examined three different models using confirmatory factor analyses on the relationships between the motor skills and latent traits across the models. Scores from all three brief versions had acceptable global fit. Although further research should be conducted, practitioners can adopt a brief version of the TGMD to assess children with VI.

The associations between vision level and early hand use in children aged 6–36 months with visual impairment: A cross-sectional, historical case note review

Vision level varies within the population of children born with visual impairment (VI). Children with profound visual impairment (PVI – with light awareness at best) are more developmentally vulnerable than peers born with typical sight or those with severe visual impairment (SVI – basic form vision). Many children with VI are dependent on their hand skills to support their development. However, the impact of vision level on the development of hand use is poorly understood. The aim of the study was to describe the associations between vision level and early hand use in children between 6 and 36 months of age with SVI and PVI. A historical case note review, including video footage of 19 children with SVI ([Formula: see text] = 19 months) and 12 children with PVI ([Formula: see text] = 16 months), was completed. Hand use was observed while the children completed the Reynell-Zinkin Scales. Observations were recorded using a data collection tool designed for the study. The tool included a checklist of developmentally appropriate hand skills expected to emerge in the first 3 years of life. The observer marked each skill as present, absent or emerging in the video clips. Children with SVI used 80.2% (95% confidence interval [CI] = [75.0, 87.5]) of the hand skills under observation. Those with PVI used 57.1% (95% CI = [46.4, 67.9]) of these skills. Vision level and hand use were positively correlated: rs  = .564 (95% CI = [.263, .765]), p < .01. This correlation was stronger than the association between developmental level and hand use: r  = .364 (95% CI = [.012, .636]), p < .05. Furthermore, 15.8% (95% CI = [0.0, 31.6]) of the children with SVI and 66.7% (95% CI = [41.7, 91.7]) with PVI showed some reluctance to touch objects ( p < .05) by withdrawing their hands actively from items offered to them. Vision level and developmental level influenced hand use; however, vision level appeared to have the greater impact. Interventions that are tailored to promote hand use according to vision level have the potential to improve functional participation.

Bone characteristics and physical fitness in children and adolescents with visual impairment

BACKGROUND

Lower habitual physical activity in adolescents with visual impairment (VI) have detrimental effect on their general health such as bone quality and physical fitness. The aim of this study was to demonstrate the bone quality in children with VI and to analyze the correlations of their bone characteristics with anthropometric and physical fitness tests.

METHODS

The participants (N=38) were adolescents (14.85±2.79yrs) with low vision (n=18) or blindness (n=20). Dual-energy-X-ray absorptiometry (DEXA) was used to measure bone mineral density (BMD), bone mineral content (BMC) of the total body and L1-L4 of the lumbar spinal region. After anthropometry physical fitness was examined by laboratory test (VO2peak) and field tests (strength and running).

RESULTS

Height, weight, body mass index (BMI), VO2peak were similar in the two groups. Blind boys showed significant higher handgrip strength. Estimated VO2peak (from 20-m shuttle running test) was significantly lower in blind children (43.84±4.42ml/kg/min) than in children with low vision (35.08±5.23ml/kg/min;p<0.001). BMD and BMC did not differ in subgroups, Z-score of total body BMD was significantly lower in blind children. Means of Z-score in L1-L4 lumbal spinal region were negative values and similar in blind and low vision adolescents' subgroups. A linear regression model in the collective group revealed significant associations of BMD (r2=0.538;p=0.0001) and BMC (r2=0.698;p=0.048) with BMI and handgrip strength test.

CONCLUSIONS

Adolescents with VI have generally decreased bone health and physical fitness level. BMI and handgrip strength are predictors of total body BMD and BMC. Suggesting that these measures may be adequate to estimate bone health.

Characterizing upper limb function in the context of activities of daily living in CLN3 disease

In CLN3 disease, impairments in motor function are frequently reported to have later onset compared to visual and cognitive decline, but upper limb motor function has yet to be explored in this population. In a cohort of 22 individuals with CLN3, we used a novel application of multiple measures to (1) characterize motor function, particularly of the upper limbs, in activities of daily living (ADLs), and (2) explore associations between motor function and age as well as visual ability, disease severity, and cognitive function, as evaluated by the Unified Batten Disease Rating Scale (UBDRS), a validated CLN3 disease measure. ADLs that required coordination, speed, and fine motor control were particularly challenging for children with CLN3 based on item-level performance across direct assessments (Jebsen-Taylor Hand Function Test [JTHFT] and MyoSet Tools) and caregiver reports (Pediatric Evaluation of Disability Inventory-Computer Adaptive Testing [PEDI-CAT] and Patient-Reported Outcomes Measurement Information System [PROMIS] Pediatric Upper Extremity). Poorer visual ability, disease severity, and cognitive function were associated with worse performance on these measures, whereas age had limited impact. These findings support the need for children with CLN3 to receive skilled clinical evaluation and treatment tailored to their individual needs, particularly in the context of ADLs, as their symptom profile progresses.

Visual Impairment among Primary School Children in Gondar Town, Northwest Ethiopia

Background

An impairment of the visual system at or shortly after birth adversely affects educational performance of children which typically occurs through vision. Limited evidence on the magnitude and causes of visual impairment is one of the reasons for the low priority given to eye care in low-income countries.

Objectives

To estimate the prevalence and determine the causes of visual impairment in primary school children in Gondar town, Northwest Ethiopia.

Materials and Methods

A descriptive cross-sectional study was conducted among 1289 children aged 5–15 years who were randomly selected in 9 primary schools (government and private) from May to June 2016. Visual acuity was measured at 6 m using Snellen's chart, and children with an acuity of less than 6/18 in the better eye underwent refraction and a detailed eye examination. A cause of their impairment was determined. Data were recorded using pretested tools. . Statistical Package for Social Sciences version 16 was used to enter and analyze the data using 95% confidence intervals.

Results

The prevalence of visual impairment was 1.8%. Refractive errors (nearly 70%) followed by strabismus and cataract, each contributing 4.3%, were the most frequent causes of visual impairment in the study population. Majority (87%) of the children had moderate degree of vision impairment, and 10–15-year age groups are the more affected ones. Children of age fifteen and above showed statistically significant association with visual impairment (p=0.005).

Conclusion

The magnitude of visual impairment in primary school children in the study area is significant. School screening programme is recommended to minimize the burden of visual impairment in the study area.