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Pandey A, Neupane S, Adhikary S, Vaidya K, Pack CC. Cortical visual impairment at birth can be improved rapidly by vision training in adulthood: A case study. Restor Neurol Neurosci 2022; 40:261-270. [PMID: 37038774 DOI: 10.3233/rnn-221294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Cortical visual impairment (CVI) is a severe loss of visual function caused by damage to the visual cortex or its afferents, often as a consequence of hypoxic insults during birth. It is one of the leading causes of vision loss in children, and it is most often permanent. OBJECTIVE Several studies have demonstrated limited vision restoration in adults who trained on well-controlled psychophysical tasks, after acquiring CVI late in life. Other studies have shown improvements in children who underwent vision training. However, little is known about the prospects for the large number of patients who acquired CVI at birth but received no formal therapy as children. METHODS We, therefore, conducted a proof-of-principle study in one CVI patient long after the onset of cortical damage (age 18), to test the training speed, efficacy and generalizability of vision rehabilitation using protocols that had previously proven successful in adults. The patient trained at home and in the laboratory, on a psychophysical task that required discrimination of complex motion stimuli presented in the blind field. Visual function was assessed before and after training, using perimetric measures, as well as a battery of psychophysical tests. RESULTS The patient showed remarkably rapid improvements on the training task, with performance going from chance to 80% correct over the span of 11 sessions. With further training, improved vision was found for untrained stimuli and for perimetric measures of visual sensitivity. Some, but not all, of these performance gains were retained upon retesting after one year. CONCLUSIONS These results suggest that existing vision rehabilitation programs can be highly effective in adult patients who acquired CVI at a young age. Validation with a large sample size is critical, and future work should also focus on improving the usability and accessibility of these programs for younger patients.
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Affiliation(s)
- Ashim Pandey
- Department of Neuro-ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Sujaya Neupane
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Boston, USA
| | - Srijana Adhikary
- Department of Pediatric Ophthalmology and Strabismus, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Keepa Vaidya
- Department of Neuro-ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Christopher C Pack
- Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
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Jayaraman D, Jacob N, Swaminathan M. Visual function assessment, ocular examination, and intervention in children with developmental delay: A systematic approach - Part 2. Indian J Ophthalmol 2021; 69:2012-2017. [PMID: 34304167 PMCID: PMC8482894 DOI: 10.4103/ijo.ijo_2396_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In India, there is increasing number of children with development delay and vision impairment with or without additional disabilities due to prematurity, brain damage, cerebral palsy, or genetic syndromes. Despite initiatives from Government of India, early intervention for these children remains a challenge across the country due to lack of trained professionals and appropriate resources. This paper describes the developmental screening tools, intervention aspects including Individualized Education Plan, procedures for handling children with cerebral visual impairment, team approach, and guidelines derived from the inputs of experts in vision rehabilitation centers of premier eye institutes in India
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Affiliation(s)
- Deiva Jayaraman
- Rehabilitation Specialist, Institute for Vision Rehabilitation, LV. Prasad Eye Institute, Hyderabad, Telengana, India
| | | | - Meenakshi Swaminathan
- Department of Pediatric Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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3
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Kooiker MJG, van der Linden Y, van Dijk J, van der Zee YJ, Swarte RMC, Smit LS, van der Steen-Kant S, Loudon SE, Reiss IKM, Kuyper K, Pel JJM, van der Steen J. Early intervention for children at risk of visual processing dysfunctions from 1 year of age: a randomized controlled trial protocol. Trials 2020; 21:44. [PMID: 31915035 PMCID: PMC6950993 DOI: 10.1186/s13063-019-3936-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/26/2019] [Indexed: 11/28/2022] Open
Abstract
Background An increasing number of children are suffering from brain damage-related visual processing dysfunctions (VPD). There is currently a lack of evidence-based intervention methods that can be used early in development. We developed a visual intervention protocol suitable from 1 year of age. The protocol is structured, comprehensive and individually adaptive, and is paired with quantitative outcome assessments. Our aim is to investigate the effectiveness of this first visual intervention program for young children with (a risk of) VPD. Methods This is a single-blind, placebo-controlled trial that is embedded within standard clinical care. The study population consists of 100 children born very or extremely preterm (< 30 weeks) at 1 year of corrected age (CA), of whom 50% are expected to have VPD. First, children undergo a visual screening at 1 year CA. If they are classified as being at risk of VPD, they are referred to standard care, which involves an ophthalmic and visual function assessment and a (newly developed) visual intervention program. This program consists of a general protocol (standardized and similar for all children) and a supplement protocol (adapted to the specific needs of the child). Children are randomly allocated to an intervention group (starting upon inclusion at 1 year CA) or a control group (postponed: starting at 2 years CA). The control group will receive a placebo treatment. The effectiveness of early visual intervention will be examined with follow-up visual and neurocognitive assessments after 1 year (upon completion of the direct intervention) and after 2 years (upon completion of the postponed intervention). Discussion Through this randomized controlled trial we will establish the effectiveness of a new and early visual intervention program. Combining a general and supplement protocol enables both structured comparisons between participants and groups, and custom habilitation that is tailored to a child’s specific needs. The design ensures that all included children will benefit from participation by advancing the age at which they start receiving an intervention. We expect results to be applicable to the overall population of children with (a risk of) VPD early in life. Trial registration Netherlands Trial Register: NTR6952. Registered 19 January 2018.
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Affiliation(s)
- Marlou J G Kooiker
- Department of Neuroscience, Erasmus Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Yoni van der Linden
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, the Hague, The Netherlands
| | - Jenneke van Dijk
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, the Hague, The Netherlands
| | - Ymie J van der Zee
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Rotterdam, The Netherlands
| | - Renate M C Swarte
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Liesbeth S Smit
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Neurology, Division of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sanny van der Steen-Kant
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Sjoukje E Loudon
- Department of Pediatric Ophthalmology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kees Kuyper
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Rotterdam, The Netherlands
| | - Johan J M Pel
- Department of Neuroscience, Erasmus Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Johannes van der Steen
- Department of Neuroscience, Erasmus Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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Tsai LT, Hsu JL, Wu CT, Chen CC, Su YC. A New Visual Stimulation Program for Improving Visual Acuity in Children with Visual Impairment: A Pilot Study. Front Hum Neurosci 2016; 10:157. [PMID: 27148014 PMCID: PMC4834310 DOI: 10.3389/fnhum.2016.00157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 03/29/2016] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to investigate the effectiveness of visual rehabilitation of a computer-based visual stimulation (VS) program combining checkerboard pattern reversal (passive stimulation) with oddball stimuli (attentional modulation) for improving the visual acuity (VA) of visually impaired (VI) children and children with amblyopia and additional developmental problems. Six children (three females, three males; mean age = 3.9 ± 2.3 years) with impaired VA caused by deficits along the anterior and/or posterior visual pathways were recruited. Participants received eight rounds of VS training (two rounds per week) of at least eight sessions per round. Each session consisted of stimulation with 200 or 300 pattern reversals. Assessments of VA (assessed with the Lea symbol VA test or Teller VA cards), visual evoked potential (VEP), and functional vision (assessed with the Chinese-version Functional Vision Questionnaire, FVQ) were carried out before and after the VS program. Significant gains in VA were found after the VS training [VA = 1.05 logMAR ± 0.80 to 0.61 logMAR ± 0.53, Z = -2.20, asymptotic significance (2-tailed) = 0.028]. No significant changes were observed in the FVQ assessment [92.8 ± 12.6 to 100.8 ±SD = 15.4, Z = -1.46, asymptotic significance (2-tailed) = 0.144]. VEP measurement showed improvement in P100 latency and amplitude or integration of the waveform in two participants. Our results indicate that a computer-based VS program with passive checkerboard stimulation, oddball stimulus design, and interesting auditory feedback could be considered as a potential intervention option to improve the VA of a wide age range of VI children and children with impaired VA combined with other neurological disorders.
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Affiliation(s)
- Li-Ting Tsai
- School of Occupational Therapy, College of Medicine, National Taiwan UniversityTaipei, Taiwan
- Occupational Therapy-Low Vision Rehabilitation, University of Alabama, BirminghamAL, USA
| | - Jung-Lung Hsu
- Section of Dementia and Cognitive Impairment, Department of Neurology, Chang Gung Memorial HospitalLinkou, Taiwan
- Graduate Institute of Humanities in Medicine, Taipei Medical UniversityTaipei, Taiwan
| | - Chien-Te Wu
- School of Occupational Therapy, College of Medicine, National Taiwan UniversityTaipei, Taiwan
| | - Chia-Ching Chen
- School of Medicine, National Yang-Ming UniversityTaipei, Taiwan
| | - Yu-Chin Su
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationNew Taipei City, Taiwan
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Maitre NL. Neurorehabilitation after neonatal intensive care: evidence and challenges. Arch Dis Child Fetal Neonatal Ed 2015; 100:F534-40. [PMID: 25710178 PMCID: PMC4784692 DOI: 10.1136/archdischild-2013-305920] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/21/2015] [Indexed: 01/28/2023]
Abstract
Neonatologists and paediatric providers of developmental care have documented poor neurodevelopmental outcomes of infants who have received neonatal intensive care due to prematurity, perinatal neurological insults such as asphyxia or congenital anomalies such as congenital heart disease. In parallel, developmental specialists have researched treatment options in these high-risk children. The goal of this review is connect the main categories of poor outcomes (sensory and motor function, cognition, communication, behaviour) studied by neonatal intensive care follow-up specialists to the research focused on improving these outcomes. We summarise challenges in designing diagnostic and interventional approaches in infants <2 years of age and review the evidence for existing therapies and future treatments aimed at improving functionality.
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Affiliation(s)
- Nathalie L Maitre
- Department of Pediatrics, Division of Neonatology, Vanderbilt University, Nashville Tennessee, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee, USA
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Kreider CM, Bendixen RM, Huang YY, Lim Y. Review of occupational therapy intervention research in the practice area of children and youth 2009-2013. Am J Occup Ther 2014; 68:e61-73. [PMID: 24581415 PMCID: PMC5362028 DOI: 10.5014/ajot.2014.011114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE. We conducted a systematic review examining the extent to which pediatric intervention research recently published in the American Journal of Occupational Therapy reflects occupational therapy's holistic occupation-based tenets. METHOD. We surveyed 10 systematic reviews and analyzed 38 single effectiveness studies for intervention approach, type, level of environmental targeting, level of occupational task and participation practice, and measures used. RESULTS. Of the 38 single effectiveness studies, 12 (32%) explicitly incorporated both environmental targets of intervention and practice of complex or in vivo occupational tasks, with steady increases during the 2009-2013 time frame. CONCLUSION. In the area of children and youth, occupational therapy is making steady gains in reflecting and demonstrating the effectiveness of the profession's holistic, occupation-based tenets. Occupational therapy researchers must be mindful to ensure that despite the reductionist nature of intervention research, interventions reflect the profession's holistic understanding of the interplay between the child, environment, and occupations.
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Affiliation(s)
- Consuelo M Kreider
- Consuelo M. Kreider, PhD, OTR/L, is Research Assistant Professor, Department of Occupational Therapy, University of Florida, PO Box 100164, Gainesville, FL 32610-0164;
| | - Roxanna M Bendixen
- Roxanna M. Bendixen, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA. At the time of the study, she was Research Assistant Professor, Department of Occupational Therapy, University of Florida, Gainesville
| | - Yu Yun Huang
- Yu Yun Huang, MS, OTR, is Doctoral Student, Department of Occupational Therapy, University of Florida, Gainesville
| | - Yoonjeong Lim
- Yoonjeong Lim, MS, OT, is Doctoral Student, Department of Occupational Therapy, University of Florida, Gainesville
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Gutman SA. State of the Journal, 2013. Am J Occup Ther 2013; 67:616-23. [DOI: 10.5014/ajot.2013.009548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The American Journal of Occupational Therapy (AJOT) has developed into a solid research journal, increasingly disseminating evidence-based research able to inform practice.
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Affiliation(s)
- Sharon A. Gutman
- Sharon A. Gutman, PhD, OTR, FAOTA, is Editor-in-Chief, American Journal of Occupational Therapy, and Associate Professor, Columbia University, Programs in Occupational Therapy, New York;
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