Are rehabilitation professionals familiar with visual impairments? A survey of professional orders in Quebec, Canada.

SIGNIFICANCE: The number of patients with mild to moderate visual impairments (MVIs) is increasing as the average age of the population increases. Thus, it is important to understand the training and resources available for rehabilitation practitioners to provide adequate care to these patients within their scope of practice. PURPOSE: This study explores rehabilitation professionals' perceptions of their competence in screening and treating patients with MVI, and identifying the tools and resources needed to increase these professionals' comfort level in managing these patients. METHODS: Data collection was carried via an online questionnaire to Quebec rehabilitation professionals and student-trainees who are members of their respective professional orders. The questionnaire consisted of 29 to 30 questions (open- and close-ended) related to demographics, service provision to MVI patients, education in MVI and future training, and future service delivery to MVI patients. RESULTS: Data were collected from 96 professionals, with 52 fully completing the questionnaire, with all the responses included in the analysis. Most respondents had little or no confidence in adequately screening or treating patients with MVI and mentioned that they knew little or nothing about the range of services offered by vision rehabilitation centers in Quebec (81%), whereas 55% at least occasionally offer services to these patients. The majority felt that their profession would benefit from continuing education on MVI (73%), with a marked interest in online training. CONCLUSIONS: Rehabilitation professionals in Quebec are not confident in identifying or treating patients presenting MVI but express an interest in attending continuing education courses given by optometrists, low vision professionals, or a member of their own profession. Numerous barriers account for this problem, including a lack of experience and competence in the assessment and treatment options for MVI, as well as a lack of informational and human resources available in their workplaces.

A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications.

Individuals with multiple disabilities are among the most challenging to serve and AAC teams often lack direction in determining effective interventions. The purpose of this scoping review was to summarize the research evidence on AAC interventions for individuals with complex communication needs and simultaneous motor, and visual impairments as part of their multiple disabilities; to consider implications for practice; and to determine gaps and directions for future research. A total of 27 studies were identified and reviewed, involving 55 unique participants with multiple disabilities. Most studies focused on direct intervention to increase requesting or choice-making, with little focus on social communication. Only two studies focused on training communication partners. Results indicated that AAC interventions can be highly effective to increase communication for individuals with multiple disabilities. However, there is an urgent need for increased rigor and more detailed participant information in future AAC intervention research with this population. Future research should investigate AAC intervention to improve social communication and increase language development, not just expression of needs and wants. Future research should focus on the needs of individuals with multiple disabilities from culturally and linguistically diverse backgrounds and on implementation of AAC within natural environments.

Training and learning support for people with vision impairment in the use of smartphones and applications (apps): an exploratory Australasian survey.

INTRODUCTION: Occupational therapists working in low vision rehabilitation make recommendations for assistive technology (AT) and provide training in AT use for people with vision impairment (PVI) to support participation and independence. Smartphones and apps are an important AT for PVI, yet little is known about the training needs of PVI or what training is currently provided. Research exploring PVI's learning and training experiences is required to inform training development. PURPOSE: This study aimed to explore the perspectives, needs, and recommendations of PVI from Australia and Singapore on smartphone training methods. METHODS: An online survey collected data between November 2020 to February 2021. Participants were recruited from Australia and Singapore using purposeful sampling. The survey had three sections: (i) demographics, (ii) use of smartphones and apps, and (iii) training. It consisted of 26 closed and open-ended questions. The quantitative results from the survey were analysed descriptively, and responses to open-ended questions were analysed using content analysis. RESULTS: Sixty-eight PVI responded to the survey, with 34 (50%) participants from each country. There were more Australians (n = 19/34, 55.9%) who had accessed formal training compared to Singaporeans (n = 11/34, 32.3%). Participants valued both formal and informal training, and self-training was the most used method for informal training (Australia: n = 29/34, 85%, Singapore: n = 22/34, 64.7%). Participants stated they preferred individualised formal training that caters to their learning needs and is provided by patient and knowledgeable trainers. They also preferred formal training, which is flexible and convenient to access, including online training with peers. CONCLUSION: Findings such as providing individualised training, ensuring increased awareness of formal training, and using both formal and informal training methods can be considered by occupational therapists to enhance and develop training for PVI in the use of smartphones and apps. CONSUMER AND COMMUNITY CONSULTATION: Consumers were involved at the development stage. Three people with vision impairment reviewed and provided feedback on the survey's accessibility and content.

Interventions for perceptual disorders following stroke.

BACKGROUND: Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non-invasive brain stimulation, pharmacological and surgical approaches. OBJECTIVES: To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living.  SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain. DATA COLLECTION AND ANALYSIS: One review author assessed titles, with two review authors independently screening abstracts and full-text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB-1 tool, and quality of evidence using GRADE.  A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update. MAIN RESULTS: We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch-somatosensory disorders. None addressed stroke-related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non-invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL):  Somatosensory disorders: one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure.  Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention.  Visual perception disorders: no trials measuring ADL compared an intervention with no treatment or control.  In addition, six trials reported ADL outcomes in a comparison of active intervention versus active intervention, relating to somatosensation (three trials), touch (one trial) and vision (two trials).   AUTHORS' CONCLUSIONS: Following a detailed, systematic search, we identified limited RCT evidence of the effectiveness of interventions for perceptual disorders following stroke. There is insufficient evidence to support or refute the suggestion that perceptual interventions are effective. More high-quality trials of interventions for perceptual disorders in stroke are needed. They should recruit sufficient participant numbers, include a 'usual care' comparison, and measure longer-term functional outcomes, at time points beyond the initial intervention period. People with impaired perception following a stroke should continue to receive neurorehabilitation according to clinical guidelines.

Rehabilitation of cortically induced visual field loss.

PURPOSE OF REVIEW: Homonymous visual field defects are a common sequela of stroke, and are assumed to be permanent within a few weeks of the event. Because consensus about the efficacy of rehabilitation is lacking, visual therapy is rarely prescribed. Here, we review current rehabilitation options and strategies in the translational pipeline that could change these perspectives. RECENT FINDINGS: The mainstays of available therapy for homonymous visual defects are compensation training and substitution, which allow patients to better use their spared vision. However, early clinical studies suggest that vision can partially recover following intensive training inside the blind field. Research into the relative efficacy of different restorative approaches continues, providing insights into neurophysiologic substrates of recovery and its limitations. This, in turn, has led to new work examining the possible benefits of earlier intervention, advanced training procedures, noninvasive brain stimulation, and pharmacological adjuvants, all of which remain to be vetted through properly powered, randomized, clinical trials. SUMMARY: Research has uncovered substantial visual plasticity after occipital strokes, suggesting that rehabilitative strategies for this condition should be more aggressive. For maximal benefit, poststroke vision-restorative interventions should begin early, and in parallel with strategies that optimize everyday use of an expanding field of view.

Clinical guidelines for the management of keratoconus patients with gas permeable contact lenses based on expert consensus and available evidence.

PURPOSE OF REVIEW: Fitting rigid gas permeable contact lenses (RGP CLs) in keratoconic patients is the most common visual rehabilitation option to improve patients' quality of life, but require long patient and practitioner chair time. The purpose of this review is to provide evidence-based clinical practice guidelines (CPG) in the management of patients with keratoconus with RGP CLs. RECENT FINDINGS: An extensive literature review from 1990 to 2017 identified 354 potentially relevant publications. Fifty-two articles were reviewed and included in the CPG. An international expert panel of eight contact lens practitioners, with vast experience in keratoconus management reviewed and appraised the CPG following the Appraisal of Guidelines for Research and Evaluation II consortium requirements. The developed CPG clearly outlines a strategy for the successful fitting of RGP CLs in patients with keratoconus. This includes how to calculate parameters of the first diagnostic lens, criteria for assessing good fit and a standardized schedule of wear time and follow-up appointments. SUMMARY: The current evidence and consensus-based CPG helps guide clinicians in a successful strategy for fitting RGP CLs in patients with keratoconus.

Influence of COVID-19 Lockdowns on the Usage of a Vision Assistance App Among Global Users With Visual Impairment: Big Data Analytics Study.

BACKGROUND: Millions of individuals with visual impairment use vision assistance apps to help with their daily activities. The most widely used vision assistance apps are magnifier apps. It is still largely unknown what the apps are used for. Lack of insight into the visual needs of individuals with visual impairment is a hurdle for the development of more effective assistive technologies. OBJECTIVE: This study aimed to investigate how needs for visual aids may vary with social activities, by observing the changes in the usage of a smartphone magnifier app when many users take breaks from work. METHODS: The number of launches of the SuperVision Magnifier app was determined retrospectively from 2018 to 2020 from among active users worldwide. The fluctuation in app usage was examined by comparing weekday vs weekend periods, Christmas and new year vs nonholiday seasons, and COVID-19 lockdowns vs the easing of restriction during the pandemic. RESULTS: On average, the app was used 262,466 times by 38,237 users each month in 2020 worldwide. There were two major trough points on the timeline of weekly app usage, one aligned with the COVID-19 lockdowns in April 2020 and another aligned with the Christmas and new year week in 2018 and 2019. The app launches declined by 6947 (11% decline; P<.001) during the lockdown and by 5212 (9% decline; P=.001) during the holiday weeks. There was no significant decline during March to May 2019. App usage compensated for seasonal changes was 8.6% less during weekends than during weekdays (P<.001). CONCLUSIONS: The need for vision assistance technology was slightly lower during breaks and lockdowns, probably because the activities at home were different and less visually demanding. Nevertheless, for the entire user population, the needs for visual aids are still substantial.

Comparing Component-Based and Occupation-Based Interventions of a Person with Visual Deficits' Performance.

This study aimed to compare the effectiveness of component-based, occupation-based, and a combined intervention for visual-scanning to improve occupational performance. This exploratory case study used a 55-year-old female, seven years post-stroke with visual field deficits, who completed a component-based intervention (Vision Coach), an occupation-based intervention (IADL activities that incorporated scanning tasks), and a combined intervention. The Assessment of Motor and Process Skills (AMPS) was completed prior to and after each intervention. Participant's data was compared between interventions and AMPS standardization sample, with observable improvements in motor skills and process skills. Visual-scanning training as a compensatory method appears to be effective for chronic visual field deficits post-stroke, particularly using component-based and occupation-based interventions in combination.

Refractive approaches to visual rehabilitation in patients with keratoconus.

PURPOSE OF REVIEW: As keratoconus is a chronic disease affecting young people, vision-related quality of life is often significantly impaired in patients with this disease. However, successful management of keratoconus, including visual rehabilitation strategies, can improve quality of life in these patients. This review will describe clinical approaches that improve vision-related quality of life in patients with stable keratoconus. RECENT FINDINGS: Several types of contact lenses including scleral lenses have been used successfully to manage keratoconus. Eyes with severe keratoconus, even those in which fitting with other types of lenses is challenging, can be successfully fitted with scleral lenses. Although laser ablative procedures, such as photorefractive keratectomy (PRK) have been traditionally contraindicated in patients diagnosed with or suspected of having keratoconus, PRK has been attempted to partially correct refractive errors in keratoconus. Although phototherapeutic keratectomy and radial keratotomy have been reported to be used in eyes with keratoconus, effectiveness and safety results have varied. Implantation of phakic intraocular lenses and intraocular lenses, including toric intraocular lenses, which primarily correct regular astigmatism, with cataract extraction or refractive lens exchange can improve vision-related quality of life in patients with keratoconus by significantly reducing cylinder while improving uncorrected visual acuity. SUMMARY: Appropriate selection and application of treatment options based on consideration of multiple factors will help patients with keratoconus, improving their vision-related quality of life and delaying or avoiding keratoplasty.

Clinical use of the Insight Inventory in cerebral visual impairment and the effectiveness of tailored habilitational strategies.

AIM: To investigate the utility of the Insight Inventory (a structured clinical inventory completed by caregivers) for assessment of children with cerebral visual impairment; and to investigate effectiveness of tailored habilitational strategies derived from the responses to the Insight Inventory. METHOD: Fifty-one eligible children (26 males, 25 females; mean age 9y 5mo, SD 3y, range 5-16y) were recruited from Great Ormond Street Hospital, London. They underwent baseline assessment including neuro-ophthalmological and neuropsychological evaluations, and parent- and child-reported ratings on a questionnaire-based measure of quality of life. Parents also completed the Insight Inventory. On the basis of responses to the Inventory, families received individualized habilitational strategies. Follow-up assessments 6 months later included repeating the Insight Inventory and quality of life questionnaires. RESULTS: Correlations were found between the Insight Inventory and the Wechsler Intelligence Scale for Children, Fourth Edition, the Beery-Buktenica Test of Visual-Motor Integration, and the Benton Facial Recognition Test, suggesting that the Insight Inventory is an effective tool to estimate visual-perceptual difficulties. At 6 months follow-up, caregiver reports indicated significant improvements in the quality of life of children below the age of 12 years. INTERPRETATION: The Insight Inventory is a simple questionnaire which covers practical aspects of cognitive visual function in everyday life. It provides in-depth information about the aspects that children struggle with. It can also guide programmes of individualized habilitation strategies, which may enhance the quality of life of younger children. WHAT THIS PAPER ADDS: Questionnaire scores demonstrate biologically plausible correlations with formal neuropsychological tests of visual function. After administration of matched practical habilitational strategies, younger children showed improvement in quality of life and functional vision scores.

Transfer and retention of oculomotor alignment rehabilitation training.

Ocular alignment defects such as strabismus affect around 5% of people and are associated with binocular vision impairments. Current nonsurgical treatments are controversial and have high levels of recidivism. In this study, we developed a rehabilitation method for ocular alignment training and examined the rate of learning, transfer to untrained alignments, and retention over time. Ocular alignment was controlled with a real-time dichoptic feedback paradigm where a static fixation target and white gaze-contingent ring were presented to the dominant eye and a black gaze-contingent ring with no fixation target was presented to the nondominant eye. Observers were required to move their eyes to center the rings on the target, with real-time feedback provided by the size of the rings. Offsetting the ring of the nondominant temporal or nasal visual field required convergent or divergent ocular deviation, respectively, to center the ring on the fixation target. Learning was quantified as the time taken to achieve target deviation of 2° (easy, E) or 4° (hard, H) for convergence (CE, CH) or divergence (DE, DH) over 40 trials. Thirty-two normally sighted observers completed two training sequences separated by one week. Subjects were randomly assigned to a training sequence: CE-CH-DE, CH-CE-DE, DE-DH-CE, or DH-DE-CE. The results showed that training was retained over the course of approximately one week across all conditions. Training on an easy deviation angle transferred to untrained hard angles within convergence or divergence but not between these directions. We conclude that oculomotor alignment can be rapidly trained, retained, and transferred with a feedback-based dichoptic paradigm. Feedback-based oculomotor training may therefore provide a noninvasive method for the rehabilitation of ocular alignment defects.

The assistance of electronic visual aids with perceptual learning for the improvement in visual acuity in visually impaired children.

PURPOSE: To investigate the effect of electronic visual aids (EVA) combined with perceptual learning (PL) for the improvement in visual acuity for moderate to severe visually impaired and blind children. METHODS: Twenty-eight 6- to 14-year-old visually impaired children (19 boys and 9 girls) were divided into two groups: PL under the assistance of EVA (Group A, 14 children) and simple PL without EVA (Group B, 14 children). The content of PL was to search the inversed "E" in the crowding strings and connected with lines, 30 minutes a day for 6 months. EVA can provide 5-10 times magnification on the 4.3-inch screen. Uncorrected distance visual acuity (UCVA), best-corrected visual acuity (BCVA), near visual acuity (NVA) and refractive error were evaluated before and 3 and 6 months after training. RESULTS: Baseline UCVA, BCVA or NVA was comparable between the two groups. Three months after training, UCVA, BCVA and NVA improved significantly in Group A (p < 0.05). At the end of training, UCVA and BCVA continued progressing in Group A compared to 3 months (p = 0.01, 0.02), but visual acuity did not show significant improvement in Group B during the same time, except that UCVA improved at the first follow-up. Refractive error had no significant change post-training in both groups. CONCLUSIONS: Visually impaired children can benefit more from the combination of PL with EVA than simple PL, and the improvement in visual acuity accompanied no significant myopic shift. It may provide a new method of treatment and rehabilitation in visually impaired children.

Optogenetic approaches to vision restoration.

Inherited retinal disease (IRD) affects about 1 in 3000 to 1 in 5000 individuals and is now believed to be the most common cause of blindness registration in developed countries. Until recently, the management of such conditions had been exclusively supportive. However, advances in molecular biology and medical engineering have now seen the rise of a variety of approaches to restore vision in patients with IRDs. Optogenetic approaches are primarily aimed at rendering secondary and tertiary neurons of the retina light-sensitive in order to replace degenerate or dysfunctional photoreceptors. Such approaches are attractive because they provide a "causative gene-independent" strategy, which may prove suitable for a variety of patients with IRD. We discuss theoretical and practical considerations in the selection of optogenetic molecules, vectors, surgical approaches and review previous trials of optogenetics for vision restoration. Optogenetic approaches to vision restoration have yielded promising results in pre-clinical trials and a phase I/II clinical trial is currently underway (ClinicalTrials.gov NCT02556736). Despite the significant inroads made in recent years, the ideal optogenetic molecule, vector and surgical approach have yet to be established.

Home-based early intervention in infants and young children with visual impairment using the Developmental Journal: longitudinal cohort study.

AIM: To investigate the effects of home-based early intervention in children with severe visual impairment (SVI) using the Developmental Journal for babies and young children with visual impairment (DJVI). METHOD: A longitudinal observational study was undertaken with a national cohort (OPTIMUM) of infants with congenital disorders of the peripheral visual system (CDPVS) and profound-SVI; and followed up after 12 months and 24 months. Intervention was categorized according to the practitioner diary records of their usual practice over 12 months from baseline comparing those receiving the DJVI and those receiving 'Other Support'. Outcome measures of cognition and language, behaviour difficulties, parenting stress, and satisfaction with parent-practitioner partnership were collected. RESULTS: In the 54 children (26 males, 28 females, baseline mean age 13.5mo, SD 2.3mo, range 8-17mo) with 'total' CDPVS (including 16 'complex' and 38 'simple' with or without known brain disorder respectively), linear mixed effects pointed towards acceleration in sensorimotor understanding and expressive language especially in the 'simple' subsample (11.72 developmental quotient, 95% confidence interval -1.17 to 24.61, p>0.05) in those receiving the DJVI. Vision level also predicted outcomes (p<0.05). The DJVI group showed improvements in behavioural withdrawal (η2 =0.20, p=0.02, 'simple') and parenting stress (d=0.78, d=0.92, p=0.02 total and 'simple' respectively) and perceived practitioner-parent relationship (η2 =0.16, p=0.01). INTERPRETATION: Infants and young children with visual impairment receiving home-based early intervention using the DJVI with a structured developmental approach had better outcomes than those receiving 'other' home-based early interventions. Moderate to large effect improvements were found in child cognition and language, behaviour and parenting stress and the perceived practitioner-parent relationship, although cognition did not reach 5% significance level. WHAT THIS PAPER ADDS: Early intervention using the Developmental Journal for babies and young children with visual impairment was associated with enhanced developmental outcomes compared to other approaches. Improvements were also found in child behaviour, parenting stress, and perceived parent practitioner outcomes. Type and complexity of visual impairment also influenced outcomes.

INTERVENCIÓN TEMPRANA DOMICILIARIA EN LACTANTES Y NIÑOS PEQUEÑOS CON DISCAPACIDAD VISUAL USANDO EL DIARIO DE DESARROLLO: ESTUDIO LONGITUDINAL DE COHORTE: OBJETIVO: Investigar los efectos de la intervención temprana en el hogar en niños con discapacidad visual grave utilizando el Diario de Desarrollo para bebés y niños pequeños con discapacidad visual (DJVI). MÉTODO: Se realizó un estudio observacional longitudinal con una cohorte nacional (OPTIMUM) de bebés con trastornos congénitos del sistema visual periférico (CDPVS) y discapacidad visual profunda-severa; y seguimiento después de 12 meses y 24 meses. La intervención se categorizó de acuerdo con los registros del diario de desarrollo del médico en su práctica habitual más de 12 meses desde el inicio, comparando los que recibieron el DJVI y los que recibieron "otro apoyo". Se recopilaron las medidas de resultado de la cognición y el lenguaje, las dificultades de comportamiento, el estrés de los padres y la satisfacción con la asociación entre padres y profesionales. RESULTADOS: En los 54 niños (26 varones, 28 mujeres, edad media de referencia 13,5 meses, DS 2,3 meses, rango 8-17 meses) con CDPVS 'total' (incluidos 16 'complejo' y 38 'simple' con o sin trastorno cerebral conocido respectivamente), los efectos mixtos lineales apuntan hacia la aceleración en la comprensión sensoriomotora y el lenguaje expresivo, especialmente en la submuestra "simple" (cociente de desarrollo 11,72, intervalo de confianza del 95% -1,17 a 24,61, p>0,05) en los que recibieron el DJVI. El nivel de visión también predijo resultados (p <0,05). El grupo DJVI mostró mejoras en la abstinencia conductual (η2 =0,20, p=0,02, 'simple') y el estrés parental (d=0,78 − d=0,92, p=0,02 total y 'simple' respectivamente) y la relación percibida entre el médico y el padre (η2 =0,16, p=0,01). INTERPRETACIÓN: Los bebés y niños pequeños con discapacidad visual que recibieron una intervención temprana en el hogar utilizando el DJVI, con un enfoque de desarrollo estructurado, tuvieron mejores resultados que los que recibieron "otras" intervenciones tempranas en el hogar. Se encontraron mejoras de efecto moderado a grande en la cognición infantil y el lenguaje, el comportamiento y el estrés parental y la relación percibida entre el médico y el padre, aunque la cognición no alcanzó el nivel de significación del 5%.

INTERVENÇÃO PRECOCE DOMICILIAR EM LACTENTES E CRIANÇAS JOVENS COM DEFICIÊNCIA VISUAL USANDO O DEVELOPMENTAL JOURNAL: ESTUDO DE COORTE LONGITUDINAL: OBJETIVO: Investigar os efeitos da intervenção precoce domiciliar em crianças com deficiência visual severa usando o Developmental Journal para lactentes e crianças jovens com deficiência visual (DJDV). METODO: Um estudo observacional longitudinal foi realizado com uma coorte nacional (OPTIMUM) de crianças com distúrbios congênitos do sistema visual periférico (DCSVP) e deficiência visual grave-profunda, estes foram acompanhados após 12 meses e 24 meses. A intervenção foi categorizada de acordo com os registros diários do profissional de sua prática habitual ao longo de 12 meses, a partir de uma linha de base, comparando aqueles que receberam a DJDV e os que receberam "outro suporte". Resultados dos testes de cognição e linguagem, dificuldades de comportamento, estresse parental e satisfação com a parceria entre pais e profissionais, foram coletados. RESULTADOS: Nas 54 crianças (26 do sexo masculino e 28 do feminino, média de idade na linha de base de 13,5 meses; DP 2,3 meses; variação de 8 a 17 meses) com DCSVP total (incluindo 16 'complexos' e 38 'simples' com ou sem distúrbio cerebral conhecido, respectivamente), efeitos mistos lineares apontaram para um avanço na compreensão sensório-motora e de linguagem expressiva, especialmente, no subgrupo 'simples' (11,72 quociente de desenvolvimento, IC 95% -1,17 a 24,61; p>0,05) naqueles que receberam o DJDV. Nível visual também foi preditivo dos desfechos (p<0,05). O grupo DJDV apresentou melhora no comportamento de retraimento social (η2 =0,20; p=0,02; 'simples'), no estresse parental (d=0,78 − d=0,92; p=0,02 total e 'simples', respectivamente) e na percepção do relacionamento profissional-pais (η2 =0,16; p=0,01). INTERPRETAÇÃO: Lactentes e crianças jovens com deficiência visual que recebem intervenção domiciliar precoce usando a DJVI com uma abordagem de desenvolvimento estruturado tiveram resultados melhores do que aqueles que receberam "outras" intervenções precoces em casa. Melhorias com efeito de moderado a grande foram encontradas na cognição e linguagem, no comportamento infantil e estresse parental, e no relacionamento percebido entre pais e profissionais, embora a cognição não tenha alcançado nível de significância de 5%.

Interventions for visual field defects in people with stroke.

BACKGROUND: Visual field defects are estimated to affect 20% to 57% of people who have had a stroke. Visual field defects can affect functional ability in activities of daily living (commonly affecting mobility, reading and driving), quality of life, ability to participate in rehabilitation, and depression and anxiety following stroke. There are many interventions for visual field defects, which are proposed to work by restoring the visual field (restitution); compensating for the visual field defect by changing behaviour or activity (compensation); substituting for the visual field defect by using a device or extraneous modification (substitution); or ensuring appropriate diagnosis, referral and treatment prescription through standardised assessment or screening, or both. OBJECTIVES: To determine the effects of interventions for people with visual field defects after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register, the Cochrane Eyes and Vision Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, PsycINFO, and PDQT Databse, and clinical trials databases, including ClinicalTrials.gov and WHO Clinical Trials Registry, to May 2018. We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts. SELECTION CRITERIA: Randomised trials in adults after stroke, where the intervention was specifically targeted at improving the visual field defect or improving the ability of the participant to cope with the visual field loss. The primary outcome was functional ability in activities of daily living and secondary outcomes included functional ability in extended activities of daily living, reading ability, visual field measures, balance, falls, depression and anxiety, discharge destination or residence after stroke, quality of life and social isolation, visual scanning, adverse events, and death. DATA COLLECTION AND ANALYSIS: Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data, and other potential sources of bias. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS: Twenty studies (732 randomised participants, with data for 547 participants with stroke) met the inclusion criteria for this review. However, only 10 of these studies compared the effect of an intervention with a placebo, control, or no treatment group, and eight had data which could be included in meta-analyses. Only two of these eight studies presented data relating to our primary outcome of functional abilities in activities of daily living. One study reported evidence relating to adverse events.Three studies (88 participants) compared a restitutive intervention with a control, but data were only available for one study (19 participants). There was very low-quality evidence that visual restitution therapy had no effect on visual field outcomes, and a statistically significant effect on quality of life, but limitations with these data mean that there is insufficient evidence to draw any conclusions about the effectiveness of restitutive interventions as compared to control.Four studies (193 participants) compared the effect of scanning (compensatory) training with a control or placebo intervention. There was low-quality evidence that scanning training was more beneficial than control or placebo on quality of life, measured using the Visual Function Questionnaire (VFQ-25) (two studies, 96 participants, mean difference (MD) 9.36, 95% confidence interval (CI) 3.10 to 15.62). However, there was low or very-low quality evidence of no effect on measures of visual field, extended activities of daily living, reading, and scanning ability. There was low-quality evidence of no significant increase in adverse events in people doing scanning training, as compared to no treatment.Three studies (166 participants) compared a substitutive intervention (a type of prism) with a control. There was low or very-low quality evidence that prisms did not have an effect on measures of activities of daily living, extended activities of daily living, reading, falls, or quality of life, and very low-quality evidence that they may have an effect on scanning ability (one study, 39 participants, MD 9.80, 95% CI 1.91 to 17.69). There was low-quality evidence of an increased odds of an adverse event (primarily headache) in people wearing prisms, as compared to no treatment.One study (39 participants) compared the effect of assessment by an orthoptist to standard care (no assessment) and found very low-quality evidence that there was no effect on measures of activities of daily living.Due to the quality and quantity of evidence, we remain uncertain about the benefits of assessment interventions. AUTHORS' CONCLUSIONS: There is a lack of evidence relating to the effect of interventions on our primary outcome of functional ability in activities of daily living. There is limited low-quality evidence that compensatory scanning training may be more beneficial than placebo or control at improving quality of life, but not other outcomes. There is insufficient evidence to reach any generalised conclusions about the effect of restitutive interventions or substitutive interventions (prisms) as compared to placebo, control, or no treatment. There is low-quality evidence that prisms may cause minor adverse events.

Interventions for hearing and vision impairment to improve outcomes for people with dementia: a scoping review.

ABSTRACTBackground:Age-related hearing and vision problems are common among people with dementia and are associated with poorer function, reduced quality of life and increased caregiver burden. Addressing sensory impairments may offer an opportunity to improve various aspects of life for people with dementia. METHODS: Electronic databases were searched using key terms dementia, hearing impairment, vision impairment, intervention, and management. Database searches were supplemented by hand searching bibliographies of papers and via consultation with a network of health professional experts. Studies were eligible for inclusion if they included adults aged over 50 with dementia with adult-onset hearing or vision impairment who had received a hearing or vision intervention in relation to cognitive function, rate of decline, psychiatric symptoms, hearing/vision-related disability, quality of life, and/or caregiver burden outcomes. A range of study designs were included. Results were summarized descriptively according to level of evidence and effect sizes calculated where possible. Risk of bias was assessed using Downs and Black's (1998) checklist. The development of the intervention was summarized according to the CReDECI2 scheme. PROSPERO review registration number 2016:CRD42016039737. RESULTS: Twelve papers describing hearing interventions and five papers describing vision interventions were included. Most were of low to moderate quality. One high quality randomized controlled trial of a hearing aid intervention was identified. Hearing interventions included provision of hearing aids, assistive listening devices, communication strategies, hearing aid trouble shooting, and cochlear implantation. Vision interventions included prism lenses, rehabilitation training, and cataract surgery. There was no consistent evidence for the positive impact of hearing/vision interventions on cognitive function, rate of cognitive decline, quality of life, or caregiver burden. CONCLUSION: Sensory interventions may promote better outcomes, but there is a need for properly powered, controlled trials of hearing and vision interventions on outcomes relevant to people living with dementia.

Enhancing general spatial skills of young visually impaired people with a programmable distance discrimination training: a case control study.

BACKGROUND: The estimation of relative distance is a perceptual task used extensively in everyday life. This important skill suffers from biases that may be more pronounced when estimation is based on haptics. This is especially true for the blind and visually impaired, for which haptic estimation of distances is paramount but not systematically trained. We investigated whether a programmable tactile display, used autonomously, can improve distance discrimination ability in blind and severely visually impaired youngsters between 7 and 22 years-old. METHODS: Training consisted of four weekly sessions in which participants were asked to haptically find, on the programmable tactile display, the pairs of squares which were separated by the shortest and longest distance in tactile images with multiple squares. A battery of haptic tests with raised-line drawings was administered before and after training, and scores were compared to those of a control group that did only the haptic battery, without doing the distance discrimination training on the tactile display. RESULTS: Both blind and severely impaired youngsters became more accurate and faster at the task during training. In haptic battery results, blind and severely impaired youngsters who used the programmable display improved in three and two tests, respectively. In contrast, in the control groups, the blind control group improved in only one test, and the severely visually impaired in no tests. CONCLUSIONS: Distance discrimination skills can be trained equally well in both blind and severely impaired participants. More importantly, autonomous training with the programmable tactile display had generalized effects beyond the trained task. Participants improved not only in the size discrimination test but also in memory span tests. Our study shows that tactile stimulation training that requires minimal human assistance can effectively improve generic spatial skills.

The neuropsychological rehabilitation of visual agnosia and Balint's syndrome.

Visual agnosia and Balint's syndrome are complex neurological disorders of the higher visual system that can have a remarkable impact on individuals' lives. Rehabilitation of these individuals is important to enable participation in everyday activities despite the impairment. However, the literature about the rehabilitation of these disorders is virtually silent. Therefore, the aim of this systematic review is to give an overview of available literature describing treatment approaches and their effectiveness with regard to these disorders. The search engines Psychinfo, Amed, and Medline were used, resulting in 22 articles meeting the criteria for inclusion. Only articles describing acquired disorders were considered. These articles revealed that there is some information available on the major subtypes of visual agnosia as well as on Balint's syndrome which practising clinicians can consult for guidance. With regard to the type of rehabilitation, compensatory strategies have proven to be beneficial in most of the cases. Restorative training on the other hand has produced mixed results. Concluding, although still scarce, a scientific foundation about the rehabilitation of visual agnosia and Balint's syndrome is evolving. The available approaches give valuable information that can be built upon in the future.

System for Face Recognition under Different Facial Expressions Using a New Associative Hybrid Model Amαß-KNN for People with Visual Impairment or Prosopagnosia.

Face recognition is a natural skill that a child performs from the first days of life; unfortunately, there are people with visual or neurological problems that prevent the individual from performing the process visually. This work describes a system that integrates Artificial Intelligence which learns the face of the people with whom the user interacts daily. During the study we propose a new hybrid model of Alpha-Beta Associative memories (Amαß) with Correlation Matrix (CM) and K-Nearest Neighbors (KNN), where the Amαß-CMKNN was trained with characteristic biometric vectors generated from images of faces from people who present different facial expressions such as happiness, surprise, anger and sadness. To test the performance of the hybrid model, two experiments that differ in the selection of parameters that characterize the face are conducted. The performance of the proposed model was tested in the databases CK+, CAS-PEAL-R1 and Face-MECS (own), which test the Amαß-CMKNN with faces of subjects of both sexes, different races, facial expressions, poses and environmental conditions. The hybrid model was able to remember 100% of all the faces learned during their training, while in the test in which faces are presented that have variations with respect to those learned the results range from 95.05% in controlled environments and 86.48% in real environments using the proposed integrated system.

Progressive resistance training for persons with intellectual disabilities and visual impairment.

BACKGROUND: Knowledge concerning the feasibility and effects of progressive resistance training (PRT) for persons with intellectual disabilities and visual impairment who are categorized in Gross Motor Function Classification System (GMFCS) Level 1 is limited. The aim of our study was to evaluate feasibility and effect of PRT on participants' Quadriceps strength and personal goals. METHODS: Eight Participants followed a PRT program for 10 weeks. Feasibility was determined by percentage of attendance and compliance. The effect of PRT was analyzed with a linear mixed model (p < 0.05) and by normalized bootstrap (95% CI). RESULTS: Participants attended 87.8% of the sessions and trained according to the PRT program, indicating sufficient compliance. Quadriceps strength increased significantly by 69%, and participants' personal goals were achieved. CONCLUSION: PRT is a feasible and potentially effective method for increasing Quadriceps strength as well as achieving personal goals in persons with intellectual disabilities and visual impairment with GMFCS Level 1.