Integration of proprioceptive signals and attentional capacity during postural control are impaired but subject to improvement in dyslexic children.

Children with developmental dyslexia suffer from delayed reading capabilities and may also exhibit attentional and sensori-motor deficits. The objective of this study was twofold. First, we aimed at investigating whether integration of proprioceptive signals in balance control was more impaired in dyslexic children when the attentional demand was varied. Secondly, we checked whether this effect was reduced significantly by using a specific treatment to improve eye control deficits and certain postural signs that are often linked to dyslexia (Quercia et al. in J Fr Ophtalmol 28:713-723, 2005, J Fr Ophtalmol 30:380-89, 2007). Thirty dyslexic and 51 treated dyslexic children (> 3 months of treatment) were compared with 42 non-dyslexic children in several conditions (mean age: 136.2 ± 23.6, 132.2 ± 18.7 and 140.2 ± 25 months, respectively). Co-vibration of ankle muscles was effected in order to alter proprioceptive information originating from the ankle. In two vibration conditions, ankle muscles were either not vibrated or vibrated at 85 Hz without illusion of any movement. These two vibration conditions were combined with two attentional conditions. In the first such condition, children maintained balance while merely fixing their gaze on a point in front of them. In the second condition, they had to look for smaller or larger stars in a panel showing forty of each kind. Balance was assessed by means of a force plate. Results indicated that the mean velocity (i.e. the total length) of the center of pressure (CoP) displacement in the 85-Hz vibration condition increased significantly more (compared with no vibration) in the dyslexic and the treated dyslexic groups than in the control group, irrespective of the attention task. Interestingly, in the condition without vibration, the attentional performance of treated children was similar to that of the control group, whereas the attentional performance of the untreated dyslexic children was significantly impaired. Altogether, these results suggest that integration of proprioceptive signals in balance control and attentional capacity are impaired in dyslexic children. However, attention capacity during the control of stance could be improved significantly.

Movement detection thresholds reveal proprioceptive impairments in developmental dyslexia.

Developmental dyslexia is associated with vision and hearing impairments. Whether these impairments are causes or comorbidities is controversial. Because both senses are heavily involved in reading, cognitive theories argue that sensory impairments are comorbidities that result from a lack of reading practice. Sensory theories instead argue that this is sensory impairments that cause reading disabilities. Here we test a discriminant prediction: whether sensory impairments in developmental dyslexia are restrained to reading-related senses or encompass other senses. Sensory theories predict that all senses are affected, whereas, according to the lack of reading practice argument, cognitive theories predict that only reading-related senses are affected. Using a robotic ergometer and fully automatized analyses, we tested proprioceptive acuity in seventeen dyslexic children and seventeen age-matched controls on a movement detection task. Compared to controls, dyslexics had higher and more variable detection thresholds. For the weakest proprioceptive stimuli, dyslexics were twice as long and twice as variable as controls. More, proprioceptive acuity strongly correlated with reading abilities, as measured by blind cognitive evaluations. These results unravel a new sensory impairment that cannot be attributed to a lack of reading practice, providing clear support to sensory theories of developmental dyslexia. Protocol registration: This protocol is part of the following registration, ClinicalTrials.gov Identifier: NCT03364010; December 6, 2017.

Action representation deficits in adolescents with developmental dyslexia.

Developmental dyslexia (DD), a severe and frequent disorder of reading acquisition, is characterized by a diversity of cognitive and motor deficits whose interactions still remain under debate. Although deficits in the automatization of sensorimotor control have been highlighted, internal action representation allowing prediction has never before been investigated. In this study, we considered action representation of 18 adolescents with pure DD and 18 age-matched typical readers. Participants actually and mentally performed a visually guided pointing task involving strong spatiotemporal constraints (speed/accuracy trade-off paradigm). While actual and mental movement times of typical readers were isochronous and both conformed to Fitts' law, the movement times of dyslexics differed between conditions, and only the actual movement times conformed to Fitts' law. Furthermore, the quality of motor imagery correlated with word reading abilities. This suggests that the process of action representation is impaired in pure DD and supports the sensorimotor perspective of DD. Theoretical implications are discussed.

Children with Dyslexia Have Altered Cross-Modal Processing Linked to Binocular Fusion. A Pilot Study.

INTRODUCTION: The cause of dyslexia, a reading disability characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities, is unknown. A considerable body of evidence shows that dyslexics have phonological disorders. Other studies support a theory of altered cross-modal processing with the existence of a pan-sensory temporal processing deficit associated with dyslexia. Learning to read ultimately relies on the formation of automatic multisensory representations of sounds and their written representation while eyes fix a word or move along a text. We therefore studied the effect of brief sounds on vision with a modification of binocular fusion at the same time (using the Maddox Rod test). METHODS: To check if the effect of sound on vision is specific, we first tested with sounds and then replaced them with proprioceptive stimulation on 8 muscular sites. We tested two groups of children composed respectively of 14 dyslexic children and 10 controls. RESULTS: The results show transient visual scotoma (VS) produced by sensory stimulations associated with the manipulation of oculomotor balance, the effect being drastically higher in the dyslexic group. The spatial distribution of the VS is stochastic. The effect is not specific for sounds but exists also with proprioceptive stimulations. DISCUSSION: Although there was a very significant difference between the two groups, we were not able to correlate the (VS) occurrence with the dyslexic's reading performance. One possibility to confirm the link between VS and reading impairment would be to find a specific treatment reducing the occurrence of the VS and to check its effect on dyslexia.

Representational Bias in the Radial Axis in Children With Dyslexia: A Landmarks Alignment Study.

To better identify the distinctive characteristics of space representation in the radial dimension, we have proposed a new paradigm: the landmarks alignment task where two parallel aluminum bars were radially presented. Children had to move a landmark along one bar and place it at the same location as the reference landmark placed by the examiner on the parallel bar. The major interest of this task was its capacity to assess space representation in the radial dimension when considering a spatial landmark that oriented the subject's attention toward the orthogonal dimension. The most important result showed that in the radial dimension children with dyslexia exhibited a forward bias on the left bar, meaning a mental underrepresentation of the leftward peripersonal space and/or a mental overrepresentation of the rightward peripersonal space. Furthermore, reading discrepancies were correlated with radial forward bias on the left bar. The experiment was also conducted in the lateral axis, showing a pseudoneglect behavior in children without dyslexia. Our landmarks alignment task had the advantage of being able to assess space representation in a complex environment. The forward radial representational bias in children with dyslexia could have implications for spatial orientation in peripersonal workspace in school situations.

Static postural control in children with developmental dyslexia.

The present investigation tries to better understand potential association and causal relationship between phonological and postural impairment due to developmental dyslexia. The study included 50 boys with developmental dyslexia and selected on the basis of their overall reading difficulties, and 42 control boys. Body sway during a quite standing posture eye open and eye closed on a force platform were tested in the two groups of subjects that were between 10 and 13 years of age. Analysis of classical parameters quantifying the centre of pressure (CP) displacements along antero-posterior and lateral axes showed a significant difference between the two groups. Dyslexic children showed on average greater instability, with greater length, variability and mean power frequency of CP displacements with or without vision. Our results demonstrate that postural parameters may discriminate between children with dyslexia and age-equivalent controls.

The distinctive vertical heterophoria of dyslexics.

In this study, we looked for the presence of vertical heterophoria (VH) in 42 dyslexic children (22 males and 20 females) aged 118.5±12.9 months who were compared with a control group of 22 nondyslexic children (eleven males and eleven females) aged 112±9.8 months. Dyslexics presented a low-level (always <1 prism diopter) VH combined with torsion. This oculomotor feature clearly separates the dyslexic group from the normal readers group. It is independent of the type of dyslexia. The essential feature of this VH is a lability that appears during specific stimulation of sensory receptors involved in postural regulation. This lability is demonstrated using a vertical Maddox test conducted under very specific conditions in which postural sensors are successively stimulated in a predetermined order. A quantitative variation in this VH may be seen during the Bielchowsky Head Tilt Test, which reveals hypertonia of the lower or upper oblique muscles. Vertical orthophoria can be achieved by placing low-power prisms asymmetrically within the direction of action of the superior or inferior oblique muscles. The selection of power and axis is not only guided by elements of the eye examination but also from observation of postural muscle tone. All these elements suggest that the VH could be of postural origin and somehow related to the vertical action of the oblique muscles. VH and torsion are not harmful per se. There is no statistical relationship between their level and the various parameters used to assess the reading skills of dyslexic children. VH and torsion could be a clinical marker of global proprioceptive dysfunction responsible for high-level multisensory disturbances secondary to poor spatial localization of visual and auditory information. This dysfunction might also explain the motor disorders concomitant to dyslexia.

Developmental dyslexia and vision.

Developmental dyslexia affects almost 10% of school-aged children and represents a significant public health problem. Its etiology is unknown. The consistent presence of phonological difficulties combined with an inability to manipulate language sounds and the grapheme-phoneme conversion is widely acknowledged. Numerous scientific studies have also documented the presence of eye movement anomalies and deficits of perception of low contrast, low spatial frequency, and high frequency temporal visual information in dyslexics. Anomalies of visual attention with short visual attention spans have also been demonstrated in a large number of cases. Spatial orientation is also affected in dyslexics who manifest a preference for spatial attention to the right. This asymmetry may be so pronounced that it leads to a veritable neglect of space on the left side. The evaluation of treatments proposed to dyslexics whether speech or oriented towards the visual anomalies remains fragmentary. The advent of new explanatory theories, notably cerebellar, magnocellular, or proprioceptive, is an incentive for ophthalmologists to enter the world of multimodal cognition given the importance of the eye's visual input.

Space representation in children with dyslexia and children without dyslexia: contribution of line bisection and circle centering tasks.

Line bisection tasks (different space locations and different line lengths) and circle centering tasks (visuo-proprioceptive and proprioceptive explorations, with left or right starting positions) were used to investigate space representation in children with dyslexia and children without dyslexia. In line bisection, children with dyslexia showed a significant rightward bias for central and right-sided locations and a leftward bias for left-sided location. Furthermore, the spatial context processing was asymmetrically more efficient in the left space. In children without dyslexia, no significant bias was observed in central lines but the spatial context processing was symmetrical in both spaces. When the line length varied, no main effect was shown. These results strengthen the 'inverse pseudoneglect' hypothesis in dyslexia. In the lateral dimension of the circle centering tasks, children showed a response bias in the direction of the starting hand location for proprioceptive condition. For radial dimension, the children showed a forward bias in visuo-proprioceptive condition and more backward error in proprioceptive condition. Children with dyslexia showed a forward bias in clockwise exploration and more accurate performance in counterclockwise exploration for left starting position which may be in accordance with leftward asymmetrical spatial context processing in line bisection. These results underline the necessity to use the line bisection task with different locations as an appropriate experimental paradigm to study lateral representational bias in dyslexia. The contribution of the present results in the understanding of space representation in children with dyslexia and children without dyslexia is discussed in terms of attentional processes and neuroanatomical substrate.

Left minineglect or inverse pseudoneglect in children with dyslexia?

This study compared the visuospatial asymmetries in children with dyslexia and healthy children by using the manual line bisection task, and investigated the processing of spatial context with a 'local' cueing paradigm consisting of geometric symbols placed on the extremities of the lines. The performance between healthy children (leftward bias) and children with dyslexia (rightward bias) was significantly different. Furthermore, the bisection mark was shifted in the direction of the unilaterally cued extremities in all children. As children with dyslexia showed a rightward bias in their spatial representation, which did not interfere with local context processing, we proposed the term 'inverse pseudoneglect' to depict their behaviour in line bisection.

Cognitive demands impair postural control in developmental dyslexia: a negative effect that can be compensated.

Children with developmental dyslexia exhibit delayed reading abilities and various sensori-motor deficits. The way these various symptoms interact remain poorly understood. The objective of this study was twofold. First, we aimed to investigate whether postural control was impaired in dyslexic children when cognitive demands are increased. Second, we checked whether this effect could be reduced significantly by a treatment aiming to recalibrate ocular proprioception. Twelve dyslexic and fifteen treated dyslexic children (>3 months of treatment) were compared with twelve non-dyslexic children in two conditions (mean age: 11.6+/-2.1, 12.5+/-1.5 and 10.6+/-1.7 years respectively). In a first condition they maintained balance while fixating a point in front of them. In the second condition the postural task was combined with a silently reading one. Balance was assessed by means of a force plate. Results demonstrated that the mean velocity (i.e. the total length) of the center of pressure (CoP) displacement was increased in the reading task only for the dyslexic group. Interestingly, for the treated children, an inverse tendency was observed: the mean velocity (i.e. the total length) and the surface of the 90% confidence ellipse of the CoP displacement decreased for 13/15 patients and for 12/15 patients respectively, while performing the reading task. Values remained similar to those observed for the control children. Altogether, these results strongly suggest that cognitive demands can impair postural control in developmental dyslexia but this interaction could be normalized. These results sustain the hypothesis of a cerebellar origin for dyslexia.