Estrategias del niño ciego para alcanzar el desarrollo cognoscitivo: Estudio cualitativo / Strategies of blind children to achieve cognitive development: A qualitative study

Introducción. Estudiar el desarrollo cognoscitivo del niño ciego supone un interés en sí mismo y proporciona pautas de intervención. Existe heterogeneidad de etiologías, pero ello no impide que se puedan conocer las características que son propias de su desarrollo. Si, aproximadamente, a los 2 años, estos bebés adquieren el lenguaje, eso significa que el último estadio de la inteligencia sensorio-motriz ha sido alcanzado. Objetivo. Determinar cuáles son las estrategias que siguen los bebés ciegos durante el período sensorio-motriz para llegar a un nivel de desarrollo adecuado. Población y método. La investigación se realizó con alumnos de la Escuela de Educación Especial dependiente de la Ciudad Autónoma de Buenos Aires. Fue un trabajo de tipo cualitativo en el que se individualizaron las coincidencias para definir estrategias. Se observaron niños ciegos de entre 3 meses y 3 años. Se tomó como unidad de análisis cada uno de los segmentos significativos de las sesiones de "juego guiado" realizado en la cámara gesell por la maestra estimuladora. Resultados. Se incluyeron 34 niños; se hicieron 55 observaciones. Se categorizaron los "modos de acción" del niño tomándolos como rasgos significativos de una estrategia. Se distinguieron cuatro ejes temáticos y cuatro etapas, sustentadas cronológicamente con adquisiciones que se consideraron "organizadores". La evaluación mostró que un 71% llegó al nivel adecuado de desarrollo cognoscitivo de acuerdo con su edad. Conclusión. Sistematizar las estrategias permitirá contar con un instrumento que posibilite detectar el retraso y definir las pautas de intervención.

Introduction. Studying the cognitive development of blind children is particularly interesting in itself and because it provides intervention guidelines. The etiology of blindness is heterogeneous but this does not hinder the possibility of establishing the characteristics typical of its development. If these children acquire language at approximately 2 years, it means the last stage of sensorimotor intelligence has been achieved. Objective. To determine the strategies that blind infants and toddlers adopt during the sensorimotor period to achieve an adequate level of development. Population and method. The study was carried out in students from a public Special Education School of the Autonomous City of Buenos Aires. This was a qualitative study for the identification of coincidences to define strategies. Blind children aged 3 months to 3 years were observed. The analysis unit was each significant segment of the "directed play" sessions conducted in a Gesell chamber and guided by the stimulation therapist. Results. Thirty-four children were included and 55 observations were made. Children's "modes of action" were categorized as significant features of a strategy. Four thematic focuses and four stages were identified and chronologically supported with acquisitions that were considered "organizers." The assessment showed that 71% of children achieved an adequate cognitive development for their age. Conclusion. Systematizing strategies will help to develop an instrument to detect delays and define intervention guidelines.

Pattern-reversal visual evoked potentials as a diagnostic tool for ocular malingering / Potenciais visuais evocados por padrões reversos como uma ferramenta diagnóstica de simulação

ABSTRACT Purpose: To investigate the contributions of transient pattern-reversal visual evoked potentials in the diagnosis of ocular malingering at a Brazilian university hospital. Methods: Adult patients with suspected malingering in one or both eyes were referred for visual evoked potential testing. Data from patients' medical records were reviewed and analyzed retrospectively. Data analysis included the distance optotype visual acuity based on a ETDRS retro-illuminated chart and the transient pattern-reversal visual evoked potential parameters of latency (milliseconds) and amplitude (microvolts) for the P100 component, using checkerboards with visual subtenses of 15' and 60'. Motivations for malingering were noted. Results: The 20 subjects included 11 (55%) women. Patient ages ranged from 21 to 61 years (mean= 45.05 ± 11.76 years; median= 49 years). In 8 patients (6 women), both eyes exhibited reduced visual acuity with normal pattern-reversal visually evoked potential parameters (pure malingerers). The remaining 12 patients (7 men) exhibited reduced vision in only 1 eye, with simulated reduced vision in the contralateral eye (exaggerators). Financial motivation was noted in 18 patients (9 men). Conclusion: Normal pattern-reversal visually evoked potential parameters with suspected ocular malingering were observed in a 20 patient cohort. This electrophysiological technique appeared to be useful as a measure of visual pathway integrity in this specific population.

RESUMO Objetivo: Investigar a contribuição dos potenciais visuais evocados por padrões reversos no diagnóstico de simulação de baixa de visão em um hospital universitário do Brasil. Métodos: Um grupo de pacientes adultos com suspeita de simulação de baixa de visão em um ou ambos os olhos foi avaliado e os dados analisados retrospectivamente. Foram medidos: acuidade visual de optotipos informada para longe utilizando a tabela ETDRS, parâmetros dos potenciais visuais evocados por padrões reversos de latência (milissegundos) e amplitude (microvolts) para o componente P100 com estímulos de ângulos visuais de 15' e 60'. A motivação do paciente para a simulação foi anotada. Resultados: Os participantes foram 20 indivíduos com 11 (55%) do sexo feminino. A idade variou de 21 a 61 anos (média= 45,05 ± 11,76 anos; mediana= 49 anos). Em 8 pacientes (6 mulheres) ambos os olhos tinham acuidade visual reduzida com parâmetros dos potenciais visuais evocados por padrão reverso normais para ambos os olhos (simuladores puros). Uma subsérie separada de 12 pacientes (7 homens) tinha visão reduzida em apenas um olho e estavam simulando redução da visão no outro olho (exacerbadores). A motivação financeira foi observada em 18 pacientes (9 homens). Conclusões: Parâmetros dos potenciais visuais evocados por padrões reversos normais foram encontrados neste grupo de 20 pacientes com suspeita de simulação. Esta técnica eletrofisiológica pode ser útil como uma medida da integridade do sistema visual nesta população de doentes.

The Parameters of Pattern Visual Evoked Potential in the Severe Visual Loss Patients in Korean

PURPOSE: To compare the characteristics of the pattern visual evoked potential (PVEP) in patients with severe visual loss and normal controls, and to demonstrate the range of PVEP parameters in normal Koreans. METHODS: The patients were divided into three groups according to visual acuity: group 1, ranging from no light perception to less than 0.02; group 2, ranging from 0.02 to 0.1; and group 3, ranging from 0.125 to 0.25. Group 4 was established as a healthy control group. The 95% confidence intervals (CIs) of the PVEP parameters were calculated for group 4. The PVEP parameters were compared among these four groups, and the amplitudes were evaluated with respect to the 95% CIs. We used the area under the curve to integrate the sensitivity and the specificity of the PVEP parameter quantitative values (7.01 to 9.57 microV and 6.75 to 10.11 microV). RESULTS: A total of 101 eyes were investigated. The 95% CIs of the P100 and N135 amplitudes of group 4 were 7.01 to 9.57 microV and 6.75 to 10.11 microV, respectively. The amplitudes of P100 and N135 were significantly higher in group 4 (p < 0.001). The P100 and N135 amplitude were below the 95% CI in all group 1 patients. The area under the curve of the P100 amplitude was the highest (0.789). CONCLUSIONS: No legally blind patient in the present study exhibited a value within the 95% CI of the controls. The P100 amplitude may be the best parameter for defining blindness in patients.

The Parameters of Pattern Visual Evoked Potential in the Severe Visual Loss Patients in Korean

PURPOSE: To compare the characteristics of the pattern visual evoked potential (PVEP) in patients with severe visual loss and normal controls, and to demonstrate the range of PVEP parameters in normal Koreans. METHODS: The patients were divided into three groups according to visual acuity: group 1, ranging from no light perception to less than 0.02; group 2, ranging from 0.02 to 0.1; and group 3, ranging from 0.125 to 0.25. Group 4 was established as a healthy control group. The 95% confidence intervals (CIs) of the PVEP parameters were calculated for group 4. The PVEP parameters were compared among these four groups, and the amplitudes were evaluated with respect to the 95% CIs. We used the area under the curve to integrate the sensitivity and the specificity of the PVEP parameter quantitative values (7.01 to 9.57 microV and 6.75 to 10.11 microV). RESULTS: A total of 101 eyes were investigated. The 95% CIs of the P100 and N135 amplitudes of group 4 were 7.01 to 9.57 microV and 6.75 to 10.11 microV, respectively. The amplitudes of P100 and N135 were significantly higher in group 4 (p < 0.001). The P100 and N135 amplitude were below the 95% CI in all group 1 patients. The area under the curve of the P100 amplitude was the highest (0.789). CONCLUSIONS: No legally blind patient in the present study exhibited a value within the 95% CI of the controls. The P100 amplitude may be the best parameter for defining blindness in patients.

Aura-like features and photophobia in sightless migraine patients / Características de fenômenos aura-relacionados e da fotofobia em enxaquecosos deficientes visuais

Migraine is a central nervous system disorder frequently expressed with paroxysmal visual dysfunctions. Objective To test the hypothesis that normal visual input is vital for the migrainous aura and photophobia. Method We studied the migraine-related visual disturbances in 8 sightless migraineurs identified among 200 visually impaired subjects. Results The main findings were the visual aura and photophobia disappearance along with blindness development, the oddness of aura – too short, colourful (e.g. blue or fire-like), auditory in nature or different in shape (round forms) – and the lack of photophobia. Conclusion We propose that the aura duration should be accepted as shorter in visually impaired subjects. The changes in aura phenotype observed in our patients may be the result of both cerebral plasticity induced by the visual impairment and/or the lack of visual input per se. Integrity of visual pathways plays a key role in migraine visual aura and photophobia. .

A enxaqueca é doença neurológica frequentemente associada a anormalidades visuais transitórias. Objetivo Testar a hipótese de que a visão normal é importante para o fenótipo da aura e da fonofobia. Método Estudamos 8 enxaquecosos deficientes visuais identificados em uma população de 200 indivíduos com visão subnormal. Resultados Os principais achados foram: o desaparecimento da aura visual e da fotofobia com o início da cegueira; a ocorrência de aura atípica – muito curta, colorida (p. ex. azul ou cor de fogo) auditiva ou diferente na forma (arredondadas); e a ausência de fotofobia. Conclusão Propomos que a duração da aura possa ser admitida como mais curta em pessoas com deficiência visual. As mudanças no fenótipo da aura observadas nos nossos pacientes pode ser o resultado da plasticidade cerebral induzida pela deficiência visual e/ou a deficiência visual em si. A integridade da via visual desempenha um papel crucial na aura enxaquecosa e na fotofobia. .

Auditory processing performance in blind people / Desempenho do processamento auditivo temporal em uma população de cegos

Hearing has an important role in human development and social adaptation in blind people. OBJECTIVE: To evaluate the performance of temporal auditory processing in blind people; to characterize the temporal resolution ability; to characterize the temporal ordinance ability and to compare the performance of the study population in the applied tests. METHODS: Fifteen blind adults participated in this study. A cross-sectional study was undertaken; approval was obtained from the Pernambuco Catholic University Ethics Committee, no. 003/2008. RESULTS: Temporal auditory processing was excellent - the average composed threshold in the original RGDT version was 4. 98 ms; it was 50 ms for all frequencies in the expanded version. PPS and DPS results ranged from 95 percent to 100 percent. There were no quantitative differences in the comparison of tests; but oral reports suggested that the original RGDT original version was more difficult. CONCLUSIONS: The study sample performed well in temporal auditory processing; it also performed well in temporal resolution and ordinance abilities.

A audição exerce um papel importantíssimo no desenvolvimento e adaptação social dos pacientes cegos. OBJETIVOS: Avaliar o desempenho do processamento temporal de cegos; caracterizar a habilidade de resolução temporal, segundo tempo e frequência; a ordenação temporal de cegos usando o teste de padrão de frequência e comparar o desempenho da população estudada para os testes de processamento aplicados. METODOLOGIA: Participaram do estudo 12 adultos portadores de cegueira. O estudo foi do tipo transversal, aprovado pelo Comitê de Ética da Universidade Católica de Pernambuco sob nº 003/2008. Para a coleta de dados, foi utilizado o RGDT em suas duas versões e os testes de padrão de duração (TPD) e de frequência (TPF). RESULTADOS: Foi evidenciado excelente desempenho para o processamento temporal, média de 4,98 para o limiar composto na versão original do RGDT e 50 ms de reposta para todas as frequências na versão expandida. Os resultados do TPD e TPF variaram de 95 por cento a 100 por cento de acertos. Não houve diferença quantitativa quando comparados os testes avaliados, mas relatos verbais apontam o RGDT original como o mais difícil. CONCLUSÃO: A amostra avaliada apresentou bom desempenho do processamento temporal, bom desempenho para as habilidades de resolução temporal e ordenação temporal.

O impacto da visão monocular congênita versus adquirida na qualidade de visão autorrelatada / Impact of congenital versus acquired monocular vision as self-reported vision

Objetivos: Quando a visão de um olho está preservada (visão monocular) e há alto risco, baixo prognóstico e/ou recursos limitados para a cirurgia do olho contralateral, não é claro se o beneficio da binocularidade supera o da reorientação para visão monocular. O objetivo é quantificar o impacto da qualidade de visão referida entre a condição binocular e monocular e, nesse último caso, entre congênita e adquirida. Métodos: Pacientes com acuidade visual (AV) com AV>0,5 em cada olho foram submetidos ao questionário estruturado de 14 perguntas (VF-14), onde a pontuação de 0 a 100 indica o nível de satisfação do paciente com sua visão, variando de baixo a alto respectivamente. Dados epidemiológicos e pontuações dos quatro grupos foram registrados e submetidos à análise estatística. Resultados: A entrevista pelo VF-14 com 56 indivíduos revelou que a pontuação mais alta foi similar entre os controles e os portadores de visão monocular congênita, e níveis intermediários e baixos foram obtidos por indivíduos com visão monocular adquirida e cegos bilaterais, respectivamente (p<0,001). As atividades mais difíceis para os indivíduos com visão monocular adquirida foram identificar letras pequenas, reconhecer pessoas, distinguir sinais de trânsito e assistir TV. Conclusão: O estudo confirmou que a perda da visão tem impacto desfavorável no desempenho referido das atividades sendo maior na visão monocular adquirida do que na congênita. Os dados sugerem que medidas de reabilitação devem ser consideradas para melhorar a qualidade da visão em doenças intratáveis ou de alto risco ou de baixo prognóstico.

Purpose: When the vision in one eye is preserved (monocular vision) and there is high risk, low prognosis and/or limited resources to the fellow eye surgery, it is unclear if the benefit of binocularity outweighs the reorientation for monocular vision. The goal is to quantify the impact of the quality of vision of both binocular and monocular condition, and in this latter case, between congenital and acquired. Methods: Patients with visual acuity (VA)>0.5 in each eye underwent a structured questionnaire of 14 questions (VF-14), which the score 0-100 indicates the level of patient satisfaction with their vision, ranging from low to high respectively. Epidemiological data and scores of the four groups were recorded and analyzed statistically. Results: The interview by the VF-14 with 56 subjects revealed that the highest score was similar between controls and patients with congenital monocular vision, and low and intermediate levels were obtained by individuals with acquired monocular vision and bilaterally blind, respectively (p<0.001). The more difficult activities for individuals with acquired monocular vision were to identify small print, recognize people, to distinguish traffic lights and watch TV. Conclusion: The study confirmed that the vision loss has an adverse impact on the performance of such activities being higher in congenital than in acquired monocular vision. The data suggest that rehabilitation measures should be considered to improve the quality of vision in intractable diseases, high risk or low prognosis.

A study of sleeping disorders in blind patients.

An internal 24-hour biological clock working in tandem with external environmental cues like bright light regulates our daily rhythms specially sleep-wake cycle. In a blind individual, due to absence of external cue endogenous rhythm may take upper hand and free running of sleep-wake cycle starts without any synchronicity with day-night cycle, creating ground for sleep disorders. To evaluate the frequency of sleep disorders, 65 blind individuals without any comorbid medical or surgical problem were interviewed according to the criteria of Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV). Simultaneously 70 persons with no visual impairment were assessed in the same manner as used for blind persons. Blind patients showed far higher presence (44.6%) of sleep problems compared to controls (15.7%), and this difference was highly significant statistically [odd's ratio (OR) = 4.32, CI 95 =1.8-10.54]. Blind patients showed far higher presence (43.1%) of DSM-IV based diagnosis compared to controls (8.6%), and this difference was highly significant statistically [OR = 8.072, CI 95 = 3.059-21.298]. Circadian sleep disorders, insomnia and hypersomnia were relatively higher in blind patients. High incidence of sleep disorders calls for development of short reliable screener for sleep disorders among blind persons and better liaison among ophthalmologists and psychiatrists for early detection of this problem.

Balance and motor coordination are not fully developed in 7 years old blind children

As crianças portadoras de deficiência visual possuem dificuldades em conhecer seu próprio corpo, objetos a sua volta e parâmetros espaciais imprescindíveis para locomoção independente. Este trabalho analisa o desenvolvimento neuropsicomotor de um grupo de crianças com deficiência visual congênita em comparação a crianças com visão normal. Avaliamos dois grupos de crianças de sete anos de idade, através do exame neurológico evolutivo (ENE). O grupo estudado era constituído de 20 crianças cegas e o grupo controle constituído de 20 crianças com visão normal, pareadas por idade e sexo. Em algumas provas, as crianças cegas foram instruídas pelo tato. As crianças portadoras de deficiência visual tiveram pior desempenho nas provas que avaliaram o equilíbrio e coordenação apendicular, quando comparadas às crianças com visão normal (p< 0,001), sugerindo que o déficit visual compromete o desenvolvimento neuropsicomotor da criança.

Causas de cegueira e baixa visäo em crianças / Causes of blindness and low vision in children

Identificar e analisar as principais causas preveníveis e tratáveis da cegueira e baixa visäo na infância. Método: 174 criançasde 3 instituiçöes de duas cidades brasileiras (Salvador e Säo Paulo) foram examinadas e os dados de cada criança foram registrados em protocolo padronizados pela OMS. Resultados: De acordo com a OMS, encontrou-se cegueira ou baixa visäo em 82 por cento das crianças. Entre as moléstias preveníveis e tratáveis, a retinopatia da prematuridade e o glaucoma foram as mais frequentes. Conclusäo: O presente estudo piloto demonstrou características similares ás encontradas em outros países em desenvolvimento, onde pelo menos 50 por cento das doenças säo preveníveis ou tratáveis com o atual desenvolvimento científico.

Características principales del niños sordo-ciego con énfasis en el aspecto comunicativo / Principals characteristics of the children deafness-blind with enphasis in the comunicative aspect

La presente investigación intenta mostrar las principales características de los niños con sordoceguera, a través de un análisis de diversos aspectos como son la etiología, el aspecto visual, el aspecto auditivo, aspecto físico-postural, aspecto emocional, aspecto comunicativo y actividad lúdica. Para ello se realizaron observaciones a 5 niños sordociegos que concurren a la Institución Fátima (para multi impedidos sensoriales) situada en Beccar, provincia de Buenos Aires, y se extrajeron datos relevantes de las Historias Clínicas de los mismos. Entre los aspectos observados, se puede destacar que el mayor número de casos de sordoceguera es producido por embriopatía rubeólica. En relación al aspecto comunicativo existen diferencias en los niños que podrían depender, en gran medida, de los restos sensoriales arpovechables con los que cuentan, del aspecto emocional y de la posibilidad que hayan tenido de recibir atención temprana y adecuada a la doble discapacidad. En la actividad lúdica se observan en todos los niños conductas relacionadas al juego sensoriomotor y, en general, realizan todas las actividades en forma solitaria, pudiendo compartirlas, en ocasiones, con los docentes pero no con su grupo de pares. Pensemos que evitar que estos niños vivan condenados a un destino de aislamiento es posible, siempre que haya un Otro que le brinde los medios necesarios para desarrollarse y constituirse como sujeto. Nosotros desde nuestra profesion podemos contribuir a que así sea

comparison of static and dynamic balance among blind, deaf and normal primary school aged children in the state of Bahrain

The purpose of this study was to compare the performance level of static and. dynamic balance among blind, deaf and non-handicapped boys and girls, aged 6-12. in the state of Bahrain. Balance was measured by the Bruminks-Oseretsky Test of Motor Prqfvaeno [subtest 2: balance] to investigate the differences between the three groups in balance performance [dynamic and static]. A total of 54 male and female students were randomly selected to serve as subjects. There were three groups: 18 blind students from Al-Noor Institute for the Blind: 18 deaf students from the Rehabilitation Center, Isa Town, who had a hearing loss of not less than 70 decibels and met the specific education criteria for placement as deaf children: and 18 nan-handicapped students fom Isa Town Primary School. Sex was represented equally in all three groups. The test items were administered to the subjects in the mannewr suggested in the manner suggested manual. The total communication system was utilized with the deaf students whereas the technique qf being pui through the movement by an assistant was used with the blind students, in order to ensure that the students understood the test directions. A two by three analysis of variance fixed model was used as the appropriate statistical tool to test the null hypothesis, with an alpha level of 0.05, power level of 0.80 and effect size of 0.25. The results of this study indicated that: 1] There was a significant difference between the male and female total balance mean scores [dynamic and static]. Female mean scores were greater than the male mean scores/or the three groups of the study. 2] There was a significant difference among the non-handicapped, blind and deaf children for total balance. The mean scores for the non-handicapped were greater than the mean scores for the deaf, and the mean scores for the deaf were greater than the mean scrores for the blind. 3] No significant difference was found between the normal children's mean scores and the deaf children's mean scores in the dynamic balance. 4] There was no significant interaction between sex of subjects and the group categories used in this study. The conclusion was reached that the deaf and blind children are inferior to non-handicapped children in total balance performance and the deaf children are not inferior to the non-handicapped children in the dynamic balance

Ritmo da secreçäo do cortisol em cegos: estudo da secreçäo na amaurose congênita e adquirida / Secrecion rhythm of cortisol in blind patient: study of secrecion in congenital acquired amaurosis

O ritmo da secreçao do cortisol de seis voluntários com amaurose total binocular foi avaliado, dosando-se o cortisol sérico horário por 48 horas. Concluímos que os amauróticos, tanto os congênitos como os adquiridos, apresentam secreçao episódica do cortisol, a maioria exibindo ritmo nicteremeral com concentraçoes médias menores, de início noturno, que aumenta progressivamente ao aproximar-se o momento de acordar, alcançando níveis máximos no período do almoço. A partir desse período volta a decrescer progressivamente. Portanto, ausência de estímulo da luz através da retina nao interferiu com a ritmicidade do cortisol.

Physical fitness of Saudi Youth with visual impairments

The purpose of the study was to examine the physical fitness of the visually impaired Saudi youth and the effect of age, severity of the impairment and type of the institution on their performance. The physical fitness of thirty visually impaired subjects, 15-24 years old, was measured by using the Physical Fitness Test for Saudi youth. The findings indicated that the physical fitness of the visually impaired individuals was lower than the 25th percentile of the test norms with the exception of the flexibility item. Also, there was no difference between the two age groups or the institution types. However, significant differences were found between the blind and partially sighted subjects in long jump, 50-meter dash and flexibility items. Thus physical fitness must be incorporated in the physical education programs for the visually impaired Saudi youth regardless of their age, impairment severity or institution type. Also, the Physical Fitness Test for Saudi youth is feasible to be used to evaluate the physical fitness of visually impaired but careful interpretation of the running items results is required

Síndrome de Charles Bonnet / Charles Bonnet Syndrome

O presente trabalho apresenta uma síndrome onde encontram-se associadas perda e alucinaçöes visuais. Tal síndrome ocorre mais frequentemete em indivíduos idosos e com estado mental preservado. Os autores revisam 17 casos discutindo os mecanismos aluninogênicos envolvidos e características diagnósticos sugestivas. Ressaltam a necessidade de considerá-la como parte do diagnóstico diferencial com doenças psiquiátricas e orgânicas manifestadas por alucinaçöes visuais

Vitamina E no tratamento da retinopatia do prematuro (ROP)? / Vitamin E in the treatment of retinopaty of prematurity

O presente trabalho por objetivo discutir os aspectos mais importantes e atuais com relaçäo à etiologia, fatores de risco, classificaçäo, problemas associados e tratamento da ROP, especialmente questionando o uso de vitaminas E