Benefits and challenges of using assistive technology in the education and rehabilitation of Individuals with visual impairments.

Purpose: Individuals with visual impairments use assistive technology in various aspects of life. Professionals who work with visually impaired people need to know about assistive technologies. The purpose of this study was to analyse the benefits and challenges of assistive technologies by assessing the degree of satisfaction with assistive technologies in different life situations expressed both by users and by professionals.Materials and Methods: Data were collected from 36 individuals with visual impairments and 27 professionals using online questionnaires. Further information was obtained from five individuals with visual impairments through focus group interviews.Results: The results show that 26 (72.2%) individuals with visual impairments and almost all professionals (N = 25; 92.6%) acknowledge the benefits of using assistive technology. They recognise the importance of assistive technology in independent living for individuals with visual impairments. However, 27 (75%) individuals with visual impairment and 26 (96.3%) professionals consider financial constraints to be the biggest problem.Conclusion: More cost-effective technologies need to be developed, and social policies and opportunities created so that every individual with visual impairment can obtain assistive technologies that meet their needs. This would increase the independence of individuals with visual impairments in all areas of life.

Assistive technology support independent living of individuals with visual impairments in all aspects of their livesIndividuals with visual impairments benefit from use of assistive technology but often cannot afford it because it is too expensiveTo increase the independence of individuals with visual impairments, we need to develop good legislation and create less expensive assistive technology that is affordable for everyoneTo find the best possible solution for individuals, we need to conduct a functional assessment and train professionals and individuals with visual impairments in the use of assistive technology.

Functional vision in children with perinatal brain damage.

UNLABELLED: Many authors have discussed the effects of visual stimulations on visual functions, but there is no research about the effects on using vision in everyday activities (i.e. functional vision). Children with perinatal brain damage can develop cerebral visual impairment with preserved visual functions (e.g. visual acuity, contrast sensitivity) but poor functional vision. OBJECTIVE: Our aim was to discuss the importance of assessing and stimulating functional vision in children with perinatal brain damage. METHODS: We assessed visual functions (grating visual acuity, contrast sensitivity) and functional vision (the ability of maintaining visual attention and using vision in communication) in 99 children with perinatal brain damage and visual impairment. All children were assessed before and after the visual stimulation program. RESULTS: Our first assessment results showed that children with perinatal brain damage had significantly more problems in functional vision than in basic visual functions. During the visual stimulation program both variables of functional vision and contrast sensitivity improved significantly, while grating acuity improved only in 2.7% of children. We also found that improvement of visual attention significantly correlated to improvement on all other functions describing vision. CONCLUSIONS: Therefore, functional vision assessment, especially assessment of visual attention is indispensable in early monitoring of child with perinatal brain damage.

Visual stimulations' critical period in infants with perinatal brain damage.

BACKGROUND: Children with perinatal brain damage have a high prevalence of visual impairment. Stimulation of vision at a critical period can encourage brain plasticity and the recovery of impaired function. OBJECTIVE: The aim of our study was to investigate when is the critical period for visual stimulation in children with perinatal brain damage. METHODS: We compared 35 children within the first eight months of life (median age = 4 months) to 35 children aged between eight and thirty months (median age = 15 months), all with perinatal brain damage. All the children were attending an early intervention program at Mali dom, Zagreb, a rehabilitation centre for children with visual impairment. We compared the results from baseline and follow-up assessments of visual functions (grating acuity and contrast sensitivity). We also compared differences in change scores between the two groups. RESULTS: Our results have shown that children who commence a visual stimulation program within the first eight months of life had more improvement in both visual functions. This improvement is statistically significant in visual acuity (p = 0.048). CONCLUSIONS: These results indicate the importance of starting a visual stimulation program within the first eight months after birth.

The effect of vibration therapy on spasticity and motor function in children with cerebral palsy: a randomized controlled trial.

As the motor system relies heavily on deep sensory stimulation, recent studies have investigated the effect of vibration stimuli. Although research suggests a positive influence of vibration on motor performance in individuals with neurological disorders, there are very limited numbers of studies in children with cerebral palsy (CP). The objective of the present study was to evaluate the effects of sound wave vibration therapy on spasticity and motor function in children with CP. In this 3-month trial, 89 children with spastic CP were randomized to either continue their physiotherapy treatment (PT) or to receive vibration therapy twice a week in addition to their PT program. The randomization was stratified according to the Gross Motor Function Classification System (GMFCS) level to ensure similar functional ability. Children were assessed at baseline and after the 12-week intervention period. The outcomes measured were spasticity level as assessed by Modified Modified Ashworth Scale (MMAS) and gross motor function as assessed by Gross Motor Function Measurement (GMFM-88). Subgroup analysis was performed for the GMFCS. Significant differences between groups were detected for changes in spasticity level and gross motor function after the three months intervention. In conclusion, vibration therapy may decrease spasticity and improve motor performance in children with CP. The results of the present trial serve as valuable input for evidence-based treatments in paediatric neurorehabilitation.

The relationship between spasticity and gross motor capability in nonambulatory children with spastic cerebral palsy.

Spasticity has been considered as a major impairment in cerebral palsy (CP), but the relationship between this impairment and motor functions is still unclear, especially in the same group of patients with CP. The aim of this investigation is to determine the relationship between spasticity and gross motor capability in nonambulatory children with spastic CP. Seventy-one children (30 boys, 41 girls) with bilateral spastic cerebral palsy and with Gross Motor Function Classification System (GMFCS) levels IV (n=34) and V (n=37) were included in the study. The spasticity level in lower limbs was evaluated using the Modified Modified Ashworth Scale and the gross motor function with the Gross Motor Function Measure (GMFM-88). Spearman's correlation analysis was used to determine the nature and the strength of the relationship. The results showed a moderate correlation between spasticity and gross motor skills (ρ=0.52 for the GMFCS level; ρ=0.57 for the GMFM-88), accounting for less than 30% of the explained variance. It seems that spasticity is just one factor among many others that could interfere with gross motor skills, even in children with severe forms of spastic CP. Knowledge of the impact of spasticity on motor skills may be useful in the setting of adequate rehabilitation strategies for nonambulatory children with spastic CP.

Stimulation of functional vision in children with perinatal brain damage.

Cerebral visual impairment (CVI) is one of the most common causes of bilateral visual loss, which frequently occurs due to perinatal brain injury. Vision in early life has great impact on acquisition of basic comprehensions which are fundamental for further development. Therefore, early detection of visual problems and early intervention is necessary. The aim of the present study is to determine specific visual functioning of children with perinatal brain damage and the influence of visual stimulation on development of functional vision at early age of life. We initially assessed 30 children with perinatal brain damage up to 3 years of age, who were reffered to our pediatric low vision cabinet in "Little house" from child neurologists, ophthalmologists Type and degree of visual impairment was determined according to functional vision assessment of each child. On the bases of those assessments different kind of visual stimulations were carried out with children who have been identified to have a certain visual impairment. Through visual stimulation program some of the children were stimulated with light stimulus, some with different materials under the ultraviolet (UV) light, and some with bright color and high contrast materials. Children were also involved in program of early stimulation of overall sensory motor development. Goals and methods of therapy were determined individually, based on observation of child's possibilities and need. After one year of program, reassessment was done. Results for visual functions and functional vision were compared to evaluate the improvement of the vision development. These results have shown that there was significant improvement in functional vision, especially in visual attention and visual communication.