Comparison of Different Modes of Oral Health Education in Visually Impaired Children.

To compare the effectiveness of various modes of oral health education in visually impaired children. A total of 100 students aged 8-15 years were included. The children were divided randomly into four groups. Children in Group I received oral hygiene instructions through Braille pamphlets. In Group II, children received instructions through nonvisual desktop access (NVDA). For children in Group III, both Braille and NVDA were used to deliver the instructions. Children included in Group IV served as controls, who did not receive any information in any form for the study period. After oral examination to record plaque and OHI-S scores, a questionnaire was given to the children to assess their knowledge scores. The same questionnaire was repeated after 1 month to reassess the knowledge score in different groups. Chi-square test, Wilcoxon test, and post hoc analysis tests were used. The mean plaque scores among the control group children at the follow-up were significantly higher (2.5 ± 0.64) than any other group. Similarly, the control group had higher mean oral hygiene simplified scores (1.75 ± 1.32) than the Braille (1.12 ± 0.65), NVDA (0.85 ± 1.38), and Braille + NVDA (0.2 ± 0.64) groups at follow-up. With regards to the mean total knowledge score, the control group scored the least (2.16 ± 1.46), while the Braille, NVDA, and Braille + NVDA groups scored 3.16 ± 1.43, 4.52 ± 1.12, and 6.36 ± 0.52, respectively. Combination of Braille and NVDA was found to be effective in educating and motivating visually impaired children regarding maintenance of oral hygiene.

The Impact of Gamified Auditory-Verbal Training for Hearing-Challenged Children at Intermediate and Advanced Rehabilitation Stages.

Background: Auditory-verbal training is essential for children with hearing challenges, and the gamification approach has become a promising direction for improving the rehabilitation experience and effect. However, the specific influence of the gamified training approach on participants at different rehabilitation stages has not been empirically studied, especially in the practical training effect caused by gamified interventions and the varying influence on children with different rehabilitation status. Objective: This article is thus intended to investigate the following research questions: (1) do the training performances of children at advanced rehabilitation stage differ before and after using the gamified training system? (2) Do the training performances of children at intermediate rehabilitation stage differ before and after using the gamified training system? (3) Do children enjoy the gamified training approach? Methods: For the purpose, a digital gamified auditory-verbal training system was originally developed, and a series of user experiments were organized. The training performance of 31 hearing-challenged children was assessed, and interviews with six professional therapists were conducted.  Results: It can be found that generally the gamified training approach can effectively facilitate the training experience and help with the basic auditory memory and expression capabilities. Moreover, it is feasible to be applied in practical training due to the high customization of digital training contents, multimodal interactive training means, and highly enjoyable training experience. Conclusions: Regarding the specific influence, the gamified way can better improve the basic auditory-verbal performance of children at the intermediate stage since the focus is more on the ease of learning and adaption to the training system. While for children at the advanced rehabilitation stage, the precise training and professional training contents are more in demand, it is not easy to achieve quick improvements. These findings and conclusions can provide insights for further explorations and applications of the gamification approach in children's auditory-verbal rehabilitation. This study was approved by the Institutional Review Board (IRB) of Shanghai Jiao Tong University with the approval number H2022213P.

[Application of speech induced ABR in rehabilitation intervention for hearing impaired children].

Objective:Exploring the electrophysiological changes of auditory rehabilitation in young children with hearing impairment, providing more methods for early assessment and intervention. Methods:Twenty children aged 2-4 were enrolled, with moderate hearing loss and no other abnormalities in the ears. Divide them into group 1 with normal hearing, group 2 with abnormal hearing, group 3 with abnormal hearing receiving hearing aid intervention for one year, and group 4 with abnormal hearing receiving hearing aid and language training rehabilitation for one year. The SmartEP auditory evoked potential instrument was used to detect speech induced ABR and conduct screening for 'Standards and Evaluating Hearing and Language Abilities of Children with Hearing Impairment in 80 enrolled children after rehabilitation training, and the latency、amplitude of speech induced ABR waveform and evaluation scale scores for each group after rehabilitation intervention were compared. Results:Compared with the normal group, the latency of each wave in the other three groups was prolonged. The differences in each wave between Group 2 and Group 3 were statistically significant, while the differences in D and F waves between Group 3 and Group 4 were statistically significant. Compared with the normal group, the maximum amplitude at F0 decreased in the other three groups, and the differences in maximum amplitude between Group 2 and Group 3, Group 2 and Group 4, and Group 3 and Group 4 were statistically significant. Compared with the normal group, the scores of the auditory language assessment scale in the hearing intervention group and the hearing aid plus language training group were significantly higher than those in the abnormal group in terms of recognition rate. The recognition rates of hearing impaired children with language training foundation are similar to those of the normal group of children. Conclusion:Auditory rehabilitation can alter the electrophysiological aspects of hearing and serve as a basis for early assessment and intervention in young children.

Potential Factors of Dental Health Behavior as a Predictor of Dental Caries Status in Visually Impaired Children: A Pilot Study.

AIM: This study aimed to explain the potential factors of dental and oral hygiene behavior as a predictor of dental caries status in children with visual impairments. MATERIALS AND METHODS: The prevalence of dental caries in visually impaired children was investigated through a cross-senal study conducted at a visually impaired special needs elementary school in Jakarta, Indonesia. The study included 25 visually impaired children aged 6-12 years, with dental caries status examined using the decayed, missing, and filled teeth (DMFT)/dmft index according to World Health Organization (WHO) criteria. Data were collected through comprehensive interviews involving the completion of 13 WHO Annex questions. RESULTS: The result showed that the overall prevalence of dental caries in visually impaired children was 64%, with an average dmft/DMFT of 2.24/0.96. Some of the factors that significantly influence the dental caries status in children with visual impairments aged 6-12 years include visiting the dentist [p = 0.029, 0.05, Pearson's Chi-square, confidence interval (CI) 95%] and the need for care (p = 0.002, 0.05, Pearson's Chi-square, CI 95%). CONCLUSION: In conclusion, the majority of visually impaired children have dental caries, which is influenced by factors, such as visiting the dentist and the need for treatment. CLINICAL SIGNIFICANCE: Visiting the dentist regularly and knowing the need for the treatment are the important factors in preventing of dental caries. How to cite this article: Darwita RR, Mayasari Y, Danaswari PVS, et al. Potential Factors of Dental Health Behavior as a Predictor of Dental Caries Status in Visually Impaired Children: A Pilot Study. J Contemp Dent Pract 2024;25(2):174-179.

Research on immersive interaction design based on visual and tactile feature analysis of visually impaired children.

To propose improved and innovative visual-tactile interaction design for visually impaired children, multi-modal combination approaches have been applied, such as voice interaction, touch interaction, and multi-modal systems, what's more, aided cognitive approaches help them deepen their understanding of objects, improve their cognitive level, and increase their interest. METHODS: To improve the amount of information in the visual-haptic interface by integrating multiple sensory information, based on the cognitive patterns of visually impaired children, a questionnaire was used to design a tactile-visual UI for the main content objects of visually impaired children when using the Internet, from which difficulties and problems in the design of visual-haptic for visually impaired children were found, and design improvements were proposed based on the principles and methods of accessible design. RESULTS: The personalized and humanized design activities enhance the confidence and improve the quality of life of the visually impaired children group and produce positive effects, improving the cognitive clarity of visually impaired children while increasing their level of understanding, imagination, learning interest and aesthetic experience. CONCLUSION: The physical and mental characteristics and visual and tactile characteristics of visually impaired children are analyzed, and the application of UI interaction design is based on these characteristics. The essence of interaction design is outlined through experiments, and it is found that with the development of the Internet, big data and artificial intelligence, visually impaired children have many difficulties in the use of the Internet, and through the improved practice of immersive interaction design, the humanized design approach is used to enhance visually impaired children's experience of using network interfaces. Through the improved practice of immersive interaction design, we improve the way of visually impaired children using the Internet, narrow the gap between them and normal children in the interaction, and give humanistic care.

Development and clinimetric assessment of a performance-based functional vision tool in visually impaired children.

Objective: Appropriate functional vision is vital for the development of visually impaired (VI) children. However, the literature currently lacks a performance-based tool for assessing functional vision, unlike the existing self-reported tools. The objective of this study is to develop and conduct a clinimetric study on a Performance-Based Functional Vision Tool (PB-FVT) specifically designed for VI children aged 3-7 and 7-10 years old. Methods: This methodological study was conducted to assess the clinimetric properties of the PB-FVT. The assessment included face validity (evaluated through cognitive interviews and an Impact Score >1.5), content validity (with criteria including content validity ratio >0.63, item content validity index >0.78, scale content validity index or average >0.8, and Kappa value >0.7), criterion validity (assessed through a concurrent test using visual acuity scores), construct validity (utilizing the known group method), relative reliability (measured by the intra-class correlation coefficient), absolute reliability (determined by the standard error of measurement and minimal detectable changes), interpretability, responsiveness, sensitivity, and specificity (analyzed via ROC curve analysis). Results: The PB-FVT was developed with 32 items, divided into five components: activities of daily living, instrumental activities of daily living, education, play, and social interaction. The results indicate that the scale demonstrates suitability in terms of validity, reliability, and other measurement characteristics. Conclusions: The valid and reliable PB-FVT may accurately assess the level of functional vision during early childhood, helping to prevent negative impacts on a child's overall development. By utilizing the PB-FVT, any functional vision impairments can be identified appropriately, enabling the planning and implementation of effective rehabilitation interventions.

Measurement of body composition by deuterium oxide dilution technique and development of a predictive equation for body fat mass among severe neurologically impaired children.

Introduction: Neurologically impaired (NI) children are at risk of malnutrition, which consequently impacts their health and quality of life. Accurate nutrition assessment is an important step in guiding appropriate nutrition support. Conventional anthropometric measurements among NI children have some limitations. Determining body composition requires more complex equipment, which is not routinely performed. This study was conducted to evaluate the association between anthropometric parameters and body composition assessed using the deuterium dilution technique (DDT) in NI children. Methods: A cross-sectional study enrolled severe NI children aged 1-20 years who received home enteral nutrition for at least 3 months. Weight, length, and 4-site skinfold thickness were measured. Body composition was determined using DDT following the International Atomic Energy Agency (IAEA) protocol. Results: A total of 37 NI children (56.76% male, median age 7.2 years) were enrolled. The prevalence of underweight, stunting, and overweight were 22, 38, and 35%, respectively. Body composition analysis showed the mean (SD) of total body water (TBW) and fat mass (FM) were 10.52 (4.51) kg and 9.51 (6.04) kg, respectively. Multivariate GLM analysis showed that the factors associated with FM were age (ß = 0.07 [0.05,0.08]; p < 0.001), body mass index (BMI) (ß = 0.82 [0.52, 1.12]; p < 0.001), biceps skinfold thickness (BSF) (ß = 0.49 [0.23,0.75]; p = 0.001), and subscapular skinfold thickness (SSF) (ß = -0.24 [-0.46,0.03]; p = 0.030). A predictive equation for FM was constructed. Conclusion: A high prevalence of malnutrition was found among severe NI children despite enteral nutrition support. Our findings showed that age, BMI, BSF, and SSF were associated with FM. The predictive equation of FM was proposed and needed to be further validated and applied to clinical practice.

Vocal health of parents of children with hearing assistive devices.

Background & Objectives: VH (Vocal health) is the need of the hour. VH of parents of children with hearing assistive devices (HAD) reveals a literature gap, during the habilitation process of their children. To explore the vocal health of parents of children with hearing assistive devices. Methods: This cross-sectional study was conducted at Riphah International University from September to December 2021. Study recruited N=384 parents of Hearing Impaired children (HIC) using HAD for at least two years, of both genders and aged 2-9 years using convenience sampling. Voice-related quality of life (V-RQOL), and vocal health Index (VHI) -10 were used for data collection. Data was analyzed on SPSS Version 25. Descriptive statistics, Anova and t-test were utilized to see difference between means of groups. P<0.05 shows significant-results. Results: Parents of children using hearing assistive devices had excellent V-RQOL score in 350(91.14%) parents. There was no significant difference in V=RQOL as regards type of hearing assistive device use (p=0.102), laterality of device use (p=0.918) and degree of hearing loss (p=0.143). However, type of hearing loss revealed significant difference (p=0.021). Also VHI score revealed significantly (p=0.008) lower means in parents of children with cochlear implants. Conclusion: Current study concludes that the parents raising hearing impaired children with hearing assistive devices, possess good vocal health as determined by VHI and V-RQOL scores with only a very small number of parents reporting vocal symptoms.

The Comparison of Anxiety Tactile Using the RMS Tactile Scan in Visually Impaired Children After Performing Oral Prophylaxis by Explaining to Them the Procedure by Verbal Tactile Method.

Background: Dental anxiety assessment for blind children is important. Appropriate knowledge of the patient's anxiety will help to review management options specific to every child. Aim: The aim of this study was to evaluate the anxiety level using the Raghavendra, Madhuri, Sujata (RMS) tactile scale (RMS-TS) of visually impaired children after explaining the oral prophylaxis procedure verbally and by the verbal-tactile method followed by performing the oral prophylaxis procedure. Materials and methods: A total of 30 children aged between 6 and 13 years were included in this study from a residential school for visually impaired children. These children were divided into two equal groups. One group was explained oral prophylaxis by verbal method and another was explained in a verbal-tactile method, preintervention and postintervention anxiety of the children was checked on the RMS-TS. Results: A comparison of mean values between the two groups was done using a t-test. Comparison of mean values in each group for before and after values were done using paired t-test and was found that anxiety had reduced in the verbal-tactile group more significantly than that of the verbal group. Conclusion: The study shows that the combination of verbal and tactile models for explaining the dental procedure is an effective way to reduce anxiety in blind children. How to cite this article: Kumbar S, Rathod SA, Patil AT, et al. The Comparison of Anxiety Tactile Using the RMS Tactile Scan in Visually Impaired Children After Performing Oral Prophylaxis by Explaining to Them the Procedure by Verbal Tactile Method. Int J Clin Pediatr Dent 2023;16(4):551-554.

Augmented Tactile Book: Design of a Multisensory Page Prototype.

In the framework of the LTA project, focusing on leisure reading for children with visual impairment, we present a prototype of multisensory illustration that will be used as a model for future accessible tactile interactive books. This multisensory illustration is based on two approaches to illustrate the storytelling. The first approach consists in embodying the character's legs with the index and middle fingers in order for the user to imitate actions such as walking. The second approach is to offer interactions feedback according to the readers actions. The main goal of this multisensory illustration prototype is to test and evaluate a selection of interactions and their associated sensors. These interactions help visually impaired readers to identify the environment of the story. They also help to understand actions behind the verbs. Readers are engaged to produce actions such as touching and imitating with their fingers. These interactions are developed according to hypotheses based on the literature. This multisensory illustration prototype was tested with a panel of children. The results comfort the idea that these interactions are useful for them.

Are Teachers Working with Visually Impaired Children Prepared to Be Advocates of Oral Health? Pilot Study.

BACKGROUND: Children and adolescents with visual impairment are at increased risk of oral cavity diseases. Pro-health education in their prevention and the role of educators and school counselors are extremely important in this aspect. The aim of the study was to collect information, and compare and analyze the level of pro-health awareness in the field of oral health prevention among teachers working with visually impaired children in Poland and Slovakia. METHODS: The questionnaire survey covered 109 school educators working with visually impaired children. The survey contained general information about participants concerning their knowledge of oral health, basic information about oral hygiene, and children's care needs in this area. The obtained results were statistically analyzed. RESULTS: The level of knowledge about oral health was assessed by the majority of respondents as rather good (60.56%), 28.44% as very good, and 11.01% as middling. Teaching children about oral hygiene at school was declared by a majority of them and over half of the correct answers were given by only 48.42% of the respondents. CONCLUSIONS: It is advisable to intensify the oral cavity diseases prevention training of teachers working with visually impaired children and youth and there is a great need to organize and carry out educational campaigns in schools for them.

Assessment of Oral Hygiene Status and Prevalence of Dental Caries and Traumatic Injuries to Anterior Teeth among Visually Impaired Children in Chennai City.

Aim: To assess the oral hygiene status and prevalence of dental caries and trauma to anterior teeth among visually impaired children in Chennai city. Settings and design-a cross-sectional study was conducted in institutionalized blind schoolchildren. Materials and methods: A total of 130 children from two blind schools were selected based on the inclusion and exclusion criteria. Oral hygiene status was assessed using the oral hygiene index-simplified (OHI-S). Dental caries were assessed using decayed-missing-filled teeth (DMFT) and decayed, extracted due to carries, filled teeth (deft) index for permanent and primary dentition, respectively. Trauma to anterior teeth was assessed using Ellis and Davey classification. Statistical analysis used-all the data were analyzed using the Statistical Package for the Social Sciences (SPSS) software 20.0. Results: The assessment of oral hygiene status showed that 54.6% of children had good oral hygiene, 45.4% had fair oral hygiene, and none had poor oral hygiene. The prevalence of dental caries in permanent and primary dentition was found to be 40 and 63.1%, respectively. The prevalence of trauma to anterior teeth was found to be 35.4%. Conclusion: Primary prevention approaches should be taught to parents and school teachers for early intervention of oral health problems. How to cite this article: Kannappan J, Srinivasan D, Chiriyankandath JL, et al. Assessment of Oral Hygiene Status and Prevalence of Dental Caries and Traumatic Injuries to Anterior Teeth among Visually Impaired Children in Chennai City. Int J Clin Pediatr Dent 2023;16(1):93-96.

Production of Tone 2 in disyllabic words in Mandarin Chinese speaking children aged 3-5 with a cochlear implant and a contralateral hearing aid.

To investigate Mandarin Tone 2 production of disyllabic words of prelingually deafened children with a cochlear implant (CI) and a contralateral hearing aid (HA) and to evaluate the relationship between their demographic variables and tone-production ability. Thirty prelingually Mandarin-speaking preschoolers with CI+HA and 30 age-matched normal-hearing (NH) children participated in the study. Fourteen disyllabic words were recorded from each child. A total of 840 tokens (14 × 60) were then used in tone-perception tests in which four speech therapists participated. The production of T2-related disyllabic words of the bimodal group was significantly worse than that of the NH group, as reflected in the overall accuracy (88.57% ± 16.31% vs 99.29% ± 21.79%, p < 0.05), the accuracy of T1+T2 (93.33% vs 100%), the accuracy of T2+T1 (66.67 ± 37.91% vs 98.33 ± 9.13%), and the accuracy of T2+T4 (78.33 ± 33.95% vs 100%). In addition, the bimodal group showed significantly inferior production accuracy of T2+T1 than T2+T2 and T3+T2, p < 0.05. Both bimodal age and implantation age were significantly negatively correlated with the overall production accuracy, p < 0.05. For the error patterns, bimodal participants experienced more errors when T2 was in the first position of the tone combination, and T2 was most likely to be mispronounced as T1 and T3. Bimodal patients aged 3-5 have T2-related disyllabic lexical tone production defects, and their performances are related to tone combination, implantation age, and bimodal age.

Validation of the Filipino translation of the impact of vision impairment for children (IVI_C) questionnaire among school children

Background@#Quality of life questionnaires provide valuable information in assessing the effects of health interventions and public health campaigns. In the Philippines, we only have a few validated questionnaires targeted specifically for children.@*Objective@#To translate to Filipino and validate the translated Impact of Vision Impairment for Children Questionnaire (IVI_C).@*Methods@#This is a translation and validation study of the IVI_C. The IVI_C was translated following international guidelines of forward–translation and back-translation methods. After completion of the Filipino IVI_C version, pretesting was performed on school-aged children 8 to 18 years old through convenience sampling in the outpatient department and Pediatric Ophthalmology and Motility Clinic at Sentro Oftalmologico Jose Rizal, Philippine General Hospital from January 1 to August 31, 2018.@*Results@#We included 130 participants in the study. The calculated Cronbach’s alpha coefficient of 0.88 for the translated Filipino version of the IVI_C suggested high reliability and internal consistency. Rasch analysis showed comparability of the Filipino translation to the original English version of the questionnaire.@*Conclusion@#Our study showed that the Filipino version of IVI_C questionnaire was of high reliability and validity.

Clinical presentations of erosive esophagitis found at endoscopy in neurologically impaired children: a historical study.

BACKGROUND: Data is lacking as to the clinical presentation of erosive esophagitis (EE) in neurologically impaired children compared to non-neurologically impaired children (non-NIC). To determinate the clinical presentation, associations, management, and outcomes of EE in neurologically impaired children compared to children without neurologic impairment. METHODS: Retrospective chart review of all esophagogastroduodenoscopies performed in pediatric patients at the University of Mississippi Medical Center from 1998 to 2020 with the diagnosis of EE. Fisher's exact test was used to compare results from neurologically impaired children group and non-NIC. A probability <0.05 was considered statistically significant. RESULTS: Forty-seven patients were diagnosed with EE and met study criteria. Twenty-six patients were neurologically impaired children, and 21 were non-neurologically impaired children. No significant difference was seen between age at diagnosis, sex, or hematologic markers of anemia. The most common indication for esophagogastroduodenoscopies in neurologically impaired children was hematemesis (65.4%), whereas abdominal pain (33.3%) was the most common in non-NIC. Neurologically impaired children were more likely to be treated with acid-blockade. Nine neurologically impaired children had gastrostomy tubes prior to diagnosis as opposed to 0 non-neurologically impaired children. After diagnosis, 8 neurologically impaired children underwent gastrostomy tube placement compared to 0 non-neurologically impaired children, and fundoplication was performed in 11 neurologically impaired children as compared to 1 non-NIC. The sensitivity of fecal occult blood test for detecting EE was higher for neurologically impaired children (91.7%) than for non-NIC (33.3%). CONCLUSIONS: EE in neurologically impaired children presents differently than in non-neurologically impaired children with blood loss being the most common presentation in neurologically impaired children. Neurologically impaired children are more likely to be treated with acid-blockade prior to diagnosis, likely due to heightened risk for gastroesophageal reflux disease (GERD). Additionally, they are more likely to undergo surgical management of EE than non-neurologically impaired children.

Case report: Dancing in the dark: A critical single case study engaging a blind father in the rehabilitation journey of his visually impaired child.

Background: Face-to-face visual contact is a key component of the early parent-child interaction, therefore a visual impairment condition of the parent or the child represents a risk factor for dyadic patterns' development. Aims: The study presents a critical single case of a blind father and a 18-month-old visually impaired child. The study aims to explore changes in the relational functioning of this dyad during an early family-centered intervention. Methods and procedures: Ten parent-child sessions were videotaped and micro-analytically coded. Data were analyzed through a State Space Grid crossing child's social cues and types of father verbalizations. Outcomes and results: Findings showed a stable increase in the amount of child social cues over time. Moreover, the dyad exhibited progressive changes in dyadic regulation, stability, and organization. The return time to the "active interaction" region of interest decreased progressively. A reduction was observed also for the time spent by the dyad in the region "no vocal contact." Conclusions and implications: This critical single case highlighted the benefits of parental engagement in early interventions for the dyadic regulation in parent-child interaction.

Total esophagogastric dissociation (TEGD) in neurologically impaired children: the floor to parents.

Total esophagogastric dissociation (TEGD) was proposed to treat gastroesophageal reflux disease (GERD) both as a rescue in case of fundoplication failure and as first-line surgery in neurologically impaired children (NIC). Aim of the study is to evaluate the impact of TEGD on the quality of life (QoL) of both NIC and their caregivers focusing on the parents' point of view. A retrospective observational study was conducted on all NIC who underwent TEGD in our center between 2012 and 2022. A questionnaire centered on the parents' point of view and investigating QoL of NIC and their caregivers was administered to all patients' parents. Data were compared using Fisher exact test and Mann-Whitney test; a p-value < 0.05 was considered statistically significant. 12 patients were enrolled in the study. Parents reported improvements in weight gain (p = 0.03), sleep disorders, apnea, regurgitation and vomiting (p < 0.01). Caregivers also declared a decrease in number of hospitalizations, particularly related to severe respiratory infections and ab ingestis pneumonia (p = 0.01). We also documented a reduction of caregivers' worries during food administration (p < 0.01). 50% of parents whose children were subjected to both fundoplication and TEGD would suggest TEGD as first line surgical treatment instead of fundoplication. According to parents' point of view, TEGD improves significantly NIC QoL and 50% of them would enthusiastically suggest TEGD as first-line surgical approach to GERD in NIC.

The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment.

Introduction: Cerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method. Patients and Methods: We developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic. Results: Based on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458). Conclusion: In medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.

Long latency auditory evoked potentials and object-related negativity based on harmonicity in hearing-impaired children.

Hearing-impaired children (HIC) have difficulty understanding speech in noise, which may be due to difficulty parsing concurrent sound object based on harmonicity cues. Using long latency auditory evoked potentials (LLAEPs) and object-related negativity (ORN), a neural metric of concurrent sound segregation, this study investigated the sensitivity of HIC in processing harmonic relation. The participants were 14 normal-hearing children (NHC) with an average age of 7.82 ± 1.31 years and 17 HIC with an average age of 7.98 ± 1.25 years. They were presented with a sequence of 200 Hz harmonic complex tones that had either all harmonic in tune or the third harmonic mistuned by 2%, 4%, 8%, and 16% of its original value while neuroelectric brain activity was recorded. The analysis of scalp-recorded LLAEPs revealed lower N2 amplitudes elicited by the tuned stimuli in HIC than control. The ORN, isolated in difference wave between LLAEP elicited by tuned and mistuned stimuli, was delayed and smaller in HIC than NHC. This study showed that deficits in processing harmonic relation in HIC, which may contribute to their difficulty in understanding speech in noise. As a result, top-down and bottom-up rehabilitations aiming to improve processing of basic acoustic characteristics, including harmonics are recommended for children with hearing loss.

A strategy to prevent tracheo-innominate artery fistula in the course of laryngotracheal separation: 9-year experience in a children's hospital.

AIM OF THE STUDY: Laryngotracheal separation (LTS) is known to be the definitive solution for intractable aspiration pneumonia in neurologically impaired children. Postoperatively, a tracheostomy cannula is usually required. However, there are fatal cannula related complications such as a tracheo-innominate artery fistula (TIAF). We present our methods of preventing TIAF. METHODS: A retrospective review in a single center from 2011 to 2019 identified 57 cases treated with LTS. We divided them into three groups: no pre-existing tracheostomy (n = 26), pre-existing tracheostomy with preservation of the pre-existing fistula (n = 20), and pre-existing tracheostomy without preservation of the pre-existing fistula (n = 11). The first group underwent traditional modified Lindeman's procedure. The second received transection of the trachea above the tracheostomy site, while the third had transection of the trachea at the tracheostomy site and creation of a distal end tracheostomy. Proper length and the angle of the cannula were selected to prevent damaging the innominate artery by the tip of the cannula. If the innominate artery compressed the trachea anteriorly, prophylactic arterial transection was considered. RESULTS: Three patients (5.3%) died from causes unrelated to the surgical treatment. Only one patient had a postoperative TIAF followed by LTS (1.8%). Other postoperative complications were: wound infection (8.8%), intratracheal granuloma (12.3%), intratracheal minor bleeding (10.5%), wound granuloma (43.9%), leakage (1.8%). No one required revision of LTS. CONCLUSION: Success rates of LTS were high without major complications in all three groups and implies a safe operation and a definitive solution to intractable aspiration.