This study retrospectively investigated the developmental perspective of 69 children (40 males, 29 females) with‘potentially simple’congenital disorders of the peripheral visual system: development was examined in the context of degree of visual impairment. Developmental and visual assessments were carried out at 10 to 16 months (Time 1) and 27 to 54 months of age (Time 2). Participants were grouped according to (1) visual status: profound visual impairment (PVI), severe visual impairment (SVI); (2) developmental status on the Reynell‐Zinkin scales. A majority of the sample showed normal development on all subscales (62% Time 1, 57% Time 2). Those with PVI were more developmentally vulnerable than SVI with a greater incidence of (1) uneven developmental profile at Time 1 (48% PVI, 16% SVI); (2) global learning difficulties at Time 2 (37% PVI, 0% SVI); (3) delay on individual subscales at Time 2 (p<0.02 PVI versus SVI); (4) deceleration (verbal comprehension 74% PVI, 24% SVI, sensorimotor understanding 70% PVI, 27% SVI); and (5) severe developmental setback (33% PVI, 7% SVI). Risk factors of visual level, age, and sex for poor developmental outcome in infants with visual impairment were established.
IntroductionThis review draws together current understanding of the impact of visual impairment (VI) on early neurodevelopmental and neurobiological processes. The impact is recognized as being substantial. Two major problems make it difficult to draw conclusions from much of the literature on this subject. The first is the heterogeneity of samples of children with VI in terms of additional impairments that introduce multiple confounding variables: in Western societies the prevalence of additional impairments is 60 to 70%. 1-3 Secondly, subgrouping according to the degree or severity of VI is inconsistent and can be suboptimal for developmental studies of infancy. Our group has reconsidered these questions of taxonomy and applied new ones to our recent research cohorts.Below we describe our research/service teams and clinic population, define the new taxonomies, and discuss the influences of VI on, and interactions between the visual, psychological, psychosocial, neurological, and genetic domains. Within the diagnostic category with the fewest confounding variables we identify a subgroup with an unfavourable outcome: those with a developmental setback. We debate how this subgroup might inform our understanding, not only of the impact of VI on neurodevelopmental processes but also of the mechanisms underlying the genesis of regressive disorders in those with VI and in the sighted. These issues are discussed in the context of research of our own and other groups and of current theory. Potential avenues for future investigation are put forward in each section.
SUMMARY A developmentally based programme (PVD) to promote the visual development of babies with severe visual impairment was evaluated in 58 infants aged between one month and 13 months of age. Progress in nine aspects of visual development was significantly greater for babies receiving the programme. This benefit extended to those with severe learning disability, or with minimal or apparently no vision at entry. The PVD favourably influenced visual outcome when introduced at any time during the first 13 months of life, although earlier introduction enabled greater benefit to be derived from the improved vision. Therefore, it is recommended that infants are referred to a developmental centre as soon as severe visual impairment is suspected. RÉSUME Promotion du développement visuel chez des nourrissons gravement mat‐voyants: évaluation d'un programme basé sur le développement Un programme basé sur le développement (PVD) pour promouvoir un développement visuel chez des nourrissons gravement mal‐voyants, a étéévalué chez 57 nourrissons ǎgés de un à treize mois. Le progrès dans neufs aspects du développement visuel fut significativement plus marqué chez les nourrissons bénéficiant du programme. Le bénéfice existait měme chez les nourrissons présentant de gros troubles des apprentissages et chez ceux qui n'avaient aucune vision au départ ou en tous cas, une vision très faible. Le PVD influencait favorablement le développement visuel quel que soit le moment de son introduction durant les treize premiers mois de la vie, vient qu'une introduction précoce ait permis un bénéfice d'amélioration de vision plus important. De ce fait, il est recommendé que les nourrissons soient adressés à un centre bien informé dès que le défaut de vision est suspecté. ZUSAMMENFASSUNG Förderung der visuellen Entwicklung bei visuell schwer behinderten Kindern: Beurteilung eines entwicklungsorientierten Programms Bei 58 Kindern, die einen Monat bis 13 Monate alt waren, wurde ein entwicklungsorientiertes Programm (PVD) zur Förderung der visuellen Entwicklung bei visuell schwer behinderten Kindern beurteilt. Kinder, die nach diesem Programm behandelt wurden, zeigten signifikant grp̈ßere Fortschritte in neun Punkten der visuellen Entwicklung. Dies betraf auch Kinder mit schweren Lernbehinderungen oder minimaler, bzw. scheinbar fehlender Sehkraft zu Beginn der Behandlung. Das PVD beeinflußte den visuellen Outcome günstig, wenn es innerhalb der ersten 13 Monate begonnen wurde, aber je früher mit dem Programm angefangen wurde, desto größer war der Nutzen, den das Kind durch das verbesserte Sehvermögen hatte. Daher wird empfohlen, daß Kinder mit dern Verdacht einer schweren Sehbehinderung so schnell wie möglich in ein Entwicklungszentrum überwiesen werden. RESUMEN Promoción del desarrollo visual en lactantes con una alteración visual grave:evaluación de un programa basado en el desarrollo Un programa basado en el desarrollo (PBD) para promover el desarrollo visual en lactantes con una alteración visual grave fue evaluada en 58 niños, de un me...
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