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Anna Krumm, Manja Company, Stephan Küster, Iliya V. Ivanov, Martin Staudt, Angelika Cordey, Claudia Gehrlich, Susanne Trauzettel-Klosinski; Effect of Explorative Saccadic Training (EST) to daily living skills in children with homonymous hemianopia (HH). Invest. Ophthalmol. Vis. Sci. 2016;57(12):4583.
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© ARVO (1962-2015); The Authors (2016-present)
HH in children caused by pre- and perinatal brain damage, trauma, tumor or as a result of epilepsy surgery leads to orientation difficulties in everyday life. We showed in a previous RCT in adult hemianopic patients the effectiveness of EST.* So far, little is known about compensatory strategies in children. This study investigates how children adapt to hemianopia, which challenges they face and how a new kids-adapted computer-based EST can improve performance in everyday search tasks.
22 children (13 right, 9 left HH), mean age 12 years 1 month (SD: 3;9, range: 6;5 -17;8), mean disease duration 6 y 4 m (SD: 4;10, range 0;1 – 16;9) and 16 normal sighted children, mean age 11 y 8 m (SD: 2;7, range: 7;8-17;3) were included. Causes of HH were ischemia (23%), tumor (23%), epilepsy surgery (27%), trauma (9%), cerebral hemorrhage (9%) and other causes (9%). We analyzed adaptive mechanisms before EST (T1), after 6 weeks EST (T2) and 6 weeks after end of EST (T3). At T2 and T3 training effect was evaluated by measuring reaction time for finding objects among different distractors on a table (table test) and everyday problems were assessed by standardized quality of life questionnaires for children (KINDL-R, IVI_C, CVAQC-25) and specific orientation questions.
19 of the 22 children showed an ipsilateral head tilt, 7 ipsilateral exotropia and 6 homonymous eccentric fixation. Search time improvement in EST and table test correlated highly (pearson correlation= 0.69, p=0.002). At T1, parents reported significantly more problems of their child getting out of the way than their children themselves (64 % vs. 50 %, Cohens Kappa= 0.62, p=0.004) and reported more improvement at T2 (parents: T1 64 %, T2 50%; children: T1 50%, T2 45%). Problems bumping into objects were reported by 46% of the parents and 41% of the children at T1, at T2 36% of the parents and children still reported difficulties.
Hemianopic children face difficulties, often only noticed by their parents, like getting out of the way and bumping into objects. The children benefit from EST and can transfer the training effect to an everyday search task. This study also shows that adaptive mechanisms like a head tilt may give a hint to discover an undetected hemianopia. *Roth et al (2009) Neurology 72(4):324-331
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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