Could the profile of visual functioning become a

Could the "profile of visual functioning" become a carrier of information between education, medicine, and social services? Lea Hyvärinen, MD, Ph. D, FAAP Technical University of Dortmund University of Helsinki With Amanda Hall Lueck and Göran Cedermark 1

Ventral and dorsal streams Mirror neuron system Insula

3 Ventral and dorsal stream/networks Mirror neuron system Insula

4 Profile of visual functioning based the learning strategy that probably will be used N= normal (1), I= impaired but useful (2), P=profound VI or blindness (3)

Assessment of Visual Functioning 1. OCULOMOTOR FUNCTIONS and REFRACTION 2. QUALITY OF VISUAL INFORMATION CLINICAL TESTS A. Information from the ophthalmologist, optometrist, neurologist B. Observation and measurements at KG and schools C. General and visual ergonomics 3. ASSESSMENT OF VISUAL PROCESSING

Ocular Motor Functions & Refraction • Fixation, Saccades, Accommodation, Following • Strabismus, Nystagmus, Head and Body Control • Refractive Errors • Corrective Spectacles, Frames, Devises 11

Reading saccades, fixations, scanning 9

Text on clear film VA reported to be 0. 63; at school 0. 02 with 50% spacing 10 This student learned to talk 6 months before this video was filmed. The letter ”V” is difficult > fixation is lost.

Simple recording 11

Unusual ”dyslexia” Letters A and V shown on an oscilloscope: Visual acuity with line test 0. 5 (3/6, 10/20), but 1. 6 when pointed at. Nyman G, Laurinen L, Hyvärinen L. Topographic instability of spatial vision as a cause of dyslectic disorder: a case study (1982) Neuropsychologica 20: 181 -186.

Assessment of Visual Functioning 1. OCULOMOTOR FUNCTIONS and REFRACTION 2. QUALITY OF VISUAL INFORMATION CLINICAL TESTS A. Information from the ophthalmologist, optometrist, neurologist B. Observation and measurements at KG and schools C. General and visual ergonomics 3. ASSESSMENT OF VISUAL PROCESSING

14 Clinical examination gives the foundation for the assessment of visual functioning Detection grating acuity Fixation to penlight, to picture, following, saccades, accommodation, convergence, visual communication Photo: Miguel G. Alvares, MD Brazil Hiding Heidi test

Clinical examination gives the foundation for the assessment of visual functioning orthoptists, therapists, nurses, optometrists, technicians, parents, rehab team OBSERVATIONS require time! Photo: Miguel G. Alvares, MD Brazil

Changes in information within the eye 16 Changes in cornea, lens, vitreous >> blurred, distorted image, photophobia Retina, distortions, changes in visual field, scotomas, photophobia Low contrast sensitivity >> round forms disappear>> demonstration

Clinical examinations • Oculomotor functions • Grating acuity • Recognition acuity • Contrast sensitivity • Visual field • Visual adaptation, filters • Motion perception Tests should be repeated in day care and at school.

Visual Sensory Functions Visual acuity, near (single, line, crowded), distance, Grating acuity Contrast sensitivity, optotype and grating tests Colour vision, Visual adaptation to changes in luminance level, filter lenses Figure in motion, Biological motion, Perception of motion at high speeds Visual field, size and scotomas, Goldmann, flicker, automatic, campimeter 18 (29)

Several tests – several VA values Distance – single 3 m/1. 9 M 1. 0, 3/3 – line 3 m/4 M 0. 63, 3/5 at 40 cm Near 40 cm – single symbols 0. 40, – screening test 0. 25, – 50% spacing 0. 20, – 25% spacing 0. 16, 19 3/7. 5 3/12 3/15 3/16 1 M 1. 6 M 2. 0 M 2. 5 M

Single optotypes sometimes the only VA test possible answering with head turn, looking at the choice 20

Oculomotor problems tactile keycard, looking can be kept on the test Cover above and below the line to be read. 21

LEA Grating Acuity Test Discrimination acuity test 22

Early Visual Processing Perception of length and orientation of lines and objects Figure-ground, object-background, stereovision, Vernier acuity Short time visual memory, matching colours 11 (40) — — / / — — Children with coding problems may perceive the lines changing their orientation.

Copying basic forms A. B. T T Task: to copy three parallell lines, cross, angle and rectangle with circle and square at corners. The tester draws the test figures while the student is watching. Student A has left sided hemiplegia and –anopia and visual acuity 0. 12 (10/80); student B has normal clinical findings in vision tests and diplegic condition (legs).

Ventral Stream Inferotemporal Networks Details in pictures, Noticing errors and missing details Perception of textures and surface qualities Recognition of familiar and unfamiliar faces Facial expressions, Body language Landmarks, Concrete objects, Pictures of concrete objects Abstract pictures of objects of different categories Abstract forms (letters, numbers) Reading words and lines of texts, Optimal reading strategy Comparison with pictures in memory, ‘Reading’ series of pictures Visual problems in copying pictures from blackboard and/or at near Crowding effect, Scanning lines of text 24 (64)

26 Cognitive vision test • • Hiding Heidi for communication LEA-Mailbox LEA-Rectangles Face pictures Heidi Expressions LEA Puzzle Crowding effekt Reading tests • OBSERVATIONS • Neuropsychological consultation

Dorsal Stream/ Parietal Networks Awareness of surrounding space, directions and distances in space Body awareness Perception of near and far space Orientation in space, map based, Memorising routes Motion perception, Depth perception, Simultaneous perception Eye-hand coordination, Grasping and throwing objects Drawing, free hand, visual imagination Copying from near/ from blackboard, motor planning and execution Mathematics, Visual attention 12 (76)

28 Visual processing and its problems VENTRAL STREAM DORSAL STREAM Direction and length of lines and objects Object-background Crowding – increased crowding Awareness of space Map based orientation in space Orientation based on routes X RECOGNITION FUNCTIONS: Concrete objects Pictures of concrete objects Visual closure – Filling in Order of 3 -4 pictures Copying basic drawings, lines, cross, angle X used for planning motor functions Perception of textures, surface qualities Y Reading as a visual task Recognition of letters and words Saccades in reading, reading without saccades Recognition of numbers and numerals Recognition of landmarks Y Recognition of facial features Recognition of facial expressions Y Y Perception/recognition of body language Y 5 Visual imagination Mathematical abstract space Y Y Y x Y Detection and discrimination of motion Y Perception of distances and depth Y Simultan perception, - agnosia y Neglect X Eye-hand- co-ordination Copying from near space, from far Use of egocentric near space Use of allocentric space Y Y Integration problems, sensory, sensomotor X Hypersensitivity to noise, visual, auditory Y Inhibitory functions, their insufficiencies Y 11

30 Rectangles – Mailbox Heidi Expressions- Colorama 26. 2. 2000; 3 years 8 (corr. 5) months

31 Matching pictures of faces normal prosopagnosi, recognition of faces had not developed In communication situations she did not perceive movements of lipps or facial expressions, listened carefully. She is therefore experienced ”autistic”. Nov. 2001, 4½ yrs

Other common problems • • • • COMMON PROBLEMS A Sensory integration B Visual overload C Auditory overload D Spec. memory problems E Hearing F Mobility G Hand functions H Executive functions I Visual ergonomics J Devices in classroom K Devices at home L Vision in participation M Attitudes of other people SUMMARY • A Communication • B Moving • C Activities of daily living • D Sustained visual tasks

Could the "profile of visual functioning" become a carrier of information between education, medicine, and social services? Lea Hyvärinen, MD, Ph. D, FAAP Technical University of Dortmund University of Helsinki With Amanda Hall Lueck and Göran Cedermark 34