This document discusses several special populations including children with cerebral palsy, Down syndrome, learning disabilities, and fragile X syndrome. It provides information on the definition, etiology, prevalence/incidence, physical and visual characteristics of each population. For cerebral palsy, it discusses the classifications, refractive characteristics, binocular vision issues, and tips for interacting with patients. For Down syndrome, it covers the definition, etiology, prevalence, physical traits, and refractive errors. It also provides updates on research related to accommodative dysfunction, bifocals, and biometric measurements in Down syndrome patients. Finally, it introduces fragile X syndrome by defining it and discussing its etiology and prevalence.
Child special needs 1 [compatibility mode]Dominick Maino
This document discusses children with special needs, including those with cerebral palsy. It defines cerebral palsy as a disorder of movement and posture appearing in early life due to brain damage. It notes the incidence and prevalence of cerebral palsy and how it is classified. The document discusses the visual characteristics of children with cerebral palsy, including their refractive errors and high prevalence of strabismus. It provides tips for interacting with children who have cerebral palsy.
Visual Diagnosis and Care of the Patient with Special Needs: SyndromesDominick Maino
- Fragile X syndrome is the most common inherited form of intellectual disability and is caused by a mutation on the X chromosome. It affects approximately 1 in 4,000 males and 1 in 8,000 females.
- Common physical characteristics include large prominent ears, a long narrow face, and intellectual disability. Proper diagnosis is important as it was often misdiagnosed in the past. Research into fragile X syndrome has increased understanding of how repeated nucleotide sequences can cause human disease.
Visual Diagnosis and Care of Patients with Special Needs: SyndromesDominick Maino
This document discusses visual diagnosis and care of patients with special needs, including those with syndromes/genetic anomalies/brain injury. It covers several conditions commonly seen in children with special needs such as cerebral palsy, Down syndrome, fragile X syndrome, autism, ADHD, acquired brain injury, and various learning disabilities. For each condition, it discusses etiology, prevalence/incidence, physical and visual characteristics. It emphasizes the importance of comprehensive eye exams and vision therapy for patients with special needs.
PDF Handout: D Maino: Visual Diagnosis and Care of the Patient with Special N...Dominick Maino
This is a copy of my handout of the lecture given in class today. (Copyright 2016). You may download and use this for any non-commercial educational purpose.
Diagnosis and Management of Special Populations 2010Dominick Maino
Diagnosis and Management of Special Populations presents the latest in the assessment and treatment of those with physical, cognitive, and behavioral abnormalities. Up to date information concerning the etiology, prevalence/incidence and physical/cognitive findings of individuals with developmental/acauired disabilities (Cerebral palsy, Down syndrome, Fragile X syndrome, autism, acquired/traumatic brain injury) will be discussed. New diagnostic and treatment techniques are reviewed. The eye care practitioner will be able to confidently provide eye and vision care for those with disability at the end of this presentation.
This course presents the latest information concerning cortical visual impairment, its etiology, diagnosis and treatment. Various topics reviewed include cortical vs cerebral visual impairment, ventral/dorsal visual streams, visual acuity, and contrast sensitivity. Also discussed are various retinoscopy techniques, overlapping functional vision disorders, and visual stimulation/therapy for these disorders.
Course Objectives
At the end of this course, the participant will:
Be able to identify cortical vs cerebral visual impairment
Be able to access various vision functions such as visual acuity, contrast sensitivity, oculomotor and accommodative disorders
Be able to treat the diagnosed vision problems with all the tools available to the optometrist (spectacles, low vision devices, vision rehabilitative techniques)
Be aware of and use outside resources to supplement and add to any therapeutic interventions recommended
Child special needs 1 [compatibility mode]Dominick Maino
This document discusses children with special needs, including those with cerebral palsy. It defines cerebral palsy as a disorder of movement and posture appearing in early life due to brain damage. It notes the incidence and prevalence of cerebral palsy and how it is classified. The document discusses the visual characteristics of children with cerebral palsy, including their refractive errors and high prevalence of strabismus. It provides tips for interacting with children who have cerebral palsy.
Visual Diagnosis and Care of the Patient with Special Needs: SyndromesDominick Maino
- Fragile X syndrome is the most common inherited form of intellectual disability and is caused by a mutation on the X chromosome. It affects approximately 1 in 4,000 males and 1 in 8,000 females.
- Common physical characteristics include large prominent ears, a long narrow face, and intellectual disability. Proper diagnosis is important as it was often misdiagnosed in the past. Research into fragile X syndrome has increased understanding of how repeated nucleotide sequences can cause human disease.
Visual Diagnosis and Care of Patients with Special Needs: SyndromesDominick Maino
This document discusses visual diagnosis and care of patients with special needs, including those with syndromes/genetic anomalies/brain injury. It covers several conditions commonly seen in children with special needs such as cerebral palsy, Down syndrome, fragile X syndrome, autism, ADHD, acquired brain injury, and various learning disabilities. For each condition, it discusses etiology, prevalence/incidence, physical and visual characteristics. It emphasizes the importance of comprehensive eye exams and vision therapy for patients with special needs.
PDF Handout: D Maino: Visual Diagnosis and Care of the Patient with Special N...Dominick Maino
This is a copy of my handout of the lecture given in class today. (Copyright 2016). You may download and use this for any non-commercial educational purpose.
Diagnosis and Management of Special Populations 2010Dominick Maino
Diagnosis and Management of Special Populations presents the latest in the assessment and treatment of those with physical, cognitive, and behavioral abnormalities. Up to date information concerning the etiology, prevalence/incidence and physical/cognitive findings of individuals with developmental/acauired disabilities (Cerebral palsy, Down syndrome, Fragile X syndrome, autism, acquired/traumatic brain injury) will be discussed. New diagnostic and treatment techniques are reviewed. The eye care practitioner will be able to confidently provide eye and vision care for those with disability at the end of this presentation.
This course presents the latest information concerning cortical visual impairment, its etiology, diagnosis and treatment. Various topics reviewed include cortical vs cerebral visual impairment, ventral/dorsal visual streams, visual acuity, and contrast sensitivity. Also discussed are various retinoscopy techniques, overlapping functional vision disorders, and visual stimulation/therapy for these disorders.
Course Objectives
At the end of this course, the participant will:
Be able to identify cortical vs cerebral visual impairment
Be able to access various vision functions such as visual acuity, contrast sensitivity, oculomotor and accommodative disorders
Be able to treat the diagnosed vision problems with all the tools available to the optometrist (spectacles, low vision devices, vision rehabilitative techniques)
Be aware of and use outside resources to supplement and add to any therapeutic interventions recommended
Dementia with Lewy Bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer's disease. It is clinically defined by dementia, hallucinations, fluctuations in alertness, and parkinsonism. Autopsy shows Lewy Bodies in the neocortex and brainstem in 15-36% of demented cases. DLB involves a core set of features including fluctuating cognition, visual hallucinations, and spontaneous motor features of parkinsonism. It is differentiated from other dementias by its symptom profile and neuropathology.
Cerebral Palsy is a motor disability appearing in early life due to brain damage. It has a prevalence of 1-4 per 1000 live births. Etiologies include prenatal, perinatal and postnatal insults. It is classified as spastic, dyskinetic or ataxic. Visual characteristics include refractive errors like hyperopia, strabismus in over 10% of cases, and reduced accommodation. Down Syndrome is a genetic condition caused by trisomy 21. Its prevalence is about 1 in 700 live births. Physical characteristics include low muscle tone, a flat facial profile, and health issues such as congenital heart defects and hearing loss.
This document provides information on Fragile X syndrome including:
- It is the most common inherited cause of intellectual disability and is an X-linked condition.
- The prevalence is 1 in 4000 males and 1 in 4000-6000 females who have the full mutation.
- Physical characteristics can include prominent ears, long narrow face, enlarged testes in males, and sensory or behavioral issues.
This document contains a list of health conditions, procedures, and treatments related to the brain and nerves. There are over 100 entries listed ranging from specific diseases and disorders like Alzheimer's disease, multiple sclerosis, and epilepsy to more general topics like anesthesia, back pain, and migraines. For each entry there is a brief 1-2 sentence description. The list also includes some patient stories about managing various neurological conditions.
Autism is a developmental disorder characterized by difficulties with social interaction and communication, and restricted or repetitive behaviors. The core behaviors include impaired social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or severely limited interests. It is estimated that 1 in 150 children have autism, which is 4 times more common in males than females. While the exact causes are unknown, autism is generally believed to involve both genetic and environmental factors. There is no cure for autism, but therapies and behavioral interventions can help children develop skills and improve symptoms.
Cerebral palsy is a neurodevelopmental condition characterized by impaired muscle tone, movement, and motor skills, caused by non-progressive disturbances in the developing fetal or infant brain. It is a heterogeneous syndrome with varied presentations. Management requires a multidisciplinary approach including physical therapy, medications to manage spasticity and other symptoms, surgery, nutrition support, and social services. Prognosis depends on factors like severity of impairment, birth weight, intelligence, physical and communication abilities, and access to care.
Ccf neuro res rapidly progressive dementia 2013 03-27applebyb
Rapidly progressive dementia can be caused by many conditions, not just prion diseases. Prion diseases should not be the default diagnosis, as there are treatable and reversible causes that could be missed. While diagnostic tests like CSF 14-3-3, EEG, and brain MRI findings can support a prion disease diagnosis, they are not specific and can be present in other non-prion conditions as well. A thorough evaluation is needed to avoid misdiagnosis, and symptomatic treatment should still be considered even for prion diseases.
1. Autism is a brain development disorder characterized by impaired social interaction and communication, as well as restricted and repetitive behaviors starting before age 3. Autism spectrum disorder (ASD) is a broader category that includes autism and other conditions like Asperger's syndrome.
2. ASD encompasses conditions with abnormalities in social interaction and communication as well as restricted interests. Specific syndromes include PDD-NOS, autism, Asperger's, childhood disintegrative disorder, and Rett syndrome.
3. While autistic children can see visually, their brains may have neurological issues preventing correct visual interpretation. Visual symptoms like poor eye contact could relate to underlying visual processing disorders.
A group of motor impairment syndromes resulting from disorders of early brain development and often associated with epilepsy and abnormalities of speech, vision and intellect
Physical disabilities and health impairments can affect children's ability to move, feel, and function. They include conditions like cerebral palsy, muscular dystrophy, epilepsy, diabetes, cystic fibrosis, and asthma. In the 2003-2004 school year, over 67,000 students received special education services under the orthopedic impairment category and over 449,000 under the other health impairments category. Physical disabilities are caused by various genetic and acquired factors and can range from mild to severe.
This presentation was delivered to students at UC San Diego on May 2, 2012 by Dawn DeStefani, BSW, who is the director of programs and services for The Glenner Memory Care Centers in San Diego. Learn more at www.glenner.org.
Children's cerebral palsy is diagnosed at Trishla Foundation by parent and doctor observation, or by analyzing deficiencies in motor skill skills or evaluating medical history. Trishla Foundation is the greatest and has been in operation since 2014. Along with India, they are assisting other countries in the fight against cerebral palsy.
Cerebral palsy is an umbrella term for physical disabilities caused by damage to the brain before or at birth. It is characterized by impaired muscle coordination and other disabilities. The prevalence is about 4 per 1000 live births. There are several types classified by motor deficit, including spastic (the most common), dyskinetic, atonic, and mixed forms. Management involves medical treatment to alleviate symptoms, physical and occupational therapy, and sometimes surgery to correct issues like scoliosis.
This document discusses vision function and functional vision anomalies in pediatric cortical visual impairment (PCVI). It begins with a history and definition of PCVI, describing how it was originally applied to adults with brain injuries and later to children. It then discusses diagnostic approaches for PCVI, including case history, visual acuity tests, refractive error tests, vision function assessments, and the use of special diagnostic tools. The document also discusses therapeutic strategies for treating PCVI, including refractive correction, vision therapy, use of lenses/devices, and considering how environmental factors and medications can affect evaluation and treatment.
This document provides an overview of dementia, including:
- The DSM-IV criteria for diagnosing dementia which requires memory impairment plus deficits in other cognitive domains as well as functional impairment.
- The most common causes of dementia, with Alzheimer's disease accounting for 70% of cases and vascular dementia 10-15%.
- Methods for diagnosing dementia including clinical assessments, neuropsychological testing, brain imaging, and lab tests to identify reversible causes.
- Approaches to managing dementia focusing on reducing cognitive and behavioral symptoms, slowing progression, and treating underlying conditions. Pharmacological options include cholinesterase inhibitors and memantine to alleviate symptoms.
This document discusses hearing impairment, including definitions, types, tests used for diagnosis, and treatment options. It defines the main types of hearing loss as conductive, sensorineural, and mixed. Diagnosis involves a medical history, physical exam, and tests like pure tone audiometry, tympanometry, and auditory brainstem response testing. Treatment depends on the underlying cause but may include medications, surgery, hearing aids, or cochlear implants. Regular screening is important due to the high prevalence of hearing loss.
Cerebral palsy (CP) is a non-progressive brain injury that causes motor dysfunction. Rehabilitation aims to improve mobility and function through various therapies while preventing deformities. It involves physiotherapy, occupational therapy, bracing, assistive devices and surgery. The goals are to improve skills like walking and sitting, and maximize a child's independence through a multidisciplinary approach involving the family. Rehabilitation is successful if it enables the child to be happy and integrated into the community while supporting the well-being of parents.
This document describes a case study of a 4-year-old female patient named SS who has Pallister-Killian Mosaic Syndrome (PKMS). PKMS is a rare genetic disorder characterized by multiple birth defects and developmental delays. The patient presented with eye rubbing and was found to have cortical visual impairment, as well as hyperopia and astigmatism. A visual evoked response test showed a cortical response to light but variability, consistent with cortical visual impairment. The treatment plan is for the patient to wear glasses full time, use eye drops for allergic conjunctivitis, repeat the visual evoked response test in a year, and begin vision rehabilitation therapy.
This document discusses binocular vision disorders and their treatment. It begins with an executive summary noting the high prevalence of binocular vision problems. It then discusses various binocular vision syndromes like convergence insufficiency and excess, their signs and symptoms. Treatment options discussed include lenses, prisms, and vision therapy. The document provides evidence from research studies supporting the effectiveness of vision therapy and optical treatment for conditions like amblyopia and convergence insufficiency.
Evidence Based Practice: Pediatrics, Binocular Vision and Patients with Speci...Dominick Maino
This document discusses evidence-based clinical practice in pediatrics and optometry, specifically for patients with special needs. It covers different perspectives of clinicians and researchers, as well as patients' views. It questions whether evidence is needed for everything, given limitations of randomized controlled trials and systematic reviews. The document also discusses levels of scientific evidence and grades of evidence in evaluating research studies and forming clinical recommendations.
Creating a Better Audience 3D Entertainment Summit Hollywood, CA 9/11Dominick Maino
This document discusses improving binocular vision to create a better audience for viewing 3D content. It notes that many people suffer from vision problems like amblyopia, strabismus, and eye coordination issues. These problems are widespread, affecting millions of people in the US alone. The presenter asks how binocular vision can be improved to create an audience that enjoys, is satisfied with, and is involved in all 3D experiences. Improving binocular vision involves noting symptoms, diagnosing any problems, and treating the issues in order to develop an engaged audience that wants to view 3D content.
Dementia with Lewy Bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer's disease. It is clinically defined by dementia, hallucinations, fluctuations in alertness, and parkinsonism. Autopsy shows Lewy Bodies in the neocortex and brainstem in 15-36% of demented cases. DLB involves a core set of features including fluctuating cognition, visual hallucinations, and spontaneous motor features of parkinsonism. It is differentiated from other dementias by its symptom profile and neuropathology.
Cerebral Palsy is a motor disability appearing in early life due to brain damage. It has a prevalence of 1-4 per 1000 live births. Etiologies include prenatal, perinatal and postnatal insults. It is classified as spastic, dyskinetic or ataxic. Visual characteristics include refractive errors like hyperopia, strabismus in over 10% of cases, and reduced accommodation. Down Syndrome is a genetic condition caused by trisomy 21. Its prevalence is about 1 in 700 live births. Physical characteristics include low muscle tone, a flat facial profile, and health issues such as congenital heart defects and hearing loss.
This document provides information on Fragile X syndrome including:
- It is the most common inherited cause of intellectual disability and is an X-linked condition.
- The prevalence is 1 in 4000 males and 1 in 4000-6000 females who have the full mutation.
- Physical characteristics can include prominent ears, long narrow face, enlarged testes in males, and sensory or behavioral issues.
This document contains a list of health conditions, procedures, and treatments related to the brain and nerves. There are over 100 entries listed ranging from specific diseases and disorders like Alzheimer's disease, multiple sclerosis, and epilepsy to more general topics like anesthesia, back pain, and migraines. For each entry there is a brief 1-2 sentence description. The list also includes some patient stories about managing various neurological conditions.
Autism is a developmental disorder characterized by difficulties with social interaction and communication, and restricted or repetitive behaviors. The core behaviors include impaired social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or severely limited interests. It is estimated that 1 in 150 children have autism, which is 4 times more common in males than females. While the exact causes are unknown, autism is generally believed to involve both genetic and environmental factors. There is no cure for autism, but therapies and behavioral interventions can help children develop skills and improve symptoms.
Cerebral palsy is a neurodevelopmental condition characterized by impaired muscle tone, movement, and motor skills, caused by non-progressive disturbances in the developing fetal or infant brain. It is a heterogeneous syndrome with varied presentations. Management requires a multidisciplinary approach including physical therapy, medications to manage spasticity and other symptoms, surgery, nutrition support, and social services. Prognosis depends on factors like severity of impairment, birth weight, intelligence, physical and communication abilities, and access to care.
Ccf neuro res rapidly progressive dementia 2013 03-27applebyb
Rapidly progressive dementia can be caused by many conditions, not just prion diseases. Prion diseases should not be the default diagnosis, as there are treatable and reversible causes that could be missed. While diagnostic tests like CSF 14-3-3, EEG, and brain MRI findings can support a prion disease diagnosis, they are not specific and can be present in other non-prion conditions as well. A thorough evaluation is needed to avoid misdiagnosis, and symptomatic treatment should still be considered even for prion diseases.
1. Autism is a brain development disorder characterized by impaired social interaction and communication, as well as restricted and repetitive behaviors starting before age 3. Autism spectrum disorder (ASD) is a broader category that includes autism and other conditions like Asperger's syndrome.
2. ASD encompasses conditions with abnormalities in social interaction and communication as well as restricted interests. Specific syndromes include PDD-NOS, autism, Asperger's, childhood disintegrative disorder, and Rett syndrome.
3. While autistic children can see visually, their brains may have neurological issues preventing correct visual interpretation. Visual symptoms like poor eye contact could relate to underlying visual processing disorders.
A group of motor impairment syndromes resulting from disorders of early brain development and often associated with epilepsy and abnormalities of speech, vision and intellect
Physical disabilities and health impairments can affect children's ability to move, feel, and function. They include conditions like cerebral palsy, muscular dystrophy, epilepsy, diabetes, cystic fibrosis, and asthma. In the 2003-2004 school year, over 67,000 students received special education services under the orthopedic impairment category and over 449,000 under the other health impairments category. Physical disabilities are caused by various genetic and acquired factors and can range from mild to severe.
This presentation was delivered to students at UC San Diego on May 2, 2012 by Dawn DeStefani, BSW, who is the director of programs and services for The Glenner Memory Care Centers in San Diego. Learn more at www.glenner.org.
Children's cerebral palsy is diagnosed at Trishla Foundation by parent and doctor observation, or by analyzing deficiencies in motor skill skills or evaluating medical history. Trishla Foundation is the greatest and has been in operation since 2014. Along with India, they are assisting other countries in the fight against cerebral palsy.
Cerebral palsy is an umbrella term for physical disabilities caused by damage to the brain before or at birth. It is characterized by impaired muscle coordination and other disabilities. The prevalence is about 4 per 1000 live births. There are several types classified by motor deficit, including spastic (the most common), dyskinetic, atonic, and mixed forms. Management involves medical treatment to alleviate symptoms, physical and occupational therapy, and sometimes surgery to correct issues like scoliosis.
This document discusses vision function and functional vision anomalies in pediatric cortical visual impairment (PCVI). It begins with a history and definition of PCVI, describing how it was originally applied to adults with brain injuries and later to children. It then discusses diagnostic approaches for PCVI, including case history, visual acuity tests, refractive error tests, vision function assessments, and the use of special diagnostic tools. The document also discusses therapeutic strategies for treating PCVI, including refractive correction, vision therapy, use of lenses/devices, and considering how environmental factors and medications can affect evaluation and treatment.
This document provides an overview of dementia, including:
- The DSM-IV criteria for diagnosing dementia which requires memory impairment plus deficits in other cognitive domains as well as functional impairment.
- The most common causes of dementia, with Alzheimer's disease accounting for 70% of cases and vascular dementia 10-15%.
- Methods for diagnosing dementia including clinical assessments, neuropsychological testing, brain imaging, and lab tests to identify reversible causes.
- Approaches to managing dementia focusing on reducing cognitive and behavioral symptoms, slowing progression, and treating underlying conditions. Pharmacological options include cholinesterase inhibitors and memantine to alleviate symptoms.
This document discusses hearing impairment, including definitions, types, tests used for diagnosis, and treatment options. It defines the main types of hearing loss as conductive, sensorineural, and mixed. Diagnosis involves a medical history, physical exam, and tests like pure tone audiometry, tympanometry, and auditory brainstem response testing. Treatment depends on the underlying cause but may include medications, surgery, hearing aids, or cochlear implants. Regular screening is important due to the high prevalence of hearing loss.
Cerebral palsy (CP) is a non-progressive brain injury that causes motor dysfunction. Rehabilitation aims to improve mobility and function through various therapies while preventing deformities. It involves physiotherapy, occupational therapy, bracing, assistive devices and surgery. The goals are to improve skills like walking and sitting, and maximize a child's independence through a multidisciplinary approach involving the family. Rehabilitation is successful if it enables the child to be happy and integrated into the community while supporting the well-being of parents.
This document describes a case study of a 4-year-old female patient named SS who has Pallister-Killian Mosaic Syndrome (PKMS). PKMS is a rare genetic disorder characterized by multiple birth defects and developmental delays. The patient presented with eye rubbing and was found to have cortical visual impairment, as well as hyperopia and astigmatism. A visual evoked response test showed a cortical response to light but variability, consistent with cortical visual impairment. The treatment plan is for the patient to wear glasses full time, use eye drops for allergic conjunctivitis, repeat the visual evoked response test in a year, and begin vision rehabilitation therapy.
This document discusses binocular vision disorders and their treatment. It begins with an executive summary noting the high prevalence of binocular vision problems. It then discusses various binocular vision syndromes like convergence insufficiency and excess, their signs and symptoms. Treatment options discussed include lenses, prisms, and vision therapy. The document provides evidence from research studies supporting the effectiveness of vision therapy and optical treatment for conditions like amblyopia and convergence insufficiency.
Evidence Based Practice: Pediatrics, Binocular Vision and Patients with Speci...Dominick Maino
This document discusses evidence-based clinical practice in pediatrics and optometry, specifically for patients with special needs. It covers different perspectives of clinicians and researchers, as well as patients' views. It questions whether evidence is needed for everything, given limitations of randomized controlled trials and systematic reviews. The document also discusses levels of scientific evidence and grades of evidence in evaluating research studies and forming clinical recommendations.
Creating a Better Audience 3D Entertainment Summit Hollywood, CA 9/11Dominick Maino
This document discusses improving binocular vision to create a better audience for viewing 3D content. It notes that many people suffer from vision problems like amblyopia, strabismus, and eye coordination issues. These problems are widespread, affecting millions of people in the US alone. The presenter asks how binocular vision can be improved to create an audience that enjoys, is satisfied with, and is involved in all 3D experiences. Improving binocular vision involves noting symptoms, diagnosing any problems, and treating the issues in order to develop an engaged audience that wants to view 3D content.
Maino D. Agenda Driven Research. Vis Dev Rehab 2015; 1(1):7-11.
Read the editorial.....
Conclusion
It is time for all to put aside our agendas,
our biases, our preconceived notions. It is time
to work together to determine best practices
even if it is contrary to prevailing opinion. The
world is not flat. Amblyopia can be treated at
any age. And optometric vision therapy is an
appropriate treatment modality for disorders of
he binocular vision system.
This document provides guidance on assessing and treating patients with special needs. It emphasizes treating patients with dignity, preparing for assessments by learning about the patient's history and abilities, using creative techniques to test visual acuity and binocular vision, and treating refractive errors and ocular health issues when possible. Comprehensive assessments include case history, acuity, refractive error, binocular vision, and ocular health evaluations. Treatment considers the patient's cognitive and motor abilities as well as therapy goals. Referrals are made for additional services beyond optometry.
Diagnosing learning related vision problemsDominick Maino
The document discusses diagnosing and treating learning related vision problems. It addresses what doctors should do to diagnose LRVP, the current research on the topic, and appropriate therapy procedures. It provides information on the prevalence of various binocular vision disorders from multiple studies and articles. It also discusses tools that can be used to measure symptoms, such as the COVD Quality of Life Outcomes Assessment, as well as common subjective complaints reported by patients with binocular vision disorders.
AOA "There's More to 3D than Meets the Eye"Dominick Maino
The American Optometric Association did an awesome job in making a potentially hard to understand topic...easier to understand. If you have problems with viewing 3D, please review this PowerPoint presentation.
This document summarizes a conference on evaluating and treating pediatric cerebral visual impairment (PCVI). The conference aims to bring professionals together to define PCVI, determine visual function in children with PCVI, and discuss therapeutic strategies. PCVI was previously referred to as cortical or cerebral visual impairment but a unified definition is needed. Evaluating visual function and functional vision is important for children with PCVI who often have ocular, visual pathway, visual processing and oculomotor issues. Treatment should begin with addressing any correctable visual issues and promoting visual development.
This document provides information on Down syndrome including:
- Down syndrome is a genetic condition caused by trisomy 21 and has a prevalence of 1 in 800-1000 live births.
- Physical characteristics include refractive errors like hyperopia and astigmatism as well as binocular vision issues like strabismus.
- Recent studies have found that bifocals can effectively treat the reduced accommodation often seen in individuals with Down syndrome.
This document discusses global developmental delay and related disorders. It begins with defining developmental milestones and types of developmental abnormalities like delay, dissociation, and deviancy. It then covers the definition, causes, risk factors, signs, and differential diagnosis of global developmental delay. The document emphasizes taking a thorough history and examination. It provides an overview of evaluating developmentally delayed children and investigating etiologies. Common genetic and metabolic causes are reviewed along with their management. The importance of a multidisciplinary approach and early intervention is stressed.
The document discusses risk factors and current understanding of Alzheimer's disease and dementia. It notes that age is the greatest non-modifiable risk factor, while hypertension, diabetes, obesity, smoking, limited cognitive activities, and an inflammatory diet can increase risk. Protective factors include stimulating cognitive activities, social engagement, physical activity, fiber-rich foods like fruits and vegetables, and anti-inflammatory nutrients like turmeric. The document also examines biomarkers for diagnosis and the progression of symptoms in Alzheimer's disease.
Autism Defined, Autism Prevalence and Primary Characteristicssworaac
The document describes a training series on autism spectrum disorders produced by the Regional Autism Advisory Council of Southwest Ohio. It defines autism as a brain-based developmental disorder affecting social interaction, communication, and behavior. The training modules cover topics like the characteristics of autism, cognition and learning, behavior, communication, and issues in adolescence and adulthood. The document provides information on the prevalence of autism and discusses the types of autism spectrum disorders.
This document discusses intellectual disabilities (ID), including definitions, causes, diagnosis, and treatment. ID is characterized by limitations in both intellectual and adaptive functioning that originate before age 18. Causes can include genetic conditions, illnesses, injuries, or environmental factors. Diagnosis involves assessing intellectual and adaptive functioning. Treatment focuses on early intervention, special education, accommodations, and addressing any co-occurring conditions. Common types of ID discussed include Down syndrome, fragile X syndrome, fetal alcohol spectrum disorder, autism, and shaken baby syndrome. Rarer conditions like Prader-Willi syndrome and Angelman syndrome are also mentioned.
Adults with autism training series module one v2 _2sworaac
This document outlines an 11-module training series on autism spectrum disorders for adults. It defines autism as a brain-based developmental disorder that affects social interaction, communication, and behavior. The modules cover topics like characteristics, cognition, sensory differences, communication, behavior, leisure skills, adolescence and more. It describes the different types of autism spectrum disorders and their prevalence compared to other conditions. While autism affects everyone differently, improved diagnosis and awareness have led to higher rates.
Allie, a 72-year old woman, was brought for evaluation of progressive memory loss. Her son reported increased issues with reasoning, orientation, and understanding where she was. During evaluation, she was upset and had difficulty finding words. The neuropsychologist determined she had moderately severe Alzheimer's disease based on her symptoms.
Neurodevelopmental disorders: are our current diagnostic labels fit for purpose?Dorothy Bishop
Slides from a talk given at University of Western Australia on Tuesday 2nd October 2012, This lecture was co-hosted by the ARC Centre of Excellence in Cognition and
its Disorders and the Institute of Advanced Studies, University of Western Australia
The document discusses the rising rates of autism diagnosis and lack of awareness about autism in the UAE. It provides background on the history of autism including the original descriptions by Kanner and Asperger. It outlines changes to the diagnostic criteria in the upcoming DSM-V, and discusses various theories about the causes and risk factors of autism including genetics, vaccines, and the gut-brain connection. Treatments discussed include behavioral therapy, education, and medication management.
2. cerebral palsy and mental retardation.pptxssuser93fc8e
Cerebral palsy is a static encephalopathy resulting from brain lesions that cause disorders of movement and posture. It is commonly caused by prenatal, natal, or postnatal insults. Symptoms vary but include spasticity, abnormal gait, and motor delays. Diagnosis involves history, exam, and brain imaging. Treatment is multidisciplinary with a focus on physical, occupational, and speech therapies. Prognosis depends on type and severity of involvement.
The document discusses co-morbidities associated with autism spectrum disorders (ASD). It first provides background on ASD diagnostic criteria and increasing prevalence rates. It then summarizes two studies that found high rates of psychiatric and medical co-morbidities in individuals with ASD, including attention-deficit/hyperactivity disorder, anxiety, depression, gastrointestinal issues, and more. Specifically, one study of over 14,000 individuals with ASD found significantly different co-morbidity prevalence between younger and older age groups. Another study of 418 patients at a child psychiatry clinic found that over half of patients with ASD had multiple co-morbid conditions requiring multidisciplinary care.
This document discusses different types and classifications of disabilities. It defines disability and outlines three dimensions recognized by the ICF: body structure/function, activities, and participation. It then describes common types of disabilities including physical, intellectual, sensory, and mental illnesses. Specific conditions are explained for each type. The document also discusses differences between impairments, disabilities, and handicaps.
Autism Defined and Overview, Autism Prevalence, and Primary Characteristicssworaac
This document outlines training modules on autism spectrum disorders provided by the Regional Autism Advisory Council of Southwest Ohio. It covers 20 topics related to autism including definitions of autism, characteristics, impacts on learning and behavior, diagnosis types, prevalence rates, facts and costs. The goal is to educate about understanding and teaching individuals with autism.
School training module one, autism defined and overviewsworaac
This document outlines training modules on autism spectrum disorders provided by the Regional Autism Advisory Council of Southwest Ohio. It covers 20 topics related to autism including definitions of autism, characteristics, impacts on learning and behavior, diagnosis types, prevalence rates, facts and costs. The goal is to educate about understanding and teaching individuals with autism.
Child care training series module one updatedsworaac
This document outlines an 11-module training series on autism spectrum disorders (ASD). The modules cover topics such as defining and diagnosing ASD, characteristics of ASD including differences in communication, behavior, and sensory processing, as well as teaching strategies. ASD is defined as a brain-based developmental disorder that affects social interaction, communication, and behavior, with prevalence of about 1 in 110 children. Symptoms and their severity can vary widely between individuals.
Presentation Handouts American Conference on Pediatric Cerebral Visual Impair...Dominick Maino
1. The document discusses pediatric cerebral visual impairment (PCVI), including defining the term, describing the history and causes of PCVI, and outlining approaches to assessing vision function in children with PCVI.
2. Key aspects of determining vision function in children with PCVI include evaluating visual acuity, oculomotor abilities, accommodation, binocular vision, depth perception, eye health, and vision information processing.
3. Therapeutic strategies for treating PCVI include refractive correction with lenses, vision therapy, and resources like assistive devices and blogs providing information on CVI. Environmental factors, medications, and other non-visual issues can also impact evaluation and treatment of children with PCVI.
Attention deficit Hyperactivity Disorder (ADHD) (justpsychiatry)Waleed Ahmad
A presentation for undergraduate Education on ADHD. for more, and for original PPTXs, visit:
https://psych.thinkific.com
My question bank:
https://psych.thinkific.com/courses/Psychiatry-question-bank-for-MRCPsych
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties with social interaction and communication, and restricted and repetitive behavior. The causes are both genetic and environmental. Genetically, ASD is highly heritable but heterogeneous, with many genes likely contributing. Environmentally, certain prenatal and perinatal factors like maternal infections may play a role. Neurologically, individuals with ASD often experience abnormal brain growth early in development, with increased brain volume and abnormalities in frontal, temporal and limbic regions.
Epilepsy is a neurological disorder characterized by recurrent seizures that are brief changes in brain activity. The document discusses the classification, causes, symptoms, and treatment of epilepsy. It notes that epilepsy can be classified as either generalized or partial seizures depending on which area of the brain is affected. The goals of treatment are to eliminate seizures without side effects through tailored medication regimens. Left untreated, epilepsy can cause health issues, cognitive impairments, and even sudden death.
Aging Oxidative Stress and Dietary OxidantsDominick Maino
This book review summarizes the text "Aging: Oxidative Stress and Dietary Antioxidants" which discusses how oxidative stress impacts the aging process and various age-related diseases. It contains 29 chapters authored by 82 contributors exploring topics like the role of antioxidants in reducing frailty, supporting cardiovascular health and preventing Alzheimer's disease. The review highlights how certain foods, herbs, spices and supplements can potentially slow aging by decreasing oxidative stress and inflammation. While technical at times, the book's diagrams and photographs help explain complex topics for readers without extensive scientific backgrounds. The reviewer recommends it for anyone wanting to better understand senior health and the science behind antioxidants.
06 17 current research that you should incorporate into yourDominick Maino
This course presents the best research posters from the 2017 American Optometric Association conference, featuring 5 presentations on topics ranging from concussive effects in veterans to myopia in children to management of central serous retinopathy and choroideremia. The document provides background on the poster selection process and encourages optometrists to submit their own case reports and clinical research for consideration in future poster sessions. It concludes with a question and answer period following the 5 presentations.
06 17 current research that you should incorporate into yourDominick Maino
This document summarizes a course featuring the best poster presentations from the 2017 AOA conference. It discusses 5 poster presentations that were selected to be highlighted covering topics like concussive effects in veterans, myopia in children in China, corneal edema, central serous retinopathy, and low vision rehabilitation for choroideremia. The document provides details on the abstract review process and encourages clinicians to submit case reports and research to the 2018 poster session.
My students and I wrote several translations of how to conduct an eye examination (mostly my students since my language skills are not very good!). I know there are many ways, and perhaps better ways to ask these questions, but this could be a starting point. Feel free to adapt this to your needs and to make this even better. Please share when you do.
My students and I wrote several translations of how to conduct an eye examination (mostly my students since my language skills are not very good!). I know there are many ways, and perhaps better ways to ask these questions, but this could be a starting point. Feel free to adapt this to your needs and to make this even better. Please share when you do.
Let me know what you think. (dmaino@ico.edu).
Neuroplasticity and Vision Therapy for Adults; A Case SeriesDominick Maino
This poster was presented at the American Optometric Association's Annual meeting in Boston, MA 06/2016
The bottom line:
The visual cortex has the capacity for experience dependent change (neuroplasticity) throughout life. Unfortunately, when it comes to the adult with binocular vision problems, this is not always recognized as being true even though there is strong clinical evidence to suggest a high level of adult neuroplasticity. Current research shows that adults tend to have numerous anomalies associated with the binocular vision system especially within certain populations. This case series demonstrates how those even approaching 70 years of age can benefit from optometric vision therapy.
Current Clinical Case Reorts & Research You Should Incorporate into Your Mode...Dominick Maino
Dominick Maino, OD, MEd, FAAO, FCOVD-A
Moderator
Featuring the Best of AOA's 2016 Poster Presentations
Saturday, July 2nd 8-10AM
Five of the very best, clinically relevant posters were chosen to be given during the American Optometric Association meeting in Boston in 2016. These posters were chosen by the AOA Poster Committee (Dr. Dominick M. Maino, Chair).
Writing the Perfect Poster Abstract in 20 Minutes or LessDominick Maino
One of the easiest ways to begin your publishing career is to present a poster during one of the many annual meetings held by professional optometry. These meetings include but are not limited to the College of Optometrists in Vision Development, American Academy of Optometry and the American Optometric Association. This presentation reviews the step by step process involved in writing an abstract that will be accepted for presentation by these and other organizations most of the time. Once the abstract is written, you are one third of the way to making a significant contribution to the optometric literature. The other two thirds include, creating the poster and writing the final paper to be submitted to an appropriate journal for publication (the last two topics will be addressed at other meetings and/or within future VDR articles). You are encouraged to bring information for a case report and/or case series that you wish to use for a poster in the future.
A,B,V's of School Performance: Academics, Behavior and VisionDominick Maino
This presentation is geared towards teachers and professional teaching staff, but can also be adapted for parents and others. It reviews the three O's of eye care (Optometry, Ophthalmology, Optician), the optometric examination, learning related vision problems and more.
060915 current research that you should incorporate into yourDominick Maino
Current Research that You Should Incorporate into Your Mode of Practice Now!
Dominick Maino, OD, MEd, FAAO, FCOVD‐A
Moderator
Featuring the Best of AOA's 2015 Poster Presentations
Jun‐27‐2015 8:00AM ‐ 10:00AM
Optic Nerve Head Drusen: A Myriad of Presentations
Jennifer L. Jones, Sylvia E. Sparrow, Christina Grosshans
Validation Study of New LCD‐Based Contrast Sensitivity Testing Method
Sarah Henderson, Jeung H Kim, Paul Harris
Bilateral Cystoid Macular Edema in Retinitis Pigmentosa and its Management
Lindsay T. Gibney
An ODE to Optic Disc Edema
Kelli Theisen
Is Binocular Balancing with Subjective Refraction a thing of the Past?
David Geffen
Optometry's Meeting 2015
Seattle, Washington
Dr. Dominick Maino Quoted in AOAFocus Article: Wearable WonderDominick Maino
".....Dominick M Maino, O.D., M.Ed., FAAO, FCOVD-A, professor of pediatrics and binocular vision at the Illinois College of Optometry and private practitioner at Lyons Family Eye Care in Chicago, imagines a world in which people with dementia wear unobtrusive GPS devices that allow family members to easily track them if they leave the safety of their homes. Or, he imagines Google Contacts, which are being designed to monitor blood glucose levels, working seamlessly with insulin pumps, so one's blood sugar never veers out of healthy range. The possibilities are endless. Already, engineers are developing bracelets for the hearing impaired that can translate hand movements into words. For optometrists such as Dr. Maino, who see a great number of patients with disabilities, such technology could be quite useful.
"In the not-too-distant future—probably in my lifetime—both in terms of prevention and monitoring of health, we will probably all be wearing one or more devices that talk to each other," Dr. Maino says. "But right now, much of this is in the development stage or just vaporware."...."
This document discusses pediatric cortical visual impairment (PCVI). It begins by defining PCVI and exploring its history. PCVI is caused by injury to the brain rather than the eyes. The document then examines diagnostic approaches for PCVI, including assessing visual acuity, refractive error, oculomotor function, and more. It also discusses functional vision anomalies that can occur with PCVI like amblyopia. The document concludes by outlining treatment approaches for PCVI like using glasses, vision therapy, and modifying the home environment to encourage visual stimulation.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
1. Dominick M. Maino, O.D., M.Ed., F.A.A.O.,
Diagnosis and F.C.O.V.D-A.
Professor,
Management of Pediatrics/Binocular Vision Service
P di i /Bi l Vi i S i
Illinois College of Optometry
Special Populations Illinois Eye Institute
3241 S. Michigan Ave. Chicago, Il. 60616
312-949-7280 (Voice) 312-949-7358 (fax)
dmaino@ico.edu MainosMemos.blogspot.com
www.ico.edu nw.optometry.net
Children with Special Needs Children with Special Needs
•Learning Disability •Autism
•ADHD •Mental Retardation/Intellectual
•C b l Palsy
Cerebral P l Disability
•Down Syndrome •Acquired/Traumatic Brain Injury
•Fragile X Syndrome •Mental Illness/Psychiatric Illness
Learning Disabilities Learning Disabilities
Reading/Dyslexia Reading/Dyslexia
Dyscalculia
Dysgraphia Reading disabilities common
Dyslexia rare
1
2. Learning Disabilities Learning Disabilities
Reading/Dyslexia Dyscalculia (Math Disability)
Language Based
g g 3 and 6% of the population
Vision Based Neurological Dyscalculia
Combination of Language/Vision Deficits in working & short term memory
Congenital/hereditary (Gerstmann syndrome: Dyscalculia + Dysgraphia)
Learning Disabilities Learning Disabilities
ADHD/ADD Etiology
Dysgraphia
Working memory (orthographic coding)
g y( g p g) Brain Functioning
Motor planning Heredity
Attentional issues Exposure to Toxic Substances
Brain Trauma, Tumors, Strokes or Disease
Functional Vision Problems
Learning Disabilities Learning Disabilities
ADHD/ADD Not Caused By: ADHD/ADD Treatment
Diet Medication
Hormones Psychotherapy
Vestibular dysfunction Education or Training
Poor parenting A combination of treatments
Television Oculomotor therapy/Vision Therapy
2
3. Cerebral Palsy
• What is it?
• What is it’s etiology?
• What is it’s prevalence/incidence?
• How is it classified?
• What are it’s visual characteristics?
Cerebral Palsy Cerebral Palsy Etiology
• Cerebral Palsy is a persistent, but not Something goes awry just before, during or
unchanging, disorder of movement and just after birth:
posture appearing in the early years of life
Prenatal
due to traumatic or inflammatory brain
damage. Neonatal
• Affects virtually all motor systems Postnatal
• Can be acquired
Cerebral Palsy Incidence/Prevalence Cerebral Palsy Incidence/Prevalence
• Incidence 2-4/1000 live births • 75% of CP occurs during pregnancy , 5% during childbirth
and/or 15% after birth up to age 3
• Prevalence 1.5-2/1000 live • 80% the etiology is unknown
• births 10% of cases are acquired (trauma) • There are 550,000-764,000 persons in the USA with
• N l lif spans, 40% live to age 40, many
Normal life li t 40 cerebral palsy
living into their senior years • The number of new cases have increased 25% during the
past decade (1990’s)
• > 1/2 million individual with CP living in USA • There are now 10,000 new cases/year.
• Average lifetime cost per person of $921,000 (in 2003
dollars)
3
4. Cerebral Palsy Classifications Cerebral Palsy Visual Characteristics
Wesson M, Maino D. Oculovisual findings in children with Down syndrome, Cerebral
Palsy, and mental retardation without specific etiology. In Maino, D. (ed)
Diagnosis and management of special populations. 1995. St. Louis, Mo. , Mosby-
• Spastic - 70-80% Yearbook Inc.:17-54.
• Binocular acuity could be evaluated in
• Dyskinetic/Athetoid - 10-15% 45% of individuals below age 13
• Ataxic - <5% • For CP patients VAs are generally
decreased when compared to those
• Mixed measured for individuals with Down
Syndrome
• Much higher incidence of ocular disease
and neurological dysfunction
Cerebral Palsy Refractive Characteristics Cerebral Palsy Refractive Characteristic
Scheiman MM. Optometric findings in children with cerebral palsy. Am J Optom Physiol
Opt 1984;61:321-333
• 60% significant refractive error • Hyperopia present 3Xs
more than when compared
• Hyperopia (>+1.50) 3X more common among to myopia
CP children than in non-affected individuals
non affected
• Other studies (Black, Breakey et al, Duckman,
• Wesson & Maino note:
• many more hyperopes
LoCasio) support increased refractive error than myopes
being present • average amount of
significant myopia is
greater
Cerebral Palsy Binocular
Cerebral Palsy InteractionTips
Characteristics
• Prevalence of strabismus exceeds that of
general population by a factor of 10! • Positioning
• Slightly more esotropia than exotropia • Right tools (objective)
• D ki ti Strabismus
Dyskinetic St bi • No sudden movement
• slow tonic deviation similar to • No loud, unexpected noises
vergence
• change from ET to XT • Speak smoothly, soothingly, softly….if
• usually associated with athetoid appropriate, sing to the patient!
classification • Smile, smile SMILE!!!
4
5. Cerebral Palsy Cerebral Palsy
Barca L, Cappelli FR, Di Giulio P, Staccioli S, Castelli E. Outpatient assessment of
neurovisual functions in children with Cerebral Palsy. Res Dev Disabil. 2010 Mar-
• Saunders KJ, Little JA, McClelland JF, Jackson AJ. Profile of refractive errors in cerebral palsy:
impact of severity of motor impairment (GMFCS) and CP subtype on refractive outcome. Invest
Apr;31(2):488-95. Epub 2009 Dec 5.
Ophthalmol Vis Sci. 2010 Jun;51(6):2885-90. Epub 2010 Jan 27.
….Overall, 73% patients had . … A significantly higher prevalence and magnitude
of refractive error was found in the CP group …..
g p
impairments …..the majority of
the Higher spherical refractive errors were
which presenting difficulties on significantly associated with the nonspastic CP ….
The presence and magnitude of astigmatism were
both visuoperceptual and greater when intellectual impairment was more
visuospatial tasks (79%).. … severe, …. High refractive errors are common in
CP, pointing to impairment of the
emmetropization process. ….
Cerebral Palsy Cerebral Palsy
Ross LM, Heron G, Mackie R, McWilliam R, Dutton GN.
McClelland JF, Parkes J, Hill N, Jackson AJ, Saunders KJ. Reduced accommodative function in dyskinetic cerebral palsy: a novel
management strategy. Dev Med Child Neurol. 2000 Oct;42(10):701-3. Links
Accommodative dysfunction in children with cerebral palsy:
a population-based study. Invest Ophthalmol Vis Sci. 2006 ….The near-vision symptoms were completely
May;47(5):1824-30. removed and reading dramatically improved with
the provision of varifocal spectacles. Varifocal
p p
Brain injury such as that present in CP has a lenses provide an optimal correction for far,
intermediate (i.e. for computer screens), and
significant impact on accommodative near distances (i.e. for reading). Managing this type
function. These findings have implications of patient with varifocal spectacles has not been
for the optometric care of children with CP previously reported. It is clearly very important
and inform our understanding of the impact to prescribe an optimal spectacle correction
to provide clear vision to
of early brain injury on visual development.
optimize learning.
Down Syndrome
From: http://www.ndss.org/aboutds/aboutds.html#Down
Children with Down syndrome have been included in regular academic
classrooms in schools across the country. In some instances they are
integrated into specific courses, while in other situations students are
fully included in the regular classroom for all subjects. The degree of
mainstreaming is based in the abilities of the individual; but the trend is
for full inclusion in the social and educational life of the community.
5
6. Down Syndrome Down Syndrome
• What is it? • Langdon Down 1866
• What is it’s etiology?
• What is it s prevalence/incidence?
it’s
• “Mongolism” no longer used
• What are it’s physical/visual characteristics? • Most common genetic anomaly
• Variable levels of ability & disability
Down Syndrome Down Syndrome Prevalence/Incidence
Down syndrome is the most commonly • 1 in 800-1000 live births
occurring genetic condition. One in • 1 in 12 for older mothers (>=49yrs of age)
every 800 to 1,000 live births is a child • Most babies with Down syndrome born to
younger mothers (80% born to moms younger than 35)
with Down syndrome, representing
ith D d ti • Most frequently encounter “viable” genetic
approximately 5,000+ births per year in anomaly
the United States alone. Today, Down • Most frequently encounter “special” patient
syndrome affects more than 350,000 • Prevalence increasing (improved survival rates)
people in the United States. http://www.nichd.nih.gov/publications/pubs/downsyndrome.cfm
Down Syndrome Etiology Down Syndrome Etiology
• Genetics • Genetics: Trisomy 21
• 95% demonstrate non-disjunction of one
chromosome during meiosis (Trisomy 21)
• 2-4% mosaicism
• 3-4% Robertsonian translocation of the long
3 4%
arm of chromosome 21 to another
chromosome usually #14
• risk of having a second child with Trisomy
21 or mosaic Down syndrome is 1 in 100.
The risk is higher if one parent is a carrier of a translocated cell.
6
7. Down Syndrome Refractive Error Down Syndrome Binocular
Characteristics
Many more hyperopes than 23-44% have strabismus
(Wesson & Maino) Down syndrome and
myopes, but those with myopia strabismus shows a constant unilateral
tended to have higher esotropia of less than 20 PD at near.
near
(Greatly reduced number show ET at distance)
magnitudes
It’s suggested that the etiology is a high
Up to 49% may exhibit some ACA ratio rather that of a basic ET
astigmatism
What’s New in Down Syndrome What’s New in Down Syndrome
Al-Bagdady M, Stewart RE, Watts P, Murphy PJ, Woodhouse JM. Bifocals Haugen OH, Hovding G, Eide GE. Biometric measurements of the eyes in teenagers and
young adults with Down syndrome.Acta Ophthalmol Scand. 2001 Dec;79(6):616-25.
and Down's syndrome: correction or treatment? Ophthalmic Physiol
Opt. 2009 Jul;29(4):416-21. Epub 2009 May 11.
CONCLUSIONS: Thinning of the corneal
Accommodation is reduced in approximately 75% of stroma may account for the steeper
children with Down's syndrome (DS). Bifocals have
(DS) cornea and the high frequency of
been shown to be beneficial and they are currently astigmatism in Down syndrome due to
prescribed regularly.. … Bifocals are an effective lower corneal rigidity. It may also be of
correction for the reduced accommodation in children
etiological importance to the increased
with DS and also act to improve accommodation with
a success rate of 65%. …. incidence of keratoconus in Down
syndrome.
Haugen OH, Hovding G, Lundstrom I.Refractive development in children Stewart RE, Woodhouse JM, Cregg M, Pakeman VH. Association
with Down's syndrome: a population based, longitudinal study. Br J Ophthalmol.
2001 Jun;85(6):714-9. between accommodative accuracy, hypermetropia, and strabismus
in children with Down's syndrome Optom Vis Sci. 2007
Feb;84(2):149-55.
….Accommodation weakness may be of
aetiological importance to the high ….This study demonstrates the marked
This st d
frequency of refractive errors association between under-
encountered in patients with Down's accommodation, hypermetropia, and
syndrome. strabismus in children with Down's
syndrome. ….
7
8. Haugen OH, Hovding G.Strabismus and binocular function in children with Stewart RE, Margaret Woodhouse J, Trojanowska LD. In
Down syndrome. A population-based, longitudinal study.Acta Ophthalmol focus: the use of bifocal spectacles with children with
Scand. 2001 Apr;79(2):133-9. Down's syndrome.Ophthalmic Physiol Opt. 2005
Nov;25(6):514-22
…The majority of the Down syndrome
children with strabismus have an …….Based on the results of this
acquired esotropia and hence a study, eye examinations of children
potential for binocularity.
binocularity with Down's syndrome should
y
Hypermetropia and accommodation routinely include a measure of
weakness are probably important accommodation at near, and bifocal
factors in esotropia ……. spectacles should be considered for
those who show under-
accommodation.
Fragile X Syndrome
• What is it?
• What is it’s etiology?
• What is it s prevalence/incidence?
it’s
• What are it’s physical/visual characteristics?
Fragile X Syndrome Fragile X Syndrome
Most frequently encountered inherited form of X-linked MR 1:600 in affected males
mental retardation (X-linked MR) 1:400 female carriers
Often misdiagnosed in the past
g p
Prevalence 2.6 cases per 1,000 in the
26 1 000
“New” syndrome that has caught the
imagination of researchers around the world general population, over 10% of all
1st human disease shown to be caused by a cases of mental retardation
repeated nucleotide sequence
8
9. Fragile X Syndrome Fragile X Syndrome Characteristics
Fra X
• Large prominent ears
1 in 4000 males with full mutation • Long narrow face
1 in 4000 to 6000 females with full • Macro-orchidism
mutation (80% affected men)
1 in 800 men are carriers
Other: hypotonia, seizures,
1 in 260 women are carriers recurrent otitis
media
Fragile X Syndrome Characteristics Fragile X Syndrome Characteristics
• Large prominent ears • Large prominent ears
• Long narrow face • Long narrow face
• Macro-orchidism (80%
( • Macro-orchidism (80%
(
affected men) affected men)
Other: hypotonia, seizures, Other: hypotonia, seizures,
recurrent otitis media recurrent otitismedia
Fragile X Syndrome Characteristics Fragile X Syndrome Characteristics
• First demonstrated genetic etiology of Gaze Avoidance
learning disability
• Variable mental retardation
• Math, language delay How do you conduct an
• Sensory integration problems examination on an individual
• Attentional deficits that won’t look at you?
• Psychiatric illnesses (shy)
9
10. Fragile X Syndrome Diagnosis
Genetics
• Triplet nucleotide repeated sequence
• cytosine, guanine, guanine (CGG)
• 0-50 CGG repeats normal, 50-200
premutation, > 200 full syndrome
• Fragile site on X chromosome (band
q27.3)
Fragile X Syndrome Ocular Findings What’s New in Fragile X Syndrome
• Hatton DD, Buckley E, Lachiewicz A, Roberts J. Ocular status of boys with fragile X syndrome: a
• Strabismus (33-50%) prospective study. J AAPOS. 1998 Oct;2(5):298-302.
• Nystagmus …observe a higher prevalence of strabismus than
that found in the general population (8% vs 0.5%
• Refractive error to 1
t 1…., 17% of th sample did have significant
f the l h i ifi t
• Accommodative dysfunctions? refractive errors. In addition to evaluating the
• Oculomotor anomalies ocular motility of children with fragile X
syndrome, cycloplegic refraction should also be
• Ocular Health? performed to determine whether refractive
• Perceptual dysfunction problems are present.
What’s New in Fragile X Syndrome What’s New in Fragile X Syndrome
Block SS, Brusca-Vega R, Pizzi WJ, Berry-Kravis E, Maino DM, Treitman TM.Cognitive and visual processing Effect of CX516, an AMPA-modulating compound, on cognition
skills and their relationship to mutation size in full and premutation female fragile X carriers.Optom Vis Sci.
2000 Nov;77(11):592-9. and behavior in fragile X syndrome: a controlled trial. Berry-
Kravis E, Krause SE, Block SS, Guter S, Wuu J, Leurgans S,
….full mutation female carriers performed more
Decle P, Potanos K, Cook E, Salt J, Maino D, Weinberg D, Lara
poorly in visual-motor processing and analysis- R, Jardini T, Cogswell J, Johnson SA, Hagerman R. J Child
synthesis on the Woodcock Johnson Psycho-
Woodcock-Johnson Psycho Adolesc Psychopharmacol. 2006 Oct;16(5):525-40.PMID:
Educational Battery-Revised, The Developmental 17069542
Test of Visual Motor Integration, and on five of the
Cognitive and visual processing skills and their relationship to
seven subtests of the Test of Visual-Perceptual mutation size in full and premutation female fragile X carriers.
Skills. Regression analyses revealed significant Block SS, Brusca-Vega R, Pizzi WJ, Berry-Kravis E, Maino DM,
negative correlations between mutation size and Treitman TM. Optom Vis Sci. 2000 Nov;77(11):592-9.PMID:
cognitive ability. … 11138833
10
11. What’s New in Fragile X Syndrome Autism
The fragile X female: a case report of the visual, visual perceptual,
and ocular health findings. Amin VR, Maino DM. J Am Optom The incidence of
Assoc. 1995 May;66(5):
Optometric findings in the fragile X syndrome. Maino DM, Wesson autism has increased
M,
M Schlange D, Cibis G, Maino JH. Optom Vis Sci. 1991
Aug;68(8):
D G JH Sci from 1 in 10,000 in
10 000
Mental retardation syndromes with associated ocular defects. Maino the 1970s to 1 in 110
DM, Maino JH, Maino SA.
J Am Optom Assoc. 1990 Sep;61(9):707-16.
today, an increase of
Ocular anomalies in fragile X syndrome. Maino DM, Schlange D, over 6,000%. …
Maino JH, Caden B. J Am Optom Assoc. 1990 Apr;61(4):316-23
Autism Autism Etiology
Yeast infections
Do Parents cause their children to be autistic ? Intolerance to specific food substances
There are autistic children born to parents who do not fit the autistic parent personality pattern. (Gluten intolerance ("Leaky Gut Syndrome"/Casein intolerance causing
Parents who do fit the description of the supposedly pathogenic parent have normal, non-autistic intestinal permeability and allowing improperly digested peptides to enter
children.
Frequently siblings of autistic children are normal.
the bloodstream and cross the blood-brain barrier which may mimic
Autistic children are behaviorally unusual "from the moment of birth " ***
from birth. neurotransmitters and result in the scrambling of sensory input. I've also
g y p
There is a consistent ratio of three or four boys to one girl. heard "Leaky Gut Syndrome" described as lack of the beneficial bacteria
Virtually all cases of twins reported in the literature have been identical, with both twins that aids digestion, and that the resulting matter in the bloodstream invokes
afflicted. *** an unnecessary immune reaction)
Autism can occur or be closely simulated in children with known organic brain damage. ***
The symptomatology is highly unique and specific.
Phenolsulphertransferase (PST) deficiency--theory that some with autism are
There is an absence of gradations of infantile autism which would low on sulphate or an enzyme that uses this, called phenol-
create "blends" from normal to severely afflicted. sulphotransferase-P. This means that they will be unable to get rid of amines
and phenolic compounds once they no longer have any use for them. These
then stay in their body and may cause adverse effects, even in the brain.
Autism Etiology Autism Etiology
Brain injury, Constitutional vulnerability
Developmental aphasia , Deficits in the reticular
activating system, An unfortunate interplay
between psychogenic and
b t h i d
neurodevelopmental factors, Structural
My Goodness!
cerebellar changes, Genetic causes, Viral Maino DM, Viola, SG, Donati R. The
Etiology of Autism. Optom Vis
causes, Immunological ties, Vaccines, Dev 2009:(40)3:150-156.
Seizures
11
12. Autism Etiology Autism
Impairment in social interactions
What the research Impairment in communication
shows… Restricted repertoire of activities
Autism Autism
Asperger
Childhood Syndrome Childhood
g
Disintegrative g
Disintegrative
Disorder Autism
A ti Disorder
Rett Syndrome
Autism US FDA Statement Autism
IOM Report: No Link Between Vaccines and Autism Thompson WW, Price C, Goodson B, Shay DK, Benson P, Hinrichsen
By Michelle Meadows VL, et al. Early thimerosal exposure and neuropsychological outcomes at 7
to 10 years. N Engl J Med. 2007 Sep 27;357(13):1281-92
There is no link between autism and the
measles-mumps-rubella (MMR) vaccine or the
Childhood Childhood
i
g
Disintegrative
vaccine preservative thi
Disorder ti thimerosal, according to a
l di t Our study does not support
g
Disintegrative
Disorder
report released by the Institute of Medicine's a causal association between early
(IOM) Immunization Safety Review exposure to mercury from thimerosal-containing vaccines and immune
Committee. globulins and deficits in neuropsychological functioning at the age of 7 to
10 years.
http://www.fda.gov/fdac/features/2004/504_iom.html
12
13. Autism Summary
Andrew Wakefield (born 1956) is a British former
surgeon and researcher best known for his discredited
work regarding the MMR vaccine and its claimed connection
Childhood
Disintegrative
ith
g
with autism and i fl
Disorder
d inflammatory bowel disease. Wakefield was the lead author
t b l di W k fi ld th l d th
of a 1998 study, published in The Lancet, which reported bowel symptoms in
twelve children diagnosed with autism spectrum disorders, to which the authors
suggested a possible link with the MMR vaccine. Though stating "We did not
Autism?
prove an association between measles, mumps, and rubella vaccine and the
syndrome described," the paper tabulated parental allegations, and adopted these
allegations as fact for the purpose of calculating a temporal link between receipt
of the vaccine and the first onset of what were described as "behavioural
symptoms“.
Mental Retardation without Specific Etiology Mental Retardation Classification
Most frequently encountered form of Intellectual Classification IQ
Disability Mild/Educable Mentally Handicapped 50-70
Moderate/Trainable Mentally Handicapped 35-55
4000 k O li Mendelian Inheritance
known Online M d li I h i Severe 20-40
in Man Profound below 20
http://www.ncbi.nlm.nih.gov/omim
10 times that are unknown!
Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
Neuroplasticity Neuroplasticity & Rehabilitation
Maino D. Neuroplasticity: Teaching an Old Brain New Tricks. Rev Optom Use it or lose it. If you do not drive specific brain functions, functional
2009. 46(1):62-64,66-70. loss will occur.
(http://www.revoptom.com/continuing_education/tabviewtest/lessonid/106025/) Use it and improve it. Therapy that drives cortical function enhances that
particular function.
ti l f ti
Specificity. The therapy you choose determines the resultant plasticity and
function.
Repetition matters. Plasticity that results in functional change requires
repetition.
Intensity matters. Induction of plasticity requires the appropriate amount
of intensity.
13
14. Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
Neuroplasticity & Rehabilitation Post Trauma Vision Syndrome Symptoms/Signs
Time matters. Different forms of plasticity take place at different times
during therapy.
Double vision
Salience matters. It has to be important to the individual. Headaches
Age matters Plasticity is easier in a younger brain, but is also possible in an
matters. brain
adult brain. Blurred vision
Transference. Neuroplasticity, and the change in function that results from Dizziness or nausea
one therapy, can augment the attainment of similar behaviors.
Interference. Plasticity in response to one experience can interfere with the Light sensitivity
acquisition of other behaviors.
Attention or concentration difficulties
Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for
rehabilitation after brain damage. J Speech Lang Hear Res 2008 Feb;51(1):S225-39.
Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
• Staring behavior (low blink rate) • Pulls away from objects when they are
• Spatial disorientation brought close to them
• Losing place when reading • Exotropia or high exophoria
• Can’t find beginning of next line when •AAccommodative i ffi i
d ti insufficiency
reading • Convergence insufficiency
• Comprehension problems when reading • Poor fixations and pursuits
• Visual memory problems • Unstable peripheral vision
Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
• Associated neuromotor Visual Midline Shift Syndrome
difficulties with balance, • Dizziness or nausea
coordination and posture
p • Spatial disorientation
p
• Perceived movement of • Consistently stays to one side of
stationary objects hallway or room
• Bumps into objects when walking
14
15. Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
Visual Midline Shift Syndrome References
• Poor walking or posture: leans back on TBI a Major Cause of Disability
heels, forward, or to one side when by Marc B. Taub, OD, FAAO, FCOVD
walking, standing or seated in a chair
lki t di t di h i Clinical O l
Cli i l Oculomotor Training in Traumatic Brain
t T i i i T ti B i
Injury by Kenneth J. Ciuffreda, OD, PhD, FAAO,
• Perception of the floor being tilted FCOVD-A, Diana P. Ludlam, BS, COVT, Neera
• Associated neuromotor difficulties with Kapoor, OD, MS, FAAO
balance, coordination and posture
Acquired/Traumatic Brain Injury Acquired/Traumatic Brain Injury
References References
• Myopia and Accommodative Insufficiency • Oculo-Visual Evaluation of the Patient with
Associated with Moderate Head Trauma Traumatic Brain Injury
by Steve Leslie B Optom FACBO FCOVD
Leslie, Optom, FACBO, by Maria Mandese, OD
Mandese
• Neuro-Optometry and the United States Legal • Traumatic Brain Injury and Binasal Occlusion
System by Alissa Proctor, OD
by Theodore S. Kadet, OD, FCOVD, R. E.
http://www.covd.org/Home/OVDJournal/OVD401/tabid/263/Default.aspx
Bodkin, JD, MBA, Attorney-at-Law
Questions? Contact:
Dominick M. Maino, OD, MEd, FAAO,FCOVD-A
Professor, Pediatric/Binocular Vision Service
Illinois Eye Institute Illinois College of Optometry
3241 S. Michigan Ave. Chicago, Il. 60616
312-949-7280 (phone) 312-949-7660 (f )
312 949 7280 ( h ) 312 949 7660 (fax)
dmaino@ico.edu
www.ico.edu www.nw.optometry.net
MainosMemos.blogspot.com
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