Li-Ting Tsai, Ling-Fu Meng, Wei-Chi Wu, Yuh Jang, Yu-Chin Su; Effects of Visual Rehabilitation on a Child With Severe Visual Impairment. Am J Occup Ther 2013;67(4):437-447. doi: 10.5014/ajot.2013.007054.
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We examined the effects of visual rehabilitation, including a chromatic luminance discrimination program and a fixation training program, on a 6-yr-old boy with severe visual impairment. Single-subject ABA and AB designs were used. The programs were conducted 2×/wk and included 6 to 7 sessions for the baseline phase and 10 to 11 sessions for the intervention phase. Play was integrated into the visual training programs. Goggle visual evoked potential (VEP) testing was used to evaluate neural activity in the primary visual cortex. Correct responses increased and response times were shortened after training in luminance discrimination. The total and maximum fixation time also improved, as did P100 latency and amplitude of VEPs. While walking, the boy was able to detect obstacles he had not noticed before training. The results indicate the value of visual training and the possibility of brain plasticity in a child with severe visual impairment.
Children with severe visual impairment still have residual visual functions. Experience-dependent plasticity from intensive visual training can be promoted in children with severe anterior visual pathway lesions even beyond the traditional visual critical periods, especially in the case of children who have only visual problems.
The underlying theoretical framework involves visual neuroscience, visual development, specific visual characteristics in children with severe visual impairment, and the correlation between visual components and functional visual performance.
Contrast sensitivity and oculomotor control are important visual elements for children with severe visual impairment. Children who are more sensitive to contrast and who accurately control eye movement are likely to be better at detecting large objects and to benefit from magnification of objects.
The properties of training materials include the size and brightness of objects, contrast between target objects and other objects, contrast between objects and surroundings, and environmental luminance.
Training programs that integrate play activities and conform to children’s cognitive abilities are suggested to encourage active participation.
Training 2×/wk for 40–50 min each session is suggested.
Children’s visual behavior and psychological response to training should be carefully observed to avoid overtraining, which can cause fatigue and emotional upset.
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