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Assessment of visual functioning with special reference to infants Lea Hyvärinen, MD, PhD, FAAP Professor h.c., Rehabilitation Sciences, University of.

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Presentation on theme: "Assessment of visual functioning with special reference to infants Lea Hyvärinen, MD, PhD, FAAP Professor h.c., Rehabilitation Sciences, University of."— Presentation transcript:

1 Assessment of visual functioning with special reference to infants Lea Hyvärinen, MD, PhD, FAAP Professor h.c., Rehabilitation Sciences, University of Dortmund Senior Lecturer, Developmental Neuropsychology, Univ. of Helsinki Tampa USF October 2011

2 Visual communication Eye contact, copying of expressions At 6 weeks, 8 weeks at the latest Social smile, active interaction at the age of 12 weeks.

3 Communication – at 8 weeks 3

4 Eye contact and social smile Normal eye contact at 6 weeks, social smile at 12 weeks. Insufficient accommodation Mirror neuron system

5 Eye contact and social smile Insufficient accommodation Near correction

6 Recommended assessments Following functions should be assessed in all infants: eye contact and social smile (accommodation ) grating acuity as detection acuity contrast sensitivity for communication

7 Grating Acuity & Heidi Face as detection acuity & communcation distance Detection tests Preferential looking 2.5%

8 Hiding Heidi low contrast pictures for assessment of communication distance Nordic faces and shadows of facial expressions are at low contrast.

9 Recommended assessments Following functions should be assessed in all infants: eye contact and social smile grating acuity as detection acuity contrast sensitivity for communication refractive errors, confrontation visual fields ocular motor functions, including accommodation observation of hand functions and copying them

10 10 Infant artists’ Mirror neuron functions Photo: Päivi Setälä At the Art Museum Pori, Finland

11 Recommended assessments Following functions should be assessed in all infants : eye contact and social smile grating acuity as detection acuity contrast sensitivity for communication refractive errors, confrontation visual fields ocular motor functions, including accommodation observation of hand functions and copying them face recognition of family members

12 Infants at risk 12 Accommodation in Hypotonic infants

13 Compensating accommodation 13

14 Watching simple pictures two years later 14

15 Infants at risk Delayed motor development in premaurely born infants 15 Combined effect of visual and motor disorder delays the development of an infant in all functional areas.

16 Constricted visual field 16 Large illuminated ball used by child’s own therapist.

17 Fixation 17 Brief fixation on the middle size picture of face

18 Accommodation difficult to measure when the infant does not look at 18 Mother’s face and voice used as the target.

19 Eye contact when reading lenses give a clear image on the retina 19

20 Reaction during assessment of her brother noises and body language show disapproval 20

21 Visually active ten weeks later: improved visual and motor functions 21 RE: GrA less than in LE > training as a part of physiotherapy

22 Infants at risk Infants with delays/difficulties in communcation All hypotonic infants: brain damage, Down All infants with Down syndrome, refraction Infants with strabismus All deaf and hard of hearing infants All infants with syndrome based risk of VI

23 Ventral and dorsal stream/network Mirror neuron system Insula MNS

24 Figure-in-motion, Pepi-test Can be Near correction Head support

25 Biological movements Johansson’s Walking Man Random movement Biological movement

26 Recommended follow-up Birth: structure of the eyes, red reflex, strabismus 6 – 8 weeks: good eye contact 12 weeks – 4th month: - active visual communication, hands found - baby follows hand movements of children and adults - fixation, following movements, convergence 7- 8 months: pincer grasp, face recognition, Hirschberg 18 months: face recognition, Hirschberg, cover test (H+c) 3rd year: (H+c), near vision acuity 4th year: (H+c), near and far vision acuity 5th year: if visual perceptual problems >> ophthalmologist

27 Infants at risk Infants with delays/difficulties in communcation All hypotonic infants: brain damage, Down All infants with Down syndrome, refraction Infants with strabismus All deaf and hard of hearing infants All infants with syndrome based risk of vision loss Paediatricians, Paediatric neurologists, Audiologists Paediatric genetisists, Psychologists, Therapists, Parents

28 Early Intervention should start EARLY It should start during the assessment.

29 Assessment of visual functioning with special reference to infants Lea Hyvärinen, MD, PhD, FAAP Professor h.c., Rehabilitation Sciences, University of Dortmund Senior Lecturer, Developmental Neuropsychology, Univ. of Helsinki Tampa USF October 2011

30 Accommodation eye contact and social smile Weak accommodation can be compensated with ”reading glasses.”


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