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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 Dortmund Senior Lecturer, Developmental Neuropsychology, Univ. of Helsinki www.lea-test.fi Tampa USF October 2011 Visual communication Social smile, active interaction at the age of 12 weeks. Eye contact, copying of expressions At 6 weeks, 8 weeks at the latest 3 Communication – at 8 weeks Eye contact and social smile Normal eye contact at 6 weeks, social smile at 12 weeks. Insufficient accommodation Mirror neuron system Eye contact and social smile Near correction Insufficient accommodation 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 Grating Acuity & Heidi Face as detection acuity & communcation distance Preferential looking Detection tests 2.5% Hiding Heidi low contrast pictures for assessment of communication distance Nordic faces and shadows of facial expressions are at low contrast. 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 At the Art Museum Pori, Finland Infant artists’ Mirror neuron functions Photo: Päivi Setälä 10 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 Accommodation in Hypotonic infants Compensating accommodation 13 Watching simple pictures two years later 14 Infants at risk Delayed motor development in premaurely born infants Combined effect of visual and motor disorder delays the development of an infant in all functional areas. 15 Constricted visual field 16 Large illuminated ball used by child’s own therapist. Fixation Brief fixation on the middle size picture of face 17 Accommodation difficult to measure when the infant does not look at Mother’s face and voice used as the target. 18 Eye contact when reading lenses give a clear image on the retina 19 Reaction during assessment of her brother noises and body language show disapproval 20 Visually active ten weeks later: improved visual and motor functions RE: GrA less than in LE > training as a part of physiotherapy 21 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 Early Intervention should start EARLY It should start during the assessment. 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 www.lea-test.fi Tampa USF October 2011 Accommodation eye contact and social smile Weak accommodation can be compensated with ”reading glasses.”