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?CTI ??CTI ?Tactual Information Processing Tactual Information Processing
Impairments in blind children born Impairments in blind children born
very prematurelyvery prematurely
Drs. Marjolein DikGZpsychologist/neuropsychologistAmsterdam
ECVPI Heidelberg 2012 M.Dik
♂♂’’95 premature birth 27wk 935gr (gemelli)95 premature birth 27wk 935gr (gemelli)
ROP (blind LP+) PVLIROP (blind LP+) PVLI
�� Sensory Information Sensory Information
processing problemsprocessing problems
�� Oversensitive for touch and Oversensitive for touch and
sound, vestibular sound, vestibular ��
�� R bodyside stronger than LR bodyside stronger than L
�� Verbal IQ (WISCIIInl) 98; Verbal IQ (WISCIIInl) 98;
performal much lower,performal much lower,
�� personality +, family +personality +, family +
�� School history: doubts about School history: doubts about
cognitve capabilities, possibly cognitve capabilities, possibly
dyslexia, severe problems in dyslexia, severe problems in
mobilitytraining and mobilitytraining and
somewhat in arithmaticsomewhat in arithmatic
�� Has just started secondary Has just started secondary
education Visioeducation Visio
ECVPI Heidelberg 2012 M.Dik
hypotheseshypotheses
recognition
action
www9.biostr.washinton.edu
ECVPI Heidelberg 2012 M.Dik
Test choicesTest choices
�� TactualTactual
�� Letterbox (direction test)Letterbox (direction test)
�� BLAT (blind learning aptitude test 6BLAT (blind learning aptitude test 6--19y)19y)
�� Tactual Form Perception (Benton) adapted 8yTactual Form Perception (Benton) adapted 8y↑↑
�� Simple Formboard Reitan 5y Simple Formboard Reitan 5y ↑↑& drawingmap& drawingmap
�� AuditoryAuditory
�� Memory: letters forward (ToMaL5Memory: letters forward (ToMaL5--19y) and 15 words test19y) and 15 words test
�� Auditory Attention & Response (Nepsy 5Auditory Attention & Response (Nepsy 5--12y)12y)
�� Count! (TEACount! (TEA--CH 5CH 5--16y)& double task16y)& double task
�� Knock & Tap (Nepsy 5Knock & Tap (Nepsy 5--12y)12y)
�� Walk, donWalk, don’’t walk (TEAt walk (TEA--Ch 5Ch 5--16y) go,no16y) go,no--gogo
ECVPI Heidelberg 2012 M.Dik
Atkinson & Braddick letterbox .
Fails task
ECVPI Heidelberg 2012 M.Dik
Blind Learning Aptitude Test (BLAT)Blind Learning Aptitude Test (BLAT)
Level ± 7y (mainly discrimination)
ECVPI Heidelberg 2012 M.Dik
Circle+circle above
f f f
ff
f
f
f
8 found after naming!
Collection of points
4points
Circle with 2 points
(± 8yrs)
ECVPI Heidelberg 2012 M.Dik
Catshe
ad
3Cross
4star
7Zigzag
8Katapult
2Doll/8
6Square
5Rectangle
1circle
9 out of 12 : age average (verbal memory?) but…
ECVPI Heidelberg 2012 M.Dik
Easy Form Board ReitanEasy Form Board Reitan
Fits 2:cross, diamond (6/7 yrs)
ECVPI Heidelberg 2012 M.Dik
Auditory aloneAuditory alone
�� Working memory (ToMal Working memory (ToMal
letters forward): age level letters forward): age level
stsc 10stsc 10
�� Longterm memoryLongterm memory (15 (15
words): 11 by second words): 11 by second
offer and in recall offer and in recall
agelevelagelevel↑↑
�� Count! (TEACount! (TEA--CH)& double CH)& double
task:task: st sc 13 (mean 10)st sc 13 (mean 10)�� Very concentrated! Nothing Very concentrated! Nothing
moves.moves.
ECVPI Heidelberg 2012 M.Dik
Auditory+propriocepsis sittingAuditory+propriocepsis sitting
�� Knock & Tap(NepsyI 5Knock & Tap(NepsyI 5--12y): score 28 out of 3012y): score 28 out of 30
�� Auditory Attention & Response (NepsyI)Auditory Attention & Response (NepsyI)
Colours replaced by texture blocks in baskets ( wood, Colours replaced by texture blocks in baskets ( wood,
smooth, felt/soft, flat rubber) and text read out alive smooth, felt/soft, flat rubber) and text read out alive
If not too fast OK
ECVPI Heidelberg 2012 M.Dik
Auditory +propriocepsis+vestibularAuditory +propriocepsis+vestibular
�� Walk, donWalk, don’’t Walk (TEAt Walk (TEA--Ch 5Ch 5--16y) 16y)
go,nogo,no--gogo
Adjusted: not as paper/pencil but by Adjusted: not as paper/pencil but by
starting standing against wall and starting standing against wall and
doing it himselfdoing it himself
Troublesome!Troublesome!
ECVPI Heidelberg 2012 M.Dik
Function profileFunction profile
0
2
4
6
8
10
12
14
16
mtl aud tou spa exc mot
level
Attentional field: misses a part in lower field
ECVPI Heidelberg 2012 M.Dik
Conclusion 1Conclusion 1
In the prematurely born blind In the prematurely born blind group there seems to be a group there seems to be a subgroup withsubgroup with
-- normal cognitionnormal cognition
-- and multiple sensory and multiple sensory limitiationslimitiations
-- mainly living in a auditory mainly living in a auditory worldworld
Asking usAsking us
-- tell me how the world tell me how the world soundssounds
-- for adjustments in for adjustments in schoolprogramsschoolprograms and examsand exams
ECVPI Heidelberg 2012 M.Dik
♂♂14 yr ex14 yr ex--pr/dysmature 28wks 740 gr pr/dysmature 28wks 740 gr
ROP SIPP, ADHD, GdlTROP SIPP, ADHD, GdlT
School questionsSchool questions
�� Is it advisable to go on with tactual Is it advisable to go on with tactual
training?training?
�� Why is reading out of braille books so Why is reading out of braille books so
difficult?difficult?
�� What to do about the sloppiness?What to do about the sloppiness?
�� How to offer new tasks?How to offer new tasks?
ECVPI Heidelberg 2012 M.Dik
Problem areas tactual profileProblem areas tactual profile
� touch sensitivity
� figure underground
� tactual spatial
� construction /reproduction
ECVPI Heidelberg 2012 M.Dik
Functional dataFunctional data
�� Known with severe over/under registration Known with severe over/under registration
problems (SIPP) from the startproblems (SIPP) from the start
�� Motor: stiffly, mobility goodMotor: stiffly, mobility good
�� Verbal concepts 88 (WISCIIIVerbal concepts 88 (WISCIII--nl)nl)
�� Auditory memories: mean for age Auditory memories: mean for age
(15wrds)(15wrds)
�� Auditory attention: mean for age (TeaAuditory attention: mean for age (Tea--Ch)Ch)
�� AuditoryAuditory-- motor integration:meanmotor integration:mean
�� PsychoPsycho--social social
ECVPI Heidelberg 2012 M.Dik
Reitan formboard 2Reitan formboard 2
Excellent with a spontaneous double task
ECVPI Heidelberg 2012 M.Dik
♂♂14 jr ex14 jr ex--pr/dysmature ROPpr/dysmature ROPSIPP, ADHD, GdlTSIPP, ADHD, GdlT
0
5
10
15
c ps tf tp s ex m
level
yrs
level yrs
C = cognitionPS = psycho-socialTF= fine touchTP= proprioceptic touchS = spatialEx = executive functionsM =motor system
Complete attentional field
ECVPI Heidelberg 2012 M.Dik
♀♀12 yr premature birth 26 wks & 12 yr premature birth 26 wks &
850 gr850 gr
ROP SIPP ASSROP SIPP ASS
School and parents askSchool and parents ask
-- Can arithmatic, mobility and spatial Can arithmatic, mobility and spatial
orientation possibly be improved?orientation possibly be improved?
-- Is there more possible in learning?Is there more possible in learning?
Tactuall profile problem areasTactuall profile problem areas
-- Propriocepsis out of own bodyPropriocepsis out of own body
-- Tactual spatialTactual spatial
ECVPI Heidelberg 2012 M.Dik
Function dataFunction data
�� SIPP:propiocepsis, vestibular and muscle SIPP:propiocepsis, vestibular and muscle
tone low. Alertness changing tone low. Alertness changing
�� Verbal understanding: 8/9 yr (WISCIIInl, Verbal understanding: 8/9 yr (WISCIIInl,
WPPSI IVnl)WPPSI IVnl)
�� SocialSocial-- emotionalemotional
�� Letterbox : OKLetterbox : OK
�� BLAT: score 12 so without help only BLAT: score 12 so without help only
discriminatory tasks (6/7yr); misses many discriminatory tasks (6/7yr); misses many
items taking up a taskitems taking up a task
BLAT: score 17 with limit testing 8/9 jrBLAT: score 17 with limit testing 8/9 jr
ECVPI Heidelberg 2012 M.Dik
++
Direct recall: cross T26 (± 5jr),After a week 4!!! More comparable to cognition
Easy formboard Reitan
ECVPI Heidelberg 2012 M.Dik
f ?
1 circle, circle2 dnkn, triangle
3 square 4 little way
5 circle
6 rectangle
7 circle
After 7: there are no more!Looked at and named the rest together(way+ circle, groupway, piece of pie, weg, crossing)f
ff
f
ff?
f
Finds 8 Level ± 6jr
ECVPI Heidelberg 2012 M.Dik
Memory and attentionMemory and attention
�� Verbal working memory:7/8 yr with digit Verbal working memory:7/8 yr with digit
span (WISCIIInl) and 15 wrd testspan (WISCIIInl) and 15 wrd test
�� Verbal long term with 15 wrd test: Tscore Verbal long term with 15 wrd test: Tscore
34 34 ±± 6/7 jr. Striking reproduction build 6/7 jr. Striking reproduction build
up, attention seems to shiftup, attention seems to shift
�� Attention for the whole haptic field: main Attention for the whole haptic field: main
problem seems to be haptic problem seems to be haptic ““gazegaze””
shifting. Impairment in directing and shifting. Impairment in directing and
planning attention planning attention
�� She remains dependent upon external She remains dependent upon external
structured environment.structured environment.
ECVPI Heidelberg 2012 M.Dik
♀♀12 yr ROP SIPP ASS12 yr ROP SIPP ASS
0
1
2
3
4
5
6
7
8
9
c e tf tp m a s
levelyrs
C = cognitionE = emotionTF= fine touchTP= touch proprioceptiveS = spatialA = attention
functionsM =motor fct
Small attentional field, ever shifting (directing attention impairment)
ECVPI Heidelberg 2012 M.Dik
Conclusions 2Conclusions 2
In the prematurely born blind In the prematurely born blind group there seems to be a group there seems to be a second subgroup withsecond subgroup with
-- Relatively normal cognitionRelatively normal cognition
-- Limited psychosocial Limited psychosocial developmentdevelopment
-- Some with severe Some with severe attentional deficitsattentional deficits
-- Light motor impairmentsLight motor impairments
Also mainly living in a Also mainly living in a auditory worldauditory world
Asking usAsking us
-- tell me how the world tell me how the world soundssounds
-- for adjustments in for adjustments in schoolprogramsschoolprograms and examsand exams
ECVPI Heidelberg 2012 M.Dik
Conclusion 3Conclusion 3
In haptic information processing a In haptic information processing a
picture as complex as in CVI appears picture as complex as in CVI appears
=CTI or tactual information =CTI or tactual information
processing impairmentprocessing impairment