tactual information processing problems site [Alleen-lezen]

?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


hypotheseshypotheses

recognition

action

www9.biostr.washinton.edu


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


Atkinson & Braddick letterbox .

Fails task


Blind Learning Aptitude Test (BLAT)Blind Learning Aptitude Test (BLAT)

Level ± 7y (mainly discrimination)


Circle+circle above

f f f

ff

f

f

f

8 found after naming!

Collection of points

4points

Circle with 2 points

(± 8yrs)


Catshe

ad

3Cross

4star

7Zigzag

8Katapult

2Doll/8

6Square

5Rectangle

1circle

9 out of 12 : age average (verbal memory?) but…


Easy Form Board ReitanEasy Form Board Reitan

Fits 2:cross, diamond (6/7 yrs)


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.


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


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!


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


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


♂♂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?


Problem areas tactual profileProblem areas tactual profile

� touch sensitivity

� figure underground

� tactual spatial

� construction /reproduction


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


Reitan formboard 2Reitan formboard 2

Excellent with a spontaneous double task


♂♂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


♀♀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


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


++

Direct recall: cross T26 (± 5jr),After a week 4!!! More comparable to cognition

Easy formboard Reitan


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


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.


♀♀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)


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


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

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