Oculomotor Training and Chinese Characters Recognition in Children With Neuromuscular Disease
Condition: Extraocular Muscle Disorder; Neuromuscular Diseases
MeSH terms: Muscular Diseases; Neuromuscular Diseases
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effects of gaze-directed oculomotor training
      incorporated with web-based curriculum readings in Chinese to enhancing fixation, saccade and
      Chinese characters recognition in schoolchildren with neuromuscular disease associated with
      congenital oculomotor anomalies.
    

Detailed description: 
      Background: schoolchildren with neuromuscular diseases associated with congenital oculomotor
      anomalies find problems in reading, even found difficulties in learning their mother-tongue
      language of Chinese.

      Objectives: (1) To test the hypothesis of using gaze-directed oculomotor training (GDOMT)
      incorporated with curriculum-based reading platform might enhance reading-related oculomotor
      skills and Chinese characters recognition; (2) To validate the outcome parameters of
      reading-related oculomotor skills by using remote eye tracker.

      Hypothesis: It has been shown that motor learning theory were effective in motor training for
      children with neuromuscular diseases. Oculomotor training to re-gain reading skills has been
      found effective for person with acquired brain injury or children with dyslexia, but there is
      no study on oculomotor training in children with neuromuscular diseases for reading. In this
      study, we hypothesize that self-initiated gaze-directed oculomotor training via e-reading
      platform (activated by horizontal saccade from left to right, then fixation dwell about 500ms
      to activate read-aloud the words phrases in Cantonese) for children with neuromuscular
      diseases associated with extra-ocular muscles anomalies, will be improved accuracy in
      fixation and saccade.

      Design: Cross-centers prospective Cohort study with quasi-experimental design; subjects of
      aged 6 to 8, randomly assigned into age-matched treatment group (N=10) or the age-matched
      control group (N=11).

      Methods: Participants (aged 6 to 8) with neuromuscular diseases, ocular health normal, normal
      intelligence, studying in main-stream special schools for children with physically
      disabilities were recruited. Participants passed the vision screening then randomized to
      age-paired matched control group (N=11) and treatment group (N=10). After time 1 measure,
      they attended reading class as usual. Therapists or teaching staff brought participants to
      library one by one and let the participant to read hardcopy or e-reading as assigned control
      or treatment group. Those therapists and teaching staff involved in training did not involve
      in repeated measures.

      Both groups explored to their curriculum-based reading materials. Participants of treatment
      group received oculomotor training by means of using a gaze-pointer interface to activate a
      reading e-platform, while control group used some ordinary hardcopy printout as placebo.

      Training sessions were provided twice per week for eight consecutive school calendar weeks.
      Occupational therapists and teachers collaborated in the reading class throughout 8 weeks.
      Participant in treatment group sat in front of the computer with the access hardware PCEye,
      gaze-directed oculomotor training was facilitated by decreasing the visual span from 20 to 10
      to 5 degrees per words phrase.

      Teacher presented the web-based reading materials in hardcopies (placebo) to control group.
      Teacher pointed to the passages and read aloud to individual. Both treatment group and
      control group have same dosage of reading.

      Control group performed the Chinese characters recognition test by gesture or verbal
      responses to the printout of web-based materials, while treatment group used gaze-access to
      select the answers same as Developmental Eye Movement Sub-test C.
    

Intervention name(s): gaze-directed oculomotor training
Intervention type(s): Other
Intervention description(s): Device: Tobii PCEye
Protocol: Visual span was calculated by the distance between human-computer and dpi of fonts. Pointer speed was programmed 120pixels (5 degrees)/1sec for image drift of reading.
Dosage: 1) gaze-access required 20 to 10 degrees per fixation to activate text-to-speech (TTS) read-aloud function; about 30 repetitions of saccade and fixation.
2) gaze-directed OMT limited to 10-5 degrees. Chinese characters recognition in multiple choice format, about 60 repetitions.
Target behavior - gaze-directed access by Tobii PCEye: reading from left to right (=horizontal mouse mover); read-aloud function by gaze dwell > 500ms. To enhance purposeful and repetitive eye movement.
Frequency: 2 session/wk x 8 wks
Duration: 30 min/session
Other intervention name(s): Tobii PCEye
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: gaze-directed oculomotor training, reading in Chinese