Viewing Strategy Training in Children With (Cerebral) Visual Impairment

Viewing Strategy Training in Children With (Cerebral) Visual Impairment: From Spontaneous Eye Movements to a Structured Viewing Strategy

Viewing strategies are strategies used to process visual Information. Many children with visual impairment seem to lack systematic viewing strategies. However, it is unknown how viewing strategies differ between children with normal vision and children with (cerebral) visual impairment. In addition, viewing strategy training is often adopted in clinical practice, but till date there is no scientific evidence about effectiveness of this approach.

The current project has two goals: (1) to measure viewing strategies used by children with normal vision, children with ocular visual impairment and children with CVI, and (2) to evaluate whether training viewing strategies results in more efficiënt visual Information processing.

Study Overview

• Status: Recruiting
• Conditions: Vision Disorders; Vision, Low
• Intervention / Treatment: Behavioral: Viewing strategy training

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Bianca Huurneman, PhD; Phone Number: 0(031)646944002; Email: biancahuurneman@visio.org

Study Locations

• Netherlands
  • Nijmegen, Netherlands
    • Recruiting
    • Royal Dutch Visio
    • Contact: Hanna Romema, MSc
    • Contact: Email: hannarozema@visio.org
    • Principal Investigator: Hanna Rozema, MSc

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 5 years to 12 years (Child)
• Accepts Healthy Volunteers: Yes

Description

Inclusion criteria typically developing children with normal vision:

• Age 5-12 years
• linear distant visual acuity of 0.1 logMAR or better
• Verbal IQ above 70
• Absence of developmental disorders or psychiatric problems like ASS or AD(H)D

Inclusion criteria for children with ocular visual impairment:

• Age 5-12 years
• Children with linear distance visual acuity better <=1.3logMAR and >0.1 logMAR
• Intact central visual field (at least > 30 degrees)
• Children with a verbal IQ above 70
• Absence of developmental disorders or psychiatric problems like ASS or AD(H)D

Inclusion criteria for children with cerebral visual impairment:

• Age 5-12 years
• Linear distance visual acuity <=0.3 logMAR
• Having the diagnosis CVI (verified by ophthalmologists)
• Children with a verbal IQ above 70
• Absence of psychiatric problems like ASS or AD(H)D

Additional inclusion criterion for study 2 (evaluating training effectiveness): children with (cerebral) visual impairment should have an indication for viewing strategy training. Training should not be indicated if children have no problems performing academic tasks (i.e. when speed and accuracy of visual processing is within the normal range). The age range for study 2 is 5-9 years.

Exclusion criteria:

• Children with VI: linear near visual acuity >1.0 logMAR
• Children with visual field defect < 30 degrees
• Children with a verbal IQ below 70
• Children who attended a form of vision training in the past two years
• Children with psychiatric problems like ASS or AD(H)D
• Auditory impairment or language impairments
• Major life events during training

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A) early training group; T0 = baseline measurement T1 = posttest (within two weeks after training) T2 = follow up measurement (6 months after training)	Behavioral: Viewing strategy training; Children receive a visual training of viewing strategies (six weeks, 2 times a week, 30 minutes). During the training, children are instructed to use specific viewing strategies (looking in a structured direction which fits the task at hand, zooming in and out / change of visual selective attentional field, visual discrimination). The verbal instructions and exercises are protocol-based. A textbook is used to describe the reactions of the children during training.
Experimental: Group B) late training group; T0 = baseline measurement T1 = test-retest reliability and natural development (over period 1 1/2-2 months after T0) T2 = posttest (within two weeks after training)	Behavioral: Viewing strategy training; Children receive a visual training of viewing strategies (six weeks, 2 times a week, 30 minutes). During the training, children are instructed to use specific viewing strategies (looking in a structured direction which fits the task at hand, zooming in and out / change of visual selective attentional field, visual discrimination). The verbal instructions and exercises are protocol-based. A textbook is used to describe the reactions of the children during training.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in reading accuracy after viewing strategy training	Radner reading test	Group A: Day 0, Month 2, Month 8; group B: Day 0, Month 2, Month 4
Changes in reading speed after viewing strategy training	Radner reading test	Group A: Day 0, Month 2, Month 8; group B: Day 0, Month 2, Month 4
Changes in visual search accuracy after training	Accuracy during conjunction search	Group A: Day 0, Month 2, Month 8; group B: Day 0, Month 2, Month 4
Changes in visual search speed after training	Speed during conjunction search	Group A: Day 0, Month 2, Month 8; Group B: Day 0, Month 2, Month 4
Changes in saccade amplitudes during reading and visual search after training	Saccade amplitudes measured using Radner reading test and conjunction search	Group A: Day 0, Month 2, Month 8; Group B: Day 0, Month 2, Month 4
Changes in fixation duration during reading and search after training	Fixation durations measured using Radner reading test and conjunction search	Group A: Day 0, Month 2, Month 8; Group B: Day 0, Month 2, Month 4
Changes in average distance between fixation points during conjunction search (EB-VSA) after training	Average distance between fixation points using Radner reading test and conjunction search	Group A: Day 0, Month 2, Month 8; Group B: Day 0, Month 2, Month 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in WISC-V visual processing speed index (VSI) after training	WISC-IV visual processing speed index	Group A: Day 0, Month 2, Month 8; Group B: Day 0, Month 2, Month 4
Changes in local visual selective attention after training	TEA-Ch Speurtocht (total number of symbols found in 1 minute)	Group A: Day 0, Month 2, Month 8; Group B: Day 0, Month 2, Month 4
Changes in global visual selective attention after training	Gestalt Closure (Kaufman-ABC), number of correct answers	Group A: Day 0, Month 2, Month 8; Group B: Day 0, Month 2, Month 4
Changes in visual identification speed after training	'DST-Plaatjes Benoemen', number of pictures correctly named within 1 minute	Group A: Day 0, Month 2, Month 8; Group B: Day 0, Month 2, Month 4

Collaborators and Investigators

• Sponsor: Royal Dutch Visio
• Collaborators: Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands
• Investigators: Principal Investigator: Bianca Huurneman, PhD, Royal Dutch Visio

Study record dates

Study Major Dates

• Study Start (Actual): October 25, 2024
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: July 12, 2022
• First Submitted That Met QC Criteria: October 26, 2022
• First Posted (Actual): October 31, 2022

Study Record Updates

• Last Update Posted (Estimated): January 7, 2026
• Last Update Submitted That Met QC Criteria: January 5, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: viewing strategies; (cerebral) visual impairment; visual rehabilitation; reading strategies; visual search strategies
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Eye Diseases; Sensation Disorders; Blindness; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Vision, Low; Vision Disorders; Blindness, Cortical
• Other Study ID Numbers: NL81584.091.22

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No