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The Covid-19 pandemic has led orthoptics to the practice of telematic rehabilitation with visually impaired children (VI). Previous research, on protocols developed during the peak of pandemic emergency, highlighted the importance of keeping similar characteristics of the traditional rehabilitation setting in the telematic one. While the world is moving forward from the pandemic, a new awareness about the importance of ICTs in healthcare has spread. Thus, visual telerehabilitation should be improved into a stand-alone method. This paper presents a six-session visual telerehabilitation program with age-specific exercises, developed via Microsoft PowerPoint, training visual attention, visual-spatial motor coordination, visual pursuit, saccadic eye movement, visual search, eye-hand coordination. The sessions are provided via Microsoft Teams where the orthoptist and the child are engaged in a video call (via tablets and personal computers) with the screen-sharing option. Moreover, two tools to monitor the effectiveness of this protocol are presented and discussed: (i) ergo-perimetric evaluation; (ii) ecological evaluation provided by parents.

Many findings suggest that visual deprivation in early life negatively affects the development of spatial competence and that sighted and visually impaired individuals use different strategies to encode spatial positions. This study aims to assess the role of vision in developing spatial coordinates by running three studies in a sample of children and adolescents with and without visual impairments (n = 42, 16 female, 8-18 years old, 100% European), using visual and auditory versions of Simon task with uncrossed and crossed hands posture. The first study assessed that visual and auditory external coordinates mature in parallel in sighted children. The second showed that if vision is available but degraded, it is sufficient to calibrate spatial performance in the auditory system, even if the visual performance remains impaired. The third experiment showed that the total lack of visual experience results in an impaired spatial performance also in the other spared modalities. Our results suggest that vision impairments have different consequences on developing spatial competence. They also highlighted the necessity of early assessment and interventions in visually impaired children that take into account different residual abilities.

Visual telerehabilitation is crucial to rise to the challenges of Covid-19 in order to advocate impaired individuals’ adaptation and social inclusion. The present research aims at detecting the predictors of the visual telerehabilitation protocol’s best outcome, also exploring variables’ interactions. The protocol by Chiossone Institute (Italy, Genoa) was administered in 2020 (March-May). Patients weekly video-called the orthoptists (by tablet or PC) to follow a personalized program on residual vision and diagnosis. The sample included seventy-five visually impaired individuals, across different age ranges (n=46 children and n=29 adults), who had all begun in person rehabilitation before pandemic. To detect the predictors of visual telerehabilitation effectiveness, orthoptists completed a self-report sheet with evaluation of the reaction time, participants socio-demographical data, diagnosis, residual vision, telematic session time-length, compliance level. Descriptive, linear regression, and moderation analyses were implemented. Children’s reaction time was predicted by age, sessions’ time-length, and compliance. Adults’ reaction time was predicted by sessions’ time length, without significant moderators. These findings encourage the combination of traditional setting elements and technological innovation.

In March 2020, the Italian Government declared a state of lockdown to curb the spread of the COVID-19 pandemic. This led to many challenges in the provision of rehabilitation services to people with disabilities. Consequently, there was a transition to the telematic provision of healthcare as an adaptive approach to the constraints posed by the pandemic. In the visual rehabilitation field, the lack of international guidelines for telematic rehabilitation led to pioneering interventions, which were challenged by difficulties in the use of technological devices by visually impaired individuals. The purpose of this chapter is to identify the peculiar features that could enable the provision of visual telerehabilitation during the pandemic by analyzing the procedures followed in the implementation of a visual telerehabilitation protocol in Italy and the outcomes thereof.

Associations between sensory features of different natures are defined as crossmodal correspondences. In the context of size perception, low pitch sound frequencies are often associated with larger objects and high pitch with smaller objects. Here we investigate such crossmodal correspondences in sighted and visually-impaired children. In Experiment 1, after listening to sounds (250–5000 Hz pure tones), children aged 6–11 years were asked to draw a circle "as big as the sound was". In Experiment 2, children aged 6–14 years who were blind or had low vision performed a similar task. In accordance with previous research, we observed that the circle size drawn depends on participants’ age and we confirm the presence of pitch-size associations in sighted children. In visually-impaired children, such associations are influenced by residual vision, suggesting an anchoring of size perception to level of residual vision. These results reveal novel dynamics underlying the advancing of visual loss and the emergence of compensatory mechanisms in childhood.

Since it has been demonstrated that spatial cognition can be affected in visually impaired children, training strategies that exploit the plasticity of the human brain should be early adopted. Here we developed and tested a new training protocol based on the reinforcement of audio-motor associations and thus supporting spatial development in visually impaired children. The study involved forty-four visually impaired children aged 6–17 years old assigned to an experimental (ABBI training) or a control (classical training) rehabilitation conditions. The experimental training group followed an intensive but entertaining rehabilitation for twelve weeks during which they performed ad-hoc developed audio-spatial exercises with the Audio Bracelet for Blind Interaction (ABBI). A battery of spatial tests administered before and after the training indicated that children significantly improved in almost all the spatial aspects considered, while the control group didn’t show any improvement. These results confirm that perceptual development in the case of blindness can be enhanced with naturally associated auditory feedbacks to body movements. Therefore the early introduction of a tailored audio-motor training could potentially prevent spatial developmental delays in visually impaired children.

Vision loss has severe impacts on physical, social and emotional well-being. The education of blind children poses issues as many scholar disciplines (e.g., geometry, mathematics) are normally taught by heavily relying on vision. Touch-based assistive technologies are potential tools to provide graphical contents to blind users, improving learning possibilities and social inclusion. Raised-lines drawings are still the golden standard, but stimuli cannot be reconfigured or adapted and the blind person constantly requires assistance. Although much research concerns technological development, little work concerned the assessment of programmable tactile graphics, in educative and rehabilitative contexts. Here we designed, on programmable tactile displays, tests aimed at assessing spatial memory skills and shapes recognition abilities. Tests involved a group of blind and a group of low vision children and adolescents in a four-week longitudinal schedule. After establishing subject-specific difficulty levels, we observed a significant enhancement of performance across sessions and for both groups. Learning effects were comparable to raised paper control tests: however, our setup required minimal external assistance. Overall, our results demonstrate that programmable maps are an effective way to display graphical contents in educative/rehabilitative contexts. They can be at least as effective as traditional paper tests yet providing superior flexibility and versatility.

This chapter reviews several findings that provide strong evidence for the effectiveness of pin-array tactile displays in enhancing spatial skills in people who are visually impaired in educational and rehabilitative contexts. Two main scenarios of use of these displays will be described: geometry and spatial memory training, and orientation and mobility training. The advantages of using pin-array tactile displays over standard rehabilitative methods in terms of increased flexibility and versatility will be discussed.

We investigate the role of refreshable tactile display in supporting the learning of cognitive maps, followed by actual exploration of a real environment that matches that map. We test both blind and low-vision persons and compare displaying maps in three information modes: with a pin array matrix, with raised paper and with verbal descriptions. We find that the pin matrix leads to a better way of externalizing a cognitive map and reduces the performance gap between blind and low-vision people. The entire evaluation is performed by participants in autonomy and suggests that refreshable tactile displays may be used to train blind persons in orientation and mobility tasks.

Background The estimation of relative distance is a perceptual task used extensively in everyday life. This important skill suffers from biases that may be more pronounced when estimation is based on haptics. This is especially true for the blind and visually impaired, for which haptic estimation of distances is paramount but not systematically trained. We investigated whether a programmable tactile display, used autonomously, can improve distance discrimination ability in blind and severely visually impaired youngsters between 7 and 22 years-old. Methods Training consisted of four weekly sessions in which participants were asked to haptically find, on the programmable tactile display, the pairs of squares which were separated by the shortest and longest distance in tactile images with multiple squares. A battery of haptic tests with raised-line drawings was administered before and after training, and scores were compared to those of a control group that did only the haptic battery, without doing the distance discrimination training on the tactile display. Results Both blind and severely impaired youngsters became more accurate and faster at the task during training. In haptic battery results, blind and severely impaired youngsters who used the programmable display improved in three and two tests, respectively. In contrast, in the control groups, the blind control group improved in only one test, and the severely visually impaired in no tests. Conclusions Distance discrimination skills can be trained equally well in both blind and severely impaired participants. More importantly, autonomous training with the programmable tactile display had generalized effects beyond the trained task. Participants improved not only in the size discrimination test but also in memory span tests. Our study shows that tactile stimulation training that requires minimal human assistance can effectively improve generic spatial skills. Electronic supplementary material The online version of this article (10.1186/s12984-019-0580-2) contains supplementary material, which is available to authorized users.

This paper presents the process and results of a set of studies within the ABBI EU project, with the general aim to co-design wearable technology (an audio bracelet) together with visually impaired children, starting at a young age. The authors discuss user preferences related to sounds and tactile materials and present the results of a focus group with very young visually-impaired children under the age of 5, together with their parents. They find that multisensory feedback (visual, tactile/haptic, auditory) is useful and that preferences vary - also the drastic and potentially unpleasant sounds and materials may have a role. Further studies investigate the possibilities of using the ABBI wearable technology for social contexts and games. In a series of game workshops children with and without visual impairments created games with wearable technology employing very simple interactivity. The authors report the created games, and note that even with this simple interactivity it is possible to create fun, inclusive and rich socially co-located games.

When developing interactive systems for children, such as serious games in the context of educational technology, it is important to take into account and address relevant cognitive and emotional child's experiences that may influence learning outcomes. Some works were done to analyze and automatically recognize these cognitive and affective states from nonverbal expressive behaviors. However, there is a lack of knowledge about visually impaired children and their body language to convey those states during learning tasks. In this paper, we present an analysis of nonverbal expressive behaviors of both blind and low-vision children, aiming at understanding what type of body communication can be an indicator of two cognitive states: engagement and confidence. In the study we consider the data collected along the EU-ICT H2020 weDRAW Project, while children were asked to solve mathematical tasks with their body. For such a dataset, we propose a list of 31 nonverbal behaviors, annotated both by rehabilitators used to work with visually impaired children and by naive observers. In the last part of the paper, we propose a preliminary study on automatic recognition of engagement and confidence states from 2D positional data. The classification results are up to 0.71 (F-score) on a three-class classification task.

Blind individuals are particularly dependent on their hearing for defining space. It has been found that both children and adults with visual impairments can struggle with complex spatial tasks that require a metric representation of space. Nonetheless the variability of methods employed to assess spatial abilities in absence of vision is wide, especially in the case of visually impaired children. For this reason, it would be necessary to define a battery of tests that appropriately assess different aspects of spatial perception and to investigate its reliability in order to provide a standard assessment of spatial abilities not only in experimental but also in clinical settings. The aim of this study is to determine the test-retest reliability of a battery of six spatial tasks (BSP, Blind Spatial Perception) and provide the first gold standard for assessing spatial cognition deficits in visually impaired children. Thirty visually impaired children aged 6-17 participated in two identical sessions, at a distance of 10 weeks, in which they performed six spatial tasks: auditory bisection, auditory localization, auditory distance discrimination, auditory reaching, proprioceptive reaching, and general mobility. Test-retest reliability was assessed using the test-retest scatter plots, intra-class correlation coefficient (ICC), and coefficient of variation (CV). The results showed good-to-excellent reliability for all six tests, with average ICC values ranging from 0.77 to 0.89 and average CV values ranging from 3.44% to 15.27%. In conclusion, the newly proposed battery (BSP) results as a reliable tool to identify spatial impairments in visually impaired children.

Pin-array displays are a promising technology that allow to display visual information with touch, a crucial issue for blind and partially sighted users. Such displays are programmable, therefore can considerably increase, vary and tailor the amount of information as compared to common embossed paper and, beyond Braille, they allow to display graphics. Due to a shortage in establishing which ideal resolution allows to understand simple graphical concepts, we evaluated the discriminability of tactile symbols at different resolutions and complexity levels in blind, blindfolded low-vision and sighted participants. We report no differences in discrimination accuracy between tactile symbols organized in 3x3 as compared to 4x4 arrays. A metric based on search and discrimination speed in blind and in low-vision participants does not change at different resolutions, whereas in sighted participants it significantly increases when resolution increases. We suggest possible guidelines in designing dictionaries of low-resolution tactile symbols. Our results can help designers, ergonomists and rehabilitators to develop usable human-machine interfaces with tactual symbol coding.

Spatial memory is a multimodal representation of the environment, which can be mediated by different sensory signals. Here we investigate how the auditory modality influences memorization, contributing to the mental representation of a scene. We designed an audio test inspired by a validated spatial memory test, the Corsi-Block test for blind individuals. The test was carried out in two different conditions, with non-semantic and semantic stimuli, presented in different sessions and displaced on an audio-tactile device. Furthermore, the semantic sounds were spatially displaced in order to reproduce an audio scene, explored by participants during the test. Thus, we verified if semantic rather than non-semantic sounds are better recalled and whether exposure to an auditory scene can enhance memorization skills. Our results show that sighted subjects performed better than blind participants after the exploration of the semantic scene. This suggests that blind participants focus on the perceived sound positions and do not use items’ locations learned during the exploration. We discuss these results in terms of the role of visual experience on spatial memorization skills and the ability to take advantage of semantic information stored in the memory.

Objective: To investigate whether training with tactile matrices displayed with a programmable tactile display improves recalling performance of spatial images in blind, low-vision and sighted youngsters. To code and understand the behavioral underpinnings of learning two-dimensional tactile dispositions, in terms of spontaneous exploration strategies. Methods: Three groups of blind, low-vision and sighted youngsters between 6 and 18 years old performed four training sessions with a weekly schedule in which they were asked to memorize single or double spatial layouts, featured as two-dimensional matrices. Results: Results showed that all groups of participants significantly improved their recall performance compared to the first session baseline in the single-matrix task. No statistical difference in performance between groups emerged in this task. Instead, the learning effect in visually impaired participants is reduced in the double-matrix task, whereas it is still robust in blindfolded sighted controls. We also coded tactile exploration strategies in both tasks and their correlation with performance. Sighted youngsters, in particular, favored a proprioceptive exploration strategy. Finally, performance in the double-matrix task negatively correlated with using one hand and positively correlated with a proprioceptive strategy. Conclusion: The results of our study indicate that blind persons do not easily process two separate spatial layouts. However, rehabilitation programs promoting bi-manual and proprioceptive approaches to tactile exploration might help improve spatial abilities. Finally, programmable tactile displays are an effective way to make spatial and graphical configurations accessible to visually impaired youngsters and they can be profitably exploited in rehabilitation.

This paper presents the process and results of a set of studies within the ABBI EU project, with the general aim to co-design wearable technology (an audio bracelet) together with visually impaired children, starting at a young age. The authors discuss user preferences related to sounds and tactile materials and present the results of a focus group with very young visually-impaired children under the age of 5, together with their parents. They find that multisensory feedback (visual, tactile/haptic, auditory) is useful and that preferences vary - also the drastic and potentially unpleasant sounds and materials may have a role. Further studies investigate the possibilities of using the ABBI wearable technology for social contexts and games. In a series of game workshops children with and without visual impairments created games with wearable technology employing very simple interactivity. The authors report the created games, and note that even with this simple interactivity it is possible to create fun, inclusive and rich socially co-located games.

This paper reports results from two workshops organized with children with visual impairments ranging from blindness to low vision. The aim of the workshops was to suggest gestures for the interaction with a small wearable audio-bracelet. Results show a preference for mechanical buttons and touch-based gestures on the device (mainly tapping and sliding), while only one tentative suggestion is made for a gesture made with the device (shaking).

Three diazabicyclo analogs of BMS-378806, in which theaxial methyl group present on its piperazine ring is replaced by a carbon bridge, were synthesized and tested, through a viral neutralization assay, on a panel of six pseudoviruses. The diazabicyclooctane and-nonane derivatives maintained a significant infectivity reduction power, whereas the diazabicycloheptane derivative was much less effective. A modeling study allowed to relate the antiviral activity to the conformational preferences of the compounds. Moreover, similarly to BMS-378806, theoretical calculations predict the existence of different conformational families corresponding to the possible arrangements at the two planar amido functions of the compounds. High-field 1H NMR spectra confirm these results, as they show two distinct series of signals. A viral neutralization assay on a panel of six HIV-related pseudoviruses allowed the determination of the antiviral activity of three diazabicyclo analogs of BMS-378806, in which the axial methyl group on its piperazine ring is replaced by a carbon bridge. The diazabicyclooctane and-nonane derivatives show a significant infectivity reduction power that is related to their conformational preference.

Attention deficit hyperactivity disorder (ADHD) is a frequent behavioral problem in young boys with fragile X syndrome (FXS), and its treatment is critical for improving social ability. The short-term efficacy of stimulant medications like methylphenidate (MPH) is well established in children with ADHD. FXS boys treated with MPH have improved attention span and socialization skills; however their mood becomes unstable at higher doses. Therefore, alternative pharmacological treatment of ADHD symptoms is desirable. A recent study showed that carnitine has a beneficial effect on the hyperactive–impulsive behavior in boys with ADHD without side effects. Our previous placebo-controlled trial indicated that L-acetylcarnitine (LAC) reduces hyperactivity in FXS boys. The objective of this study was to determine the efficacy of LAC in a larger sample of FXS boys with ADHD. The study design was randomized, double blind placebo controlled, parallel, and multicenter (with eight centers involved in Italy, France, and Spain). Sixty-three FXS males with ADHD (aged 6–13 years) were enrolled; 7 patients dropped out, 56 completed the one-year treatment, and 51 were included in the statistical analysis. Both groups improved their behavior, showing that psychosocial intervention has a significant therapeutic effect. However, we observed a stronger reduction of hyperactivity and improvement of social behavior in patients treated with LAC, compared with the placebo group, as determined by the Conners' Global Index Parents and the Vineland Adaptive Behavior Scale. Our results show that LAC (20–50 mg/kg/day) represents a safe alternative to the use of stimulant drugs for the treatment of ADHD in FXS children. © 2008 Wiley-Liss, Inc.

It is not clear what role visual information plays in the development of space perception. It has previously been shown that in absence of vision, both the ability to judge orientation in the haptic modality and bisect intervals in the auditory modality are severely compromised (Gori, Sandini, Martinoli & Burr, 2010; Gori, Sandini, Martinoli & Burr, 2014). Here we report for the first time also a strong deficit in proprioceptive reproduction and audio distance evaluation in early blind children and adults. Interestingly, the deficit is not present in a small group of adults with acquired visual disability. Our results support the idea that in absence of vision the audio and proprioceptive spatial representations may be delayed or drastically weakened due to the lack of visual calibration over the auditory and haptic modalities during the critical period of development.

This study was designed to assess the effectiveness of the Audio Bracelet for Blind Interaction (ABBI) system for improving mobility and spatial cognition in visually impaired children. The bracelet is worn on the wrist and the key feature is to provide an audio feedback about body movements to help visually impaired children to build a sense of space. Nine early blind children took part at this study. The study lasted 12 weeks. Once per week each child participated in a 45-minutes ABBI rehabilitation with trained professionals. He also had to use it one hour per day at home alone or with one relative. The mobility and spatial cognition abilities were measured before and after a 12-weeks rehabilitation program with three different tests. Results showed that the use of the Audio Bracelet for Blind Interaction allowed the early blind children to significantly improve their mobility and spatial abilities. Although an extended study including a larger number of participants is needed to confirm these data, the present results are encouraging. They do suggest that ABBI could be used for rehabilitate the sense of space in visually impaired children.