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Numerous research studies have demonstrated the scope and value of eye movement recording (EMR). There is now potential for EMR to be helpful in a range of clinical contexts and it could be developed as a routine part of the repertoire of clinical investigations offered by the NHS, at least in tertiary centres. We highlight potential uses and challenges below, as a prelude to further development and debate., Peer Reviewed, Postprint (author's final draft)

Neurological Vision Impairment (NVI) detrimentally impacts upon quality of life, as daily activities such as reading and crossing the road often become significantly impaired. Therapy strategies for NVI based on visual scanning of on-screen stimuli have recently been demonstrated as effective at improving functional vision. However, these strategies are repetitive, monotonous and unsuitable for use with children and young adults. This project explores the design of a game-based therapy programme that aims to support participant engagement and adherence. We first outline requirements for this software, before reporting on the iterative design process undertaken in collaboration with young people, therapists and teachers at a centre for vision impairment. Our work provides insights into the participatory design of games in collaboration with young people with special needs, and reflects upon the tension of balancing game challenge, therapy goals, and accessibility. Furthermore, it highlights the potential of games to empower special populations by providing a medium through which to communicate the subjective experience of specific impairments.

Over the last 150 years, human manual reaction times (RTs) have been recorded countless times. Yet, our understanding of them remains remarkably poor. RTs are highly variable with positively skewed frequency distributions, often modeled as an inverse Gaussian distribution reflecting a stochastic rise to threshold (diffusion process). However, latency distributions of saccades are very close to the reciprocal Normal, suggesting that "rate" (reciprocal RT) may be the more fundamental variable. We explored whether this phenomenon extends to choice manual RTs. We recorded two-alternative choice RTs from 24 subjects, each with 4 blocks of 200 trials with two task difficulties (easy vs. difficult discrimination) and two instruction sets (urgent vs. accurate). We found that rate distributions were, indeed, very close to Normal, shifting to lower rates with increasing difficulty and accuracy, and for some blocks they appeared to become left-truncated, but still close to Normal. Using autoregressive techniques, we found temporal sequential dependencies for lags of at least 3. We identified a transient and steady-state component in each block. Because rates were Normal, we were able to estimate autoregressive weights using the Box-Jenkins technique, and convert to a moving average model using z-transforms to show explicit dependence on stimulus input. We also found a spatial sequential dependence for the previous 3 lags depending on whether the laterality of previous trials was repeated or alternated. This was partially dissociated from temporal dependency as it only occurred in the easy tasks. We conclude that 2-alternative choice manual RT distributions are close to reciprocal Normal and not the inverse Gaussian. This is not consistent with stochastic rise to threshold models, and we propose a simple optimality model in which reward is maximized to yield to an optimal rate, and hence an optimal time to respond. We discuss how it might be implemented. © 2014 Harris, Wadding

Introduction: Rehabilitation can improve visual outcomes for adults with acquired homonymous visual field loss. However, it is unclear whether (re)habilitation improves visual outcomes for children because previous training schedules have been tiresome, uninteresting, and failed to keep them engaged. In this study we assessed whether children and young people with homonymous visual field loss would adhere to six weeks of unsupervised compensatory training using a specialised video game. Methods: Participants aged between 7 and 25 with homonymous visual field loss completed table-top assessments of visual search across four site visits. Two baseline assessments separated by four weeks evaluated spontaneous improvements before training began. Participants were then given a copy of the video game to use unsupervised at home for six weeks. Two follow-up assessments separated by four weeks were then conducted to evaluate immediate and acutely maintained effects of training. Results. 15 candidates met the inclusion-exclusion criteria, 9 participated, and 8 completed the study. Participants completed an average of 5.6 hours training unsupervised over the six weeks. Improvements on in-game metrics plateaued during week 3 of training. The time taken to find objects during table-top activities improved by an average of 24% (95% CI [2%, 46%]) after training. Discussion: The findings demonstrate that children and young people with homonymous visual field loss will engage with gamified compensatory training, and can improve visual outcomes with less time commitment than adults have required with non-gamified training in previous studies. Appropriately powered, randomised controlled trials are required to evaluate the validity and generalisability of observed training effects. Implications for practitioners: We conclude that (re)habilitation specialists can use specialist video games and gamification to engage children and young people with homonymous visual field loss in long-te

Partial and homonymous visual field loss (HVFL) is a common consequence of post-chiasmatic injury to the primary visual pathway or injury to the primary visual cortex. Different approaches to rehabilitation have been reported for older adults with HVFL and there is evidence to support the use of compensatory training over other proposed therapies. We reviewed the literature to investigate the current state of the art of rehabilitation and habilitation strategies for children and young people with HVFL, and whether there is enough evidence to support the use of these strategies in the paediatric population. We have provided an overview of the existing literature on children and young people with HVFL, a brief overview of rehabilitation strategies for adults with HVFL, and evidence on whether these different interventions have been applied with children and young people effectively. We found that there have been very few studies to investigate these strategies with children and young people, and the quality of evidence is currently low. New research is required to evaluate which strategies are effective for children and young people with HVFL and whether new strategies need to be developed.

Neurological Vision Impairment (NVI) detrimentally impacts upon quality of life, as daily activities such as reading and crossing the road often become significantly impaired. Therapy strategies for NVI based on visual scanning of on-screen stimuli have recently been demonstrated as effective at improving functional vision. However, these strategies are repetitive, monotonous and unsuitable for use with children and young adults. This project explores the design of a game-based therapy programme that aims to support participant engagement and adherence. We first outline requirements for this software, before reporting on the iterative design process undertaken in collaboration with young people, therapists and teachers at a centre for vision impairment. Our work provides insights into the participatory design of games in collaboration with young people with special needs, and reflects upon the tension of balancing game challenge, therapy goals, and accessibility. Furthermore, it highlights the potential of games to empower special populations by providing a medium through which to communicate the subjective experience of specific impairments.

Involving young people with complex needs in game design can be a challenging research endeavor, particularly when working within a school context. In this paper, we discuss findings from two case studies where we worked with young adults with visual impairment, and young people with mobility disabilities. We focus on ethical challenges that emerged during the research process, and we discuss management strategies to foster the establishment of inclusive and engaging field research into video games for young people with complex needs.

Evidence has accumulated that visual rehabilitation for patients with neurological visual impairment can be effective. Unfortunately, the existing therapy tools are repetitive, uninteresting, and unsuitable for use with children. This project aims to improve the engaging qualities of visual rehabilitation for children, through the design of therapy tools based on game design principles. Development is ongoing in a participatory, user-centred manner in conjunction with a specialist centre for childhood visual impairment. This paper outlines design requirements and briefly reports early findings of the development process.