312,031 research outputs found

    Functional visual fields: A cross-sectional UK study to determine which visual field paradigms best reflect difficulty with mobility function

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    Objectives: To develop an appropriate method of assessing visual field (VF) loss which reflects its functional consequences, this study aims to determine which method(s) of assessing visual fields best reflect mobility difficulty. Setting: This cross-sectional observational study took place within a single primary care setting. Participants attended a single session at a University Eye Clinic, Cambridge, UK, with data collected by a single researcher (HS), a qualified optometrist. Participants: 50 adult participants with peripheral field impairment were recruited for this study. Individuals with conditions not primarily affecting peripheral visual function, such as macular degeneration, were excluded from the study. Primary and secondary outcome measures: Participants undertook three custom and one standard binocular VF tests assessing visual field to 60 degrees, and also integrated monocular threshold 24-2 visual fields (IVF). Primary VF outcomes were average mean threshold, percentage of stimuli seen, and VF area. VF outcomes were compared to self-reported mobility function assessed with the Independent Mobility Questionnaire, and time taken and patient acceptability were also considered. Receiver Operating Characteristic (ROC) curves determined which tests best predicted difficulty with mobility tasks. Results: Greater VF loss was associated with greater self-reported mobility difficulty with all field paradigms (R2 0.38-0.48, all p<0.001). All four binocular tests were better than the IVF at predicting difficulty with at least three mobility tasks in ROC analysis. Mean duration of the tests ranged from 1min 26sec (±9sec) for kinetic assessment to 9min 23sec (±24 sec) for IVF. Conclusions: The binocular VF tests extending to 60 deg eccentricity all relate similarly to self-reported mobility function, and slightly better than integrated monocular VFs. A kinetic assessment of VF area is quicker than and as effective at predicting mobility function as static threshold assessment

    Mobile landscapes and transport tourism: the visual experience of mobility during cruises and coach tours

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    This study aims to analyze the visual aspects of transport tourists’ experience of mobility focusing on British cruise and coach tourists’ international travel experiences. The qualitative data was collected using semi-structured in-depth interviews with coach and cruise tourists and analyzed using thematic analysis. The visual experience of mobility (demonstrated in the paper by the example of cruises and coach tours) is critical in the formation of transport tourism experiences. The mobile tourist landscapes emerge from the interplay of the subjective experiences of particular modes of mobility (vehicle or vessel) and routes, whereby the two key visual elements are the changing scenery and views of everyday local life as experienced whilst traveling. In terms of research limitations, the present study focuses particularly on the visual elements of passive transport tourism experiences. It does not account for other tourist activities nor does it study the experiences associated with active transport tourism. Future research could perform a holistic analysis of tourists’ experiences of transport in all its forms. The findings point to the centrality of the experience of mobility in transport tourism experience. The following two key aspects of the experience emerged: the importance of variation of the scenery that the tourist consumes during their tour and a desire to observe mundane, everyday life elements of the destination, which should be taken into account by the tour operators and service providers in the route design and marketing. Originality/value: Coach and cruise tourism are rarely analyzed together; this study demonstrates considerable parallels between the two in considering them as transport tourism, a mode of recreational activity where mobility is the central part of the tourist experience and should, therefore, be considered a tourist attraction in and of itself

    Individual heat map assessments demonstrate vestronidase alfa treatment response in a highly heterogeneous mucopolysaccharidosis VII study population.

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    Mucopolysaccharidosis (MPS) VII is an ultra-rare, progressively debilitating, life-threatening lysosomal disease caused by deficiency of the enzyme, β-glucuronidase. Vestronidase alfa is an approved enzyme replacement therapy for MPS VII. UX003-CL301 was a phase 3, randomized, placebo-controlled, blind-start study examining the efficacy and safety of vestronidase alfa 4 mg/kg intravenously administered every 2 weeks to 12 patients with MPS VII. Due to the rarity of disease, broad eligibility criteria resulted in a highly heterogeneous population with variable symptoms. For an integrated view of the diverse data, the changes from baseline (or randomization for the placebo period) in clinical endpoints were grouped into three functional domains (mobility, fatigue, and fine motor + self-care) and analyzed post-hoc as subject-level heat maps. Mobility assessments included the 6-minute walk test, 3-minute stair climb test, Bruininks-Oseretsky test (BOT-2) gross motor function subtests, and patient-reported outcome assessments (PROs) related to movement, pain, and ambulation. Fatigue assessments included the Pediatric Quality of Life Multidimensional Fatigue Scale and other fatigue-related PROs. Fine motor + self-care assessments included BOT-2 fine motor function subtests and PROs for eating, dressing, hygiene, and caregiver assistance. Most subjects showed improvement in at least one domain. Two subjects improved in two or more domains and two subjects did not show clear improvement in any domain. Both severely and mildly affected subjects improved with vestronidase alfa in clinical assessments, PRO results, or both. Heat map analysis demonstrates how subjects responded to treatment across multiple domains, providing a useful visual tool for studying rare diseases with variable symptoms

    The Impact of Visual Impairments on Mobility Performance in Community-Dwelling Older Adults

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    Background and Purpose: Falls are a major concern for elderly adults and can have a significant impact on overall health and well-being. Declines in vision with aging may be related to the development of fear of falling (FOF) and impaired mobility. It is possible that impaired vision due to common eye diseases can increase the FOF avoidance behavior and affect mobility function in this population. The purpose of this study was to investigate the relation among visual impairment, mobility performance, and FOF avoidance behavior in older adults. Methods: Inclusion criteria for eligible participants were: 50 years of age and older, able to walk 50 m without assistance, and able to understand simple instructions related to the assessments. A total of 455 participants from local community adult activity centers (males=152, females=303; age=73.1±7.7 years, range=51-97 years) participated. Physical mobility was assessed using an instrumented Timed Up-and-Go test. Visual acuity (VA) was tested using a standard Snellen chart. Avoidance behavior was assessed using the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). Participants’ general health and presence of eye diseases (age-related macular degeneration, cataracts, and glaucoma) was assessed using a survey of medical history. A two-way ANOVA was used to investigate effect of VA and avoidance behavior on TUG performance. An additional two-way ANOVA test was used to investigate the effect of self-reported eye disease and avoidance behavior on TUG performance. Results and Discussion: There was a statistically significant difference between avoiders and non avoiders’ TUG score (avoiders=12.45±5.85 sec, non-avoiders 8.29±3.48, p\u3c0.001). The VA has no significant effect on TUG time (no impairment= 8.69 ± 3.49 sec, mild impairment= 9.42 ± 5.05 sec, moderate impairment= 8.11 ± 2.08 sec, severe impairment= 9.45 ± 2.68 sec, p=0.791). There is no significant VA group by avoider group interaction (p=0.66). There was also a statistically significant difference in TUG scores between participants with and without eye disease (eye disease=9.37±5.08, no eye disease=8.29±2.80, p=0.004). There is no significant eye disease by avoider group interaction (p=0.144). iv Conclusion: The results of this study indicated that the presence of one or more self-reported eye diseases and higher FOF avoidance behavior were both associated with decreased mobility. Contrary to the initial hypothesis of the present study, there was no relation between VA and mobility, nor VA and FOF avoidance behavior. It is important for clinicians to inquire about the presence of eye diseases and administer the FFABQ to older adults in order to identify risk factors related to decline in physical mobility. Presently, the continued use of the Snellen chart to assess for VA as a part of fall risk assessment may be inadequate. Future studies should focus on developing a more comprehensive clinical assessment of vision that expands beyond visual acuity for the geriatric population

    Understanding Orientation and Mobility learning and teaching for primary students with vision impairment: a qualitative inquiry

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    Orientation and Mobility is a uniquely crafted pedagogical practice blending specific microteaching skills to enable students with vision impairment to achieve functional interpretation of extra-personal and peri-personal space. Linked to student wellbeing, social participation, employment and self-determination, Orientation and Mobility is a cornerstone of equity and access for students with vision impairment. Despite this, in mainstream primary education little is known about Orientation and Mobility learning and teaching and how it aligns with the Australian Curriculum. Orientation and Mobility learning and teaching is examined from the perspectives of three female primary school students with vision impairment, a parent, a teacher, the researcher, and a panel of Orientation and Mobility specialists. These perspectives are interwoven with a detailed reflexive interrogation of the Orientation and Mobility lessons over one school semester within the contexts of the Far North and North Queensland Department of Education regions and the Australian Curriculum. This study explores how one Queensland Orientation and Mobility teacher, the researcher, explicitly communicates nonvisual, visual, tactile, and auditory concepts to primary school students with vision impairment. Drawing on Bronfenbrenner's bioecological systems theory, the Orientation and Mobility learning experiences are captured through an interpretative methodology comprising narrative inquiry and autoethnography, both underpinned by hermeneutic phenomenology. Insider researcher data are gathered from semi structured interviews, online panel responses, and audio recordings of the Orientation and Mobility lessons. Autoethnographic field notes, document materials, and reflexive teaching journals are used to support the thematic and discourse analysis. Results confirm that for the non-expert participants there was a substantial lack of awareness of the impact of vision impairment on learning and development, and the potential contribution of Orientation and Mobility. Systemic and cultural barriers to equitable inclusive education for these North and Far North Department of Education students with vision impairment were uncovered. Orientation and Mobility learning and teaching was clearly shown to overlap with and embed content from the Australian Curriculum. A key finding was the isolation of a core set of micro-teaching skills pertinent to Orientation and Mobility learning and teaching. These skills were identified as: Orientation and Mobility teacher attention to dialogic language and feedback, extended interaction wait times, and shared attention to spatial and contextual environments within the Orientation and Mobility lesson. As this skill set can be used to design Orientation and Mobility learning and teaching experiences that explicitly scaffold the development of non-visual, visual, tactile, auditory, and kinaesthetic pre-cursor concepts, it was given the appropriated name of practice architecture. An important practical outcome of the research was the formulation of an ontogenetic model of Orientation and Mobility learning and teaching. This model, which closely follows the natural development of each student with vision impairment, may serve as a tool that enables teachers to more systematically chart the biophysical attributes of the student with vision impairment. It thereby provides a learning and teaching framework for designing interactions with students with vision impairment. The ontogenetic framework has the potential to facilitate greater integration of what–and–how learning occurs in Orientation and Mobility with what–and–how learning might occur in the regular classroom
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