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Aprendizagem e Leitura - Síndrome de Irlen
Abstract
Todos consideramos a leitura como uma habilidade natural e automática porque a realizamos sem esforço algum. Entretanto, para muitas crianças e adultos, o ato de ler é um verdadeiro pesadelo e esta é a realidade para 10 a 15% da população. A leitura é a habilidade mais difícil e complexa que a espécie humana desenvolveu. Embora sejam necessários muitos anos para aprender a falar, exigimos apenas um ano ou pouco mais para que as crianças aprendam a ler (Refs. 1-3). Ler não é intuitivo como falar. Embora haja uma área do córtex específica para a linguagem, isto não ocorre na leitura.
Quando se lê, há estimulação da parte posterior do cérebro, incluindo o lobo occipital, que se ativa pelo formato das letras. O giro angular transcreve os grafemas em fonemas e a região de Wernicke acessa o significado. Em síntese, percebe-se como são complexos os processamentos neurológicos da leitura e linguagem e, infelizmente, não concedemos aos alunos tempo adequado para este aprendizado.
Na realidade, a pressão atual é muito maior: Espera-se que crianças na educação infantil (antiga pré-escola) já sejam capazes de reconhecer uma letra, associá-la ao respectivo som e reconhecê-las em palavras. Não há dúvidas que há uma exigência excessiva desde cedo e muitas crianças não estarão maduras o suficiente para lidar com a complexidade exigida para a leitura (Refs. 4 - 23). As dificuldades podem afetar a autoimagem das crianças, como também seu interesse pelo aprendizado em geral, tornando a mágica do acesso à escola um terrível pesadelo. Por isto, é necessário identificar esta população e resgatá-las precocemente, antes que a leitura se transforme em uma dificuldade intransponível.
Excluindo-se os déficits mentais e a cegueira, a Dislexia de desenvolvimento e a Síndrome de Irlen são duas as principais causas especificas de aquisição da Leitura. A Dislexia vem sendo amplamente discutida e já há amplo conhecimento sobre a importância do apoio multidisciplinar que, não raro, será necessário ao longo de toda a vida de seu portador em suas formas mais severas de manifestação.
É oportuno que professores e gestores tenham acesso às informações sobre a Síndrome de Irlen.
... Some studies (Altman, 2003;Guimarães & Guimarães, 2013;Miyasaka et al., 2019;Sacoman, 2020;Wilkins et al., 2001) showed that there are six main visual alterations in IS: photophobia (resistance and sensitivity to light or complaints of brightness/reflections of white paper), contrast distortions (difficulty adapting between light and dark), problems in a visuospatial resolution (sensation of blurring and movement of letters), restriction of the focal range (low ability to focus on the most relevant parts of the text and poor collection of characters in each fixation), difficulty in maintaining focus (premature fatigue or visual stress) and problems with depth perception. Similarly, Guimarães (2011) noted that these problems are observed as tearing and a burning sensation that, consequently, produces fatigue, the need to rub the eyes, and the presence of headaches. ...
... Among the IS reading difficulties, Guimarães and Guimarães (2013) found problems in reading acquisition among Brazilian students. These authors also noticed that, although they had good verbal fluency, reasoning agility, intelligence, and were participatory, students with IS tended to fail a lot in reading tasks. ...
... Although not directly comparable, this study provides new empirical data for consideration since the researchers used three tasks of the PROLEC-R. In this sense, even though, there is more research that supports that people with Irlen syndrome present problems in reading (Guimarães & Guimarães, 2013), the analyses have been to date limited in terms of empirical procedures and only some have focused solely on detailing reading speed (for example, Hollis & Allen, 2006). Hence, several authors have questioned previous research confirming the existence of the Irlen syndrome, its influence on reading, and the types of evaluation and intervention used (Griffiths et al., 2016;Ritchie et al., 2011;2012;Uccula et al., 2014). ...
Visual perceptual distortions and physical discomfort that cause difficulties in reading are some of the characteristics of Irlen syndrome. This study examined if students with Irlen syndrome, assessed with different reading tasks, show differences in reading skills when compared to those without this condition. Participants were 110 fourth and fifth graders (mean age = 8.6 years), 55 with Irlen syndrome (ISG group)and 55 without this syndrome (control group). Researchers applied the Irlen Reading Perceptual Scale to evaluate the Irlen Syndrome and the PROLEC-R Test to assess reading processes. The results showed significant group differences in Word Reading, Pseudoword Reading, Punctuation Marks, Sentence, and Text Comprehension. Oral comprehension in the auditory modality was not significantly different, which would support the idea that Irlen syndrome seems to be related to visual sensory processes. In conclusion, participants with Irlen syndrome showed impaired reading processes that might affect overall visual comprehension but not oral reading comprehension.
... Ademais, uma vez que o estresse visual frequentemente coexiste com a dificuldade de leitura, Transtorno de Déficit de Atenção/Hiperatividade e Transtorno do Espectro Autista, a identificação diferencial é imprescindível para a intervenção correta e eficaz . A ausência da identificação e intervenção do estresse visual pode contribuir para um desestímulo do aluno frente à sua capacidade de aprender, afetando sua autoestima, seu interesse pelos estudos, assim como para o aumento das taxas de evasão e abandono escolar, que já são relativamente elevadas no Brasil (Auriglietti, 2014;Guimarães & Guimarães, 2013;Silva Filho & Araújo, 2017). ...
O estresse visual é definido como uma disfunção do processamento visual, de base neuronal, com um déficit do sistema magnocelular e no córtex visual primário. Ele é caracterizado por distorções visuoperceptuais e desconforto visual progressivo na leitura. O presente estudo verificou a prevalência do estresse visual entre escolares do 3º e 4º ano do ensino fundamental (7 a 10 anos) com dificuldade de leitura, assim como investigou o efeito do uso de lâminas espectrais na habilidade de leitura. Todos os participantes elegíveis (n = 58) apresentavam dificuldade de leitura e adequada acuidade visual binocular. As lâminas espectrais foram selecionadas e distribuídas aos alunos para uso por três meses. A Escala de Percepção Visual de Leitura, o Teste de Taxa de Leitura e o Teste de Leitura - Compreensão e Sentença caracterizaram as condições pré e pós-intervenção. Os resultados indicaram prevalência de 12% de estresse visual (sintomas severos). Após a intervenção, foi verificado que o uso das lâminas espectrais promoveu incremento da compreensão de sentenças e da taxa de leitura. Assim, conclui-se que o estresse visual é uma disfunção muito prevalente entre crianças com dificuldade de leitura e que as lâminas espectrais são um método eficaz de intervenção para reduzir o estresse visual na leitura.
ABSTRACT
Visual stress is defined as a neuronal-based dysfunction of visual processing, with a deficit in the magnocellular system and in the primary visual cortex. It is characterized by visual-perceptual distortions and progressive visual discomfort in reading. The present study verified the prevalence of visual stress among students from 3rd and 4th grades of elementary school (7 to 10 years old) with reading difficulties, as well as investigated the effect of the use of overlays on reading ability. All eligible participants (n = 58) had reading difficulties and adequate binocular visual acuity. Overlays were selected and distributed to students for use for three months. The Visual Reading Perception Scale, the Reading Rate Test and the Reading Test - Comprehension and Sentence characterized the pre- and post- intervention conditions. The results indicated a 12% prevalence of visual stress (severe symptoms). After the intervention, it was verified that the use of spectral slides promoted an increase in sentence comprehension and reading rate. Thus, it is concluded that visual stress is a very prevalent disorder among children with reading difficulties and that overlays are an effective method of intervention to reduce visual stress in reading.
... A perda da qualidade da visão pode ocorrer mesmo após sanados os problemas refracionais e demais patologias do globo ocular. Os profissionais que trabalham com a visão devem ter clareza na distinção entre os sintomas referentes às alterações da visão binocular e os decorrentes dos Distúrbios do Processamento Visual (DPV) [1][2][3][4][5][6]. O Quadro 1 sumariza os sintomas específicos e os em comum para auxiliar no diagnóstico diferencial e no tratamento dos problemas de visão. ...
https://sistemaparaevento.com.br/evento/simasp2019/trabalhosaprovados/naintegra/7826
INTRODUÇÃO: O Distúrbio do Processamento Visual (DPV) é caracterizado por sintomas de astenopia, fotossensibilidade, cansaço visual progressivo em leitura e distorções visuoperceptuais (percepção do texto em movimento, desfocado e embaralhado). Na visão espacial podem ocorrer dificuldades na percepção de profundidade, de movimento e de sensibilidade ao contraste, mesmo com o exame oftalmológico normal. Esses sintomas do DPV podem se confundir com os sintomas das alterações da motilidade ocular das heteroforias, da insuficiência de convergência (IC), da amplitude de fusão (AF) e PPC reduzidos. A partir de uma amostra clínica, foi verificada a proporção de pacientes com problemas ortópticos e/ou DPV.
Métodos
Foram avaliados em teste ortóptico 60 pacientes, de 6 a 46 anos, média de 15 anos, sintomáticos à leitura e com desconforto para longe. Os pacientes não apresentaram alteração ao exame oftalmológico, com acuidade visual para longe 20/20 em cada olho e J1 para perto, eram emétropes ou com ametropia corrigida. O teste ortóptico avaliou a AV com a melhor correção refracional, medida do desvio para longe e perto ao prisma e cover, versões, PPC, AF com prismas para longe e perto e estereopsia com Titmus. A triagem para DPV segue o protocolo IRPS (Irlen Reading Perceptual Scale), cujo estresse visual desencadeado é atenuado com a sobreposição de lâminas espectrais (overlay) para leitura, alterando o contraste e brilho do papel e filtrando específicas frequências da luz visível. O uso de óculos com lentes espectrais é indicado para os pacientes que têm sintomas espaciais e na leitura mais severos.
Resultados
Dos 60 casos, 14 (23%) ficaram assintomáticos após tratamento ortóptico. Dos demais 46 pacientes (77%) com DPV , 13 (22%) realizaram terapia ortóptica, 33 (55%) com teste ortóptico normal. Todos os 46 casos usaram overlay com bom resultado, com 8 em uso de óculos com filtro espectral (DPV severa). 30 encaminhados para o exame completo neurovisual e 8 não precisam das lentes espectrais, somente overlay (DPV leve). Todos os pacientes referiram melhora no desempenho escolar ou laboral.
Conclusões
É importante realizar avaliação e tratamento oftalmológico e ortóptico para posterior rastreio do DPV. Há pacientes que apresentam alterações ortópticas coexistentes ao DPV, onde a terapia ortóptica se impõe prioritária e após normalizada a visão binocular estes farão o tratamento para readequar o processamento visual.
Visual Stress (VS) is an abnormal visuoperceptual condition caused by an imbalance in light adaptation ability which yields reading deficits. It was first described in 1983 and, since then, has been treated with the usage of colored spectral filters, either as Irlen overlays either as lenses for symptoms relief. However, the limited options of overlays compromise the pursuit for the patient’s optimal filter so that a device that could provide a broader range of colors would improve achievements for both screeners and patients. The present work aims to develop a micro-controlled RGB LED device whose goal is to reproduce Irlen overlays combinations chromaticities through colored light metamers. Such a device can open possibilities for better diagnosing Visual Stress (VS) by providing screeners a much more extensive range of colors than regular overlays and glasses and, therefore, allowing more accurate scrutiny of the optimal chromatic point for the patient. For the pursuit of this goal, a LED controller based on PWM (Pulse Width Modulation) of currents was built, and a color reproduction methodology was developed to ensure chromaticity matching. From the 47 filters considered, 22 showed a ratio Δ E/JND < 6 and, thus, laid within a range that could provide the reading performance associated with its corresponding filter. Reproduction methodology was effective and demanded 5 main inputs: LED individual and white point color coordinates plus LED characterization curves. The controller proved to be effective for color manipulation inside the device’s gamut, which opens the possibility for both readjustment of the chromaticity, if it is found to vary with patient’s aging, and further connection to an eye tracker to shorten the search for the optimal point.
Saccades were recorded longitudinally from 28 infants aged 1-7 months, using d.c.-electrooculography, in a clinically practical manner. Six uninstructed naive adults acted as controls. In localizing a peripheral visual target, infants produced sequences of conspicuously hypometric saccades. Within a recording session, the degree of hypometria varied greatly from one trial to the next. The average degree of hypometria was worse for greater target eccentricities. There was a systematic improvement with age, although adult levels were not reached by 7 months. The amplitude of a secondary saccade tended to compensate for the undershoot of the primary saccade, and sequences of fixed-magnitude saccades were not prominent. In spite of the variability in primary saccade amplitude, primary saccades only rarely overshot the target. Thus, as with adults, hypermetria should be considered abnormal even in the 1-month old. It is concluded that saccadic hypometria is a part of normal development, and that its measurement in a clinical setting is practical and potentially useful in the visuomotor assessment of the young infant.
Background / Purpose:
Of the 10% of children who find it unexpectedly difficult to learn to read fluently despite normal intelligence, health and education (developmental dyslexia), many have impaired development of visual magnocellular neurons. This impairs their ability to visually process letters properly. Magnocellular neurons are responsible for directing visual attention and eye movements during reading, hence for accurately sequencing letters.
Main conclusion:
Accumulating evidence suggests that many dyslexics have visual magnocellular deficits, as well as auditory and cerebellar magnocellular deficits due to genetic effects on neural migration during brain development, immune anomalies, lack of omega 3 docosahexaenoic (DHA) acid and eicosapentaenoic acid (EPA). These can be helped by blue or yellow filters and omega-3 supplements.
Accurate recordings of eye movements of children 4 and 5 years old show that their eye movement differed from those of adults. During maintained fixation, saccades were large (1° to 2°) and smooth eye movement speeds were high (45 minutes of arc per second). Saccade latencies were highly variable during target step tracking. Smooth pursuit latencies were longer than those of adults. These hitherto unknown characteristics limit a child's ability to use eye movements to acquire visual information.
Forty volunteers reporting consistent reading problems were divided into three groups on the basis of an assessment of degree of scotopic sensitivity. Four speeded visual processing tasks involving word matching and letter and number identification were administered to all subjects using three plastic overlays, one of a colour maximizing visual efficiency, one chosen at random and one with no colour. For subjects with high scotopic sensitivity, the use of optimal coloured overlays yielded significantly better results on some visual tasks than the other two overlays. Implications of these findings are discussed.
SYNOPSIS
20 children with clinically diagnosed migraine were asked to wear either a rose coloured tint or density matched blue tint for a period of 4 months. The frequency, duration and intensity of migraine attacks were recorded, together with the amount of visually provoked beta activity in the EEG. After one month's wear all the children in the study revealed an initial improvement in headache frequency. However, only those children wearing rose tints sustained this improvement up to 4 months, when the mean headache frequency had improved from 6.2 per month to 1.6 per month. The headache frequency of those children wearing blue tints revealed no overall improvement after 4 months. The improvements in headache frequency in children wearing rose tints correlated with a reduction in visually provoked bets activity. Key words: children, migraine, photophobia, tint, visual evoked responses
Meares-Irlen Syndrome (MIS) is characterised by symptoms of visual stress and visual perceptual distortions that are alleviated by using individually prescribed coloured filters. Coloured overlays (sheets of transparent plastic that are placed upon the page) are used to screen for the condition. MIS is diagnosed on the basis of either the sustained voluntary use of an overlay or an immediate improvement (typically of more than 5%) on the Wilkins Rate of Reading Test (WRRT). Various studies are reviewed suggesting a prevalence of 20–34% using these criteria. Stricter criteria give a lower prevalence: for example, 5% of the population read more than 25% faster with an overlay. It has been alleged that MIS is more common in dyslexia, but this has not been systematically investigated. We compared a group of 32 dyslexic with 32 control children aged 7–12 years, matched for age, gender and socio-economic background. Participants were tested with Intuitive Overlays, and those demonstrating a preference had their rate of reading tested using the WRRT with and without their preferred overlay. Both groups read faster with the overlay, and more so in the dyslexic group. ANOVA revealed no significant effect of group, but a significant improvement in WRRT with overlay (p=0.009) and a significant interaction between group and overlay (p=0.031). We found a similar prevalence of MIS in the general population to that in previous studies and a prevalence in the dyslexic group that was a little higher (odds ratio for >5% criterion: 2.6, 95% confidence limit 0.9–7.3). The difference in prevalence in the two groups did not reach statistical significance. We conclude that MIS is prevalent in the general population and possibly a little more common in dyslexia. Children with dyslexia seem to benefit more from coloured overlays than non-dyslexic children. MIS and dyslexia are separate entities and are detected and treated in different ways. If a child has both problems then they are likely to be markedly disadvantaged and they should receive prompt treatments appropriate to the two conditions. It is recommended that education professionals as well as eye-care professionals are alert to the symptoms of MIS and that children are screened for this condition, as well as for other visual anomalies.
Vergence to static targets presented at five distances between 25 and 200 cm from the subject was measured in 631 infants aged between 17 and 120 days. Photographic images of the eyes were magnified and measured to yield information on the monocular and binocular eye positions for each target. Vergence data were fit by a linear function and compared to the vergence calculated from target distance and each infant's measured interpupillary distance. Differences in vergence across targets were also evaluated for each subject by calculating the change in angle of rotation for each eye. Many of even the youngest infants showed good ocular alignment both monocularly and binocularly, although the youngest infants showed the greatest variability in vergence. However, the median difference in vergence angle between the eyes for even the youngest group was < 4 deg (6.8 prism D), and some of this difference is attributed to versional eye movements and to slightly off-axis head position across trials. The average infant of 1–2 months showed substantially better vergence than has been reported in some recent studies. Apparently, oculomotor constraints are not a significant barrier to the development of the higher forms of binocularity that begin to emerge in the months immediately following the interval studied here, and may form the substrate for later developments in binocular vision.
Although accommodative facility testing is used widely in the evaluation of accommodation in children, published normative data are not available for this age group. Current values being used are based upon studies of adult populations. In order to establish norms, 542 elementary schoolchildren were screened. Those that passed a specific set of criteria were included in the accommodative facility assessment. We used a new target and instructional set, which took into consideration the problems associated with subjective testing of young children. The results revealed lower mean accommodative facility values for both monocular and binocular accommodative facility than the values obtained previously from adult populations. These new findings can be used as a clinical guide to evaluate accommodative facility in young children