Search results for: neurocognitive impairment

Authors: A. Badran, M. Hollocks, H. Markus

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Background: Common risk factors for cardiovascular disease are associated with age-related cognitive decline. There has been much interest in treating modifiable cardiovascular risk factors in the hope of reducing cognitive decline. However, there is currently no validated neuropsychological test to assess the subclinical cognitive effects of vascular risk. The Brief Memory and Executive Test (BMET) is a clinical screening tool, which was originally designed to be sensitive and specific to Vascular Cognitive Impairment (VCI), an impairment characterised by decline in frontally-mediated cognitive functions (e.g. Executive Function and Processing Speed). Objective: To cross-sectionally assess the validity of the BMET as a measure of the subclinical effects of vascular risk on cognition, in an otherwise healthy elderly cohort. Methods: Data from 346 participants (57 ± 10 years) without major neurological or psychiatric disorders were included in this study, gathered as part of a previous multicentre validation study for the BMET. Framingham Vascular Age was used as a surrogate measure of vascular risk, incorporating several established risk factors. Principal Components Analysis of the subtests was used to produce common constructs: an index for Memory and another for Executive Function/Processing Speed. Univariate General Linear models were used to relate Vascular Age to performance on Executive Function/Processing Speed and Memory subtests of the BMET, adjusting for Age, Premorbid Intelligence and Ethnicity. Results: Adverse vascular risk was associated with poorer performance on both the Memory and Executive Function/Processing Speed indices, adjusted for Age, Premorbid Intelligence and Ethnicity (p=0.011 and p<0.001, respectively). Conclusions: Performance on the BMET reflects the subclinical effects of vascular risk on cognition, in age-related cognitive decline. Vascular risk is associated with decline in both Executive Function/Processing Speed and Memory groups of subtests. Future studies are needed to explore whether treating vascular risk factors can effectively reduce age-related cognitive decline.

Keywords: age-related cognitive decline, vascular cognitive impairment, subclinical cerebrovascular disease, cognitive aging

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Authors: Bambang Wispriyono, Satria Pratama, Haryoto Kusnoputranto, Faisal Yunus, Meliana Sari

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Introduction/objective: The impact of the development of motor vehicles is increasing the number of pollutants in the air. One of the substances that cause serious health problems is NO2. The health impacts arising from exposure to NO2 include pulmonary function impairment. The purpose of this study was to determine the relationship of NO2 exposure on the incidence of pulmonary function impairment. Methods: We are using a cross-sectional study design with 110 traffic police who were divided into two groups: exposed (police officers working on the highway) and the unexposed group (police officers working in the office). Election subject convenient sampling carried out in each group to the minimum number of samples met. Results: The results showed that the average NO2 in the exposed group was 18.72 ppb and unexposed group is 4.14 ppb. Pulmonary dysfunction on exposed and unexposed groups showed that FVC (Forced Vital Capacity) value are 88.68 and 90.27. And FEV1 (Forced Expiratory Volume in One) value are 94.9 and 95.16. Some variables like waist circumference, Body Mass Index, Visceral Fat, and Fat has associated with the incidence of Pulmonary Dysfunction (p < 0.05). Conclusion: Health monitoring is needed to decreasing health risk in Policeman.

Keywords: NO2, pulmonary dysfunction, police traffic, Jakarta

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Authors: Francisco Alvarado, Luz Ramírez

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Corneal diseases are one of the main causes of visual impairment and affect almost 4 million, and this study assesses the effects of deep anterior lamellar keratoplasty (DALK) with porcine corneal stroma and postoperative topical treatment with tacrolimus in patients with infectious keratitis. No patient was observed with clinical graft rejection. Among the cases: 2 were positive to fungal culture, 2 with Aspergillus and the other 8 cases were confirmed by bacteriological culture. Corneal diseases are one of the main causes of visual impairment and affect almost 4 million. This study assesses the effects of deep anterior lamellar keratoplasty (DALK) with porcine corneal stroma and postoperative topical treatment with tacrolimus in patients with infectious keratitis. Receiver bed diameters ranged from 7.00 to 9.00 mm. No incidents of Descemet's membrane perforation were observed during surgery. During the follow-up period, no corneal graft splitting, IOP increase, or intolerance to tacrolimus were observed. Deep anterior lamellar keratoplasty seems to be the best option to avoid xenograft rejection, and it could help new surgical techniques in humans.

Keywords: ophthalmology, cornea, corneal transplant, xenografts, surgical innovations

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Authors: Anna Czyż

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This article is focused on the issues of stress and coping with the stress of young people with profound hearing loss. Perceptional disorders, especially visual or hearing defects, are the reason of homeostasis dysfunction. Biopsychological development can become poor. A substitute reality is formed as a result of compensatory activities of other senses. The hearing disorder itself is a stress-inducing factor, affecting the quality of human functioning. In addition, the limitations of perceptual capabilities in the context of the functioning environment can contribute to increasing the amount of stressors, as well as the specific sensitivity to the stressors, and the use of specific strategies to overcome the difficulties. The appropriate study was conducted on a sample of 92 students, aged 16 -19 years old, 43 females, 49 males. For diagnostic purposes, the standardized psychological' research tools were used. The level of the stress and the strategies of coping with the stress were evaluated. The results of the research indicate that level of the stress is indifferent. The most frequently chosen strategies for coping with the stress in the sample are concentrated on 1) acceptation, 2) 'doing something different', 3) searching of emotional supporting, 4) searching of instrumental supporting, and the factors (grouped items) of coping with the stress are concentrated on 1) searching of support, 2) acceptance. The relationships in both male and female research groups were specified. Also the relationships between the highlighted variables were determined.

Keywords: cooping stress, deaf, hearing impairment, quality of life, stress, stress

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Authors: A. V. Sokolov, S. V. Vorobyev, A. Yu. Efimtcev, V. Yu. Lobzin, I. A. Lupanov, O. A. Cherdakov, V. A. Fokin

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Alzheimer’s disease (AD) is the most common form of dementia. Different brain regions are involved to the pathological process of AD. The purpose of this study was to evaluate brain activation by visual memory task in patients with Alzheimer's disease and determine correlation between memory impairment and atrophy of memory specific brain regions of frontal and medial temporal lobes. To investigate the organization of memory and localize cortical areas activated by visual memory task we used functional magnetic resonance imaging and to evaluate brain atrophy of patients with Alzheimer's disease we used voxel-based morphometry. FMRI was performed on 1.5 T MR-scanner Siemens Magnetom Symphony with BOLD (Blood Oxygenation Level Dependent) technique, based on distinctions of magnetic properties of hemoglobin. For test stimuli we used series of 12 not related images for "Baseline" and 12 images with 6 presented before for "Active". Stimuli were presented 3 times with reduction of repeated images to 4 and 2. Patients with Alzheimer's disease showed less activation in hippocampal formation (HF) region and parahippocampal gyrus then healthy persons of control group (p<0.05). The study also showed reduced activation in posterior cingulate cortex (p<0.001). Voxel-based morphometry showed significant atrophy of grey matter in Alzheimer’s disease patients, especially of both temporal lobes (fusiform and parahippocampal gyri); frontal lobes (posterior cingulate and superior frontal gyri). The study showed correlation between memory impairment and atrophy of memory specific brain regions of frontal and medial temporal lobes. Thus, reduced activation in hippocampal formation and parahippocampal gyri, in posterior cingulate gyrus in patients with Alzheimer's disease correlates to significant atrophy of these regions, detected by voxel-based morphometry, and to deterioration of specific cognitive functions.

Keywords: Alzheimer’s disease, functional MRI, voxel-based morphometry

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Authors: Sheena Christabel Pravin, M. Palanivelan

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Speech disfluencies are common in spontaneous speech. The primary purpose of this study was to distinguish linguistic disfluencies from stuttering disfluencies in bilingual Tamil–English (TE) speaking children. The secondary purpose was to determine whether their disfluencies are mediated by native language dominance and/or on an early onset of developmental stuttering at childhood. A detailed study was carried out to identify the prosodic and acoustic features that uniquely represent the disfluent regions of speech. This paper focuses on statistical modeling of repetitions, prolongations, pauses and interjections in the speech corpus encompassing bilingual spontaneous utterances from school going children – English and Tamil. Two classifiers including Hidden Markov Models (HMM) and the Multilayer Perceptron (MLP), which is a class of feed-forward artificial neural network, were compared in the classification of disfluencies. The results of the classifiers document the patterns of disfluency in spontaneous speech samples of school-aged children to distinguish between Children Who Stutter (CWS) and Children with Language Impairment CLI). The ability of the models in classifying the disfluencies was measured in terms of F-measure, Recall, and Precision.

Keywords: bi-lingual, children who stutter, children with language impairment, hidden markov models, multi-layer perceptron, linguistic disfluencies, stuttering disfluencies

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Authors: Alshaimaa Abdelwahab, Allegra Cattani, Caroline Floccia

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Assessing children’s language is fundamental for changing their developmental outcome as it gives a chance for a quick and early intervention with the suitable planning and monitoring program. The importance of language assessment lies in helping to find the right test fit for purpose, in addition to achievement and proficiency. This study examines the validity of a new Arabic assessment tool, the Arabic Communicative Development Inventory ‘Arabic CDI’. It assesses the development of language in Arabic children in different Arabic countries, allowing to detect children with language delay. A concurrent validity is set to compare the Arabic CDI to the Arabic Language test. Twenty-three typically developing Egyptian healthy children and their mothers participated in this study. Their age is 24 months (+ or -) two weeks. The sample included 13 males and 10 females. Mothers completed the Arabic CDI either before or after the Arabic Language Test was conducted with the child. The score for comprehension in the Arabic CDI (M= 52.7, SD= 9.7) and words understood in the Arabic Language Test (M= 59.6, SD= 12.5) were strongly and positively correlated (r= .62, p= .002). At the same time, the scores for production in the Arabic CDI (M= 38.4, SD= 14.8) and words expressed in the Arabic Language Test (M= 52.1, SD= 16.3) were also strongly and positively correlated (r= .82, p= .000). The new Arabic CDI is an adequate tool for assessing the development of comprehension and production at Arabic children. In addition, it could be used for detecting children with language impairment. Standardization of the Arabic CDI across 18 different Arabic dialects in children aged 8 to 30 months is underway.

Keywords: Arabic CDI, assessing children, language development, language impairment

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Authors: A. Kavita Murugkar, B. Anurag Kashyap

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With the Rights for Persons with Disabilities Act (RPWD Act) 2016, the Indian government has made it mandatory for all establishments, including Heritage Sites, to be accessible for People with Disabilities. However, recent access audit surveys done under the Accessible India Campaign by Ministry of Culture indicate that there are very few accessibility measures provided in the Heritage sites for people with disabilities. Though there are some measures for the mobility impaired, surveys brought out that there are almost no provisions for people with vision impairment (PwVI) in heritage sites thus depriving them of a reasonable physical & intellectual access that facilitates an enjoyable experience and enriching interpretation of the Heritage Site. There is a growing need to develop multisensory interpretative tools that can help the PwVI in perceiving heritage sites in the absence of vision. The purpose of this research was to examine the usability of an audio-tactile model as a haptic and sound-based strategy for augmenting the perception and experience of PwVI in a heritage site. The first phase of the project was a multi-stage phenomenological experimental study with visually impaired users to investigate the design parameters for developing an audio-tactile model for PwVI. The findings from this phase included user preferences related to the physical design of the model such as the size, scale, materials, details, etc., and the information that it will carry such as braille, audio output, tactile text, etc. This was followed by the second phase in which a working prototype of an audio-tactile model is designed and developed for a heritage site based on the findings from the first phase of the study. A nationally listed heritage site from the author’s city was selected for making the model. The model was lastly tested by visually impaired users for final refinements and validation. The prototype developed empowers People with Vision Impairment to navigate independently in heritage sites. Such a model if installed in every heritage site, can serve as a technological guide for the Person with Vision Impairment, giving information of the architecture, details, planning & scale of the buildings, the entrances, location of important features, lifts, staircases, and available, accessible facilities. The model was constructed using 3D modeling and digital printing technology. Though designed for the Indian context, this assistive technology for the blind can be explored for wider applications across the globe. Such an accessible solution can change the otherwise “incomplete’’ perception of the disabled visitor, in this case, a visually impaired visitor and augment the quality of their experience in heritage sites.

Keywords: accessibility, architectural perception, audio tactile model , inclusive heritage, multi-sensory perception, visual impairment, visitor experience

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Authors: Jun Hong Lee

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Background: Many dementia patients complain insomnia and depressive mood, and hypnotics and antidepressants are being prescribed. As prevalence of dementia is increasing, insomnia and depressive mood are becoming more important. Objective: We evaluated insomnia and depression in outpatients of dementia center. Patients and Methods/Material and Methods: We reviewed medical records of the patients who visited outpatients clinic of NHIS Ilsan Hospital Dementia Center during 2016. Results: Total 716 patients are included; Subjective Memory Impairment (SMI) : 143 patients (20%), non-amnestic Mild Cognitive Impairment (MCI): single domain 70 (10%), multiple domain 34 (5%), amnestic MCI: single domain 74 (10%), multiple domain 159 (22%), Early onset Alzheimer´s disease (AD): 9 (1%), AD 121 (17%), Vascular dementia: 62 (9%), Mixed dementia 44 (6%). Hypnotics and antidepressants are prescribed as follows; SMI : hypnotics 14 patients (10%), antidepressants 27 (19%), non-amnestic MCI: single domain hypnotics 9 (13%), antidepressants 12 (17%), multiple domain hypnotics 4 (12%), antidepressants 6 (18%), amnestic MCI: single domain hypnotics 10 (14%), antidepressants 16 (22%), multiple domain hypnotics 22 (14%), antidepressants 24 (15%), Early onset Alzheimer´s disease (AD): hypnotics 1 (11%), antidepressants 2 (22%), AD: hypnotics 10 (8%), antidepressants 36 (30%), Vascular dementia: hypnotics 8 (13%), antidepressants 20 (32%), Mixed dementia: hypnotics 4 (9%), antidepressants 17 (39%). Conclusion: Among the outpatients of Dementia Center, MCI and SMI are majorities, and the number of MCI patients are almost half. Depression is more prevalent in AD, and Vascular dementia than MCI and SMI, and about 22% of patients are being prescribed by antidepressants and 11% by hypnotics.

Keywords: insomnia, depression, dementia, antidepressants, hypnotics

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Authors: Thyagi Ponnamperuma

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Background: Comorbidity between posttraumatic stress disorder (PTSD) and other psychological problems is common. Recent studies focused to investigate the underlying relationship between PTSD and comorbid psychopathologies. Among adolescents, higher rates of emotional and behavioral problems (EBP) have been reported following trauma, often coexisted with PTSD. The current study, thus, examined the relationship of posttraumatic stress symptoms to EBP in adolescents exposed to a variety of traumatic events. Further, the study investigated the relationship of trauma and comorbid PTSS to the self-perceived negative impact of EBP on daily functioning. Methods: Participants were 729 Sri Lankan adolescents (age 12 to 16 years; 54.9% female) living in areas impacted in varying degrees by the 2004 tsunami. In 2008, school-based screening was conducted and completed measures of, trauma exposure, PTSS, EBP, and related functional impairment. Results: Participants reported a high prevalence of trauma exposure (n = 438), including interpersonal violence (n = 155). DSM-IV criteria for full or partial PTSD were met by 23.7% of the trauma-exposed sample. Across all participants, 13.4% and 16.7% displayed clinically relevant levels of EBP and functional impairment, respectively. Among the trauma-exposed, 7% met criteria for both EBP and PTSD. EBP total scores and caseness were significantly higher in trauma-exposed adolescents with PTSD than in either those without PTSD or the non-traumatized control group. In subscale analysis, higher prevalence of serious emotional, conduct, and hyperactivity problems were reported in the PTSD positive group; the PTSD negative group did not differ significantly from the control group on any of the problem scales. In regression analyses, PTSS (β = .28, p < .001) and interpersonal violence (β = .13, p = .033) were significant predictors of EBP, cumulative trauma (β = .11, p = .076) showed no significant effect. Further, PTSS exacerbated the impact of EBP on daily functioning (β = 0.29, p = .023). Conclusion: PTSS were closely linked to EBP in adolescents, even years after the traumatic experience. PTSD and emotional and behavioral problems together pose a heightened risk for impaired daily functioning. Longitudinal studies are needed to clarify the causal pathway.

Keywords: adolescents, comorbidity, emotional and behavioral problems, functional impairment, posttraumatic stress, traumatic events

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Authors: Eyup Bayram Guzel

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There have been growing awareness that technology offers unique and promising advantages by offering up-to-data educational materials in promoting teaching and learning materials, new strategies for building enhanced communication environment for people with disabilities and specifically for this study concentrated on the students with deafness and hearing impairments. Creating e-learning environment where teachers and students work in collaboration to develop better educational outcomes is the foremost reason of conducting this research. This study examined the perspectives of special education teachers’ regarding an application of e-learning software called Multimedia Builder on the students with deafness and hearing impairments. Initial and follow up interviews were conducted with 15 special education teachers around the scope of qualitative case study. Grounded approach has been used to analyse and interpret the data. The research results revealed that application of Multimedia Builder software were influential on reading, sign language, vocabulary improvements, computer and ICT usage developments and on audio-visual learning achievements for the advantages of students with deafness and hearing impairments. The implications of the study encouraged the ways of using e-learning tools and strategies to promote unique and comprehensive learning experiences for the targeted students and their teachers.

Keywords: e-learning, special education, deafness and hearing impairment, computer-ICT usage.

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Authors: Carlos Theran, Yohn Parra Bautista, Victor Adankai, Richard Alo, Jimwi Liu, Clement G. Yedjou

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Alzheimer's disease (AD) is a neurodegenerative disorder primarily characterized by deteriorating cognitive functions. AD has gained relevant attention in the last decade. An estimated 24 million people worldwide suffered from this disease by 2011. In 2016 an estimated 40 million were diagnosed with AD, and for 2050 is expected to reach 131 million people affected by AD. Therefore, detecting and confirming AD at its different stages is a priority for medical practices to provide adequate and accurate treatments. Recently, Machine Learning (ML) models have been used to study AD's stages handling missing values in multiclass, focusing on the delineation of Early Mild Cognitive Impairment (EMCI), Late Mild Cognitive Impairment (LMCI), and normal cognitive (CN). But, to our best knowledge, robust performance information of these models and the missing data analysis has not been presented in the literature. In this paper, we propose studying the performance of five different machine learning models for AD's stages multiclass prediction in terms of accuracy, precision, and F1-score. Also, the analysis of three imputation methods to handle the missing value problem is presented. A framework that integrates ML model for AD's stages multiclass prediction is proposed, performing an average accuracy of 84%.

Keywords: alzheimer's disease, missing value, machine learning, performance evaluation

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Authors: Francesco Angelucci, Katerina Veverova, Alžbeta Katonová, Lydia Piendel, Martin Vyhnalek, Jakub Hort

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Alzheimer's disease (AD) is a central nervous system (CNS) disease characterized by loss of memory, cognitive functions and neurodegeneration. Plasmin is an enzyme degrading many plasma proteins. In the CNS, plasmin may reduce the accumulation of A, and have other actions relevant to AD pathophysiology. Brain plasmin synthesis is regulated by two enzymes: one activating, the tissue plasminogen activator (tPA), and the other inhibiting, the plasminogen activator inhibitor-1 (PAI-1). We investigated whether tPA and PAI-1 serum levels in AD and amnestic mild cognitive impairment (aMCI) patients are altered compared to cognitively healthy controls. Moreover, we examined the PAI-1/tPA ratio in these patient groups. 40 AD, 40 aMCI and 10 healthy controls were recruited. Venous blood was collected and PAI-1 and tPA serum concentrations were quantified by sandwich ELISAs. The results showed that PAI-1 levels increased in AD and aMCI patients. This increase negatively correlated with cognitive deficit measured by MMSE. Similarly, the ratio between tPA and PAI-1 gradually increases in aMCI and AD patients. This study demonstrates that AD and aMCI patients have altered PAI-1 serum levels and PAI-1/tPA ratio. Since these enzymes are CNS regulators of plasmin, PAI-1 serum levels could be a marker reflecting a cognitive decline in AD.

Keywords: Alzheimer disease, amnestic mild cognitive impairment, plasmin, tissue-type plasminogen activator

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Authors: Marcela de Oliveira, Guilherme Giacomini, Allan Felipe Fattori Alves, Ana Luiza Menegatti Pavan, Maria Eugenia Dela Rosa, Fernando Antonio Bacchim Neto, Diana Rodrigues de Pina

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It is estimated that each year one death every 10 seconds (about 2 million deaths) in the world is attributed to tuberculosis (TB). Even after effective treatment, TB leaves sequelae such as, for example, pulmonary fibrosis, compromising the quality of life of patients. Evaluations of the aforementioned sequel are usually performed subjectively by radiology specialists. Subjective evaluation may indicate variations inter and intra observers. The examination of x-rays is the diagnostic imaging method most accomplished in the monitoring of patients diagnosed with TB and of least cost to the institution. The application of computational algorithms is of utmost importance to make a more objective quantification of pulmonary impairment in individuals with tuberculosis. The purpose of this research is the use of computer algorithms to quantify the pulmonary impairment pre and post-treatment of patients with pulmonary TB. The x-ray images of 10 patients with TB diagnosis confirmed by examination of sputum smears were studied. Initially the segmentation of the total lung area was performed (posteroanterior and lateral views) then targeted to the compromised region by pulmonary sequel. Through morphological operators and the application of signal noise tool, it was possible to determine the compromised lung volume. The largest difference found pre- and post-treatment was 85.85% and the smallest was 54.08%.

Keywords: algorithm, radiology, tuberculosis, x-rays exam

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Authors: Chia-Feng Lu, Yuh-Jen Wang, Shin Teng, Yu-Te Wu, Sui-Hing Yan

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Brain functional networks based on resting-state EEG data were compared between patients with mild Alzheimer’s disease (mAD) and matched patients with amnestic subtype of mild cognitive impairment (aMCI). We integrated the time–frequency cross mutual information (TFCMI) method to estimate the EEG functional connectivity between cortical regions and the network analysis based on graph theory to further investigate the alterations of functional networks in mAD compared with aMCI group. We aimed at investigating the changes of network integrity, local clustering, information processing efficiency, and fault tolerance in mAD brain networks for different frequency bands based on several topological properties, including degree, strength, clustering coefficient, shortest path length, and efficiency. Results showed that the disruptions of network integrity and reductions of network efficiency in mAD characterized by lower degree, decreased clustering coefficient, higher shortest path length, and reduced global and local efficiencies in the delta, theta, beta2, and gamma bands were evident. The significant changes in network organization can be used in assisting discrimination of mAD from aMCI in clinical.

Keywords: EEG, functional connectivity, graph theory, TFCMI

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Authors: Shubham Dwivedi, Raghavender Medishetti, Rita Rani, Aarti Sevilimedu, Pushkar Kulkarni, Yogeeswari Perumal

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Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder of early onset, characterized by impaired sociability, cognitive function and stereotypies. There is a significant urge to develop and establish new animal models with ASD-like characteristics for better understanding of underlying mechanisms. The aim of the present study was to develop a cost and time effective zebrafish model with quantifiable parameters to facilitate mechanistic studies as well as high-throughput screening of new molecules for autism. Zebrafish embryos were treated with valproic acid and a battery of behavioral tests (anxiety, inattentive behavior, irritability and social impairment) was performed on larvae at 7th day post fertilization, followed by study of molecular markers of autism. This model shows a significant behavioural impairment in valproic acid treated larvae in comparison to control which was again supported by alteration in few marker genes and proteins of autism. The model also shows a rescue of behavioural despair with positive control drugs. The model shows robust parameters to study behavior, molecular mechanism and drug screening approach in a single frame. Thus we postulate that our 7 days zebrafish larval model for autism can help in high throughput screening of new molecules on autism.

Keywords: autism, zebrafish, valproic acid, neurodevelopment, behavioral assay

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Authors: Mathula Thangarajh

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Duchenne muscular dystrophy (DMD) is a severe form of X-linked muscular dystrophy caused by mutations in the dystrophin gene resulting in progressive skeletal muscle weakness. Boys with DMD also have significant cognitive disabilities. The intelligence quotient of boys with DMD, compared to peers, is approximately one standard deviation below average. Detailed neuropsychological testing has demonstrated that boys with DMD have a global developmental impairment, with verbal memory and visuospatial skills most significantly affected. Furthermore, the total brain volume and gray matter volume are lower in children with DMD compared to age-matched controls. These results are suggestive of a significant structural and functional compromise to the developing brain as a result of absent dystrophin protein expression. There is also some genetic evidence to suggest that mutations in the 3’ end of the DMD gene are associated with more severe neurocognitive problems. Our working hypothesis is that (i) boys with DMD do not make gains in neurodevelopmental skills compared to typically developing children and (ii) women carriers of DMD mutations may have subclinical cognitive deficits. We also hypothesize that there may be an intergenerational vulnerability of cognition, with boys of DMD-carrier mothers being more affected cognitively than boys of non-DMD-carrier mothers. The objectives of this study are: 1. Assess the neurodevelopment in boys with DMD at 4-time points and perform baseline neuroradiological assessment, 2. Assess cognition in biological mothers of DMD participants at baseline, 3. Assess possible correlation between DMD mutation and cognitive measures. This study also explores functional brain abnormalities in people with DMD by exploring how regional and global connectivity of the brain underlies executive function deficits in DMD. Such research can contribute to a better holistic understanding of the cognition alterations due to DMD and could potentially allow clinicians to create better-tailored treatment plans for the DMD population. There are four study visits for each participant (baseline, 2-4 weeks, 1 year, 18 months). At each visit, the participant completes the NIH Toolbox Cognition Battery, a validated psychometric measure that is recommended by NIH Common Data Elements for use in DMD. Visits 1, 3, and 4 also involve the administration of the BRIEF-2, ABAS-3, PROMIS/NeuroQoL, PedsQL Neuromuscular module 3.0, Draw a Clock Test, and an optional fMRI scan with the N-back matching task. We expect to enroll 52 children with DMD, 52 mothers of children with DMD, and 30 healthy control boys. This study began in 2020 during the height of the COVID-19 pandemic. Due to this, there were subsequent delays in recruitment because of travel restrictions. However, we have persevered and continued to recruit new participants for the study. We partnered with the Muscular Dystrophy Association (MDA) and helped advertise the study to interested families. Since then, we have had families from across the country contact us about their interest in the study. We plan to continue to enroll a diverse population of DMD participants to contribute toward a better understanding of Duchenne Muscular Dystrophy.

Keywords: neurology, Duchenne muscular dystrophy, muscular dystrophy, cognition, neurodevelopment, x-linked disorder, DMD, DMD gene

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Authors: Justin Lee, Siraj Shaikh, Alice Chu MD

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Children with cerebral palsy (CP) commonly present with upper extremity impairment, affecting one or both extremities, and are classified using the Manual Ability Classification Scale (MACS). The MACS defines bimanual hand abilities for children ages 4-18 years in everyday tasks and is a gradient scale, with I being nearly normal and V requiring total assistance. Children with more severe upper extremity impairment (MACS III-V) are often underrepresented, and relatively few effective therapies have been identified for these patients. Current orthoses are static and are only meant to prevent the progression of contractures in these patients. Other limitations include cost, comfort, accessibility, and longevity of the orthoses. Taking advantage of advances in 3D printing technology, we have created a highly customizable upper extremity orthotic that can be produced at a low cost. Iterations in our design have resulted in an orthotic that is custom fit to the patient based on scans of their arm, made of rigid polymer when needed to provide support, flexible material where appropriate to allow for comfort, and designed with a mechanical pulley system to allow for some functional use of the arm while in the orthotic. Preliminary data has shown that our orthotic can be built at a fraction of the cost of current orthoses and provide clinically significant improvement in assisting hand assessment (AHA) and pediatric quality of life scores (PedsQL).

Keywords: upper extremity orthosis, upper extremity, orthosis, 3-D printing, cerebral palsy, occupational therapy, spasticity, customizable

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Authors: Husain Rajib, K. S. Kishor, D. G. Jewel

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Background: Uncorrected refractive error is a common cause of preventable visual impairment in pediatric age group which can be lead to blindness but early detection of visual impairment can reduce the problem that will have good effective in education and more involve in social activities. Glasses are the cheapest and commonest form of correction of refractive errors. To achieve this, patient must exhibit good compliance to spectacle wear. Patient’s attitude and perception of glasses and eye health could affect compliance. Material and method: A Prospective community based cross sectional study was designed in order to evaluate the knowledge, attitude and practices about refractive errors and eye health amongst the primary school going children. Result: Among 140 respondents, 72 were males and 68 were females. We found 50 children were myopic and out of them 26 were male and 24 were female, 27 children were hyperopic and out of them 14 were male and 13 were female. About 63 children were astigmatic and out of them 32 were male and 31 were female. The level of knowledge, attitude was satisfactory. The attitude of the students, teachers and parents was cooperative which helps to do cycloplegic refraction. Practice was not satisfactory due to social stigma and information gap. Conclusion: Knowledge of refractive error and acceptance of glasses for the correction of uncorrected refractive error. Public awareness program such as vision screening program, eye camp, and teachers training program are more beneficial for wearing and prescribing spectacle.

Keywords: refractive error, stigma, knowledge, attitude, practice

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Authors: Saleh N. Maodaa

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Background: Lead (Pb) is an environmental pollutant causing serious health problems, including impairment of reproduction. Visnagin (VIS) is a furanochromone with promising antioxidant and anti-inflammatory effects; however, its protective efficacy against Pb toxicity has not been investigated. Objective: This study evaluated the protective effect of VIS on Pb reproductive toxicity, impaired steroidogenesis and spermatogenesis, oxidative stress and inflammation. Methods: Rats received VIS (30 or 60 mg/kg) and 50 mg/kg lead acetate for 3 weeks, and blood and testes samples were collected. Results: Pb intoxication impaired the pituitary-testicular axis (PTA), manifested by the decreased serum levels of gonadotropins and testosterone. Pb decreased sperm count, motility and viability, increased sperm abnormalities, and downregulated the steroidogenesis markers StAR, CYP17A1, 3β-HSD and 17β-HSD in the testis of rats. VIS significantly increased serum gonadotropins and testosterone, alleviated sperm parameters and upregulated steroidogenesis. In addition, VIS decreased pro-inflammatory cytokines, testicular lipid peroxidation and DNA fragmentation, downregulated Bax, and enhanced antioxidants and Bcl-2 Conclusion: These results demonstrate the protective effect of VIS against Pb reproductive toxicity in rats. VIS improved serum gonadotropins and testosterone, enhanced steroidogenesis and spermatogenesis, and attenuated oxidative injury, inflammation and apoptosis. Therefore, VIS is a promising candidate for the protection against Pb-induced reproduction impairment.

Keywords: pituitary-gonadal axis, cytokines, DNA damage, apoptosis

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Authors: Gali Moritz, Jacqueline H. Becker, Jyoti V. Ankam, Kimberly Arcoleo, Matthew Wysocki, Roee Holtzer, Juan Wisnivesky, Paula J. Busse, Alex D. Federman, Sunit P. Jariwala, Jonathan M. Feldman

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Objective: Cognitive impairment (CI), whose incidence is greater among ethnic/racial minorities, is a significant barrier to asthma self-management (SM) behaviors and outcomes in older adults. The aim of this study was to examine the relationships between CI, assessed using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Hispanic participants. Additionally, we evaluated whether using two different MoCA cutoff scores influenced the association between CI and study outcomes. Methods: Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N=165) age≥ 60 years and used for analysis. Cognition was assessed using the MoCA. Asthma control, asthma-related quality of life (QOL), inhaled corticosteroid (ICS) dosing, and ICS adherence were assessed using self-report. The inhaler technique was observed and rated. Results: Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% CI rates, respectively. CI, defined using the 23 cutoff score, was significantly associated with worse asthma control (p=.04) and worse ICS adherence (p=.01). With a cutoff score of 26, only asthma-related QOL was significantly associated with CI (p=.03). Race/ethnicity and education did not moderate the relationships between CI and asthma SM behaviors and outcomes. Conclusions: CI in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define CI.

Keywords: cognition, respiratory, elderly, testing, adherence, validity

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Authors: Humara Bano, Nyla Anjum

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Disability in any form has great impact not only for the person facing it but also for its family members too. This effect may be so severe that may lead to mal adjustment of any member of the family in society as well. This impact has also been multiplied due to negative attitudes of the society, unawareness about the needs of special needs and no legislation for the parents of children with special needs. As a result not only the separations among the parents have been reported but also the normal siblings in the home are also badly affected in their daily lives. The situation is more challenging when more than one child with disability is present in the family. The main objectives of this paper are to unfold the relationship of variety of disabilities (hearing, visual or physical impairment, mental retardation, speech impairment) in i) developing depression in home setting, ii) social exclusion, iii) anxiety and aggression and iv) development of insecure feelings among family members of the persons with disabilities, as well as, v) to identify coping strategies to manage the special needs by family members too. To reach on conclusion about fifty families (having any sort of disability in their homes) have been interviewed on basis of convenient sampling. Correlation, ANOVA and different analysis have been used to identify the relationship of disability in developing depression among family members in line of above mentioned problems. Results revealed that depression due to disability among families is a common phenomenon and adversely have affected their lives in daily routines as well as in following their life achievements. Coping with the situation and recommending various remedies by parents is the positive reflection of this study too that can help to families in managing their mental health.

Keywords: depression, anxiety and aggression, social exclusion, parents of children with special needs

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Authors: M. Testa, L. Peotta, S. Giusiano, B. Lazzolino, U. Manera, A. Canosa, M. Grassano, F. Palumbo, A. Bombaci, S. Cabras, F. Di Pede, L. Solero, E. Matteoni, C. Moglia, A. Calvo, A. Chio

Abstract:

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease of adulthood, which primarily affects the central nervous system and is characterized by progressive bilateral degeneration of motor neurons. The degeneration processes in ALS extend far beyond the neurons of the motor system, and affects cognition, behaviour and language. To outline the prevalence of language deficits in an ALS cohort and explore their profile along with demographic and neuropsychological data. A full neuropsychological battery and language assessment was administered to 56 ALS patients. Neuropsychological assessment included tests of executive functioning, verbal fluency, social cognition and memory. Language was assessed using tests for verbal comprehension, production and pragmatics. Patients were cognitively classified following the Revised Consensus Criteria and divided in three groups showing different levels of language deficits: group 1 - no language deficit; group 2 - one language deficit; group 3 - two or more language deficits. Chi-square for independence and non-parametric measures to compare groups were applied. Nearly half of ALS-CN patients (48%) reported one language test under the clinical cut-off, and only 13% of patents classified as ALS-CI showed no language deficits, while the rest 87% of ALS-CI reported two or more language deficits. ALS-BI and ALS-CBI cases all reported two or more language deficits. Deficits in production and in comprehension appeared more frequent in ALS-CI patients (p=0.011, p=0.003 respectively), with a higher percentage of comprehension deficits (83%). Nearly all ALS-CI reported at least one deficit in pragmatic abilities (96%) and all ALS-BI and ALS-CBI patients showed pragmatic deficits. Males showed higher percentage of pragmatic deficits (97%, p=0.007). No significant differences in language deficits have been found between bulbar and spinal onset. Months from onset and level of impairment at testing (ALS-FRS total score) were not significantly different between levels and type of language impairment. Age and education were significantly higher for cases showing no deficits in comprehension and pragmatics and in the group showing no language deficits. Comparing performances at neuropsychological tests among the three levels of language deficits, no significant differences in neuropsychological performances were found between group 1 and 2; compared to group 1, group 3 appeared to decay specifically on executive testing, verbal/visuospatial learning, and social cognition. Compared to group 2, group 3 showed worse performances specifically in tests of working memory and attention. Language deficits have found to be spread in our sample, encompassing verbal comprehension, production and pragmatics. Our study reveals that also cognitive intact patients (ALS-CN) showed at least one language deficit in 48% of cases. Pragmatic domain is the most compromised (84% of the total sample), present in nearly all ALS-CI (96%), likely due to the influence of executive impairment. Lower age and higher education seem to preserve comprehension, pragmatics and presence of language deficits. Finally, executive functions, verbal/visuospatial learning and social cognition differentiate the group with no language deficits from the group with a clinical language impairment (group 3), while attention and working memory differentiate the group with one language deficit from the clinical impaired group.

Keywords: amyotrophic lateral sclerosis, language assessment, neuropsychological assessment, language deficit

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Authors: Shivani Tiwari, Prathibha Karanth, B. Rajashekhar

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Impairments of syntactic morphology are often considered central in children with Specific Language Impairment (SLI). In English and related languages, deficits of tense-related grammatical morphology could serve as a clinical marker of SLI. Yet, cross-linguistic studies on SLI in the recent past suggest that the nature and severity of morphosyntactic deficits in children with SLI varies with the language being investigated. Therefore, in the present study we investigated the morphosyntactic deficits in a group of children with SLI who speak Kannada, a morphologically complex Dravidian language spoken in Indian subcontinent. A group of 15 children with SLI participated in this study. Two more groups of typical developing children (15 each) matched for language and age to children with SLI, were included as control participants. All participants were assessed for morphosyntactic comprehension and expression using standardized language test and a spontaneous speech task. Results of the study showed that children with SLI differed significantly from age-matched but not language-matched control group, on tasks of both comprehension and expression of morphosyntax. This finding is, however, in contrast with the reports of English-speaking children with SLI who are reported to be poorer than younger MLU-matched children on tasks of morphosyntax. The observed difference in impairments of morphosyntax in Kannada-speaking children with SLI from English-speaking children with SLI is explained based on the morphological richness theory. The theory predicts that children with SLI perform relatively better in morphologically rich language due to occurrence of their frequent and consistent features that mark the morphological markers. The authors, therefore, conclude that language-specific features do influence manifestation of the disorder in children with SLI.

Keywords: specific language impairment, morphosyntax, Kannada, manifestation

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Authors: A. Kherraf, S. Ouarrak, L. Azzouzi, R. Habbal

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Introduction: Preserved LVEF heart failure is an important cause of mortality and morbidity in hypertensive patients. A strong correlation between impaired diastolic function and longitudinal systolic dysfunction. could have several explanations, first, the diastole is an energy dependent process, especially during its first phase, it also includes active systolic components during the phase of iso volumetric relaxation, in addition, the impairment of the intrinsic myocytic function is part of hypertensive pathology as evidenced by recent studies. METHODS AND MATERIALS: This work consists of performing in a series of 333 hypertensive patients (aged 25 to 75 years) a complete echocardiographic study, including LVEF by Simpson biplane method, the calculation of the indexed left ventricular mass, the analysis of the diastolic function, and finally, the study of the longitudinal deformation of the LV by the technique of speckletracking (calculation of the GLS). Patients with secondary hypertension, leaky or stenosing valve disease, arrhythmia, and a history of coronary insufficiency were excluded from this study. RESULTS: Of the 333 hypertensive patients, 225 patients (67.5%) had impaired diastolic function, of which 60 patients (18%) had high filling pressures. 49.39% had echocardigraphic HVG, Almost all of these patients (60 patients) had low GLS. There is a statistically very significant relationship between lower GLS and increased left ventricular filling pressures in hypertensive patients. These results suggest that increased filling pressures are closely associated with atrioventricular interaction in patients with hypertension, with a strong correlation with impairment of longitudinal systolic function and diastolic function CONCLUSION: Overall, a linear relationship is established between increased left ventricular mass, diastolic dysfunction, and longitudinal LV systolic dysfunction

Keywords: hypertension, diastolic function, left ventricle, heart failure

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Authors: Xiao Wang, Qinge Zhang

Abstract:

Background: This randomized, open-label study examined the therapeutic effects of computerized cognitive training (CCT) combined with selective serotonin reuptake inhibitors (SSRIs) on cognitive impairment among patients with late-life depression (LLD). Method: Study data were collected from May 5, 2021, to April 21, 2023. Outpatients who met diagnostic criteria for major depressive disorder according to the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria (i.e., a total score on the 17-item Hamilton Depression Rating Scale (HAMD-17) ≥ 18 and a total score on the Montreal Cognitive Assessment scale (MOCA) <26) were randomly assigned to receive up to 12 weeks of CCT and SSRIs treatment (n=57) or SSRIs and Control treatment (n=61). The primary outcome was the change in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores from baseline to week 12 between the two groups. The secondary outcomes included changes in the HAMD-17 score, Hamilton Anxiety Scale (HAMA) score and Neuropsychiatric Inventory (NPI) score. Mixed model repeated measures (MMRM) analysis was performed on modified intention-to-treat (mITT) and completer populations. Results: The full analysis set (FAS) included 118 patients (CCT and SSRIs group, n=57; SSRIs and Control group, n =61). Over the 12-week study period, the reduction in the ADAS-cog total score was significant (P < 0.001) in both groups, while MMRM analysis revealed a significantly greater reduction in cognitive function (ADAS-cog total scores) from baseline to posttreatment in the CCT and SSRIs group than in the SSRI and Control group [(F (1,115) =13.65, least-squares mean difference [95% CI]: −2.77 [−3.73, −1.81], p<0.001)]. There were significantly greater improvements in depression symptoms (measured by the HAMD-17) in the CCT and SSRIs group than in the control group [MMRM, estimated mean difference (SE) between groups −3.59 [−5.02, −2.15], p < 0.001]. The least-squares mean changes in the HAMA scores and NPI scores between baseline and week 8 were greater in the CCT and SSRIs group than in the control group (all P < 0.05). There was no significant difference between groups on response rates and remission rates by using the last-observation-carried-forward (LOCF) method (all P > 0.05). The most frequent adverse events (AEs) in both groups were dry mouth, somnolence, and constipation. There was no significant difference in the incidence of adverse events between the two groups. Conclusions: CCT combined with SSRIs was efficacious and well tolerated in LLD patients with cognitive impairment.

Keywords: late-life depression, cognitive function, computerized cognitive training, SSRIs

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Authors: Mohammad Maeiyat, Ali Maeiyat Ivatlou, Rasul Fani Khiavi, Abouzar Maeiyat Ivatlou, Parya Maeiyat

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Purpose: Considering the fact that visual impairment is still one of the countries health problem, this study was conducted to determine the causes of blindness and low vision in visually impaired membership of Ardabil Province welfare organization. Methods: The present study which was based on descriptive and national-census, that carried out in visually impaired population supported by welfare organization in all urban and rural areas of Ardabil Province in 2013 and Collection of samples lasted for 7 months. The subjects were inspected by optometrist to determine their visual status (blindness or low vision) and then referred to ophthalmologist in order to discover the main causes of visual impairment based on the international classification of diseases version 10. Statistical analysis of collected data was performed using SPSS software version 18. Results: Overall, 403 subjects with mean age of years participated in this study. 73.2% were blind, 26.8 % were low vision and according gender grouping 60.50 % of them were male, 39.50 % were female that divided into three groups with the age level of lower than 15 (11.2%) 15 to 49 (76.7%), and 50 and higher (12.1%). The age range was 1 to 78 years. The causes of blindness and low vision were in descending order: optic atrophy (18.4%), retinitis pigmentosa (16.8%), corneal diseases (12.4%), chorioretinal diseases (9.4%), cataract (8.9%), glaucoma (8.2%), phthisis bulbi (7.2%), degenerative myopia (6.9%), microphtalmos ( 4%), amblyopia (3.2%), albinism (2.5%) and nistagmus (2%). Conclusion: in this study the main causes of visual impairments were optic atrophy and retinitis pigmentosa, thus specific prevention plans can be effective in reducing the incidence of visual disabilities.

Keywords: blindness, low vision, welfare, ardabil

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Authors: J. Fox, J. Randhawa, M. Chan, L. Campbell, A. Weakely, D. J. Harvey, S. Tomaszewski Farias

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Early identification of individuals at risk for conversion to dementia provides an opportunity for preventative treatment. Many older adults (30-60%) report specific subjective cognitive decline (SCD); however, previous research is inconsistent in terms of what types of complaints predict future cognitive decline. The purpose of this study is to identify which specific complaints from the Everyday Cognition Scales (ECog) scales, a measure of self-reported concerns for everyday abilities across six cognitive domains, are associated with: 1) conversion from a clinical diagnosis of normal to either MCI or dementia (categorical variable) and 2) progressive cognitive decline in memory and executive function (continuous variables). 415 cognitively normal older adults were monitored annually for an average of 5 years. Cox proportional hazards models were used to assess associations between self-reported ECog items and progression to impairment (MCI or dementia). A total of 114 individuals progressed to impairment; the mean time to progression was 4.9 years (SD=3.4 years, range=0.8-13.8). Follow-up models were run controlling for depression. A subset of individuals (n=352) underwent repeat cognitive assessments for an average of 5.3 years. For those individuals, mixed effects models with random intercepts and slopes were used to assess associations between ECog items and change in neuropsychological measures of episodic memory or executive function. Prior to controlling for depression, subjective concerns on five of the eight Everyday Memory items, three of the nine Everyday Language items, one of the seven Everyday Visuospatial items, two of the five Everyday Planning items, and one of the six Everyday Organization items were associated with subsequent diagnostic conversion (HR=1.25 to 1.59, p=0.003 to 0.03). However, after controlling for depression, only two specific complaints of remembering appointments, meetings, and engagements and understanding spoken directions and instructions were associated with subsequent diagnostic conversion. Episodic memory in individuals reporting no concern on ECog items did not significantly change over time (p>0.4). More complaints on seven of the eight Everyday Memory items, three of the nine Everyday Language items, and three of the seven Everyday Visuospatial items were associated with a decline in episodic memory (Interaction estimate=-0.055 to 0.001, p=0.003 to 0.04). Executive function in those reporting no concern on ECog items declined slightly (p <0.001 to 0.06). More complaints on three of the eight Everyday Memory items and three of the nine Everyday Language items were associated with a decline in executive function (Interaction estimate=-0.021 to -0.012, p=0.002 to 0.04). These findings suggest that specific complaints across several cognitive domains are associated with diagnostic conversion. Specific complaints in the domains of Everyday Memory and Language are associated with a decline in both episodic memory and executive function. Increased monitoring and treatment of individuals with these specific SCD may be warranted.

Keywords: alzheimer’s disease, dementia, memory complaints, mild cognitive impairment, risk factors, subjective cognitive decline

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Authors: Joseph Ampratwum, Yaw Nyadu Offei, Afua Ntoaduro, Frank Twum

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The use of computer assistive technology has captured the attention of individuals with visual impairment. Children with visual impairments who are tactual learners have one unique need which is quite different from all other disability groups. They depend on the use of computer assistive technology for reading, writing, receiving information and sending information as well. The objective of the study was to assess students’ competencies in the use of computer assistive technology at Akropong School for the Blind in Ghana. This became necessary because little research has been conducted to document the competencies and challenges in the use of computer among students with visual impairments in Africa. A case study design with a mixed research strategy was adopted for the study. A purposive sampling technique was used to sample 35 students from Akropong School for the Blind in the eastern region of Ghana. The researcher gathered both quantitative and qualitative data to measure students’ competencies in keyboarding skills and Job Access with Speech (JAWS), as well as the other challenges. The findings indicated that comparatively students’ competency in keyboard skills was higher than JAWS application use. Thus students had reached higher stages in the conscious competencies matrix in the former than the latter. It was generally noted that challenges limiting effective use of students’ competencies in computer assistive technology in the School were more personal than external influences. This was because most of the challenges were due to the individual response to the training and familiarity in developing their competencies in using computer assistive technology. Base on this it was recommended that efforts should be made to stock up the laboratory with additional computers. Directly in line with the first recommendation, it was further suggested that more practice time should be created for the students to maximize computer use. Also Licensed JAWS must be acquired by the school to advance students’ competence in using computer assistive technology.

Keywords: computer assistive technology, job access with speech, keyboard, visual impairment

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Authors: Said S. Almaiuof

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Integration Program Through Physical Education Lessons for The Influence of Some Physical Fitness Health-Related Components in Visual Handicapped Children. Propose of the study: The aim of this study is to design and evaluate a program for the physical education lesson to improve the cardio-respiratory endurance, considering the lesson of physical education as one of the educational means to achieve the society aims toward health and fitness, concerning the importance of the cardio-respiratory endurance as an essential one of the physical fitness health-related components. And this program tried to give them hand of help as a part of the society having the same rights as the rest of the society. Methodology: The researcher used the experimental method as a suitable method for this study and tested its hypothesis. The subject of the research selected randomly of the two classes from primary education in TRIPOLI-LIBYA, it was 28 boys (14-15) years old, then divided into groups, experimental group, n=13, which practiced the special exercises program and control group, n=15, which only practiced the normal school program. The selected child subjected to a medical examination in order to make sure that they are healthy, and the Vo2max measured by cycle ergometry and test some physical fitness makers before and after the program. Results: The study cleared that the experimental group developed in all physical variation in comparison with the control group which has a little development in a general balance only. Results are following: 1. The experimental group was successful more than the control group in all the research variation. 2. There were some improvements in time of keeping Balance in control group only. Discussion /conclusion: According to statistical analysis of data related to the values of the variables in this study; the suggested exercise program according to development the cardio respiratory endurance (CRE), and some physical fitness more than the program which already implemented in the school was less effective, just there is developing on keep balancing. It’s statistically significant (p<0.05) after applying this program. Improving the experimental group on (CRE), balance, running, sit and reach, from the suggested exercise program of what indicate the partaking program positive in improve those physical variables, and the selected exercises may contributed in improving the (CRE) for visual impairment and its pivotal in visual impairment children’s life. A health-related physical education curriculum can provide students with substantially more physical activity during physical education classes. The results show that the physical rehabilitation program for visual impairment children helped them in developing their defects due to the injury which means that this program should be in every organization having this part of people to increase their production and give them hand of help as a part of the society having the same rights as the rest of the society and to establish the idea of sport for all.

Keywords: visual handicapped, cardio-respiratory endurance, health, ergometry, education

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