The broad goal of this clinical trial is to demonstrate whether a one-month rehabilitative training with our medical device, iReach, can promote the recovery of spatial and sensorimotor abilities and the cortical reorganization process in children with visual impairment between 3 and 36 months of age.
Development and clinical validation of a novel multisensory medical device: iReach. This device will be used for the rehabilitation and recovery of spatial and sensorimotor abilities compromised by early visual impairment (i.e., blindness or moderate to severe low vision) in children aged between 3 and 36 months. In addition to its clinical value, the investigators aim to fill a technological and methodological gap. Currently, there are no certified medical devices for early intervention, that is, systems that are intuitive, simple, and designed for rehabilitation in the early stages of development. In detail, the goals of the current clinical trial are: 1. To verify that the number of adverse events is zero, considering reports from the attending physician; 2. To assess improvements in stationary and locomotion abilities, assessed with the Peabody Developmental Motor Scale (PDMS-2) indices; 3. To evaluate further improvements in i) reaction time (s) and frequency and accuracy of response (%) to uni- and multisensory (audio-tactile) stimulations; ii) time to reach and grasp an object (s); iii) number of attempts required to reach and grasp an object (%); iv) number of times the midline of the body is crossed to reach a lateral object (%); v) number of times an object is grasped with two hands if it is larger than the hand (%). These parameters will be extracted from video recordings; 4. To highlight changes in EEG power (dB) in the alpha band (8-12 Hz) measured in the occipital scalp area following rehabilitation with iReach. iReach, is composed of two devices called Anchors, and a reference Tag, that can be placed either on both the body or external objects. Each Anchor measures its distance from the Tag and translates it into sensory feedback, whose intensity and time duration parameters are configurable. iReach can emit acoustic, vibrational, and RGB light stimuli, either alone or in combination, and is turned on via a button located on the external cover, which is manufactured through 3D printing. This study is divided into two phases: usability and rehabilitation. The usability phase is aimed at defining the temporal durations of audio-tactile stimulations that will then be used in the rehabilitation phase. The patients enrolled in the iReach Device group of this phase will be involved in a one-month rehabilitation procedure (i.e., training) and will perform activities with iReach presented in the form of games that target localization, locomotion, grasping, and reaching skills. The training will be conducted both at home and at the clinical center and will be preceded and followed by two identical experimental sessions (pre- and post-training), which will monitor improvements in spatial and sensorimotor abilities following rehabilitation. Finally, an additional follow-up experimental session is planned four months after the post-training to verify whether these improvements are still present or not, both behaviorally and cortically. The participants enrolled in the Normal clinical activity group of the experimental phase will only be involved in the pre- and post-training sessions and the follow-up session without undergoing rehabilitation with iReach. The tasks the participants will have to undergo are designed for the specific age bin (i.e., 3-6 months, 6-12 months, 12-36 months)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
55
The iReach Device group will take part in playful multisensory motor and spatial activities for one month both at the clinic and at home with the medical device iReach.
Incidence of Device Adverse Events
Verification of the absence of device adverse events in the use of the medical device (MD);
Time frame: Month 1 - Month 12, the entire duration of the clinical trial
Change in motor skills after training with iReach medical device
The assessment of the change in certain motor skills (e.g., stability, and locomotion) after one month of intensive use of iReach. These changes will be quantified through the indices of the Peabody Developmental Motor Scales -2 (PDMS-2). The tasks included in these scales will be adapted to be executable by children with visual impairments. The PDMS-2 scales are widely used in clinical practice and allow for robust and reliable measurements. Higher scores result in better outcomes. The performance values are quantified through an indicator named "Total Motor Quotient," which spans from a minimum range equal to 35-69, representing a strong deficit, to a maximum range of 131-165, indicating the best performance.
Time frame: Month 3 - Month 12
Perceptual responses to multisensory stimuli
Evaluation of the number of correct responses and reaction times (in seconds), to uni- and multisensory (audio-tactile) stimuli.
Time frame: Month 1 - Month 12
Change in motor abilities following the rehabilitation with the iReach medical device
Evaluation of the changes in motor tasks in terms of: i) time to reach and grasp an object (in seconds) ii) number of attempts required to reach and grasp an object; iii) number of times the midline of the body is crossed to reach a lateral object; iv) number of times an object is grasped with two hands when its size exceeds that of the hand.
Time frame: Month 1 - Month 12
Variation in the power of the cortical activity following the rehabilitation with the iReach medical device
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Evaluation of the variation in power expressed by the alpha band (8-12 Hz) of the EEG recorded in the occipital area (dB).
Time frame: Month 1 - Month 12