Eye Poking Research Articles

Best Practice Alerts: A Poke in the Eye or an Efficient Method for Safer Prescribing?

Best Practice Alerts: A Poke in the Eye or an Efficient Method for Safer Prescribing?

Addressing Self-Injurious Behavior in the Medically Complex Child: Identifying the Root Cause vs Blocking Resulting Behavior.

Gillian is a 7-year-old nonverbal, internationally adopted girl with significant visual impairment (sees shadows and objects with high contrast), moderate-severe hearing loss, autism spectrum disorder, profound intellectual disability, and a seizure disorder. She resided in an orphanage until age 4 years when she was adopted by her mother. She is referred to the multidisciplinary team in developmental-behavioral pediatrics by her gastroenterologist, who is managing her constipation, for evaluation and management of self-injurious behavior that occurs before bowel movements.Gillian's adoptive mother reported that Gillian has a history of repetitive and self-injurious behavior including hitting her head with the palm of her hand and poking her eyes. The head-hitting behavior has resulted in consistent bruising to her forehead and nasal bridge. The eye poking is of significant concern because of the possibility of resultant injury including corneal abrasion or retinal detachment. Eye poking occurs exclusively during the hour before stooling, at home and school, and is accompanied by screaming, pacing, and increased aggression toward her mother/teachers. Mother typically responds by blocking the eye poking, redirecting Gillian to the toilet, providing prompts to use calming strategies (e.g., deep breathing), or providing sensory input by rubbing her arms/back. Teachers respond in a similar way at school. Gillian's mother has tried to place goggles over Gillian's eyes during eye poking, but this resulted in increased aggressive behaviors.Gillian is not fully bowel trained but will sit on the toilet to urinate when prompted. She completes toilet-sits at home/school 5 to 7 times daily. Gillian passes small, soft bowel movements 2 to 4 times daily on a bowel management regimen consisting of polyethylene glycol 3350 17 grams twice daily and liquid senna 8.8 mg daily. Seizures are reportedly well controlled with an antiepileptic medication managed by her neurologist. Previous medical evaluation by otolaryngology, ophthalmology, neurology, and gastroenterology did not identify a source of pain or other cause for the eye poking. Physical examination reveals normal bowel sounds and a mildly distended abdomen but is otherwise unremarkable. What are your next steps for evaluation and treatment?

Repetitive Eye Poking in an Infant — A Diagnostic Conundrum

Repetitive Eye Poking in an Infant — A Diagnostic Conundrum

Rubbing salt on the wound.

The quotation ‘People who peek through key-holes have to expect an occasional poke in the eye’ comes to mind in view of the recently published LACC Trial in the New England Journal of Medicine showing significantly worse survival following ‘keyhole’ surgery (laparoscopic or robotic) in early stage cervical cancer (Ramirez et al. N Engl J Med 2018;379:1895–904). A second study in the same edition reinforced the results by also showing a worse survival with ‘keyhole’ surgery (Melamed et al. N Engl J Med 2018;379:1905–14). This must be considered to be as unfortunate as having ‘both eyes poked at the same time via the same keyhole’. Before gynaecological oncologists have regained full sight, comes this third publication focusing on fertility-sparing surgery in early stage cervical cancer which ‘rubs salt on the wound’ by also showing excellent survival with an abdominal approach. The study by Li et al. (BJOG 2019; 126:1169–74) the largest published series on abdominal radical trachelectomy (ART) demonstrating a 98.6% 5-year survival, agrees well with the abdominal arm in the LACC trial of 99% 3-year survival and contrasts significantly with the laparoscopic arm of 93.8% 3-year survival. In addition, the results are comparable to previous publications on ART and add substantially to the literature (previously, 866 cases with a cumulative mortality rate of 1.4%). Of interest are the results on tumours larger than 2 cm with a recurrence rate of 5.3% compared with 2.0% in tumours <2 cm (nonsignificant P value). Analysis of the New England Journal of Medicine publications identified that it was in this sub-group specifically there were the greatest differences in recurrences. It is also in this sub-group that survival differences are the greatest compared with vaginal radical trachelectomy (cumulative recurrence rate of 23.9%), which also utilises a laparoscopic approach (BJOG 2019;126:1169–74). Data following total laparoscopic radical trachelectomy are limited. Consistent with this, is the FIGO 2018 re-classification of cervix cancer reducing the cut-off between IB1 and IB2 tumours from 4 to 2 cm (Bhatla et al. Int J Gynaecol Obstet 2018;143 (Suppl 2):22–36). Where does all this leave us? Is the problem the surgeon or the tools or the procedure? Many are questioning the surgical techniques in order to retain a minimally invasive approach including the use of manipulators, the CO2 pneumoperitoneum, tumour exposure to the peritoneum and the surgical radicality. It's also time to reflect. Fertility-sparing or not, why have different surgeons/centres been advocating different surgical procedures/approaches? One explanation is the Collingridge dilemma stating that technological advances contain two components; (1) information: where the effects of technological advances cannot be predicted until they are extensively developed and widely used in clinical practice, and (2) power: where control (by the use of robust clinical evaluations) is difficult when the technology has become entrenched (Collingridge. The Social Control of Technology. London, UK: Palgrave Macmillan, 1981). This is highlighted by the Pacing problem, where innovations develop exponentially while control mechanisms develop incrementally. The solution would be the Precautionary principle, where innovations should not be embraced until developers can prove they will not cause harm. Critics argue this will not eliminate innovations developing in the wrong direction but result in no innovations developing at all. Although it is painful to have to revert back to an abdominal route, the solace is that ‘rubbing salt on the wound’, regardless of the additional pain, will help the wound recover faster. And so, for women with a stage IB2 cervical tumour (FIGO 2018) who wish to preserve fertility, the recommended operation should be an ‘abdominal’ radical trachelectomy. None declared. A completed disclosure of interests form is available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Reversing neurodevelopmental disorders: Successful intervention for eye poking in a girl with Potocki–Chaffer Syndrome

Reversing neurodevelopmental disorders: Successful intervention for eye poking in a girl with Potocki–Chaffer Syndrome

Effects of an Antecedent Intervention on Repetitive Behaviors of a Child With Autism

Repetitive self-injurious eye poking and stereotypic hand clapping were assessed in a child with autism and hearing impairment. A functional behavioral assessment conducted to identify the variables maintaining eye-poking behaviors indicated automatic reinforcement. Choice and environmental enrichment strategies were implemented to decrease the motivating operations associated with eye poking. Providing a choice of toys to hold in his hand led to the greatest reductions in both repetitive eye poking and hand clapping. Three follow-up observations were conducted 9 months after the intervention, which indicated that eye poking was eliminated and hand clapping was greatly reduced. This antecedent intervention was simple and effective, two hallmarks of sustainable behavior interventions.

Technological supports to promote choice opportunities by two children with fragile X syndrome and severe to profound developmental disabilities.

This study was aimed at assessing whether technological supports (i.e. optic sensors such as photocells) were successful enabling two boys with fragile X syndrome and severe to profound developmental disabilities to perform occupation and choice opportunities. A second goal of the study was to reduce stereotyped behaviours (i.e. hand mouthing and eye poking) exhibited by the participants. Finally, the third purpose of the study was to verify the rehabilitative effects of the intervention program on the indices of happiness of the participants. The study has been conducted according to a non-concurrent multiple baseline design across participants followed by intervention and cross over phases, where the associations between behavioural responses and environmental consequences were systematically inverted. Moreover, a maintenance phase was assessed. The results demonstrated that the technology is useful to facilitate employment and opportunities of choice, showing a growth of the indices of happiness and a decrease of stereotyped behaviours, from both participants involved. Clinical, practical and psychological implications of the findings are discussed.

Manneristic Behaviors of Visually Impaired Children

Aim: To review the literature on visual impairment in children in order to determine which manneristic behaviors are associated with visual impairment, and to establish why these behaviors occur and whether severity of visual impairment influences these behaviors.Methods: A literature search utilizing PubMed, OVID, Google Scholar, and Web of Knowledge databases was performed. The University of Liverpool (www.liv.ac.uk/orthoptics/research) and local library facilities were also searched.Results: The main manneristic or stereotypic behaviors associated with visual impairment are eye-manipulatory behaviors, such as eye poking and rocking. The degree of visual impairment influences the type of behavior exhibited by visually impaired children. Totally blind children are more likely to adopt body and head movements whereas sight-impaired children tend to adopt eye-manipulatory behaviors and rocking. The mannerisms exhibited most frequently are those that provide a specific stimulation to the child. Theories to explain these behaviors include behavioral, developmental, functional, and neurobiological approaches. Although the precise etiology of these behaviors is unknown, it is recognized that each of the theories is useful in providing some explanation of why certain behaviors may occur. The age at which the frequency of these behaviors decreases is associated with the child’s increasing development, thus those visually impaired children with additional disabilities, whose development is impaired, are at an increased risk of developing and maintaining these behaviors. Certain manneristic behaviors of the visually impaired child may also help indicate the cause of visual impairment.Conclusions: There is a wide range of manneristic behaviors exhibited by visually impaired children. Some of these behaviors appear to be particularly associated with certain causes of visual impairment or severity of visual impairment, thus they may supply the practitioner with useful information. Further research into the prevalence of these behaviors in the visually impaired child is required in order to provide effective management.

A Poke in the Eye with a Sharp Spike: Nanoculture and the Future of SF

We may be living in dark times, but the future—that is, the future of nanotechnology, which for Colin Milburn’s purposes in Nanovision is to say the future—is bright. So astonishingly, blindingly bright, in fact, as to utterly confound our ability to properly perceive it, much less grasp what it might hold for us. For nanotech, more than any other single technological undertaking, is drawing humanity inexorably toward a moment—dubbed the Singularity by Vernor Vinge, the Spike by Damien Broderick—when all the conceptual models that lend structure and meaning to present-day reality will have to be either discarded or radically upgraded. With Nanovision, Milburn joins a growing chorus of voices in technoculture studies who take seriously the proposition that, in some sense or another, the Singularity is coming. Until it does, judging from the cross section of tech-sector rhetoric curated here, nanotech has assumed the mantle of Last Best Hope for the faltering project of technoscientific Progress and the twentieth-century economies of production and consumption it once drove. Politicians and pitchmen tout nanothis and nano-that as the next big tech boom, while techno-libertarian prophets of posthumanity take the opportunity to double down on their most cherished presumption: that perpetually expanding markets and exponentially proliferating tech are inevitable and mutually ratifying truths. Elsewhere, ostensibly above the fray, researchers and engineers working toward the realization of actual nanotechnologies disdain the wild-eyed pulp sensibility that has contaminated the discourse on nano, though even these soberminded paragons of hard science are prone to making some truly extraordinary assertions of their own about what it will make possible. Whoever is doing the talking, it seems, the prefix “nano-“ is synonymous with breathtaking, inconceivably momentous change: it is a signifier of Singularity. Nanovision opens with the observation that all this commercial gloss and utopian bluster—the sort of talk that David M. Berube derides as “nanohype”—have so overloaded the collective perceptual pathways and cognitive apparatus of contemporary technoculture as to induce, in Milburn’s conceit, a sort of hysterical blindness. It is as though the historical transformation that awaits us is emitting a glare of such overpowering radiance that we cannot possibly make out what it is or what it might mean—only that it is coming. In fact, to the degree that nano-discourse posits some version of Singularity as inevitable, without being able to offer any coherent description of what a post-Singular reality might actually look like, “the imagination of nanotechnology creates its own blindness” (12)—in order to overcome it. More than just a dazzling flash of futurity reflected

Two Children with Multiple Disabilities Increase Adaptive Object Manipulation and Reduce Inappropriate Behavior via a Technology-assisted Program

Persons with severe to profound multiple disabilities, such as intellectual, visual, and motor disabilities, may be characterized by low levels of adaptive engagement with the environment (Holburn, Nguyen, & Vietze, 2004; Mechling, 2006). They may also display forms of inappropriate, stereotypical behavior (like hand mouthing, that is, putting their fingers into or over their mouths) or inappropriate postures and dystonic or spastic behavior (for example, tilting their heads forward or stretching their legs) (Lancioni, Singh, O'Reilly, Sigafoos, Didden et al. 2008; Luiselli, 1998; Matson & LoVullo, 2008). Educational efforts that are directed at these persons need to encompass the dual goal of promoting adaptive responses and reducing inappropriate behavior to improve the persons' overall situation. A form of educational intervention that has recently been put forward to pursue such a dual goal relies on programs involving microswitch clusters. One such cluster could be used, for example, to monitor adaptive object manipulation and eye poking and to ensure that the manipulation responses lead to positive stimulation only if performed in the absence of eye poking. Intervention programs that are based on microswitch clusters have been fairly successfully applied by Lancioni and his colleagues with 15 participants with multiple disabilities (see, for example, Lancioni, O'Reilly et al., 2008; Lancioni, Singh, O'Reilly, Sigafoos, Didden et al., 2008; Lancioni, Singh, O'Reilly, Sigafoos, Oliva et al., 2008; Lancioni et al., 2009). The aim of the study reported here was to extend the evidence available by involving two new participants (children), one of whom exhibited an inappropriate behavior that had not been targeted before (dystonic-spastic stretching of one or both arms) and new cluster technology. This technology allowed small manipulations of objects to serve as adaptive responses and to produce positive stimulation and it interrupted any ongoing stimulation if one or both of the participant's hands were withdrawn from the objects for two seconds or more. Basically, the technology did not monitor the inappropriate behavior per se--dystonicspastic stretching of one or both arms or hand mouthing--but a precursor of it (hand withdrawal) via relatively noninvasive devices. METHOD Participants The participants, Glen and Hugh, were 5.6 and 9.9 years old, respectively, and were rated in the severe to profound range of intellectual disability, although no IQ scores were available. They were diagnosed with encephalopathy that was due to premature birth and perinatal hypoxia, presented with spastic tetraparesis combined with dystonic movements for Glen, and spent most of their time in wheelchairs. They had no speech or any other specific means of communication (Glen) or showed some echolalic expressions but with no obvious communication goals (Hugh). On the basis of previous systematic behavioral observations, Hugh was reported to see only light displays in front of him, while Glen was reported to see relatively large objects within about 1 meter (about 39 inches) and at the center of the visual field (see Morse, Teresi, Rosenthal, Holmes, & Yatzkan, 2004; Sakai et al., 2002). Also, Glen had some previous experience with microswitches. Both participants lived at home with their parents and attended daily educational programs that focused on physiotherapy and general stimulation. The study presented here was approved by the scientific and ethics committee of the Lega F. D'Oro, Osimo, Italy. Parents and teachers provided informed consent for the study. Position, adaptive responses, inappropriate behavior, and technology Glen and Hugh were seated at a desk in front of a box that had a base that was 37 centimeters by 27 centimeters (about 15 inches by 11 inches) and was l0 centimeters (about 4 inches) high and open at the top, and contained five to seven objects. …

New eyewear regulations draw ire of optometrists

Changes to eyewear regulations in British Columbia have drawn praise from some opticians and consumers, but most Canadian optometrists consider them a poke in the eye. Two amended regulations in particular have become topics of debate (see sidebar for a more complete list). One allows opticians to

USING A STIMULUS CORRELATED WITH REPRIMANDS TO SUPPRESS AUTOMATICALLY MAINTAINED EYE POKING

A functional analysis indicated that chronic eye poking exhibited by a woman with profound mental retardation persisted in the absence of social contingencies. We initiated a procedure in which a therapist delivered a punisher (mild reprimand) contingent on eye poking in the presence, but not the absence, of a neutral stimulus (wristbands). Subsequently, eye poking was suppressed when the participant wore the wristbands in novel environments without the reprimand contingency.

A poke in the eye: Inhibiting HIV‐1 protease through its flap‐recognition pocket

A novel mechanism of inhibiting HIV-1 protease (HIVp) is presented. Using computational solvent mapping to identify complementary interactions and the Multiple Protein Structure method to incorporate protein flexibility, we generated a receptor-based pharmacophore model of the flexible flap region of the semiopen, apo state of HIVp. Complementary interactions were consistently observed at the base of the flap, only within a cleft with a specific structural role. In the closed, bound state of HIVp, each flap tip docks against the opposite monomer, occupying this cleft. This flap-recognition site is filled by the protein and cannot be identified using traditional approaches based on bound, closed structures. Virtual screening and dynamics simulations show how small molecules can be identified to complement this cleft. Subsequent experimental testing confirms inhibitory activity of this new class of inhibitor. This may be the first new inhibitor class for HIVp since dimerization inhibitors were introduced 17 years ago.

A poke in the eye.

Loss of vision is a common problem in older adults and can result in functional impairment and accidental injury. The four most common causes of vision loss in this age group are age-related macular degeneration (AMD), cataracts, glaucoma, and diabetic retinopathy, and on page 16 Dr David Pountney gives an excellent overview of the current state of affairs for AMD treatment.

Promoting Adaptive Foot Movements and Reducing Hand Mouthing and Eye Poking in a Boy with Multiple Disabilities through Microswitch Technology

This study assessed the viability of a microswitch cluster (i.e. a combination of microswitches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behavior in a boy with profound multiple disabilities. The boy was initially taught an adaptive foot‐movement response that activated a motion microswitch and produced preferred stimuli. Subsequently, his foot response led to preferred stimuli only if it occurred in the absence of aberrant behavior (i.e. hand mouthing and eye poking which were detected through optic microswitches). Moreover, full access to the stimuli required that the boy refrain from aberrant behavior during their presentation as well. The study also included a 3‐month post‐intervention check and a social validation assessment. Data showed that the boy (i) increased his adaptive responding, (ii) learned to perform this responding largely free from aberrant behavior and refrained from that behavior for most of the session time, and (iii) maintained this performance at the post‐intervention check. The social validation ratings of 40 teachers and teacher assistants significantly favored the last intervention period (in which aberrant behavior was reduced) over the initial period.

GPi deep brain stimulation for Tourette syndrome improves tics and psychiatric comorbidities

Tourette syndrome (TS) is characterized by phonic and motor tics and psychiatric comorbidities including attention-deficit (± hyperactivity) disorder (AD/HD), obsessive-compulsive behavior (OCB), anxiety, depression, and others.1 The efficacy and safety of deep brain stimulation (DBS) in movement disorders are established, and their applicability to neuropsychiatric conditions is expanding. We describe the results of bilateral DBS of the globus pallidus interna (GPi) in a 16-year-old boy with severe, medication-refractory TS. This left-handed boy presented at age 15 years for evaluation of escalating TS. Tics began at age 3, OCB by age 5, and AD/HD, coprolalia, copropraxia, and loud screaming by age 7. Haloperidol, pimozide, fluphenazine, benzodiazepines, guanfacine, selective serotonin reuptake inhibitors, tetrabenazine, and botulinum toxin injections (vocal cords) failed to relieve symptoms, including touching and grabbing others, self-gagging until emesis, eye poking, facial self-excoriations, self-hitting, and screaming until hoarse. Anxiety, depression, hyperactivity, and impulsivity were notable, while inattention and opposition were less problematic. His marked academic and social impairment prompted consideration of DBS surgery. Neuropsychological evaluation assessed suitability …

A preliminary description of the occurrence of proto-injurious behavior in typically developing children.

Abstract Self-injurious (SIB) is a disorder typically associated with developmental disabilities. However, throughout early childhood, some typically developing children also display that is topographically similar to SIB but does not cause injury, commonly referred to as behavior (PIB). To date, little research has examined the occurrence of these behaviors in typically developing children. In the current paper, we present preliminary data from a sample of typically developing children in the southeastern United States for whom caregivers reported the occurrence of PIB. The results are discussed in comparison to the occurrence of these behaviors in other populations and in terms of implications for understanding the developmental course of SIB. Keywords: childhood development, descriptive questionnaire, proto-injurious behavior, self-injurious ********** Self-injurious (SIB) has been defined as an act in which an individual produces physical damage to his or her own body (Tate & Baroff, 1966). Examples of frequently observed SIB among individuals with developmental disabilities include head banging, self-hitting, self-pinching, self-scratching, pica, hand mouthing, eye poking, and hair pulling (Iwata et al., 1994; Johnson & Day, 1992). The occurrence of chronic SIB can lead to physical sequelae including hematomas, severe tissue damage, and in some cases, death. General prevalence estimates of SIB among individuals with developmental disabilities are 10 to 20% (Oliver, Murphy, & Corbett, 1987; Schroeder, Schroeder, Smith, & Dalldorf, 1978). SIB, which is interpreted as abnormal and disruptive among individuals with developmental disabilities, may also occur in developmentally typical children. However, such is rarely interpreted as abnormal or disruptive in non-disabled children primarily because it rarely produces longterm tissue damage (Hyman, Fisher, Mercugliano, & Cataldo, 1990). In many cases, such is viewed as developmentally normal (Lourie, 1949; Thelen, 1979). Although the form of the topographically resembles SIB (e.g., contact of the head to a hard surface), the often does not resemble SIB along other dimensions (e.g., intensity, frequency), and usually requires no direct intervention. Thus, of this type may be considered non-clinical forms of SIB. However, it is possible that some of these forms have the potential to develop into clinically significant problems; thus, this class of is often referred to as behavior (PIB; Berkson & Tusa, 2002). In general, the extant literature has focused primarily on the occurrence of proto-injurious head banging in young children of typical development. For example, using questionnaires mailed to the mothers of full-term, developmentally typical infants, De Lissovoy (1961) noted the occurrence of head banging in 15.2% of 487 children. Sallustro and Atwell (1978) administered questionnaires to the parents of 525 children (aged 3 to 72 months) and noted head banging to occur in 5.1% of their sample. Similarly, Kravitz and colleagues reported the occurrence of head banging in 3.6% of a sample of 135 typically developing children (Kravitz, Rosenthal, Teplitz, Murphy, & Lesser, 1960) and in 7% of the sample of infants less than 12 months old (Kravitz & Boehm, 1971). Thus, in the research discussed above, the occurrence of head banging ranged from 3.6% to 15.2% of typically developing children. However, less is known about the occurrence of other topographies of PIB (e.g., self-hitting) among typically developing children. A possible exception is research conducted by Troster, Brambring, and Beelmann (1991) who presented data on the occurrence of PIB and repetitive movements in children with visual impairments. In surveys of 85 caregivers of visually impaired children ranging in age from 10 to 82 months, Troster et al. …

Visual impairment in people with low intellectual abilities

Institute de Brink in the North of The Netherlands is a residence people with profound to severe intellectual disabilities (ID) and severe visual impairment (VI). Ophthalmologic records from all residents were kept over the passed 30 years. We have reviewed and classified 160 records according to the classification of F. Meire [1] [F.M. Meire. Genetics in ophthalmology. Bull. Soc. Belge Ophtalmol. 269 (1998) 3–4]. Data on visual acuity, refractive errors, strabismus and ocular diagnoses were assembled as well as ophthalmic problems met during residency. Also additional handicaps were recorded. In the whole group, 155 records were complete for use. 64% of the residents appeared to be functionally blind (WHO category 0020 vision <0.05). In the group with functional vision, N=55, nystagmus and strabismus were more frequently seen as compared with the normal population. Optic atrophy was found most of the time as an end stage of Cerebral Visual Impairment (CVI). Classification of the causes of the ophthalmic problems showed that in the nongenetic group pre- and perinatal problems were the main causes of VI and in the genetic group syndromal anomalies. Severe and profound ID are seen in combination with other handicaps like deafness and motor handicaps which ask for special care. In this group, residents with congenital cataract had a bad prognosis. Eye poking was another problem with complications leading to blindness. Behavioural therapy and stimulation of the resident may prevent this behaviour.

The use of conditional probability analysis to identify a response chain leading to the occurrence of eye poking

In contrast to the literature on shaping adaptive behavior chains, few applied studies have described procedures for identifying and treating behavior chains involving problem behavior such as self-injury. The present study expands upon past work by conducting a conditional probability analysis and within-session analysis to identify a response chain leading to the occurrence of self-injurious behavior. Based on the hypothesis that stereotypy and self-injury constituted a response chain, the effects of blocking stereotypy were examined. Reductions in both self-injury and in response effort for treatment implementation were observed.

What's So Funny About a Poke in the Eye? The Prevalence of Violence in Comedy Films and Its Relation to Social and Economic Threat in the United States, 1951-2000

We examined the violent content of the top-grossing comedy films from 1951 to 2000. Comedic violence increased sharply around 1970 and has been relatively consistent since then. Aggressors were depicted in somewhat more positive terms than targets, but in general, the message of comedic violence was not one of good triumphing over evil. Top-grossing comedy films featured more violence when unemployment, suicide, homicide, divorce, and the consumer price index were higher.