Ussge of Assistive Technology to Promote Inclusive Practices in Educational System

Introduction

"The real miracle of technology may be the capacity it has to remove previously insurmountablebarriers faced by persons with disabilities" -Simon

           

            Technology has great potential in providing access for all learners, and the ability to access the general education curriculum. Assistive technology is a generic term that includes assistive, adaptive,and rehabilitative devices for individuals with disabilities and includes virtually anythingthat might be used to compensate for lack of certain abilities, rangingfrom low-tech devices like crutches or a special grip for a pen, to more advanced items like hearing aids and glasses, to high-tech devices such as computers with specialized software forhelping dyslexics to read (WHO, 2009).

Curriculum Adaptation and Technology Integration

            Access to the general education curriculum involves the placement of students with disabilities ingeneral education classrooms, which requires the adaptation of the curriculum content so that itproves meaningful to every student as an equal participant in the learning process.Assistive and instructional technologies are a part of the larger research-based interventionstrategies, that in terms of the accessibility to the general education curriculum, imply the modification of the classroom like equipping students with disabilities with graphic organizers orconcept mapping software, or allowing students who have difficulty writing to respond verbally toa peer rather than producing a written assignment, use of talking text readers, or specific assistivetechnology communication devices designed for receptive and expressive communication to easelearning and equal participation of all students with differential abilities

Assistive technology has the potential to augment abilities and bypass or compensate forbarriers that disabilities create. As educational reforms include the applicationof technology to support and expand classroom curricula, assistive technology can provide bothroutine and customized access to the general curricula for students with disabilities.

Assistive Technology for Students with Mobility Impairments

            Students having difficulty with fine motor skills may require larger keyboard while using a computer,an on-screen keyboard or speech recognition programs to coordinate with their learningtasks. The use of a standard keyboard in a computer with access to a 'mouth- or head-stick,where the keys can be pressed with the pointing device can help students with mobility impairments;while Track balls, head trackers and touch screens can serve as suitable alternatives to thecomputer mouse. Software utilities can create 'sticky keys' that electronically latch the SHIFT,CONTROL, and other keys to allow sequential keystrokes to input commands that normallyrequire two or more keys to be pressed simultaneously.

            Students with mobility impairments, using a wheel chair, may have their computer desksadjusted to a comfortable height, to pull up to the computer to work. Keyboard guards can beused by individuals with limited _ne motor control, and repositioning the keyboard and monitormay help in enhancing accessibility; like mounting keyboards perpendicular to tables or wheelchairtrays at head-height to assist individuals with limited mobility using pointing devices to presskeys, and use of disk guides for inserting and removing diskettes. Left-handed and right-handedkeyboards available for individuals who need to operate the computer with one hand, have theprovision of more efficient key arrangements, than standard keyboards designed for two-handedusers.

            For users with severe mobility impairments, keyboard emulation, including scanning and Morsecode input, can be used with special switches that make use of at least one muscle over whichthe individual has voluntary control like - head, finger, knee, or mouth. In scanning input, lightsor cursors scan letters, and symbols are displayed on computer screens or external devices, wherehundreds of switches tailor input devices to individual needs. Speech recognition systems allowusers to control computers by speaking words and letters, where a particular system is 'trained'to recognize specific voices. Abbreviation expansion and word prediction software can also helpin reducing input demands for commonly used text and keyboard commands; and on-screen helpmay assist in efficient access to user guides for individuals who are unable to turn pages in books.

            Architectural or physical environmental barriers like the absence of ramps, elevators, automaticdoors, Braille signage, and telecommunication devices, are also seen to deter and restrictthe participation of students with disabilities. Therefore, infrastructural changes and adjustmentsin the schools and educational institutions (Campbell, 1989), like the availability of ramps; accessibilityto classroom, workspace and labs through lifts; washrooms having counters and sinks withadjustable heights can be ensured through applicability of universal design for ease in accessibility,and can help address the hidden barriers preventing the equal access and participation ofstudents with mobility impairments in education and social life.

Assistive Technology for Students with Visual Impairment/Blindness

            Visually impaired students have difficulty accessing visual material in printed form or on thecomputer screen, where standard keyboards can aid in accessing Braille input devices, with Braillekey labels assisting with the keyboard use. The OBR (Optical Braille Recognition) software canenable users having visual impairment to read Braille documents on a standard A4 scanner, scanthe Braille document, analyze the dot pattern, translate the text, and present it on the computerscreen. Refreshable Braille displays allow line-by-line translation of screen text into Braille, whichcan help in detailed editing. The Braille printers provide the 'hard copy' output for the visuallyimpaired users. Scanners with optical character recognition can read printed material; whichcan then be stored electronically on computers, and be read using speech synthesis, or printedusing Braille translation software and Braille printers. Such systems provide independent accessto journals, syllabi, and homework assignments for the visually impaired students. Speech outputsystems can be used to read screen text, while the screen readers or the text-to-speech softwarelike JAWS (Job Access with Speech) can help the user in adjusting the volume, pitch and speedof reading, and in choosing or adjusting to a male or female voice according to their preference.

            Screen readers including navigation tools allow users to skip from headline to headline, or categoryto category while reading. Using the synthetic speech, the computer can read text passages,analyze the phonetic structure of words and attempt re-constructing words by putting together astring of synthetic phonemes, ensuring easy understandability of the message by the student. Theuse of earphones for individuals using speech output systems can reduce and limit the distractionsfor other individuals present.

            Audio materials like talking books and audio cassettes of recorded lessons can be used bystudents with visual impairment. The use of sophisticated audio devices, CD players, cassetteplayers, and recording machines can be used to record lectures, books and other study materialsand help students in submitting their assignments in audio formats. The descriptive video servicewith a narrative verbal description of the visual elements displayed on the screen enables thestudents to automatically hear the descriptions of all the visual elements, providing the studentswith visual impairment an opportunity for better socialization and knowledge building (Petty, 2012).

Assistive Technology for Students with Low Vision

            Students with low vision may find the standard size of letters on the computer screen or printeddocuments too small to read, while some may also not be able to distinguish one color from another.Use of large print key labels, special equipment for the modification of display or printeroutput, computer-generated symbols, both text and graphics enlarged on the monitor or printer,can prove useful to students with low vision, especially in using standard word processing, electronicmail, spreadsheet, and other software applications. Adjusting the color of the monitoror changing the foreground and background colors, through special software like reversing thescreen from black on white to white on black for individuals who are light sensitive, can helpimprove access and readability. Anti-glare screens can make screens easier to read, while voiceoutput systems can also be used by people with low vision. The printed material can be readby scanners with optical character recognition and stored electronically on computers, where itcan be read using speech synthesis or printed in large print. Assistive devices that are suitablefor students with low vision may be used to aid in efficient learning like close circuit television,magnifying glasses and hand magnifiers, Braille language, talking calculators and tape recordings(Burgstahler, 1992).

Assistive Technology for Students with Hearing and/or Speech Impairments

            Word processing and educational software may help hearing impaired students in developing writingskills. Alternatives to audio output can assist the hearing-impaired computer user, in placeof using a standard keyboard and mouse. Advanced speech synthesizers may act as substitutevoices, providing a compensatory tool for students who cannot communicate verbally. Studentswith portable systems can participate in class discussions once adapted computers provide themwith intelligible speaking voices. Students with hearing and/or speech impairments can use standardwritten or on-screen documentation without difficulty, with the development of adequatespeech and language patterns using supportive aids like recorded tapes, speech trainers, photoalbums, articulation charts, concrete objects and other visual cues, for language learning, speechtraining, and speech correction. While 'text-telephones' can help in allowing phone conversationsto be typed and read rather than be spoken and heard, the 'computerized speech recognition software allows the computer to change a spoken message into a readable text document that canbe easily read by the hearing impaired students.

Assistive Technology for Students with Specific Learning Disabilities

            For students having Specific Learning Disabilities, educational software can help in skill building, by offering multisensory experiences, positive reinforcement, individualized instruction, andrepetition. Students having difficulty processing written information can complete writing assignmentsand tutorial lessons with the aid of computers, like the standard word processor may provea valuable tool for students with Dysgraphia, an inability to write legibly. Quiet work areas andear protectors may make computer input easier for students who are hypersensitive to backgroundnoise and get easily distracted. Adaptive devices like large print displays, alternative colors onthe computer screen, and voice output can help in compensating reading problems. 'ElectronicMath Sheets' help in the organization, alignment and working of the Math problems on a computerscreen, where the numbers appearing can be read aloud through the speech synthesizer, helping students facing difficulty in aligning Math problems using pencil and a paper. Softwarelike 'Abbreviation expanders' can prove helpful with word processing to create, store, and re-useabbreviations for frequently used words or phrases, to ensure proper spellings for students who have difficulty in writing. The Paper-based Pen technology, can record andlink audio to what the student writes using the pen and the special paper, enabling note-takingwhile recording the teacher's lecture simultaneously, which the student can also listen to later bytouching the pen to the corresponding handwriting or diagrams. This technology proves useful forstudents struggling with listening, writing, memory and reading skills. Students having difficultyinterpreting visual material can improve comprehension and the ability to identify and correct errorswhen words are spoken or printed in large fonts. Computer documentation in electronic formsmay be used with enlarged character and voice synthesis devices to ensure better accessibility tothose with reading difficulties.

            Assistive technology has a major role in remediating and compensating the performance deficitsexperienced by students, enhancing the students' performance; and ensuring effective evaluationas an accommodation during testing, offering adequate solutions when an extended evaluation isneeded. Effective technology integration in education can therefore help in addressing the functionalbarriers experienced by students with disabilities, providing them with equitable learningopportunities and a leveled field to rightly exhibit their differential abilities, through provision ofnecessary support and an equally accessible learning environment to all.

Conclusion

            Inclusion or integration is an important part of equal opportunity in education. Demands for inclusive education have increased and fostered major changes to schooling and education. Students with disabilities are educated alongside their peers within the local community therefore mainstream schools are required to adapt to accommodate a diverse group of students with a variety of needs. Approaches to the inclusion of children and young people into mainstream classrooms, and the identification and recognition of special educational needs, is an integral part of daily school work. The wellbeing and actualization of developmental and learning potential within a diverse student population is challenging the organization of learning settings. Assistive Technology helps in the Full Inclusion of Children with special in general classrooms.

References

           

·         Ahmad, FouziaKhursheed (2014): "Assistive Provisions for the Education of Studentswith Learning Disabilities in Delhi Schools." International Journal of Fundamentaland Applied Research, vol.2, no 9. pp.9-16.

·         Ahmad, FouziaKhursheed (2015a): "Challenging Exclusion: Issues and Concerns inInclusive Education in India." Researchpaedia, vol.2, no.1, pp.15-32.

·       Ahmad, FouziaKhursheed (2015b): "Exploring the Invisible: Issues in Identificationand Assessment of Students with Learning Disabilities in India." Transcience: AJournal of Global Studies vol.6, no 1. pp. 91-107.

·         Burgstahler, Sheryl. (1992): Computing Services for Disabled Students in Institutionsof Higher Education. Ph. D. Dissertation. University of Washington.

·       Campbell, P.H. (1989): Students with physical disabilities. In R. Gaylord-Ross (Ed.),Integration strategies for students with handicaps (pp. 53-76). Baltimore, MD:Brooks.

disabilities/technology/en/

·       Petty, R. E. (2012): Technology Access in the Workplace and Higher Education forPersons with Visual Impairments: An Examination of Barriers and Discussion ofSolutions. Independent Living Research Utilization at TIRR: Houston, Texas.

·         WHO (2009): "Assistive devices/technologies", Available at: http://www.who.int/

TECHNOLOGY – A Boon to Persons with Learning Difficulties

TECHNOLOGY – A Boon to Persons with Learning Difficulties

     

What Is Assistive Technology?

Assistive technology can be defined as any item, piece of equipment or system that helps people bypass, work around or compensate for learning difficulties. Assistive technology is an umbrella term, which can be divided into two main groups: hardware and software. Hardware refers to actual equipment.     Eg: Tape recorders and Calculators.

Software refers to the programs that run on computers, telling the computers what to do.

The purpose of assistive technology is to work around specific deficits, rather than fixing them. It helps people with learning differences reach their full potential and live satisfying, rewarding lives. Assistive technology, however, should be a part of an overall program to help individuals with learning differences.

Why Use Assistive Technology?

Learning disabilities are professionally diagnosed learning difficulties— with reading, writing, speaking, listening, spelling, reasoning or math—that are the result of a presumed central nervous system dysfunction. Learning disabilities are neither cured nor outgrown. Children with learning differences grow up to be adults with learning differences. However, with hard work and helpful tools, children with learning differences can greatly improve their success in these areas. Assistive technology is one such tool.

Although we tend to think of learning differences in terms of the school setting, individuals with learning differences must also function at home, in the workplace, at social gatherings and in recreational activities. Easily portable tools—many of which are pocket-sized—allow individuals to bring a bypass strategy into many different settings.

Types of Assistive Technology:

Written Language Technologies

Word processors are computer-based writing systems that enable the user to type text onto a computer screen before printing on paper. In this way, the user can easily remove or add words, move sentences, and correct punctuation and spelling. Text is also easily underlined, boldfaced or centered. The ability to rearrange text in these ways may help reduce a writer’s fear of making errors, since the text can be changed easily. This frees the user to focus on what she wants to express, rather than on making the paper error-free.

Spell checkers are part of most word processing programs. They are also available as stand-alone desktop and pocket-size tools. Those attached to word processors scan a written document, show the user (usually by visually highlighting the word) any misspelled words, and offer a list of suggestions for the correctly-spelled word. Stand-alone spell checkers require users to enter the word (the way they think it is spelled) on a small keyboard. Some devices will simply verify and correct the spelling on a small screen; others offer a complete dictionary and thesaurus. Other devices actually “speak” the words by means of a speech synthesizer, allowing the user to hear as well as see text.

Proofreading programs are sometimes called “grammar checkers”. They are used in combination with word processing programs to check for errors in grammar, punctuation, capitalization and word usage. Suspected errors are identified on the computer monitor, and the user is given a chance to correct them before printing the document.

Speech synthesizers, together with screen review software, enable the user to hear text on a computer screen spoken aloud. Words are spoken in a computerized or “synthetic” voice through a sound card installed either inside or outside the computer. Users can review text they have written by reading it on the computer screen while, at the same time, hearing the words spoken aloud. Hearing the text may help persons catch writing errors—such as problems with grammar, or words that have been left out—that they might not have noticed by reading it. Speech synthesis is especially helpful to those who are better listeners than readers.

Speech recognition systems allow a person to operate a computer by speaking to it. In combination with a word processor, the user dictates to the system through a microphone. The spoken words then appear as text on the computer screen. There are two basic types of systems: discrete and continuous speech. Discrete systems require a short pause of approximately 1/10 of a second between words. Continuous speech systems allow the user to dictate without pausing between words. If speech recognition systems incorrectly recognize a word, the user can choose the correct word from a list of similar sounding words displayed on the screen.

Outlining programs, which are now included as part of many word processing programs, help the user create outlines. With just a few simple key strokes (or clicks with the mouse), the program automatically creates Roman numerals for major headings, and letters and numbers for minor headings. If the user decides to move text around, the program reorganizes the Roman numerals, letters and numbers for the headings.

Brain storming/Mind mapping programs enables writers to create a diagram of their ideas before writing an outline. First, the user types a main idea into the computer. That idea is displayed on the computer screen. Then the user types in related ideas that appear in different shapes—such as circles, ovals or rectangles—surrounding the main idea. Ideas can be linked with the main idea, or with each other, by lines. Ideas are easily moved and placed into different groups. After the diagram is completed, it can be changed to an outline automatically. This “free-form” graphic approach can be quite helpful to individuals who find it difficult to express their ideas in writing.

Word prediction Word prediction software can help a user during word processing by "predicting" a word the user intends to type. Predictions are based on spelling, syntax, and frequent/recent use. This prompts kids who struggle with writing to use proper spelling, grammar, and word choices, with fewer keystrokes.

Alternative keyboards allow the user to customize the keyboard by changing the layout and appearance of the keys. For example, in the standard position, the top row (of the alphabetic keys) starts with Q-W-E-R-T-Y. Alternative keyboards allow users to create their own order. For example, you can change the keys to go in alphabetical order, A-B-C-D-E-F. The letters can also be made larger in size. Specific options depend on the particular product. Individuals who have difficulty typing may find these devices helpful.

Reading Technologies

Optical character recognition (OCR) systems, when combined with speech synthesis, might be thought of as reading machines. The OCR enables the user to input hard copy text, such as books and letters, directly into a computer. The computer— or, more specifically, the speech synthesizer – reads the text back out loud. The OCR works with a scanner. The scanner reads images and text from the printed page. Next, it inputs the information into a computer file, and then onto a computer screen. The OCR changes the printed text from the scanner into computer/electronic text.

Tape recorders can be used to play audio taped text. Persons with reading differences can work around their problems by listening to recorded text (books, journals, newspapers), rather than reading it. Organizations offering audiotaped text generally require verification of a learning disability from a qualified professional. Keep in mind that not all audiotapes work on all tape recorders; they may have varying speeds (1 7/8 ips, 15/16 ips) and formats (two-track, four-track). So check to be sure that the tapes will work with your playback unit.

Variable speech control (VSC) tape recorders enable the listener to play audiotaped text faster or slower than it was originally recorded, without losing the actual sounds of the words. This feature may be quite useful for persons who understand spoken language better when the material is presented at a slower pace. VSC tape recorders typically allow listeners to slow down the original recording speed by 25% and increase the playback speed up to 100%.

Listening Technologies

Personal FM listening systems bring a speaker’s voice directly into a listener’s ear by means of a small transmitter unit (with a microphone), and an equally small receiver unit (with a head- or ear-phone). These wireless systems make the speaker’s voice sound stronger, which benefits those who have difficulty focusing on what a speaker is saying. A dial on the receiver unit controls the volume.

Varied tape recorders are used to capture spoken information, such as a teacher’s instructions or a classroom lecture. This permanent record allows people to refer back to an oral presentation. People who have difficulty processing, understanding or remembering what they hear may find this helpful. VSC tape recorders may be particularly helpful, since they allow the user to slow down or speed up the recording.

Organization / Memory Technologies

Personal data managers are available as software packages for a computer or as electronic hand-held devices. They may be useful to persons with organizational or memory difficulties. These managers provide a way to store and retrieve large amounts of personal information easily. For example, a user could keep phone numbers, addresses, important dates, appointments and reminders in a personal data manager. The person enters information on a keyboard, keypad or a stylus, and retrieves information the same way. The information is then displayed on a computer monitor or small liquid crystal display (LCD).

Free-form databases are software programs that enable the user to type notes into the computer in much the same way as he might write them down on a piece of paper. The note is displayed on the computer screen and can be stored in the computer’s memory. Specific notes are retrieved by typing in any piece of information contained in the note. For example, “Mike,” “birth” or “Dec.” could be used to retrieve the note, “Mike’s birthday is on December 8.” Such systems may be helpful to those persons who have difficulty organizing and remembering important information.

Math Technologies

Talking calculators use a built-in speech synthesizer to speak number, symbol or operation keys as they are pressed. They also read back answers from completed calculations. Hearing the numbers or symbols may help some people find input errors, such as pressing the wrong key. Also, hearing the answer aloud helps users double check for errors that may have been made when copying numbers, such as transposing 91 for 19, or confusing a 6 with a 9.

Electronic math worksheets can help the user organize, align and navigate through basic math problems on a computer screen. Addition, subtraction, multiplication and division problems are entered via keyboard or mouse and automatically aligned to the correct vertical format. Numbers on the screen can be read aloud by means of a speech synthesizer. These software programs may be helpful for individuals who have difficulty organizing and aligning math problems with pencil and paper.

Abbreviation expanders used with word processing programs which allow a user to create, store, and re-use abbreviate frequently-used words or phrases. This can save the user keystrokes and ensure proper spelling of words and phrases he has coded as abbreviations.

Electronic math work sheets are software programs that can help a user organize, align, and work through math problems on a computer screen. Numbers that appear onscreen can also be read aloud via a speech synthesizer. This may be helpful to people who have trouble aligning math problems with pencil and paper.

Graphic organizers and outlining programs help users who have trouble organizing and outlining information as they begin a writing project. This type of program lets a user "dump" information in an unstructured manner and later helps him organize the information into appropriate categories and order.

Information/data managers tool helps a person plan, organize, store, and retrieve his calendar, task list, contact data, and other information in electronic form. Personal data managers may be portable, hand-held devices, computer software, or a combination of those tools working together by "sharing" data.

Conclusion:

Assistive technology cannot fix or eliminate learning difficulties. However, by learning to capitalize on their strengths and bypass their weaknesses, individuals with learning differences can lead satisfying, successful lives. Thus assistive technology helps increase the independence of persons with learning differences.

References

·         Alliance for Technology Access.                                                                    www.ataccess.org

·         The American Printing House for the Blind, Inc.                                           www.aph.org

·         Center for Applied Special Technology (CAST)                                            www.cast.org

·         Center on Disabilities at California State University, Northridge.                 www.csun.edu/cod/

·         Closing the Gap                                                                                              www.closingthegap.com

·         International Society for Augmentative and

          Alternative Communication (ISAAC)                                                  www.isaac-online.org

·         Recording for the Blind and Dyslexic (RFB&D)                                          www.rfbd.org

·         RESNA Technical Assistance Project                                                            www.resna.org

·         Trafford Center for Technology and Learning Disabilities (TCTLD)   E-mail: center@frostig.org

·         http://www.readingrockets.org/article/assistive-technology-kids-learning-disabilities-overview

STRABISMUS OR SQUINT

Introduction

The medical name for squint is strabismus. It is a condition where the eyes do not look in the same direction. Whilst one eye looks forwards to focus on an object, the other eye turns either inwards, outwards, upwards or downwards. Most squints occur in young children.

A child with a squint may stop using the affected eye to see with. This can lead to visual loss called amblyopia, which can become permanent unless treated early in childhood. This treatment usually involves patching the good eye, to force the use of the affected eye. Sometimes surgery is needed to correct the appearance of a squint.

What is Squint

Squint is a misalignment of the two eyes so that both the eyes are not looking in the same direction. This misalignment may be constant, being present throughout the day, or it may appear sometimes and the rest of the time the eyes may be straight. It is a common condition among children.
        When the eyes are not aligned properly, each of the eyes is focusing on a different object and sends signal to the brain. These two different images reaching the brain lead to confusion and may have either of the two effects:

        A child would ignore the image coming from the deviated eye, and thus sees only one image. But in the process, he loses the depth perception. This suppression of the image from the deviating eye results in poor development of vision in this eye, which is known as Amblyopia.

Types of strabismus

There are different types of strabismus. They can be described by the cause or by the way the eye turns. The following terms describe strabismus by the positions of the eye:

• Hypertropia is when the eye turns upwards
• Hypotropia is when the eye turns downwards
• Esotropia is when the eye turns inwards
• Exotropia is when the eye turns outwards

An early diagnosis of strabismus will enable more effective treatment.

What are the symptoms of Squint Children

The sign of a squint is fairly obvious from an early age. One of the eyes does not look straight ahead. A minor squint may be less noticeable. Infants and newborns may go cross-eyed, especially if they are tired. This does not mean that they have a squint. Parents can check with their doctor.

If a child has one eye closed, or turns their head when looking at you, this could be a sign of a possible squint. Strabismus is normally either present at birth or it develops in the first 6 months after birth.

         In a child, the parents may notice the deviation of eyes. It is important to remember that the eyes of a newborn are rarely aligned at birth. Most establish alignment at 3-4 weeks of age. Therefore squint in any child who is more than one month old must be taken seriously and should be evaluated by an ophthalmologist.

          A squint can be a cosmetic problem. Many older children and adults who did not have their squint treated as a child have a reduced self-esteem because of the way their squint looks.

What causes Squint

       The exact cause of squint is not really known. The movement of each eye is controlled by six muscles that pull the eye in various directions. A squint develops when the eye muscles do not work in a balanced way and the eyes do not move together correctly. This loss of coordination between the muscles of the two eyes leads to misalignment. This misalignment may be the same in all directions of gaze, or in some conditions the misalignment may be more in one direction of gaze, e.g., in squint due to nerve palsy.

Strabismus can be:

• congenital, meaning a person is born with it
• hereditary, or running in families, suggesting a genetic link
• the result of an illness or long-sightedness
• due to a lesion on a cranial nerve

If the eye cannot focus the light as it comes in through the lens, this is known as a refractive error.

Other problems that can lead to strabismus include:

• myopia, or short-sightedness
• hypermetropia, or long-sightedness
• astigmatism, where the cornea is not curved properly

A refractive error tends to make the affected eye turn inward, in an attempt to get better focus. Strabismus that results from refractive errors tends to emerge later on, usually around the age of 2 years or older.

Diagnosis and treatment

        Children and babies should have routine eye checks as they develop. The American Optometric Association recommends starting eye tests at 9 months, or earlier if the child has a constant eye turn. If there are signs of strabismus, the physician or optician will refer the child to an ophthalmologist.

      The ophthalmologist will probably use eye drops that dilate the pupils before the test is done. The Hirschberg test, or Hirschberg corneal reflex test, is used to assess whether the patient has strabismus.

      The ophthalmologist shines a light in the eye and observes where the light reflects from the corneas. If the eyes are well-aligned, the light will go to the center of both corneas. If it does not, the test can show whether the patient has exotropia, hypertropia, esotropia or hypotropia.

Treatment options

       Prompt treatment reduces the risk of complications, such as amblyopia, or lazy eye. The younger the patient is, the more effective treatment is likely to be.

Treatment options include:

• Glasses: If hypermetropia, or long-sightedness, is causing the squint, glasses can usually correct it.
• Eye patch: Worn over the good eye, a patch can get the other eye, the one with the squint, to work better.
• Botulinum toxin injection, or botox: this is injected into a muscle on the surface of the eye. The doctor may recommend this treatment if no underlying cause can be identified, and if signs and symptoms appear suddenly. The botox temporarily weakens the injected muscle, and this can help the eyes to align properly.
• Eye drops and eye exercises may help.

      Surgery is only used if other treatments are not effective. It can realign the eyes and restore binocular vision. The surgeon moves the muscle that connects to the eye to a new position. Sometimes both eyes need to be operated on to get the right balance.

Exercises

A standard type of exercise for strabismus is home-based pencil pushups (HBPP).

To do HBPP, follow these steps:

1. Hold a pencil at arm's length, around midway between the eyes
2. Look at the pencil while moving it toward the nose, and try to maintain a single image of it
3. Keep moving the pencil toward the nose until you can no longer see it as a single image
4. Hold the pencil at the closest point where a single image is possible
5. If you cannot regain a single image, start again

A study of patients who did two sets of 20 "push-ups" each day for 12 weeks suggested that the exercise can be "an easy, cost-free, and effective therapy."

Conclusion

      Treatment of strabismus and amblyopia in childhood reduces the risk of later visual and employment disadvantage and maintains a more stable ocular alignment. Treatment of amblyopia in adulthood is not yet a possibility. There will be an increasing trend to early squint surgery in young children and an increase in demand for strabismus surgery in elderly patients.

References:

·         https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539363/

·         http://www.eyerobics.com.au/squint.html

·         http://www.medicalnewstoday.com/articles/164512.php