visual aids research

• Corpus ID: 41964870

Impact of Visual Aids in Enhancing the Learning Process Case Research: District Dera Ghazi Khan.

• Ghulam Shabiralyani , K. Hasan , +1 author N. Iqbal
• Published 2015
• Journal of Education and Practice

237 Citations

The impact of visual aids on students’ academic performance: a case of mkuranga district secondary schools, teachers’ perception towards the use of visual learning aids in efl classroom, the use of audio-visual aids in enhancing students’ speaking motivation in efl speaking classes, efficacy of audio-visual teaching materials in efl classes: the case of two elementary schools in addis ababa, ethiopia, visual literacy in the lived experiences of bsed students in utilizing canva, visual materials in classroom teaching learning: a case study on nonformal primary school, using visual aids to enhance third year undergraduate teacher trainee students’ academic performance in reproduction and growth in flowering plants, smart visual syllabus for higher education: a solution during the covid-19 global lockdown, application of visual didactic regulators in distance learning, effectiveness of visual aids in teaching of english at secondary school level, 9 references, implications of learning theories for effective technology integration and pre-service teacher training : a critical literature review, educational technology, the benefit of integrating technology into the classroom, horizons in human geography, computers in the classroom, models in geography, social science research methods, related papers.

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Making the Most of Visual Aids

Three strategies for using visual aids to encourage students to engage more deeply with course content.

Most teachers understand the power of visual aids in helping students grasp content. Teachers value the support that visuals lend to classroom instruction because they encourage students to make associations between pieces of information, soak up chunks of course content quickly, and function as a memory aid.

But sometimes we teachers don’t approach the use of visual aids as carefully as we should. We may be too lax in monitoring how students interpret visuals (allowing the oversimplification of content) or how students create visuals (which shows whether they understand what should be included). As a result, students struggle to make the needed connection with course content.

As an educator who relies on graphic organizers and charts in the classroom, I have three strategies for using visual aids without sacrificing course content.

Sharing Intent

We often naively believe that a visual can stand on its own with minimal explanation. Instead, we should directly communicate to students what we hope for them to see (or interpret) based on the lesson at hand. For example, it’s useful to help students explore why the visual was selected and what the key characteristics of it are, and to identify the non-essential elements of it. And we should specify what we intend for the students to know after examining it. For instance, Professor Howard Cox’s purpose in integrating props like an officer’s cap and a replica revolver into his lectures on fiction set during the Civil War is to help build his students’ foundational knowledge about an author’s purpose and inspiration.

If time allows, I like to share a “runner-up” image and invite students to consider why the image didn’t make the cut. This discussion can deepen their understanding. And teachers can use prompts to help students reach that deeper understanding. Examples include “This image is a stronger representation of the concept because _____” and “This image makes me think about _____ from our lesson, which is important because _____.”

Activating Discussion

Most teachers encourage some level of class discourse when presenting a visual aid, but we need to go a step further. We can promote a conversation about how the visual helps in processing the course content. For example, ask students to share how the visual reinforces—or challenges—what they previously learned about relevant vocabulary terms. In my College Readiness class, we review a line graph that compares letter grades and attendance, discussing how the upward direction of the lines supports our expectations of a connection between consistent attendance and higher grades. We also question the story presented by the graph: Beyond lower grades, what consequences do absentee students face?

To increase students’ processing opportunities, use a think-aloud to get students talking about what makes a visual useful vs. the qualities that seem less important to understanding the theme or central message of the graphic or its connection to other content.

Push students to think deeper. For instance, in order to promote retrieval practice , put the visual away and ask students to break down the concepts represented in the visual relying solely on their memory. It’s important to discuss any discrepancies between what the students recall and what’s actually present in the image.

This is an excellent opportunity to explore misconceptions about the concept at hand. It’s also an ideal time to highlight any blind spots or typical areas of confusion related to the concept. For example, when sharing a bar graph, caution students that the measurement scale can lead them to misread it, especially if the y-axis starts with a random number instead of zero or if information is measured in the short term instead of the long term.

Creating Visual Aids as a Class

I believe involving students in the design of visual aids is essential to foster buy-in and learning ownership, but initially, students may hesitate to create their own visuals and take on the designer role.

Establishing design parameters for students should help. For example, limit their format options by specifying the type of graphic organizer or chart they can use, and provide time to discuss what kinds of visuals would potentially work best based on the content at hand. You can also assign a specified number of key concepts—based on the content reviewed—that students are required represented with their visual.

For students who continue to seem uncertain about creating a visual on their own, educator Matt Miller explains the value of maintaining a library of icons  (related to the topic, of course). Such a library allows students to focus on making meaning from the course material instead of becoming frustrated with the design work.

In addition to parameters, offer models. Make a point of asking students if it’s OK to share their visual with peers, and let them know why you wish to share their work. And teacher models are priceless. Dr. Deidra Gammill, a high school teacher in Mississippi, makes a habit of including images in her notes in order to provide concrete examples for her students to follow.

It’s not enough for a visual to capture attention—it should help students become more engaged. Over time, I’ve learned that aligning visual aids with course content is a deliberate process, one that is harder than I realized when I was starting out. With appropriate attention, we can ensure that our visual aids are windows to our lessons’ purpose and construction.

Visual Aids Supporting the Learning of Children in Our Classrooms

• First Online: 12 October 2016

Cite this chapter

• Nikki Cardillo 4  

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The focus of this study was to find out how teachers valued visual aids within the classroom, what students or learners they felt benefit most, and what visual aids they incorporate in their teaching practices. From observation I saw examples of visual aids being used beneficially for behaviour management, for modelling tasks to be undertaken by students, and for classroom management through the implementation of a visual timetable. I also discussed visual aids with six teachers, all of whom indicated that visual aids were very important for creating interest and engaging students, although the types of learners they felt benefitted most and the type of visual aids they incorporate varied. I had initially thought that visual aids were there to assist visual learners and students with learning difficulties, but this experience opened my mind to their various benefits for many more students than I had originally thought. Students and classrooms are different and it is up to the teacher to select the most appropriate resources to maximise effectiveness. Selecting relevant visual aids can support and enhance learning opportunities for all students, not just individuals or a select group.

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Department of Education, Training and Employment. (2014). Tips for visual cueing systems. http://education.qld.gov.au/asd-online-resource-kit/schools/learning-environment/docs/visual-cueing-systems.doc . Accessed 7 Jan 2016.

University of Alabama School of Medicine—UAB. (2005). Successfully using visual aids in your presentation . http://www.uab.edu/uasomume/fd2/visuals/page2.htm . Accessed 7 Jan 2016.

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Cardillo, N. (2017). Visual Aids Supporting the Learning of Children in Our Classrooms. In: Geng, G., Smith, P., Black, P. (eds) The Challenge of Teaching. Springer, Singapore. https://doi.org/10.1007/978-981-10-2571-6_20

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Action & Brain Lab research shows how early exposure to sign language enhances perception

Imagine you are watching a ballet performance with a friend who is a professional ballerina, suggests Dr. Lorna Quandt, Co-Director of Gallaudet’s Visual Language and Visual Learning Center. Assuming you are not also a professional ballerina, the two of you are experiencing something different. “She knows the names of the moves, and she has done the moves. You’re just watching something interesting to look at,” she says. Because of that, your friend will be more accurate at predicting how the choreography will unfold.

Using this idea, Quandt’s Action & Brain Lab (ABL) has been digging into a related question: Are people who are fluent in sign language experts in human movement more generally? ABL’s new paper on this research, “ Differences in Biological Motion Perception Associated with Hearing Status and Signed Language Exposure ,” has been officially accepted for publication in the Journal of Experimental Psychology: General.

To test her question, Quandt had subjects look at moving images on a screen. Each participant saw a display of moving dots representing the joints on the body of a person engaged in a physical activity. “Instead of seeing a person running or swinging a golf club, you just see the dots, which is this pared down, simplistic representation,” she explains. Then they were asked whether this movement requires a ball. To make the test more difficult, some of the videos were flipped upside down.

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It is also relevant to an ongoing debate over whether deaf people should be allowed to drive. “If we have literal data showing that deaf people see movement better, maybe that can fight against backward-thinking laws,” Quandt says.

As the next step in her research, Quandt plans to look into the neural underpinnings of this heightened perception and try to understand more about what is happening in a deaf person’s brain while seeing movement​.

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Use of audio-visual aids and case studies to enhance understanding of family medicine among medical students

Stephen t. engmann.

1 Family Medicine Unit, Manna Mission Hospital, Accra, Ghana

2 Family Health Medical School, Family Health University College, Accra, Ghana

Teaching family medicine to medical students is primarily intended to aid in their understanding of the distinctive and significant role that the speciality performs within the healthcare system. Improving medical students’ comprehension of family medicine may have an impact on their decision to pursue family medicine as a speciality. It is important to use innovative evidence-based teaching and learning strategies and ensure that medical students receive extra learning opportunities in family medicine. This is a short report highlighting the use of audio-visual aids and case studies to enhance the understanding of family medicine principles among undergraduate medical students attending a private university in Ghana.

Contribution

This short report offers family medicine teachers and educators at the undergraduate level an example of how to apply audio-visual aids and case studies to enhance the understanding of family medicine principles among students. The report contributes to the growth of family medicine as a speciality within the African context.

In sub-Saharan Africa (SSA), family medicine is still developing and is responsive to the unique requirements of the communities it serves as well as organisational structures and health system designs. 1 Helping medical students to comprehend the unique and significant role family medicine plays within the healthcare system is the primary objective of teaching family medicine. 2 A study in Ghana among medical students reported a good familiarity with family medicine, yet few of them wish to specialise in it because of an inadequate understanding of the field. 3 , 4 The medical students lacked the knowledge necessary to influence their decision to pursue family medicine as a speciality. 4 It was, therefore, necessary to provide medical students with early exposure to the principles of family medicine. 3 , 4 , 5 In most undergraduate curricula, there is little room for family medicine instruction and so more needs to be done to promote inclusivity within this field. 6

Medical education should be flexible enough to accept and make use of multidisciplinary teaching paradigms, beginning in the preclinical years. 7 The core values of family medicine among students and trainees can be strengthened by encouraging one another and sharing and using innovative educational methods. 8 These core principles of family medicine that students are exposed to include compassionate care; a holistic approach to care focusing on the whole person, the family and the community; continuity and coordination of care; a trusted patient–physician relationship and lifelong learning. 2 Following this background, this short report highlights the use of audio-visual aids and case studies to enhance the understanding of family medicine principles among undergraduate medical students in a private university college in Ghana.

Experience of introducing medical students to family medicine

This short report is an account of the teaching and learning activities in family medicine undertaken by the author at the Family Health Medical School of the Family Health University College located in the Greater Accra region of Ghana. Family Health Medical School is a private medical school affiliated to the University of Ghana. 9 As part of the medical school curriculum, students are exposed to family medicine through lectures during their coordinated course in medicine and surgery in the fourth year of their medical training. During this period, the students are introduced to the concepts, principles and core values of family medicine. The author has been a course instructor or lecturer for family medicine in the school since the year 2021. The topics students are taught to introduce them to family medicine include Patient–Centred Care and the Family Physician, Family Dynamics in Health and Disease, General Systems Approach to Health and Disease, Coordination in Patient Care, Communication in Family Medicine and the Role of Spirituality in Patient Care. During these lecture sessions, audio-visual aids and case studies are employed to enhance the understanding of students in the different aspects of the field of family medicine.

Use of audio-visual aids

An audio-visual aid has been defined as any tool that expands on what a person already knows from reading by using sight and sound. 10 When there is a clear connection between the visual aids and the course material, students find the sessions relevant and beneficial. 10 , 11 Furthermore, using audio-visual aids in the classroom can help teachers improve lesson ideas and give students new ways to digest knowledge. 11 In the use of these aids by the author, videos chosen for this purpose are usually concise with a direct message about the topic and are of short duration to avoid the boredom that can arise from watching a long video. The videos serving as audio-visual aids are downloaded from youtube and are played and projected on a screen through a projector. Students are usually encouraged to share their reflections on the video with the class after watching the video. Table 1 12 , 13 , 14 , 15 shows the video description and web links to some of the videos used for teaching.

Video description and web links to sample videos used for teaching medical students.

Source: Please see the full reference list of the article Engmann ST. Use of audio-visual aids and case studies to enhance understanding of family medicine among medical students. Afr J Prm Health Care Fam Med. 2024;16(1), a4278 https://doi.org/10.4102/phcfm.v16i1.4278 , for more information

Use of case studies

Findings from a meta-analysis on the effectiveness of case-based learning suggests that it is an active teaching strategy when applied in pharmacy and medical education. 16 Case studies are frequently used to enhance and supplement didactic instructional content, and they can be customised for a range of teaching contexts. 17 , 18 The case study approach encourages students to get the theoretical knowledge and practical skills necessary to carry out their professional duties. 18 The use of case studies has been demonstrated to boost students’ interest in contemporary medical issues and solutions to problems in the international medical community. 18 For example, in the teaching of the students at the Family Health Medical School, one of the areas where case studies were applied was in the coordination of care. Separate case studies are presented to students to demonstrate care coordination as well as fragmented care. ‘Ms. G: A case study in fragmented care’ is an example of a case study used during lectures. 19 This case study serves as an example of the dangers of fragmented care, which involves numerous clinicians who are not efficiently exchanging information. ‘Ms. H: A case study in coordinated care’ is another case study used to illustrate how care coordination can be organised by a primary care doctor. 19 The case discussions that follow help students to understand care coordination and enable them to compare that to care fragmentation. In the case of fragmented care, students are guided to propose how fragmentation could have been avoided to achieve better care outcomes.

Reflections

From the experience of the author, the audio-visual aids are able to capture students’ attention. They make it easier to convey the concepts and principles of family medicine. The videos used are intended to summarise the didactic lectures delivered and consolidate the information received from the lecturing material more simply. Furthermore, the use of case studies is a way of identifying and implementing strategies that will give medical students both an academic foundation and practical experience.

The early introduction of family medicine concepts to medical students is necessary to address the inadequacies in understanding the field. Students’ understanding can be enhanced through employing innovative teaching methods like the use of audio-visual aids and case study methods. The next steps would involve researching the impact of these teaching and learning aids in improving the understanding of students in the field of family medicine.

How to cite this article: Engmann ST. Use of audio-visual aids and case studies to enhance understanding of family medicine among medical students. Afr J Prm Health Care Fam Med. 2024;16(1), a4278. https://doi.org/10.4102/phcfm.v16i1.4278

Note: Special Collection: Innovative educational methods for FM training in Africa.

• Open access
• Published: 31 August 2024

Prevalence of cerebral visual impairment in developmental and Epileptic Encephalopathies: a systematic review protocol

• Martina Giorgia Perinelli 1 ,
• Megan Abbott 3 , 4 ,
• Ganna Balagura 1 ,
• Antonella Riva 1 ,
• Elisabetta Amadori 2 ,
• Alberto Verrotti 5 ,
• Scott Demarest 3 , 4 &
• Pasquale Striano   ORCID: orcid.org/0000-0002-6065-1476 1 , 2  

Systematic Reviews volume  13 , Article number:  223 ( 2024 ) Cite this article

Metrics details

Developmental and Epileptic Encephalopathies (DEEs) are defined by drug-resistant seizures and neurodevelopmental disorders. Over 50% of patients have a genetic cause. Studies have shown that patients with DEEs, regardless of genetic diagnosis, experience a central visual function disorder known as Cerebral (cortical) Visual Impairment (CVI). The prevalence of CVI in DEE patients is currently unknown. A quantitative synthesis of existing data on the prevalence rates of this condition would aid in understanding the magnitude of the problem, outlining future research, and suggesting the need for therapeutic strategies for early identification and prevention of the disorder.

The protocol followed the PRISMA-P statement for systematic review and meta-analysis protocols. The review will adhere to the JBI Manual for Evidence Synthesis (Systematic Reviews of Prevalence and Incidence) and use the CoCoPop framework to establish eligibility criteria. We will conduct a comprehensive search of several databases, including MEDLINE, EMBASE, Science Direct, Scopus, PsychINFO, Wiley, Highwire Press, and Cochrane Library of Systematic Reviews. Our primary focus will be determining the prevalence of cerebral visual impairments (Condition) in patients with developmental and epileptic encephalopathy (Population). To ensure clarity, we will provide a narrative summary of the risk of bias in the studies we include. The Cochrane Q statistic will be used to assess heterogeneity between studies. If the quantitative synthesis includes more than 10 studies, potential sources of heterogeneity will be investigated through subgroup and meta-regression analyses. Meta(bias)es analysis will also be performed. The quality of evidence for all outcomes will be evaluated using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology.

This protocol outlines a systematic review and meta-analysis to identify, collect, evaluate, and integrate epidemiological knowledge related to the prevalence of CVI in patients with DEEs. To the best of our knowledge, no other systematic review and meta-analysis has addressed this specific issue. The results will provide useful information for understanding the extent of the problem, outlining future research, and suggesting the need for early identification strategies.

Systematic review registrations

This Systematic Review Protocol was registered in PROSPERO (CRD42023448910).

Peer Review reports

Introduction

Background and rationale.

Developmental and Epileptic Encephalopathies (DEEs) are characterized by epileptic seizures, mainly drug-resistant, neurodevelopmental disorders (neuro- and psychomotor regression, intellectual disability, cognitive impairment, behavioural disorders, and relational difficulties) [ 1 ]. In both clinical and pre-clinical studies, it has been observed that patients with DEEs, regardless of the genetic diagnosis, present a disorder of visual functions of central origin defined in the literature as “Cerebral (cortical) Visual Impairment” (CVI) [ 1 ]. The clinical features of CVI differ from patient to patient [ 2 ] and are represented by a broad spectrum of visual disorders that include ophthalmological, oculomotor and perceptual anomalies [ 3 ]. Patients with DEEs may present with oculomotor and perceptual alterations, and visuospatial and visuo-perceptual dysfunctions [ 1 ]. The clinical presentations are attributable to anomalies of the primary visual pathway and associated visual areas. Abnormalities of the oculomotor apparatus and ocular system can be associated.

The ILAE Task Force on Nosology and Syndrome Definition divides DEEs according to the age of onset of the first seizure [ 1 ]. More than half of patients have a genetic aetiology.

To date, the relationship between epileptic seizures, neurodevelopmental disorders and CVI is very complex and severe neuro- and psychomotor delay and intellectual disability often have a strong negative impact on the quality of life of patients and their caregivers/families.

Different studies conducted in recent years [ 4 , 5 , 6 , 7 , 8 , 9 ] in patients with CDKL5 Developmental and Epileptic Encephalopathy (CDKL5-DEE) have shown that CVI is one of the main features of the disease. Similarly, studies conducted in the early 2000s in patients with West Syndrome [ 10 , 11 , 12 ] demonstrated that visual function skills were already impaired at the onset of the spasms. Studies with similar results have been conducted in patients with Dravet syndrome [ 13 , 14 ]. Furthermore, CVI is a common feature of other forms of DEEs. For instance, it has been identified in patients with mutations in the KCNQ2 [ 15 ], SCN3A [ 16 ], SCN8A [ 17 ] and GRIN2B [ 18 ] genes. Nowadays, the prevalence of CVI in patients with DEEs, regardless of genetic diagnosis, is unknown. A quantitative summary of the existing data on the prevalence rates of this condition would aid in comprehending the extent of the problem, outlining future research, and suggesting the need for therapeutic strategies for early identification and prevention of the disorder. Early identification allows the implementation of “early intervention” programs necessary to address difficulties already emerging as risk conditions for neuro-developmental disorders during “critical periods” of neuronal plasticity [ 19 ]. Cortical circuits show a maximum sensitivity to sensory stimuli induced by experience in the postnatal period [ 20 ] compared to adulthood. Exposure to an “enriched environment”, as occurs in early neuro-rehabilitative intervention, stimulates axonal plasticity and synaptic reorganization [ 21 ] and has been shown to accelerate the development of the visual system [ 22 , 23 ]. In this theoretical framework, the quantitative analysis of the prevalence rate of CVI in patients with a diagnosis of DEEs, according to the ILAE classification [ 1 ], is therefore necessary. A preliminary search for previous systematic reviews was conducted in the Cochrane Library, PubMed and PROSPERO.

This systematic review aims to describe the prevalence of Cerebral Visual Impairment (CVI) among patients with a diagnosis of Developmental and Epileptic Encephalopathies (DEEs) according to the 2021 International League Against Epilepsy (ILAE) classification [ 1 ].

The proposed systematic review will address the following questions:

What is the prevalence of CVI among patients with DEEs?

What study methodological characteristics explain the heterogeneity in results?

This study followed the PRISMA-P statement [ 24 ] for systematic review and meta-analysis protocols and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) network [ 25 ]. The JBI Manual for Evidence Synthesis (Systematic Reviews of Prevalence and Incidence) [ 24 ] will be used for the review [ 26 ].

Inclusion criteria

We will use the condition, context and population framework (CoCoPop) for the systematic review of prevalence and incidence to formulate the eligibility criteria [ 27 ].

Condition: CVI must have been diagnosed and examined by a physician in clinical studies with an objective neuro-visual assessment. The diagnosis of CVI is indicated for children showing abnormal visual responses that cannot be attributed to the eyes themselves. Despite intense stimulation, a child may not be able to fixate and follow, and his/her reaction to faces is abnormal [ 2 , 3 , 4 ].

Context: there will be no restrictions by type of setting.

Population: We will include clinical studies examining patients with Developmental and Epileptic Encephalopathies (DEE) of broad genetic aetiologies. There will be no restrictions based on sex, age, race/ethnicity, or geographic region. DEEs described in eligible clinical studies must have been diagnosed by a physician based on the criteria from the ILAE Epilepsy Diagnosis.org Task Forces [ 1 ]. DEEs are defined as diseases where there is a developmental impairment related to both the underlying aetiology independent of epileptiform activity and epileptic encephalopathy. We will include studies involving patients with “Early Infantile DEE” with onset under 3 months of age and other syndromes which either typically present after 3 months of age or have a spectrum of onset encompassing early and late infancy.

Studies: We will include all completed publications reporting the assessment of CVI in patients with DEEs in clinical (observational, cohort studies, cross-sectional studies, retrospective studies) and pre-clinical (in vivo) studies.

Outcome measure: the primary outcome will be the prevalence of CVI indicating the number of people with DEEs that have the disorder at a given point in time. The secondary outcome will be the prevalence of a specific genetic mutation in the group of patients with DEEs and associated CVI, by calculating the number of patients with a specific genetic diagnosis of DEEs and CVI divided by the total number of patients with DEE and CVI.

Language: We will include articles reported in English and Italian.

Search strategy

Comprehensive literature searches of electronic bibliographic databases will be conducted. The specific search strategies will be created by a Health Sciences Librarian with expertise in systematic review searching using Medical Subject Headings (MeSH) and text words related to CVI and DEEs. An independent librarian, not associated with the project, will peer-review the MEDLINE strategy developed by the project team. A draft search strategy for PubMed is provided in Additional file 1. We will search MEDLINE, EMBASE, Science Direct, Scopus, PsychINFO, Web of Science, Wiley and Highwire Press and Cochrane Library of Systematic Reviews. No time restrictions will be placed on the date of publication. Upon completion, identified citations will be exported to a cloud-based citation manager for study selection. A final grey literature search will be conducted on medical books and reports from experts, as well as a review of a trial register for any ongoing and unpublished studies. Further, to ensure literature saturation we will scan the reference lists of included studies or relevant reviews identified through the search. Duplicate citations will be removed. The search strategies will be updated until the end of the review.

Study selection

All records will be independently assessed by two reviewers and reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Following the initial search, titles and abstracts of articles will be screened for eligibility. Second, full texts will be reviewed. As a final step, references will be manually searched for all articles considered to identify relevant reports that were missed in the search strategy. A discussion will be conducted between the reviewers in case of disagreements.

Data collection process

A data extraction form will be designed to extract equivalent information from each study report. From each eligible study, data will be extracted independently and in duplicate by two reviewers. Before starting the review, calibration exercises will be conducted to ensure consistency across reviewers. When data are ambiguous or missing from the published study, we will contact the corresponding authors of the included studies to obtain any key information. Furthermore, we will discuss the potential impact of missing data as a limitation. Data extraction will be independently cross-checked.

Data collection will include the following items:

Study Details :

Reviewer: details and ID of the primary reviewer

Study ID/ Record number

Date when the data extraction will be filled

Study title: full title of the study

Author’s name,

Year of publication

Journal in which the article is published

Study method :

Aims of the study

Study design (cross-sectional. Cohort, or randomized control trial)

Setting (hospital-or community-based)

Follow-up or study duration for cohort studies and clinical trials

Study population: sample size, mean or median age, age range, sex ratio, inclusion and exclusion criteria of participants

Primary outcome: CVI

Secondary outcome: genetic diagnosis DEEs

Covariates : method used to assess CVI, mean or median age at diagnosis of DEEs, proportion of patients without CVI, acquired neurodevelopmental milestones, developmental quotient (DQ) and Intellectual Quotient (IQ).

Prevalence estimates (e.g. number of subjects with the disorder, proportion and 95% confidence interval), where prevalence is not directly reported and is feasible, it will be calculated using reported case numbers and sample sizes in individual studies

Prevalence estimates of genetic diagnosis of DEEs and CVI will be calculated using reported case numbers divided by the total sample size

Author’s comments

Reviewer comments.

Risk of bias assessment

The “JBI Critical Appraisal Checklist for Studies reporting prevalence data” [ 27 ] conceived by the JBI research organization based in the Faculty of Health and Medical Sciences at the University of Adelaide, South Australia will be used to assess the risk of bias in prevalence studies on selected articles. The tool includes 9 questions and the overall appraisal (include, exclude, seek further info). Quality assessment will be undertaken by two reviewers independently. The reviewers will then discuss the results of the critical appraisal for the final appraisal. Disagreements will be resolved by discussion, and a third reviewer may be required.

Data synthesis and meta-analysis

Investigation of heterogeneity.

Heterogeneity between studies will be assessed using Cochran’s Q statistic ( p  > 0.05). In addition, the I 2 statistic will be used to measure the percentage of inter-study variability [ 28 ]. The value of I 2 will be classified as small if 0 < I 2  < 25%, medium if 25% < I 2  ≤ 50%, and large if I 2  > 50% [ 28 ]. The category of the I 2 statistic will determine whether a meta-analysis is possible.

Characteristics of included studies will be presented in summary tables and narrative text. In expectation of prevalence varying between studies and populations, pooled prevalence estimates for the prespecified outcomes of interest will be calculated by applying a random-effects model [ 29 ]. The results will be presented graphically in a forest plot. R software version 3.6.1 (R Core Team, Vienna, Austria) will be used to combine data, along with 95% confidence intervals (95% CI).

If the I 2 is large, then a meta-analysis will be considered not possible, and a narrative qualitative summary will be done. The narrative description will include a presentation of the quantitative data reported in individual studies, along with the point and interval estimates for the effects, where available. Otherwise, a meta-analysis will be deemed feasible.

Additional analyses

If more than 10 studies are included in the quantitative synthesis, the potential sources of heterogeneity will be investigated by subgroup and meta-regression analyses [ 29 , 30 ]. The potential effect modifiers considered will be the following: genetic diagnosis of DEEs, child neurodevelopment, DQ or IQ, or neurodevelopmental regression, seizure onset, type of studies (observational vs experimental), and type of CVI assessments.

We will use the model F value and its statistical significance to assess whether there is evidence for an association between any of the covariates and the outcome; all covariates with p -value < 0.1 in bivariate models will be added to the multivariable model, in which a p -value < 0.05 will be considered statistically significant. The model fit will be assessed using the proportion of the between-study variance explained by the covariates (adjusted R2) [ 31 ]. To control for the risk of type I error when performing meta-regression with multiple covariates, we will perform Monte Carlo permutation tests to calculate P values adjusted for type 1 error and we will check if there is a change in statistical significance [ 32 ].

Meta-bias(es)

A. publication bias across studies.

If 10 or more eligible studies are found, the symmetry of the funnel chart will be used to assess publication bias, supplemented by quantitative analysis using Egger’s test. The test represents a regression analysis in which the precision of each included study is defined as the independent variable, while the ratio between its effect size and its standard error is the dependent variable. If the test is not statistically significant, it is possible to reject the hypothesis in favour of the presence of a publication bias [ 33 ].

B. Sensitivity analyses

The robustness of the results will be assessed by performing sensitivity analyses to measure the impact of low-quality studies (identified through the risk of bias). Low-quality studies will be removed one by one and the meta-analysis will be rerun. We will then compare the results of meta-analyses with and without assessed studies, also considering the study sample size, the strength of evidence, and the impact on aggregated effect size. However, if all included studies are at high risk of bias, no sensitivity analysis will be performed.

Confidence in cumulative estimate

Grade assessment.

The quality of evidence for all outcomes will be judged using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology [ 34 ] as suggested in the literature study on conducting systematic reviews of the literature on the prevalence of a given pathology in a category of individuals [ 35 ]. The quality of evidence will be assessed in all areas of risk of bias. Additional domains may be considered where appropriate. Quality will be adjudicated as high, moderate, low or very low [ 36 , 37 ].

The systematic review and meta-analysis presented in this protocol will identify, collect, evaluate and integrate the epidemiological knowledge underlying the prevalence of CVI in patients with DEEs. We are not aware of another systematic review and meta-analysis addressing the specific issue. In our opinion, this systematic review will fill the gap by estimating the pooled global prevalence of CVI in DEE patients useful for understanding the extent of the problem, outlining future research, and suggesting the need for early identification strategies.

The results of this study will be of interest to multiple audiences, including patients, their families, caregivers, clinicians, researchers, scientists, and policymakers.

Scientific communities can better understand how and what to implement in protocols and intervention programs for patients with DEEs by having objective data on the prevalence of this disorder. In addition, this may be useful for the creation of neuro-visual assessment protocols to be used in clinical practices and to incorporate patients into neuro-rehabilitation programs (early intervention) as soon as possible.

Strengths and limitations

The intended systematic review and meta-analysis will fill the knowledge gap on the prevalence of CVI in patients with DEEs. The eligible studies will be identified through a methodical literature search followed by a rigorous screening process; we will then use robust meta-analysis tools to pool the data and provide reliable estimates of the global prevalence of CVI in DEE patients. We anticipate that we will identify knowledge gaps to be filled by new epidemiological research considering that the prevalence of CVI in patients with DEEs has been poorly covered in the literature. In this regard, implications for future epidemiological research will be discussed in the final manuscript.

Conclusions

The purpose of this systematic review is to provide evidence supporting or refuting the hypothesis that CVI is prevalent in a large percentage of patients with DEEs, regardless of genetic diagnosis.

Overall, the review will complement the evidence base on the causes of developmental and epileptic encephalopathies. Similarly, it can provide scientific evidence for a neurovisual assessment protocol that can be validated and then proposed to epilepsy clinics and paediatric neurological departments.

Thus, a patient can be included in an “early intervention” program to prevent and support neuro and psychomotor development, as well as in a precision medicine program to prevent/treat epileptic seizures at the onset.

Availability of data and materials

Not applicable.

Abbreviations

CDKL5 Developmental and Epileptic Encephalopathies

Condition, Context and Population framework

Cerebral Visual Impairment

Developmental and Epileptic Encephalopathies

Developmental Quotient

Grading of Recommendations Assessment Development and Evaluation

International League Against Epilepsy

Intellectual Quotient

Medical Subject Headings

Preferred Reporting Items for Systematic Reviews and Meta-analyses

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Acknowledgements

This work was developed within the Framework of the DINOGMI Department of Excellence of MIUR 2018-2022 (legge 232 del 2016). Research supported by PNRR-MUR-M4C2 PE0000006 Research Program “MNESYS”—A multiscale integrated approach to the study of the nervous system in health and disease. IRCCS ‘G. Gaslini’ is a member of ERN-Epicare.

The open publication fee was paid by funding 'HUMANITAS MIRASOLE SPA - NET2019' granted to PS.

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Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, IRCCS Istituto “G. Gaslini”, Via Gaslini 5, 16148, Genova, Italy

Martina Giorgia Perinelli, Ganna Balagura, Antonella Riva & Pasquale Striano

IRCCS Istituto Giannina Gaslini, Genoa, Italy

Elisabetta Amadori & Pasquale Striano

Department of Neurology, Children’s Hospital Colorado, Aurora, CO, USA

Megan Abbott & Scott Demarest

Department of Pediatrics, University of Colorado at Denver, Aurora, CO, USA

Department of Medical and Surgical Sciences, Pediatric Clinic, University of Perugia, Perugia, Italy

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Contributions

M.G.P, M.A conceived and designed the analysis and developed the theoretical framework. M.G.P wrote the protocol. A.R, G.B contributed to the design and implementation of the protocol. M.S.V, E.A worked on the manuscript. S.D, A.V, P.S supervised the project. All authors read and approved the final manuscript.

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Correspondence to Pasquale Striano .

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Perinelli, M.G., Abbott, M., Balagura, G. et al. Prevalence of cerebral visual impairment in developmental and Epileptic Encephalopathies: a systematic review protocol. Syst Rev 13 , 223 (2024). https://doi.org/10.1186/s13643-024-02638-6

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