BACKGROUND: Congenital ocular motor apraxia (C-OMA) is the inability to elicit a voluntary horizontal saccade. Compensatory head thrusts are commonly seen during horizontal fixation shifts. Vertical gaze movements and smooth pursuits remain intact. Associated findings of C-OMA are hypotonia, speech and motor delays. This association with developmental delays has lead some to believe that C-OMA may be part of a wider syndrome.
CASE REPORT(S). A 7 year-old white male diagnosed at age 1 with ocular motor apraxia presented with a history of difficulties in school, particularly in reading. Clinical observation revealed full EOM's, but deficient horizontal saccades with associated compensatory head thrusts. OKN testing elicited a positive response horizontally with some degree of "lock-up". Although saccades could be generated, performance deteriorated with multiple saccades in rapid succession. On the DEM horizontal subtest, 45 omissions were made illustrating the effect of apraxia on reading eye movements. Deficits were found in multiple areas of visual information processing (VIP). Laterality and directionality was found to be undeveloped, visual motor integration in the 9th percentile, and visual closure in the 1st percentile. During the testing it became evident that the patient lacked Gestalt processing. A plan for vision therapy was designed to improve laterality and directionality, VIP with an emphasis on closure, and therapy to develop
compensatory eye movement strategies to maximize efficiency for reading. Due to the paucity of normal saccadic eye movements and delays in reading, it was recommended that he begin a reading program to enhance sight word recognition and develop a word for word approach to reading emphasizing word location.
CONCLUSIONS. Previous literature concentrated on the diagnosis and etiology of the condition, but did not address the impact of the condition on VIP and academic achievement. This poster presents a video depicting the classic signs of C-OMA, discusses the implications of the condition, and the management of a seven-year-old boy.