{"id":4320,"date":"2025-02-11T12:07:35","date_gmt":"2025-02-11T11:07:35","guid":{"rendered":"https:\/\/www.acotv.org\/?p=4320"},"modified":"2025-02-12T17:32:17","modified_gmt":"2025-02-12T16:32:17","slug":"avaluacio-i-tractament-dels-moviments-sacadics-oculars","status":"publish","type":"post","link":"https:\/\/www.acotv.org\/ca\/avaluacio-i-tractament-dels-moviments-sacadics-oculars\/","title":{"rendered":"AVALUACI\u00d3 I TRACTAMENT DELS MOVIMENTS SAC\u00c0DICS OCULARS"},"content":{"rendered":"\n

Avaluaci\u00f3 dels moviments sac\u00e0dics. Test DEM.<\/mark><\/strong><\/p>\n\n\n\n

Els moviments sac\u00e0dics s\u00f3n els moviments r\u00e0pids que serveixen per portar la informaci\u00f3 visual a la f\u00f2vea dels ulls. El test DEM <\/strong>(Developmental Eye Movement<\/em>) \u00e9s un test que valora la qualitat dels moviments sac\u00e0dics de petita amplitud (els que s\u2019utilitzen durant la lectura), a m\u00e9s de poder observar si hi han dificultats en el processament de descodificaci\u00f3 fonol\u00f2gica o processament autom\u00e0tic (RAN). El test, de baixa demanda cognitiva, permet valorar la motilitat ocular i\/o el RAN en nens de 6 a 14 anys, i utilitza n\u00fameros per a la seva administraci\u00f3 per tal de qu\u00e8 es pugin valorar els moviments oculars i el RAN separadament, ja que no intervenen processos de descodificaci\u00f3 del llenguatge.<\/p>\n\n\n\n

El test valora la capacitat dels moviments sac\u00e0dics a trav\u00e9s d\u2019una lectura vertical de 80 n\u00fameros (separat per 2 parts) i una lectura horitzontal de 80 n\u00fameros disposats en 16 files. Les indicacions, igual en la lectura vertical i horitzontal, \u00e9s que el nen\/a llegeixi el m\u00e9s r\u00e0pid que pugi i en veu alta tots els n\u00fameros sense pausa, per\u00f2 controlant e intentant no equivocar-se (sense deixar que segueixi amb el dit ja que valorem una habilitat purament visual). Mentrestant, l\u2019observador del test anota els temps emprats per cada apartat vertical, horitzontal i els errors en una fulla. Posteriorment es realitzen els c\u00e0lculs per adquirir els valors de normalitat segons l\u2019edat.<\/p>\n\n\n\n

\"\"
Figura 1. <\/strong>A l\u2019esquerra del tot es mostra la imatge de les lectures verticals (Test A i B), al centre la lectura horitzontal (Test C) i a la dreta la fulla d\u2019anotacions del observador (DEM ScoreSheet<\/em>).<\/figcaption><\/figure>\n\n\n\n

Estudis han observat un vincle entre el test DEM i una mala efic\u00e0cia lectora sobretot si s\u2019observa una mala execuci\u00f3 en l\u2019apartat de la lectura horitzontal, indicant que el processament cognitiu requerit per realitzar la prova est\u00e0 estretament lligat amb el proc\u00e9s lector.<\/p>\n\n\n\n

Ara b\u00e9, ja que durant la lectura intervenen molts processos, \u00e9s un error atribuir una mala puntuaci\u00f3 del DEM causa d\u2019una mala efic\u00e0cia lectora. Hem de tenir en compte que \u00e9s un indicador de risc, no significa que una mala puntuaci\u00f3 del DEM en nens\/es amb dificultats lectores sigui causa dels moviments oculars.<\/p>\n\n\n\n

En altres paraules, una mala execuci\u00f3 del test DEM indicaria un risc en l\u2019aprenentatge acad\u00e8mic en qu\u00e8 les habilitats oculomotores i l\u2019atenci\u00f3 visual no s\u00f3n de qualitat o s\u00f3n immadures per l\u2019edat.<\/p>\n\n\n\n

Neurologia dels moviments sac\u00e0dics oculars<\/strong><\/h2>\n\n\n\n

Per realitzar un moviment sac\u00e0dic cal tenir en ment que cal activar i relaxar m\u00fasculs agonistes i antagonistes de forma coordinada i precisa per dirigir la mirada en la direcci\u00f3 i velocitat apropiada. Aquest esfor\u00e7 de coordinaci\u00f3 es pot dur a terme gr\u00e0cies a diversos grups de neurones que treballen conjuntament.<\/p>\n\n\n\n

En els moviments sac\u00e0dics horitzontals, les neurones d\u2019activaci\u00f3 r\u00e0pida de la formaci\u00f3 pontinaparamediana, dins del bulb raquidi, generen una ordre premotora que es transmet als nuclis motors que activen el recte extern ipsilateral. Les interneurones d\u2019aquest nucli permeten que hi hagi comunicaci\u00f3 amb l\u2019agonista de l\u2019altre ull, el recte intern, mitjan\u00e7ant el fascicle longitudinal medial.<\/p>\n\n\n\n

L\u2019activaci\u00f3 d\u2019aquests dos m\u00fasculs agonistes (ipsilateral i recte intern) a cada un dels ulls, permet que tots dos es moguin en la mateixa direcci\u00f3. Per\u00f2, tal com hem dit, tamb\u00e9 cal que els m\u00fasculs antagonistes es relaxin per facilitar el moviment. Aquesta tasca recau en altres neurones d\u2019activaci\u00f3 r\u00e0pida, activades de forma t\u00f2nica i que permeten la relaxaci\u00f3 dels agonistes just abans de l\u2019inici del moviment.<\/p>\n\n\n\n

La finalitzaci\u00f3 del moviment sac\u00e0dic horitzontal requereix l\u2019activaci\u00f3 dels m\u00fasculs antagonistes, a trav\u00e9s de l\u2019integrador neuronal, que transforma les senyals f\u00e0siques d\u2019entrada en t\u00f2niques de sortida. L\u2019integrador neuronal d\u2019aquest proc\u00e9s es situa al complex rostral de l\u2019hipogl\u00f2s.<\/p>\n\n\n\n

Els moviments sac\u00e0dics verticals tenen un control neurol\u00f2gic diferent que els moviments horitzontals. D\u2019aquesta manera, els moviments verticals s\u2019originen a les neurones premotores del mesenc\u00e8fal. Les neurones d\u2019activaci\u00f3 r\u00e0pida del nucli intersticial rostral dels fascicle longitudinal medial originen els moviments sac\u00e0dics verticals. Les neurones d\u2019activaci\u00f3 r\u00e0pida m\u00e9s caudals activen l\u2019elevaci\u00f3 de manera bilateral, generant senyals per al recte superior i l\u2019oblic inferior, mentre que les neurones d\u2019activaci\u00f3 r\u00e0pida m\u00e9s rostrals activen el descens generen senyals per al recte inferior i l\u2019oblic superior.<\/p>\n\n\n\n

L\u2019integrador neuronal per aquest moviment es troba en aquest cas al nucli intersticial de Cajal. La comissura posterior \u00e9s important en la transmissi\u00f3 d\u2019informaci\u00f3 d\u2019un costat a l\u2019altre, de manera que la lesi\u00f3 d\u2019aquesta \u00e0rea alterar\u00e0 sobretot els moviments sac\u00e0dics ascendents.<\/p>\n\n\n\n

El control superior (nivell cortical) del moviment sac\u00e0dic es duu a terme a:<\/p>\n\n\n\n

    \n
  • L\u00f2bul frontal<\/strong>: On hi han 3 \u00e0rees implicades en el control del moviment ocular:\n
      \n
    • Camp ocular frontal:<\/strong> Preparaci\u00f3 i generaci\u00f3 dels moviments sac\u00e0dics intencionals, ja sigui cap a un objecte present (moviment intencional), objecte no present (moviment predictiu), objecte que ha desaparegut (moviment per mem\u00f2ria) o objecte localitzat en direcci\u00f3 oposada (moviment antisac\u00e0dic).<\/li>\n\n\n\n
    • Camp ocular suplementari<\/strong>: Localitzat a la part medial del gir superior frontal, a la part superior del solc paracentral. Est\u00e0 connectat a totes les \u00e0rees relacionades amb el moviment ocular i al c\u00f2rtex parietal posterior. Est\u00e0 involucrat en moviments en els que cal coordinar moviments sac\u00e0dics amb moviments del cos.<\/li>\n\n\n\n
    • C\u00f2rtex prefrontal dorsolateral<\/strong>: Participa en la inhibici\u00f3 dels moviments sac\u00e0dics, per\u00f2 tamb\u00e9 en la mem\u00f2ria espacial a curt termini i en processos de decisi\u00f3. Aix\u00f2 fa que aquest camp sigui important en el moviment sac\u00e0dic guiat per mem\u00f2ria i en el  moviment sac\u00e0dic predictiu.<\/li>\n<\/ul>\n<\/li>\n\n\n\n
    • L\u00f2bul parietal:<\/strong> La part posterior del l\u00f2bul parietal est\u00e0 relacionada amb el control dels moviments sac\u00e0dics i l’atenci\u00f3. Aquest fet posa de manifest la import\u00e0ncia de l’atenci\u00f3 en els moviments sac\u00e0dics. Aquesta \u00e0rea realitza una actualitzaci\u00f3 de la informaci\u00f3 espacial despr\u00e9s d’un moviment ocular. <\/li>\n\n\n\n
    • C\u00f2rtex cingulat<\/strong>: Dividit entre c\u00f2rtex cingulat anterior i posterior. La part anterior participa en el control del moviment sac\u00e0dic intencional, en conjunci\u00f3 amb el camp ocular frontal. La part posterior, en contrast amb l’anterior, participa en el control del moviment sac\u00e0dic reflex en comptes del moviment sac\u00e0dic intencional.<\/li>\n<\/ul>\n\n\n\n
      \"\"
      Figura 3 <\/strong>\u00c0rees corticals que controlen, preparen i executen els moviments sac\u00e0dics oculars. Adaptat de Pierrot-Deseilligny C, Milea D, M\u00fcri R. Eye movement control by the cerebral cortex.Current Opinion in Neurology <\/em>(2014);17:17-25.  <\/figcaption><\/figure>\n\n\n\n

      Tractament dels moviments oculars sac\u00e0dics<\/strong><\/h2>\n\n\n\n

      Tal com hem vist el tractament no pot limitar-se a entrenar muscularment el moviment ocular, sin\u00f3 que ha d\u2019anar enfocat a l\u2019estimulaci\u00f3 de les rutes on es controlen i programen els moviments sac\u00e0dics.<\/p>\n\n\n\n

      Abans d\u2019entrenar els moviments sac\u00e0dics \u00e9s important avaluar les funcions del cerebel (integraci\u00f3, desenvolupament, ritme), control corporal (psicomotricitat, lateralitat, reflexes primitius) i visi\u00f3 perif\u00e8rica ja qu\u00e8 contribueixen al control del moviment ocular sac\u00e0dic.<\/p>\n\n\n\n

      Per tal d\u2019estimular aquestes estructures i millorar els moviments oculars la ter\u00e0pia visual ha de fer \u00fas de varis exercicis en l\u2019\u00e0mbit de desenvolupament motor (reflexes primitius, psicomotricitat) i coneixement del sistema vestibular per millorar el sistema oculomotor.<\/p>\n\n\n\n

      Exercicis <\/strong>per una correcta integraci\u00f3 i estimulaci\u00f3 dels moviments sac\u00e0dics oculars:<\/p>\n\n\n\n

        \n
      1. Ter\u00e0pia de Moviment R\u00edtmic (TMR),equilibri (ulls tancats i oberts).<\/li>\n\n\n\n
      2. Exercicis de consci\u00e8ncia corporal, psicomotricitat, integraci\u00f3 hemisf\u00e8rica (cos call\u00f3s) i exercicis de integraci\u00f3 bilateral.<\/li>\n\n\n\n
      3. Exercicis de visi\u00f3 perif\u00e8rica.<\/li>\n\n\n\n
      4. Exercicis d\u2019estimulaci\u00f3 del sistema vestibular: Rotacions de cap + moviments oculars, rotacions corporals + moviments oculars, visi\u00f3 din\u00e0mica etc…<\/li>\n\n\n\n
      5. Entrenament dels sac\u00e0dics oculars (amb integraci\u00f3 de ritme, equilibri etc.)<\/li>\n<\/ol>\n\n\n\n

        En la seg\u00fcent Figura 4<\/strong> es mostra un resum de les \u00e0rees que estimulen cada exercici en el Sistema Nervi\u00f3s Central.<\/p>\n\n\n\n

        \"\"
        Figura 4. <\/strong>\u00c0rees del Sistema Nervi\u00f3s Central (SNC) que estimulen els exercicis de 1.Ter\u00e0pia de Moviment R\u00edtmic; 2.Integraci\u00f3 hemisf\u00e8rica; 3.Visi\u00f3 perif\u00e8rica; 4.Sistema vestibular.<\/figcaption><\/figure>\n\n\n\n

        Refer\u00e8ncies<\/strong><\/h2>\n\n\n\n

        Ayton LN, Abel LA, Fricke TR, McBrien NA<\/strong>. \u201cDevelopment Eye Movement Test: What is it really measuring?\u201d Optometry and Vision Science,<\/em> (2009);86:722-730.<\/p>\n\n\n\n

        Coubard, Olivier A<\/strong>. \u00abSaccade and vergence eye movements: a review of motor and premotor commands.\u00bb European Journal of Neuroscience<\/em> (2013);38:3384-3397.<\/p>\n\n\n\n

        Krauzlis, Richard J., Lee P<\/strong>. Lovejoy, and AlexandreZ\u00e9non.<\/strong> \u00abSuperior colliculus and visual spatial attention.\u00bb Annual review of neuroscience<\/em> 36 (2013).<\/p>\n\n\n\n

        Leigh, R. John, and David S. Zee<\/strong>. \u201cThe neurology of eye movements\u201d.Oxford University Press, USA (2015).<\/p>\n\n\n\n

        Leinenger, Mallorie, and Keith Rayner<\/strong>. \u00abEye movements and visual attention during Reading.\u00bb The Handbook of Attention<\/em> (2015); 281.<\/p>\n\n\n\n

        Medland C, Walter H<\/strong>, Woodhouse M<\/strong>. \u201cEye movements and poor reading:does the Developmental Eye Movement test measure cause or effect?\u201d Ophthalmic and Physiological Optics<\/em> (2010); 30:740-747.<\/p>\n\n\n\n

        Pierrot-Deseilligny C, Milea D, M\u00fcri R<\/strong>. Eye movement control by the cerebral cortex. Current Opinion in Neurology <\/em>(2014);17:17-25.<\/p>\n\n\n\n

        Powers M, Grisham D, Riles P<\/strong>. \u201cSaccadic tracking skills of poor readers in high school\u201d. Optometry<\/em> (2008);79:228\u201334.<\/p>\n\n\n\n

        Ptak, Radek, and Ren\u00e9 M<\/strong>. M\u00fcri. \u00abThe parietal cortex and saccade planning: lessons from human lesion studies.\u00bb Frontiers in human neuroscience<\/em> (2013).<\/p>\n\n\n\n

        Rayner, Keith.<\/strong>\u00abThe neural control of eye movements in acquired and developmental reading Disorders \u2018.\u00bb Studies in Neurolinguistics<\/em> (2013);97.<\/p>\n\n\n\n

        Schall, Jeffrey D<\/strong>. \u00abProduction, control, and visual guidance of saccadic eye movements.\u00bb ISRN neurology<\/em> (2013).<\/p>\n\n\n\n

        Schmitt, Lauren M., et al<\/strong>. \u00abSaccadic eye movement abnormalities in autism spectrum disorder indicate dysfunctions in cerebellum and brainstem.\u00bbMolecular autism<\/em> (2014);15:1.<\/p>\n\n\n\n

        Article el\u00b7laborat per:
        Marc Argil\u00e9s Sans
        <\/strong>Doctor en enginyeria \u00f2ptica per la Universitat Polit\u00e8cnica de Catalunya (UPC). 
        Professor lector al Departament d\u2019\u00d2ptica i Optometria (UPC).
        Membre de l\u2019Associaci\u00f3 Catalana d\u2019Optometria i Ter\u00e0pia Visual (ACOTV) i fellow de l\u2019European Academy of Optometry and Optics <\/em><\/p>\n\n\n\n

        Manel Garabito Montoya<\/strong>
        Llicenciat en Biologia<\/em>
        M\u00e0ster en Medicina Traslacional<\/em><\/p>\n\n\n\n

        <\/p>\n","protected":false},"excerpt":{"rendered":"

        En aquest article explorem l\u2019avaluaci\u00f3 i el tractament dels moviments sac\u00e0dics oculars des d\u2019una perspectiva neurol\u00f2gica. Una visi\u00f3 pr\u00e0ctica i fonamentada que pot enriquir i refor\u00e7ar la intervenci\u00f3 cl\u00ednica en Ter\u00e0pia Visual.<\/p>\n","protected":false},"author":2,"featured_media":12380,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ocean_front_end_style_editor":"no","ocean_post_layout":"","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"0","ocean_second_sidebar":"0","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"0","ocean_custom_header_template":"0","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"0","ocean_menu_typo_font_family":"0","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"0","ocean_post_oembed":"","ocean_post_self_hosted_media":"","ocean_post_video_embed":"","ocean_link_format":"","ocean_link_format_target":"self","ocean_quote_format":"","ocean_quote_format_link":"post","ocean_gallery_link_images":"off","ocean_gallery_id":[],"footnotes":""},"categories":[24],"tags":[66,72,67],"class_list":["post-4320","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bloc","tag-optometria-ca","tag-problemesdaprenentatge","tag-terapiavisual-ca","entry","has-media"],"yoast_head":"\nAVALUACI\u00d3 I TRACTAMENT DELS MOVIMENTS SAC\u00c0DICS OCULARS - Asociaci\u00f3n Catalana de Optometr\u00eda y Terapia Visual<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.acotv.org\/ca\/avaluacio-i-tractament-dels-moviments-sacadics-oculars\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"AVALUACI\u00d3 I TRACTAMENT DELS MOVIMENTS SAC\u00c0DICS OCULARS - Asociaci\u00f3n Catalana de Optometr\u00eda y Terapia Visual\" \/>\n<meta property=\"og:description\" content=\"En aquest article explorem l\u2019avaluaci\u00f3 i el tractament dels moviments sac\u00e0dics oculars des d\u2019una perspectiva neurol\u00f2gica. 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