Joan Brien

Joan Brien

 

 

This article demonstrates how important it is for children to be screened for the presence of Irlen Syndrome, which is a Perceptual processing dysfunction, sometimes known as Scotopic Sensitivity and Meares-Irlen Syndrome.

Many children experience symptoms of Irlen Syndrome without ever being diagnosed.  

https://www.teachstarter.com/classroom-mysteries-perceptual-processing-disorders/

Saturday, 26 November 2016 21:27

COLOURED OVERLAYS

Irlen overlays are the first step in helping someone who has been identified as having Irlen Syndrome. Once the symptoms have been identified, the next step is to put the different coloured overlays over the printed page to see if it removes the visual distortions and discomfort being experienced by the client. It is really important that once the preferred coloured overlays are selected, that they are used to determine if they actually help the reading. The overlays are simply removing some of the wavelengths of light that are causing the distortions, but they help word recognition. It is like someone neding reading glasses, trying to read without them and then putting them on. The effect is immediate.

 

How would you feel if you had to read words you could not see?

This is reality for some children.. do you think they would like school?

See video below

Thursday, 24 November 2016 12:50

THE TREATMENT FOR IRLEN SYNDROME

The treatment for Irlen Syndrome is NOT a programme but IS a method to help visual processing dysfunction. Many critics of Irlen suggest that if a child is diagnosed with Irlen Syndrome and provided Irlen lenses, it somehow removes the possibility of  them ever taking advantage of the special education programmes that are provided in schools. This is not the case. These children sometimes still need that specialist education to help them to "catch up" on what they have missed out on in their earlier years. 

See video below.

Tuesday, 22 November 2016 21:34

HELPING YOUR CHILD READ ACCURATELY

This video below explains ways in which you can help your child to read successfully. These children sometimes appear to be having difficulties reading, but sometimes, it is just the "technique" of reading that they use.

Tuesday, 22 November 2016 20:13

DYSLEXIA AND IRLEN SYNDROME

Dyslexia is associated with reading difficulties for no apparent reason. If you look at the literal meaning of dyslexia, it is defined by the Collins English Dictionary as follows:

"a developmental disorder which can cause learning difficulty in one or more of the areas of reading, writing, and numeracy" 

It has a Nontechnicalname "word blindness"

Unfortunately, people who have been told that they have dyslexia, often have Irlen Syndrome, AND THAT IS WHAT IS CAUSING THEIR DYSLEXIA!

The symptoms of dyslexia have been variously described as words moving, reversing words, inserting words, omitting words, missing lines when reading as well as other things that happen for some people when reading. These symptoms are also the symptoms of Irlen Syndrome, which is a visual processing dysfunction. Visual processing occurs when our brain processes the visual signals sent to the visual cortex from our eyes. It is not a problem with our eyesight. 

Monday, 21 November 2016 20:35

COLOURED OVERLAYS

 

 

When ever we are looking at white paper, all of the visible light spectrum (the rainbow) is reflected into our eyes. For people with Irlen Syndrome, some of these wavelengths of light cause visual distortions and discomfort. This makes it difficult for some children to learn to read. The coloured overlays actually filter out some wavelengths of light and so remove the visual distortions and discomfort. This makes it much easier for the children to learn to read, because they can focus on what they are trying to learn. 

Irlen Syndrome: Educators and MDs Speak Out

By: AAIC  in AdvertorialIn The Classroom July 14, 2016 0

 

The reason most people become educators, is to effect the lives of the next generation of humanity, in a tangible way, during their crucial juvenile years. For some students, learning seems remarkably easy, and they grow to enjoy the school experience. But for other seemingly bright kids, learning comes with formidable, and sometimes invisible, challenges, that stand in their way of achieving academic success.

One of these challenges, has to do with brain processing problems, caused by a timing fault in messages running from the optic nerve to the brain. Encompassing hundreds of unique conditions, these disorders are known as Irlen Syndrome. Courting a history of controversy within the education and medical sectors, Irlen Syndrome has now become the elephant in the room, for many students facing these “invisible” challenges.

The following quotes are from some of the leading educators, medical doctors and education specialists, from across the USA and Australia. They’ve been compiled in the hope of offering new information, on this long debated issue.

Dr. France Morrow, Adjunct Professor of Psychology, Washington State University: “My research studies have identified Irlen Syndrome as a primary reason that students avoid reading and struggle with reading and learning. With the appropriate colored transparencies, college students gained nearly four grade levels in reading and middle school students gained from one year to five years in reading. Irlen Syndrome is the principal and most widespread “invisible” barrier to reading and learning for upwards of forty percent of student populations.”

Sue Willows-Raznikov, Learning Strategies Coordinator, Department of Teaching and Learning at the School of Medicine, Stanford University, California: “As the Learning Strategy Coordinator at Stanford University, I have been interested and involved for over 30 years with a number of methodologies for enhancing the student’s process of learning. Since my initial training as an Irlen Screener, I have used the Irlen questions and have identified dozens and dozens of students who have gone on to use the Irlen lenses. One example is a second year medical student in the Medical Program at Stanford University who was a slow reader and always got headaches while reading. With her Irlen overlay, her reading speed immediately increased from 145 words per minute to 190 words per minute with comprehension.”

Dr. Daniel Amen, M.D., Amen Clinics, Newport Beach, CA: “When I first learned about Irlen Syndrome, I was skeptical. I never heard about it in my psychiatry training program. Yet, over time I had friends and family members who benefited from the treatment. Remarkably, when people obtain benefit from the treatment, it helps to balance brain function. One of the factors that drew me to Irlen Syndrome and the Irlen treatment is its simplicity and effectiveness.”

Dr. Robert Dobrin, M.D., F.A.A.P: “During a 15-month period, I evaluated 460 patients, including both adults and children. Using questions that would uncover problems related to light sensitivity and reading difficulties, I found 122 patients. Many were treated with (Irlen) tinted lenses and were enthusiastic about their improvement. For these patients, Irlen Syndrome is an authentic diagnosis.

LouAnne Johnson, author of the best-selling book The Queen of Education, Rules for Making Schools Work, which inspired the movie Dangerous Minds: “I have repeatedly seen dramatic, instantaneous response to using Irlen Filters and other transparent overlays; I am now convinced that Irlen Syndrome does exist and that it may be responsible for many of the so-called learning disabilities in our schools. I also believe that screening for Irlen Syndrome should be a regular part of every school health program.”

David M. Hailey & Anthony R. Lea, Health Technology Division, Australian Institute of Health: “…our feeling as disinterested outsiders is that the technique developed by Helen Irlen addresses a severe, unmet need in the community, has promise, and has benefited many individuals…”

Wes Nedrow, Special Education Director of Lower Kuskokwim School, District, Alaska: “We have been convinced of the value of Irlen Filters. All special education referrals must have a Irlen screening as part of the referral process. Secondly, we have placed over 800 colored overlays in our schools to be used by students. We have evidence of children in three months going from non-reader to grade level reader and no longer a behavior problem, children going from a C/D student to an A/B student on one report period, and attendance has gone from chronic absences with stomachaches to regular attendance; and a dyslexic 12 year old who could not read the most simple of reading material, in spite of four years in a special education resource room, being able to read a book at the 4th grade level immediately upon placing on the colored filters.”

John Bald, Literacy Expert, Consultant-National Curriculum Council, writer-The Mail: “It is the single most important advance in the treatment of reading difficulties I’ve ever seen.”

Dr. Robert J. Van Maren, Superintendent, USD 204, Kansas: “The Irlen Method has been an amazingly simple and effective way to diagnose and provide support for students who struggle with reading. We have found that students who can be helped in no other way have success with using this method. I would consider this an essential component to a successful program providing a comprehensive program of reading support and instruction.”

Lorraine Hammond, author of "When Bright Kids Fail": “The relative simplicity of wearing Irlen Filters or using plastic sheets to correct color sensitivities that interfere with reading and the dramatic effects Irlen Filters have had on some individuals have made this a popular choice of treatment.”

Susan Renick-Blount, Director, Exceptional Student Education – Region II, Dade County Public School System, Florida: “As a Director overseeing exceptional student education for the Dade County Public School system in Miami, Florida, I am extremely skeptical of any new or unique techniques. Since piloting the Irlen Approach to Reading, the percentage of students that have been helped to increase their perceptual reading ability is genuinely impressive, and I endorse promoting the technique to a larger number of students.”

For more information, visit www.aaic.org.au

Tuesday, 13 September 2016 21:20

Article in Education Review July 2016

Friday, 20 May 2016 17:35

RESEARCH ARTICLES

REVIEW OF RESEARCH ON THE USE OF COLOURED LENSES

While much of the early literature was unpublished and of poor scientific design, there are now numerous controlled studies which have reported positive results for the use of coloured lenses. These studies have all been reported in peer reviewed journals, using reviewers with expertise in this field, who are unlikely to recommend the publication of studies which are methodologically unsound. I have listed these studies below, with their full references attached. The largest number of controlled studies report improvement in reading when using coloured plastic overlays, coloured computer monitors, and one study which illuminates text with coloured light (Bouldoukian, Wilkins, & Evans, 2002; Chase, Ashourzadeh, Kelly, Monfette, & Kinsey, 2003; Croyle, 1998; Evans & Joseph, 2002; Jeanes, Busby, Martin, Lewis, Stevenson, Pointon et al., 1997; Kriss & Evans, 2005; Noble, Orton, Irlen, & Robinson, 2004; Northway, 2003; Ray, Fowler, & Stein, 2005; Scott, McWhinnie, Taylor, Stevenson, Irons, & Lewis, 2002; Singleton & Trotter, 2005; Solan, Brannan, Ficarra, & Byrne, 1997; Solan, Ficarra, Brannan, & Rucker, 1998; Tyrrell, Holland, Dennis, & Wilkins, 1995; Wilkins, Jeanes, Pumfrey, & Laskier, 1996; Wilkins & Lewis, 1999; Wilkins, Lewis, Smith, Rowland, & Tweedie, 2001; Williams, Le Cluyse, & Littell, 1996). There are also numerous studies which report improvements in eye strain, headaches and reading when using coloured lenses (Chronicle & Wilkins, 1991; Evans, Patel, & Wilkins, 2002; Good, Taylor, & Mortimer, 1991; Harris & MacRow-Hill, 1999; Lightstone, Lightstone, &  Wilkins, 1999; Robinson & Conway, 2000; Robinson & Foreman, 1999; Wilkins, 1993; Wilkins, Patel, Adjamian, & Evans, 2002). In particular, the paper by Chase et al. (2003), describes a series of four studies which found that the accuracy of oral reading was poorer when using red filters in comparison to blue and green filters. These results were used to support physiological evidence that red light suppresses functioning of the Magnocellular visual neural pathway, with reading being better when longer wavelengths of light (red) are removed from the light source by the use of blue filters. A number of these studies have used placebo controls (Bouldoukian et al., 2002; Evans & Joseph, 2002; Jeanes et al., 1997; Ray et al., 2005; Robinson & Foreman, 1999; Wilkins, Evans, Brown, Busby, Wingfield, Jeanes, & Bald, 1994; Wilkins & Lewis, 1999; Wilkins et al., 2002). Such placebo studies are possible because the effects of coloured filters can be assessed without subjects being aware of the precise chromacity of the colour which provides optimal results for them(Wilkins, Huang, & Cao, 2004). In addition, people who respond to the use of colour are also likely to have abnormalities in accommodation (Simmers, Gray, & Wilkins, 2001), significant changes in visual evoked potentials when using coloured filters (Huang, Cooper, Satana, Kaufman, & Cao, 2003; Riddell, Wilkins, Zemori, Gordon, & Hainline, 1998) as well as differences in biochemical profiles (Robinson, Roberts, McGregor, Dunstan, & Butt, 2001; Sparkes, Robinson, Dunstan, & Roberts, 2003; Sparkes, Robinson, Roberts, & Dunstan, 2006), all of which could not be attributed to placebo effects.

 

REFERENCES

Bouldoukian, J., Wilkins, A. J., & Evans, B. J. W. (2002). Randomised controlled trial of the effect of coloured overlays on the rate of reading of people with specific learning difficulties. Ophthalmic and Physiological Optics, 22, 55-60.

Chase, C., Ashourzadeh, A., Kelly, C., Monfette, S., & Kinsey, K. (2003). Can the magnocellular pathway read? Evidence from studies of colour. Vision Research, 43, 1211-1222. Chronicle, E. P. & Wilkins, A. J. (1991).

Colour and visual discomfort in migraineurs. The Lancet, 338, 890.

Croyle, L. (1998). Rate of reading, visual processing, colour and contrast. Australian Journal of Learning Disabilities, 3(3), 13-20

Evans, B. J. W., & Joseph, F. (2002). The effect of coloured filters on the rate of reading in an adult study population. Ophthalmic and Physiological Optics, 22, 525-535.

Evans, B. J. W., Patel, R., & Wilkins A. J. (2002). Optometric function in visually sensitive migraine before and after treatment with tinted spectacles. Ophthalmological and Physiological Optics, 22, 130-142.

Good, P. A., Taylor, R. H., & Mortimer, M. J. (1991). The use of tinted glasses in childhood migraine. Headache, September, 533-536.

Harris, D. & MacRow-Hill (1999). Application of Chroma-Gen haloscopic lenses to patients with dyslexia: A double-masked placebo-controlled trial. Journal of the Optometric Association, 70(1), 629-640.

Huang, J., Cooper, T. G., Satana, D. Kaufman, D. L., & Cao, Y. (2003). Visual distortion provoked by a stimulus in migraine associated with hyperneural activity. Headache, 43, 664-671.

Jeanes, R., Busby, A., Martin, J., Lewis, E., Stevenson, N., Pointon, D., & Wilkins, A. (1997). Prolonged use of coloured overlays for classroom reading. British Journal of Psychology, 88, 531-548.

Kriss, I., & Evans,  B. J. W. (2005). The relationship between dyslexia and Meares-Irlen Syndrome. Journal of Research in Reading, 28(3), 350-364.

Kyd, L. J. C., Sutherland, G. F. M., & McGettrick, P. M. (1992). A preliminary appraisal of the Irlen screening process for scotopic sensitivity syndrome and the effect of Irlen coloured overlays on reading. The British Orthoptic Journal, 49, 24-30.

Lightstone, A., Lightstone, T., & Wilkins, A. J. (1999). Both coloured overlays and coloured lenses can improve reading fluency, but their optimal chromacities differ. Ophthalmological and Physiological Optics, 19(4), 279-285.

Noble, J., Orton, M., Irlen, S., & Robinson, G. L. (2004). A field study of the use of coloured overlays on reading achievement. Australian Journal of Learning Disabilities, 9(2), 14-26.

Northway, N. (2003). Predicting the continued use of overlays in school children: A comparison of the Development Eye Movement test and the Rate of Reading test. Ophthalmic and Physiological Optics, 23(5), 457-463.

Ray, N. J., Fowler, S., & Stein, J. F. (2005). Yellow filters can improve magnocellular function: Motion sensitivity, convergence, accommodation and reading. Annals of the New York Academy of Sciences, 1039, 283-293.

Riddell, P. M., Wilkins, A. J., Zemori, V., Gordon, J., & Hainline, J. (1998). The effects of coloured lenses on visual evoked response in photophobic children. Investigative Ophthalmology & Visual Science (Abstract), 39 (Suppl.), pp. 181.

Robinson, G. L.,  & Conway, R. N. F. (1994). Irlen filters and reading strategies: Effects of coloured filters on reading achievement, specific reading strategies and perception of ability. Perceptual & Motor Skills, 79, 467-483.

Robinson, G. L., & Conway, R. N. F. (2000). Irlen lenses and adults: A small scale study of reading speed, accuracy, comprehension and self-image. Australian Journal of Learning Disabilities, 5(1), 4-13.

Robinson, G. L., & Foreman, P. J. (1999). Scotopic Sensitivity/Irlen Syndrome and the use of coloured filters: A long-term placebo controlled and masked study of reading achievement and perception of ability. Perceptual and Motor Skills, 89, 83-113.

Robinson, G. L., McGregor, N. R., Roberts, T. K., Dunstan, R. H., & Butt, H. (2001). A biochemical analysis of people with chronic fatigue who have Irlen Syndrome: Speculation concerning immune system dysfunction. Perceptual and Motor Skills, 93, 486-504.

Scott, L., McWhinnie, H., Taylor, L., Stevenson, N., Irons, P., Lewis, E., Evans, B., & Wilkins, A. (2002). Coloured overlays in schools: Orthoptic and optometric findings. Ophthalmological and Physiological Optics, 22, 156-165.

Simmers, A. J., Gray, L. S., & Wilkins, A. J. (2001). The influence of tinted lenses upon ocular accommodation. Vision Research, 41, 1229-1238.

Singleton, C., & Trotter, S. (2005). Visual stress in adults with and without dyslexia. Journal of Research in Reading, 28(3), 365-379.

Solan, H. A., Brannan, J. R., Ficarra, A., & Byrne, R. (1997). Transient and sustained processing: Effects of varying luminance and wavelength on reading comprehension. Journal of the American Optometric Association, 68(8), 502-510.

Solan, H. A., Ficarra, A., Brannan, J. R., & Rucker, F. (1998). Eye movement effiency in normal and reading disabled elementary school children: Effects of varying luminance and wavelength. Journal of the American Optometric Association, 69(7), 455-464.

Sparkes, D. L., Robinson, G. L., Dunstan, H., & Roberts, T. K. (2003). Plasma cholesterol levels and Irlen Syndrome: Preliminary study of 10- to 17-year-old students. Perceptual and Motor Skills, 97, 743-758.

Sparkes, D. L., Robinson, G. L., Roberts, T. K., & Dunstan, H. (2006). General health and associated biochemistry in a visual-perceptual subtype of dyslexia. In F. Columbus (Ed.), Learning Disabilities: New Research. NY: Nova Science Publications.

Tyrrell, R., Holland, K., Dennis, D., & Wilkins, A. (1995). Coloured overlays, visual discomfort, visual search and classroom reading. Research in Reading, 18, 10-23.

Wilkins, A. J. (1993). Reading and visual discomfort. In D. M. Willows, R. S. Kruk, & E. Corcos (Eds.), Visual processes in reading and reading disabilities. Hillsdale, NJ: Lawrence Erlbaum.

Wilkins, A. J., Evans, B. J. W., Brown, J. A., Busby, A. E., Wingfield, A. E., Jeanes, R. J., &  Bald, J. (1994). Double-masked placebo-controlled trial of precision spectral filters in children who use coloured overlays. Ophthalmological and Physiological Optics, 14, 365-370.

Wilkins, A. J., Jeanes, R. J., Pumfrey, P. D., & Laskier, M. (1996). Rate of reading test: Its reliability and its validity in the assessment of the effects of coloured overlays. Ophthalmic and Physiological Optics, 16, 365-370.

Wilkins, A. J. & Lewis, E. (1999). Coloured overlays, text and texture. Perception, 28, 641-650.

Wilkins, A. J., Lewis, E., Smith, F., Rowland, F., & Tweedie, W. (2001). Coloured overlays and their benefits for reading. Journal of Research in Reading, 24(1), 41-64.

Wilkins, A. J., Patel, R., Adjamian, P., & Evans, B. J. W. (2002). Tinted spectacles and visually-sensitive migraine. Cephalagia, 22, 711-719.

Williams, M. C., Le Cluyse, K., & Littell, R. (1996). A wavelength specific intervention for reading disability. In R. P. Garzia & R. London (Eds.), Vision and Reading. St Louis: Mosby.

Compiled by the late Dr Greg Robinson. Associate Professor Special Education

The University of Newcastle NSW Australia

 

MORE RECENT ARTICLES

  1. A Functional neuroimaging case study of Meares-Irlen syndrome/visual stress (MISViS). Chouinard BD, Zhou CI, Hrybouski S, Kim ES, Cummine J.

            Brain Topogr. 2012 Jul;25(3):293-307.

            http://www.ncbi.nlm.nih.gov/pubmed/22124535

  1. Screening for dyslexia, dyspraxia and Meares-Irlen syndrome in higher education. Nichols SA, McLeod JS, Holder RL, McLeod HS

    Dyslexia 2009 Feb;15(1):42-60.

    http://www.ncbi.nlm.nih.gov/pubmed/19089876

  2. Meares-Irlen syndrome – a need for increasing awareness in the general public. Kapoor S.

    Ophthalmic Physiol Opt. 2008 May;28(3):291

    http://www.ncbi.nlm.nih.gov/pubmed/18426430

  3. The effect of coloured filters on the rate of reading in an adult student population. Evans BJ, Joseph F.

            Ophthalmic Physiol Opt. 2002 Nov;22(6):535-45

            http://www.ncbi.nlm.nih.gov/pubmed/12477018

  1. A preliminary investigation into the aetiology of Meares-Irlen syndrome.

    Evans BJ, Wilkins AJ, Brown J, Busby A, Wingfield A, Jeanes R, Bald J.

            Ophthalmic Physiol Opt 1996 Jul;16(4): 286-96

            http://www.ncbi.nlm.nih.gov/pubmed/8796197

  1. Visual Perceptual Difficulties and the impact on children’s learning: Are teachers missing the page? Christopher Boyle, Divya Jindal-Snape

    British Journal of Support for Learning 2012 27(4) 166-171

    http://onlinelibrary.wiley.com/doi/10.1111/1467-9604.12001/abstract

  2. Colors, colored overlays, and reading skills. Arcangelo Uccula, Mauro Enna, Claudio Mulatti

    Front Psychol. 2014; 5:833

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114255/

  3. A comparison of two-coloured filter systems for treating visual rading difficulties. Roger Hall, Micola Ray, Priscilla Harries, John Stein

    Disabil Rehabil 2013 Dec; 35(26): 2221-2226

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862071/

  4. The Educational Challenge of Irlen Syndrome Siegfried Othmer, PhD

    EEG Info Newsletter – Articles and Discussion on Neurofeedback and Biofeedback

    http://news.eeginfo.com/the-educational-challenge-of-irlen-syndrome/

  5. Treating reading difficulties with colour. Lisa M Henderson, Robert H Taylor, Brendan Barrett, Philip G Griffiths.

    BMJ 2014; 349:g5160

    http://www.bmj.com/content/349/bmj.g5160

  6. Coloured Filters Enhance the Visual Perception of Social Cues in Children with Autism Spectrum Disorders. Amanda K Ludlow, Elaine Taylor-Whiffen, Arnold J Wilkins.

            ISRN Neurol. 2012; 2012:298098

http://www.hindawi.com/journals/isrn/2012/298098/

  1. A placebo-controlled trial of tinted lenses in adolescents with good and poor academic performance: reading accuracy and speed. Genis Cardona, Rosa Boras, Elvira Peris, Marina Castane.

    J Optom. 2010;3(2):94-101

    http://www.sciencedirect.com/science?_ob=ArticleListURL&_method=list&_ArticleListID=-937296512&_sort=r&_st=13&view=c&md5=750511b51500714a4e9f0073cfbe67dc&searchtype=a

  2. Specific Visual Symptoms and Signs of Meares-Irlen Syndrome in Korean

    Minwook Chang, Seung-Hyun Kim, Joo-Young Kim, Yoonae A Cho

    Korean J Ophthalmol 2014; 28(2): 159-163

    http://synapse.koreamed.org/DOIx.php?id=10.3341/kjo.2014.28.2.159

  3. Functional Magnetic Resonance Imaging Findings in Meares-Irlen Syndrome: A Pilot Study. Ji Hyun Kim, Hye-Jin Seo, Suk-Gyu Ha, Seung-Hyun Kim

            Korean J Ophthalmol 2015; 29(2): 121-125

            http://synapse.koreamed.org/DOIx.php?id=10.3341/kjo.2015.29.2.121

  1. Using coloured filters to reduce the symptoms of visual stress in children with reading delay. Harries P, Hall R, Ray N, Stein J.

    Scand J Occup Ther 2015 Mar;22(2): 153-60

    http://www.ncbi.nlm.nih.gov/pubmed/25581284

  2. Levels of visual stress in Proficient Readers: Effects of Spectral Filtering of Fluorescent Lighting on Reading Discomfort.   Loew SJ, Rodriguez C, Marsh NV, Jones GL, Munez JC, Watson K.

    Span J Psychol 2015 Aug 10; 18:E58

            http://www.ncbi.nlm.nih.gov/pubmed/26255657

  1. A Prospective Genetic Marker of the visual-perception disorder Meares-Irlen syndrome. Loew SJ, Watson K.

    Percept Mot Skills. 2012 Jun;114(3): 870-82

            http://www.ncbi.nlm.nih.gov/pubmed/22913027

       1.  A girl with dyslexia suspected to have Irlen syndrome, completely relieved by wearing tinted lenses.

            No To Hattatsu. 2015 Nov;47(6):445-8

          https://www.ncbi.nlm.nih.gov/pubmed/26717646

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 4