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Hong HT, Jeong MG, Kim KT. Feasibility of Computerized Visuomotor Integration System for Visual Field Defects and Spatial Neglect in Poststroke Patients. Ann Rehabil Med 2024; 48:146-154. [PMID: 38658046 PMCID: PMC11058365 DOI: 10.5535/arm.230028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/18/2024] [Accepted: 03/05/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To develop a computerized visuomotor integration system for assessment and training of visual perception impairments and evaluate its safety and feasibility in patients with a stroke. Visual field defects and spatial neglect lead to substantial poststroke impairment. Most diagnostic assessments are anchored in traditional methods, and clinical effects of rehabilitation treatments are limited. METHODS The CoTras Vision system included two evaluations and four training modules. The evaluation modules were based on the Albert's test and Star cancellation test, and training modules were based on visual tracking, central-peripheral integration, and visuomotor perception techniques. Bland-Altman plots for agreement with the traditional paper-and-pencil test were performed, and the modified Intrinsic Motivation Inventory, Patient Satisfaction Questionnaire, and Simulator Sickness Questionnaire were conducted. RESULTS Ten patients with acute stroke completed the study. Bland-Altman plots revealed good agreements for Albert's test (mean difference, -0.3±4.5) and Star cancellation test (mean difference, 0.3±0.7). The mean±standard deviation scores of the modified Intrinsic Motivation Inventory, Patient Satisfaction Survey, and Simulator Sickness Questionnaire were 84.7±30.6, 40.5±7.9, and 34.0±34.5 respectively. CONCLUSION The CoTras Vision system is feasible and safe in patients with stroke. Most patients had a high degree of motivation to use the system and did not experience severe adverse events. Further studies are needed to confirm its usefulness in stroke patients with visual field defects and hemineglect symptoms. Furthermore, a large, well-designed, randomized controlled trial will be needed to confirm the treatment effect of the CoTras Vision system.
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Affiliation(s)
- Hyeon-Taek Hong
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
- Department of Rehabilitation Science, Graduate School, Daegu University, Gyeongsan, Korea
| | - Myeong Geun Jeong
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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2
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Lucatello S, De Angelis S, Di Lorenzo C, Iosa M, Magnotti L, Di Paolo M, De Luca M, Buzzi MG, Tramontano M. FunctionaL Assessment Scale of Hemianopia (FLASH): A New Multidisciplinary Tool to Assess Hemianopia in Patients with Severe Acquired Brain Injury. Healthcare (Basel) 2023; 11:2883. [PMID: 37958027 PMCID: PMC10647452 DOI: 10.3390/healthcare11212883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Severe acquired brain injury (sABI) encompasses a range of neurological impairments. Visual dysfunction, particularly homonymous visual field defects (HVFDs) and homonymous hemianopia (HH), commonly afflicts sABI survivors, affecting their cognitive and motor rehabilitation. This study presents the FunctionaL Assessment Scale of Hemianopia (FLASH), developed to analyze the most common postural behaviors exhibited by sABI patients with hemianopia during activities of daily living. A comparison to traditional static automated perimetry for diagnosing visual field deficits (VFDs) to determine the sensitivity and specificity of the FLASH was used. Additionally, this study also aimed to assess its reliability. METHODS Fifty-six patients (25 F, 31 M, mean age 60.59 ± 14.53) with strokes in the sub-acute phase (<6 months from the onset) were assessed with both FLASH and a Humphrey Field Analyzer. RESULTS After removing two items found to be less reliable than others, FLASH showed high sensitivity (81%) and specificity (77%) when compared to static automated perimetry. Inter-rater reliability was also high, with an intra-class correlation coefficient of 0.954, as well as the internal consistency computed by Cronbach's alpha, equal to 0.874. CONCLUSION FLASH could offer a valuable and cost-effective screening tool for VFD in sABI patients during neurorehabilitation, with potential implications for healthcare cost reduction.
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Affiliation(s)
- Susanna Lucatello
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.L.); (S.D.A.); (C.D.L.); (L.M.); (M.D.L.); (M.G.B.)
| | - Sara De Angelis
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.L.); (S.D.A.); (C.D.L.); (L.M.); (M.D.L.); (M.G.B.)
| | - Concetta Di Lorenzo
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.L.); (S.D.A.); (C.D.L.); (L.M.); (M.D.L.); (M.G.B.)
| | - Marco Iosa
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.L.); (S.D.A.); (C.D.L.); (L.M.); (M.D.L.); (M.G.B.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Luisa Magnotti
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.L.); (S.D.A.); (C.D.L.); (L.M.); (M.D.L.); (M.G.B.)
| | - Marta Di Paolo
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.L.); (S.D.A.); (C.D.L.); (L.M.); (M.D.L.); (M.G.B.)
| | - Maria De Luca
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.L.); (S.D.A.); (C.D.L.); (L.M.); (M.D.L.); (M.G.B.)
| | - Maria Gabriella Buzzi
- Fondazione Santa Lucia IRCCS, 00179 Rome, Italy; (S.L.); (S.D.A.); (C.D.L.); (L.M.); (M.D.L.); (M.G.B.)
| | - Marco Tramontano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138 Bologna, Italy
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Fahrenthold BK, Cavanaugh MR, Jang S, Murphy AJ, Ajina S, Bridge H, Huxlin KR. Optic Tract Shrinkage Limits Visual Restoration After Occipital Stroke. Stroke 2021; 52:3642-3650. [PMID: 34266305 PMCID: PMC8545836 DOI: 10.1161/strokeaha.121.034738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral visual hemifield, initiating a process of trans-synaptic retrograde degeneration. The present study examined functional implications of this process, asking if degeneration impacted the amount of visual recovery attainable from visual restoration training in chronic patients, and if restoration training impacted optic tract (OT) shrinkage. Methods: Magnetic resonance imaging was used to measure OT volumes bilaterally in 36 patients with unilateral occipital stroke. From OT volumes, we computed laterality indices (LI), estimating the stroke-induced OT shrinkage in each case. A subset of these chronic patients (n=14, 13±6 months poststroke) underwent an average of nearly 1 year of daily visual restoration training, which repeatedly stimulated vision in their blind field. The amount of visual field recovery was quantified using Humphrey perimetry, and post training magnetic resonance imaging was used to assess the impact of training on OT shrinkage. Results: OT LI was correlated with time since stroke: it was close to 0 (no measurable OT shrinkage) in subacute participants (<6 months poststroke) while chronic participants (>6 months poststroke) exhibited LI >0, but with significant variability. Visual training did not systematically alter LI, but chronic patients with baseline LI≈0 (no OT shrinkage) exhibited greater visual field recovery than those with LI>0. Conclusions: Unilateral OT shrinkage becomes detectable with magnetic resonance imaging by ≈7 months poststroke, albeit with significant interindividual variability. Although visual restoration training did not alter the amount of degeneration already sustained, OT shrinkage appeared to serve as a biomarker of the potential for training-induced visual recovery in chronic cortically blind patients.
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Affiliation(s)
- Berkeley K. Fahrenthold
- Flaum Eye Institute (B.K.F., M.R.C., S.J., K.R.H.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Matthew R. Cavanaugh
- Flaum Eye Institute (B.K.F., M.R.C., S.J., K.R.H.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Subin Jang
- Flaum Eye Institute (B.K.F., M.R.C., S.J., K.R.H.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Allison J. Murphy
- Neuroscience Graduate Program (A.J.M.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | | | | | - Krystel R. Huxlin
- Flaum Eye Institute (B.K.F., M.R.C., S.J., K.R.H.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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4
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Halbertsma HN, Elshout JA, Bergsma DP, Norris DG, Cornelissen FW, van den Berg AV, Haak KV. Functional connectivity of the Precuneus reflects effectiveness of visual restitution training in chronic hemianopia. NEUROIMAGE-CLINICAL 2020; 27:102292. [PMID: 32554320 PMCID: PMC7303670 DOI: 10.1016/j.nicl.2020.102292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/17/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023]
Abstract
Visual field defects in chronic hemianopia can improve through visual restitution training, yet not all patients benefit equally from this long and exhaustive procedure. Here, we asked if resting-state functional connectivity prior to visual restitution could predict training success. In two training sessions of eight weeks each, 20 patients with chronic hemianopia performed a visual discrimination task by directing spatial selective attention towards stimuli presented in either hemifield, while suppressing eye movements. We examined two effects: a sensitivity change in the attended (trained) minus the unattended (control) hemifield (i.e., a training-specific improvement), and an overall improvement (i.e., a total change in sensitivity after both sessions). We then identified five visual resting-state networks and evaluated their functional connectivity in relation to both training effects. We found that the functional connectivity strength between the anterior Precuneus and the Occipital Pole Network was positively related to the attention modulated (i.e., training-specific) improvement. No such relationship was found for the overall improvement or for the other visual networks of interest. Our finding suggests that the anterior Precuneus plays a role in attention-modulated visual field improvements. The resting-state functional connectivity between the anterior Precuneus and the Occipital Pole Network may thus serve as an imaging-based biomarker that quantifies a patient's potential capacity to direct spatial attention. This may help to identify hemianopia patients that are most likely to benefit from visual restitution training.
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Affiliation(s)
- Hinke N Halbertsma
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Joris A Elshout
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Douwe P Bergsma
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans W Cornelissen
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, Groningen, the Netherlands
| | - Albert V van den Berg
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen V Haak
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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5
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Facchin A, Vallar G, Daini R. The Brentano Illusion Test (BRIT): An implicit task of perceptual processing for the assessment of visual field defects in neglect patients. Neuropsychol Rehabil 2019; 31:39-56. [PMID: 31438751 DOI: 10.1080/09602011.2019.1655067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In brain damaged patients with unilateral spatial neglect (USN), the differential diagnosis between the presence and absence of a unilateral visual half-field deficit (VHFD) is hampered by the similarity of their phenomenology. The absence of stimuli detection in the contralateral visual field, indeed, can be due to the co-occurrence of USN and VHFD or the sole presence of the USN. The disentangling of the two conditions is required to devise more specific rehabilitation programmes. Daini et al. [2002. Exploring the syndrome of spatial unilateral neglect through an illusion of length. Experimental Brain Research, 144(2), 224-237.] reported a difference in performance for the two conditions when the tasks required the bisection of Brentano illusory stimuli. Only when USN and VHFD co-occurred, the leftward illusory effect was disrupted. Based on previous findings, in this cross-sectional study, we developed the Brentano Illusion Test (BRIT), a clinical tool that helps the identification of VHFD in USN patients. The BRIT is a simple behavioural test of line bisection aimed at verifying the presence or absence of implicit processing in USN and thus helping the diagnosis of VHFD in USN patients; it also provides normative data for the line bisection task and the length effect.
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Affiliation(s)
- Alessio Facchin
- Department of Psychology, Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milano, Italy.,University Research Centre in Optics and Optometry, University of Milano-Bicocca (COMiB), Milano, Italy.,Institute of Research and Studies in Optics and Optometry, Vinci, Italy
| | - Giuseppe Vallar
- Department of Psychology, Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milano, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Roberta Daini
- Department of Psychology, Milan Centre for Neuroscience (NeuroMI), University of Milano-Bicocca, Milano, Italy.,University Research Centre in Optics and Optometry, University of Milano-Bicocca (COMiB), Milano, Italy
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6
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Bulboaca1 AE, Bulboaca A, Stanescu I, Boarescu PM, Chirilă I, Bulboaca A, Dogaru G. Homonymous hemianopsia versus unilateral spatial neglect rehabilitation strategies in stroke patients. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract Visual rehabilitation therapy is one of the most problematic issue in stroke rehabilitation. The difficulties consist in specific assessment of visual deficit and poor results reports by the authors of the clinical studies. Opposite, experimental studies reports encouraging results that give hopes in this specific rehabilitation therapy. There are still difficult to analyze different aquisitions concerning various visual residual deficits after stroke, the main rehabilitation targgets being motor rehabilitation in order to ensure at least a partial autonomy in day by day life. All the studies that proved there are chances for a better quality of life if there is an improvement of visual abilities together with motor and cognitive skills with a better rehabilitation prognosis. The aim of this paper is to make a brief report regarding two of the most important visual deficits after stroke as are homonymous hemianopsia and neglect. Starting with differential diagnosis, neuroplasticity and specific rehabilitation available method, the main issues are discussed. a better understanding of phenomena that are associated with spontaneous rehabilitation, or enhancing the progress of recuperation by various method, could be able to bring a new light and hopefully better results in rehabilitation for these patients Key words: stroke, visual impairment, visual rehabilitation, neuroplasticity, homonymous hemianopsia,
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Affiliation(s)
| | - Angelo Bulboaca
- "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Ioana Stanescu
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Paul-Mihai Boarescu
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Chirilă
- County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Alexandra Bulboaca
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriela Dogaru
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
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7
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Bhatnagar S, Anderson M, Chu M, Kuo D, Azuh O. Rehabilitation Assessment and Management of Neurosensory Deficits After Traumatic Brain Injury in the Polytrauma Veteran. Phys Med Rehabil Clin N Am 2018; 30:155-170. [PMID: 30470419 DOI: 10.1016/j.pmr.2018.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Neurosensory deficits after traumatic brain injury can frequently lead to disability; therefore, diagnosis and treatment are important. Posttraumatic headaches typically resemble migraines and are managed similarly, but adjuvant physical therapy may be beneficial. Sleep-related issues are treated pharmacologically based on the specific sleep-related complaint. Fatigue is difficult to treat; cognitive behavioral therapy and aquatic therapy can be beneficial. Additionally, methylphenidate and modafinil have been used. Peripheral and central vestibular dysfunction causes dizziness and balance dysfunction, and the mainstay of treatment is vestibular physical therapy. Visual dysfunction incorporates numerous different diagnoses, which are frequently treated with specific rehabilitation programs.
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Affiliation(s)
- Saurabha Bhatnagar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA 02025, USA.
| | - Meredith Anderson
- Department of Physical Medicine and Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Michael Chu
- Department of Physical Medicine and Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Daniel Kuo
- Department of Physical Medicine and Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Ogo Azuh
- Department of Physical Medicine and Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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8
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Abstract
Much remains to be understood about visual system malfunction following injury. The resulting deficits range from dense, visual field scotomas to mild dysfunction of visual perception. Despite the predictive value of anatomical localization studies, much patient-to-patient variability remains regarding (a) perceptual abilities following injury and (b) the capacity of individual patients for visual rehabilitation. Visual field perimetry is used to characterize the visual field deficits that result from visual system injury. However, standard perimetry mapping does not always precisely correspond to underlying anatomical or functional deficits. Functional magnetic resonance imaging can be used to probe the function of surviving visual circuits, allowing us to classify better how the pattern of injury relates to residual visual perception. Identifying pathways that are potentially modifiable by training may guide the development of improved strategies for visual rehabilitation. This review discusses primary visual cortex lesions, which cause dense contralateral scotomas.
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Affiliation(s)
- Stelios M Smirnakis
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts 02115.,Department of Neurology, Jamaica Plain Campus, Veterans Administration Boston Healthcare System, Boston, Massachusetts 02130.,Harvard Medical School, Boston, Massachusetts 02115;
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9
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Jafarlou F, Jarollahi F, Ahadi M, Sadeghi-Firoozabadi V, Haghani H. Oculomotor rehabilitation in children with dyslexia. Med J Islam Repub Iran 2017; 31:125. [PMID: 29951425 PMCID: PMC6014809 DOI: 10.14196/mjiri.31.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Dyslexia is the most common learning disorder. Visual and oculomotor deficits in dyslexic children have been reported. The purpose of this study was to measure oculomotor parameters and analyze the effect of oculomotor rehabilitation strategies on dyslexia. Methods: Binocular eye movements were recorded by oculomotor subtype of videonystagmography (VNG) testing on 30 children with dyslexia and 20 typical reader children (aged 8-12) in both genders. Dyslexic children were diagnosed with DSM-V scale by experts in reading disorder centers. We studied those children with developmental dyslexia, who had deficits in eye movements recording. Dyslexic children were divided into 2 groups of case and control. Oculomotor rehabilitation (including fixation, saccade, and tracking training) was performed in case group for 1 hour, twice weekly for 8 weeks. Before the intervention, results of oculomotor tests were compared between 3 groups (healthy, case, and control). Then, to analyze the effect of the intervention, results of oculomotor tests were compared between case and control groups in pre- and post- intervention stage. Data were analyzed by independent and paired samples t tests, ANOVA, and repeated measures tests in SPSS v. 21. Results: There were significant differences in oculomotor characteristics of dyslexic children in comparison with those reported in typical children. Oculomotor rehabilitation intervention had a positive effect on improvement of oculomotor responses and eye movements in dyslexic children. Moreover, there was no statistically significant difference between dyslexic children and non-dyslexic children in oculomotor skills after the training. Conclusion: Our results showed the positive effects of oculomotor rehabilitation on eye movements. Primary oculomotor assessment in dyslexic children and early use of oculomotor rehabilitation combined with other treatments are highly recommended.
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Affiliation(s)
- Fatemeh Jafarlou
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farnoush Jarollahi
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ahadi
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Sadeghi-Firoozabadi
- Deputy Head of Psychological Labs, Department of Psychology, Faculty of Education & Psychology, Shahid Beheshti University, Tehran, Iran
| | - Hamid Haghani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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10
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Hadid V, Lepore F. From Cortical Blindness to Conscious Visual Perception: Theories on Neuronal Networks and Visual Training Strategies. Front Syst Neurosci 2017; 11:64. [PMID: 28912694 PMCID: PMC5583595 DOI: 10.3389/fnsys.2017.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/11/2017] [Indexed: 12/13/2022] Open
Abstract
Homonymous hemianopia (HH) is the most common cortical visual impairment leading to blindness in the contralateral hemifield. It is associated with many inconveniences and daily restrictions such as exploration and visual orientation difficulties. However, patients with HH can preserve the remarkable ability to unconsciously perceive visual stimuli presented in their blindfield, a phenomenon known as blindsight. Unfortunately, the nature of this captivating residual ability is still misunderstood and the rehabilitation strategies in terms of visual training have been insufficiently exploited. This article discusses type I and type II blindsight in a neuronal framework of altered global workspace, resulting from inefficient perception, attention and conscious networks. To enhance synchronization and create global availability for residual abilities to reach visual consciousness, rehabilitation tools need to stimulate subcortical extrastriate pathways through V5/MT. Multisensory bottom-up compensation combined with top-down restitution training could target pre-existing and new neuronal mechanisms to recreate a framework for potential functionality.
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Affiliation(s)
- Vanessa Hadid
- Département de Sciences Biomédicales, Université de MontréalMontréal, QC, Canada
| | - Franco Lepore
- Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Département de Psychologie, Université de MontréalMontréal, QC, Canada
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Abstract
PURPOSE To discuss the clinical case of a patient suffering visual dysfunction secondary to a metabolic brain injury, the patient's visual rehabilitative treatment, and outcomes. CASE REPORT A 24-year-old Caucasian male presented to the Southern Arizona Veteran's Affairs Healthcare System's Traumatic Brain Injury (TBI) eye clinic for evaluation and treatment of visual dysfunction secondary to an anoxic brain injury suffered 4 months before. Symptoms included persistent right homonymous hemianopia, oculomotor dysfunction, and a visual information processing deficit. After 5 weeks of vision rehabilitation, the patient was reassessed and displayed significant improvement in both signs and symptoms. CONCLUSIONS The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a metabolic syndrome that causes hyponatremia and, in severe cases, encephalopathy and anoxic brain injury. Damage to the visual pathways can produce visual field, ocular motility, and binocular vision deficits. Comprehensive treatment including rehabilitative vision therapy bolstering the natural neuroplasticity process can provide improvements in patients' quality of life.
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Abstract
The incidence of cortically induced blindness is increasing as our population ages. The major cause of cortically induced blindness is stroke affecting the primary visual cortex. While the impact of this form of vision loss is devastating to quality of life, the development of principled, effective rehabilitation strategies for this condition lags far behind those used to treat motor stroke victims. Here we summarize recent developments in the still emerging field of visual restitution therapy, and compare the relative effectiveness of different approaches. We also draw insights into the properties of recovered vision, its limitations and likely neural substrates. We hope that these insights will guide future research and bring us closer to the goal of providing much-needed rehabilitation solutions for this patient population.
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Affiliation(s)
- Michael D Melnick
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA
| | - Duje Tadin
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA The Flaum Eye Institute, University of Rochester, Rochester, NY, USA The Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Krystel R Huxlin
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA The Flaum Eye Institute, University of Rochester, Rochester, NY, USA The Center for Visual Science, University of Rochester, Rochester, NY, USA
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13
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Turco S, Albamonte E, Ricci D, Fortini S, Amore FM. Bernhard Sabel and 'Residual Vision Activation Theory': a History Spanning Three Decades. Multisens Res 2015; 28:309-30. [PMID: 26288902 DOI: 10.1163/22134808-00002499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This review has the purpose of retracing the work of Professor Bernard Sabel and his group over the last 2-3 decades, in order to understand how they achieved formulation of the 'Residual Vision Activation Theory'. The methodology proposed is described, from the first studies in 1995 with High Resolution Perimetry requiring a six-months training period, to the new technologies, such as repetitive transorbital Alternating Current Stimulation, that require ten days of training. Vision restoration therapy has shown improvement in visual responses irrespective of age at the training, lesion aetiology and site of lesion. The hypothesis that visual training may induce network plasticity, improving neuronal networks in cortical and subcortical areas of both hemispheres, appears to be confirmed by recent studies including observation of the cerebral activity by fMRI and EEG. However, the results are quite variable and the mechanisms that influence cerebral activity are still unclear. The residual vision activation theory has been much criticized, both for its methodology and analysis of the results, but it gave a new impulse to the research in this area, stimulating more studies on induced cerebral plasticity.
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Gall C, Brösel D, Franke GH. Mental distress in patients with cerebral visual injury assessed with the german brief symptom inventory. Front Aging Neurosci 2015; 7:51. [PMID: 25999848 PMCID: PMC4418273 DOI: 10.3389/fnagi.2015.00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/28/2015] [Indexed: 11/13/2022] Open
Abstract
Background While there are reports on vision-related quality of life in patients with vision impairment caused by both ophthalmic and brain diseases, little is known about mental distress. In fact, mental distress after cerebral visual injury has been widely ignored. Methods Mental health symptoms were assessed in 122 participants with visual field defects after brain damage (72 male, mean age 58.1 ± 15.6 years), who completed the German Brief Symptom Inventory (BSI) at their homes after they had been asked by phone for their participation. Results Clinically relevant mental distress was present in 25.4% of participants with cerebral visual injury. In case of multisensory impairment, an increased amount and intensity of mental distress symptoms was observed compared to the subsample with only visual impairment. Conclusion Assessment of comorbid mental health symptoms appears to be clinically meaningful in brain-damaged patients with visual sensory impairment. In case of clinically relevant mental distress, psychological supportive therapies are advisable especially in subjects with cerebral visual injury and comorbidities affecting other sensory modalities as well.
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Affiliation(s)
- Carolin Gall
- Department of Rehabilitation Psychology, AHW, Magdeburg-Stendal University of Applied Sciences , Stendal , Germany ; Department of Psychiatry, AMEOS Hospital , Haldensleben , Germany
| | - Doreen Brösel
- Department of Psychiatry, AMEOS Hospital , Haldensleben , Germany
| | - Gabriele Helga Franke
- Department of Rehabilitation Psychology, AHW, Magdeburg-Stendal University of Applied Sciences , Stendal , Germany
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Loetscher T, Chen C, Wignall S, Bulling A, Hoppe S, Churches O, Thomas NA, Nicholls MER, Lee A. A study on the natural history of scanning behaviour in patients with visual field defects after stroke. BMC Neurol 2015; 15:64. [PMID: 25907452 PMCID: PMC4417296 DOI: 10.1186/s12883-015-0321-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/15/2015] [Indexed: 11/23/2022] Open
Abstract
Background A visual field defect (VFD) is a common consequence of stroke with a detrimental effect upon the survivors’ functional ability and quality of life. The identification of effective treatments for VFD is a key priority relating to life post-stroke. Understanding the natural evolution of scanning compensation over time may have important ramifications for the development of efficacious therapies. The study aims to unravel the natural history of visual scanning behaviour in patients with VFD. The assessment of scanning patterns in the acute to chronic stages of stroke will reveal who does and does not learn to compensate for vision loss. Methods/Design Eye-tracking glasses are used to delineate eye movements in a cohort of 100 stroke patients immediately after stroke, and additionally at 6 and 12 months post-stroke. The longitudinal study will assess eye movements in static (sitting) and dynamic (walking) conditions. The primary outcome constitutes the change of lateral eye movements from the acute to chronic stages of stroke. Secondary outcomes include changes of lateral eye movements over time as a function of subgroup characteristics, such as side of VFD, stroke location, stroke severity and cognitive functioning. Discussion The longitudinal comparison of patients who do and do not learn compensatory scanning techniques may reveal important prognostic markers of natural recovery. Importantly, it may also help to determine the most effective treatment window for visual rehabilitation.
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Affiliation(s)
- Tobias Loetscher
- School of Psychology, University of South Australia, Adelaide, Australia.
| | - Celia Chen
- Department of Ophthalmology, Flinders University, Adelaide, Australia.
| | - Sophie Wignall
- School of Psychology, Flinders University, Adelaide, Australia.
| | | | - Sabrina Hoppe
- Max Planck Institute for Informatics, Saarbrucken, Germany.
| | - Owen Churches
- School of Psychology, Flinders University, Adelaide, Australia.
| | - Nicole A Thomas
- School of Psychology, Flinders University, Adelaide, Australia.
| | | | - Andrew Lee
- Flinders Comprehensive Stroke Centre, Flinders Medical Centre, Adelaide, Australia.
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Urbanski M, Coubard OA, Bourlon C. Visualizing the blind brain: brain imaging of visual field defects from early recovery to rehabilitation techniques. Front Integr Neurosci 2014; 8:74. [PMID: 25324739 PMCID: PMC4179723 DOI: 10.3389/fnint.2014.00074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/03/2014] [Indexed: 01/04/2023] Open
Abstract
Visual field defects (VFDs) are one of the most common consequences observed after brain injury, especially after a stroke in the posterior cerebral artery territory. Less frequently, tumors, traumatic brain injury, brain surgery or demyelination can also determine various visual disabilities, from a decrease in visual acuity to cerebral blindness. Visual field defects is a factor of bad functional prognosis as it compromises many daily life activities (e.g., obstacle avoidance, driving, and reading) and therefore the patient's quality of life. Spontaneous recovery seems to be limited and restricted to the first 6 months, with the best chance of improvement at 1 month. The possible mechanisms at work could be partly due to cortical reorganization in the visual areas (plasticity) and/or partly to the use of intact alternative visual routes, first identified in animal studies and possibly underlying the phenomenon of blindsight. Despite processes of early recovery, which is rarely complete, and learning of compensatory strategies, the patient's autonomy may still be compromised at more chronic stages. Therefore, various rehabilitation therapies based on neuroanatomical knowledge have been developed to improve VFDs. These use eye-movement training techniques (e.g., visual search, saccadic eye movements), reading training, visual field restitution (the Vision Restoration Therapy, VRT), or perceptual learning. In this review, we will focus on studies of human adults with acquired VFDs, which have used different imaging techniques (Positron Emission Tomography, PET; Diffusion Tensor Imaging, DTI; functional Magnetic Resonance Imaging, fMRI; Magneto Encephalography, MEG) or neurostimulation techniques (Transcranial Magnetic Stimulation, TMS; transcranial Direct Current Stimulation, tDCS) to show brain activations in the course of spontaneous recovery or after specific rehabilitation techniques.
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Affiliation(s)
- Marika Urbanski
- Service de Médecine et de Réadaptation Gériatrique et Neurologique, Hôpitaux de Saint-Maurice Saint-Maurice, France ; Inserm, U 1127, ICM FrontLab Paris, France ; CNRS, UMR 7225, ICM FrontLab Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, UMRS 1127 Paris, France ; Institut du Cerveau et de la Moelle Épinière, ICM FrontLab Paris, France
| | - Olivier A Coubard
- The Neuropsychological Laboratory, CNS-Fed Paris, France ; Laboratoire Psychologie de la Perception, UMR 8242 CNRS-Université Paris Descartes Paris, France
| | - Clémence Bourlon
- Service de Médecine et de Réadaptation, Clinique Les Trois Soleils Boissise-le-Roi, France
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Atypical retinotopic organization of visual cortex in patients with central brain damage: congenital and adult onset. J Neurosci 2013; 33:13010-24. [PMID: 23926256 DOI: 10.1523/jneurosci.0240-13.2013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
It remains unclear to what extent retinotopic maps can undergo large-scale plasticity following damage to human visual cortex. The literature has predominately focused on retinotopic changes in patients with retinal pathologies or congenital brain malformations. Yet, damage to the adult visual cortex itself is common in cases such as stroke, tumor, or trauma. To address this issue, we used a unique database of fMRI vision maps in patients with adult-onset (n=25) and congenital (n=2) pathology of the visual cortex. We identified atypical retinotopic organization in three patients (two with adult-onset, and one with congenital pathology) consisting of an expanded ipsilateral field representation that was on average 3.2 times greater than healthy controls. The expanded representations were located at the vertical meridian borders between visual areas such as V1/V2. Additionally, two of the three patients had apparently an ectopic (topographically inconsistent) representation of the ipsilateral field within lateral occipital cortex that is normally associated with visual areas V3/V3A (and possibly other areas). Both adult-onset cases had direct damage to early visual cortex itself (rather than to the afferent drive only), resulting in a mostly nonfunctional hemisphere. The congenital case had severe cortical malformation of the visual cortex and was acallosal. Our results are consistent with a competitive model in which unilateral damage to visual cortex or disruption of the transcallosal connections removes interhemispheric suppression from retino-geniculate afferents in intact visual cortex that represent the vertical meridian and ipsilateral visual field.
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