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Mena-Garcia L, Pastor-Jimeno JC, Maldonado MJ, Coco-Martin MB, Fernandez I, Arenillas JF. Multitasking Compensatory Saccadic Training Program for Hemianopia Patients: A New Approach With 3-Dimensional Real-World Objects. Transl Vis Sci Technol 2021; 10:3. [PMID: 34003888 PMCID: PMC7873505 DOI: 10.1167/tvst.10.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/25/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine whether a noncomputerized multitasking compensatory saccadic training program (MCSTP) for patients with hemianopia, based on a reading regimen and eight exercises that recreate everyday visuomotor activities using three-dimensional (3D) real-world objects, improves the visual ability/function, quality of life (QL), and functional independence (FI). Methods The 3D-MCSTP included four in-office visits and two customized home-based daily training sessions over 12 weeks. A quasiexperimental, pretest/posttest study design was carried out with an intervention group (IG) (n = 20) and a no-training group (NTG) (n = 20) matched for age, hemianopia type, and brain injury duration. Results The groups were comparable for the main baseline variables and all participants (n = 40) completed the study. The IG mainly showed significant improvements in visual-processing speed (57.34% ± 19.28%; P < 0.0001) and visual attention/retention ability (26.67% ± 19.21%; P < 0.0001), which also were significantly greater (P < 0.05) than in the NTG. Moreover, the IG showed large effect sizes (Cohen's d) in 75% of the total QL and FI dimensions analyzed; in contrast to the NTG that showed negligible mean effect sizes in 96% of these dimensions. Conclusions The customized 3D-MCSTP was associated with a satisfactory response in the IG for improving complex visual processing, QL, and FI. Translational Relevance Neurovisual rehabilitation of patients with hemianopia seems more efficient when programs combine in-office visits and customized home-based training sessions based on real objects and simulating real-life conditions, than no treatment or previously reported computer-screen approaches, probably because of better stimulation of patients´ motivation and visual-processing speed brain mechanisms.
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Affiliation(s)
- Laura Mena-Garcia
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
| | - Jose C. Pastor-Jimeno
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel J. Maldonado
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
- Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria B. Coco-Martin
- Universidad de Valladolid, Valladolid, Spain
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Itziar Fernandez
- Universidad de Valladolid, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Juan F. Arenillas
- Universidad de Valladolid, Valladolid, Spain
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Sahraie A, Cederblad AMH, Kenkel S, Romano JG. Efficacy and predictors of recovery of function after eye movement training in 296 hemianopic patients. Cortex 2020; 125:149-160. [DOI: 10.1016/j.cortex.2019.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/08/2019] [Accepted: 12/02/2019] [Indexed: 11/29/2022]
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Sabel BA, Flammer J, Merabet LB. Residual vision activation and the brain-eye-vascular triad: Dysregulation, plasticity and restoration in low vision and blindness - a review. Restor Neurol Neurosci 2019; 36:767-791. [PMID: 30412515 PMCID: PMC6294586 DOI: 10.3233/rnn-180880] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vision loss due to ocular diseases such as glaucoma, optic neuropathy, macular degeneration, or diabetic retinopathy, are generally considered an exclusive affair of the retina and/or optic nerve. However, the brain, through multiple indirect influences, has also a major impact on functional visual impairment. Such indirect influences include intracerebral pressure, eye movements, top-down modulation (attention, cognition), and emotionally triggered stress hormone release affecting blood vessel dysregulation. Therefore, vision loss should be viewed as the result of multiple interactions within a “brain-eye-vascular triad”, and several eye diseases may also be considered as brain diseases in disguise. While the brain is part of the problem, it can also be part of the solution. Neuronal networks of the brain can “amplify” residual vision through neuroplasticity changes of local and global functional connectivity by activating, modulating and strengthening residual visual signals. The activation of residual vision can be achieved by different means such as vision restoration training, non-invasive brain stimulation, or blood flow enhancing medications. Modulating brain functional networks and improving vascular regulation may offer new opportunities to recover or restore low vision by increasing visual field size, visual acuity and overall functional vision. Hence, neuroscience offers new insights to better understand vision loss, and modulating brain and vascular function is a promising source for new opportunities to activate residual vision to achieve restoration and recovery to improve quality of live in patients suffering from low vision.
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Affiliation(s)
- Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Josef Flammer
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Lotfi B Merabet
- Department of Ophthalmology, The Laboratory for Visual Neuroplasticity, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
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Neuronal mechanisms of motion detection underlying blindsight assessed by functional magnetic resonance imaging (fMRI). Neuropsychologia 2019; 128:187-197. [PMID: 30825453 DOI: 10.1016/j.neuropsychologia.2019.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/27/2022]
Abstract
Brain imaging offers a valuable tool to observe functional brain plasticity by showing how sensory inputs reshape cortical activations after a visual impairment. Following a unilateral post-chiasmatic lesion affecting the visual cortex, patients may suffer a contralateral visual loss referred to homonymous hemianopia. Nevertheless, these patients preserve the ability to unconsciously detect, localize and discriminate visual stimuli presented in their impaired visual field. To investigate this paradox, known as blindsight, we conducted a study using functional magnetic resonance imaging (fMRI) to evaluate the structural and functional impact of such lesion in a 33-year old patient (ML), who suffers a complete right hemianopia without macular sparing and showing strong evidences of blindsight. We thus performed whole brain and sliced thalamic fMRI scan sequences during an event-related motion detection task. We provided evidence of the neuronal fingerprint of blindsight by acquiring and associating neural correlates, specific structures and functional networks of the midbrain during blindsight performances which may help to better understand this condition. Accurate performance demonstrated the presence of residual vision and the ability to unconsciously perceive motion presented in the blind hemifield, although her reaction time was significantly higher in her blind-field. When the normal hemifield was stimulated, we observed significant contralateral activations in primary and secondary visual areas as well as motion specific areas, such as the supramarginal gyrus and middle temporal area. We also demonstrated sub-thalamic activations within the superior colliculi (SC) and the pulvinar. These results suggest a role of secondary subcortical structures in normal spontaneous motion detection. In a similar way, when the lesioned hemifield was stimulated, we observed contralateral activity in extrastriate areas with no activation of the primary lesioned visual cortex. Moreover, we observed activations within the SC when the blind hemifield was stimulated. However, we observed unexpected ipsilateral activations within the same motion specific areas, as well as bilateral frontal activations. These results highlight the importance of abnormal secondary pathways bypassing the primary visual area (V1) in residual vision. This reorganization in the structure and function of the visual pathways correlates with behavioral changes, thus offering a plausible explanation for the blindsight phenomenon. Our results may potentially impact the development of rehabilitation strategies to target subcortical pathways.
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Hazelton C, Pollock A, Walsh G, Brady MC. Scanning training for rehabilitation of visual field loss due to stroke: Identifying and exploring training tools in use. Br J Occup Ther 2018. [DOI: 10.1177/0308022618809900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
IntroductionVisual field loss affects one fifth of stroke survivors, limiting daily activities and reducing quality of life. Scanning training is a commonly used intervention, but there is variation in how this is delivered. This study aimed to identify the scanning training tools used in Scotland and describe their training parameters, delivery and suitability for use with stroke survivors.MethodAn email survey identified scanning training tools used in Scotland. Two expert panel meetings gained consensus on the motor, language and cognitive skills required to use each scanning training tool. Video capture techniques gathered objective measures of training parameters.ResultsTen scanning training tools were identified. These tools used four delivery methods: paper-based, computer software, web-based and specialised equipment. They aimed to improve reading, perception or general visual skills. Fast, saccadic eye movements were most frequently targeted: two interventions also encouraged head movements. Session duration, frequency and therapist support varied considerably. The level of motor, language and cognitive skills required for each tool was determined.ConclusionScanning training tools used in Scotland vary in delivery modality, functional abilities required for use and visual skills trained. This information will support clinical decision-making and inform future research on training effectiveness and feasibility.
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Affiliation(s)
- Christine Hazelton
- Research Fellow, Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, UK
| | - Alex Pollock
- Senior Research Fellow, NMAHP Research Unit, Glasgow Caledonian University, UK
| | - Glyn Walsh
- Senior Lecturer (retired), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Marian C Brady
- Professor, NMAHP Research Unit, Glasgow Caledonian University, UK
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Heutink J, Indorf DL, Cordes C. The neuropsychological rehabilitation of visual agnosia and Balint’s syndrome. Neuropsychol Rehabil 2018; 29:1489-1508. [DOI: 10.1080/09602011.2017.1422272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Joost Heutink
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Visually Impaired and Blind People, Department of Knowledge, Expertise & Innovation, Huizen, The Netherlands
| | - Dana L. Indorf
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Christina Cordes
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Visually Impaired and Blind People, Department of Knowledge, Expertise & Innovation, Huizen, The Netherlands
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Sabel BA, Cárdenas-Morales L, Gao Y. Vision Restoration in Glaucoma by Activating Residual Vision with a Holistic, Clinical Approach: A Review. J Curr Glaucoma Pract 2018; 12:1-9. [PMID: 29861576 PMCID: PMC5981087 DOI: 10.5005/jp-journals-10028-1237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 01/07/2023] Open
Abstract
How to cite this article: Sabel BA, Cárdenas-Morales L, Gao Y. Vision Restoration in Glaucoma by activating Residual Vision with a Holistic, Clinical Approach: A Review. J Curr Glaucoma Pract 2018;12(1):1-9.
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Affiliation(s)
- Bernhard A Sabel
- Professor, SAVIR Center, Magdeburg, Germany; Institute for Medical Psychology, Otto von Guericke University of Magdeburg Magdeburg, Germany
| | - Lizbeth Cárdenas-Morales
- Lecturer, Institute for Medical Psychology, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Ying Gao
- Researcher, SAVIR Center, Magdeburg, Germany; Institute for Medical Psychology, Otto von Guericke University of Magdeburg Magdeburg, Germany
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Fontenot JL, Bona MD, Kaleem MA, McLaughlin WM, Morse AR, Schwartz TL, Shepherd JD, Jackson ML. Vision Rehabilitation Preferred Practice Pattern®. Ophthalmology 2018; 125:P228-P278. [DOI: 10.1016/j.ophtha.2017.09.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022] Open
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Bergsma DP, Elshout JA, van den Berg AV. Segregation of Spontaneous and Training Induced Recovery from Visual Field Defects in Subacute Stroke Patients. Front Neurol 2017; 8:681. [PMID: 29326645 PMCID: PMC5736566 DOI: 10.3389/fneur.2017.00681] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/29/2017] [Indexed: 12/17/2022] Open
Abstract
Whether rehabilitation after stroke profits from an early start is difficult to establish as the contributions of spontaneous recovery and treatment are difficult to tease apart. Here, we use a novel training design to dissociate these components for visual rehabilitation of subacute stroke patients with visual field defects such as hemianopia. Visual discrimination training was started within 6 weeks after stroke in 17 patients. Spontaneous and training-induced recoveries were distinguished by training one-half of the defect for 8 weeks, while monitoring spontaneous recovery in the other (control) half of the defect. Next, trained and control regions were swapped, and training continued for another 8 weeks. The same paradigm was also applied to seven chronic patients for whom spontaneous recovery can be excluded and changes in the control half of the defect point to a spillover effect of training. In both groups, field stability was assessed during a no-intervention period. Defect reduction was significantly greater in the trained part of the defect than in the simultaneously untrained part of the defect irrespective of training onset (p = 0.001). In subacute patients, training contributed about twice as much to their defect reduction as the spontaneous recovery. Goal Attainment Scores were significantly and positively correlated with the total defect reduction (p = 0.01), percentage increase reading speed was significantly and positively correlated with the defect reduction induced by training (epoch 1: p = 0.0044; epoch 2: p = 0.023). Visual training adds significantly to the spontaneous recovery of visual field defects, both during training in the early and the chronic stroke phase. However, field recovery as a result of training in this subacute phase was as large as in the chronic phase. This suggests that patients benefited primarily of early onset training by gaining access to a larger visual field sooner.
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Affiliation(s)
- Douwe P Bergsma
- Department of Cognitive Neuroscience, Section of Biophysics, Donders Centre for Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Joris A Elshout
- Department of Cognitive Neuroscience, Section of Biophysics, Donders Centre for Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Albert V van den Berg
- Department of Cognitive Neuroscience, Section of Biophysics, Donders Centre for Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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Matteo BM, Viganò B, Cerri CG, Meroni R, Cornaggia CM, Perin C. Transcranial direct current stimulation (tDCS) combined with blindsight rehabilitation for the treatment of homonymous hemianopia: a report of two-cases. J Phys Ther Sci 2017; 29:1700-1705. [PMID: 28932016 PMCID: PMC5599849 DOI: 10.1589/jpts.29.1700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Homonymous hemianopia is one of the most common symptoms following neurologic damage leading to impairments of functional abilities and activities of daily living. There are two main types of restorative rehabilitation in hemianopia: "border training" which involves exercising vision at the edge of the damaged visual field, and "blindsight training," which is based on exercising the unconscious perceptual functions deep inside the blind hemifield. Only border effects have been shown to be facilitated by transcranial direct current stimulation (tDCS). This pilot study represents the first attempt to associate the modulatory effects of tDCS over the parieto-occipital cortex to blindsight treatment in the rehabilitation of the homonymous hemianopia. [Subjects and Methods] Patients TA and MR both had chronic hemianopia. TA underwent blindsight treatment which was combined with tDCS followed by blindsight training alone. MR underwent the two training rounds in reverse order. [Results] The patients showed better scores in clinical-instrumental, functional, and ecological assessments after tDCS combined with blindsight rehabilitation rather than rehabilitation alone. [Conclusion] In this two-case report parietal-occipital tDCS modulate the effects induced by blindsight treatment on hemianopia.
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Affiliation(s)
- Barbara Maria Matteo
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Barbara Viganò
- School of Psychology, University of Milan-Bicocca,
Italy
| | - Cesare Giuseppe Cerri
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Roberto Meroni
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Cesare Maria Cornaggia
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Cecilia Perin
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
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Nyffeler T, Paladini RE, Hopfner S, Job O, Nef T, Pflugshaupt T, Vanbellingen T, Bohlhalter S, Müri RM, Kerkhoff G, Cazzoli D. Contralesional Trunk Rotation Dissociates Real vs. Pseudo-Visual Field Defects due to Visual Neglect in Stroke Patients. Front Neurol 2017; 8:411. [PMID: 28861036 PMCID: PMC5562679 DOI: 10.3389/fneur.2017.00411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/31/2017] [Indexed: 11/16/2022] Open
Abstract
In stroke patients, the clinical presentation of visual field defects (VFDs) is frequently accompanied by visual neglect, i.e., the inability to attend and respond to the contralesional space. However, the diagnostic discrimination between the lack of reactions to contralesional stimuli due to VFDs or visual neglect is challenging during clinical examination. This discrimination is particularly relevant, since both clinical pictures are associated with different therapeutic approaches and outcomes. The aim of this study was to systematically investigate the effectiveness of trunk rotation toward the contralesional side-a manipulation dissociating the coordinate system of the trunk from that of the head and eyes-in disentangling real VFDs from "pseudo-VFDs" that occur due to visual neglect. Twenty patients with a left-sided VFD after a right-hemispheric stroke (10 additionally showing visual neglect in neuropsychological testing, VFD + neglect; 10 without neglect, VFD) were tested with Goldmann perimetry in both standard and trunk rotation conditions. In the standard condition, both VFD and VFD + neglect patients showed a conspicuous narrowing of the left visual field. However, trunk rotation triggered strikingly different patterns of change in the two groups: it elicited a significant increase in visual field extension in the VFD + neglect group, but left visual field extension virtually unchanged in the VFD group. Our results highlight contralesional trunk rotation as a simple, viable manipulation to effectively and rapidly disentangle real VFDs from "pseudo-VFDs" (i.e., due to visual neglect) during clinical examination.
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Affiliation(s)
- Thomas Nyffeler
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Rebecca E. Paladini
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Simone Hopfner
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Oliver Job
- Eye Clinic, Luzerner Kantonsspital, Luzern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Tobias Pflugshaupt
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Tim Vanbellingen
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stephan Bohlhalter
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - René M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- University Neurorehabilitation Clinics, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Georg Kerkhoff
- Clinical Neuropsychology and Neuropsychological Outpatient Unit, Saarland University, Saarbrücken, Germany
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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de Haan GA, Melis-Dankers BJM, Brouwer WH, Tucha O, Heutink J. The Effects of Compensatory Scanning Training on Mobility in Patients with Homonymous Visual Field Defects: Further Support, Predictive Variables and Follow-Up. PLoS One 2016; 11:e0166310. [PMID: 27935973 PMCID: PMC5147814 DOI: 10.1371/journal.pone.0166310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 10/24/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction People with homonymous visual field defects (HVFD) often report difficulty detecting obstacles in the periphery on their blind side in time when moving around. Recently, a randomized controlled trial showed that the InSight-Hemianopia Compensatory Scanning Training (IH-CST) specifically improved detection of peripheral stimuli and avoiding obstacles when moving around, especially in dual task situations. Method The within-group training effects of the previously reported IH-CST are examined in an extended patient group. Performance of patients with HVFD on a pre-assessment, post-assessment and follow-up assessment and performance of a healthy control group are compared. Furthermore, it is examined whether training effects can be predicted by demographic characteristics, variables related to the visual disorder, and neuropsychological test results. Results Performance on both subjective and objective measures of mobility-related scanning was improved after training, while no evidence was found for improvement in visual functions (including visual fields), reading, visual search and dot counting. Self-reported improvement did not correlate with improvement in objective mobility performance. According to the participants, the positive effects were still present six to ten months after training. No demographic characteristics, variables related to the visual disorder, and neuropsychological test results were found to predict the size of training effect, although some inconclusive evidence was found for more improvement in patients with left-sided HVFD than in patients with right-sided HFVD. Conclusion Further support was found for a positive effect of IH-CST on detection of visual stimuli during mobility-related activities specifically. Based on the reports given by patients, these effects appear to be long-term effects. However, no conclusions can be drawn on the objective long-term training effects.
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Affiliation(s)
- Gera A. de Haan
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio: Centre of Expertise for Blind and Partially Sighted People, Haren, The Netherlands
- * E-mail:
| | - Bart J. M. Melis-Dankers
- Royal Dutch Visio: Centre of Expertise for Blind and Partially Sighted People, Haren, The Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Joost Heutink
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Royal Dutch Visio: Centre of Expertise for Blind and Partially Sighted People, Haren, The Netherlands
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Abstract
BACKGROUND Homonymous visual field defects (HVFD) are common after postchiasmatic acquired brain injury and may have a significant impact on independent living and participation in society. Vision-related difficulties experienced in daily life are usually assessed using questionnaires. The current study 1) links the content of 3 of these questionnaires to the International Classification of Functioning, Disability and Health (ICF) and 2) provides analyses of vision-related difficulties reported by patients with HVFD and minimal comorbidities. METHODS Fifty-four patients with homonymous hemianopia or quadrantanopia were asked about difficulties experienced in daily life because of their HVFD. This was performed during a structured interview including 3 standardized questionnaires: National Eye Institute Visual Functioning Questionnaire, Independent Mobility Questionnaire, and Cerebral Visual Disorders Questionnaire. The reported difficulties were linked to the ICF according to the ICF linking rules. Main outcome measures were presence or absence of experienced difficulties. RESULTS The ICF linking procedure resulted in a classification table that can be used in future studies of vision-related difficulties. Besides well-known difficulties related to reading, orientation, and mobility, a high proportion of patients with HVFD reported problems that previously have not been documented in the literature, such as impaired light sensitivity, color vision, and perception of depth. CONCLUSIONS A systematic inventory of difficulties experienced in daily life by patients with HVFD was performed using the ICF. These findings have implications for future study, assessment and rehabilitation of patients with HVFD.
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The Effects of Compensatory Scanning Training on Mobility in Patients with Homonymous Visual Field Defects: A Randomized Controlled Trial. PLoS One 2015; 10:e0134459. [PMID: 26275160 PMCID: PMC4537273 DOI: 10.1371/journal.pone.0134459] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/07/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction Homonymous visual field defects (HVFD) are a common consequence of postchiasmatic acquired brain injury and often lead to mobility-related difficulties. Different types of compensatory scanning training have been developed, aimed at decreasing consequences of the HVFD by changing visual scanning. Aim The aim of the present study is to examine the effects of a compensatory scanning training program using horizontal scanning on mobility-related activities and participation in daily life. Method The main interest of this study is to assess the effectiveness of training on mobility-related activities and participation in daily life. Visual scanning tests, such as dot counting and visual search, and control measures for visual functions and reading have been included as well. First, it is examined how performance on scanning and mobility-related measures is affected in patients with HVFD by comparing scores with scores of a healthy control group (n = 25). Second, the effect of training is assessed using an RCT design, in which performance of 26 patients before and after training is compared to performance of 23 patients in a waiting list control group. Results Self-reported improvements after training were found, accompanied by improvements in detecting peripheral stimuli and avoiding obstacles during walking, especially in dual task situations in which a second task limits the attentional capacity available for compensatory scanning. Training only improved mobility-related activities in which detection of peripheral stimuli is important, while no improvement was found on tests that require other visual skills, such as reading, visual counting and visual search. Conclusion This is the first RCT to evaluate the effects of a compensatory scanning training that is based on a systematic horizontal scanning rhythm. This training improved mobility-related activities. The results suggest that different types of compensatory scanning strategies are appropriate for different types of activities. Trial Registration ISRCTN Registry ISRCTN16833414
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Dundon NM, Bertini C, Làdavas E, Sabel BA, Gall C. Visual rehabilitation: visual scanning, multisensory stimulation and vision restoration trainings. Front Behav Neurosci 2015; 9:192. [PMID: 26283935 PMCID: PMC4515568 DOI: 10.3389/fnbeh.2015.00192] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/09/2015] [Indexed: 12/16/2022] Open
Abstract
Neuropsychological training methods of visual rehabilitation for homonymous vision loss caused by postchiasmatic damage fall into two fundamental paradigms: “compensation” and “restoration”. Existing methods can be classified into three groups: Visual Scanning Training (VST), Audio-Visual Scanning Training (AViST) and Vision Restoration Training (VRT). VST and AViST aim at compensating vision loss by training eye scanning movements, whereas VRT aims at improving lost vision by activating residual visual functions by training light detection and discrimination of visual stimuli. This review discusses the rationale underlying these paradigms and summarizes the available evidence with respect to treatment efficacy. The issues raised in our review should help guide clinical care and stimulate new ideas for future research uncovering the underlying neural correlates of the different treatment paradigms. We propose that both local “within-system” interactions (i.e., relying on plasticity within peri-lesional spared tissue) and changes in more global “between-system” networks (i.e., recruiting alternative visual pathways) contribute to both vision restoration and compensatory rehabilitation, which ultimately have implications for the rehabilitation of cognitive functions.
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Affiliation(s)
- Neil M Dundon
- Department of Psychology, University of Bologna Bologna, Italy ; Centre for Studies and Research in Cognitive Neuroscience, University of Bologna Cesena, Italy
| | - Caterina Bertini
- Department of Psychology, University of Bologna Bologna, Italy ; Centre for Studies and Research in Cognitive Neuroscience, University of Bologna Cesena, Italy
| | - Elisabetta Làdavas
- Department of Psychology, University of Bologna Bologna, Italy ; Centre for Studies and Research in Cognitive Neuroscience, University of Bologna Cesena, Italy
| | - Bernhard A Sabel
- Medical Faculty, Institute of Medical Psychology, Otto-von-Guericke University of Magdeburg Magdeburg, Germany
| | - Carolin Gall
- Medical Faculty, Institute of Medical Psychology, Otto-von-Guericke University of Magdeburg Magdeburg, Germany
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Brodtmann A, Puce A, Darby D, Donnan G. Extrastriate visual cortex reorganizes despite sequential bilateral occipital stroke: implications for vision recovery. Front Hum Neurosci 2015; 9:224. [PMID: 25972800 PMCID: PMC4412053 DOI: 10.3389/fnhum.2015.00224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/08/2015] [Indexed: 12/02/2022] Open
Abstract
The extent of visual cortex reorganization following injury remains controversial. We report serial functional magnetic resonance imaging (fMRI) data from a patient with sequential posterior circulation strokes occurring 3 weeks apart, compared with data from an age-matched healthy control subject. At 8 days following a left occipital stroke, contralesional visual cortical activation was within expected striate and extrastriate sites, comparable to that seen in controls. Despite a further infarct in the right (previously unaffected hemisphere), there was evolution of visual cortical reorganization progressed. In this patient, there was evidence of utilization of peri-infarct sites (right-sided) and recruitment of new activation sites in extrastriate cortices, including in the lateral middle and inferior temporal lobes. The changes over time corresponded topographically with the patient's lesion site and its connections. Reorganization of the surviving visual cortex was demonstrated 8 days after the first stroke. Ongoing reorganization in extant cortex was demonstrated at the 6 month scan. We present a summary of mechanisms of recovery following stroke relevant to the visual system. We conclude that mature primary visual cortex displays considerable plasticity and capacity to reorganize, associated with evolution of visual field deficits. We discuss these findings and their implications for therapy within the context of current concepts in visual compensatory and restorative therapies.
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Affiliation(s)
- Amy Brodtmann
- Behavioural Neuroscience, Florey Institute for Neuroscience and Mental Health, University of Melbourne Melbourne, VIC, Australia
| | - Aina Puce
- Department of Psychological and Brain Sciences, Indiana University Bloomington, IN, USA
| | - David Darby
- Behavioural Neuroscience, Florey Institute for Neuroscience and Mental Health, University of Melbourne Melbourne, VIC, Australia
| | - Geoffrey Donnan
- Behavioural Neuroscience, Florey Institute for Neuroscience and Mental Health, University of Melbourne Melbourne, VIC, Australia
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Coubard OA, Urbanski M, Bourlon C, Gaumet M. Educating the blind brain: a panorama of neural bases of vision and of training programs in organic neurovisual deficits. Front Integr Neurosci 2014; 8:89. [PMID: 25538575 PMCID: PMC4256986 DOI: 10.3389/fnint.2014.00089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/31/2014] [Indexed: 01/13/2023] Open
Abstract
Vision is a complex function, which is achieved by movements of the eyes to properly foveate targets at any location in 3D space and to continuously refresh neural information in the different visual pathways. The visual system involves five main routes originating in the retinas but varying in their destination within the brain: the occipital cortex, but also the superior colliculus (SC), the pretectum, the supra-chiasmatic nucleus, the nucleus of the optic tract and terminal dorsal, medial and lateral nuclei. Visual pathway architecture obeys systematization in sagittal and transversal planes so that visual information from left/right and upper/lower hemi-retinas, corresponding respectively to right/left and lower/upper visual fields, is processed ipsilaterally and ipsialtitudinally to hemi-retinas in left/right hemispheres and upper/lower fibers. Organic neurovisual deficits may occur at any level of this circuitry from the optic nerve to subcortical and cortical destinations, resulting in low or high-level visual deficits. In this didactic review article, we provide a panorama of the neural bases of eye movements and visual systems, and of related neurovisual deficits. Additionally, we briefly review the different schools of rehabilitation of organic neurovisual deficits, and show that whatever the emphasis is put on action or perception, benefits may be observed at both motor and perceptual levels. Given the extent of its neural bases in the brain, vision in its motor and perceptual aspects is also a useful tool to assess and modulate central nervous system (CNS) in general.
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Affiliation(s)
- Olivier A Coubard
- The Neuropsychological Laboratory, CNS-Fed Paris, France ; Laboratoire Psychologie de la Perception, UMR 8242 CNRS-Université Paris Descartes Paris, France
| | - Marika Urbanski
- Service de Médecine et de Réadaptation Gériatrique et Neurologique, Hôpitaux de Saint-Maurice Saint-Maurice, France ; Institut du Cerveau et de la Moelle Epinière (ICM), Sorbonne Universités, Université Pierre et Marie Curie UM 75, Inserm U 1127, CNRS UMR 7225 Paris, France
| | - Clémence Bourlon
- Service de Médecine et de Réadaptation, Clinique Les Trois Soleils Boissise-le-Roi, France
| | - Marie Gaumet
- The Neuropsychological Laboratory, CNS-Fed Paris, France
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