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Namgung E, Kwon SU, Han M, Kim G, Kim HY, Park K, Cho M, Choi H, Nah H, Lim HT, Kang D. Digital therapeutics using virtual reality-based visual perceptual learning for visual field defects in stroke: A double-blind randomized trial. Brain Behav 2024; 14:e3525. [PMID: 38773793 PMCID: PMC11109502 DOI: 10.1002/brb3.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double-blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL-based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs. METHODS Stroke outpatients with VFDs (>6 months after stroke onset) were randomized into NV (defective field training) or Nunap Vision-Control (NV-C, central field training) groups. Both interventions provided visual perceptual training, consisting of orientation, rotation, and depth discrimination, through a virtual reality head-mounted display device 5 days a week for 12 weeks. The two groups received VFD assessments using Humphrey visual field (HVF) tests at baseline and 12-week follow-up. The final analysis included those completed the study (NV, n = 40; NV-C, n = 35). Efficacy measures included improved visual area (sensitivity ≥6 dB) and changes in the HVF scores during the 12-week period. RESULTS With a high compliance rate, NV and NV-C training improved the visual areas in the defective hemifield (>72 degrees2) and the whole field (>108 degrees2), which are clinically meaningful improvements despite no significant between-group differences. According to within-group analyses, mean total deviation scores in the defective hemifield improved after NV training (p = .03) but not after NV-C training (p = .12). CONCLUSIONS The current trial suggests that VPL-based digital therapeutics may induce clinically meaningful visual improvements in patients with poststroke VFDs. Yet, between-group differences in therapeutic efficacy were not found as NV-C training exhibited unexpected improvement comparable to NV training, possibly due to learning transfer effects.
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Affiliation(s)
- Eun Namgung
- Asan Institute for Life SciencesAsan Medical CenterSeoulSouth Korea
| | - Sun U. Kwon
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Moon‐Ku Han
- Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamSouth Korea
| | - Gyeong‐Moon Kim
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hahn Young Kim
- Department of NeurologyKonkuk University Medical Center, Konkuk University College of MedicineSeoulSouth Korea
| | - Kwang‐Yeol Park
- Department of NeurologyChung‐Ang University Hospital, Chung‐Ang University College of MedicineSeoulSouth Korea
| | | | | | - Hyun‐Wook Nah
- Department of NeurologyChungnam National University Sejong Hospital, Chungnam National University College of MedicineSejongSouth Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Dong‐Wha Kang
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
- Nunaps Inc.SeoulSouth Korea
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Taroza S, Burkauskas J, Mickuviene N, Kazukauskiene N, Podlipskyte A. Psychometrics and validation of the EQ-5D-5L instrument in individuals with ischemic stroke in Lithuania. Front Psychol 2023; 14:1284859. [PMID: 38125861 PMCID: PMC10731357 DOI: 10.3389/fpsyg.2023.1284859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background Experiencing stroke is associated with deterioration in health-related quality of life (HRQL). One of the generic tools used for HRQL assessment is the EuroQol instrument of five dimensions and five levels (EQ-5D-5L), which has not yet been validated in Lithuania. This study aimed to evaluate validity, reliability, and factor structure of the EQ-5D-5L instrument in a sample of Lithuanian individuals at the end of the first week after experiencing ischemic stroke (IS). Methods The study had a cross-sectional design, including 134 individuals [61.9% men and 38.1% women; median (IQR) age was 66 years (59-73) years, in the final analysis]. Alongside the EQ-5D-5L, psychological distress was evaluated using the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Assessment-7 (GAD-7); neurological impairment with the National Institutes of Health Stroke Scale (NIHSS); and functional independence with the Barthel index (BI). Confirmatory factor analysis (CFA) was performed for validation of the factor structure. Results The internal consistency of the EQ-5D-5L instrument was 0.81. A significant ceiling effect (17.2%) of the descriptive part of the EQ-5D-5L was detected. The convergent validity of the EQ-5D-5L descriptive system was confirmed, with significant correlations with the other scales used, except for the visual analog scale. The two-factor ("physical" and "emotional") model was confirmed by CFA, with acceptable fit [root mean square error of approximation (RMSEA) = 0.045, RMSEA 90% CI = 0.000-0.145; comparative fit indices (CFI) = 0.996; non-normal fit index (NFI) = 0.983; Tucker-Lewis Index (TLI) = 0.936; χ2/df = 1.27)]. Conclusion This study provides information on the psychometric properties of the EQ-5D-5L instrument in Lithuanian individuals, showing that the EQ-5D-5L descriptive system is a reliable and valid tool for HRQL assessment. The Lithuanian version of the descriptive part of the EQ-5D-5L instrument is best expressed as a two-factor model, estimating the physical and emotional dimensions of HRQL in individuals who have experienced IS.
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Affiliation(s)
- Saulius Taroza
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
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Fooken J, Baltaretu BR, Barany DA, Diaz G, Semrau JA, Singh T, Crawford JD. Perceptual-Cognitive Integration for Goal-Directed Action in Naturalistic Environments. J Neurosci 2023; 43:7511-7522. [PMID: 37940592 PMCID: PMC10634571 DOI: 10.1523/jneurosci.1373-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 11/10/2023] Open
Abstract
Real-world actions require one to simultaneously perceive, think, and act on the surrounding world, requiring the integration of (bottom-up) sensory information and (top-down) cognitive and motor signals. Studying these processes involves the intellectual challenge of cutting across traditional neuroscience silos, and the technical challenge of recording data in uncontrolled natural environments. However, recent advances in techniques, such as neuroimaging, virtual reality, and motion tracking, allow one to address these issues in naturalistic environments for both healthy participants and clinical populations. In this review, we survey six topics in which naturalistic approaches have advanced both our fundamental understanding of brain function and how neurologic deficits influence goal-directed, coordinated action in naturalistic environments. The first part conveys fundamental neuroscience mechanisms related to visuospatial coding for action, adaptive eye-hand coordination, and visuomotor integration for manual interception. The second part discusses applications of such knowledge to neurologic deficits, specifically, steering in the presence of cortical blindness, impact of stroke on visual-proprioceptive integration, and impact of visual search and working memory deficits. This translational approach-extending knowledge from lab to rehab-provides new insights into the complex interplay between perceptual, motor, and cognitive control in naturalistic tasks that are relevant for both basic and clinical research.
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Affiliation(s)
- Jolande Fooken
- Centre for Neuroscience, Queen's University, Kingston, Ontario K7L3N6, Canada
| | - Bianca R Baltaretu
- Department of Psychology, Justus Liebig University, Giessen, 35394, Germany
| | - Deborah A Barany
- Department of Kinesiology, University of Georgia, and Augusta University/University of Georgia Medical Partnership, Athens, Georgia 30602
| | - Gabriel Diaz
- Center for Imaging Science, Rochester Institute of Technology, Rochester, New York 14623
| | - Jennifer A Semrau
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware 19713
| | - Tarkeshwar Singh
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania 16802
| | - J Douglas Crawford
- Centre for Integrative and Applied Neuroscience, York University, Toronto, Ontario M3J 1P3, Canada
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Colwell MJ, Demeyere N, Vancleef K. Visual perceptual deficit screening in stroke survivors: evaluation of current practice in the United Kingdom and Republic of Ireland. Disabil Rehabil 2022; 44:6620-6632. [PMID: 34455876 DOI: 10.1080/09638288.2021.1970246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Visual perceptual deficits are frequently underdiagnosed in stroke survivors compared to sensory vision deficits or visual neglect. To better understand this imparity, we evaluated current practice for screening post-stroke visual perceptual deficits. METHODS We conducted a survey targeted at professionals working with stroke survivors involved in screening visual perceptual deficits across the United Kingdom and the Republic of Ireland. RESULTS Forty orthoptists and 174 occupational therapists responded to the survey. Visual perceptual deficit screening was primarily conducted by occupational therapists (94%), with 75∼100% of stroke survivors screened per month. Respondents lacked consensus on whether several common post-stroke visual deficits were perceptual or not. During the screening, respondents primarily relied on self-reports and observation (94%), while assessment batteries (58%) and screening tools were underutilised (56%) and selected inappropriately (66%). Respondents reported lack of training in visual perception screening (20%) and physical/cognitive condition of stroke survivors (19%) as extremely challenging during screening. CONCLUSIONS Visual perceptual deficits are screened post-stroke at a similar rate to sensory vision or visual neglect. Underdiagnosis of visual perceptual deficits may stem from both reliance on subjective and non-standardised screening approaches, and conflicting definitions of visual perception held among clinicians. We recommend increased training provision and use of brief performance-based screening tools.IMPLICATIONS FOR REHABILITATIONLack of agreement among clinicians on what constitutes as visual perceptual or sensory vision deficits may prove problematic, as precise and exact language is often required for clinical decision-making (e.g., referrals).Biases for more familiar visual (perceptual) deficits held among clinicians during the screening process may lead to other visual deficits being missed.To avoid problems being missed, clinicians should aim to use standardised assessments rather than stroke survivor self-report and observations of function when screening for visual perceptual difficulties.
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Affiliation(s)
- Michael J Colwell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Kathleen Vancleef
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Kim Y, Im S, Oh J, Jung Y, Jun SY. Detection of post-stroke visual field loss by quantification of the retrogeniculate visual pathway. J Neurol Sci 2022; 439:120297. [DOI: 10.1016/j.jns.2022.120297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
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Hreha K, Sonnenfeld M, Na A, Kitchens R, Reistetter TA. Lessons Learned and Future Actions: Modifying a Stroke Specific Self-Management Program. FRONTIERS IN HEALTH SERVICES 2022; 2:841082. [PMID: 36925874 PMCID: PMC10012748 DOI: 10.3389/frhs.2022.841082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/11/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Self-management programs have been shown to be effective at providing support to individuals who want to manage chronic health conditions independently. It has been shown that adapting self-management programs for different diagnostic groups, such as stroke, is essential. OBJECTIVE To report modifications made during trial implementation, the barriers identified during the delivery of an evidence based, stroke-specific self-management program and minor data (including strategies made) from a small cohort of stroke survivors with multiple chronic conditions. METHODS Prospective type III hybrid implementation-effectiveness trial for stroke survivors, with chronic conditions, living in the community, and interested in self-management. Modifications were reported by the following: (1) researcher reflections (2) barriers to implementation and (3) strategies used to address the barrier using the Consolidated Framework for Implementation Research (CFIR) guidelines from field notes. RESULTS Twenty-five individuals consented (42% of eligible sample) at the time of acute stroke and five were interested in continuing at the 3-month call. Multiple barriers to implementation were identified, resulting in modifications. For example, before the group sessions began, the COVID-19 pandemic necessitated changes to the intervention delivery. The protocol was modified to an online mode of delivery. In total, there were seven modifications made. CONCLUSIONS The CFIR was a facilitative tool to report barriers and strategies and emphasized the importance of comprehensive reporting. The modifications to the study were an essential first step to address the research climate and needs of this stroke cohort. Next steps include continued research with a larger cohort to implement effective strategies and answer the clinical question of effectiveness of the adapted and modified intervention.
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Affiliation(s)
- Kimberly Hreha
- Division of Occupational Therapy, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, United States
| | - Mandi Sonnenfeld
- University of Texas Medical Branch, Division of Rehabilitation Science, Galveston, TX, United States
| | - Annalisa Na
- Physical Therapy and Rehabilitation Sciences Department, Drexel University, Philadelphia, PA, United States
| | - Riqiea Kitchens
- University of Texas Medical Branch, Department of Occupational Therapy, Galveston, TX, United States
| | - Timothy A. Reistetter
- Department of Occupational Therapy University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Garcia C, Collins R, McCabe D, Galvin R, Boland P. Impact of visual field loss post-stroke on activities of daily living: a prospective cohort study. Neuropsychol Rehabil 2022:1-16. [PMID: 35679176 DOI: 10.1080/09602011.2022.2081219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study investigated the ADL performances of people with VFL after an acute stroke using an observation-based evaluation of ADL skills, the Assessment of Motor and Process Skills. The AMPS was administered on initial assessment and at ≥11 weeks follow-up on 58 adults with a mild stroke, with (n = 16) and without VFL (n = 42), over a 13-month period. The AMPS guidelines on clinically relevant difference of 0.30 logits were used to determine the differences of the groups' ADL performance on initial assessment and follow-up. The study found that the ADL motor and process scores did not differ significantly on initial assessment. The study observed no clinically relevant difference between the ADL motor and process scores of between the VFL and non-VFL on initial assessment and follow-up but demonstrated clinically relevant improvements in ADL motor and process scores of both groups from initial assessment to follow-up. VFL does not have an additional negative impact on ADL performance of those with a mild stroke and does not impede improvement of ADL performance over time.
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Affiliation(s)
| | | | - Djh McCabe
- Tallaght University Hospital, Dublin, Ireland.,Vascular Neurology Research Foundation, Dept of Neurology, and Stroke Services, Tallaght University Hospital, Dublin, Ireland.,Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK.,Academic Unit of Neurology School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Comparison of vision-related quality of life in patients with homonymous hemianopia and monocular blindness. Sci Rep 2022; 12:6558. [PMID: 35449232 PMCID: PMC9023462 DOI: 10.1038/s41598-022-10626-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Abstract
To evaluate the vision-related quality of life (QoL) in patients with homonymous hemianopia (HH). The study compared the QoL in 32 patients with HH and 33 patients with monocular blindness. Best-corrected visual acuity (BCVA) and visual field test were investigated. The National Eye Institute-Visual Function Questionnaire 25 (NEI VFQ-25) and independent mobility questionnaires (IMQs) were used to assess their perceived visual and physical functioning abilities. The results of QoL questionnaires were compared in two groups. The mean deviation (MD) in the better eye was significantly lower in the HH group than in the monocular blindness group. The composite scores of NEI-VFQ and IMQs were significantly lower in the HH patients than in the monocular blindness patients. The driving-related score was significantly lower in patients with right hemianopsia than in those with left hemianopsia. The outdoor activity-related score was significantly lower in patients aged less than 55 years than in patients aged 55 years and more. Homonymous hemianopia had a negative impact on patients’ QoL by limiting their vision related activities compared to monocular blindness. The MD of the better eye in the HH patients reflects the binocular visual field and can affect the real visual function and QoL.
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Cavanaugh MR, Tadin D, Carrasco M, Huxlin KR. Benefits of Endogenous Spatial Attention During Visual Double-Training in Cortically-Blinded Fields. Front Neurosci 2022; 16:771623. [PMID: 35495043 PMCID: PMC9046589 DOI: 10.3389/fnins.2022.771623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/08/2022] [Indexed: 12/12/2022] Open
Abstract
Recovery of visual discrimination thresholds inside cortically-blinded (CB) fields is most commonly attained at a single, trained location at a time, with iterative progress deeper into the blind field as performance improves over several months. As such, training is slow, inefficient, burdensome, and often frustrating for patients. Here, we investigated whether double-location training, coupled with a covert spatial-attention (SA) pre-cue, could improve the efficiency of training. Nine CB participants completed a randomized, training assignment with either a spatial attention or neutral pre-cue. All trained for a similar length of time on a fine direction discrimination task at two blind field locations simultaneously. Training stimuli and tasks for both cohorts were identical, save for the presence of a central pre-cue, to manipulate endogenous (voluntary) SA, or a Neutral pre-cue. Participants in the SA training cohort demonstrated marked improvements in direction discrimination thresholds, albeit not to normal/intact-field levels; participants in the Neutral training cohort remained impaired. Thus, double-training within cortically blind fields, when coupled with SA pre-cues can significantly improve direction discrimination thresholds at two locations simultaneously, offering a new method to improve performance and reduce the training burden for CB patients. Double-training without SA pre-cues revealed a hitherto unrecognized limitation of cortically-blind visual systems’ ability to improve while processing two stimuli simultaneously. These data could potentially explain why exposure to the typically complex visual environments encountered in everyday life is insufficient to induce visual recovery in CB patients. It is hoped that these new insights will direct both research and therapeutic developments toward methods that can attain better, faster recovery of vision in CB fields.
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Affiliation(s)
- Matthew R. Cavanaugh
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, United States
| | - Duje Tadin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, United States
- Department of Brain and Cognitive Sciences and Center for Visual Science, University of Rochester, Rochester, NY, United States
| | - Marisa Carrasco
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - Krystel R. Huxlin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, United States
- Department of Brain and Cognitive Sciences and Center for Visual Science, University of Rochester, Rochester, NY, United States
- *Correspondence: Krystel R. Huxlin,
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Burgos-Blasco B, Perez-Garcia P, Fernandez-Vigo JI, Benito-Pascual B, Hernandez-Garcia E, Saenz-Frances F, Santos-Bueso E. Binocular Visual Field and Vision-Related Quality of Life in Patients With Hemianopia. J Neuroophthalmol 2022; 42:e217-e224. [PMID: 34001737 DOI: 10.1097/wno.0000000000001286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemianopias can have a severe impact on functional ability and quality of life (QoL). Binocular visual field (VF) analysis is clinically more relevant to visual function than monocular VF. The aim is to analyze the binocular VF of patients with hemianopias and its association with the monocular VF and to assess the QoL of these patients through questionnaires specifically related to vision compared with healthy controls. METHODS The case-control study included patients with hemianopias and controls. Sex, age, general history, etiology, location of the lesion, and time since the lesion appeared were recorded. Monocular VF and Esterman binocular VF were performed. VF defect, mean defect (MD), and Esterman scores were recorded. Visual Activities Questionnaire (VAQ-33) and Visual Function Questionnaire (VFQ-25) questionnaires were administered. RESULTS Twenty patients with hemianopia and 22 healthy controls were included. The Esterman score in homonymous hemianopia patients (n = 17) correlated with best eye MD (r = -0.62, P = 0.01), worst eye MD (r = -0.70, P = 0.002), and average MD (r = -0.68, P = 0.003). Compared with healthy control subjects, patients with homonymous hemianopia had significantly lower VFQ-25 score and in 10/12 subscales (all P < 0.001). VAQ-33 scores revealed lower overall and subscales scores with the exception of light/dark adaptation (P = 0.08). Correlations were found between monocular and binocular VF scores and general vision (r = -0.55), peripheral vision (on both questionnaires, r-range -0.75 to 0.47), VFQ-25 and VAQ-33 overall scores (r = -0.59, -0.49 and 0.50), and glare disability (r = 0.53 and 0.67). CONCLUSIONS Hemianopic VF defects involve a major alteration in the patients' vision-related QoL.
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Affiliation(s)
- Barbara Burgos-Blasco
- Ophthalmology Department (BB-B, PP-G, JIF-V, BB-P, EH-G), Hospital Clínico San Carlos, Madrid, Spain ; and Ophthalmology Department (FS-F, ES-B), Instituto de Investigación sanitaria del Hospital Clínico San Carlos (IdISSC), IIORC, Universidad Complutense, Madrid, Spain
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Hashemi H, Mehravar F, Asgari S, Emamian MH, Fotouhi A. Visual functions and disability in Iranian adults: a population-based study. BMC Ophthalmol 2022; 22:30. [PMID: 35057773 PMCID: PMC8781046 DOI: 10.1186/s12886-022-02262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Vision-related quality of life is related to severity of visual impairments and show the impact of eye diseases on daily activities. This study aims to assess visual functions and disability and its association with age, gender, education, marital status, and economic status in adults aged 45–69 years.
Methods
Data in this population-based study were from the second phase of the Shahroud eye cohort study and collected by using a Short-Form Visual Functioning Scale. The scores of visual function and disability were calculated based on Rasch-transformed scores of the National Eye Institute visual functioning questionnaire, where a more negative score indicates a better situation. Multiple linear regression was used to investigate the factors associated with visual functions.
Results
Among 4737 participants the visual function data for 4715 people were analyzed. The visual function of 75.3, 17.1 and 7.5% of participants were “ideal and good”, “moderate”, and “bad and very bad”, respectively, while 0.06% were unable for vision. The running mean of the visual function was calculated to be − 3.95 ± 0.02. The visual performance was worse in females than the males (β = 0.14, p = 0.005). Visual function improved with increasing levels of education (β = − 1.06, p < 0.001). It was worse in low-economic (β = 0.016, p = 0.005) and moderate-economic (β = 0.28, p < 0.001) participants than high-economic ones.
Conclusion
The visual function of Iranian adults aged 45–69 years was moderate. The male gender, higher education and the higher economic status had a better visual function.
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Räty S, Ruuth R, Silvennoinen K, Sabel BA, Tatlisumak T, Vanni S. Resting-state Functional Connectivity After Occipital Stroke. Neurorehabil Neural Repair 2021; 36:151-163. [PMID: 34949135 DOI: 10.1177/15459683211062897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Resting-state functional magnetic resonance imaging (rsfMRI) reflects spontaneous activation of cortical networks. After stroke, these networks reorganize, both due to structural lesion and reorganization of functional connectivity (FC). OBJECTIVE We studied FC in chronic phase occipital stroke patients with homonymous visual field defects before and after repetitive transorbital alternating current stimulation (rtACS). METHODS This spin-off study, embedded in the randomized, sham-controlled REVIS trial, comprised 16 chronic occipital stroke patients with visual field defect and 12 healthy control subjects. The patients underwent rsfMRI at baseline, after two weeks of rtACS or sham treatment, and after two months of treatment-free follow-up, whereas the control subjects were measured once. We used a multivariate regression connectivity model to determine mutual prediction accuracy between 74 cortical regions of interest. Additionally, the model parameters were included into a graph to analyze average path length, centrality eigenvector, centrality degree, and clustering of the network. The patients and controls at baseline and the two treatment groups were compared with multilevel modeling. RESULTS Before treatment, the patients and controls had similar whole-network prediction accuracy and network parameters, whereas centrality eigenvector differed in perilesional regions, indicating local modification in connectivity. In line with behavioral results, neither prediction accuracy nor any network parameter changed systematically as a result of rtACS rehabilitation compared to sham. CONCLUSIONS Whole-network FC showed no difference between occipital stroke patients and healthy population, congruent with the peripheral location of the visual network in relation to the high-density cortical core. rtACS treatment in the given setting did not affect FC.
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Affiliation(s)
- Silja Räty
- Department of Neurology, 3836Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Advanced Magnetic Imaging Centre, 174277Aalto University, Espoo, Finland
| | - Riikka Ruuth
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katri Silvennoinen
- Department of Neurology, 3836Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Clinical and Experimental Epilepsy, 61554UCL Queen Square Institute of Neurology, London, UK
| | - Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-v, -Guericke University of Magdeburg, Magdeburg, Germany
| | - Turgut Tatlisumak
- Department of Clinical Neurosciences/Neurology, 70712Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simo Vanni
- Department of Neurology, 3836Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Xu J, Wu Z, Nürnberger A, Sabel BA. Reorganization of Brain Functional Connectivity Network and Vision Restoration Following Combined tACS-tDCS Treatment After Occipital Stroke. Front Neurol 2021; 12:729703. [PMID: 34777199 PMCID: PMC8580405 DOI: 10.3389/fneur.2021.729703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: Non-invasive brain stimulation (NIBS) is already known to improve visual field functions in patients with optic nerve damage and partially restores the organization of brain functional connectivity networks (FCNs). However, because little is known if NIBS is effective also following brain damage, we now studied the correlation between visual field recovery and FCN reorganization in patients with stroke of the central visual pathway. Method: In a controlled, exploratory trial, 24 patients with hemianopia were randomly assigned to one of three brain stimulation groups: transcranial direct current stimulation (tDCS)/transcranial alternating current stimulation (tACS) (ACDC); sham tDCS/tACS (AC); sham tDCS/sham tACS (Sham), which were compared to age-matched controls (n = 24). Resting-state electroencephalogram (EEG) was collected at baseline, after 10 days stimulation and at 2 months follow-up. EEG recordings were analyzed for FCN measures using graph theory parameters, and FCN small worldness of the network and long pairwise coherence parameter alterations were then correlated with visual field performance. Result: ACDC enhanced alpha-band FCN strength in the superior occipital lobe of the lesioned hemisphere at follow-up. A negative correlation (r = −0.80) was found between the intact visual field size and characteristic path length (CPL) after ACDC with a trend of decreased alpha-band centrality of the intact middle occipital cortex. ACDC also significantly decreased delta band coherence between the lesion and the intact occipital lobe, and coherence was enhanced between occipital and temporal lobe of the intact hemisphere in the low beta band. Responders showed significantly higher strength in the low alpha band at follow-up in the intact lingual and calcarine cortex and in the superior occipital region of the lesioned hemisphere. Conclusion: While ACDC decreases delta band coherence between intact and damaged occipital brain areas indicating inhibition of low-frequency neural oscillations, ACDC increases FCN connectivity between the occipital and temporal lobe in the intact hemisphere. When taken together with the lower global clustering coefficient in responders, these findings suggest that FCN reorganization (here induced by NIBS) is adaptive in stroke. It leads to greater efficiency of neural processing, where the FCN requires fewer connections for visual processing.
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Affiliation(s)
- Jiahua Xu
- Institute of Medical Psychology, Medical Faculty, Otto-V.-Guericke University of Magdeburg, Magdeburg, Germany.,Faculty of Computer Science, Otto-V.-Guericke University of Magdeburg, Magdeburg, Germany
| | - Zheng Wu
- Institute of Medical Psychology, Medical Faculty, Otto-V.-Guericke University of Magdeburg, Magdeburg, Germany.,Faculty of Computer Science, Otto-V.-Guericke University of Magdeburg, Magdeburg, Germany
| | - Andreas Nürnberger
- Faculty of Computer Science, Otto-V.-Guericke University of Magdeburg, Magdeburg, Germany
| | - Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-V.-Guericke University of Magdeburg, Magdeburg, Germany
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14
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Association between vision impairment and cognitive decline in older adults with stroke: Health and Retirement Study. Aging Clin Exp Res 2021; 33:2605-2610. [PMID: 33428171 DOI: 10.1007/s40520-020-01776-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Stroke survivors may experience multiple residual symptoms post-stroke, including vision impairment (VI) and cognitive decline. Prior studies have shown that VI is associated with cognitive decline, but have not evaluated the contribution of VI to post-stroke cognitive changes. We used data from four waves (2010-2016) of the Health and Retirement Study to investigate the cognitive trajectories of stroke survivors with and without VI. Vision (excellent-very good[ref], good, fair-poor) and stroke diagnosis were self-reported. Cognition was defined using the Telephone Interview for Cognitive Status. Regression was used to model the association between vision and change in cognitive function, adjusting for confounders. The final sample included 1,439 stroke survivors and the average follow-up time was 4.1 years. Fair-poor overall (B = -1.30, p < 0.01), near (B = -1.53, p < 0.001), and distance (B = -1.27, p < 0.001) vision were associated with significantly lower baseline cognitive function. VI was not associated with the rate of cognitive decline. Future research should determine whether specific types of VI potentiate the risk of cognitive impairment and dementia in stroke survivors.
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15
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Räty S, Borrmann C, Granata G, Cárdenas-Morales L, Schoenfeld A, Sailer M, Silvennoinen K, Holopainen J, De Rossi F, Antal A, Rossini PM, Tatlisumak T, Sabel BA. Non-invasive electrical brain stimulation for vision restoration after stroke: An exploratory randomized trial (REVIS). Restor Neurol Neurosci 2021; 39:221-235. [PMID: 34219679 PMCID: PMC8461672 DOI: 10.3233/rnn-211198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Occipital strokes often cause permanent homonymous hemianopia leading to significant disability. In previous studies, non-invasive electrical brain stimulation (NIBS) has improved vision after optic nerve damage and in combination with training after stroke. Objective: We explored different NIBS modalities for rehabilitation of hemianopia after chronic stroke. Methods: In a randomized, double-blinded, sham-controlled, three-armed trial, altogether 56 patients with homonymous hemianopia were recruited. The three experiments were: i) repetitive transorbital alternating current stimulation (rtACS, n = 8) vs. rtACS with prior cathodal transcranial direct current stimulation over the intact visual cortex (tDCS/rtACS, n = 8) vs. sham (n = 8); ii) rtACS (n = 9) vs. sham (n = 9); and iii) tDCS of the visual cortex (n = 7) vs. sham (n = 7). Visual functions were evaluated before and after the intervention, and after eight weeks follow-up. The primary outcome was change in visual field assessed by high-resolution and standard perimetries. The individual modalities were compared within each experimental arm. Results: Primary outcomes in Experiments 1 and 2 were negative. Only significant between-group change was observed in Experiment 3, where tDCS increased visual field of the contralesional eye compared to sham. tDCS/rtACS improved dynamic vision, reading, and visual field of the contralesional eye, but was not superior to other groups. rtACS alone increased foveal sensitivity, but was otherwise ineffective. All trial-related procedures were tolerated well. Conclusions: This exploratory trial showed safety but no main effect of NIBS on vision restoration after stroke. However, tDCS and combined tDCS/rtACS induced improvements in visually guided performance that need to be confirmed in larger-sample trials. NCT01418820 (clinicaltrials.gov)
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Affiliation(s)
- Silja Räty
- HUS Neurocenter, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carolin Borrmann
- Institute of Medical Psychology, Otto-v.-Guericke University of Magdeburg Medical Faculty, Magdeburg, Germany
| | - Giuseppe Granata
- Institute of Neurology, Policlinic A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Lizbeth Cárdenas-Morales
- Institute of Medical Psychology, Otto-v.-Guericke University of Magdeburg Medical Faculty, Magdeburg, Germany.,Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Ariel Schoenfeld
- Clinic of Neurorehabilitation, Kliniken Schmieder, Heidelberg, Germany
| | - Michael Sailer
- MEDIAN Klinik NRZ Magdeburg, An-Institut für Neurorehabilitation, Otto-von-Guericke University, Magdeburg, Germany
| | - Katri Silvennoinen
- HUS Neurocenter, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Juha Holopainen
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Francesca De Rossi
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients - IAPB, Italian Branch, Rome, Italy
| | - Andrea Antal
- HUS Neurocenter, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Clinic for Neurology, University Medical Center of Göttingen, Germany
| | - Paolo M Rossini
- Department Neuroscience & Neurorehabilitation, IRCCS San Raffaele-Pisana, Rome, Italy
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bernhard A Sabel
- Institute of Medical Psychology, Otto-v.-Guericke University of Magdeburg Medical Faculty, Magdeburg, Germany
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16
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Elshout JA, Bergsma DP, van den Berg AV, Haak KV. Functional MRI of visual cortex predicts training-induced recovery in stroke patients with homonymous visual field defects. NEUROIMAGE-CLINICAL 2021; 31:102703. [PMID: 34062384 PMCID: PMC8173295 DOI: 10.1016/j.nicl.2021.102703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
Damage to the visual brain typically leads to vision loss. Vision loss may be partially recovered with visual restitution training (VRT) Cortical responses to visual stimulation do not always lead to visual awareness. A mismatch between Humphrey and neural perimetry predicts training outcome. This finding has important implications for better rehabilitation strategies.
Post-chiasmatic damage to the visual system leads to homonymous visual field defects (HVDs), which can severely interfere with daily life activities. Visual Restitution Training (VRT) can recover parts of the affected visual field in patients with chronic HVDs, but training outcome is variable. An untested hypothesis suggests that training potential may be largest in regions with ‘neural reserve’, where cortical responses to visual stimulation do not lead to visual awareness as assessed by Humphrey perimetry—a standard behavioural visual field test. Here, we tested this hypothesis in a sample of twenty-seven hemianopic stroke patients, who participated in an assiduous 80-hour VRT program. For each patient, we collected Humphrey perimetry and wide-field fMRI-based retinotopic mapping data prior to training. In addition, we used Goal Attainment Scaling to assess whether personal activities in daily living improved. After training, we assessed with a second Humphrey perimetry measurement whether the visual field was improved and evaluated which personal goals were attained. Confirming the hypothesis, we found significantly larger improvements of visual sensitivity at field locations with neural reserve. These visual field improvements implicated both regions in primary visual cortex and higher order visual areas. In addition, improvement in daily life activities correlated with the extent of visual field enlargement. Our findings are an important step toward understanding the mechanisms of visual restitution as well as predicting training efficacy in stroke patients with chronic hemianopia.
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Affiliation(s)
- J A Elshout
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D P Bergsma
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A V van den Berg
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K V Haak
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
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17
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Abstract
Introduction Over the past decade, yoga has gained popularity in health care. The benefits of yoga can go beyond the physical to address the psychosocial and emotional. Such gains can be beneficial for people who have had a stroke. As a leading cause of disability, stroke can lead to challenges returning to daily activities. Occupational therapists may use yoga to promote engagement in daily activities after stroke. This study aimed to understand how and why occupational therapists integrate yoga into stroke rehabilitation. Methods This study involved occupational therapists practicing in the United States. Ten occupational therapists using yoga in practice participated in a semi-structured interview. Interview data were transcribed and analyzed using deductive and inductive coding. Themes emerged from the data related to the benefits of using yoga in stroke rehabilitation. Results According to this study, yoga is currently being used as a treatment technique and merged with occupational therapy. Yoga may promote client-centered recovery; bring “context” to therapy; and address physical, emotional, and psychosocial needs following stroke. Conclusion Individuals who have had a stroke may face challenges related to both physical and psychosocial engagement. The use of yoga in occupational therapy may be beneficial after stroke for both physical and psychosocial rehabilitation.
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18
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Rowe FJ, Hepworth LR, Howard C, Hanna KL, Currie J. Impact of visual impairment following stroke (IVIS study): a prospective clinical profile of central and peripheral visual deficits, eye movement abnormalities and visual perceptual deficits. Disabil Rehabil 2020; 44:3139-3153. [PMID: 33347793 DOI: 10.1080/09638288.2020.1859631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM This study evaluates the spectrum of visual impairment in stroke survivors. METHODS The Impact of Visual Impairment after Stroke (IVIS) study is a multi-centre, acute stroke unit, prospective epidemiology study. Comprehensive visual examination was offered to all stroke survivors. RESULTS 1500 stroke admissions were recruited. 1204 stroke survivors had visual assessment. Reduced central vision was documented in 529, visual field loss in 308, ocular motility abnormalities in 533 stroke survivors, visual perception deficits in 59 stroke survivors and visual inattention in 315 stroke survivors. About half, regardless of visual impairment type, were visually asymptomatic. Recovery, whether full or partial, was best for central vision, ocular motility abnormalities and visual perception deficits (about 70% improvement) occurring over a mean follow-up period of 2-3 months. CONCLUSIONS Incidence of impaired central vision, visual field loss, ocular motility disorders and visual inattention was 29.4%, 24.8%, 39.3% and 26.2% respectively. Visual impairment was more likely to occur in more severe stroke and older stroke survivors. Asymptomatic cases raise concerns for acute stroke units where robust specialist vision screening is not routine. Those with partial/no recovery require specialist follow-up and management whilst the wide range of abnormalities highlight the need for specialist visual assessment acutely.Implications for rehabilitationVisual impairment is a common consequence of stroke.Incidence of visual impairment is about 60%.Significant numbers of stroke survivors are visually asymptomatic, highlighting the need for standardised vision assessments.Many stroke survivors have persistent long-term visual impairment, necessitating referral and access to specialist eye care services.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Claire Howard
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Kerry L Hanna
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Jim Currie
- Patient and Public Representative, Different Strokes, UK
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19
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Efficacy of Visual Retraining in the Hemianopic Field after Stroke: Results of a Randomized Clinical Trial. Ophthalmology 2020; 128:1091-1101. [PMID: 33242498 DOI: 10.1016/j.ophtha.2020.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the efficacy of motion discrimination training as a potential therapy for stroke-induced hemianopic visual field defects. DESIGN Clinical trial. PARTICIPANTS Forty-eight patients with stroke-induced homonymous hemianopia (HH) were randomized into 2 training arms: intervention and control. Patients were between 21 and 75 years of age and showed no ocular issues at presentation. METHODS Patients were trained on a motion discrimination task previously evidenced to reduce visual field deficits, but not in a randomized clinical trial. Patients were randomized with equal allocation to receive training in either their sighted or deficit visual fields. Training was performed at home for 6 months, consisting of repeated visual discriminations at a single location for 20 to 30 minutes daily. Study staff and patients were masked to training type. Testing before and after training was identical, consisting of Humphrey visual fields (Carl Zeiss Meditech), macular integrity assessment perimetry, OCT, motion discrimination performance, and visual quality-of-life questionnaires. MAIN OUTCOME MEASURES Primary outcome measures were changes in perimetric mean deviation (PMD) on Humphrey Visual Field Analyzer in both eyes. RESULTS Mean PMDs improved over 6 months in deficit-trained patients (mean change in the right eye, 0.58 dB; 95% confidence interval, 0.07-1.08 dB; mean change in the left eye 0.84 dB; 95% confidence interval, 0.22-1.47 dB). No improvement was observed in sighted-trained patients (mean change in the right eye, 0.12 dB; 95% confidence interval, -0.38 to 0.62 dB; mean change in the left eye, 0.10 dB; 95% confidence interval, -0.52 to 0.72 dB). However, no significant differences were found between the alternative training methods (right eye, P = 0.19; left eye, P = 0.10). CONCLUSIONS To date, no widely accepted therapy is available to treat HH. This study evaluated the efficacy of a promising potential treatment, visual perceptual training. We failed to find a difference between treatment training within the deficit field and control training within the sighted field when performed in a home environment.
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20
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Woutersen K, Geuzebroek AC, van den Berg AV, Goossens J. Useful Field of View Performance in the Intact Visual Field of Hemianopia Patients. Invest Ophthalmol Vis Sci 2020; 61:43. [PMID: 32446248 PMCID: PMC7405799 DOI: 10.1167/iovs.61.5.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Postchiasmatic brain damage commonly results in an area of reduced visual sensitivity or blindness in the contralesional hemifield. Previous studies have shown that the ipsilesional visual field can be impaired too. Here, we examine whether assessing visual functioning of the “intact” ipsilesional visual field can be useful to understand difficulties experienced by patients with visual field defects. Methods We compared the performance of 14 patients on a customized version of the useful field of view test that presents stimuli in both hemifields but only assesses functioning of their intact visual half-field (iUFOV) with that of equivalent hemifield assessments in 17 age-matched healthy control participants. In addition, we mapped visual field sensitivity with the Humphrey Field Analyzer. Last, we used an adapted version of the National Eye Institute Visual Quality of Life-25 to measure their experienced visual quality of life. Results We found that patients performed worse on the second and third iUFOV subtests, but not on the first subtest. Furthermore, patients scored significantly worse on almost every subscale, except ocular pain. Summed iUFOV scores (assessing the intact hemifield only) and Humphrey field analyzer scores (assessing both hemifields combined) showed almost similar correlations with the subscale scores of the adapted National Eye Institute Visual Quality of Life-25. Conclusions The iUFOV test is sensitive to deficits in the visual field that are not picked up by traditional perimetry. We therefore believe this task is of interest for patients with postchiasmatic brain lesions and should be investigated further.
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21
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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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22
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Personality and stress influence vision restoration and recovery in glaucoma and optic neuropathy following alternating current stimulation: implications for personalized neuromodulation and rehabilitation. EPMA J 2020; 11:177-196. [PMID: 32547650 PMCID: PMC7272530 DOI: 10.1007/s13167-020-00204-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
Abstract
Purpose Identifying factors that affect recovery or restoration of neurological function is a key goal of rehabilitation in neurology and ophthalmology. One such factor can be prolonged mental stress, which may be not only the consequence of nervous system damage but also a major risk factor, or cause, of neural inactivation. Using the visual system as a model of neural injury, we wished to study how patients' stress and personality profiles correlate with vision recovery as induced by therapy with alternating current stimulation (ACS) in patients with optic nerve damage. Methods Personality and stress questionnaires were sent retrospectively to a clinical convenience sample of patients who suffer low vision due to optic nerve damage, which had previously been treated with ACS. The questionnaires included the NEO Five-Factor Inventory (NEO-FFI), the Trier Inventory of Chronic Stress (TICS), and the Flammer syndrome (FS) checklist, which probes signs of vascular dysregulation (VD). These scores were then correlated with the extent of ACS-induced vision restoration as recorded 1-3 years earlier by perimetric visual field tests. Results Two NEO-FFI personality factors (lower neuroticism, higher conscientiousness) and the presence of physiological Flammer signs were associated with greater recovery as were individual items of the factors openness and agreeableness. Single NEO-FFI item analysis revealed that recovery relates to greater extraversion (optimistic and happy), openness (less guided by authorities for decisions on moral issues), and agreeableness (argue less, like working with others, thoughtful, considerate) as well as the presence of FS signs (cold hands/feet, hypotension, slim body shapes, tinnitus). This suggests that patients with better recovery were more calm, peaceful and secure, hard-working, and reliable, and with high organizational skills. In contrast, patients with poor recovery had a tendency to be emotionally unstable, anxious, unhappy and prone to negative emotions, impulsive, careless, and unorganized. Chronic stress assessed with TICS did not correlate with recovery. Conclusion Vision restoration induced by ACS is greater in patients with less stress-prone personality traits and those who show signs of VD. Prospective studies are now needed to determine if personality has (i) a causal influence, i.e., patients with less stress-prone personalities and greater VD signs recover better, and/or (ii) if personality changes are an effect of the treatment, i.e., successful recovery induces personality changes. Though the cause-effect relationship is still open, we nevertheless propose that psychosocial factors and VD contribute to the highly variable outcome of vision restoration treatments in low vision rehabilitation. This has implications for preventive and personalized vision restoration and is of general value for our understanding of outcome variability in neuromodulation and neurological rehabilitation.
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23
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Busza A, Schneider CL, Williams ZR, Mahon BZ, Sahin B. Using Vision to Study Poststroke Recovery and Test Hypotheses About Neurorehabilitation. Neurorehabil Neural Repair 2019; 33:87-95. [PMID: 30744530 DOI: 10.1177/1545968319827569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Approximately one-third of stroke patients suffer visual field impairment as a result of their strokes. However, studies using the visual pathway as a paradigm for studying poststroke recovery are limited. In this article, we propose that the visual pathway has many features that make it an excellent model system for studying poststroke neuroplasticity and assessing the efficacy of therapeutic interventions. First, the functional anatomy of the visual pathway is well characterized, which makes it well suited for functional neuroimaging studies of poststroke recovery. Second, there are multiple highly standardized and clinically available diagnostic tools and outcome measures that can be used to assess visual function in stroke patients. Finally, as a sensory modality, the assessment of vision is arguably less likely to be affected by confounding factors such as functional compensation and patient motivation. Given these advantages, and the general similarities between poststroke visual field recovery and recovery in other functional domains, future neurorehabilitation studies should consider using the visual pathway to better understand the physiology of neurorecovery and test potential therapeutics.
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Affiliation(s)
- Ania Busza
- 1 University of Rochester, Rochester, NY, USA
| | - Colleen L Schneider
- 1 University of Rochester, Rochester, NY, USA.,2 Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Bradford Z Mahon
- 1 University of Rochester, Rochester, NY, USA.,2 Carnegie Mellon University, Pittsburgh, PA, USA
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Hepworth LR, Rowe FJ, Burnside G. Development of a patient reported outcome measures for measuring the impact of visual impairment following stroke. BMC Health Serv Res 2019; 19:348. [PMID: 31151449 PMCID: PMC6544926 DOI: 10.1186/s12913-019-4157-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background Among the available patient-reported outcome measures (PROMs) there is an absence of a PROM with a specific focus on the impact of the wide variety of visual impairments following stroke. Our aim was to develop a patient reported quality of life outcome measure for stroke survivors with visual impairment. Methods Potential items were sourced from a combination of existing PROMs from a systematic review and qualitative in-depth interviews, duplicates were removed and items shortlisted. The initial pilot instrument was created following a ranking exercise of these potential items and consultation with stroke survivors. Version 1 was piloted with 37 stroke survivors at acute and chronic stages. Version 2 was piloted with 243 stroke survivors with visual impairment at acute and chronic stages. This data was analysed using the Rasch measurement model. Simultaneously, items from Version 2 underwent a Delphi process with stroke survivors and stroke clinicians, to assess the importance of each item. Final consensus decisions on item removal were made using the combined analysis from the Rasch measurement model and Delphi process in a nominal group meeting. Results Due to the wide range of rank given to the majority of categories/items, only two items were discarded. Version 1 comprised of 102 items with 5 response categories relating to amount of difficulty. The pilot of Version 1 allowed item reduction based on analysis of floor/ceiling effects and not applicable responses. Version 2 comprised of 62 items. Within the nominal group meeting, the expert panel created a set of rules which aided them with decision making in addition to the Rasch and Delphi analysis data. This resulted in the removal of 43 items and the combination of seven items to create three new items. The expert panel also recommended the rewording of three items. Conclusion The Brain Injury associated Visual Impairment Impact Questionnaire (BIVI-IQ-15), a 15-item instrument with 4 response categories has been developed for capturing vision-related quality of life of stroke survivors with any of the predominant types of visual impairment, in the presence of other impairments and for both inpatients and outpatients. Electronic supplementary material The online version of this article (10.1186/s12913-019-4157-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 1-5 Brownlow Street, Liverpool, L69 3GL, Liverpool, UK
| | - Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 1-5 Brownlow Street, Liverpool, L69 3GL, Liverpool, UK.
| | - Girvan Burnside
- Department of Biostatistics, University of Liverpool, Waterhouse Building Block F, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
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Visual Function Questionnaire as an outcome measure for homonymous hemianopia: subscales and supplementary questions, analysis from the VISION trial. Eye (Lond) 2019; 33:1485-1493. [PMID: 30996338 DOI: 10.1038/s41433-019-0441-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We conduct supplementary analyses of the NEI VFQ-25 data to evaluate where changes occurred within subscales of the NEI VFQ-25 leading to change in the composite scores between the three treatment arms, and evaluate the NEI VFQ-25 with and without the Neuro 10 supplement. METHODS A prospective, multicentre, parallel, single-blind, three-arm RCT of fourteen UK acute stroke units was conducted. Stroke survivors with homonymous hemianopia were recruited. Interventions included: Fresnel prisms for minimum 2 h, 5 days/week over 6-weeks (Arm a), Visual search training for minimum 30 min, 5 days/week over 6-weeks (Arm b) and standard care-information only (Arm c). Primary and secondary outcomes (including NEI VFQ-25 data) were measured at baseline, 6, 12 and 26 weeks after randomisation. RESULTS Eighty seven patients were recruited (69% male; mean age (SD) equal to 69 (12) years). At 26 weeks, outcomes for 24, 24 and 22 patients, respectively, were compared to baseline. NEI VFQ-25 (with and without Neuro 10) responses improved from baseline to 26 weeks with visual search training compared to Fresnel prisms and standard care. In subscale analysis, the most impacted across all treatment arms was 'driving' whilst the least impacted were 'colour vision' and 'ocular pain'. CONCLUSIONS Composite scores differed systematically for the NEI VFQ-25 (Neuro 10) versus NEI VFQ-25 at all time points. For subscale scores, descriptive statistics suggest clinically relevant improvement in distance activities and vision-specific dependency subscales for NEI VFQ-25 scores in the visual search treatment arm. TRIAL REGISTRATION Current Controlled Trials ISRCTN05956042.
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Hazelton C, Pollock A, Taylor A, Davis B, Walsh G, Brady MC. A qualitative exploration of the effect of visual field loss on daily life in home-dwelling stroke survivors. Clin Rehabil 2019; 33:1264-1273. [PMID: 30935223 DOI: 10.1177/0269215519837580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the effect of visual field loss on the daily life of community-dwelling stroke survivors. DESIGN A qualitative interview study. PARTICIPANTS Adult stroke survivors with visual field loss of at least six months' duration. METHODS Semi-structured interviews were conducted with a non-purposive sample of 12 stroke survivors in their own homes. These were recorded, transcribed verbatim and analyzed with the framework method, using an inductive approach. RESULTS Two key analytical themes emerged. 'Perception, experience and knowledge' describes participant's conflicted experience of having knowledge of their impaired vision but lacking perception of that visual field loss and operating under the assumption that they were viewing an intact visual scene when engaged in activities. Inability to recognize and deal with visual difficulties, and experiencing the consequences, contributed to their fear and loss of self-confidence. 'Avoidance and adaptation' were two typologies of participant response to visual field loss. Initially, all participants consciously avoided activities. Some later adapted to vision loss using self-directed head and eye scanning techniques. CONCLUSIONS Visual field loss has a marked impact on stroke survivors. Stroke survivors lack perception of their visual loss in everyday life, resulting in fear and loss of confidence. Activity avoidance is a common response, but in some, it is replaced by self-initiated adaptive techniques.
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Affiliation(s)
- Christine Hazelton
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anne Taylor
- 2 Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Bridget Davis
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Glyn Walsh
- 3 Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Marian C Brady
- 1 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Costela FM, Saunders DR, Kajtezovic S, Rose DJ, Woods RL. Measuring the Difficulty Watching Video With Hemianopia and an Initial Test of a Rehabilitation Approach. Transl Vis Sci Technol 2018; 7:13. [PMID: 30147995 PMCID: PMC6106868 DOI: 10.1167/tvst.7.4.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/04/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE If you cannot follow the story when watching a video, then the viewing experience is degraded. We measured the difficulty of following the story, defined as the ability to acquire visual information, which is experienced by people with homonymous hemianopia (HH). Further, we proposed and tested a novel rehabilitation aid. METHODS Participants watched 30-second directed video clips. Following each video clip, subjects described the visual content of the clip. An objective score of information acquisition (IA) was derived by comparing each new response to a control database of descriptions of the same clip using natural language processing. Study 1 compared 60 participants with normal vision (NV) to 24 participants with HH to test the hypothesis that participants with HH would score lower than NV participants, consistent with reports from people with HH that describe difficulties in video watching. In the second study, 21 participants with HH viewed clips with or without a superimposed dynamic cue that we called a content guide. We hypothesized that IA scores would increase using this content guide. RESULTS The HH group had a significantly lower IA score, with an average of 2.8, compared with 4.3 shared words of the NV group (mixed-effects regression, P < 0.001). Presence of the content guide significantly increased the IA score by 0.5 shared words (P = 0.03). CONCLUSIONS Participants with HH had more difficulty acquiring information from a video, which was objectively demonstrated (reduced IA score). The content guide improved information acquisition, but not to the level of people with NV. TRANSLATIONAL RELEVANCE The value as a possible rehabilitation aid of the content guide warrants further study that involves an extended period of content-guide use and a randomized controlled trial.
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Affiliation(s)
- Francisco M. Costela
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Daniel R. Saunders
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sidika Kajtezovic
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, MA, USA
| | - Dylan J. Rose
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, MA, USA
| | - Russell L. Woods
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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People with Hemianopia Report Difficulty with TV, Computer, Cinema Use, and Photography. Optom Vis Sci 2018; 95:428-434. [PMID: 29683986 DOI: 10.1097/opx.0000000000001215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Our survey found that participants with hemianopia report more difficulties watching video in various formats, including television (TV), on computers, and in a movie theater, compared with participants with normal vision (NV). These reported difficulties were not as marked as those reported by people with central vision loss. PURPOSE The aim of this study was to survey the viewing experience (e.g., frequency, difficulty) of viewing video on TV, computers and portable visual display devices, and at the cinema of people with hemianopia and NV. This information may guide vision rehabilitation. METHODS We administered a cross-sectional survey to investigate the viewing habits of people with hemianopia (n = 91) or NV (n = 192). The survey, consisting of 22 items, was administered either in person or in a telephone interview. Descriptive statistics are reported. RESULTS There were five major differences between the hemianopia and NV groups. Many participants with hemianopia reported (1) at least "some" difficulty watching TV (39/82); (2) at least "some" difficulty watching video on a computer (16/62); (3) never attending the cinema (30/87); (4) at least some difficulty watching movies in the cinema (20/56), among those who did attend the cinema; and (5) never taking photographs (24/80). Some people with hemianopia reported methods that they used to help them watch video, including video playback and head turn. CONCLUSIONS Although people with hemianopia report more difficulty with viewing video on TV and at the cinema, we are not aware of any rehabilitation methods specifically designed to assist people with hemianopia to watch video. The results of this survey may guide future vision rehabilitation.
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Gao Y, Sabel BA. Microsaccade dysfunction and adaptation in hemianopia after stroke. Restor Neurol Neurosci 2018; 35:365-376. [PMID: 28800343 DOI: 10.3233/rnn-170749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Besides the reduction of visual field size, hemianopic patients may also experience other poorly understood symptoms such as blurred vision, diplopia, or reduced visual acuity, which may be related to microsaccade function. OBJECTIVE To determine (i) if microsaccades are altered in hemianopia; (ii) how altered microsaccade features correlate with visual performances; and (iii) how their direction relates to visual field defect topography. METHODS In this case-control study, microsaccades of hemianopic stroke patients (n = 14) were assessed with high-resolution eye-tracking technique, compared with those of healthy controls (n = 14), and correlated with visual performances, visual field defect parameters and lesion age. RESULTS Patients' microsaccades had (i) larger amplitude (P = 0.027), (ii) longer duration (P = 0.042), and (iii) impaired binocular microsaccade conjugacy (horizontal: P = 0.002; vertical: P = 0.035). Older lesions were associated with poorer binocular conjugacy (horizontal: r(14) = 0.67, P = 0.009; vertical: r(14) = 0.75, P = 0.002) and larger microsaccade amplitudes (r(14) = 0.55, P = 0.043). (iv) Half of the patients had a microsaccade bias towards the seeing field (monocular: P = 0.002; binocular: P < 0.001) which was associated with faster reactions to super-threshold visual stimuli in areas of residual vision (P = 0.042). Finally, (v) patients with more binocular microsaccades (r(14) = 0.59, P = 0.027) and lower microsaccade velocity (r(14) = -0.66, P = 0.011) had better visual acuity. CONCLUSIONS Hemianopia leads not only to the loss of visual field but also to microsaccade enlargement and impaired binocular conjugacy, suggesting malfunctioning microsaccade control circuits which worsen over time. But a microsaccade bias towards the seeing field, which suggests greater allocation of attention, accelerates stimulus detection. Microsaccades may play a role to compensate for vision impairment and provide a basis for vision restoration and plasticity, which deserves further exploration.
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Affiliation(s)
- Ying Gao
- Institute of Medical Psychology, Medical Faculty, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto von Guericke University of Magdeburg, Magdeburg, Germany
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Jang SH, Chang CH, Jung YJ, Kim SH, Seo JP. Optic radiation injury in patients with aneurismal subarachnoid hemorrhage: A preliminary diffusion tensor imaging report. Neural Regen Res 2018; 13:563-566. [PMID: 29623945 PMCID: PMC5900523 DOI: 10.4103/1673-5374.228763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Visual field defect is one of the various clinical manifestations in patients with subarachnoid hemorrhage (SAH). Little is known about the pathogenic mechanism of visual field defect in SAH. In the current study, we investigated the diffusion tensor imaging (DTI) finding of the optic radiation in patients with SAH following rupture of a cerebral artery aneurysm. We recruited 21 patients with aneurismal SAH (12 males, 9 females, mean age, 52.67 years; range, 41–68 years) who showed no definite lesion along the visual pathway. Twenty-one age-and sex-matched normal control subjects were also recruited. DTI data were acquired at an average of 5.9 weeks (range: 3–12 weeks) after onset and reconstruction of the optic radiation was performed using DTI-Studio software. The fractional anisotropy value, apparent diffusion coefficient value, and fiber number of the optic radiation were measured. The fractional anisotropy value of the optic radiation was significantly decreased, and the apparent diffusion coefficient value was significantly increased, in patients with aneurismal SAH than in normal control subjects. However, there was no significant difference in the fiber number of the optic radiation between patients with aneurismal SAH and normal control subjects. The decrement of fractional anisotropy value and increment of apparent diffusion coefficient value of the optic radiation in patients with aneurismal SAH suggest optic radiation injury. Therefore, we recommend a thorough evaluation for optic radiation injury in patient with aneurismal SAH.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Young Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Jeong Pyo Seo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
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Elshout JA, Bergsma DP, Sibbel J, Baars-Elsinga A, Lubbers P, Van Asten F, Visser-Meily J, Van Den Berg AV. Improvement in activities of daily living after visual training in patients with homonymous visual field defects using Goal Attainment Scaling. Restor Neurol Neurosci 2018; 36:1-12. [DOI: 10.3233/rnn-170719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- 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, The Netherlands
| | - 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, The Netherlands
| | - Jacqueline Sibbel
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Annette Baars-Elsinga
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paula Lubbers
- St. Maartenskliniek Rehabilitation, Nijmegen, The Netherlands
| | - Freekje Van Asten
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The 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, The Netherlands
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Hepworth LR, Rowe FJ. Using Delphi methodology in the development of a new patient-reported outcome measure for stroke survivors with visual impairment. Brain Behav 2018; 8:e00898. [PMID: 29484260 PMCID: PMC5822587 DOI: 10.1002/brb3.898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/16/2017] [Accepted: 11/17/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction The aim of this study was to ascertain what items stroke survivors and stroke care professionals think are important when assessing quality of life for stroke survivors with visual impairment for inclusion in the new patient-reported outcome measure. Methods A reactive Delphi process was used in a three-round electronic-based survey. The items presented consisted of 62 items originally sourced from a systematic review of existing vision-related quality of life instruments and stroke survivor interviews, reduced and refined following a ranking exercise and pilot with stroke survivors with visual impairment. Stakeholders (stroke survivors/clinicians) were invited to take part in the process. A consensus definition of ≥70% was decided a priori. Participants were asked to rank importance on a 9-point scale and categorize the items by relevance to types of visual impairment following stroke or not relevant. Analysis of consensus, stability, and agreement was conducted. Results In total, 113 participants registered for the Delphi survey of which 47 (41.6%) completed all three rounds. Response rates to the three rounds were 78/113 (69.0%), 61/76 (81.3%), and 49/64 (76.6%), respectively. The participants included orthoptists (45.4%), occupational therapists (44.3%), and stroke survivors (10.3%). Consensus was reached on 56.5% of items in the three-round process, all for inclusion. A consensus was reached for 83.8% in the categorization of items. The majority (82.6%) of consensus were for relevant to 'all visual impairment following stroke'; two items were deemed 'not relevant'. Conclusion The lack of item reduction achieved by this Delphi process highlights the need for additional methods of item reduction in the development of a new PROM for visual impairment following stroke. These results will be considered alongside Rasch analysis to achieve further item reduction. However, the Delphi survey remains important as it provides clinical and patient insight into each item rather than purely relying on the psychometric data.
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Affiliation(s)
- Lauren R. Hepworth
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
| | - Fiona J. Rowe
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
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Räty S, Silvennoinen K, Tatlisumak T. Prehospital pathways of occipital stroke patients with mainly visual symptoms. Acta Neurol Scand 2018; 137:51-58. [PMID: 28804875 DOI: 10.1111/ane.12807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Occipital ischemic strokes typically cause homonymous visual field defects, for which means of rehabilitation are limited. Intravenous thrombolysis is increasingly and successfully used for their acute treatment. However, recognition of strokes presenting with mainly visual field defects is challenging for both patients and healthcare professionals. We studied prehospital pathways of occipital stroke patients with mainly visual symptoms to define obstacles in their early recognition. MATERIALS & METHODS This observational, retrospective, registry-based study comprises occipital stroke patients with isolated visual symptoms treated at the neurological emergency department of Helsinki University Central Hospital in 2010-2015. We analyzed their prehospital pathways, including time from symptom onset to admission at the neurological emergency department (ODT), the number of points of care, the percentage of patients with ODT≤4.5 hours, and factors associated with delay. RESULTS Among 245 patients, only 20.8% arrived within 4.5 hours and 6.5% received IV thrombolysis. Delayed arrival was most often due to patients' late contact to health care. Of the patients, 27.3% arrived through at least two points of care, and differential diagnostics to ophthalmologic disorders proved particularly challenging. ODT≤4.5 hours was associated with EMS utilization, direct arrival, and atrial fibrillation; a visit at an ophthalmologist and initial misdiagnosis were associated with ODT>4.5 hours. After multivariable analysis, only direct arrival predicted ODT≤4.5 hours. CONCLUSIONS Occipital stroke patients with visual symptoms contact health care late, are inadequately recognized, and present with complex prehospital pathways. Consequently, they are often ineligible for IV thrombolysis. This presents a missed opportunity for preventing permanent visual field defects.
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Affiliation(s)
- S. Räty
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - K. Silvennoinen
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - T. Tatlisumak
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
- Department of Clinical Neurosciences/Neurology; Institute of Neurosciences and Physiology; Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital; Gothenburg Sweden
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Turton AJ, Angilley J, Longley V, Clatworthy P, Gilchrist ID. Search training for people with visual field loss after stroke: A cohort study. Br J Occup Ther 2017. [DOI: 10.1177/0308022617743481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction People with visual field loss after stroke often experience difficulties in everyday activities. The purpose of this study was to assess the acceptability of search training as used within occupational therapy and the feasibility of possible measures for use in a future trial. Method Nine participants took part in a goal oriented intervention that was delivered three times a week for 3 weeks. Patient reports of acceptability and outcomes using the Visual Function Questionnaire-25 were collected. Participants’ room-search behaviour before and after the intervention was recorded using a head-worn camera. Results Eight participants completed nine treatment visits. All participants reported improved awareness and attention to the blind side during activities following the intervention. Seven participants’ change scores on the Visual Function Questionnaire-25 exceeded six points. Patterns of head-direction behaviour and overall room-search times were variable across patients; markedly, improved performance was only evident in the most severely affected participant. Conclusion The intervention was acceptable. The Visual Function Questionnaire-25 is a feasible measure for assessing patient-reported outcomes. While the room search was informative about individuals’ behaviour, more sophisticated methods of gaze tracking would allow search processes to be determined in real-world activities that are relevant to patients’ goals.
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Affiliation(s)
- Ailie J Turton
- Senior Lecturer, Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Jayne Angilley
- Clinical Specialist Occupational Therapist Stroke, Stroke Therapy Team, Camborne and Redruth Community Hospital, Cornwall Partnership NHS Foundation Trust, UK
| | - Verity Longley
- PhD Student, School of Psychological Sciences, University of Manchester, UK
| | - Philip Clatworthy
- Consultant Stroke Neurologist, North Bristol NHS Trust, UK
- Stroke Association Thompson Family Senior Clinical Lecturer, University of Bristol, UK
| | - Iain D Gilchrist
- Professor of Neuropsychology, School of Experimental Psychology, University of Bristol, UK
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Rowe FJ, Conroy EJ, Bedson E, Cwiklinski E, Drummond A, García- Fiñana M, Howard C, Pollock A, Shipman T, Dodridge C, MacIntosh C, Johnson S, Noonan C, Barton G, Sackley C. Choice of outcome measures for the VISION pilot trial of interventions for hemianopia. Acta Neurol Scand 2017; 136:551-553. [PMID: 28980307 DOI: 10.1111/ane.12772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Affiliation(s)
- F. J. Rowe
- Department of Health Services Research; University of Liverpool; Liverpool UK
| | - E. J. Conroy
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - E. Bedson
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - E. Cwiklinski
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - A. Drummond
- School of Health Sciences; University of Nottingham; Nottingham UK
| | | | - C. Howard
- Department of Orthoptics; Salford Royal NHS Foundation Trust; Manchester UK
| | - A. Pollock
- Nursing Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - T. Shipman
- Department of Orthoptics; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - C. Dodridge
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - C. MacIntosh
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - S. Johnson
- Eye Clinic Impact Team; Royal National Institute for the Blind; Birmingham UK
| | - C. Noonan
- Department of Ophthalmology; Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | - G. Barton
- Department of Elderly Care; Warrington and Halton Hospitals NHS Foundation Trust; Warrington UK
| | - C. Sackley
- Division of Health and Social Care; King's College; London UK
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36
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Wolf A, Coros A, Bierer J, Goncalves S, Cooper P, Van Uum S, Lee DH, Proulx A, Nicolle D, Fraser JA, Rotenberg BW, Duggal N. Quantitative evaluation of vision-related and health-related quality of life after endoscopic transsphenoidal surgery for pituitary adenoma. J Neurosurg 2016; 127:409-416. [PMID: 27715435 DOI: 10.3171/2016.7.jns16200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic resection of pituitary adenomas has been reported to improve vision function in up to 80%-90% of patients with visual impairment due to these adenomas. It is unclear how these reported rates translate into improvement in visual outcomes and general health as perceived by the patients. The authors evaluated self-assessed health-related quality of life (HR-QOL) and vision-related QOL (VR-QOL) in patients before and after endoscopic resection of pituitary adenomas. METHODS The authors prospectively collected data from 50 patients who underwent endoscopic resection of pituitary adenomas. This cohort included 32 patients (64%) with visual impairment preoperatively. Twenty-seven patients (54%) had pituitary dysfunction, including 17 (34%) with hormone-producing tumors. Patients completed the National Eye Institute Visual Functioning Questionnaire and the 36-Item Short Form Health Survey preoperatively and 6 weeks and 6 months after surgery. RESULTS Patients with preoperative visual impairment reported a significant impact of this condition on VR-QOL preoperatively, including general vision, near activities, and peripheral vision; they also noted vision-specific impacts on mental health, role difficulties, dependency, and driving. After endoscopic resection of adenomas, patients reported improvement across all these categories 6 weeks postoperatively, and this improvement was maintained by 6 months postoperatively. Patients with preoperative pituitary dysfunction, including hormone-producing tumors, perceived their general health and physical function as poorer, with some of these patients reporting improvement in perceived general health after the endoscopic surgery. All patients noted that their ability to work or perform activities of daily living was transiently reduced 6 weeks postoperatively, followed by significant improvement by 6 months after the surgery. CONCLUSIONS Both VR-QOL and patient's perceptions of their ability to do work and perform other daily activities as a result of their physical health significantly improved by 6 months after endoscopic resection of pituitary adenoma. The use of multidimensional QOL questionnaires provides a precise assessment of perceived outcomes after endoscopic surgery.
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Affiliation(s)
| | | | | | | | | | | | - Donald H Lee
- Department of Medical Imaging, London Health Sciences Centre; and
| | - Alain Proulx
- Department of Ophthalmology, Ivey Eye Institute, and
| | | | | | - Brian W Rotenberg
- Department of Otolaryngology-Head & Neck Surgery, St. Joseph's Hospital, London, Ontario, Canada
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Norup A, Guldberg AM, Friis CR, Deurell EM, Forchhammer HB. An interdisciplinary visual team in an acute and sub-acute stroke unit: Providing assessment and early rehabilitation. NeuroRehabilitation 2016; 39:451-61. [PMID: 27589515 DOI: 10.3233/nre-161376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the work of an interdisciplinary visual team in a stroke unit providing early identification and assessment of patients with visual symptoms, and secondly to investigate frequency, type of visual deficits after stroke and self-evaluated impact on everyday life after stroke. METHODS For a period of three months, all stroke patients with visual or visuo-attentional deficits were registered, and data concerning etiology, severity and localization of the stroke and initial visual symptoms were registered. One month after discharge patients were contacted for follow-up. RESULTS Of 349 acute stroke admissions, 84 (24.1%) had visual or visuo-attentional deficits initially. Of these 84 patients, informed consent was obtained from 22 patients with a mean age of 67.7 years(SD 10.1), and the majority was female (59.1%). Based on the initial neurological examination, 45.4% had some kind of visual field defect, 27.2% had some kind of oculomotor nerve palsy, and about 31.8% had some kind of inattention or visual neglect. The patients were contacted for a phone-based follow-up one month after discharge, where 85.7% reported changes in their vision since their stroke. CONCLUSION In this consecutive sample, a quarter of all stroke patients had visual or visuo-attentional deficits initially. This emphasizes how professionals should have increased awareness of the existence of such deficits after stroke in order to provide the necessary interdisciplinary assessment and rehabilitation.
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Affiliation(s)
- Anne Norup
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Mette Guldberg
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Claus Radmer Friis
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Maria Deurell
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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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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Tsymbalov KS, Fetkenhour DR. Recognized homonymous hemianopsia and delirium during the admission examination leading to diagnosis and appropriate treatment of a new stroke. Neuropsychiatr Dis Treat 2016; 12:1385-8. [PMID: 27366070 PMCID: PMC4913969 DOI: 10.2147/ndt.s109345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This case report describes the detection of homonymous hemianopsia and delirium during the admission physical examination of a patient with esophageal adenocarcinoma, resulting in the new diagnosis of subacute hemorrhagic stroke. The poststroke visual field defect can result in significant disability and reduction in quality of life. Patients with visual field cut show a severely reduced quality of life and require additional neuropsychological and visual rehabilitation. Only thorough physical examination is able to challenge prior negative positron emission tomography scan, leading to the diagnosis of subacute stroke and, following appropriate treatment, secondary stroke prophylaxis and rehabilitation, instead of brain radiation and chemotherapy.
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Affiliation(s)
- Konstantin S Tsymbalov
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Douglas R Fetkenhour
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
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Sand KM, Wilhelmsen G, Naess H, Midelfart A, Thomassen L, Hoff JM. Vision problems in ischaemic stroke patients: effects on life quality and disability. Eur J Neurol 2015; 23 Suppl 1:1-7. [DOI: 10.1111/ene.12848] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/27/2022]
Affiliation(s)
- K. M. Sand
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - G. Wilhelmsen
- Department of Special Needs Education; Bergen University College; Bergen Norway
| | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Centre for Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
| | - A. Midelfart
- Institute of Neuroscience; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - L. Thomassen
- Department of Clinical Medicine; University of Bergen; Bergen Norway
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - J. M. Hoff
- Department of Neurology; Haukeland University Hospital; Bergen Norway
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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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42
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Hepworth LR, Rowe FJ, Harper R, Jarvis K, Shipman T, Rodgers H. Patient reported outcome measures for visual impairment after stroke: a systematic review. Health Qual Life Outcomes 2015; 13:146. [PMID: 26374628 PMCID: PMC4572686 DOI: 10.1186/s12955-015-0338-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 09/02/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this review was to identify patient reported outcome measures (PROMs) for use in research and clinical practice involving individuals with visual impairment following stroke and to evaluate their content validity against quality assessment criteria. Method A systematic review of the literature was conducted to identify articles related to the development and/or validation of PROMS. We searched scholarly online resources and hand searched journals. Search terms included MESH terms and alternatives relating to PROMs, visual impairments and quality of life. Data were extracted relating to the development and validation of the included instruments. The quality of the development process was assessed using a modified version of a PROM quality assessment tool. Results A total of 142 PROMs were identified, 34 vision-specific PROMs were relevant and available to be analysed in this review. Quality appraisal identified four highly rated instruments: the National Eye Institute Visual Functional Questionnaire (NEI-VFQ), Activity Inventory (AI), Daily Living Tasks Dependant on Vision (DLTV) and Veterans Affairs Low Visual Function Questionnaire (VA LV VFQ). The four instruments have only been used with either a limited number of stroke survivors or a sub-population within visual impairment following stroke. Conclusion No instruments were identified which specifically targeted individuals with visual impairment following stroke. Further research is required to identify the items which a population of stroke survivors with visual impairment consider to be of most importance. The validation of a combination of instruments or a new instrument for use with this population is required. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0338-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren R Hepworth
- Department of Health Services Research, Whelan Building (1.10), University of Liverpool, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Fiona J Rowe
- Department of Health Services Research, Whelan Building (1.10), University of Liverpool, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Robert Harper
- Manchester Royal Eye Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, M13 9WL, UK.
| | - Kathryn Jarvis
- School of Health Sciences, University of Liverpool, Liverpool, L69 3GB, UK.
| | - Tracey Shipman
- Department of Orthoptics, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, S10 2JF, Sheffield, UK.
| | - Helen Rodgers
- Institute of Neuroscience and Institute for Ageing, Newcastle University, Newcastle upon Tyne, NE2 4AE, UK.
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Turton AJ, Angilley J, Chapman M, Daniel A, Longley V, Clatworthy P, Gilchrist ID. Visual search training in occupational therapy – an example of expert practice in community-based stroke rehabilitation. Br J Occup Ther 2015. [DOI: 10.1177/0308022615600180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Visual searching is an essential component of many everyday activities. Search training is practised as part of occupational therapy to improve performance skills both in people with hemianopia and those with spatial inattention post stroke. Evaluation of the effectiveness of such training first requires a systematic and detailed description of the intervention. To this end, this study describes the practice of a specialist occupational therapist. Method Single sessions of intervention delivered by the occupational therapist to five participants with visual search disorders post stroke were video recorded. The recordings were analysed for content using a framework approach. Results The occupational therapist educated participants about the impact of their visual impairment on everyday activities. She used instructions, spatial cueing, placement of objects and verbal feedback to train increased amplitudes of eye and head movements, to direct attention into the blind field or neglected space and to encourage systematic searching during occupations and activities. Activities were graded by manipulating the area for attention and complexity in the environment. Conclusion This investigation provides a detailed description of a specialist occupational therapist’s community-based intervention for improving visual search post stroke.
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Affiliation(s)
- Ailie J Turton
- Senior Lecturer, University of the West of England, Bristol, UK
| | - Jayne Angilley
- Clinical Specialist Occupational Therapist (Stroke), West Stroke Team Camborne & Redruth Community Hospital, Peninsula Community Health, Cornwall, UK
| | - Marie Chapman
- Occupational Therapist, National Star College, Gloucestershire, UK
| | - Anna Daniel
- Occupational Therapist, North Bristol NHS Trust, Bristol, UK
| | - Verity Longley
- PhD Student, School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Philip Clatworthy
- Consultant Stroke Neurologist, North Bristol NHS Trust and University of Bristol, Bristol, UK
| | - Iain D Gilchrist
- Professor of Neuropsychology, University of Bristol, Bristol, UK
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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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45
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Gall C, Silvennoinen K, Granata G, de Rossi F, Vecchio F, Brösel D, Bola M, Sailer M, Waleszczyk WJ, Rossini PM, Tatlisumak T, Sabel BA. Non-invasive electric current stimulation for restoration of vision after unilateral occipital stroke. Contemp Clin Trials 2015; 43:231-6. [PMID: 26072125 DOI: 10.1016/j.cct.2015.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
Occipital stroke often leads to visual field loss, for which no effective treatment exists. Little is known about the potential of non-invasive electric current stimulation to ameliorate visual functions in patients suffering from unilateral occipital stroke. One reason is the traditional thinking that visual field loss after brain lesions is permanent. Since evidence is available documenting vision restoration by means of vision training or non-invasive electric current stimulation future studies should also consider investigating recovery processes after visual cortical strokes. Here, protocols of repetitive transorbital alternating current stimulation (rtACS) and transcranial direct current stimulation (tDCS) are presented and the European consortium for restoration of vision (REVIS) is introduced. Within the consortium different stimulation approaches will be applied to patients with unilateral occipital strokes resulting in homonymous hemianopic visual field defects. The aim of the study is to evaluate effects of current stimulation of the brain on vision parameters, vision-related quality of life, and physiological parameters that allow concluding about the mechanisms of vision restoration. These include EEG-spectra and coherence measures, and visual evoked potentials. The design of stimulation protocols involves an appropriate sham-stimulation condition and sufficient follow-up periods to test whether the effects are stable. This is the first application of non-invasive current stimulation for vision rehabilitation in stroke-related visual field deficits. Positive results of the trials could have far-reaching implications for clinical practice. The ability of non-invasive electrical current brain stimulation to modulate the activity of neuronal networks may have implications for stroke rehabilitation also in the visual domain.
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Affiliation(s)
- Carolin Gall
- Institute of Medical Psychology, University of Magdeburg, Medical Faculty, Magdeburg 39120, Germany.
| | - Katri Silvennoinen
- Department of Neurology, Helsinki University Central Hospital (HUCH), Helsinki 00290, Finland
| | - Giuseppe Granata
- Department of Geriatrics, Neuroscience & Orthopedics, Catholic University of Rome, Rome 00198, Italy; IRCCS S.Raffaele Pisana, Rome 00163, Italy
| | - Francesca de Rossi
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients - IAPB, Italian Branch, Italy
| | | | - Doreen Brösel
- Institute of Medical Psychology, University of Magdeburg, Medical Faculty, Magdeburg 39120, Germany
| | - Michał Bola
- Institute of Medical Psychology, University of Magdeburg, Medical Faculty, Magdeburg 39120, Germany
| | | | - Wioletta J Waleszczyk
- Department of Neurophysiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw 02-093, Poland
| | - Paolo M Rossini
- Department of Geriatrics, Neuroscience & Orthopedics, Catholic University of Rome, Rome 00198, Italy; IRCCS S.Raffaele Pisana, Rome 00163, Italy
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital (HUCH), Helsinki 00290, Finland
| | - Bernhard A Sabel
- Institute of Medical Psychology, University of Magdeburg, Medical Faculty, Magdeburg 39120, Germany
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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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Kaneko S, Kanekawa M. Evaluation of Health-Related Quality of Life Associated with Provision of Healthcare to Stroke Patients Living at Home in Japan. Health (London) 2015. [DOI: 10.4236/health.2015.79126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Central retinal artery occlusion (CRAO) is a major cause for severe visual impairment. Its effect on vision-related quality of life has not yet been determined. The purpose of the present study was thus to assess vision-related quality of life in patients with CRAO using the 39-item National Eye Institute Visual Function Questionnaire. METHODS The case-control study comprised 26 patients with unilateral CRAO and a control group consisting of 26 control subjects, matched for age and sex. Vision-related quality of life was measured using the 39-item National Eye Institute Visual Function Questionnaire. RESULTS After Bonferroni correction, the median 39-item National Eye Institute Visual Function Questionnaire composite score was significantly lower in patients with CRAO than in those in the control group (P(corr) < 0.001). Patients with CRAO showed significantly lower median scores in 9 of 12 subscales: general vision (P(corr) < 0.001), peripheral vision (P(corr) < 0.001), difficulties with near-vision activities (P(corr) < 0.001), difficulties with distance-vision activities (P(corr) < 0.001), role difficulties as a result of vision problems (P(corr) < 0.001), dependency on others because of vision problems (P(corr) < 0.001), limitations in social functioning because of vision problems (P(corr) < 0.001), mental health symptoms because of vision problems (P(corr) < 0.001), and general health (P(corr) = 0.008). CONCLUSION Our data suggest that vision-related quality of life is reduced in patients with CRAO.
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49
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Jung JH, Peli E. Impact of high power and angle of incidence on prism corrections for visual field loss. OPTICAL ENGINEERING (REDONDO BEACH, CALIF.) 2014; 53:10.1117/1.OE.53.6.061707. [PMID: 24497649 PMCID: PMC3909527 DOI: 10.1117/1.oe.53.6.061707] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Prism distortions and spurious reflections are not usually considered when prescribing prisms to compensate for visual field loss due to homonymous hemianopia. Distortions and reflections in the high power Fresnel prisms used in peripheral prism placement can be considerable, and the simplifying assumption that prism deflection power is independent of angle of incidence into the prisms results in substantial errors. We analyze the effects of high prism power and incidence angle on the field expansion, size of the apical scotomas, and image compression/expansion. We analyze and illustrate the effects of reflections within the Fresnel prisms, primarily due to reflections at the bases, and secondarily due to surface reflections. The strength and location of these effects differs materially depending on whether the serrated prismatic surface is placed toward or away from the eye, and this affects the contribution of the reflections to visual confusion, diplopia, false alarms, and loss of contrast. We conclude with suggestions for controlling and mitigating these effects in clinical practice.
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Affiliation(s)
- Jae-Hyun Jung
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114-2500, USA, ,
| | - Eli Peli
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114-2500, USA, ,
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50
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Clatworthy PL, Warburton EA, Tolhurst DJ, Baron JC. Visual contrast sensitivity deficits in 'normal' visual field of patients with homonymous visual field defects due to stroke: a pilot study. Cerebrovasc Dis 2013; 36:329-35. [PMID: 24193224 DOI: 10.1159/000354810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/05/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Homonymous visual field defects (VFD) are common following stroke, and often recover, partially or fully, by unknown mechanisms. In clinical practice, visual field recovered on perimetry is often considered perceptually normal. However, studies have shown contrast sensitivity (CS) deficits in patients with stroke and homonymous VFD. This study investigated the origin of visual CS loss in patients with VFD due to stroke. We hypothesised that CS deficits would be found in visual field areas appearing normal on perimetry, in patients with ischaemic stroke affecting the retrochiasmal visual system, and that the spatiotemporal properties of this CS loss would be consistent with those of 'blindsight', perhaps suggesting similar underlying mechanisms. METHODS CS measurements were made in 20 healthy participants, and in 7 patients with stroke causing homonymous VFD sparing foveal vision, measured using Humphrey static perimetry (SITA-Fast 24-2 procedure). Importantly, patients with concomitant visuospatial neglect were excluded. CS measurements were made using a modification of the method of increasing contrast, corrected for reaction time. Three spatial stimuli were used, at several spatial frequencies: (1) large sinusoidal gratings; (2) foveal Gabor patches; and (3) Gabor patches presenting in the putatively recovered visual field, near VFD. Stimuli with different temporal profiles were used to selectively stimulate transient and sustained visual channels, to provide insight into mechanisms of visual loss and/or recovery. Analysis of variance (ANOVA) was used in the analysis of the measurements, allowing for correction for age and stimulus eccentricity. RESULTS ANOVA for sustained grating stimuli showed orientation-selective (horizontal) CS loss (p = 0.025); no such loss was apparent in the central visual field (foveal Gabor stimuli). Localised CS close to VFD was reduced in stroke-affected hemifields compared with unaffected hemifields (p ≤ 0.005), though these areas appeared normal on perimetry. In these areas, CS was relatively preserved for transient compared with sustained stimuli (Wilcoxon signed rank tests). CONCLUSIONS The finding of specific CS deficits in the normal-appearing visual field of patients with homonymous VFD due to stroke suggests that static perimetry provides an inadequate assessment of visual function in these patients, with clear implications for testing of vision in clinical practice. The results are consistent with relative sparing of the transient/magnocellular visual channel. These findings demand further investigation. If confirmed in larger, longitudinal studies, this will have important implications for the mechanisms of recovery, and may provide a target for visual rehabilitation - for example, using repeated detection practice ('perceptual learning').
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Affiliation(s)
- Philip L Clatworthy
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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