Neurovisual rehabilitation in cerebral blindness.

OBJECTIVE The efficacy of a systematic training of saccadic eye movements was evaluated in hemianopic patients with three main objectives: (1) to determine the role of visual field recovery, (2) to assess the transfer of treatment gains to functional outcome measures, and (3) to evaluate the patients' subjective experience throughout therapy. DESIGN Within-subject repeated measures design. The mean follow-up interval was 3 months (range, 1 to 10 months). SETTING Outpatients of a day clinic for the treatment of neuropsychological disorders that is associated with a city hospital. PATIENTS A consecutive sample of 22 hemianopic patients without neglect after unilateral stroke. Follow-up was possible in all cases. INTERVENTIONS Saccadic eye movement strategies were treated regularly (30-minute daily sessions 5 days per week; 25 to 27 total treatment sessions). MAIN OUTCOME MEASURES Visual perimetry results, visual search field within the scotoma, visual search on projected slides with wide eccentricity, search times for identifying objects visually on a table (table test), and standardized rating of the degree of subjective visual impairment due to the field defect. All outcome measures were planned before initiation of the study. RESULTS (1) Increase in visual search field size (mean, 30 degrees). (2) Training-related visual field increases in 12 (54%) of 22 patients (mean increase, 6.7 degrees; range, 2 degrees to 24 degrees). (3) Transfer of treatment gains to functional measures (table test) and improvement after training in patients' subjective rating of their visual impairments. (4) Stability of improvements at the 3-month follow-up visit. (5) Return to part-time work in 20 (91%) of 22 patients. All mentioned results were significant (nonparametric tests; alpha level, .05; two-sided; adjusted for the number of tests). CONCLUSIONS Training of compensatory eye movement strategies restores oculomotor functions, improves performance in functional visual activities, and reintegrates hemianopic patients into vocational life.

[1]  H. Büning,et al.  Nichtparametrische Statistische Methoden , 1994 .

[2]  M. Coltheart,et al.  NEUROPSY CHOLOGICAL REHABILITATION , 1994 .

[3]  G. Kerkhoff.  Displacement of the egocentric visual midline in altitudinal postchiasmatic scotomata , 1993, Neuropsychologia.

[4]  Discussion: Evaluation in Constructing Neuropsychological Treatments , 1992 .

[5]  G. Kerkhoff,et al.  Rehabilitation of homonymous scotomata in patients with postgeniculate damage of the visual system: saccadic compensation training. , 1992, Restorative neurology and neuroscience.

[6]  M. Reding,et al.  Fresnel prisms improve visual perception in stroke patients with homonymous hemianopia or unilateral visual neglect , 1990, Neurology.

[7]  S. Berrol,et al.  Issues in cognitive rehabilitation. , 1990, Archives of neurology.

[8]  B. Volpe,et al.  The efficacy of cognitive rehabilitation in patients with traumatic brain injury. , 1990, Archives of neurology.

[9]  H S Levin,et al.  Cognitive Rehabilitation: Unproved but Promising , 1990 .

[10]  M. Reding,et al.  Focused stroke rehabilitation programs improve outcome. , 1989, Archives of neurology.

[11]  B. Dobkin.  Focused stroke rehabilitation programs do not improve outcome. , 1989, Archives of neurology.

[12]  Jason W. Brown.  Neuropsychology of Visual Perception , 1989 .

[13]  M M Mesulam,et al.  Visual hemispatial inattention: stimulus parameters and exploratory strategies. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[14]  M. Reding,et al.  Rehabilitation outcome following initial unilateral hemispheric stroke. Life table analysis approach. , 1988, Stroke.

[15]  T. Langfitt,et al.  Visual field defects in relation to head injury severity. A neuropsychological study. , 1988, Archives of neurology.

[16]  Hiroshi Tsukagoshi,et al.  Eye-fixation patterns in homonymous hemianopia and unilateral spatial neglect , 1987, Neuropsychologia.

[17]  L. Lapointe,et al.  Comparison of clinic, home, and deferred language treatment for aphasia. A Veterans Administration Cooperative Study. , 1986, Archives of neurology.

[18]  P. Bach-y-Rita,et al.  Visual field rehabilitation in the cortically blind? , 1985, Journal of neurology, neurosurgery, and psychiatry.

[19]  J Zihl,et al.  Visual field recovery from scotoma in patients with postgeniculate damage. A review of 55 cases. , 1985, Brain : a journal of neurology.

[20]  A. Rossier,et al.  Posttraumatic cervical syringomyelia. Incidence, clinical presentation, electrophysiological studies, syrinx protein and results of conservative and operative treatment. , 1985, Brain : a journal of neurology.

[21]  A. Rosenquist,et al.  Ischemic lesions of the occipital cortex and optic radiations , 1985, Neurology.

[22]  R. Leigh,et al.  The neurology of eye movements , 1984 .

[23]  L. Stark,et al.  Saccadic eye movement strategies in patients with homonymous hemianopia , 1981, Annals of neurology.

[24]  T. Schenkenberg,et al.  Line bisection and unilateral visual neglect in patients with neurologic impairment , 1980, Neurology.

[25]  J Zihl,et al.  Restitution of visual function in patients with cerebral blindness. , 1979, Journal of neurology, neurosurgery, and psychiatry.

[26]  S. Holm.  A Simple Sequentially Rejective Multiple Test Procedure , 1979 .

[27]  J Weinberg,et al.  Visual scanning training effect on reading-related tasks in acquired right brain damage. , 1977, Archives of physical medicine and rehabilitation.

[28]  H. Savir,et al.  Homonymous hemianopsia and rehabilitation in fifteen cases of C.C.I. , 1977, Scandinavian journal of rehabilitation medicine.

[29]  M. Sanders.  Handbook of Sensory Physiology , 1975 .

[30]  Denis Williams,et al.  VISUAL FUNCTION IN PATIENTS WITH HOMONYMOUS HEMIANOPIA PART ITHE VISUAL FIELDS , 1962 .