[ARTICLE] The Effects of Compensatory Scanning Training on Mobility in Patients with Homonymous Visual Field Defects: Further Support, Predictive Variables and Follow-Up – Full Text HTML

 

Abstract

Introduction

People with homonymous visual field defects (HVFD) often report difficulty detecting obstacles in the periphery on their blind side in time when moving around. Recently, a randomized controlled trial showed that the InSight-Hemianopia Compensatory Scanning Training (IH-CST) specifically improved detection of peripheral stimuli and avoiding obstacles when moving around, especially in dual task situations.

Method

The within-group training effects of the previously reported IH-CST are examined in an extended patient group. Performance of patients with HVFD on a pre-assessment, post-assessment and follow-up assessment and performance of a healthy control group are compared. Furthermore, it is examined whether training effects can be predicted by demographic characteristics, variables related to the visual disorder, and neuropsychological test results.

Results

Performance on both subjective and objective measures of mobility-related scanning was improved after training, while no evidence was found for improvement in visual functions (including visual fields), reading, visual search and dot counting. Self-reported improvement did not correlate with improvement in objective mobility performance. According to the participants, the positive effects were still present six to ten months after training. No demographic characteristics, variables related to the visual disorder, and neuropsychological test results were found to predict the size of training effect, although some inconclusive evidence was found for more improvement in patients with left-sided HVFD than in patients with right-sided HFVD.

Conclusion

Further support was found for a positive effect of IH-CST on detection of visual stimuli during mobility-related activities specifically. Based on the reports given by patients, these effects appear to be long-term effects. However, no conclusions can be drawn on the objective long-term training effects.

Fig 1. Full study design. a Neuropsychological testing in the inclusion phase including Mini Mental State Examination [7], Trailmaking Test [8], Complex Figure of Rey [9], and Hospital Anxiety and Depression Scale [10]; b including the neuropsychological tests Nederlandse Leestest voor Volwassenen [11] and 15 Word Test [12,13]; c including the neuropsychological test Digit Span (subtest of the WAIS) [14]; d treatment—non-treatment comparison (RCT) [5]; e within-group comparison of training effect (analysis described in the present paper); FU = follow up.

Introduction

Homonymous visual field defects (HVFD) are caused by postchiasmatic brain damage and in most cases do not fully recover [13]. People with HVFD often report difficulty detecting obstacles located in the blind periphery in time when moving around. This may result in feelings of insecurity and even in collisions and may have a serious impact on participation in society [4].

Several training programs have been developed aimed at optimal compensation for the HVFD by adapting eye movements. One of these, the IH-CST (InSight-Hemianopia Compensatory Scanning Training), trains patients to apply a systematic, wide horizontal scanning rhythm. Recently, a randomized controlled trial (RCT) [5] showed that the IH-CST specifically improves detection of peripheral stimuli and avoiding obstacles when moving around, especially in dual task situations. No evidence was found for an improvement in visual functions (including visual field size), reading or searching for targets on a display.

In this paper, the within-group effects of the IH-CST are analyzed in a larger patient group than in the previously reported RCT [5]. Performance of patients with HVFD at the pre-assessment and post-assessment are compared with the performance of a healthy control group. The results of a follow-up assessment are reported, as well as the associations between subjective and objective performance. Furthermore, it will be examined whether the changes between the pre-assessment and post-assessment can be predicted by certain factors. As concluded in a recent systematic review of the literature on HVFD [6], more research is needed on the predictive variables of training effects. Knowing which variables are related to the effects of training would enable rehabilitation workers to deploy the best rehabilitation program for the individual patient. This may improve efficacy of rehabilitation. The potentially predictive variables are selected for their clinical relevance. In a rehabilitation setting, it is often questioned whether training effects can be predicted by demographic characteristics, variables related to the visual disorder, and neuropsychological test results [6]. In short, the aim of the present study is to examine the effects of IH-CST in terms of subjective and objective mobility-related measures, including the long-term effects and the influence of several factors on the effect of training.

Continue —> The Effects of Compensatory Scanning Training on Mobility in Patients with Homonymous Visual Field Defects: Further Support, Predictive Variables and Follow-Up

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