[ARTICLE] Development and Implementation of a New Telerehabilitation System for Audiovisual Stimulation Training in Hemianopia – Full Text

Telerehabilitation, defined as the method by which communication technologies are used to provide remote rehabilitation, although still underused, could be as efficient and effective as the conventional clinical rehabilitation practices. In the literature, there are descriptions of the use of telerehabilitation in adult patients with various diseases, whereas it is seldom used in clinical practice with child and adolescent patients. We have developed a new audiovisual telerehabilitation (AVT) system, based on the multisensory capabilities of the human brain, to provide a new tool for adults and children with visual field defects in order to improve ocular movements toward the blind hemifield. The apparatus consists of a semicircular structure in which visual and acoustic stimuli are positioned. A camera is integrated into the mechanical structure in the center of the panel to control eye and head movements. Patients can use this training system with a customized software on a tablet. From hospital, the therapist has complete control over the training process, and the results of the training sessions are automatically available within a few minutes on the hospital website. In this paper, we report the AVT system protocol and the preliminary results on its use by three adult patients. All three showed improvements in visual detection abilities with long-term effects. In the future, we will test this apparatus with children and their families. Since interventions for impairments in the visual field have a substantial cost for individuals and for the welfare system, we expect that our research could have a profound socio-economic impact avoiding prolonged and intensive hospital stays.

Introduction

Telerehabilitation, defined as the method by which communication technologies are used to provide remote rehabilitation, although still underused, could be as efficient and effective as the conventional clinical rehabilitation practices (1). In the literature, we can find some descriptions of the use of telerehabilitation in adult patients for various types of disorder, whereas it is seldom used in clinical practice with children and adolescents (2).

The development and use of telerehabilitation program are slow because they are affected by many logistical factors, such as regional economic resources, medical technical support systems, and population quality, but their potential is very high, as they are conceived and studied to improve patients’ ability to perform activities from daily life, thereby increasing their independence (3). For example, for adult post-stroke patients, telerehabilitation is widely used with the main goal of giving disabled people the same quality of motor, cognitive, and neuropsychological rehabilitation at home as they would have in-home visit and day-care rehabilitation (4, 5–7).

So far, the application of telerehabilitation during childhood has been primarily limited to preterm babies (8) and children with hemiplegia (9, 10), with autism spectrum disorders (11), with speech and language disorders (12, 13), and with learning difficulties (14–16). Despite the well-known impact of visual defects on cognitive functioning and neurological recovery (17), no study has yet investigated the application of telerehabilitation with children with visual impairments.

Here, we describe an innovative telerehabilitation platform, which consists in an audiovisual telerehabilitation (AVT) system, developed for children and adults with visual field defects caused by post-chiasmatic brain lesions. The AVT system allows patients to exercise independently, in an intensive, active, and functional way and in a familiar environment, under remote supervision; it consists of a mobile device platform with remote control, which is accessible directly from home and suitable both for adults, adolescents, and children from the age of 8.

The AVT system is based on a very promising multisensory audiovisual therapy, originally developed for the treatment of adults and children with visual field defects caused by brain lesions (18, 19). Basically, this training aims to stimulate multisensory integration mechanisms in order to reinforce visual and spatial compensatory functions (i.e., implementation of oculomotor strategies). In this first phase of the study, we tested the feasibility and efficacy of AVT in three adult patients with chronic visual field defects, in order to explore how the apparatus can be implemented at home.[…]

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Figure 1. Magnetic resonance imaging of the brain and visual field campimetry of S1, S2, and S3.

[ARTICLE] Audio-Visual Stimulation Improves Visual Search Abilities in Hemianopia due to Childhood Acquired Brain Lesions

Abstract

Results obtained in both animal models and hemianopic patients indicate that sound, spatially and temporally coincident with a visual stimulus, can improve visual perception in the blind hemifield, probably due to activation of ‘multisensory neurons’, mainly located in the superior colliculus.

In view of this evidence, a new rehabilitation approach, based on audiovisual stimulation of visual field, has been proposed, and applied in adults with visual field reduction due to unilateral brain lesions. So far, results have been very encouraging, with improvements in visual search abilities. Based on these findings, we have investigated the possibility of inducing long-lasting amelioration also in children with a visual deficit due to acquired brain lesions. Our results suggest that, in the absence of spontaneous recovery, audiovisual training can induce activation of visual responsiveness of the oculomotor system also in children and adolescents with acquired lesions and confirm the putatively important role of the superior colliculus (SC) in this process.

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