Posts Tagged Hemianopia
[Abstract] Adaptation to post-stroke homonymous hemianopia – a prospective longitudinal cohort study to identify predictive factors of the adaptation process
To determine any factors that predict how an individual will adapt to post-stroke hemianopic visual field loss, with close monitoring of the adaptation process from an early stage.
Materials and methods
The Hemianopia Adaptation Study (HAST) is a prospective observational longitudinal cohort clinical study. Adult stroke survivors (n = 144) with new onset homonymous hemianopia were monitored using standardised mobility assessment course (MAC) as the primary outcome measure of adaptation.
Several baseline variables were found to be good predictors of adaptation. Three variables were associated with adaptation status at 12-weeks post-stroke: inferior % visual field, % total MAC omissions, and MAC completion time (seconds). Baseline measurements of these variables can predict the adaptation at 12 weeks with moderate to high accuracy (area under ROC curve, 0.82, 95% CI 0.74–0.90). A cut-off score of ≤25% target omissions is suggested to predict which individuals are likely to adapt by 12-weeks post-stroke following gold standard care.
Adaptation to hemianopia is a personal journey with several factors being important for prediction of its presence, including MAC outcomes and extent of inferior visual field loss. A clinical recommendation is made for inclusion of the MAC as part of a functional assessment for hemianopia.
- Implications for rehabilitation
- The mobility assessment course (MAC) should be considered as an assessment of mobility/scanning in the rehabilitation of patients with homonymous hemianopia.
- A cut-off score of ≤25% omissions on MAC could be employed to determine those likely to adapt to hemianopia long-term.
- Targeted support and therapy for patients with significant visual loss in the inferior visual field area should be considered.
NovaVision’s mission is to improve the vision of patients with neurological visual impairments and enhance the quality of life for our patients and their families; therefore we provide a portfolio of CE Marked therapy and diagnostic products for vision disorders resulting from a stroke or brain injury.
Our therapies are evidence-based, supported by decades of scientific research and clinical studies.
NovaVision’s UK subsidiary, Sight Science, was founded on the back of the successful research activities of Professor Arash Sahraie and colleagues at the University of Aberdeen. This research led to the development of the Neuro-Eye Therapy™ (NeET) program designed for the visual rehabilitation of patients who have suffered visual field loss as a result of brain injury, most often following a stroke. In 2012 Sight Science was acquired by NovaVision and Professor Sahraie became a Scientific Advisor to the NovaVision group whilst retaining his role as Professor and Chair in Vision Sciences at the University of Aberdeen.
Compensation, Restoration and Substitution.
Rehabilitation Of Vision Deficits
Visual field deficits after stroke or brain injury can be overlooked early on as more severe, and life-threatening, injuries sustained from the stroke or brain injury are treated. Patients should undergo a vision evaluation as soon as possible after their injury. Even if a patient does not perceive any problems with his or her vision, defects may be present, and they can have an extensive impact on the patient’s life and may affect other rehabilitation efforts.
Spontaneous Improvement And Recovery
Within three months of a stroke or brain injury, it is common for patients to experience some spontaneous improvement and occasionally full resolution of their visual field deficits. In other words, some vision difficulties will clear up by themselves. However, in many cases, spontaneous recovery is only partial and the remaining vision difficulties require therapeutic intervention.
Alternative Therapeutic Strategies
There are three main strategies for potential visual rehabilitation: Substitution, Compensation and Restoration.
NovaVision provides a portfolio of CE Marked therapy and diagnostic products focused on Compensation and Restoration. Vision Restoration Therapy (VRT) and NeuroEyeCoach are highly complementary restoration and compensation therapies, which NovaVision offers in a therapy suite providing broad benefits to patients. Neuro-Eye Therapy (NeET) is also a vision restoration therapy offered on its own.
What Is NeuroEyeCoach?
NeuroEyeCoach is designed to re-train the ability of a patient to scan the environment, re-integrate left and right vision and make the most of their remaining visual field. The program is self-adaptive and adjusts the task difficulty to the patient’s deficits and progress while encouraging eye movement efficiency. NeuroEyeCoach is supported by decades of clinical research and studies.
On a recently published three-center study it concludes that NeuroEyeCoach can be viewed as being the first evidence based gold standard registered medical device accessible to patients at home or in clinical settings.
- Designed to improve visual search performance, navigation and object finding skills
- Systematic training program with 12 levels of increasing difficulty, adapts to responses of patient
- Program is performed in the comfort of the patient’s home using their own computer
- Professional Models enable patients to perform program in-clinic under supervision, or at home monitored by therapist
- Designed to be relatively quick, be completed in 2-4 weeks
- Provided in a therapy suite with Vision Restoration Therapy
What Is Vision Restoration Therapy?
VRT is designed to restore vision loss due to neurological brain damage and is clinically supported through years of research and studies, including a 302 patient study in which notable improvements were seen in over 70% of the patients.
- Therapy is personalised for the vision deficit and updated monthly
- VRT does not require surgery or medication of any kind
- Therapy is done at home on the patient’s own computer and on their own schedule
- VRT uses light to stimulate the border between the seeing and blind areas
- Improvement does not depend on how long ago their vision loss occurred (Efficacy is independent of lesion age)
- Provided in a therapy suite with NeuroEyeCoach
What Is Neuro-Eye Therapy?
Like VRT, NeET is designed to restore vision loss due to neurological brain damage and is also clinically supported by scientific papers and many years of research carried out at the University of Aberdeen.
- The visual stimuli are customised to the area of damage for each individual and the program is interactive, adapting automatically as your visual sensitivity increases
- NeET is non-invasive, not requiring additional medication
- NeET uses object images to stimulate the border zone, moving deep into the blind zone over time
- Therapy is done at home on the patient’s own computer and to their own schedule
Vision Restoration Therapy
This type of therapy provides actual improvement in the range or sensitivity of the patient’s field of vision. NovaVision’s VRT uses repetitive light stimulation to activate impaired visual functions in areas of partial injury (“transition zones”), strengthening the residual vision and neuronal networks. The concept of repetitive stimulation has proven effective in the recovery of other functions such as movements of lower limbs after stroke. NovaVision provides its internet-delivered, at-home computer based VRT in a therapy suite with its complementary NeuroEyeCoach vision compensation therapy.
NovaVision’s Sight Science NeET works on the basis that repeated stimulation of the blind or transition areas by specific spatial patterns can lead to increases in sensitivity of the blind areas, strengthening the residual vision and neuronal networks. Repetitive stimulation has proven effective in the recovery of other functions such as movements of lower limbs after stroke.
Vision Compensation Therapy
Using saccadic training, patients are trained to scan their surroundings rapidly and continuously in order to direct their gaze toward the blind field, bringing the previously unseen objects within their sighted field. NovaVision’s NeuroEyeCoach re-trains a patient to move their eyes effectively, re-integrate left and right vision and to make the most of their remaining visual field. NovaVision provides its internet-delivered, at-home computer based NeuroEyeCoach in a therapy suite with its complementary VRT vision restoration therapy as well as on its own.
Homonymous visual field defects, such as hemianopia, involve partial blindness in both eyes which occurs following damage to the parts of the brain responsible for processing visual information. They are one of the most common and disabling consequences of brain damage, with the visual loss impacting on numerous everyday activities like crossing the street, avoiding obstacles, shopping, reading and driving.
Here in the psychology department at Durham University we have been investigating homonymous visual field defects and have been developing training programs that may be used in the rehabilitation of such impairments. The aim of our training is not to try and restore the lost vision but rather to help people to learn compensatory strategies to help them overcome the difficulties which they experience due to the visual deficit.
Our most recent training program (Durham Reading and Exploration training; DREX) is computer-based and self-adjusting, allowing people to train themselves easily in their own home. It involves a series of tasks which encourage visual exploration. These gradually get more difficult thereby promoting the development of more efficient eye-movements and increased visual awareness. Half of the training is also specifically tailored towards improving reading, a common problem associated with visual field loss. For more information about the training then please view the training details page. Please do not hesitate to get in touch with us for further information. Our details can be found on the contact us page.
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A new study will assess the affect of providing eye scanning training to stroke survivors.
30 October 2020 by Selina Powell
New research will investigate the effectiveness of eye scanning training in improving the vision and everyday independence of stroke survivors.
The collaboration between Fight for Sight and the Stroke Association was announced on World Stroke Day (October 29).
A group of 71 stroke survivors that receive eye scanning training will be compared to a control group that does not receive the training.
The study participants will be monitored for six months with information collected during routine eye clinic visits.
Eye scanning training encourages stroke survivors to look into the ‘blind’ side of their visual field, which can improve their adaptation to loss of vision.
The study will be carried out by University of Liverpool researchers and incorporate a paper-based visual scanning programme, with participants able to practise at home.
Professor Fiona Rowe, from the University of Liverpool, highlighted that the research builds on a promising pilot trial.
“Visual scanning training has the potential to benefit stroke survivors by improving their adaptation to hemianopia and it can be done at anytime, anywhere. There is also potential for cost-savings in the NHS and social care sector through maximising stroke survivors’ use of their remaining vision, and therefore lessening its impact on daily life activities,” she emphasised.
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Unilateral blindness can be rehabilitated by multisensory training.
Training stimuli must be arranged in spatiotemporally congruent assemblies.
The training protocol is effective in human and non-human animals.
The midbrain superior colliculus is believed to support recovered vision.
The diversity of our senses conveys many advantages; it enables them to compensate for one another when needed, and the information they provide about a common event can be integrated to facilitate its processing and, ultimately, adaptive responses. These cooperative interactions are produced by multisensory neurons. A well-studied model in this context is the multisensory neuron in the output layers of the superior colliculus (SC). These neurons integrate and amplify their cross-modal (e.g., visual-auditory) inputs, thereby enhancing the physiological salience of the initiating event and the probability that it will elicit SC-mediated detection, localization, and orientation behavior. Repeated experience with the same visual-auditory stimulus can also increase the neuron’s sensitivity to these individual inputs. This observation raised the possibility that such plasticity could be engaged to restore visual responsiveness when compromised. For example, unilateral lesions of visual cortex compromise the visual responsiveness of neurons in the multisensory output layers of the ipsilesional SC and produces profound contralesional blindness (hemianopia). The possibility that multisensory plasticity could restore the visual responses of these neurons, and reverse blindness, was tested in the cat model of hemianopia. Hemianopic subjects were repeatedly presented with spatiotemporally congruent visual-auditory stimulus pairs in the blinded hemifield on a daily or weekly basis. After several weeks of this multisensory exposure paradigm, visual responsiveness was restored in SC neurons and behavioral responses were elicited by visual stimuli in the previously blind hemifield. The constraints on the effectiveness of this procedure proved to be the same as those constraining SC multisensory plasticity: whereas repetitions of a congruent visual-auditory stimulus was highly effective, neither exposure to its individual component stimuli, nor to these stimuli in non-congruent configurations was effective. The restored visual responsiveness proved to be robust, highly competitive with that in the intact hemifield, and sufficient to support visual discrimination.
EyeLab Visual Field Test
A simulated ‘Esterman Visual Field Test’
(EVFT) for commercial vehicle drivers
Please select one of the following two options:
EVFT enables drivers to test if they have the required field of vision as defined in the Regulations in the Appendix below. This is a legal requirement for commercial vehicle drivers in the UK and many other countries.
EyeLab recommends that EVFT is checked every 12 months when taking the SeeDrivePro routine test. This will conform to the DVLA ‘Esterman Test’ which is described in the Regulations.
In addition to the vision test SeeDrivePro commercial vehicle drivers should have a minimum standard of visual field (peripheral vision) as tested with an Esterman Visual Field Test.
What you will need
A computer monitor or TV with a minimum horizontal width of 16 inches (41cms) or a laptop connected to the internet which has a HDMI output plus a HDMI cable to connect your laptop to the monitor.
This test should be supervised to ensure that you remain correctly positioned throughout the test.
To Continue visit Site —-> https://www.eyelab.co.uk/seedrivepro-visual-field-test/
Famous Physical Therapists Bob Schrupp and Brad Heineck demonstrate an easy to perform visual test for someone who has had a stroke or cerebral vascular accident.
[Abstract + References] Cognitive training in an everyday-like virtual reality enhances visual-spatial memory capacities in stroke survivors with visual field defects
Visual field defects due to hemi- or quadrantanopia after stroke represent an under-recognized neurological symptom with inefficient instruments for neurorehabilitation to date. We here examined the effects of training in a virtual reality (VR) supermarket on cognitive functions, depressive symptoms, and subjective cognitive complaints in patients with hemianopia/quadrantanopia and healthy controls.
During a 14-day rehabilitation program, 20 patients and 20 healthy controls accomplished a real-life-like shopping task in a VR supermarket. A comparison between pre- and post-training standard neuropsychological measures, depressive symptoms, and subjective memory complaints allowed us to assess a putative transfer of rehabilitation effects from the training tasks to specific cognitive functions.
The results indicate that VR training may improve performance not only in the trained task but also in specific neuropsychological functions. After the training, both patients and controls showed improved performances in visual scanning, mental rotation, visuoconstruction, and cognitive flexibility. Moreover, depressive symptoms were attenuated in both groups. In the patient group compared to the control group, the training particularly resulted in improved visual memory retrieval and reduced memory complaints.
The results of the current study suggest that VR training can improve particularly visual-spatial skills in patients with hemianopia or quadrantanopia. Our study thus introduces an interesting novel treatment approach to improve cognitive functions relevant to daily life in stroke patients with visual field defects
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