Visual field restorative rehabilitation after brain injury

Abstract

About 20%-30% of patients undergoing neurological rehabilitation report visual field defects, one of the most frequent of which is homonymous hemianopsia (loss of the same half of the visual field in both eyes). There is still no consensus as to whether homonymous hemianopsia is best treated in a restorative or compensatory manner. The aim of this review is to describe the effects of restorative rehabilitation, whose long-term efficacy is still being debated. We analyzed 56 articles describing the use of various techniques used to promote visual field recovery but concentrating on two approaches: "border training," which involves exercising vision at the edge of the damaged visual field, and "blindsight training," which is based on exercising unconscious perceptual functions in the mild of the blind hemifield where the scotoma is deep. Both techniques have been supported by functional imaging studies showing evidence of cortical rearrangement (plasticity) after rehabilitation. Although no formal meta-analysis was possible, the results of a semiquantitative evaluation suggested that the improvement in visual skills obtained is related to the type of training used: Border rehabilitation seems to improve the detection of visual stimuli, whereas blindsight rehabilitation seems to improve their processing. Finally, the addition of transcranial direct current stimulation seems to enhance the effects of visual field rehabilitation.

Transcranial direct current stimulation (tDCS) combined with blindsight rehabilitation for the treatment of homonymous hemianopia: a report of two-cases

“…Our previous paper 42 ) strongly suggest that blindsight rehabilitation improves the processing of visual stimuli, so it is possible that stimulation of associative areas could facilitate this processing mechanism.…”

The Effectiveness of Three-Dimensional Glasses in the Visual Field Defect in Patients with Traumatic Brain Injury: A Novel Therapy (TAMKAN’s Technique)

“…Studies have reported that repeated stimulation synchronizes neuronal firing in the same areas, and, as this synchronization requires attentional activation, it leads to synaptic plasticity. 4,7 We think that 3D vision rehabilitation combined with this treatment increases this plasticity in our study. Perimetry evaluations made at the end of the study support these results.…”

“…A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Travmatik beyin hasarı; görme alanı defekti; görme tedavisi; üç boyutlu gözlük Arif Uğur TAMKAN a , Ebru KARACA UMAY a been carried out, there is still no consensus on an effective method to treat TBI-related visual field loss. 4,5 We presented three-dimensional (3D) glasses and computer-based attention treatment which is used as a new treatment method in two patients with visual field defect and severe TBI (Written consent was obtained from patients and their relatives).…”

Revisiting Vision Rehabilitation

“…Repeated in daily sessions, it may modulate brain network plasticity. After unilateral occipital strokes, cortical transcranial direct current stimulation combined with rehabilitation enhanced recovery of homonymous hemianopic visual field defects (Gall et al, 2015 ; Matteo et al, 2016 ).…”