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.


METHODS
Within-subject repeated measures design. The mean follow-up interval was 3 months (range, 1 to 10 months).


METHODS
Outpatients of a day clinic for the treatment of neuropsychological disorders that is associated with a city hospital.


METHODS
A consecutive sample of 22 hemianopic patients without neglect after unilateral stroke. Follow-up was possible in all cases.


METHODS
Saccadic eye movement strategies were treated regularly (30-minute daily sessions 5 days per week; 25 to 27 total treatment sessions).


METHODS
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.
Kerkhoff
G
G
EKN Entwicklungsgruppe Klinische Neuropsychologie, City Hospital Bogenhausen, Munich, Germany.
Münssinger
U
U
Meier
E K
EK
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000150:complications / Q000628:therapy*; D005260:Female; D006423:Hemianopsia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014794:Visual Fields