Attentional cueing improves vision restoration therapy in patients with visual field defects.
BACKGROUND
In patients with postgenicular lesions of the visual system, areas of residual vision (ARVs) are the main predictor of recovery induced by vision restoration therapy (VRT). In these partially defective regions, the elevated perceptual thresholds can be acutely reduced by attentional cueing.


OBJECTIVE
To examine whether directing attention to ARVs using a visuospatial cue also increases long-term neural plasticity and thus enhances permanent training outcome.


METHODS
In a prospective, randomized clinical trial, treatment outcome was compared in patients with postgenicular visual system lesions who received either standard VRT (control group [CG]; n = 10) or VRT with attentional cueing (experimental group [EG]; n = 9). Visual field size was determined before and after a 6-month treatment period using Tubingen Automated Perimetry and computer-based high-resolution perimetry (HRP) and in regular intervals throughout this period by HRP and detection performance in VRT.


RESULTS
In the area of the cue, restoration of vision was significantly greater than during VRT without cueing: cued patients showed a much more pronounced shift of the visual field border toward the blind area than that observed in the CG or in uncued regions of the EG. Focusing attention at ARVs during treatment changed topographic and temporal patterns of recovery as compared with uncued regions of the visual field.


CONCLUSIONS
Use of a visuospatial cue to focus attention at areas of residual vision amplifies long-term neuronal plasticity. The authors propose that top-down signals preactivate partially damaged areas of V1, thus linking visual and attentional neuronal networks, with the effect of permanently increasing conscious visual perception.
Poggel
Dorothe A
DA
Institute of Medical Psychology, Otto von Guericke University of Magdeburg, Germany.
Kasten
Erich
E
Sabel
Bernhard A
BA
D000328:Adult; D001288:Attention / Q000502:physiology*; D001931:Brain Mapping; D002544:Cerebral Infarction / Q000150:complications; D003463:Cues; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D009473:Neuronal Plasticity / Q000502:physiology*; D010775:Photic Stimulation; D011446:Prospective Studies; D012684:Sensory Thresholds / Q000502:physiology*; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D058609:Visual Field Tests; D014794:Visual Fields; D014795:Visual Pathways / Q000503:physiopathology