Recovery of visual fields in brain-lesioned patients by reaction perimetry treatment.
BACKGROUND
The efficacy of treatment in hemianopic patients to restore missing vision is controversial. So far, successful techniques require laborious stimulus presentation or restrict improvements to selected visual field areas. Due to the large number of brain-damaged patients suffering from visual field defects, there is a need for an efficient automated treatment of the total visual field.


METHODS
A customized treatment was developed for the reaction perimeter, permitting a time-saving adaptive-stimulus presentation under conditions of maximum attention. Twenty hemianopic patients, without visual neglect, were treated twice weekly for an average of 8.2 months starting 24.2 months after the insult. Each treatment session averaged 45 min in duration.


RESULTS
In 17 out of 20 patients a significant and stable increase of the visual field size (average 11.3 degrees +/- 8.1) was observed as well as improvement of the detection rate in the defective visual field (average 18.6% +/- 13.5). A two-factor cluster analysis demonstrated that binocular treatment was in general more effective in augmenting the visual detection rate than monocular. Four out of five patients with a visual field increase larger than 10 degrees suffered from hemorrhage, whereas all seven patients with an increase of 5 degrees or less suffered from infarction. Most patients reported that visual field restoration correlated with improvement of visual-related activities of daily living.


CONCLUSIONS
Rehabilitation treatment with the Lubeck Reaction Perimeter is a new and efficient method to restore part of the visual field in hemianopia. Since successful transfer of treatment effects to the occluded eye is achieved under monocular treatment conditions, it is hypothesized that the damaged visual cortex itself is the structure in which recovery takes place.
Schmielau
Fritz
F
Institute for Medical Psychology and Special Neurorehabilitation, University of Lübeck, Germany. schmielau@medpsy.uni-luebeck.de
Wong
Edward K
EK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006423:Hemianopsia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000295:instrumentation / Q000379:methods*; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D058609:Visual Field Tests / Q000295:instrumentation / Q000379:methods*; D014794:Visual Fields
Brain. 1985 Jun;108 ( Pt 2):335-65
4005527
Nat Med. 1998 Sep;4(9):1083-7
9734406
Adv Neurol. 1997;73:195-206
8959215
Restor Neurol Neurosci. 1995 Jan 1;8(3):113-27
21551894
Brain. 1977 Dec;100(4):655-70
415795
Exp Brain Res. 1981;44(2):159-69
7286104
Acta Neurol Scand. 1999 Apr;99(4):252-4
10225358
Vision Res. 2002 Mar;42(6):781-7
11888543
Br J Ophthalmol. 2005 Jan;89(1):30-5
15615742
Eur J Neurosci. 2002 May;15(10):1585-96
12059966
Exp Brain Res. 2000 Nov;135(1):34-40
11104125
J Neurol Neurosurg Psychiatry. 1979 Apr;42(4):312-22
458478
AMA Arch Neurol Psychiatry. 1957 Dec;78(6):568-84
13478215
Q J Exp Psychol. 1967 Aug;19(3):232-45
4965358
J Neurophysiol. 1977 Jan;40(1):74-94
401874
J Physiol. 1974 Feb;236(3):549-73
4207129
Nature. 1994 Apr 21;368(6473):737-40
8152484
J Neurol Neurosurg Psychiatry. 1985 Nov;48(11):1113-24
4078577
Restor Neurol Neurosci. 1992 Jan 1;4(4):245-54
21551879
Restor Neurol Neurosci. 1989 Jan 1;1(1):47-63
21551547
Arch Neurol. 1994 May;51(5):474-81
8179497