Neurovisual Rehabilitation in Cerebral Blindness

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Abstract
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. Design: Within-subject repeated measures design. The mean follow-up interval was 3 months (range, 1 to 10 months). Setting: Outpatients of a day clinic for the treatment of neuropsychological disorders that is associated with a city hospital. Patients: A consecutive sample of 22 hemianopic patients without neglect after unilateral stroke. Follow-up was possible in all cases. Interventions: Saccadic eye movement strategies were treated regularly (30-minute daily sessions 5 days per week; 25 to 27 total treatment sessions). Main Outcome Measures: 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°). (2) Training-related visual field increases in 12 (54%) of 22 patients (mean increase, 6.7°; range, 2° to 24°). (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; α 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.