Abstract
Compensatory approaches to rehabilitation of vision loss as a result of brain injury are aimed at improving the efficacy of eye movements, enabling patients to bring the otherwise unseen stimuli into their sighted field. Eye movement training has shown promise in a large number of studies in small clinical populations. Nevertheless, there remain two problems; standardisation and wide accessibility. NeuroEyeCoach™ (NEC) has been developed to address both. The therapy is based on the visual search approach and is adaptive to the patient's level of disability and the task difficulty is varied systematically through a combination of set-size and target/distractor similarity. Importantly, the therapy can be accessed online or in clinical settings, to enhance accessibility. Here we have reported on the findings from the first 296 consecutive cases who have accessed and completed NEC online, the largest cohort of patients studied to date. Patients' performance on two objective (visual search times and errors) and one subjective (self-reported disability) measures of performance were assessed before and after therapy. The findings showed that patients improved in search time, had less errors and improved disability scores in 87% (255/294), 80% (236/294) and 66% (167/254) of all cases respectively. We examined factors age, sex, side of blindness, age at the onset of brain injury, and time elapsed between the brain injury and start of therapy as predictors of both objective and subjective measures of improvements. Age was a significant predictor of improved search errors with older patients showing larger improvements. Time between brain injury and intervention negatively influenced search reaction time, however, none of the factors could predict improved subjective reports of disability.
Highlights
Areas of blindness in the visual field could arise as a result of lesions along the visual pathways
A scatter plot of post-vs. pre-therapy RT is shown in Fig. 1A. 87% of the cases (255/294) fell below the equal performance line indicating that the majority of patients had improved reaction times after completing the therapy compared to their baseline performance
As the majority of brain injuries are caused by stroke, which is often lateralised in the brain, most patients have a sighted/intact field and only suffer partial sight loss in one hemifield
Summary
Areas of blindness in the visual field could arise as a result of lesions along the visual pathways. Compensatory techniques rely on the patient’s intact visual field for processing the otherwise unseen stimuli, by using eye movements to bring their image onto the intact field Such compensatory approach is intuitive, spontaneous adaptation and development of an effective eye movement pattern is seen in only 40% of hemianopic patients (Zihl, 1995) and the majority of cases shows inefficient eye movements years after the injury. In a collaborative approach Sahraie et al (2016) reported on development of NeuroEyeCoachTM (NEC), an eye movement intervention that was based on the original visual search task that had shown to be effective in improving search performance in hemianopia (Zihl, 1995) ( described below). Improvements in RT, ER and DS have been analysed in relation to age, sex, side of blindness, age at the onset of brain injury, and time elapsed between the brain injury and start of therapy
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