Rehabilitative treatment of alexia

Abstract

Abstract Purpose Homonymous hemianopia is the commonest form of acquired homonymous visual field defect; it can affect visual search and reading, producing alexia. For these patients we use different rehabilitative techniques such us eye movement‐based therapies, in which the damaged visual field is more effectively sampled with compensatory or adaptative eye movements. Methods Four left occipital stroke patients with complete right homonymous hemianopia (2 female) aged 40 to 70 years, took part. They were Spanish speaking and right‐handed. All of them had complete impairment of right parafoveal vision assessed with a Humphrey perimeter. Recordings were made while the participants silently read 10 trails of single words, 10 trails each of three‐and‐five word arrays. For word arrays, the average fixation time per word was calculated. Single‐ word and text reading speed and comprehension and several cognitive functions were assessed in all patients. Results Eye movement’s therapy approaches to rehabilitation attempt to improve visual performance by the application of a regularized framework of eye movement training, with practice over 20 h of intensive training.As a group the patients had significantly shorter mean single word and text reading and comprehension after training (p<0.001) and demonstrated a variety of mechanisms to account for this. Improvements were confined to the training period and maintained at follow up. Conclusion Patients can improve visual search and reading with practice. These changes translate to improved overall reading and visual function, assessed objectively and subjectively, suggesting that they represent good training effects. The underlying mechanism may involve the adoption of compensatory eye movement strategies and these techniques all rely on mass practice.