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Nahum L, Ptak R. Rehabilitation of hemianopia and visuospatial hemineglect with a mixed intervention including adapted boxing therapy: An exploratory case study. Neuropsychol Rehabil 2024:1-18. [PMID: 38506693 DOI: 10.1080/09602011.2024.2329379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
Visual field loss and visuospatial neglect are frequent consequences of cerebral stroke. They often have a strong impact on independence in many daily activities. Rehabilitation aiming to decrease these disabilities is therefore important, and several techniques have been proposed to foster awareness, compensation, or restitution of the impaired visual field. We here describe a rehabilitation intervention using adapted boxing therapy that was part of a pluridisciplinary intervention tailored for a particular case. A 58-year-old man with left homonymous hemianopia (HH) and mild visuospatial hemineglect participated in 36 sessions of boxing therapy six months after a right temporo-occipital stroke. Repeated stimulation of his blind and neglected hemifield, and training to compensate for his deficits through improved use of his healthy hemifield were performed through boxing exercises. The patient showed a stable HH before the beginning of the training. After six months of boxing therapy, he reported improved awareness of his visual environment. Critically, his HH had evolved to a left superior quadrantanopia and spatial attention for left-sided stimuli had improved. Several cognitive functions and his mood also showed improvement. We conclude that boxing therapy has the potential to improve the compensation of visuospatial impairments in individual patients with visual field loss.
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Affiliation(s)
- Louis Nahum
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Radek Ptak
- Laboratory of Cognitive Neurorehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
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Salatino A, Zavattaro C, Gammeri R, Cirillo E, Piatti ML, Pyasik M, Serra H, Pia L, Geminiani G, Ricci R. Virtual reality rehabilitation for unilateral spatial neglect: A systematic review of immersive, semi-immersive and non-immersive techniques. Neurosci Biobehav Rev 2023; 152:105248. [PMID: 37247829 DOI: 10.1016/j.neubiorev.2023.105248] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION In recent decades, new virtual reality (VR)-based protocols have been proposed for the rehabilitation of Unilateral Spatial Neglect (USN), a debilitating disorder of spatial awareness. However, it remains unclear which type of VR protocol and level of VR immersion can maximize the clinical benefits. To answer these questions, we conducted a systematic review of the use of VR for the rehabilitation of USN. METHOD Studies between 2000 and 2022 that met the inclusion criteria were classified according to their research design and degree of immersion (non-immersive, NIVR; semi-immersive, SIVR; immersive, IVR). RESULTS A total of 375 studies were identified, of which 26 met the inclusion criteria. Improvements were found in 84.6% of the reviewed studies: 85.7% used NIVR, 100% used SIVR and 55.6% used IVR. However, only 42.3% of them included a control group and only 19.2% were randomized control trials (RCT). CONCLUSION VR protocols may offer new opportunities for USN rehabilitation, although further RCTs are needed to validate their clinical efficacy.
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Affiliation(s)
- Adriana Salatino
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; Department of Life Sciences, Royal Military Academy, Hobbema 8, 1000 Brussels, Belgium
| | - Claudio Zavattaro
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Roberto Gammeri
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Emanuele Cirillo
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Maria Luisa Piatti
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Maria Pyasik
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, Italy
| | - Hilary Serra
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Lorenzo Pia
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy
| | - Giuliano Geminiani
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy
| | - Raffaella Ricci
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy.
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Leitner MC, Ladek AM, Hutzler F, Reitsamer H, Hawelka S. Placebo effect after visual restitution training: no eye-tracking controlled perimetric improvement after visual border stimulation in late subacute and chronic visual field defects after stroke. Front Neurol 2023; 14:1114718. [PMID: 37456634 PMCID: PMC10339290 DOI: 10.3389/fneur.2023.1114718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction A significant number of Restitution Training (RT) paradigms claim to ameliorate visual field loss after stroke by re-activating neuronal connections in the residual visual cortex due to repeated bright light-stimulation at the border of the blind and intact fields. However, the effectiveness of RT has been considered controversial both in science and clinical practice for years. The main points of the controversy are (1) the reliability of perimetric results which may be affected by compensatory eye movements and (2) heterogeneous samples consisting of patients with visual field defects and/or visuospatial neglect. Methods By means of our newly developed and validated Virtual Reality goggles Salzburg Visual Field Trainer (SVFT) 16 stroke patients performed RT on a regular basis for 5 months. By means of our newly developed and validated Eye Tracking Based Visual Field Analysis (EFA), we conducted a first-time full eye-movement-controlled perimetric pre-post intervention study. Additionally, patients subjectively rated the size of their intact visual field. Results Analysis showed that patients' mean self-assessment of their subjective visual field size indicated statistically significant improvement while, in contrast, objective eye tracking controlled perimetric results revealed no statistically significant effect. Discussion Bright-light detection RT at the blind-field border solely induced a placebo effect and did not lead to training-induced neuroplasticity in the visual cortex of the type needed to ameliorate the visual field size of stroke patients.
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Affiliation(s)
- Michael Christian Leitner
- Salzburg University of Applied Sciences, Salzburg, Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Anja-Maria Ladek
- Research Program for Experimental Ophthalmology and Glaucoma Research, Department of Ophthalmology and Optometry, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
- Department of Ophthalmology and Optometry, SALK, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Florian Hutzler
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Herbert Reitsamer
- Research Program for Experimental Ophthalmology and Glaucoma Research, Department of Ophthalmology and Optometry, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
- Department of Ophthalmology and Optometry, SALK, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Hawelka
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
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Soans RS, Renken RJ, John J, Bhongade A, Raj D, Saxena R, Tandon R, Gandhi TK, Cornelissen FW. Patients Prefer a Virtual Reality Approach Over a Similarly Performing Screen-Based Approach for Continuous Oculomotor-Based Screening of Glaucomatous and Neuro-Ophthalmological Visual Field Defects. Front Neurosci 2021; 15:745355. [PMID: 34690682 PMCID: PMC8526798 DOI: 10.3389/fnins.2021.745355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
Standard automated perimetry (SAP) is the gold standard for evaluating the presence of visual field defects (VFDs). Nevertheless, it has requirements such as prolonged attention, stable fixation, and a need for a motor response that limit application in various patient groups. Therefore, a novel approach using eye movements (EMs) - as a complementary technique to SAP - was developed and tested in clinical settings by our group. However, the original method uses a screen-based eye-tracker which still requires participants to keep their chin and head stable. Virtual reality (VR) has shown much promise in ophthalmic diagnostics - especially in terms of freedom of head movement and precise control over experimental settings, besides being portable. In this study, we set out to see if patients can be screened for VFDs based on their EM in a VR-based framework and if they are comparable to the screen-based eyetracker. Moreover, we wanted to know if this framework can provide an effective and enjoyable user experience (UX) compared to our previous approach and the conventional SAP. Therefore, we first modified our method and implemented it on a VR head-mounted device with built-in eye tracking. Subsequently, 15 controls naïve to SAP, 15 patients with a neuro-ophthalmological disorder, and 15 glaucoma patients performed three tasks in a counterbalanced manner: (1) a visual tracking task on the VR headset while their EM was recorded, (2) the preceding tracking task but on a conventional screen-based eye tracker, and (3) SAP. We then quantified the spatio-temporal properties (STP) of the EM of each group using a cross-correlogram analysis. Finally, we evaluated the human-computer interaction (HCI) aspects of the participants in the three methods using a user-experience questionnaire. We find that: (1) the VR framework can distinguish the participants according to their oculomotor characteristics; (2) the STP of the VR framework are similar to those from the screen-based eye tracker; and (3) participants from all the groups found the VR-screening test to be the most attractive. Thus, we conclude that the EM-based approach implemented in VR can be a user-friendly and portable companion to complement existing perimetric techniques in ophthalmic clinics.
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Affiliation(s)
- Rijul Saurabh Soans
- Department of Electrical Engineering, Indian Institute of Technology – Delhi, New Delhi, India
- Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Remco J. Renken
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - James John
- Department of Electrical Engineering, Indian Institute of Technology – Delhi, New Delhi, India
| | - Amit Bhongade
- Department of Electrical Engineering, Indian Institute of Technology – Delhi, New Delhi, India
| | - Dharam Raj
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tapan Kumar Gandhi
- Department of Electrical Engineering, Indian Institute of Technology – Delhi, New Delhi, India
| | - Frans W. Cornelissen
- Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Salzburg Visual Field Trainer (SVFT): A virtual reality device for (the evaluation of) neuropsychological rehabilitation. PLoS One 2021; 16:e0249762. [PMID: 34529704 PMCID: PMC8445436 DOI: 10.1371/journal.pone.0249762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE "Visual Restitution Therapies" (VRT) claim to ameliorate visual field defects of neurological patients by repeated visual light stimulation, leading to training-related neuroplasticity and resulting in reconnection of lesioned neurons in early cortical areas. Because existing systems are stationary, uncomfortable, and unreliable, we developed a training instrument based on virtual reality goggles. The goal of the "Salzburg Visual Field Trainer" (SVFT) is twofold: (1) The device facilitates the clinical evaluation of established neuropsychological rehabilitation approaches, such as VRT. (2) The device enables patients to independently perform VRT based (or other) neuropsychological training methodologies flexibly and comfortably. METHODS AND ANALYSIS The SVFT was developed on the principles of VRT. Individual configuration of the SVFT is based on perimetric data of the respective patient's visual field. To validate the utmost important aspect of neuropsychological rehabilitation methodologies-that is displaying stimuli precisely in desired locations in the user's visual field-two steps were conducted in this proof-of-concept study: First, we assessed the individual "blind spots" location and extent of 40 healthy, normal sighted participants. This was done with the help of our recently developed perimetric methodology "Eye Tracking Based Visual Field Analysis" (EFA). Second, depending on the individual characteristics of every participant's blind spots, we displayed-by means of the SVFT-15 stimuli in the respective locations of every participants' blind spots and 85 stimuli in the surrounding, intact visual area. The ratio between visible and non-visible stimuli, which is reflected in the behavioral responses (clicks on a remote control) of the 40 participants, provides insight into the accuracy of the SVFT to display training stimuli in areas desired by the investigator. As the blind spot is a naturally occurring, absolute scotoma, we utilized this blind area as an objective criterion and a "simulated" visual field defect to evaluate the theoretical applicability of the SVFT. RESULTS Outcomes indicate that the SVFT is highly accurate in displaying training stimuli in the desired areas of the user's visual field with an accuracy of 99.0%. Data analysis further showed a sensitivity of .98, specificity of .99, a positive predictive value of .96, a negative predictive value of .996, a hit rate of .99, a random hit rate of .74 and a RATZ-Index of .98. This translates to 14.7% correct non-reactions, 0.7% false non-reactions, 0.3% false reactions and 84.3% correct reactions to displayed test stimuli during the evaluation study. Reports from participants further indicate that the SVFT is comfortable to wear and intuitive to use. CONCLUSIONS The SVFT can help to investigate the true effects of VRT based methodologies (or other neuropsychological approaches) and the underlying mechanisms of training-related neuroplasticity in the visual cortex in neurological patients suffering from visual field defects.
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