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Carvalho R, Athayde MSDS, Vieira A, Detanico D, Kons RL. Magnitude and Direction of Interlimb Asymmetry and the Association of Interlimb Asymmetry with Physical Performance in Judo Athletes with Visual Impairment. Percept Mot Skills 2024:315125241286625. [PMID: 39331949 DOI: 10.1177/00315125241286625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
For judo athletes with visual impairments and their coaches, understanding possible muscle adaptations can be challenging. As it is commonplace for these adaptations to include interlimb asymmetry, we analyzed the magnitude and direction of interlimb asymmetry in judo athletes with visual impairments and verified the association of this asymmetry with their unilateral physical performances. Participants were 18 elite judo athletes (10 male, 8 female) with visual impairments. These athletes performed three physical tests: countermovement jump (CMJ), medicine ball throw (MBT), and handgrip strength (HGS), while we conducted unilateral right and left side assessments using the interlimb asymmetry equation for each physical test. Our main results showed that the CMJ and MBT tests presented asymmetry values above 10%; with CMJ significantly higher than HGS (p = 0.050), and with inconsistencies across the three tests in the direction of interlimb asymmetry (k = -0.22-0.26). Unilateral CMJ (left limb) was negatively correlated with asymmetry (r = -0.51; p = 0.031), and unilateral MBT (right limb) was positively correlated with asymmetry (r = 0.52; p = 0.024). Based on these results, coaches should prioritize regular assessments of interlimb asymmetry using these specific tests. This data can guide the construction of training programs aimed at minimizing asymmetry and enhancing overall physical performance. Continuous monitoring and adjustment of training strategies based on asymmetry findings are crucial for optimizing muscle balance in judo athletes with visual impairments.
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Affiliation(s)
- Raiane Carvalho
- Department of Physical Education, Federal University of Bahia, Salvador, Brazil
| | | | - Amilton Vieira
- Strength and Conditioning Laboratory, University of Brasilia, Brasilia, Brazil
| | - Daniele Detanico
- Biomechanics Laboratory, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Rafael Lima Kons
- Department of Physical Education, Federal University of Bahia, Salvador, Brazil
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Hwang AD, Jung J, Bowers A, Peli E. Egocentric Boundaries on Distinguishing Colliding and Non-Colliding Pedestrians while Walking in a Virtual Environment. IS&T INTERNATIONAL SYMPOSIUM ON ELECTRONIC IMAGING 2024; 36:2141-2148. [PMID: 38390289 PMCID: PMC10883473 DOI: 10.2352/ei.2024.36.11.hvei-214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Avoiding person-to-person collisions is critical for visual field loss patients. Any intervention claiming to improve the safety of such patients should empirically demonstrate its efficacy. To design a VR mobility testing platform presenting multiple pedestrians, a distinction between colliding and non-colliding pedestrians must be clearly defined. We measured nine normally sighted subjects' collision envelopes (CE; an egocentric boundary distinguishing collision and non-collision) and found it changes based on the approaching pedestrian's bearing angle and speed. For person-to-person collision events for the VR mobility testing platform, non-colliding pedestrians should not evade the CE.
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Affiliation(s)
- Alex D Hwang
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School, Cambridge, Massachusetts, USA
| | - Jaehyun Jung
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School, Cambridge, Massachusetts, USA
| | - Alex Bowers
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School, Cambridge, Massachusetts, USA
| | - Eli Peli
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA; Harvard Medical School, Cambridge, Massachusetts, USA
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Houston KE, Peli E, Luo G, Bowers AR, Woods RL. Effects of Perceptual-motor Training on Collision Judgments with Peripheral Prism Expanded Vision. Optom Vis Sci 2022; 99:875-884. [PMID: 36594755 DOI: 10.1097/opx.0000000000001957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
SIGNIFICANCE Peripheral prisms (p-prisms) improve blind-side detection of hazards in hemianopia by shifting the image of the hazard into the intact visual field. Collision judgments can be made accurately after detection by using a gaze shift to fixate the hazard in the prism-free portion of the lens, but this is slow relative to normal peripheral vision. A prior study found that prism adaptation for visual direction did not occur with general wear. We developed a perceptual-motor training regimen that resulted in accurate pointing at p-prism targets after six 1-hour sessions. PURPOSE This study aimed to determine if improvements in pointing accuracy from perceptual-motor training generalized to collision judgments during simulated walking. METHODS Participants with hemianopia (n = 13) made collision judgments in virtual reality for a person appearing 0.4 to 13.5° from the walking path. Judgments were measured under fixed gaze, requiring collision judgments via the p-prism image only, and free gaze, representing a more natural scenario. Measurements were made without and with p-prisms immediately after fitting, after a 2-week acclimation, after training, and 3 months later. Controls (n = 13) did one visit without p-prisms. RESULTS Controls had 100% detection and symmetrically distributed collision judgments for the central 33 and 36% of hazards under fixed gaze and free gaze, respectively. In hemianopia, the seeing side was not different from controls. Blind-side detection was reduced without p-prisms to 40% fixed gaze and 82% free gaze and improved with p-prisms to 99% fixed gaze and 97% free gaze (P < .001). When first worn, fixed-gaze prism side collisions were 63 versus 37% on the seeing side and 41 versus 39% for free gaze (P < .001). There was a small improvement for fixed gaze after the 2-week acclimation (53%, P < .001), but no improvements from training or an additional 3 months of use. CONCLUSIONS P-prisms improved detection, but collision judgments were inaccurate when seen only via the p-prisms and did not improve with perceptual-motor training. Patients should continue to be advised to turn their head and eyes to fixate the hazard after detection.
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Affiliation(s)
| | - Eli Peli
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Gang Luo
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Alex R Bowers
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Houston KE, Keilty M, Collins C, Trehan R, Mouldovan T, Stuckart K, Engelhardt N, Nadeau M, Rovito CA, Merabet LB. Development and 5-year Evaluation of Diagnosis-Specific Protocols for Visual Neuro-Rehabilitation in a Multicenter Inpatient Rehabilitation Network. Arch Rehabil Res Clin Transl 2022; 5:100246. [PMID: 36968165 PMCID: PMC10036222 DOI: 10.1016/j.arrct.2022.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To provide a retrospective evaluation of a new eye and vision rehabilitation care pathway in a U.S. multi-site inpatient rehabilitation network involving the occupational therapy (OT) staff and a consulting doctor of optometry (OD) specializing in vision rehabilitation. Design Retrospective study. Setting Two Inpatient Rehabilitation Facilities (IRFs) and 1 Long Term Acute Care Hospital (LTACH). Participants There were 2083 records reviewed (44% women, avg. age 59 years). The most common diagnoses were hemispatial neglect (19.2%), homonymous field defects (18.5%), and oculomotor cranial nerve palsies (16.7%) (N=2083). Interventions Clinical care was reviewed where diagnosis-specific protocols were developed and training was provided to OTs in order to reinforce OD-prescribed interventions during daily treatment sessions, including (1) third, fourth, and sixth ocular cranial nerve palsies (OCNPs) with prisms fitted for full time, postural adaptation training, and oculomotor re-education using pursuits, saccades, head-rotations, and binocular vision exercises including alternate cover and vergence; (2) homonymous hemianopia with training awareness of field loss, eccentric viewing, and fitting of Peli lens for optical field expansion; and (3) prism adaptation therapy (PAT) for left hemispatial neglect. Main Outcome Measures Frequency of diagnoses. Hypothesis Diagnoses with developed protocols were most common. Secondarily, feasibility and efficacy by anonymous OT survey. Results 2083 vision consults were performed over 5 years. The most common diagnoses were hemispatial neglect (n=399, 19.2%), homonymous field defects (n=386, 18.5%), and OCNPs (n=347, 16.7%). None of the OTs reported the protocols were infeasible and 63% (IQR 38%-69%) reported their patients benefited from the interventions. The survey suggested prism for OCNPs helped in 42%, and Peli lens and PAT both helped in 38%. Conclusions Data support the feasibility of this inpatient eye and vision rehabilitation care pathway which may be used as a foundation for creating or refining similar programs elsewhere. Uniform administration of IRF-based visual neuro-rehabilitation care could provide a substrate for future clinical trials to evaluate efficacy.
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Affiliation(s)
- Kevin E. Houston
- Spaulding Rehabilitation Hospital Cape Cod, Sandwich, MA
- Spaulding Hospital for Continuing Medical Care Cambridge, Cambridge, MA
- Spaulding Rehabilitation Hospital, Boston, MA
- Massachusetts Eye and Ear, Optometry and Vision Rehabilitation Service, Boston, MA
- Harvard Medical School, Department of Ophthalmology, Boston, MA
- Schepens Eye Research Institute, Boston, MA
- Corresponding author Kevin E. Houston, OD, MSc, Massachusetts Eye and Ear, 243 Charles St. Boston, MA 02114.
| | - Matthew Keilty
- Spaulding Rehabilitation Hospital Cape Cod, Sandwich, MA
| | | | - Ritika Trehan
- Spaulding Hospital for Continuing Medical Care Cambridge, Cambridge, MA
| | | | | | | | - Melanie Nadeau
- Massachusetts Eye and Ear, Optometry and Vision Rehabilitation Service, Boston, MA
- Harvard Medical School, Department of Ophthalmology, Boston, MA
- Schepens Eye Research Institute, Boston, MA
| | - Craig A. Rovito
- Spaulding Rehabilitation Hospital, Boston, MA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA
| | - Lotfi B. Merabet
- Spaulding Rehabilitation Hospital, Boston, MA
- Massachusetts Eye and Ear, Optometry and Vision Rehabilitation Service, Boston, MA
- Harvard Medical School, Department of Ophthalmology, Boston, MA
- Schepens Eye Research Institute, Boston, MA
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Sayed AM, Shousha MA, Baharul Islam MD, Eleiwa TK, Kashem R, Abdel-Mottaleb M, Ozcan E, Tolba M, Cook JC, Parrish RK. Mobility improvement of patients with peripheral visual field losses using novel see-through digital spectacles. PLoS One 2020; 15:e0240509. [PMID: 33052969 PMCID: PMC7556490 DOI: 10.1371/journal.pone.0240509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate see-through Augmented Reality Digital spectacles (AR DSpecs) for improving the mobility of patients with peripheral visual field (VF) losses when tested on a walking track. DESIGN Prospective Case Series. PARTICIPANTS 21 patients with peripheral VF defects in both eyes, with the physical ability to walk without assistance. METHODS We developed the AR DSpecs as a wearable VF aid with an augmented reality platform. Image remapping algorithms produced personalized visual augmentation in real time based on the measured binocular VF with the AR DSpecs calibration mode. We tested the device on a walking track to determine if patients could more accurately identify peripheral objects. MAIN OUTCOME MEASURES We analyzed walking track scores (number of recognized/avoided objects) and eye tracking data (six gaze parameters) to measure changes in the kinematic and eye scanning behaviors while walking, and assessed a possible placebo effect by deactivating the AR DSpecs remapping algorithms in random trials. RESULTS Performance, judged by the object detection scores, improved with the AR DSpecs (P<0.001, Wilcoxon rank sum test) with an average improvement rate of 18.81%. Two gaze parameters improved with the activated algorithm (P<0.01, paired t-test), indicating a more directed gaze on the central path with less eye scanning. Determination of the binocular integrated VF with the DSpecs correlated with the integrated standard automated perimetry (R = 0.86, P<0.001), mean sensitivity difference 0.8 ± 2.25 dB (Bland-Altman). CONCLUSIONS AR DSpecs may improve walking maneuverability of patients with peripheral VF defects by enhancing detection of objects in a testing environment.
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Affiliation(s)
- Ahmed M. Sayed
- Biomedical Engineering Department, Helwan University, Helwan, Egypt
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Electrical Engineering and Computer Science, MSOE University, Milwaukee, WI, United States of America
- * E-mail: (MAS); (AS)
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Department of Electrical and Computer Engineering, University of Miami, Miami, FL, United States of America
- Biomedical Engineering Department, University of Miami, Miami, FL, United States of America
- * E-mail: (MAS); (AS)
| | - MD Baharul Islam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Department of Computer Science, American University of Malta, BML, Malta
| | - Taher K. Eleiwa
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Faculty of Medicine, Department of Ophthalmology, Benha University, Benha, Egypt
| | - Rashed Kashem
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Mostafa Abdel-Mottaleb
- Department of Electrical and Computer Engineering, University of Miami, Miami, FL, United States of America
| | - Eyup Ozcan
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
- Net Eye Medical Center, Gaziantep, Turkey
| | - Mohamed Tolba
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Jane C. Cook
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Richard K. Parrish
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
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Sayed AM, Kashem R, Abdel-Mottaleb M, Roongpoovapatr V, Eleiwa TK, Abdel-Mottaleb M, Parrish RK, Abou Shousha M. Toward Improving the Mobility of Patients with Peripheral Visual Field Defects with Novel Digital Spectacles. Am J Ophthalmol 2020; 210:136-145. [PMID: 31606442 DOI: 10.1016/j.ajo.2019.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the efficacy of novel Digital spectacles (DSpecs) to improve mobility of patients with peripheral visual field (VF) loss. DESIGN Prospective case series. METHODS Binocular VF defects were quantified with the DSpecs testing strategy. An algorithm was implemented that generated personalized visual augmentation profiles based on the measured VF. These profiles were achieved by relocating and resizing video signals to fit within the remaining VF in real time. Twenty patients with known binocular VF defects were tested using static test images, followed by dynamic walking simulations to determine if they could identify objects and avoid obstacles in an environment mimicking a real-life situation. The effect of the DSpecs were assessed for visual/hand coordination with object-grasping tests. Patients performed these tests with and without the DSpecs correction profile. RESULTS The diagnostic binocular VF testing with the DSpecs was comparable to the integrated monocular standard automated perimetry based on point-by-point assessment with a mismatch error of 7.0%. Eighteen of 20 patients (90%) could identify peripheral objects in test images with the DSpecs that they could not previously. Visual/hand coordination was successful for 17 patients (85%) from the first trial. The object-grasping performance improved to 100% by the third trial. Patient performance, judged by finding and identifying objects in the periphery in a simulated walking environment, was significantly better with the DSpecs (P = 0.02, Wilcoxon rank sum test). CONCLUSIONS DSpecs may improve mobility by facilitating the ability of patients to better identify moving peripheral hazardous objects.
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Affiliation(s)
- Ahmed M Sayed
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA; Biomedical Engineering Department, Helwan University, Helwan, Egypt
| | - Rashed Kashem
- Department of Electrical and Computer Engineering, University of Miami, Miami, Florida, USA
| | - Mostafa Abdel-Mottaleb
- Department of Electrical and Computer Engineering, University of Miami, Miami, Florida, USA
| | | | - Taher K Eleiwa
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA; Department of Ophthalmology, Faculty of Medicine, Benha University, Egypt
| | - Mohamed Abdel-Mottaleb
- Department of Electrical and Computer Engineering, University of Miami, Miami, Florida, USA
| | - Richard K Parrish
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA; Department of Electrical and Computer Engineering, University of Miami, Miami, Florida, USA; Biomedical Engineering Department, University of Miami, Miami, Florida, USA.
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The Effects of Hemianopia on Perception of Mutual Gaze. Optom Vis Sci 2019; 96:860-865. [PMID: 31664014 DOI: 10.1097/opx.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Individuals with left hemianopic field loss (HFL), especially with neglect history, may have greater difficulties than individuals with right HFL in judging the direction of another person's gaze. PURPOSE Individuals with HFL often show a spatial bias in laboratory-based perceptual tasks. We investigated whether such biases also manifest in a more real-world task, perception of mutual gaze direction, an important, nonverbal communication cue in social interactions. METHODS Participants adjusted the eye position of a life-size virtual head on a monitor at a 1-m distance until (1) the eyes appeared to be looking straight at them, or (2) the eyes were perceived to be no longer looking at them (to the right and left). RESULTS Participants with right HFL (n = 8) demonstrated a rightward error in line bisection but made gaze judgments within the range of normally sighted controls (n = 17). Participants with left HFL without neglect history (n = 6) made leftward errors in line bisection and had more variable gaze judgments; three had estimates of gaze direction outside the reference range. Four participants with left HFL and neglect history made estimates of gaze direction that were to the right of the reference range. CONCLUSIONS Our results suggest that individuals with left HFL, especially with neglect history, may have greater difficulties than individuals with right HFL in compensating for low-level spatial biases (as manifested in line bisection) when performing the more complex, higher-level task of judging gaze direction.
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Peripheral Prisms Improve Obstacle Detection during Simulated Walking for Patients with Left Hemispatial Neglect and Hemianopia. Optom Vis Sci 2019; 95:795-804. [PMID: 30169355 DOI: 10.1097/opx.0000000000001280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
SIGNIFICANCE The first report on the use of peripheral prisms (p-prisms) for patients with left neglect and homonymous visual field defects (HVFDs). PURPOSE The purpose of this study was to investigate if patients with left hemispatial neglect and HVFDs benefit from p-prisms to expand the visual field and improve obstacle detection. METHODS Patients (24 with HVFDs, 10 of whom had left neglect) viewed an animated, virtual, shopping mall corridor and reported if they would have collided with a human obstacle that appeared at various offsets up to 13.5° from their simulated walking path. There were 40 obstacle presentations on each side, with and without p-prisms. No training with p-prisms was provided, and gaze was fixed at the center of expansion. RESULTS Detection on the side of the HVFD improved significantly with p-prisms in both groups, from 26 to 92% in the left-neglect group and 43 to 98% in the non-neglect group (both P < .001). There was a tendency for greater improvement in the neglect patients with p-prisms. For collision judgments, both groups exhibited a large increase in perceived collisions on the side of the HVFD with the prisms (P < .001), with no difference between the groups (P = .93). Increased perceived collisions represent a wider perceived safety margin on the side of the HVFD. CONCLUSIONS Within the controlled conditions of this simulated, collision judgment task, patients with left neglect responded well to initial application of p-prisms exhibiting improved detection and wider safety margins on the side of the HVFD that did not differ from non-neglect patients. Further study of p-prisms for neglect patients in free-gaze conditions after extended wear and in real-world mobility tasks is clearly warranted.
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Bosma MS, Nijboer TCW, Caljouw MAA, Achterberg WP. Impact of visuospatial neglect post-stroke on daily activities, participation and informal caregiver burden: A systematic review. Ann Phys Rehabil Med 2019; 63:344-358. [PMID: 31200080 DOI: 10.1016/j.rehab.2019.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age<65 versus≥65 years. METHODS PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool. RESULTS Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age≥65), and 2 on caregiver burden (1 study with mean age≥65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences. CONCLUSIONS AND IMPLICATIONS VSN has a negative impact not only on patients' independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN should be systematically and carefully assessed during rehabilitation. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice. SYSTEMATIC REVIEW REGISTRATION NO PROSPERPO Registration No. CRD42018087483.
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Affiliation(s)
- Martine S Bosma
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands; Zorggroep Florence, Laan van Vredenoord 1, 2289 DA, Rijswijk, The Netherlands.
| | - Tanja C W Nijboer
- Center of excellence for rehabilitation medicine, UMC Utrecht brain center, university medical center Utrecht, and De Hoogstraat rehabilitation, Utrecht, The Netherlands; Utrecht university, department of experimental psychology, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Monique A A Caljouw
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of public health and primary care, Leiden university medical center, Post zone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Abstract
PURPOSE OF REVIEW Spatial neglect is asymmetric orienting and action after a brain lesion, causing functional disability. It is common after a stroke; however, it is vastly underdocumented and undertreated. This article addresses the implementation gap in identifying and treating spatial neglect, to reduce disability and improve healthcare costs and burden. RECENT FINDINGS Professional organizations published recommendations to implement spatial neglect care. Physicians can lead an interdisciplinary team: functionally relevant spatial neglect assessment, evidence-based spatial retraining, and integrated spatial and vision interventions can optimize outcomes. Research also strongly suggests spatial neglect adversely affects motor systems. Spatial neglect therapy might thus "kick-start" rehabilitation and improve paralysis recovery. Clinicians can implement new techniques to detect spatial neglect and lead interdisciplinary teams to promote better, integrated spatial neglect care. Future studies of brain imaging biomarkers to detect spatial neglect, and real-world applicability of prism adaptation treatment, are needed.
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Affiliation(s)
- A M Barrett
- Stroke Rehabilitation Research, Kessler Foundation, East Hanover, NJ, USA.
| | - K E Houston
- Harvard Medical School, Department of Ophthalmology, Spaulding Rehabilitation Hospital, Boston, MA, USA
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Spreij LA, Ten Brink AF, Visser-Meily JMA, Nijboer TCW. Simulated driving: The added value of dynamic testing in the assessment of visuo-spatial neglect after stroke. J Neuropsychol 2018; 14:28-45. [PMID: 30325578 PMCID: PMC7154737 DOI: 10.1111/jnp.12172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visuo-spatial neglect (VSN) is generally assessed with neuropsychological paper-and-pencil tasks, which are often not sensitive enough to detect mild and/or well-compensated VSN. It is of utmost importance to develop dynamic tasks, resembling the dynamics of daily living. OBJECTIVE A simulated driving task was used to assess (1) differences in performance (i.e., position on the road and magnitude of sway) between patients with left- and right-sided VSN, recovered VSN, without VSN, and healthy participants; (2) the relation between average position and VSN severity; and (3) its diagnostic accuracy in relation to traditional tasks. METHODS Stroke inpatients were tested with a cancellation task, the Catherine Bergego Scale and the simulated driving task. RESULTS Patients with left-sided VSN and recovered VSN deviated more regarding position on the road compared to patients without VSN. The deviation was larger in patients with more severe VSN. Regarding diagnostic accuracy, 29% of recovered VSN patients and 6% of patients without VSN did show abnormal performance on the simulated driving task. The sensitivity was 52% for left-sided VSN. Right-sided VSN was not well detected, probably due to the asymmetric layout. CONCLUSIONS Based on these results, the simulated driving task should not be the only task to assess VSN, especially in its current form. Given the heterogenic nature of VSN, the assessment should always consist of several tasks varying in nature and complexity and include a dynamic task to detect mild and/or recovered VSN. A symmetric design should be used when designing novel tasks to assess right-sided VSN.
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Affiliation(s)
- Lauriane A Spreij
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands
| | - Antonia F Ten Brink
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Tanja C W Nijboer
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, The Netherlands.,Department of Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands
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Abstract
PURPOSE Patching for double vision is a common palliative treatment for head-trauma patients with acquired strabismus when prisms are not feasible. METHODS We review literature on spatial neglect and discuss possible effects of monocular occlusion on spatial attention. RESULTS Patching the left eye has been shown to worsen spatial judgments in some brain-injured patients with left neglect by inhibiting the right superior colliculus further impairing contralateral leftward orienting (the Sprague Effect). CONCLUSIONS Because more peripheral parts of the visual field increasingly project to the contralateral superior colliculus with the temporal crescent being entirely contralateral, avoiding patching of the temporal crescent was advised, and in most cases can be achieved by taping off the spectacle lens and avoiding an elastic eye patch.
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Bowers AR. Driving with homonymous visual field loss: a review of the literature. Clin Exp Optom 2016; 99:402-18. [PMID: 27535208 DOI: 10.1111/cxo.12425] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/02/2016] [Accepted: 02/26/2016] [Indexed: 01/13/2023] Open
Abstract
Driving is an important rehabilitation goal for patients with homonymous field defects (HFDs); however, whether or not people with HFDs should be permitted to drive is not clear. Over the last 15 years, there has been a marked increase in the number of studies evaluating the effects of HFDs on driving performance. This review of the literature provides a much-needed summary for practitioners and researchers, addressing the following topics: regulations pertaining to driving with HFDs, self-reported driving difficulties, pass rates in on-road tests, the effects of HFDs on lane position and steering stability, the effects of HFDs on scanning and detection of potential hazards, screening for potential fitness to drive, evaluating practical fitness to drive and the efficacy of interventions to improve driving of persons with HFDs. Although there is clear evidence from on-road studies that some people with HFDs may be rated as safe to drive, others are reported to have significant deficits in skills important for safe driving, including taking a lane position too close to one side of the travel lane, unstable steering and inadequate viewing (scanning) behaviour. Driving simulator studies have provided strong evidence of a wide range in compensatory scanning abilities and detection performance, despite similar amounts of visual field loss. Conventional measurements of visual field extent (in which eye movements are not permitted) do not measure such compensatory abilities and are not predictive of on-road driving performance. Thus, there is a need to develop better tests to screen people with HFDs for visual fitness to drive. We are not yet at a point where we can predict which HFD patient is likely to be a safe driver. Therefore, it seems only fair to provide an opportunity for individualised assessments of practical fitness to drive either on the road and/or in a driving simulator.
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Affiliation(s)
- Alex R Bowers
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
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Houston KE, Bowers AR, Fu X, Liu R, Goldstein RB, Churchill J, Wiegand JP, Soo T, Tang Q, Peli E. A Pilot Study of Perceptual-Motor Training for Peripheral Prisms. Transl Vis Sci Technol 2016; 5:9. [PMID: 26933522 PMCID: PMC4771076 DOI: 10.1167/tvst.5.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/22/2015] [Indexed: 11/24/2022] Open
Abstract
Purpose Peripheral prisms (p-prisms) shift peripheral portions of the visual field of one eye, providing visual field expansion for patients with hemianopia. However, patients rarely show adaption to the shift, incorrectly localizing objects viewed within the p-prisms. A pilot evaluation of a novel computerized perceptual-motor training program aiming to promote p-prism adaption was conducted. Methods Thirteen patients with hemianopia fitted with 57Δ oblique p-prisms completed the training protocol. They attended six 1-hour visits reaching and touching peripheral checkerboard stimuli presented over videos of driving scenes while fixating a central target. Performance was measured at each visit and after 3 months. Results There was a significant reduction in touch error (P = 0.01) for p-prism zone stimuli from pretraining median of 16.6° (IQR 12.1°–19.6°) to 2.7° ( IQR 1.0°–8.5°) at the end of training. P-prism zone reaction times did not change significantly with training (P > 0.05). P-prism zone detection improved significantly (P = 0.01) from a pretraining median 70% (IQR 50%–88%) to 95% at the end of training (IQR 73%–98%). Three months after training improvements had regressed but performance was still better than pretraining. Conclusions Improved pointing accuracy for stimuli detected in prism-expanded vision of patients with hemianopia wearing 57Δ oblique p-prisms is possible and training appears to further improve detection. Translational Relevance This is the first use of this novel software to train adaptation of visual direction in patients with hemianopia wearing peripheral prisms.
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Affiliation(s)
- Kevin E Houston
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Alex R Bowers
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Xianping Fu
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Information Science and Technology College, Dalian Maritime University, Dalian, China
| | - Rui Liu
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Ophthalmology Department, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Robert B Goldstein
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jeff Churchill
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jean-Paul Wiegand
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Tim Soo
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Qu Tang
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Eli Peli
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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