FunctionaL Assessment Scale of Hemianopia (FLASH): A New Multidisciplinary Tool to Assess Hemianopia in Patients with Severe Acquired Brain Injury

BACKGROUND

Severe acquired brain injury (sABI) encompasses a range of neurological impairments. Visual dysfunction, particularly homonymous visual field defects (HVFDs) and homonymous hemianopia (HH), commonly afflicts sABI survivors, affecting their cognitive and motor rehabilitation. This study presents the FunctionaL Assessment Scale of Hemianopia (FLASH), developed to analyze the most common postural behaviors exhibited by sABI patients with hemianopia during activities of daily living. A comparison to traditional static automated perimetry for diagnosing visual field deficits (VFDs) to determine the sensitivity and specificity of the FLASH was used. Additionally, this study also aimed to assess its reliability.

METHODS

Fifty-six patients (25 F, 31 M, mean age 60.59 ± 14.53) with strokes in the sub-acute phase (<6 months from the onset) were assessed with both FLASH and a Humphrey Field Analyzer.

RESULTS

After removing two items found to be less reliable than others, FLASH showed high sensitivity (81%) and specificity (77%) when compared to static automated perimetry. Inter-rater reliability was also high, with an intra-class correlation coefficient of 0.954, as well as the internal consistency computed by Cronbach's alpha, equal to 0.874.

CONCLUSION

FLASH could offer a valuable and cost-effective screening tool for VFD in sABI patients during neurorehabilitation, with potential implications for healthcare cost reduction.

Ganglion Cell Topography Indicates Pre- or Postnatal Damage to the Retro-Geniculate Visual System, Predicts Visual Field Function and May Identify Cerebral Visual Impairment in Children - A Multiple Case Study

In this paper, we quantify the degree of ganglion cell layer thinning due to retrograde trans-synaptic degeneration (RTSD) from retro-geniculate damage in six cases who had homonymous visual field defects known since childhood. Three had prenatal injuries, occurring close to mid-gestation and in the first parts of the early and late third trimester, respectively, and representing injuries at different early developmental stages. Three had later acquired injuries, at age 1.5, 4 and 13 years. The impact of the injury to the optic radiations was revealed by fibre tractography. The ganglion cell thinning corresponded with the visual field defects and the extent and location of the primary brain damage. The most important sign of RTSD was asymmetry of the ganglion cell topography within the macular area.

Spontaneous recovery and treatment effects in patients with homonymous visual field defects: a meta-analysis of existing literature in terms of the ICF framework

Homonymous visual field defects (HVFDs) are a common consequence of posterior brain injury. Most patients do not recover spontaneously and require rehabiliation. To determine whether a certain intervention may help an individual patient, it is necessary to predict the patient's level of functioning and the effect of specific training. We provide an overview of both the existing literature on HVFDs in terms of the International Classification of Functioning, Disability, and Health (ICF) components and the variables predicting the functioning of HVFD patients or the effect of treatment. We systematically analyzed 221 publications on HVFD. All variables included in these articles were classified according to the ICF, as developed by the World Health Organization, and checked for their predictive value. We found that ICF helps to clarify the scope of the existing literature and provides a framework for designing future studies, which should consider including more outcome measures related to Activities and Participation. Although several factors have been described that predict HVFD patients' level of functioning or the effects of training, additional research is necessary to identify more.