Rehabilitation For Acquired Visual Field Defects: Development Of A Bottom-Up Approach (VISIOTRAIN)

Civil Hospices of Lyon

Status

Completed

Conditions

Acquired Visual Field Defects

Treatments

Other: Treatment A

Other: Treatment B

Study type

Interventional

Funder types

Other

Identifiers

NCT01730560

2010-A00702-37 (Other Identifier)

2010.615

Details and patient eligibility

About

Cortical Visual Field Defects (CFVD) are common after acquired brain injury. They often cause problems with reading and visual exploration which impact on patients' quality of life. Apart from the substitutive method that uses prisms directly placed on glasses, two main rehabilitative methods have been explored previously: one restorative and one compensatory. The most effective methods seem to be based on compensatory training paradigms that target eye movements. They rely on voluntary mass-practice that induces changes in exploratory saccadic behaviour, particularly into the blind hemifield. Previous studies using this method have shown changes in visual scanning patterns but with only a marginal profit in terms of functional benefit.

In the present study, the investigators developed a new approach to the compensatory visual field training based solely on a bottom-up mechanism. It does not require the patients' ability to voluntarily maintain attention oriented to the affected field, which may be difficult for brain-damaged patients. As previously reported in other pathological contexts (e.g. use of prism adaptation or sensory stimulation in neglect patients), bypassing voluntary and conscious implication of the patient can produce improvements by a more automatic process.

The investigators hypotheses are: 1) that a novel ramp-step search paradigm can be used by hemianopic patients to automatically improve targeted eye movements into their blind visual field; and 2) that this will lead to behavioural improvements on ecologically valid tests of visual search.

Enrollment

22 patients

Sex

All

Ages

18 to 80 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Male/Female
Stroke (ischemia or hemorrhage) documented by CTscan or MRI
Traumatic brain injury (TBI) documented by CTscan or MRI
Right or Left hemianopia defined by perimetry
All subjects must be between the ages of 18-80
Aetiology of visual field defect : Stroke (ischemia or hemorrhage)
Delay post-stroke : at least 6 months
Only one lesion on CTscan or MRI (performed in a maximal delay of 6 months)
Corrected monocular visual acuity > 5/10
Possible understanding of experimental conditions
Patient being able to be quiet and sit during at least 2 hours
Having given written informed consent prior to any procedure related to the study
Availability for the period of the study
Covered by a Health System where applicable, and/or in compliance with the recommendations of the national laws in force relating to biomedical research

Exclusion criteria

Ophthalmologic criteria : monocular visual acuity < 4/10, strabismus , diplopia , ocular instability , nystagmus, maculopathy , glaucoma , retinopathy , orthoptic rehabilitation
Neurologic criteria : sever phasic disturbances , neurologic degenerative affection , non controlled seizure , severe handicap non compatible with prolonged sit position or concentration during 30 consecutive minutes
No command of french language
Non stabilized medical situation
Females who are pregnant, nursing, or planning a pregnancy during the study period, or females of childbearing potential, not using a reliable means of contraception.
Not under any administrative or legal supervision