Visual Rehabilitation in Children With Homonymous Hemianopia: a Pilot Study on Virtual-reality Stimulation
Condition: Hemianopia; Brain Tumor; Children, Only
MeSH terms: Brain Neoplasms; Hemianopsia
Study type: Interventional

Summary: 
      There are currently no visual rehabilitation strategies for children presenting visual field
      defects consecutive to a brain tumor or its treatment. This study seeks to investigate the
      use of a home-based stimulation visual rehabilitation program using immerse-virtual reality
      (IVR) in children aged 4-10 years old with a diagnosis of hemianopia
    

Detailed description: 
      A brain tumor and its treatment can affect the visual system at different levels, from the
      optic nerves (through compression or infiltration). Children with brain tumors can present
      visual impairments like decreased visual acuity and contrast sensitivity, loss of color
      vision, and visual field loss such as hemianopias. Patients with hemianopia present
      difficulties in detecting stimuli in the defective visual field and show defective scanning
      and exploration. Moreover, they show a rotation and compression of the auditory space leading
      to imprecise localization of sound across both hemispaces. Patients with hemianopia naturally
      develop oculomotor strategies to compensate for visual field loss, but visual rehabilitation
      procedures must still be developed to optimize/improve visual perception in the blind field.
      Several studies demonstrated that these patients could improve visual perception in the
      damaged hemifield after a stimulation procedure where auditory and visual stimuli were
      temporally and spatially correlated. Such audiovisual stimulation programs induce a
      functional and anatomical reorganization of the visual connectivity in subcortical and
      cortical structures over time.

      The current strategies rely on a significant workload, over 30 hours of audiovisual
      stimulation using static, spatially, and temporally coherent stimuli displayed on large
      screens/panels in a clinical setting. These strategies require frequent visits to the clinic
      impeding the patients' adherence and compliance and increasing the burden of disease. We seek
      to develop an audiovisual stimulation procedure using immersive virtual reality (IVR) using a
      head-mounted display (HMD). This is an emerging and very promising visual rehabilitation
      approach using high-technology devices. It is developed to provide sensory stimulation with
      better ecological validity due to virtual reality, greater flexibility due to home-based
      programs, and improved efficiency due to patient-tailored protocols. IVR is a versatile
      technology, allowing its potential use for the rehabilitation of a variety of low-vision
      conditions. There are currently limited practical results on whether this technology is
      suitable for low-vision patients to use at home and if it can be deployed on a large scale. A
      few case reports/series studies suggested the potential effectiveness of IVR on visual
      perception in teenagers, adults, and the elderly but more information as to the potential of
      use and effectiveness of this technology in children and young teenagers is necessary
    

Intervention name(s): Immersive Virtual-Reality Stimulation
Intervention type(s): Device
Intervention description(s): IVR stimulation every 2 days (± 1 day) at any time during the day (delivery).
Intervention model: Single Group Assignment
Intervention model description: Visual rehabilitation using home based audiovisual rehabilitation in immersive virtual reality.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: hemianopia; Brain tumor; children