A telerehabilitation program to improve visual perception in children and adolescents with hemianopia consecutive to a brain tumour: a single-arm feasibility and proof-of-concept trial
Authors: Misawa Mariana , Bajin Inci Yaman , Zhang Bill , Daibert-Nido Monica , Tchao Danielle , Garcia-Giler Eduardo , Cheung Kyle , Appel Lora , Nasir Pi , Reginald Arun , Tabori Uri , Bartels Ute , Ramaswamy Vijay , Markowitz Samuel N. , Bouffet Eric , Reber Michael 
Published: January 2024

Background

Brain tumour in children can induce hemianopia, a loss of conscious vision, profoundly impacting their development and future prospects, yet no effective intervention exists for this pediatric population. This study aims to explore the feasibility, safety, and potential effectiveness of a home-based audiovisual stimulation in immersive virtual-reality (3D-MOT-IVR) to restore visual perception.

Method

In a phase 2a, open-labeled, nonrandomized, single arm study, 10 children and adolescents with stable hemianopia were enrolled to perform 20-minute sessions of 3D-MOT-IVR every other day for six weeks from home. We assessed feasibility by monitoring completion rates, remote data transfer, qualitative feedback. Safety was evaluated using validated cybersickness questionnaires. Comprehensive vision assessments were conducted pre- and post-intervention, with follow-ups at 1- and 6-month intervals.

Results

The home-based 3D-MOT-IVR intervention proved both feasible and safe, with no reported adverse events. All participants completed the prescribed stimulations and the pre- and post- intervention assessment points, 90% completed the follow-ups. Remarkably, the outcomes revealed significant improvements post-intervention: 50% of participants showed enhanced visual perception in their blind field, while 70% exhibited increased reading speed. Importantly, these positive effects were sustained at the 6-month follow-up. A robust correlation emerged between 3D-MOT-IVR performance and improved visual perception in the blind field, emphasizing the intervention’s effectiveness.

Conclusion

Our findings underscore the feasibility and safety of home-based 3D-MOT-IVR as a potential intervention for hemianopia in children. These promising results lay a strong foundation for a larger randomized controlled trial, offering hope for a meaningful breakthrough in visual rehabilitation for this vulnerable population.

Key Points

Absence of rehabilitation programs for children with visual field loss consecutive to brain tumour.

Design of a home-based, personalized, 3D audiovisual stimulation in virtual-reality.

Restoration of visual perception in the blind field after 3D-MOT-IVR.

Importance of the Study

Many children with a brain tumour suffer from visual field defects (hemianopia) dramatically impacting their cognitive and social growth with difficulties learning, limited mobility and thus restricted participation in physical activities and peer engagement. Later in adulthood, hemianopia affects social interactions and limits employment opportunities. Individuals with this condition present impaired visual scanning and exploration often associated with defective sound localization, deteriorating spatial detection. There is no visual rehabilitation intervention for children with hemianopia. This feasibility/proof-of-concept trial showed that a dynamic audiovisual stimulation in virtual-reality conducted every other day for 6 weeks is a feasible, safe and acceptable intervention, restoring visual perception in the blind field of 50% of the participants and improving activities of daily living. The personalized intervention was administered at home through a remotely controlled virtual-reality device, reducing the burden of disease by limiting in clinic visits and providing specialized care to children living outside urban areas.