Multisensory Rehabilitation of Hemianopia

Study Overview
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Brief Summary
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The current proposal is to generate proof of concept evidence that hemianopia can be successfully rehabilitated in humans when this multisensory rehabilitation paradigm is used.

Detailed Description
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The over-arching objective is to evaluate the functional recovery of vision in hemianopic patients engaged with a multisensory training paradigm. Unilaterally blind participants will participate in weekly training sessions in which they are exposed to high-density spatiotemporally congruent and consistent visual-auditory stimulation. The participants will be tested on a battery of visual tasks probing different levels of function in different environments in a longitudinal study to track recovery.

Official Title
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Non-Invasive Multisensory Rehabilitation of Hemianopia

Conditions
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Hemianopia

Intervention / Treatment
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* Device: multisensory rehabilitation paradigm


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adults (<85) of either sex diagnosis of a stable homonymous hemianopia (>6 months) with absence of hemineglect lesion encompassing at least primary visual cortex but sparing parietal cortex normal auditory and cognitive function willingness to participate in the three month program ability to perform the visual discriminations in their intact field Exclusion Criteria: adults (>85) normal auditory and cognitive function unwilling to participate in the three month program inability to perform the visual discriminations in their intact field

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Interventional Model Description: Subjects will participate in weekly sessions (1.5-2 hours) for three months which contain baseline testing, training, and repeated testing of visual recovery
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Unilaterally blind Subjects will be exposed to visual-auditory stimulation<br>The over-arching objective is to evaluate the functional recovery of vision in hemianopic patients engaged with a multisensory training paradigm. Unilaterally blind participants will participate in weekly training sessions in which they are exposed to high-density spatiotemporally congruent and consistent visual-auditory stimulation. The participants will be tested on a battery of visual tasks probing different levels of function in different environments in a longitudinal study to track recovery. | Device: multisensory rehabilitation paradigm<br>* In initial (training) sessions, subjects will be exposed (and respond) to spatiotemporally congruent pairs of visual-auditory stimuli presented within their blinded field, with occasional probes of unisensory visual stimuli on both sides of space. Once recovery of visual responsiveness in the contralesional field is observed, sessions will alternate between training/testing and testing only sessions in which performance on the visual battery will be re-assessed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of points detected | To assess recovery of function - number of detected visual points in both hemifields (discrete count variable, higher values are better) | 3 months | 
| Reaction time | To assess recovery of function - reaction time of visual detection (continuous variable, lower values are better) | 3 months | 
| Distance between perceived and actual stimulus location | To assess recovery of function - localization accuracy/error (continuous variable, lower error is better) | 3 months | 
| Low-vision visual functioning questionnaire (LV-VFQ-48) | information processing, and visual motor skills) and overall visual ability estimated from difficulty ratings using the 48-item Veterans Affairs Low-Vision Visual Functioning Questionnaire. The difficulty of each item is rated using the ordered response categories (lower is better): (1) not difficult, (2) slightly/moderately difficult, (3) extremely difficult, and (4) impossible. Patients were also allowed to respond that they do not perform an activity for nonvisual reasons. | Baseline | 
| Low-vision visual functioning questionnaire (LV-VFQ-48) | information processing, and visual motor skills) and overall visual ability estimated from difficulty ratings using the 48-item Veterans Affairs Low-Vision Visual Functioning Questionnaire. The difficulty of each item is rated using the ordered response categories (lower is better): (1) not difficult, (2) slightly/moderately difficult, (3) extremely difficult, and (4) impossible. Patients were also allowed to respond that they do not perform an activity for nonvisual reasons. | Month 3 | 
| Humphrey visual field test | The Humphrey visual field test measures the entire area of peripheral vision that can be seen while the eye is focused on a central point. The Humphrey visual field test can also be used to detect conditions within the optic nerve of the eye, and certain neurological conditions as well. A normal visual field measures about 90 degrees temporally, 50 degrees superiorly and nasally, and 60 degrees inferiorly. (higher scores are better) | Baseline | 
| Humphrey visual field test | The Humphrey visual field test measures the entire area of peripheral vision that can be seen while the eye is focused on a central point. The Humphrey visual field test can also be used to detect conditions within the optic nerve of the eye, and certain neurological conditions as well. A normal visual field measures about 90 degrees temporally, 50 degrees superiorly and nasally, and 60 degrees inferiorly. (higher scores are better) | Month 3 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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visual cortex injury, stroke, blindness, cortical damage