Abstract
Despite the fact that almost one-third of patients suffer from visual deficits following brain damage; neuro-visual rehabilitation to compensate for visual field deficits is relatively neglected in the clinical setting. This is in contrast to physio and speech therapies, which are the bread and butter of rehabilitative programs. Likewise, programs that address coping with dementia usually concentrate on language, memory and cognitive skills, but often fail to address the deficits experienced by the subset of patients suffering from progressive cortico-visual dysfunction. Herein, we will review the different approaches to neuro-visual rehabilitation, mainly concentrating on restorative and compensatory treatments. While the first claims to restore vision in the blind visual field, the latter attempts to improve the use of the remaining intact field. These approaches differ in their premise regarding the ability of the adult human brain to adapt following damage, reflecting different attitudes toward the presumed treatment target organ. While restorative therapies claim to reactivate inactive neurons within or around the damaged cortices, compensatory approaches aim to improve voluntary eye movements to compensate the visual loss. We will also briefly discuss the use of optical devices for bypassing the visual deficit as well as the use of the blind-sight phenomena to convert non-conscious visual abilities in the blind visual field into awareness. The various therapeutic approaches will be discussed in the context of patients suffering from hemianopsia and in patients suffering from posterior cortical atrophy. We will argue that of all, the compensatory strategies have shown the most promising results.
Similar content being viewed by others
References
Rowe F, Brand D, Jackson CA et al (2009) Visual impairment following stroke: do stroke patients require vision assessment? Age Ageing 38:188–193
Clarke G (2005) Incidence of neurological vision impairment in patients who suffer from an acquired brain injury. Int Congr Ser 1282:365–369
Burack-Weiss A (1992) Psychological aspects of aging and vision loss. In: Faye E, Stuen CS (eds) The aging eye and low vision: a study guide for physicians New York. Lighthouse, NY, pp 29–34
Wandell BA, Smirnakis SM (2009) Plasticity and stability of visual field maps in adult primary visual cortex. Nat Rev Neurosci 10:873–884
Baker CI, Peli E, Knouf N, Kanwisher NG (2005) Reorganization of visual processing in macular degeneration. J Neurosci 25:614–618
Kerkhoff G (1999) Restorative and compensatory therapy approaches in cerebral blindness: a review. Restor Neurol Neurosci 15:255–271
Suchoff IB, Kapoor N, Ciuffreda KJ, Rutner D, Han E, Craig S (2008) The frequency of occurrence, types, and characteristics of visual field defects in acquired brain injury: a retrospective analysis. Optometry 79:259–265
Zihl J, von Cramon D (1985) Visual field recovery from scotoma in patients with postgeniculate damage. A review of 55 cases. Brain 108(Pt 2):335–365
Kerkhoff G (2000) Neurovisual rehabilitation: recent developments and future directions. Am J Ophthalmol 130:687–688
Schaadt AK, Schmidt L, Reinhart S et al (2014) Perceptual relearning of binocular fusion and stereoacuity after brain injury. Neurorehabil Neural Repair 28:462–471
Schaadt AK, Schmidt L, Kuhn C et al (2014) Perceptual relearning of binocular fusion after hypoxic brain damage: four controlled single-case treatment studies. Neuropsychology 28:382–387
Funk J, Finke K, Reinhart S et al (2013) Effects of feedback-based visual line-orientation discrimination training for visuospatial disorders after stroke. Neurorehabil Neural Repair 27:142–152
Grunda T, Marsalek P, Sykorova P (2013) Homonymous hemianopia and related visual defects: restoration of vision after a stroke. Acta Neurobiol Exp 73:237–249
Moss AM, Harrison AR, Lee MS (2014) Patients with homonymous hemianopia become visually qualified to drive using novel monocular sector prisms. J Neuroophthalmol 34:53–56
Peli E (2000) Field expansion for homonymous hemianopia by optically induced peripheral exotropia. Optom Vision Sci Off Publ Am Acad Optom 77:453–464
O’Neill EC, Connell PP, O’Connor JC, Brady J, Reid I, Logan P (2011) Prism therapy and visual rehabilitation in homonymous visual field loss. Optom Vision Sci Off Publ Am Acad Optom 88:263–268
Bowers AR, Keeney K, Peli E (2014) Randomized crossover clinical trial of real and sham peripheral prism glasses for hemianopia. JAMA Ophthalmol 132:214–222
Sabel BA, Henrich-Noack P, Fedorov A, Gall C (2011) Vision restoration after brain and retina damage: the “residual vision activation theory”. Prog Brain Res 192:199–262
Kasten E, Wust S, Behrens-Baumann W, Sabel BA (1998) Computer-based training for the treatment of partial blindness. Nat Med 4:1083–1087
Sabel BA, Kasten E (2000) Restoration of vision by training of residual functions. Curr Opin Ophthalmol 11:430–436
Sabel BA (1999) Restoration of vision I: neurobiological mechanisms of restoration and plasticity after brain damage: a review. Restor Neurol Neurosci 15:177–200
Sabel BA (1997) Unrecognized potential of surviving neurons: within systems plasticity, recovery of function, and the hypothesis of minimal residual structure. Neuroscientist 3:366–370
Wessinger CM (1998) Those that were blind can now see. Nat Med 4:1005–1006
McFadzean RM (2006) NovaVision: vision restoration therapy. Curr Opin Ophthalmol 17:498–503
Poggel DA, Mueller I, Kasten E, Sabel BA (2008) Multifactorial predictors and outcome variables of vision restoration training in patients with post-geniculate visual field loss. Restor Neurol Neurosci 26:321–339
Bouwmeester L, Heutink J, Lucas C (2007) The effect of visual training for patients with visual field defects due to brain damage: a systematic review. J Neurol Neurosurg Psychiatry 78:555–564
Schuett S (2009) The rehabilitation of hemianopic dyslexia. Nat Rev 5:427–437
Lovie-Kitchin JMJ, Riobinson J, Brown B (1990) What areas of the visual field are important for mobility in low vision patients? Clin Vision Sci 5:249–263
Zihl J (1995) Eye movement patterns in hemianopic dyslexia. Brain 118(Pt 4):891–912
Weiskrantz L, Warrington EK, Sanders MD, Marshall J (1974) Visual capacity in the hemianopic field following a restricted occipital ablation. Brain 97:709–728
Sanders MD, Warrington EK, Marshall J, Wieskrantz L (1974) “Blindsight”: vision in a field defect. Lancet 1:707–708
Taub E, Mark VW, Uswatte G (2014) Implications of CI therapy for visual deficit training. Front Integrat Neurosci 8:78
Stoerig P (2008) Functional rehabilitation of partial cortical blindness? Restor Neurol Neurosci 26:291–303
Chokron S, Perez C, Obadia M, Gaudry I, Laloum L, Gout O (2008) From blindsight to sight: cognitive rehabilitation of visual field defects. Restor Neurol Neurosci 26:305–320
Cowey A (2010) The blindsight saga. Experimental brain research 200:3–24
Zihl J (1995) Visual scanning behavior in patients with homonymous hemianopia. Neuropsychologia 33:287–303
Trauzettel-Klosinski S, Brendler K (1998) Eye movements in reading with hemianopic field defects: the significance of clinical parameters. Graefe’s archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie 236:91–102
Meienberg O, Zangemeister WH, Rosenberg M, Hoyt WF, Stark L (1981) Saccadic eye movement strategies in patients with homonymous hemianopia. Annals of neurology 9:537–544
Ishiai S, Furukawa T, Tsukagoshi H (1987) Eye-fixation patterns in homonymous hemianopia and unilateral spatial neglect. Neuropsychologia 25:675–679
Nelles G, Esser J, Eckstein A, Tiede A, Gerhard H, Diener HC (2001) Compensatory visual field training for patients with hemianopia after stroke. Neurosci Lett 306:189–192
Schuett S, Heywood CA, Kentridge RW, Zihl J (2008) Rehabilitation of hemianopic dyslexia: are words necessary for re-learning oculomotor control? Brain 131:3156–3168
Spitzyna GA, Wise RJ, McDonald SA et al (2007) Optokinetic therapy improves text reading in patients with hemianopic alexia: a controlled trial. Neurology 68:1922–1930
Kerkhoff G, Munssinger U, Haaf E, Eberle-Strauss G, Stogerer E (1992) Rehabilitation of homonymous scotomata in patients with postgeniculate damage of the visual system: saccadic compensation training. Restor Neurol Neurosci 4:245–254
Schuett S, Heywood CA, Kentridge RW, Dauner R, Zihl J (2012) Rehabilitation of reading and visual exploration in visual field disorders: transfer or specificity? Brain 135:912–921
Roth T, Sokolov AN, Messias A, Roth P, Weller M, Trauzettel-Klosinski S (2009) Comparing explorative saccade and flicker training in hemianopia: a randomized controlled study. Neurology 72:324–331
Benson DF, Davis RJ, Snyder BD (1988) Posterior cortical atrophy. Arch Neurol 45:789–793
Crutch SJ, Lehmann M, Schott JM, Rabinovici GD, Rossor MN, Fox NC (2012) Posterior cortical atrophy. Lancet Neurol 11:170–178
McMonagle P, Deering F, Berliner Y, Kertesz A (2006) The cognitive profile of posterior cortical atrophy. Neurology 66:331–338
Yong KX, Shakespeare TJ, Cash D, Henley SM, Warren JD, Crutch SJ (2014) (Con)text-specific effects of visual dysfunction on reading in posterior cortical atrophy. Cortex J Dev Study Nerv Syst Behav 57:92–106
Yong KX, Rajdev K, Shakespeare TJ, Leff AP, Crutch SJ (2015) Facilitating text reading in posterior cortical atrophy. Neurology 85:339–348
Mendez MF (2001) Visuospatial deficits with preserved reading ability in a patient with posterior cortical atrophy. Cortex J Dev Study Nerv Syst Behav 37:535–543
Shakespeare TJ, Kaski D, Yong KX et al (2015) Abnormalities of fixation, saccade and pursuit in posterior cortical atrophy. Brain 138:1976–1991
Shakespeare TJ, Pertzov Y, Yong KX, Nicholas J, Crutch SJ (2015) Reduced modulation of scanpaths in response to task demands in posterior cortical atrophy. Neuropsychologia 68:190–200
Riddoch MJ (1990) Visual agnosia: disorders of object recognition and what they tell us about normal vision: farah. Mj Biol Psychol 31:299–303
Shames H, Raz N, Levin N (2015) Functional neural substrates of posterior cortical atrophy patients. J Neurol 262:1751–1761
Pisella L, Biotti D, Vighetto A (2015) Combination of attentional and spatial working memory deficits in Balint-Holmes syndrome. Ann N Y Acad Sci 1339:165–175
Acknowledgments
Levin N. has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie Grant agreement No 641805.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Raz, N., Levin, N. Neuro-visual rehabilitation. J Neurol 264, 1051–1058 (2017). https://doi.org/10.1007/s00415-016-8291-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-016-8291-0