Analysis of Motor Performance Improvement Following Visual Rehabilitation Treatment in Individuals with Visual Field Defects Due to Acquired Brain Injury
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Visual field
研究概览
简要总结
Acquired brain injury" refers to brain damage that impacts neurological processing, making daily activities challenging and often causing vision issues like binocular dysfunction, oculomotor problems, and visual field loss. In Spain, visual rehabilitation is limited, although it is more common in other countries.
These patients generally need an interdisciplinary approach involving professionals like physiotherapists and optometrists and often face mobility, balance, and spatial perception difficulties. Treatment tools include lenses, prisms, and technologies like virtual reality (VR). The Visionary VR program, presented by Dr. Portela, has shown promising results in visual field recovery by stimulating the affected area.
Visual rehabilitation is based on brain plasticity and involves three key strategies:
Prisms to expand the visual field. Compensatory therapy to improve eye movement. Restitution therapy to restore the visual field.
详细描述
Acquired brain injury is a term that covers all brain damage, and it is common for such an injury to have a profound effect on neurological processing. This can negatively impact how a person performs their daily activities. Many of these patients experience various vision problems alongside general health deterioration. A high percentage of individuals exhibit deficits in binocular fusion, oculomotor dysfunctions, and visual field loss (Ciuffreda, 2007). While visual rehabilitation for these patients is common in other countries, in Spain, these treatments within rehabilitation are usually only carried out occasionally.
Acquired brain injury can be due to various causes, including strokes, trauma, and tumours. It should be noted that due to the aging population, the number of strokes increases every year, and mortality from this cause is decreasing, leading to a growing number of patients with sequelae. Patients with brain injury may require rehabilitation treatment from various professionals, including physiotherapists, occupational therapists, speech therapists, and optometrists. Treatment in these cases should be interdisciplinary, considering the multiple disabling conditions these patients suffer from.
Since acquired brain injury can affect any area of the visual system, a rigorous evaluation of vision is necessary, paying attention to ocular health, visual function, motor function and binocular system, oculomotor skills, accommodative state, and the integrity of the visual field (Callahan, 2003).
In addition to visual field loss, patients with hemianopia may suffer from symptoms such as dizziness, vertigo, or nausea. There is also an increased risk of falls due to mobility issues, posture problems, gait variability, and balance, as well as difficulty navigating obstacles. Alterations in body schema and location can also occur, with this altered spatial perception impacting motor coordination, orientation, and object location (Kotecha, 2013).
Visual field loss can take different forms, including central loss, hemianopia, quadrantanopia, and altitudinal loss. Hemianopia refers to the loss of half the visual field, either right or left. Depending on the area of the visual pathway where the lesion occurs, bitemporal hemianopia, homonymous hemianopia, or superior/inferior quadrantanopia can develop. Quadrantanopia refers to the loss of a quadrant of the visual field. Visual field tests provide relevant information about the location of the brain lesion in these cases (Ruddy, 2022).
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult subjects diagnosed with acquired brain injury either from a stroke or trauma.
- •Subjects without cognitive impairment.
- •Subjects without pre-existing musculoskeletal disorders prior to the acquired brain injury.
- •Subjects without hemineglect.
- •Subjects with more than 6 months of progression since the brain injury.
- •Subjects who have an electronic device such as a computer and internet access to perform the exercises at home.
- •Subjects with altitudinal visual field loss, hemianopia, or quadrantanopia with the central field preserved and at least 0.5 visual acuity.
排除标准
- •Not signing the informed consent.
- •Previous severe mental pathology to eliminate possible confounding factors if their daily activities are already affected.
- •Uncontrolled epilepsy.
- •Subjects with glaucoma or retinal pathologies affecting the visual field.
- •Subjects with previous ocular surgery (cataract or refractive surgery) with less than 6 months of progression.
- •Subjects who are not stable in any associated clinical pathology or otherwise diagnosed.
- •Subjects who have previously undergone visual rehabilitation for the field defect.
- •Not performing the proposed home exercises.
研究组 & 干预措施
VR Study Group
Once the patient is included in the study, 12 weekly sessions of visual rehabilitation, each lasting 45 minutes, will be scheduled. A Virtual Reality device will be used along with the Visionary Sport visual therapy software.
干预措施: Virtual Reality rehabilitation (Other)
结局指标
主要结局
Visual field
时间窗: 15 minutes
The threshold test will be used in a 30-2 field size with fixation monitoring.
Balance
时间窗: 15 minutes
The stabilometric study will be conducted using the Podoprint® pressure platform (Grupo Namrol, Barcelona, Spain). A balance assessment will be conducted after 6 sessions and after 12 sessions of treatment.
次要结局
- Visual Acuity(2 minutes)
- Subjective refraction(5 minutes)
- Worth test(1 minute)
- Ramdom Dot 2(2 minutes)
- Cover Test(1 minute)
- Maddox rod test(1 minute)
- Near point of convergence(2 minutes)
- Fusional vergences with prism bars(4 minutes)
- Accommodative amplitude(1 minutes)
- Accommodative facility test(3 minutes)
- NSUCO test (Northeastern State University College of Optometry's Oculomotor test)(2 minutes)
- DEM test (Developmental Eye Movement test )(3 minutes)
- DIVE device (Device for an Integral Visual Examination)(3 minutes)
- Lawton and Brody Scale for Instrumental Activities of Daily Living (IADL)(3 minutes)
- Barthel Index(3 minutes)
- WHOQOL-BREF Questionnaire(3 minutes)
研究者
Carmen Lopez
Ph.D. from the University of Zaragoza
Universidad de Zaragoza