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Neuropsychological training methods of visual rehabilitation for homonymous vision loss caused by postchiasmatic damage fall into two fundamental paradigms: \"compensation\" and \"restoration\". Existing methods can be classified into three groups: Visual Scanning Training (VST), Audio-Visual Scanning Training (AViST) and Vision Restoration Training (VRT). VST and AViST aim at compensating vision loss by training eye scanning movements, whereas VRT aims at improving lost vision by activating residual visual functions by training light detection and discrimination of visual stimuli. This review discusses the rationale underlying these paradigms and summarizes the available evidence with respect to treatment efficacy. The issues raised in our review should help guide clinical care and stimulate new ideas for future research uncovering the underlying neural correlates of the different treatment paradigms. We propose that both local \"within-system\" interactions (i.e., relying on plasticity within peri-lesional spared tissue) and changes in more global \"between-system\" networks (i.e., recruiting alternative visual pathways) contribute to both vision restoration and compensatory rehabilitation, which ultimately have implications for the rehabilitation of cognitive functions.

Background A frequent post stroke disorder in lateralized attention is visuospatial neglect (VSN). As VSN has a strong negative impact on recovery in general and independence during daily life, optimal treatment is deemed urgent. Next to traditional stroke treatment, non-invasive brain stimulation offers the potential to facilitate stroke recovery as a complementary approach. In the present study, visual scanning training (VST; the current conventional treatment) will be combined with transcranial alternating current stimulation (tACS) to evaluate the additive effects of repeated sessions of tACS in combination with six-weeks VST rehabilitation. Methods In this double-blind randomized placebo-controlled intervention study (RCT), we will compare the effects of active tACS plus VST to sham (placebo) tACS plus VST, both encompassing 18 VST training sessions, 40 minutes each, during 6 weeks. Chronic stroke patients with VSN (> 6 months post-stroke onset) are considered eligible for study participation. In total 22 patients are needed for the study. The primary outcome is change in performance on a cancellation task. Secondary outcomes are changes in performance on a visual detection task, two line bisection tasks, and three measures to assess changes in activities of daily living. Assessment is at baseline, directly after the first and ninth training session, after the last training session (post training), and 1 week and 3 months after termination of the training (follow-up). Discussion If effective, a tACS-VST rehabilitation program could be implemented as a treatment option for VSN. Trial registration ClinicalTrials.gov ; registration number: NCT05466487; registration date: July 18, 2022 retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT05466487

WE COMPARED, FOR THE FIRST TIME, THE OVERALL AND DIFFERENTIAL EFFECTS OF THREE OF THE MOST WIDELY USED LEFT NEGLECT (LN) TREATMENTS: visual scanning training (VST), limb activation treatment (LAT), and prism adaptation (PA). Thirty-three LN patients were assigned in quasi-random order to the three groups (VST, LAT, or PA). Each patient received only one type of treatment. LN patients' performance on everyday life tasks was assessed four times (over a period of 6 weeks): A1 and A2 (i.e., the two pre-treatment assessments); A3 and A4 (i.e., the two post-treatment assessments). LN patients in each of the three treatment conditions were treated for the same number of sessions (i.e., 20). The results showed that improvements were present in the majority of the tests assessing the peripersonal space in everyday life activities. Our findings were independent of unspecific factors and lasted for at least 2 weeks following the end of the treatments. There were no interactions, however, between LN treatments and assessments. We suggest that all three treatments can be considered as valid rehabilitation interventions for LN and could be employed for ameliorating LN signs.

Spatial motor-intentional \"Aiming\" bias is a dysfunction in initiation/execution of motor-intentional behavior, resulting in hypokinetic and hypometric leftward movements. Aiming bias may contribute to posture, balance, and movement problems and uniquely account for disability in post-stroke spatial neglect. Body movement may modify and even worsen Aiming errors, but therapy techniques, such as visual scanning training, do not take this into account. Here, we evaluated (1) whether instructing neglect patients to move midline body parts improves their ability to explore left space and (2) whether this has a different impact on different patients. A 68-year-old woman with spatial neglect after a right basal ganglia infarct had difficulty orienting to and identifying left-sided objects. She was prompted with four instructions: \"look to the left,\" \"point with your nose to the left,\" \"point with your [right] hand to the left,\" and \"stick out your tongue and point it to the left.\" She oriented leftward dramatically better when pointing with the tongue/nose, than she did when pointing with the hand. We then tested nine more consecutive patients with spatial neglect using the same instructions. Only four of them made any orienting errors. Only one patient made >50% errors when pointing with the hand, and she did not benefit from pointing with the tongue/nose. We observed that pointing with the tongue could facilitate left-sided orientation in a stroke survivor with spatial neglect. If midline structures are represented more bilaterally, they may be less affected by Aiming bias. Alternatively, moving the body midline may be more permissive for leftward orienting than moving right body parts. We were not able to replicate this effect in another patient; we suspect that the magnitude of this effect may depend upon the degree to which patients have directional akinesia, spatial Where deficits, or cerebellar/frontal cortical lesions. Future research could examine these hypotheses.

Background Acquired homonymous visual field defects (HVFDs) result in significant disability, reducing quality of life. Spontaneous recovery occurs within the first months, then the likelihood of vision recovery decreases, making rehabilitation necessary. HVFDs rehabilitation is typically lengthy and intensive, done on an outpatient basis, hardly compatible with the return to everyday life. Telerehabilitation represents an option for continuing the therapy in the chronic phase of the disease, offering long-term support after hospital discharge. It also allows individuals with HVFDs to exercise independently, intensively, and actively at home, in a familiar environment, under remote supervision. However, the efficacy of telerehabilitation for chronic HVFDs in adults still requires empirical support. Methods This single-arm clinical trial assesses the efficacy of a home-based, remote-supervised, compensatory audio-visual training (AVT) in 26 adults with chronic HVFDs following a brain lesion. Immediate and long-term (up to 6 months) effects on visual field scanning, reading, activities of daily living and mood were assessed. Predictors of treatment-induced gains were also investigated considering behavioral, neuro-ophthalmological (visual field perimetry and visual evoked potentials) and neuroradiological variables (structural imaging of grey- and white-matter damages). Finally, the efficacy of the home-based AVT was compared to that of its in-person version (16 new participants with chronic HVFDs). Results Home-based AVT improves accuracy and speed of visual search, reading, mood, and disability in the activities of daily living, with improvements persisting up to 6 months after the end of the training (baseline vs. post-training assessments, all ps < 0.04). Post-treatment gains correlate with the severity of visual search deficit and the efficiency of multisensory integration (rs = -0.7/-0.5, all ps < 0.04). Neuro-ophthalmological and neuroradiological (structural connectivity) parameters are unaffected by the AVT, in line with its compensatory nature, although being associated to its efficacy (all ps < 0.03). Finally, the telerehabilitation version of the AVT produces effects comparable to the in-person AVT. Conclusion Multisensory training delivered in telerehabilitation is feasible and effective for ameliorating oculomotor compensation of visual field loss, improving mood and reducing functional disabilities in adults with chronic HVFDs. Trial registration This study was retrospectively registered at clinicaltrials.gov (NCT06341777; 26/03/2024).

People with homonymous visual field defects (HVFD) often report difficulty detecting obstacles in the periphery on their blind side in time when moving around. Recently, a randomized controlled trial showed that the InSight-Hemianopia Compensatory Scanning Training (IH-CST) specifically improved detection of peripheral stimuli and avoiding obstacles when moving around, especially in dual task situations. The within-group training effects of the previously reported IH-CST are examined in an extended patient group. Performance of patients with HVFD on a pre-assessment, post-assessment and follow-up assessment and performance of a healthy control group are compared. Furthermore, it is examined whether training effects can be predicted by demographic characteristics, variables related to the visual disorder, and neuropsychological test results. Performance on both subjective and objective measures of mobility-related scanning was improved after training, while no evidence was found for improvement in visual functions (including visual fields), reading, visual search and dot counting. Self-reported improvement did not correlate with improvement in objective mobility performance. According to the participants, the positive effects were still present six to ten months after training. No demographic characteristics, variables related to the visual disorder, and neuropsychological test results were found to predict the size of training effect, although some inconclusive evidence was found for more improvement in patients with left-sided HVFD than in patients with right-sided HFVD. Further support was found for a positive effect of IH-CST on detection of visual stimuli during mobility-related activities specifically. Based on the reports given by patients, these effects appear to be long-term effects. However, no conclusions can be drawn on the objective long-term training effects.

Driving is an everyday task involving a complex interaction between visual and cognitive processes. As such, an increase in the cognitive and/or visual demands can lead to a mental overload which can be detrimental for driving safety. Compiling evidence suggest that eye and head movements are relevant indicators of visuo-cognitive demands and attention allocation. This study aims to investigate the effects of visual degradation on eye-head coordination as well as visual scanning behavior during a highly demanding task in a driving simulator. A total of 21 emmetropic participants (21 to 34 years old) performed dual-task driving in which they were asked to maintain a constant speed on a highway while completing a visual search and detection task on a navigation device. Participants did the experiment with optimal vision and with contact lenses that introduced a visual perturbation (myopic defocus). The results indicate modifications of eye-head coordination and the dynamics of visual scanning in response to the visual perturbation induced. More specifically, the head was more involved in horizontal gaze shifts when the visual needs were not met. Furthermore, the evaluation of visual scanning dynamics, based on time-based entropy which measures the complexity and randomness of scanpaths, revealed that eye and gaze movements became less explorative and more stereotyped when vision was not optimal. These results provide evidence for a reorganization of both eye and head movements in response to increasing visual-cognitive demands during a driving task. Altogether, these findings suggest that eye and head movements can provide relevant information about visuo-cognitive demands associated with complex tasks. Ultimately, eye-head coordination and visual scanning dynamics may be good candidates to estimate drivers’ workload and better characterize risky driving behavior.

Homonymous visual field defects (HVFD) are a common consequence of postchiasmatic acquired brain injury and often lead to mobility-related difficulties. Different types of compensatory scanning training have been developed, aimed at decreasing consequences of the HVFD by changing visual scanning. The aim of the present study is to examine the effects of a compensatory scanning training program using horizontal scanning on mobility-related activities and participation in daily life. The main interest of this study is to assess the effectiveness of training on mobility-related activities and participation in daily life. Visual scanning tests, such as dot counting and visual search, and control measures for visual functions and reading have been included as well. First, it is examined how performance on scanning and mobility-related measures is affected in patients with HVFD by comparing scores with scores of a healthy control group (n = 25). Second, the effect of training is assessed using an RCT design, in which performance of 26 patients before and after training is compared to performance of 23 patients in a waiting list control group. Self-reported improvements after training were found, accompanied by improvements in detecting peripheral stimuli and avoiding obstacles during walking, especially in dual task situations in which a second task limits the attentional capacity available for compensatory scanning. Training only improved mobility-related activities in which detection of peripheral stimuli is important, while no improvement was found on tests that require other visual skills, such as reading, visual counting and visual search. This is the first RCT to evaluate the effects of a compensatory scanning training that is based on a systematic horizontal scanning rhythm. This training improved mobility-related activities. The results suggest that different types of compensatory scanning strategies are appropriate for different types of activities. ISRCTN Registry ISRCTN16833414.

Background Impaired vision is one of the commonest and most disabling consequence following stroke. Among all visual impairments, eye movement disorders are found in 70% of stroke patients which include nystagmus, strabismus, gaze palsies, disconjugate eye movements and cranial nerve palsies. They have a wide ranging impact on balance and activities of daily livings by creating difficulties in maintaining normal alignment and appropriate movement of eyes. The purpose of this study was to examine the effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders. Methods This study is a randomized controlled trial and was conducted in the University of Lahore Teaching Hospital from May 2019 to October 2020. A sample of 64 patients was recruited and randomly allocated into experimental and control group. 32 patients in experimental group were treated with visual scanning exercises along with task specific approach and 32 patients in control group were treated with task specific approach alone. Pre and post assessment of balance and activities of daily livings was assessed on BERG BALANCE SCALE and BARTHEL INDEX SCALE at baseline and at 4 th week. Results Intra-group analysis of BERG BALANCE SCALE in experimental group showed statistically significant result ( p  < 0.05) in all items except in items 4, 13 and 14 respectively. Intra-group analysis of BERG BALANCE SCALE in control group showed statistically significant result ( p  < 0.05) in items 3, 5, 8 and 12 respectively, whereas remaining all items showed statistically insignificant result. Intra-group analysis of BARTHEL INDEX SCALE in experimental group showed statistically significant result in all items ( p  < 0.05) except in items 9 and 10 respectively. Intra-group analysis of BARTHEL INDEX in control group showed statistically significant result ( p  < 0.05) in items 1, 3, 4 and 8 respectively whereas remaining all items showed statistically insignificant result. Inter-group analysis showed statistically significant result in total scores of BERG BALANCE SCALE ( p  = 0.000) and BARTHEL INEX SCALE ( p  = 0.033). Conclusion Visual scanning exercises along with task specific approach were found to be more effective in comparison to task specific approach alone. Trial registration Trial registration number: [IRCT20190717044237N1], trial registration date: 10/11/2019,

Mid-air collision is one of the top safety risks in general aviation. This study addresses the description and experimental assessment of multimodal Augmented Reality (AR) applications for training of traffic procedures in accordance with Visual Flight Rules (VFR). AR has the potential to complement the conventional flight instruction by bridging the gap between theory and practice, and by releasing students’ time and performance pressure associated with a limited simulator time. However, it is critical to assess the impact of AR in the specific domain and to identify any potential negative learning transfer. Multimodal AR applications were developed to address various areas of training: guidance and feedback for the correct scanning pattern, estimation if an encountering traffic is on collision course and application of the relevant rules. The AR applications also provided performance feedback for collision detection, avoidance and priority decisions. The experimental assessment was conducted with 59 trainees (28 women, 31 men) assigned to an experimental group (AR training) and a control group (simulator training). The results of tests without AR in the flight simulator show that the group that trained with AR obtained similar levels of performance like the control group. There was no negative training effect of AR on trainees’ performance, workload, situational awareness, emotion nor motivation. After training the tasks were perceived as less challenging, the accuracy of collision detection has improved, and the trainees reported less intense negative emotions and fear of failure. Furthermore, a scanning pattern test in AR showed that the AR training group performed the scanning pattern significantly better than the control group. In addition, there was a significant gender effect on emotion, motivation and preferences for AR features, but not on performance. Women liked the voice interaction with AR and the compass hologram more than men. Men liked the traffic holograms and the AR projection field more than women. These results are important because they provide experimental evidence for the benefits of multimodal AR applications that could be used complementary to the flight simulator training.