Many people will tell you that when it comes to rehabilitation, it’s better to start early. Not only from a motivational point of view, but from a medical point of view. Conditions become harder to treat as they enter a more chronic phase. This reasoning holds true for many areas of stroke rehabilitation. However, the value of early intervention in visual field defects is not always evident. Hemianopia (the visual field loss that occurs in about 30% of stroke patients) often undergoes spontaneous recovery during its subacute phase (usually in the 3 to 6 months following stroke). This fact makes it difficult to distinguish between effective, early rehabilitation, and a naturally occurring improvement in the condition.
The benefits of early intervention
Faced with the question of whether early intervention is of clinical value in hemianopia, a group of Dutch researchers developed a novel training program. They designed the program to differentiate between rehabilitation-related improvements and spontaneous recovery in the condition. The training involved patients focusing on a ring at the center of a screen with both eyes. A dot and line appeared for five seconds in the peripheral field. Patients had to press a key indicating whether the dot moved clockwise or counter-clockwise.
Patients experiencing subacute hemianopia received a treatment program focused on a specific problem region associated with a visual defect. A second, untrained region was used to monitor spontaneous recovery. Patients with chronic hemianopia underwent the same program, but without the expectation of spontaneous recovery.
The researchers found that when it comes to visual field defects, it pays to start early. Recovery in the trained region for ‘subacute’ patients was almost two times of that observed in the untrained region. The results suggested that training could provide ongoing benefit over spontaneous recovery with time. And, interestingly, improvements were also seen in the untrained region of chronic patients (albeit around one-third of that seen with training), suggesting that training of one specific area could contribute to overall recovery from hemianopia.
So talk with your physician about the possible benefit of post-stroke visual training. It could make a significant contribution to your post-stroke visual-field recovery.
The lead author of this study is Dr. Bergsma from the Department of Cognitive Neuroscience, Section of Biophysics, Donders Centre for Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.