Homonymous hemianopia and visual neglect: Part II ― rehabilitation

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Abstract

This article is the second part of a literary review of the most common and difficult to differentiate between visual–spatial disorders, namely, homonymous hemianopia and unilateral spatial neglect, which occur after a right hemisphere stroke. In the first part of the review, the phenomenology of these disorders, diagnostic methods, and criteria for their difference were comprehensively explored.

The second part highlights modern methods of rehabilitation based on the recommendations of the World Federation for Neurorehabilitation. For the rehabilitation of homonymous hemianopia, the following interventions are recommended: saccadic training, hemianopic reading training, restorative visual field training, etc. For the rehabilitation of the neglect syndrome, the following interventions are encouraged: visual scanning training, optokinetic/smooth pursuit therapy, prism adaptation, eye patching, noninvasive brain stimulation, etc.

Recommendations on the methods and timing of their implementation are presented, and modern clinical studies are highlighted. In addition, the innovative methods of eye tracking and virtual reality are described.

The information presented herein is sent to rehabilitation medicine specialists.

About the authors

Marina A. Shurupova

Federal center of brain research and neurotechnologies; Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Medical and Rehabilitation Scientific Center "Russkoe pole"; Lomonosov Moscow State University

Author for correspondence.
Email: shurupova@fccps.ru
ORCID iD: 0000-0003-2214-3187
SPIN-code: 7030-9954

Cand. Sci. (Biol.)

Russian Federation, Moscow; Chekhov; Moscow

Alina D. Aizenshtein

Federal center of brain research and neurotechnologies

Email: aizenshtein@fccps.ru
ORCID iD: 0000-0001-7442-0903
SPIN-code: 6638-1549
Russian Federation, Moscow

Galina E. Ivanova

Federal center of brain research and neurotechnologies; The Russian National Research Medical University named after N.I. Pirogov; Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology

Email: reabilivanova@mail.ru
ORCID iD: 0000-0003-3180-5525
SPIN-code: 4049-4581

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow; Moscow

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2. Fig. 1. Rehabilitation session of a patient with hemianopia on an alternative communication device using the eye-tracking method C-Eye II Pro (AssisTech Sp. Z o.o., Poland) at the Federal State Budgetary Institution “Federal Center for Brain and Neurotechnology” of the FMBA of Russia. Saccadic training (SCT) was performed: when the patient fixes his/her gaze (the red circle is the patient’s gaze) on the stimulus (cat), the stimulus moves to another position.

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3. Fig. 2. Free Eye-Search Therapy Software (https://www.eyesearch.ucl.ac.uk) for saccadic training. Left: familiarization of the patient with the target stimulus (paper clip). Right: a correctly completed task through the detection of the target stimulus using a computer mouse.

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4. Fig. 3. Training of hemianopic reading on the free English Read-Right service (https://www.readright.ucl.ac.uk/). The red arrow indicates the movement of the text string from right to left. The text presentation settings are shown below.

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5. Fig. 4. Rehabilitation session of a patient with neglect syndrome on a RehaCom (HASOMED GmbH, Magdeburg, Germany) (in this modification, the simulator is built into C-Eye II Pro, but no eye tracking was carried out in the simulator) at the Federal State Budgetary Institution “Federal Center for Brain and Neurotechnology” of the FMBA of Russia. Visual training (VST) is performed in the “Saccades” module: the patient fixes his/her gaze in the center (in the sun) and must detect which side (left or right) the target stimulus (bus) appeared by pressing the corresponding button on the keyboard. White “snowflakes” on the monitor as additional optokinetic stimulation from right to left.

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6. Fig. 5. Passive therapies of neglect syndrome: prism adaptation (а, b) and eye patching (с, d). а — appearance of the prismatic goggles; b — adaptation of the patient following prism therapy (the ipsilateral error to the right when indicating the center of the line becomes smaller after therapy); с — appearance of glasses with patches; d — offering patches on the right half-fields of vision of both eyes in patients with left-sided neglect and stroke of the right hemisphere; the right hemisphere is stimulated, and the activation of the left hemisphere decreases, which leads to the restoration of interhemispheric balance. (According to N. Smania et al., [54] and Y. Rossetti et al., [56], with changes). ЛПЗ — left field of vision; ППЗ — right field of vision; ЛП — left hemisphere; ПП — right hemisphere.

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