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Comparing explorative saccade and flicker training in hemianopia: a randomized controlled study


Roth, T; Sokolov, A N; Messias, A; Roth, P; Weller, M; Trauzettel-Klosinski, S (2009). Comparing explorative saccade and flicker training in hemianopia: a randomized controlled study. Neurology, 72(4):324-331.

Abstract

OBJECTIVE: Patients with homonymous hemianopia are disabled on everyday exploratory activities. We examined whether explorative saccade training (EST), compared with flicker-stimulation training (FT), would selectively improve saccadic behavior on the patients' blind side and benefit performance on natural exploratory tasks. METHODS: Twenty-eight hemianopic patients were randomly assigned to distinct groups performing for 6 weeks either EST (a digit-search task) or FT (blind-hemifield stimulation by flickering letters). Outcome variables (response times [RTs] during natural search, number of fixations during natural scene exploration, fixation stability, visual fields, and quality-of-life scores) were collected before, directly after, and 6 weeks after training. RESULTS: EST yielded a reduced (post/pre, 47%) digit-search RT for the blind side. Natural search RT decreased (post/pre, 23%) on the blind side but not on the seeing side. After FT, both sides' RT remained unchanged. Only with EST did the number of fixations during natural scene exploration increase toward the blind and decrease on the seeing side (follow-up/pre difference, 238%). Even with the target located on the seeing side, after EST more fixations occurred toward the blind side. The EST group showed decreased (post/pre, 43%) fixation stability and increased (post/pre, 482%) asymmetry of fixations toward the blind side. Visual field size remained constant after both treatments. EST patients reported improvements in social domain. CONCLUSIONS: Explorative saccade training selectively improves saccadic behavior, natural search, and scene exploration on the blind side. Flicker-stimulation training does not improve saccadic behavior or visual fields. The findings show substantial benefits of compensatory exploration training, including subjective improvements in mastering daily-life activities, in a randomized controlled trial.

OBJECTIVE: Patients with homonymous hemianopia are disabled on everyday exploratory activities. We examined whether explorative saccade training (EST), compared with flicker-stimulation training (FT), would selectively improve saccadic behavior on the patients' blind side and benefit performance on natural exploratory tasks. METHODS: Twenty-eight hemianopic patients were randomly assigned to distinct groups performing for 6 weeks either EST (a digit-search task) or FT (blind-hemifield stimulation by flickering letters). Outcome variables (response times [RTs] during natural search, number of fixations during natural scene exploration, fixation stability, visual fields, and quality-of-life scores) were collected before, directly after, and 6 weeks after training. RESULTS: EST yielded a reduced (post/pre, 47%) digit-search RT for the blind side. Natural search RT decreased (post/pre, 23%) on the blind side but not on the seeing side. After FT, both sides' RT remained unchanged. Only with EST did the number of fixations during natural scene exploration increase toward the blind and decrease on the seeing side (follow-up/pre difference, 238%). Even with the target located on the seeing side, after EST more fixations occurred toward the blind side. The EST group showed decreased (post/pre, 43%) fixation stability and increased (post/pre, 482%) asymmetry of fixations toward the blind side. Visual field size remained constant after both treatments. EST patients reported improvements in social domain. CONCLUSIONS: Explorative saccade training selectively improves saccadic behavior, natural search, and scene exploration on the blind side. Flicker-stimulation training does not improve saccadic behavior or visual fields. The findings show substantial benefits of compensatory exploration training, including subjective improvements in mastering daily-life activities, in a randomized controlled trial.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:18 Nov 2009 14:24
Last Modified:05 Apr 2016 13:33
Publisher:American Academy of Neurology
ISSN:0028-3878
Publisher DOI:10.1212/01.wnl.0000341276.65721.f2
PubMed ID:19171828
Permanent URL: http://doi.org/10.5167/uzh-24075

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