Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Santorso, Vicenza, Italy (D.D.P., F.P., C.R., M.Z., C.P.); Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota Twin Cities, Minneapolis (A.V.d.W.); Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota Twin Cities, Minneapolis (T.B.); Unità Operativa di Neuroradiologia, Vicenza, Italy (M.M.); Unità Operativa Complessa di Neurochirurgia, Vicenza, Italy (L.Z.); Neurometrika, Potomac, Maryland (T.Z.), and Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania (E.O'C.); and Unità Operativa Complessa di Medicina Nucleare, Vicenza, Italy (A.L.).
J Neurol Phys Ther. 2017 Jul;41(3):164-172. doi: 10.1097/NPT.0000000000000189.
Spontaneous visual recovery is rare after cortical blindness. While visual rehabilitation may improve performance, no visual therapy has been widely adopted, as clinical outcomes are variable and rarely translate into improvements in activities of daily living (ADLs). We explored the potential value of a novel rehabilitation approach "cognitive therapeutic exercises" for cortical blindness.
The subject of this case study was 48-year-old woman with cortical blindness and tetraplegia after cardiac arrest. Prior to the intervention, she was dependent in ADLs and poorly distinguished shapes and colors after 19 months of standard visual and motor rehabilitation. Computed tomographic images soon after symptom onset demonstrated acute infarcts in both occipital cortices.
The subject underwent 8 months of intensive rehabilitation with "cognitive therapeutic exercises" consisting of discrimination exercises correlating sensory and visual information.
Visual fields increased; object recognition improved; it became possible to watch television; voluntary arm movements improved in accuracy and smoothness; walking improved; and ADL independence and self-reliance increased. Subtraction of neuroimaging acquired before and after rehabilitation showed that focal glucose metabolism increases bilaterally in the occipital poles.
This study demonstrates feasibility of "cognitive therapeutic exercises" in an individual with cortical blindness, who experienced impressive visual and sensorimotor recovery, with marked ADL improvement, more than 2 years after ischemic cortical damage.Video Abstract available for additional insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A173).
皮质盲患者自发恢复视力的情况罕见。虽然视觉康复可能会改善患者的表现，但由于临床结果存在差异，且很少能转化为日常生活活动（ADL）的改善，因此没有广泛采用任何视觉疗法。我们探讨了一种新的康复方法“认知治疗性练习”对皮质盲的潜在价值。
该病例研究的对象是一名 48 岁女性，因心脏骤停后出现皮质盲和四肢瘫痪。在干预前，她在 ADL 方面依赖他人，且在标准视觉和运动康复 19 个月后，对形状和颜色的辨别能力很差。发病后不久的计算机断层扫描图像显示双侧枕叶皮质急性梗死。
该患者接受了 8 个月的密集康复治疗，包括“认知治疗性练习”，即进行关联感觉和视觉信息的辨别练习。
视野扩大；物体识别能力提高；可以看电视；手臂自主运动的准确性和流畅性提高；行走改善；ADL 独立性和自理能力提高。康复前后神经影像学检查的减影显示，双侧枕叶极的局部葡萄糖代谢增加。
这项研究证明了“认知治疗性练习”在皮质盲个体中的可行性，该个体在缺血性皮质损伤 2 年多后经历了令人印象深刻的视觉和感觉运动恢复，ADL 显著改善。视频摘要可提供来自作者的更多见解（请观看视频，补充数字内容 1，可在 http://links.lww.com/JNPT/A173 获得）。
