Elshout Joris A, Bergsma Douwe P, Sibbel Jacqueline, Baars-Elsinga Annette, Lubbers Paula, Van Asten Freekje, Visser-Meily Johanna, Van Den Berg Albert V
Department of Cognitive Neuroscience, Section of Biophysics, Donders Centre for Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Restor Neurol Neurosci. 2018;36(1):1-12. doi: 10.3233/RNN-170719.
Stroke is the most common cause of homonymous visual field defects (HVFDs). Yet, there is no standard protocol for composing a rehabilitation program.
In this study we assess ADL gain of visual training for vision restoration in HVFD patients by means of Goal Attainment Scaling.
Thirty-five patients trained two predefined regions of the visual field successively at home. In each region we compared the effects of both training rounds, one of which was thus 'directed' and the other 'undirected'. Visual fields were measured with Humphrey and Goldmann perimetry. QoL was assessed with three stroke-related questionnaires and ADL with Goal Attainment Scaling (GAS).
Visual training improved the visual field for both Goldmann (ECSG = 5.82±0.94 mm; p = <0.001; n = 31) and Humphrey (0.79±0.20 dB; p = <0.001; n = 28) perimetry. All standardized stroke questionnaires were significantly improved after training (p < 0.039; n = 29), but showed no significant relation with either type of field improvement (p > 0.359). About 75% of the patients improved on their (personalized) GAS score. Interestingly, after both training rounds the GAS score increased in proportion to the extent of visual field improvement, for Goldmann border shift (p = 0.042; r = 0.38; n = 29) but not for Humphrey sensitivity increase (p = 0.337; r = 0.192; n = 28). Multiple regression revealed that GAS score was linearly related to the directed training component for Humphrey perimetry, but not for undirected training.
Together these data suggest that (1) visual training aimed at vision restoration leads to visual field improvement and (2) the extent of visual field improvement is linearly related to the improvement of personal activities of daily living as evaluated by means of GAS. In conclusion, a personalized evaluation to assess treatment success showed the clinical significance of a visual training for vision restoration.
中风是同向性视野缺损（HVFDs）最常见的病因。然而，目前尚无制定康复计划的标准方案。
在本研究中，我们通过目标达成量表评估视觉训练对HVFD患者视力恢复的日常生活活动（ADL）改善情况。
35例患者在家中先后对两个预定义的视野区域进行训练。在每个区域，我们比较了两轮训练的效果，其中一轮为“定向”训练，另一轮为“非定向”训练。使用Humphrey视野计和Goldmann视野计测量视野。使用三份与中风相关的问卷评估生活质量，使用目标达成量表（GAS）评估ADL。
视觉训练改善了Goldmann视野计（等效背景敏感度增益[ECSG]=5.82±0.94mm；p<0.001；n=31）和Humphrey视野计（0.79±0.20dB；p<0.001；n=28）测量的视野。所有标准化中风问卷在训练后均有显著改善（p<0.039；n=29），但与任何一种视野改善类型均无显著相关性（p>0.359）。约75%的患者（个性化）GAS评分有所改善。有趣的是，两轮训练后，GAS评分均与视野改善程度成比例增加，对于Goldmann边界移位（p=0.042；r=0.38；n=29）而言是这样，但对于Humphrey敏感度增加（p=0.337；r=0.192；n=28）并非如此。多元回归分析显示，GAS评分与Humphrey视野计的定向训练成分呈线性相关，但与非定向训练无关。
这些数据共同表明：（1）旨在恢复视力的视觉训练可改善视野；（2）视野改善程度与通过GAS评估的个人日常生活活动改善呈线性相关。总之，用于评估治疗成功与否的个性化评估显示了视觉训练对视力恢复具有临床意义。
