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A Model for the Prediction of Outcomes of Recession / Resection Surgery for Primary Constant Esotropias
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
A. Kailasanathan, S. Mirza, R.D. Brown
We looked retrospectively at the results of uniocular recession/resection repairs for 88 patients with primary constant esotropias with and without an accommodative element performed by one surgeon and his trainees. We included patients who had childhood esotropia with onset of esotropia after 6 months of age. The management of amblyopia was independent of surgery. Patients were excluded if they had neurological disease, paralytic squints, previous strabismus surgery or had strabismus syndromes and pattern deviations. None of the patients underwent prism adaptation therapy. All patients had preoperative esotropia measurements the day before surgery and all measurements were taken with full refractive correction. Postoperative measurements were taken 2–6 weeks after surgery and once more all measurements were taken with full refractive correction.
Rehabilitation of Visual Perceptual and Visual Spatial Disorders in Adults and Children
Published in Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten, Tamara Ownsworth, Neuropsychological Rehabilitation, 2017
Barbara A. Wilson, Joe Mole, Tom Manly
Making repeated reaches whilst wearing >10° rightward deviating prism glasses causes learning/adaptation which, when the prisms are removed, results in a leftward deviating after-effect. In patients with left neglect, improved attention to the left persisted for at least an hour after a single prism training session (Rossetti et al., 1998) and, in one non-RCT study, was detectable six weeks after a more protracted period of daily 20-minute training (Frassinetti et al., 2002). Other results have been less encouraging. In an RCT, Turton et al. (2009), for example, found that prism-trained patients improved more than the control group on a pointing task but found no overall effect on more everyday measures (see also Nys et al., 2008). Of course, as discussed, the absence of group level effects in an RCT does not mean that prism adaptation would not be effective in an individual. The key is to take a single-case experimental approach, trying and evaluating each intervention or combination of interventions to see which, if any, is most effective. In an example of this, Tunnard and Wilson (2014) compared several neglect strategies (musical stimulation, anchoring, vibratory stimulation, limb activation + anchoring, anchoring + vibratory stimulation). Although some improvement was seen after each intervention, anchoring + vibratory stimulation were most effective in this single case. For a review of novel insights in the rehabilitation of neglect please see Fasotti and van Kessel (2013).
Rehabilitation and management of visual dysfunction following traumatic brain injury
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
Large amounts of yoked prism, such as 15 prism diopters, may be used in therapy to force problem solving and increase flexibility in the sensorimotor system. Activities, such as walking or tapping a swinging ball, while wearing these prisms involve recalibration and integration of vestibular, proprioceptive, kinesthetic, and extraocular efferent copy systems. This is an extremely effective technique for disrupting habitual patterns in patients who have been unresponsive to more instrument-based therapies so that, with guidance, they can reorganize their visual–motor system in a more adaptive manner. Therapeutically, yoked prisms are only worn for periods extending from a few minutes to a few hours. It is important to note that, in an observer with a normal visual system, prism adaptation would be expected to occur with long-term wear. Presumably, those individuals who experience a long-term compensatory effect wearing yoked prism full time have visual dysfunction that precludes prism adaptation to this prescription. This reasoning makes sense in that if these patients had been able to do the sort of reorganization that prism adaptation requires, they would probably not have sustained an egocentric visual midline shift.
Vision Beyond Vision: Lessons Learned from Amblyopia
Published in Journal of Binocular Vision and Ocular Motility, 2023
To support our hypothesis that the cerebellum is responsible for the deficits we found, we conducted another set of experiments to examine motor adaptation in amblyopia. Specifically, we investigated how patients with amblyopia adapted their saccades and limb reaching movements after introducing an unexpected perturbation. In the first experiment, we evaluated saccadic adaptation when a target stepped backward unexpectedly during ongoing saccades. We found that patients had reduced ability to adapt compared to controls.38 In a second experiment, we introduced perturbations to visually-normal participants based on the spatiotemporal uncertainty we measured in patients with amblyopia.39 We found that the saccadic adaptation in visually-normal participants not only became deficient, but its extent was also identical to the abnormal pattern seen in patients. These findings provide strong evidence for the role of spatiotemporal uncertainty in causing abnormal adaptations in amblyopia. In a third experiment, we introduced perturbations in the form of a laterally-displacing prism to assess limb reaching movements. We found that patients with amblyopia had deficient prism adaptation compared to controls.40 Taken together, amblyopia is associated with impaired motor control and abnormal motor adaptation, both of which are functions of the cerebellum.
Longley et al.: Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury. Cochrane Database of Systematic Reviews, 2021
Published in Neuropsychological Rehabilitation, 2022
I then categorized the intervention offered to patients, as proposed by Longley et al. (2021). Two of the 6 studies focused on a functional visual treatment (Svaerke et al., 2019; Turgut et al., 2018). Both reported significant effects on neuropsychological neglect tests and one also on ADL performance. Two studies used galvanic stimulation (Nakamura et al., 2015; Schmidt et al., 2013). Both studies used a restricted range of outcome tests, one focusing exclusively on the arm position sense. Both documented positive results; however, it cannot be ruled out that the improvements exclusively related to the ongoing stimulation, because there was no assessment hours later. The other two studies used prism adaptation either alone or combined with eye pursuit (Facchin et al., 2019; Keller et al., 2009). Both studies showed significant improvements. However, one of these studies did not specify the primary outcome parameter and found improvement only in one test, although the groups were compared on four tests (Keller et al., 2009). Therefore, a lack of alpha level correction is a problem in evaluating the evidence of this study.
Impact of eliminating visual input on sitting posture and head position in a patient with spatial neglect following cerebral hemorrhage: a case report
Published in Physiotherapy Theory and Practice, 2021
Peii Chen, Shannon E. Motisi, Christina Cording, Irene Ward, Neil N. Jasey
The following case report is of an individual who had a hemorrhagic stroke damaging her right basal ganglia and surrounding subcortical areas in the frontal lobe. Due to her severe posture impairment, extreme gaze preference toward the right side (Figure 1), and inconsistent responses to multi-step commands, the patient could not be assessed reliably using conventional paper-based visuospatial tests (e.g. line bisection and target cancelation) or through instruction-dependent examinations for extinction in any sensory modalities. Extinction refers to a phenomenon when ipsilesional stimuli extinguishes the perception of contralesional stimuli when both stimuli are presented simultaneously (Baylis, Simon, Baylis, and Rorden, 2002). The patient’s spatial neglect was diagnosed via a standardized observation process during daily-life situations. Because of her low functional level, we found it challenging to administer evidence-based treatments such as prism adaptation, visual scanning, and optokinetic stimulation suggested in the practice guidelines by Winstein et al. (2016).