Rehabilitation For Acquired Visual Field Defects: Development Of A Bottom-Up Approach (VISIOTRAIN)

July 25, 2018 updated by: Hospices Civils de Lyon

Cortical Visual Field Defects (CFVD) are common after acquired brain injury. They often cause problems with reading and visual exploration which impact on patients' quality of life. Apart from the substitutive method that uses prisms directly placed on glasses, two main rehabilitative methods have been explored previously: one restorative and one compensatory. The most effective methods seem to be based on compensatory training paradigms that target eye movements. They rely on voluntary mass-practice that induces changes in exploratory saccadic behaviour, particularly into the blind hemifield. Previous studies using this method have shown changes in visual scanning patterns but with only a marginal profit in terms of functional benefit.

In the present study, the investigators developed a new approach to the compensatory visual field training based solely on a bottom-up mechanism. It does not require the patients' ability to voluntarily maintain attention oriented to the affected field, which may be difficult for brain-damaged patients. As previously reported in other pathological contexts (e.g. use of prism adaptation or sensory stimulation in neglect patients), bypassing voluntary and conscious implication of the patient can produce improvements by a more automatic process.

The investigators hypotheses are: 1) that a novel ramp-step search paradigm can be used by hemianopic patients to automatically improve targeted eye movements into their blind visual field; and 2) that this will lead to behavioural improvements on ecologically valid tests of visual search.

Study Overview

Status

Completed

Study Type

Interventional

Enrollment (Actual)

22

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Saint Genis Laval, France, 69235
        • Service de Médecine Physique et de Réadaptation,Hôpital Henry Gabrielle

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Male/Female
  • Stroke (ischemia or hemorrhage) documented by CTscan or MRI
  • Traumatic brain injury (TBI) documented by CTscan or MRI
  • Right or Left hemianopia defined by perimetry
  • All subjects must be between the ages of 18-80
  • Aetiology of visual field defect : Stroke (ischemia or hemorrhage)
  • Delay post-stroke : at least 6 months
  • Only one lesion on CTscan or MRI (performed in a maximal delay of 6 months)
  • Corrected monocular visual acuity > 5/10
  • Possible understanding of experimental conditions
  • Patient being able to be quiet and sit during at least 2 hours
  • Having given written informed consent prior to any procedure related to the study
  • Availability for the period of the study
  • Covered by a Health System where applicable, and/or in compliance with the recommendations of the national laws in force relating to biomedical research

Exclusion Criteria:

  • Ophthalmologic criteria : monocular visual acuity < 4/10, strabismus , diplopia , ocular instability , nystagmus, maculopathy , glaucoma , retinopathy , orthoptic rehabilitation
  • Neurologic criteria : sever phasic disturbances , neurologic degenerative affection , non controlled seizure , severe handicap non compatible with prolonged sit position or concentration during 30 consecutive minutes
  • No command of french language
  • Non stabilized medical situation
  • Females who are pregnant, nursing, or planning a pregnancy during the study period, or females of childbearing potential, not using a reliable means of contraception.
  • Not under any administrative or legal supervision

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Arm 1:Treatment A
Treatment A (active) followed by treatment B (neutral)

The computer-based training task consists of a novel ramp-step search paradigm with a stimulus traversing the screen from left to right or right to left. Subjects are asked to pursue the stimulus (ramp phase) and then saccade to find its location when it suddenly jumps (step phase). The stimulus is an open spinning circle. At the end of each movement, the gap can be located at the top or at the bottom, and patients are asked to indicate this location by pushing the response button as quickly as possible.

The starting point will alternate between left and right. The training task includes 3 sessions with 100 movements each. Reaction Times and errors will be monitored online to ensure that the patient performs the task correctly.

Each treatment phase has the same pattern:

  • two visits in pre-tests evaluation (V1 and V2),
  • one visit to perform treatment (A or B) and to assess immediate and 2h post-effects (V3),
  • two visits after treatment (V4 at one week and V5 at one month).
Experimental: Arm 2: Treatment B
Treatment B (neutral) followed by treatment A (active)

Placebo treatment using the same computer-based training task, but including only the ramp phase.

Each treatment phase has the same pattern:

  • two visits in pre-tests evaluation (V1 and V2),
  • one visit to perform treatment (A or B) and to assess immediate and 2h post-effects (V3),
  • two visits after treatment (V4 at one week and V5 at one month).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Difference in performance (mean reaction time - RT) of an ecological visual search task between pre-tests and immediate post-test for each patient according to treatment (A or B).
Time Frame: 1 week
1 week

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Errors and omissions at each evaluation session for the visual search task
Time Frame: 1, 2 and 5 weeks
Mean RT difference, errors and omissions at several visual tasks (rapid scanning task, exploratory visual tasks, reading task) at each evaluation session Parameters of visual field perimetry before and after treatment Oculo-motor parameters during the different tasks (i.e. amplitude and latencies for saccades and fixations)
1, 2 and 5 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Sophie Jacquin-Courtois, MD, PhD, Service de Médecine Physique et de Réadaptation

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 29, 2010

Primary Completion (Actual)

June 13, 2018

Study Completion (Actual)

June 13, 2018

Study Registration Dates

First Submitted

November 15, 2012

First Submitted That Met QC Criteria

November 20, 2012

First Posted (Estimate)

November 21, 2012

Study Record Updates

Last Update Posted (Actual)

July 26, 2018

Last Update Submitted That Met QC Criteria

July 25, 2018

Last Verified

July 1, 2018

More Information

Terms related to this study

Other Study ID Numbers

  • 2010.615
  • 2010-A00702-37 (Other Identifier: ID-RCB)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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