98th Annual Meeting DOG 2000

V 521

Computer-based eye movement training in homonymous hemianopia after stroke

J. Esser*, G. Nelles**, A. Tiede**, A. Eckstein*, K. P. Steuhl*, H. Gerhard**:

Objective: To test the hypothesis that adaptation to persisting homonymous hemianopia can be facilitated by training of eye movements.

Methods: 21 healthy subjects and17 patients (mean age 60, 6 female), 8 with left and 9 with right homonymous hemianopia following unilateral PCA stroke. Pre-training baseline testing: evaluating the perception (number of missed reactions, MR) and reaction-time (RT) to luminance stimuli in each hemifield. Condition A (static): head fixed; fixation of a central point on a trainingboard (44° x 90°; 40 stimuli) and reaction to randomly presented light stimuli. Condition B (dynamic): like condition B but searching defined patterns of lights by use of eye movements. After baseline evaluation, a computer-based eye movement training (CEMT) was administered for 4 weeks (5 d/ wk): scanning the board to detect a defined stimulus pattern on the board without head movements. Duration of stimulus presentation was adjusted according to performance. After training: the change in the number of MR and in the RT in the affected hemifield was measured. The functional performance on a hemianopia-specific standardized self-rating scale af 10 activities of daily living (ADL) was assessed.

Results: Control subjects, condition A: Median RT to stimuli in the left and the right hemifield was not different (423 vs 427 ms). Condition B: RT in then right hemifield was shorter compared to the left. (951 vs 1054 ms, p<0,001). There were no MR in control subjects. Left hemianopia: similar number of MR (median 28.5 vs 30.5) and RT (1022 vs 1062 ms) in the affected hemifield at pre- and posttraining evaluation during condition A, but less MR (20.0 vs 14.0; p<0.02) and improvement RT (3000vs.1754 ms; p<0.02) during condition B. Right hemianopia: significant improvement in the number of MR (30.0 vs 23.0; p<0.02) and a trend to faster RT (1196 vs 964; n.s.) to stimuli of the right hemifield during condition A. improvement of both perception of stimuli (MR 18.0 vs 13.0; p<0.02) and RT (1466 vs 1167 ms;p<0,05) during condition B. All patients: improvement of ADL-skills. Hemianosia on perimetry after CEMT remained unchanged in all cases.

Discussion: CEMT improves perception and reaction to stimuli presented in the affected hemifield as well as ADL performance.

*Univ.-Augenklinik & ** Neurolog. Therapiezentrum (NETZ) D-45122 Essen