Restorative Neurology and Neuroscience - Volume 36, issue 2

Authors: Casco, Clara | Barollo, Michele | Contemori, Giulio | Battaglini, Luca

Article Type: Research Article

Abstract: Background: In recent years, the introduction of visual rehabilitation for patients with homonymous visual field defects has been met with both enthusiasm and caution. Despite the evidence that restitutive training results in expansion of the visual field, several concerns have been raised. Objective: We tested the effectiveness of a new rehabilitative protocol called “Neuro Restoration Training” (NRT) in reducing visual field defects and in restituting visual functions in the restored hemianopic area. Methods: Ten patients with homonymous visual field defects (lesion age >6 months) where trained in detecting low contrast Gabor patches randomly presented in the …blind field, which refers to regions of 0 dB sensitivity, and along the hemianopic boundary between absolute (0 dB) and partial blindness (>0 dB). Training included static, drifting, and flickering Gabors in different blocks. Positions along the hemianopic boundary were systematically shifted toward the blind field according to the threshold reduction during the training. Before and after the training, we assessed visual field expansion and improvement in different high-level transfer tasks (i.e., letter identification and shape recognition) performed in the hemianopic boundary and in the blind field. Results: NRT led to significant visual field enlargement (≈5 deg), as indicated by the conventional Humphrey perimetry, and two custom made evaluations of visual field expansion with eye movement control (one static and one dynamic). The restored area acquired new visual functions such as small letter recognition and perception of moving shapes. Finally, for some patients, NRT also improved detection, either aware or not, of high contrast flickering grating and recognition of geometrical shapes entirely presented within the blind field. Conclusion: These results suggest that NRT may lead to visual field enlargement and translate into untrained visual functions. Show more

Keywords: Hemianopia, Neuro Restoration Training, visual field, training, contrast sensitivity

DOI: 10.3233/RNN-170752

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 275-291, 2018

Authors: Morone, Giovanni | Masiero, Stefano | Coiro, Paola | De Angelis, Domenico | Venturiero, Vincenzo | Paolucci, Stefano | Iosa, Marco

Article Type: Research Article

Abstract: Background: Robotic walking training improves probability to reach an autonomous walking in non-ambulant patients affected by subacute stroke. However, little information is available regarding the prognostic factors for identifying best responder patients. The purpose of the present study is therefore to investigate the clinical features of patients with subacute stroke that might benefit more from robotic walking therapy. Methods: One hundred subacute inpatients randomized in robotic or conventional gait training were assessed at baseline and after 4 weeks of training performed 5 times per week. Forward Binary Logistic Regression was performed using functional ambulation category (FAC) as dependent …variable and as independent variables: trunk function (trunk control test), global ability (Barthel Index), age, sex, time from stroke and beginning of rehabilitation, side and type of stroke, and in the first analysis also type of treatment. Results: The parameters that have a significant effect on the FAC-score at discharge were a higher BI-score at admission, a higher TCT-score at admission, a short time from the ictus and a robotic therapy. The variance explained by these four factors was 78%. When the two groups were separately analysed for type of treatment, a higher BI-score and a short time from stroke resulted in good prognosis for conventional therapy, whereas only a high TCT-score improved efficacy of robotic training. Conclusion: Efficacy of robotic walking training was not associated with global ability at admission. Hence, more severely disabled patients may obtain greater benefit from robotic training, independently by other factors, except the need of a residual trunk control that was identified as a good prognostic factor for robotic walking training. Show more

Keywords: Hemiparesis, walking, subacute stroke, robot-assisted training

DOI: 10.3233/RNN-170799

Citation: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 293-299, 2018