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Homonymous hemianopia is one of the most common symptoms following a neurologic damage and has many negative effects on functional abilities and daily activities.
There are two main kind of restorative rehabilitation of hemianopia: "border training", which involves exercising vision at the edge of the damaged visual field, and "blindsight training", which is based on exercising the unconscious perceptual functions in the mild of the blind hemifield.
In literature only border training effects were shown to be facilitated by transcranial direct current stimulation (tDCS).
The investigators treat two patients with blindsight rehabilitation associated to tDCS over parieto-occipital cortex. The two patients undergo a cycle of blindsight treatment associated to tDCS and a cycle of blindsight training alone in inverted order.
Aim of the study is to investigate if the anodic stimulation of perilesional areas enhance the improvement induced by blindsight rehabilitation treatment.
The study design is a crossover AB BA. Treatment A consist in a cycle of blindsight training associated to tDCS, Treatment B consist in a a cycle of blindsight training alone.
During the blindsight training, the patient is asked to maintain central fixation and is exposed to visual stimuli in his blind hemifield. The patient task is detection and/or discrimination of stimuli.
During each session the patient is subjected to around 700 different stimuli variously associated in space and/or time.
One out of two blindsight training cycles is associated to tDCS treatment. Anodal tDCS is applied using a battery-driven constant current stimulator, and a pair of surface saline-soaked sponge electrodes (5 x 5 cm). Current intensity is of 2 mA (Fade-in/-out= 10 sec), for a total duration of 30 min. The stimulation start at the beginning of the rehabilitation session, and continue for 30 min, during treatment.
Anode is placed over the parieto-occipital cortex. The cathode is placed in the contralateral supraorbital position.
To assess the actual improvement patients performed:
All these investigations is performed before the treatment and after each cycle
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Blindsight training associated to tDCS | Experimental | During the blindsight training (one-hour time), the patient is asked to maintain central fixation and is exposed to visual stimuli in his blind hemifield. The patient task is detection and/or discrimination of stimuli. During each session the patient is subjected to around 700 different stimuli variously associated in space and/or time. tDCS stimulation start at the beginning of the rehabilitation session, and continue for 30 min, during treatment. Anode is placed over the parieto-occipital cortex. The cathode is placed in the contralateral supraorbital position. |
|
| Blindsight training alone | Active Comparator | During the blindsight training (one-hour time), the patient is asked to maintain central fixation and is exposed to visual stimuli in his blind hemifield. The patient task is detection and/or discrimination of stimuli. During each session the patient is subjected to around 700 different stimuli variously associated in space and/or time. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Blindsight Training associated to tDCS | Other | The patient undergo visual rehabilitation while his brain is electrically stimulated with tDCS. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in Humphrey visual field 30.2 SITA standard test | 10 weeks and 20 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Battery for Attentional Performance (TAP) subtest: Visual Field | 10 weeks and 20 weeks | |
| International Classification of Functioning (ICF) | 20 weeks | |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Barbara M Matteo | Università degli Studi di Milano - Bicocca | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Polo universitario presso I.C. Zucchi | Carate Brianza | CB | 20841 | Italy |
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| ID | Term |
|---|---|
| D006423 | Hemianopsia |
| D020521 | Stroke |
| ID | Term |
|---|---|
| D014786 | Vision Disorders |
| D012678 | Sensation Disorders |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
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| Blindsight Training alone | Other | The patient undergo visual rehabilitation |
|
| Change in Schuhfried Vienna Test Peripheral Perception (PP-R) |
| 10 weeks and 20 weeks |
| D001766 |
| Blindness |
| D005128 | Eye Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |