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Visual and Motor Recovery After "Cognitive Therapeutic Exercises" in Cortical Blindness: A Case Study
Daniele De Patre1, Ann Van de Winckel, Franca Panté
1Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Santorso, Vicenza, Italy (D.D.P., F.P., C.R., M.Z., C.P.); Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota Twin Cities, Minneapolis (A.V.d.W.); Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota Twin Cities, Minneapolis (T.B.); Unità Operativa di Neuroradiologia, Vicenza, Italy (M.M.); Unità Operativa Complessa di Neurochirurgia, Vicenza, Italy (L.Z.); Neurometrika, Potomac, Maryland (T.Z.), and Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania (E.O'C.); and Unità Operativa Complessa di Medicina Nucleare, Vicenza, Italy (A.L.).
Background And Purpose:
Spontaneous visual recovery is rare after cortical blindness. While visual rehabilitation may improve performance, no visual therapy has been widely adopted, as clinical outcomes are variable and rarely translate into improvements in activities of daily living (ADLs). We explored the potential value of a novel rehabilitation approach "cognitive therapeutic exercises" for cortical blindness.
Case Description:
The subject of this case study was 48-year-old woman with cortical blindness and tetraplegia after cardiac arrest. Prior to the intervention, she was dependent in ADLs and poorly distinguished shapes and colors after 19 months of standard visual and motor rehabilitation. Computed tomographic images soon after symptom onset demonstrated acute infarcts in both occipital cortices.
Intervention:
The subject underwent 8 months of intensive rehabilitation with "cognitive therapeutic exercises" consisting of discrimination exercises correlating sensory and visual information.
Outcomes:
Visual fields increased; object recognition improved; it became possible to watch television; voluntary arm movements improved in accuracy and smoothness; walking improved; and ADL independence and self-reliance increased. Subtraction of neuroimaging acquired before and after rehabilitation showed that focal glucose metabolism increases bilaterally in the occipital poles.
Discussion:
This study demonstrates feasibility of "cognitive therapeutic exercises" in an individual with cortical blindness, who experienced impressive visual and sensorimotor recovery, with marked ADL improvement, more than 2 years after ischemic cortical damage.Video Abstract available for additional insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A173).
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