Telerehabilitation for visual field defects with a multisensory training: a feasibility study

Acquired homonymous visual field defects (HVFDs) result in significant disability, reducing quality of life. Spontaneous recovery occurs within the first months, then the likelihood of vision recovery decreases, making rehabilitation necessary. HVFDs rehabilitation is typically lengthy and intensive, done on an outpatient basis, hardly compatible with the return to everyday life. Telerehabilitation represents an option for continuing the therapy in the chronic phase of the disease, offering long-term support after hospital discharge. It also allows individuals with HVFDs to exercise independently, intensively, and actively at home, in a familiar environment, under remote supervision. However, the efficacy of telerehabilitation for chronic HVFDs in adults still requires empirical support.

This single-arm clinical trial assesses the efficacy of a home-based, remote-supervised, compensatory audio-visual training (AVT) in 26 adults with chronic HVFDs following a brain lesion. Immediate and long-term (up to 6 months) effects on visual field scanning, reading, activities of daily living and mood were assessed. Predictors of treatment-induced gains were also investigated considering behavioral, neuro-ophthalmological (visual field perimetry and visual evoked potentials) and neuroradiological variables (structural imaging of grey- and white-matter damages). Finally, the efficacy of the home-based AVT was compared to that of its in-person version (16 new participants with chronic HVFDs).

Home-based AVT improves accuracy and speed of visual search, reading, mood, and disability in the activities of daily living, with improvements persisting up to 6 months after the end of the training (baseline vs. post-training assessments, all ps < 0.04). Post-treatment gains correlate with the severity of visual search deficit and the efficiency of multisensory integration (rs = -0.7/-0.5, all ps < 0.04). Neuro-ophthalmological and neuroradiological (structural connectivity) parameters are unaffected by the AVT, in line with its compensatory nature, although being associated to its efficacy (all ps < 0.03). Finally, the telerehabilitation version of the AVT produces effects comparable to the in-person AVT.

Multisensory training delivered in telerehabilitation is feasible and effective for ameliorating oculomotor compensation of visual field loss, improving mood and reducing functional disabilities in adults with chronic HVFDs. Trial registration This study was retrospectively registered at clinicaltrials.gov (NCT06341777; 26/03/2024).