Rigorous visual training teaches the brain to see again after stroke

Posted By News On March 31, 2009 - 9:30pm
Rigorous visual training teaches the brain to see again after stroke

By doing a set of vigorous visual exercises on a computer every day for several months, patients who had gone partially blind as a result of suffering a stroke were able to regain some vision, according to scientists who published their results in the April 1 issue of the Journal of Neuroscience.

Such rigorous visual retraining is not common for people who suffer blindness after a stroke. That's in contrast to other consequences of stroke, such as speech or movement difficulties, where rehabilitation is common and successful.

"We were very surprised when we saw the results from our first patients," said Krystel Huxlin, Ph.D., the neuroscientist and associate professor who led the study of seven patients at the University of Rochester Eye Institute. "This is a type of brain damage that clinicians and scientists have long believed you simply can't recover from. It's devastating, and patients are usually sent home to somehow deal with it the best they can."

The results are a cause for hope for patients with vision damage from stroke or other causes, said Huxlin. The work also shows a remarkable capacity for "plasticity" in damaged, adult brains. It shows that the brain can change a great deal in older adults and that some brain regions are capable of covering for other areas that have been damaged.

Huxlin studied seven people who had suffered a stroke that damaged an area of the brain known as the primary visual cortex or V1, which serves as the gateway to the rest of the brain for all the visual information that comes through our eyes. V1 passes visual information along to dozens of other brain areas, which process and make sense of the information, ultimately allowing us to see.

Patients with damage to the primary visual cortex have severely impaired vision – they typically have a difficult or impossible time reading, driving, or getting out to do ordinary chores like grocery shopping. Patients may walk into walls, oftentimes cannot navigate stores without bumping into goods or other people, and they may be completely unaware of cars on the road coming toward them from the left or right.

a participant in a visual recovery experiment at the University of Rochester Medical Center performs a visual test. Credit: Richard Baker/University of Rochester

Depending on where in the brain the stroke occurred, most patients will be blind in one-quarter to one-half of their normal field of view. Everything right or left of center, depending on the side of the stroke, might be gray or dark, for instance.

Building on blindsight

Despite the stroke, the patients' eyes are taking in visual information. It's just that the damaged brain cannot make sense of it to create vision.

Huxlin's team sought to build on this "blindsight" – visual information, of which the patient is unaware, that still reaches the brain. A few past studies have shown promise for the idea of building on blindsight to improve a person's vision.

"The question is whether we can we recruit other, healthy regions of the brain to benefit the person's vision. Can we train those brain regions so hard and stimulate the brain to such a degree that this visual information is brought to consciousness, so the person is aware of what they're seeing?" said Huxlin.

Huxlin began the study with seven people, four women and three men, ranging from their 30s to their 80s, who had had a stroke anywhere from eight to 40 months before the experiment began. All had suffered substantial damage to the primary visual cortex. The funding to support the work came from Research to Prevent Blindness, the Pfeiffer Foundation, the Schmitt Foundation, and the National Eye Institute.

The team focused on motion perception, since it's an aspect of vision critical for most everyday tasks. The team's aim was to see if the brain's middle temporal region, which was healthy in the participants, could be stimulated so extensively that it could take on some of the tasks normally handled by the visual cortex.

The five participants who performed the training and completed the experiment had significantly improved vision. They were able to see in ways they weren't able to before the experiment began. A few found the experiment life-changing – a couple of participants are driving again, for instance, or have gained the confidence to go shopping and exercise frequently.

Following the dancing dots that can't be "seen"

To do the experiment, participants fix their gaze on a small black square in the middle of a computer screen; scientists use a sensitive eye tracker to make sure patients keep staring at the square.

Every few seconds, a group of about 100 small dots appears within a circle on the screen, somewhere in the person's damaged visual field – in other words, when the patients stare at the square, they don't initially see the dots. The dots twinkle into existence, appear to move as a group either to the left or the right, then disappear after about one-half second. Then the patient has to choose whether the dots are moving left or right. A chime indicates whether he or she chose correctly, providing feedback that lets the brain know whether it made the right choice and speeding up learning.

But how do patients choose if they can't consciously see the dots?

"The patients can't see the dots, but they're aware that there is something happening that they can't quite see. They might say, 'I know that there's something there, but I can't make any sense of it,'" said Huxlin, who is also a faculty member in the departments of Ophthalmology, Neurobiology and Anatomy, Brain and Cognitive Sciences, and in the Center for Visual Science.

But the brain is able to make some sense of it all, even though the patient is unaware that he or she is seeing anything. When forced to make a choice, patients typically start out with a success rate of around 50 percent by guessing. Over a period of days, weeks or months, that number goes to 80 or 90 percent, as the brain learns to "see" a new area, and the visual information moves from blindsight to consciousness. Patients eventually become aware of the dots and their movement.

As patients improve, researchers move the dots further and further into what was the patient's blind area, as a way to challenge the brain, to coax it to see a new area.

"Basically, it's exercising the visual part of the brain every day," said Huxlin. "It's very hard work, very grueling. By forcing patients to choose, you're helping the brain re-develop."

The patients in the study did about 300 tests at a time, which translated roughly to sitting in front of a computer for 15 to 30 minutes once or twice a day, every day, for nine to 18 months. It's an exhausting task, especially for someone whose brain is working extra-hard to accomplish it.

Working with Huxlin on the work were Tim Martin, Ph.D., post-doctoral research associate; Kristin Kelly, formerly a technical associate and now a medical student; former graduate student Meghan Riley; neuro-ophthalmologist Deborah Friedman, M.D.; neurologist W. Scott Burgin, M.D.; and Mary Hayhoe, Ph.D., formerly of the Department of Brain and Cognitive Sciences at the University of Rochester, and now at the University of Texas at Austin. The University of Rochester has filed a patent on the technology.

DON'T KNOW WHAT YOU WANT IN homepage: SO PLACED ?
THIS ARTICLE IS JUST WHAT I NEED. MARCH 8TH 2011 I HAD TWO STROKES WHICH AFFECTED MY BRAIN CAUSING LOSS OF VISION ON THE LEFT.. HEMINOPSIA.

HOW CAN I FIND THESE COMPUTER EYE EXERCISES SO THAT I CAN RETRAIN MY BRAIN TO SEE PROPERLY AGAIN. THE LOSS IS NOT ENTIRELY THE WHOLE LEFT BUT SEEMS TO BE RATHER A ROUND AREA TO THE LEFT THAT IS NOT BLACK BUT GRAYED OUT. SOME COLOR COMES THROUGH. I HAVE BEEN TO A LOW VISION DR WHO IS ATTEMPTING FOR THE 4TH TIME TO FIT YOKED PRISMS TO MY CURRENT LENSES WHICH ARE FOR MYOPIA BUT ARE A SMALLER CORRECTION. I HAVE EMAILED TO DR ELI PELI AND HE RESPONDED SAYING MY CURRENT MYOPIA CORRECTION IS MINIMAL BUT HE DOES NOT HAVE A LOT OF ENCOURAGEMENT REGARDING THE SUCCESS OF YOKED PRISMS. I FEEL MY VISION IS VERY SLIGHTLY IMPROVED BUT NOT ENOUGH THAT I FEEL COMFORTABLE TO DRIVE OR EVEN WALK VERY FAST DUE TO NOT SEEING SOMETHING THAT I MIGHT RUN INTO OR TRIP OVER. THIS ARTICLE ALTHOUGH INFORMATIVE AND ENCOURAGING DOES NOT GIVE ANY DIRECTION AS TO WHERE ONE WITH THIS VISION PROBLEM CAN GO FOR THIS EYE EXERCISE THERAPY. ALL I HAVE RECEIVED SO FAR REGARDING THERAPY IS "LOOK TO THE LEFT"..."MOVE YOUR EYES AND HEAD TO THE LEFT". AFTER HEARING THIS 5 THOUSAND TIMES, I AM FEELING DISCOURAGED AND FEEL I NEED MORE GUIDANCE THAN THIS. I HAVE PAID FOR AN ACCOUNT ONLINE WITH LUMOCITY.COM BUT THE EXERCISES AREN'T WHAT I EXPECTED THEM TO BE FOR THIS TYPE OF VISION LOSS. I WANT TO RETRAIN MY BRAIN AND HELP IT TO COMPENSATE AROUND THE STOKES DAMAGE.

ANY DIRECTION OF HELP YOU CAN SEND TO ME REGARDING THE SUCCESS OF THE STUDIES YOU REFER TO IN THIS ARTICLE WILL BE GREATLY APPRECIATED.

WAITING ANXIOUSLY TO HEAR FROM YOU,
BETTY FORTEZZO
7492 PURITAN AVE
LAS VEGAS, NV 89123 702-521-5414 ITISBJF@COX.NET

If you would e mail me I am a neurological optometrist and work with folks with traumatic brain injuries to help retrain the brain. The brain that changes itself by dodge would be a good book to read

Trying to help a middle aged female stroke victim get some help
SHE IS HAVING ISSUES FOCUSING AND SAYS SHE FEELS LIKE HER EYES
ARE CONSTANTLY SHAKING, "LIKE AN EARTHQUAKE....

IF YOU KNOW OF ANY AGENCIES...TO HAVE HER CONTACT I AM SURE
SHE WOULD APPRECIATE THE EFFORT...

I WORK FOR BAYADA NURSES AS A AIDE....THE WOMANS DAUGHTER LIVES WITH
HER MOTHER...THE DAUGHTER IS A REGISTERED NURSE.

BETWEEN THE TWO OF US, HOPEFULLY WE CAN HELP HER RETURN TO HER
FIELD. I WILL PASS ALONG ANY INFO YOU CAN PROVIDE. THANKS IN ADVANCE

SUE CREEK 717 449 3057

I had a post cerebral artery infarct following open heart surgery leaving me with left homonymous hemianopsia and would like to know how I could find the computer exercises to improve my vision. I work in a busy pediatric clinic and vision loss is often frustrating.

i am so greatfull to sea your site and its resources!
i have suffered so much since my "minor fender bender" lack of resources, support and belief in my ailiment is just the icing on the cake
ive lost everyting from my job and career to my daily life of me
my eye problem started eminintly upon my attempt to drive away and off to work
from accident the pain excruciating the inability to be visualy aware of my surroundings or to function capabily tramatic when everyone acted as though i were crazy or making it up
i still struggle with focus and attention to daily life cant drive and the fact that people including my (due to accident etc) ex think im attempting to scam the insurance company! come on people~~~~2 years in 4 weeks! i cant drive i cant do basic math i cant live a normal life~~~
i struggle to do the job i once taught people how to do! so many steps backwards and down! it is nt a blow to my ego nor an insult~~~
it is just a struggle to be a whole person at half of who i was
i cry every day and keep my chin up too
life shouldnt be so hard!
i wish i could turn back the clock i am glad that i am now so aware of what people suffer through hopefulply one day i will recpuperate and make a difference in those who suffer and struggle as i
thank you for your help
that alone is such a relief! to read the list of symptoms people suffer through and see im not alone is such a wonderfull thing!

I AM VERY MUCH A CANDIDATE FOR THIS TYPE OF STUDY SINCE I AM NOW AWARE OF THE NEGLECT OR LOSS OF MY LEFT SIDE VISION, AND WOULD GREATLY APPRECIATE THE INFORMATION OF WHERE TO OBTAIN THE STUDY MENTIONED IN THIS ARTICLE. I WOULD BE MOST GRATEFUL I STRUGGLE WITH MY FOOD AND LOOKING FOR ANY ITEM PLACED IN THE LEFT SIDE OF ME, SO THIS WOULD HELP ME RE-GAIN OR IMPROVE MY ABILITY TO SEE. PLEASE ADVICE. SINCERELY AND THANKFUL JOE GUERRERO

Iam a 67 year old active female until August 18, 2012. I woke up about 3:30 am with a terrible headache on my right front head. I opened my eyes and it was totally dark. I woke my husband and he drove me to the hospital nearby and they life-flighted me to St Luke's Hospital in downtown Houston. I have been unable to find help in a place the size of Houston for any training to help my left visual loss. If you know of any or any ideas or computer exercises as described above, I would greatly appreciate any help. Thank you

My husband had a stroke 9/28/12 with Homonymous Hemaniopsia. This was due to an unnecessary Angiogram with contrast given to him by a doctor. His business requires full peripheral vision from both eyes.
Please email information regarding your tests. He is very depressed, angry and has lost his business due to this disability.
Any help will be much appreciated.

We have been providing vision rehabilitation therapy for stroke victims for over 40 years. It is general ocular motor training, improving visual fixation ability, using whatever accommodation the patient has and suplementing that with approriate spectacle lenses, designed for specific activities such as reading, sewing, arts and crafts projecte, etc. Optometric Rehabilitation Therapy offers much hope for this population.

My 16yr old son recently suffered a stroke,losing his perefial vision,as he was 2 month away from obtaining his driving licence,this is devastating to him,anything that could help him maybe recover some of his sight,so he could drive would b a godsend.

Hello I just came across this article and was hoping I can obtain more information on the visual exercise you are offering on the computer. My husband recently suffered a right occipital intracerbral hematoma and homonymous hemianopia. My husband has lost a portion of vision in bothe eyes as well as his left peripheal. He feels that his vision is distorted at times. What if anything can I do for visual therapy for him to regain some or all of his vision.
Please, Please guide us I have been hitting walls with what can be done in this recovery period.

Denise
denisei427@yahoo.com

I am a 61 year old female who suffered a cerebral cortex stroke affecting the Thalmic region. on April 29th 2013. I have a left sided Hemianopia and my whole visual field is affected by a background gray snow which flickers constantly. while typing this I am looking thru and can read letters
I am not able to drive or acieve independence because of the visual problems following my stroke.
i would appeal for your help in being able to have access to your neuro rehabilitation software. I live in Toledo OHIO.
I am grateful for any help or advice.
Barbara Mutgi

My husband suffered a traumatic brain injury a year ago. His pupils don't respond to light as his eyes took a direct blow from the injury crushing both eye sockets along with bleeding throughout the brain. He is 31 years old and slowly making cognitive progress. He tells me he's blind. Do you have any advice to stimulate his eyes? The doctor says his optic nerves aren't severed.

My husband had a huge stroke in June 2013 and is now left with left sided neglect. His eyes are physically ok but his brain can't organise the images so that he sees. Do we have access to nay online tools such as those you have outlined above. I am using computer games that are very basic and I notice he is getting better but it would be good to havfe a way of measuring any improvement.
If anyone out there has any ideas let us know.
Thanks
Janet
Australia

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