Rehabilitation of visual perception in cortical blindness.
Rehabilitation of visual perception in cortical blindness.
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DOI：
10.1016/b978-0-12-819410-2.00030-8
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发表时间：
2022
影响因子：
--
通讯作者：
Huxlin, Krystel R
中科院分区：
文献类型：
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作者：
Saionz, Elizabeth L;Busza, Ania;Huxlin, Krystel R
失明是中风后影响初级视皮层的常见后遗症，表现为对侧病灶、半球形视野切割。这可以是单方面的，也可以是双边的，但不太常见。虽然人们普遍认为，经过短暂的自发改善，视力丧失变得稳定和永久，但积累的数据表明，视觉训练可以恢复一些视力丧失，即使在中风后很长时间。在这里，我们回顾了不同的康复方法在成人发作的皮质盲（CB），专注于视觉恢复方法。这项工作的大部分是在慢性中风患者中进行的，部分恢复了视觉辨别和亮度检测。然而，为了实现这一目标，患者必须长时间（通常是几个月）训练，恢复的视力并不完全正常。一些辅助训练，如非侵入性，经颅脑刺激，和药理学开始被调查，他们的潜力，以增加训练的CB患者的疗效。然而，这些方法仍然是探索性的，在采用之前需要进行更多的研究。尽管如此，在确定成人视觉系统保留了恢复可塑性的能力后，最近的注意力转向了亚急性中风后时期。从感觉运动脑卒中康复中获得灵感，最近首次尝试在亚急性脑卒中患者中进行视觉训练。与中风后6个月以上开始的相同训练相比，它在更大的盲野部分上更快地改善了视力，并获得了更多的视觉辨别能力（即，慢性期）。总之，现在的证据表明，枕叶卒中后的视觉神经可塑性可以通过一系列视觉训练方法可靠地招募。此外，中风后的视觉可塑性似乎是动态的，在损伤后早期有一个关键的机会窗口，可以更快、更广泛地恢复更大范围的视觉感知能力。
Blindness is a common sequela after stroke affecting the primary visual cortex, presenting as a contralesional, homonymous, visual field cut. This can occur unilaterally or, less commonly, bilaterally. While it has been widely assumed that after a brief period of spontaneous improvement, vision loss becomes stable and permanent, accumulating data show that visual training can recover some of the vision loss, even long after the stroke. Here, we review the different approaches to rehabilitation employed in adult-onset cortical blindness (CB), focusing on visual restoration methods. Most of this work was conducted in chronic stroke patients, partially restoring visual discrimination and luminance detection. However, to achieve this, patients had to train for extended periods (usually many months), and the vision restored was not entirely normal. Several adjuvants to training such as noninvasive, transcranial brain stimulation, and pharmacology are starting to be investigated for their potential to increase the efficacy of training in CB patients. However, these approaches are still exploratory and require considerably more research before being adopted. Nonetheless, having established that the adult visual system retains the capacity for restorative plasticity, attention recently turned toward the subacute poststroke period. Drawing inspiration from sensorimotor stroke rehabilitation, visual training was recently attempted for the first time in subacute poststroke patients. It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated more than 6 months poststroke (i.e., in the chronic period). In conclusion, evidence now suggests that visual neuroplasticity after occipital stroke can be reliably recruited by a range of visual training approaches. In addition, it appears that poststroke visual plasticity is dynamic, with a critical window of opportunity in the early postdamage period to attain more rapid, more extensive recovery of a larger set of visual perceptual abilities.