Explorative Saccade Training for Children with Homonymous Hemianopia: Case Report and Presentation of a Planned Study
Introduction: Homonymous hemianopia (HH) in children caused by trauma, tumor, pre- and perinatal brain damage or as a result of epilepsy surgery leads to orientation difficulties in daily life. So far, little is known about compensatory strategies in children. Visual exploration training evidently improves orientation ability and with its quality of life in adults.1 We report on a current therapeutic success and present a planned intervention study.
Case Report: At the age of 2 years, a previously healthy girl suffers a febrile right focused status epilepticus and develops a hemiconvulsion-hemiplegia epilepsy syndrome with persistent right hemiparesis. At consultation at the age of 5 years, HH is proven by campimetry. Quite noteworthy is that she avoids looking to the right side and that she shows an ipsilateral anomalous head posture (AHP) to 15 degrees. There is a preference for exploration of attractions from her left (seeing) side, whereas items on her right are rarely noticed. Her parents have been asked to provide attractions to her right while playing, but to pay attention to her carrying out search movements only through eye movements, not through head turns. Before and after “training,” visual search was tested with the “table test.” Search time is taken for each item on the table and both sides. One year later, she had developed a changed search strategy with preference to the right side and less search time in her affected field (from 74 to 15 seconds). Her AHP has decreased to 5 degrees and her parents reported better orientation skills.
Conclusion: This case report shows that even playful explorative saccade training can result in a better search strategy as well as better orientation in daily life. A new explorative saccade training for children will be evaluated in an ongoing study. Compensatory strategies and training benefit will be tested by orthoptic examination, search tasks with an eye tracker, “table test,” and quality of life questionnaires. Different patient groups with pre- and perinatal, later acquired and HH because of surgery will be included and compared.
Keywords: homonymous hemianopia, explorative saccade training, rehabilitation.
Reference1 Roth T, Sokolov AN, Messias A, Roth P, Weller M, Trauzettel-Klosinski S. Comparing explorative saccade and flicker training in hemianopia: a randomized controlled study. Neurology 2009;72(4):324–331