Development and Implementation of a New Telerehabilitation System for Audiovisual Stimulation Training in Hemianopia

Abstract

Telerehabilitation, defined as the method by which communication technologies are used to provide remote rehabilitation, although still underused, could be as efficient and effective as the conventional clinical rehabilitation practices. In the literature, there are descriptions of the use of telerehabilitation in adult patients with various diseases, whereas it is seldom used in clinical practice with child and adolescent patients. We have developed a new audiovisual telerehabilitation (AVT) system, based on the multisensory capabilities of the human brain, to provide a new tool for adults and children with visual field defects in order to improve ocular movements toward the blind hemifield. The apparatus consists of a semicircular structure in which visual and acoustic stimuli are positioned. A camera is integrated into the mechanical structure in the center of the panel to control eye and head movements. Patients can use this training system with a customized software on a tablet. From hospital, the therapist has complete control over the training process, and the results of the training sessions are automatically available within a few minutes on the hospital website. In this paper, we report the AVT system protocol and the preliminary results on its use by three adult patients. All three showed improvements in visual detection abilities with long-term effects. In the future, we will test this apparatus with children and their families. Since interventions for impairments in the visual field have a substantial cost for individuals and for the welfare system, we expect that our research could have a profound socio-economic impact avoiding prolonged and intensive hospital stays.

Continuity of Care During COVID-19 Lockdown: A Survey on Stakeholders' Experience With Telerehabilitation

“…Skepticism about the potential efficacy of telerehabilitation in promoting improvement and goal enhancement has been reported elsewhere in the literature, and it could explain reluctance to consider telerehabilitation as a replacement of face-to-face therapy (39,40). This reluctance may also be related to the lack of knowledge and experience of this practice, despite the fact that telerehabilitation has shown its efficacy on motor, speech, and cognitive outcomes of adults with neurological disabilities, according to the recent review by Maresca et al (41)(42)(43)(44).…”

Tele-Neuro-Rehabilitation in Italy: State of the Art and Future Perspectives

“…In fact, the presence of visual defects can be very debilitating and interfere with daily life, negatively affecting the prognosis of stroke and the independence of the person, with a significant negative emotional impact and social implications. Tinelli et al (94) developed an audiovisual telerehabilitation system, based on the brain's multisensory ability, in order to provide a new tool to improve eye movements toward the blind half-field. This tool has been tested on three adult patients, leading to improvements in visual detection skills with long-term effects.…”

“…This tool has been tested on three adult patients, leading to improvements in visual detection skills with long-term effects. Therefore, the results showed that in stroke, telerehabilitation could be a promising, convenient and accessible tool for more patients, relieving the NHS (94). In addition, remote rehabilitation allows intense and prolonged intervention for patients who may not be able to access the healthcare system.…”

Audio-visual Stimulation for Visual Compensatory Functions in Stroke Survivors With Visual Field Defect; a Systematic Review

“…Seven original research articles recruited HH patients and trained them on AVT in order to study the effects of multisensory training on oculomotor scanning behaviour in comparison to the VT. A total of 71 patients (and 36 controls) were recruited for the AVT and tested on the same apparatus before and after the training period, either on unimodal visual detection task or on both uniand multimodal visual detection tasks. These included the following study types; two randomised control studies (n=32) (18, 26), two cohort studies (n=40) (27,28), one case control study (n=24) (12), and two uncontrolled longitudinal studies (n=11) (15,29). The training duration varied between 2 weeks and 2 months, except in one study where one practice and one experimental session were undertaken, and the evaluation was performed during the experiment (29).…”