Ординатура / Офтальмология / Английские материалы / Training‐induced Visual Field Recovery in Chronic Stroke Patients_Bergsma_2011

•RFT leidt tot een afname in de omvang van het visuele velddefect in ca. 75% van de patiënten;

•RFT kan leiden tot een verbeterde waarneming van andere stimuli dan die voor training werden gebruikt;

•Veldvergroting dient bij voorkeur te worden uitgedrukt in de hoeveelheid corticaal hersenweefsel dat bij de veldvergroting is betrokken. Op deze wijze wordt rekening gehouden met de mogelijke locaties in het visuele veld, waar veldvergrotingen plaats kunnen hebben.

•De data suggereren dat drempelwaarden van die corticale maat ongeveer 6 mm bedraagt.

De corticale maat ECSG vertoont een hogere correlatie –die ook nog eens significant is met de geobserveerde prestatieveranderingen dan ABS (gemiddeld aantal graden grensverschuiving), die ook nog eens niet significant is. Daarom is de conclusie gerechtvaardigd, dat veldvergroting dient te worden uitgedrukt in ECSG en niet in ABS.

In hoofdstuk 7 wordt vervolgens nog gespeculeerd over de mogelijkheid dat patiënten tijdens training een vaardigheid ontwikkelen die een effect heeft op visuele perceptie processen. Deze vaardigheid betreft het kunnen richten van de visuele attentie in de richting van het velddefect, wat stimulusdetectie zou verbeteren door top down mechanismen die de gedeeltelijk beschadigde neuronale gebieden activeren, met mogelijk op termijn het effect dat de bewuste visuele perceptie blijvend is. RFT zou patiënten dus als het ware leren om de aandacht te richten op visuele input, waarvan hij/zij zich voorheen niet bewust was. De patiënt wordt zich door training bewust van deze input, wat bij perimetrie een groter gezichtsveld oplevert en een verbetering van de prestatie op visuele taken zoals lezen of kleuren en vormen herkennen. Dit verklaart mogelijk waarom sommige patiënten geen herstel laten zien: als een overgangsgebied afwezig is, dan zijn er geen gedeeltelijk beschadigde gebieden waarop het top down mechanisme van de verhoogde visuele attentie zich kan richten en, als gevolg daarvan, blijft trainingseffect achterwege.

Al het bovenstaande lijken de stelling te rechtvaardigen, dat de grote inspanning van RFT voor een deel van patiënten met gezichtsveld defecten zeer veel baat geeft. RFT moet dus bereikbaar zijn voor deze groep mensen en het hoort daarom thuis bij revalidatie instellingen of –afdelingen. Voor een implementatie van de methode in de revalidatie praktijk is het van belang dat een prognose instrument wordt ontwikkeld, zodat voorafgaand aan intensieve training een inschatting kan worden gemaakt van de te verwachten gezichtsveld opbrengst.

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