Article

Visual field defects after posterior cerebral artery stroke can be
improved by vision restoration training (VRT), but when combined with
transcranial direct current stimulation (tDCS), which alters brain excitability,
vision recovery can be potentiated in the chronic stage. To date, the combination
of VRT and tDCS has not been evaluated in postacute stroke rehabilitation.
OBJECTIVES: To determine whether combined tDCS and VRT can be effectively
implemented in the early recovery phase following stroke, and to explore the
feasibility, safety and efficacy of an early intervention. DESIGN: Open-label
pilot study including a case series of 7 tDCS/VRT versus a convenience sample of
7 control patients (ClinicalTrials.gov ID: NCT02935413). SETTING: Rehabilitation
center. SUBJECTS: Patients with homonymous visual field defects following a
posterior cerebral artery stroke. METHODS: Seven homonymous hemianopia patients
were prospectively treated with 10 sessions of combined tDCS (2.mA, 10 daily
sessions of 20 minutes) and VRT at 66 (+/-50) days on average poststroke. Visual
field recovery was compared with the retrospective data of 7 controls, whose
defect sizes and age of lesions were matched to those of the experimental
subjects and who had received standard rehabilitation with compensatory eye
movement and exploration training. RESULTS: All 7 patients in the treatment group
completed the treatment protocol. The safety and acceptance were excellent, and
patients reported occasional skin itching beneath the electrodes as the only
minor side effect. Irrespective of their treatment, both groups (treatment and
control) showed improved visual fields as documented by an increased mean
sensitivity threshold in decibels in standard static perimetry. Recovery was
significantly greater (P < .05) in the tDCS/VRT patients (36.73% +/- 37.0%) than
in the controls (10.74% +/- 8.86%). CONCLUSION: In this open-label pilot study,
tDCS/VRT in subacute stroke was demonstrated to be safe, with excellent
applicability and acceptance of the treatment. Preliminary effectiveness
calculations show that tDCS/VRT may be superior to standard vision training
procedures. A confirmatory, larger-sample, controlled, randomized, and
double-blind trial is now underway to compare real-tDCS- versus
sham-tDCS-supported visual field training in the early vision rehabilitation
phase.
LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS