Rehabilitation Activities for Hemianopic Field Loss

 

 

Penlight Field Awareness

 

Objective:  To increase the patient’s awareness of his/her field deficit and to improve their ability to

compensate by constantly scanning into the area of loss.

 

Materials:  Two small hand-held penlights

 

  With patient seated in front of therapist, alternately stimulate the patient’s normal field and abnormal field with penlight held approximately 20 degrees to patient’s temporal side.  Patient is instructed to quickly move their eyes to look at the light that is turned on.  Even in patient’s abnormal field, he or she should see the glow of the light and make a refixation movement to look at the light.  If the patient seems to be unresponsive to the light in their abnormal filed, move the light closer to their midline.  As the patient becomes more comfortable with the procedure, slowly move the penlight further form the midline or perform the procedure monocularly for increased difficulty.  After each correct refixation, the patient should look straight ahead at the examiner to await the next target.  At first, any amount of head movement is allowed in the refixation process; however, gradually try to reduce the head movement and allow a wider saccade.

 

 

Peripheral Visualization

 

Materials:  None

 

  With patient seated or standing comfortably in a room with minimal distraction, have the patient scan to the side of their damaged field.  Ask the patient to remember as many objects off to the side as possible.  Have the patient look straight ahead and attempt to visualize all of the objects that were in their missing field.  With the patient still looking straight ahead, ask them to point to the area where they remember a particular object to be, for example, a window or a door knob, etc.  While the patient is still pointing, have them turn their head so that they can now view the missing field and check to see if their visualization of that field was correct.  Repeat this procedure until consistent and accurate responses are given.

  This procedure can also be done as a home technique to rebuild awareness in a neglect and to aid in compensatory strategies in hemianopia.

 

 

Eye Throwing

 

Objective:  To improve the patient's ability to scan for objects in their weaker field.

 

Materials:  None

 

  Have patient sit comfortably and view a selected fixation target at a comfortable distance directly in front of the patient. Select a second fixation target approximately 30 to 40 degrees into the patient's field of loss.

  For a left hemianopia/neglect, the patient will look to their right and develop the feeling of throwing their eyes as far to the left as possible. They should pass the second fixation object as they move their eyes to the left, then quickly make a refixation on that object. Hold it for approximately 5 seconds. Next, they look back at the center object of fixation and repeat the activity attempting to throw their eyes slightly further to the left each time the activity is performed.

  For a right hemianopia/neglect, the patient will begin by looking to their left and throwing their eyes as far to the right as possible past the pre-determined object of fixation and then making a quick refixation to the target for approximately 5 seconds.

  A normal saccadic eye movement is often difficult for these patients since the second target is often located in the patient's blind field. Making the large eye-throwing maneuver allows the target to be located within the patient's dominant field making the location of the target much simpler.

 

 

Headlight Pointing

 

Materials:  Hat or helmet with laser pointer or flashlight attached to top.

 

  With light mounted on top of patient's head, the therapist calls out different objects in the room. The patient then looks directly at the object making sure the light illuminates the correct target.

  Once the patient shows some skill with the basic technique, the light can be turned slightly in the direction of the field loss. This requires the patient to make a saccadic eye movement into their missing field to check for accuracy of the light on the target.

Hallway Splitting

 

Materials:  Yard stick or measuring device.

 

The patient should be asked to walk down a long corridor or hallway keeping the area on their left and right exactly equal. If the patient tends to walk closer to one side than the other, they should be stopped and the therapist should measure the distance to the wall from their right and from their left. The therapist should then make the necessary adjustment to the patient so that they are, once again, in the center. This type of feedback allows the patient to make necessary compensations for their disrupted spatial perception.

 

Once the patient is fairly accurate at splitting the hallway, the therapist may add a strip of scotch tape down the center of the patient's spectacles covering the entire pupil. This forces the patient to utilize their peripheral vision when performing this activity.

 

 

Flashlight Tag

 

Materials:  2 flashlights, colored acetate to make one light a different color.

 

The therapist and patient face a blank wall in a darkened room from a distance of 8-12 feet. Both flashlights are shined onto the wall and the patient is made aware of which light is theirs. The therapist moves their light quickly to one side and stops. The patient is asked to quickly locate the light and place their light on the other light. This is repeated in different directions giving prompting when the patient cannot locate the light. The therapist can then play "Follow the Leader" by moving their light slowly and asking the patient to keep their light on top of the therapist's light.

Head Touch Fixations

 

Materials:  None

 

Therapist should stand or sit behind the patient and randomly touch them on the side of their head asking them to quickly look in the same direction that they are touched. A second observer may be necessary in front of the patient to monitor the patient's success with moving their eyes in the appropriate direction. The patient should hold their fixation in the specified direction as long as the therapist is touching the temple area and should look straight ahead when neither side is touched.

 

Patient's with hemianopia/neglect will typically perform much better on their dominant side, but may have great difficulty maintaining fixation in the direction of their missing field. The therapist should alternate sides, but should give greater attention to the patient's weaker field.

 

Solitaire

Cards should be spread out in a wide field of view in front of the patient, making it necessary for the patient to continually saccades into their neglected field.

Peripheral Playing Cards

 

Therapist should isolate 6 to 12 pairs of matching cards and randomly affix them to the wall to the right, left and center wall of a small room.  Keep in mind that patients are going to be asked to match up “pairs” of cards so place one card on the right wall and its pair on an opposite wall, whenever possible.  The patient is then asked to find as many pairs of cards as possible by searching the wall on their left and matching it with the appropriate card on the right.  The therapist can also request that the patient seek out specific cards and find its pair.

 

To increase difficulty, visualization skills can be used by asking the patient to scan one wall and remember the location of as many cards as possible.  The patient is then allowed to search the opposite wall and identify as many matching pairs as they can remember.

 

To further increase difficulty, the patient can be given a set time of 1 to 2 minutes to find as many matched pairs as possible.  This score can be measured against the patient’s own best score from prior days as an incentive to improve their processing speed.

Activities formulated by:

Donna Simonian OD

Kevin Chauvette OD F.C.O.V.D