Multisensory training with telerehabilitation for brain injured children with visual field defects

Visual field defects (VFDs) are frequent consequence of acquired brain injuries in childhood, whether due to trauma, stroke, or tumors. VFDs can substantially impact children's quality of life, by impairing, for example, their ability to orient themselves in space, to read efficiently or to locate objects, which in turn reduces their personal autonomy and participation in daily life. Given the high plasticity of the visual system during early development, and considering that spontaneous recovery is often incomplete, the development of interventions aimed at promoting visual function recovery is both necessary and promising. The present study investigated the efficacy of a novel telerehabilitation program based on compensatory multisensory audio-visual training (AVT) for children with chronic VFDs, while also exploring factors associated with its effectiveness. In this single-arm clinical trial, 23 children and adolescents with severe VFDs completed a 3-weeks, home-based AVT intervention delivered under remote supervision. Immediate post-intervention effects and sustained improvements at the 6-month follow-up were evaluated by measuring oculomotor visual exploration, visual detection, reading abilities, daily functioning, and mood. Furthermore, potential predictors of intervention-induced gains were examined, including behavioral, neuro-ophthalmological and neuroradiological factors. Home-based AVT improves visual field exploration by increasing its speed and by enhancing visual detections both during eye movements and under fixed-gaze conditions. It also leads to improvements in daily functioning and anxiety. Gains in blind-field detection and visual field sensitivity emerge at follow-up, indicating effects beyond oculomotor compensation. These benefits persist for up to 6 months after the end of intervention. Intervention-induced gains were associated with the severity of visual search impairment, performance on the blindsight task, limitations in activities of daily living, and the structural connectivity of the optic radiation. Multisensory compensatory training delivered via telerehabilitation is both feasible and effective for improving oculomotor compensation for visual field loss, as well as for enhancing mood and reducing functional disability in children and adolescents with acquired brain lesion. Leveraging the high plasticity of the developing visual system, the intervention may also promote partial restorative effects in the affected visual field. This study was retrospectively registered at clinicaltrials.gov (NCT06341777; 26/03/2024).