While optical therapy employs optical devices to assist the damaged visual field, eye movement therapy uses compensation and neurological adaptation to help the patient adjust to the change in their visual field. Visual restitution therapy looks to improve the patient’s visual field directly, but the way in which this occurs seems to work through a combination of compensation and other visual training techniques. The grouping of these different methods together would be ideal to help a patient regain as much of their vision as possible, as individual strategies may only improve particular functions of vision (ex: the improvement of reading ability may not translate to improve visibility for driving).

HHA: Treatment

Homonymous hemianopia is a visual field defect characterized by partial or complete blindness in the same half of the visual field of both eyes. It is a very common post-stroke diagnosis, though it can also result from other brain trauma or tumors. While some patients spontaneously recover their vision within the first few months, others endure permanent damage. Individuals with permanent deficits have several treatment options, including optical therapy, eye movement therapy, and visual restitution therapy. To compensate, a person with left-sided homonymous hemianopia might turn their head to the left to bring objects into their intact right-sided visual field.

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Stroke can be clinically recognized through a sudden or rapid onset of symptoms which reflect global or focal deficit of neurological function, lasting around 24 hours or yielding death. Due to infarction or hemorrhage of the central nervous system, it is classified as both a neurological disorder and vascular injury. There are associations between stroke development and hypertension, diabetes, history of smoking, and more. Despite the wide range of severity in symptoms, strokes are generally characterized by difficulties with motor function, visual deficits, speech and language deficits, pain, and other difficulties with daily life activities which yield a strong dependence on a caregiver or nursing facility. Combinations of pharmacological- and rehabilitation-based treatments are the most common strategies to help a patient improve their overall function. 

Stroke

- Loss of vision or blindness in half of one's visual field
- Most commonly is permanent; can occur temporarily due to migraines
- Two major types of permanent hemianopia: heteronymous and homonymous hemianopia
- The image below represents vision of an individual without any damage to their visual fields. Use this as a reference for heteronymous and homonymous hemianopia

Hemianopsia/Hemianopia

Homonymous Hemianopia

There are a variety of rehabilitation approaches and goals with regards to stroke, depending on the severity of the patient’s symptoms. There are three main approaches to any form of rehabilitation for stroke patients: restoration, compensation, and modification. The restoration approach looks to retrain parts of the central nervous system in order to restore functions of damaged brain tissue; the compensation approach hopes to adapt the individual’s behavior to their loss of functionality; the modification approach alters the patient’s environment to promote daily function. Altogether, these three approaches can improve brain and daily life function after this major medical event.

Rehabilitation Approaches

Aphasia is a language disorder which is typically acquired after stroke. It is characterized by impairment of language-based processes, such as auditory comprehension, reading, oral expression, and writing. The level of impairment depends upon the type of aphasia, which also depends upon the damaged brain region. There are two levels of intensity: acute and chronic. While those with acute post-stroke aphasia may reach some level of normalcy in their linguistic centers of the brain, many with chronic aphasia struggle to receive sufficient treatment, whether due to the required time and intensity of treatment or financial restrictions — there are very few recovery stories in those with chronic aphasia.  

Aphasia

Based on the information provided in the scenario below, what is the most likely medical event occurring? Justify your answer by explaining how the pattern and onset of the symptoms support your conclusion.

Clinical Symptom Analysis

Based on the sudden onset and specific combination of symptoms presented in the case study below, what is the most likely medical event that has occurred? Justify your answer by linking the patient's history and symptoms to the characteristics of this event.

Common post-stroke treatment options depend on the severity of the condition and include outpatient, home-health, and inpatient rehabilitation therapies. A team-based approach, often integrating physical, occupational, and speech therapy, provides comprehensive care. In addition to rehabilitation, pharmacologic treatments are frequently prescribed. Specific complications arising from a stroke also necessitate tailored treatments, such as optical therapy for visual deficits or mental health treatments and selective serotonin reuptake inhibitors (SSRIs) for depression.

Stroke Treatment Options

- Lesions in an optic tract, causing a loss of vision in the opposite visual field in both eyes (for example, a lesion in the right optic tract would result in loss of vision of the left visual field).
- Causes include schizencephaly, stroke, tumors, and other trauma to brain
- The following image represents vision of someone with left homonymous heminopsia


Homonymous Hemianopsia

- Bitemporal hemianopsia
- Binasal hemianopsia

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