Multisensory training with telerehabilitation for brain-damaged children with visual field defects

Background: 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 their ability to orient themselves in space, to read efficiently or 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. Methods: In this single-arm clinical trial, 23 children and adolescents with chronic VFDs completed a three-week, home-based AVT intervention delivered under remote supervision. Post-intervention immediate and sustained improvements in oculomotor visual exploration, visual detection, reading abilities, daily living performances and mood state were evaluated. Furthermore, potential predictors of treatment-induced gains were examined, including behavioral, neuro-ophthalmological and neuroradiological factors. Results: Home-based AVT enhances oculomotor visual field exploration by increasing its speed, reduces disability in daily living, and has positive effects on mood; In the long term, the treatment also appears to induce blindsight. Although primarily a compensatory intervention targeting eye movements, AVT also seems to induce an enlargement of the visual field. These benefits persist for up to 6 months after the end of training. Treatment-induced gains were associated with the severity of visual search impairment, blindsight performance, difficulties in activities of daily living and the structural connectivity of the optic radiation. Conclusion: Multisensory compensatory training delivered via telerehabilitation is both feasible and effective for improving oculomotor compensation for visual field loss, enhancing mood, and reducing functional disabilities in children and adolescents with acquired brain lesion. Leveraging the high plasticity of the visual system during childhood, the treatment may also provide partial restorative effects on the compromised visual field. Trial registration: This study was retrospectively registered at clinicaltrials.gov (NCT06341777; 26/03/2024)