Visual processing streams: interactions, impairments and implications for rehabilitation

The present thesis is organized in three sections. Section 1 (chapter 2) provides a general overview of the cortical and subcortical brain structures that are involved in visual processing and the way these systems interact. Three visual streams are described: a ventral, occipitotemporal stream for processing information related to specialized recognition of objects and faces; a dorsal, occipitoparietal stream for processing information related to movement, location and motor action; and a subcortical, cortico-amygdalar and thalamo-amygdalar pathway for processing of emotion-related information. Also, some of the most important visual impairments due to brain damage will be discussed. In section 2 (chapters 3 and 4) rehabilitation methods of damage to specific parts of the visual system will be reviewed. Section 3 (chapters 5, 6 and 7) consists of experimental studies that focus on interactions between overt and covert recognition of faces and emotional facial expressions. Finally, chapter 8 provides a summary of main findings of this thesis, which will be discussed in chapter 9.

The neuropsychological rehabilitation of visual agnosia and Balint’s syndrome

Visual agnosia and Balint’s syndrome are complex neurological disorders of the higher visual system that can have a remarkable impact on individuals’ lives. Rehabilitation of these individuals is important to enable participation in everyday activities despite the impairment. However, the literature about the rehabilitation of these disorders is virtually silent. Therefore, the aim of this systematic review is to give an overview of available literature describing treatment approaches and their effectiveness with regard to these disorders. The search engines Psychinfo, Amed, and Medline were used, resulting in 22 articles meeting the criteria for inclusion. Only articles describing acquired disorders were considered. These articles revealed that there is some information available on the major subtypes of visual agnosia as well as on Balint’s syndrome which practising clinicians can consult for guidance. With regard to the type of rehabilitation, compensatory strategies have proven to be beneficial in most of the cases. Restorative training on the other hand has produced mixed results. Concluding, although still scarce, a scientific foundation about the rehabilitation of visual agnosia and Balint’s syndrome is evolving. The available approaches give valuable information that can be built upon in the future

Effects of low visual acuity on neuropsychological test scores:A simulation study

Objective: To systematically examine the effect of low visual acuity (LVA) on a number of commonly used neuropsychological tests. Method: In this study, the influence of LVA on a number of commonly used neuropsychological tests was examined in 238 healthy older adults (aged 50–80) without visual or neurological impairment. LVA was simulated using simulation glasses. Results: It was found that a simulated LVA of ∼0.2 (decimal acuity; Snellen 6/30 or 20/100, LogMAR 0.7) had a negative impact on test performance for the Trail Making Test, Complex Figure of Rey (copy score), and Visual Object and Space Perception battery subtest 3, but not for the Mini Mental State Examination and Balloons test. For some tests, the negative impact of LVA increased with age. Conclusions: These results have important implications for the use of neuropsychological tests in the visually impaired population. More specifically, when administering the Trail Making Test, Complex Figure of Rey (copy score), and Visual Object and Space Perception Battery subtest 3 to older people with LVA, low test scores should be interpreted with great caution. Low test scores on the Mini Mental State Examination and Balloons Test are not likely to be caused by LVA and are more likely to reflect actual cognitive impairment. The results contribute to the validity of neuropsychological assessment of older people with visual impairment, leading to more effective and more patient-based rehabilitation

The effect of target speed on perception of visual motion direction in a patient with akinetopsia

Although much research has been devoted to the neural correlates of motion perception, the processing of speed of motion is still a topic of discussion. Apart from patient LM, no in-depth clinical research has been done in the past 20 years on this topic. In the present study, we investigated patient TD, who suffered from the rare disorder akinetopsia due to bilateral lesions of V5 after stroke. By means of a Random-Dot-Kinematogram (RDK) in which speed was varied systematically, it was found that TD was impaired in perceiving the direction of movement at speeds exceeding 9 deg/s. Our study suggests that V5 plays an important role in processing high-speed visual motion and further implies that V5 does not play a crucial role in processing low-speed visual motion. A remarkable finding, which has not been shown before, was that TD always reported the opposite direction of the actual movement at a speed of 24 deg/s. This suggests a form of the continuous wagon wheel illusion, which might have been caused by intact brain areas operating at different sampling rates than area V5

Compensatory behaviour of visually impaired cyclists in everyday settings

This study investigated whether visually impaired cyclists, compared to cyclists without visual limitations, take other, potentially safer routes to destinations in their own living environment and whether they ride at a lower speed. In total, 19 matched pairs of a visually impaired cyclist and a normally sighted peer from the same neighbourhood recorded their everyday bicycle rides, using GPS action cameras. In addition, they completed an 'assigned ride', a ride for which only a starting and an ending point were provided by the researcher. A risk-assessment procedure showed that the route taken by visually impaired cyclists during this assigned ride was not less risky than the route taken by the normally sighted cyclists. Analysis of the everyday rides showed that, on average, cyclists with a visual impairment more frequently (i.e. for longer periods) cycled at a speed below 10 km/h compared to cyclists without visual impairment. Also, the visually impaired participants' cruising speed was 1.4 km/h lower than that of their normally sighted counterparts. In conclusion, no evidence was found that visually impaired cyclists compensate strategically by taking different, potentially safer routes than normally sighted cyclists when riding in their own environment. They may (unconsciously) compensate tactically for their visual function limitations by riding at a lower speed when necessary. Mobility trainers in vision rehabilitation as well as road designers could apply these findings to optimise the cycling mobility of visually impaired people

Eye Movement Evaluation in Multiple Sclerosis and Parkinson's Disease Using a Standardized Oculomotor and Neuro-Ophthalmic Disorder Assessment (SONDA)

Evaluating the state of the oculomotor system of a patient is one of the fundamental tests done in neuro-ophthalmology. However, up to date, very few quantitative standardized tests of eye movements' quality exist, limiting this assessment to confrontational tests reliant on subjective interpretation. Furthermore, quantitative tests relying on eye movement properties, such as pursuit gain and saccade dynamics are often insufficient to capture the complexity of the underlying disorders and are often (too) long and tiring. In this study, we present SONDA (Standardized Oculomotor and Neurological Disorder Assessment): this test is based on analyzing eye tracking recorded during a short and intuitive continuous tracking task. We tested patients affected by Multiple Sclerosis (MS) and Parkinson's Disease (PD) and find that: (1) the saccadic dynamics of the main sequence alone are not sufficient to separate patients from healthy controls; (2) the combination of spatio-temporal and statistical properties of saccades and saccadic dynamics enables an identification of oculomotor abnormalities in both MS and PD patients. We conclude that SONDA constitutes a powerful screening tool that allows an in-depth evaluation of (deviant) oculomotor behavior in a few minutes of non-invasive testing