A telerehabilitation program to improve visual perception in children and adolescents with hemianopia consecutive to a brain tumor: a single-arm feasibility and proof-of-concept trial.

Autor:	Misawa M; Ophthalmology and Vision Science, University of Toronto, 27 King's College Cir, Toronto, ON, M5S1A1, Canada.; Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T2S8, Canada., Bajin IY; Neuro-Oncology, The Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G1E8, Canada., Zhang B; Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, 60 Leonard Av, Toronto, ON, M5T0S8, Canada.; Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Cir, Toronto, ON, M5S1A1, Canada., Daibert-Nido M; Ophthalmology and Vision Science, University of Toronto, 27 King's College Cir, Toronto, ON, M5S1A1, Canada.; Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T2S8, Canada., Tchao D; OpenLab, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada., Garcia-Giler E; Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, 60 Leonard Av, Toronto, ON, M5T0S8, Canada., Cheung K; Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, 60 Leonard Av, Toronto, ON, M5T0S8, Canada., Appel L; OpenLab, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada.; Faculty of Health, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada., Nasir P; Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, 60 Leonard Av, Toronto, ON, M5T0S8, Canada., Reginald A; Ophthalmology and Vision Science, University of Toronto, 27 King's College Cir, Toronto, ON, M5S1A1, Canada.; Neuro-Oncology, The Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G1E8, Canada.; Ophthalmology and Vision Science, The Hospital of Sick Children, 170 Elizabeth St, Toronto, ON, M5G1E8, Canada., Tabori U; Neuro-Oncology, The Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G1E8, Canada., Bartels U; Neuro-Oncology, The Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G1E8, Canada., Ramaswamy V; Neuro-Oncology, The Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G1E8, Canada., Markowitz SN; Ophthalmology and Vision Science, University of Toronto, 27 King's College Cir, Toronto, ON, M5S1A1, Canada.; Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T2S8, Canada., Bouffet E; Neuro-Oncology, The Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G1E8, Canada., Reber M; Ophthalmology and Vision Science, University of Toronto, 27 King's College Cir, Toronto, ON, M5S1A1, Canada.; Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, 60 Leonard Av, Toronto, ON, M5T0S8, Canada.; Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Cir, Toronto, ON, M5S1A1, Canada.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2024 Nov 29; Vol. 78, pp. 102955. Date of Electronic Publication: 2024 Nov 29 (Print Publication: 2024).
DOI:	10.1016/j.eclinm.2024.102955
Abstrakt:	Background: Brain tumor in children can induce hemianopia, a loss of conscious vision, profoundly impacting their development and quality of life, yet no effective intervention exists for this pediatric population. This study aimed to explore the feasibility, safety, and potential effectiveness of a home-based audiovisual stimulation in immersive virtual-reality (3D-MOT-IVR) to improve visual function and functional vision. Methods: In a phase 2a, open-labeled, nonrandomized, single-arm study, conducted from July 2022 to October 2023 (NCT05065268), 10 children and adolescents with stable hemianopia were enrolled to perform 20-min sessions of 3D-MOT-IVR every other day for six weeks from home. We assessed feasibility by monitoring adoption, adherence and completion rates, remote data transfer and qualitative feedback. Safety was evaluated using validated cybersickness questionnaires. Comprehensive vision assessments following standardized low-vision evaluation procedures were conducted pre- and post-intervention, with follow-ups at 1- and 6 months. Findings: The home-based 3D-MOT-IVR intervention proved both feasible and safe, with no reported adverse events. All participants completed the prescribed stimulations and the pre- and post-intervention assessment points, 90% completed the follow-ups. Nine out of ten participants showed clinically meaningful enhancement in visual function and/or functional vision, namely binocular visual field restoration and increased reading speed, but two showed concomitant deterioration in monocular visual field. These positive effects were sustained at the 6-month follow-up. Exploratory outcomes revealed a significant positive correlation between the performance at the 3D-MOT-IVR intervention and the visual perception at the binocular visual field test. Interpretation: Our findings underscore the feasibility and safety of home-based audiovisual stimulation in immersive virtual-reality as a potential intervention for improving visual perception in children/adolescents with hemianopia consecutive to a pediatric brain tumor. These promising results lay a strong foundation for a larger randomized controlled trial, offering hope for a meaningful breakthrough in visual rehabilitation for this vulnerable population. Funding: Meagan Bebenek Foundation and University Health Network Foundation. Competing Interests: The authors declare no conflict of interest. (© 2024 The Author(s).)
Databáze:	MEDLINE
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