Visual and motor recovery after "cognitive therapeutic exercises" in cortical blindness: A case study

Daniele De Patre, Ann Van de Winckel, Franca Panté, Carla Rizzello, Marina Zernitz, Mariam Mansour, Lara Zordan, Thomas A. Zeffiro, Erin E. O'Connor, Teresa Bisson, Andrea Lupi, Carlo Perfetti

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background and Purpose: Spontaneous visual recovery is rare after cortical blindness. While visual rehabilitation may improve performance, no visual therapy has been widely adopted, as clinical outcomes are variable and rarely translate into improvements in activities of daily living (ADLs). We explored the potential value of a novel rehabilitation approach "cognitive therapeutic exercises" for cortical blindness. Case Description: The subject of this case study was 48-year-old woman with cortical blindness and tetraplegia after cardiac arrest. Prior to the intervention, she was dependent in ADLs and poorly distinguished shapes and colors after 19 months of standard visual and motor rehabilitation. Computed tomographic images soon after symptom onset demonstrated acute infarcts in both occipital cortices. Intervention: The subject underwent 8 months of intensive rehabilitation with "cognitive therapeutic exercises" consisting of discrimination exercises correlating sensory and visual information. Outcomes: Visual fields increased; object recognition improved; it became possible to watch television; voluntary arm movements improved in accuracy and smoothness; walking improved; and ADL independence and self-reliance increased. Subtraction of neuroimaging acquired before and after rehabilitation showed that focal glucose metabolism increases bilaterally in the occipital poles. Discussion: This study demonstrates feasibility of "cognitive therapeutic exercises" in an individual with cortical blindness, who experienced impressive visual and sensorimotor recovery, with marked ADL improvement, more than 2 years after ischemic cortical damage.

Original languageEnglish (US)
Pages (from-to)164-172
Number of pages9
JournalJournal of Neurologic Physical Therapy
Volume41
Issue number3
DOIs
StatePublished - 2017

Keywords

  • Cognitive
  • PET
  • Plasticity
  • Sensorimotor
  • Vision

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