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Bernhard A Sabel

Publications and source records attributed to Bernhard A Sabel.

14 recordsLinked to original sources
PubMed2006

Visual field recovery after vision restoration therapy (VRT) is independent of eye movements: an eye tracker study.

AIM: It has been argued that patients with visual field defects compensate for their deficit by making more frequent eye movements toward the hemianopic field and that visual field enlargements found after vision restoration therapy (VRT) may be an artefact of such eye movements. In order to determine if this was correct, we recorded eye movements in hemianopic subjects before and after VRT. METHODS: Visual fields were measured in subjects with homonymous visual field defects (n=15) caused by trauma, cerebral ischemia or haemorrhage (lesion age >6 months). Visual field charts were plotted using both high-resolution perimetry (HRP) and conventional perimetry before and after a 3-month period of VRT, with eye movements being recorded with a 2D-eye tracker. This permitted quantification of eye positions and measurements of deviation from fixation. RESULTS: VRT lead to significant visual field enlargements as indicated by an increase of stimulus detection of 3.8% when tested using HRP and about 2.2% (OD) and 3.5% (OS) fewer misses with conventional perimetry. Eye movements were expressed as the standard deviations (S.D.) of the eye position recordings from fixation. Before VRT, the S.D. was +/-0.82 degrees horizontally and +/-1.16 degrees vertically; after VRT, it was +/-0.68 degrees and +/-1.39 degrees , respectively. A cluster analysis of the horizontal eye movements before VRT showed three types of subjects with (i) small (n=7), (ii) medium (n=7) or (iii) large fixation instability (n=1). Saccades were directed equally to the right or the left side; i.e., with no preference toward the blind hemifield. After VRT, many subjects showed a smaller variability of horizontal eye movements. Before VRT, 81.6% of the recorded eye positions were found within a range of 1 degrees horizontally from fixation, whereas after VRT, 88.3% were within that range. In the 2 degrees range, we found 94.8% before and 98.9% after VRT. Subjects moved their eyes 5 degrees or more 0.3% of the time before VRT versus 0.1% after VRT. Thus, in this study, subjects with homonymous visual field defects who were attempting to fixate a central target while their fields were being plotted, typically showed brief horizontal shifts with no preference toward or away from the blind hemifield. These eye movements were usually less than 1 degrees from fixation. Large saccades toward the blind field after VRT were very rare. CONCLUSION: VRT has no effect on either the direction or the amplitude of horizontal eye movements during visual field testing. These results argue against the theory that the visual field enlargements are artefacts induced by eye movements.

Adult↗
PubMed2006

Improving residual vision by attentional cueing in patients with brain lesions.

Visual attention is crucial for almost all processes of visual perception, particularly when perception is difficult. We were interested in the effects of cueing spatial attention in patients with cerebral lesions who face difficulties in visual perception in areas of residual vision at the border of visual field defects. In 23 patients with visual field loss due to post-geniculate brain lesions, stimulus detection performance and reaction times were mapped with high-resolution computer-based perimetry. A cueing procedure using Gestalt completion to attract attention to areas of residual vision was implemented in this test and performance compared in attended and unattended conditions. Stimulus detection and reaction times in areas of residual vision improved significantly under attended conditions. The extent of this effect depended on the size of areas of residual vision within the cued field. Unexpectedly, facilitation was also observed, though to a lesser extent, in invalid cueing conditions, suggesting an unspecific increase of alertness in unattended areas. Our findings show that top-down influences are relevant for visual field testing. Visuo-spatial attention may change patterns of neural activation and induce short-term plasticity not only in the intact visual system but also in the presence of visual field loss after brain lesions. Attentional cueing induces a co-activation of the lesioned visual system and (intact) attentional networks in the brain inducing immediate facilitation of visual perception. This effect may be relevant for designing new strategies to permanently improve vision during neuropsychological rehabilitation.

Adult↗
PubMed2006

Visual hallucinations during visual recovery after central retinal artery occlusion.

BACKGROUND: Charles Bonnet syndrome is characterized by complex, formed visual hallucinations that occur in patients without psychiatric disorders. To the best of our knowledge, it has not been described following central retinal artery occlusion. OBJECTIVE: To describe 2 patients who experienced formed visual hallucinations characteristic of Charles Bonnet syndrome after sudden, severe visual loss precipitated by central retinal artery occlusion. PATIENTS: Two patients, aged 77 and 63 years respectively, experienced sudden deterioration of vision following central retinal artery occlusion. Formed visual hallucinations occurred in patient 1 six days later and in patient 2 two days later. RESULTS: The hallucinations appeared both within and at the borders of the patients' residual intact visual fields. They occurred during periods when the patients experienced partial visual recovery associated with enlargement of their visual fields. The visual recovery and hallucinations both ceased at the same time. CONCLUSIONS: We propose that the hallucinations are likely the result of deafferentation and their occurrence during visual recovery suggests that they are a correlate of visual system plasticity.

Aged↗
PubMed2004

Attentional cueing improves vision restoration therapy in patients with visual field defects.

BACKGROUND: In patients with postgenicular lesions of the visual system, areas of residual vision (ARVs) are the main predictor of recovery induced by vision restoration therapy (VRT). In these partially defective regions, the elevated perceptual thresholds can be acutely reduced by attentional cueing. OBJECTIVE: To examine whether directing attention to ARVs using a visuospatial cue also increases long-term neural plasticity and thus enhances permanent training outcome. METHODS: In a prospective, randomized clinical trial, treatment outcome was compared in patients with postgenicular visual system lesions who received either standard VRT (control group [CG]; n = 10) or VRT with attentional cueing (experimental group [EG]; n = 9). Visual field size was determined before and after a 6-month treatment period using Tubingen Automated Perimetry and computer-based high-resolution perimetry (HRP) and in regular intervals throughout this period by HRP and detection performance in VRT. RESULTS: In the area of the cue, restoration of vision was significantly greater than during VRT without cueing: cued patients showed a much more pronounced shift of the visual field border toward the blind area than that observed in the CG or in uncued regions of the EG. Focusing attention at ARVs during treatment changed topographic and temporal patterns of recovery as compared with uncued regions of the visual field. CONCLUSIONS: Use of a visuospatial cue to focus attention at areas of residual vision amplifies long-term neuronal plasticity. The authors propose that top-down signals preactivate partially damaged areas of V1, thus linking visual and attentional neuronal networks, with the effect of permanently increasing conscious visual perception.

Adult↗
PubMed2004

Rearrangement of the retino-collicular projection after partial optic nerve crush in the adult rat.

The establishment of retino-collicular topography is a well-investigated model of axon pathfinding and it was believed that this topography is irreversibly fixed throughout life. We now report that, after partial crush of the adult rat optic nerve, the anterograde transport of intravitreally-injected tracers via axons of surviving retinal ganglion cells (RGC) in all retinal quadrants is confined to the rostro-medial part of the superior colliculus (SC). This indicates that the retino-collicular topography is rearranged after partial crush of the adult rat optic nerve. The reorganization starts in the injured optic nerve where surviving axonal fibres are demyelinized and bundled in the periphery of the optic nerve distal to the crush site. This is followed by a displacement of surviving axons to the medial part of the optic tract (OT) within 2 weeks. The infiltration of macrophages with the subsequent production of tumour necrosis factor-alpha at the lesion site is a prerequisite for the altered retino-collicular projection as blockade of tumour necrosis factor-alpha signalling with the neutralizing antibody Infliximab abolishes reorganization in the SC and lateralization of RGC axons in the optic nerve and OT. This suggests that optic nerve inflammation is necessary for a progressive bundling of surviving RGC axons, probably via clearance of cellular debris which, in turn, may lead to a redistribution of RGC axons to the medial OT and rostro-medial SC.

Animals↗
PubMed2004

Vision restoration therapy (VRT) efficacy as assessed by comparative perimetric analysis and subjective questionnaires.

PURPOSE: We wished to evaluate the efficacy of vision restoration therapy (VRT) in patients with post-chiasmatic brain damage using different functional perimetric tests. These were compared with measures of subjective vision and reaction time. METHODS: An open trial was conducted with hemianopia/scotoma (n=16) patients. Before and after 6 months of VRT results of high resolution (HRP) and Tuebingen automated perimetry (TAP) were evaluated and compared to performance in a Scanning Laser Ophthalmoscope (SLO) as previously reported. Whereas TAP and HRP used above-threshold or near-threshold individual target stimuli on grey background, the SLO used a psychophysical task of detection of three black targets (reverse stimulus) on bright red, patterned background. Subjective testimonials of activities of daily living (ADL) were probed with questionnaires and interviews. RESULTS: Before VRT, the visual field border as assessed by SLO was located significantly closer to the vertical midline than the HRP and TAP border (border mismatch). After VRT the SLO border was still unchanged whereas HRP measurements revealed significant border shifts due to improved stimulus detection (p<0.0001) and improved reaction time (p<0.005) . Fewer misses were also observed in both eyes with TAP (p<0.01) which was primarily due to a significant shift of the absolute borders. Thus, VRT potentiated the mismatch between the SLO borders and the HRP/TAP borders. Fixation performance and the blind spot position remained unchanged after VRT. ADL ratings in the questionnaire improved significantly after VRT which was confirmed by independent patient testimonials. CONCLUSIONS: We replicated earlier findings that VRT improves stimulus detection in HRP and TAP perimetry which were accompanied by subjective, visual improvements. These changes are not caused by fixation or eye movement artifacts. Because the SLO border was located significantly closer to the vertical midline before VRT ("border mismatch") and, in contrast to HRP and TAP, did not change after VRT, we interpret this border mismatch to indicate that the SLO task was too difficult to perform and thus insensitive to VRT effects. Significant reaction time improvements indicate that plasticity of temporal processing might play an important role in vision restoration after brain damage. A further description of the precise psychophysical nature of the restored areas of residual vision is now warranted.

Adult↗
PubMed2003

Neglect and hemianopia superimposed.

In patients with posterior-parietal brain damage it is often difficult to decide whether left-sided omissions in perimetry are due to primary visual loss or due to visual neglect. We investigated 11 patients with combined neglect/hemianopia and 11 patients with pure hemianopia using a visual search task with single or double stimulation conditions. The second stimulus was either the fixation point itself (like in perimetry) or a distractor appearing in the hemifield opposite to the target. The fixation point did not worsen left-sided perception, but its disappearance led to a bias of exploration towards the right side in neglect patients but not in pure hemianopics. A distractor in the intact hemifield worsened the performance to left-sided stimuli, that is, neglect patients behaved as if they were completely hemianopic, even in intact parts of the visual field (VF). Three of the neglect patients showed unconscious processing of the distractor in the left VF, suggesting that the visual field defect was produced by neglect mechanisms rather than primary visual loss. This visual search paradigm appears to be helpful in understanding of the nature of hemianopia versus neglect deficits in individual patients.

Adult↗
PubMed2002

Blindsight after optic nerve injury indicates functionality of spared fibers.

Some patients with lesions in the geniculostriate pathway (GSP) can respond to visual stimuli in the blind field without conscious acknowledgement. The substrate for this "blindsight" is controversial: whether it is the uninjured extrastriate pathway (EXP), which bypasses the lesion site, or residual fibers within damaged visual cortex ("islands of vision"). Using stimulus detection, localization, and spatial summation tasks, we have found blindsight in patients with damage both in the optic nerve (ON) and EXP. The prevalence and functional characteristics of their blindsight are indistinguishable from that in patients with GSP lesions, so blindsight does not require a completely intact EXP. The present findings support the view that a few surviving ON axons within an area of primary damage are sufficient to mediate blindsight: Several combinations of partially intact pathways can transmit information to the extrastriate cortex and the sum of activation of all visual fibers surviving the injury determines if and to what extent blindsight occurs.

Adult↗
PubMed2002

Changes in visual cortex excitability in blind subjects as demonstrated by transcranial magnetic stimulation.

Any attempt to restore visual functions in blind subjects with pregeniculate lesions provokes the question of the extent to which deafferented visual cortex is still able to generate conscious visual experience. As a simple approach to assessing activation of the visual cortex, subjects can be asked to report conscious subjective light sensations (phosphenes) elicited by focal transcranial magnetic stimulation (TMS) over the occiput. We hypothesized that such induction of phosphenes can be used as an indicator of residual function of the visual cortex and studied 35 registered blind subjects after partial or complete long-term (>10 years) deafferentation of the visual cortex due to pregeniculate lesions. TMS was applied over the visual cortex in 10 blind subjects with some residual vision (visual acuity <20/400; Group 1), 15 blind subjects with very poor residual vision (only perception of movement or light; Group 2), 10 blind subjects without any residual vision (Group 3) and 10 healthy controls. A stimulation mapping procedure was performed on a 1 x 1 cm skull surface grid with 130 stimulation points overlying the occipital skull. We analysed the occurrence of phosphenes at each stimulation point with regard to frequency and location of phosphenes in the visual field. Previous experiments have shown that repetitive TMS reliably elicits brief flashes of white or coloured patches of light. Therefore, stimulation was performed with short trains of seven consecutive 15 Hz stimuli applied with an intensity of 1.3 times the motor threshold. Under such conditions, phosphenes occurred in 100% of subjects in Group 1, in 60% of Group 2 and in 20% of Group 3. Phosphene thresholds were normal, but the number of effective stimulation sites was significantly reduced in Groups 2 and 3. The results indicate that in blind subjects there is alteration in TMS-induced activation of the deafferented visual cortex or processes engaged in bringing the artificial cortex input to consciousness. The ability to elicit phosphenes is reduced in subjects with a high degree of visual deafferentation, especially in those without previous visual experience.

Adolescent↗
PubMed2002

Acute moderate alcohol consumption affects cardiovascular responses in healthy males with different tolerance levels.

We investigated the effect of acute moderate alcohol consumption or placebo on respiratory sinus arrhythmia (RSA) in 48 healthy participants with different levels of alcohol tolerance but no abuse. In the electrocardiogram recording, auditory stimuli were presented at defined points in the respiratory cycle, which allows a non-invasive measure of CNS control over RSA. After alcohol consumption we found a decrease in RSA with auditory stimulation. Moreover, individuals with low tolerance showed only a slight change in the RSA after alcohol intake compared to baseline, whereas the placebo drink led to a reduced RSA. In subjects with high alcohol tolerance, alcohol consumption led to a reduction of RSA, with no change after placebo. These results suggest a centrally driven influence on RSA that is changed by alcohol ingestion depending upon subjects' levels of alcohol tolerance.

Acoustic Stimulation↗