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

Visual field defects (VFDs) are a frequent consequence of acquired brain injuries in childhood (trauma, stroke, brain tumors) and significantly impact a child's autonomy and quality of life. Thanks to the high plasticity of the developing visual system, a targeted rehabilitation program can support functional recovery even in the chronic phase.

Results

This single-arm clinical trial assessed the efficacy of a home-based, remotely supervised audio-visual training (AVT) in 23 children and adolescents with chronic VFDs. The three-week protocol was delivered through the AvDesk device (Linari Medical), a semicircular panel with LEDs and loudspeakers, with remote fixation control and online session monitoring by the therapist.

Home-based AVT increased the speed of oculomotor visual field exploration, improved visual detection performance and reduced disability in daily living, with positive effects on mood and anxiety. Benefits were maintained up to 6 months after the end of treatment.

Although primarily a compensatory intervention targeting eye movements, AVT also appears to induce an enlargement of the visual field on automated perimetry and the emergence of blindsight phenomena, suggesting a possible restorative effect mediated by developmental plasticity of the visual system. The largest gains were observed in children with more severe visual exploration deficits, better baseline blindsight performance and greater structural damage to the optic radiation.

Telerehabilitation with AVT proves to be feasible and effective also in pediatric patients, offering an intensive intervention that fits daily life and is sustainable, with remote clinical supervision.