EP3104764B1 - Procédé et appareil d'entraînement de la vision - Google Patents

Procédé et appareil d'entraînement de la vision Download PDF

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Publication number
EP3104764B1
EP3104764B1 EP14881439.5A EP14881439A EP3104764B1 EP 3104764 B1 EP3104764 B1 EP 3104764B1 EP 14881439 A EP14881439 A EP 14881439A EP 3104764 B1 EP3104764 B1 EP 3104764B1
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target
subject
visual
trial
patient
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German (de)
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EP3104764A4 (fr
EP3104764A1 (fr
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Joyce SCHENKEIN
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H5/00—Exercisers for the eyes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5023—Interfaces to the user
    • A61H2201/5048—Audio interfaces, e.g. voice or music controlled
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H23/00—Percussion or vibration massage, e.g. using supersonic vibration; Suction-vibration massage; Massage with moving diaphragms
    • A61H23/02—Percussion or vibration massage, e.g. using supersonic vibration; Suction-vibration massage; Massage with moving diaphragms with electric or magnetic drive

Definitions

  • the present invention relates to an apparatus and methodology to retrain visual function in patients who have sustained damage to areas of visual processing in the brain.
  • blindsight This phenomenon of unconscious visual processing, called "blindsight" has been investigated in both humans and animals.
  • Human subjects were generally stroke or accident victims who lost all or a substantial portion of their visual fields.
  • the animals had been surgically altered to eliminate all cortex associated with conscious vision.
  • U.S. Patent No. 7,753,524 also concerns the portion of the field which is to be stimulated and extends the type of visual target to include colors and spiraling stimuli.
  • Huxlin U.S. Patent No. 7,549,743 . created a vision training device with the following features:
  • test stimulus is briefly presented (for approximately 500 milliseconds) and the patient either correctly responds to it or fails to respond.
  • Moments later a new target with different parameters (location or motion) ensues.
  • a training session involves hundreds of trials.
  • the patient indicates target detection with a button press.
  • the patient's response speed is fed back to the software as an indirect measure of visual function, e.g., those test areas corresponding to an absent or delayed response are assumed to represent either blind or visually degraded field. Performance feedback is not implemented; Sabel assumes that the mere act of focusing attention upon the blind field is therapeutic.
  • Document US 2011/0066069 A1 shows an apparatus for quantitative assessment of visual form discrimination of a subject comprising a display device, an input device, a control device, and a tangible computer readable medium.
  • a quantitative assessment profile of visual form discrimination by psychophysical responses is generated on a tangible computer readable medium.
  • At least one scene is presented to a subject on a display, the scene comprising a plurality of elements and a background, at least one geometric characteristic of at least one is distorted, the contrast level of the predetermined section of the scene is modulated, the predetermined section is moved relative to the scene, the movement being tracked by said subject via at least one input device, feedback from the subject is received via the input device, the received feedback is quantitatively refined relative to the scene, at least one distorted geometric characteristic is adjusted relative to the accuracy of the quantitatively refined feedback, the critical threshold parameter for the subject is calculated, and the critical threshold parameter onto a tangible computer readable medium is recorded.
  • a system for training the visual system of a human by presenting visual stimuli to said human comprising: a hand held display unit device comprising a display for displaying visual stimuli to a trainee and input means for receiving input from the trainee in response to the stimuli, and a server computer, wherein the server is wirelessly connected to the hand held display unit.
  • the hand held device is a digital mobile device configured to be held by the trainee.
  • Document US 2006/0270945 A1 discloses a system for testing a subject for cognitive impairment, comprising a display to present to the subject stimuli comprising an image of a smoothly moving object, repeatedly moving over a tracking path, a video sensor for sensing eye movements of the subject, and a computer configured to analyze the subject's eye movements to determine at least accuracy and variability of the subject's visual pursuit of the display of the smoothly moving object, and determine, based on the analyzing, if the subject has a cognitive impairment.
  • the present approach does not involve the mapping of transitional zones or selecting only a portion of the blind field to train. This is because clinical testing has shown the blind field to be non-uniform, with areas of relative sensitivity interspersed with those of deep blindness; a finding that could not be predicted from perimetrically evaluated fields.
  • the outcome of visual training using the present invention shows a widening of the entire field (including the sighted hemifield) even when visual targets are randomly presented anywhere within the blind field (and despite the fact that the sighted field is not specifically stimulated), as more fully described below.
  • the same (temporally changing) target is repeatedly cycled for a flexible but relatively long duration (generally determined entirely by the patient).
  • a new trial begins only when the patient initiates it with a key press.
  • an easily detected target might be viewed for a few seconds before the next trial is initiated.
  • a target which is not detected will be displayed for as long as the patient wishes. It has been determined that new patients need upwards of five (and frequently twenty) minutes with a single target in order to understand/recognize it. Thus, an hour's session may involve working with only a few targets for very long durations.
  • presentation of the visual stimulus is always accompanied ("shadowed") by a stimulus of another modality which exactly mimics the temporal characteristics of the target. For example, if the visual target has a frequency of 0.5 Hz, then the companion ("shadow") click or vibration occurs in synchrony with this visual target.
  • the purpose of this non-visual accompaniment is to aid the patient in knowing "what he is seeking”.
  • this non-visual input will provide an additional and reliable source of excitation for these weakly responding visual cells.
  • biofeedback overcomes these limitations by reliably associating an external signal with the subliminal biological event. For example, by allowing a patient to "hear” the fluctuation of his blood pressure, he learns to isolate the neural activity reliably associated with increases and decreases (a form of classical conditioning) and to actively control it. In the present design, the subject is enabled to "hear/feel" the accuracy of his visuo-motor estimates of target location to help isolate and identify the visual neural responses specific to the target. For example, in the style of a Geiger counter, feedback indicates the accuracy of his motor search for the target by increasing its temporal frequency as his hand nears the target and decreasing as he goes off course. Correct hand/stylus placement is associated with the maximal and very rapid frequency of audible sound/vibration.
  • the present approach takes advantage of unconscious visual-motor pathways which are important in the " blindsight" phenomenon (Perrine & Jeanerod, 1978 ).
  • the reliable correspondence between hand position, sound/vibration and weak visual information enable the patient to recognize and isolate the unconscious vision-related component of his experience from other neural activity, to strengthen it, and ultimately understand it as sight.
  • subject and “patient” both are used herein to refer to an individual using the retraining system and method disclosed herein.
  • the preferred embodiment for retraining the visual system is comprised of a conventional computer 10 including a CPU (Central Processing Unit) and having a hard drive containing one or more computer programs in a format executable by the CPU.
  • the CPU containing the software can be connected via internet to the training device.
  • Other programmable devices which can be used include a game box, or virtual reality device.
  • the computer or other programmable device is connected to the following peripheral devices.
  • a computer monitor 20 (or any visual display capable of displaying a light or image specified by the programs), for example a CRT, LCD, array of LEDs, OLED, virtual reality goggles and the like is connected to computer 10.
  • Touch device 30 represents an interface for detecting a patient's hand position (for example, a touch screen overlay (such as is available from Keytec Inc TX, USA)).
  • a touch screen overlay such as is available from Keytec Inc TX, USA
  • a light pen such as is available from Interactive Computer Products, Inc. CA, USA
  • a photocell such as is available from Interactive Computer Products, Inc. CA, USA
  • virtual reality glove also known as a virtual reality glove, a data glove or a cyber glove
  • any device known in the art which is capable of responding selectively to the subject's hand position with respect to the a target displayed on monitor 20, as more fully described below.
  • the stylus can be a handheld photocell which responds with increased voltage to increased target proximity. If the monitor 20 is a CRT, the stylus can be a lightpen (such as that made by Interactive Computer Products, Inc).
  • Standard audio speakers 60 are connected to computer 10. Sound intensity can be adjusted to a level which is comfortable to the patient.
  • the training procedure can be adapted to goggles sensitive to eye position, where correct target localization results in auditory feedback.
  • the T1 and T2 combinations can vary in size and spatial location, so that during the course of a trial, the smallest size travels a short distance (while simultaneously expanding) into the largest size, and then "explodes” (with corresponding sound effects indicating motion and a "pop").
  • target is intended to include any type of temporally changing visual stimulus which can be associated with additional non-visual sensory information.
  • the spatial configurations of the target can include all those to which the normal visual system is responsive, including those typically used in vision research, such as sinusoidal gratings, checkerboards, spirals, etc.
  • a brief click is played to mimic the temporal frequency of the visual information.
  • a tactile pulse can be synchronized to the visual display frequency.
  • the feedback frequency of the sound decreases.
  • Prerecorded sound clips are associated with each feedback zone.
  • reinforcement zones outline the target area, it is possible for the patient to use this multimodal feedback to locate and learn (with his auditory and motor systems) the spatial details (shape/size/spatial envelope of motion) of a visual target, which he cannot see.
  • FIG. 4 describes a trial format for a subject. While he fixates ahead 410, a clicking target is presented 420 to a random location within his blind field. At 430 he is encouraged to place his hand or the stylus upon the target and to be guided by feedback at 440. Active motor involvement not only maximizes the contribution of unconscious visual-motor pathways to learning, it is more effective than passive activity (i.e. verbal report) in establishing a visual-spatial map (Hein et al, 1970).
  • the subject is encouraged to concentrate upon the target and try to determine why this location is correct.
  • he may be told to look directly at the target with his sighted field and then return his gaze to fixation.
  • he is encouraged to manually explore the region around the target and to observe the change in feedback as he deviates from the correct location. The patient may develop his own strategy for "understanding" the location of the target.
  • the search can be repeated with a competing light in the sighted hemifield, adjustments may be made in the intensity of the competing light and it may be turned on and off by the patient.
  • a first trial is initiated at step 550, during which the patient searches for a desired time, (step 555). At any time during this search, he has the option of using a competing light at step 558, as described below. Or, by hitting the keyboard 40 ( Fig 1 ), the subject may initiate a new trial (step 560), in which the same target is displayed in a different location. The same sequence of steps is repeated at 565 and 568. This procedure is iterated as many times as the subject desires.
  • a last trial is conducted at step 570. At the conclusion of the session, the search data is printed and stored, at step 580.
  • the patient who succeeds at locating the target in the presence of the competing light will subsequently switch it on and off, trying to maintain his percept of the target.
  • Each drawing documents all search paths made for several targets in a single sixty to ninety minute session.
  • the search path for each target was created in color as the hand moved across the screen (each target having its own associated color path to differentiate it from the search paths for other targets shown in that session).
  • FIG. 8 demonstrates the visual fields of a second patient, a seventy seven year old man with hemi-blindness due to occipital stroke.
  • His CAT scan showed (1) a low density area in the left occipital lobe with effacement of the sulci and (2) obliteration of the left occipital horn. He was first seen fifteen months post-traumatically. His baseline evaluation showed total absence of vision in the right field. After two months of training, (seventeen sessions), his functional field crossed the midline, enabling him to read and to see his entire face in the mirror.
  • the data that is saved, and used in a manner different than that the prior art includes:
  • Trial duration is automatically recorded. In general, less time is spent exploring targets in locations of greater sensitivity. However, a trial could also be rejected if the target is randomly placed in a very similar location as in an earlier trial belonging to the same session. Thus, this information may be less valuable.
  • results obtained from nine patients, (seven with homonymous hemianopia of longstanding duration (nine months or greater) and two studied at three months after stroke) have contributed to the following understanding:
  • the blind field is not uniformly blind. If the entire visual field is trainable, some areas will show improvement before others.
  • the phantom When more than one target is experienced; the phantom one being near the border of the sighted field and the true one being on target. On occasion, the two are connected by an imagined arc of light. Over time, the phantom experience lessens.
  • Fluctuation of the visual experience is extremely common.
  • the same target which is mastered at one time during the session may have to be retrained later that session. This is particularly true after a very difficult condition is introduced; for example, if room illumination is raised. Under this circumstance, an "easy target” may suddenly become invisible for several minutes, even if complete darkness is restored. (This is suggestive of a longstanding inhibitory effect).
  • the general trend is toward improvement over sessions. Stray light which enters the good field is of little value in pinpointing the target location. The naive subject will report that he sees nothing and that he cannot locate the target except by sound. In cases where stray light is detected, the patient commonly begins his search along the border of his sighted field, surprised by the absence of feedback. For targets far from midline, stray light is frequently unnoticed; a patient may sit beside a brilliant flashing target asking "Tell me when we're ready to start.”

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  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Epidemiology (AREA)
  • Pain & Pain Management (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Rehabilitation Therapy (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
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Claims (15)

  1. Un appareil d'entraînement de la vision humaine, comprenant: un affichage (20) destiné à être vu par un sujet humain; un dispositif programmable pour générer une cible (T1, T2) sur ledit affichage (20), la cible (T1, T2) étant présentée pour être visualisée dans des régions d'un champ visuel d'un sujet dans lequel le sujet est aveugle ou malvoyant sur son pourtour;
    un moyen pour que le sujet indique (30, 50) une succession de positions devinées de la cible (T1, T2) sur l'affichage (20);
    un moyen pour déterminer en permanence une distance entre une position actuellement déterminée de la cible (T1, T2) et une position réelle de la cible (T1, T2), et pour fournir au sujet une rétroaction sensorielle constamment mise à jour, représentative de cette distance, permettant ainsi sous réserve de localiser la cible (T1, T2) avec des déplacements successifs vers l'emplacement réel de la cible (T1, T2);
    et un moyen d'enregistrement pour enregistrer des suppositions successives du sujet concernant l'emplacement de la cible (T1, T2) sur l'affichage (20).
  2. Appareil selon la revendication 1, dans lequel le dispositif programmable comprend un ordinateur (10), une boîte de jeu et un dispositif de réalité virtuelle.
  3. Appareil selon la revendication 1, dans lequel les moyens pour indiquer au sujet d'indiquer une position devinée de la cible comprennent ceux sélectionnés dans le groupe comprenant un écran tactile, un stylo optique, une cellule photoélectrique, un gant de souris ou un dispositif de saisie virtuel.
  4. Appareil selon la revendication 1, dans lequel l'affichage (20) comprend un moniteur d'ordinateur, un dispositif d'affichage de réalité virtuelle ou un dispositif activé sur le Web.
  5. Appareil selon la revendication 1, dans lequel le dispositif programmable est programmé pour générer de manière aléatoire un emplacement de cible pour chaque essai et dans ledit emplacement, pour afficher une cible se répétant temporellement (T1, T2) de telle sorte que les changements temporels de la cible (T1, T2).) se produisent de manière continue et répétitive tout au long d'un essai de recherche.]\
  6. Appareil selon la revendication 5, dans lequel le dispositif programmable est programmé pour que les changements temporels de la cible (T1, T2) incluent au moins un élément sélectionné dans le groupe constitué d'alternances de motif spatial, forme, couleur, contraste, luminance, taille. , position spatiale et nombre, permettant de varier la variété cible et la facilité de détection.
  7. Appareil selon la revendication 1, dans lequel, au cours d'un essai, la cible (T1, T2) est présentée de manière répétée en un endroit et dans lequel un clic auditif ou une impulsion tactile est produit et synchronisé pour se produire simultanément avec les déclenchements de la cible (T1, T2) pour le signal. procès entier.
  8. Appareil selon la revendication 1, dans lequel la durée prédéfinie d'un essai peut être remplacée par une pression sur une touche pour mettre fin à l'essai en cours et initier un nouvel essai.
  9. Appareil selon la revendication 1, dans lequel les moyens pour fournir une rétroaction sensorielle fournissent au sujet au moins une information audio ou tactile au sujet et dont la fréquence d'apparition est inversement liée à la distance entre la position estimée et la position réelle de la cible (T1, T2).
  10. Appareil selon la revendication 9, dans lequel les informations de retour audio ou tactile sont continuellement disponibles pour le sujet au cours d'un essai et peuvent être contrôlées par le sujet pour faire une pause et reprendre.
  11. Appareil selon la revendication 1, comprenant en outre une source de lumière concurrente (90) pouvant être déplacée vers une partie du champ de vision dans laquelle le sujet n'est pas aveugle.
  12. Appareil selon la revendication 11, dans lequel la source de lumière concurrente (90) est présentée simultanément, en synchronisme avec la cible (T1, T2) en tant que cible (T1, T2) est présentée à une partie du champ dans laquelle le sujet est aveugle.
  13. Appareil selon la revendication 11, dans lequel le niveau d'éclairage et la présence ou l'absence de l'éclairage concurrent est contrôlé par le sujet.
  14. Appareil selon la revendication 1, comprenant en outre un moniteur de position des yeux (70) pour fournir des données audit dispositif programmable représentatif de la direction du regard du sujet tout en utilisant ledit appareil de sorte que les mouvements des yeux s'écartant d'une direction de fixation puissent donner lieu à une son audible pour conseiller le sujet.
  15. Appareil selon la revendication 1, comprenant en outre un moyen pour générer un enregistrement du chemin de suppositions successives à partir des suppositions du sujet.
EP14881439.5A 2014-02-10 2014-02-10 Procédé et appareil d'entraînement de la vision Active EP3104764B1 (fr)

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PCT/US2014/015523 WO2015119630A1 (fr) 2014-02-10 2014-02-10 Procédé et appareil d'entraînement de la vision

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EP3104764A4 EP3104764A4 (fr) 2017-03-22
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US11301993B2 (en) 2017-02-17 2022-04-12 The Schepens Eye Research Institute, Inc. Treatment of ocular disorders using a content guide for viewing images
GB201711916D0 (en) * 2017-07-24 2017-09-06 Moon Hub Virtual reality training system and method
CN107661198A (zh) * 2017-08-29 2018-02-06 中山市爱明天使视光科技有限公司 基于恢复及提升视力的眼睫状肌体训练的模拟场景互动系统
WO2020056265A1 (fr) 2018-09-14 2020-03-19 De Oro Devices, Inc. Dispositif d'aide à la marche et procédé de traitement de troubles de la marche
CN113439682A (zh) * 2021-06-07 2021-09-28 中国人民解放军军事科学院军事医学研究院 用于灵长类动物三维运动目标拦截的训练装置及方法

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AU2005278771B2 (en) * 2004-09-03 2010-03-25 Ucansi Inc Systems and methods for improving visual perception
US7549743B2 (en) * 2005-01-06 2009-06-23 University Of Rochester Systems and methods for improving visual discrimination
JP2009542368A (ja) * 2006-06-30 2009-12-03 ノバビジョン， インコーポレイテッド 偏心視の診断および治療システム
US20110066069A1 (en) * 2009-09-16 2011-03-17 Duffy Charles J Method and system for quantitative assessment of visual form discrimination
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EP3104764A1 (fr) 2016-12-21
WO2015119630A1 (fr) 2015-08-13

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