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Brain and Nerve No to Shinkei Volume 56, Issue 5 （May 2004）

Brain and Nerve 脳と神経 56巻5号（2004年5月発行）

Japanese English

原著

同名性視野狭窄にともなう探索障害に対する代償訓練―残存視野機能低下例での検討 Visual Search Training for a Case of Homonymous Field Defect with Multiple Visual Dysfunctions 平山和美 ¹ , 境信哉 ² , 山脇理恵 ³ , 近藤裕見子 ⁴ , 鈴木妙実 ¹ , 藤本ちあき ⁵ , 山鳥重 ⁶ , 森悦朗 ¹ Kazumi Hirayama ¹ , Shinya Sakai ² , Rie Yamawaki ³ , Yumiko Kondo ⁴ , Taemi Suzuki ¹ , Chiaki Fujimoto ⁵ , Atsushi Yamadori ⁶ , Etsuro Mori ¹ ¹東北大学大学院医学系研究科障害科学高次機能障害学 ²北海道大学医学部保健学科作業療法学専攻 ³初台リハビリテーション病院リハビリテーション部作業療法室 ⁴東北大学大学院生命科学研究科脳情報処理研究室 ⁵東北大学医学部附属病院リハビリテーション部 ⁶神戸学院大学人文学部 ¹Division of Neuropsychology, Department of Disability Medicine, Tohoku University Graduate School of Medicine ²Department of Occupational Therapy, Hokkaido University School of Health Sciences ³Division of Occupational Therapy, Department of Rehabilitation, Hatsudai Rehabilitation Hospital ⁴Department of Developmental Biology and neuroscience, raduate School of Life Science, Tohoku University ⁵Department of Rehabilitation, Tohoku University Hospital ⁶Faculty of Humanities Sciences, Kobe Gakuin University キーワード： homonymous hemianopia , rehabilitation , saccadic eye movement , cerebral achromatopsia , cerebral amblyopia Keyword: homonymous hemianopia , rehabilitation , saccadic eye movement , cerebral achromatopsia , cerebral amblyopia pp.403-413

発行日 2004年5月1日 Published Date 2004/5/1

DOI https://doi.org/10.11477/mf.1406100282

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Abstract 文献概要
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　要旨　多発性脳梗塞にて中心部と左上1/4視野のみを残す同名性視野狭窄，大脳性弱視，大脳性色盲，形態視障害をきたし，部屋や物を見つけられないなど視覚的探索の障害された症例に対して，衝動性眼球運動を用いた訓練を施行した。色のコントラスト感度は保たれており，訓練用には有色（緑）刺激を用いた。ベースライン期には有色刺激に比して無色（白）刺激の成績が不良だったが，訓練後には，探索の範囲，刺激配列の探索とも無色刺激の成績も同等に向上し，生活動作アンケートの結果も改善した。後2者はフォローアップ期に低下したので在宅訓練を追加，再び改善した。残存視野機能の障害された症例にも本訓練が有効な場合のあることが示された。

　A 72-year-old right handed man developed right homonymous hemianopia without macular sparing, left homonymous lower quadranopia with macular sparing, cerebral amblyopia, cerebral achromatopsia, impaired form vision, and mild right hemispatial neglect, after multiple cerebral infarctions, involving bilateral occipital cortices. His intelligence and memory were deteriorated moderately. He failed to notice objects located in the affected visual field, because of his severely impaired visual search. When ordinary lighting was used, he showed severe right-sided omissions on the line cancellation test. However, omissions were less marked under the brighter lighting.

　By using a modified method of Kerkhoff and Vianen （1994）, he was trained to make saccadic eye movements toward affected regions to find a target and to search and point at targets arranged randomly. As the sensitivity for contrast of isoluminante red and green stimuli was preserved well at high spatial frequencies despite the decreaced contrast sensitivity for brightness, we used green targets as the training stimuli. After the training, search field and pointing range that could be covered by the patient increased in size for both green and white targets, and daily activities improved. Moreover, after the training, he no longer showed discrepancy in line cancellation performances between ordinary and brighter lighting conditions.

　In the follow up period, the search field and the performance on the line cancellation test were maintained, while the performance of pointing targets array declined. The family members complained of mild re-deterioration of daily activities. Then, the training for searching and pointing re-introduced at home. After the training, his pointing performance and daily activities, evaluated by questionnaires to his family members, improved again.

　In conclusion, it was suggested that disordered visual search after a homonymous field defect can be treated effectively, even if multiple visual dysfunctions were associated.

（Received : January 22, 2004）