Over the last year and a half we have been busy developing a computer game for young people with visual field loss caused by brain injury that builds on neuro-rehabilitation training programmes involving specialised computer software. These training programmes have been assessed in adults and significant improvements in functional vision have been observed, improving skills of independent living and quality of life. However, these training programmes are typically tedious and time-consuming so we have been exploring the potential of using computer game technology to increase motivation and engagement with rehabilitation. Now, we want to assess whether the computer game we have developed can improve the way in which young people with visual field loss use their vision and assess whether similar functional improvements occur that transfer to activities of daily living.
It’s been a while since I was last able to update the site, and that’s not because there haven’t been interesting things to discuss but because there have just been too many interesting things going on to have time to discuss them. Over the last two months we have presented our early research findings in both Melbourne (Australia) and San Francisco (USA), and visited the Veterans Affairs’ Western Blind Rehabilitation Centre in Palo Alto (USA) to discuss their rehabilitation program for veterans with acquired brain injury. In between those visits we hosted our own international conference at the WESC Foundation with delegates arriving from all over Europe and the US, which was a great success. Conor Linehan, one of our collaborating academics has also presented recently in Toronto (Canada) at the ACM CHI Conference on human factors in computing systems. All in all, it’s been a busy couple of months. I now have a bit of breathing space while we make preparations for research participant recruitment, so I can finally sit down and add a post to our blog. I thought I’d talk a little bit about Neurogaming.
Earlier this month, I attended a conference and expo dedicated to Neurogaming. When I first booked the tickets to the conference I wasn’t entirely sure what to expect, except that there were going to be people there from academia, industry and the commercial sector – and that there was going to be at least one panel talking about developing computer games for neurorehabilitation. As it turns out the conference covered a range of topics from virtual and augmented reality to neurofeedback and biosensors to games for education, wellness and therapy.
It was very interesting to explore the expo and witness the up-and-coming Oculus Rift virtual reality headset in action alongside other cutting edge technology such as head, body and arm trackers that were certainly capable of simulating physical presence in the virtual reality games that I had a chance to play. Also of interest were the number of startup companies involved in neurofeedback and neurocontrol using EEG headbands, which seem to have reached a price point where they are now mass marketable. The headbands have been adapted from the rather bulky (and unfashionable) caps that you might find in a psychology lab to smaller wireless sensor arrays that can be worn easily while out about. The headbands I saw at the conference were most often used to pick up prefrontal cortex activity, which can give a measure of “attention” as a form of neurofeedback to those practicing mindfulness training or even cognitive behavioural therapy for attention deficit disorders.
The field is still relatively new so it will be interesting to see how things progress, but if any of you are interested you can watch the panel discussions that were recorded during the conference here.
WESC Foundation’s Research and Development team were on ITV Westcountry News on Monday 26 May 2014 telling the public all about the computer game we have developed in collaboration with the University of Lincoln to help visually impaired young people improve their vision.
You can watch the news report by clicking here.
A recent article in the British Journal of Ophthalmology has reviewed the results of published studies investigating how we might best help children with visual impairment who also have a condition affecting their neurodevelopment (Williams et al., 2014)*. They found strong evidence to support the effectiveness of providing spectacles to improve distance or near vision, and to support the use of ultraviolet light (as opposed to normal white light) as an environmental modification during visual training exercises. They also found suggestive evidence to support specific training strategies for improving acuity and the efficiency of eye movements. What was less clear was evidence to suggest whether the improvements in visual skills observed in the lab transfer to general skills and daily activities: something we refer to as functional vision.
The debate about whether or not rehabilitation strategies for visual field loss are effective often centers around the mechanism of effect, and whether observed improvements are the result of changes in the actual visual field (e.g. restoration of neural pathways) or the result of functional changes (e.g. compensatory eye movements). It is important to understand the mechanisms that may underlie rehabilitation, and the evidence that significant improvements can be observed is still controversial. However, it is equally important to determine whether any clinical improvements that we do see will translate to useful improvements in vocational, educational and daily-life activities (e.g. reading or mobility), and lead to a general improvement in quality of life.
Reading is one skill in particular that visual field loss can impact on in a variety of ways, depending on the location and size of the visual field loss. For those reading English (and other languages read from left to right) it may be difficult to locate the next word on the same line if you have a right-sided visual field loss, and it can be difficult to locate the start of the next line if you have a left-sided visual field loss. When the field loss includes an area of the central field called the macular region there is often a corresponding loss of visual acuity and reading small text becomes more difficult.
The evidence for improvements in reading ability after vision rehabilitation is variable but suggests positive outcomes that depend on the specific training program, and on the specific area of the visual field loss. For those interested in therapy options for patients who have difficulty reading as a result of visual field loss you may wish to visit University College London’s Read-Right website, where they offer a free web-based therapy for patients with hemianopic alexia. Patients can register to join and use the service here.
*Cathy Williams is a consultant senior lecturer at the University of Bristol, and paediatric consultant at Bristol Eye Hospital. She will be working in collaboration with us at the WESC Foundation and the University of Lincoln to help with participant recruitment for a study that we will be running later in the year to investigate whether eye movement training using computer game software may be beneficial for young people with visual field loss.
Vision 2014 is the 11th International Conference on Low Vision, which occurs once every three years and this year will take place in Melbourne, Australia. The themes of the conference are Advancing research, upgrading practice, and improving participation. I will be giving a rapid fire oral presentation about our current research project: “A computer game designed to improve sight for children with visual field loss.” as well as presenting a research poster at the exhibition.
The draft program for the Vision 2014 conference looks particularly promising with an entire day set aside for neurological vision impairment, and other symposia include updates on low vision technology, bionic implants and rehabilitation delivery.
The WESC international conference will be taking place onsite at Exeter, UK on the 30th April and 1st May with a followup day on the 2nd May to discuss a specific neurological visual impairment: Batten disease, also known as neuronal ceroid lipofuscinosis. The first day will have talks from Dr. Christine Roman-Lantzy on the CVI Range (which is an approach to assessment and intervention for children with neurological vision impairment) as well as a presentation on the Children & Families bill from Claire Dorer of NASS. On the second day we have presentations on the implications of visual impairment after stroke from Dr. Fiona Rowe of the University of Liverpool, and a presentation from Prof. Rob Scott on developments with the Brainport. If you are interested in finding out more details about this conference and would be interested in attending please feel free to contact WESC using the email address: firstname.lastname@example.org.
Hopefully I will see some of you there.