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The rehabilitation of hemianopic dyslexia

Nature Reviews Neurology volume 5, pages 427–437 (2009)Cite this article

Abstract

Hemianopic dyslexia is a frequent and disabling functional impairment following brain injury. This form of dyslexia is an acquired reading disorder whereby patients with homonymous visual field defects have persistent and severe reading difficulties, despite having intact language functions. Hemianopic dyslexia has received little attention from researchers and clinicians, and this article is the first to review the rehabilitation of patients with the condition. In light of advances in our knowledge about the nature and causes of hemianopic dyslexia, I critically examine the available treatment methods for visual field disorders and evaluate their efficiency in alleviating hemianopic dyslexia. On the basis of the reviewed evidence, I suggest that compensatory therapies, which attempt to reorganize eye-movement control, are superior to restorative therapies, which aim at visual field restitution. For the rehabilitation of hemianopic dyslexia, I recommend a treatment protocol that involves the systematic and repetitive practice of specific eye movements for reading. Despite increasing evidence for the effectiveness of this treatment protocol, which has clinically relevant long-term benefits, the underlying mechanism of the therapeutic effect is still unclear. Indeed, more research is required to further improve the efficiency of rehabilitation in patients with hemianopic dyslexia.

Key Points

  • Hemianopic dyslexia is not simply the product of the visual field defect, but is caused by a disorder of control of visual information processing and eye movements in reading

  • Assessment of hemianopic dyslexia should include perimetric visual field testing and examination of reading performance and eye movements, and consideration of the underlying brain injury, maladaptive strategies and comorbidities

  • Compensatory therapies are preferred over restorative therapies in the rehabilitation of hemianopic dyslexia, as the former directly address the primary cause (of hemianopic dyslexia) and efficiently alleviate reading impairments

  • Rehabilitation of hemianopic dyslexia requires the systematic massed practice of specific reading eye movements, using moving or static words or word-like material and preferably conducted in a supervised, errorless learning condition

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Figure 1: Foveal and parafoveal visual field in homonymous visual field defects.
Figure 2: Foveal and parafoveal visual field in patients with a central scotoma.
Figure 3: Eye-movement recordings in normal readers and patients with unilateral homonymous hemianopia.

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I would like to thank Josef Zihl and the four peer reviewers for their insightful comments and suggestions on an earlier version of this manuscript.

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    Susanne Schuett

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Schuett, S. The rehabilitation of hemianopic dyslexia. Nat Rev Neurol 5, 427–437 (2009). https://doi.org/10.1038/nrneurol.2009.97

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