U.S. patent application number 14/278776 was filed with the patent office on 2015-11-19 for wearable systems and methods for treatment of a neurocognitive condition.
This patent application is currently assigned to Kessler Foundation Inc.. The applicant listed for this patent is Kessler Foundation Inc.. Invention is credited to Anna M. Barrett, Peii Chen, Geoffrey Hill.
Application Number | 20150331260 14/278776 |
Document ID | / |
Family ID | 54480470 |
Filed Date | 2015-11-19 |
United States Patent
Application |
20150331260 |
Kind Code |
A1 |
Chen; Peii ; et al. |
November 19, 2015 |
WEARABLE SYSTEMS AND METHODS FOR TREATMENT OF A NEUROCOGNITIVE
CONDITION
Abstract
Provided are wearable systems and methods for treatment of a
neurocognitive impairment, disease or disorder in a patient in need
thereof comprising a visual field occluder useful, for example, in
prism adaptation therapy.
Inventors: |
Chen; Peii; (New York,
NY) ; Barrett; Anna M.; (South Orange, NJ) ;
Hill; Geoffrey; (New City, NY) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Kessler Foundation Inc. |
West Orange |
NJ |
US |
|
|
Assignee: |
Kessler Foundation Inc.
West Orange
NJ
|
Family ID: |
54480470 |
Appl. No.: |
14/278776 |
Filed: |
May 15, 2014 |
Current U.S.
Class: |
348/122 ;
351/159.58; 359/601 |
Current CPC
Class: |
G02B 5/003 20130101;
G02C 7/14 20130101; H04N 5/2621 20130101 |
International
Class: |
G02C 7/14 20060101
G02C007/14; H04N 5/262 20060101 H04N005/262; G02B 5/00 20060101
G02B005/00 |
Claims
1. A wearable system for treatment of a neurocognitive impairment,
disease or disorder in a patient in need thereof, comprising: a
visual field occluder releasably worn by the patient during the
treatment comprising an opaque screen and attachment system, the
attachment system configured to releasably attach the visual field
occluder onto the patient.
2. The wearable system according to claim 1, further comprising
eyewear worn by the patient with at least one lens having a prism
mounted thereon.
3. The wearable system according to claim 1, wherein the
neurocognitive impairment, disease or disorder comprises spatial
neglect.
4. The wearable system according to claim 2, wherein the prism is
rotatable.
5. The wearable system according to claim 1, wherein the opaque
screen is comprised of a paperboard, fiberboard, foam board,
plastic, metal, wood, fiberglass or textile material or
combinations thereof.
6. The wearable system according to claim 1, wherein the visual
field occluder further comprises adjusting mechanism to adjust the
opaque screen vertically, horizontally or angularly relative to the
visual field of the patient.
7. The wearable system according to claim 1, wherein the attachment
system is comprised of one or more straps, wires or tubing or
combinations thereof.
8. The wearable system according to claim 1, wherein the attachment
system releasably attaches the visual field occluder around the
torso of the patient.
9. The wearable system according to claim 1, wherein the attachment
system releasably attaches the visual field occluder around the
neck of the patient.
10. The wearable system according to claim 1, wherein the system is
portable.
11. The wearable system according to claim 1, wherein the wearable
system is used in conjunction with a table-top device housing
targets used in a prism adaptation procedure.
12. A method of treating a neurocognitive impairment, disease or
disorder in a patient in need thereof, comprising the steps of:
placing eyewear onto the patient, the eyewear comprising at least
one lens having a prism mounted thereon; placing a visual field
occluder onto the patient such that the visual field occluder is
releasably worn by the patient to substantially block visual
feedback of arm movement of the patient during the treatment; and
performing a prism adaptation procedure with the patient.
13. The method according to claim 12, wherein the neurocognitive
impairment, disease or disorder comprises spatial neglect.
14. The method according to claim 12, further comprising an initial
step of determining a pre-exposure baseline measurement of pointing
performance prior to placing the eyewear onto the patient.
15. The method according to claim 12, wherein the prism adaptation
procedure comprises the steps of: exposing the patient to prismatic
displacement to produce adaptation; and measuring post-exposure
after-effect of adaptation persistence.
16. Eyewear for treatment of a neurocognitive impairment in a
patient in need thereof, comprising: a frame; at least one lens
having a prism mounted thereon; and a visual field occluder
attached to the frame comprising an opaque screen; the visual field
occluder configured to substantially block visual feedback of arm
movement of the patient when the eyewear is worn during the
treatment.
17. The eyewear according to claim 16, wherein the prism is
rotatable.
18. The eyewear according to claim 16, wherein the opaque screen is
comprised of a paperboard, fiberboard, foam board, plastic, wood,
fiberglass or textile material or combinations thereof.
19. The eyewear according to claim 16, wherein the visual field
occluder further comprises an adjusting system, the adjustment
system configured to enable adjustment of the opaque screen
vertically, horizontally or angularly relative to the visual field
of the patient.
20. The eyewear according to claim 16, wherein the opaque screen is
retractable.
21. The eyewear according to claim 16, wherein the eyewear is a
pair of eye glasses.
22. The eyewear according to claim 16, wherein the eyewear is a
pair of goggles.
23. A wearable system for treatment of a neurocognitive impairment,
disease or disorder in a patient in need thereof, comprising:
eyewear having at least one display screen configured to be visible
by at least one eye of a patient and otherwise blocking a portion
of the patient's view beyond the eyewear for the at least one eye;
at least one camera disposed on the eyewear configured to capture
video images in front of the eyewear; and a video processor coupled
to the at least one display screen and the at least one camera, the
video processor configured to provide video images captured by the
camera to the at least one display screen; the video images
including a selectable prismatic effect and blocking of substantial
portions of arm movement of the patient when worn by the
patient.
24. The wearable system according to claim 23, wherein the at least
one camera and at least one display screen includes at least one
respective camera and display screen for each eye of the
patient.
25. The wearable system according to claim 23, wherein the coupling
of the video processor to the at least one display screen and the
at least one camera includes at least one wireless coupling.
26. The wearable system according to claim 23, wherein the
neurocognitive impairment, disease or disorder comprises spatial
neglect.
27. The wearable system according to claim 26, wherein the
selectable prismatic effect is to select the magnitude and the
direction of a visual-field shift.
28. The wearable system according to claim 23, wherein the video
processor enables adjustment of the blocking portion of the
displayed video images vertically, horizontally or angularly.
29. The wearable system according to claim 24, wherein the video
processor further comprises an output configured for providing
video display signals to a second display.
30. The wearable system according to claim 23, wherein the eyewear
is eye glasses.
31. The wearable system according to claim 23, wherein the eyewear
is goggles.
32. A wearable system for treatment of a neurocognitive impairment,
disease or disorder in a patient in need thereof, comprising:
eyewear having at least one light transmissive panel configured to
be visible by at least one eye of a patient, said panel having a
first region without an obstructive view and a second region
selectively blocking said patient's view; a prism mounted on said
panel; and a processor coupled to the at least one panel, the
processor configured to control the selective blocking of said
second region to substantially block visual feedback of arm
movement of the patient when the eyewear is worn during the
treatment.
Description
FIELD OF THE INVENTION
[0001] The instant invention generally relates to a wearable system
for treatment of a neurocognitive impairment, disease or disorder
in a patient, and specifically to such a system employing a visual
field occluder.
[0002] All documents cited to or relied upon below are expressly
incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0003] Since Yves Rossetti and colleague's seminal report
(Rossetti, et al. "Prism Adaptation to a Rightward Optical
Deviation Rehabilitates Left Hemispatial Neglect," Nature,
395(6698), 166-169 (1998)), many researchers and clinicians have
studied prism adaptation for treating the neurocognitive disorder
of spatial neglect (also known as hemispatial neglect, unilateral
spatial neglect, visual inattention, visuospatial inattention,
visuospatial neglect or visual neglect). Spatial neglect is a
neurocognitive disorder affecting attentional control, spatial
perception and representation, and motor action planning Spatial
neglect commonly occurs after a stroke or brain injury. Individuals
with spatial neglect demonstrate a failure or slowness to respond,
orient or initiate towards contra-lesional stimuli.
Right-brain-damaged individuals often neglect the left side, and
the left-brain-damaged neglect the right side. Individuals with
diffuse brain injuries usually demonstrate left-sided spatial
neglect. Individuals with spatial neglect unfortunately have poor
outcomes after standard and usual rehabilitative care. Prism
adaptation treatment, by contrast, provides for a promising therapy
protocol effectively addressing spatial neglect post stroke or
brain injury and helps patients recover to functional
independence.
[0004] Prism adaptation treatment (PAT) is a visuomotor procedure
involving target-oriented arm movement guided by prism-shifted
vision. During a treatment session, the patient wears prism goggles
while performing tasks such as reaching to targets. The treatment
effect is observed after the prisms are removed when the patient
re-adapts to the normal visual world. At this time, the prism
aftereffect is apparent; the patient's arm movement becomes more
toward the left side if he/she adapted to the right-shifting
prisms. In individuals with spatial neglect, the prism aftereffect
is significant, lasting longer than healthy individuals and
transferred to everyday activities. Thus, PAT shows promising
therapeutic effects, reducing spatial neglect's adverse impact on
functional behavior.
[0005] To enhance prism adaptation and, thus, the prism aftereffect
as well as therapeutic effects, it is typical in the art to use an
occluder to block the visual feedback of a certain portion of a
patient's arm movements during a treatment session. The occlusion
can achieve the so-called concurrent or terminal exposure. The
concurrent version is to occlude the initial part of arm movement,
allowing the patients to see their forearm, hand, finger and the
target. The terminal version is to occlude the entire arm, allowing
only the final hand/finger position and the target visible.
[0006] To achieve either version of occlusion, the art uses a
"prism adaptation box," almost always fixed on a desk or
workstation. Such cumbersome "box" occluders have the disadvantages
of, for example, being stationary, non-moveable during prism
adaptation and non-flexible to different individuals' shoulder
heights. Further, patients have to stay very close to the box and
sometimes are required to use an uncomfortable chin rest.
[0007] There, thus, exists a need in the art for a portable and
wearable visual field occluder to provide a patient undergoing PAT
with freedom of arm movement in any direction to any location
without being constrained by the conventional "box" occluders.
SUMMARY OF THE INVENTION
[0008] The present invention is directed to a wearable system for
treatment of a neurocognitive impairment, disease or disorder in a
patient in need thereof, comprising: a visual field occluder
releasably worn by the patient during the treatment comprising an
opaque screen and attachment system, the attachment system
configured to releasably attach the visual field occluder onto the
patient.
[0009] The invention is also directed to a method of treating a
neurocognitive impairment, disease or disorder in a patient in need
thereof, comprising the steps of: placing eyewear onto the patient,
the eyewear comprising at least one lens having a prism mounted
thereon; placing a visual field occluder onto the patient such that
the visual field occluder is releasably worn by the patient to
substantially block visual feedback of arm movement of the patient
during the treatment; and performing a prism adaptation procedure
with the patient.
[0010] The invention is further directed to eyewear for treatment
of a neurocognitive impairment in a patient in need thereof,
comprising: a frame; at least one lens having a prism mounted
thereon; and a visual field occluder attached to the frame
comprising an opaque screen; the visual field occluder configured
to substantially block visual feedback of arm movement of the
patient when the eyewear is worn during the treatment.
[0011] The invention is additionally directed to a wearable system
for treatment of a neurocognitive impairment, disease or disorder
in a patient in need thereof, comprising: eyewear having at least
one display screen configured to be visible by at least one eye of
a patient and otherwise blocking a portion of the patient's view
beyond the eyewear for the at least one eye; at least one camera
disposed on the eyewear configured to capture video images in front
of the eyewear; and a video processor electrically coupled to the
at least one display screen and the at least one camera, the video
processor configured to provide video images captured by the camera
to the at least one display screen; the video images including a
selectable prismatic effect and blocking of substantial portions of
arm movement of the patient when worn by the patient.
BRIEF DESCRIPTION OF THE FIGURES
[0012] FIG. 1 is a perspective view of the opaque screen and
attachment system used in an exemplary embodiment of the visual
field occluder of the present invention.
[0013] FIG. 2 is a perspective view of an exemplary wearable system
embodiment of FIG. 1 comprising a visual field occluder reversibly
attached around the neck of a patient and prism goggles.
[0014] FIG. 3 is a perspective view of an alternative wearable
system embodiment of the invention comprising a visual field
occluder reversibly attached around the torso of a patient.
[0015] FIG. 4 is a perspective view of an exemplary wearable system
embodiment of the present invention used by a patient in a prism
adaptation therapy session.
[0016] FIG. 5 is a perspective view of an exemplary eyewear
embodiment of the present invention having a visual field occluder
attached thereon.
[0017] FIG. 6 is a set of graphs showing preliminary treatment
outcomes using embodiments of the invention in prism adaptation
treatment of patients with spatial neglect.
[0018] FIG. 7 depicts an exemplary alternative embodiment of the
present invention employing digital video processing to perform the
visual field occlusion.
DETAILED DESCRIPTION OF THE INVENTION
[0019] It is to be understood that the figures and descriptions of
the present invention have been simplified to illustrate elements
that are relevant for a clear understanding of the present
invention, while eliminating, for the purpose of clarity, many
other elements found in typical systems and arrangements. Those of
ordinary skill in the art will recognize that other elements and/or
steps are desirable and/or required in implementing the present
invention. However, because such elements and steps are well known
in the art, and because they do not facilitate a better
understanding of the present invention, a discussion of such
elements and steps is not provided herein. The disclosure herein is
directed to all such variations and modifications to such elements
and methods known to those skilled in the art. Furthermore, the
embodiments identified and illustrated herein are for exemplary
purposes only, and are not meant to be exclusive or limited in
their description of the present invention.
[0020] The present invention generally relates to a system, device
and method for treating a neurocognitive impairment, disease or
disorder in a patient in need of such treatment. The invention is
useful, for example, in prism adaptation treatment for individuals
suffering from spatial neglect.
Exemplary Embodiments of the Invention
[0021] A wearable system is provided for treatment of a
neurocognitive impairment, disease or disorder in a patient in need
thereof, comprising a visual field occluder releasably worn by the
patient during the treatment. The visual field occluder is useful
for blocking the view of the initial arm movement of the patient
during, for example, a prism adaptation therapy session. The visual
field occluder comprises an opaque screen which can be made of any
material commonly used in the art. Such materials include, for
example, commercially available paperboard, fiberboard, foam board,
plastic, metal, wood, fiberglass or textile material or
combinations thereof.
[0022] In another embodiment of the invention, the material for the
screen can be transparent but made opaque by covering it with an
opaque cover made of, for example, paper or cloth. Any combination
of materials and methods can be used to make the screen as long as
the patient's view of his or her arm movement is blocked during
therapy.
[0023] FIG. 1 shows an example of a visual field occluder of the
present invention. Opaque screen 1 made of, for example, plastic
having recess 2 which comfortably accommodates the neck of the
patient when the opaque screen is releasably attached onto the
patient.
[0024] The visual field occluder also comprises an attachment
system configured to releasably attach the visual field occluder
onto the patient. The attachment system is comprised of one or more
straps, wires or tubing or combinations thereof and can be made of
any commercially available material such as, for example, nylon,
polyester lanyard, plastic, leather, metal or textile material or
combinations thereof. As shown in FIG. 1, attachment system 3 can
be made of tubing, such as metal or plastic tubing, substantially
strong enough to accommodate opaque screen 1 mounted thereon. The
attachment system releasably attaches the visual field occluder
onto the patient so as to make the system portable.
[0025] In another embodiment of the wearable system, and as also
shown in FIG. 1, the visual field occluder further comprises
adjusting mechanism 4 to adjust the opaque screen relative to the
visual field of the patient. For example, the adjusting mechanism
can adjust the opaque screen vertically, horizontally or angularly
or combinations thereof relative to the visual field of the
patient. Adjusting mechanism 4 can be part of attachment system 3
(as shown in FIG. 1) or attached to opaque screen 1 (not shown) or
combinations thereof.
[0026] In one embodiment, the visual field occluder is releasably
attached around the neck of the patient by metal tubing. As seen in
FIG. 2, a patient is shown with opaque screen 1 reversibly attached
to his neck via attachment system 5.
[0027] In another embodiment, the visual field occluder is
releasably attached around the torso of the patient by straps. As
seen in FIG. 3, a patient is shown with opaque screen 1 reversibly
attached on his shoulders via torso strap 8.
[0028] The wearable system of the invention can further include
eyewear having lenses and prisms thereon for the treatment of, for
example, spatial neglect. Examples of prism lenses are those that
are commonly used in the art and can be found, for example, in U.S.
Pat. No. 4,779,972 and US Published Application No. 2012/0062838,
the contents of both of which are expressly incorporated by
reference herein. As seen in FIG. 2, goggles 6 comprise lenses with
prisms 7 mounted thereon. The base of prism 7 is directed toward
the visual field loss to bring the entire visual field toward
ispilesional side of space. Prism 7 may be of any standard lens
material, shape and power and may be fixed or rotatable on the
lens. In patients with left-sided spatial neglect (after
right-brain damage), a prism can be used with a thicker part on the
left. For example, 20-diopter prism lenses shift the entire visual
field 11.3 degrees to the right. For patients with right-sided
neglect, in turn, lenses with the thicker part on the right can be
used.
[0029] In another embodiment of the invention, the visual field
occluder can be a part of the eyewear worn by the patient. Examples
of eyewear include, for example, glasses and goggles. In this
embodiment, and as shown in FIG. 5, the eyewear includes frame 9,
at least one lens having a prism 10 mounted thereon, and visual
field occluder 11 attached to the frame comprising an opaque
screen. Visual field occluder 11 is configured to substantially
block visual feedback of arm movement of the patient when the
eyewear is worn during the treatment.
[0030] Suitable materials for opaque screen 11 include, for
example, a plastic, wood, fiberglass or textile material or
combinations thereof. Further, visual field occluder 11 can include
an adjusting system, the adjustment system configured to enable
adjustment of the opaque screen vertically, horizontally or
angularly relative to the visual field of the patient. Opaque
screen 11 can be fixed or retractable for ease of storage.
[0031] FIG. 7 depicts a system 50 in accordance with alternative
embodiment of the present invention that employs video processing
for providing the required visual field occlusion and/or the
prismatic effect. The system 50 comprises eyewear 60 coupled to a
processor 90, such as a video processor, via communication line
100. The depicted eyewear 60 comprises a frame 65 such as, for
example, an eye glass or goggle frame having mounted thereon left
and right video display screens 70 and 75. In one embodiment, the
eye glass or goggle frame is opaque and configured to block
peripheral vision. The video display screens 70 and 75 are
positioned so as to be in the vision field of the left and right
eyes of a patient (not shown) wearing such eyewear 60. When eyewear
60 is worn by a patient, the display screens 70 and 75, alone or in
combination with the frame 65, substantially block or blackout the
patients view in front of or beyond the display screens 70 and
75.
[0032] Eyewear 60 further comprises left and right video cameras 80
and 85 mounted proximate the left and right video display screens
70 and 75. More specifically, the cameras 80 and 85 are positioned
so that when eyewear 60 is worn by a patient, the cameras 80 and 85
capture at least a portion of the field of vision that a patient
would have under normal circumstances when not wearing the eyewear
60. The cameras 80 and 85 are coupled to the video processor via
the communication line 100 and, correspondingly, the video
processor 90 is likewise coupled by the communication line 100 to
the display screens 70 and 75.
[0033] The exemplary video processor 90 depicted in FIG. 7 is a
general purpose computer connected to an input device 92 such as a
keyboard and/or mouse, and a display 95. In operation, the video
processor 90 is configured to receive signals received from the
cameras 80 and 85, process such signals and provide a corresponding
processed signal to the eyewear display screens 70 and 75. In
addition, the video processor 90 is operable to display the
processed signals on the display 95 alone or in a split screen
configuration with the signals received from the cameras 80 and
85.
[0034] In operation, a patient wearing the eyewear 60 will view in
the display screens 70 and 75 processed video images. These
processed video images correspond to images captured by the cameras
80 and 85, respectively, processed by the video processor to
emulate the required visual field occlusion in the screens 70 and
75, i.e., blacking out of substantial portions of the patients arm
movements, as well as to image emulation of images passed through a
prism, selectable by software operating in the video processor 90
or selectable by a clinician using the video processor input device
92. Numerous techniques are useable by the video processor 90 for
providing the visual field occlusion including the video processing
technique described in, for example, US Patent Application Publn.
No. 2013/0093788, which is incorporated by reference herein.
[0035] Alternate methods for providing the visual field occlusion
emulation may include a clinician using the input device 92 to set
or adjust a defined block out region defined by a horizon line
(either collectively or individually for the right and left eyes)
on the display 95 for which the video processor 90 may black out
the region located below the horizon line in the display 95 and
corresponding displays 70 and 75. Further, the video processor 90
may utilize information from an angle sensor (not shown) disposed
on the eyewear 60 for adjusting the height of such horizon line as
the patient moves the position angle of their head while looking up
or down.
[0036] The required prism effect of the processed signals supplied
to the video screens 70 and 75 may be implemented by the video
processor emulation or prisms disposed proximate lens of cameras 80
and 85. Specifically, the eyewear 60 may use selectively rotatable
or substitutable prisms proximate the camera lenses to achieve the
desired prism angle and direction in a substantially similar manner
to the use of the prisms in the eyewear of the previously described
embodiments of the invention with respect to FIGS. 2, 4 and 5. In
one embodiment, the selectable prismatic effect is to select the
magnitude and the direction of a visual-field shift.
[0037] The particular type of display screen used for the display
screens 70 and 75 is not critical to practicing the present
invention. Many different types of display screens are suitable for
display screens 70 and 75 including, for example, light emitting
diodes ("LED") including but not limited to organic LEDs ("OLEDs")
and active-matrix, OLED, liquid crystal displays ("LCD") including
but not limited to thin-film transistor ("TFT"), backlit and
active-matrix LCDs display screens.
[0038] In addition, the video display screens 70 and 75 of the
depicted eyewear 60 are intended to blackout the view of a patient
wearing the eyewear 60. In the alternative, light transmissive
panels may be used instead of the display screens 70 and 75. Such
light transmissive panels such as, for example, twisted nematic
(TN) LCD panels include at least one region that may be selectively
blacked out. In such configurations, the patient wearing the
eyewear 60 will be able to see through a first region of the light
transmissive panels and not be able to see through a second region
providing the desired visual field occlusion. Such LCD panels
having a voltage applied across the liquid crystals in the second
regions as controlled by the processor 90 automatically or under
the control of a clinician using the input device 92. It should be
understood that in such embodiments, the desired prismatic effect
may be achievable by attaching prisms adjacent the TN LCD screens,
for example, in a substantially similar manner to the use of the
prisms in the eyewear of the previously described embodiments of
the invention with respect to FIGS. 2, 4 and 5. In addition, it
would be further advantageous for such eyewear to be goggles or to
include an opaque insert between any gap between such eyewear and
the patients cheeks or other facial structures to the view of the
patient's arm(s).
[0039] It should be readily understood that the general purpose
computer is depicted in FIG. 7 as the video processor 90 for ease
of illustration and is not intended to be a limitation of the
invention. Suitable alternative video processor configurations are
useable with the present invention including, for example,
application specific video processors wearable by a patient or
incorporated into the eyewear 60. Moreover, for greater freedom of
movement by a patient the communication line 100 may be flexible
communication cable or fiber optic cable or may be a wireless link
using, for example, the Bluetooth or Zigbee wireless communication
standard, or an infra-red communications link.
[0040] Further, the exemplary embodiment depicted in FIG. 7
includes separate display screens 70 and 75. However, in
alternative embodiment a single display screen in, for example,
goggles for eyewear 60 is useable with present invention wherein
the single display screen is configured to operate in, for example,
a split configuration to provide respective images to a patient's
left and right eyes based upon display signals received from the
video processor 60.
[0041] In addition, the exemplary embodiment 50 includes separate
cameras 80 and 85 for illustration purposes only. A single camera
disposed on, for example, a bridge area 68 may also be useable in
accordance with the invention, especially with the use of a single
display screen with the eyewear.
Exemplary Methods of Using Certain Embodiments of the Invention
[0042] The embodiments of the invention are useful for treating a
neurocognitive impairment, disease or disorder, an example of which
is spatial neglect. In one embodiment of the invention, the
treatment used is PAT as described in "Prism Adaptation to a
Rightward Optical Deviation Rehabilitates Left Hemispatial
Neglect," Nature, 395(6698), 166-169 (1998), incorporated herein by
reference. PAT is a visuomotor procedure involving target-oriented
arm movement guided by prism-shifted vision. The treatment
typically begins by determining a patient's pre-exposure baseline
measurement of pointing performance. After the baseline is
measured, eyewear comprising at least one lens having a prism
mounted thereon is donned by the patient. The visual field occluder
of the invention is placed onto the patient such that the visual
field occluder is releasably worn by the patient, as shown in FIG.
2. In another embodiment of the invention, the eyewear worn by the
patient has the visual field occluder already attached thereon
(FIG. 5). The patient is then exposed to prismatic displacement to
produce adaptation, followed by measurement of post-exposure
after-effect of adaptation persistence. The preceding is presented
in greater detail in Example 1 below.
EXAMPLES
[0043] The disclosure is further illustrated by the following
examples, which are not to be construed as limiting this disclosure
in scope or spirit to the specific procedures herein described. It
is to be understood that the examples are provided to illustrate
certain embodiments and that no limitation to the scope of the
disclosure is intended thereby. It is to be further understood that
resort may be had to various other embodiments, modifications, and
equivalents thereof which may suggest themselves to those skilled
in the art without departing from the spirit of the present
disclosure and/or scope of the appended claims.
Example 1
Prism Adaptation Treatment Using Embodiments of the Invention
[0044] In this Example, a patient underwent the Kessler Foundation
Prism Adaptation Treatment (KF-PAT.TM.) for left-sided spatial
neglect (after right-brain damage) using the wearable system of the
invention. The same principles and systems apply for treating
right-sided spatial neglect.
I. Determination of Patient Eligibility
[0045] Patients with spatial neglect were defined by standardized
assessment. To detect the presence and measure the severity of
spatial neglect, the Kessler Foundation Neglect Assessment Process
(KF-NAP.TM.) was used. But the Catherine Bergego Scale, the
Behavioral Inattention Test (BIT), the Bells test, the Apples test
or other established tests detecting and measuring spatial neglect
can also be used. Patients were not eligible if they had a history
of vertigo (a result of a disturbance of the body's balancing
mechanism, located in the inner ear).
[0046] Apparatus
[0047] The following tools were used to complete the
KF-PAT.TM.:
[0048] Prism Goggles: For patients with left-sided spatial neglect
(after right-brain damage), prism lenses with the thicker part on
the left could be used. For example, 20-diopter prism lenses
shifted the entire visual field 11.3 degrees to the right. An
opaque frame was used to block peripheral vision.
[0049] Position Board: Three white rectangles indicating the left,
center, and right positions were used. Each white rectangle had a
central marker at the edge facing the therapist.
[0050] Ruler Board: Zero was marked at the center of the board.
Centimeters (cm) were marked to the left/right of the board.
Positive was going right; negative is going left (relative to the
patient).
[0051] Visual-proprioceptive task (VPT) Box: The board stood
upright for patient to point under during the visual-proprioceptive
pointing task.
[0052] Visual Field Occluder (VFO): To block the view of the
initial arm movement from the patient during prism adaptation. The
visual field occluder of FIG. 1 of the invention was used.
II. Basic Principles of KF-PAT.TM.
[0053] During the visual-proprioceptive pointing task or during the
prism adaptation, if the patient was unable to locate the target
(the pen, line, or circle), up to five verbal cues were given. For
example, "Look more to the left. Keep looking to the left. Turn
your head more. Turn your neck more." The therapist provided the
verbal cues from the midline of the patient (rather than talking to
the patient from his/her left or right side). If the patient was
still unable to locate the target after five cues, the trial was
skipped and moved on to the next.
[0054] The therapist's position was set right in front of the
patient. This principle was directly related to the previous one.
All auditory cues from the therapist came from the center. The
following additional cues were acceptable: [0055] a. During pre-
and post-prism visual-proprioceptive pointing tasks, a pen was
wiggled or a brightly-colored pen as the target was used. [0056] b.
During prism adaptation, the therapist used his/her finger to trace
the line or the circle while giving verbal instructions, the
patient was not asked to follow an object or the therapist's finger
from the center to the side.
[0057] Patient's movement always started from the body center. The
patient was initially reminded/cued for each movement. Additional
cues were provided for remainder of treatment as needed.
[0058] Extra practice was given for a patient with severe neglect.
When a patient with very severe neglect was encountered, the
patient was given a practice session. The patient was asked to
bisect lines and circles without the goggles of the invention.
During the practice, the patient was asked to trace the line or
touch the circle before the actual bisecting and marking.
Optionally, his/her head or his/her arm was toward the left. This
practice helped familiarize the patient with the task prior to the
actual treatment session.
III. Performance of a Therapy Session Using Embodiments of the
Invention
[0059] Tasks were administered in the following order:
Proprioceptive pointing, visual-proprioceptive pointing, prism
adaptation, proprioceptive pointing, visual-proprioceptive pointing
and determination of nausea. Repeating the pointing tasks before
and after prism adaptation was necessary to observe whether the
patient adapted to prisms. That is, the mean of the post-prism
pointing errors should be a smaller value or more negative than the
mean of the pre-prism pointing errors, indicating a leftward shift
of pointing behavior. This is called prism aftereffect. Research
suggested that those who did not show prism aftereffect may receive
little therapeutic benefit from the PAT.
[0060] 1. Proprioceptive Pointing
[0061] Apparatus Used: Position board, ruler board, eye mask (or
disposable mouth-nose mask), KF-PAT.TM. administration and data
sheet and pen.
[0062] Set up: The patient was positioned at the center of a table,
preferably adjusted to a comfortable height. An eye mask was placed
on the patient. The therapist sat directly in front of the patient
and aligned the center of the ruler board and the center of the
position board to the midline of the patient. Thus, zero was at the
patient's center. Positive numbers went towards the patient's right
(therapist's left).
[0063] Verbal instructions were given: [0064] First Trial: "I am
going to blindfold you now. Without looking at your hand I would
like you to make a fist and bring your hand to your chest. Then,
point your index finger straight ahead of you until your arm is
fully extended." [0065] Subsequent Trials: "Good. Bring your hand
to your chest, and point straight ahead." [0066] Directions to
Therapist: [0067] The deviation from 0 was written down, noting "+"
for right-sided deviation and "-" for left-sided deviation (related
to the patient's perspective). [0068] After each trial, the patient
was reminded to return his/her hand to his/her chest as needed.
[0069] 2. Visual-Proprioceptive Pointing [0070] Apparatus: Position
board, ruler board, VPT box, opaque apron or cloth, KF-PAT.TM.
administration and data sheet and pen.
[0071] Set up: The patient was positioned at the center of the
table. The position board was laid on the table. The VPT Box was
set up, wherein the side with the central markers was facing
towards the therapist. An apron or cloth was draped over the
patient's shoulders and top of the tabletop board so he/she was
unable to see his/her arms and hands. The center of the position
board was aligned with the midline of the patient.
[0072] Verbal Instructions were given: [0073] First Trial: "Now I
am going to hold up my pen. What I would like you to do is start by
making a fist and bringing your hand to your chest. Then, reach
ahead to point at the pen. The pen is on/in the
(left/right/center)" [0074] Subsequent Trials: "Good. Bring your
hand to your chest. Now point to the pen on/in the
(left/right/center)"
[0075] 3. Prism Adaptation
[0076] Apparatus: Prism goggles, position board, KF-PAT.TM.
administration and data sheet, visual field occluder (VFO) of the
present invention, marker and visuomotor exercise sheets.
[0077] Set up: As shown in FIG. 4, the position board was placed on
the table and centered to the patient's body. The visual field
occluder of the invention was placed on the patient. The prism
goggles were placed on the patient. The therapist sat directly
across from the patient. It was ensured that the patient was able
to see all 3 white boxes on the position board. If not, the VFO or
the height of table was adjusted as needed.
[0078] Verbal Instructions were given and results recorded: [0079]
First Trial: "Now that you are wearing the prism goggle, I would
like you to take this marker, bring your hand to your chest, and
then mark the center of the (line/circle) that is located to your
(left/right/center)" [0080] Subsequent Trials: "Good. Bring your
hand back to your chest; now mark the center of the (line/circle)
to your (left/right/center)."
[0081] 4. Nausea Profile
[0082] The nausea profile was a seventeen-item questionnaire used
to provide information whether the patient was experiencing
negative side effects of the prisms. The therapist administered the
nausea profile immediately after each of the first three
sessions/days of PAT. If the patient showed no signs of nausea, the
questionnaire was discontinued after the third day. If the patient
did show signs of nausea, the therapist continued to administer the
nausea profile for the rest of the sessions. If symptoms were
severe, the therapist discontinued the treatment.
Example 2
Results of Prism Adaptation Therapy Session
[0083] Following the therapy session from Example 1, and as shown
in FIG. 6, patients with perceptual-attentional "where" bias only
(n=7) showed no improvement after KF-PAT.TM., while those with
motor-intentional "aiming" bias only (n=5) or both types of bias
(n=12) demonstrated continuous functional recovery. The results
suggested that KF-PAT.TM. using the visual field occluder of the
invention may selectively improve function in neglect patients with
motor-intentional "aiming" deficits. Goedert, K. M., Chen, P.,
Boston, R., Foundas, A. L., & Barrett, A. M. (2014). Presence
of motor-intentional aiming deficit predicts functional improvement
of spatial neglect with prism adaptation. Neurorehabilitation and
Neural Repair, 28(5), 483-492.
[0084] The invention is further described by the following numbered
paragraphs:
1. A wearable system for treatment of a neurocognitive impairment,
disease or disorder in a patient in need thereof, comprising:
[0085] a visual field occluder releasably worn by the patient
during the treatment comprising an opaque screen and attachment
system, the attachment system configured to releasably attach the
visual field occluder onto the patient.
2. The wearable system according to paragraph 1, further comprising
eyewear worn by the patient with at least one lens having a prism
mounted thereon. 3. The wearable system according to paragraph 1,
wherein the neurocognitive impairment, disease or disorder
comprises spatial neglect. 4. The wearable system according to
paragraph 2, wherein the prism is rotatable. 5. The wearable system
according to paragraph 1, wherein the opaque screen is comprised of
a paperboard, fiberboard, foam board, plastic, metal, wood,
fiberglass or textile material or combinations thereof. 6. The
wearable system according to paragraph 1, wherein the visual field
occluder further comprises adjusting mechanism to adjust the opaque
screen vertically, horizontally or angularly relative to the visual
field of the patient. 7. The wearable system according to paragraph
1, wherein the attachment system is comprised of one or more
straps, wires or tubing or combinations thereof. 8. The wearable
system according to paragraph 1, wherein the attachment system
releasably attaches the visual field occluder around the torso of
the patient. 9. The wearable system according to paragraph 1,
wherein the attachment system releasably attaches the visual field
occluder around the neck of the patient. 10. The wearable system
according to paragraph 1, wherein the system is portable. 11. The
wearable system according to paragraph 1, wherein the wearable
system is used in conjunction with a table-top device housing
targets used in a prism adaptation procedure. 12. A method of
treating a neurocognitive impairment, disease or disorder in a
patient in need thereof, comprising the steps of:
[0086] placing eyewear onto the patient, the eyewear comprising at
least one lens having a prism mounted thereon;
[0087] placing a visual field occluder onto the patient such that
the visual field occluder is releasably worn by the patient to
substantially block visual feedback of arm movement of the patient
during the treatment; and
[0088] performing a prism adaptation procedure with the
patient.
13. The method according to paragraph 12, wherein the
neurocognitive impairment, disease or disorder comprises spatial
neglect. 14. The method according to paragraph 12, further
comprising an initial step of determining a pre-exposure baseline
measurement of pointing performance prior to placing the eyewear
onto the patient. 15. The method according to paragraph 12, wherein
the prism adaptation procedure comprises the steps of:
[0089] exposing the patient to prismatic displacement to produce
adaptation; and
[0090] measuring post-exposure after-effect of adaptation
persistence.
16. Eyewear for treatment of a neurocognitive impairment in a
patient in need thereof, comprising:
[0091] a frame;
[0092] at least one lens having a prism mounted thereon; and
[0093] a visual field occluder attached to the frame comprising an
opaque screen; the visual field occluder configured to
substantially block visual feedback of arm movement of the patient
when the eyewear is worn during the treatment.
17. The eyewear according to paragraph 16, wherein the prism is
rotatable. 18. The eyewear according to paragraph 16, wherein the
opaque screen is comprised of a paperboard, fiberboard, foam board,
plastic, wood, fiberglass or textile material or combinations
thereof. 19. The eyewear according to paragraph 16, wherein the
visual field occluder further comprises an adjusting system, the
adjustment system configured to enable adjustment of the opaque
screen vertically, horizontally or angularly relative to the visual
field of the patient. 20. The eyewear according to paragraph 16,
wherein the opaque screen is retractable. 21. The eyewear according
to paragraph 16, wherein the eyewear is a pair of eye glasses. 22.
The eyewear according to paragraph 16, wherein the eyewear is a
pair of goggles. 23. A wearable system for treatment of a
neurocognitive impairment, disease or disorder in a patient in need
thereof, comprising:
[0094] eyewear having at least one display screen configured to be
visible by at least one eye of a patient and otherwise blocking a
portion of the patient's view beyond the eyewear for the at least
one eye;
[0095] at least one camera disposed on the eyewear configured to
capture video images in front of the eyewear; and
[0096] a video processor coupled to the at least one display screen
and the at least one camera, the video processor configured to
provide video images captured by the camera to the at least one
display screen; the video images including a selectable prismatic
effect and blocking of substantial portions of arm movement of the
patient when worn by the patient.
24. The wearable system according to paragraph 23, wherein the at
least one camera and at least one display screen includes at least
one respective camera and display screen for each eye of the
patient. 25. The wearable system according to paragraph 23, wherein
the coupling of the video processor to the at least one display
screen and the at least one camera includes at least one wireless
coupling. 26. The wearable system according to paragraph 23,
wherein the neurocognitive impairment, disease or disorder
comprises spatial neglect. 27. The wearable system according to
paragraph 26, wherein the selectable prismatic effect is to select
the magnitude and the direction of a visual-field shift. 28. The
wearable system according to paragraph 23, wherein the video
processor enables adjustment of the blocking portion of the
displayed video images vertically, horizontally or angularly. 29.
The wearable system according to paragraph 24, wherein the video
processor further comprises an output configured for providing
video display signals to a second display. 30. The wearable system
according to paragraph 23, wherein the eyewear is eye glasses. 31.
The wearable system according to paragraph 23, wherein the eyewear
is goggles. 32. A wearable system for treatment of a neurocognitive
impairment, disease or disorder in a patient in need thereof,
comprising:
[0097] eyewear having at least one light transmissive panel
configured to be visible by at least one eye of a patient, said
panel having a first region without an obstructive view and a
second region selectively blocking said patient's view;
[0098] a prism mounted on said panel; and
[0099] a processor coupled to the at least one panel, the processor
configured to control the selective blocking of said second region
to substantially block visual feedback of arm movement of the
patient when the eyewear is worn during the treatment.
REFERENCES
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Barrett, A. M. (2014). Presence of motor-intentional aiming deficit
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be understood that the invention is not limited to the particular
embodiments of the invention described above, as variations of the
particular embodiments may be made and still fall within the scope
of the appended claims.
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