Walsh & Hoyt: Treatment and Rehabilitation for Homonymous Hemianopia

Spontaneous recovery of homonymous visual field defects occurs in no more than 20% of patients within the first several months after brain injury. Thus, despite a certain amount of plasticity even in the adult cerebral cortex, patients with visual field defects have a consistently poor rehabilitation outcome. The exact anatomic location of the lesion causing the homonymous hemianopia does not appear to affect the functional outcome; however, the greater the number of associated neurologic deficits, the more difficult the rehabilitation and the poorer the functional performance. Contributing further to the poor functional improvement is the advanced age of most of these patients, a factor associated even in normal individuals with progressive cognitive, sensory, and motor deficits. Finally, the presence of neglect, especially in patients with nondominant hemisphere lesions, also interferes with the rehabilitation process.