Nervous System Diseases

Immune System Diseases

All Conditions

Symptoms and General Pathology

Heart and Blood Diseases

Nutritional and Metabolic Diseases

Gland and Hormone Related Diseases

Musculoskeletal Diseases

Wounds and Injuries

Behaviors and Mental Disorders

Neoplasms

Skin and Connective Tissue Diseases

Multiple Sclerosis

Sclerosis

Stroke

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Brain Injuries

Cognition Disorders

Cognitive Dysfunction

Parkinsonian Disorders

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Brain Diseases

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Movement Disorders

Synucleinopathies

Neurodegenerative Diseases

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Demyelinating Autoimmune Diseases, CNS

Autoimmune Diseases of the Nervous System

Demyelinating Diseases

Craniocerebral Trauma

Trauma, Nervous System

Neurocognitive Disorders

Mental Disorders

Psychotic Disorders

inertial sensor based system (wearable sensors, LEGSys, Biosensics LLC) will be used for balance training with computerized feedback. The balance training program is focused on lower extremities including ankle joint exercise and virtual obstacle crossing tasks.

The control group will ask to perform a home based program includes similar exercise components as proposed in the experimental group, however without computerized feedback. Exercises include postural balance tasks, such as backward and forward weight shifting, as well as dynamic balance exercises, such as marching in place (comparable to virtual obstacle crossing in experimental group).

Subjects will perform progressive and computerized foot and ankle exercises which include weight shifting, ankle reaching task while standing, and virtual obstacle crossing task (i.e. balancing on single leg) using wearable sensors technology (Exergaming) equipment). Subjects will perform these exercises for 4-6 weeks, twice per week. The duration of exercise per session is anticipated to be 30-45 minutes.

Exergame

Subjects in the control group will ask to perform a standard home based balance program for 4-6 weeks. The home based program includes similar exercise components as proposed in the experimental group, however without computerized feedback and Exergaming equipment.

Home based balance training

Bijan Najafi, PhD

Bijan S Najafi, PhD

Explore the benefit of the game-based virtual reality system in improving lower extremity kinematics and balance in patients suffering from disease/disorders including Diabetes, Cancer, Multiple Sclerosis, Arthritis, Parkinson's disease, Cognitive Disorders, Brain Injury, Stroke or Frailty. A four to six weeks of training with 2 training session/week will be provided.

Individuals suffering from certain disorders/diseases including diabetes, arthritis, cancer, osteoarthritis, stroke, Parkinson's disease, cognitive impairment or brain Injury are more likely to experience a fall or a fall-related injury than healthy individuals during to impaired postural stability or diminished joint perception. Under certain circumstance they may also experience pain, depression, anxiety, and a decreased quality of life. The investigators' research has been designed to provide exercise training using non-invasive body-worn sensors (similar to those used in an iPhone®) to provide real-time visual information about joint motion in a virtual environment. These sensors will be worn using a vest, t-shirt or elastic band. The investigators will, 1) assess changes in participant's perception of lower extremity position while they perform these exercises; 2) motivate and guide simple exercise performance in the clinic/home, using an interactive game-like scheme; and 3) assess changes in participant's postural stability and gait as a result of provided exercise training. The information gathered will provide new understanding about more helpful rehabilitation strategies that improve postural stability in patient population.

Exploring the Effectiveness of Sensor-based Balance Training on Patient Outcome Measures

Balance will be quantified by measuring area of sway of center of mass (with unit of cm2) during quite standing according to Romberg's protocol and using validated instrument (BalanSens, Biosensics, MA, USA)

Gait Speed (with unit of m/sec) will be measured using validated wearable technology (LEGSys, Biosensics, MA, USA) and during walking with habitual and fast speed walking

Stride Length (with unit of meter) will be measured using validated wearable technology (LEGSys, Biosensics, MA, USA) and during walking with habitual and fast speed walking

Stride time (with unit of second) will be measured using validated wearable technology (LEGSys, Biosensics, MA, USA) and during walking with habitual and fast speed walking

Average of walking steps (no unit) per day will be measured during 48 hours of daily physical activity monitoring using a validated wearable sensor technology (PAMSys, Biosensics, MA, USA)

Daily average of walking bout (continuous walking without stop, with unit of steps) will be measured over 48 hours monitoring of physical activity using a validated wearable sensor technology (PAMSys, Biosensics, MA, USA)

Daily average of standing bout (continuous standing without changing in posture with unit of seconds) will be measured over 48 hours monitoring of physical activity using a validated wearable sensor technology (PAMSys, Biosensics, MA, USA)

Daily average of longest walking bout (longest continuous walking without stop per day, with unit of steps) will be measured over 48 hours monitoring of physical activity using a validated wearable sensor technology (PAMSys, Biosensics, MA, USA)

University of Arizona

Professor of Surgery

Eye Diseases

Brain Injuries, Traumatic

Brain Neoplasms

Vision, Low

Hemianopsia

Central Nervous System Neoplasms

Nervous System Neoplasms

Vision Disorders

Sensation Disorders

Neurologic Manifestations

Blindness

Quality of Life

The patients will undergo baseline assessment and receive the intervention, being assessed after the intervention.

The patients will perform the same tests for assessment as in group A, however, no intervention will be done. They may enrol in the study as group B after completing group B participation.

The training of oculomotor functions is done on the biofeedback module of a microperimeter MAIA.

Biofeedback training

MONICA DAIBERT NIDO, MD

Monica Daibert Nido, MD

Patients with brain injury secondary to stroke, surgery, or trauma frequently suffer from homonymous hemianopia, defined as vision loss in one hemifield secondary to retro- chiasmal lesion. Classic and effective saccadic compensatory training therapies are current aim to reorganize the control of visual information processing and eye movements or, in other words, to induce or improve oculomotor adaptation to visual field loss. Patients learn to intentionally shift their eyes and, thus, their visual field border, into the area corresponding to their blind visual field. This shift brings the visual information from the blind hemifield into the seeing hemifield for further processing. Patients learn, therefore, to efficiently use their eyes "to keep the 'blind side' in sight". Biofeedback training (BT) is the latest and newest technique for oculomotor control training in cases with low vision when using available modules in the new microperimetry instruments. Studies in the literature highlighted positive benefits from using BT in a variety of central vision loss, nystagmus cases, and others.The purpose of this study is to assess systematically the impact of BT in a series of cases with hemianopia and formulate guidelines for further use of this intervention in vision rehabilitation of hemianopia cases in general.

Background

Patients with brain injury secondary to stroke, surgery, or trauma frequently suffer from homonymous hemianopia, defined as vision loss in one hemifield secondary to retro- chiasmal lesion. About 45% of stroke survivors have homonymous hemianopia. A deficit in vision and spatial perception can cause slowdown of the rehabilitation progress in physiotherapy.

According to Kerkhoff 1patients face three main visual behavioral problems: (1) impaired eye movements (including saccades) leading to defective visual and spatial exploration, (2) hemianopic reading deficit (hemianopic alexia) because of the parafoveal field loss and (3) deviated subjective midline. 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.

Most important, the capability to read is fundamental for daily living and an essential prerequisite for education and success in our modern society, so this disorder can have a profound effect on patients' lives. Patients with visual field loss usually fail to adapt to their reading impairment (80% of cases). In these cases, word identification and the abilities to plan and guide reading eye movements are disturbed.

In spite of these facts, visual rehabilitation program on a larger scale is still missing in most rehabilitation centers and clinics. This is decurrent to the generalized belief that lesions of the lateral geniculate nucleus and striate cortex lead to a permanent loss of vision. According to scientific findings, this does not always have to be true.

Classic and effective saccadic compensatory training therapies are current.5 They aim to reorganize the control of visual information processing and eye movements or, in other words, to induce or improve oculomotor adaptation to visual field loss. Such therapies involve the systematic and repetitive practice of specific eye movements for reading or for visual exploration. Patients learn to intentionally shift their eyes and, thus, their visual field border, into the area corresponding to their blind visual field. This shift brings the visual information from the blind hemifield into the seeing hemifield for further processing. Patients learn, therefore, to efficiently use their eyes "to keep the 'blind side' in sight". The training-induced, efficient oculomotor adaptation to visual field loss becomes manifest as a change of reading (or visual exploration) eye-movement patterns and indicates the functional reorganization of the control of visual information processing and eye movements.6

Biofeedback training for active eye movement control was never used in hemianopia cases before. Biofeedback training (BT) is the latest and newest technique for oculomotor control training in cases with low vision when using available modules in the new microperimetry instruments.7-9 Studies in the literature highlighted positive benefits from using BT in a variety of central vision loss, nystagmus cases, and others.10-18 The purpose of this study is to assess systematically the impact of BT in a series of cases with hemianopia and formulate guidelines for further use of this intervention in vision rehabilitation of hemianopia cases in general.

Rationale for the study

The deviation of the subjective midline in hemianopia cases brings visual perception from a line of objects in the surrounds to be at a much higher-level of perception/cognition, thus disturbing reading, gait and balance. Besides that, impaired saccades also cause wrong exploration patterns and deteriorated visual search. It results in the prolonged exploration time of a scene and can lead to significant problems in daily life such as inability to navigate around various obstacles (cars, people and other objects). It also causes a cognitive deficit while extracting information from a visual scene. 1 A combination of factors such as reduced contrast sensitivity, impaired visual search and inaccurate fixation contributes to the matter.

Visual information extraction from the parafoveal visual field provides the basis for planning and guiding of reading eye movements. Therefore, patients with hemianopia have difficulties in shifting their gaze systematically from left to right (in right-sided field loss) or finding the beginning of a new line (in left sided field loss). Such eye movements are optimized by visual feedback. BT promotes luminous and auditory biofeedback, which potentializes its efficacy in vision rehabilitation.

BT in the microperimeter module provides the accurate and efficient oculomotor training necessary to relocate the subjective midline to the seeing field in 1-20 or even more, as needed. BT also improves dramatically fixation stability and saccades. The advantage of this training method over classic training is potentially great. Firstly, the highest retinal sensitivity convenient point can be identified considering the whole visual field. The microperimeter provides real time scrutiny of ocular movements on a screen, and the therapist is able to select precisely the trained retinal locus (FFT) to be used by the patient on top of the microperimeter visual field. Finally, according to the patients' response the FFT can be readjusted. Eight cases trained with BT for hemianopia in our low vision rehabilitation (LVR) service had marked improvements in fixation stability, and microperimeter fields.

Expansion of visual space in the direction of the blind field and compression of visual space in the direction of the seeing field may be a contributory factor to the altered perception of their egocentric directional sense and overall more veridical mapping of their visual space, as well as the resultant shift in their positional centre of gravity. We hypothesize that BT promotes this field relocation.

Conventional visual exploration training studies have confirmed that 10 to 25 training sessions in a 6-week period can be effective for hemianopia patients to adopt these strategies. BT is able to achieve significant results in 5 weekly sessions of 20 minutes each, according to 8 cases treated in our service.

Study hypothesis

The visual and audio parts of the BT program improve in a synergistic way oculomotor control through attention improvement and volitional eye movements towards pre-designated targets. Improved oculomotor control results in better fixation stability of eyes. Better fixation stability in turn results in better navigation for distance and near vision reading. Dual sensory BT is a therapy used in low vision for more than ten years, showing good results for near and distance vision in cases with macular degeneration and other pathologies. The study hypothesis, never tested before, is that BT in cases with hemianopia will impact positively oculomotor control and visual acuity as it was proven to do in cases with macular degeneration.

Significance of the study

Vision is a major sensory input to the human brain. Half of the afferent neuronal fibers projecting to the brain originate from the eyes. Intact visual abilities are an important condition enabling us to orient ourselves in our world. Pambakian and Kennard 20 reported that 50% of all neurological admissions into hospitals in the United Kingdom are due to a stroke and 30% percent of them are reported to have hemianopia.

Numbers of hemianopic patients reported in the Czech Republic are similar and somewhat lower due to differences in diagnostics and classification of nosological units.21 Visual impairments are present in 20 to 40% of patients in neurological rehabilitation centers.

If brain visual plasticity is possible to be achieved from conventional vision training methods, specialized training with BT needs to be investigated as a tool to improve significantly a cortical visual disorder. There is need for simple and more effective visual training which could be used in LVR in large scale for hemianopia cases. Furthermore, BT needs to be evaluated in terms of quality of life (QoL) improvement to the patients.

The objectives set for this trial is to verify if BT impacts on oculomotor control in cases with hemianopia and results in better fixation stability, reading speed and QoL in those trained with BT.

A group of patients have the intervention and another group has control tests. The control group crosses over to the interventional group

The assessor does not know if the patient is in the control group, treatment group or cross over group.

Biofeedback for Hemianopia Vision Rehabilitation

Biofeedback Training to Improve Fixation Stability, Visual Function Outcomes, and Quality of Life in Hemianopia Cases

As measure by the MAIA microperimeter at the BCEA 63% ellipse area.

Paracentral (2 central vertical columns) and total average in dB as measured by the MAIA microperimeter.

Measured with the Colenbrander 100% charts

As measured with the Massof - 48 questionnaire

University of Toronto

University Health Network, Toronto

Assistant Professor

Infections

Diseases and Abnormalities at or Before Birth

Inflammation

Communicable Diseases

Congenital Abnormalities

Ischemic Stroke

Ischemia

Central Nervous System Infections

Vascular Malformations

Hemorrhagic Stroke

Central Nervous System Vascular Malformations

Disease Attributes

Cerebrovascular Disorders

Vascular Diseases

Cardiovascular Abnormalities

Nervous System Malformations

Micronutrients

All Drugs and Chemicals

Hematinics

Pharmaceutical Solutions

Iron

Ferrosoferric Oxide

Parenteral Nutrition Solutions

All subjects in the experimental arm will have a single intravenous dose of ferumoxytol (5 mg Fe/kg), to be administered 24 hours before the subject undergoes ferumoxytol-enhanced magnetic resonance imaging (MRI). These subjects will subsequently undergo surgery, and tissue analysis of surgically resected samples (specifically the number of iron-containing and non-iron-containing macrophages) will be correlated with imaging features on ferumoxytol-enhanced MRI.

Ferumoxytol

Correlative analysis for macrophage detection and quantification. This applies for all patients in the experimental arm who undergo ferumoxytol infusion.

Tissue Analysis

All subjects in the experimental arm who undergo ferumoxytol infusion will subsequently have MRI.

Magnetic Resonance Imaging

Michael Iv, MD

This pilot clinical trial study will assess the inflammatory response of brain tumors or other central nervous system conditions in pediatric and adult patients using ferumoxytol-enhanced MRI. Imaging features will be correlated with the number of inflammatory cells (macrophages) at histopathology. Determining the extent of inflammation associated with pathologies in the central nervous system may be helpful for diagnostic and prognostic purposes as well as monitoring treatment response of current and future immunotherapies.

In this study, we will establish the MR imaging characteristics of macrophages in malignant brain tumors and other CNS conditions in the pediatric and adult populations using ferumoxytol, an ultrasmall superparamagnetic iron oxide (USPIO) particle that is approved for the treatment of iron deficiency anemia in patients with chronic kidney disease. The investigators will correlate the MR signal of ferumoxytol uptake with the number of macrophages in surgical specimen at histopathology. This information may potentially offer clinicians a new means for risk stratification and monitoring treatment efficacy.

Using Ferumoxytol-Enhanced MRI to Measure Inflammation in Patients With Brain Tumors or Other Conditions of the CNS

MR Imaging of Inflammatory Responses in the Central Nervous System With Ferumoxytol-Enhanced MRI

Michael Iv

Clinical Assistant Professor

Digestive System Diseases

Ear, Nose, and Throat Diseases

Head and Neck Neoplasms

Deglutition Disorders

Participants with dysphagia received baseline testing of dysphagia and dysphagia handicap. Then received training on how to use a vibrotactile device for self training at home. They used the device for 3 months and returned for re-evaluation on testing of dysphagia and feedback on the device

Patients used the device for 60 trials of retraining swallowing at home each day and also had the device turned on throughout the day in automatic mode to intermittently trigger every few minutes to trigger a swallow for saliva control

Dysphagia retraining with device

Erin Kamarunas, PhD

The purpose of this study is to develop appropriate training methods and gather participant feedback on their use of the Passy Muir Swallowing Self-Training Device (PMSST). The PMSST is a small device that provides external vibratory stimulation to the larynx during swallowing and swallowing training. A secondary purpose of the study is to determine how 3 months of use of the PMSST affects swallowing physiology, brain activation, oral intake and quality of life. This was an uncontrolled pilot study aimed at gaining patient feedback on use of the vibratory device.

The investigators are currently developing the Passy Muir Swallowing Self-Trainer to continue treatment of dysphagia after the patient is discharged to home. The self-training device is worn around the neck with motors placed externally on the skin over the thyroid cartilage to provide vibratory stimulation to the larynx. The vibrations activate the sensory receptors inside the larynx which excite central nervous system (CNS) control for swallowing and can help the patient to initiate swallowing. Patients can use the self-training device at home to promote swallowing rehabilitation during daily swallowing practice. The device can also be programmed to vibrate at regular intervals throughout the day to promote saliva swallows. Using this method, the patient can continue their swallowing therapy independently and in a manner that is cost effective. A previous Phase I trial compared the clinical outcomes of 8 patients with chronic dysphagia using either an intramuscular electrical stimulation implant device or an external vibratory stimulator to practice swallowing daily at home. Functional outcomes of oral intake improved with both devices. As the external vibratory stimulation has the advantage of being external and completely noninvasive, it has been selected for further development as a self-training device. A second pilot study examined the effect of different frequencies of vibration on the swallowing frequency of healthy participants and found swallowing rate significantly increased from baseline when using a vibration of either 70 Hz or 150 Hz (Mulheren and Ludlow, 2017). Data has also been collected on the effect of different vibration characteristics on swallowing in participants who have swallowing problems after stroke (Kamarunas et al., in press).

Purpose: The purpose of this study is to allow patients with chronic dysphagia to use the Self-Trainer for daily swallowing practice in their home and collect feedback on device use and satisfaction and use. Objective information on the effectiveness of self-training for swallowing rehabilitation will also be gathered.

Objectives:

1. To develop and evaluate training for participants and caregivers to use the self-trainer.
2. To gather participant feedback on the use of the device after 3 months of daily practice.
3. To determine how 3 months of daily practice with the Passy Muir Swallowing Self-Trainer affects swallowing physiology, brain activation, oral intake, and quality of life in participants with chronic dysphagia.

Use of the Passy Muir Swallowing Self Trainer

Study of the Use of the Passy Muir Swallowing Self Trainer by Persons With Dysphagia

An ordinal scale of 7 levels of severity of swallowing disorder with 1 being the lowest level and 7 being the highest level.

Level 1 is Severe dysphagia Nothing per oral and unable to tolerate any per oral liquid/substance safely.

Level 2 is Moderately severe dysphagia, requires maximum assistance or use of strategies with partial per oral only, tolerates at least one consistency safely with total use of strategies.

Level 3 is Moderate Dysphagia, requires total assist, supervision, or strategies with two or more consistencies restricted.

Level 4 is Mild-moderate Dysphagia, Requires intermittent supervision/cueing, one or two consistencies restricted level 5 is Mild dysphagia: requires distant supervision may need one diet consistency restricted Level 6 Within functional limits, modified independence Level 7 Normal in all situations

Total handicap Score from 0 (no Handicap) to 100 (Severe Handicap)

Calibrated kinematic measures from videofluoroscopic imaging during a modified barium swallow study. Computed the change in peak elevation in millimeters during swallowing from the rest position before swallowing for two structures: the larynx and the hyoid bone. The peak elevation of the two structures were compared by subtracting the hyoid peak elevation from the laryngeal peak elevation. If the measure was positive the larynx was elevated to a greater degree than the hyoid bone resulting in vestibule closure and airway protection during the swallow.

The level of cortical activation for swallowing was measured using near infra-red spectroscopy. Overall blood oxygenation level during swallowing was compared with the level during a non activation period prior to swallowing. To compute Z scores, the change in overall level between swallowing and prior to swallowing was divided by the standard deviation of the level prior to swallowing. The Z scores measured prior to and post device use for 3 months were compared.

Passy Muir Inc.

James Madison University

Professor

Severe Adverse Event: Diagnosis of Aspiration Pneumonia

Patients using vibrotactile device over 3 months at home while practicing swallowing and to manage salivary by swallowing during waking hours

Laryngeal Vibrotactile Stimulation

Participants with dysphagia received external laryngeal vibrotactile stimulation to trigger swallowing for swallowing retraining. Participants received training on the device and were then given a device to take home for 3 months.

Passy Muir Swallowing Self Trainer: External vibratory stimulation to the larynx to trigger swallow reflex in patients with dysphagia

Age, Continuous

Sex: Female, Male

Race (NIH/OMB)

United States

Region of Enrollment

There are 7 levels of oral intake that are assigned by the examiner based on patient and caretaker reports or oral intake. These 7 levels are

1. Nothing by mouth (Severe)
2. Tube dependent with minimal attempts at food or liquid (Moderate/Severe)
3. Tube dependent with consistent oral intake (Moderate)
4. Total oral diet of a single consistency
5. Total oral diet with multiple consistencies, requiring special preparations or compensations
6. Total oral diet with multiple consistencies, without requiring special preparation, with specific limitations
7. Total oral diet no restrictions

Functional Oral Intake Scale

Dr. Erin Kamarunas

Examined change in DOSS for each participant from before to after three months of device use. Examined numbers of participants who showed either worsening of DOSS, no improvement in DOSS or improvement of DOSS.

Patients with Severe/Moderate to Severe dysphagia, chronic for more than 6 months, nutrition is by enteric means, may be able to ingest one consistencies with supervision

Change in Dysphagia Outcome and Severity Scale (DOSS) Rating

Pre Device use DHI score

Post Use DHI Score

Participants with dysphagia received external laryngeal vibrotactile stimulation to trigger swallowing

Dysphagia Handicap Index (DHI)

Patients using vibrotactile device over 3 months at home while practicing swallowing and to manage salivary flow by swallowing during waking hours

Only 5 patients were able to undergo a repeated modified barium swallow study after device use.

Laryngeal Elevation Relative to Hyoid Elevation for Vestibule Closure

Baseline evaluation before receiving a device

Baseline Before Device Use

After vibrotactile device over 3 months at home for practicing swallowing and to manage salivary flow by swallowing during waking hours

After Device Use for 3 Months

Same patients before and after device use

Cortical Activation for Swallowing

Participants with dysphagia received an external laryngeal vibratory stimulation device, The Passy Muir Swallowing Self Trainer, to assist with swallowing retraining. Participants and their caregivers received training to criterion on how to use the device and were then given a device to take home for 3 months for daily use in swallowing training and for saliva swallowing throughout the day. They were asked to use the device for a minimum of 60 practice trials of swallowing their own and to wear the device to assist with saliva swallowing. All participants were evaluated on their swallowing using modified barium swallow examination and patient questionnaires immediately before device training and on return 3 months later. They also completed questionnaires on the device characteristics on return.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Exploring the Effectiveness of Sensor-based Balance Training on Patient Outcome Measures	NCT02777060	Diabetes Cancer Multiple Sclero... Arthritis Parkinson's Dis... Cognitive Disor... Brain Injury Stroke	Exergame Home based bala...	18 Years -	University of Arizona
Biofeedback for Hemianopia Vision Rehabilitation	NCT05397873	Hemianopsia, Ho... Brain Injury Stroke Brain Tumor Brain Trauma	Biofeedback tra...	18 Years - 90 Years	University Health Network, Toronto
Using Ferumoxytol-Enhanced MRI to Measure Inflammation in Patients With Brain Tumors or Other Conditions of the CNS	NCT02452216	Brain Injury Central Nervous... Central Nervous... Central Nervous... Hemorrhagic Cer... Ischemic Cerebr... Primary Brain N... Brain Cancer Brain Tumors	Ferumoxytol Tissue Analysis Magnetic Resona...	2 Years -	Stanford University
Use of the Passy Muir Swallowing Self Trainer	NCT02848664	Stroke Brain Injury Head and Neck C...	Dysphagia retra...	13 Years - 100 Years	James Madison University
Use of the Passy Muir Swallowing Self Trainer	NCT02848664	Stroke Brain Injury Head and Neck C...	Dysphagia retra...	13 Years - 100 Years	James Madison University
Using Ferumoxytol-Enhanced MRI to Measure Inflammation in Patients With Brain Tumors or Other Conditions of the CNS	NCT02452216	Brain Injury Central Nervous... Central Nervous... Central Nervous... Hemorrhagic Cer... Ischemic Cerebr... Primary Brain N... Brain Cancer Brain Tumors	Ferumoxytol Tissue Analysis Magnetic Resona...	2 Years -	Stanford University
Biofeedback for Hemianopia Vision Rehabilitation	NCT05397873	Hemianopsia, Ho... Brain Injury Stroke Brain Tumor Brain Trauma	Biofeedback tra...	18 Years - 90 Years	University Health Network, Toronto

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