Helping People With Partial Blindness

Durham Reading and Exploration (DREX) is the result of 10 years of research by experts in Durham's Department of Psychology.

A clinical trial of the home-based training programme recently won the Durham research team the 2015 British Psychological Society's William Inman prize.

Here Dr Alison Lane and Dr Stephen Dunne, of the Department of Psychology, explain how the (DREX) training came about and what its benefits could be.

What did you find in your research?
We have been developing a training tool to aid in the rehabilitation of individuals with a partial visual loss after brain injury who are impaired in many everyday activities such as reading and navigating safely around their environment. Our research involved the development and evaluation of a computer-based training programme aimed at helping such individuals to compensate for their loss of vision by increasing their visual awareness and ability to make effective eye movements. We found that simple training can lead to significant improvements in a variety of tasks including reading and finding objects, which also led to improvements in quality of life. In order to improve the ease and accessibility of the training, we have recently developed a multiplatform app, which is called Durham Reading and Exploration (DREX) training.

How did you carry out your research?
Individuals with visual field defects after brain injury were recruited from local hospitals to take part in a clinical trial. Half of the patients completed the DREX training, which involves a series of tasks that encourage exploration and which gradually get more difficult, thereby promoting more efficient eye movements. The other half of patients received control training which did not involve making any eye movements. The training was completed by users in their own homes and the feasibility of the training was examined. Various assessment tasks were performed both before and after training to investigate changing performance with regards to both visual functioning and everyday behaviours. Significantly greater gains were observed following DREX than the control intervention, and the majority of users required minimal assistance outside of an occasional phone call to check their progress.

Why is this research important?
Individuals with visual field defects are impaired on a wide variety of simple, everyday tasks such as reading, finding their way around, shopping and crossing the street, for instance. This reduces independence and has a negative impact on quality of life. The chances of meaningful recovery without intervention are low, making compensatory rehabilitation for such people important.

DREX is an effective, free and accessible training tool for individuals with visual impairment. The new training app further increases the ease of use and being multiplatform means that people can train with confidence using a device that they already own (e.g. laptop, Apple iPad or Android tablet). Once the app is downloaded, there is also no requirement for an internet connection thereby further widening access. The training is completed by users in their own homes in the absence of clinical supervision so that they are in control of their rehabilitation and can incorporate it into their everyday lives with minimal disruption. The DREX app has some built-in assessments that allow individuals to monitor their own performance and improvements with ease.

Another new feature of the DREX system is a web service for clinicians - https://apps.dur.ac.uk/drex/portal/login/. If the individual patient-user wishes to do so, they can share their data with their doctor using this confidential service. Once paired, the clinician can access the user's training and assessment results allowing them to monitor progress remotely and thereby suggest ways of maximising rehabilitation success.

What are the next steps?
The DREX app is available for download for free via Google Play and the Apple Store (search for DREX). Further details are also available via our Website: www.durham.ac.uk/drex. The aim is for the app to be freely available and to be used on a national level to help individuals with partial visual loss to compensate effectively in their daily life. We are currently working with various NHS Trusts to ensure that individuals who may benefit from the training can access it with ease. Furthermore, a clinical trial is planned for later this year to further validate the use of the training with touch-screen devices.

Who funded the research and who did you collaborate with?
The clinical trial determining the effectiveness of the computer-based training was funded by the National Institute for Health Research. The principal investigator was Professor Thomas Schenk (previously of Durham University), with collaborators from local NHS Trusts, including Professors David Mendelow and Gary Ford. Dr Lina Aimola was responsible for the data collection. The conversion of the training into a multiplatform app, the addition of the clinician web service, and subsequent work was funded by the Academic Health Science Network. Current Durham University staff members also involved in DREX include Dr Dan Smith and Dr Amanda Ellison. The research was published in Neurorehabilitation and Neural Repair.

Who do people contact if they want to know more?
Contact Dr Alison Lane, DREX Project Director, or Dr Stephen Dunne, DREX Project Manager, on + 44 (0)191 334 0105; email drex.training@durham.ac.uk.