Visual perceptual remediation for individuals with schizophrenia: Rationale, method, and three case studies

Abstract

Objective: Few studies have evaluated the effects of visual remediation strategies in schizophrenia despite abundant evidence of visual-processing alterations in this condition. We report preliminary, case-study-based evidence regarding the effects of visual remediation in this population.

Method: We describe implementation of a visual-perceptual training program called ULTIMEYES (UE) and initial results through 3 brief case studies of individuals with schizophrenia. UE targets broad-based visual function, including low-level processes (e.g., acuity, contrast sensitivity) as well as higher level visual functions. Three inpatients, recruited from a research unit, participated in at least 38 sessions 3 to 4 times per week for approximately 25 min per session. Contrast sensitivity (a trained task), as well as acuity and perceptual organization (untrained tasks), were assessed before and after the intervention. Levels of progression through the task are also reported.

Results: UE was well tolerated by the participants and led to improvements in contrast sensitivity, as well as more generalized gains in visual acuity in all 3 participants and perceptual organization in 2 participants. Symptom profiles were somewhat different for each participant, but all were symptomatic during the intervention. Despite this, they were able to focus on and benefit from training. The adaptive nature of the training was well suited to the slower progression of 2 participants.

Conclusions and implications for practice: These case studies set the stage for further research, such as larger, randomized controlled trials of the intervention that include additional assessments of perceptual function and measures of cognition, social cognition, and functional outcomes. (PsycINFO Database Record

Figure 1

Game screenshot. Static search with distractors. Participants are asked to select the targets, and ignore the distractors. As levels progress, distractors look more and more like targets. Of note, both targets and distractors are typically much lower contrast than they appear here. Figure reprinted with permission from Deveau, Lovcik, et al., 2014.

Figure 2

Examples of Gabor-defined contours with different D values (D=ratio of mean background spacing and spacing between neighboring contour elements; i.e, left: D = 1.4, right: D = 0.85). In the bottom panels, Gabor elements were replaced by disks. Without orientation cues, the contour remains invisible at D < 1, and this is the range where perceptual organization depends on long-range spatial interactions. Note that these images only show the area around the contour. The actual test stimuli are much larger and consist of regions without contours (i.e., with background noise only). Figure reprinted with permission from Silverstein, Kovacs, Corry, & Valone, 2000.