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Schow T, Wehling EI, Falkenberg HK, Norup A, Kristensen KS. Assessment of visual problems after acquired brain injury: a survey of current practice in Danish hospitals. J Rehabil Med 2024; 56:jrm28793. [PMID: 38742932 PMCID: PMC11107834 DOI: 10.2340/jrm.v56.28793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES To explore current hospital practice in relation to the assessment of vision problems in patients with acquired brain injury. DESIGN A survey study. SUBJECTS A total of 143 respondents from hospital settings, with background in occupational therapy and physical therapy, participated in the survey. METHODS The survey questionnaire, developed collaboratively by Danish and Norwegian research groups, encompassed 22 items categorically covering "Background information", "Clinical experience and current practice", "Vision assessment tools and protocols", and "Assessment barriers". It was sent out online, to 29 different hospital departments and 18 separate units for occupational therapists and physiotherapists treating patients with acquired brain injury. RESULTS Most respondents worked in acute or subacute hospital settings. Few departments had an interdisciplinary vision team, and very few therapists had formal education in visual problems after acquired brain injury. Visual assessment practices varied, and there was limited use of standardized tests. Barriers to identifying visual problems included patient-related challenges, knowledge gaps, and resource limitations. CONCLUSION The study emphasized the need for enhanced interdisciplinary collaboration, formal education, and standardized assessments to address visual problems after acquired brain injury. Overcoming these challenges may improve identification and management, ultimately contributing to better patient care and outcomes in the future.
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Affiliation(s)
- Trine Schow
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark; Neurorehabilitation-Cph, Copenhagen, Denmark.
| | - Eike Ines Wehling
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Helle K Falkenberg
- Department of optometry, radiography and lighting design, University of South-Eastern Norway, Notodden, Norway
| | - Anne Norup
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark; Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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Sharp N, Hepworth LR. Treating Visual Inattention in Acute Stroke Survivors Using a Therapy Scanning Wall: A Proof-of-Concept Study. Br Ir Orthopt J 2023; 19:71-77. [PMID: 37577068 PMCID: PMC10417920 DOI: 10.22599/bioj.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Visual inattention is common following right hemisphere stroke, with up to 80% of patients being affected. Visual inattention following stroke is linked to poorer outcomes. There is no clear evidence for how visual inattention should be treated in the hospital inpatient setting. Objective To explore the practical implications and possible benefits of using a visual scanning wall in a stroke rehabilitation unit as an assessment and treatment tool for visual inattention. Methods This proof-of-concept study recruited stroke survivors with visual inattention. Participants used the scanning wall for scanning training five days a week for two weeks. Assessments using the scanning wall and modified Albert's test were conducted at baseline and at day 14. Both participants and staff delivering the training were asked to complete an acceptability questionnaire. Results All participants demonstrated an improvement in the number of pictures identified from baseline to day 14. There was a mean improvement of 9.20 (95% CI 4.77 to 13.63) in the 14 days. This is a statistically significant improvement in the scanning wall score between baseline line and day 14 (p = 0.01). All participants and staff reported the scanning wall as acceptable to use. Conclusion This proof-of-concept study has demonstrated the scanning wall could be used to assess for visual inattention in extra personal space. Also, it could be beneficial and is acceptable for the treatment of visual inattention within a hospital inpatient setting for acute stroke survivors.
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Affiliation(s)
- Natalie Sharp
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
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Xu M, Qian L, Wang S, Cai H, Sun Y, Thakor N, Qi X, Sun Y. Brain network analysis reveals convergent and divergent aberrations between mild stroke patients with cortical and subcortical infarcts during cognitive task performing. Front Aging Neurosci 2023; 15:1193292. [PMID: 37484690 PMCID: PMC10358837 DOI: 10.3389/fnagi.2023.1193292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Although consistent evidence has revealed that cognitive impairment is a common sequela in patients with mild stroke, few studies have focused on it, nor the impact of lesion location on cognitive function. Evidence on the neural mechanisms underlying the effects of mild stroke and lesion location on cognitive function is limited. This prompted us to conduct a comprehensive and quantitative study of functional brain network properties in mild stroke patients with different lesion locations. Specifically, an empirical approach was introduced in the present work to explore the impact of mild stroke-induced cognitive alterations on functional brain network reorganization during cognitive tasks (i.e., visual and auditory oddball). Electroencephalogram functional connectivity was estimated from three groups (i.e., 40 patients with cortical infarctions, 48 patients with subcortical infarctions, and 50 healthy controls). Using graph theoretical analysis, we quantitatively investigated the topological reorganization of functional brain networks at both global and nodal levels. Results showed that both patient groups had significantly worse behavioral performance on both tasks, with significantly longer reaction times and reduced response accuracy. Furthermore, decreased global and local efficiency were found in both patient groups, indicating a mild stroke-related disruption in information processing efficiency that is independent of lesion location. Regarding the nodal level, both divergent and convergent node strength distribution patterns were revealed between both patient groups, implying that mild stroke with different lesion locations would lead to complex regional alterations during visual and auditory information processing, while certain robust cognitive processes were independent of lesion location. These findings provide some of the first quantitative insights into the complex neural mechanisms of mild stroke-induced cognitive impairment and extend our understanding of underlying alterations in cognition-related brain networks induced by different lesion locations, which may help to promote post-stroke management and rehabilitation.
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Affiliation(s)
- Mengru Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Linze Qian
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Sujie Wang
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
| | - Huaying Cai
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Sun
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Nitish Thakor
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Xuchen Qi
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing, China
| | - Yu Sun
- Key Laboratory for Biomedical Engineering of Ministry of Education of China, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
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Hounslow R, Rohde A, Finch E. What is the usage of the Brisbane Evidence Based Language Test in clinical practice?: A speech language therapy survey. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023. [PMID: 36703552 DOI: 10.1111/1460-6984.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A number of practice barriers (e.g., time constraints, patient comorbidities and competing demands) exist as regards the evidence-based assessment of adult language within the acute hospital setting. There is need for an evidence-based, diagnostically validated, adaptable, comprehensive and efficient aphasia assessment. The Brisbane Evidence Based Language Test (EBLT) was developed to meet this need for a clinically appropriate and diagnostically robust assessment measure. Since the release of the EBLT, there has been no detailed investigation into speech and language therapists' (SLT) use and perceptions of the assessment. To inform future research and improvements to the EBLT, a better understanding of current language assessment practices, use and thoughts on the EBLT are required. AIMS To investigate SLTs' current language assessment practices; and to explore the current usage and future directions of the Brisbane EBLT. METHODS & PROCEDURES A convergent parallel mixed-methods study design with an electronic survey was utilized. The survey consisted of 16 multiple-choice, multiple-answer and free-text questions that explored respondents' perceptions of current language assessment measures, ideal language assessment features, Brisbane EBLT use, positives and negatives, and future directions for the EBLT. The survey was developed on Qualtrics and disseminated via email, social media and professional networks. Snowball sampling was used. Study inclusion criteria required participants to be qualified SLTs with clinical experience working with patients with aphasia. Quantitative data were analysed via descriptive and correlative statistics, and qualitative data were analysed via content analysis. OUTCOMES & RESULTS The survey was completed by 115 SLTs from Australia, New Zealand, the United States, the UK, Canada, France, Lebanon and Belgium. Many respondents identified that a range of assessments is required to meet SLT clinical needs in the assessment of aphasia. Key desirable assessment features reported were: comprehensive, efficient, evidence-based, responsive and flexible. The EBLT was the most frequently used standardized measure reported by respondents (used by 78.63%). The EBLT reportedly has many positive features; however, respondents indicated dislike of the form layout, scoring and responsiveness. The majority of respondents indicated that the development of additional EBLT tests (94.29%) and additional cut-off scores (95.15%) would benefit their clinical practice. CONCLUSIONS & IMPLICATIONS The study findings indicate that SLT assessment of language is complex and multifaceted. While the EBLT is reportedly used widely by SLTs, respondents identified areas for further research which would optimize the test's usability within their practice, to ultimately improve patient outcomes. WHAT THIS PAPER ADDS What is already known on the subject Previous studies have explored existing SLT adult language assessment practices within acute settings; however, the most recent comprehensive study was completed in 2010. In 2020, the development, diagnostic validation, intra- and interrater reliability of the Brisbane EBLT were published. As of yet there has not been an investigation into clinician use and perspectives of the assessment since its release. What this paper adds to existing knowledge This study provides contemporary data about international aphasia assessment practices, as well as descriptive and qualitative information on the current use of the Brisbane EBLT, and the positives, negatives, and future directions for the assessment measure. What are the potential or actual clinical implications of this work? The study suggests that no one language assessment currently satisfies all SLTs' assessment needs. It additionally implies that a large proportion of SLTs believe that it is best practice to use multiple language assessment measures and select these based on the patient's presentation and context. Further research is required to aid the development of additional EBLT test versions and cut-off scores to improve SLT adult language assessment practices.
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Affiliation(s)
- Rhiannon Hounslow
- School of Health and Rehabilitation Sciences, The University, of Queensland, Brisbane, QLD, Australia
| | - Alexia Rohde
- Australian Centre for Health Services Innovation, Kelvin Grove, QLD, Australia
- School of Public Health and Social Work, Brisbane, QLD, Australia
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University, of Queensland, Brisbane, QLD, Australia
- Speech Pathology Department Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
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Roushdy T, Mikhail NW, Abdelaziz SR. NIHSS is deficient in acute stroke presenting with cortical deafness; clinical skills remain the backbone: a case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:38. [PMID: 37009469 PMCID: PMC10041474 DOI: 10.1186/s41983-023-00645-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Background National institutes of health stroke scale (NIHSS) is used, since its appearance in analysis of stroke in any national or international single center or multicenter study. It is also the golden standard assessment scale for stroke patients whether by emergency medical services on the way to hospital or by emergency room staff and by neurologists whether juniors or senior consultants. Yet, it is not capable of identifying all stroke cases. Along the current case report a relatively rare case of cortical deafness is presented highlighting its rarity and its vascular mechanism as well as how defective is NIHSS in recognizing it.
Case presentation 72-year-old female patient presented with sudden episodic less than 60 min duration of bilateral deafness; initial imaging showed right hemispheric encephalomalacia of old stroke. Patient was initially managed as psychogenic case especially that her NIHSS was zero. On returning again to emergency room she was administered thrombolysis and regained full hearing power. Follow-up imaging revealed a new ischemic stroke along her left auditory cortex explaining her cortical deafness.
Conclusion Cortical deafness might be missed especially that NIHSS does not detect it. NIHSS role as the only golden standard scale for diagnosing and following up stroke cases ought to be revised.
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Affiliation(s)
- Tamer Roushdy
- grid.7269.a0000 0004 0621 1570Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
| | - Narges W. Mikhail
- grid.7269.a0000 0004 0621 1570Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
| | - Shaimaa Ramadan Abdelaziz
- grid.7269.a0000 0004 0621 1570Neurology Department, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
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Colwell MJ, Demeyere N, Vancleef K. Visual perceptual deficit screening in stroke survivors: evaluation of current practice in the United Kingdom and Republic of Ireland. Disabil Rehabil 2022; 44:6620-6632. [PMID: 34455876 DOI: 10.1080/09638288.2021.1970246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Visual perceptual deficits are frequently underdiagnosed in stroke survivors compared to sensory vision deficits or visual neglect. To better understand this imparity, we evaluated current practice for screening post-stroke visual perceptual deficits. METHODS We conducted a survey targeted at professionals working with stroke survivors involved in screening visual perceptual deficits across the United Kingdom and the Republic of Ireland. RESULTS Forty orthoptists and 174 occupational therapists responded to the survey. Visual perceptual deficit screening was primarily conducted by occupational therapists (94%), with 75∼100% of stroke survivors screened per month. Respondents lacked consensus on whether several common post-stroke visual deficits were perceptual or not. During the screening, respondents primarily relied on self-reports and observation (94%), while assessment batteries (58%) and screening tools were underutilised (56%) and selected inappropriately (66%). Respondents reported lack of training in visual perception screening (20%) and physical/cognitive condition of stroke survivors (19%) as extremely challenging during screening. CONCLUSIONS Visual perceptual deficits are screened post-stroke at a similar rate to sensory vision or visual neglect. Underdiagnosis of visual perceptual deficits may stem from both reliance on subjective and non-standardised screening approaches, and conflicting definitions of visual perception held among clinicians. We recommend increased training provision and use of brief performance-based screening tools.IMPLICATIONS FOR REHABILITATIONLack of agreement among clinicians on what constitutes as visual perceptual or sensory vision deficits may prove problematic, as precise and exact language is often required for clinical decision-making (e.g., referrals).Biases for more familiar visual (perceptual) deficits held among clinicians during the screening process may lead to other visual deficits being missed.To avoid problems being missed, clinicians should aim to use standardised assessments rather than stroke survivor self-report and observations of function when screening for visual perceptual difficulties.
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Affiliation(s)
- Michael J Colwell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Kathleen Vancleef
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Zhang N, Li C, Chen J, Liu X, Wang Z, Ni J. Research hotspots and frontiers about role of visual perception in stroke: A bibliometric study. Front Neurol 2022; 13:958875. [PMID: 36188385 PMCID: PMC9524359 DOI: 10.3389/fneur.2022.958875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background Visual perception is a dynamic process of perceiving the environment through sensory input and transforming sensory input into meaningful concepts related to environmental visual knowledge. Many studies focusing on the role of visual perception after stroke have been published in various journals. However, a bibliometric analysis in the domain of visual perception after stroke is still lacking. This study aimed to deliver a visual analysis to analyze the global trends in research on the role of visual perception after stroke in the last 10 years. Methods The literature was derived from the Web of Science core collection database from 2012 to 2021. The collected material was limited to English articles and reviews. CiteSpace and Microsoft Excel were used for bibliographic analysis. Results A total of 298 articles were included in the analysis. The annual number of publications increased from 23 to 42 in the last decade. Rehabilitation was the main research hotspot (n = 85). Journal of Physical Therapy Science published the largest number of papers (n = 14). The most influential author, institution, and country were Rowe FJ (n = 17), League of European Research Universities (n = 45), and England (n = 54), respectively. The keywords with the longest burst period are field defect, hemineglect, disorder, and quality of life. Conclusion This study analyzes the papers on the role of visual perception after stroke in the past 10 years and provides a new perspective for research in this field. At present, the number of articles in this field is not large and the cooperation network is not close enough. In the future, it is necessary to strengthen the cooperation among various countries, institutions, and authors. In addition, large samples and randomized controlled trials are needed to identify the potential treatments and pathophysiology for visual perceptual impairment after stroke.
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Affiliation(s)
- Nannan Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chong Li
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jianmin Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiahua Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhiyong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- *Correspondence: Zhiyong Wang
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Jun Ni
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Kim Y, Im S, Oh J, Jung Y, Jun SY. Detection of post-stroke visual field loss by quantification of the retrogeniculate visual pathway. J Neurol Sci 2022; 439:120297. [DOI: 10.1016/j.jns.2022.120297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
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Kaiser AP, Villadsen KW, Samani A, Knoche H, Evald L. Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects. Front Psychol 2022; 13:787382. [PMID: 35391965 PMCID: PMC8982678 DOI: 10.3389/fpsyg.2022.787382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.
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Affiliation(s)
- Alexander Pilgaard Kaiser
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Westergaard Villadsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Afshin Samani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark,*Correspondence: Lars Evald,
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Rowe FJ, Hepworth LR, Kirkham JJ. Development of core outcome sets and core outcome measures for central visual impairment, visual field loss and ocular motility disorders due to stroke: a Delphi and consensus study. BMJ Open 2022; 12:e056792. [PMID: 35304397 PMCID: PMC8935181 DOI: 10.1136/bmjopen-2021-056792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Reporting of research for stroke-related visual impairment is inconsistent. The aim of this study was to define three core outcome sets (COS) and related core outcome measurements (COM) for central visual impairment, visual field loss and ocular motility disorders in stroke research. DESIGN The consensus process consisted of an online three-round Delphi survey followed by a consensus meeting of key stakeholders. SETTING UK-wide survey. PARTICIPANTS Stakeholders included orthoptists, occupational therapists, ophthalmologists, stroke survivors and COS users such as researchers, journal editors and guideline developers. OUTCOME MEASURES For COS development, a list of potentially relevant visual outcomes was created after review of the literature and further grouped into outcome domains. For COM development, a list of potential instruments was created after review of the literature and quality appraised for reliability and validity. RESULTS COS-119 potential outcomes extracted from published literature. Similar assessment outcomes were grouped into 24 outcome domains. Delphi process included 123 participants in round 1, 65 round 2, 51 round 3. Twelve participants attended the consensus meeting with recommended outcome domains for central visual impairment (visual acuity, functional vision, quality of life), visual field loss (visual fields, functional vision, quality of life) and ocular motility disorders (eye alignment, eye movements, functional vision, quality of life). COM-52 test options extracted from the COS outcomes and grouped into 16 domains. Thirteen participants attended the COM consensus meeting. Recommended instruments for measurement of these outcomes include; Logarithm of the Minimal Angle of Resolution visual acuity, cover test, cardinal position eye movement assessments, peripheral visual field perimetry, Visual Function Questionnaire-25. CONCLUSIONS COS and COM are defined for vision research for stroke survivors. Their use has potential to reduce heterogeneity in routine clinical practice and improve standardisation and accuracy of vision assessment. Future research is required to evaluate the use of these COS and COM.
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Affiliation(s)
- Fiona J Rowe
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Lauren R Hepworth
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Centre for Biostatistics, Manchester University, Manchester Academic Health Science Centre, Manchester, UK
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Mathisen TS, Eilertsen G, Ormstad H, Falkenberg HK. 'If we don't assess the patient's vision, we risk starting at the wrong end': a qualitative evaluation of a stroke service knowledge translation project. BMC Health Serv Res 2022; 22:351. [PMID: 35296327 PMCID: PMC8925164 DOI: 10.1186/s12913-022-07732-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background Visual impairments (VIs) affect 60% of stroke survivors and have negative consequences for rehabilitation and quality of life poststroke. Symptoms of VIs post stroke are difficult to identify for stroke survivors and health care professionals without using a structured vision assessment. In this study, we qualitatively evaluate the implementation outcomes after implementing a structured visual assessment with the Competence, Rehabilitation of Sight after Stroke Vision (KROSS) assessment tool in stroke care services. Methods This is a qualitative study comprising four focus group interviews. The health care personnel (HCP) involved in the implementation or with experience using the KROSS assessment tool in practice were invited to participate. We used Proctor et al.’s definitions of implementation outcomes as a framework, which informed the interview guide and analysis. We used a deductive - inductive content analysis, as described by Elo and Kyngäs. Results The participants found the structured vision assessment with the KROSS tool as being acceptable; they expressed a motivation and intention to use the new routine in practice. They believed it was important to assess their patient’s visual function because it influenced other rehabilitation activities and activities of daily living. Most of the participants reported having adopted the vision assessment in their practice, except for those participants from the home care services who experienced that they have few stroke survivors to follow up on. The assessment was believed to be more appropriate to perform within the rehabilitation services where there is more of a focus on functional assessments. Although vision assessment was new to all the participants, they felt that they improved their vision assessment skills by regularly using the assessment tool. Together with sufficient instructions and supervision, they believed that vison assessment was feasible for their practise. Including the vison assessment in the existing routines and systems was important to promote sustainable implementation. Conclusion Implementing a structured vision assessment with the KROSS tool in health care services was experienced as acceptable and feasible. The new routine led to increased attention towards poststroke VIs and increased collaboration with vision experts. Tailoring the routine to each practice and how they organise their work can support the integration of a vision assessment in their routines. To promote better vision care poststroke vision assessment and follow up should be included in the stroke care pathways. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07732-w.
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Affiliation(s)
- Torgeir S Mathisen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway. .,USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.,Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Heidi Ormstad
- Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.,USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
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Rehabilitation of visual perception in cortical blindness. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:357-373. [PMID: 35034749 DOI: 10.1016/b978-0-12-819410-2.00030-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blindness is a common sequela after stroke affecting the primary visual cortex, presenting as a contralesional, homonymous, visual field cut. This can occur unilaterally or, less commonly, bilaterally. While it has been widely assumed that after a brief period of spontaneous improvement, vision loss becomes stable and permanent, accumulating data show that visual training can recover some of the vision loss, even long after the stroke. Here, we review the different approaches to rehabilitation employed in adult-onset cortical blindness (CB), focusing on visual restoration methods. Most of this work was conducted in chronic stroke patients, partially restoring visual discrimination and luminance detection. However, to achieve this, patients had to train for extended periods (usually many months), and the vision restored was not entirely normal. Several adjuvants to training such as noninvasive, transcranial brain stimulation, and pharmacology are starting to be investigated for their potential to increase the efficacy of training in CB patients. However, these approaches are still exploratory and require considerably more research before being adopted. Nonetheless, having established that the adult visual system retains the capacity for restorative plasticity, attention recently turned toward the subacute poststroke period. Drawing inspiration from sensorimotor stroke rehabilitation, visual training was recently attempted for the first time in subacute poststroke patients. It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated more than 6 months poststroke (i.e., in the chronic period). In conclusion, evidence now suggests that visual neuroplasticity after occipital stroke can be reliably recruited by a range of visual training approaches. In addition, it appears that poststroke visual plasticity is dynamic, with a critical window of opportunity in the early postdamage period to attain more rapid, more extensive recovery of a larger set of visual perceptual abilities.
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Dubé C, Jin Y, Powers BG, Li G, Labelle A, Rivers MS, Gumboc IM, Bussières AE. Vision Evaluation Tools for Adults With Acquired Brain Injury: A Scoping Review. The Canadian Journal of Occupational Therapy 2021; 88:340-351. [PMID: 34658251 PMCID: PMC8640270 DOI: 10.1177/00084174211042955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background. Unrecognized visual deficits (VDs) following an acquired brain
injury (ABI) may impact clients’ rehabilitation. Little is known about evaluation tools
used in vision rehabilitation. Purpose. To systematically explore the
literature describing evaluation tools used for VD on adults with ABI.
Method. Using a scoping review methodology, we searched in MEDLINE(Ovid),
Embase, CINAHL, PsycINFO, and the grey literature from inception to 2020. Quantitative and
thematic analyses were performed. Findings. Of the 83 studies reporting on 86
evaluation tools, 47% used multiple tools to assess VD. Tools were mostly used by
occupational therapists and psychologists to evaluate intermediate, intermediate to high,
and high-level visual skills. Clinicians tend to select specific tools that focus on
different levels of the hierarchy of visual skills. Implications. Future
research should investigate the optimal timeframe for assessment of VD and the
psychometric properties of tools to ensure comprehensive VD evaluation.
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Affiliation(s)
- Camille Dubé
- Corresponding author: Camille Dubé,
McGill University Faculty of Medicine, School of Physical and Occupational Therapy, 3654
Prom Sir-William-Osler, Hosmer House 205, Montreal, QC H3G 1Y5, Canada.
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De-Rosende-Celeiro I, Rey-Villamayor A, Francisco-de-Miguel I, Ávila-Álvarez A. Independence in Daily Activities after Stroke among Occupational Therapy Patients and Its Relationship with Unilateral Neglect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7537. [PMID: 34299988 PMCID: PMC8306679 DOI: 10.3390/ijerph18147537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022]
Abstract
More research is needed to better understand the impact of occupational therapy (OT) in stroke patients and syndromes of unilateral neglect (UN) and anosognosia. A prospective, observational, longitudinal design was conducted on a sample of 27 OT patients. The objectives were to examine: (1) the presence of UN and anosognosia; (2) the functional outcomes; and (3) the association of UN at baseline with functional status at discharge from OT. The outcomes were Barthel (functional independence) and the Rivermead Mobility Index (RMI). The baseline proportion of participants with UN was 33% according to the Star Cancellation Test (STC), and 48.1% according to the Catherine Bergego Scale (CBS) therapist-version. There was a significant difference between the therapist and participant-rated CBS scores (p = 0.004). Functional independence improved significantly between the initial and final assessments (p < 0.001); the effect size (r) was large (r = 0.61). There was a significant improvement in RMI scores (p < 0.001), which was large in size (r = 0.59). Both the STC and CBS-therapist scores were significantly correlated with the Barthel (p < 0.001, p = 0.005, respectively) and with the RMI (p = 0.004, p = 0.028, respectively). The participants substantially enhanced their functional status skills. UN and anosognosia were common problems, and neglect was associated with worse OT program outcomes.
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Affiliation(s)
- Iván De-Rosende-Celeiro
- Occupational Therapy Research Unit in Non-Pharmacological Interventions, University of A Coruña, 15071 A Coruña, Spain;
| | | | | | - Adriana Ávila-Álvarez
- Occupational Therapy Research Unit in Non-Pharmacological Interventions, University of A Coruña, 15071 A Coruña, Spain;
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Mathisen TS, Eilertsen G, Ormstad H, Falkenberg HK. Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services. BMC Health Serv Res 2021; 21:497. [PMID: 34030691 PMCID: PMC8147019 DOI: 10.1186/s12913-021-06467-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/29/2021] [Indexed: 01/10/2023] Open
Abstract
Background Stroke is a leading cause of disability worldwide. Visual impairments (VIs) affect 60% of stroke survivors, and have negative consequences for rehabilitation and post-stroke life. VIs after stroke are often overlooked and undertreated due to lack of structured routines for visual care after stroke. This study aims to identify and assess barriers and facilitators to the implementation of structured visual assessment after stroke in municipal health care services. The study is part of a larger knowledge translation project. Methods Eleven leaders and municipal interdisciplinary health care professionals participated in qualitative interviews. During two workshops, results from the interviews were discussed with 26 participants from municipal health care services and user representatives. Data from interviews and workshops were collected before the intervention was implemented and analyzed using content analysis. Results The analysis identified individual and contextual barriers and facilitators. The individual barriers were related to the participants' experiences of having low competence of visual functions and vision assessment skills. They considered themselves as generalists, not stroke experts, and some were reluctant of change because of previous experiences of unsuccessful implementation projects. Individual facilitators were strong beliefs that including vision in stroke care would improve health care services. If experienced as useful and evidence based, the new vision routine would implement easier. Contextual barriers were experiences of unclear responsibility for vision care, lack of structured interdisciplinary collaboration and lack of formal stroke routines. Time constraints and practical difficulties with including the vision tool in current medical records were also expressed barriers. Contextual facilitators were leader support and acknowledgement, in addition to having a flexible work schedule. Conclusions This study shows that improving competence about VIs after stroke and skills in assessing visual functions are particularly important to consider when planning implementation of new vision routines in municipal health care services. Increased knowledge about the consequences of living with VIs after stroke, and the motivation to provide best possible care, were individual facilitators for changing clinical practice. Involving knowledge users, solutions for integrating new knowledge in existing routines, along with easily accessible supervision in own practise, are essential facilitators for promoting a successful implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06467-4.
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Affiliation(s)
- Torgeir S Mathisen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway. .,USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.,Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | | | - Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.,USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
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Hepworth LR, Howard C, Hanna KL, Currie J, Rowe FJ. "Eye" Don't See: An Analysis of Visual Symptom Reporting by Stroke Survivors from a Large Epidemiology Study. J Stroke Cerebrovasc Dis 2021; 30:105759. [PMID: 33813079 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/03/2021] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
AIM The purpose was to explore the reported symptoms of post-stroke visual impairment from a large multi-centre prospective epidemiology study. METHODS Visual assessment, including a case history, visual acuity, ocular alignment, ocular motility, visual fields, visual inattention and visual perception, was attempted for all stroke admissions to three acute stroke units. RESULTS Of 1500 stroke admissions, 1204 received a visual assessment, of which 867 had one or more visual impairments. Of those identified with visual impairment 44.4% reported visual symptoms. The most common visual symptoms were blurred/altered vision (22.1%), field loss (12.6%), diplopia (9.9%) and reading difficulties (9.7%). 703 were identified to have a new visual impairment, 47.1% reported visual symptoms. No visual symptoms were reported by 38.4% and 14.5% were unable to report symptoms. Visual symptoms were first reported at a median of 3 days (IQR2-8) and mean of 16.0 days (SD39.8) from stroke onset. Those that reported symptoms were younger (p<0.001) and more independent (p<0.001) than those who were asymptomatic or unable to report. No significant difference was found between likelihood of reporting visual symptoms or not based on severity of reduced central vision, visual field loss or visual inattention. Stroke survivors with a manifest squint and cranial nerve palsies were significantly more likely to report symptoms. CONCLUSIONS Almost 40% of stroke survivors with new onset visual impairment do not or cannot report visual symptoms. This highlights the importance of objective screening to ensure stroke survivors receive appropriate and timely referral to specialist services to access necessary treatment.
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Affiliation(s)
- Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd floor, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom
| | - Claire Howard
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd floor, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom
| | - Kerry L Hanna
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd floor, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom
| | - Jim Currie
- Patient and Public Involvement Representative, United Kingdom
| | - Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd floor, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom.
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Vancleef K, Colwell MJ, Hewitt O, Demeyere N. Current practice and challenges in screening for visual perception deficits after stroke: a qualitative study. Disabil Rehabil 2020; 44:2063-2072. [PMID: 33016779 DOI: 10.1080/09638288.2020.1824245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We document current clinical practice and needs in screening for visual perception problems after stroke to inform development of new screening tools. MATERIALS AND METHODS We interviewed 12 occupational therapists and 13 orthoptists. Interviews were thematically analysed using the Value Proposition Canvas, a model which establishes challenges and facilitators in what people want to achieve. RESULTS Participants' understanding of visual perception varied and often included sensory and cognitive deficits. Occupational therapists commonly screened for visual field deficits and hemispatial neglect, while other aspects of visual cognition were rarely assessed. A positive screening result triggered an orthoptic referral. Screening generally occurred during functional assessments and/or with in-house developed tools. Challenges to practice were: lack of time, lack of training, environmental and stroke survivor factors (e.g., aphasia), insufficient continuation of care, and test characteristics (e.g., not evidence-based). Facilitators were: quick and practical tools, experienced staff or tools with minimal training requirements, a streamlined care pathway. CONCLUSIONS Screening employs non-standardised assessments and rarely covers higher visual perceptual deficits. We demonstrates the need for an evidence-based visual perception screen, which should ideally be 15 min or less, be portable, and require minimal equipment. The screen should be suitable for bedside testing and aphasia-friendly.Implications for rehabilitationThere is a high demand for training on what visual perception deficits are and how to screen for them.Building local relationships between orthoptists and occupational therapists is perceived as highly beneficial for providing good vision and visual perception care for stroke survivors.Occupational therapists should be alert for visual perceptual deficits in their patients preferably through systematic screening with standardised assessments such as the shortened version of the Rivermead Perceptual Assessment Battery or Occupational Therapy Adult Perceptual Screening Test.
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Affiliation(s)
- Kathleen Vancleef
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Michael J Colwell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Olivia Hewitt
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Rowe FJ, Hepworth L, Howard C, Bruce A, Smerdon V, Payne T, Jimmieson P, Burnside G. Vision Screening Assessment (VISA) tool: diagnostic accuracy validation of a novel screening tool in detecting visual impairment among stroke survivors. BMJ Open 2020; 10:e033639. [PMID: 32532765 PMCID: PMC7295409 DOI: 10.1136/bmjopen-2019-033639] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Screening for visual problems in stroke survivors is not standardised. Visual problems that remain undetected or poorly identified can create unmet needs for stroke survivors. We report the validation of a new Vision Impairment Screening Assessment (VISA) tool intended for use by the stroke team to improve identification of visual impairment in stroke survivors. METHODS We conducted a prospective case cohort comparative study in four centres to validate the VISA tool against a specialist reference vision assessment. VISA is available in print or as an app (Medicines and Healthcare products Regulatory Agency regulatory approved); these were used equally for two groups. Both VISA and the comprehensive reference vision assessment measured case history, visual acuity, eye alignment, eye movements, visual field and visual inattention. The primary outcome measure was the presence or absence of visual impairment. RESULTS Two hundred and twenty-one stroke survivors were screened. Specialist reference vision assessment was by experienced orthoptists. Full completion of screening and reference vision assessment was achieved for 201 stroke survivors. VISA print was completed for 101 stroke survivors; VISA app was completed for 100. Sensitivity and specificity of VISA print was 97.67% and 66.67%, respectively. Overall agreement was substantial; K=0.648. Sensitivity and specificity of VISA app was 88.31% and 86.96%, respectively. Overall agreement was substantial; K=0.690. Lowest agreement was found for screening of eye movement and near visual acuity. CONCLUSIONS This validation study indicates acceptability of VISA for screening of potential visual impairment in stroke survivors. Sensitivity and specificity were high indicating the accuracy of this screening tool. VISA is available in print or as an app allowing versatile uptake across multiple stroke settings.
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Affiliation(s)
- Fiona J Rowe
- Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren Hepworth
- Health Services Research, University of Liverpool, Liverpool, UK
| | - Claire Howard
- Health Services Research, University of Liverpool, Liverpool, UK
| | - Alison Bruce
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Health Sciences, University of York, York, UK
| | | | - Terry Payne
- Computer Science, University of Liverpool, Liverpool, Merseyside, UK
| | - Phil Jimmieson
- Computer Science, University of Liverpool, Liverpool, Merseyside, UK
| | - Girvan Burnside
- Biostatistics, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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Rowe FJ, Hepworth LR, Howard C, Hanna KL, Helliwell B. Developing a stroke-vision care pathway: a consensus study. Disabil Rehabil 2020; 44:487-495. [DOI: 10.1080/09638288.2020.1768302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R. Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Claire Howard
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Kerry L. Hanna
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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Smith KG, Bhutada AM. Detailed Vision Screening Results from a Cohort of Individuals with Aphasia. APHASIOLOGY 2019; 35:186-199. [PMID: 33986558 PMCID: PMC8112606 DOI: 10.1080/02687038.2019.1702918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/02/2019] [Indexed: 06/12/2023]
Abstract
BACKGROUND Visual functioning is often affected in persons with aphasia following stroke and other brain injuries. Characterizing the visual functioning of persons with aphasia is imperative in both clinical and research domains; however, visual functioning of persons with aphasia is infrequently assessed or described in either domain. AIMS This study aims to examine the utility of various visual screening measures as indicated by Hallowell (2008) and document the results of the screening tools for a cohort of persons with aphasia. METHODS & PROCEDURES Twenty-three individuals with chronic aphasia completed a detailed vision screening using a visual case history, the Visual Activities Questionnaire, the McDowell Vision Screening, an Amsler grid, the line bisection task, and the National Institute of Health Stroke Scale item 3-visual. OUTCOMES & RESULTS Two-thirds of the participants reported significant visual histories with only one participant reporting stroke-related visual deficits. On average, the group rated visual difficulty during daily activities as never or rarely occurring, with the least difficulty reported for color discrimination and the most difficulty with visual acuity and visual search, though still only occurring rarely. All participants passed the cover/uncover screening task measuring ocular alignment and motility, the color perception screening task, and several tasks measuring ocular function. Failing scores, however, were assigned for about half of the participants for distance visual acuity, and only three participants for near visual acuity. Visual fields were normal for about two-thirds of the participants and all participants presented with normal visual attention. CONCLUSIONS The results suggest that visual deficits are common in persons with aphasia, but are not necessarily related to the stroke that the person experienced. The results highlight the need to screen the vision of persons with aphasia both for clinical purposes and research protocols to ensure visual deficits are treated, compensated for, or controlled.
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Affiliation(s)
- Kimberly G. Smith
- Department of Speech Pathology and Audiology, University of South Alabama
- Department of Communication Sciences and Disorders, University of South Carolina
| | - Ankita M. Bhutada
- Department of Speech Pathology and Audiology, University of South Alabama
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NICULA C, NICULA D, BULBOACĂ AE. Non-surgical correction of diplopia after stroke- a strong impact factor on quality of life-minireview. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
One of the most frequent disorders accompanied by diplopia is represented by stroke. Beyond different symptoms of stroke, diplopia constitutes an important clinical factor in influencing the quality of life in surviving patients. In this paper we discuss the visual impairment associated with stroke location, types of diplopia, the clinical examination, and the nonsurgical treatment of diplopia. The purpose of diplopia treatment is to restore binocular vision and eliminate the double vision. The most used nonsurgical treatment for diplopia is the optical correction by the prisms. Another therapeutic option is the botulinum toxin injections.
Key words: diplopia, stroke, visual rehabilitation, prism correction,
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Affiliation(s)
- Cristina NICULA
- Department of Ophthalmology, “Iuliu Hatieganu”University of Medicine and Pharmacy”, Cluj- Napoca, Romania, Oculens Clinic, Cluj-Napoca, Romania
| | | | - Adriana Elena BULBOACĂ
- Department of Pathophysiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj- Napoca, Romania
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Revet M, Immerzeel J, Voogt L, Paulis W. Patients with neuropsychological disorders short after stroke have worse functional outcome: a systematic review and meta-analysis. Disabil Rehabil 2019; 43:2233-2252. [PMID: 31766909 DOI: 10.1080/09638288.2019.1693642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate if patients with neuropsychological disorders (neglect, aphasia, or cognitive dysfunction measured with the Mini-mental state examination) short after stroke have different functional outcome at follow-up compared to patients without these disorders. METHODS Embase, Medline-Ovid, PsycINFO, Cochrane CENTRAL, Web of Science and Google Scholar were systematically searched for cohort studies up to 3 March 2019. PRISMA guidelines were followed. Functional outcome had to be measured with the Barthel Index or the Functional Independence Measure. If at least three studies studying the same neuropsychological disorder reported functional outcome at comparable follow-up, meta-analysis were performed and the quality of evidence was assessed using GRADE. RESULTS The search resulted in 5398 unique articles and finally 27 articles were included. Pooled results show a standardized mean difference of -0.93 (95% confidence interval [-1.27 to -0.59]), indicating that the group with neglect short after stroke has significant lower functional outcome at follow-up. Regarding aphasia, the standardized mean difference was -0.50 (95% confidence interval [-0.72 to -0.28]). It appears in the limited articles available that patients with cognitive dysfunction have lower scores for functional outcome. CONCLUSIONS Patients with neglect or aphasia, especially aphasia with comprehension deficits, short after stroke have significant worse functional outcome.Implications for rehabilitationClinicians should perform an extensive screening for neglect, aphasia, and cognitive disorders to make sure to diagnose the different neuropsychological disorders correctly.When patients with neuropsychological disorders are referred for rehabilitation, it can be expected that they need a longer rehabilitation period or may never reach the same level of functioning.Clinicians should pay attention to instructions of training moments outside therapy and involve caregivers and patients family making these training moments more effective.
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Affiliation(s)
- Mirjam Revet
- Department of Physiotherapy Studies and Research Centre of Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Jeroen Immerzeel
- Department of Physiotherapy, De Zellingen - Rijckehove, Capelle aan den IJssel, The Netherlands
| | - Lennard Voogt
- Department of Physiotherapy Studies and Research Centre of Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Winifred Paulis
- Department of Physiotherapy Studies and Research Centre of Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Hepworth L, Rowe F. Short-Listing the Program Choice for Perimetry in Neurological Conditions (PoPiN) Using Consensus Methods. Br Ir Orthopt J 2019; 15:125-132. [PMID: 32999983 PMCID: PMC7510368 DOI: 10.22599/bioj.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neurological conditions frequently cause visual field loss, commonly resulting in perimetry requests for suspected or known conditions. Currently there are no national guidelines for perimetry in neurological conditions. A wide choice of perimetry programs exists. An inappropriate program choice could fail to detect visual field loss. Two phases in this study determined preference of perimetry programs for detection of visual field loss in four common neurological conditions (idiopathic intracranial hypertension (IIH), optic neuropathies, chiasmal compression and stroke), to aid the design of research and clinical practice guidelines. METHODS A survey consisted of 47 perimetry programs. Orthoptists and neuro-ophthalmologists were asked which perimetry programs they considered important for use in the four neurological conditions. These programs were short-listed for discussion in a consensus meeting. A nominal group technique was used for the consensus meeting to reach consensus on the three most favoured perimetry programs appropriate for the four conditions. RESULTS Twenty-six participants completed the survey (51% return rate). Nine programs were found to be not applicable to any of the conditions. The short-lists for the conditions varied between six and ten perimetry programs. Seven participants discussed the survey results at a consensus meeting to agree the three most favoured perimetry programs for IIH, optic neuropathy and chiasmal compression (manual/semi manual kinetic, static 30-2 and full-field 120) and for stroke (manual/semi manual kinetic, static 30-2 and monocular Esterman). CONCLUSION A wide range of perimetry programmes were explored thoroughly through survey and consensus methods in order to determine clinician preference for their use in neuro-ophthalmic practice. The three most favoured perimetry programs for the four conditions was established.
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Rowe FJ, Hepworth LR, Kirkham JJ. Development of core outcome sets for vision screening and assessment in stroke: a Delphi and consensus study. BMJ Open 2019; 9:e029578. [PMID: 31501115 PMCID: PMC6738691 DOI: 10.1136/bmjopen-2019-029578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Visual impairment following stroke is common with a reported incidence of visual impairment in 60% of stroke survivors. Screening for visual impairment is neither routine nor standardised. This results in a health inequality where some stroke survivors receive comprehensive vision assessment to identify any existent visual problems while others receive no vision assessment leaving them with unmet needs from undiagnosed visual problems. The aim of this study was to define two core outcome sets (COS), one for vision screening and one for full visual assessment of stroke survivors. DESIGN A list of potentially relevant visual assessments was created from a review of the literature. The consensus process consisted of an online 3-round Delphi survey followed by a consensus meeting of the key stakeholders. PARTICIPANTS Stakeholders included orthoptists, occupational therapists, ophthalmologists, stroke survivors and COS users such as researchers, journal editors and guideline developers. SETTING University. OUTCOME MEASURES COS. RESULTS Following the consensus process we recommend the following nine assessments for vision screening: case history, clinical observations of visual signs, visual acuity, eye alignment position, eye movement assessment, visual field assessment, visual neglect assessment, functional vision assessment and reading assessment. We recommend the following 11 assessments for full vision assessment: case history, observations, visual acuity, eye alignment position, eye movement assessment, binocular vision assessment, eye position measurement, visual field assessment, visual neglect assessment, functional vision assessment, reading assessment and quality of life questionnaires. CONCLUSIONS COS are defined for vision screening and full vision assessment for stroke survivors. There is potential for their use in reducing heterogeneity in routine clinical practice and for improving standardisation and accuracy of vision assessment. Future research is required to evaluate the use of these COS and for further exploration of core outcome measures.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
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Stroke Survivor and Caregiver Perspectives on Post-Stroke Visual Concerns and Long-Term Consequences. Behav Neurol 2018; 2018:1463429. [PMID: 30402166 PMCID: PMC6193320 DOI: 10.1155/2018/1463429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/16/2018] [Indexed: 11/18/2022] Open
Abstract
Approximately 800,000 people in the United States have a stroke annually. Up to two thirds of stroke survivors have some visual problems, which result in disability and can affect survivors' overall rehabilitation outcomes. Although some post-stroke visual impairments can be corrected and respond well to intervention, ocular signs can be subtle and may not be recognized or reported by the stroke survivor but rather by a vigilant caregiver. The purpose of this study was to explore the post-stroke visual concerns and consequences expressed by stroke survivors and caregivers. This study employed a qualitative design using semistructured interviews conducted with a convenience sample of stroke survivors and caregivers recruited from either a community support group or skilled nursing and long-term care facilities. Interviews were recorded and transcribed verbatim. Comparative content analysis was used to identify vision-related themes by two independent coders. All research team members completed quality checking of coding. Twenty participants (11 stroke survivors and 9 caregivers) expressed visual concerns or consequences following stroke: (1) eye movement problems, (2) perceptual issues, and (3) consequences of vision problems or issues, which affected their daily life/quality of life. Stroke survivors and caregivers reported receiving vision care from (1) eye doctors, (2) occupational therapists, and (3) other healthcare professionals. All vision care providers need to be observant of potential post-stroke visual concerns. Stroke survivors should have a thorough vision evaluation to optimize their independence in everyday activities and quality of life.
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Rowe FJ, Hepworth LR, Hanna KL, Howard C. Visual Impairment Screening Assessment (VISA) tool: pilot validation. BMJ Open 2018; 8:e020562. [PMID: 29511021 PMCID: PMC5855179 DOI: 10.1136/bmjopen-2017-020562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To report and evaluate a new Vision Impairment Screening Assessment (VISA) tool intended for use by the stroke team to improve identification of visual impairment in stroke survivors. DESIGN Prospective case cohort comparative study. SETTING Stroke units at two secondary care hospitals and one tertiary centre. PARTICIPANTS 116 stroke survivors were screened, 62 by naïve and 54 by non-naïve screeners. MAIN OUTCOME MEASURES Both the VISA screening tool and the comprehensive specialist vision assessment measured case history, visual acuity, eye alignment, eye movements, visual field and visual inattention. RESULTS Full completion of VISA tool and specialist vision assessment was achieved for 89 stroke survivors. Missing data for one or more sections typically related to patient's inability to complete the assessment. Sensitivity and specificity of the VISA screening tool were 90.24% and 85.29%, respectively; the positive and negative predictive values were 93.67% and 78.36%, respectively. Overall agreement was significant; k=0.736. Lowest agreement was found for screening of eye movement and visual inattention deficits. CONCLUSIONS This early validation of the VISA screening tool shows promise in improving detection accuracy for clinicians involved in stroke care who are not specialists in vision problems and lack formal eye training, with potential to lead to more prompt referral with fewer false positives and negatives. Pilot validation indicates acceptability of the VISA tool for screening of visual impairment in stroke survivors. Sensitivity and specificity were high indicating the potential accuracy of the VISA tool for screening purposes. Results of this study have guided the revision of the VISA screening tool ahead of full clinical validation.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Kerry L Hanna
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Claire Howard
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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Pula JH, Yuen CA. Eyes and stroke: the visual aspects of cerebrovascular disease. Stroke Vasc Neurol 2017; 2:210-220. [PMID: 29507782 PMCID: PMC5829892 DOI: 10.1136/svn-2017-000079] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 01/05/2023] Open
Abstract
A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the most disabling residual effect after a cerebral infarction. Transient vision problems can likewise be a harbinger of stroke and prompt evaluation after recognition of visual symptoms can prevent future vascular injury. In this review, we discuss the visual aspects of stroke. First, anatomy and the vascular supply of the visual system are considered. Then, the different stroke syndromes which involve vision are discussed. Finally, topics involving the assessment, prognosis, treatment and therapeutic intervention of vision-specific stroke topics are reviewed.
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Affiliation(s)
- John H Pula
- Department of Neurology, NorthShore University HealthSystem, Chicago, Illinois, USA
| | - Carlen A Yuen
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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