The effect of visual scanning exercises integrated into task-specific activities on the functional ability in patients with visual perceptual disorders post stroke

Abstract

Stroke is the first cause of disability and second most frequent cause of mortality after ischemic heart disease in adults worldwide. The influence of visual system impairment on the patient’s functional ability and quality of life are still largely neglected in neurological rehabilitation. Therapists are seldom concerned with the visual status and ability of their patients. Members of the rehabilitation team rarely assess, monitor or treat impairment of visual efficiency processes and visual information processing dysfunction that may be observed in patients after a stroke. In the absence of specific intervention visual deficits stabilise and become permanent due to poor or almost absent spontaneous recovery of the visual system in stroke patients. A matched-pair randomised controlled trial was conducted. Twenty-four (24) participants were screened based on their functional activity level as measured on the Stroke Activity Scale (SAS). When a participant’s SAS score matched a previously allocated participant’s score, that particular participant was placed in the opposite group from the existing matched participant. If the newly assessed participant’s SAS did not match another participant’s SAS, the participant was randomly allocated to either the experimental or the control group. The process was repeated until (24) patients had been allocated into two groups consisting of twelve (12) participants per group as they were admitted to Tshwane Rehabilitation Centre (TRC). Group 1 (Experimental Group) received saccadic eye movement training with visual scanning exercises integrated with task-specific activities and Group 2 (Control Group) received task-specific activities for four (4) consecutive weeks. Participants functional progress on body impairment and functional activity level were assessed and documented on a weekly basis during the intervention period of four (4) weeks. In order to determine whether the integration of visual scanning through saccadic eye movement training had a permanent or long-term effect on the participants’ functional ability and quality of life after rehabilitation had been terminated, functional progress on body impairment-, functional activity and participation levels as well as their perceived quality of life were assessed and documented eight (8), twelve (12), sixteen (16) and twenty (20) weeks after admission to the rehabilitation facility. A large number of participants were lost to follow-up following discharge from the TRC after the intervention period of four (4) weeks. As result of the small sample group at week eight (8), week twelve (12), week sixteen (16) and week twenty (20), these results were not discussed. Results of the matched-pair randomised controlled trial indicated that the effect of saccadic eye movement training with visual scanning exercises integrated with task specific activities as an intervention for participants that presented with unilateral spatial inattention, visual-spatial disorders and visual-constructive disorders poststroke resulted in significant improvement in impairment level. This improvement related to oculomotor visual performance, visual attention, depression as well as results on functional activity level with regard to the ability to independently complete ADL after four (4) weeks of rehabilitation. It may therefore be concluded that saccadic eye movement training with visual scanning exercises integrated with task-specific activities as an intervention tend to improve functional ability in participants that presented with unilateral spatial inattention, visual-spatial disorders and visual-constructive disorders post-stroke.