Mx of hemianopia and stroke related visual fields loss

Question 1

What area of the brain is most commonly involved in stroke?

Answer 1

the occipital and/or parietal lobes

Question 2

What kinds of stroke related visual problems are there?

Answer 2

eye movement abnormalities, poor NPC, left side hemianopia struggle to find start of sentences.

Question 3

What problems may they have with visual acuity?

Answer 3

• numbers/symbols/tumbling E may be more successful than letters
• matching technique may be helpful
• are numbers/letters being missed at start/end of line?

Question 4

What problems may they have with visual fields?

Answer 4

• automated computerised testing can be fatiguing
• at least do confrontation
  = counting fingers may not be possible - wiggle finger instead?

Question 5

What problems may they have with EOM evaluation?

Answer 5

• may need to rely on your own observation
• ‘dolls eye reflex’ manually moving px head while they fixate on a target
• diplopia?

Question 6

How can you test for perceptual deficits?

Answer 6

Line bisection test
Drawing test (clock)
Cancellation test

Question 7

What problems may they have with reading?

Answer 7

can they read the words?
do they understand their meaning?
are words consistently missed at start/end of each line?
-macular splitting or macular sparing?

Question 8

Difference between macular splitting and macular sparing?

Answer 8

Splitting - full hemifield visual field loss
Sparing - most of hemifield loss except the centre

Question 9

What problems may they have with refraction?

Answer 9

• always start with ret
• extra time required
• modifications of instruments may be required

Question 10

Management strategies for stroke?

Answer 10

advise
refractive error correction
management of diplopia - occlusion, prism
management of hemianopia - scanning training, prisms, stimulation
glare control
low vision devices
typoscope
tactile feedback - finger at start/end of line
assistive devices
referral to occupational therapy, orientation and mobility training, physiotherapy

Question 11

What is scanning training?

Answer 11

encourage px to become aware and look into affected field. walk around room in direction of affected side. make eye movement to left whenever left foot is picked up while walking