Stroke Rehabilitation Flashcards

Question

what is the likelihood of recovery from a visual field defect and what is the most common type of visual field defect

Answer 1

Visual field loss due to stroke usually hemianopic (often associated with visual inattention) Recovery (if occurs expected within 4 – 6/52) 45% recovered (7% full recovery, 38% partial – VIS study) Partial or complete, quad or hemi Within first 4-6 weeks beest recovery of visual field loss Only half recover fully

Answer 2

Visual fields to confrontation 1m distance Present your hands at midway Compare with your own ‘normal’ field Hands (hemianopia) Finger counting Kinetic targets (move out to in)

Answer 3

Head positioning / bed position Scanning / use of markers for first and last word when reading Exaggerated head movements Lighting Read right BIOS Information leaflet Vision Sim for carers Driving advice

Answer 4

Group 1 driving is defined in the legislation: A field of at least 120° on the horizontal measured using a target equivalent to the white Goldmann III4e settings. The extension should be at least 50° left and right. In addition, there should be no significant defect in the binocular field that encroaches within 20° of the fixation above or below the horizontal meridian. This means that homonymous or bitemporal defects that come close to fixation, whether hemianopic or quadrantanopic, are not usually acceptable for driving.

Answer 5

requires the method to be a binocular Esterman field test may request monocular full field charts in specific conditions exceptionally, may consider a Goldmann perimetry assessment carried out to strict criteria Fields must be reliable Esterman binocular chart <20% false-positives Monocular charts and Goldmann perimetry, fixation accuracy will also be considered.

Answer 6

Group 1 drivers whose previous full driving entitlement was removed because of a field defect failing to satisfy the standard may be eligible for individual relicensing consideration as exceptional cases under the following strict criteria: defect must have been present for at least 12 months caused by an isolated event or a non-progressive condition there must be no other condition or pathology regarded as progressive and likely to be affecting the visual fields sight in both eyes no uncontrolled diplopia no other impairment of visual function clinical confirmation of full functional adaptation

Answer 7

When reading, rulers and markers can be used to highlight the beginning and end of sentences and to help a patient keep their position along a line of text. Strategies to help include exaggerated eye and head movements / rotating text into different position. Vertical reading is more challenging Requires patient to ‘re-learn’ Practising reading moving text has been shown to improve reading speeds on normal text

Answer 8

smooth pursuits vergences saccades optokinetic (own) vestibular ocular reflex (VOR)

Answer 9

Typoscopes / line guides Issue of low vision aids /magnifiers

Answer 10

Smooth pursuits Is the patient able to fix and follow into the cardinal positions of gaze? Are they smooth? Are they jerky? Do the eyes move fully into the area of gaze? Saccades These should be fast and accurate re-fixations between gaze Can be used to differentiate types of gaze palsies? Are we under-estimating the number of gaze palsies?

Answer 11

Blood pressure lowering Removal of anticoagulant treatments Reducing intracranial pressure

Answer 12

Advanced knowledge of vision Referral to ophthalmology / ECLO / LVA service Advice on CVI registration Treatment and management of vision and eye movement disorders Prescribe coloured overlay for glare Advise to attend optician or arrange domiciliary care- (they come to your home)

Answer 13

Vergence Convergence issues? VOR Doll’s head testing Differential diagnosis of supranuchlear gaze palsies

Answer 14

General consensus that a test battery is advantageous-.i.e. do more than 1 test Multitude of tests to choose from Limited guidance on interpretation of results

Answer 15

Use of general visual stimulation: objects, relatives on neglecting side, family photos etc. Eye scanning and tracking games – cards, boards games, connect 4, jigsaws, wall games Coloured stickers/vertical line guides of high contrast when reading Apps - Visual therapy apps (Visual Attention Therapy App), Eye search BIOS information leaflet Bed position Encourage staff and visitors to always sit on the affected side of the person with neglect. For people who like looking out the window or into the hallway, have their bed positioned so those things are on their affected side. Interesting items like colorful lights, photographs, or the television can be placed on the affected side. People with visual inattention are often highly distractible and find it difficult to sustain their attention. Before they embark on any important tasks, try to reduce environmental distractions such as background noise and extra people. Their inattention is likely to be much worse when they are fatigued. While challenging the affected side is therapeutic, if you have something very important to show them or tell them, do it on the strong side as not to frustrate the person.

Answer 16

Perceptual deficits accounted for 18% of visual impairment in VIS Study Largest group of patients with left sided visual inattention/neglect (14%) Small number had visual hallucinations (2.5%) and object agnosia- when a pt struggles to identify what an object is (2.2%)

Answer 17

Variable signs/symptoms from complete unawareness of anything on one side to missing odd letter/word from a line of text Important predictor of poor functional recovery and outcome; requires longer in-patient stay Recovery: greatest in first month post-stroke- quicker adaptation = better rehabilitation May co-exist with visual field loss

Answer 18

Cortical blindness is the total or partial loss of vision in a normal appearing eye. Caused by damage to the occipital cortex In most cases the total loss of vision is not permanent and some vision may recover Anton – Babinski syndrome – a rare occurrence where people with cortical blindness have little or no insight into their loss of vision. People with this condition often report no loss of vision and are adamant their vision is normal.

Answer 19

Visual hallucinations / Charles Bonnet syndrome Often with hemianopia Under reported Reassurance helpful

Answer 20

Symptoms may include double vision, oscillopsia (moving images) or reading difficulty Alleviate diplopia using occlusion/eye patch or advice on head postures Patch can be worn over either eye