Search training for people with visual field loss after stroke: a cohort study Short title



Download 211.28 Kb.
Page2/2
Date conversion16.05.2018
Size211.28 Kb.
1   2

Table 2. Goals and activities

Participant

Goals

Activities used in intervention

A

To improve reading ability and speed.

To improve use of computer.

To drive on public roads.


Reading written instructions, Computer game of Mahjong

Finding tools in shed.



Remedial activities to improve amplitude of eye movements

Search training – spelling out words from letters on post-it notes on wall. Sorting words across table.



B

To return to work

To drive (essential for work)

To walk outside independently

To use computer for work-based tasks



Outdoor mobility, walking, crossing roads and riding bicycle on side road.

Computer game ‘Dr Monocle’s Mansion’ visual scanning.

Working on case study on the computer

Remedial activities: card search on table; searching for items around house: Catch and throw game to increase speed of orientation to the left; Searching for laser pointer dot at speed.

Spelling words on from letters on post-it notes placed over the wall.



C

To be able to drive again.

To be able to go out and about in community with confidence.

To be able to prepare food at home.


Walking outside; Shopping in familiar supermarket and in unfamiliar supermarket; Searching for items in kitchen and garage.

Searching of post-it notes on tree trunks outside.

Visit to park and searching for wildlife.

Remedial activities: card games such as solitaire, matching games


D

To be able to vacuum the carpet in the house.

To walk around outside with confidence, including fetching grandchildren from school

To be able to get her own meals.


Kitchen tasks incorporating visual searching: organising freezer, making a cup of tea with items moved to different places than usual

Outdoor mobility was the main focus of treatment. Walking outside and crossing road.



Remedial activities to train systematic search starting from the affected side: Searching for pegs with high contrast tape and without. Searching for features in pictures. Card search.

E

To return to work as a chef in busy kitchens, being confident and quick when using knives.

Driving


Cooking, preparing more complex meals as the treatment progressed and to simulate restaurant tasks these were timed.

Mobility outdoors: walking and negotiating roads whilst talking.

Visit to job centre with the therapist to discuss options for access to work.

Remedial activities to promote his insight into his visual deficit.


F

To read the newspaper, do crossword puzzles, word search

To be able to go out to look at the shops

To be able to use a powered wheelchair


Selecting clothes in wardrobe, kitchen search for tins, pouring water from jug to mug, preparation of ingredients for baking buns

Wheelchair driving indoors

Washing and dressing including finding objects and clothing needed

Hoovering and dusting



Remedial activities- Letter search on post it notes table top

G

To be able to use a powered wheelchair in the home environment.

To be able to put the washing in the washing machine.

To make a snack for herself.

Gardening.



visual search with kitchen items

making bed

loading washing machine using long handled reacher

making sandwich

reading from magazine

mobility in powered wheelchair

Remedial activities – table top card game; picture matching over wide field on floor; throwing and catching a ball


H

To be able to attend to people on the left side.

To attend to objects on the left side when eating.

To be able to move safely around the house without bumping into things.

To be able to prepare vegetables.

To be able to iron.


preparing a sandwich

silk painting craft

dressing

ironing


games on ipad

kitchen tasks, cleaning cutlery drawer, cleaning grill machine

Remedial activities- playing cards and post it note word search


I

To be able to drive

To be able to read and use the computer

To be more aware of the layout of the kitchen environment


keyboard search

room searches: kitchen, office, garage

making hot drink

sorting filing system

outdoor mobility and locating things in environment and shops

Remedial activities- narrow field table top post it notes and card searches; ball throwing and catching



Table 3. Participants’ observations of the benefit of the intervention

Participant

Responses to the questions – What difference has the treatment made to you?

What did you like about the Occupational Therapy; What did you not like?

Benefit rating / 10

A

‘The treatment has made me more aware of my disability and has provided me with ideas of how to overcome tasks that have been difficult.’ Found all the strategies helpful and still adopts them, but activities did not stretch him enough.

‘I need to scan using my eyes when completing a task.’

‘Now I make an effort when talking to my wife when she is sitting on my right side.’

Liked: Reading, being timed to find keys, scanning in the workshop

Not liked: scanning the room, participant felt this was a memory test and his memory was too good. The search tasks were not challenging enough.


6

B

‘I pay attention more to the left side, although I still have visual problems.’

Liked: Scanning exercises for eyes; Not liked: None

5

C

‘A great help getting me to understand the limitations that I did not realise I had. I thought when I was coming out of hospital I was fine, thought I could do everyday things. It made me realise how badly it has affected me.’

[Giving an example regarding safety in the kitchen, when using a knife]: ‘I am turning my head to look at the tomato to get the right thickness. I find it easier to hold the tomato, missing my finger and thumb. It has made me safer.’

No likes or dislikes reported in responses


8

D

‘Helped to find objects, previously I couldn’t find objects even if they were right in front of me.’ ‘I can get my own meals now.’

Liked: Out walking in the community, finding objects; Not liked: None

7

F

‘I can look for things and turn my head more. My head is more central. I can do cleaning. I can look out of the window and see my family arriving; watch TV and Olympic sports, world affairs. I still struggle with the phone.’

Liked: Finding the paper bits is helpful. Picking up paper bits from floor with the hoover, picked out my clothes in the morning, put on my cream and a bit of perfume. Everything was helpful.

Not liked: none

10

G

I’ have been put back on the map again. I was lifted, given another chance; I feel as if I’ve improved since the OT has been going on’

Liked: All helpful; Not liked: None

No rating given

H

‘I am far more aware of scanning, and it has made a difference for me doing everyday tasks. Easier to find things now. I have improved considerably. ‘

Liked: She used a lot of pressure at looking at her – eye contact, putting things out of my sight on my side. I liked doing the cutlery drawer, putting things back and turning head to look for items

Not liked: When I wanted to do it one way and S wanted to do it another way – the way I do things is different. I understand why it was like this but having to learn new ways of doing things is difficult.

8

I

‘I feel more confident each time I go out.’; ‘I have not mastered the computer keyboard’

‘I cannot make as much progress in the kitchen as I would like’



Liked: ‘Going to the shop was fun; Not liked: None

6

Table 4. VFQ25 scores

Participant *

A

C

D

E

F

G

H

I

Composite score

























Before training

82.7

56.0

20.3

59.0

45.1

90.0

60.3

45.6

After training

91.6

87.8

65.6

88.8

67.3

93.6

70.3

52.2

Change in composite score

8.9

31.8

45.3

29.8

22.2

3.6

10.0

6.6

Change scores in each domain

Visual function

























Gen vision

0

0

20

20

20

0

40

20

Near

-8

25

17

25

25

0

25

8

Distance

0

-8

46

50

0

***

-9

0

Peripheral

50

50

25

25

***

***

25

0

Colour **

0

50

75

0

***

***

0

0

Socio-emotional function

Social function

0

50

50

25

0

0

0

25

Role

25

100

37

75

37

25

12

63

Dependency

0

25

75

17

33

0

-9

-50

Mental health

12

-6

62

31

37

0

6

-19

VFQ 25 questionnaire items are scored so that a high score represents better functioning * Participant B did not complete VFQ25 post intervention, his composite score before intervention was 83.6. ** Colour is a question that asks participants to rate how much difficulty they have picking out and matching clothes because of eyesight. Participants in this study may have difficulty picking out clothing due to search difficulties rather than due to colour vision. ***Participants responded to questions about activities in distance, peripheral and colour with the option: Stopped doing this for other reasons or not interested in doing this; for example, the peripheral vision item is a question that asks ‘Because of your eyesight, how much difficulty do you have noticing objects off to the side while you are walking along? Participants F & G could not answer this question since they are unable to walk.



Figure legends

Figure 1. Room search and Head worn camera (inset)

A Go-Pro digital head worn video camera secured with an elastic strap (inset). The position of the camera was aligned using a laser pointer to ensure the camera was facing straight ahead when the participant was looking at an object directly in front of them.

The object was hidden in eight sections of the room: left upper, left lower, central left upper, central left lower, central right upper, central right lower, right upper, right lower. A grid drawn later by the tester was used for analysis of the searches.

Figure 2 Participants’ room search performances before and after the intervention

Individual participants are labelled A-I on the x axis of each chart. Dark bars represent scores before intervention, light open bars after intervention. The error bars in Graphs A and B represent mean 95% confidence intervals (CI) for the individual’s before and after intervention conditions. Each of these CIs are based on an average of 162 head-directions (range: 52-266) in Graph A. In Graph B ‘early search’ was defined as the first five head directions in each search and these data are again plotted with mean 95% Cis. These CIs are based on an average of 62 head-directions (range: 46-76). For Graphs C and D median search times plotted. The bars on these graphs represent the inter quartile range (IQR) in each case. Note that these medians and IQRs are based on only 8 observations each and that the trials were timed-out at 120 seconds.



1   2


The database is protected by copyright ©dentisty.org 2016
send message

    Main page