Visual perceptual deficit screening in stroke survivors: evaluation of current practice in the United Kingdom and Republic of Ireland

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 REHABILITATION

• Lack 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.

Keywords:

• Service evaluation
• visual perception
• visual cognition
• occupational therapy
• assessment
• screening

Acknowledgements

We thank the orthoptists and occupational therapists involved in providing feedback on the survey design and formatting of the pilot survey. We also thank Viktorija Jancevska for assistance in participant recruitment, data collection and data handling. We acknowledge the British and Irish Orthoptic Society, Association of Occupational Therapists of Ireland, and Royal College of Occupational Therapists for their assistance in distributing the survey online, as well as the clinicians who took the time to complete the survey. In addition, we would like to thank Philip Clatworthy for facilitating this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data will be made publicly available on Figshare upon publication of the study. Reviewers can consult the data at the following webpages:

• Data: https://figshare.com/s/d5e637a3c0888db02053

• Survey: https://figshare.com/s/815af71d3486069a8f76

• Analysis script: https://figshare.com/s/71e9be425ca285aa97aa

Additional information

Funding

This work was financially supported by the Stroke Association under fellowships TSA PDF 2017/03 (KV) and TSA LECT 2015/02 (ND).