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

Figures & data

Table 1. Survey constructs, example items, and prefabricated responses.

Construct	Example item	Example (prefabricated) responses^a
Understanding of sensory vision and visual perception	Q: Do you consider any of the following to be visual perception functions? (Section 1)	Visual acuity; object recognition; visual neglect; visual fields^a
Current practice in screening for deficits	Q: Which information source do you use while screening for visual perception difficulties in a stroke survivor?	Asking the stroke survivor’s family about experienced problems
Barriers to practice	Q: How challenging are the following barriers while screening for visual perception in stroke survivors?	Staff shortages; limited contact time; lack of staff training
Facilitators to practice	Q: Which of the following features would be helpful in a tool for screening for visual perception difficulties following stroke?	Suitability for persons with limited concentration or alertness; Results which are easy to interpret

^aExamples included are not an exhaustive list of responses provided to survey participants.

Table 2. Operational definitions of visual problems, visual perception and visual neglect provided to research participants within the survey.

Domain	Operational definition provided to survey respondents
Visual problem (sensory vision)	“Visual problems refer to sensory visual impairments. These impairments are attributed to damage to the early visual pathways from the eye to the primary visual cortex. Examples include reduced visual acuity, visual field problems like hemianopia, eye movement problems like nystagmus and strabismus, cataracts, macular degeneration, stereoblindness, etc.”
Visual Perception	“Visual perception refers to the processing of visual information by areas in the occipital, parietal and temporal cortex (beyond the primary visual cortex). It is a dynamic process of translating sensory input into meaningful concepts. Examples of visual perceptual deficits include apperceptive and associative agnosia, prosopagnosia, akinetopsia, achromatopsia, problems in visuospatial abilities.”
Visual Neglect	“Visual inattention or hemispatial neglect is reduced awareness to visual stimuli in the contralesional side. It is sometimes considered to be part of visual perception, while others attribute this to an attentional deficit. These definitions will be provided at the bottom of each page going forward. Please refer back to these at any point if required.”

Figure 1. Flowchart of participant inclusion and exclusion process. *Survey completions include instances where respondents reached the end of the survey with most items completed (≥95%); **Excluded due to out of area (n = 3), other clinical specialty (n = 12), or missing key information (n = 19).

Figure 2. Geographical Spread of Clinician Respondents. Instances of missing region data from UK clinicians were n = 3.

Figure 3. (A, B) Definitions and importance of sensory visual and visual perception domains, as rated by occupational therapists. Response rates for all items herein fall between 98 and 100% (n = 170–174).

Figure 4. (A, B) Definitions and importance of sensory visual and visual perception domains, as rated by orthoptists. Response rates for all items herein fall between 95 and 100% (n = 38–40).

Figure 5. (A, B) Rate of screening and average length of screening window across stroke services. Respondent data from clinicians working hyperacute/acute or community rehabilitation/ESD exclusively were analysed herein. Response rate was 89–99% per item. Respondents unable to provide answer was 1–8 per item.

Table 3. Clinicians involved in clinical screening of sensory vision and visual perception difficulties.

	Sensory vision screening (Respondents = 214)	Visual perception screening (Respondents =214)	Visual neglect screening (Respondents =214)
Profession	% (responses)	% (responses)	% (responses)
Occupational therapy	75 (160)	88 (188)	86 (185)
Orthoptics	20 (43)	12 (25)	14 (30)
Physiotherapy	16 (35)	8 (18)	17 (37)
Clinical (neuro-)psychology	1 (2)	7 (14)	6 (12)
Medical professional	24 (51)	5 (10)	16 (34)
Multidisciplinary team/ward staff	9 (20)	3 (7)	3 (7)
Speech and language therapy	1 (3)	1 (2)	2 (4)
Staff nurses	2 (5)	<1 (1)	4 (9)
Therapy assistants	<1 (1)	<1 (1)	0 (0)
Ophthalmology	3 (7)	0 (0)	<1 (1)
Other external staff (A&E, GP)	2 (4)	0 (0)	0 (0)
Optometry	1 (2)	0 (0)	0 (0)

Note. Non-response for these items varied between 2 and 3% (n = 5–7). 1 respondent selected “Don’t know” for visual perception screening. Respondents were able to select multiple responses for this question, resulting in a greater number of responses than respondents.

Figure 6. Frequency of use and importance of information sources used by respondents to inform visual perception screening. Response rates for all items was 100% (n = 214). *A distinction between visual perception tests and screening tools was made within the survey, referring to “screening tools” as “Set of shorter tests and questions to screen for a range of functions in a short time, usually less than 20 min. This might then prompt follow-up by more in-depth assessment of specific functions and/or by a referral to specialist service.”

Table 4. Standardised clinical tests used in screening of visual perception difficulties.

Assessment	Frequency of use
Standardised screen tool or battery (n = 125)	% (n)
Rivermead Perceptual Assessment Battery	34 (42)
Oxford Cognitive Screen	21 (26)
Behavioural Inattention Test	21 (26)
Visual Object and Space Perception Battery	14 (17)
Montreal Cognitive Assessment	11 (14)
Chessington Occupational Therapy Neurological Battery	9 (11)
Addenbrookes Cognitive Examination	8 (10)
Brain Injury Visual Assessment Battery for Adults	6 (7)
Motor-Free Visual Perception Test	2 (3)
Rookwood Driving Battery	2 (2)
Birmingham Cognitive Screen	2 (2)
Occupational Therapy Adult Perceptual Screening Test	2 (2)
Specific screening tests (n = 125)
Cancellation Tests (Line, Bell, Hearts, Stars, Balloon)	23 (29)
Line bisection	22 (27)
Clock Test	7 (9)
Copying Test	3 (4)
Object recognition test	3 (4)
Colour recognition test	2 (3)
2D/3D construction	2 (2)

Note. Response rate for this item was 58% (125 out of 214), while the question was intended for respondents who mentioned in the previous question that they used standardised batteries or screening tools during assessments (n = 123) two additional respondents completed this question. Only tests that were mentioned by at least two participants are included in the table.

Figure 7. (A, B) Current challenges and facilitators to screening of visual perception problems following stroke. Response rates for all items ranged from 97 to 99% (n = 207–212).

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