Current practice and challenges in screening for visual perception deficits after stroke: a qualitative study

Abstract

Purpose

We document current clinical practice and needs in screening for visual perception problems after stroke to inform development of new screening tools.

Materials and methods

We interviewed 12 occupational therapists and 13 orthoptists. Interviews were thematically analysed using the Value Proposition Canvas, a model which establishes challenges and facilitators in what people want to achieve.

Results

Participants’ understanding of visual perception varied and often included sensory and cognitive deficits. Occupational therapists commonly screened for visual field deficits and hemispatial neglect, while other aspects of visual cognition were rarely assessed. A positive screening result triggered an orthoptic referral. Screening generally occurred during functional assessments and/or with in-house developed tools. Challenges to practice were: lack of time, lack of training, environmental and stroke survivor factors (e.g., aphasia), insufficient continuation of care, and test characteristics (e.g., not evidence-based). Facilitators were: quick and practical tools, experienced staff or tools with minimal training requirements, a streamlined care pathway.

Conclusions

Screening employs non-standardised assessments and rarely covers higher visual perceptual deficits. We demonstrates the need for an evidence-based visual perception screen, which should ideally be 15 min or less, be portable, and require minimal equipment. The screen should be suitable for bedside testing and aphasia-friendly.

Implications for rehabilitation

• There is a high demand for training on what visual perception deficits are and how to screen for them.

• Building local relationships between orthoptists and occupational therapists is perceived as highly beneficial for providing good vision and visual perception care for stroke survivors.

• Occupational therapists should be alert for visual perceptual deficits in their patients preferably through systematic screening with standardised assessments such as the shortened version of the Rivermead Perceptual Assessment Battery or Occupational Therapy Adult Perceptual Screening Test.

Keywords:

• Visual perception
• screening
• stroke
• assessment
• clinical needs
• facilitators
• barriers

Acknowledgments

We would like to express our sincere gratitude to all the participating allied health professionals who gifted their time. In addition we would like to thank Philip Clatworthy and Claire Murray for facilitating this project. This work was supported by the Stroke Association under TSA PDF 2017/03; and under TSA LECT 2015/02.

Disclosure statement

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

Data availability

Given the small group of stroke orthoptists and stroke occupational therapists in England, sharing the interview transcripts would potentially disclose participants’ identity.