A new 15-minute tool to screen stroke survivors for visual perception problems has been launched by researchers from Durham and Oxford universities.
The free screening tool could make it easier for health professionals to identify difficulties in patients after a stroke and meet the need for an assessment that is quick and simple to administer.
The research behind the screening tool, funded by the National Institute for Health and Care Research (NIHR) and the Stroke Association, is published in Clinical Rehabilitation today.
Up to 76 per cent of stroke survivors may have visual perception problems but the majority of these currently go undiagnosed due to the lack of easy, reliable assessments.
Problems include people struggling to recognise day-to-day objects, faces and movements as well as difficulties with reading and hand-eye coordination. If problems are not spotted, it can severely impact someone’s quality of life, their ability to take part in activities, their independence and can pose risks. For example, people may not recognise loved ones or it may not be safe to drive, cook meals or use the stairs.
Surveys of occupational therapists show there is a need for a standardised tool and training in visual perception screening.
The new test, called the Oxford Visual Perception Screen (OxVPS), is a simple paper-based set of 10 tasks which checks for a wide range of visual perception problems after brain injury. These include object and face recognition, reading, eye-hand coordination, and neglect of the left or right side of space. In the tasks, patients are asked to recognise drawings of objects, faces, read a short paragraph, or draw a geometrical figure.
Developed with feedback from stroke survivors, as well as internationally recognised experts in neuropsychology, health professionals and healthy volunteers, the assessment takes 15 minutes to carry out, is portable and the results are easy to interpret.
Although there are various other tests available, they are time-consuming to carry out, not suitable for patients with communication difficulties and only assess a limited range of visual perception functions. Health professionals therefore mostly rely on observations and self-reporting.
Lead author, Dr Kathleen Vancleef, from Durham University’s Department of Psychology, said: “Screening stroke survivors for visual perception problems with a simple and quick test is crucial to avoid difficulties being missed and knowing what kind of support and rehabilitation someone needs. Knowing what is happening to them can make a huge difference to stroke survivors. For example, it can help ease the anxiety stroke survivors can feel around no longer recognising family members or seeing things that are not really there.
“Clinicians have asked for a standardised assessment that does not take too long, can be learned quickly and is suitable for their patients with speech, concentration and movement difficulties. We hope that our new test can fill this gap and give more patients access to screening.”
Brin Helliwell experienced visual perception problems after his stroke. He said: “My care team did not mention this could be an effect of the stroke and I was too scared to bring it up. Screening is important to make sense of what you are experiencing.”
In this study, the screening tool was tested with 107 healthy individuals of different ages to establish what ‘normal’ scores are for the screening.
The team also tested the tool with eight stroke survivors and people with poor vision which showed that the tool can tell the difference between difficulties because of eyesight problems and difficulties because of brain-related issues.
Further testing is currently being carried out with patients on stroke wards of three hospitals, but the screening tool is already available for free for clinical use for publicly funded research and healthcare, including the NHS by visiting https://oxvps.webspace.durham.ac.uk/.
Mark Dearing is a Highly Specialist Orthoptist at University Hospital of North Durham. He said: “The tool is a condensed way of being able to see if there any visual perception issues with our patients that we might be able to help with.”
The research team hopes to continue rolling out the assessment across health professionals within the NHS as well as identify a commercial partner to further develop the tool for the international market.
It is wonderful to finally be able to present this now standardised tool and make it available for allied health professionals in stroke to use. The OxVPS was conceived and started at Oxford, expanding on the now well-known first-line Oxford Cognitive Screen. OxVPS allows more specific follow-on screening of perception difficulties, including screening for more rare, but impactful perception difficulties like agnosia.
The visual report provides an easy to interpret guide, in line with our previous screening tools, highlighting the patient’s strengths alongside difficulties on the different aspects of perception in a handy overview profile.”
Professor Nele Demeyere, Department of Experimental Psychology, University of Oxford
Although OxVPS is not intended to provide a diagnosis for any of the visual perceptual conditions, it aims to inform choices for follow-up assessments and rehabilitation options.
Dr Louise Flanagan, Head of Research at the Stroke Association, said: “Every day, 240 people wake up to devastating effects of stroke. The brain damage caused by a stroke can leave survivors unable to move, see, speak or even swallow. Vision problems after stroke can make it difficult for survivors to do basic tasks like safely cross the road or recognise their family and friends. This understandably causes great anxiety for survivors who want to go about their everyday lives independently.
“The Stroke Association is pleased to have funded this project to develop a quick, simple and effective vision test which will make life easier and more enjoyable for stroke survivors. The charity funds many projects like this which have the potential to make a real and tangible difference to the lives of people affected by stroke. We hope in time that OxVPS will be used by stroke patients and clinicians around the world.”
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Alister Lees, Assistant Neurological Vision Rehabilitation Specialist, Visibility Scotland, said: “An absolute definite need and I would love for it to become the standard visual perception screening tool.”
Kirsty Forrester, Occupational Therapist, Leeds Teaching Hospitals NHS Trust, said: “What I really like about the OxVPS, and I think it really stands out, is the reading test. That’s brilliant because there’s nothing else I’ve found because I’ve searched for reading tests. So this is the only reading test that’s out there.”
