Department of Experimental Psychology, University of Oxford, Oxford, UK.
The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK.
Disabil Rehabil. 2022 May;44(10):2063-2072. doi: 10.1080/09638288.2020.1824245. Epub 2020 Oct 5.
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 rehabilitationThere 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.
目的：我们记录了目前在中风后视觉感知问题筛查方面的临床实践和需求，为开发新的筛查工具提供信息。
材料与方法：我们采访了 12 名作业治疗师和 13 名视轴矫正师。使用价值主张画布（Value Proposition Canvas）对访谈进行主题分析，该模型确定了人们想要实现目标的挑战和促进因素。
结果：参与者对视觉感知的理解各不相同，通常包括感觉和认知缺陷。作业治疗师通常筛查视野缺陷和半空间忽视，而其他方面的视觉认知则很少评估。阳性筛查结果会引发视轴矫正转诊。筛查通常在功能评估期间或使用内部开发的工具进行。实践中的挑战包括：时间不足、培训不足、环境和中风幸存者因素（如失语症）、护理连续性不足以及测试特点（如缺乏证据基础）。促进因素包括：快速实用的工具、经验丰富的员工或具有最小培训要求的工具、简化的护理途径。
结论：筛查采用非标准化评估，很少涵盖更高的视觉感知缺陷。我们证明了需要一种基于证据的视觉感知筛查，该筛查最好在 15 分钟或更短时间内完成，便携且所需设备最少。该筛查应适合床边测试，且对失语症友好。
对康复的启示：需要对视觉感知缺陷是什么以及如何进行筛查进行培训。视轴矫正师和作业治疗师之间建立本地关系被认为对为中风幸存者提供良好的视力和视觉感知护理非常有益。作业治疗师应通过使用标准化评估（如 Rivermead 感知评估电池缩短版或职业治疗成人感知筛查测试）进行系统筛查，最好注意到患者的视觉感知缺陷。
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