Department of Experimental Psychology, University of Oxford, Oxford, UK.
Disabil Rehabil. 2022 Nov;44(22):6620-6632. doi: 10.1080/09638288.2021.1970246. Epub 2021 Aug 29.
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 REHABILITATIONLack 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.
目的:与感觉视觉缺陷或视觉忽视相比,中风幸存者经常被漏诊视觉知觉缺陷。为了更好地理解这种差异,我们评估了目前筛查中风后视觉知觉缺陷的实践。
方法:我们对参与筛查视觉知觉缺陷的英国和爱尔兰共和国的中风幸存者的专业人员进行了一项调查。
结果:40 名斜视矫正师和 174 名作业治疗师对调查做出了回应。视觉知觉缺陷筛查主要由作业治疗师进行(94%),每月筛查 75%至 100%的中风幸存者。受访者对几种常见的中风后视觉缺陷是否为知觉缺陷缺乏共识。在筛查过程中,受访者主要依赖自我报告和观察(94%),而评估工具(58%)和筛查工具的使用不足(56%)和选择不当(66%)。受访者报告说,在筛查过程中,缺乏视觉感知筛查(20%)和中风幸存者的身体/认知状况(19%)的培训是极具挑战性的。
结论:中风后视觉知觉缺陷的筛查率与感觉视觉或视觉忽视的筛查率相似。视觉知觉缺陷的漏诊可能源于对主观和非标准化筛查方法的依赖,以及临床医生对视觉知觉的定义存在冲突。我们建议增加培训的提供和使用简短的基于表现的筛查工具。
对康复的影响:临床医生对什么构成视觉知觉或感觉视觉缺陷缺乏一致意见,这可能会造成问题,因为临床决策(例如转介)通常需要精确和准确的语言。
在筛查过程中,临床医生对更熟悉的视觉(知觉)缺陷的偏见可能导致其他视觉缺陷被忽视。
为了避免遗漏问题,临床医生在筛查视觉知觉困难时,应尽量使用标准化评估,而不是依赖中风幸存者的自我报告和对功能的观察。
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