Wijesundera Chamini, Crewther Sheila G, Wijeratne Tissa, Vingrys Algis J
School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
Department of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia.
Front Neurol. 2022 Feb 16;13:757431. doi: 10.3389/fneur.2022.757431. eCollection 2022.
As measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients.
Sixty AIS patients (65 ± 14 years, 33 males) without pre-existing visual/neurological disorders and acuity better than 6/12 were tested at their bedside during the first week post-stroke and were compared to 40 controls (64 ± 11 years, 15 males). Visual field sensitivity, quantified as mean deviation (dB) and visual acuity (with and without luminance noise), were tested on MRFn (Melbourne Rapid Field-Neural) iPad application. Visuomotor capacity was assessed with the Lee-Ryan Eye-Hand Coordination (EHC) iPad application using a capacitive stylus for iPad held in the preferred hand.Time to trace 3 shapes and displacement errors (deviations of >3.5 mm from the shape) were recorded. Diagnostic capacity was considered with Receiver Operating Characteristics. Vision test outcomes were correlated with National Institutes of Health Stroke Scale (NIHSS) score at the admission.
Of the 60 AIS patients, 58 grasped the iPad stylus in their preferred right hand even though 31 had left hemisphere lesions. Forty-one patients (68%) with better than 6/12 visual acuity (19 right, 19 left hemisphere and 3 multi-territorial lesions) returned significantly abnormal visual fields. The stroke group took significantly longer (AIS: 93.4 ± 60.1 s; Controls: 33.1 ± 11.5 s, < 0.01) to complete EHC tracing and made larger displacements (AIS: 16,388 ± 36,367 mm; Controls: 2,620 ± 1,359 mm, < 0.01) although both control and stroke groups made similar numbers of errors. EHC time was not significantly different between participants with R ( = 26, 84.3 ± 55.3 s) and L ( = 31, 101.3 ± 64.7 s) hemisphere lesions. NIHSS scores and EHC measures showed low correlations (Spearman R: -0.15, L: 0.17). ROC analysis of EHC and vision tests found high diagnostic specificity and sensitivity for a fail at EHC time, or visual field, or Acuity-in-noise (sensivity: 93%, specificity: 83%) that shows little relationship to NIHSS scores.
EHC time and vision test outcomes provide an easy and rapid bedside measure that complements existing clinical assessments in AIS. The low correlation between visual function, NIHSS scores and lesion site offers an expanded clinical view of changes following stroke.
由于可测量的感觉和运动功能障碍是中风诊断的关键，我们研究了基于平板电脑的客观视觉和视觉运动能力评估在急性轻 - 中度缺血性中风（AIS）患者中的价值。
60例AIS患者（65±14岁，33例男性），既往无视觉/神经疾病且视力优于6/12，在中风后第一周于床边进行测试，并与40例对照组（64±11岁，15例男性）进行比较。使用MRFn（墨尔本快速视野 - 神经）iPad应用程序测试视野敏感度，以平均偏差（dB）和视力（有和无亮度噪声）进行量化。使用Lee - Ryan眼手协调（EHC）iPad应用程序，用优势手持的用于iPad的电容式触控笔评估视觉运动能力。记录追踪3种形状的时间和位移误差（偏离形状>3.5毫米）。使用受试者工作特征曲线来评估诊断能力。视力测试结果与入院时的美国国立卫生研究院卒中量表（NIHSS）评分相关。
60例AIS患者中，58例用其优势右手握住iPad触控笔，尽管31例有左半球病变。41例视力优于6/12的患者（68%）（19例右侧、19例左半球和3例多区域病变）视野明显异常。中风组完成EHC追踪的时间明显更长（AIS：93.4±60.1秒；对照组：33.1±11.5秒，<0.01），并且位移更大（AIS：16,388±36,367毫米；对照组：2,620±1,359毫米，<0.01），尽管对照组和中风组的错误数量相似。右半球病变（n = 26，84.3±55.3秒）和左半球病变（n = 31，101.3±64.7秒）的参与者之间EHC时间无显著差异。NIHSS评分与EHC测量显示低相关性（Spearman相关系数：右侧为 -0.15，左侧为0.17）。EHC和视力测试的ROC分析发现，对于EHC时间、视野或噪声下视力测试失败具有高诊断特异性和敏感性（敏感性：93%，特异性：83%），且与NIHSS评分关系不大。
EHC时间和视力测试结果提供了一种简单快速的床边测量方法，可补充AIS现有的临床评估。视觉功能、NIHSS评分和病变部位之间的低相关性为中风后的变化提供了更广泛的临床视角。
