Current practice and challenges in screening for visual perception deficits after stroke: a qualitative study
Vancleef K., Colwell MJ., Hewitt O., Demeyere N.
AbstractAIMWe aimed to document current clinical practice and needs in screening for visual perception problems after stroke to inform development of new screening tools.METHODSWe interviewed 25 health care professionals (12 occupational therapists, 13 orthoptists) from 16 organisations in England. Interviews were transcribed and coded in NVivo Software. Data were thematically analysed using the Value Proposition Canvas, a model which establishes what people want to achieve, the challenges they face and what facilitates their jobs.RESULTSParticipants’ 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. They decided on referrals to orthoptists for further assessment. 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 to practice were: quick and practical tools, experienced staff or tools with minimal training requirements, a streamlined care pathway between a stroke unit and eye hospital supported by occupational therapists and orthoptists.CONCLUSIONScreening employs non-standardised assessments and rarely covers visual perceptual deficits in higher order perception. Our service evaluation demonstrates the need for a standardised visual perception screen, which should ideally be 15 minutes or less, be portable, and require minimal equipment. The screen should be suitable for bedside testing in noisy environments, inclusive for participants with aphasia and evidence-based.