Abstract
Visual impairment, specifically eye movement disorders and vestibular dysfunction may have a negative influence on the functional recovery in post-stroke patients. This type of sensory dysfunction may further be associated with poor functional outcome in patients' post-stroke. In phase 1, a cross-sectional survey (n = 100) will be conducted to determine the prevalence of eye movement disorders and vestibular dysfunction in patients who sustained a stroke. A cross-sectional clinical trial (n = 60) will be conducted during phase 2 of the study to determine the effect of the combination of vestibular rehabilitation therapy (VRT) and visual scanning exercises (VSE) (experimental group) integrated with task-specific activities compared with the effect of task-specific activities as an intervention (control group) on patients who present with eye movement impairment and central vestibular dysfunction post-stroke. An audiologist will assess (a) visual acuity (static and dynamic), (b) nystagmus, (c) saccadic eye movements, (d) smooth pursuit eye movements, (e) vestibulo-ocular reflex, and (f) saccular, utricular, and vestibular nerve function. An independent physiotherapist will assess (1) cognitive function, (2) residual oculomotor visual performance, (3) visual-perceptual system, (4) functional balance, (5) gait, (6) functional ability, (7) presence of anxiety and/or depression, and (8) level of participation in physical activity. Ethics approval has been obtained from the Ethics Committee of the Faculty of Health Sciences at the University of Pretoria (UP) (374/2015). The study will be submitted as fulfillment for the PhD degree at UP. Dissemination will include submission to peer-reviewed professional journals and presentation at congresses. Training of rehabilitation team members on the integration of VSE and VRT into task-specific activities in rehabilitation will be done if the outcome of the experimental group's functional performance is clinically and statistically significantly better than the control group on the Barthel Index. Pan African Clinical Trials Registry (PACTR201509001223262).
Highlights
A recent Cochrane review of interventions for eye movement disorders in post-stroke patients concluded that “eye movement disorders may affect over 70% of stroke patients” (1)
A cross-sectional survey will be conducted during phase 1 of the study to determine (1) the prevalence of visual impairments and central vestibular dysfunction in patients who are in the sub-acute phase post-stroke and (2) whether there is an association between the prevalence of visual impairments and central vestibular dysfunction in sub-acute post-stroke patients’ (a) cognitive function, (b) residual oculomotor visual performance, (c) visual–perceptual system, (d) functional balance, (e) gait, (f) functional ability, and (g) presence of anxiety and/or depression
A cross-sectional clinical trial will be conducted during phase 2 of the study to determine the effect of the combination of vestibular rehabilitation therapy (VRT) and visual scanning exercises (VSE) integrated with task-specific activities received by patients (Group 1) in the sub-acute phase post-stroke compared with patients who received task-specific activities alone (Group 2) on their: (a) visual impairments, (b) central vestibular dysfunction, (c) cognitive function, (d) visual–perceptual function, (e) residual oculomotor visual performance, (f) functional balance, (g) functional ability, (h) gait, and (i) level of anxiety and/ or depression
Summary
A recent Cochrane review of interventions for eye movement disorders in post-stroke patients concluded that “eye movement disorders may affect over 70% of stroke patients” (1). Results of a matched-pair randomized controlled trial conducted by Van Wyk et al (12) indicated that visual scanning exercises (VSE) with saccadic eye movement training during task-specific activities for patients with USN following a stroke resulted in significant improvement on impairment and functional activity level after 4 weeks of rehabilitation. Vestibular rehabilitation therapy (VRT) is indicated in patients with central and peripheral vestibular dysfunction (14), it is recommended that “enhanced engagement with physical, cognitive, and social stimulation that include novel and multi-modal stimulation result in better general functional outcomes” (13). Limited evidence on the prevalence of (a) visual impairments eye movement disorders and (b) central vestibular dysfunction in patients post-stroke has been identified in the literature. The long-term effect of VSE and VRT integrated with task-specific activities on patients’ activities related to participation needs to be investigated
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