Abstract
Aim:To conduct a feasibility study using vertical reading for stroke survivors with homonymous hemianopia. Feasibility objectives included assessing the appropriateness of testing methods, outcomes and amount of recruitment possible. Vertical reading has yet no empirical evidence for its use in homonymous hemianopia.Method:A cross-over design was used involving stroke survivors with homonymous hemianopia. Three reading directions (horizontal; 90° clockwise rotation; 90° anti-clockwise rotation) were assessed in a randomised order whilst measuring reading speed.Results:Seven participants with stroke-induced homonymous hemianopia were recruited (25.9% recruitment rate). The mean horizontal reading speed was 120.3 (SD 33.9) words per minute. When reading vertically (downwards) at 90° clockwise rotation the mean reading speed was 62.7 (SD 43.4) words per minute. When reading vertically (upwards) at 90° anti-clockwise rotation the mean reading speed was 74.6 (SD 53.5) words per minute.Conclusions:This feasibility study has informed and provided vital information for planning and developing future studies for vertical reading. The primary outcome measure for future studies should be reading acuity, taking account of both speed and errors. Further preliminary studies are required which incorporate a practice element to assess for any improvement over time.
Highlights
A frequent presentation is that of a homonymous hemianopia, which is estimated to occur in approximately 45–50% of acute stroke cases (Ali et al 2013)
A total of seven individuals with hemianopia dyslexia were recruited over 12 months from a single site (25.9% recruitment rate)
Ischaemic stroke was the aetiology for six participants (86%), the other being due to a haemorrhage
Summary
Visual problems are a common sequelae of stroke; approximately 72% of stroke survivors suffer a visual problem following stroke (Rowe et al 2016). Homonymous hemianopia can cause a variety of problems, the most common of which include difficulties with reading and visual exploration (Kerkhoff 2000; Zihl 2000). There are many causes of reading difficulty after stroke, including reduced concentration, cognitive impairment, visual problems and difficulties with lexical processing (Rowe et al 2011). Stroke-induced visual field loss is a major contributor to reading problems. Rowe et al (2011) reported that more than two-thirds of patients who complained of reading difficulty had visual field loss. As a result of severe visual field loss, over three-quarters of patients continue to suffer with reading difficulties, known as hemianopic dyslexia (Zihl 1995). Hemianopic dyslexia is described as ‘an acquired reading disorder whereby patients with homonymous visual field defects have persistent and severe reading difficulties, despite having intact language function’ (Schuett 2009). It has been shown that reading impairments have a significant effect on an individual’s quality of life (Gall et al 2009; Papageorgiou et al 2007)
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