Rivermead Perceptual Assessment Battery Research Articles

Current practice and challenges in screening for visual perception deficits after stroke: a qualitative study

Purpose We document current clinical practice and needs in screening for visual perception problems after stroke to inform development of new screening tools. Materials and methods We interviewed 12 occupational therapists and 13 orthoptists. Interviews were thematically analysed using the Value Proposition Canvas, a model which establishes challenges and facilitators in what people want to achieve. Results Participants’ 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. A positive screening result triggered an orthoptic referral. 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 were: quick and practical tools, experienced staff or tools with minimal training requirements, a streamlined care pathway. Conclusions Screening employs non-standardised assessments and rarely covers higher visual perceptual deficits. We demonstrates the need for an evidence-based visual perception screen, which should ideally be 15 min or less, be portable, and require minimal equipment. The screen should be suitable for bedside testing and aphasia-friendly. Implications for rehabilitation There is a high demand for training on what visual perception deficits are and how to screen for them. Building local relationships between orthoptists and occupational therapists is perceived as highly beneficial for providing good vision and visual perception care for stroke survivors. Occupational therapists should be alert for visual perceptual deficits in their patients preferably through systematic screening with standardised assessments such as the shortened version of the Rivermead Perceptual Assessment Battery or Occupational Therapy Adult Perceptual Screening Test.

Comparison of efficacy of the Test of Visual Perceptual Skills-3 and the Rivermead Perceptual Assessment Battery with Performance of Indian drivers on driving simulator for determining off-road perceptual skills: A pilot study

Background: Driving simulator (DS) is frequently used in traffic research in order to study various traffic scenarios with related traffic phenomena. This current pilot study assesses off-road driving skills of Indian drivers using driving simulator and perceptual test batteries such as the Test of Visual Perceptual Skills-3 (TVPS-3) and the Rivermead Perceptual Assessment Battery (RPAB). Objectives: The objective of this study is to determine the off-road skills of Indian drivers using DS and comparing their performance on visual perceptual test batteries (TVPS-3 and RPAB). Study Design: An observational cross-sectional study design was chosen for the research. Methods: A sample size of 30 participants, based on convenient sampling method, who met the following inclusion criteria were included: participants with driving experience of ≥1 year, age range: 20–60 years, and no obvious visual and/or physical impairment or other such comorbidities. Participants underwent evaluation in two phases. Phase 1 included screening of participants for inclusion criteria and assessment of screened participants on DS. Driving Simulator: Participants were tested on “city driving test” for 10 min. In Phase 2, after completing assessment on driving simulator, participants were randomly assigned to either of the perceptual tests. By perceptual tests, participants' perceptual abilities were assessed either using RPAB or TVPS-3. Results: The RPAB group had 12 males and 3 females, whereas the TVPS-3 group had 11 males and 4 females. The mean age for the RPAB group was 40.33 ± 11.33 and for the TVPS-3 group was 40 ± 11.06. Pearson's correlation to compare the visual perceptual tests and performance on DS was found to be statistically significant (RPAB group: r = 0.80, P = 0.00, 95% confidence interval [CI]: 0.50–0.92 and TVPS-3 group: r = 0.82,P = 0.00, 95% CI: 0.56–0.93). The performance of Indian drivers on perceptual tests and driving simulator is highly correlated. Conclusion: There is a strong positive correlation between off-road driving skills (DS) with visual perceptual skills (tested on TVPS-3 and RPAB).

Convergent validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) with two other cognitive-perceptual tools in a South African context

Background and aim: Occupational therapists working in the field of neuro-rehabilitation need to use screening tools which demonstrate validity and reliability to correctly identify patients with cognitive-perceptual impairments. The Occupational Therapy Adult Perceptual Screening Test (OT-APST) is a screening tool which was developed to identify patients with visual perceptual problems and apraxia following a stroke or other forms of acquired brain injury. Other instruments available are the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the Rivermead Perceptual Assessment Battery (RPAB). These tools evaluate similar constructs such as visual agnosia, body scheme, unilateral neglect and constructional skills but are too lengthy to use as screening tools. The aim of the study was to determine the convergent validity of the OT-APST with two other cognitive-perceptual tools commonly used in South Africa, namely the Dynamic Occupational Therapy Cognitive Assessment (DLOTCA) and the RPAB when administered to patients with a primary diagnosis of stroke. Method: A quantitative cross-sectional study was conducted on a sample of 32 participants with a primary diagnosis of stroke. Participants completed the three tools and subscales were compared with the Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA) cognitive areas and the RPAB items. Results: Five subscales of the OT-APST had significant correlations with similar DLOTCA and/or the RPAB subscales. Only the Apraxia subscale did not correlate with the referencing tools. Conclusion: This study provides further evidence of the convergent validity of the OT-APST when compared to the DLOTCA and RPAB. Although the OT-APST was standardised on an Australian population, it proved to be another option of a visual perceptual screening tool to identifying visual perceptual problems in patients with stroke in South Africa. Key words: Cognitive-perceptual, Stroke, convergent validity, Occupational therapy Adult Perceptual Screening Test (OT-APST), Dynamic Occupational Therapy Cognitive Assessment (DLOTCA), Rivermead Perceptual Assessment Battery (RPAB).

Convergent validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) with two other cognitive-perceptual tools in a South African context

BACKGROUND AND AIM: Occupational therapists working in the field of neuro-rehabilitation need to use screening tools which demonstrate validity and reliability to correctly identify patients with cognitive-perceptual impairments. The Occupational Therapy Adult Perceptual Screening Test (OT-APST) is a screening tool which was developed to identify patients with visual perceptual problems and apraxia following a stroke or other forms of acquired brain injury. Other instruments commonly used in South Africa are the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the Rivermead Perceptual Assessment Battery (RPAB). These tools evaluate similar constructs such as visual agnosia, body scheme, unilateral neglect and constructional skills but are too lengthy to use as screening tools. The aim of the study was to determine the convergent validity of the OT-APST with two other cognitive-perceptual tools, namely the Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA) and the RPAB when administered to patients with a primary diagnosis of stroke. METHOD: A quantitative cross-sectional study was conducted on a sample of 32 participants with a primary diagnosis of stroke. Participants completed the three tools and subscales were compared with the DLOTCA cognitive areas and the RPAB items. RESULTS: Five subscales of the OT-APST had significant correlations with similar DLOTCA and/or the RPAB subscales. Only the Apraxia subscale did not correlate with the referencing tools. CONCLUSION: This study provides further evidence of the convergent validity of the OT-APST when compared to the DLOTCA and RPAB. Although the OT-APST was standardised on an Australian population, it proved to be another option of a visual perceptual screening tool to identifying visual perceptual problems in patients with stroke in South Africa. Key words: Cognitive-perceptual, stroke, convergent validity, Occupational Therapy Adult Perceptual Screening Test (OT-APST), Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA), Rivermead Perceptual Assessment Battery (RPAB)

Occupational Therapy Practice in Predriving Assessment Post Stroke in the Irish Context: Findings From a Nominal Group Technique Meeting

Purpose: Practice in the area of predriving assessment for people with stroke varies, and research findings are not always easily transferred into the clinical setting, particularly when such assessment is not conducted within a dedicated driver assessment programme. This article explores the clinical predriving assessment practices and recommendations of a group of Irish occupational therapists for people with stroke. Method: A consensus meeting of occupational therapists was facilitated using a nominal group technique (NGT) to identify specific components of cognition, perception, and executive function that may influence fitness to return to driving and should be assessed prior to referral for on-road evaluation. Standardised assessments for use in predriving assessment were recommended. Results: Thirteen occupational therapists participated in the NGT meeting. Strongest consensus emerged for the inclusion of cognitive components of attention and speed of processing; perceptual components of spatial awareness, depth perception, and visual inattention; and executive components of planning, problem solving, judgment, and self-awareness. Consensus emerged for the use of the following standardised tests: Behavioural Assessment of Dysexecutive Syndrome (BADS), Test of Everyday Attention (TEA), Brain Injury Visual Assessment Battery for Adults (biVABA), Rivermead Perceptual Assessment Battery (RPAB), and Motor Free Visual Perceptual Test (MVPT). Conclusion: Tests were recommended that gave an indication of the patient’s underlying component skills in the area of cognition, perception, and executive functions considered important for driving. Further research is needed in this area to develop clinical practice guidelines for occupational therapists for the assessment of fitness to return to driving after stroke.

Occupational Therapy Practice in Predriving Assessment Post Stroke in the Irish Context: Findings From a Nominal Group Technique Meeting

Purpose: Practice in the area of predriving assessment for people with stroke varies, and research findings are not always easily transferred into the clinical setting, particularly when such assessment is not conducted within a dedicated driver assessment programme. This article explores the clinical predriving assessment practices and recommendations of a group of Irish occupational therapists for people with stroke. Method: A consensus meeting of occupational therapists was facilitated using a nominal group technique (NGT) to identify specific components of cognition, perception, and executive function that may influence fitness to return to driving and should be assessed prior to referral for on-road evaluation. Standardised assessments for use in predriving assessment were recommended. Results: Thirteen occupational therapists participated in the NGT meeting. Strongest consensus emerged for the inclusion of cognitive components of attention and speed of processing; perceptual components of spatial awareness, depth perception, and visual inattention; and executive components of planning, problem solving, judgment, and self-awareness. Consensus emerged for the use of the following standardised tests: Behavioural Assessment of Dysexecutive Syndrome (BADS), Test of Everyday Attention (TEA), Brain Injury Visual Assessment Battery for Adults (biVABA), Rivermead Perceptual Assessment Battery (RPAB), and Motor Free Visual Perceptual Test (MVPT). Conclusion: Tests were recommended that gave an indication of the patient’s underlying component skills in the area of cognition, perception, and executive functions considered important for driving. Further research is needed in this area to develop clinical practice guidelines for occupational therapists for the assessment of fitness to return to driving after stroke.

Dressing after a Stroke: A Survey of Current Occupational Therapy Practice

The objective of this study was to determine occupational therapists' beliefs about the influence of cognitive impairment on dressing difficulties and to ascertain current practice when treating dressing problems. The study design was a questionnaire survey of occupational therapists experienced in stroke care who treated patients with dressing difficulties. Out of 137 questionnaires sent, 76 (55.5%) were returned. The frequency of dressing practice provided by the occupational therapists ranged from two to four times a week. Only 43% of the therapists used standardised assessments and the most common one used was the Rivermead Perceptual Assessment Battery. Apraxia was reported by 76% of the therapists as influencing a patient's ability to dress, neglect by 71 % and memory problems by 63%. Seventy-six per cent of the therapists reported that orientating clothing and relating it to body parts was a major dressing difficulty. Other dressing difficulties reported were sequencing by 56% and failing to dress the affected side by 34%. Ninety-eight per cent of the therapists spent time providing the practice of specific functional skills on a repetitive basis; however, 60% continued to use table-top tasks aimed at targeting a particular cognitive impairment. The majority of the therapists felt that cognitive impairment was a major reason for dressing difficulties in stroke patients. With the exception of one, all the therapists provided repetitive practice on dressing tasks and over half continued to use table-top tasks. The evidence to support the types of treatment used by occupational therapists remains controversial. Further research into this area is required.

The Rivermead Perceptual Assessment Battery: Can it predict functional performance?

One of the major concerns of occupational therapy for people who have had a stroke is the functional consequence of impairment. The current study investigated the relationship between client test performance on the Rivermead Perceptual Assessment Battery (RPAB) and functional performance at admission and discharge from rehabilitation, as measured by the Functional Independence Measure (FIMSM instrument). The two aims of the study were: (i) to determine if a relationship exists between the RPAB and functional performance; and (ii) to ascertain if the RPAB could predict discharge functional performance. Forty‐six adults were assessed by the RPAB and the FIMSM over an 18‐month period. The multiple regression technique, backward elimination was used to address the research questions. The results indicated that no relationship exists between the RPAB and functional performance on admission to rehabilitation. However, the presence or absence of a visual perceptual disorder as indicated on the RPAB, combined with FIMSM admission scores were significant in predicting FIMSM discharge scores. A client’s age was found to be as predictive of functional performance as the RPAB, requiring far less time and effort to administer and include in the predictive equation. Results also indicate that people with a visual perceptual problem, as assessed by the RPAB, will achieve significantly lower scores on the FIMSM at discharge from rehabilitation than people without a visual perceptual disorder. The use of the RPAB as an assessment tool and its predictive abilities are discussed in light of the findings of this study.

Perceptual differences between stroke patients with cerebral infarction and intracerebral hemorrhage

Objective: To assess perceptual performances of patients with intracerebral hemorrhage (ICH) compared with those of ischemic patients early after stroke and to analyze the psychometric properties of three perceptual tests used in the study.Design: Cross-sectional study.Setting: A rehabilitation unit at a teaching hospital.Patients: Twenty-two stroke patients with ICH and 22 demographically matched stroke patients with infarction.Main Outcome Measures: Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), Rivermead Perceptual Assessment Battery (RPAB), and Motor-Free Visual Perception Test (MVPT).Results: Stroke patients with ICH had significantly more severe deficits on a task of thinking operations than did patients with infarction. A significant lateralized effect of stroke existed in the ICH group, with patients with right-hemisphere strokes scoring lower than patients with left-hemisphere strokes on the figure-ground discrimination subtest of the RPAB. A considerable overlap among the three instruments was found. Yet, the observed correlations between supposedly similar subtests from the tests proved to be moderate, indicating that to a certain extent these test measures tap different perceptual processes. Four factors were generated from a joint LOTCA-RPAB-MVPT factor analysis. They assessed different facets of perceptual functioning, including higher-level and lower-level perceptual skills, part/whole conceptual integration, and color perception. This factor pattern accounted for 75.5% of the variance.Conclusions: Higher-level perceptual functions tend to be relatively susceptible to ICH stroke pathology early in the course of the disease. This information has important clinical implications in the early treatment planning for the stroke patients with ICH, such that specific compensatory strategies for these deficiencies should be devised to facilitate a successful rehabilitation. Knowledge regarding the influences of specific deficits on the performance of daily activities may also be useful to the patients' family.

Visual perception and hand function in persons with multiple sclerosis

AbstractThe purpose of this study was to investigate the relationships between hand function performance and visual perceptual function in people with multiple sclerosis (MS). Twenty‐two participants, 19 women and 3 men, with a clinical diagnosis of MS were evaluated using the interim Australian version of the Jebsen Test of Hand Function (JTHF) (Agnew and Maas, 1982a) and the Rivermead Perceptual Assessment Battery (RPAB) (Whiting et al., 1985). Results indicated that participants exhibit hand function problems and difficulties with visuospatial and visuomotor tasks. Four of the subtests in the JTHF (card turning, manipulating small objects, moving large light objects and moving large heavy objects) were moderately to highly correlated with three RPAB subtests (right/left copying shapes, right/left copying words and cancellation) measuring inattention function. Based on task analysis, high correlation between subtests of the two assessments may indicate that both assessments involve a motor component. The suitability of these assessments for establishing relationships between hand function and non‐motor visual perceptual skills in persons with MS is therefore questioned. In view of the small sample size, however, larger‐scale research is needed to confirm this claim. The present study provides some evidence to support the neuro‐anatomical model proposed by Botez and associates (1989). Further research should aim to design an appropriate and sensitive instrument for evaluating visual perceptual dysfunction in people with MS. Copyright © 1998 Whurr Publishers Ltd.

The Rivermead Perceptual Assessment Battery: Its Relationship to Selected Functional Activities

Thirty-five stroke patients were assessed on the Rivermead Perceptual Assessment Battery (RPAB) and three functional activities. The activities chosen had reported constructional components. A checklist was developed to measure a person's performance on the constructional components of each activity objectively. The RPAB results were correlated with those of making a sandwich and packing a lunchbox, putting on a cardigan and setting a table. A statistically significant relationship was found between the RPAB and the selected functional tasks. The results also suggest that a clinical relationship exists between performance on the RPAB and the three tasks, therefore assumptions can be made about a person's performance on these tasks using the results from the RPAB.

The Rey Figure Copy as a Screening Instrument for Perceptual Deficits after Stroke

The aim of the study was to investigate the use of the Rey figure for screening patients for perceptual impairment following stroke. Stroke patients in a trial of a stroke unit were assessed using the Rey figure copy at entry to the study. Those admitted to the stroke unit were also assessed on the Rivermead Perceptual Assessment Battery (RPAB). In 61 patients assessed consecutively on both tests, using conventional clinical cut-off points the Rey figure copy was impaired in 31 out of 32 patients who were impaired on the RPAB. Fifteen patients who failed the Rey figure did not have perceptual problems on the RPAB, indicating that deficits on the Rey figure are not only due to perceptual problems. A receiver operating characteristic curve was plotted to compare different cut-off points. The Rey figure may be used as a brief screening assessment for perceptual deficits following stroke.

Treatment of the neglect syndrome in stroke patients using a contingency electrical stimulator

Two patients with major infarcts in the right middle cerebral artery territory associated with severe perceptual problems including tactile neglect were treated with a contingency electrical stimulator. This delivered electrical stimuli to the forearm skin on the neglected side whenever the patient moved the contralateral normal arm, with the intention of drawing the patient's attention to the neglected side. The effect of this treatment was assessed in a single case design using the Rivermead Perceptual Assessment Battery. Both patients had a statistically significant improvement in tests of perceptual function during the period of the study. In addition, there was a significant difference between the treatment and the baseline periods: the differences between the slopes of the regression lines fitted to the scores were statistically significant, favouring the treatment periods. This supported the inference that the changes were at least in part due to the treatment rather than merely the natural history of the disease. These results suggest that this approach to treating an otherwise intractable condition should be further investigated.

The Clinical Usefulness of the Rivermead Perceptual Assessment Battery: Statistical Considerations

The Rivermead Perceptual Assessment Battery (RPAB) is designed to assess visual perception deficits in people suffering from stroke and head Injury. It Is one of the few standardised perceptual assessments specifically developed for occupational therapists. This article examines some aspects of the statistical background of the RPAB. The RPAB authors have reported limited statistical data, which Is Insufficient to understand fully the clinical usefulness of this assessment tool. Reliability and validity are examined and the implications of test results are discussed. The true score range for patients on each subtest is calculated, as well as the amount of change over time required before clinicians can be confident that such change represents a real improvement or decline In the patient's ability. Further, the discriminative power of each subtest is examined, as are the criteria for determining the presence and type of perceptual deficit. These statistical analyses were based on the data reported in the test's manual, as well as from patients assessed at The Prince Henry Hospital, Sydney, over a 2-year period.

The Rivermead Perceptual Assessment Battery in Acute Stroke

Eighty-six elderly subjects completed the Rivermead Perceptual Assessment Battery (RPAB) within 14 days of stroke. The RPAB was scored with either a criterion score (number of subtests above cut-off) or total score, calculated by weighting all 16 subtest scores. Three shortened versions of the RPAB were also assessed. The RPAB results were compared with those of line bisection, line cancellation and drawing tests. Perceptual impairment as defined by the RPAB was equally common in dominant and non-dominant hemisphere stroke. RPAB criterion and total scores were correlated with line cancellation, line bisection, limb power and cognitive score. Both RPAB scores were significant univariate predictors of functional outcome and discharge residence. In multivariate models, Barthel ADL score at day 7 and RPAB criterion score were significant predictors of functional outcome; Barthel ADL score at day 7 was the only significant predictor of discharge residence for subjects previously living at home. Total RPAB score was no more useful than criterion score. The shortened RPAB version A predicted outcome as successfully as the full RPAB. The shortened RPAB version A as a screening test of perception following acute stroke is recommended.

Perceptual impairment after stroke: improvements during the first 3 months.

The aim of the study was to assess changes in perceptual abilities during the first 3 months after stroke using a prospective observational design. The sample was from a hospital with a catchment population of 205,000. Seventy persons aged 60+ admitted with non-lacunar stroke were given the Rivermead Perceptual Assessment Battery, 2 weeks after stroke. Three months post-stroke subjects were reassessed on subtests they had initially failed. The improvements in performance on all 16 subtests of the RPAB were significant, and large in relationship to the maximal possible improvement had all subjects achieved perfect scores on follow-up. Performance on line bisection and line cancellation also improved significantly. In spite of these improvements 64% of subjects still had perceptual impairment as defined by an RPAB score of 0-12 at 3 months post-stroke. It is concluded that perceptual abilities improved greatly during the first 3 months after non-lacunar stroke but nevertheless perceptual impairments remain common at 3-month follow-up.

Routine screening of brain-damaged patients: a comparison of the Rivermead Perceptual Assessment Battery and the Chessington Occupational Therapy Neurological Assessment Battery

Thirty-two brain damaged patients undergoing rehabilitation were assessed independently by the Rivermead Perceptual Assessment Battery (RPAB) and the Chessington Occupational Therapy Neurological Assessment Battery (COTNAB). The detection of perceptual deficits was similar with both batteries. The RPAB was quicker and slightly easier to use but the COTNAB was considered to give considerably more information. This led us to conclude that the COTNAB was the preferred battery for routine use in our clinical setting. Patients found both batteries acceptable with no particular preference for one over the other.

The recovery of perceptual problems after stroke and the impact on daily life

The frequency of perceptual problems in stroke patients and the impact of daily life, were assessed at one month and two years after onset of the stroke. Ninety patients were assessed on the Rivermead Perceptual Assessment Battery (RPAB) and an Activities of Daily Living (ADL) scale. Perceptual problems were identified in 69% of patients on the one month assessment and in 74% of patients on the two-year assessment. There was no significant difference in the frequency or severity of perceptual problems, between the two assessments. Significant improvement occurred in activities such as mobility, preparing a hot drink and crossing a road. There remained a significantly high correlation between perceptual problems and independence in activities of daily living.

Evaluation of a comprehensive assessment battery for stroke patients

The authors describe their experience of evaluating a battery of tests to assess function in patients with stroke and head injuries. They consisted of the Abbreviated Mental Test Score, Ravens Progressive Coloured Matrices, Hospital Anxiety and Depression Scale (HAD), Motricity Index, Shortened Rivermead Perceptual Assessment Battery (RPAB), Frenchay Aphasia Screening Test (FAST) and Barthel's Activities of Daily Living Index. These were applied to 50 patients, six of whom had had a head injury and 44 a stroke. Over 80% of subjects were able to complete the battery. Reasons for failure amongst the remainder were language problems, poor concentration and short term memory loss. Abnormalities in one aspect of cerebral function often compromised tests designed to assess another aspect of this. For example, upper limb incoordination interfered with RPAB, language difficulties affected the Abbreviated Mental Test, and HAD, and hemianopia compromised both RPAB and FAST tests. The battery can usually be completed within 1h, and could be performed by a wide range of professionals. It is likely to be particularly useful in screening for abnormalities requiring more detailed evaluation by particular professionals, and in monitoring the progress of patients during the course of treatment.

The Rivermead Perceptual Assessment Battery: its application to stroke patients and relationship with function

The Rivermead Perceptual Assessment Battery (RPAB) was developed to identify deficits in visual perception. This study sought to examine the relationship of the RPAB to performance in activities of daily living (ADL), and to investigate the concurrent validity of the RPAB. Subjects were 101 stroke patients admitted for inpatient rehabilitation. The RPAB was administered on admission to rehabilitation; prior to this, the treating therapists used the RPAB categories to provide a consensus opinion of the presence of perceptual deficits. The Australian ADL Index was administered on admission to and discharge from rehabilitation. ADL performance improved for all patients during rehabilitation, but patients identified by the RPAB as having perceptual deficits performed more poorly at both admission and discharge than did patients without deficits. However, scores on individual RPAB categories and cognate ADL activities were not consistently related. There was little agreement between the RPAB and the therapists' expert opinion. This result was interpreted in the context of an informal evaluation, made by the testing therapist, of the reasons for failing individual subtests. It was concluded that diagnostic use of the RPAB should combine test scores with observations made during testing, and that the validity of the RPAB must still be questioned.