Abstract
Date Presented 04/02/2022
After a stroke, patients may have some degree of visual field deficit. There is a current lack of consensus on the best practices for improving these deficits. The goal of this study is to determine whether Bioness Integrated Therapy System touch screen technology more effectively improves visual field deficits than conventional table-top exercises. Preliminary Bell’s Test data for 10 participants are presented. These data suggest that patients may benefit more from an interactive technology-based regimen than conventional exercises.
Primary Author and Speaker: Heidi Fagan
Additional Authors and Speakers: Jaclyn Lavigne
Contributing Authors: John J. Pulaski, Henry C. Hrdlicka, Emily Meise, Megan Palmer, Amanda Meyer
PURPOSE: Many patients admitted to inpatient rehabilitation after acute neurological injury, such as stroke, have some degree of visual field deficit. Occupational Therapists (OTs) are trained to screen, assess, and treat these deficits. Many of the current interventions are either compensatory or restorative, however, there is conflicting evidence on what the current best practice is to improve visual field loss. The purpose of this study is to determine if the integration of touch screen technology into an OT regimen positively impacts visual field awareness. Specifically, our goal is to determine if the use of Bioness Integrated Therapy System® (BITS) touch screen technology is more effective in improving visual field awareness than conventional vision interventions involving table-top and pen and pencil activities. To our knowledge, there is currently a paucity of literature that assesses the effectiveness of BITS touch-screen technology in improving visual field deficits in stroke or brain injury patients.
DESIGN: This is a quasi-randomized controlled intervention study. Subjects were recruited from adults currently undergoing inpatient rehabilitation for an acute neurological visual field deficit following an acute neurological event, such as a stroke. Visual field deficits were diagnosed by visual field testing issued by a licensed Neuro-Optometrist.
METHOD: The study was conducted at a Long-Term Acute Care Hospital (LTACH) in the Northeastern United States. Upon signing an informed consent, subjects were alternately assigned to either the Control or BITS intervention treatment groups. The Control group were prescribed a conventional treatment regimen consisting of various table-top and pen and paper exercises. The BITS group were prescribed a treatment regimen consisting of similar exercises, but using BITS touch screen technology. Both groups were given 6 treatment sessions by an OT investigator. OTs also delivered pre- and post-intervention Bell’s testing to each subject; pre- and post-intervention Visual Field testing was delivered by a licensed Neuro-Optometrist.
RESULTS: Complete preliminary Bell’s Test data for 10 subjects, including 5 Control and 5 BITS subjects is available. The primary metrics captured by the Bell’s Test include number of Bells/items correctly identified, number of Bells/items omitted, number of distractors mistakenly identified, and total test and realization times. Preliminary data were analyzed using multiple t-tests. All pre-intervention Bell’s Test metrics were similar between groups, indicating subjects had similar baseline visual deficits independent of group assignment. In the Control group, no parameters were found to be significantly different between pre- and post-assessments. In the BITS group, the mean (SD) number of correct items increased from 21 (11) to 28 (7) (p = 0.014) following the intervention. Comparing the post-intervention assessments between groups, the number of items correctly identified in the BITS group trended towards being significantly greater than the Control [16 (10) vs 28 (7); p = 0.058]. Preliminary visual field data is available for 5 BITS and 3 Control subjects. The data suggests, of the 8 visual fields, 8/8 fields were either significantly improved (p<0.05) or trended towards significance (p<0.01) in the BITS group. In the Control, only 4/8 fields suggested an improvement.
CONCLUSIONS: These preliminary data suggest patients with visual field deficits may benefit more from an interactive technology based OT regimen than conventional table-top exercises. We believe the potential impact of the study is to help develop best practices in the rehabilitation of visual field deficits in the LTACH setting and to add to the paucity of BITS related literature.
References
Deng, Y. M., Chen, D. D., Wang, L. Y., Gao, F., Sun, X., Liu, L., Lei, K., Wang, S. R., Mo, D. P., Ma, N., Song, L. G., Huo, X. C., Xu, X. T., Yan, T. Y., & Miao, Z. R. (2018). Visual field impairment predicts recurrent stroke after acute posterior circulation stroke and transient ischemic attack. CNS neuroscience & therapeutics, 24(2), 154–161. https://doi.org/10.1111/cns.12787
Mancuso, M., Damora, A., Abbruzzese, L., Navarrete, E., Basagni, B., Galardi, G., Caputo, M., Bartalini, B., Bartolo, M., Zucchella, C., Carboncini, M. C., Dei, S., Zoccolotti, P., Antonucci, G., & De Tanti, A. (2019). A New Standardization of the Bells Test: An Italian Multi-Center Normative Study. Frontiers in Psychology, 9, 2745. https://doi.org/10.3389/fpsyg.2018.02745
Rowe, F. J., Barton, P. G., Bedson, E., Breen, R., et al. (2014). A randomised controlled trial to compare the clinical and cost-effectiveness of prism glasses, visual search training and standard care in patients with hemianopia following stroke: a protocol. BMJ open, 4(7), e005885. https://doi.org/10.1136/bmjopen-2014-005885
