Screening for visual deficits at a rehabilitation unit early in the rehabilitation process after stroke

Eike Wehling; Eirik Vikane; Siri Hanne Betten Lysgård; Tina Taule; Silje Karin Pedersen; Anne Helen Jacobsen; Eline A. Kordt

doi:10.15626/sjovs.v18i1.4223

Authors

Eike Wehling University of Bergen https://orcid.org/0000-0002-3186-3023
Eirik Vikane Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway https://orcid.org/0000-0001-9393-1581
Siri Hanne Betten Lysgård Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
Tina Taule Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway https://orcid.org/0000-0002-9094-347X
Silje Karin Pedersen Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
Anne Helen Jacobsen Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway https://orcid.org/0009-0008-7000-3932
Eline A. Kordt Department of Occupational Therapy, Orthopaedical Clinic, Haukeland University Hospital, Bergen, Norway

DOI:

https://doi.org/10.15626/sjovs.v18i1.4223

Keywords:

visual impairment, stroke, subacute, NIHSS, neurorehabilitation

Abstract

Stroke patients are not routinely screened for visual deficits despite recommendations on the importance of vision for safety and design of rehabilitation plans. The aim was to examine if it was feasible to expose rehabilitation patients to vision screening. Secondly, we aimed to examine the agreement between the vision screening and items from a neurological stroke screening tool specifically targeting vision and neglect. Over a period of 6 months, patients arriving at a rehabilitation unit after having had a stroke were consecutively included. Data on aetiology, severity, and location of the stroke, time since the original admission, scores on the National Institutes of Health Stroke Scale (NIHSS), and results from a short screening/observation battery were registered. Cohen’s kappa was calculated to examine the agreement between results from the screening/observation battery and NIHSS items. Nighty-six percent of the patients were able to undergo screening of basic visual functions. Impairment was found in 52% of the patients, and 67% of these showed impairment in more than one function. Visual impairment occurred for all levels of stroke severity. Reduced distance visual acuity was found in 15% of all patients. Accordance between the screening/observation battery and NIHSS items varied between κ = 0.36 and κ = 0.64. Screening battery vs NIHSS items showed impairment in 31% vs. 21% of patients for oculomotor deficits, 31% vs. 34% for visual field deficits and 31% vs. 29% for neglect. Results show that patients are assessable for basic visual functions early in the rehabilitation process. Items from the NIHSS cannot replace a dedicated vision screening tool because they exclude essential functions such as visual acuity, and oculomotor deficits may go undetected. Only the visual field assessment indicates substantial agreement and high sensitivity. Regarding stroke severity, agreement was substantial only in the severe group. In summary, we conclude that the NIHSS items cannot be recommended to replace systematic screening of visual function and neglect.

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