Feasibility and user-experience of virtual reality in neuropsychological assessment following stroke.

Virtual Reality (VR) offers the possibility to assess cognitive functioning in a dynamic environment resembling daily life. In this cross-sectional study, we used two user interfaces, namely non-immersive VR by using a computer monitor (CM) and immersive VR by using a head-mounted display (HMD). We investigated (1) potential differences in feasibility, user-experience, and a potential preference for one user interface over another between stroke patients and healthy controls; (2) potential differences in feasibility, user-experience, and preference between patients referred for inpatient rehabilitation care and patients referred for outpatient rehabilitation care; and (3) potential demographic and clinical characteristics that were related to patients' preference for one user interface over another. Stroke patients (n = 88) and healthy controls (n = 66) performed a VR-task with a CM and HMD. Both user interfaces were feasible to use, irrespective of clinical referral (in- or outpatient rehabilitation care). Patients reported an enhanced feeling of engagement, transportation, flow, and presence, but more negative side effects when tested with a HMD, compared to a CM. The majority of stroke patients had no preference for one user interface over the other, yet younger patients tended to prefer a HMD. VR seems highly feasible in stroke patients.

Visual daily functioning of chronic stroke patients assessed by goal attainment scaling after visual restorative training: an explorative study.

OBJECTIVE: To determine visual training effects on measures of daily life activities in cerebral blindness patients. METHOD: The study design was an explorative pre-post test design of patients in the chronic phase of stroke (≯8 months) with visual field defects. Twelve hemianopic patients were trained by using visual restorative training, which is aimed at reducing the visual field defect. Goal attainment scaling (GAS) was applied to assess whether the functional impact of visual field defects on daily life activities was reduced after defects were reduced. RESULTS: Visual field defect reduction was observed in all 12 patients to varying degrees. GAS score improvements were observed in 9 patients. In 5 of these 9 patients, all goals were attained or over-attained; in 2 of these patients, some goals were attained and other goals were not attained; and in 2 patients, goals were not attained. As a group, patients significantly improved their GAS scores (t test, P <.005). The correlation between GAS and defect reduction was not significant (Pearson's r = 0.37, P ≯ .01). It is likely that this was due to the fact that the set goals were not tuned to the part of the visual field where defect reduction could be expected. This, in turn, may have led to slightly underestimated results. CONCLUSIONS: Visual restorative function training does not only lead to visual field enlargement, as assessed with dynamic Goldmann perimetry, but it may also lead to a subjective improvement of daily visual functioning as evaluated by means of GAS.

Improvement in activities of daily living after visual training in patients with homonymous visual field defects using Goal Attainment Scaling.

BACKGROUND: Stroke is the most common cause of homonymous visual field defects (HVFDs). Yet, there is no standard protocol for composing a rehabilitation program. OBJECTIVE: In this study we assess ADL gain of visual training for vision restoration in HVFD patients by means of Goal Attainment Scaling. METHODS: Thirty-five patients trained two predefined regions of the visual field successively at home. In each region we compared the effects of both training rounds, one of which was thus 'directed' and the other 'undirected'. Visual fields were measured with Humphrey and Goldmann perimetry. QoL was assessed with three stroke-related questionnaires and ADL with Goal Attainment Scaling (GAS). RESULTS: Visual training improved the visual field for both Goldmann (ECSG = 5.82±0.94 mm; p = <0.001; n = 31) and Humphrey (0.79±0.20 dB; p = <0.001; n = 28) perimetry. All standardized stroke questionnaires were significantly improved after training (p < 0.039; n = 29), but showed no significant relation with either type of field improvement (p > 0.359). About 75% of the patients improved on their (personalized) GAS score. Interestingly, after both training rounds the GAS score increased in proportion to the extent of visual field improvement, for Goldmann border shift (p = 0.042; r = 0.38; n = 29) but not for Humphrey sensitivity increase (p = 0.337; r = 0.192; n = 28). Multiple regression revealed that GAS score was linearly related to the directed training component for Humphrey perimetry, but not for undirected training. CONCLUSION: Together these data suggest that (1) visual training aimed at vision restoration leads to visual field improvement and (2) the extent of visual field improvement is linearly related to the improvement of personal activities of daily living as evaluated by means of GAS. In conclusion, a personalized evaluation to assess treatment success showed the clinical significance of a visual training for vision restoration.