Search

BackgroundVisual field defects are a common consequence of stroke, and compensatory eye movement strategies have been identified as the most promising rehabilitation option. There has been a move toward compensatory telerehabilitation options, such as the Durham Reading and Exploration (DREX) training app, which significantly improves visual exploration, reading, and self-reported quality of life. ObjectiveThis study details an iterative process of liaising with stroke survivors, carers, and health care professionals to identify barriers and facilitators to using rehabilitation tools, as well as elements of good practice in telerehabilitation, with a focus on how the DREX package can be maximized. MethodsSurvey data from 75 stroke survivors informed 12 semistructured engagement activities (7 focus groups and 5 interviews) with 32 stroke survivors, 10 carers, and 24 occupational therapists. ResultsThematic analysis identified key themes within the data. Themes identified problems associated with poststroke health care from both patients’ and occupational therapists’ perspectives that need to be addressed to improve uptake of this rehabilitation tool and telerehabilitation options generally. This included identifying additional materials or assistance that were required to boost the impact of training packages. The acute rehabilitation setting was an identified barrier, and perceptions of technology were considered a barrier by some but a facilitator by others. In addition, 4 key features of telerehabilitation were identified: additional materials, the importance of goal setting, repetition, and feedback. ConclusionsThe data were used to try to overcome some barriers to the DREX training and are further discussed as considerations for telerehabilitation in general moving forward.

Social determinants of health (SDH), such as social isolation and loneliness, are often more frequently experienced in brain injury survivors. The paper explores the personal experiences of loneliness among brain injury survivors during lockdown to negate health inequalities and improve rehabilitation for this population in the future. Twenty-four brain injury survivors participated in semi-structured interviews and questionnaires relating to loneliness, resilience and wellbeing. Three themes (the experience of loneliness, loneliness during the pandemic and loneliness after the pandemic) explored survivors' experiences of loneliness generally post-brain injury, but also chronicle how these feelings developed in lockdown and survivors' feelings regarding society returning to 'normal'. Future interventions should focus on reframing survivors' beliefs regarding societal expectations and minimise the pressure they experience to keep up with their peers physically and emotionally. Additionally, we recommend creating accessible peer support options for all brain injury survivors as an important step for alleviating loneliness. [ABSTRACT FROM AUTHOR]

Patients with homonymous visual field defects experience disabling functional impairments as a consequence of their visual loss. Compensatory visual exploration training aims to improve the searching skills of these patients in order to help them to cope more effectively. However, until now the efficacy of this training has not been compared to that of a control intervention. Given that exploration training uses the visual search paradigm, which is known to require visual attention, in this study the efficacy of the technique was compared with training that requires visual attention but not exploration. Participants completed either exploration training (n = 21), or attention training followed by exploration training (n = 21). Assessment of the visual field, visual search, reading and activities of daily living were performed before and after each intervention that the participants completed. The results revealed that both the exploration training and the attention training led to significant improvements in most of the visual tasks. For most of the tasks exploration training did not prove superior to attention training, and for reading both types of intervention failed to yield any benefits. The results indicate that attention plays a large role in the rehabilitation of homonymous visual field defects.

This study explored stroke survivors’ experiences of loneliness. Drawing on interviews with 29 community-dwelling stroke survivors living in the Northeast of England, we found several themes: loneliness as being alone, the season or time, lack of understanding from those without any experience of stroke, reduced autonomy, and deterioration of social relations. It is important that healthcare professionals pay attention to the aspects of life that may increase the chances of a stroke survivor becoming lonely after being discharged from hospital, and to measure loneliness in stroke survivors a more valid scale should include items that touch on the aspects reported here. [ABSTRACT FROM AUTHOR]

Visual search is a task often used in the rehabilitation of patients with cortical and non-cortical visual pathologies such as visual field loss. Reduced visual acuity is often comorbid with these disorders, and it remains poorly defined how low visual acuity may affect a patient's ability to recover visual function through visual search training. The two experiments reported here investigated whether induced blurring of vision (from 6/15 to 6/60) in a neurotypical population differentially affected various types of feature search tasks, whether there is a minimal acceptable level of visual acuity required for normal search performance, and whether these factors affected the degree to which participants could improve with training. From the results, it can be seen that reducing visual acuity did reduce search speed, but only for tasks where the target was defined by shape or size (not colour), and only when acuity was worse than 6/15. Furthermore, searching behaviour was seen to improve with training in all three feature search tasks, irrespective of the degree of blurring that was induced. The improvement also generalised to a non-trained search task, indicating that an enhanced search strategy had been developed. These findings have important implications for the use of visual search as a rehabilitation aid for partial visual loss, indicating that individuals with even severe comorbid blurring should still be able to benefit from such training. [ABSTRACT FROM AUTHOR]

We investigated the role of reference electrode placement (ipsilateral v contralateral frontal pole) on conjunction visual search task performance when the transcranial direct current stimulation (tDCS) cathode is placed over right posterior parietal cortex (rPPC) and over right frontal eye fields (rFEF), both of which have been shown to be causally involved in the processing of this task using TMS. This resulted in four experimental manipulations in which sham tDCS was applied in week one followed by active tDCS the following week. Another group received sham stimulation in both sessions to investigate practice effects over 1 week in this task. Results show that there is no difference between effects seen when the anode is placed ipsi or contralaterally. Cathodal stimulation of rPPC increased search times straight after stimulation similarly for ipsi and contralateral references. This finding does not extend to rFEF stimulation. However, for both sites and both montages, practice effects as seen in the sham/sham condition were negated. This can be taken as evidence that for this task, reference placement on either frontal pole is not important, but also that care needs to be taken when contextualizing tDCS "effects" that may not be immediately apparent particularly in between-participant designs. [ABSTRACT FROM AUTHOR]

Visual perception can be influenced by the content of working memory. Previous studies have shown this influence can be enough to improve unconscious visual discrimination in healthy participants and conscious visual discrimination in neuropsychological patients with extinction. Here, these findings are extended by examining the effects of holding an object in working memory on unconscious visual perception in a person with hemianopia. The results revealed significantly enhanced detection accuracy when there was an exact match between the colour and orientation of the discrimination target and the item in working memory. However, the facilitatory effect was greatly reduced when only colour or orientation was matched with the item being held in memory. A control experiment confirmed these effects were not due to visual priming. These results are consistent with the proposal that working memory guided perceptual facilitation is driven by signal enhancement. More broadly, the data are interpreted in terms of a biased competition account of visual perception. [ABSTRACT FROM AUTHOR]

The existence of a network of brain regions which are activated when one undertakes a difficult visual search task is well established. Two primary nodes on this network are right posterior parietal cortex (rPPC) and right frontal eye fields. Both have been shown to be involved in the orientation of attention, but the contingency that the activity of one of these areas has on the other is less clear. We sought to investigate this question by using transcranial direct current stimulation (tDCS) to selectively decrease activity in rPPC and then asking participants to perform a visual search task whilst undergoing functional magnetic resonance imaging. Comparison with a condition in which sham tDCS was applied revealed that cathodal tDCS over rPPC causes a selective bilateral decrease in frontal activity when performing a visual search task. This result demonstrates for the first time that premotor regions within the frontal lobe and rPPC are not only necessary to carry out a visual search task, but that they work together to bring about normal function. [ABSTRACT FROM AUTHOR]

Successful interaction with the environment often involves the identification and localization of an item. Right posterior parietal cortex (rPPC) is necessary for the completion of conjunction but not feature visual search, regardless of the attentional requirements. One account for this dissociation is that the rPPC is primarily involved in processing spatial information. For target identification, conjunction tasks require that spatial information is used to determine if features occur at the same location, whereas feature search does not require such a process. This account suggests that if the requirement to localize the target is made explicit, then rPPC may also be necessary for feature search. This was examined using TMS and by manipulating the response mode: Participants were either required to press a button indicating the presence/absence of the target or else had to point to the target. TMS over rPPC did not disrupt performance of the feature task when a button press was required but significantly increased response time and movement time for the same task in the pointing condition. Conjunction search in both response conditions was significantly impaired by TMS. Performance on a task that required pointing to a target in the absence of distractors and thus did not involve visual search was unaffected by rPPC stimulation. We conclude that rPPC is involved in coding and representing spatial information and is therefore crucial when the task requires determining whether two features spatially co-occur or when search is combined with explicit target localization via a visuomotor transformation. [ABSTRACT FROM AUTHOR]

This study explored stroke survivors' experiences of loneliness. Drawing on interviews with 29 community-dwelling stroke survivors living in the Northeast of England, we found several themes: loneliness as being alone, the season or time, lack of understanding from those without any experience of stroke, reduced autonomy, and deterioration of social relations. It is important that healthcare professionals pay attention to the aspects of life that may increase the chances of a stroke survivor becoming lonely after being discharged from hospital, and to measure loneliness in stroke survivors a more valid scale should include items that touch on the aspects reported here.

The loss of visual function is a common and debilitating effect of brain injury. Such effects include the inability to attend to the contralesional part of space (visual neglect) and loss of vision in part of the visual field in both eyes (homonymous visual field defects). The underlying mechanism of these functional deficits are varied which explains why no one intervention is effective in their treatment. In this chapter, we examine the cognitive neuroscience that underlies visual performance and attention with particular focus on what we know about visual exploration using search tasks in the laboratory. We then discuss how this knowledge has informed the development of interventions for poor visual function and how these can be maximized., (© 2020 Elsevier B.V. All rights reserved.)