Vision and Visuomotor Performance Following Acute Ischemic Stroke
BackgroundAs measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients.MethodsSixty AIS patients (65 ± 14 years, 33 males) without pre-e...
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Frontiers Media S.A.
2022-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.757431/full |
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| author | Chamini Wijesundera Chamini Wijesundera Sheila G. Crewther Sheila G. Crewther Tissa Wijeratne Tissa Wijeratne Algis J. Vingrys |
| author_facet | Chamini Wijesundera Chamini Wijesundera Sheila G. Crewther Sheila G. Crewther Tissa Wijeratne Tissa Wijeratne Algis J. Vingrys |
| author_sort | Chamini Wijesundera |
| collection | DOAJ |
| description | BackgroundAs measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients.MethodsSixty AIS patients (65 ± 14 years, 33 males) without pre-existing visual/neurological disorders and acuity better than 6/12 were tested at their bedside during the first week post-stroke and were compared to 40 controls (64 ± 11 years, 15 males). Visual field sensitivity, quantified as mean deviation (dB) and visual acuity (with and without luminance noise), were tested on MRFn (Melbourne Rapid Field-Neural) iPad application. Visuomotor capacity was assessed with the Lee-Ryan Eye-Hand Coordination (EHC) iPad application using a capacitive stylus for iPad held in the preferred hand.Time to trace 3 shapes and displacement errors (deviations of >3.5 mm from the shape) were recorded. Diagnostic capacity was considered with Receiver Operating Characteristics. Vision test outcomes were correlated with National Institutes of Health Stroke Scale (NIHSS) score at the admission.ResultsOf the 60 AIS patients, 58 grasped the iPad stylus in their preferred right hand even though 31 had left hemisphere lesions. Forty-one patients (68%) with better than 6/12 visual acuity (19 right, 19 left hemisphere and 3 multi-territorial lesions) returned significantly abnormal visual fields. The stroke group took significantly longer (AIS: 93.4 ± 60.1 s; Controls: 33.1 ± 11.5 s, p < 0.01) to complete EHC tracing and made larger displacements (AIS: 16,388 ± 36,367 mm; Controls: 2,620 ± 1,359 mm, p < 0.01) although both control and stroke groups made similar numbers of errors. EHC time was not significantly different between participants with R (n = 26, 84.3 ± 55.3 s) and L (n = 31, 101.3 ± 64.7 s) hemisphere lesions. NIHSS scores and EHC measures showed low correlations (Spearman R: −0.15, L: 0.17). ROC analysis of EHC and vision tests found high diagnostic specificity and sensitivity for a fail at EHC time, or visual field, or Acuity-in-noise (sensivity: 93%, specificity: 83%) that shows little relationship to NIHSS scores.ConclusionsEHC time and vision test outcomes provide an easy and rapid bedside measure that complements existing clinical assessments in AIS. The low correlation between visual function, NIHSS scores and lesion site offers an expanded clinical view of changes following stroke. |
| first_indexed | 2024-12-17T10:34:13Z |
| format | Article |
| id | doaj.art-0e7eb7f7395545a7aad6f6129f7d6498 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-17T10:34:13Z |
| publishDate | 2022-02-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-0e7eb7f7395545a7aad6f6129f7d64982022-12-21T21:52:26ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-02-011310.3389/fneur.2022.757431757431Vision and Visuomotor Performance Following Acute Ischemic StrokeChamini Wijesundera0Chamini Wijesundera1Sheila G. Crewther2Sheila G. Crewther3Tissa Wijeratne4Tissa Wijeratne5Algis J. Vingrys6School of Psychology and Public Health, La Trobe University, Melbourne, VIC, AustraliaDepartment of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, AustraliaSchool of Psychology and Public Health, La Trobe University, Melbourne, VIC, AustraliaDepartment of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, AustraliaSchool of Psychology and Public Health, La Trobe University, Melbourne, VIC, AustraliaDepartment of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, AustraliaDepartment of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, AustraliaBackgroundAs measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients.MethodsSixty AIS patients (65 ± 14 years, 33 males) without pre-existing visual/neurological disorders and acuity better than 6/12 were tested at their bedside during the first week post-stroke and were compared to 40 controls (64 ± 11 years, 15 males). Visual field sensitivity, quantified as mean deviation (dB) and visual acuity (with and without luminance noise), were tested on MRFn (Melbourne Rapid Field-Neural) iPad application. Visuomotor capacity was assessed with the Lee-Ryan Eye-Hand Coordination (EHC) iPad application using a capacitive stylus for iPad held in the preferred hand.Time to trace 3 shapes and displacement errors (deviations of >3.5 mm from the shape) were recorded. Diagnostic capacity was considered with Receiver Operating Characteristics. Vision test outcomes were correlated with National Institutes of Health Stroke Scale (NIHSS) score at the admission.ResultsOf the 60 AIS patients, 58 grasped the iPad stylus in their preferred right hand even though 31 had left hemisphere lesions. Forty-one patients (68%) with better than 6/12 visual acuity (19 right, 19 left hemisphere and 3 multi-territorial lesions) returned significantly abnormal visual fields. The stroke group took significantly longer (AIS: 93.4 ± 60.1 s; Controls: 33.1 ± 11.5 s, p < 0.01) to complete EHC tracing and made larger displacements (AIS: 16,388 ± 36,367 mm; Controls: 2,620 ± 1,359 mm, p < 0.01) although both control and stroke groups made similar numbers of errors. EHC time was not significantly different between participants with R (n = 26, 84.3 ± 55.3 s) and L (n = 31, 101.3 ± 64.7 s) hemisphere lesions. NIHSS scores and EHC measures showed low correlations (Spearman R: −0.15, L: 0.17). ROC analysis of EHC and vision tests found high diagnostic specificity and sensitivity for a fail at EHC time, or visual field, or Acuity-in-noise (sensivity: 93%, specificity: 83%) that shows little relationship to NIHSS scores.ConclusionsEHC time and vision test outcomes provide an easy and rapid bedside measure that complements existing clinical assessments in AIS. The low correlation between visual function, NIHSS scores and lesion site offers an expanded clinical view of changes following stroke.https://www.frontiersin.org/articles/10.3389/fneur.2022.757431/fullacute ischemic strokeeye-hand coordinationvisual fieldvisual acuity-in-noisevisionvisuomotor function |
| spellingShingle | Chamini Wijesundera Chamini Wijesundera Sheila G. Crewther Sheila G. Crewther Tissa Wijeratne Tissa Wijeratne Algis J. Vingrys Vision and Visuomotor Performance Following Acute Ischemic Stroke Frontiers in Neurology acute ischemic stroke eye-hand coordination visual field visual acuity-in-noise vision visuomotor function |
| title | Vision and Visuomotor Performance Following Acute Ischemic Stroke |
| title_full | Vision and Visuomotor Performance Following Acute Ischemic Stroke |
| title_fullStr | Vision and Visuomotor Performance Following Acute Ischemic Stroke |
| title_full_unstemmed | Vision and Visuomotor Performance Following Acute Ischemic Stroke |
| title_short | Vision and Visuomotor Performance Following Acute Ischemic Stroke |
| title_sort | vision and visuomotor performance following acute ischemic stroke |
| topic | acute ischemic stroke eye-hand coordination visual field visual acuity-in-noise vision visuomotor function |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.757431/full |
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