Vision rehabilitation after stroke

Otprilike 66% osoba nakon moždanog udara ima poteškoće s vidom koja utječu na ishode cjelokupne rehabilitacije i svakodnevni život. Rehabilitacijom vida utječe se na oporavak oštećenih vidnih funkcija i funkcionalni vid, a što predstavlja mogućnost za optimiziranje učinka sveobuhvatne funkcionalne rehabilitacije, uspješnije obavljanje aktivnosti svakodnevnog života i povećanje kvalitete života. Cilj ovog istraživanja bio je procijeniti učinke rehabilitacije vida na oporavak vidnog polja i vidne percepcije nakon moždanog udara te na kvalitetu života vezanu uz zdravlje i funkcionalnost vida. U istraživanju je sudjelovao jedan ispitanik s homonimnim gubitkom desnog vidnog polja na oba oka te disfunkcija vidne percepcije. Rehabilitacija vida sastojala se od vježbi vida na Space Fixatoru i računalne igre Space Owl. Vježbe su se provodile unutar 15 termina u trajanju od 30 minuta. Devet termina je provedeno u Krapinskim toplicama gdje je ispitanik bio na rehabilitaciji, a šest termina je provedeno u domu ispitanika. Inicijalnom i finalnom procjenom mjerio se utjecaj vježbi. Testom konfrontacije metodom olovka i papir mjerena je širina vidnog polja, DMCO STANDARD testom mjerena je širina polja vidnog pretraživanja, a pomoću NeuroEyeCoach aplikacije mjerena je brzina percepcije prilikom vidnog pretraživanja. Radi procjene vidne percepcije konstruiran je Upitnik za procjenu vidne percepcije. Za ispitivanje kvalitete života korišten je Upitnik vidnog funkcioniranja (VFQ-25). Rezultati pokazuju da vježbe vida pozitivno utječu na povećanje širine vidnog pretraživanja i brzine percepcije prilikom vidnog pretraživanja, čime se kompenzira smanjena širina vidnog polja. Također, zabilježen je i djelomičan oporavak vidnog polja, ali ovakav rezultat metodološki nije validan. Vježbe vida pospješuju i vidnu percepciju, a značajnija poboljšanja zabilježena su na varijablama „Vidna percepcija oblika“, „Vidnomotorna integracija“ i „Brzina vidne percepcije“. Ispitivanjem kvalitete života, pozitivan učinak vježbi vida je zabilježen u nekim komponentama vidnog funkcioniranja, ponajviše na varijabli „Periferni vid“. Međutim, značajan pozitivan učinak nije zabilježen kod doživljaja zdravlja vida te kod socijalnih i emocionalnih reakcija vezanih uz teškoće vida. Dakle, rezultati istraživanja ukazuju da vježbe vida pozitivno utječu na oporavak kod gubitka vidnog polja, odnosno kompenzaciju takvog gubitka te pospješuju vidnu percepciju. Međutim, rehabilitacija vida trebala bi obuhvatiti i druge aspekte ovakvih oštećenja, primjerice socioemocionalni aspekt. Na kraju, ističe se potreba za daljnjim istraživanjem ove problematike te implementacije programa rehabilitacije vida kao dio sveobuhvatne funkcionalne rehabilitacije nakon moždanog udara.After suffering stroke, about 66% of people have vision difficulties, which negatively influence rehabilitation and life in general. Vision rehabilitation aims to recover damaged vision functions, as well as functional vision, and can subsequently optimize the effects of functional rehabilitation, make activities of daily living more efficient, and raise the quality of life for the person. The goal of this research was to assess the effects of vision rehabilitation on recovery of visual field and visual perception after stroke, and how does vision rehabilitation affect the quality of life regarding vision functionality and health. The research was done on one man who suffered stroke, and had homonymous loss of right visual field on both eyes, as well as visual-perceptive malfunctions. The vision rehabilitation consisted of vision therapy on the Space Fixator, and computer game Space Owl. The therapy was held in 15 sessions, each lasted 30 minutes; 9 sessions were held in Krapinske Toplice and 6 sessions were done in the home of the subject. The effect of the therapy was measured with initial and final assessment. The visual field width was measured with the pencil and paper method, the DMCO STANDARD test was used to measure the width of field of visual exploration, and with NeuroEyeCoach software was used to measure perceptual speed during visual exploration. For the assessment of visual perception, the Visual Perception Questionnaire was constructed. To examine the life quality, the Visual Function Questionnaire (VFQ) was used. The results suggest that vision therapy significantly expands the width of visual field exploration, as well as perceptual speed during visual exploration, which compensate the loss of visual field width. Furthermore, a partial recovery of visual field was also measured, but the results are not methodologically valid. Vision therapy also improves visual perception, and the most significant improvements were noticed in the following variables: "Visual form perception", "Visual motor integration", and "Perceptual visual speed." During the examination of life quality, positive effect of the therapy was measured in some components of visual functioning, mostly in the "Peripheral vision" variable. However, no significant effect was measured in the subject's perception of his vision related health, nor in the social or emotional reactions connected to visual difficulties. The results of the research suggest that vision therapy positively influences recovery after visual field loss, and the compensation of such loss, and it improves visual perception. However, vision rehabilitation should include other aspects of vision impairment, like for an example the social-emotional aspect. In conclusion, further research on this subject is needed, and vision rehabilitation procedure should be implemented in global functional rehabilitation after stroke