FAST is blind to vision loss

When I talk to people who have suffered a stroke, one of the things I often hear is "I did the FAST test and...".  For some it's a life-saver as it prompts them to seek urgent medical attention or call an ambulance.  But for people with vision loss it's at best of no use and at worst can delay diagnosis of a stroke.

Please email me at the address above and tell me your story.

One man told me that he called an ambulance crew because he couldn't see.  The ambulance crew did the FAST test and told him he hadn't had a stroke.  In the Emergency Department he kept telling people he couldn't see until they sent him to an ophthalmologist who told him he'd had a stroke.  By that time it was too late for him to be treated with clot-busting drugs (thrombolysis).

A woman told me that it took her a week to have her stroke diagnosed, despite going straight to her GP and reporting vision loss.

What happened to you?  Please email me at the address at the top of this page.


The FAST test needs to change to incorporate a test of vision.  I intend to apply to run a project to develop an extended FAST test, including vision loss (maybe the V-FAST test?).  Please let me know if you are happy for me to use your story in the application.  Not all stories will be able to be used, but I'm interested to hear about your experience.

Thanks!

Phil Clatworthy

Scientific Review of New Neglect Rehab Methods

A recent scientific review published in the Free to Access journal Frontiers in Human Neuroscience describes four new methods for rehabilitation of neglect:

• Non-invasive brain stimulation (using magnets (TMS) and weak direct currents (tDCS))
• Drug treatments
• Prism adaptation
• Virtual reality

The conclusion?  We need more research.

The article is free, but pretty technical.  Get it HERE.

Registering as "Partially Sighted" in the UK

Did you know that patients with hemianopia may be eligible for registration as "partially sighted". The Department for Work and Pensions say that "a gross defect of visual fields (of both eyes, such as hemianopia)" is an example of a visual impairment that would qualify for registration as partially sighted (see this web page).

Not everyone with vision impairment related to stroke, brain injury, or neurological problems, will be eligible. Registration can only be done by a consultant ophthalmologist. Your GP could refer you to one.

There are benefits to registration, as explained in this leaflet, and on this web page on the RNIB's web site.  Benefits can include help with NHS costs, discounted travel and, well, benefits.

Vycor Medical (NovaVision) buys SightScience

Vycor Medical, the company that owns NovaVision, has bought all shares in SightScience, a company previously owned by Professor Arash Sahraie and Aberdeen University. This company produces "Neuro-Eye Therapy", which intends to increase visual sensitivity to specific stimuli in "blind" visual field. For a minimum of 5 years Professor Sahraie will be NovaVision's Chief Scientific Officer, according to this press release from NovaVision. The company hopes this move will "considerably strengthen NovaVision’s ability to penetrate the European market and increase European revenues". It notes particularly that "Sight Science has a strong position in the UK".

What hemianopic alexia looks like

Here are 2 YouTube videos showing how the eyes of 2 people move when reading 5 short words.  The red trace shows where the eyes are pointing. 

TOP: Person with normal vision.
BOTTOM: Person with right homonymous hemianopia (described below).


The person with normal vision (top) generally just looks at each word only once and can read them quickly. This video has been slowed down to compare with the other.
The person with loss of vision to the right of the midline (right homonymous hemianopia) takes a long time to read the words and looks at each word a number of times.  This is largely because this person can't use the right visual field to see where to send the eyes next.
For those of you who are interested, where the eyes stop briefly is a "fixation", and where they move rapidly is a "saccade".

Eye-Search: FREE web-based visual search training

I've told you about ReadRight before - well, University College London and Dr Alex Leff are doing it again (trying to help train the eye movements of people with hemianopia), only this time with visual search aka "looking for things".  In this blog post I talked about a paper describing the lack of transfer between training visual search and reading (that is, visual search doesn't really help reading and vice versa).  So it made sense for the UCL group to complement their reading rehabilitation method with one intended to rehabilitate visual search.

The training task is a bit different from other visual search training - they use a "ramp-step" task, where an object is followed as it moves smoothly across the screen - it then jumps across to the other side of the screen, and the person doing the training has to make a rapid eye movement to its new location.  This is repeated lots of times.

Preliminary results in a few participants were published in this paper in the journal Cortex this year.  The study, in 7 patients with hemianopia and 6 healthy participants, found that after training (300 goes at the training task, taking 30 minutes in total), patients were significantly quicker to find things in a picture of a cluttered desk than they had been before training (healthy participants weren't).  The patients had long-standing hemianopia and the researchers tested them twice before training to make sure they didn't recover in-between, and to check that the tests gave similar results on both sessions without training (so the crowded desk task seemed reliable).

If you want to give it a try, click on the logo.

 

Vision at the UK Stroke Forum 2012

 The UK Stroke Forum will be in Harrogate this year, 4-6 December 2012.

There is a session on vision, with Fiona Rowe (Liverpool University) talking about visual symptoms after stroke, Alex Leff (Institute of Neurology) talking about web-based therapy for hemianopic alexia (reading difficulty due to hemianopia), and Audrey Bowen (Manchester University) talking about assessment and treatment of unilateral spatial neglect.

Hopefully Alex Leff will also talk about his new web-based therapy, Eye-Search - a description of this will be on this blog very soon.  If you can't wait, go to The EYE-SEARCH web site.

The session (Parallel Session 2D) will be held in the Kings Suite from 14:30 to 15:45 on Wed 5th December.

Programme as follows:
Vision and Visual Symptoms
Chair: Claire Howard (Highly Specialist Orthoptist, BIOS Stroke and Neuro Rehab Special Interest Group Lead)
14:30 - 14:50
Patient reported visual symptoms following stroke
Dr Fiona Rowe (Senior Lecturer, University of Liverpool)
14:50 - 15:10
Web-based therapy for reading difficulty due to hemianopia
Dr Alex Leff (Clinical Senior Lecturer and Honorary Consultant Neurologist, Institute of Neurology & National Hospital Queen Square)
15:10 - 15:30
Unilateral spatial neglect: an appraisal of the assessment and treatment options
Dr Audrey Bowen (Senior Lecturer in Psychology, University of Manchester)