A comparison of two approaches in the treatment of perceptual problems after stroke
Perceptual problems are common following stroke and affect the patients' functional ability, suggesting that these problems should be treated. Eighty patients admitted to the Nottingham Stroke Unit, were assessed for perceptual and functional abilities, using standardised assessments (Rivermead Perceptual Assessment Battery, Barthel ADL Index and Edmans ADL index). Each patient identified as having perceptual problems, was randomly allocated to one of two groups for perceptual treatment. One group followed the transfer of training approach and one group followed the functional approach. The study compared the effectiveness of the two approaches in improving perceptual and functional abilities. Treatment was given for 2.5 hours per week for six weeks. On completion of the six weeks treatment, each patient was reassessed for perceptual and functional abilities. There was no significant difference between the treatment groups on patient characteristics or impairments. The results also showed no significant difference between the treatment groups before and after treatment on perceptual ability total scores, individual perceptual subtest scores, or functional ability total scores (Mann Whitney U 642.5-798.0, p > 0.05). Wilcoxon Matched Pairs Signed Ranks Tests showed a significant improvement after treatment, on perceptual and functional abilities, (perceptual z = 6.02, p<0.001, functional z = 6.72, p<0.001). These results indicated the improvement in perceptual abilities was equivalent using either of the two approaches. Therefore, a no treatment group of 20 patients was studied. The results showed similar results between the treatment and no treatment groups, suggesting that neither treatment approach improved outcome. However, these results may have been influenced by spontaneous recovery or the effects of the Stroke Unit.