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Title: Visual field loss after stroke : a mixed methods exploration of scanning training interventions
Author: Hazelton, Christine Roberta
ISNI:       0000 0004 6422 0141
Awarding Body: Glasgow Caledonian University
Current Institution: Glasgow Caledonian University
Date of Award: 2015
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Background: Visual field loss (VFL) affects around one fifth of stroke survivors. Typically it makes the person blind to one side of space, however the impact this has on daily life is not clearly described. Scanning training aims to compensate for VFL by improving the eye movements made into the affected field. This project sought to explore the impact of VFL on daily life and investigate the effect, feasibility and mechanisms of action of scanning training. Methods: Scanning training was defined as a complex intervention and a novel pragmatic, mixed methods approach used. Scanning training effects, feasibility and theories of action were systematically identified and synthesised in a rigorous review of the literature. An email survey used snowball sampling to identify currently used interventions, and their components were described using methods that included consensus-based expert panel assessment. Stroke survivors were interviewed and their perceptions of the impact of VFL explored using qualitative analysis. The effect and feasibility of four interventions were explored using an n-of-1 study, involving qualitative interviews and quantitative measures. Key Findings: Scanning interventions for VFL had limited published quantitative evidence of effect (n=33 (30 low quality) studies). Few studies reported feasibility measures or qualitative data. Understanding of proposed mechanisms of action was hampered by ambiguous definitions and descriptions. Ten home-based scanning interventions used in Scotland were identified, with four different delivery modalities. They trained saccadic eye movements, predominantly in the central 35° and used a wide variety of exercises. Levels of support required varied. Stroke survivors (n=12, median age 55.5 [42-80] years) reported that VFL impacted on their practical abilities, social interactions and emotions (notably fear and self-confidence). Eleven of this cohort (median age 56 [42-80] years) completed training with scanning interventions. All four interventions proved feasible to use, but the effect of therapy was less clear. Quantitative measures showed no effect, but participants reported improved visual skills, cognition, emotions and practical abilities. The intervention and participant factors associated with feasibility and effect were identified and a new model of scanning training mechanisms of action proposed. Conclusion: Stroke survivors report a broad and profound impact of VFL on their daily lives. Scanning training interventions are feasible and perceived by stroke survivors to have a beneficial effect on their emotions and abilities in everyday activities. Using mixed methods is a new approach in this field, but has provided unique insight into VFL and its rehabilitation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available