A Cross-sectional Survey and Cross-sectional Clinical Trial to Determine the Prevalence and Management of Eye Movement Disorders and Vestibular Dysfunction in Post-Stroke Patients in the Sub-Acute Phase: Protocol

Abstract

IntroductionVisual impairment, specifically eye movement disorders and vestibular dysfunction may have a negative influence on the functional recovery in post-stroke patients. This type of sensory dysfunction may further be associated with poor functional outcome in patients’ post-stroke.MethodsIn phase 1, a cross-sectional survey (n = 100) will be conducted to determine the prevalence of eye movement disorders and vestibular dysfunction in patients who sustained a stroke. A cross-sectional clinical trial (n = 60) will be conducted during phase 2 of the study to determine the effect of the combination of vestibular rehabilitation therapy (VRT) and visual scanning exercises (VSE) (experimental group) integrated with task-specific activities compared with the effect of task-specific activities as an intervention (control group) on patients who present with eye movement impairment and central vestibular dysfunction post-stroke. An audiologist will assess (a) visual acuity (static and dynamic), (b) nystagmus, (c) saccadic eye movements, (d) smooth pursuit eye movements, (e) vestibulo-ocular reflex, and (f) saccular, utricular, and vestibular nerve function. An independent physiotherapist will assess (1) cognitive function, (2) residual oculomotor visual performance, (3) visual–perceptual system, (4) functional balance, (5) gait, (6) functional ability, (7) presence of anxiety and/or depression, and (8) level of participation in physical activity.Ethics and disseminationEthics approval has been obtained from the Ethics Committee of the Faculty of Health Sciences at the University of Pretoria (UP) (374/2015). The study will be submitted as fulfillment for the PhD degree at UP. Dissemination will include submission to peer-reviewed professional journals and presentation at congresses. Training of rehabilitation team members on the integration of VSE and VRT into task-specific activities in rehabilitation will be done if the outcome of the experimental group’s functional performance is clinically and statistically significantly better than the control group on the Barthel Index.Trial RegistrationPan African Clinical Trials Registry (PACTR201509001223262).

WITHDRAWN: Intrarater and Interrater Reliability of Dynamic Gait Index in Post Stroke Patients With Eye Movement Disorders

“…Eye movement disorders that occur as a result of stroke includes, gaze palsies, cranial nerve palsies, strabismus, vergence abnormalities and nystagmus (6). With these eye movement disorders, a patient is unable to respond e ciently to visual inputs from the environment which may result in decreased dynamic stability leading to an increased risk of falls (7). Frequency of falls that occur in the post-stroke population in the initial three to four months is about 34% and the majority of these falls (40-90%) occur during walking (8).Thus, to prevent falls in post-stroke patients with eye movement disorders the evaluation of dynamic balance and gait disorders is of signi cant clinical importance (9).…”

Effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders: a randomized controlled trial

“…These eye movement disorders are caused due to damage of extraocular muscle of eye, damage to cranial nerves supplying to these eye muscles or to the neural pathways that are involved in controlling these nerves [7]. After stroke, patients with eye movement disorders present themselves clinically as, difficulty in maintaining an eye contact and to pay concentration on tasks, complaining of headaches and eye strain, closing or covering of one eye during the performance of different activities or during conversation because of diplopia or blurred vision, letters move about on page while reading, inability to see objects or person appearing abruptly from one side, constantly rubbing their eyes and squinting [9,10]. Post stroke patients with these visual impairments may cause balance and gait deficits which leads to increased risk of fall [11].…”

Effects of Gaze Stability Exercises with Proprioception Training to Improve Gait and Functional Independence in Cerebellar Ataxic Patients

“…If you have trouble "maintaining the regular eyes position," you may notice that your eyes do not move in the same direction or by the same amount. 13 Acquired brain damage can induce hemiparesis, aphasia, cognitive deficits, dysphagia, visual impairments, neglect, ataxia, and vestibular dysfunction, according to researchers and physicians. 14 The vestibular system's part in this synchronized effort is to evaluate linear and angular acceleration of the head, which delivers vital information required to keep upright stance and spatial placement.…”