Hemianopia after stroke: A randomized controlled trial of the effectiveness of a standardized versus an individualized rehabilitation program, on scanning ability whilst walking

BACKGROUND: Homonymous hemianopia post-stroke reduces independence. OBJECTIVE: To compare the effectiveness of a standardized program versus current individualized therapy in patients with homonymous hemianopia. METHODS: Single-blind randomized controlled trial, 24 patients (54% male), mean age (65 +/- 4.3), mean time since stroke (51 +/- 52.3 days), recruited from rehabilitation and vision services in Adelaide, Australia. Participants were randomized to a combined standardized scanning and mobility program of 7 weeks, 3 times per week or to individualized therapy recommended by clinicians. Primary outcome was an assessment of scanning ability whilst walking. Secondary outcomes included measures of visual scanning, reading, and vision related quality of life (QOL). RESULTS: No significant differences were found between intervention groups for the primary outcome measure of scanning ability whilst walking at 7 weeks and at 3 months (P> 0.05). However, at 3 months significant differences were found for the QOL National Eye Institute Visual functioning Questionnaire (NEI VFQ25) total score (P = 0.03) and dependency sub-score (P = 0.03) measures. CONCLUSIONS: A standardized intervention of static scanning and mobility training improved QOL. Allocation of resources to visual rehabilitation services point towards the implementation of more mobility practice over a longer period of time.