Vision on the Road: Vision Rehabilitation for Driving After Stroke

University of South-Eastern Norway52 enrolled

Overview

The goal of this clinical trial is to learn if vision training works to improve functional vision in people with visual field loss after stroke. The investigators want to know more about how people perceive their own functional vision and ability to compensate for visual field loss in daily activities. The main questions the study aims to answer are: * Does vision training improve dimensions of functional vision? * How does vision training affect the participants's perception of functional vision and the ability to compensate for visual field loss? Researchers will compare the effect of home-based vision training to standard care (no vision training) on functional vision. Participants will: * Participate in home-based vision training or standard care for 8 weeks * Be contacted once a week by phone * Keep a training diary

AIM: The overall aim is to obtain knowledge about the effects of compensatory visual rehabilitation strategies on functional vision in people with stroke who do not meet the health prerequisites for visual field, as defined in the Driving licences regulations in Norway. Specifically, to describe the effect on functional vision and the compensatory vision strategies related to traffic situations. Secondary, to explore markers for perceived functional vision and functional visual field that may predict an effect of visual rehabilitation. DESIGN: The study will be performed as an open, controlled and randomized trial with semi-cross-over design. The participants will be allocated to an immediate- or delayed intervention following a pre-randomized list. The participants are allocated to immediate intervention (Fast track; Group A) will be investigated at baseline, after 8 and 20 weeks. The remaining participant are allocated to delayed intervention (Delayed start; Group B) will start the intervention 8 weeks after the baseline and investigated at baseline, week 8, week 20 and week 28. SETTING /RECRUITMENT The study sample will consist of adults with post-stroke visual field defects. All the three sub-studies will have the same study sample.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Interventions

Compensatory scanning trainingOTHER

Individual home-based vision training exercises for 20 minutes every day for 8 weeks. A training program with online and manual oculomotor exercises, scanning and visual search-exercises. Weekly short follow up-conversation by telephone to check in and keep the motivation high with the participants.

Delayed Compensatory scanning trainingOTHER

Delayed track start. Individual home-based vision training exercises for 20 minutes every day for 8 weeks. A training program with online and manual oculomotor exercises, scanning and visual search-exercises. Weekly short follow up-conversation by telephone to check in and keep the motivation high with the participants.

Eligibility

Sex: ALLMin age: 20 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion criteria: * Adults aged 20-85 years with a visual field defect following stroke * Norwegian Class 1 driving licence revoked no more than five years ago * Speak a Scandinavian language * Able to provide written informed consent * Motivated and willing to participate in study activities for a total of 20 to 28 weeks * Own a personal computer (for digital follow-up and online vision training) * Able to travel to Oslo for data collection Exclusion criteria: * Presence of strabismus and/or visual neglect * Eye disease or other health conditions that do not meet the health requirements for a Norwegian Class 1 driver's license * Cognitive impairment, dementia, severe psychiatric diagnosis, or inability to provide written informed consent

Outcomes

Primary Outcomes

Visual Field measured with Saccadic Reaction Time in ms

Changes/improvements of Saccadic Reaction Time (SRT) measured in milliseconds with BulbiCAM

Time frame: Two measurements (1 hour between assessments) at baseline, post-intervention (8 weeks) (post-intervention group A, post-control/pre-intervention group B) and a final measurement (long-term effect) 12 weeks after intervention (20 weeks after baseline).

Secondary Outcomes

Pre/post-intervention changes in Reading speed measured with International Reading Speed Text (IReST)

Measurement of reading speed in words per minute pre/post-intervention using the International Reading Speed Text (IReST).

Time frame: Baseline, post-intervention (8 weeks) and long term-effect 12 weeks post-intervention (20 weeks) for both groups

Pre/post-intervention changes in quality of life among stroke survivors with visual field defects

Pre-/post-intervention changes in self-reported Euroqol -item QoL scale (EQ5D). The EQ-5D-5L includes five dimensions with a level score from 1 (= no problems) to 5 (= Extreme problems / Unable to perform) resulting in a 5-digit health state, which describes their current health. Another scoring option is to report a utility score (index value) where the health state is converted into a country-specific value set range from 1.000 (perfect health) to 0.000 (death). Results may also be presented as level sum score across all five dimensions with minimum score: 5 (best health: 11111), maximum score: 25 (worst health: 55555). Higher scores indicate worse health. The VAS scale rate overall health on a scale from 0 (worst imaginable) to 100 (best imaginable).

Time frame: Baseline, post-intervention (8 weeks) and long-term effect 12 weeks post-intervention (20-weeks) for both groups.

Pre/post-intervention changes in Canadian Occupational Performance Measure (COPM)

The COPM is used to identify up to five self-perceived problems related to activity performance. It assesses both performance and satisfaction with performance across these activities. Scoring is based on two scales: Performance score: ranges from 1 to 10, where a higher score indicates better performance. Satisfaction score: ranges from 1 to 10, where a higher score indicates greater satisfaction with performance.Total performance score: sum of scores across all identified activities (range: 1-50). Total satisfaction score: sum of satisfaction ratings across all identified activities (range: 1-50). Mean scores: dividing the total score by the number of activities rated. Changes in both mean performance and mean satisfaction scores from baseline to follow-up are used to evaluate the impact of the intervention.

Time frame: Baseline, post-intervention (8 weeks) and 12 weeks post-intervention (20 weeks).

Pre/post-intervention vision function (fixation stability) tests measured with BulbiCAM

Changes in vision functions (fixation stability in mm) pre/post-intervention measured with BulbiCAM. Two measurements with one hour between tests each time

Pre/post-intervention vision function (saccades) tests measured with BulbiCAM

Changes in saccades measured in latency ms pre/post-intervention measured with BulbiCAM. Two measurements with one hour between tests each time

Pre/post-intervention changes in BIVI-IQ score

The Brain Injury assosiated Visual Impairment Questionnaire (BIVI-IQ) is developed to assess the impact of brain injury associated visual impairment on an individual's vision-related quality of life by 15 questions. Level sum score 0-3 on each question. A higher score indicates greater impact and more difficulty.