The Effectiveness of Visual Scanning Training to Improve Functional Performance Poststroke: A Case Study in Eastern North Carolina

Rationale: Although an abundance of research exists regarding overall rehabilitation interventions poststroke, there is a lack of evidence for treatment of visual deficits. Additionally, eye tracking glasses may be used to further understand the effects of visual field deficits poststroke, though no studies have yet used eye tracking in the context of daily occupations. Purpose: This study evaluated the effectiveness of component-based, occupation-based, and combined occupational therapy treatment for visual scanning training on improving occupational performance in instrumental activities of daily living. The second portion of the study described the differences in visual scanning tendencies during cooking and driving, between an individual with a visual field deficit poststroke and a healthy control of similar age and gender. Design: This study used a case study design with a health control for the eye tracking portion. Participant: The participant was a 55-year-old female who had a stroke 7 years prior. Methods: One participant with a visual field deficit poststroke underwent three visual scanning treatments - component-based, occupation-based, and combined. The researchers administered the Assessment of Motor and Process Skills (AMPS) and took standardized measures on the Vision Coach (full field, 60 dots, all red, speed 0, fixator off) at pretest, after the component-based intervention, after the occupation-based intervention, and after the combined intervention to determine the change in occupational performance - measured by motor skills and process skills - after each intervention. After the interventions were complete, the participant completed a cooking tasks and a task on the driving simulator, while wearing the Tobii Glasses Pro 2 eye tracking glasses. Analysis: Data from the AMPS was compared between times and to the AMPS standardization sample to determine observable improvements. Vision Coach data was also compared between times. The participant's eye tracking data - duration of first fixation, total visit duration, and heat maps - were compared to a healthy control of the same age and gender. Results: With regards to the AMPS and in order of time, the participant scores of motor skills were 1.4 (mild to moderate increased physical effort), 1.8 (questionable to mild increased physical effort), 2.0 (questionable increased physical effort), and 1.8 (questionable to mild increased physical effort). Her scores of process skills were 0.8 (questionable to mild inefficiency), 1.0 (questionable inefficiency), 0.8 (questionable to mild inefficiency), 1.2 (questionable inefficiency). As per the AMPS standardization sample, an observable difference is one of 0.30 logits or more. Comparison of the eye tracking measures and heat maps revealed differences between time spent viewing areas of the visual field, including during two crashes on the driving simulator. Discussion: Overall, visual scanning training as a compensatory method was effective for this participant and could therefore be considered by occupational therapists when treating clients with chronic visual field deficits poststroke, with the combined training being most effective. This study also supports the use of eye tracking glasses during occupations to understand visual scanning tendencies between individuals with and without visual deficits

The Effectiveness of Visual Scanning Training to Improve Functional Performance Poststroke: A Case Study in Eastern North Carolina

Rationale: Although an abundance of research exists regarding overall rehabilitation interventions poststroke , there is a lack of evidence for treatment of visual deficits. Additionally , eye tracking glasses may be used to further understand the effects of visual field deficits poststroke , though no studies have yet used eye tracking in the context of daily occupations. Purpose: This study evaluated the effectiveness of component-based , occupation-based , and combined occupational therapy treatment for visual scanning training on improving occupational performance in instrumental activities of daily living. The second portion of the study described the differences in visual scanning tendencies during cooking and driving , between an individual with a visual field deficit poststroke and a healthy control of similar age and gender. Design: This study used a case study design with a health control for the eye tracking portion. Participant: The participant was a 55-year-old female who had a stroke 7 years prior. Methods: One participant with a visual field deficit poststroke underwent three visual scanning treatments - component-based , occupation-based , and combined. The researchers administered the Assessment of Motor and Process Skills (AMPS) and took standardized measures on the Vision Coach (full field , 60 dots , all red , speed 0 , fixator off) at pretest , after the component-based intervention , after the occupation-based intervention , and after the combined intervention to determine the change in occupational performance - measured by motor skills and process skills - after each intervention. After the interventions were complete , the participant completed a cooking tasks and a task on the driving simulator , while wearing the Tobii Glasses Pro 2 eye tracking glasses. Analysis: Data from the AMPS was compared between times and to the AMPS standardization sample to determine observable improvements. Vision Coach data was also compared between times. The participant's eye tracking data - duration of first fixation , total visit duration , and heat maps - were compared to a healthy control of the same age and gender. Results: With regards to the AMPS and in order of time , the participant scores of motor skills were 1.4 (mild to moderate increased physical effort) , 1.8 (questionable to mild increased physical effort) , 2.0 (questionable increased physical effort) , and 1.8 (questionable to mild increased physical effort). Her scores of process skills were 0.8 (questionable to mild inefficiency) , 1.0 (questionable inefficiency) , 0.8 (questionable to mild inefficiency) , 1.2 (questionable inefficiency). As per the AMPS standardization sample , an observable difference is one of 0.30 logits or more. Comparison of the eye tracking measures and heat maps revealed differences between time spent viewing areas of the visual field , including during two crashes on the driving simulator. Discussion: Overall , visual scanning training as a compensatory method was effective for this participant and could therefore be considered by occupational therapists when treating clients with chronic visual field deficits poststroke , with the combined training being most effective. This study also supports the use of eye tracking glasses during occupations to understand visual scanning tendencies between individuals with and without visual deficits

Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts.

INTRODUCTION:Wheelchair users worldwide are at high risk of developing secondary health conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Society of Wheelchair Professionals (ISWP) has developed a Hybrid Course based on the World Health Organization's Wheelchair Service Training Package-Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet access that reduces the in-person training exposure from five to three and a half days, making it less expensive and more convenient for both trainees and trainers. METHODS:The Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters Higher Educational Rubric, web design guidelines for low bandwidth, experts' opinions, and the best practices for blended course design. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken by six graduate students in Rehabilitation Sciences at the University of Pittsburgh by measuring pre- and post knowledge using the validated ISWP Wheelchair Service Provision-Basic Test. The outcome measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others' evaluation and the results of the training intervention. RESULTS:Hybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision-Basic Test after participating in the training, with an average increase of 10.84±5.42, p = 0.004, Cohen's d = 1.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of three evaluations and reported a percentage of agreement between evaluators of 84%. CONCLUSIONS:The Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Science graduate students

Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts

<div><p>Introduction</p><p>Wheelchair users worldwide are at high risk of developing secondary health conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Society of Wheelchair Professionals (ISWP) has developed a Hybrid Course based on the World Health Organization’s Wheelchair Service Training Package—Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet access that reduces the in-person training exposure from five to three and a half days, making it less expensive and more convenient for both trainees and trainers.</p><p>Methods</p><p>The Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters Higher Educational Rubric, web design guidelines for low bandwidth, experts’ opinions, and the best practices for blended course design. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken by six graduate students in Rehabilitation Sciences at the University of Pittsburgh by measuring pre- and post knowledge using the validated ISWP Wheelchair Service Provision—Basic Test. The outcome measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others’ evaluation and the results of the training intervention.</p><p>Results</p><p>Hybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision—Basic Test after participating in the training, with an average increase of 10.84±5.42, p = 0.004, Cohen’s <i>d</i> = 1.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of three evaluations and reported a percentage of agreement between evaluators of 84%.</p><p>Conclusions</p><p>The Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Science graduate students.</p></div

Quiz results and individual questions feedback.

<p>Quiz results and individual questions feedback.</p

Evaluators’ percentage of agreement.

<p>Evaluators’ percentage of agreement.</p

Test results from the Quality Matters Higher Education Rubric and the additional Hybrid Subcommittee items.

<p>Test results from the Quality Matters Higher Education Rubric and the additional Hybrid Subcommittee items.</p

Examples of questions automatically evaluated.

<p>Examples of questions automatically evaluated.</p

Online and in-person training agenda.

<p>Online and in-person training agenda.</p

Hybrid Coturse content distribution.

<p>Hybrid Coturse content distribution.</p