Vision Rehabilitation after a Stroke: The Importance of Occupational Therapy

Stroke, or cerebrovascular accident (CVA) is a variety of disorders characterized by the sudden onset of neurological deficits caused by vascular injury to the brain. This damage in the brain disrupts blood flow, limits oxygen supply to surrounding cells and leads to brain tissue death or infarction. It is the third leading cause of death in the United States and a leading cause of chronic disability among adults. Depending on the location of the stroke, people may experience loss of motor, neurological and perceptual function, as well as double vision, blurring, headaches, or inability to detect obstacles.

Vision Rehabilitation Projects Manager Yu-Pin Hsu, EdD, OTR/L, SCLV explained that as many as two thirds of people who have had a stroke experience some changes to their vision. How a person is affected depends on where the stroke occurred in the person’s brain.

Occupational therapists (OTs) assist people who suffer from stroke to regain their independence in their activities of daily living. Not only do OTs address the loss of motor and neurological impairments through the provision of interventions, they can advise on environmental modifications, so that people with visual deficits can use their functional vision to live safely and independently.

Visual field deficit (VFD) is the most common visual loss associated with stroke, and homonymous hemianopsia is the type of VFD occurring most often. Hemianopsia affects half of the visual field. Homonymous means the deficits involve both eyes.

Not only can stroke affect the visual field, it can also affect visual attention. Hemi-inattention describes a patient’s tendency to ignore objects on one side of the visual field and can occur with or without a VFD. Neglect is a complex deficit occurring when a person is unable to locate objects surrounding them or their own body (right vs left).

The first thing someone needs to learn who has experienced vision loss from a stroke is awareness, said Dr. Hsu. Awareness of what has happened and why, for example, they bump into things, trip over objects or don’t see all the traffic in the street, only some of it. Rehabilitation can begin with marking items in the home, creating contrast and making sure that the lighting is suitable. But as far as vision rehabilitation goes, that may just be the beginning.

Learning new ways of seeing things is paramount to vision rehabilitation, but it’s hard work and takes practice. For example, learning to scan the environment so that you don’t bump into things and so that you see all the traffic in the street is a skill that an OT can teach. If you have a stroke, patients should make sure they receive a thorough vision exam and, if necessary, referral for vision rehabilitation and occupational therapy.