Kessler Foundation researchers and clinicians describe the effects of binocular occlusion in a patient with spatial neglect and severe posture impairment. Their report was published recently in Physiotherapy Theory and Practice.

The study participant was a 53-year-old woman who experienced a hemorrhagic stroke. Complications of the hemorrhagic stroke of the right basal ganglia and surrounding area included marked right gaze, severe postural asymmetry, and inadequate responses to multi-step commands.

These symptoms limited her ability to participate in therapy and hindered the use of conventional paper-based tools for evaluating her for spatial neglect.

Under these circumstances, the diagnosis of spatial neglect was based on the Kessler Foundation Neglect Assessment Process (KF-NAP), ie, observation of her performance of daily life activities, according to a media release from Kessler Foundation.

The team found evidence in the literature that indicated that some individuals performed better on tests of spatial neglect when visual stimuli were eliminated. They hypothesized that eliminating visual input would increase spatial awareness on the contralesional side, which in turn, would reduce the rightward deviations in gaze and posture. Improving posture and gaze could improve the patient’s ability to participate effectively in her rehabilitation.

To eliminate visual stimuli, the patient was blindfolded during therapy sessions, and the stroke team evaluated her behavior with and without binocular occlusion. They measured three outcome measures: head position, weight distribution, and the degree of contact between buttocks and therapy mat (buttock-mat contact). These measurements were recorded at baseline, during binocular occlusion, immediately after removal of blindfold, and three minutes after removal.

All three measures showed immediate improvement during binocular occlusion, with return to baseline at three minutes after the intervention, the release explains.

“We documented that while the patient was blindfolded, she sat up straighter, and her posture was more centered,” Peii Chen, PhD,  senior research scientist in the Center for Stroke Rehabilitation Research, says. “It is unclear why visual stimuli was such a strong factor in this patient’s symptoms of spatial neglect.”

Further research is needed to investigate the usefulness of this type of intervention in rehabilitative care, per the release.

“It is important to look at ways to support upright and centered posture in our patients recovering from stroke,” she notes, “because posture and positioning are essential to participating in many therapies and in performing activities of daily life.”

[Source(s): Kessler Foundation, Science Daily]