The Montreal Cognitive Assessment (MoCA) was used to assess for mild cognitive impairment due to the high prevalence of cognitive impairment following stroke and its potential impact on reading ( Gramstad et al. In order to explore this hypothesis, the purpose of this study was to conduct a feasibility study using vertical reading with stroke survivors with homonymous hemianopia.Ī routine full orthoptic and visual field assessment using the monocular and binocular Esterman programmes were completed with stroke survivors to establish eligibility. We hypothesize that vertical reading would increase reading speed compared to horizontal reading in stroke survivors with homonymous hemianopia, with a 90° clockwise turn having increased benefits for individuals with a right hemianopia, and a 90° anti-clockwise turn having increased benefits for individuals with a left hemianopia. This means that it can be used in everyday life as an adjunct or potential replacement for more complex strategies. It is a simple technique which could be used without the need for equipment or modification of text. This technique has since been mentioned by other authors, however no empirical data is available ( Sabel & Trauzettel-Klosinksi 2005 Trauzettel-Klosinski 2010). It first appears in a short article being reported by a patient ( Wang 2003). One intervention, which is only briefly mentioned in the literature, is vertical reading. The literature is lacking evidence on simple compensatory strategies that patients can use. ( 2005) concluded that many of the rehabilitation techniques currently in the literature are ‘labour-intensive, and … require relatively specific facilities’. Studies which focused on improved saccadic eye movements, which are a necessity for reading, found significant improvements in the reading outcome they used ( Bolognini et al. Using a cross-over trial of reading training and visual exploration training, reading was only found to improve following reading training, concluding that task specific training is required ( Schuett et al. Interventions specific to reading with visual field loss include optokinetic therapy ( Ong et al. There are a range of interventions available to aid rehabilitation of homonymous visual field defects, including restorative, compensatory and substitutive options. Hemianopic dyslexia has characteristic eye movement patterns whilst reading, which are a cause for the reduction in reading speed, due to the ineffective nature of the natural compensatory strategies adopted ( McDonald et al. Patients also tend to use their linguistic knowledge to complete words, resulting in errors ( Schuett et al. ![]() This is combined with individuals missing parts of words, particularly prefixes with left hemianopia and suffixes with right hemianopia. The reading speed for patients with right-sided defects slows by around 50%, whilst a left-sided defect is reported to increase the time taken to read by around 40% ( Trauzettel-Klosinski & Brendler 1998). It manifests itself with significantly reduced reading speed, which varies dependent on the amount of macular sparing present ( Schuett et al. Hemianopic dyslexia most commonly arises in patients with less than 5° of macular sparing. It has been shown that reading impairments have a significant effect on an individual’s quality of life ( Gall et al. Reading is essential in many areas of daily life, impacting independence. Hemianopic dyslexia is described as ‘an acquired reading disorder whereby patients with homonymous visual field defects have persistent and severe reading difficulties, despite having intact language function’ ( Schuett 2009). As a result of severe visual field loss, over three-quarters of patients continue to suffer with reading difficulties, known as hemianopic dyslexia ( Zihl 1995). ( 2011) reported that more than two-thirds of patients who complained of reading difficulty also had visual field loss. ![]() Stroke-induced visual field loss is a major contributor to reading problems. There are many causes of reading difficulty after stroke, including reduced concentration, cognitive impairment, visual problems and difficulties with lexical processing ( Rowe et al. Homonymous hemianopia can cause a variety of problems, the most common of which include difficulties with reading and visual exploration ( Kerkhoff 2000 Zihl 2000). ![]() A frequent presentation is that of a homonymous hemianopia, which is estimated to occur in approximately 45–50% of acute stroke cases ( Ali et al. Visual problems are a common sequelae of stroke approximately 72% of stroke survivors suffer a visual problem following stroke ( Rowe et al.
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