Interventions for perceptual disorders following stroke

Abstract

Background Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non‐invasive brain stimulation, pharmacological and surgical approaches. Objectives To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living. Search methods We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors. Selection criteria We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain. Data collection and analysis One review author assessed titles, with two review authors independently screening abstracts and full‐text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB‐1 tool, and quality of evidence using GRADE. A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update. Main results We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch‐somatosensory disorders. None addressed stroke‐related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non‐invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL): Somatosensory disorders : one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure. Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention. Visu...

The relationship between Rating of Everyday Arm‐use in the Community and Home (REACH) scale affected arm‐use assessment, activity and participation after stroke

“…This is consistent with findings in previous studies, which showed that 33 to 61% return to driving after a stroke (Aufman et al, 2013;Perrier et al, 2010;Venketasubramanian & Chan, 2023). Our simple measure of arm use explained 34% of the variability in return to driving, which is large given that various impairments that present in stroke such as motor, visual, cognitive, perceptual, and sensory deficits can affect the ability to drive (Akinwuntan et al, 2012;Bolognini et al, 2016;Hazelton et al, 2022). It is possible that stroke survivors who return to driving have better arm function or less disability, which can translate into more social activities (Aufman et al, 2013;Legh-Smith et al, 1986;Schnitzler et al, 2019), which contributed to the greater participation that we observed.…”

Interventions for Perceptual Disorders in Stroke: A Systematic Review

“…This Cochrane review update and expansion assessed the effectiveness of interventions for perceptual disorders after stroke. 1…”