Feasibility of measuring vertical perception in acute stroke. V1.
Research type
Research Study
Full title
Identifying vertical perception loss in people with acute stroke. A feasibility study.
IRAS ID
333405
Contact name
Amelia C
Contact email
Sponsor organisation
University of WInchester
Duration of Study in the UK
0 years, 8 months, 5 days
Research summary
Research Summary:
Some people are unable to align to vertical after they have a stroke. This means they are unaware when they are upright so are less able to complete daily activities safely. Current methods for identifying vertical alignment are not possible outside of a laboratory environment. This research will establish if it is acceptable and feasible to use three assessments, that relate to the laboratory measure of vertical alignment, to help identify those people with stroke who cannot align to vertical in an acute setting. It is hoped that early identification will allow for more effective rehabilitation strategies to be developed to improve function for people following stroke.
The research aim is to establish the feasibility of completing the Catherine Bergego Scale, Scale for Contraversive Pushing (SCP) and bucket test with acute stroke patients to assist with identification of vertical alignment loss.
Participants will be anyone diagnosed with stroke who is admitted to the stroke unit at Royal Hampshire County Hospital (over a six month period) for at least 72 hours.
Participants will be asked to complete the assessments with a therapist 48 hours after admission. If they are not completed for any reason attempts will be made to complete them at one, two and four weeks after admission. Some participants will have them completed again on discharge. The Catherine Bergego Scale and SCP are observational and will involve a therapist watching the participant undertake daily activities. The bucket test involves a therapist placing a bucket in front of the face of the participant and asking them to identify when a line on the bottom of the bucket is vertical.
If it is feasible and acceptable to complete these assessments then further research can use them as an acceptable measure of vertical alignment in the clinical setting.Summary of Results:
We would like to thank all the people with stroke and their friends and families for taking part in this study.
Identifying vertical perception deficits in people with acute stroke: A feasibility study.
This research was carried out by Amelia Shaw, Dr Louise Johnson, Dr Katherine Cook, Dr Hazel Brown and Dr James Faulkner. This project was part of Amelia Shaw’s PhD at the University of Winchester and took place on the acute stroke unit at Hampshire Hospitals NHS Foundation Trust, where Amelia is also employed.
Introduction
We know that some people do not know where upright is once they have a stroke. This is because they cannot use information from their vision, touch and balance to get a sense of where upright is. This does not happen to everyone who has a stroke but is more common in people who have a stroke on the right side of the brain. There is a known association between this inability to know where upright is and some specific changes in posture that are commonly seen following stroke. We know that many people with stroke who present with ‘neglect’ (inability to attend to one side) and/or ‘lateropulsion’ (leaning or tilting towards the weak side) often also do not know where upright is.
People with stroke who do not know where upright is appear to not do as well as those that do. They often remain in hospital longer, take longer in rehabilitation and need more help with daily tasks. They are also more at risk of falling over.
Currently we can measure ‘neglect’ and ‘lateropulsion’ in an acute stroke unit but we cannot identify the ability of people with stroke to know where upright is. This can be done in a laboratory.
The aim of this research was to see if it was feasible to identify if people knew where upright was, within four weeks of having a stroke, using three assessments. We also wanted to gain some information on how the ability to know where upright is changes over the first few weeks following a stroke. It is hoped that this information will allow us to do more research with people with stroke who do not know where upright is. This further research would be aimed at helping these people have better outcomes following rehabilitation.
People who have had a stroke helped the researchers to design the information sheets, consent forms and the survey used in the study.
Method
Therapists working on a stroke unit attempted the three assessments within 3 days of admission on people with stroke. They did this over a six-month period (1st May to 31st October 2024). The assessments were one that identified neglect (the Catherine Bergego Scale); one that identified lateropulsion (scale for contraversive pushing); and one that measured the ability to align to upright (the bucket test). If a patient was unable to complete the assessments, three further attempts were made during the first four weeks of their hospital stay. Information on the results of the assessments, how many days after admission they were completed and how long they took to complete was collected. If participants could not complete the assessments the reasons why were recorded.
We asked people with speech and cognitive problems to be in this study – if they could not agree to the study themselves we asked someone who knew them to give permission on their behalf.
To help us know if it was feasible to complete these assessments we asked participants to complete a survey on their experience of completing the assessments. We also spoke to the therapists who did the assessments to see what they thought about doing them.
Once we had all this data we used it to see if it was feasible to use these assessments to identify people with stroke who do not know where upright is.
Unfortunately, one participant died during the study but this was due to their stroke and was not related to their involvement in the trial.
Results
Fifty three people with stroke took part in the study over 6 months. These people were representative of the usual admissions to a stroke unit. Of the 53, 50 (94%) were able to complete all three assessments within four weeks of having a stroke and 51 were able to complete two of the three assessments within four weeks of their stroke. Most people completed the assessments at five days after their stroke and the assessments took around 11 minutes to complete.
The number of people who did not know where upright was was high – 35/53 (66%) – but they did not all show symptoms. There was a trend for those who did not know where upright was to stay in hospital longer, to participate in more rehabilitation and to need more care on discharge. However, it was not possible to know if this was purely due to their inability to know where upright was or if it was more related to other symptoms such as weakness or cognitive difficulties.
The participants who completed the survey and the therapists who completed the assessments agreed that it was acceptable and possible to complete the assessments soon after people have had a stroke.
Discussion
The results of the study showed that it is feasible to use three assessments to identify people with stroke who do not know where upright is very soon after they have had a stroke. The assessments could usually be completed within five days of stroke and did not take very long to complete.
The number of people who did not know where upright was about two thirds. For most people this showed up on the bucket test. This is a new finding. The ability to know where upright is is not often assessed in the hospital setting, it is now important that we do assess this. Not everyone who did not know where upright was had problems with doing daily tasks like walking and getting washed and dressed in the stroke unit. However, we do not know if they had problems with balance and walking in the community once they left hospital. These results will allow us to do further research to see what rehabilitation treatments can help people improve this problem and to see if the problem gets better over time.REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
24/YH/0010
Date of REC Opinion
5 Feb 2024
REC opinion
Further Information Favourable Opinion