Development and 5-year Evaluation of Diagnosis-Specific Protocols for Visual Neuro-Rehabilitation in a Multicenter Inpatient Rehabilitation Network

Kevin E Houston; Matthew Keilty; Caroline Collins; Ritika Trehan; Talia Mouldovan; Kim Stuckart; Nancy Engelhardt; Melanie Nadeau; Craig A Rovito; Lotfi B Merabet

doi:10.1016/j.arrct.2022.100246

Development and 5-year Evaluation of Diagnosis-Specific Protocols for Visual Neuro-Rehabilitation in a Multicenter Inpatient Rehabilitation Network

Arch Rehabil Res Clin Transl. 2022 Nov 17;5(1):100246. doi: 10.1016/j.arrct.2022.100246. eCollection 2023 Mar.

Authors

Kevin E Houston^{1

2

3

4

5

6}, Matthew Keilty¹, Caroline Collins¹, Ritika Trehan², Talia Mouldovan³, Kim Stuckart³, Nancy Engelhardt³, Melanie Nadeau^{4

5

6}, Craig A Rovito^{3

7}, Lotfi B Merabet^{3

4

5

6}

Affiliations

¹ Spaulding Rehabilitation Hospital Cape Cod, Sandwich, MA.
² Spaulding Hospital for Continuing Medical Care Cambridge, Cambridge, MA.
³ Spaulding Rehabilitation Hospital, Boston, MA.
⁴ Massachusetts Eye and Ear, Optometry and Vision Rehabilitation Service, Boston, MA.
⁵ Harvard Medical School, Department of Ophthalmology, Boston, MA.
⁶ Schepens Eye Research Institute, Boston, MA.
⁷ Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA.

Abstract

Objective: To provide a retrospective evaluation of a new eye and vision rehabilitation care pathway in a U.S. multi-site inpatient rehabilitation network involving the occupational therapy (OT) staff and a consulting doctor of optometry (OD) specializing in vision rehabilitation.

Design: Retrospective study.

Setting: Two Inpatient Rehabilitation Facilities (IRFs) and 1 Long Term Acute Care Hospital (LTACH).

Participants: There were 2083 records reviewed (44% women, avg. age 59 years). The most common diagnoses were hemispatial neglect (19.2%), homonymous field defects (18.5%), and oculomotor cranial nerve palsies (16.7%) (N=2083).

Interventions: Clinical care was reviewed where diagnosis-specific protocols were developed and training was provided to OTs in order to reinforce OD-prescribed interventions during daily treatment sessions, including (1) third, fourth, and sixth ocular cranial nerve palsies (OCNPs) with prisms fitted for full time, postural adaptation training, and oculomotor re-education using pursuits, saccades, head-rotations, and binocular vision exercises including alternate cover and vergence; (2) homonymous hemianopia with training awareness of field loss, eccentric viewing, and fitting of Peli lens for optical field expansion; and (3) prism adaptation therapy (PAT) for left hemispatial neglect.

Main outcome measures: Frequency of diagnoses.

Hypothesis: Diagnoses with developed protocols were most common. Secondarily, feasibility and efficacy by anonymous OT survey.

Results: 2083 vision consults were performed over 5 years. The most common diagnoses were hemispatial neglect (n=399, 19.2%), homonymous field defects (n=386, 18.5%), and OCNPs (n=347, 16.7%). None of the OTs reported the protocols were infeasible and 63% (IQR 38%-69%) reported their patients benefited from the interventions. The survey suggested prism for OCNPs helped in 42%, and Peli lens and PAT both helped in 38%.

Conclusions: Data support the feasibility of this inpatient eye and vision rehabilitation care pathway which may be used as a foundation for creating or refining similar programs elsewhere. Uniform administration of IRF-based visual neuro-rehabilitation care could provide a substrate for future clinical trials to evaluate efficacy.

Keywords: Cranial nerve diseases; Hemianopsia; Hemispatial neglect; Neurorehabilitation; Palsy; Rehabilitation; Saccadic eye movement.