Orthoptists working closer with acute stroke wards to assess patients’ vision

Orthoptists are working closer with stroke teams as part of a rehabilitation programme to ensure patients who have had a stroke have sight assessments and treatment required to preserve their vision.

The work is part of Lancashire and South Cumbria Integrated Stroke and Neurorehabilitation Delivery Network (ISNDN) and has been introduced across the four provider trusts acute stroke wards - East Lancashire Teaching Hospitals NHS Trust (ELHT), Lancashire Teaching Hospitals NHS Foundation Trust (LTH), Blackpool Teaching Hospital (BTH) and University Hospitals of Morecambe Bay (UHMBT).

Stroke can affect the visual pathways of the eye and this can affect vision in different ways including:

• visual field loss
• blurry vision
• double vision
• reading difficulty
• moving images
• other problems such as dry eyes and sensitivity to light.

Stroke can also affect areas of the brain that process the information that you see and can cause problems such as visual neglect, judging depth and movement, recognising objects and people and visual hallucinations.

The additional Orthoptist posts means all stroke patients admitted to the acute stroke ward will be screened.

Conrad Beacham, Orthoptic Services Manager for Blackpool Teaching Hospitals NHS Foundation Trust, said: “The additional Orthoptic staffing that we now have in place, which includes a new service Lead, will allow us to see our patients on the ward and feedback to the multidisciplinary team in an appropriate timeframe. This is vital in terms of forming a co-ordinated approach in helping the patient on the road to recovery.

“The Orthoptist will be able to identify sight impairing conditions on the ward and offer practical advice, coping strategies or in some instances treatment, where an eye muscle imbalance is found that is causing double vision.

“The Orthoptist will offer follow up appointments for more in depth examinations at a later date where necessary, and we are fortunate enough to have also been granted funding for a new Octopus Perimeter, which we use to accurately test patients that have damage to their peripheral vision.”

Elaine Day, ISNDN Manager for Lancashire and South Cumbria, said: “Around 60% of new stroke patients have a visual defect which is why it’s really important that Orthoptists are involved at the start of a patients’ rehabilitation journey post-stroke.

“As well as vision, about 70% of patients have a psychological need following stroke and 50% of patients feel abandoned when they leave hospital. We are working towards a reduction in these figures by ensuring our patients receive the right support, at the right time and in the right place.”

Sharon Walkden, Programme Manager for the ISNDN, said: “Vision can be really affected by stroke, so it is really important that patients are assessed as timely as possible. Orthoptists working closer with our acute stroke teams will ensure patients have the right care and treatment.”

LSC PCB Stroke Programme Improvements

The LSC ISNDN Stroke Programme has seen some fantastic improvements including the recently rolled out NeuroRehabilitation Online (NROL)  across ELTH, UHMBT, BTH and Lancashire and South Cumbria NHS Foundation Trust. NROL is a group rehabilitation programme for people who have had a stroke or have other neurological conditions. You can find out more about NROL here.
Patient feedback on the programme has been largely positive including:

• 96% of patients liked that NROL was an online activity and felt they had enough space and equipment to access NROL
• 98% of patients felt that the NROL staff paid attention to their needs
• 95% of patients felt that NROL was an important part of their rehabilitation
• Patient comment: “I was able to understand my feelings more.”
• Patient comment: “Introduced me to exercises that were helpful that I wouldn't have known about.”
• Patient comment: “Being able to speak to people in a similar situation gave me more confidence.”

Other improvements of the programme include:

• Working with the Stroke Association to promote the importance of ACT F.A.S.T. (Face, Arms, Speech, Time) amongst our workforce
• Introducing Brainomix across the four acute hospitals as part of the National Optimising Stroke Imaging Protocol (NOSIP). Every patient that has had a stroke that comes into our hospitals has a computerised tomography (CT) scan. The Brainomix e-Stroke tools will analyse these scans and help to guide treatment and transfer decisions. A key part of this tool is to flag if a patient is eligible for thrombolysis - a clot-busting drug - or if they are eligible to undergo a thrombectomy – a procedure to remove a clot from the brain. Further role out of Cerebral Perfusion Scanning is expected Autumn 2023, this will identify those strokes who are late presenters, that will benefit from thrombolysis or thrombectomy.  This allows more patients to get the right treatment, in the right place, at the right time