HABIT: Hemianopia Activity-Based inTervention

The aim of this project is to produce a treatment for loss of vision after stroke in adults that can be used in NHS services from early hospital-based rehabilitation and care at home.

Visual field loss, the inability to see to one side (“hemianopia”), affects around one third of people with stroke; in the UK that’s more than 30,000 people each year, and 5 million worldwide. Clinicians, patients and carers say treating visual problems after stroke is a top research priority.

People with hemianopia have the impression of a complete visual world, yet often have severe difficulties because of their visual loss. Many people cannot find things or read easily, lose balance or bump into things and sometimes fall when walking, become overwhelmed by crowded spaces and cannot drive. This reduces confidence, independence and quality of life and increases loneliness.

There is no standard treatment for stroke-related visual field loss; no treatment has enough evidence to be recommended for use across the NHS. Occupational therapists are the main people who treat visual field loss, but lack of knowledge about how to treat people limits what can be done. Best research evidence supports training people to compensate for visual field loss by “scanning” (looking repeatedly across into the affected area of vision), teaching them to search for and pay attention to the affected side of vision, and re-training them in reading. The study team have previously published how visual rehabilitation based on these principles can be practiced in community occupational therapy. We need to make these treatments work for everyone who needs them.

We will work with people with visual loss after stroke, professional and family carers and therapists to design a manual showing how to use the treatment, and videos for training and educating health professionals, patients and carers. We will then try out the training, manual and videos in several different NHS centres, and improve them based on feedback from therapists, stroke survivors and carers. People with hemianopia will be involved throughout the study. Local stroke survivors with hemianopia are willing to support the study and joined a group meeting to discuss this project. We will pay two of these people to join the Study Management Group and others to help with videos and written materials.

When this study ends we will publicise the results to scientists, stroke survivors and the public, by giving talks, posting on the web and publishing results in journals. We will ensure people with visual problems can access this material. This information will help patients and the NHS improve care. We will then apply for further money to evaluate the usefulness of this approach.