Vertical perception following stroke: a survey of rehabilitation therapists’ opinions on the impact of vertical perception deficits on rehabilitation and recovery

Background/Aims Following stroke, people can present with spatial perceptual deficits, which are associated with vertical perception deficits and are known to negatively influence the outcome of rehabilitation. It is not known how vertical perception deficits influence rehabilitation therapists’ assessment and treatment choices. A survey of mainly UK-based physiotherapists and occupational therapists was undertaken to explore views and current practice in relation to vertical perception following stroke. Specifically, the survey investigated rehabilitation therapists’ views on terminology, assessment and treatment, impact on functional outcome and clinical decision making. Methods An online survey was completed by a convenience sample of 70 rehabilitation therapists (52 physiotherapists and 18 occupational therapists). Results Vertical perception deficits were commonly encountered by respondents and were diagnosed mainly through observation. Respondents were confident in their ability to assess and treat vertical perception deficits. Vertical perception deficits were understood to be associated with pushing behaviour, neglect, weight-bearing asymmetry and decreased balance. Respondents understood it was related to severe, right-sided strokes with sensory and proprioceptive loss, but were inconsistent in their awareness of the specific brain regions involved in vertical perception deficits, specifically in posterior circulation strokes. Respondents reported that stroke survivors with vertical perception deficits require longer periods of rehabilitation, and overall have a worse functional outcome than those without. A variety of treatment options were used to address vertical perception deficits. Conclusions Further research should investigate the treatment and assessment used by rehabilitation therapists in relation to vertical perception deficits following stroke. Implications for practice Vertical perception deficits are commonly encountered in stroke rehabilitation. Rehabilitation therapists identify this mainly through observation. There are currently no methods to quantify vertical perception deficits in the clinical environment. Individuals living with vertical perception deficit may require longer periods of rehabilitation. At present, there are no evidence-based interventions to address vertical perception deficits in people who have had a stroke.