Please select the eligibility criteria that correspond to the clinical trial below.
Title: Visual Cue Training to Improve Walking and Turning After Stroke: a Pilot Study
Brief Summary: Given that visual information comprises one of the most important and salient sources of information used during walking, that visual cues have been shown to be more effective than auditory cues in triggering gait adjustments and that stroke survivors have been reported to become more dependent on visual cues, the investigators hypothesize that visual cues would be more effective in triggering gait recovery and adaptability following stroke than interventions not including visual cues.

The investigators will integrate visual cues with walking and turning practice, and contrast this intervention to routine overground walking practice. Stroke participants recruited from NHS stroke rehabilitation clinics in the West Midlands, will be randomized to one of three gait rehabilitation groups. Each group will receive the same frequency and duration of treatment delivered by qualified physiotherapists. Overground visual cue training (OVCT) and usual care (UC) groups will be treated in participating NHS sites. Treadmill training with visual cues (TVCT) will take place at the University of Birmingham.


Options:
A: Inclusion Criteria:

1. Primary eye diagnosis (in better seeing eye) of either macular degeneration, macular dystrophy, macular hole or inflammatory disease of the macula
2. Habitual visual acuity (in better seeing eye) better than 20/500 but less than 20/100

Exclusion Criteria:

1. does not have a phone
2. does not speak English
3. has previously received low vision services as part of an inpatient blind rehabilitation program
4. has participated in a low vision program that provided low vision devices to meet reading needs with low vision therapy administered by an occupational therapist or vision rehabilitation professional since most recent significant decrease in vision
5. has English literacy less than 5th grade level
6. has habitual visual acuity in better seeing eye of equal to or better than 20/100, less than or equal to 20/500
7. fails Telephone Interview of Cognitive Status (TICS) screening (score of 30 or lower)
8. has history of stroke with aphasia
9. has other health condition that would preclude follow-up (e.g. significant malignancy or life-threatening disease)
10. is unable or unwilling to attend clinic visits required for the study
11. has severe hearing impairment that interferes with participation in telephone questionnaires
12. reports significant loss of vision since last eye exam
13. has vitreous hemorrhage, serous or hemorrhagic detachment of the macula, clinically significant macular edema or cystoid macular edema that is likely to result in further loss or improvement in vision after treatment in better seeing eye
14. plans cataract extraction in the next 6 months.
B: Inclusion Criteria:

* Aged 55 years or over
* Low vision
* Living independently in the community or in a home for older people
* Able to see large obstacles and to go outside for a short walk or doing groceries
* One of the following:

  1. experiencing difficulties with safely crossing a street
  2. experiencing difficulties with recognising acquaintances outdoors
  3. willing to become recognisable as being partially sighted by using the identification cane
* Written informed consent
* Orientation and Mobility training (O\&M-training) in the use of an identification cane

Exclusion Criteria:

* Cognitive impairment (a score of less than 4 on the Abbreviated Mental Test 4)
* Language or hearing problems that impede completing an interview by telephone
* Confinement to bed or possible nursing home admission that impede completion of the O\&M-training
* Permanent use of a walking aid incompatible with the use of an identification cane
* Having recently received an O\&M-training in the use of an identification cane and permanent use of this cane
C: Inclusion Criteria:

* Age 18+
* Legal blindness (visual acuity worse than 20/200 but better than no/bare light perception, and/or visual field less than 20º, in the better eye)
* Any ocular disease diagnosis that is expected to remain relatively stable throughout a 3-6 month period
* Being healthy to the extent that participation yoga therapy would not exacerbate any existing disease conditions;
* Willingness to participate on a weekly basis for the 12-week intervention;
* Moderate to severe sleep disturbances, defined as ratings of 5 or greater on the PSQI

Exclusion Criteria:

* Significant changes to vision within the most recent 3-month period
* Inability to understand study procedures or communicate responses to visual stimuli in a consistent manner
* Clinically diagnosed or clinically significant sleep disorder (e.g., sleep apnea) or a medical or psychiatric condition (e.g., chronic pain) responsible for sleep complaints;
* Use of prescription sleep medication more than once a week for duration of the study;
* Use of other psychotropic medication;
* Current recipient of sleep disorder treatment;
* Consumption of more than 2-3 alcoholic beverages per day
* Smoking more than 10 cigarettes per day;
D: Inclusion Criteria:

* Diagnosis of stroke
* Able to walk 10 metres with or without assistance
* Residual paresis in the lower limb (Fugl-Meyer Lower Limb score less than 34)
* Informed written consent.

Exclusion Criteria:

* Gait speed more than 0.8 m/s
* Patients with a premorbid (retrospective) modified Rankin Scale score of greater than 3
* Gait deficits attributable to non-stroke pathology
* Visual impairments preventing use of visual cue training (as assessed by Apple Cancellation test
* Concurrent progressive neurologic disorder, acute coronary syndrome, severe heart failure, confirmed or suspected lower-limb fracture preventing mobilization, and those requiring palliative care
* Inability to follow a three step command (as assessed by Modified mini-mental status exam).

Answer: D