Please select the eligibility criteria that correspond to the clinical trial below.
Title: The HEP-OKS Pilot Study - a Randomized Controlled Trial of Hemifield Eye Patching and Optokinetic Stimulation to Treat Hemispatial Neglect in Stroke Patients
Brief Summary: Spatial neglect represents one of the major cognitive disorders following stroke. Patients patients fail to be aware of objects or people to their left and orientate instead to their right side. Enduring neglect has been found to be a poor prognostic indicator for functional independence following stroke. Despite some promising experimental accounts there are no established treatments for this condition.

The aim of this study is to test whether a combined treatment with hemifield eye patching (HEP) and optokinetic stimulation (OKS) can permanently reduce neglect behaviour and improve functional outcome in patients with hemispatial neglect following stroke.

The investigators hypothesise that the treatment with HEP and OKS will lead to a greater reduction of neglect scoring in the neglect test battery as well as a greater improvement in functional independence scores as compared to the spontaneous clinical course of the usual-care control group.


Options:
A: Inclusion Criteria:

* Patient has provided written consent prior to entry into the study
* Males or females, 18 - 85 years of age
* Evidence of ischemic or hemorrhagic stroke confirmed by CT or MRI head scan
* Patient with onset of symptoms less than 3 months (for iHOME Acute) or patient more than 6 months (for iHOME Chronic) at the time of randomization
* Measurable deficit of the upper extremity ≥3 according to the Chedoke McMaster scale e.g. participants should be able to touch their chin and contralateral knee to be eligible (for iHome Acute), or measurable deficit of the upper extremity ≥4 according to the Chedoke McMaster scale e.g. participants should be able to touch their chin and contralateral knee to be eligible (for iHome Chronic)
* Functional independence prior to present stroke (mRS = 0-1)
* Patient is alert, medically stable according to the treating physician and able to follow simple verbal commands

Exclusion Criteria:

* Patient had stroke onset more than 3 months ago (for iHOME Acute) or patient had stroke onset less than 6 months ago (for iHOME Chronic)
* Inability to follow verbal commands or having global aphasia
* Severe illness with life expectancy less than 3 months
* Uncontrolled hypertension, unstable angina, or recent myocardial infarction
* History of seizures
* Participation in another clinical trial involving rehabilitation or investigational drug
* Unable to comply with the protocol
* Patient has any condition(s) that would warrant exclusion from the study
* Any medical condition that might confound the interpretation of results or put the patient at risk
B: Inclusion Criteria:

* At least 18 years of age.
* Sighted in both eyes, with monocular visual acuity (best corrected vision), of at least 20/50 in each eye.
* Complete homonymous hemianopia of more than 3 months duration
* Refractive error within the -5 dioptre to +5 dioptre range
* No significant cognitive impairment
* No history of wearing the Peli system of peripheral prisms for hemianopic field expansion (patients who have worn another type of prismatic correction for hemianopia such as yoked prisms or the Gottlieb VAS system can participate in the study)
* No physical or mental disabilities, including cognitive dysfunction, balance problems or other deficits that could impair ability to walk or use the peripheral prism spectacles.
* Able to walk (using a cane or walker is OK) or control the movements of their own wheelchair.
* In sufficiently good health to attend four in-office visits.

Exclusion Criteria:

* Diagnosis of dementia
* Diagnosis of visual neglect
* History of seizures in the last 6 months
* Incomplete hemianopia
C: 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).
D: Inclusion Criteria:

* Right hemisphere stroke
* Spatial neglect as determined by pathological scores in at least two tests of a neglect test battery (Azouvi et al., JNNP, 2004)
* Age \> 18 years old
* Informed consent signature

Exclusion Criteria:

* Bilateral or previous unilateral stroke lesions
* Pre-existing neurodegenerative disease
* Inability to give informed consent

Answer: D