Visual scanning is a fundamental skill for navigating our environment and performing daily activities. For individuals in acute care settings, particularly after neurological events like stroke or traumatic brain injury, deficits in visual scanning are common and can significantly impact their recovery and independence. Occupational therapy plays a crucial role in addressing these challenges through targeted interventions. This article explores effective occupational therapy acute care interventions focused on improving visual scanning, helping patients regain their ability to interact with their surroundings.
Understanding Visual Scanning Deficits in Acute Care
In the acute care context, visual scanning deficits often manifest as visual neglect or inattention, where individuals struggle to perceive or attend to stimuli on one side of their visual field, typically the side opposite to the brain lesion. This is not a problem with vision itself, but rather with attention and awareness. These deficits can affect a patient’s ability to perform self-care tasks like eating and dressing, navigate their hospital room safely, and participate effectively in rehabilitation. Addressing visual scanning is therefore a priority in acute occupational therapy interventions.
Occupational Therapy Interventions for Visual Scanning Enhancement
Occupational therapists utilize a range of activities to improve visual scanning in acute care. These interventions are designed to be adaptable to the patient’s current abilities and progressively challenge them as they recover. Here are some key strategies:
Cancellation Tasks for Focused Attention
Cancellation tasks are a foundational intervention to improve focused visual attention and systematic scanning. These tasks involve presenting a field of stimuli, such as letters, numbers, or symbols, on a page and asking the patient to identify and cancel a specific target stimulus.
For example, a therapist might present a sheet filled with various letters and ask the patient to cross out every instance of the letter “A”. In acute care, these tasks can be simplified initially, perhaps using larger stimuli or fewer distractors. Encouraging a systematic left-to-right, top-to-bottom scanning pattern is crucial, especially for patients with left-sided neglect. The complexity can be gradually increased by using more visually similar distractors, larger arrays of stimuli, or more complex patterns. Cancellation tasks are beneficial in improving sustained attention and organized visual search strategies, skills essential for many daily activities.
Reading Tasks: Re-training Directional Scanning
Reading is inherently a visual scanning task, making it an excellent therapeutic activity. In acute care, adapted reading tasks can help patients relearn to scan from left to right and attend to both sides of the page.
A practical adaptation involves using a bright line or colored tape placed vertically along the left margin of reading material like books or newspapers. This visual cue prompts the patient to start their scan from the left edge, compensating for neglect. Tactile cues can also be added, such as a Velcro or sandpaper strip at the margin, providing physical feedback to reinforce the starting point. Numbering lines can further structure the task. Patients can be instructed to track each line with their finger to enhance visual scanning and ensure they return to the left margin for each new line. These adapted reading exercises not only improve visual scanning but also can maintain cognitive engagement and language skills during the acute recovery phase.
Mealtime Activities: Integrating Therapy into Daily Routines
Mealtime, a routine daily activity in acute care, provides a natural and functional context for visual scanning interventions. Occupational therapists can transform mealtime into a therapeutic opportunity by strategically structuring the environment and task demands.
Positioning oneself on the patient’s affected side and encouraging eye contact during conversation promotes attention to the neglected visual field. For patients requiring feeding assistance, staff can be trained to do the same. Placing a brightly colored tape on the affected side of the meal tray or table acts as an anchor, drawing visual attention to that side. Strategically placing utensils, food items, and drinks on the neglected side encourages active visual scanning across their visual field to locate and interact with these items. These mealtime modifications integrate visual scanning practice into a functional and necessary daily activity, enhancing carryover and relevance.
Visual Search Tasks: Functional Object Location
Visual search tasks are designed to mimic real-world scenarios where individuals need to find specific objects within a cluttered environment. These tasks are highly relevant in acute care for improving a patient’s ability to locate items in their hospital room or during therapy sessions.
Therapists can set up visual search scenarios by strategically placing common objects in front of the patient, including some on their neglected side. The patient is then asked to find specific items. For instance, a therapist might ask a patient to find their water glass, call button, or television remote among other items on their bedside table. For more structured tasks, playing cards can be laid out, and the patient is asked to pick them up in a numerical or suit order. Verbal cues, such as “Remember to look to your left,” can be helpful prompts, encouraging self-cueing strategies. Games like “I Spy” or “Spot the Difference” can also be adapted for visual search practice, making therapy more engaging.
Environmental Scanning and Navigation in Acute Care
While full-scale navigation tasks might be limited in acute care, adapting environmental scanning activities to the hospital setting is crucial. This helps patients become more aware of and interact with their immediate surroundings, promoting safety and orientation.
Therapists can encourage patients to actively scan their hospital room, identifying key objects like the door, bathroom, nurse call button, and personal belongings. During mobility within the hospital unit, patients can be prompted to describe objects or landmarks on their affected side. Simple maze tasks, either paper-based or computer-based, can also be used to practice systematic visual scanning and planning in a confined space. For a more active task within the hospital environment, numbered sticky notes can be placed on the walls in a hallway, and the patient can be asked to find them in sequence.
Maze for visual scanning practice
Conclusion: Occupational Therapy’s Role in Visual Scanning Recovery
Occupational therapy acute care interventions are vital for addressing visual scanning deficits following neurological injury. By employing targeted and adaptable strategies like cancellation tasks, adapted reading, mealtime modifications, visual search activities, and environmental scanning exercises, occupational therapists can significantly improve a patient’s visual awareness and functional abilities. These interventions are crucial for enhancing patient safety, independence, and participation in rehabilitation during the acute recovery phase and beyond, laying a foundation for improved quality of life.
