Table 3.
Included studies examining the effects of visual skills training on cognitive functions and activities of daily living in stroke patients
| References | No. of subjects (sex); age (mean ± SD, or range); location; main symptoms | Time since stroke, mean (SD) | Groups; type of intervention; visual skills targeted | Intervention: no. of training weeks/sessions; single session duration | Outcome measures of cognitive function | Results, mean (SD) | Level of evidence |
|---|---|---|---|---|---|---|---|
| Chen et al. [55] | 80 (28 F, 52 M); 57.74 ± 8.54 yrs; various; cognitive dysfunction | < 3 months |
INT (n = 40); visual skills training CON (n = 40); conventional physiotherapy and gait rehabilitation |
INT: 4 wk / 16 sessions; 30 min Visual skills training focused on multiple executive functions; attention, memory ability, spatial orientation CON: no details reported |
MoCA (score) Global cognitive function pre-/post-intervention |
MoCA: INT pre: 13.0 (2.2) CON pre: 13.0 (2.2) INT post: 18.0 (1.5) CON post: 14.5 (2.2) |
+ |
| Fadle et al. [76] |
INT (2 F, 13 M); 54 ± 6.5 yrs; NA; NA CON (3 F, 12 M); 53.2 ± 5.91; NA; NA |
INT: 8.33 (2.35) months CON: 8.66 (1.95) months |
INT (n = 15); visuomotor training CON (n = 15); physical therapy and cognitive training |
INT: 4 wk / 28 sessions; 30 min Visual and kinesthetic visuomotor exercises CON: 4 wk / 28 sessions; 60 min Cognitive and dual-task training, time up and go task with phonologic fluency |
MoCA (score) Global cognitive function pre-/post-intervention |
MoCA: INT pre: 21.33 (2.28) CON pre: 20.53 (1.64) INT post: 24.2 (2.54) CON post: 22.13 (1.99) |
- |
| Schoettke [77] |
INT (7 F, 9 M); 64.1 ± 8.5 yrs; various; motor dysfunction CON (7 F, 6 M); 65.4 ± 10.9 yrs; various; motor dysfunction |
INT: 1.7 (0.7) months CON: 1.3 (0.4) months |
INT (n = 16); visual-cognitive training CON (n = 13); physical- and occupational therapy |
INT: 3 wk / 13 sessions; NA Visual-cognitive training combined with conventional rehabilitation CON: no details reported Physical- and occupational therapy |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 69.38 (21.20) CON pre: 63.46 (26.57) INT post: 83.44 (16.90) CON post: 68.85 (26.71) |
+ |
| Pashang et al. [78] |
INT (1 F, 9 M); 53.9 ± 9.73 yrs; right hemisphere; cognitive dysfunction CON (4 F, 6 M); 57.7 ± 12.16 yrs; right hemisphere; cognitive dysfunction |
INT: 11.9 months CON: 20.3 months |
INT (n = 10); visual-cognitive training CON (n = 10); drug- and physical therapy |
INT: 8 wk / 8 sessions; 60 min Visual-cognitive training program combined with drug- and physical therapy CON: no details reported Drug- and physical therapy |
V-CPT (number) Selective attention pre-/post-intervention |
V-CPT: INT pre: 34.40 (28.63) CON pre: 55.80 (21.25) INT post: 42.70 (27.67) CON post: 58.70 (22.07) |
- |
| He et al. [57] |
INT (15 F, 17 M); 66.0 ± 6.9 yrs; various; cognitive dysfunction CON (14 F, 18 M); 67.0 ± 5.9 yrs; various; cognitive dysfunction |
< 6 months | ö |
INT: 6 wk / 36 sessions; 80 min 20 min of physical therapy 20 min of occupational therapy 20 min of swallowing and speech function training 20 min of eye-movement training CON: 6 wk / 36 sessions; 80 min 20 min of physical therapy 20 min of occupational therapy 20 min of swallowing and speech function training 20 min of cognitive training |
MoCA (score) Global cognitive function MBI (score) Activities of daily living pre-/post-intervention |
MoCA: INT pre: 14.6 (2.6) CON pre: 14.5 (2.4) INT post: 17.3 (2.3) CON post: 16.0 (2.3) MBI: INT pre: 42 (18.52) CON pre: 42 (16.30) INT post: 65 (13.33) CON post: 61 (14.07) |
++ |
| Kim et al. [79] |
INT (6 F, 9 M); 70.7 ± 6.6 yrs; NA; cognitive dysfunction CON (7 F, 8 M); 71.4 ± 5.2 yrs; NA; cognitive dysfunction |
INT: 4.4 (4.0) months CON: 4.9 (6.3) months |
INT (n = 15); visuomotor training CON (n = 15); occupational therapy |
INT: 4 wk / 32 sessions; 30 min 20 sessions of occupational therapy 12 sessions of visuomotor training CON: 4 wk / 20 sessions; 30 min occupational therapy |
MMSE (score) Global cognitive function MBI (score) Activities of daily living V-CPT (number) Selective attention TMT-A (sec) Visual processing speed WAIS-DS (score) Working memory function pre-/post-intervention |
MMSE: INT pre: 19.7 (5.6) CON pre: 19.3 (5.3) INT post: 21.1 (5.9) CON post: 22.7 (4.7) MBI: INT pre: 33.2 (13.7) CON pre: 46.9 (14.4) INT post: 48.7 (12.9) CON post: 61.6 (17.0) V-CPT: INT pre: 76.7 (31.4) CON pre: 106.4 (22.6) INT post: 100.9 (34.0) CON post: 109.2 (30.9) TMT-A: INT pre: 248.8 (227.2) CON pre: 283.6 (193.6) INT post: 226.9 (216.1) CON post: 273.7 (216.2) WAIS-DS: INT pre: 3.4 (0.5) CON pre: 3.5 (0.6) INT post: 3.3 (0.6) CON post: 3.7 (0.8) |
- |
| Batool et al. [80] |
INT (15 F, 17 M); 55.63 ± 5.90 yrs; NA; visual disorders CON (13 F, 19 M); 54.38 ± 8.78 yrs; NA; visual disorders |
3–6 months |
INT (n = 32); visual scanning training CON (n = 32); functional task training |
INT: 4 wk / 24 sessions; 45 min 30-minute functional task training 15 min of visual scanning training CON: 4 wk / 24 sessions; 45 min 30-minute functional task training 15 min placebo random eye movements |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 18.28 (7.47) CON pre: 20.31 (7.72) INT post: 32.66 (12.69) CON post: 26.25 (10.70) |
++ |
| De Luca et al. [56] |
INT (6 F, 9 M); 30.93 ± 11.10 yrs; NA; cognitive dysfunction CON (10 F, 10 M); 39.75 ± 15.43 yrs; NA; cognitive dysfunction |
3–6 months |
INT (n = 15); visual skills training CON (n = 20); standard cognitive rehabilitation |
INT: 8 wk / 24 sessions; NA Visual skills-based neurocognitive training combined with standard cognitive rehabilitation CON: no details reported Standard cognitive rehabilitation |
MMSE (score) Global cognitive function MBI (score) Activities of daily living pre-/post-intervention |
MMSE: INT pre: 21.2 (2.74) CON pre: 23.0 (4.81) INT post: 23.7 (2.66) CON post: 23.0 (4.22) MBI: INT pre: 20.0 (38.88) CON pre: 25.0 (31.48) INT post: 70.0 (29.63) CON post: 40.0 (32.5) |
- |
| Kerkhoff et al. [81] |
INT (4 F, 8 M); 64 ± 3 yrs; right hemisphere; visual disorders CON (5 F, 7 M); 64 ± 3 yrs; right hemisphere; visual disorders |
INT: 1.0 (0.1) months CON: 1.2 (0.2) months |
INT (n = 6); visual scanning training CON (n = 6); standard cognitive rehabilitation combined with physical therapy |
INT: 4 wk / 20 sessions; 30 min 30-minute functional task training 15 min of visual scanning training CON: 4 wk / 20 sessions; 30 min 30-minute functional task training 15 min placebo random eye movements |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 11.0 (4.0) CON pre: 15.0 (5.0) INT post: 28.0 (5.0) CON post: 26.0 (8.0) |
+ |
| Westerberg et al. [82] |
INT (1 F, 8 M); 55 ± 8 yrs; various; cognitive dysfunction CON (5 F, 4 M); 53.6 ± 8 yrs; various; cognitive dysfunction |
INT: 19.3 (6.2) months CON: 20.8 (6.2) months |
INT (n = 9); visual-spatial training CON (n = 9); no intervention |
INT: 5 wk / 25 sessions; 40 min Software-based visual-spatial cognitive training CON: - |
WAIS-DS (score) Working memory function ST (sec) Selective attention pre-/post-intervention |
WAIS-DS: INT pre: 5.8 (1.0) CON pre: 5.7 (0.9) INT post: 7.3 (1.0) CON post: 5.7 (1.3) ST: INT pre: 108.0 (11) CON pre: 147.0 (54) INT post: 93.0 (19) CON post: 124.0 (48) |
+ |
| Prokopenko et al. [59] |
INT (4 F, 6 M); 59.5 ± 2.5 yrs; various; cognitive dysfunction CON (1 F, 8 M); 62.55 ± 2.45 yrs; various; cognitive dysfunction |
< 6 months |
INT (n = 10); visual-spatial training CON (n = 9); physical therapy |
INT: 10 days / 10 sessions; 30–40 min Software-based visual-spatial cognitive training CON: no details reported |
MMSE (score) Global cognitive function MoCA (score) Global cognitive function pre-/post-intervention |
MMSE: INT pre: 25 (5.93) CON pre: 25.8 (5.19) INT post: 28.2 (2.96) CON post: 26.6 (5.93) MoCA: INT pre: 20.6 (4.44) CON pre: 20.2 (6.66) INT post: 26.1 (2.96) CON post: 21.3 (9.63) |
- |
| Yoo et al. [83] |
INT (15 F, 8 M); 53.2 ± 8.8 yrs; NA; cognitive dysfunction CON (14 F, 9 M); 56.3 ± 7.9 yrs; NA; cognitive dysfunction |
INT: 11.8 (7.5) months CON: 10.7 (6.2) months |
INT (n = 23); visual-spatial training CON (n = 23); physical- and occupational therapy |
INT: 5 wk / 25 sessions; 30 min Visuomotor coordination, visual impairment, spatial imagination, memory, focus, attention CON: no details reported |
TMT-A (sec) Visual processing speed WAIS-DS (score) Working memory function pre-/post-intervention |
TMT-A: INT pre: 71.62 (22.31) CON pre: 68.48 (25.54) INT post: 65.68 (24.51) CON post: 67.36 (22.50) WAIS-DS: INT pre: 3.62 (1.35) CON pre: 3.72 (1.23) INT post: 4.32 (1.32) CON post: 3.86 (1.41) |
+ |
| Kim et al. [84] |
INT (8 F, 5 M); 58.9 ± 3.1 yrs; NA; NA CON (9 F, 4 M); 57.4 ± 3.5 yrs; NA; NA |
> 6 months |
INT (n = 13); vision control dual-task training CON (n = 13); unstable supporting plane dual-task balance training |
INT: 5 wk / 25 sessions; 30 min Visual restriction recognition task exercises CON: 5 wk / 25 sessions; 30 min Somatosensory control balance exercises |
TMT-A (sec) Visual processing speed TMT-B (sec) Cognitive flexibility ST (sec) Selective attention pre-/post-intervention |
TMT-A: INT pre: 32.9 (3.0) CON pre: 32.0 (2.7) INT post: 30.9 (2.9) CON post: 29.8 (3.1) TMT-B: INT pre: 45.8 (3.0) CON pre: 45.9 (6.1) INT post: 42.2 (3.2) CON post: 41.7 (6.4) ST: INT pre: 44.7 (7.9) CON pre: 45.9 (6.7) INT post: 40.6 (8.2) CON post: 42.1 (5.5) |
+ |
| Mazer et al. [85] |
INT (12 F, 35 M); 65.5 ± 11.4 yrs; NA; NA CON (15 F, 35 M); 66.5 ± 8.9 yrs; NA; NA |
INT: 3.0 (1.7) months CON: 2.2 (0.9) months |
INT (n = 47); visual skills training CON (n = 50); occupational therapy and cognitive skills training |
INT: 5–10 wk / 20 sessions; 30–60 min Visual skills training targetting visual processing speed, divided- and selective visual attention CON: 5–10 wk / 20 sessions; 30–60 min Somatosensory control balance exercises |
TMT-A (sec) Visual processing speed TMT-B (sec) Cognitive flexibility pre-/post-intervention |
TMT-A: INT pre: 67.5 (3.9) CON pre: 67.7 (36.0) INT post: 49.4 (16.1) CON post: 57.3 (27.6) TMT-B: INT pre: 207.2 (147.0) CON pre: 207.2 (116.3) INT post: 139.9 (66.0) CON post: 161.6 (81.2) |
++ |
| Liu et al. [58] |
INT (8 F, 22 M); 52.5 ± 7.5 yrs; right hemisphere; motor dysfunction CON (11 F, 19 M); 53.0 ± 14.5 yrs; right hemisphere; motor dysfunction |
INT: 0.6 months CON: 0.6 months |
INT (n = 30); visual feedback training CON (n = 30); functional electric stimulation combined with conventional therapy |
INT: 3 wk / 15 sessions; 20 min Motor imagery-based brain-computer interface training CON: 3 wk / 15 sessions; 20 min Functional electric stimulation |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 54.5 (15.41) CON pre: 52.5 (18.30) INT post: 80.0 (17.26) CON post: 62.5 (17.33) |
+ |
| Rizkalla [86] |
INT (4 F, 5 M); 65.0 ± 9.31 yrs; right hemisphere; cognitive dysfunction CON (3 F, 6 M); 67.0 ± 7.81 yrs; right hemisphere; cognitive dysfunction |
INT: 0.5 (0.1) months CON: 0.6 (0.1) months |
INT (n = 9); visual skills training CON (n = 9); physical-, occupational- and speech therapy |
INT: 4 wk / 20 sessions; 60 min Visuospatial scanning, visuospatial construction, complex visuospatial-visuomotor activity, mirror neuron training, complex visual skills homework CON: no details reported |
MMSE (score) Global cognitive function MoCA (score) Global cognitive function TMT-A (sec) Visual processing speed TMT-B (sec) Cognitive flexibility MBI (score) Activities of daily living WAIS-DS (score) Working memory function pre-/post-intervention |
MMSE: INT pre: 20.67 (2.35) CON pre: 19.00 (3.64) INT post: 26.00 (2.45) CON post: 19.22 (4.87) MoCA: INT pre: 17.11 (2.57) CON pre: 16.11 (3.33) INT post: 21.78 (2.99) CON post: 15.89 (6.11) TMT-A: INT pre: 145.00 (101.00) CON pre: 136.11 (100.62) INT post: 109.11 (90.81) CON post: 133.78 (101.60) TMT-B: INT pre: 257.22 (65.72) CON pre: 273.67 (64.14) INT post: 201.56 (77.36) CON post: 270.89 (66.31) MBI: INT pre: 34.44 (18.45) CON pre: 39.44 (8.08) INT post: 61.67 (24.75) CON post: 42.78 (7.95) WAIS-DS: INT pre: 5.11 (1.27) CON pre: 5.44 (1.13) INT post: 6.67 (1.41) CON post: 5.67 (1.66) |
+ |
| Tramontano et al. [87] |
INT (6 F, 9 M); 52.8 ± 9.2 yrs; various; cognitive dysfunction CON (7 F, 8 M); 61.7 ± 15.2 yrs; various; cognitive dysfunction |
< 6 months |
INT (n = 15); visual-spatial training CON (n = 15); balance training combined with conventional rehabilitation |
INT: 4 wk / 20 sessions; 60 min 40 min of conventional rehabilitation 20 min of visual-spatial, specular vision, and target identification training CON: 4 wk / 20 sessions; 60 min 40 min of conventional rehabilitation 20 min of balance training |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 70.9 (18.71) CON pre: 69.1 (24.42) INT post: 92.4 (11.12) CON post: 70.1 (21.36) |
+ |
| Moon et al. [88] |
INT (10 F, 10 M); 54.00 ± 14.63 yrs; NA; cognitive dysfunction CON (11 F, 9 M); 56.95 ± 12.86 yrs; NA; cognitive dysfunction |
INT: 1.0 (0.1) months CON: 1.1 (0.1) months |
INT (n = 18); eye-tracking visual cognitive training CON (n = 21); conventional cognitive training |
INT: 6 wk / 30 sessions; 30 min Eye-tracking visual attention and processing training CON: 6 wk / 30 sessions; 30 min Computerized cognitive rehabilitation |
MMSE (score) Global cognitive function MBI (score) Activities of daily living V-CPT (number) Selective attention pre-/post-intervention |
MMSE: INT pre: 21.55 (5.68) CON pre: 21.50 (4.13) INT post: 25.70 (3.37) CON post: 25.10 (3.59) MBI: INT pre: 46.25 (17.80) CON pre: 59.00 (23.86) INT post: 62.75 (18.33) CON post: 76.05 (20.12) V-CPT: INT pre: 45.30 (20.16) CON pre: 39.85 (15.57) INT post: 53.00 (21.94) CON post: 42.90 (15.35) |
- |
| Van Wyk [89] |
INT (6 F, 6 M); 19–74 yrs; NA; visual disorders CON (6 F, 6 M); 19–74 yrs; NA; visual disorders |
NA |
INT (n = 12); eye movement training CON (n = 12); task-specific activities |
INT: 4 wk / 20 sessions; 45 min Saccadic eye movement training and visual scanning with task-specific activities CON: 4 wk / 20 sessions; 45 min Task-specific activities |
MMSE (score) Global cognitive function MBI (score) Activities of daily living pre-/post-intervention |
MMSE: INT pre: 21.0 (3.95) CON pre: 20.7 (5.12) INT post: 25.4 (2.02) CON post: 24.1 (3.06) MBI: INT pre: 42.9 (18.40) CON pre: 46.3 (18.11) INT post: 85.4 (16.44) CON post: 65.4 (27.84) |
+ |
| Zhu et al. [90] |
INT (6 F, 10 M); 57.75 ± 16.75 yrs; various; motor dysfunction CON (7 F, 8 M); 56.89 ± 17.93 yrs; various; motor dysfunction |
< 3 months |
INT (n = 16); visual feedback training CON (n = 15); conventional rehabilitation |
INT: 8 wk / 48 sessions; 210–270 min 30-minute visual feedback training 180–240 min of conventional rehabilitation CON: 8 wk / 48 sessions; 180–240 min 180–240 min conventional rehabilitation, Bobath and Brunnstrom approaches, proprioceptive neuromuscular facilitation techniques, physical exercise, daily activities, physical- and occupational therapy |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 42.75 (11.09) CON pre: 43.78 (12.11) INT post: 72.33 (11.82) CON post: 63.75 (10.45) |
+ |
| Zhang et al. [91] |
INT (6 F, 14 M); 66.90 ± 4.42 yrs; NA; NA CON (5 F, 15 M); 67.55 ± 4.94 yrs; NA; NA |
INT: 2.2 (0.3) months CON: 2.3 (0.3) months |
INT (n = 20); visual feedback training CON (n = 20); balance training |
INT: 3 wk / 15 sessions; 40 min 20 min of visual feedback training 20 min of balance training CON: 3 wk / 15 sessions; 20 min 20 min of balance training |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 29.50 (8.87) CON pre: 30.00 (8.89) INT post: 61.75 (10.3) CON post: 49.50 (10.99) |
+ |
| Wang et al. [92] |
INT (1 F, 14 M); 56.73 ± 10.73 yrs; NA; motor dysfunction CON (14 M); 59.43 ± 9.75 yrs; NA; motor dysfunction |
INT: 4.0 (1.2) months CON: 4.7 (1.5) months |
INT (n = 15); visuomotor training CON (n = 14); health education combined with conventional rehabilitation |
INT: 4 wk / 20 sessions; 210 min 30-minute visuomotor training 180 min of conventional rehabilitation CON: 4 wk / 20 sessions; 210 min 30-minute health education 180 min of conventional rehabilitation |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 57.73 (16.24) CON pre: 63.82 (16.25) INT post: 78.64 (13.73) CON post: 71.71 (17.94) |
++ |
| Braun et al. [93] |
INT (13 F, 5 M); 77.7 ± 7.4 yrs; NA; NA CON (9 F, 9 M); 77.9 ± 7.4 yrs; NA; NA |
INT: 1.4 (0.6) months CON: 1.1 (0.8) months |
INT (n = 18); visuomotor training CON (n = 18); difficult task homework combined with conventional rehabilitation |
INT: 6 wk; no details reported Visuomotor training combined with multi-professional rehabilitation CON: 6 wk; no details reported Multi-professional rehabilitation |
MBI (score) Activities of daily living pre-/post-intervention |
MBI: INT pre: 11.17 (4.1) CON pre: 12.22 (5.4) INT post: 15.00 (4.5) CON post: 14.94 (5.5) |
+ |
| Luukkainen-Markkula et al. [94] |
INT (4 F, 2 M); 57.8 ± 11.8 yrs; right hemisphere; motor dysfunction CON (3 F, 3 M); 59.5 ± 8.4 yrs; right hemisphere; motor dysfunction |
INT: 3.2 (2.1) months CON: 2.7 (2.2) months |
INT (n = 6); visual scanning training CON (n = 6); arm activation training combined with conventional rehabilitation |
INT: 8 wk / 32 sessions; 90 min 20 min of visual scanning training 30 min of physical therapy 40 min of occupational therapy CON: 8 wk / 32 sessions; 90 min 45 min of arm activation training 25 min of physical therapy 20 min of occupational therapy |
WAIS-DS (score) Working memory function pre-/post-intervention |
WAIS-DS: INT pre: 9.5 (3.7) CON pre: 8.4 (5.5) INT post: 12.0 (3.9) CON post: 10.6 (5.1) |
+ |
INT = Intervention group; CON = Control group; MoCA = Montreal Cognitive Assessment; WAIS-DS = Wechsler Adult Intelligence Scale digit span score; MMSE = Mini-Mental Status Examination; MBI = Modified Barthel Index; V-CPT = Visual Continuous performance test; TMT-A = Trail Making Test Part A; TMT-B = Trail Making Test Part B; ST = Stroop test; Level of evidence: low quality (−), acceptable quality (+), and high quality (++), according to the Scottish Intercollegiate Guidelines Network Methodology checklist