WO2007070954A2

WO2007070954A2 - Method for assessment and rehabilitation after acquired brain injury

Info

Publication number: WO2007070954A2
Application number: PCT/AU2006/001947
Authority: WO
Inventors: Gayle Elizabeth Clarke; Allison Dorothy Hayes; Gregory William Liddle; Raymond John Liddle; Donald Frederick Verlander
Original assignee: Neuro Vision Technology Pty Ltd
Priority date: 2005-12-20
Filing date: 2006-12-20
Publication date: 2007-06-28
Also published as: WO2007070954A3

Abstract

The present invention relates to a method for the assessment and rehabilitation of vision impairment. In particular, the invention is concerned with the assessment, rehabilitation, training methods and equipment used for the management of individuals with acquired brain injury and visual impairment resulting therefrom. The method involves a client being referred to an assessor and their details entered into a client management database. The client is then assessed, rehabilitated, and subsequently assessed using a series of tests.

Description

Method for assessment and rehabilitation after acquired brain injury

FIELD OF THE INVENTION

The present invention relates to a method for the assessment and rehabilitation of vision impairment. In particular, the invention is concerned with the assessment, rehabilitation, training methods and equipment used for the management of individuals with acquired brain injury and visual impairment resulting therefrom.

BACKGROUND OF THE INVENTION

Acquired brain injury refers to any type of brain injury that occurs after birth. That is, brain injury resulting from an event such as stroke, trauma, infection, disease or prolonged lack of oxygen. Persons affected by an acquired brain injury will often suffer from impaired vision whereby typically the visual range of the person is significantly reduced. It is not uncommon for the person affected to lose sight or suffer from severe deterioration in typically one half of their normal visual field, whilst retaining normal sight in the unimpaired portion.

Traditionally, the testing and diagnosis of the limitations of a person's visual field is conducted either in a clinical confrontational manner or via the use of a visual field analyser. These tests effectively map out the person's remaining visual field or sphere of vision, where objects are visible and distinguished. Clinical confrontational testing involves a clinician quickly determining the patient's extent of vision loss by requesting that the patient fix their gaze on a central point while moving an object through their field of vision. This test may be undertaken with the use of a pen, or alternative object, and enables the clinician to study the appearance and movement of the patient's eyes. Visual field analysers also require a patient to fix their gaze at a central point while various lights or other visual stimuli are displayed. The patient then notes which stimuli are visible within their field of vision. With enough visual stimuli the patient's effective visual field can be mapped out accurately for diagnosis and rehabilitation purposes. Once the remaining visual field is determined and mapped out, a suitable rehabilitation program focussing on utilising the remaining vision can be devised. The problem with a traditional visual analyser is that it has limited use for rehabilitation and can only be used in some circumstances for the purpose of improving deteriorated vision. Clinical confrontational testing is also limited in its rehabilitation capability and is used to monitor progress or recession not to administer therapeutic programs. Both these predominantly testing devices and methods offer little use in assisting the patient to utilise more effectively their remaining sight. This is as the patient's head is fixed in position and their gaze is fixed at a central point. By instructing the patient to move their head and eyes in order to view the stimuli, the patient can effectively increase their field of vision.

Traditional methods of testing vision impairment and subsequent rehabilitation techniques are specific to the purpose of either analysing or rehabilitating the patient. In order to assess and map the patient's remaining field of vision, traditional vision analysing equipment requires an operator to fire the sequence of visual stimuli and record whether the patient has seen the stimuli. This effectively precludes the clinician or operator from observing the patient's eye behaviour and head movement during testing. The observation of movement is important in determining the extent of the patient's vision loss, as the patient may compensate and attempt to view the stimuli with their remaining vision. Also the vision analyser can only be used to map out the patient's visual range and in certain circumstances rehabilitate the patient's deteriorated vision where they are unable to distinguish between different stimuli.

Other problems arising from the use of traditional vision analysers are that patients are required to concentrate and focus on a central point for a lengthy period of time, causing fatigue and inaccuracy of results. The level of concentration and complexity of instructions required to complete the task may also lead to a person who is suffering from other impairments, such as cognitive or hearing, obtaining an inaccurate result.

The human eye has a tendency to focus on or move towards any new visual stimuli, making traditional visual analysers inaccurate in determining a visual field map. This phenomenon also makes progress analysis difficult to accomplish, as conditions cannot easily be replicated. Also standardised or repetitive tests can be inaccurate, as the patient may grow accustomed to the visual stimuli and move his/her eye according. 5

a test to establish the level of mobility of said person and said person's ability to recognise targets and landmarks.

Preferably said series of tests to visually rehabilitate said person include: a test to define said person's width of visual field and to allow a comparison with the visual field width assessment; a test to reinforce the degree of head and eye turn necessary for said person to fixate on the perimeter of the affected visual field, to reduce the amount of prompting needed for said person to fixate on the perimeter and to establish a pattern of scanning from the perimeter of said affected field towards a mid-line of said display means; a test to reinforce said person' s ability to scan from the perimeter of the affected visual field, to attend to multiple visual stimuli and to increase said person's ability to anticipate the presence of visual information in the absence of visual cues; a test to reinforce said person's scanning pattern from the perimeter of the affected visual field towards said mid-line, to reduce said person's amount of prompting needed to establish and maintain a systematic search pattern and to establish a speed of scanning allowing for consistent and accurate detection of visual stimuli; a test to reinforce the scanning pattern from the perimeter of the affected visual field to said mid-line to reinforce said person's ability to maintain attention in the affected visual field whilst said visual stimuli are displayed in the unaffected visual field, and to increase the speed at which said person can detect changes in said visual stimuli; a test to reinforce said person's ability to scan from the perimeter of the affected visual field and to identify any difficulties regarding said person's spatial reasoning and spatial memory; a test to improve said person's hand eye coordination, ambulation, motor skills, sensory perception, neurological behaviour, reading comprehension and writing ability; a test to improve said person's ability to conduct every day tasks; and a test to improve the mobility of said person and said person's ability to recognise targets and landmarks.

Preferably said series of tests for assessment are the same series of tests used by said assessor in said follow up assessment. In preference the results of said series of tests are recorded into said software package as one of eight outcomes for consistent data entry.

Preferably said results of said person's tests for assessment and rehabilitation can be reviewed to monitor progress or regression using the software package.

Preferably said results of said person's tests for assessment and rehabilitation are recorded by the assessor and can be displayed graphically and printed.

Preferably said software package can be run in demonstration mode for the purpose of training at least said assessor to use the software package to conduct said series of tests and utilise said client management database.

Preferably said software package is configurable so that the desired level of functionality required by said assessor is provided.

Preferably said method further includes the step of providing training and a training manual to use the method for assessment and rehabilitation of said person to at least one said assessor

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several implementations of the invention and, together with the description, serve to explain the advantages and principles of the invention. Figures 1 - 4 of the drawings show the relationship between users of the system for assessment and rehabilitation, the software and the hardware used for the implementation of the present invention. Figures 5 - 32 of the drawings are samples taken from the software embodiment of the present invention and figures 33 - 35 illustrate the processes of assessing and rehabilitating clients and training assessors.

Figure 1 is a flow chart illustrating the relationship between users and the software component of the present invention;

Figure 2 is a flow chart illustrating the relationship between users, the software and hardware components; 7

Figure 3 is a flow chart illustrating the relationship between multiple software users and hardware components;

Figure 4 is a flow chart illustrating the relationship between the users and the software whereby the software includes a client management database;

Figure 5 is a sample display of a preferred software embodiment whereby a client's identification details is entered into the software's client management database;

Figure 6 is a sample display demonstrating the functionality and method of filtering and retrieving client information from the client management database;

Figure 7 is a sample of a client's personal details displayed as to be printed from the client management database;

Figure 8 is a sample display demonstrating the ability to archive client details to another database;

Figure 9 is a sample display of a client's assessment and rehabilitation history;

Figure 10 is a sample display of a client' s completed tasks for rehabilitation purposes;

Figure 11 is sample display of a client's medical history;

Figure 12 is a sample display of a client's relevant medical history and the physical location of the lesion;

Figure 13 is a sample display of a new client's assessment details;

Figure 14 is a sample display of a client's details regarding the ability to complete tasks relating to activities of daily living; 8

Figure 15 is a sample display of a client's neurological assessment, including a checklist containing an assessment on the client's ambulation, motor-skills and sensory perception;

Figure 16 is a sample display of a client's neurological behaviour assessment checklist;

Figure 17 is a sample display of a client's functional vision assessment, including an assessment of the appearance of the eye;

Figure 18 is a sample display of a client's static visual assessment using a scanning device, included are the various exercises used for assessment;

Figure 19 is a sample display of a client's dynamic tasks assessment, including provisions for different venues for testing, familiarity with surroundings, complexity, road crossing skills and the level of supervision required;

Figure 20 is a sample display of a pen and paper test for a client's visual assessment, including the display of eight outcome boxes;

Figure 21 is a sample display of a mobility assessment for a client, including a reporting mechanism;

Figure 22 is a sample display of a client's assessment summary;

Figure 23 is a sample display of a client's rehabilitation or training, including exercises utilising a static scanning device;

Figure 24 is a sample display of a client's rehabilitation or training, including take home exercises;

Figure 25 is a sample display of a client's rehabilitation or training, including exercises for improving landmark and target recognition; Figure 26 is a sample display of a client's summary of rehabilitation or training, including goals met and results of the exercises performed;

Figure 27 is a sample display of a client's summary of assessment and training for follow up purposes, typically performed several months after the completion of training or rehabilitation;

Figure 28 is a sample display of a summary report for printing, including the client's activity;

Figure 29 is a sample display of the results of a client's initial assessment and subsequent assessments for monitoring purposes;

Figure 30 is a sample display of the client management database's network functions;

Figure 31 is a sample display of the client management database's site configuration and customisation facilities;

Figure 32 is a sample display of the client management database in demo mode for training clinicians;

Figure 33 is a flow chart illustrating the various steps over the life cycle of a client's assessment and rehabilitation;

Figure 34 is a flow chart illustrating the processes involved in assessing a client's functional assessment; and

Figure 35 is a flow chart illustrating the rehabilitation process for a client undertaken by three different groups of clinicians; mobility therapists, occupational therapists, and optometrists or ophthalmologists.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following detailed description of the invention refers to the accompanying drawings. Although the description includes exemplary embodiments, other 10

embodiments are possible, and changes may be made to the embodiments described without departing from the spirit and scope of the invention. Figures 1 - 4 of the drawings show the relationship between users of the system for assessment and rehabilitation, the software, and the hardware used for the implementation of the present invention. Figures 5 - 32 of the drawings are samples taken from the software embodiment of the present invention and figures 33-35 are flow charts demonstrating the processes a client would undertake in assessment and rehabilitation.

Figure 1 illustrates, in a flow chart, the typical situation in which the present invention would be implemented. A referrer 10, typically a health care professional, a direct client 12, or a hospital 14 would refer a client to be assessed and rehabilitated by an assessor 16. The assessor would then report his/her findings to the referrer 18 and use the software embodiment of the present invention to enter information into a client management database and retrieve information necessary to conduct a series of tests for the assessment and rehabilitation of vision loss resulting from an acquired brain injury. These tests are typically; static scanning exercises 22 using a scanning device, table top exercises 24 referring to pen and paper based eye exercises, home exercises 26 referring to pen and paper based exercises conducted by the client outside of the clinic, and dynamic scanning exercises 28, performed by the client 30.

Figure 2 illustrates the preferred embodiment of the assessor 32 using the software 34 in the preferred environment. The software is used to facilitate a series of exercises 36 by providing instruction and in the case of a static scanning device, provide the predetermined sequences necessary to perform the required tests. The static scanning device is a display means with a plurality of light emitting devices switchable between on and off conditions in predetermined sequences. The software could also be adapted to drive other equipment used in the assessment and rehabilitation of a client. The software 34 interacts with a hard drive 38 for the storage and retrieval of client data and also with an FTP server 40 or network drive to back up such client information. The network server provides client information globally for statistical research, auditing and support capabilities. Both the hard drive and the FTP server have the ability to access a printer 42 and 44.

Figure 3 illustrates another embodiment of the present invention whereby multiple assessors 46 access the software 48 over a shared network 50 to conduct 11

exercises 52, interact with a web server 54 and save and retrieve files from a database server 56. The database server also has printing capabilities 58. In this embodiment, the database server collates centrally information from the assessors using the software.

In a further embodiment of the present invention as shown in figure 4, the system is further automated to receive client information at a reception 60 or from a referrer 62 and this information is stored into a central server 64. This embodiment is envisioned to be used in a large clinical environment whereby client information is entered at a central reception or by a referrer with a compatible data entry system. A report 66 is generated by the server and is sent to the referrer confirming the status of the client. A plurality of software packages 68 are then connected to this server 64 for use by assessors 70 and trainers 72. The software is preferably stored on a portable computing device for ease of ease of use and reliability. In this larger operating environment, there is a distinction between an assessor, conducting only the assessment portion of the client's vision loss, and a trainer conduct the series of tests required for the rehabilitation of the client. There is also the provision for auditing and quality assurance 74 to ensure the client's wellbeing and consistent service.

The method for visual assessment and rehabilitation following an acquired brain injury includes a client management database for the storage of client assessment and rehabilitation information as part of the software. The software is integral to the system and interacts with the necessary hardware and users to form part of the present invention.

Illustrated in Figure 5 is a sample screen taken from the software component 110 of the present invention. Shown in Figure 5, in the left hand side field of the sample screen, is the section headings indicating the type of information that can be entered into and retrieved from the client management database. The section heading titled client 112 refers to client information. Other section headings indicate the type of data that can be stored, processed and displayed including: title, client history, episodes, assessment, training, follow up, reports, outcomes, and network.

Figure 5 displays a sample screen of a client's information, as shown when the button titled select client 112 is activated. Buttons titled; select client 114, find client 12

116 and new client 118 allow the user of the system 110 to display, search and enter a client's details 120 into the database. Button 122, archive, allows the user to archive the client's records to another database for safe keeping.

Figure 6 illustrates a sample display when find client 116 activated. Displayed is pop-up window 124 displaying the following information; client's name, test date range, location of test, instructor and status of test. Each of these fields displayed in the pop-up search window 124, is of a drop-down type display, where all options are displayed for ease of searching. Also displayed are buttons for sorting 126 and printing a client's information 128. If a user of the system 110 wished to print a client's details then they would simply select the client from the list and select the print client button 128. The result of this process is displayed in the sample screen illustrated in Figure 7 where a client's personal details are presented in an easy to print format 130. The client's details can be archived in another database and shown in figure 8 is a sample display of a user wishing to archive such details after depressing the archive 122 button. In this figure it can be seen that the user may send information to the archive using the send button 130 or retrieve information using the retrieve from archive button 132. Information that is archived or about to be archived is displayed in the panel 134.

Figure 9 is a sample display of a client's history of assessment and rehabilitation, as displayed when the section heading client history 136 and the general overview button 138 are selected. Displayed in the client's history, in field 142, is information regarding when any episodes, assessment, rehabilitation/training or follow up work took place. Further information relating to the tests undertaken in regards to assessment 144, rehabilitation 146 and follow up 148 is also displayed. The follow up component refers to a series of follow up test to monitor progress or regression of a client. The information displayed, relating to particular tests undertaken by the client, gives a user the ability to see what has been done and what components need to be completed. This information also allows an auditing body to check if the users are conducting a sufficient number of tests and whether the test conducted are applicable to the client's particular needs.

The client's rehabilitation history is displayed when the training overview button 140 is pressed, as shown in figure 10. In this specification the term training is 13

used with respect to rehabilitating the client through repetition and with respect to the tuition of assessors. Displayed are the static training exercises 150, table top/home exercises 152 and dynamic training exercises 154 undertaken by the client and their status of completion. These tests and exercises will be discussed in detail in the following figures.

Figure 11 displays the client management database's ability to enter a new episode or incident for a client. Under the section heading episodes 156, a new episode or incident can be recorded into the database by activating the new episode button 158 and utilising the drop-down menus found in the current medical information field 160. The drop-down menus give the user a fixed number of options to assist in the consistent entering of data and also in subsequent analysis. Also, shown in this figure is the ability to store the name and contact details of rehabilitation therapists in field 162. Figure 12 displays any relevant further information pertaining to both new and pre-existing cases of vision impairment 164 and the physical location of the lesion 166.

Figure 13 displays the procedure of information gathering when undertaking the new assessment of a client, as shown under the section heading assessment 168. Figure 13 shows the following information entered into the database: assessor and date of assessment details 170, referral information 172, and personal support information 174. Personal support information 174 is shown in Figure 14 and includes information pertaining to whether or not assistance is required with personal care, domestic tasks, shopping, and whether the client has a support network available to assist them in these tasks.

Figure 15 shows the neurological assessment component of a client's assessment, as entered into the database. Field 176 displays the checklist required for assessing the client's ambulation and field 178 displays the checklist required for the assessment of the client's motor skills. Field 180 displays the checklist required for the assessment of the client's level of sensory perception.

Figure 16 displays the checklist required for the assessment of the client's neurological behaviour 182. This includes details on the client's deficiencies in attention, cognitive abilities, emotions stability, language, numeracy and memory. 14

Figure 17 displays the procedure for completing the functional vision assessment of the client. Field 186 shows the titles of the different functional visual characteristics assessed including; eye and eye-lid appearance, visual behaviour and change thereof, pupil responses and others. Instructions for the assessor to correctly conduct each assessment technique are displayed when the appropriate title is selected. These instructions are displayed both visually in field 188, and in a textual form 190. Also, to ensure the outcome of a client's assessment is recorded into the database correctly, eight buttons 192 are used to display the eight outcomes that the assessor can choose from. In this figure, no visual assessment test has been selected therefore the buttons 192 for recording the eight possible outcomes have no available options marked.

Displayed in figure 18 is a graphical representation of the static assessment device 194, instructions for its use 196 and the ability to control the device and select the various tests 198. The visual stimuli assessment device or static assessment device consists of two rows often equally spaced multi coloured visual stimuli, with a central dot marked on the device for focussing the client's attention. The visual stimuli are light emitting devices capable of being switched on and off in a predetermined sequence. Eight outcome buttons 192 are again provided to consistently record the results of these tests. The scanning device allows both the client and the assessor to gain an understanding of the extent of vision loss hence forming an important part of the rehabilitation process. As the vision deficit is neurological, a client may not necessarily be aware of any associated reduction in their visual field and hence must be made aware before any scanning techniques can be developed. The process of scanning refers to a client developing the ability to compensate for their visual deficit by scanning their head, body and eyes across the normal visual range.

Displayed in figure 19 is a sample client's tasks or exercises and variations thereof, used for the dynamic assessment of that client. The different tasks assess landmark and target recognition, spatial orientation, unilateral and bilateral scanning, public transport, and road crossing, reflecting real life scenarios. These are displayed in fields 200 and 202. To further reflect real life scenarios, variables such as venue location, familiarity and complexity are introduced. Displayed in field 204 are the 15

instructions for the various assessment tests or techniques selected. Provisions for the recording of outcomes are also provided in the form of eight possible results 192.

Other assessment techniques utilised by the system for assessment and rehabilitation involve the use of prior art tests. These are written tests utilising the Rivermead conventional and behavioural tests as displayed in Figure 20. Field 206 lists these tests and has the provision to record and display a client's score against the test. A graphical representation of the test is displayed in field 208 and instructions for the assessor or user is displayed in field 210. Displayed in this figure are the eight possible outcome boxes used for the consistent recording of a client's results. These are: fatigue 212, instructions 214, attention 216, incomplete 218, completed 220, training 222, no training 224 and not applicable 226. The accuracy of the assessment is dependent on the training and skill of the assessor required to interpret the response of the client and categorise it in one of the eight outcomes. Guidance is provided to the assessors, typically clinicians, in understanding and classifying a client's result, taking into consideration; level of fatigue, circumstances rendering the tests inappropriate, effects of instruction or cueing, whether further rehabilitation is possible and required, and whether the test was completed adequately. An extensive tuition manual and process is included in the method for visual assessment and rehabilitation.

Displayed in figure 21 is a graphical representation of the assessment for mobility, as shown in field 230. This test involves the placement of targets and obstructions around a course to simulate real life scenarios. The results of the assessment are recorded in field 232 and the instructions for the assessor are displayed in fields 234 and 236.

Figure 22 illustrates a sample display of a client's assessment summary. Field

238 displays the client's goals of mobility. These goals are to be independently mobile within: a home environment, a local residential area, a shopping area or anywhere in the city. Other client goals are: to use public transport, drive a car or operate an electric wheelchair. The types of assessment undertaken by an assessor are displayed in field 240 and are functional visual, static, dynamic, pen and paper and mobility assessment. The results of which are displayed in field 136 with the eight standardised outcomes displayed in field 192. 16

Figure 23 illustrates a sample display of a client undertaking a new rehabilitation program. The term training is used to indicate that the training of clients is performed through repetition in order to rehabilitate and improve the client's effective visual range. These repeated tasks assist the client to develop scanning techniques to better use their residual vision.

The rehabilitation program is located under the section heading training 244 in figure 23 and the trainer or assessor's details and location are displayed in field 246. The exercises used for rehabilitation are taken from the same pool of exercises used for assessment, however, the same test is not generally used for both assessment and rehabilitation purposes as a client may learn the test and produce inaccurate results. Displayed in this figure is a graphical representation of the scanning device 248 and the different tests available to be selected in field 250. Instructions on how to complete the tasks are displayed in field 252 and the outcomes for the rehabilitation program are displayed in field 192.

Figure 24 displays take home rehabilitation exercises for the client as listed in field 254. Shown in field 256 is a sample graphical representation of text with instructions given in field 258. The outcomes of these rehabilitative tests are displayed in the outcome field 192.

In order to assist the client in developing their independence and mobility, rehabilitation is conducted for the purpose of more effectively utilising their remaining field of vision in real life situations. Displayed in figure 25 in field 260 are the variables used in training a client to negotiate real life scenarios. These are the same variable as the dynamic assessment shown in figure 19. The results of these tests are shown in field 264 and from this the assessor can categorise the client's performance into one of the eight outcome boxes in field 192. Instructions are also displayed to assist the assessor in conducting the rehabilitation, in field 266.

Figure 26 displays a sample summary of a client's rehabilitation or training program including goals achieved 268 and exercises completed. The client's goals of mobility are displayed to compare goals met and intended goals. Field 270 allows for the assessor to view a summary of the three different types of rehabilitative exercises performed, static, take home and dynamic, and these results are displayed in field 272. 17

The software based embodiment also has the function of facilitating a follow up assessment on the client, using the same functional, static, dynamic and mobility tests as the original assessment to monitor the client's progress. Shown in figure 27 is a sample display screen of a client undertaking a follow up assessment after selecting the follow up button 274. The assessor's details are submitted in field 276 and in this figure the various functional visual assessment tests are displayed for use by the assessor in field 278. Field 280 displays a graphical representation of the instructions and field 282 displays details of the assessment.

The method for visual assessment and rehabilitation following an acquired brain injury includes in its software embodiment a research component whereby the software collates empirical data which can be used to identify and analyse trends. In one embodiment of the invention, client information from all users would be able to be retrieved and viewed centrally and any trends associated with the location of the lesion and vision impairment can be deduced. These trends can then be used to set a bench mark for client rehabilitation.

Figure 28 displays a sample report of a client's assessment for printing whereby the report function is selected using the heading reports 284. Field 286 allows for the report content to be selected and customised when displayed in field 288. The report can also be printed in a print friendly format using the print button 290.

Figure 29 illustrates a sample graphical summary of a client's initial assessment and their last or follow up assessment, quickly demonstrating the effectiveness of the rehabilitation program. This display is shown under the section heading outcomes 292 with the initial assessment displayed in field 294, and the follow up assessment in field 296.

Figure 30 displays the ability of the client management database to access a server to back up files. This is accessed under the heading network 298. The server settings and other software settings can be customised under the site configuration facility 300. In this facility site information 302 such as the name and address of the organisation can be configured, as well as: report generation 304, referrer information 306, reference tables for retrieving information 308, registration information 310, 18

training information 312 and support information 314. Access to these settings will be given to users on a priority basis, whereby, users cannot access all the customisation features available to a systems administrator. The facility also affords the user the ability to search the records of the client management database when selecting the reference tables tab 308.

Figure 32 displays the software's ability to be run in demo mode 316 for the purpose of training or teaching users, typically assessors, to use the program and to conduct the required tests.

Figure 33 illustrates the preferred embodiment of client participation and method of operation 320 for the system of visual assessment and rehabilitation. The process 320 for a client begins at step 322 with a referral from an associated clinician. The assessor would then view the client's medical history at step 324 and assess the cause of their vision impairment 326. Vision impairments, such as ocular-motor deficiencies 328 and ocular disease 332, are referred to an optometrist 334 or an ophthalmologist 338 for suitable treatment. In the case of a client displaying evidence of visual field loss 330 or in the case of clients referred by an optometrist or an ophthalmologist, a client's details are added to the client management database. An assessor would then assess the client using a scanning device 336 and it is used to assess a client's vision impairment by monitoring their ability to recognise visual stimuli.

Following the outcome of the assessment of a client's vision impairment, rehabilitation processes may be implemented. This includes liaising with other health care professionals such as; speech therapists 340, occupational therapists 342 and physiotherapists 344. The system also has provisions for further testing and assessment, should a client require it. This includes a Rivermead behavioural inattention test 346, mobility assessment course 348 and pen and paper exercises 350. The first stage of rehabilitation for a client with visual field impairment 352 involves exercises utilising the scanning device. The client is asked to view different stimuli in the form of predetermined light sequences to more effectively utilise their residual vision. 19

To further assist the client in rehabilitation and utilising their residual vision more effectively in real life scenarios, a dynamic training component 354 provides a series of exercises aimed at increasing the client's mobility. That is, to give the client the ability and confidence to safely cross a road, negotiate obstacles and other tasks associated with being independent and mobile. Following the rehabilitation process, further assessment is conducted to assess whether the client has achieved a baseline level of performance. The assessment process includes Rivermead behavioural tests 356, scanning device assessment 358, functional independence measure 360, and mobility assessment 362. The system for visual assessment and rehabilitation also contains the provision for specific training of assessors using this system. The training is intended to be tailored to the particular expertise of the assessor and accommodates orientation and mobility instructors, vision rehabilitation professionals, occupational therapists, special education teachers and other rehabilitation staff.

Figure 34 illustrates a flow chart 264 for clinicians assessing a client's functional vision. This assessment will generally be completed by optometrists and ophthalmologists and the flow chart is indicative of the training an assessor would receive. An assessor would make an observation of the eye Hd appearance 366, eye appearance 368 and any visual behavioural characteristics 370. An assessor would then observe the client's pupil response to stimuli 372, their perception of visual changes 374 and compare this with any pre-existing ocular conditions 376. Tests would then be conducted to assess the client's central and peripheral field of vision, 378 and 380, as well as an Amsler grid assessment 382. The training incorporated in the system is aimed at instructing an assessor to recognise and interpret client behaviour during testing. Observations include ocular movement left and right, 384 and 386, convergence and shifting of gaze, 388 and 390, and the client's hand eye coordination 392. Further testing is conducted for the purpose of determining a client's recognition of colour 394, contrast 396, their visual acuity 398, and ability to read print 400 and 402.

Figure 35 illustrates the aspects of rehabilitation specific to the three groups of assessors; occupational therapists, mobility therapists, optometrists and ophthalmologists. After the static scanning training or rehabilitation process 404, there are three distinct areas of rehabilitation. An occupational therapist will provide 20

assistance to the client with daily living activities 408, personal care 410 dressing and grooming 412, meal preparation 414, shopping 416 and recreational activities 418. A mobility therapist will conduct a mobility assessment course 422 then focus on assisting the client with dynamic scanning training and with negotiating scenarios both indoors 426 and outdoors 428. An optometrist, after conducting a Rivermead behavioural test 432, will conduct further tests for the purpose of assisting the client to improve their remaining vision. These tests include pen and paper tests 434, letter, word and symbol recognition tests 436 and reading comprehension 438 tests. In order to determine client progress and the success of the rehabilitation program, each stream of rehabilitation ends with an assessment 420, 430 and 440.

It is envisaged that a hardcopy based embodiment of the system could be used by persons or organisations not required to maintain searchable records. It is also apparent the many alternative arrangements of data on a screen may be contemplated and that the invention is not to be limited in any way to the manner of expression shown here.

Further advantages and improvements may very well be made to the present invention without deviating from its scope. Although the invention has been shown and described in what is conceived to be the most practical and preferred embodiment, it is recognized that departures may be made therefrom within the scope and spirit of the invention, which is not to be limited to the details disclosed herein but is to be accorded the full scope of the claims so as to embrace any and all equivalent devices and apparatus.

In any claims that follow and in the summary of the invention, except where the context requires otherwise due to express language or necessary implication, the word "comprising" is used in the sense of "including", i.e. the features specified may be associated with further features in various embodiments of the invention.

Claims

21CLAIMS:

1. A method for visually assessing and rehabilitating a person suffering vision impairment resulting from an acquired brain injury including the following steps: said person is referred to at least one assessor; said assessor utilises at least one software package to access and store information pertaining to said person; said assessor performs a series of tests to visually assess said person; said assessor performs said series of tests to visually rehabilitate said person; and said assessor performs said series of tests to conduct a follow up visual assessment to monitor said person.

2. A method as in claim 1 wherein said method further includes the step of said software package being utilised by at least one said assessor to conduct said series of tests and record results of said tests.

3. A method as in claim 1 wherein said method further includes the step of providing a portable software package installed on a dedicated portable computing device.

4. A method as in claim 1 wherein said method further includes the step of said software package accessing at least one hard drive to store and retrieve information pertaining to said person and at least one server to store and retrieve information pertaining to said person globally.

5. A method as in any of the above claims wherein said software package includes a client management database accessing and storing data oruat least one said hard drive and at least one said server.

6. A method as in any of the above claims wherein said software package further includes the capacity of training assessors to use said software package, conduct said series of tests of assessment and rehabilitation, use testing equipment, and a use said client management database. 22

7. An apparatus and method as in any of the above claims wherein said software package and said server possess a research function in which said person's data can be accumulated from a plurality of assessors and software packages.

8. An apparatus and method as in any of the above claims wherein said software package drives said testing equipment including a scanning device comprising of a display means with a plurality of visual stimuli switchable between on and off conditions, whereby said plurality of visual stimuli switch between on and off conditions in a predetermined sequence stored in said software package.

9. A method as in any of the above claims wherein said series of tests to visually assess said person include: a test to functionally assess said person's eye appearance, left and right ocular functions for the acquisition of a client's condition; a test to assess said person's neurological condition; a test to establish said person's capacity to understand instructions and respond to visual stimuli, and to determine visual scanning behaviour; a test to .establish said person's presence of a visual field loss and ability to fixate on a central target; a test to establish said person's ability to detect multiple visual stimuli and identify perceived changes in intensity of the visual stimuli; a test to establish said person's degree of head and eye turn required to fixate on the perimeter of said person's affected visual field; a test to establish said person's ability to attend to multiple visual stimuli; a test to establish said person's ability to utilise a systematic searching or scanning pattern to detect said visual stimuli and observe said person's speed of scanning; a test to establish whether said person can attend to said visual stimuli in the affected visual field whilst in the presence of changing visual stimuli in the unaffected visual field; a test to reinforce said person's strategy of scanning from the perimeter of the affected visual field and the limitations of vision in the affected visual field; 23

a test to establish said person's hand eye coordination, ambulation, motor skills, sensory perception, neurological behaviour, reading comprehension and writing ability; a test to establish said person's ability to conduct every day tasks; and a test to establish the level of mobility of said person and said person's ability to recognise targets and landmarks.

10. A method as in any of the above claims wherein said series of tests to visually rehabilitate said person include: a test to define said person's width of visual field and to allow a comparison with the visual field width assessment; a test to reinforce the degree of head and eye turn necessary for said person to fixate on the perimeter of the affected visual field, to reduce the amount of prompting needed for said person to fixate on the perimeter and to establish a pattern of scanning from the perimeter of said affected field towards a mid- line of said display means; a test to reinforce said person's ability to scan from the perimeter of the affected visual field, to attend to multiple visual stimuli and to increase said person's ability to anticipate the presence of visual information in the absence of visual cues; a test to reinforce said person's scanning pattern from the perimeter of the affected visual field towards said mid-line, to reduce said person's amount of prompting needed to establish and maintain a systematic search pattern and to establish a speed of scanning allowing for consistent and accurate detection of visual stimuli; a test to reinforce the scanning pattern from the perimeter of the affected visual field to said mid-line to reinforce said person's ability to maintain attention in the affected visual field whilst said visual stimuli are displayed in the unaffected visual field, and to increase the speed at which said person can detect changes in said visual stimuli; a test to reinforce said person's ability to scan from the perimeter of the affected visual field and to identify any difficulties regarding said person's spatial reasoning and spatial memory; 24

a test to improve said person's hand eye coordination, ambulation, motor skills, sensory perception, neurological behaviour, reading comprehension and writing ability; a test to improve said person's ability to conduct every day tasks; and a test to improve the mobility of said person and said person's ability to recognise targets and landmarks.

11. A method as in any of the above claims wherein said series of tests for assessment are the same series of tests used by said assessor in said follow up assessment.

12. A method as in any of the above claims wherein the results of said series of tests are recorded into said software package as one of eight outcomes for consistent data entry.

13. A method as in any of the above claims wherein said results of said person's tests for assessment and rehabilitation can be reviewed to monitor progress or regression using the software package.

14. A method as in any of the above claims wherein said results of said person's tests for assessment and rehabilitation are recorded by the assessor and can be displayed graphically and printed.

15. A method as in any of the above claims wherein said software package can be run in demonstration mode for the purpose of training at least said assessor to use the software package to conduct said series of tests and utilise said client management database.

16. A method as in any of the above claims wherein said software package is configurable so that the desired level of functionality required by said assessor is provided.

17. A method as in claim 1 further including the step of providing training and a training manual to use the method for assessment and rehabilitation of said person to at least one said assessor.