ASSESSMENT OF VISION AND VISUAL-ATTENTION IN MINIMALLY RESPONSIVE BRAIN-INJURED PATIENTS

Sensory, motor, and cognitive assessment is a critical priority in the care of minimally responsive brain-injured patients, However, their i nconsistent pattern of responding may interfere with the use of tradit ional forms of assessment such as the mental status or neurological ex aminations, In this article we describe a quantitative method, based o n single-subject experimental design, for evaluating vision and visual attention in this patient population, In a series of randomized trial s, combinations of a blank card, a colorful photograph, and no stimulu s are presented to either or both visual fields while horizontal eye m ovements are observed. The relationship between the side and nature of the visual stimulus and the frequency of eye movements is analyzed to determine visual function iri one or both eyes, We report six cases o f minimally responsive patients assessed with this method, In case A, we show evidence of functional vision in both visual fields. Case B al so shows functional fields, but with a monocular visual deficit. Cases C and D show a homonymous hemianopsia which, in case D, is further co mplicated by a monocular visual deficit, Finally, cases E and F show p atterns of left and right visual extinction, Thus, this objective and quantitative method leads to conclusions about patients' visual functi on that are not readily apparent by clinical observation and that allo w appropriate modifications in further assessment or treatment. (C) 19 95 by the American Congress of Rehabilitation Medicine and the America n Academy of Physical Medicine and Rehabilitation