Foundations in Low Vision Rehabilitation II

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Foundations in Low Vision Rehabilitation II
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Instructors Information

• Mary Warrens contact information
• Email address warrenm_at_uab.edu
• Phone number 934-1800
• Office Hours by appointment
• Office 340
• Beth Barstows contact information email
  addressbarstow_at_eyes.uab.edu
• 325-8115

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Class Materials

• Required Books
• Understanding Low Vision-Jose
• Living with Macular Degeneration-Mogk
• Ponchillia, P.E. Ponchillia, S.V. (1996).
  Foundations of rehabilitation teaching with
  persons who are blind or visually impaired. New
  York American Foundation for the Blind Press.
• Duffy, M. (2002). Making life more livable
  Simple adaptations for living at home after
  vision loss. New York American Foundation for
  the Blind Press.
• Additional Readings
• Copy available at LRC desk reference 589

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• Lectures will be posted on the OT web page at
  least one day before class
• Password mw679
• Outside Learning Activity Assignments must be
  typed
• Forms posted on the website in word format
• Due dates for Learning Activities are listed on
  the topic outline
• In class learning activities due at the end of
  class

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Learning Activities

• 1. Find one article or story that older adults
  would enjoy reading. Using the readability index,
  level the article at 2-3rd or 4-5th grade level.
  
• 2. Survey a public library to see what it has to
  offer low vision patrons
• 3. Wearing a blindfold complete two different
  ADLs
• 4. Select a partner and complete the functional
  mobility assignment (details given in class)
• 5. Spend one day without driving and write up
  your experience
• 6. Using the computers in the assistive tech
  lab
• Critique three software programs designed to
  improve screen access
• Compare the accessibility features of the Mac and
  PC
• 7. Interview a person with low vision

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Due Dates Learning Activities

• LA 1 September 9th
• LA 2 September 16th
• LA 3 September 23rd
• LA 4 October 21st
• LA 5 October 28th
• LA 6 November 18th
• LA 7 December 9th

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Extra Credit Activity15 points

• Available to students who did not complete it
  this summer
• Observe a low vision examination by an
  optometrist or ophthalmologist in either the low
  vision service at the UAB Center for Low Vision
  Rehabilitation and complete the summary form
  describing the evaluation process and the results
  of the evaluation.
• Observations must be scheduled through
• Lee or Janice at 488-0736
• Identify yourself as an OT student taking Marys
  class
• Only one person at a time can observe the
  doctors exam

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Student Evaluation

• Three written exams 75
• Short answer, multiple choice
• In and Out of Class Learning Activities 25
• One Extra Credit Activity 15pts

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Grading Scale

• A 90-100
• B 80-89
• C 70-79
• F 69 or below

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Absences

• Notify me by phone or email if you will need to
  miss a class. Since this class relies on class
  lecture and demonstration with little outside
  reading, attendance is very important.
• One excused absence will be accepted
• Each additional absence will result in deduction
  of 10 points from your test grade
• Topic outline lists the dates class will be held
  and the topics
• Final exam is on

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Exam Dates

• Exam 1 September 30th
• Exam 2 November 4th
• Final Exam December 9th

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Observing in Low Vision Clinic

• Clinic is located on the third floor of the
  Callahan Eye Foundation Hospital
• Directly across the street from RMSB
• Suite 380
• Schedule OT clinic observations with Beth
• Schedule Physician observations with Lee
• 488-0736
• Review the guidelines sheet (posted on the
  website) before coming and bring a signed copy
  along with you
• Sign in and out on the clipboard each time you
  observe

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Quick Review of OT 679
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Vision is the primary sensory system used to
interact with the environment

• Contributes significantly to

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Vision is the primary sensory system used to
interact with the environment

• Contributes significantly to
• Cognition
• Motor control
• Postural control
• Social interactions

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Causes of Visual Impairment

• Age
• Trauma
• Congenital abnormalities
• Diseases
• Inherited
• Acquired

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Changes in Visual Function are Related to the
Structure Damaged in the Visual System

• Damage to the iris

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Changes in Visual Function are Related to the
Structure Damaged in the Visual System

• Damage to the iris
• Photophobia
• Accommodation

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Changes in Visual Function are Related to the
Structure Damaged in the Visual System

• Damage to the iris
• Photophobia
• Accommodation
• Central area of retina

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Changes in Visual Function are Related to the
Structure Damaged in the Visual System

• Damage to the iris
• Photophobia
• Accommodation
• Central area of retina
• Reading acuity
• Color vision
• Contrast sensitivity

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• Optic nerve

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• Optic nerve
• Visual field deficit
• central or peripheral or both
• Photophobia

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• Optic nerve
• Visual field deficit
• central or peripheral or both
• Photophobia
• Occipital lobe

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• Optic nerve
• Visual field deficit
• central or peripheral or both
• Photophobia
• Occipital lobe
• Cortical visual processing
• Primarily object identification

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• Optic nerve
• Visual field deficit
• central or peripheral or both
• Photophobia
• Occipital lobe
• Cortical visual processing
• Primarily object identification
• Parietal lobe

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• Optic nerve
• Visual field deficit
• central or peripheral or both
• Photophobia
• Occipital lobe
• Cortical visual processing
• Primarily object identification
• Parietal lobe
• Spatial orientation

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• Optic nerve
• Visual field deficit
• central or peripheral or both
• Photophobia
• Occipital lobe
• Cortical visual processing
• Primarily object identification
• Parietal lobe
• Spatial orientation
• Temporal lobe

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• Optic nerve
• Visual field deficit
• central or peripheral or both
• Photophobia
• Occipital lobe
• Cortical visual processing
• Primarily object identification
• Parietal lobe
• Spatial orientation
• Temporal lobe
• Object identification

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Because of the importance of vision to
adaptation, a person with vision, no matter how
limited, will attempt to use vision to adapt
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Treatment is justified only if the visual
impairment prevents or significantly interferes
with completion of a necessary activity of daily
living

• Purpose of eval is to link visual impairment to
  functional impairment
• Information gathered during eval is used for
  treatment planning
• Identify strengths, weaknesses and rehab potential

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Occupational History

• Background information
• Health history
• Visual history
• Social history
• Reading and writing history
• Previous level of performance
• Current reading and writing problems
• Current modifications

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Occupational History cont

• ADL history
• What is a typical day like?
• Resources
• Modifications implemented

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Visual Function Evaluations

• Visual acuity
• Size of print read unaided
• Minimum number of diopters of magnification
• Contrast sensitivity function
• Difficulty detecting low contrast features
• PRL function
• Ability to use a magnifier

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Reading Performance Evaluations

• Mnread acuity
• Visual Skills for Reading (Pepper test)
• Low Vision Comprehension Assessment (Morgan)

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• Indepth ADL assessment
• Determine specific changes in ADL performance

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Treatment

• Client centered approach
• Older adults require assistance in ADLs for many
  different reasons
• Come to terms with reduced independence
• But there are always activities they want to
  retain or regain independence in

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Treatment cont

• Environmental and task modification is a large
  part of treatment
• Increasing the persons ability to use their
  remaining vision is the primary treatment
  approach
• Education is an essential component of treatment
• Goal is always occupational performance

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Final Test Answers

• Question 3
• The fovea
• Question 4
• Reading add is the lens used to compensate for
  lack of accommodation

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Spectacle Prescription
Question 19
OD
-1.25 -2.25 x 20 2.50
Spherical power to correct for myopia
Orientation astigmatism correction
Reading add
Amount of astigmatism correction needed
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• Question 22
• Gain a wider field of view when holding a
  magnifier closer
• Question 23
• 8 x 20 telescope
• 8 is strength of magnifier 8x
• 20 is width of objective lens 20mm
• Question 24
• 8x 30 gives brighter image
• 30/8 3.75
• 30/10 3

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• Question 27
• Reverse telescope because it would provide more
  field
• Question 28
• 4 x 30 telescope
• 8 x 20 is too strong
• Reverse wont supply enough magnification
• Telemicroscope is v. expensive and doesnt work
  as well for distance