Facilitating ADL Performance in Persons Without Usable Vision

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Facilitating ADL Performance in Persons Without
Usable Vision
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Learning Objectives

• Understands non visual approach to ADL
  independence
• Establishes appropriate ADL goal
• Selects appropriate strategies for task
  completion
• Selects appropriate adaptive equipment
• Compares and contrasts the visual and non visual
  approach to ADL

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Lessons from Learning Activity 3

• QWhat capabilities does a person lose with
  blindness that could affect safety and
  independence in daily activities ?

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Lessons Learned from Learning Activity 3

• Q What capabilities must a person have in order
  to complete ADLs without vision?

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General Strategies for Vision Substitution

• Modify the task
• Modify the environment
• Use other systems to substitute for vision in
  completing the task

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Compensatory Strategy 1 Modify the Task
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Strategies

• Reduce the number of steps necessary to complete
  the task
• Eliminate the need to use vision to complete
  steps of the task
• Use different materials to produce the same
  results
• Use the same supplies in a different way
• Use different materials to obtain different but
  acceptable results

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Example of Application of These Strategies

• Making brownies 101

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Reduce the number of steps needed to complete the
task

• QHow can the number of steps required to make
  brownies be
• reduced?

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Answer

• Use a brownie mix

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Eliminate the need for vision to complete steps
of the task

• QHow can vision be eliminated on some of the
  steps used to make brownies?

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Answer

• Dip the measuring spoon into oil or water rather
  than pour the liquid into a measuring spoon
• Works for dry measurements too
• Use fingers and margarine to grease pan, rather
  than spray

oil
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Use different materials to produce the same
results

• Q What different materials can be used to
  produce the same results?

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Answer

• Use Toll House or Pillsbury ready to bake
• Brownies (just open the package and place in the
  pan

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Practice Session

• Modify the task of making a veggie and hamburger
  pizza

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Making a Veggie/Hamburger Pizza

• Reduce the number of steps
• Eliminate use of vision

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Making a Veggie/Hamburger Pizza

• Use different materials to obtain the same result
• Use the same supplies in a different way
• Use different materials to obtain different but
  acceptable results

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Compensatory Strategy 2 Modify the Environment
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• Vision is such a reliable and rapid sense,
  persons with vision can live in disorganized,
  fluctuating and cluttered environments and still
  be able to locate objects and function
  independently
• Persons without vision do not
• have that luxury

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Strategies to Modify the Environment

• Eliminate clutter
• Store items only 1 row deep and unstacked
• Create work centers
• Store items used for similar purposes together
• Locate items close to where the person uses them
• Make use of commercially available systems to
  organize closets, drawers etc.

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Eliminate clutter, and store items only one-two
rows deep and un-stacked
Cluttered, no organization
Organized
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Create work centers and store items close to
where they will be used
Items for brushing teeth stored Together next to
sink
Tea items stored together next to stove
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Store Items Used for Similar Purposes Together
Cleaning supplies stored together
Baking items stored together
Modified spice rack
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Make use of commerciallyavailable organization
systems
Battery holder
Implement holder
Knife holder
Sponge/soap dispenser for kitchen
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The Organization Motto
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The Organization Motto

• A place for everything and everything in its
  place
• Client should know the exact location of every
  item

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Compensatory Strategy 3 Use Other Sensory
Systems to Substitute for Vision
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Sensory Substitution

• Sensory systems available to use to substitute
  for vision
• Tactual/proprioceptive
• Auditory
• Olfactory

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• No one kind of sensory input is important by
  itself
• We use all types of sensory input together to
  verify each other and reinforce the sequencing of
  a task
• All sensory input is used within the CONTEXT of
  the task

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Context is Extremely Important

• Person can draw on visual, tactual, olfactory,
  auditory memories of completion of the task
• First step is to make the person aware of the
  information s/he is receiving through other
  sensory systems
• Use self-reflection and have the person ask
• How did I know that?
• What sense told me?

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What senses is this person using besides vision
to guide completion of this task ?
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Tactual Substitution

• To effectively use the tactual system, the
  person must maintain close physical contact with
  tools and supplies to maintain orientation to the
  work space and to the task.

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Tactual input can be used to label products to
aid in identification

• Any labeling system must be made WITH the person
  not FOR the person
• Keep it simple
• Consider the persons tactual ability

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Q What Qualities should Tactual Labels possess?
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Qualities of Tactual Labels

• Durable
• Able to withstand environmental changes
• Reusable
• Placement should not hinder use of item
• Person must be able to attach label independently
  or arrange for assistance

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Stick on markings
Tactual marking of clothing with brass safety pins
Tactual marking of food with rubber bands
Bump dots
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Auditory Substitution

• Auditory system typically supplements vision but
  can be used as a substitute

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Auditory Substitution

• Auditory system typically supplements vision but
  can be used as a substitute
• Talking devices
• Sounds that items make when being used
• Ticking of a timer
• Clinking of a metal spoon in a bowl
• Crackling of bacon as it cooks

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Q What kind of talking devicesare available?
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Talking Devices

• Calculators
• Scales
• BP cuffs
• Glucose monitors, pill organizers
• Clocks, watches
• Caller ID
• Measuring tapes, stud finders, light locators
• Telephones
• Computers
• PDAs

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Q Can auditory input be used to identify the
contents of a can of food?
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Q Can auditory input be used to help identify
the contents of a can of food?

• Yes, peas slosh in a can when shaken but cream
  soup doesnt

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Q How can auditory input be used to tell when
food is done?
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Q How can auditory input be used to tell when
food is done?

• Crunch of toast or bacon or the sound of popcorn
  popping

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Olfactory System

• Can be used with tactual and auditory to
  determine when food is done
• Food changes odor as it cooks
• Can help identify personal care and hygiene
  products
• Can help identify cleaning products

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Making Use of Community Resources
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Community Resources

• Q What are some services a community might
  routinely provide that would be helpful to
  persons with low vision?

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Community Resources
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Community Resources

• Transportation services
• Assistance for yardwork,
• Assistance for housekeeping
• Grocery/pharmacy delivery
• Meals on wheels
• Voice activated dialing
• Large print and descriptive video services

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Where can you find information on services for
person with visual impairment?
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Where can you find information on services for
person with visual impairment?

• American Foundation for the Blind
• Lighthouse
• National Eye Institute

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Catalogs Carrying Adaptive Equipment

• Maxi Aides
• www.maxiaids.com
• Lighthouse Low Vision Products
• www.lowvision.com
• Independent Living Aides
• www.independentliving.com
• LSS Group
• www.lssgroup.com

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In Class Activity

• Maxine lost all her vision when her glaucoma got
  out of control
• She now needs to learn to complete all activities
  without using her vision

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Groups

• One
• Medication management
• Two
• Telephone usage
• Three
• Grooming
• Four
• Eating
• Five
• Sewing repairs
• Six
• Laundry

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Medication Management

• Non visual modifications

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Telephone Usage

• Non visual modifications

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Grooming

• Non visual modifications

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Eating

• Non visual modifications

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Sewing Repairs

• Non visual modifications

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Laundry

• Non visual modifications

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In Class Activity

• Maxine still wants to be able to prepare her
  famous lasagna.
• What non visual adaptations can she make to
  complete this task?

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MAXINES FAMOUS LASAGNA 1 ground beef 1 large
onion chopped 2 garlic cloves minced 4 large
tomatoes, peeled, seeded and chopped 2 6 oz
cans of tomato paste 1 tablespoon of chopped
fresh basil 2 teaspoons of chopped fresh
oregano 1/4 tsp of black pepper 1 tsp salt 1/4
cup chopped black olives 9 lasagna noodles 2
cups fresh mozzarella cheese (grated) 1/2 cup
Parmesan cheese (grated)
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Chop the onion, basil, olives, and oregano and
mince the garlic. In a large saucepan, cook the
beef, onions and garlic until meat is no longer
pink, drain. Prepare the tomatoes and stir into
the beef mixture along with the tomato paste,
basil, oregano, salt and pepper. Bring to a
boil. Reduce heat and simmer for 40-50 minutes
until thickened. Meanwhile cook the noodles and
shred the cheeses. When sauce is ready, stir in
the olives. Spray a 13 inch x 9 in x 2 in baking
pan with vegetable oil. Spread 1/4 of the sauce
in the prepared pan. Top with three noodles, and
a third of the mozzarella and Parmesan cheeses.
Repeat layers. Top with remaining noodles, sauce
and cheeses. Bake, uncovered, at 350 degrees for
35-40 minutes or until bubbly. Let stand for 15
minutes before cutting. Serves 12
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Recipe Modifications

• Step 1 chop
• Step 2 cook the beef
• Step 3 tomatoes

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• Step 4 mix in ingredients
• Step 5 bring to a boil

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• Step 6 shred cheese
• Step 7 layer
• Step 8 bake