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Assistive Technology Assessment for Individuals with Acquired Brain Injury and Vision Assistive Technology Assessment for Individuals with Acquired Brain Injury and Vision

Assistive Technology Assessment for Individuals with Acquired Brain Injury and Vision - PowerPoint Presentation

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Assistive Technology Assessment for Individuals with Acquired Brain Injury and Vision - PPT Presentation

Presented by William Hersh MSLVR CLVT Overview Visual system dysfunction What is Access A note on Teams A structured approach to providing AT services Making the assessment protocol more effective in addressing the unique needs of those with CVI ID: 930285

vision amp technology team amp vision team technology visual access tools skills strategies task field individuals change cvi approach

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Slide1

Assistive Technology Assessment for Individuals with Acquired Brain Injury and Vision Loss

Presented by

William Hersh, MSLVR, CLVT

Slide2

Overview

Visual system dysfunction

What is Access?

A note on Teams

A structured approach to providing AT services

Making the assessment protocol more effective in addressing the unique needs of those with CVI

Technology

Case Study

Slide3

When structures of the eye don’t function as they should

Acuity

Contrast

Field

Accommodation/Focus

Light Dark Adaptation

Color

Stereoscopy/Convergence

Motility

Slide4

Refractive Errors

Slide5

Snellen

Slide6

Amsler Grid

Slide7

Scotoma

Slide8

Ocular impairment affectsVisual Skills

Fixation

Eye Movement (Saccade and pursuit)

Shifting Gaze

Localizing

Scanning

Tracking

Tracing

Slide9

Fixation

Slide10

Saccade and Pursuit, Shifting Gaze, Localizing, Scanning

Slide11

Tracking

Slide12

Tracing

Slide13

Ocular Impairments, missing visual skills, and CVI affect

Perception

Discrimination/matching

Closure (letter recognition from partial image)

Figure-Ground

Form constancy (recognition regardless of size or orientation)

Visual memory

Visual motor FunctionVisual emotional function

Slide14

Discrimination

Slide15

Closure

Slide16

Figure Ground

Slide17

Form ConstancyWhat am I?

Slide18

Form ConstancyIs this better?

Slide19

Closure with inferior Scotoma

IUMRING TO GONGIUSIQNS

Slide20

Visual Memory Can be Misleading

IUMRING TO GONGIUSIQNS

Slide21

More Reading with Scotoma

Slide22

AccessHolistic Model

Person with a disability – motivated and amenable to available access methods (tools & strategies)

The task and task components have to be inherently accessible (i.e. to the tools and strategies as they currently exist) or able to be modified

Tools and strategies to redress access barriers have to be available

The skills and knowledge necessary to effectively use the tools and strategies must be developed

Team must be in place and committed

Slide23

Structured approach to achieving Access

Identify task(s)

Identify barrier(s) – (barriers may be present in any of the components of the access model).

Explore the inherent accessibility of task- Universal Access

Select AT tools & vision strategies

Skill with AT tools & strategies are developed/taught

Help maintain consumer motivation by taking small achievable steps

Communicate with the team to foster cohesion and support for the process

Slide24

Assessment & EvaluationTeam Players

Ophthalmologist (no specialization in low vision)

Ophthalmologist (specializing in low vision)

Social Worker/ Case manager

Assistive Technology Specialist

O&M

TVI (K-12)

CVI - Low Vision Therapist, OT, PT, Speech Language Pathologist (Additional specialists when needed)Family and community support …..

Slide25

More on Teams

unidisciplinary

: developing competence in one’s own field

intradisciplinary

: believing that you and others in your field can make contributions to individuals with disabilities

Multidisciplinary

:

recognizing the important contributions of other disciplines to individuals with disabilitiesenunciating a philosophy that comprehensive services based on individual needs must be made available to all individuals with disabilities

Slide26

More on TeamsCont.

interdisciplinary

: working with other disciplines in the development of jointly planned programs for individuals with disabilities

transdisciplinary

: committing oneself to teaching, learning, and working with others across traditional disciplinary boundaries to better serve individuals with disabilities

Slide27

A Structured Approach To AT Service Delivery

Establish connection with the team – at specialist is a supportive role

Gather information

history (Visual, Physical, Cognitive, Social)

Reports, other assessments

Etc.

Discover and set goals

Break goals down into tasks

Slide28

A Structured Approach To AT Service Delivery

Cont.

Analyze barriers

Choose Tools (usually compensatory)

Provide Training

Follow up (possible re-evaluation – new team members – sometimes starting from scratch)

Slide29

Does the protocol change?

Typical measures of eye function (e.g. acuity, field, contrast, etc.) are not an indicator for how the visual system functions – it does not tell us how the person is going to use their vision – so it cannot be used as the sole basis for selecting technology – especially for those with CVI.

Slide30

Does the protocol change?Cont.

Color

Latency

Movement

Complexity

Visual Field

Novelty

Reflex ResponseDistance ViewingLight GazingVisually Directed Reach

Slide31

Does the protocol change?Cont.

More emphasis on Team and role release

Breaking down tasks into components may require additional breakdown into even smaller steps

Understanding skills hierarchy and analysis of skills deficits may require more focus

May Vision Therapy prior to or in conjunction with provision of AT to address gaps in skills

Slide32

Does the protocol change?Cont.

Decision to use AT as therapeutic tool or as compensatory tool or both

Ongoing formative assessment – MCB may drop in and out of process over a period of months or years – a RECURSIVE PROCESS

Remaining available as a resource to the team

Who should take the leading role? MCB?

Other considerations?

Slide33

Technology

Compensatory (tool) or Rehabilitation (therapeutic) – in the middle?

Low Tech? High Tech? Both?

Interface type?

Community support & the team?

Follow up? Follow along?

The future

Slide34

Tech Devices

Black Light

Video Magnifier

HH Magnifiers

Refreshable Braille Display

OCR

Monocular

Portable VM

Spectacle MountedDomeLight with MagnifierPortable VMPortable VM

Slide35

More Tech Devices

NOIR Filters

Synthesizers

Demo

PDA

Bioptic

Tablet

Software

Slide36

The Future of Technology Algorithmic Intelligence

Algorithmically intelligent software

Tutors

Formative evaluations

Self adapting software (don’t we already have this?)

Algorithmically intelligent environments

your clothes

Your homeYour carAlgorithmically intelligent ecosystemsYour town, city, …

Slide37

The Future

Flexible Interface

Wearable Devices

In Our Clothes

Gestural Interface

Slide38

The FutureCont.

Natural User Interface

Self Driving Car

Slide39

The FutureCont.

Can’t find it on the open market?

Maybe ask a friend??

$250 !! He made it in his garage !

Slide40

Case StudyiPad Calendar

Joe Smith

Background – cerebral stroke during surgery resulted in functional vision loss characteristic of CVI.

Team – Spouse, OT, Speech Path, Ophthalmologist, other medical specialists, MCB team members – CM, O&M, Supervisor, AT Specialist.

Desired Task – to be able to access the calendar on an iPad and to independently schedule and check appointments.

Task components (specific to accessing the calendar)

Barriers – acuity loss, field loss, visually guided motor dysfunction

Slide41

Case StudyiPad Calendar

Addressing Barrier w/existing technology – magnification, increased contrast, repositioning device, teach scanning skills, lighting, seating, spacing of icons, redisplaying calendar content so that targets are further apart & seen is less complex, alternative display, different device, tactual feedback, etc., pen friend as memory aid.

Addressing Barrier in the future?

Slide42

Suggestion Box

We need to rely more heavily on a team approach

We should be prepared for the time investment that will be required to make progress

We will need to find creative ways to balance resources with need – for example – role release.

We need to develop in house expertise and redundancy

Utilize technologies not usually part of the VI tool kit – e.g. Jelly Bean Switch, Wire Bead Manipulative, Vision Stimulation Apps, etc.

Embrace the high rate of change in technology and find ways to stay on the leading edge

Slide43

Works Consulted

Cook, A. M., & Hussey, S. M. (2002).

Assistive Technologies Principles and Practice.

St. Louis: Mosby, Inc.

Joyce, B., & Weil, M. (1986).

Models of Teaching.

Englewood Cliffs: Prentice-Hall, Inc.

Lueck, A. H., & Dutton, G. N. (2015). Vision And The Brain - Understanding Cerebral Visual Impairment in Children. New York: AFB Press.

Slide44

Works Consulted

Cont.

Presley, I., &

D'Andrea

, F. M. (2008).

Assistive Technology for Students Who Are Blind or Visually Impaired - A Guide to Assessment.

New York: AFB Press.

Scheiman, M. (2002). Understanding and Managing Vision Deficits - A guide for Occupational Therapists. Thorofare: SLACK Incorporated.  

Slide45

Images

Images from Google Images and from Vendor Websites.

Slide46

Questions?

Contact Information

William.hersh@state.ma.us

413.781.7214