Kimberly Holt OTR OTD The only thing worse than being blind is having sight but no vision Keller 1996 Purpose This continuing education program will educate occupational therapists OTs about evidencebased interventions that address lowvision including low vision equipmen ID: 738624
Download Presentation The PPT/PDF document "Evidence-Based Low Vision Interventions ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Evidence-Based Low Vision Interventions for the Occupational Therapist
Kimberly Holt, OTR, OTDSlide2
“The only thing worse than being blind is having sight but no vision.”
(Keller, 1996)Slide3
Purpose
This continuing education program will educate occupational therapists (OTs) about evidence-based interventions that address low-vision, including low vision equipment, environmental modifications, reading ability, community accessibility, safety, and performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs) to allow clients to increase their participation in their desired occupations
.Slide4
Course Outline
Purpose
Background and Stats of Low Vision
Definitions
Types of Diagnoses
Lab exercise: Simulation glasses
Outcome measures/AssessmentsRehabilitation TeamMedicareVision 2025Occupational Therapy Framework-III: Domain and Process
Person-Environment-Occupation model
Rehabilitative frame of reference
Education of Therapists
Occupational Performance
Client Readiness
Client Participation
Occupational Therapy Interventions
Specific Interventions for ADLs, IADLs, and Leisure
Lab ActivitiesSlide5
Prevalence of Low Vision
The geriatric population, ages 65+, is expected to double by the year 2050. This translates to 1 in every 5 Americans.
(Ortman, Velkoff, & Hogan, 2014)
Age-related low-vision disorders are estimated to reach 68 million by the year 2030.
(National Eye Institute [NEI], n.d.b)The American Occupational Therapy Association (AOTA) has recently identified low vision as an area of growing concern due to this increase of age-related vision loss and its impact on daily functioning
(n.d.a)
.Slide6
What do you need to know?
What is visual acuity?
What is a visual field?
What is low-vision?
What does it mean for a person to be legally blind?
Slide7
What is visual acuity?
Visual acuity is a person’s vision usually measured at a distance of 20 feet.
“If you have 20/20 vision, you can see clearly at 20 feet what should normally be seen at that distance. If you have 20/100 vision, it means that you must be as close as 20 feet to see what a person with normal vision can see at 100 feet.”
(American Optometric Association, AOA, 2015c, p. 1)Slide8
What is a visual field?
A visual field is the range or area of vision a person can see with his/her eyes fixed on one point.
A normal visual field is approximately 60° medially towards the nose and 100° laterally towards the ear from medial central vision. The average person with normal vision has a 160° angle of vision in each eye.
(AOA, 2015a)Slide9
What is low-vision?
Low-vision is a visual acuity of 20/60 or worse in the better eye that is not correctable by eyeglasses, contact lenses, or surgical interventions.
(AOA, 2015b)Slide10
What is blindness?
Legal blindness is a visual acuity of 20/200 in the best eye or a visual field of 20° or less.
(AOA, 2015b)Slide11
What causes low-vision?
4 main low vision diagnoses which account for 75% of age-related vision deficits.
(NEI, n.d.b)
Macular Degeneration
Glaucoma
CataractsDiabetic Retinopathy The complications of these diagnoses affect multiple areas of daily living.
(Perlmutter, Bhorade, Gordon, Hollingsworth, & Baum, 2010) Slide12
Age-Related Macular Degeneration
Age-related macular degeneration (AMD) blurs the central portion of vision.
Damage to the macula causes AMD and results in blurry or dark portions of central vision.
Medical treatments can slow the effects of the disease, but not reverse it.
AMD affects daily activities such as reading, writing, driving, the ability to see faces of people or cooking dials, and any fine detail activity.
(NEI, 2015a) Slide13
Age-related Macular Degeneration
Butterfly, April 19, 2014. Courtesy of Kimberly Holt.
AMD butterfly, October 20, 2015. Courtesy of Kimberly Holt.Slide14
Age-Related Macular Degeneration
“
What affects the heart affects the eyes”
Leading cause of low vision
Modifiable Risk Factors
Lifestyle Habits
WeightExerciseDiet
High BP
High Cholesterol
SmokingSlide15
Glaucoma
Glaucoma causes loss to peripheral vision.
Increased pressure in the eye causes damage to the optic nerve resulting in glaucoma. Medical treatment can stop or reduce progression of the disease.
Glaucoma reduces a client’s ability to see items to the side and tunnel vision is a common name for this disorder.
Glaucoma impacts balance, navigation, and body awareness.
(NEI, n.d.a) Slide16
Glaucoma
Butterfly, April 19, 2014. Courtesy of Kimberly Holt.
Glaucoma butterfly, October 20, 2015. Courtesy of Kimberly Holt.Slide17
Glaucoma
Leading cause of blindness
Regular eye exams can help to diagnose and provide early treatment to preserve treatment.
Eye drops
Decrease intraocular pressure
Risk Factors
Hypertension
Diabetes
Heart disease
HypothyroidismSlide18
Cataracts
Cataracts are a clouding of the lens of the eye.
Proteins clumping together decreases the amount of light that can pass through the lens of the eye.
Medical treatment involves surgery to replace the damaged lens with an artificial lens. Cataracts blur all vision in the affected eye causing an interference with daily activities.
Glare and double vision may also be involved with this disorder. It impacts reading, writing, and ADL/IADL tasks.
(NEI, 2009) Slide19
Cataracts
Butterfly, April 19, 2014. Courtesy of Kimberly Holt
.
Cataract butterfly, October 20, 2015. Courtesy of Kimberly Holt.Slide20
Diabetic Retinopathy
Diabetic retinopathy presents as blind spots or floaters throughout the visual field.
Damage to the blood vessels that feed the retina causes this disorder and it results from high blood sugar levels from diabetes.
Medial treatment includes controlling the diabetes through interventions such as medicine, diet and exercise; these treatments can stop the progression of the disease and subsequent eye disorder.
Diabetic retinopathy causes difficulty with everyday activities and the specific visual impairment varies from person to person. It impacts all daily activities depending on the portion of the visual field lost.
(NEI, 2015b) Slide21
Diabetic Retinopathy
Butterfly, April 19, 2014. Courtesy of Kimberly Holt.
Diabetic retinopathy butterfly, October 20, 2015. Courtesy of Kimberly Holt.Slide22
Diabetic Retinopathy
Leading cause of blindness in adults YOUNGER than 65
Modifiable risk factors
Undiagnosed diabetes
Poorly controlled glucose
Poorly controlled BP
Lack of exercisePoor diet
ObesitySlide23
LAB EXERCISE #1
These vision simulation glasses allow us to understand what the visual impairments would look like.Slide24
Any Questions?Slide25
Low-Vision Rehabilitation Team
Optometrists
OD
Diagnose, treat and manage vision disorder
Evaluate and prescribe optic devices
Provide low vision services
OphthalmologistsMDLimited understanding of vision rehabDiagnose and prognosis disease processPRIMARY referral source for low vision servicesSlide26
Low Vision Team cont.
Certified low-vision therapists (CLVT)
Rehab professional
Exam required
OM, RT, Nurse, OT
Help clients use remaining vision to perform ADL and use magnifiers
Certified vision rehabilitation therapists (CRVT)
Rehabilitation teacher
Address ADL
Experts in Braille
College prep
Occupational therapists
1991 OT able to treat Low vision clients – almost 20 years in low vision
70% of medically based services
(
Sokul
-McKay &
Michels
, 2005)
Slide27
Rehabilitation Team cont.
Occupational therapists play an important role on the low-vision rehabilitation team.
Occupational therapists can:
Educate medical professionals
Assist clients and their families adapt or compensate for vision loss.
Teach clients compensatory and adaptive techniques.
(Marinoff, 2012)Slide28
Medicare
Medicare recognizes the need for low-vision services and covers low-vision as a primary and secondary diagnosis for treatment by an occupational therapist.
(AOTA, n.d.b)
Clinical experience has shown clients typically state they do not always see their vision deficits as a treatable condition; rather, they see it is as a product of the aging process. Slide29
Vision 2025
Occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living.
(AOTA, 2017)Slide30
Occupational Therapy Framework-III: Domain and Process
Occupational therapists can address deficits in clients’ performance skills, cultural, and personal interactions, and client factors as they relate specifically to low-vision disorders.
(AOTA, 2014)Slide31
OT Framework III- cont.
Many factors influence occupational performance
Client Factors
Values, beliefs, spirituality
Body functions
Sensory, motor, and mental
Body structures
EyesSlide32
OT Framework III- cont.
Performance Patterns
Habits, routines, roles used in daily occupations
Environment
Physical
Social
Contexts
Cultural, personal, temporal, and virtualSlide33
OT Framework III- cont.
Vision deficits may affect a client’s:
Performance Skills– affecting motor skills such as reaching, grasping and manipulating objects.
Processing Skills – causing difficulties such as navigating within his or her environment or organizing items needed for a task.
Cultural and Personal interactions - which could lead to withdrawal from desired activities and could cause clients to experience difficulty reading facial expressions or interpreting body language, which further complicates their personal interactions and may make social situations uncomfortable and awkward.
(AOTA, 2014)Slide34
Person-Environment-Occupation model
Using the Person-Environment-Occupation model (PEO), an occupational therapist can assist the person to increase the occupational performance with his or her desired activities by addressing the client’s identified areas of concern.
(Law et al., 1996)
Vision loss causes a problem between a person and the environment, even in familiar settings. Slide35
Rehabilitative Frame of Reference
Occupational therapists are able to treat their clients through the rehabilitative frame of reference by providing adaptations to the environment that use compensatory techniques to address the diagnosis or client factors related to low-vision.
(Trombly, 2008)
Evidence-based interventions are essential for the client with low vision to regain confidence and independence in their home and community environments.
(Mohler, Neufeld, & Perlmutter, 2015)Slide36
Education of Therapists
Education to therapists on low-vision interventions is essential.
In one study, only 52% of occupational therapists felt they received adequate preparation in their educational process to treat clients diagnosed with low vision.
(Winner, Yuen, Vogtle, & Warren, 2014)
Another study concluded only 25% of therapists felt confident in performing assessments and interventions for vision loss.
(Campion, Awang, & Ward, 2010) Slide37
Performance
Vision loss is often a progressive disease, and clients often experience decreased independence and increased safety risks within their daily environments. It is important for therapists to assess and treat low-vision in clients given that vision has such a large influence on occupational performance.
(Blaylock, Barstow, Vogtle, & Bennett, 2015)Slide38
Performance cont.
A qualitative study examined the client and therapist’s perspective on how chronic conditions affect occupational performance in clients with low-vision.
Low-vision affected clients’ performance of cooking, shopping, and going to work, and these were more difficult when a chronic condition affected their physical abilities as well
.
Clients also discussed how they compensated for their vision loss and other conditions with use of adaptive equipment, modifications to the environment, or changes in their routine.
Therapists viewed dementia was the most inhibitory co-morbidity, since it affects the ability to adapt to activities.
(Barstow, Warren, Thaker, Hallman, & Batts, 2015)Slide39
Client Readiness
A positive attitude and social support system enable a person to live purposefully with his or her vision loss; thus, the client will engage more in daily occupations.
Clients’ readiness for change will influence their ability to adapt or compensate for vision loss.
(Mohler, Neufeld, & Perlmutter, 2015) Slide40
Readiness cont.
This qualitative study focused on the impact of vision loss.
The researchers discussed clients’ views on how their vision loss was a pivotal point in their life, and the clients discussed how the loss of sight impacted their daily occupations.
Learning adaptive techniques prepared the clients for the possible future decline of their vision.
Many clients stated they struggled to find new purposeful ways to spend their time.
(Girdler, Packer, & Boldy, 2008)Slide41
Client Participation
The researchers reported, people with a visual impairment participate in daily activities less than the reference population without low-vision deficits.
Occupational therapists can assist clients to make changes in areas of life that are meaningful and purposeful by recognizing and understanding the self-reported limitations of their clients.
(Alma et. al, 2011)
A Level I, randomized controlled trial (CEBM, 2011),noted a decrease in participation in daily activities when a client demonstrated a visual impairment of worse than 20/40 as compared to the normal visual acuity of better than 20/40.
This study suggested that vision interventions could have a positive affect on a client’s daily functioning and quality of life.
(Perlmutter, Bhorade, Gordon, Hollingsworth, & Baum, 2010)Slide42
Participation cont.
This study concluded that clients who received single-component training, such as leisure skills training, eccentric viewing techniques, or mobility skills, increased ADL participation, and decreased social isolation.
The researchers concluded clients are more successful when taught how to use low-vision devices, problem-solving strategies, and when they are given information about resources in their community.
(Liu, Brost, Horton, Kenyon, & Mears, 2013)Slide43
Assessments
Most occupational therapy assessments address occupation or occupational performance; however, most do not address the visual functioning of the client.
(Warren, 1998)
Several assessments are available to determine the needs of a client with low-vision.Slide44
Canadian Occupational Performance Measure (COPM)
A standardized client-centered outcome measure
It allows the therapist to measure the changes in a client’s perception of his or her occupational performance.
This assessment can allow a therapist and client to make purposeful goals for low-vision therapeutic interventions.
(Law et al., 2014)Slide45
Brain Injury Visual Assessment Battery for Adults (biVABA)
The biVABA is an assessment that helps determine what strategies a client will need to be successful with his or her therapeutic interventions.
It focuses on multiple assessments for visual impairments such as visual acuity, contrast sensitivity, visual field, oculomotor function, and visual attention.
(Warren, 1998)Slide46
Mini-Mental State Examination (MMSE)
The MMSE determines cognitive function of a client.
It allows a therapist to see if they are able learn and understand low-vision therapeutic interventions.
Modifications to this test exclude the visual questions and use an adapted scoring method.
(Folstein, Folstein, & McHugh, 1975)Slide47
Low Vision Exam
The low vision examination is usually complete by an ophthalmologist or optometrist.
OT’s may complete depending on setting- to determine what vision is useable not what vision is gone. (very important distinction)
Occupational therapists working in low vision should emphasize what abilities a client has remaining.Slide48
Components of a Low Vision Exam
High contrast acuity
Low contrast acuity
Visual field integrity
Color visionSlide49
Acuity
Acuity is the ability to see small details and color.
There are two types of high contrast acuity
Distance
ReadingSlide50
High contrast Acuity
High contrast acuity is measured by using a Snellen chart and is based on what a “normal” person can see at 20 feet.
This test is used for standard vision.
It is important to note that the Snellen Chart only tests to 20/200 and a person with low vision will usually require additional tests to determine accurate visual acuity
.Slide51
Visual Acuity
Low vision acuity test charts such as the ETDARS Chart measures vision at 1 meter which allows ranges up to 20/1000 and less.
It controls spacing between letters and has the same number of characters on each line.Slide52
MN Read Acuity Charts
The MN Read Acuity Charts are continuous-text formatted visual acuity charts.
They measure a client’s reading acuity and speed by having a client read sentences that progressively get smaller in print.
This test allows the occupational therapist to determine the appropriate size of font needed for a client to read accurately.
(Mansfield, Legge, Luebker, & Cunningham, 1994)Slide53
Example of the MN Read
MNREAD, Precision Vision. Reprinted with permission.Slide54
Low Contrast Acuity
Measures the ability to see an image as it blends with its background.
Many environmental features are low contrast
Impacts clients with macular deteriorationSlide55
Low Contrast Acuity
Impacts daily activities such as
Water on a floor
Clear glass with water
Facial features
Outdoor environmentsSlide56
Low Contrast
Can you spot the water?Slide57
Good Contrast
Sidewalk, July 14, 2017. Courtesy of Kimberly Holt.
Sidewalk2, July 14, 2017. Courtesy of Kimberly Holt.Slide58
Low Contrast Sensitivity Chart
The
Pelli
-Robson Chart is an example of a low contrast evaluation.Slide59
Visual Field Exam
Microperimetry examines only the central 20* of visual field
Performed by low vision MD or OD.
As OT’s we can request print out of results from Dr.’s to help us understand what areas of the visual field are impaired
.Slide60
Clinical Assessments for OT
Occupational Therapists should screen for scotomas in the central visual field of clients.
Provides information on clients ability for success with reading and occupational performance of tasks.Slide61
Central Visual Screen- Clock TestSlide62
Clock Test
Have client look at center of clock and without moving his/her eyes, instruct the client to identify if any areas are distorted, blurry, or missing.
Make sure client does NOT move/scan clock face.
Note any areas identified by the client
This indicated the area of the potential scotoma or blind spot.Slide63
Occupational Therapy Interventions
Occupational therapy interventions to address low-vision include:
Eccentric Viewing
Reading/Writing
Magnification
Lighting
Sensory substitutions
Mobility
Adaptive/Assistive Devices
Home safety
(Fok, Polgar, Shaw, & Jutai, 2011; Nguyen, Weismann, &
Trauzettel
-
Klosinski
, 2009; Vukicevic & Fitzmaurice, 2009)Slide64
Eccentric Viewing cont.
The eccentric viewing technique involves focusing the central vision or blurred area on a different portion of the object or words to allow the client to use their peripheral vision to read.
While this technique can be difficult to learn, continuing to practice the technique can allow this technique to become second nature.
(Galbraith, n.d.)Slide65
Eccentric Viewing
Eccentric viewing does not change or improve vision; rather, it is a technique that can benefit clients in their everyday life.
Eccentric viewing is a visual technique that clients with macular degeneration or central vision loss can use to increase their reading skills needed for ADL/IADL tasks.
(Galbraith, n.d.) Slide66
Eccentric Viewing cont.
Instruct the client to look at the center of the target and without moving his/her eyes locate eth area of the clock that was blurry/distorted before.
Instruct the client to look above the card to see if the clock becomes more complete and clear.
You can cue the client by moving your and in the direction you want them to look.
Repeat with moving the eyes above/below and left /right of the image to find the best location to complete the image.
When the PRL is located explain to the client what this area is and how it will be used for task completion.Slide67
Preferred Retinal Locus (PRL)
The PRL is the site of the best vision when the fovea is damaged.
Once a client has located their PRL – eccentric viewing training techniques can be taught to the clientSlide68
Eccentric Viewing cont.
RSlide69
Eccentric Viewing
Once a client is able to locate their PRL, they will need to work on purposeful eye movements.
Locate and fixate on target (clock or letter)
Gaze shirt between target
Track a moving target
View targets near and far
Pre reading exercisesComprehension exercisesSlide70
Eccentric Viewing cont.
The results of one study indicated that utilizing eccentric viewing techniques is a useful strategy when performing ADL activities, and a significant improvement was noted after eccentric viewing training in near vision loss.
(Vukicevic & Fitzmaurice, 2009)
While some studies showed improvement in reading and ADL tasks, researchers in this study stated the full potential of eccentric viewing trainings needed more research.
(Gaffney, Margrain, Bunce, & Binns, 2014) Slide71
Eccentric Viewing Cont.
Eccentric Viewing techniques can impact the performance of daily activities in clients with age-related macular degeneration.
The study concluded that training in eccentric viewing techniques has a positive effect on daily living skills.
(Hong, Park, Kwon, &
Yoo
, 2014)Slide72
Magnification
Clients with low-vision have difficulty with reading tasks. Occupational therapists can teach clients compensatory techniques, and they can teach clients how to use adaptive devices to assist with this task.
A higher magnification, such as 10x power, would allow for a smaller viewing area as compared to a 3x power magnifier.
Many types of magnifiers are available.
Stand magnifiers
Hand-held magnifiers
Telescopes or a monocularNeck wrap magnifiersMagnification lamps
(American Foundation for the Blind, 2015b)Slide73
Magnification
Once a client can read without magnification utilizing their PRL a magnifier can be introduced.
Educate the client on limitation of the device
Restrictions of field of view
Maximum size of magnificationSlide74
Magnifier Use-
Stand Magnifier
Lay magnifier on the reading material
Have the person wear glasses if they use them
Slide the magnifier across the line of print
To move to the next line of print
Return the magnifier to the left side by pulling it back over the line of print just readMove to the next line of printSlide75
Magnifier Use-
Hand Held Magnifier
Begin by laying the magnifier on the page and then pull it away until the print comes into focus.
Move the magnifier across the pate
To move to the next line of print
Return the magnifier to the left side by pulling it back over the line of print just read
Move the magnifier down to the next line
This magnifier requires greater control of a person’s PRLSlide76
Magnifiers
4x hand-held magnifier [Image]. Reprinted with permission from LS&S.
10x hand-held magnifier [Image]. Reprinted with permission from LS&S.
10x stand magnifier [Image]. Reprinted with permission from LS&S.
3x stand magnifier [Image]. Reprinted with permission from LS&S.Slide77
Magnifiers Cont.
Magnifying lamp [Image]. Reprinted with permission from LS&S.
Monocular [Image]. Reprinted with permission from LS&S.
Neck-wrap magnifier [Image]. Reprinted with permission from LS&S.Slide78
High Tech Electronic Magnification
Desktop CCTV
CCTV [Image]. Reprinted with permission from LS&S.Slide79
High Tech – Electronic Magnification
Stand units paired with computers
Ruby HD from Freedom ScientificSlide80
Lab Exercise #2 –
Low Vision TrialSlide81
Writing
A client may need assistance with writing tasks.
They will need to be able to read what they have written.
Teach the client the PBS technique
Print
Block Letters
Space it outHave client write a shopping list /then write using PBS technique – which is easier to read?Writing guides can be useful but difficult to use.Slide82
PBS Technique
PBS, July 17, 2014. Courtesy of Kimberly Holt.Slide83
Reading
The loss of the ability to read is a major problem for clients when performing everyday activities.
Sans serif typefaces such as Arial or Veranda are easier to read than serif typefaces such as Times New Roman.
A font size of 16 to 18 points is optimal for reading with or without the use of a magnifier.
(Russell-Minda et al., 2007)
Moderately strong evidence supports the use of electronic magnification.
Strong evidence supports increased reading abilities in clients participating in an occupational therapy intervention program.
(Smallfield, Clem, & Myers, 2013)Slide84
Reading Cont.
In one study, reading ability increased from 16% to 94% with the use of low-vision aids such as a hand-held magnifier or closed-circuit television (CCTV).
Reading speed increased with the use of a visual aid in clients with a visual acuity of less then 20/200.
(Nguyen, Weismann, & Trauzettel-Kloswinski, 2009)Slide85
Lighting
Lighting can impact multiple activities in a person’s daily routine.
Types of light bulbs
Incandescent – being phased out
Fluorescent – best overall lighting, even illumination, some strobing, limited with variety
Halogen – task and room lighting, minimal glare, even illumination / but Hot lighting – not to close to client
LED – instant on , expensive, bulb life is yearsNatural lighting
Slide86
Lighting cont.
Lighting fixtures
Table lamps
Floor lamps
Gooseneck lamps
Under counter lighting
Disk LightsAutomatic night lights
(American Foundation for the Blind, 2015a)Slide87
Lighting cont.
These researchers performed a qualitative study to determine if assistive lighting could reduce falls in clients with low vision.
The researchers identified seven themes important in assistive lighting: appropriate, sufficient, even, adjustable, sustainable, simple, and adaptable.
The study concluded that assistive lighting, whether portable or fixed, helps clients perform many daily activities such as navigating their environment, meal preparation, grooming tasks, and medication management.
(Fisk & Raynham, 2014)Slide88
Lighting cont.
Perlmutter et al. (2013) developed a Home Environment Lighting Assessment (HELA) to assess home lighting of older adults with low vision.
While this assessment will be useful for near task lighting, it is not designed for overall lighting such as a bedroom or hallway, which is crucial for mobility and safety. Slide89
Lighting Examples
Gooseneck lamp [Image]. Reprinted with permission from LS&S.
Disc light [Image]. Reprinted with permission from LS&S.
Task lamp [Image]. Reprinted with permission from LS&S.Slide90
Sensory Substitutions
Sensory substitution is an alternative to devices, and clients can utilize their sense of touch or hearing to compensate for vision loss.
Since vision impacts most daily activities, teaching clients safe techniques and how to use adaptive devices are important interventions.
(Williams, Ray, Griffith, & De
l’Aune
, 2011)Sensory SubstitutionsLiquid level indicatorBump dots
Tactile Paint
Beads of safety pins to identify clothing
Talking devices
Slide91
Sensory Substitutions cont.
Sensory substitutions are a common strategy used for clients with impaired sight.
The researchers in this study evaluated the use of sensory devices.
A long cane and braille are the two sensory substitutions most frequently used throughout time.
(Williams, Ray, Griffith, & De l’Aune, 2011) Slide92
Tactile Dots and Paint
Bump dot orange [Image]. Reprinted with permission from LS&S.
Bump dot black [Image]. Reprinted with permission from LS&S.
Bump dot clear [Image]. Reprinted with permission from LS&S.
Tactile paint orange [Image]. Reprinted with permission from LS&S.Slide93
Environments
Clients may have increased difficulty navigating environments due to:
Lighting
– glare, brightness, unevenness
Background contrast
– sidewalks and stairways may not be marked
Background patterns
– moving people on sidewalks in restaurants (can’s judge speed of movements), multiple patterns in a home, or in a building (brick wall/ tile floor)
Obstacles/hazards
– objects on floor Slide94
Mobility
Maneuvering unfamiliar environments can be hazardous and confusing.
Teaching clients to use a blind cane or assistive animal can allow them to explore the community independently.
(Barstow, Warren,
Thaker
, Hallman, & Batts, 2015)Utilizing adaptive markings such as contract paint or tactile skid strips can increase safety and mobility at home. Slide95
Mobility cont.
A grounded theory qualitative study assessed the effects of low-vision on clients with mobility issues.
The authors concluded that clients want others to see them as normal, not as having a visual disability.
Clients preferred to make mobility choices that were the least invasive of others and resembled the normal mobility of others
.
(Ball & Nicole, 2015)Slide96
Assistive Devices
Clients can use multiple devices and adaptive techniques to help accommodate vision loss. Assistive devices can range from low tech to high tech, inexpensive to costly, and portable to fixed.
A client may use a low-vison assistive device in any area of daily occupations.
Meal preparation assistive devices
Talking devices
Magnifiers
Technological interventionsComputer programs Slide97
Assistive Devices cont.
A qualitative study focused on why older adults choose a particular low vision assistive device (LVAD). The need for selecting low-vision interventions and devices is important for understanding the positive and negative aspects of LVAD from a client’s point of view.
The study concluded that interaction with low-vision service providers improved the client’s ability to obtain and successfully utilize LVAD.
Occupational therapy services provided the participant with the training needed to use a selected device and resources.
The study encouraged low-vision support groups to allow participants to exchange information about their experiences with adapting to their low-vision diagnosis and their LVAD used to increase independence in their daily routines.
(Copolillo & Teitelman, 2005)Slide98
Assistive Devices cont.
One study examined the effects of assistive device usage in clients with low vision and depression. The results showed that the use of optical devices for daily activities resulted in a decline in depression over time, allowing clients to increase their occupational performance.
(Horowitz, Brennan, Reinhardt, & MacMillan, 2006)
Another qualitative study identified seven categories of low vision device use.
The study concluded that while many participants have multiple devices available to them, musical devices, note-taking devices, ADL aids, lighting, and magnifiers were labeled the most important to assist with daily occupations.
(Fok, Polgar, Shaw, & Jutai, 2011) Slide99
Home Safety Assessments
Many clients are choosing to age in place, thus requiring the need to ensure their safety at home through a standardized home assessment that focuses on clients with low vision.
This study focused on examining three home safety assessments in regard to the participants’ perspective of the impact low vision plays in home safety.
The authors concluded that common home assessments do not address a patient’s needs for intervention due to vision loss, making it difficult for occupational therapists to provide necessary recommendations for a patient’s safety.
Occupational therapist will need further evaluation of how vision loss affects a participant’s safety within the home environment along with the commonly used assessments.
(Barstow, Bennett, & Vogtle, 2011)Slide100
Low Vision Interventions for Activities of Daily Living
Feeding
Grooming
Dressing
Bathing
Mobility
(AOTA, 2014)Slide101
ADLs cont.
Low-vision affects a client’s ability to perform daily occupations, and teaching clients adaptive techniques for compensation can be of great assistance.
One study found that decreasing visual acuity increased limitations with ADLs, IADLs, mobility tasks, or a combination of the three.
(Laitinen et al., 2007)Slide102
ADLs cont.
This study determined that clients receiving interventions required less assistance than those that did not receive the low-vision interventions.
This study indicated that educating clients on problem-solving strategies could help maintain the ability to participate in ADL and IADL tasks longer even with declining vision.
(Eklund, Sjostrand, & Dahlin-Ivanoff, 2008)Slide103
ADLs cont.
In this study, occupational therapists trained clients in reading, lighting, and magnification skills specific to each client’s vision loss.
Following three sessions, participants increased the ability to read medication labels from 58% to 94%.
It is important for clients to understand the correct dosage and frequency of the prescribed medication.
(Markowitz, Kent, Schuchard, & Fletcher, 2008) Slide104
Feeding
Clock technique, November 2, 2015. Courtesy of Kimberly Holt.
Learning, sight, and sound (LS&S, n.d.), LS&S Product Catalog. Reprinted with permission.Slide105
Hygiene and Grooming
Magnifying mirror [Image]. Reprinted with permission from LS&S.
Magnifying nail clippers [Image]. Reprinted with permission from LS&S.
Magnifying lamp [Image]. Reprinted with permission for LS&S.Slide106
Dressing or Clothing Management
Pin Identify, October, 20,2015. Courtesy of Kimberly Holt
.
Disc light [Image]. Reprinted with permission from LS&S.
Button hook [Image]. Reprinted with permission from LS&S.Slide107
Bathing
Grab bar [Image]. Reprinted with permission from LS&S.Slide108
Mobility
Cane [Image]. Reprinted with permission from LS&S.
Monocular [Image]. Reprinted with permission from LS&S.
Contrast tape [Image]. Reprinted with permission from LS&S.Slide109
Low-Vision Interventions for Instrumental Activities of Daily Living
Communication Management
Financial Management
Medication Management
Meal Preparation
Shopping
(AOTA, 2014)Slide110
Communication
Envelope guide [Image]. Reprinted with permission from LS&S.
Signature guide [Image]. Reprinted with permission from LS&S.
Bold-lined paper [Image]. Reprinted with permission from LS&S.
Task lamp [Image]. Reprinted with permission from LS&S.
Letter writing guide [Image]. Reprinted with permission from LS&S.
Big button telephone [Image]. Reprinted with permission from LS&S.Slide111
Time Management
Black face clock [Image]. Reprinted with permission from LS&S.
Talking watch [Image]. Reprinted with permission from LS&S.
Talking alarm clock [Image]. Reprinted with permission from LS&S.Slide112
Financial Management
Talking calculator [Image]. Reprinted with permission from LS&S.
Check writing guide [Image]. Reprinted with permission from LS&S.
Magnifying lamp [Image]. Reprinted with permission from LS&S.Slide113
Medication Management
Talking glucometer [Image]. Reprinted with permission from LS&S.
Eye drop guide [Image]. Reprinted with permission from LS&S.
Jumbo pill boxes [Image]. Reprinted with permission from LS&S.
Syringe magnifier [Image]. Reprinted with permission from LS&S.
Sure shot [Image]. Reprinted with permission from LS&S. Slide114
Meal Preparation
Contrast cutting board [Image]. Reprinted with permission from LS&S.
Jumbo timer [Image]. Reprinted with permission from LS&S.
Liquid level indicator [Image]. Reprinted with permission from LS&S.
Contrast measure cups [Image]. Reprinted with permission from LS&S.Slide115
Shopping
Identify cards, October 20, 2015. Courtesy of Kimberly Holt
Shopping cards, October 20, 2015. Courtesy of Kimberly Holt
.Slide116
Low Vision Interventions for Leisure Tasks
Vision loss and the subsequent decrease in social participation can lead to client isolation.
A client may withdraw from social interactions because shaking hands, making eye contact, and social greetings cause anxiety or discomfort along with the inability to perform the tasks due to vision loss.
There are many devices to assist a client to continue with the leisure task of choice.
(Berger, McAteer, Schreier, &
Kaldenberg, 2013)Slide117
Leisure cont.
This study examined leisure participation with older adults with low-vision.
Environmental adaptation and problem-solving approaches were two of the four themes the researchers developed.
Participants learned strategies that older adults with low vision use, to assist with everyday activities; these studies showed an increase in participation in ADLs.
(Berger, McAteer, Schreier, & Kaldenberg, 2013) Slide118
Leisure Activities
Tactile dominos [Image]. Reprinted with permission from LS&S.
Illuminated remote [Image]. Reprinted with permission from LS&S.
Jumbo remote [Image]. Reprinted with permission from LS&S.
Large print playing cards [Image]. Reprinted with permission from LS&S.
Needle threader [Image]. Reprinted with permission from LS&S.
Large print bingo cards [Image]. Reprinted with permission from LS&S.Slide119
APPSSlide120
Aipoly
Vision
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
Aipoly
Vision: Sight for the blind and visually impaired
Apple
artificial intelligence technology that can process any item, color, environment from your iPhone or iPad's camera and verbally state the item you want to identify, without taking a picture.
This technology has many languages to select from.
assist with independence in daily occupations.
AMD- can not identify specific colors, this app will tell him/her the color of the clothing he/she would like to identify.
This app can verbally identify labels in supermarket and food items on shelves.
http://aipoly.com/ (Links to an external site.)
FreeSlide121
TapTapSee
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
TapTapSee
Apple or Android products 4.0 and up.
This app utilizes the cloud and your camera on your phone to help you identify objects, colors, or what you have taken a picture of.
pick out a shirt or shoes to match to an outfit, to ascertain that you have the correct cooking ingredient for your meal, to determine what office/classroom/bathroom you are about to enter, or identify an item you are retrieving.
identify objects verbally
To use this app, the user must point his or her camera at the object, tap the screen twice, then wait as the image is sent to the cloud for identification.
The user must have the TalkBack or Voice Over feature turned on and the cloud's database will identify the object then verbally state what the object being viewed is.
(
https://play.google.com/store/apps/details?id=com.msearcher.taptapsee.android&hl=en
(Links to an external site.)
)
http://www.wonderbaby.org/articles/taptapsee-app-review
(Links to an external site.)
)
FreeSlide122
NoSquint
by
Surfels
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
NoSquint
by
Surfels
Apple
NoSquint
offers a large number pad, large contact photos, large print contact names, large print contact search, and voice over as you dial or choose a contact. It allows you to dial phone numbers and view contacts in a low vision friendly format.
This app allows a low vision user with some useable vision to be able to dial a number or choose a contact on their iPhone without using voiceover technology (Siri).
This is beneficial because some users are concerned about privacy when using their phones or are simply not interested in having their phone talk to them at all times.
It offers greater flexibility than the standard phone app for persons needing larger print and larger pictures. For the user who does prefer voiceover, that option is available too.
ttps://itunes.apple.com/us/app/nosquint/id586896395?mt=8
0.99Slide123
Color Grab
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
Color Grab by
Loomatix
Android
color identification application that picks, captures, and recognizes colors of objects in the environment by pointing the camera at the object.
The name of the color and the nickname of the color is listed on the screen and the app will say the color if you press the volume button.
If you press volume up, the app reads the name of the color. If you press volume down, the app reads the nickname of the color. For example, "Dark Brown" for the name and "Coffee" for the nickname.
This app is very easy to use and appears to be accurate in color recognition.
It would assist a person with low vision who had difficulty with color recognition, contrast, or color blindness to choose appropriate colors when getting dressed, for craft/art activities, etc.
The text on screen that states the color name is very small, however, the availability of audible reading of the color name compensates for the small print size.
www.loomatix.com
(Links to an external site.)
FreeSlide124
Visor-low vision magnifier
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
Visor-low vision magnifier
Android
Provides magnification for reading
The application allows for changes in color of print of white on black, black and white and yellow and blue.
Also providing auto focusing for increased magnification.
Buttons for changing standout in a larger image. Also able to take a picture of magnification for storage on phone in photos for needs for recipes, phone numbers etc.
Provides magnification with the use of your phone for on the go
Also allowing to take a enlarged picture so storage of a grocery list or items for use away from home.
Also more incognito so not as many people will be able to see that it's a magnifier just using your cell phone
https://youtu.be/83QTtkGL94U
FreeSlide125
iDentifi
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
iDentifi
Apple iOS 10.1.1 and above
The app uses artificial intelligence to analyze for objects in photo (either taken or selected from photo library) in order to give the user a verbal description of the image (either a description of the object or dictation of text in image depending on the mode selected).
The voiceover accessibility function has to be used in conjunction with the app. There are more than 25 languages output available e.g. English, Mandarin, Cantonese, Indonesian, Japanese, Thai, Italian, Swedish, Portuguese, Spanish, Turkish.
This app is useful in object recognition for persons with low vision. It allows greater independence for the user in daily tasks such as grocery shopping (able to identify items and words on packaging e.g. Natural Pistachios), self-navigating in indoor environment (e.g. door, fan in the way of travel) and reading out loud in the selected language (e.g. books/ newspaper/ medication packaging).
http://getidentifi.com/#demo-video-section
FreeSlide126
Digit-Eyes
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
Digit-Eyes by Digital Miracles, LLC
Apple IOS 6.1 or later
This app reads UPC and QR codes and provides text and audio response identifying the item, with specific details such as brand,
flavor, size, cooking directions, or dosage information, with a database of over 37 million products.
Users can also create their own labels by voice or text, including washable labels for clothing.
read codes on hard-to-see items and tell the user the songs on a CD and the color of the nail polish or distinguish antibiotic ointment from hydrocortisone cream.
purchase or print QR labels at home and personalize them by scanning a blank label and recording a message that is stored and retrieved when the label is scanned again, allowing the user to
place labels wherever needed, such as: on dates in a calendar to remember appointments or a friend’s birthday, on leftover food with a description and preparation date, on a house key for easier identification, and on folders of important documents for legal and financial management.
https://itunes.apple.com/us/app/digit-eyes/id376424490?mt=8 (Links to an external site.)
Full version
9.99
Digit-Eyes Lite FreeSlide127
iMove
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
iMove
Apple iOS 8.0 or later
Used for navigation.
The app is fully accessible with VoiceOver and is easy to navigate and use; all buttons are clearly labeled.
iMove supports independent mobility of visually impaired people.
Know the address where they are;
Know points of interest around them (e.g. schools, stations, pubs, etc.);
Record speech notes associated to the person's location. A speech note will be played every time the person is close to the place where it has been recorded;
Customize the messages.
For example, the person can choose to be warned about the address where they are, the current orientation and speed, about speech notes, nearby points of interest, etc.
Promote independence in navigating familiar environments.
completing IADL's such as going into town to take care of banking needs, paying bills, or simply for socialization such as to go visit a family member or a friend.
In addition, the iMove app is available in many different languages, which make it much more useful to a greater number of people.
http://www.everywaretechnologies.com/
(Links to an external site.)
FreeSlide128
IDEAL Currency Identifier
Application Name:
Operating System:
Description
Appropriateness of App for clients with LV
Website:
Price
IDEAL Currency Identifier V2.0
Android
The app helps to identify paper currency.
The user simply holds the phone directly over the currency and moves it slowly up and away until the program reads the denomination and whether the reading is from the front or back of the bill. Note that the user has to have a text-to-speech voice installed (available by default on most mobile phones).
removes the need for another person to identify currency received or given, thereby increasing the person with low vision's independence.
The person with low vision can also integrate the currency with a strategy of folding money in particular ways to quickly recall the denomination.
https://www.ed.gov/news/press-releases/us-department-education-announces-new-app-identify-us-currency
(Links to an external site.)
https://www.youtube.com/watch?v=hhEhrOg5Q6I
FreeSlide129
Other Apps
LookTel
Money Reader
Reads currency – paper and coins
LookTel
Recognizer
Identifies objects stored into system by consumerVizWizTake a picture and ask a person in real time for an answerEyeNote
US paper currency identifier
Color Id free
Identifies colors using camera on phone in real timeSlide130
Questions?Slide131
Lab Activity #3
Glucometer UseSlide132
Lab Trials #4
Write Check
Pour Glass of Water
Read Can good labels
Measure in syringe
Play cards
Write grocery list cursive/PBSMedication ManagementSlide133
Kitchen
Kitchen, October 20, 2015. Courtesy of Kimberly Holt
.Slide134
Cooking
Cooking, October 20, 2015. Courtesy of Kimberly Holt.Slide135
Water GlassSlide136
Bathroom
Bathroom, October 20, 2015. Courtesy of Kimberly Holt
.Slide137
Medication
Medicine, October 20, 2015. Courtesy of Kimberly Holt.Slide138
MedicationSlide139
Clothing Management
Clothing, October 20, 2015. Courtesy of Kimberly Holt.Slide140
Closet OrganizationSlide141
Communication
Telephone, November 2, 2015. Courtesy of Kimberly Holt.Slide142
Reading
Book, October 20, 2015. Courtesy of Kimberly Holt
.Slide143
Mobility
Stairs, October, 20, 2015. Courtesy of Kimberly Holt
.Slide144
Mobility
Wall, July 14, 2017. Courtesy of Kimberly Holt.
Hallway, July 14, 2017. Courtesy of Kimberly Holt.Slide145
Mobility
Outdoor shadow, July 17,2017. Courtesy of Kimberly Holt.
Hallway, July 14, 2017. Courtesy of Kimberly Holt.Slide146
Office/Desk Space
Messy Desk, September 24,2017. Courtesy of Kimberly Holt. Slide147
BedroomSlide148
Hospital/SNF RoomSlide149
Closing…
Low-vison affects clients in all areas of their life. “Since occupation is central in the process of adapting to age-related vision loss, then occupation therapy… has a moral obligation to contribute” to these disease processes (Girdler, Packer, & Boldy, 2008, p.118). Together we can make a difference for these clients and help them regain independence. Slide150
Any Questions or Comments?Slide151
References
Alma, M., Van Der Mei, S.,
Melis-Dankers
, B., Van Tilburg, T.,
Groothoff
, J., &
Suurmeijer, T. (2011). Participation of the elderly after vision loss. Disability and Rehabilitation, 33(1), 63-72. doi:10.3109/09638288.2010.488711American Foundation for the Blind. (2015a). Lighting and glare. Retrieved from http://www.visionaware.org/info/everyday-living/home-modification-/lighting-and-glare/123
American Foundation for the Blind. (2015b). What are low vision optical devices? Retrieved from
http://www.visionaware.org/info/your-eye-condition/eye-health/low-vision/low-vision-optical-devices/1235
American Occupational Therapy Association. (2007). AOTA’s
Centennial Vision
and executive summary.
The American Journal of Occupational Therapy
,
61
(6), 613-614.
American Occupational Therapy Association. (2014). Occupational therapy framework: Domain and process (3rd ed.).
The American Journal of Occupational Therapy
,
68
, S1-S51.
American Occupational Therapy Association. (
n.d.a
). Emerging niche in productive aging. Retrieved from
http://www.aota.org/Practice/Productive-Aging/Emerging-Niche/Low-Vision.aspx
American Occupational Therapy Association. (
n.d.b
). Living with low vision. Retrieved from http://www.aota.org/about-occupational-therapy/;atients-clients/adults/lowvision.aspx
American Optometric Association. (2015a). Glaucoma. Retrieved from
http://www.aoa.org/patients-and-
public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/glaucoma?sso=ySlide152
References
American Optometric Association. (2015b). Low vision. Retrieved from
http://www.aoa.org/patients-and-public/caring-for-your-vision/low-vision?sso=y
American Optometric Association. (2015c). Visual Acuity: What is 20/20 vision? Retrieved from
http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/visual-acuity?sso=y
Ball, E., & Nicolle, C. (2015). Changing what it means to be “normal”: A grounded theory study of the mobility choices of people who are blind or have low vision.
Journal of Visual Impairment & Blindness, 109(4), 291-301.
Barstow, B. A., Bennett, D. K., &
Vogtle
, L. K. (2011). Perspectives on home safety: Do home safety assessments address the concerns of clients with vision loss?
The American Journal of Occupational Therapy
,
65
(6), 635-642.
Barstow, B., Warren, M.,
Thaker
, S., Hallman, A., & Batts, P. (2015). Client and therapist perspectives on the influence of low vision and chronic conditions on performance and occupational therapy intervention.
The American Journal of Occupational Therapy
,
69
(3), 1-8.
Berger, S.,
McAteer
, J.,
Schreier
, K., &
Kaldenberg
, J. (2013). Occupational therapy interventions to improve leisure and social participation for older adults with low vision: A systematic review.
The American Journal of Occupational Therapy
,
67
(3), 303-311.
Blaylock, S., Barstow, B.,
Vogtle
, L., & Bennett, D. (2015). Understanding the occupational performance experiences of individuals with low vision.
British Journal of Occupational Therapy
,
78
(7), 412-421. doi:10.1177/030802215577641Slide153
References
Campion, C.,
Awang
, D., & Ward, G. (2010). Broadening the vision: The education and training needs of occupational therapists working with people with sight loss.
British Journal of Occupational Therapy
,
73(9), 413-421.Center for Evidence-Based Medicine. (2011). OCEBM levels of evidence. Retrieved from www./cebm.net/ocebm-levels-of-evidence/Copolillo, A., & Teitelman, J. (2005). Acquisition and integration of low vision assistive devices: Understanding the decision-making process of older adults with low vision.
The American Journal of Occupational Therapy
,
59
(3), 305-313.
Eklund
, K.,
Sjostrand
, J., &
Dahlin-Ivanoff
, S. (2008). A randomized controlled trial of a health-promotion
programme
and its effect on ADL dependence and self-reported health problems for the elderly visually impaired.
Scandinavian Journal of Occupational Therapy
,
15
, 68-74. doi:0.1080/11038120701442963
Fisk, M., & Raynham, P. (2014). Assistive lighting for people with sight loss.
Disability & Rehabilitation: Assistive Technology
,
9
(2), 128-135.
Fok
, D.,
Polgar
, J., Shaw, L., &
Jutai
, J. (2011). Low vision assistive technology device usage and importance in daily occupations.
Work
,
39
, 37-48. doi:10.3233/WOR-2011-1149
Folstein
, M.,
Folstein
, S., & McHugh, P. (1975). “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician.
Journal of Psychiatric Research
,
12
, 189-198. doi:10.1016/0022-3956(75)90026-6
Gaffney, A.,
Margrain
, T., Bunce, C., &
Binns
, A. (2014). How effective is eccentric viewing training? A systematic literature review.
Ophthalmic & Physiological Optics
,
34
, 427-437.Slide154
References
Galbraith, J. (
n.d.
). Living well with low vision: Self-training in eccentric viewing. Retrieved from
http://lowvision.preventblindness.org/library/low-vision-rehabilitation/self-training-in-eccentric-viewing
Girdler, S.,
Boldy, D., Dhaliwal, S., Crowley, M., & Packer, T. (2010). Vision self-management for older adults: A randomised controlled trial. British Journal of Ophthalmology, 94(2), 223-228.
Girdler, S., Packer, T., &
Boldy
, D. (2008). The impact of age-related vision loss.
Occupational Therapy Journal of Research
,
28
(3), 110-120.
Hong, S., Park, H., Kwon, J., &
Yoo
, E. (2014). Effectiveness of eccentric viewing training for daily visual activities for individuals with age-related macular degeneration: A systematic review and meta-analysis.
NeuroRehabilitation
,
34
(3), 587-595.
Horowitz, A., Brennan, M., Reinhardt, J., & MacMillan, T. (2006). The impact of assistive device use on disability and depression among older adults with age-related vision impairments.
Journal of Gerontology
,
61B
, S274-S280.
Keller, H. (1996). In
C.Ward
(Ed.).
Helen Keller: The story of my life
(Dover Print Editions ed.). New York: Dover Publications Inc.
Laitinen
, A.,
Sainio
, P., Koskinen, S.,
Rudanko
, S.,
Laatikainen
, L., &
Aromaa
, A. (2007). The association between visual acuity and functional limitations: Findings from a nationally representative population survey.
Ophthalmic Epidemiology
,
14
, 333-342. doi:10.1080/01658100701473713
Law, M., Baptiste, S., Carswell, A., McColl, M., Polatajko, H., & Pollock, N. (2014).
COPM: Canadian Occupational Performance Measure
(5th ed.). Ottawa, Ontario: CAOT Publications ACE.Slide155
References
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance.
Canadian Journal of Occupational Therapy
,
63
(1), 9-23.
Liu, C., Brost, M., Horton, V., Kenyon, S., & Mears, K. (2013). Occupational therapy interventions to improve performance of daily activities at home for older adults with low vision: A systematic review. The American Journal of Occupational Therapy, 67(3), 279-287.
Mansfield, J.,
Legge
, G.,
Ludbker
, A., & Cunningham, K. (1994).
MNRead
Acuity Charts: Continuous-text reading-acuity charts for normal and low vision
. Long Island City, NY: Lighthouse Low Vision Products.
Marinoff
, R. (2012). Referral patterns in low vision: A survey of mid-south tri-state eye care providers.
Journal of Behavioral Optometry
,
23
(1), 13-23.
Markowitz, S., Kent, C.,
Schuchard
, R., & Fletcher, D. (2008). Ability to read medication labels improved by participation in a low vision rehabilitation program.
Journal of Visual Impairment & Blindness
,
102
(12), 774-777.
Mohler, A., Neufeld, P., & Perlmutter, M. (2015). Factors affecting readiness for low vision interventions in older adults.
The American Journal of Occupational Therapy
,
69
(4), 1-10.
National Eye Institute. (2009). Facts about cataract. Retrieved from
https://nei.nih.gov/health/cataract/cataract_facts
National Eye Institute. (2015a). Facts about age-related macular degeneration. Retrieved from
https://nei.nih.gov/health/maculardegen/armd_factsSlide156
References
National Eye Institute. (2015b). Facts about diabetic eye disease. Retrieved from
https://nei.nih.gov/health/diabetic/retinopathy
National Eye Institute. (
n.d.a
). Facts about glaucoma. Retrieved from
https://nei.nih.gov/health/glaucoma/glaucoma_factsNational Eye Institute. (n.d.b). Information for healthy vision: Low vision. Retrieved from http://nei.nih.gov/lowvision
Nguyen, N., Weismann, M., &
Trauzettel-Klosinski
, S. (2009). Improvement of reading speed after providing of low vision aids in patients with age-related macular degeneration.
Acta
Ophthalmologica
,
87
, 849-853.
Ortman
, J.,
Velkoff
, V., & Hogan, H. (2014). An aging nation: The older population in the United States. Retrieved from
https://www.census.gov/prod/2014pubs/p25-1140.pdf
Perlmutter, M.,
Bhorade
, A., Gordon, M., Hollingsworth, H., & Baum, M. C. (2010). Cognitive, visual, auditory, and emotional factors that affect participation in older adults.
The American Journal of Occupational Therapy
,
64
(4), 570-579.
Perlmutter, M.,
Bhorade
, A., Gordon, M., Hollingsworth, H.,
Engsberg
, J., & Baum, M. C. (2013). Home lighting assessment for clients with low vision.
The American Journal of Occupational Therapy
,
67
(6), 674-682.
Russell-
Minda
, E.,
Jutai
, J., Strong, G., Campbell, K., Gold, D., Pretty, L., & Wilmot, L. (2007). The legibility of typefaces for readers with low vision: A research review.
Journal of Visual Impairment & Blindness
,
101
(7), 402-415.Slide157
References
Smallfield
, S., Clem, K., & Myers, A. (2013). Occupational therapy interventions to improve the reading ability of older adults with low vision: A systematic review.
The American Journal of Occupational Therapy
,
67
(3), 288-295.Sokol-Mckay, D., & Michels, D. (2005). Facing the challenges of macular degeneration: Therapeutic interventions for low vision. OT Practice, 10(9), 10-15.
Spence, C. (2014). The skin as a medium for sensory substitution.
Multisensory Research
,
27
(5), 293-312.
Trombly
, C. (2008). Conceptual foundations for practice. In M. Radomski, & C.
Trombly
(Eds.),
Occupational therapy for physical dysfunction
(6th ed., pp. 1-22). Philadelphia: Lippincott, Williams, & Wilkins.
Vukicevic
, M., & Fitzmaurice, K. (2009). Eccentric viewing training in the home environment: Can it improve the performance of activities of daily living?
Journal of Visual Impairment & Blindness
,
103
(5), 277- 290.
Warren, M. (1998).
Brain Injury Visual Assessment Battery for Adults
. Lenexa, KS:
visABILITIES
Rehab Services.
Williams, M., Ray, C., Griffith, J., & De
l’Aune
, W. (2011). The use of a tactile-vision sensory substitution system as an augmentative tool for individuals with visual impairments.
Journal of Visual Impairment & Blindness
,
105
(1), 45-50.
Winner, S., Yuen, H., Vogtle, L., & Warren, M. (2014, January/February). Factors associated with comfort level of occupational therapy practitioners in providing low vision services.
American Journal of Occupational Therapy
,
68
, 96-101. doi:10.5014/ajot.2014.009142Slide158
Kimberly Holt, OTR, OTD
409-790-0219
Kimberly_holt@hotmail.com