Vision rehabilitation By Angela West, MOT, OTR/L, CLVT, CAPS - PowerPoint Presentation

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Vision rehabilitation

By Angela West, MOT, OTR/L, CLVT, CAPS

Senior

PasstheOT.com

Tutor

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Quick anatomy/Physiology review

Rods – responsible for night and black/white vision, peripheral vision

Cones- responsible for color, fine detail, central

vision (the MACULA has the highest concentration of cones)Scotoma – clinical term for “blind spot” in the visual fields of vision loss, blurriness, or distortion. Cataract – progressive opaqueness of the lens, resulting in blurred vision

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Visual terms

Visual reception – how your brain RECEIVES visual stimuli/input

Ocular motor functions: clarity, visual fields, eye muscle movements, convergence, divergence, accommodation

These are also called “foundational visual skills”Diplopia? Nystagmus? Strabismus? Stereopsis?Visual perception – how your brain PROCESSES visual stimuli/input receivedVisual spatial relationsVisual memory

Figure ground

Visual closure

Visual motor integrationVisual discriminationForm Constancy

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Low vision versus legal blindness

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Macular degeneration

Progressive blurring or visual loss of CENTRAL vision.

MA

C

ULA – the “4 C’s of AMD”

“Cones”

“Central” “Color” “Clarity”

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Macular Degeneration Interventions

Eccentric Viewing Techniques: A method of scanning peripheral visual fields to optimize vision using another point in the retina that has not been damaged by AMD – also called a

psuedofovea training.

Amsler Grid Training and Education Optical/Non Optical Device Training to compensate for impaired visual acuityEnvironmental modifications –optimize lighting, decreasing clutter, increasing contrast/high contrastPatient education on condition and its prognosis Community Resource Training/Support GroupsPsychosocial impact/implications secondary to vision loss

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glaucoma

Elevated intraocular pressure in the eye (IOP) due to decrease

vitrous

/

aquous

humor outflow - ultimately leading to progressive optic nerve damage and

loss of peripheral vision

. Described as “pinhole vision”.

Generally affects both eyes, however one eye can have more advanced progressive loss than the other.

Photophobia: “fear of lighting” – too much lighting can actually be painful for these folks

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Glaucoma interventions

Medication management – eye drops

Organized visual scanning patterns/visual sweep techniques to use central vision – LIGHTHOUSE strategies

“Electronic magnification devices is often useful because it allows for increased visability of text by increasing contrast and brightness rather than size of the text” Safety during functional and community mobility Environmental modifications, especially with lighting because night vision is typically severely impaired with this population. (PHOTOPHOBIA!)Patient education on the condition and its prognosis Psychosocial impact/implications due to vision loss

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Diabetic retinopathy

Often referred to as “Swiss cheese vision”/”Cow Patch” vision. Patients experience fluctuating, distorted vision with multiple blind spots presented in both central/peripheral vision due to diabetes.

Symptoms also include difficulty with focusing/fixating on an object, loss of color vision, impaired contrast sensitivity, and reports of “floaters”.

Also can experience photophobia

What other considerations do we have to keep in mind for these folks??

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Diabetic Retinopathy

interventions

Amsler Grid Training Eccentric Viewing Special Tinted glasses to reduce glare and sharpen acuity Environmental Modifications (especially to address contrast sensitivity, tactile bump dots to account for severe vision loss)CCTV/Electronic Magnification DevicesCommunity Resource TrainingPsychosocial Implications

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CVA related visual deficits

Homonymous Hemianopsia

Quadranopsia

-- can result in visual

apraxias

What’s the difference between visual in/

hemiattention

and hemi neglect?

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Vision assessments

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Question #1

What condition damages the optic nerve, causes increased pressure in the eye, and results in tunnel vision?

A) Macular Degeneration

B) Homonymous HemianopsiaC) Diabetic RetinopathyD) Glaucoma

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Question #2

A client has severe low vision secondary to diabetic retinopathy. The client wishes to independently cook family meals. Which client factor would be most important to assess prior to engaging the client in a cooking activity?

ROM

Visual Field function

Tactile Discrimination

Activity Tolerance

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Question #3

A middle aged client has macular degeneration resulting in moderate visual impairment. The client works as a data entry clerk and wants to continue working but is having difficulty seeing the computer screen. The OT will be adapting the client’s work computer with new software to improve accessibility. What computer feature of this new software would be most effective for this client?

Braille keyboard compatibility

Character enlargementOptical character recognitionVoice-to-text speech

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Question #4

An OT completes an evaluation with a 6-year old child and the results indicate that the child has deficits in visual discrimination affecting handwriting. Based on this information, what strategy might the therapist include in the intervention plan to best address visual discrimination?

Multisensory writing techniques to reinforce correct letter formation and to emphasize the differences between similar letters

Dot-to-dot and maze worksheets

Cue the student to use his fingers to move the pencil while completing writing tasks

Practice writing letters in sand with shaving cream

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Question #5

The director of rehabilitation asks a newly hired OTR® to provide occlusion to a client who is experiencing diplopia to enable the client to more fully participate in rehabilitation. Which action should the OTR take FIRST in response to this request?

Provide occlusion to the client and notify the director that the task has been completed

Refuse the director’s request, because occlusion is inappropriate for an OTR to provideExplain to the director that occlusion can be provided only under the direction of a physician or CLVT specialistRefer the request to another OTR with more experience in oculomotor function

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Question #6

An outpatient occupational therapist is developing an intervention plan for a client with primary open angle glaucoma. What would be the best option to include in the intervention plan for this client?

Environmental control unit operations training

Use of bold-lined paper and bold pens for writing tasks

Large-print labels on commonly used kitchen items

Training in rotation of head and trunk to scan environment during functional mobility activity

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Question #7

After stroke, a client has difficulty orienting to relevant visual stimuli on the left side, including food on the plate and grooming items on the counter. The client completes feeding and grooming tasks swiftly and with reduced effort. What symptom would the OTR® report in the client’s evaluation results?

Hemispatial

visual neglectVisual discrimination deficitVisual field deficitMotor neglect

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Question #8

A client reports diplopia and demonstrates asymmetrical pupil sizes and a droopy eyelid. What would be MOST appropriate for the OTR

®

to evaluate?

Oculomotor function

Visual acuity

Contrast sensitivity

Visual fields

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Question #9

An OTR is working with a client who has difficulties with visual skills as a results of damage to the central nervous system. Which visual skill is related to CNS damage?

Visual memory

StereopsisFigure groundKinesthesia

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Question #10

An older adult client with a history of falls and glaucoma is referred to occupational therapy for evaluation and intervention. Which strategy should the OTR® teach the client to compensate for impaired vision due to glaucoma?

Use a colorful, patterned tablecloth.

Place dinner plate to the left of midline.

Rotate head to choose clothing from a closet.

Pour coffee into a dark colored mug.

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Question #12

When working on home modifications with a patient who has low vision, what is the MOST APPROPRIATE home modification to the patient’s bedroom to enhance the patient’s independence when dressing?

 Increase the distance between the patient and the object

 Increase glare from sunlight Optimize lighting Decrease contrast sensitivity with nightstand items

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references

Kaldenburg

, J., & Smallfield, S. (2013). Occupational therapy practice guidelines for older adults with low vision. Bethesda, MD: AOTA Press.Whittaker, S., Scheiman, M., Solok-McKay, D. (2016). Low Vision Rehabilitation: A Practical Guide for Occupational Therapists 2nd Edition. Slack Incorporated.