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: 606635
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Assistive Technology Assessment for Individuals with Acquired Brain Injury and Vision Loss
Presented by
William Hersh, MSLVR, CLVTSlide2
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 StudySlide3
When structures of the eye don’t function as they should
Acuity
Contrast
Field
Accommodation/Focus
Light Dark Adaptation
Color
Stereoscopy/Convergence
MotilitySlide4
Refractive ErrorsSlide5
SnellenSlide6
Amsler GridSlide7
ScotomaSlide8
Ocular impairment affectsVisual Skills
Fixation
Eye Movement (Saccade and pursuit)
Shifting Gaze
Localizing
Scanning
Tracking
TracingSlide9
FixationSlide10
Saccade and Pursuit, Shifting Gaze, Localizing, ScanningSlide11
TrackingSlide12
TracingSlide13
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 functionSlide14
DiscriminationSlide15
ClosureSlide16
Figure GroundSlide17
Form ConstancyWhat am I?Slide18
Form ConstancyIs this better?Slide19
Closure with inferior Scotoma
IUMRING TO GONGIUSIQNSSlide20
Visual Memory Can be Misleading
IUMRING TO GONGIUSIQNSSlide21
More Reading with ScotomaSlide22
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 committedSlide23
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 disabilitiesSlide26
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 disabilitiesSlide27
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 tasksSlide28
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 ReachSlide31
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 skillsSlide32
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 futureSlide34
Tech Devices
Black Light
Video Magnifier
HH Magnifiers
Refreshable Braille Display
OCR
Monocular
Portable VM
Spectacle MountedDomeLight with MagnifierPortable VMPortable VMSlide35
More Tech Devices
NOIR Filters
Synthesizers
Demo
PDA
Bioptic
Tablet
SoftwareSlide36
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 InterfaceSlide38
The FutureCont.
Natural User Interface
Self Driving CarSlide39
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 dysfunctionSlide41
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 edgeSlide43
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