1. Visual Impairment By James Watson

2. What is Visual Impairment? A limitation of one or more functions of the eye (or visual system) Most common vision impairments affect: The sharpness or clarity of vision (visual acuity); The normal range of what you can see (visual fields) Main cause of visual impairment is Cataract in all areas of the world, except for developed countries In developed countries, Age-related macular degeneration, Diabetic Retinopathy and Glaucoma have emerged as potential threats Other causes are Childhood blindness, Trachoma, Onchocerciasis and many others including Diabetes, Retinitis Pigmentosa and accidents

3. How Our Eyes Work

4. Cataracts Formed in the lens of the eye As people get older, the lens of the eye gets cloudy; worse it becomes the fog gets thicker Mostly affects older population, but sometimes kids can have them Cure: Can be fixed with surgery

5. Age-Related Macular Degeneration One of the leading causes of blindness among older population With this disease, the middle of the back of the eye called the macula is diseased Cure: Currently no cure as of yet

6. Retinitis Pigmentosa Usually begins when young and gets worse as person gets older, often leaving person blind as adult In the beginning, person may have trouble seeing at night, and later their field of vision gets less and less in each eye Cure: At this time scientists are not sure exactly how it forms and there is no cure

7. Diabetic Retinopathy Caused by diabetes which can strike child and adults The blood vessels or tubes in the back of the eye break and blood flows into or damages part of the eye that help a person see. Cure: Sometimes surgery or medicines can help both with diabetic retinopathy and diabetes

8. Why is our Eyes and Eyesight important? Our eyes are our window into the world Eyes perform daily tasks such as distinguishing between light and dark, perceiving colors, recognizing spatial contrasts and adapting effortlessly at any distance and all light conditions

9. Who is Affected by Blindness? It is estimated that blindness affects close to 45-50 million people worldwide Every 5 seconds, one person in the world goes blind An additional 135 million are estimated to have low vision and this number is expected to double by 2020 Diseases such as Trachoma and Onchocerciasis are decreasing and becoming less of a problem with intervention, improvement of facilities and improvement in socioeconomic conditions

10. Global Blindness Chart

11. Prevalence and Causes of Blindness Remain vastly different in different parts of the world Greatly influenced by socioeconomic status, geographical and political factors These factors contribute to wide variations in the patterns of blindness between developed and developing countries

12. The Effect of Visual Impairment on Exercise Fear of physical activity; Afraid they are going to hurt themselves Lack of confidence in performing the activity and insecurity Activities of daily living tend to demand more energy from visually impaired individuals Higher risk of potentially injuring themselves if precautions are not taken Children who are visually impaired consistently exhibited lower levels of fitness than sighted peers

13. Case Study Information 42 year old male; Has Retinitis Pigmentosa / Completely Blind Weight = 75 kg; Height = 183 cm Family History - Mother age 70 and Father age 74, in good health Non-Smoker Sedentary Lifestyle – Used to exercise all the time before injuring himself; Has not exercised in over a year

14. Case Study Information No medication; Takes a Men’s Multivitamin & 2 Fish oil a day Total Cholesterol = 193 mg/dl; HDL = 42; LDL = 127 FBG = 83 mg/dl No information given on hypertension Past Injuries = Broken Arm from falling

15. Risk Stratification Checklist ☑ Age – Less than 45 years old ☑ Family History – No previous heart attack or Bypass surgery or sudden death in the family ☑ Cigarette Smoking – Non Smoker ☑ Sedentary Lifestyle – Has not participated in moderate physical activity at least 3 days/week for 3-months ☑ Obesity – BMI is 22.4; Less than 30 kg/m^2 ☑ Hypertension – No information given

16. Risk Stratification Checklist ☑ Dyslipidemia – TC is less than 200 mg/dl; LDL less than 130 and HDL greater than 40 ☑ Pre-Diabetes – FBG is less than 100 mg/dl ☑ Client is not Symptomatic and does not have any known cardiac, pulmonary or metabolic disease

17. Risk Stratification Assessment From the checklist, we can derive 2 risk factors 1. Sedentary Lifestyle 2. No information given on Hypertension We will consider him a Moderate Risk client since has 2 total risk factors

18. Goals of Client Increase dynamic stability in upright position Be able to run 9 minute mile on the track Become stronger to help lift furniture around the house

19. Special Considerations Since client is blind, accommodations must be made to make sure the risk of injury is minimalized. Remember that people with visual impairments tend to exert more energy throughout the day and may not be able to exercise as hard or may become tired at a faster rate.

20. Exercise Tests Flamingo Balance Test - Would be used to assess his balance on each leg to see if one side is able to balance better than the other 1-Mile Run Test – Will run the mile with him as his sighted guide to see how long it will take him before beginning his exercise prescription

21. Exercise Prescription - Cardiorespiratory Frequency – 5 days a week, preferably daily Intensity – Moderate 12-14 RPE Duration – 30-60 minutes Mode = Aerobic Activity Tandem Bicycling, Treadmills, Sighted Guide Walking/Jogging

22. Exercise Prescription – Resistance Training Frequency – Each major muscle group trained 2-3 days a week Intensity – 60%-70% of 1RM (moderate to hard intensity) due to novice exerciser improving strength Time – No specific duration Type – Resistance exercises involving each main muscle group Repetitions – 8-12 to improve his strength and power Sets – 2-4 sets with rest intervals of 2-3 minutes in between

23. Exercise Prescription – Neuromotor Exercise Training Frequency – 2-3 times a week Intensity – Hard enough that it is challenging but easy enough that he is not risking injury Time – 20-30 minutes Type – Exercises involving motor skills, proprioceptive exercise training and multifaceted activities including tai ji, yoga, bosu ball training

24. Conclusion Being able to make modifications for those with visual impairment is crucial in helping them attain their goals and greatly reduce the risk of injury. An understanding of how they see the world and working within that is where most progress will be made. These clients and patients are going to rely on us to help them have a better quality of life and we can help accomplish this through our personalized exercise prescription.

25. References Guidelines for Trainers with Clients with Visual Impairments : NCHPAD - Building Inclusive Communities. (n.d.). Retrieved January 4, 2015, from http://www.nchpad.org/838/4261/Guidelines~for~Trainers~with~Clients~with~Visual~Impairments http://www.nchpad.org/838/4261/Guidelines~for~Trainers~with~Clients~with~Visual~Impairments (n.d.). Retrieved January 4, 2015, from http://jalili.co/covi/Academic/Reviews/ch07.pdfhttp://jalili.co/covi/Academic/Reviews/ch07.pdf Causes of blindness and visual impairment. (n.d.). Retrieved January 4, 2015, from http://www.who.int/blindness/causes/en/ http://www.who.int/blindness/causes/en/ The eye is our most important sensory organ, the window to the world and the prerequisite for an active life. (n.d.). Retrieved January 4, 2015, from https://www.eschenbach-optik.com/en/The-eye-and-eyesight.445.0.htmlhttps://www.eschenbach-optik.com/en/The-eye-and-eyesight.445.0.html How Blindness is Caused. (n.d.). Retrieved January 4, 2015, from http://www.mcwdn.org/Blind/BlindnessCauses.htmlhttp://www.mcwdn.org/Blind/BlindnessCauses.html Fitness for Individuals Who Are Visually Impaired or Deafblind. (n.d.). Retrieved January 4, 2015, from http://www.aph.org/pe/art_lieberman3.html