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1 Implementing Low Vision Rehab Assessment Intervention Planning.

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1 1 Implementing Low Vision Rehab Assessment Intervention Planning

2 2 Steps to Successful Intervention Identify the limitations the client is experiencing in daily occupations Determine how well the client is able to use remaining vision Design treatment intervention –Increase the visibility of the environment –Enable the client to use remaining vision more effectively

3 3 Client’s ability to use remaining vision Four key visual functions –Acuity –Contrast sensitivity –Visual field –Color vision

4 4 Acuity Measured using low vision test chart –Measures acuity from 20/20-20/1000 –Provides visual impairment level –Provides a rough estimate of the strength of the magnifier

5 5 Eye Dominance Test Materials –Card with 8mm hole –Target Important to know because it explains challenges in using magnifiers and remaining vision

6 6 Reading Acuity Best chart is MNread acuity Combination reading acuity and reading performance test Measures reading acuity to 20/400 Also measures reading speed and critical print size

7 7 Contrast Sensitivity Function (CSF) Ability to see image as it degrades in contrast from its background Important to know because most environment features are low contrast

8 8 Can you see the water on the floor? Reduction in CSF Client will have difficulty detecting low contrast features –Water spilled on a floor –Gray cars moving against a gray background –Facial features –A glass filled with water –Filling a glass with water

9 9 Scotoma and PRL Location Instruct client to look at center of the target and without moving his/her eye and tell you if certain areas of the target look blurry, faded, distorted or missing Note the location of the blurred or missing vision –Indicates location of scotoma Repeat-having client look off center to see if blurry area clears up –Indicates location of the PRL

10 10 Ability to use PRL Locate Track Gaze Shift

11 11 Color Vision Changes in color vision are largely caused by impairment of cone function –Always occurs to some extent with macular diseases Also occurs as a by-product of aging –Yellowing lens restricts short wave length color

12 12 Visual Skills for Reading Test (aka the Pepper test) Assesses visual decoding components of reading Determines whether the scotoma interferes with reading

13 13 Additional Information Dark/light adaptation Glare sensitivity Phantom vision

14 14 Intervention

15 15 Self Report Interview Format is Optimal Self report gives person chance to establish priorities Observation of a few key activities is necessary to confirm report –Some clients over or under estimate abilities

16 16 Treatment Approach Maximize use of current visual ability –Teach person to use remaining vision more effectively –Modify environment to increase visibility to enable client to use remaining vision

17 17 Develop Ability to Use PRL Establish efficiency of PRL as the new locus for spatial orientation Accomplished by presenting tasks that require proficiency using PRL –Challenging visual system/CNS to adapt Rationale: –Research shows poor control of gaze or unstable fixation contributes to the significantly lower reading rates observed in persons with macular scotomas –Proficiency using PRL is more predictive of reading ability than acuity

18 18 Training PRL Practice with Clock Locating, tracking, gaze shift Pre-reading exercises

19 19 Magnify Magnifier is not a magic pill but just a piece of adaptive equipment Changes with magnification –Reduced viewing field –Shortened focal distance –Monocular use of eye

20 20 Basic Technique: Stand Magnifier Lay the magnifier on the reading material View using the reading add of the bifocal Pull 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 read –Move the magnifier down to the next line

21 21 Basic Technique Hand Held Magnifier Begin by laying magnifier on the page and pulling it away until the print comes into focus View using distance portion of the eyeglasses Two techniques for reading –Hold the text steady and move the magnifier or –Hold the magnifier steady and move the reading material

22 22 Move-the-Magnifier Reading Technique Hold the reading material steady Move the magnifier across the page Return to the left side by moving the magnifier back over the line just read Move the magnifier down to the next line

23 23 Move-the-Reading-Material Technique Hold the magnifier steady Move the reading material under the magnifier Return to the left side by moving the reading material back under the magnifier over the line of print just read Move the reading material to the next line

24 24 Basic Technique Microscopes (Spectacles) Have the client locate the focal point by holding his/her hand up to the lens then moving it away until it comes into focus –Place the reading material there Can use either technique of moving the reading material or moving the magnifier Be sure the page is evenly illuminated at all times

25 25 Basic Technique: CCTV Be sure the client understands how the CCTV works –Location of the camera –Size and focus controls –Polarity –Operation of X-Y table Demonstrate each function and have the client practice

26 26 Basic Technique: CCTV Determine the smallest size print the client can see by starting at maximum magnification and gradually decreasing the size –Want smallest print possible to maximize the number of characters on the screen Find the area of the screen that the client can see best

27 27 Basic Technique: CCTV Break the task into small learning components –Start by moving the XY table for the client while the client concentrates on reading –Introduce operation of XY table by placing your hands on client’s hands and moving the table –After practice, remove your hands and have the client operate the table alone

28 28 Same reading technique is taught –Move the table to move the line of print across the screen –Return to the left side by returning over the same line of text before dropping down to the next line Outline columns with a marker to help the client keep his/her place

29 29 Handwriting Technique with the CCTV Reduce the level of magnification Have the client hold the pen and move the hand in until he/she can see the pentip Watch the screen when writing

30 30 Basic Instruction Principles Avoid fatigue and stress –Observe client very carefully –First treatment sessions should be short Ensure successful performance –Break the task down –Use good quality reading materials Sans serif font, spaced text, simple –Use reading materials client will enjoy

31 31 Control lighting –Good ambient lighting will reduce eye strain –Reading materials should be well illuminated (no glare) Make sure client is using good ergonomics

32 32 Increase Visibility of the Task Ensure lighting is optimal for task performance Use contrast to increase visibility of key objects and landmarks Minimize background pattern Magnify and enlarge Organize

33 33 Lighting Persons with macular disease perform better with additional light because it allows use of relative scotomas Orange areas (threshold scotomas can still function with good illumination decreasing the size of the scotoma

34 34 Desired Light Qualities Even illumination –No surface shadow Maximum lumens Minimum glare Flexible placement –To get optimum positioning

35 35 Address both room and task lighting –Room lighting Overhead light fixtures, floor and table lamps, windows –Task lighting Reading lamps, flashlights etc. Determine the type of lighting that works best –Incandescent –Fluorescent –Halogen –Full spectrum

36 36 Use Contrast to Increase Visibility of Key Components of Task Items

37 37 Minimize Background Pattern Like static on a radio, makes it more difficult to locate item needed Use solid colors on background and support surfaces Eliminate clutter When you can’t eliminate pattern, increase contrast of key structures

38 38 Use solid color for background surfaces

39 39 Reduce and Eliminate Clutter

40 40 Enlarge

41 41 Organize No organization Items grouped by type on separate shelves; handles marked with contrasting tape

42 42 Enhance Visual Components/ Augment with Other Sensory Input Use various materials to mark features of objects to increase their visibility or allow another sensory system to identify them 1 2 3 4 1. Colored plastic tape 2. Tactile adhesive dots 3. Black marking pen 4. Hi marks-tactual marking substance

43 43 Example of Combination of Visual and Tactual Marking Microwave key pad marked with hi marks Door opener marked with black velcro dot

44 44 Modify the Environment Eliminate clutter Store items only 1 row deep and unstacked Create work centers –Store items used for similar purposes together Locate items close to where they are used Make use of commercially available systems to organize closets, drawers etc.

45 45 Modify the Task Simplify –Eliminate tasks –Reduce visual steps Reinforce routine –Nailcare –Medications –cleaning

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