1. Vision Rehabilitation Throughout the Lifespan Working with Older Adults with Low Vision Chris Nelms, OTR/L, MLVR May 7, 2011

2. The Goals of Independent Living Skills Training with the Older Adult Help them remain in their home safely and independently Develop ways to use their remaining vision Help then know how and when to use devices and strategies in addition or instead of their vision to do independent living skills Safety

3. PERFECT FIT FOR LOW VISION OCCUPATIONAL THERAPIST

4. OCCUPATIONAL THERAPY Training in disability and aging Ability to address physical, psychological, cognitive and social needs of clients Safety assessments

5. Identifying the Challenges and Goals Reading Medicine Management and Health Money Management Home Management Communications Home Safety Food Preparation Personal care and hygiene

6. Education Clients need to be educated about –The eye disease they have –The outlook for their future –The expectations of vision rehabilitation

7. Rehabilitation Strategies Adapting the Environment –Lighting –Color and Contrast –Eliminate Clutter –Organize –Labeling –Magnification

8. Lighting Appropriate lighting can make all of the difference to a person with Low Vision Lighting is preferential you need to look at the glare and quality of light to see what works best for the client

9. Lighting The closer the light is to the object the more intense and brighter it appears Light should be directed towards what you are trying to see

10. Lighting

11. Incandescent bulbs are cheaper to buy, but use more electricity and are hotter Fluorescent bulbs use less electricity and are cooler to use Halogen bulbs use less electricity but are very hot LED bulbs are the most efficient in their use of electricity and last the longest

12. Contrast and Color High contrast makes it easier to locate objects Use of bright colors against white or black background

13. Color and Contrast Pouring coffee into a white cup and milk into a dark cup or glass Cutting meat on a white board and chicken on a black cutting board Using a towel of contrasting color on a light surface to find things

14. Eliminate Clutter

15. Organize

16. Labeling Use tactile labeling –Bump dots, Braille, puff paint –Rubber bands, safety pins Use large print labels Use auditory labels

17. RNIB PenFriend

18. ID Mate Summit Bar Code Reader

19. Magnification Use larger print – enlarge on Xerox, buy large print books, write larger Bring things closer Use magnifiers –Hand held –Stand –Video

20. Magnification The higher the magnification the smaller the field of view - Stronger isn’t always better Each magnifier has its own length of focus and it is important to keep the magnifier that distance from what you are reading.

21. Resources for adaptive equipment Maxiaids.com Shoplowvision.com Independentliving.com LSSproducts.com

22. Maximizing Vision through Eccentric Viewing/ PRL What is a PRL? Preferred Retinal Locus That area of the retina that the best visual acuity can be located on. Learning to use another part of the retina to see takes training

23. Vision is more than 20/20 sight 20/20 sight only describes whether a person can read a letter 3/8 of an inch in height from 20 feet It does not tell anything about color vision, peripheral vision, depth perception or other visual skills that we use daily

24. Vision is Understanding

26. Eccentric Viewing Is training the client to point their eye in a different direction to see better Is training the brain to understand what it is seeing with a different part of the retina

27. Maximizing Vision through Eccentric Viewing/ PRL Determining near acuity Evaluation of the PRL Eccentric Viewing Training Improving Reading Ability Using it in ILS

28. Determine near acuity Single Letter Acuity Continuous Text Acuity

29. Evaluation of the PRL Use of the Clock Method Use of the Playing Card Method

31. CAT

33. Eccentric Viewing Training Using PRL to see single letters or short words Using PRL to see ILS items Using PRL to see Faces Using PRL with Optical devices

34. Improving Reading Ability Retraining the brain to understand what it is seeing and how to look with the PRL Starting with short words and good spacing and progressing Starting at an appropriate size type and working towards their goal

35. Using PRL in Daily Living Using PRL to see markings better rather than feeling for them. Practicing using the PRL for watching television or when looking at friends or family

36. Medications Large letter labeling Organization strategies Pill boxes Auto refill through the pharmacy

37. Diabetic Education Research shows that keeping the blood glucose at a stable level, will help reduce the diverse secondary effects of Diabetes

38. Talking Meters Prodigy Voice Prodigy Auto Code Advocate Advocate Redi-Code

39. Drawing up Insulin Safe Shot Count-A-Dose Syringe Support Insulin Pens

40. Safe Shot Safe Shot (#80010) –Can use any syringe –Needs a sighted person to set it at the correct setting –Good for large doses of insulin

42. Prodigy Count-A-Dose Count-A-Dose (#50166) –Used with 50 unit ½ cc syringes –Counts in 1 unit increments –Can be used with 2 bottles of insulin –Cumbersome to do large doses of insulin

44. Syringe Support Syringe Support (#50113) –Used with 100 Unit 1cc syringes –Each rotation in 2 units of measure –Cumbersome to do large doses of insulin

46. Insulin Pens Available by prescription only Not available in all types of insulin More expensive than regular insulin and syringes Cumbersome to do large doses of insulin

49. Resources for adaptive equipment Maxiaids.com Shoplowvision.com Independentliving.com LSSproducts.com