1. CH 59: Patient with a Sensory Impairment DH201 Clinician Sciences Lisa Mayo, RDH, BSDH “You have two hands, one to help yourself and the second to help others.” ?

2. 1.Visual Impairment 2.Hearing Impairment Objectives

3.  Definition: person with a disability who has a physical or mental impairment that substantially limits major life activities  Hearing & Visually impaired fall under this act  Business’s must provide services & devises Americans with Disabilities Act

4. Visually Impaired

5.  Cover a broad spectrum from the slightly affected to the completely blind with no perception of light  Many cases: blindness is secondary to a primary condition that may have been the cause of the blindness (ex: diabetes)  Legally blind: legal term, not medical  Central vision (or acuity) of not more than 20/200 in the better eye with correction (glasses)  Peripheral fields (side vision) of no more than 20 degrees diameter or 10 degrees radius Visual Impairment

6. Causes of blindness:  Leading cause: diabetic retinopathy, age-related macular degeneration, senile cataracts, glaucoma, vascular disease, trauma, infections  Children: ½ is of prenatal origin, particularly resulting from maternal infections (rubella, syphilis, toxoplasmosis) Visual Impairment

7. Which of the following is a visual impairment? A) Diplopia B) Otitis media C) Vertigo D) Tinnitus E) Sensorineural loss Review

8. A)Diplopia Diplopia is double vision. The other choices are all conditions that affect hearing. Answer

9. Legally blind is defined as central visual acuity of 20/100. This means that the person who has received the best optical correction can see at 100 feet what a normal-visioned person can see at 200 feet. a.The first statement is true, and the second statement is false. b.The first statement is false, and the second statement is true. c.Both statements are false. d.Both statements are true. NBQ

10. Legally blind is defined as central visual acuity of 20/100. This means that the person who has received the best optical correction can see at 100 feet what a normal-visioned person can see at 200 feet. a.The first statement is true, and the second statement is false. b.The first statement is false, and the second statement is true. c.Both statements are false. d.Both statements are true. NBQ

11. All but one of the following may be a problem for an 85-yr old woman with a vision problem. Which one is the EXCEPTION? a. Glare from the dental light b. Heavy shag rug in the waiting room c. Changes in color between the tile floor and the carpet d. Raised door thresholds e. Signs on the receptionist’s desk NBQ

12. All but one of the following may be a problem for an 85-yr old woman with a vision problem. Which one is the EXCEPTION? a. Glare from the dental light b. Heavy shag rug in the waiting room c. Changes in color between the tile floor and the carpet d. Raised door thresholds e. Signs on the receptionist’s desk NBQ

13.  Assistance in completing the personal questionnaire  Relay on your tone of voice more heavily than others (cannot see your facial expressions or body language)  Lower chair before bringing pt to the op & move all barriers out of the way  Explain why you are leaving the room and when you will be back  Guide dogs: do not distract the dog, do not touch the dog, ask pt where best place is for the dog (usually lie in the corner of the tx room) DH Care for the Totally Blind Patient

14. Clinical procedures  Describe each step in detail of your appt  Explain instruments, materials, flavors, etc…  Let children touch and hold non-sharp instruments so they can feel it and become familiar with it  Prepare pt for power instruments, water, prophy cup, ect…  Speak before touching patient DH Care for the Totally Blind Patient

15. Escorting a Blind Patient You Pt

16. When being escorted, a blind client holds the arm of the person acting as the escort just below the escort’s wrist. Then the client walks beside and slightly behind the escort. a.The first statement is true, and the second statement is false. b.The first statement is false, and the second statement is true. c.Both statements are false. d.Both statements are true. NBQ

17. When being escorted, a blind client holds the arm of the person acting as the escort just below the escort’s wrist. Then the client walks beside and slightly behind the escort. a.The first statement is true, and the second statement is false. b.The first statement is false, and the second statement is true. c.Both statements are false. d.Both statements are true. NBQ

18. Failure of the liquid in the eye to drain resulting in increased pressure and optic nerve destruction defines: a.Cataract b.Retrolental fibroplasia c.Retinitis pigmentosa d.Glaucoma NBQ

19. Failure of the liquid in the eye to drain resulting in increased pressure and optic nerve destruction defines: a.Cataract b.Retrolental fibroplasia c.Retinitis pigmentosa d.Glaucoma NBQ

20.  Chair position: supine may bother a pt with glaucoma (increase pain & pressure)  Light: avoid light in pt eye’s = increased sensitivity to light  OHI: position pt for best vision  Ex: glaucoma = no peripheral vision, so sit directly in front of pt  Cannot see fine detail (small radiograph) DH Care for Partially Sighted

22. Hearing Impaired

23.  Deaf: When hearing is impaired to the extent that it has no practical value for the purpose of spoken communication  Hard of hearing: defective but functional w/ or w/out hearing aid  Causes of hearing impairment  Outer, middle, inner ear mechanisms  Heredity, prenatal infection in the mother (rubella), birth trauma are significant in the earliest years Hearing Impairment

24. Marlee Matlin Golden Globes Academy Award Oscar http://www.youtube.com/watch? v=xSXaWa-brlc

25. Types 1.Conductive hearing loss: Outer or middle ear involvement of the conduction pathways to the inner ear 2.Sensorineural hearing loss: damage to sensory 3.Mixed hearing loss: combo 4.Central hearing loss: Damage of the nerves or nuclei of the central nervous system in the brain or the pathways to the brain Hearing Impairment Wilkins p.912

26. Conductive hearing loss is defined as damage to the: A) outer or middle ear conduction pathways to the inner ear B) sensory hair cells of the inner ear or the nerves of the inner ear C) nerves or nuclei of the central nervous system in the brain or the pathways to the brain D) inner, middle, and outer ear pathways Review

27. A) Outer or middle ear conduction pathways to the inner ear Conductive hearing loss is defined as damage to the outer or middle ear conduction pathways to the inner ear. Sensorineural hearing loss is damage to the sensory hair cells of the inner ear or the nerves that supply the inner ear. Central hearing loss is damage of the nerves or nuclei of the central nervous system in the brain or the pathways to the brain. Answer

28. Hearing Impairment

29.  Hearing aids  Electronic device that amplifies & shapes sound waves that enter the external auditory canal  In-the-ear model or Canal aid model  Cochlear implants  Small electronic device that helps provide a sense of sound to a child or adult who is profoundly deaf or severely hard of hearing  Does not restore normal hearing Hearing Impairment

30.  American Sign Language (ASL)  Fingerspelling in the air – combined w/ALS  Speech-reading (lip reading)  Write down instructions  Clipboard with a marker-type pen attached and large paper, at least 8-1/2 x 11 inches Modes of Communication

31. (Reprinted with permission from Lange LG. The Gallaudet survival guide to signing. Washington: Gallaudet University Press; 1990.)

32. (Adapted with permission from Lane LG. The Gallaudet survival guide to signing. Washington, DC: Gallaudet University Press; 1990.)

35.  Patient with hearing aid  Do NOT touch a hearing aid when it is turned on  Turn off when using a power-driven dental instrument  Patient with partial hearing ability  Speak clearly and distinctly  Face the patient  Eliminate interfering noises: suction Dental Hygiene Care

36. Speech-reader  Face them straight on, do not turn to side  Speak in normal tone, do not exaggerate words  Slow the pace of speech, pause more frequently than usual  Do not raise voice, raising voice can distort lip movements and make lip reading more difficult Dental Hygiene Care

37.  General suggestions  Written appointment card  Telecommunication Relay Service (TRS) to call a deaf patient directly with appointment reminders Dental Hygiene Care

38. A patient with a hearing aid may need which modification in delivery of dental hygiene therapy? A) Remove eyeglasses B) Cover ear canal with gauze C) Speak very loudly and slowly so the patient can hear you over other noise D) Remove or turn off hearing aid when using a power-driven scaler Review

39. D) Remove or turn off hearing aid when using a power-driven scaler It is important to ask patients with hearing aids to turn them off or to take them out when using a power-driven scaler. The noise can be amplified many times, making it uncomfortable for patients. All other modifications listed are unnecessary. Answer

40. Mr. Smith is 90 years old and wears a hearing aid. Which of the following will be important when communicating with Mr.Smith? a.Speak as loud as you can b.Speak slowly and enunciate c.Don’t communicate with him d.Communicate only with his spouse NBQ

41. Mr. Smith is 90 years old and wears a hearing aid. Which of the following will be important when communicating with Mr.Smith? a.Speak as loud as you can b.Speak slowly and enunciate c.Don’t communicate with him d.Communicate only with his spouse NBQ