Occupational Therapy & Visual Rehabilitation Presenter: Linda Clemente, OTR/L HealthSouth Rehabilitation Hospita

1. Occupational Therapy& Visual Rehabilitation Presenter: Linda Clemente, OTR/LHealthSouth Rehabilitation Hospital of Tinton Falls

2. What is Occupational Therapy? An allied health profession that uses “occupation” or purposeful activity to help people with physical, developmental, or emotional disabilities lead independent, productive, and satisfying lives.

3. Goals of Occupational Therapy It is the application of core values, knowledge, and skills to assist clients to engage in everyday activities that they want and need to do in manner that supports health and participation. O.T.’s provide skills, compensatory techniques, and adaptive techniques in order to improve performance as a holistic approach.

4. Occupational Therapy should be meaningful, purposeful, and enjoyable. • A fundamental concept in O.T. is that the activity (occupation ) must be interesting and must intrinsically promote correct movement or behavior. • The ultimate goal is to have people return to their highest level of independence in their self care and activities of daily living, including leisure, and work hardening.

5. Professionals on the Rehab Team • Vision rehab is a team effort • Physiatrist • Internal Medicine • Nurses • Ophthalmologist • Neuro-optometrist • Occupational Therapist • Physical Therapist • Speech Therapist • Psychologist /Social Worker

6. Additional professionals include- Orientation Mobility Specialists: When visual acuity is impaired to create travel limitations. Certified Vision Rehabilitation Therapist: When vision is so impaired that blind technique is necessary. Teacher of the Visually impaired: Involved if client is K- 12.

7. What O.T is NOT : O.T. is NOT visual therapy O.T.’s DONOT diagnose O.T’s DO NOT consider low vision or visual deficits without it’s relationship to performance in A.D.L’s

8. Vision is a complex and dynamic neurologic process The eyes collect light which is transferred into a signal that is sent to the visual center of the brain. It is those signals that the brain translate into what we know as vision.

9. TWO VISUAL SYSTEMS Anterior Visual System All structures anterior to the optic chiasm: cornea, iris, pupil, lens, aqueous and vitreous humor, retina, and optic nerve. 2. Posterior Visual System Optic chiasm, optic tracts, lateral geniculate nucleus, superior/inferior colliculi, geniculocalcarine tracts, and the occipital cortex

10. The cortical processing centers assist in processing visual information. These centers include: the temporal and parietal circuits, prefrontal and medial temporal lobe, the brain stem, and the cerebellum. The TRIAD of the anterior, posterior, and cortical system allows for functional vision. All components compliment one another.

11. The visual system is closely linked with our motor/postural and vestibular systems. This enables us to plan movements, move within our environment, an maintain an upright position in space. The visual system allows us to accurately attend to environmental information, integrate it, and use it to make daily decisions

12. Vision is the primary way we acquire information It is the primary way we acquire patterns. 1/3 to 1/2 of the brain is devoted to pure visual processing. 90% of sensory input is VISION.

13. *Vision is the FIRST system to alert us to danger or pleasure. *Vision enables us to be anticipatory. *Vision allows us to plan for situations.

14. Vision provides speed -We can instantly identify an item with vision. -We can also use other senses, but it will take longer. -Vision allows us to adapt to dynamic environments( a temporal/timing component things are moving in addition to you moving)

15. WE USE VISION FOR: -Decision Making-executive functioning. -Social Interactions-facial expressions. -Motor and postural control-planning ahead for what we will encounter ie. ice, stairs, closed door.

16. We are visually dependent!!!!! It is NOT easy for other systems to take over, especially with age. People will always attempt to use vision to complete occupations and activities.

18. Visual Hierarchy Model Visual acuity needs to be assessed prior to treatment techniques of fixation, scanning, tracking for eye hand coordination to perform ADL’s The building block for increased independence with ADL’s and functional mobility.

19. Adaption through vision Visuocognition Visual memory Pattern Recognition Scanning Attention= Alert and Attending Oculomotor Control Visual Field Visual Acuity vvVVpPsOOCOsasWWWWWW Warren 2009

20. Visual Impairment: Can occur secondary to illness, trauma, and age • Disease/Condition: • Parkinson’s • Multiple Sclerosis • Degenerative myopia • Diabetic retinopathy • Glaucoma • Optic Nerve Trauma / Atrophy • Stargardt’s disease • Degenerative myopia

21. Trauma: Stroke Traumatic Brain Injury Aquired Brain Injury Age: Cataracts Age related Macular Degeneration ******Combination of causes*******

22. Visual Impairment 1. The quality and amount of visual input into the brain can be altered. (the acuity can be changed) 2. The brain’s ability to process normal visual input can be altered. BOTH can be altered. EITHER WAY………. THERE IS A DECREASE IN THE ABILITY TO USE VISION FOR OCCUPATIONS

23. Consequences of Visual Impairment Difficulty completing VISION DEPENDENT activities (reading and driving are the two most important vision dependent tasks). Feeding, grooming, dressing are less dependent on vision. Decreased SPEED in completing tasks and Errors in decision making when vision is impaired

24. Behavioral Changes that can occur with vision impairment: • *Decreased Confidence • *Increased anxiety and uncertainty in responding to the environment • *Increased passiveness in decision making • *Difficulty with tasks in dynamic environments • *Community activities are the most challenging: • driving • shopping • working • participation in sports

25. O.T. Screening *** Make sure client has glasses on*** ***Make sure they are clean*** ** Check side effects of medication** Make sure vision is assessed appropriately through a optometrist and continue the communication between staff to ensure success of treatment goals and patient satisfaction.

26. THREE GENERAL PRINCIPLES FOR ENHANCING VISUAL PERFORMANCE Increase visibility of the task or the environment…..make things brighter A. Use contrast to increase visibility

29. B. Minimize the background Pattern Clean up the clutter Organize similar items/separate colors.

30. Minimize background pattern

31. Organize

32. C. Provide Optimal Lighting Even illumination Minimize glare Flexible placement: aim for even illumination and brightness Task lighting Carry a penlight

33. *Fluorescent Lighting: even illumination, but limited placement flexibility ( pulsing light bothers some people) **Halogen Lighting: high quality light minimum glare, but is “hot light” ***LED Lighting: Instant on, high intensity, low glare ****Simulated daylight light: increases contrast, increases clarity, low energy

34. D. ENLARGE: make things BIGGER Enlarge with Contrast ie. Large button calculator Large button remote Large print cards, bingo Move in closer

35. E. MANAGE GLARE SENSITIVITY Reduce glare sources Use proper window covering Cover reflective surfaces( floors, shiny counter) Use filters to control incoming light(wear clip on or fitover glasses, visor may be helpful)

38. 2. ORGANIZE Structuring your physical space helps with cognitive functioning. Increased participation if things are organized. Predictability of the physical space.

39. 3. Simplify Tasks Eliminate steps that require vision Address both the cognitive and visual impairment

40. Homonymous Hemianopia

41. Behavior Changes in H.H 1.Persons will adopt a narrow search pattern confined to the sound side or midline 2.Person will scan VERY slowly towards deficit side—This slows down a person during ADL’s and can affect their ability to navigate through dynamic environments

42. 3. Person misses or misidentifies visual detail on the blind side Person has impaired reading performance Person has difficulty with tasks that have small detail 4. Person has reduced monitoring of the hand Person has impaired grapho-motor skills Person has difficulty pouring liquids

43. 5. Person has changes in Mobility Appears hesitant, anxious Person prefers to follow vs lead Person exhibits an uncertain gait Person tends to watch their feet Trailing of arms with ambulation Comes very close to obstacles Often stops to search

44. 6. Changes in Orientation Insufficient visual input to accurately map space on involved side. An inability to scan fast enough to comprehend scene as a whole Tendency to get lost Tends to avoid independent travel Very uncomfortable navigating alone

45. 7. Changes in reading **** Omissions on the involved side Misidentification of words and numbers Poor page navigation may skip lines Reduced reading accuracy and speed ***** reading is not always involved if the fovea is not

46. 8. Changes in Handwriting*** Writing may drift up/down on the line May write on top of other words Positions words incorrectly ****This occurs only if the H.H is on the same side as the dominant hand

47. 9. Changes in A.D. L. This happens in areas that depend on vision to complete Requires monitoring of a wide visual field Driving Shopping Community Events Yard Work Meal Preparation Financial Management Housekeeping Selfcare

48. What do we do? Spontaneous and complete recovery will not occur for many clients THE KEY IS COMPENSATION To teach compensatory strategies , you must know the location and extent of the visual field deficit

49. Person must learn to use their remaining vision more effectively to compensate for missing vision Environment must support participation Compensation/adaptation is a client’s only option since a visual field deficit might have a permanent impairment

50. Education is a KEY adjunct to intervention. Education assists a client to become aware of location and extent of deficit. Education lets a client know how it has affected their occupational performance.