Finding out about functional vision AAC SIG: Making Sense of AAC November 4th 2014
Jan 19, 2016
Finding out about functional vision
AAC SIG: Making Sense of AAC
November 4th 2014
Judy Bell
Independent consultant in visual impairment & complex needs
What the session will cover
Brief considerations of:• The nature of functional vision• The differences between functional &
clinical vision assessment • Who might carry out functional vision
assessment• The aspects of functional vision that will
impact on the choice and use of AAC• How these aspects might be assessed
The nature of functional vision
Functional Vision
Functional vision is the way an individual uses his or her sight in everyday situations
Functional Vision
An individual’s level of functional vision will vary according to both internal (e.g. health, hunger, tiredness etc.) and external conditions (e.g. location, lighting etc.)
Functional and clinical vision assessment
Functional vision assessment
• Assessment is via observation of structured activities and interaction in everyday situations
• Assessment takes place in an environment which is familiar to the individual
Clinical assessment of vision
• Direct clinical examinations are undertaken
• Standardised test material is used
• Assessment is usually within a clinical setting such as an optometrist’s examining room or hospital clinic
Individuals involved in functional vision assessment
• Often co-ordinated by a QTVI or QTMSI although anyone who knows and works with the individual can undertake such an assessment
• The observations of those who know the child well contribute to the assessment
Practitioners who may be involved in clinical vision assessment
• Ophthalmologist (eye doctor)• Optometrist (ophthalmic optician)• Orthoptist (specialist in binocular vision & eye
movements)• Paediatrician• School nurse
Usually these practitioners are not familiar to the individual
Aspects covered by clinical vision assessment
• Appearance & health of eyes• Refraction• Eye movements• Alignment of gaze & binocular vision • Visual acuity (distance)• Visual acuity (near)• Visual field• Contrast sensitivity• Colour vision
Aspects covered by clinical vision assessment
Visual acuity (distance)
Visual acuity distance: Snellen
• Fraction-like figure, e.g. 6/6, 6/12, 6/18, 6/24, 6/36, 6/60
• Bottom figure refers to the distance at which an individual with normal sight would be able to perceive image clearly
• Top figure refers to distance at which the person being tested is able to perceive the image clearly
Visual acuity distance: logMAR
Using the logMAR system, visual acuity is recorded as a decimal figure 0.0 to 1.0.
1.0 equates to Snellen 6/60
0.6 equates to Snellen 6/24
0.1 equates to Snellen 6/7.7
0.0 equates to Snellen 6/6
Clinical vision: Assessment to threshold
• Clinical vision assessment tests to the threshold at which an individual is able to see clearly
• No individual will willingly perform to visual threshold 100% of the time
Functional vision: Assessment of typical use of vision
• Functional assessment identifies how an individual uses his or sight in identified situations
• Functional vision assessment provides a picture of an individual’s ‘typical’ use of vision in everyday situations
Clinical and Functional Assessment
• Functional assessment should be ongoing
• Clinical assessment needs to be undertaken on a regular basis
Clinical and Functional Assessment
• Together, the clinical and functional assessment of vision provide a full picture of the visual needs of an individual
• Both will be required in order to determine the nature of AAC to be used.
Aspects of functional vision that will impact on the choice and use of AAC
AAC: Aspects of functional vision
Initial considerations:
• Willingness/reluctance to use vision
• Preferred sensory channel(s) – single or multi-channel
• Variability of vision
AAC: Aspects of functional vision
• Near vision will be main, but not only, concern
• If signing is used, an assessment of distance vision will be important in order to establish optimal distances
• Difficulties with distance vision will affect incidental learning & subjects available for communication
AAC: Aspects of functional vision
Near vision – consider preferred
• Lighting: – Strength – Type (natural, colour, LED, overhead,
backlighting, task etc.)
AAC: Aspects of functional vision
Near vision – consider preferred
• Size of stimulus (bigger not always better)
• Distance of stimulus (function of size)
• Position of stimulus (direction and plane)
AAC: Aspects of functional vision
Near vision – consider preferred
• Contrast
• Colour
• Tone
AAC: Aspects of functional vision
Colour, tone & contrast
Colours of a similar tone – poor contrast
Photocopy
Colour, tone & contrast
Colours with tonal contrast
Photocopy
Colour, tone & contrast
AAC: Aspects of functional vision
Near vision - consider
• Tracking skills: direction, speed, midline
• Scanning skills: direction, speed, midline, coverage
• Shift of attention from one stimulus to another: direction, speed, midline, coverage
AAC: Aspects of functional vision
Near vision - consider
• Visually directed reach and grasp– Locate, look & reach or….– Locate, look away & reach
AAC: Aspects of functional vision
Near vision - consider
• Clutter – stimulus & stimulus/background
• Visual distraction
AAC: Aspects of functional vision
• Clutter – stimulus & stimulus/background: Visual distraction
AAC: Aspects of functional vision
• Clutter – stimulus & stimulus/background: Visual distraction
AAC: Aspects of functional vision
• Clutter – stimulus & stimulus/background: Visual distraction
AAC: Aspects of functional vision
Near vision - consider
• Time taken for visual processing & response
AAC: Aspects of functional vision
Near vision – consider preferred• Movement of stimulus
– Constant – Intermittent– Still
• Sound production related to stimulus– Nature– Duration – intermittent or constant
• Nature of images– Photographs or drawings
How aspects of functional vision might be assessed
Functional vision assessment
• Observation in normal environment
• Observation of structured intervention and response
• Interview with those who know individual in different settings
Functional vision assessment
• Various schedules and profiles
• JB 2009 – Functional vision observations & assessment sheets – downloadable from website
Contact
Judy Bell
07748 657463
www.judybellassociates.com