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

Vision Rehabilitation Throughout the Lifespan

Working with Older Adults with Low Vision

Chris Nelms, OTR/L, MLVRMay 7, 2011

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

PERFECT FIT FOR LOW VISION

OCCUPATIONAL THERAPIST

OCCUPATIONAL THERAPY

• Training in disability and aging

• Ability to address physical, psychological, cognitive and social needs of clients

• Safety assessments

Identifying the Challenges and Goals

• Reading• Medicine Management and Health• Money Management• Home Management• Communications• Home Safety• Food Preparation• Personal care and hygiene

Education

• Clients need to be educated about

–The eye disease they have

–The outlook for their future

–The expectations of vision rehabilitation

Rehabilitation Strategies

• Adapting the Environment–Lighting–Color and Contrast–Eliminate Clutter–Organize–Labeling–Magnification

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

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

Lighting

Lighting• 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

Contrast and Color• High contrast

makes it easier to locate objects

• Use of bright colors against white or black background

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

Eliminate Clutter

Organize

Labeling• Use tactile labeling

–Bump dots, Braille, puff paint

–Rubber bands, safety pins

• Use large print labels

• Use auditory labels

RNIB PenFriend

ID Mate Summit Bar Code Reader

Magnification• Use larger print – enlarge on Xerox,

buy large print books, write larger• Bring things closer• Use magnifiers

–Hand held–Stand–Video

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.

Resources for adaptive equipment

• Maxiaids.com

• Shoplowvision.com

• Independentliving.com

• LSSproducts.com

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

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

Vision is Understanding

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

Maximizing Vision through Eccentric Viewing/ PRL

• Determining near acuity

• Evaluation of the PRL

• Eccentric Viewing Training

• Improving Reading Ability

• Using it in ILS

Determine near acuity

• Single Letter Acuity

• Continuous Text Acuity

Evaluation of the PRL

• Use of the Clock Method

• Use of the Playing Card Method

CAT

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

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

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

Medications

• Large letter labeling

• Organization strategies

• Pill boxes

• Auto refill through the pharmacy

Diabetic Education

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

Talking Meters

• Prodigy Voice

• Prodigy Auto Code

• Advocate

• Advocate Redi-Code

Drawing up Insulin

• Safe Shot

• Count-A-Dose

• Syringe Support

• Insulin Pens

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

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

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

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

Resources for adaptive equipment

• Maxiaids.com

• Shoplowvision.com

• Independentliving.com

• LSSproducts.com