Transcript Low Vision Functional Assessment for O/M’s

Evaluating, Communicating and Applying
Results
Flavia Steiner-Viggiani, M.Ed. COMS,
CLVT
Welcome Everybody!
Michigan AER Conference, 2009
Goals for this workshop
 Develop a better understanding of the
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components of a FVA and how they relate to a
meaningful educational practice.
Gain experience in performing some of the
assessment techniques.
Learn how to structure the information in a
comprehensive report.
Explore some of the possible goals for a mobility
program based on the results of the FVA
Get ideas on materials, toys and charts used.
Share challenges and ask questions
Michigan AER Conference, 2009
Characteristics of a Meaningful
Functional Vision Assessment
Relevant,
comprehensive
and holistic
It looks at VISION within a
CONTEXT
Looks at vision as
a dynamic process
Communication
Emotions
Cognition
Establishes the
STRENGHTS =
Educational
Tools
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Exposes the
CHALLENGES=
Educational
Goals
And Objectives
80 % Observation
20% evaluation, testing and
structured activities
A process that helps us grow as
teachers and makes us look at
students as completely unique
individuals
Michigan AER Conference, 2009
How does the process look like?
1. Preparation and Observation
2. Thinking, wondering and evaluating
3. Communicating
4. Moving Forward
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Preparation
What do you know about the student?
Concerns or questions
From teachers, specialists and family
members.
Medical Records and/or Reports
Ocular and Medical records, educational
evaluations,
previous educational concerns stated in
the IEP
Michigan AER Conference, 2009
Rules for a thoughtful
Observation
1. Be quiet. Sit and observe without getting
involved in anything else. Be 100%
present in that moment.
2. Don’t assume. Just observe and learn.
3. Take your time to find the uniqueness of
this particular student.
4. When you feel comfortable, start writing
down some of your observations.
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Observing the student
 NEAR TASKS:
 Lunch, table work, snack, reading, art, science.
 INTERMEDIATE TASKS:
 Recognizing people, reading close signs, social
interactions
 DISTANCE TASKS:
 Traveling, reading signs, recognizing people without
sound input, looking at traffic signals, circle time,
copying from the board.
Michigan AER Conference, 2009
Observing the environment and
relevant educational aspects
 Illumination:
 Levels and types of illumination, contrast and glare
 Environment:
 complexity and amount of sensory input
 Use of other senses:
 visual vs. tactile, auditory
 Levels of assistance:
 degrees of independence and motivation
 Communication:
 concrete symbols, pictures, verbal, multi sensory.
 Emotional behavior:
 Frustration levels, stamina, advocacy.
 Community traveling skills
 Levels of Independence, Orientation, Mobility skills, Visual awareness
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Ivan
Cognitive delays
Cerebral Palsy
PVL
Optic Nerve Atrophy
TVI
OM
PT
Speech and Language
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Thinking, Wondering and Evaluating
What do I need to know?
What areas do I need to evaluate further after
observing the
student?
Components of the FLVA
How will I structure the environment?
Complexity, lighting, familiar people, brakes, contrasting
surfaces.
What materials are appropriate for this student?
Age, interests, salient features of objects, size, textures,
cognitively meaningful.
Michigan AER Conference, 2009
Planning and Evaluation
General observation (ocular health)
Near and Distance Vision (clinical, functional)
Visual Fields (gross observation)
Color awareness (matching, preference)
Ocular Observations (alignment, motilities)
Visual behaviors (visual skills)
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General Observation of Ocular Health
EYE APPEARANCE
1. Eyelashes
2. Conjunctiva
3. Cornea (opacity,
cloudiness)
4. Rubbing, scratching,
watering
5. Inflammation.
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Formal Visual Acuities at Distance
and Near
Formal or Clinical VA
 Uses clinically calibrated visual charts
to obtain resolution acuity results
(object identification)
 Require the cognitive ability to identify
pictures or letters
 Usually designed for testing at 10 feet
(distance)
 At near, they are designed to be tested
at 40 cm.
 “At 10 feet of distance, Flavia was able to
identify a 3.5 in. symbol, which
represents an acuity of 20/200 using the
Patti Pics Chart”
 “Flavia was able to identify a 4 mm. size
letter at 10 inches” (functional
notation)
 ALWAYS make a copy of the actual
chart for a concrete representation
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Functional Visual Acuities
Functional VA
 Used in very young children or
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students and adults with
intellectual disabilities.
Students who present challenges
staying visually attentive or
motivated.
Uses real life motivating objects
It is a good idea to start from a
distance and move closer to identify
the point when the student makes
eye contact or reaches out.
It is notated using the size of the
object FIRST and then viewing
distance.
It specifies the conditions of the
environment.
“Flavia is able to identify a 2 in. tall,
green cereal bowl from 5 feet when
placed on the table on a black mat”
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Converting Formal Visual Acuities
into Snellen Notation
 The goal is to obtain a fraction with the
number 20 in the numerator (top number)
 For example, if the acuity is 5/80, by
multiplying 5 times 4, we obtain a numerator
equal to 20.
 We use the same number 4 to multiply the
bottom number 80 (denominator)
 The Snellen acuity is: 20/320
 Incorrect: 20/60 at 5 feet.
 Correct: 5/60. Visual acuity is: 20/240
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Let’s Practice!
An acuity of 10/100 is:
20/200
An acuity of 5/40 is:
20/160
An acuity of 5/400 is:
20/1600
An acuity of 10/15 is:
20/30
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Peripheral Visual Field
Assessment
 Modified Confrontation with both eyes
open
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Best performed with two evaluators involved.
Functional and qualitative. Not clinical.
Uses 2 targets: one central and one peripheral.
Target needs to be symmetrical.
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Flashlight or penlight
Lava flashlight
Toy and hanger
Small finger puppet
Let’s do it!
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How do we communicate the
results?
 Use observational terms, not clinical diagnostic terms.
 Flavia was able to identify the presence of the 1.5 in. yellow star on
the right side of the peripheral field without difficulties. However,
when the target was presented inferiorly, Flavia spotted the star when
the object was almost at chin level. When the target was presented
from the left side, Flavia had difficulties spotting the object until it
reached a distance of 1 or 2 inches of her face. She did not appear to
have challenges identifying the star superiorly”
 If you have any difficulties testing or if the results are not consistent
or reliable, or if there are no eye reports or visual field testing done
in the past, always refer the student for more testing in a clinical
setting.
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Color discrimination and
awareness
 Color helps us determine:
 Contrasting surfaces
 Type of print and color based on background
 Challenges identifying objects around the environment
 Predominant color for tactile symbols, maps, and objects in
the environment (street signs, bus numbers, pedestrian
signals, traffic lights)
 What materials can we use?
 Wheatley Kit with shapes and colors
 Color squares (Paint catalogues)
 Interactive games that include color (Candyland®, Legos®)
 Color sticks or beads
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Ocular Observations
Are both eyes aligned? Are they deviated? When?
1. Observe if both eyes work as a team, move together
in a steady fashion and remain centered when the
child is looking “centrally” or in “primary gaze”.
2. Many children with multiple disabilities have eye
turns or deviations, especially those with Cerebral
Palsy.
3. What are some of the implications of eye turns?
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Ocular Motilities
 Ability of the eye muscles to control eye movement. It
is directly related to the ability of the eyes to move
together as a team in all positions of gaze.
 What materials do we use?
◦ Follow a penlight
◦ Follow an object without a sound (puppet, toy, shinny object,
slinky, fun pencil erasers, key chains, etc)
◦ Ask the student/client to follow the object with their eyes only
without moving their heads. Make note of difficulties!
Note: make sure that the only stimulus is visual, so that the
student
is not following the sound, but only the object.
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Visual Skills
 Shifting Gaze (changing visual attention
between two objects)
 Tracking (following a moving target)
 Scanning (organized search pattern)
Materials used:
 Wooden beads, toys
 M&M’s over a contrasting surface
 Moving toy (car or ball) Without a sound!
 Puppets
 Illuminated toys
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Thinking about a telescope?
Consider these aspects:
 Visual field
 Visual acuity
 Physical/cognitive issues
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Thinking about incorporating a
telescope
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Look at the distance acuity
Calculate diopters
Divide by 4 to obtain the X power of magnification.
Example: Acuity: 20/400
400 divided by 20= 20Diopters
20 divided by 4= 5X
Always star with something slightly below the
magnification. For example, start with 4X telescope and
evaluate functionally how it works.
 Make sure that you share this information with the whole
team, doctors and parents, so that everyone is on the same
page. Doctors can also assess acuity using the telescope in
the clinical setting and make other recommendations.
Michigan AER Conference, 2009
Communicating your
findings
Writing the report:
Always use observational statements
“John appeared to be visually distracted by the activity in the
classroom, the sounds of the environment and the visual stimuli”
Include all aspects related to visual behaviors
John was not using any communication method or system during the
evaluation. It seems that he has difficulties focusing on two dimensional
pictures. However, he did seem to be interested in concrete objects.
Always include: cognition, communication ,emotional
aspects and how they relate to vision.
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Thinking about O/M Goals
 Language
 How does the student communicate and understand?
 What are some of the Speech and Language goals?
 Physical Considerations:
 What are the strenghts and limitations?
 What are some of the PT goals?
 Cognition:
 What is the learning style of this student?
 What are the academic goals?
 Vision:
 What is the learning media? (tactile, Braille, large print)
 What are some of the Vision goals?
Michigan AER Conference, 2009
Ivan’s IEP Goals
1. Speech: “Nori will increase the use of relevant language within the context
of social interactions.”
2. Vision: “Nori will demonstrate tactile awareness and discrimination.”
3. O/M: “Nori will increase his orientation skills in familiar and unfamiliar
environments”
4. Physical Therapy: “With the use of special adaptive equipment, Nori will
improve his up-right posture and gait.”
5. Academics: “Nori will increase his understanding of ascending and
descending numbers on a line from 0 to 100.”
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Ivan’s School Job
Attendance Helper
Skills:
1. Build a tactile map of the school building.
2. Determine routes and sequence of classrooms.
3. Cane practice
4. Social skills and use of language.
5. Development of tactile skills and recognition of
raised numbers.
6. Increasing endurance, walking, posture and
dexterity. Michigan AER Conference, 2009
Same Goal but Different Road
“Nori will use a hand-made tactile map to find at least 3 destinations
within the school building”
“Nicholas will choose a desirable destination within the school building by
choosing between 2 real pictures”
Same goal: Understanding the layout of the school building
Different Road:
Tactile map vs. real pictures (learning media, functional vision)
Complexity of the task (cognition)
Amount of assistance (advocacy, cognition, emotional)
Forced choice vs. more flexibility (cognition)
Language vs. pointing (communication)
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Questions?
Michigan AER Conference, 2009
[email protected]
Michigan AER Conference, 2009