Transcript hospital/institute/center

Occupational Therapy &
Vision Rehabilitation
Presented by:
Margaret A. Waskiewicz MS, OTR/L
Unit Supervisor, Adult Outpatient OT
Special acknowledgement: Christina Finn MS, OTR/L
Defining Vision
•More than 20/20
•Ability to interpret and understand what we are seeing
•“It is the total ability to organize light input and recognize
spatial relationships between things and to build an internal
representation of reality” (Paul Harris, 1998)
Diagnosis
CVA/Stroke
**TBI**
Parkinson’s Disease
Multiple Sclerosis
Concussion
Common Vision Diagnoses
•Homonymous Hemianopsia
•Homonymous Quadrantonopsia
•Optic Neuritis
•Convergence Insufficiency
Common Visual Complaints
•“I get tired when trying to read”
•“When I turn too quickly I get dizzy”
•“I feel like it is difficult to find things”
•“I am seeing double”
•“My vision is blurry”
•“My depth is off”
•“I am skipping lines when reading”
Impact on Functional Activities
•Self-Care/ADL
•Household/IADL
•Reading/Computer/Work-Related Tasks
•Community Mobility & Driving
•Quality of Life
Occupational Therapy
Evaluation & Vision Screen:
What Do We Look At?
OT Evaluation:
•Functional complaints
•ADL:
•Managing buttons/fasteners
•Lower body self-care
•Showering
•IADL:
•Community:
•Grocery Shopping
•Crossing the street
•Navigating from home to
destination
•Household:
•Cooking
•Cleaning
•Laundry
•Paying bills/writing checks
•Work Related Tasks
•Writing, reading, computer
use
•Writing sample
•Wold Sentence Copying
•Reading sample
•DEM, K-D Test
•QOL: NFQ-25
**Consider quality and safety
not just independent or not!
•Physical Function
•Basic AROM
•Hand Eye Coordination:
•9 hole peg test
•Purdue pegboard
•Grip/Pinch
•Qualitative observations about
posture (head tilt, rotated head,
tilted pelvis)
OT Vision Screen:
•Basic Test of Near & Far
Acuity
•Oculomotor:
•Pursuits
•Saccades
•Ocular ROM (monocular and
binocular)
•consider if symptoms are provoked
•Binocular:
•Convergence/Divergence
•Brock String
•Stereopsis
•Worth 4 Dot for Suppression
•Eye Alignment:
• Phoria cards
• Cover/Uncover Test
•Visual Fields
•Visual Perceptual Testing
(LOTCA, Behavioral
Inattention Test, MVPT)
Adaptations, Interventions &
Treatment
Adaptations to Improve Comfort with
Reading and Computer Use
•Line Guide
•Colored Tints
•Anti-Glare screen
•Reduce Glare
•Ergonomics/Rest Breaks
Adaptations for Low Vision
•Increase Contrast
•Reduce Glare
•Reduce Clutter
•Assistive Technology:
•Screen Readers
•Screen Magnifiers
•Large button keyboards
OT Treatment for Oculomotor Skills
•Improving visual scanning/saccades
•Improving smooth pursuits/tracking
•Incorporate into functional activity
Posture & use of body movements are all considered!
OT Treatment for Oculomotor Skills
•Monocular/binocular strengthening
•H, X, O
•4-corners
•Clock
•Post-its
•Crossword Puzzle
•Letter cancellation
•Multi-matrix
•Vision coach
•Biometrics
Management of Double
Vision/Binocular Impairments in OT
•Compensation
•Partial Occlusion
•Teach eye teaming skills and how to
use in a functional context
•Integration of body movements with eye
movements
Management of Double
Vision/Binocular Impairments in OT
•Pencil push-ups
•Straw Piercing
•Brock string
•Thumb/Post-it
•Static
•Dynamic
•With environmental distractions
Referrals for Vision Rehab
•Appropriate Referrals
•Concussion with saccadic
impairment
•Visual Disturbance
•Diplopia
•Visuospatial neglect
•Concussion with convergence
insufficiency
•TBI with impaired saccades
•Dizzy patient of unknown
etiology with oculomotor
impairments
•Inappropriate Referrals
•Strabismus for several years
•Elderly patient with changes in
vision (ie. accommodation)
•Macular degeneration
•Glaucoma
•Cataracts
Who Is Involved?
•Occupational Therapist
•Neuro-ophthalmologist
•Neuro-optometrist
•Physiatrist
•Other rehab services
•PT
•Vestibular PT
•SLP
•Neuropsychology/psychology
•Nursing
•Social work
•Vocational rehab
Conclusion
•The visual system allow us to make sense of our world
and to be able to adapt to our ever changing environment.
•Our vision is also involved in up to 85% of our perception,
learning and mental acquisition of knowledge.
References
•Brown, C., Tolefson, N., Dunn, W., Cromwell, R. & Filion, D. (2001). The adult
sensory profile: measuring patterns of sensory processing. American Journal
of Occupational Therapy, 55, 75-82.
•Ciuffreda, K.J., Kapoor, N., Rutner, D., Sucholf, I.B., Han, M.E., & Craig, S.
Occurrence of oculomotor dysfunctions in acquired brain injury: A
retrospective analysis (2007)
•Goodrich, G.L., Flyg, H.M.,Kirby, J.E., Chea-Yo Chang, C., Martinsen, G.L.
(2013). Mechanisms of TBI and Visual Consequences in Military and Veteran
Populations. Optometry and Vision Science, 90, 105-112.
•Khan, F., Baguley, I.J., & Cameron, I.D. (2003). Rehabilitation after
traumatic brain injury. MJA Practice Essentials, 178, 290-295.