1 / 20

Occupational Therapy & Vision Rehabilitation

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

amoser
Download Presentation

Occupational Therapy & Vision Rehabilitation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Occupational Therapy & Vision Rehabilitation Presented by: Margaret A. Waskiewicz MS, OTR/L Unit Supervisor, Adult Outpatient OT Special acknowledgement: Christina Finn MS, OTR/L

  2. 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)

  3. Diagnosis CVA/Stroke **TBI** Parkinson’s Disease Multiple Sclerosis Concussion

  4. Common Vision Diagnoses • Homonymous Hemianopsia • Homonymous Quadrantonopsia • Optic Neuritis • Convergence Insufficiency

  5. 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”

  6. Impact on Functional Activities • Self-Care/ADL • Household/IADL • Reading/Computer/Work-Related Tasks • Community Mobility & Driving • Quality of Life

  7. Occupational Therapy Evaluation & Vision Screen: What Do We Look At?

  8. 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)

  9. 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: • Phoriacards • Cover/Uncover Test • Visual Fields • Visual Perceptual Testing (LOTCA, Behavioral Inattention Test, MVPT)

  10. Adaptations, Interventions & Treatment

  11. Adaptations to Improve Comfort with Reading and Computer Use • Line Guide • Colored Tints • Anti-Glare screen • Reduce Glare • Ergonomics/Rest Breaks

  12. Adaptations for Low Vision • Increase Contrast • Reduce Glare • Reduce Clutter • Assistive Technology: • Screen Readers • Screen Magnifiers • Large button keyboards

  13. 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!

  14. 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

  15. 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

  16. Management of Double Vision/Binocular Impairments in OT • Pencil push-ups • Straw Piercing • Brock string • Thumb/Post-it • Static • Dynamic • With environmental distractions

  17. 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

  18. Who Is Involved? • Occupational Therapist • Neuro-ophthalmologist • Neuro-optometrist • Physiatrist • Other rehab services • PT • Vestibular PT • SLP • Neuropsychology/psychology • Nursing • Social work • Vocational rehab

  19. 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.

  20. 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.

More Related