Rehabilitation of the Visually Impaired

Diplomate Emeritus in Low Vision

Frank W. DiChiara O.D. F.A.A.O.

• Publisher: Page Publishing, Inc.
• Year: 2021
• ISBN:
  9781662424472
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

This book is about the visually impaired. It describes the usual elements of low vision—the low-vision examination, the corrective devices, microscopes, telescopes, hand and stand magnifiers, and nonoptical aids. There is so much more, and the book can be a great reference for the social worker, the physical therapist, the occupational therapist, the optometrist and ophthalmologist, and anyone who works with visually impaired individuals. There is a wealth of information that our authors have made available to the reader. The optics are simple to understand. Anyone who works with visually impaired will comprehend the pathology as most will have been exposed to them.

Contributions have been made by prominent men and women such as Dr. Paul Ajamian, Dr. Wayne Hoeft, Dr. Lawrence Kline, Dr. William Padula, Dr. Bruce Rosenthal, Dr. Tracy Williams, and Dr. Norman Weiss. They are some icons in the field of low vision.

Chapter One

Vision Rehabilitation

Christopher A. Butler, BA,

Executive Director of In-Sight

What is Vision Rehabilitation?

Low-vision evaluations provide a critical bridge to independence for people living with vision loss. Teaching patients the proper use of directed lighting, magnification, glare control, lenses, and other devices helps people to use their remaining vision more effectively and efficiently.

For adults living with vision loss, however, the low-vision evaluation may only be the first step on the road to independence. Vision rehabilitation programs are a logical next step for people with visual impairments as they provide the tools, techniques, and peer support needed to increase confidence and independence at home, school, work, and in the community.

Vision rehabilitation programs can comprise a number of different specialties, including independent living skills training, assistive technology, orientation and mobility, peer support groups, reading services, and recreational programs.

Vision rehabilitation programs are offered in every state through nonprofit agencies that specialize in working with people who are blind and visually impaired, state government agencies, the veteran’s administration, as well as some for-profit companies that employ professionals such as occupational therapists.

Vision rehabilitation, when offered through a nonprofit VA hospital or state agency, is typically provided at low or no cost to the patient. Many of these agencies offer center-based programs as well as training that can be provided in a patient’s home or in the community. Some agencies also offer residential programs that house people for the duration of their training, which provides the opportunity to practice skills without the distractions and obstacles that they may encounter at home.

Different agencies have their own admission standards and may require a patient to be below a certain income level, have a certain level of acuities or fields, or live within a particular geographic area in order to qualify for some services.

Vision rehabilitation programs are typically staffed by certified vision rehabilitation teachers (CVRT), certified orientation and mobility specialists (COMS), certified low-vision therapists (CLVT), social workers, and other specially trained professionals who are skilled at helping people living with visual impairments to achieve their independent living goals.

The VisionServe Alliance (https://visionservealliance.org/) has a comprehensive list of nonprofit agencies that provide services for people who are blind and visually impaired.

Independent Living Skills Training

When someone is living with a visual impairment, especially when its onset is later in life, even the most basic tasks can seem like an insurmountable challenge. Everything from putting toothpaste on a toothbrush to eating out in a restaurant suddenly becomes a source of anxiety and frustration.

The fear of being embarrassed, lost, or unable to successfully complete a task may lead the person to exhibit feelings of isolation, depression, and anger.

The important thing to understand is that people who are blind and visually impaired can do almost anything that fully sighted people can do. With advances in technology, combined with common sense adaptations, people with visual impairments live full, active, and happy lives.

Independent living skills training, often provided by a vision rehabilitation teacher, can help people develop a set of simple adaptive techniques to reclaim their independence.

These adaptive techniques may focus on training the brain to pay more attention to information that comes from our other senses: hearing, taste, touch, and smell. It also may include using simple tools, such as bump dots, to help make everyday tasks easier.

The first step in the independent living training process is generally an assessment, which helps to determine what the person’s specific goals are. The assessment will include a conversation with the person about what things they are struggling with. They may also be asked to complete a series of activities designed to evaluate their current skills, and the vision rehabilitation teacher may make a visit to the person’s home to assess simple changes that could be made to increase safety and independence. As a part of the process, the vision rehabilitation teacher may also reach out to family members, friends, and caregivers about their perceptions of the person’s strengths and needs.

Some of the suggestions a vision rehabilitation teacher may make while visiting a person’s home are fairly simple and straightforward. Eliminating scatter rugs to avoid tripping over them, moving furniture closer to the television to make it easier to see, installing fluorescent tape on stair treads to decrease the chance of falls, and increasing lighting under kitchen cabinets are easy and inexpensive things that people can do to improve their safety and independence.

Other recommendations from the vision rehabilitation teacher might require the person to invest a bit more time and effort in training and practice, but the results are well worth it.

For instance, many people with visual impairments struggle with using kitchen appliances such as microwaves, stoves, and ovens because they can no longer clearly see the buttons or dials used to set the proper time or temperature. While the person might be able to use a hand magnifier for this task, many people say that they find it cumbersome to carry a magnifier with them everywhere they go in their home. A vision rehabilitation teacher may suggest the use of bump-ons, which are small peel and stick silicone dots, to create a tactile marker. A bump-on placed on the “five” and “start” buttons of the microwave, for instance, will help people to find the most critical parts of the keypad. Once a person can find the “five” with some practice, they can easily locate all the other numbers.

Independent living training can encompass a large array of topics, but most programs offer comprehensive training in the following topics:

• Organization and labeling which provides the foundation for many other skills—creating an organizational and labeling system helps people more easily find items in their kitchen, bathroom, closets, and office spaces, as well as prescription medications and other important items.
• Communication skills include learning about adaptations for writing such as using low-vision pens, bold-lined pads, and signature guides—using phones that are specially designed for people living with vision loss, and for some people, it may also include lessons in braille.
• Home management covers all the daily living skills needed to be independent in our own homes, including learning adaptive skills for cooking, cleaning, washing clothes, and basic home repairs.
• Personal self-care, including shaving, brushing teeth, and applying makeup.
• Financial management helps people learn how to pay their bills using large print checks or check guides, identify currency, and maintain their financial records.
• Mealtime skills help people learn adaptive techniques for identifying what is on their plate, finding and applying the right amount of seasonings, cutting food, pouring without spilling, and other tasks that can become a challenge with low or no vision.

Not everyone will engage in training in all these areas. In most programs, a training plan is developed that is tailored to a person’s specific needs and interests.

The people who are the most successful in these programs are those who commit to consistently practicing and implementing the skills they learn in all aspects of their lives.

A great example of successful independent living training is Harold, a man in his mid-seventies who came to In-Sight for vision rehabilitation training. Throughout the training process, he was resistant, always pointing out that his wife did all the cooking, cleaning, laundry, household finances, and other activities of daily living. So in his mind, there was no reason for him to learn these skills for himself. He would often remind us that he was here simply because his family made him come.

About six months after Harold finished his training with us, his wife unexpectedly passed away. Suddenly, Harold was on his own. Thanks to the initial training as well as the follow-up support he received once he was on his own, he was able to live independently in his own home for several more years.

Assistive Technology

Advances in technology have helped to make people living with vision loss more independent than ever. Computers, video magnifiers, and smart devices have made it easier for people with visual impairments to access information, connect, and communicate.

Just like fully sighted people, those living with low and no vision can successfully use computers and tablets to access information, communicate via e-mail, play games, interact on social media, shop, and much more. Most computer platforms now come with basic screen magnification and screen readers built into them, which makes it possible for people with low or no vision to access them easily. Depending on their needs, some people may also invest in specialized software that provides more powerful tools for accessing the computer, such as screen magnifiers and text to speech capabilities.

Most smartphones now come equipped with a wide range of accessibility features that can be toggled on, including the ability to enlarge text, change the color and contrast of the background and text, magnify items on the screen, a voice-over feature that reads text to the user, and a smart assistant, such as SIRI on Apple products, that can retrieve inf...