low vision

Vision Evaluation Assessment Screening in Acute Care and Acute Rehab

Vision Assessment Evaluation Featured

Occupational therapists should try to establish a baseline for vision upon admission whenever possible in acute care and acute rehab. OTs can use this battery of visual screens to quickly establish such as baseline to compare to at discharge. If a suspected condition warrants additional assessment, OTs can use a more sensitive and thorough tool … Read more

Visual-Perceptual Hierarchy: Episode 3 – OT Dude Podcast

OTDUDE Podcast Cover 4

Occupational therapists may work with clients who have visual-perceptual deficits. The visual-perceptual hierarchy pyramid can help to intuitively explain our vision and perception from either a top-down or a bottom-up approach. This episode will explain each level of the hierarchy with examples and wrap everything together to explain how occupational therapists can use this model … Read more

Occupational Therapy Tips for Interacting with Persons with Blindness

General Guidelines

Communication

  • Treat Blind people as individuals.
  • Identify yourself when entering a room.
  • Speak directly to the individual.
  • Give specific directions (instead of vague directions).
  • Touch the arm or use their name when addressing them to let them know you are speaking to them.
  • Words like “blind” or “see” are fine to use.
  • Do not shout.

Assisting a Blind Person

  • Introduce yourself and ask them if they need assistance.
  • Provide assistance if requested.
  • Respect the wishes of the person who is blind.
  • Do not insist on helping if declined.

Giving Directions

  • Be as specific as possible.
  • Do not point and give directions at the same time.

Guiding a Blind Person

  • Allow them to hold your arm and follow you as you walk.
  • Hesitate briefly at a curb or flight of stairs.
  • Tell the person whether the steps go up or down.
  • Allow the person to find the handrail and edge of step before proceeding.
  • Do not grab them and try to steer them.
  • Do not grab their cane.

Guide Dog Etiquette

  • Do not grab the guide dog harness.
  • Do not pet, feed, or distract a guide dog.

OT Treatment

Refer clients to an Orientation and Mobility Specialist or Vision Rehabilitation Therapist.

The Orientation & Mobility Specialist is a certified instructor who has received specialized training in teaching people who are blind or visually impaired to travel safely, gracefully and efficiently throughout their environments including indoor and outdoor, familiar and unfamiliar. An Orientation and Mobility Specialist teaches people who are blind and visually impaired specific skills they need in order to know where they are and how to move independently, safely, efficiently to where they want to be. Usually, the O&M Specialist works with students individually.  

A Vision Rehabilitation Therapist is a “counterpart to O&M specialists, teaching all other skill areas except outdoor travel: Dining skills, home management, personal management, communication skills (including braille), low vision skills, adaptive technology, adjustment to blindness counseling, self-advocacy, pre-employment skills, and adaptations for leisure activities”. In other words, a VRT “instructs persons with vision impairments in the use of compensatory skills and assistive technology that will enable them to live safe, productive, and interdependent lives. Vision rehabilitation therapists work in areas that enhance vocational opportunities, independent living, and the educational development of persons with vision loss, and may include working in center based or itinerant settings”.

Both professionals can be useful referral resources for patients with blindness.

Feeding and Eating

One way to tell what food is on the plate is to use the clock reference system. Think of the plate as a clock face with:
• 12:00 at the top (the edge that is farthest away from the person eating)
• 6:00 at the bottom (the edge that is closest to the person eating)
The clock reference system can help form a mental picture of where each food item is located on the plate. For persons with difficulty using this system, a simpler alternative is using a compass reference system in which food is described with North, South, East, West; north-east, north-west, etc.

  • Utilize adaptive equipment such as plateguards, straws, dycem, and so on.
  • Promote the other senses of smell, touch, proprioception, and sound.
  • Use the fork and the tip of the knife to periodically check the location and arrangement of the food on the plate.
  • To locate the beverage on the table, slide a hand across the tabletop to find the glass and pick it up from the bottom to keep it from tipping over.
  • Consider serving certain foods in a bowl instead of plate.
  • Ask for or assist with pre-cutting certain foods such as meats.
  • Practice makes perfect.

Toileting

Dressing

  • Keep clothing organized.
  • Provide hand over hand assistance when introducing the skill. Fade assistance as needed.
  • Color Detector Apps can use the camera to detect the color of clothes.

Showering

  • Turn on cold water first, then mix with warm. Test with tactile.
  • Rely on senses for showering, e.g. shampoo, soap.
  • Use tactile aids, e.g. rubber bands located on top/middle/bottom of products such as body wash vs. shampoo vs. conditioner.
  • Keep items easily within reach.
  • Purchase items that are not breakable, e.g. plastic instead of glass.
  • Utilize pump-style dispensers.
  • Install grab bars.
  • Consider the use of shower chairs to minimize slipping.
  • Use non-slip mats.

General Assistance Technology & Smartphone Apps

  • Be My Eyes is a free app that connects blind and low-vision people with sighted volunteers and company representatives for visual assistance through a live video call.
  • Labeling Apps such as TalkingTag allow stickers to tag objects and be scanned and read to identify the object.
  • Amazon Echo (Alexa) and Google Home can alert about unlocked doors and windows; answer general questions instead of using a computer or smartphone.
  • Explore the many Smartphone Accessibility Features (both IOS and Android).
  • Educate on use of Siri or text-to-speech functions; including for texting.
  • Tape recorder or App for recording reminders and memos.
  • Life Alert for certain individuals at-risk for falls.

IADLs

  • Finance
    • Money reader App
    • Talking Calculator App
  • Navigation with GPS/Map Apps
  • Shopping
    • Ask a sighted friend to help shop.
  • Pets
    • Automatic pet feeders and litter cleaners.
  • Reading
    • Audiobooks and public library for free reader devices.
Additional Reading
Check out our post for Tips and Interventions for Low Vision.

Low Vision Visual Deficit Interventions for Occupational Therapy

Refer to an ophthalmologist or optometrist. Meanwhile, OTs can provide interventions to enable the use of the client’s remaining visual acuity. OT Interventions Increase background contrast Use black on white. Or apply bright colors (e.g., markers, tape). Increase illumination Using different types of light sources, color temperature, softness, placement, and wattage (higher is better). Without … Read more