tota low vision foundations - tota - texas …：全部的低视力的基础-总-德克萨斯…

Occupational Therapy Rolein Low VisionBy Serena Speaker OTR SCLVNovember 8, 2013TOTA Mountain Central ConferenceObjectives1. Participant will understand basic anatomy of the visual system and primary low vision conditions affecting older adults.2. Participant will be able to describe how low vision conditions influence occupational performance.3. Participant will be able to compare and contrast the role of the occupational therapist specialist and generalist in low vision rehab.4. Participant will demonstrate techniques to improve ADLS function with low tech devices.What is low vision?nDefinition of low Vision -a visual impairment severe enough to interfere with occupational performance but allowing some usable visionnLegal Blindness (used to qualify persons for benefits and services) Best corrected visual acuity of 20/200 or less in better eye (BE) or visual field of 20 degrees or less in the better eyeSource: Warren, Mary, MS, OTR/L, FAOTA (2008) Low Vision: Occupational Therapy Evaluation and Intervention with Older Adults, Revised Editin. Bethesda, M. AOTA Press.nLow vision is primarily an acquired condition that is an issue of agingn2/3 are over age 65n30% over age 75nMost are caused by 3 age related conditions-Macular Degeneration, Glaucoma, Diabetic retinopathynThese account for 90% of low vision referralsVisual Perceptual HierarchySeven levels of visual processing Permission From Mary Warren PhD, FAOTA, OTDFoundation Level1. visual acuity2. visual field3. oculomotorcontrolSecond LevelAttention1. Alert2. AttendingThird LevelnScanning-ability to look side to sideLevel Four-Pattern RecognitionnCNS must have high quality, accurate visual input to complete object recognition.1.Visual acuity ensures the clarity of visual input2.Visual field integrity ensures the presence of vision-that all of the visual input from the environment is represented3.Oculomotor control ensure that visual information is acquired rapidly and accurately when the body is in motion or at rest for perceptual stabilityLevel FivenVisual memory-the ability to recall or match the visual object to ones memory. When an R is an R and is the first letter in Run. Or a picture or viewing a water glass means that there is a memory that means this glass of water will be able to quench my thirst.Level SixnVisuocognition- the ability to use the visual memory and then relate to past experiences on a cognitive level. The ability to recognize a bank check register and then be able to record the check, determine the balance in the check book and then reconcile the balance with the bank statement. Visual tasks that require cognitive input on a high level of processing from the initial visual input.Level SevennAdaptation through Vision1. Solve Problems2. Formulate plans3. Make decisionsSource: Warren, Mary, MS, OTR/L, SCLV.FAOTA and Elizabeth Barstow, MS, OTR/L, SCLV (2011). Occupational Therapy Intervention for Adults with Low Vision, Bethesda, Md, AOTA Press.Low vision is issue of agingnOlder adults associate low vision with normal aging processn2/3 have at least one other chronic medical condition (LV with diabetes=6X greater likelihood of problems shopping and socializing, LV with CVD=7X)nWomans Issue-more likely to live alone, 75% of men with low vision are married and have in-home support compared to 30% for women ICD-9 CMS Definitions of Low Vision and Blindness table.n Individuals will not meet CMS medical necessity requirements unless Visual Acuity is worse than 20/60 in the better seeing eye or visual field less than 20 degrees.n OTs provide services under Part A-acute care, Part B or Home Health umbrella.n Additional credentialing is encouraged: SCLV by AOTA and or CLVT by ACVREP.nOccupational Therapy Practice Framework(AOTA) published 2002, revised in revised in 2008nEcology of Human Performance Modelq published 1994 by Dunn, Brown Presbyopia; lens thickens andloses flexibilityq bifocalsnFloaters: strands of protein that float in vitreousq generally benign unless accompanied by bright flashes of light or significant increase in numbernDry eyesq lacrimal glands decrease secretionq medication exacerbates condition, treat with artificial tearsnIncreased need for lightq pupil diameter decreases, lens thickens and yellowsq 80 yo needs up to10X more light than 23 yonGlare susceptibilityq lens and cornea become less smoothq protein strands cause light to scatterq increased discomfortnReduced dark/light adaptationq more difficult to go from b