This week Laura @LYBOT will host #OTALK
About 285 million people in the world have a visual impairment: 39 million are blind and 246 million have low vision. Well over half of these individuals are over the age of 50. Approximately 90% of these individuals live in developing countries, where they may not have access to correction for refractive errors (e.g. glasses), eye health services, or OT. Leading causes of visual impairment are cataracts, refractive errors, glaucoma, and macular degeneration. (World Health Organization, 2014). Low vision can affect occupational performance in many areas, from community mobility, to physical exercise to chosen leisure activities (e.g. Schoessow, 2010; Rees, Saw, Lamoureux & Keeffe, 2007). Clearly this is a large community of people who could be served by OT’s, and who perhaps are already! During this week’s #OTalk we will dive into a conversation about how OT’s are contributing and can contribute to the team of people serving individuals who have a visual impairment. The following are some ideas to get us started. OT’s can help:
● Enhance occupational performance and support complex needs of individuals with multiple conditions
● Contribute to an assessment of visual function
● Assess cognition, motor skills, and positioning as they relate to device and compensatory strategy use (Schoessow, 2010; Kaldenberg, Markowitz, Markowitz & Markowitz 2006)
● Make environmental modifications (e.g. add contrast or improve lighting)
● Work with individuals to highlight and use their strengths
● Recommend and train individuals for the use of assistive devices with consideration of environmental, social and personal factors.
As OT’s concerned with the empowerment of individuals and communities, we feel it is important to address the terms we choose because words can make a big difference in shaping attitudes and shifting awareness. Person-first language is promoted within most North American organizations/communities, while terms such as ‘disabled person’, which emphasize the social model of disability (i.e. a person is disabled by the society) are favoured in other parts of the world. Many members of the blind community have chosen to favour ‘blind person’ as an identifier for individuals who have a range of visual impairments. I (Laura) personally prefer to refer to myself as a blind person, choosing this identity first language because it emphasizes that I consider blindness to be a valuable part of who I am. Some use impairment to describe the embodied experience and disability to describe the interactional experience wherein a person is in some way barred from participation; however, the terms impairment and disability have also been criticized for having overly negative connotations. Linguistic choices are important, controversial, ever evolving, and diverse. In our discussion we use the term ‘person with a visual impairment’ as a compromise between the social model (i.e. the disability is not within the person, as person ‘with’ a disability would suggest) and discourses regarding the importance of acknowledging the embodied experience of an impairment. During the discussion we may use other terms, as will individuals who join the conversation – you are encouraged to think about what terms you might choose and why.
● Following are few interesting links on the topic: a blog on Gotta Be OT, a blog by Cara Liebowitz, and a blog by Rachel Kassenbrock.
What is Happening
Following are profiles demonstrating how OT’s are contributing to the empowerment of people who have visual impairments – they are drawn from the Canadian Association of Occupational Therapists’ OT in Low Vision Rehabilitation Network.
A Clinical Example
Melissa de Wit OT Reg. (Ont.) is working in stroke and geriatric in-patient rehabilitation. She is part of a passionate interdisciplinary in-patient team and collaborates with an optometrist in functional assessment and treatment of visual impairments resulting from acquired brain injury, including visual midline shift, visual neglect, impaired visual memory, visual field cuts, diplopia, and cranial nerve palsies. She has participated in several international specialized courses associated with assessment and treatment for visual processing disorders, neuro-visual postural therapy and prism therapy. Melissa is certified in Neuro-Developmental Treatment and is an authorizer for mobility aids in Ontario, Canada. She also has a passion for therapeutic horseback riding and is certified with the American Hippotherapy Association. Other occupational pursuits Melissa enjoys include being a proud mother, playing soccer, horseback riding, reading and gardening.
A Research/Clinical Example
Dr. Tanya Packer is a professor of Occupational Therapy at Dalhousie University in Halifax, Nova Scotia, Canada. She has been heavily involved in low vision rehabilitation research around the world. In Australia, Tanya contributed to research on, among many other topics, the psychological and emotional aspects of vision loss. She was also involved in research on self-management programs for people with vision loss , which were associated with improvements in occupational participation and well-being. A notable self-management program that Tanya co-developed in Australia, called Living Safe, has, with her efforts, been implemented at CNIB in Halifax. Living Safe teaches self-defence skills to people with a visual impairment. It aims to increase confidence in home and community environments. A CNIB article showcasing positive reviews of the program can be found here. Currently, in addition to her research work, Tanya serves on the National Board for CNIB and works closely with Dalhousie students who complete fieldwork placements at CNIB.
Conclusion & Invitation
From promoting research and evidence-based practice, to using their holistic OT perspective to empower individuals in removing barriers to participation, OT’s have a strong role to play within vision rehab. We gave only a couple of examples of how OT’s are contributing, and invite you to share more when you join us on August 30th 2016 at 12 noon Pacific Daylight Time (click here for a time-zone conversion). We will discuss questions such as:
● How can OT uniquely contribute to the interdisciplinary team in vision rehab?
● How can we prove the value of OT in vision rehab?
● What experience of working with people with visual impairments have you had?
Note 1: As the OT in Low Vision Rehabilitation Network develops we are working on articles, workshops, and presentations to discuss the role of OT in this area. The transcript from this #OTalk may be used to contribute to a greater understanding of the global story. Any ideas or tweets used will be anonymous. If you do not wish to have any of your tweets or a particular tweet used, please let us know. The research ethics board at the University of British Columbia has been consulted and it was concluded that ethical approval for this was unnecessary.
Note 2: Thank you to Ellen Johnson, Kathleen Sullivan, and Minnie Teng for their assistance putting this blog together.
Kaldenberg, J., Markowitz, M., Markowitz, R. E., & Markowitz, S. N. (2011). The multi-disciplinary nature of low vision rehabilitation- A case report. Work, 39(1), 63-66.
Schoessow, K. (2010) Shifting from compensation to participation: a model for occupational therapy in low vision. British Journal of Occupational Therapy, 73(4), 160-169.
Rees, G., Saw, C. L., Lamoureux, E. L., & Keeffe, J. E. (2007). Self-management programs for adults with low vision: needs and challenges. Patient education and counseling, 69(1), 39-46.
World Health Organization. (2014). Visual impairment and blindness: Fact sheet N°282. Retrieved from http://www.who.int/mediacentre/factsheets/fs282/en/