ADLs/ IADLs + Neglect + Low Vision Flashcards
1
Q
Posterior Hip Precautions
A
BIC
- No Bending > 90 deg, hip flexion
- – teach LBD with reacher
- – also don’t bring leg up or squat
- No Internal Rotation: no turning toes in
- – no kicking shoe off with other foot
- No Crossing Legs: at either hips or ankles, no crossing midline/hip adduction
- – may place pillow between legs to sleep
2
Q
Spinal Precautions
A
BLT
- No Bending at spine
- – teach bringing feet to lap for LBD
- No Lifting anything heavier than 5 lbs (a gallon of milk)
- No Twisting at spine
- – cannot twist trunk to wipe
3
Q
AM PAC: Activity Measure for Post-Acute Care
A
- outcome tool that measures activity limitations in areas of mobility, daily activities, and cognition.
- scored on the amount of hands-on assist required to complete each item
- completed by client, family member, or clinician
- after the fact report, not observation
- short form and computer based formats available
- – 8 different short forms
4
Q
AM PAC Scoring
A
- total or unable (total/dependent assist)
- a lot (max/mod assist)
- a little (min/CGA/supervision) 4. none (modified independent/ independent)
5
Q
AM PAC Modifiers
A
- CH: 0% impaired
- CI: 1-20% impaired
- CJ: 20-40% impaired
- CK: 40-60% impaired
- CL: 60-80% impaired
- CM: 80-100% impaired
- CN: 100% impaired
6
Q
Intervention Strategies For
- use of 1 hand only
- Weakness
- Low-endurance
A
- one handed techniques, equipment to stabilize, make bilateral tasks unilateral
- let gravity assist, lightweight objects, devices to increase leverage
- energy conservation/work simplification
7
Q
Intervention Strategies For
- Decreased ROM
- Decreased coordination
- Decreased memory
A
- long handled tools, built up tools, positioning of items
- stabilize object or body part, decrease need for coordination, adaptive devices
- decrease need for memory, develop habits, best fit for success
8
Q
Intervention Strategies For
- Decreased vision
- Decreased sensation
- Low back pain
A
- lighting, contrast, use other senses
- use other senses, increase tactile input
- positioning, long-handled equipment
9
Q
Intervention Strategies for Orthopedic and Neurological Diagnoses
A
- Dress: affected then unaffected side
- Undress: unaffected then affected side
- Hemiparesis: do not add equipment unless needed, it is hard to learn and don’t want to be reliant if not necessary
- Be mindful of leaning/slumping to one side
10
Q
Unilateral Neglect
A
- failure to report, respond, or orient to novel/meaningful stimuli presented to the side opposite a brain lesion
- – when this failure cannot be attributed to motor or sensory deficits
- almost always L neglect (seen with R brain damage)
- an attention based impairment (lateralized attention deficit)
- Safety issue: may not demonstrate caution because they don’t realize things are there/can’t compensate well for neglect
11
Q
Unilateral Neglect
A
- failure to report, respond, or orient to novel/meaningful stimuli presented to the side opposite a brain lesion
- – when this failure cannot be attributed to motor or sensory deficits
- almost always L neglect (seen with R brain damage)
- an attention based impairment (lateralized attention deficit)
- personal and spatial neglect can occur together or separately
12
Q
Neglect Safety Issues
A
- Safety issue: may not demonstrate caution because they don’t realize things are there
- or can’t compensate well for neglect
- discharge with 24/7 supervision even if walking and talking
13
Q
Spatial Neglect
A
- locating objects, reading, watching tv, locating voices
- inattention to visual stimuli in the environment
- Near Spatial or Far Spatial
14
Q
Body Neglect
A
- shaving, combing hair, bathing
- does not integrate/use L side of body, does not attend to hair on left side of head/face
- personal neglect
- inattention to one side of the body
15
Q
Coexisting Cognitive Impairments
A
- these may or may not occur with neglect
- unilateral sensory/motor loss
- generalized attention deficits
- visual field deficits (hemianopsia)
- loss of postural control
- physical features disorientation
16
Q
Behaviors Seen with Neglect
A
- Extinction: unable to feel sensations on one side of the body when both are stimulated (that arm test)
- may only bathe, shave, comb one side of the body
- eat from only one side of the plate, read only one side of a book
- hard time locating voices on left side
17
Q
Paper and Pen Assessments for Neglect
A
- Cancellation: in a field with a variety of objects cross out only these ones
- Line Bisection: cross out all of the lines on this page
- Design copying: copy a simple picture
- Drawing a clock, house, flower - see whether they draw both sides
18
Q
Formal Assessments for Neglect
A
- helps to generate levels of assistance that people may need, safety implications, provides a “why” to clinical observations/judgements
- A-ONE
- AMPS
- Catherine Bergego Scale
- Behavioral Inattention Scale
- Baking Tray Test
- Comb & Razor/Compact Test
19
Q
A-ONE: Arnadottir OT-ADL Neurobehavioral Evaluation
A
- uses standardized and structured observation during daily tasks of feeding, bathing, dressing, hygiene, mobility, communication
- evaluates apraxia, neglect, spatial relations, perseveration, topographical disorientation, agnosias
- requires 5 day training
20
Q
AMPS: Assessment of Motor and Processing Skills
A
- Measures how well a client performs familiar activities of daily living in terms of physical effort, efficiency, safety, and independence
- Can be used to determine appropriate occupation-based interventions and goals
- Requires 5-day training
21
Q
Catherine Bergego Scale
A
- standardized checklist to detect presence and degree of unilateral neglect during observation of everyday life situations
22
Q
Behavioral Inattention Scale
A
- Short screening of battery tests to determine the presence and extent of visual neglect on a sample of everyday life problems faced by those with visual inattention
23
Q
- Baking Tray Test
2. Comb & Razor/Compact Test
A
- tests for spatial neglect
2. screens for spatial neglect in client’s personal space by assessing performance in functional activities
24
Q
Intervention Strategies for Addressing Neglect
A
- Awareness Training
- Scanning Training
- Limb Activation
- Mental Imagery
- Partial Visual Occlusion
- Prisms
- Computerized Training
- Sustained Attention Training
- Environmental Adaptations
25
Q
Neglect Strategies from Glen Gillen Ch (were there more?)
A
- Awareness Training
- Scanning Training
- Lighthouse Strategy
- Limb Activation
- Mental Imagery
26
Q
Awareness Training
A
- includes video feedback
- using meaningful activities
- discuss task performance: anticipated difficulties, strategies, evaluate performance
- give feedback: verbal, visual, physical guidance
- discuss compensatory strategies
27
Q
Scanning Training
A
- trunk, head, and neck rotation
- scanning while static standing (“look left”)
- Lighthouse Strategy
28
Q
Lighthouse Strategy
A
- combines scanning training with visual imagery
- uses a picture of a lighthouse on the wall as a reminder
- Be like a lighthouse: look left and right
29
Q
Limb Activation
A
- movement of contralesional side may approve awareness
- find then encourage affected side movements
30
Q
Mental Imagery
A
- good for people without active movement
- first practice twice on the R side then imagined 4 times on the L side
31
Q
The problem with computerized training
A
- how well do they transfer to functional tasks in the real world?
32
Q
Environmental Adaptations (Neglect)
A
- for clients who do not respond to remediation/restorative approaches/self-generated strategies
- Ex: putting grooming items on right side of bathroom counter
- Ex: putting bright tape on the left side to cue the patient to pay attention to that side
33
Q
Macular Degeneration
A
- gray spot in the middle due to a central scotoma
- central scotoma: lesion between optic nerve head and chiasm
- obscured central vision, but area around the spot is pretty clear
34
Q
Glaucoma
A
- dark around the sides, clear in the middle
- pressure causes compression of optic nerves
35
Q
Retinopathy
A
- black spots
- caused by damaged blood vessels in the retina
- usually the result of diabetes
36
Q
Cataracts
A
- Blurry
- the lens of the eye becomes cloudy
37
Q
Normal Age Related Visual Changes
A
- decreased visual acuity
- presbyopia (farsightedness caused by loss of elasticity of the lens of the eye)
- Floaters
- dry eyes
- increased need for light
- difficulty with glare
- difficulty adapting to light and dark
- reduced contrast sensitivity
- reduced color perception
- reduced depth perception
38
Q
A. Vision: 20/# (ex: 20/40)
B. VF stands for
A
A. you can see from 20 ft what someone should see from # ft
- so 20/40 means you need to get 2x closer to see it
B. Visual field - should be pretty wide, over 180 deg with peripheral vision
39
Q
- Moderate Vision Loss
- Severe Vision Loss
- Profound Vision Loss
- Near Total Vision Loss
A
- 20/70 - 20/100 or VF 21-61 deg
- 20/200 - 20/400 or VF 11-20 deg
- 20/500 - 20/1000 or VF 6-10 deg
- 20/2000 (no light perception) or VF < 5 deg
40
Q
Legal Blindness
A
20/200 or VF < 20 deg
41
Q
MA Driving Requirements for Vision
A
- Unrestricted: 20/40 best corrected eye
- Day-Time Restricted: 20/70 best corrected eye
- Bioptic telescopes are allowed
- Visual field > 120 deg required
42
Q
Low Vision Team
A
- opthalmologist
- optometrist
- rehab teacher
- orientation and mobility specialist
- low vision therapist
- OT, PT
43
Q
Distance Acuity
A
- macula
- Test: Distance Visual Acuity Chart
- client reads letters from eye chart 20 ft away, test one eye at a time
- Near: hold card about 13-16”
- if client is 20/40 or worse, refer to specialist
44
Q
Testing Scanning
A
- ability to search visually for objects
- Scanboard Test
- – should read in an organized way: clockwise, counterclockwise, rectlinear
- – most start L hand corner and read L to R top to bottom
- does client miss words or one side only or throughout?
45
Q
Accommodation (Vision)
and testing it
A
- ability of eye to adjust focus at different distances
- the process by which the vertebrate eye changes optical power to maintain a clear image or focus on an object as its distance varies
- Test: listening to client concerns
46
Q
Testing Range of (Eyeball) Motion
A
- move a pen in a large H, 12” in front of client
- can the client follow the pen to the far edges of the H (far field of eye movement)
47
Q
Pursuits/Tracking
A
- movements that keep an image steady on the retina, track a moving object when stationary
- jerkiness is abnormal
- Test: client follows target moving only eyes, not head
- – horizontal, vertical, diagonal, circular
- may be palsy of the muscle
- eye may stop right at midline
48
Q
Saccades
A
- sequenced rapid eye movements that change the line of sight, used extensively in reading.
- Test: client quickly looks back and forth b/w 2 points held about 6” apart. Can the client find the 2 points easily or do they continue searching for the target
- Think of a tennis match (can they look back and forth?)
49
Q
Testing Convergence
A
- client follows target as it approaches bridge of his/her nose and back out again to the start point.
- Can the client follow target or does he/she lose eye contact and/or complain of blurry vision.
- When does the target become one object? Break point should occur about 6”in front of nose.
50
Q
Ocular Alignment
A
- crucial to coordinated function of both eyes and visual processing in general. If eyes are not aligned, client may experience diplopia, vertigo, confusion.
- Are the eyes straight out?
51
Q
Nystagmus
and testing it
A
- involuntary movement of the eyes (usually back and forth)
- Test: Client looks straight ahead, shine pen into his/her eye, observe the reflection of the light in the cornea of the eye. Is the reflection of the light in the same position in both eyes?
52
Q
Estropia
A
- one eye deviated inward
- reflection of a penlight will occur on lateral aspect of pupil in that eye
53
Q
Extropia
A
- one eye deviated outward
- reflection of a penlight will occur on medial aspect of the pupil
54
Q
Normal Monocular Visual Field
A
- 60 deg up
- 70-75 deg down
- 60 deg inward
- 100-110 outward
55
Q
Testing Visual Field
A
- Confrontation testing. — Can be done w/ or w/o an eye patch.
- Client looks straight ahead at therapist’s nose and indicates when he/she detects stimulus in R/L and superior/inferior visual fields.
- – Looking for the “visual cut” in which client doesn’t see stimulus until it’s near midline or as it gets closer to another visual field.
- Ansler Grid: cover one eye, look at dark dot in center of grid, are any lines broken, blurry or missing?
56
Q
Reading involves
A
- letter recognition
- contrast sensitivity (normal 2.8%)
- convergence/divergence
- accommodation
- saccadic eye movement/tracking
- cognitive processing
57
Q
Intervention Strategies for People with Vision Loss
A
- use remaining vision
- lighting: most important
- minimize glare
- increase contrast
- magnification
- eccentric viewing
- use other senses
58
Q
Increasing Lighting
A
- most important!
- Improves function for tasks that involve detail such as choosing clothes
- Lighting more important for those with worse vision
- Increased quality of life from task light
- The closer light is to task, the brighter the light will be (task specific lighting, such as for reading or writing)
59
Q
Assessing Lighting
A
- spaces with bright lights then dark - pupils will have hard time transitioning - even illumination would be better
- Indirect vs direct lighting
- Type of fixture and covering (want bulbs to be completely covered)
- Fit of bulb to fixture (too big? Too small?)
- Working light bulbs
- Transition of lighting
- Positioning of light
- Access to light
60
Q
Minimizing Glare
A
- Ex: big screen TV faces window
- use shades on bulbs
- position edge of lampshade below eye level
- sheer curtains to cut down on glare but still allow light to enter (light diffuses)
- use low gloss polish
- cover shiny surfaces (table cloth)
- matte instead of glossy paper
- baseball cap
- filters, polarized sunglasses
61
Q
Increasing Contrast
A
- Delineate boundaries on tub, stairs, etc.
- use bright pillows, rugs, colored tape (a red pillow shows where a white couch is vs the white carpet)
62
Q
Magnification
A
- Relative distance magnification
- Relative size magnification
- Large print books, telephones with large number buttons, watch face with large numbers…
- Angular magnification (optics)
- Electronic magnification
= How do you know which kind of magnification they need?
63
Q
Magnification Power
A
- x2 to x14 (2 times to 14 times)
- So for example +5D/4 = 1.25x in order to read
- Decreased contrast will need much more magnification
64
Q
Stronger magnifier = ____ field of view
A
- Smaller
- So you want the lowest magnifier that will make it functional in order to maximize field of view
65
Q
Buying Magnifiers
A
- Cost as a barrier
- Magnifications not usually covered by 3rd party payers
- Stand magnifier vs hand magnifier – consider if the client has a tremor, fatigue, activity endurance think about how they have to hold it at a good focal distance
66
Q
Eccentric Viewing
A
- For people with macular degeneration
- Using peripheral vision to compensate for loss of central vision
- – but visual acuity is not as good in periphery than central (macula is central)
- Try this: make a fist and put it on the bridge of your nose. What do you see? How do you compensate? (turn your head)
- – Slight upright (2 o’clock) or left (10 o’clock) most commonly used for eccentric viewing
67
Q
Interventions for Vision Loss: Using Other Senses
A
- Hearing: high pitches are lost first so use male voice for assistive devices
- Tactile: raised dots, knots, rubber bands, paper clips, braille
- – Most older adults cannot read braille because 2- and 3-point discrimination decreases over time
68
Q
Interventions for Vision Loss: Organization
A
- Working with home helpers, don’t change the strategies that the client has already established (may be easier for helper, but not for client) - advocate so the home helper keeps them intact
69
Q
Assertiveness Training
for vision loss
A
- Ex: asking customer service for help
- Recommend AT - OTs need to keep up with technology trends to make best recommendations
70
Q
Problem Solving Training
for vision loss
A
- most effective strategy; active problem solving with best outcomes
- Establish realistic goals
- Brainstorm solutions, try out solutions, choose best solution, implement solution, evaluate the outcome
- Looks very similar to OT process (Goal, Plan, Do, Check)
71
Q
Low Vision vs Neurological Impairments:
(A) Rates, (B) Functional Implications
1. Visual Field Impairment
2. Visual Inattention (Neglect)
A
- A. 25%L, 36%R
B. Reading deficits, visual motor deficits, balance/mobility deficits - A. 65%L, 82%R
B. Reading deficits, visual motor deficits, balance/mobility deficits
** Visual Field Impairment looks a lot like Neglect!
72
Q
Low Vision vs Neurological Impairments:
(A) Rates, (B) Functional Implications
1. Convergence Insufficiency
2. Accommodative Deficits
A
- A. 40-56%
B. Reading deficits, diplopia, blurred vision - trouble looking at something near then something far or vice versa
A. 21-56%
B. Reading deficits, diplopia, blurred vision
73
Q
Low Vision vs Neurological Impairments:
(A) Rates, (B) Functional Implications
1. Pursuits and Saccades Deficits
2. Fixation Instability
A
- advanced tracking, important for reading
A. 25-59%
B. reading deficits, visual motor deficits, balance/vestibular deficits, blurred vision - A. 5-13%
B. reading deficits, visual motor deficits, blurred vision
** Balance separates these two
74
Q
Low Vision vs Neurological Impairments:
(A) Rates, (B) Functional Implications
1. Strabismus
2. Diplopia
A
- cross-eyed
A. 11-32%
B. binocular vision deficits, depth perception deficits, potential visual deficits, eye movement deficits, double vision, balance deficits - seeing double
A. 19%
B. blurred vision, balance/vestibular deficits, nausea, reading deficits, visual motor deficits
75
Q
Visual Perception
A
hopefully there is a later/different deck notecard that talks about this in depth
76
Q
Methods of Field Enhancement
A
- Scanning
- Field Displacement
- Field Enhancement
- Minification: reverse magnification
77
Q
Minification
A
- reverse magnification
- for someone with bilateral peripheral field restriction
- must have good visual acuity (minification worsens acuity)
- makes objects smaller and farther away thereby widening the field
- use least power possible to maintain clarity
- do not use for someone who is confused –> increased risk of falling if walking while minifying
78
Q
Evaluate Mobility Awareness
A
- Increase efficiency of information gathering; enhance visual scanning skills;
- orientation and mobility instructor (referral)
- use of adaptive devices, including quad cane
79
Q
Visual Field Deficit Interventions
A
- Scanning
- Adaptive Strategies
a. Prism
b. Scrolling text
c. Reorientation of material
d. Anchoring
e. Patching
80
Q
- Scanning (Visual Field Deficits)
A
- most used and most effective strategy
- Systematic scanning methods. Small range of movements in all directions
- – Left to right, then top to bottom
- Training with a certified orientation and mobility instructor
- Yellow acetate e.g. apply on the left side of the glasses
- – This is to train them to scan (“now make everything yellow”) – make sure they are scanning into the area of the impaired visual field
81
Q
2a. Prism
A
- effective for hemianopsia and neglect
- Sector Prism, Peli Prism, Gottlieb Prism
- Prism reflects the image
- Prism puts a “ghost” of an image in the patient’s non-seeing area in the functional retinal area
- Base of prism placed in direction of field loss
- Allows person to see object with a smaller eye or head movement; no effect until person shifts gaze into prism
- Ghost image or purposeful double vision to cue person to look to the side of impairment
•Limited evidence to support use of prisms – improvements in QOL, improved VF awareness and improved community mobility using 40 diopter prism
82
Q
2b. Scrolling Text
A
- Limited evidence to support use of scrolling text to improve reading performance in individuals with VF deficits
– right to left scrolling text improved reading saccades and reading speeds after 4 weeks of daily sessions
83
Q
2c. Reorientation of material
2d. Anchoring
A
• Limited to no evidence to support use of anchoring, cueing, and reorientation techniques to improve reading performance
84
Q
2e. Patching
A
- Limited evidence to support the use of patching to improve scanning and ADL performance
- E.g. you need to keep the patch on in order for it to be effective. Effect goes away when the patch is removed
