Exam 13: Adult Sensory Loss (Part 2) Flashcards
sensation
the processing of information about the external world by the sensory organs of the body
feedback systems:
both rely on intact sensation
feedback
action performed-sensory feedback on performance (catching toe while walking)
feed-forward
anticipatory adjustments prior to performance (muscle tone increase prior to standing)
sensory input: vision
- acuity
- oculomotor control
- visual scanning
sensory input: touch
- sharp/ dull/ pain
- thermal sensation
- localization of touch
- light touch/ deep touch
sensory input: proprioception
- joint receptors
- position of body
sensory input: vestibular
- position of semicircular canals in relation to gravity
additional sensory inputs
- hearing
- smell/ taste
problem spots within the eye
- cornea
- lens
- retina
- macula
areas of deficit in vision: eyeball
- retina (retinopathy)
- lens
areas of deficit in vision: eye muscles
- will cause tracking or convergence problems
- ciliary muscles control enlargement/ contraction of iris
- diplopia = double vision
- lazy eye
areas of deficit in vision: visual pathways including optic nerve
- anywhere from eyes to occipital lobe
- optic nerve strokes or damage
areas of deficit in vision: brain
- occipital lobe
- cortical blindness
- untreated “lazy” eye
visual acuity
- how clearly the eye discriminates detail and contrast
myopia
nearsightedness
hyperopia
farsightedness
presbyopia
age related farsightedness
astigmatism
spoon-shaped cornea
problems for people age 65+
- presbyopia
- cataracts
- macular degeneration
- visual field cuts
- diabetic retinopathy
- gradual vision loss starting at age 40 and continuing to worsen until around age 65
symptoms of presbyopia
- blurred vision at a normal reading distance
- headaches or eye strain after reading
- holding objects farther away in order to see better
- symptoms may worsen if tired or in a dimly lit area
etiology of presbyopia
- the lens in your eye hardens as you age
- the lens becomes less flexible which makes it harder to adjust to distances
cataracts
- often develops as a person ages
- most common type of REVERSIBLE vision loss
- requires surgical prosthetic lens placed in the eye
- clouded or discolored lens is removed
symptoms of cataracts
- blurry or cloudy vision
- poor night vision
- decreased color perception
- loss in contrast sensitivity
risk factors of cataracts
- increasing age
- smoking cigarettes
- UV-B exposure
- obesity
- trauma
- inflammation
- high blood pressure
- hormone replacement therapy
- drinking excessive amounts of alcohol
general precautions post cataract surgery
- avoid bending too far with head below the waist
- do not lift more than 10 lbs
- prevent straining on the toilet
- keep out of swimming pools/ hot tubs
symptoms to watch out for post cataract surgery
- sudden drop in vision
- sudden or worsening pain
- inflammation or blurry vision
macular degeneration
- leading cause of vision loss
- it is incurable
- the center portion of the eye is damaged (cones: color & fine vision)
- can occur in one or both eyes
dry MD symptoms
- develops slowly
- early, intermediate, advanced
- increasing blurriness
- low light difficulty
- reduced central vision
- peripheral vision is intact
wet MD symptoms
- dry can develop into wet overtime
- sudden, painless vision loss
risk factors of MD
- age
- genetics
- caucasians more likely
- smoking
- cardiovascular issues
- females > males
- UV light exposure
- diet and obesity
precautions of MD
- safety and injury risk
- people with MD are at risk for social isolation and withdrawal, which can lead to or exacerbate depression
hemianopia
visual field cuts
causes of hemianopia
- stroke (most common)
- TBI
- aneurysm
brain areas affected in hemianopia
- occipital lobe, parietal lobe, temporal lobe
symptoms of hemianopia
- bumping into things
- missing objects on affected side
- difficulty reading, double vision
- depression & anxiety
- impaired driving
treatment for hemianopia
- patient is aware of field cut and can compensate for it
- prism glasses are used to expand visual field
- homonymous hemianopia is more common after CVA
oculomotor control visual scanning
- motor function of the muscles in the eye is impaired
- intrinsic & extrinsic
- damage either at muscle level, cranial nerve level, brain motor centers for that area
- tests: convergence/ divergence
- following an object: test in all 4 quadrants, assess tracking as the person crosses midline
diabetic retinopathy
- umbrella term for ALL retina disorders caused by diabetes
- 2 major types:
- nonproliferative retinopathy (early, most common)
- proliferative retinopathy (advanced, more serious)
nonproliferative retinopathy (most common) (NRDR)
- blood vessels in back of eye balloon/ form pouches
- typically no vision loss
- often no symptoms
- some leakage of fluid which may cause swelling of the macula and blurred vision
proliferative retinopathy (more serious) (PDR)
- blood vessels are damaged, close off, and new vessels start growing
- new blood vessels are weak and can lead to vitreous hemorrhage, causing vision loss
- scar tissue can grow and then shrink which can lead to retina detachment
- new blood vessels interfere with flow of fluid and pressure may build up, damaging the optic nerve and leading to glaucoma
diabetic retinopathy symptoms
- spots or dark strings floating in your vision (floaters)
- blurred vision
- fluctuating vision
- impaired color vision
- dark or empty areas in your vision
- vision loss
- usually affects both eyes
glaucoma
- a group of diseases that cause damage to the optic nerve
- the most common cause is an increase in pressure to the eye
- fluid in anterior chamber of eye doesn’t drain
- 2 major types:
- open-angle glaucoma
- closed-angle glaucoma
- if untreated, can lead to vision loss and blindness
open-angle glaucoma symptoms
- at first there are no symptoms
- leads to loss in peripheral vision
- if untreated, can lead to blindness
closed-angle glaucoma symptoms
- suddenly blurry vision
- severe eye pain
- nausea
- headache
- see halos around lights
glaucoma risk factors
- age 40+
- diabetic
- family history
- high eye pressure
- african, hispanic, or asian heritage
- long-term use of steroid meds
- nearsighted
- farsighted
occupational impacts of low vision
- ADLs
- IADLs
- Work
role of OT in low vision
- preventing accidents and injury
- teaching new skills
- modifying the task or environment
- promoting a healthy lifestyle
- obtain specialty certification for low vision
preventing accidents & injury
- managing clutter
- keeping walkways clear
- ensuring adequate lighting
- manage layout of furniture
- keep doors completely open or shut
- preventing falls with contrast and placement of items in home
- kitchen modifications
- AE/ assistance devices
hearing loss stats
- hearing impairments are more prevalent than vision loss
- hearing loss can be associated with balance problems, ambulation difficulties, and an increased incidence in falls
- 1/3 people between 65-74
- 85-90% in nursing homes
presbycusis
- age related hearing loss
- can be related to sound exposure, genetic predisposition, and normal aging
otosclerosis
- hardening of the small bones of the ear, which fixates them and they can’t vibrate
- can have surgery to reverse this or implant prosthetics
sensorineural hearing loss
- hair cell damage or loss of sensory hair cells in cochlea
- loss is gradual; people lose the ability to hear high-frequency sounds
- sounds may be distorted, making language difficult to hear
- speak in a low voice directly to the person
sensorineural: sensory
- loss of hair cells in the basilar membrane
- high-frequency hearing loss
- may not hear ringing phone, doorbell, dripping water
sensorineural: neural
- loss of the auditory nerve fibers
- inability to distinguish speech sounds
sensorineural: mechanical
- degeneration of the vibrating membrane in the cochlea
- several sounds in various frequencies are present at the same time, making discrimination difficult
conductive hearing loss
- inability of the external ear to conduct waves to the inner ear
- causes: ear wax (cerumen) buildup, fluid accumulation in middle ear
- treatments: cleaning ears, meds, surgery, hearing aids, cochlear implants
tinnitus
- ringing in the ear
- associated with many hearing loss conditions (Meniere’s)
- assess individual for cardiovascular disease, anemia, and hypothyroidism
- most noticeable at night
psychosocial aspects of hearing immpairments
- isolation/ loneliness
- elders reluctant to ask for clarification
- experience embarrassment and vulnerability
- communication can become exhausting
- paranoia, suspicion, accusations of lying
observable behaviors that may indicate hearing loss
- speaking loudly
- high volume
- asking for you to repeat
- not responding
- confused look and inappropriate responses
- withdrawing from social situations
recommendations for improving elder communication
- inform/ educate
- increase self-confidence in adaptations
- improve work/ living environment (reduce background noise)
- add carpets to floors, drapes on windows, and upholstered furniture
- improve environmental safety
- add fire/ smoke alarms, add flashing lights for phones/ doorbell
- reduce risk for falls
- avoid startling - always approach from front
- enhance conversation
- speak in a low, slow tone, stand in front of and show your lips
recommendations for improving elder communication cont.
- closed-captioned TVs
- telephones that can be typed into
- reduce glare by improving lighting
- use a “pocket talker” in therapy
assistive hearing devices
- hearing aids
- determined by an audiologist
- modern devices are smaller and fit in the ear
- more cosmetically appealing
- battery cost is a factor
- assisted listening device (ALD)
- mic and amplifier and headset (pocket talker)
- reduces background noise & amplifies sound
proprioception
- sensory receptors for this sensation are in the joint
- provide information to the brain regarding the position of the body part in space, including joint position
stereognosis
- PERCEPTUAL; requires cognition
- have person say what they call it (schema)
- best practice is to show them the item and have them identify it/ you tell them what it is
- testing a person to see what they are holding in their hand using only tactile input/ previous knowledge
cause of loss of taste & smell
- chronic sinusitis or sinus polyps
- dementia can dampen sensory receptors and processing
- age related changes: decreased sensitivity to flavors and decreased appetite, decreased safety awareness due to loss of smell
- older adults prone to malnutrition and dehydration (failure to thrive)
interventions for loss of taste & smell
primarily compensatory for decreased food intake
- use non salt spices, onions, etc.
- utilize feeding routine, don’t rely on hunger
- use visual cues (smoke alarm) since they won’t smell it
- print large dates on food items to make sure that food hasn’t spoiled
developing a vestibular deficit
injury
- damage to area the controls balance, eye movement, and hearing
- meds can cause injury
genetics
- hereditary deafness - can lead to vest. disorders
environmental conditions
- Meniere’s Disease - inner ear disorder causes vertigo
- atmospheric pressure
- allergies (flare ups)
vertigo (what is the most common type??)
- most common type of vertigo is benign paroxysmal positional vertigo
- increases risk of falls
- decreases occupational performance
- can be caused by vestibular or cerebellar dysfunction
signs & symptoms for vestibular deficits
- chronic dizziness
- imbalance (& ataxia)
- vision disturbance
- hearing changes
- cognitive
-psychological changes - other symptoms (nausea, ear pain, slurred speech)
vestibular rehabilitation therapy (VRT)
- used to treat vestibular disorders (BPPV)
- brain learns to use other senses to compensate for the issues through movement retraining & exercises)
- advanced training is required as an OT
- alternative to meds or surgeries
- may be used in addition to OT interventions
fall risk factors
- history or falls (& near falls)
- fear of falling
- multiple meds
- decreased eyesight, hearing, or mobility
- urinary incontinence/ urgency
- weakness
- bp changes
- environmental hazards
causes of falls in elderly
- environmental (yard/ walkway issues)
- lighting deficits
- lack of handrails
- uneven surfaces
- unstable or poorly placed furniture
- throw rugs & pets
- inaccessible items
biological causes of falls
- vision
- cardiovascular
- neurologic
- cognitive changes
- urinary/ bowel issues
- poor sensation in feet
- weakness
- sensory
- depth perception, acuity
- vision
- spatial organization & misinterpreting visual info; vision conditions
sensory processing & integration in adults
- can carryover from childhood
- can develop with a TBI
- can be seen in mental illness
- SI has been successfully used with adults in many capacities
