Sensory impairment seminar Flashcards
senses
The Big 5 senses • Sight • Hearing • Smell • Touch • Taste But really up to 21 • Nociception • Equilibrioception • Chemoreception • Proprioception • Magnetoception
sensory impairment
When one or more of a person’s senses is no longer normal
A person does not have to have full loss of a sense to be sensory impaired
dentistry and sensory impairment impact
Sensory impaired patients want & need dental treatment like all of us
UK law requires that we accommodate patients with a disability as “far as reasonably practicable”
Sight & hearing impairment patients are most relevant to dentistry
You may end up treating sensory impaired patients…
judgement preconceptions
Instant unconscious judgement – be aware when see sensory impaired as will affect how you see them
Seeing people how they want to be seen
equal access for those who are sensory impaired
Those with sensory impairment often have:
- Low confidence
- Require support
In how they experience and interact with the environment around them
people with sensory disability
WANT TO
feel safe
have things to do
stay health
not have to deal with discriminations
people with sensory disability
ACHIEVE BY
feeling listened to
have a say in the support they are provided with
respected
services that response to their needs and wishes
people with sensory disability
results in
confidence
skills
mobility
what services are needed for people with a disability (5)
communication
accessing services
mobility
rehabilitation
accessibility and isolation
- should be able to do everything - walk, cycle, sport etc
HIGHLIGHTS BARRIERS
2 disabled groups that are often forgotten
older people
learning disabled
older people disability
Sensory impairments are not responded to
Major factor in falls
Dementia and sensory loss
learning disabled
10 x more likely to have a hearing impairment
new terminology for
partially sighted
sight impaired
new terminology for
blind
severely sight impaired
visual impairment prevalence
least 1 billion people have a near or distance vision impairment that could have been prevented or has yet to be addressed.
The majority of people with vision impairment and blindness are over the age of 50 years.
There are 1.2 million people living with sight loss who are aged 75 years and over:
- 1 in 9 people aged 60 years and over
- 1 in 5 people aged 75 years and over
- 1 in 2 people aged 90 years and over
Most live in developed countries
leading cause of vision impairment and blindness
uncorrected refractive errors and cataracts.
sight loss in UK
More than two million people are estimated to be living with sight loss in the UK today.
This sight loss is severe enough to have a significant impact on their daily lives
cost of eye health and sight loss in UK
Estimated cost of eye health and sight loss in the UK is estimated to be around £28 billion every year
The UK’s healthcare cost linked to eye health is estimated to be at least £3 billion every year
- It is predicted that by 2050 the number of people with sight loss in the UK will double to over four million
frequency of sight loss UK
Every day 250 people start to lose their sight in the UK.
- equivalent to one person every six minutes
One in five people will live with sight loss in their lifetime
is sight loss avoidable
yes
At least half of all cases of sight loss in the UK are avoidable
how can sight loss be amended
The majority of sight loss due to refractive error can be corrected by wearing the right prescription glasses.
Many forms of cataract are treatable.
If detected and treated early, some sight loss due to glaucoma, AMD and diabetic retinopathy could be avoided.
inequalities in vision impairment
People on low incomes:
- Prevalence of sight loss is associated with having a lower income .
Difficulty in getting to an optometrist and concerns about the cost of glasses can result in people not going for eye tests as often as they want, or delaying visits until they experience symptoms – forced
variation across countries
Proportion of vision impairment attributable to cataract is higher in low- and middle-income countries than high-income countries.
In high income countries, diseases such as diabetic retinopathy, glaucoma and age-related macular degeneration are more common.
In low-income countries congenital cataract is a leading cause, whereas in middle-income countries it is more likely to be retinopathy of prematurity.
People from certain ethnic communities are at greater risk of some of the leading causes of sight loss yet many are unaware of this
- Black African and Caribbean people are four to eight times more at risk of developing certain forms of glaucoma compared to white people
- The risk of diabetic eye disease is around three times greater in South Asian people compared to white people
- Black African and Caribbean people are also at a higher risk of diabetic eye disease
visual impairment classification categories
Distance vision impairment:
Near vision impairment:
distance vision impairment divisions
Mild – presenting visual acuity worse than 6/12
Moderate – presenting visual acuity worse than 6/18
Severe – presenting visual acuity worse than 6/60
Blindness – presenting visual acuity worse than 3/60
near vision impairment
Presenting near visual acuity worse than N6 or M.08 with existing correction.
AMD
age related macular degeneration
causes of visual impairment UK
from most to least
uncorrected refracted error 42%
AMD 25%
Cataract 20%
Glaucoma 8%
Diabetic Retinopathy 5%
symptoms of visual impairment
Severe, sudden eye pain
Recurrent pain in or around the eye
Hazy, blurred, or double vision
Seeing flashes of light or sudden bright floating spots
Seeing rainbows or halos around lights
Seeing floating “spider webs”
Seeing a “curtain coming down” over one eye
Sensing a “cup filling up with ink” in one eye
Unusual, even painful, sensitivity to light or glare
Swollen, red eyes
Changes in the colour of the iris
White areas in the pupil of the eye
Sudden development of persistent floaters
Itching, burning, or a heavy discharge in the eyes
Gritty Feelings
Any sudden change in vision
get any changes in eye appearance, feeling etc – get checked
cataract
Cataract is clouding of the lens of the eye which prevents clear vision.
Majority related to ageing process
Occasionally children can be born with the condition
Cataract may develop after eye injuries, inflammation, and some other eye diseases.
According to the latest assessment, cataract is responsible for 51% of world blindness
- Although cataracts can be surgically removed, in many countries’ barriers exist that prevent patients to access surgery.
Cataract remains the leading cause of blindness.
- As people in the world live longer, the number of people with cataract is anticipated to grow.
Cataract is also an important cause of low vision in both developed and developing countries.
leading cause of blindness
cataract
age related macular degeneration
Age-related macular degeneration (AMD) is a condition affecting older people
Involves the loss of the person’s central field of vision.
It occurs when the macular (or central) retina develops degenerative lesions.
- The macula, a tiny area within the retina at the back of the eye.
- The cells of the macula are photoreceptor cells, which means they’re sensitive to light and play a vital role in our ability to see details and colour. These cells become damaged and scarred.
- It is thought that circulatory insufficiency, with reduction in the blood flow to the macular area, also plays a part.
Several forms of AMD exist
two classes of AMD
wet - severe, sudden, BAD
dry
wet AMD
Causes severe sight loss in a matter of months
can develop very rapidly, resulting in more sudden sight loss.
Growth of new vessels under retina which then break and leak into the macula
Occurs when unhealthy new blood vessels begin to grow under the macula and leak blood and fluid (this is why it’s called ‘wet’ macular degeneration), which then causes scarring to develop within the macula cells
dry AMD
Bilateral condition
90% of cases
Thought to have a hereditary element and myopia may be a predisposing factor.
Gradual loss of central vision.
Person becomes unable to recognise people because they cannot see their faces clearly, cannot see bus numbers etc.
Layers of the macula become progressively thinner, causing it to function less effectively.
glaucoma
group of diseases that have as a common end-point
Characteristic optic neuropathy which is determined by both structural change and functional deficit.
It’s usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye.
- Caused by a rise in intraocular pressure.
(Normal pressure is 10-21mmHg)
Normally > 50 yrs.
It can affect people of all ages but is most common in adults in their 70s and 80s.
Symptoms not generally noticed until there is a marked visual loss (coming in from edges)
Sight will never recover
Generally, a bilateral condition, affects one eye before the other
2 most common forms of glaucoma are
primary open angle glaucoma (POAG)
angle closure glaucoma (ACG)
primary open angle glaucoma (POAG)
Slow and insidious onset
Anterior chamber angle is open
Caused by the drainage channels in the eye becoming gradually clogged over time
angle closure glaucoma (ACG)
Less common
More acute
Caused by the drainage in the eye becoming suddenly blocked,
Can raise the pressure inside the eye very quickly
diabetic retinopathy
composed of a characteristic group of lesions found in the retina of individuals having had diabetes mellitus for several years.
The abnormalities that characterise diabetic retinopathy occur in predictable progression with minor variations in the order of their appearance.
Diabetic retinopathy is considered to be the result of vascular changes in the retinal circulation.
In the early stages vascular occlusion and dilations occur.
- It progresses into a proliferative retinopathy with the growth of new blood vessels.
Macular oedema (the thickening of the central part of the retina) can significantly decrease visual acuity.
causes of diabetic retinopathy
The retina is the light-sensitive layer of cells at the back of the eye. It converts light into electrical signals which are sent to the brain through the optic nerve. Once received, the brain interprets these signals to produce the images that you see.
To work effectively, the retina needs a constant supply of blood, which it receives through a network of tiny blood vessels.
Over time, continuously high blood sugar levels can cause the blood vessels to become blocked or to leak.
This damages the retina and stops it from working, usually in 3 main stages:
- background retinopathy – tiny bulges develop in the blood vessels, which may bleed slightly but this doesn’t usually affect vision
- pre-proliferative retinopathy – more severe and widespread changes affect the blood vessels, including more significant bleeding into the eye
- proliferative retinopathy – scar tissue and new blood vessels, which are weak and bleed easily, develop on the retina. This can result in some loss of vision
3 stages of diabetic retinopathy
background retinopathy
pre-proliferative retinopathy
proliferative retinopathy
background retinopathy stage in diabetic retinopathy
tiny bulges develop in the blood vessels, which may bleed slightly but this doesn’t usually affect vision
pre-proliferative retinopathy stage in diabetic retinopathy
more severe and widespread changes affect the blood vessels, including more significant bleeding into the eye
proliferative retinopathy stage in diabetic retinopathy
scar tissue and new blood vessels, which are weak and bleed easily, develop on the retina. This can result in some loss of vision
risk factors for diabetic retinopathy
Duration of diabetes
Level of glycemia
Presence of high blood pressure
Dependence on insulin
Pregnancy
Levels of selected serum lipids
Nutritional
Genetic factors
hemianopia
blindness in one half of the visual field.
- Hemianopia is a functional defect which can affect the right or left side.
This loss can be caused by a variety of medical conditions – stroke being the most common
- Stroke patients with weakness of, for example, the right arm and leg have right sided poor vision.
Sight loss can be upper, lower, left or right
treatment of visual impairment
Treatment depends on the condition diagnosed
Early diagnosis may be crucial
Medical
Surgical
Non-invasive
prevention of visual impairments
Regular eye exams
Protect eyes from the sun
Protective eye wear at work
Know family history
Seek treatment quickly
Stop smoking
Eating healthy and managing obesity
misconceptions of those with visual impairment
They are all totally blind
They must wear dark glasses
They must use a white cane or a guide dog to get around
They have sensitive hearing and special sense of touch (heightened)
They use Braille to read (uncommon now)
Certain activities are too difficult for them to try
They do not look at you when you talk to you
examples of difficulties experienced by those with visual impairment
Not being able to access printed material
Difficulty in accessing the Internet/electronic devices
Difficulty in getting to destinations and around the built environment
Lack of awareness of others as to how to help
Accessing unfamiliar buildings and environments
maximising communication for people with visual impairment in dental setting
Always identify yourself even in known surroundings
Always use names to identify people - especially in a group situation
Keep the visually impaired person informed of people moving around and/or leaving the room
Tell them what your doing before you do it – putting the chair back / LA / slow speed
Do not use non-verbal communication e.g. pointing in the direction of something, shrugging shoulders, pulling faces
Provide information in alternative formats:
- CD, email, extra large print, audio tapes, electronic formats, braille, moon,
Allow extra time
Prepare the surgery appropriately
Arrange for the alternative formats to be provided
Take time to get the environment right
hearing can be affected by (3)
Disease
Disorder
Injury
Estimated 9 million people affected in UK
Approx. 75% are > 60 years old
hearing impairment prevalence
Around 466 million people worldwide have disabling hearing loss, and 34 million of these are children.
- estimated by 2050 over 900 million people will have disabling hearing loss.
Hearing loss may result from genetic causes, complications at birth, certain infectious diseases, chronic ear infections, the use of particular drugs, exposure to excessive noise, and ageing.
60% of childhood hearing loss is due to preventable causes.
- billion young people (aged between 12–35 years) are at risk of hearing loss due to exposure to noise in recreational settings.
Unaddressed hearing loss poses an annual global cost of US$ 750 billion.
Current estimates suggest an 83% gap in hearing aid need and use
hearing loss classed as
A person who is not able to hear as well as someone with normal hearing – hearing thresholds of 25 dB or better in both ears
may be mild, moderate, severe, or profound.
affect one ear or both ears and difficulty in hearing conversational speech or loud sounds.
functional impact of hearing impairment
Ability to communicate with others
Spoken language development is often delayed in children
Adverse effect on the academic performance of children
Increased rates of grade failure and greater need for education assistance
Access to suitable accommodations is important for optimal learning experiences but are not always available
social and emotional impact of hearing impairment
Exclusion from communication can have a significant impact on everyday life causing feelings of:
- Loneliness
- Isolation
- Frustration
financial impact of hearing impairment
Annual global cost of US$ 750 billion. This includes health sector costs (excluding the cost of hearing devices), costs of educational support, loss of productivity, and societal costs.
In developing countries, children with hearing loss and deafness rarely receive any schooling.
Adults with hearing loss also have a much higher unemployment rate.
Higher percentage of people with hearing loss and in employment are in the lower grades of employment compared with the general workforce.
hearing impairment thresholds
(along with measurement in decibel loss - dBHL (25 normal))
Mild 20 – 40 decibels
Moderate 41 – 70 decibels
Severe 71 – 95 decibels
Profound 95+ decibels
‘normal conversation’ level
at a distance of 1 meter is between 50-60dBHL
COVID19:
- masks - stop lipreading,
- social distancing double distance
causes of hearing loss can be
congenital
acquired
congenital hearing loss causes
Maternal rubella, syphilis or certain other infections during pregnancy;
Low birth weight;
Birth asphyxia
Inappropriate use of particular drugs during pregnancy, such as aminoglycosides, cytotoxic drugs, antimalarial drugs, and diuretics;
Severe jaundice in the neonatal period
acquired hearing loss causes
Infectious diseases including meningitis, measles and mumps;
Chronic ear infections;
Collection of fluid in the ear (otitis media);
Medicines, such as those used in the treatment of neonatal infections, malaria, drug-resistant tuberculosis, and cancers;
Injury to the head or ear;
Excessive noise, including occupational noise such as that from machinery and explosions;
Recreational exposure to loud sounds
Ageing, in particular due to degeneration of sensory cells;
Wax or foreign bodies blocking the ear canal
signs of hearing impairment
Inactivity
Reduced development of speech & language skills
Deterioration of speech
Reduced social & emotional development
Irritability
Autistic like behaviour/ Confusion
clues to a hearing problem in a person
Unawareness of surroundings
Failure to respond to sound
Asking for sentences to be repeated
Speaking in an unusually loud voice
Change in tone
Withdrawing from life
spending time alone
treatment and prevention of hearing impairments
Early detection
Early management – surgical or medical
Rehabilitation
Immunisation
- key component in prevention in children
- need to know science behind to have effective conversation with pt,
Avoidance of some drugs
Reducing occupational exposure
e.g. high-speed use with ear plugs
types of hearing aid (4)
- Behind the ear – most common
- In the ear
- In the canal
- Completely in the canal
Battery operated – may struggle with dexterity
maximising communication with hearing impaired in dental setting
Ask if they want to use a loop system
Try to establish the person’s preferred communication method
- If necessary, book BSL interpreters, lip reader, note taker well in advance. This should be recorded in patients’ notes.
Face the person, don’t turn away Use clear speech, normal lip pattern, don’t shout Use finger spelling Speak at ear level Repeat, rephrase Write things down, type Reduce background noise - Ensure there is no echo - room with soft furnishings No radio etc
Ask people to repeat important information back to you – understanding
Make sure hearing aids are switched on and functioning
Allow extra time – reduce stress for dentist
Prepare an appropriate room
Book the necessary communication support
good ways to act in dental setting with hearing impaired pts
Face the person, don’t turn away
Use clear speech, normal lip pattern, don’t shout
Use finger spelling
Speak at ear level
Repeat, rephrase
Write things down, type
Reduce background noise
- Ensure there is no echo - room with soft furnishings
No radio etc
Book the necessary communication support
