Sensory Impairment Tutorial Flashcards
Name the 5 ‘big’ senses?
- Sight
- Hearing
- Smell
- Touch
- Taste
How many senses do we have?
- Have up to 21 senses
Name 5 senses that aren’t the 5 ‘big’ senses?
- Nociception
- Equilibrioception
- Chemoreception
- Proprioception
- Magnetoception
What is sensory impairment?
- When one or more of a person’s senses is no longer normal
Does a person need to have full loss of a sense to be sensory impaired?
- No
What do people with sensory impairment often have? (2)
- Low confidence
- Require support
In how they experience and interact with the environment around them
What are sensory impaired groups that we often forget? (2)
Older people:
- Sensory impairments are not responded to
- Has a major factor in falls (which older people find it harder to recover from)
- Dementia and sensory loss
Learning Disabled:
- 10x more likely to have a hearing impairment
What is the current terminology for partially sighted?
- Sight impaired
What is the current terminology for blind?
- Severely sight impaired
What are the leading causes of vision impairment and blindness?
- Uncorrected refractive errors and cataracts
What age are the majority of people with vision impairment and blindness?
- Over the age of 50
Where do most people with vison impairment and blindness live?
- In developed countries
How many cases of sight loss in the UK are avoidable?
- At least half of all cases
If detected early could some sight loss due to glaucoma, age related macular degeneration and diabetic retinopathy be avoided?
- Yes
What is the prevalence of sight loss associated with?
- 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 thy experience symptoms
What disease that could cause vison impairment is more common in low and middle income countries?
- Cataracts
low income:
- congenital cataract is the leading cause
Middle income:
- Retinopathy of prematurity
What diseases that could cause vison impairment is more common in high income countries? (3)
- Diabetic retinopathy, glaucoma and age related macular degeneration are more common
The international classification of diseases 11 (2018) classifies vision impairment into 2 groups. What are these 2 groups?
- Distance vision impairment (short sighted)
- Near vision impairment (long sighted)
What are the categories of distance vision impairment? (4)
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 then 3/60
What is near vision impairment?
- Presenting near visual acuity worse than N6 or M.08 with existing correction
What are symptoms of visual impairment? (16)
- Severe, sudden eye pain
- Recurrent pain in or around the eye
- Hazy, blurred, or double vision
- Seeing flashes or light or sudden bright floating spots
- Seeing rainbows or halos around light
- Seeing floating ‘spiders webs’
- Seeing a ‘curtain coming down’ over one eye
- Seeing 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 feeling
- Any sudden changes in vision
What are cataracts?
- Cataracts is clouding of the lens of the eye which prevents clear vision
What are cataracts majorly related to?
- The aging process
however occasionally children can be born with the condition
When might cataracts develop (other than old age)? (3)
- Cataracts may develop after eye injuries, inflammation and some other eye diseases
What is the macular?
- The central part of the retina (the cells here are photoreceptor cells which allow us to see light)
What is macular degeneration?
- Age related disease affecting older people
- Involves the loess of the person’s central field of vision
- IT occurs when the macular (or central retina) develops degenerative lesions
- The cells in the macular become damaged and scarred
- It is thought that circulatory insufficiency, with a reduction in the blood flow to the macular area also plays a part
- Several forms of AMD exist
What are the 2 types of macular degeneration?
- Wet
- Dry
What is ‘wet’ macular degeneration?
- 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 BV’s begin to grow under the macula and leak blood and fluid (This is why it is called wet), which then causes scarring to develop within the macula cells
What is ‘dry’ macular degeneration?
- 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
Are macular degeneration cases mostly wet or dry?
- Dry (90% of cases)
What can Glaucoma be regarded as?
Can be regarded as a group of diseases that have as a common end point
What is Glaucoma?
- Characteristic optic neuropathy which is determined by both structural change and functional deficit
What is Glaucoma usually caused by?
- IT is usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye
If not diagnosed and treated early what can Glaucoma lead to?
- Can lead to loss of vision
What age group is Glaucoma most common in?
- IT can affect people of all ages but is most common in adults in their 70s and 80s
Is Glaucoma a bilateral condition?
- Generally a bilateral condition, affects one eye before the other
Once Glaucoma has affected the eye will sight recover?
- No it will never recover
What are the 2 most common forms of Glaucoma?
- Primary open angle glaucoma
2. Angle closure glaucoma
What are the characteristics of Primary open angle glaucoma? (3)
- Slow and insidious onset
- Anterior chamber angle is open
- Caused by the drainage channels in the eye becoming gradually clogged over time
What are the characteristics of angle closure glaucoma? (4)
- Less common
- More acute
- Caused by the drainage in the eye becoming suddenly blocked
- Can raise the pressure inside the eye very quickly
What is diabetic retinopathy?
- DR is composed of a characteristic group of lesions fond 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
- DR 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 BV’s
- Macular oedema (the thickening of the central part of the retina) can significantly decrease visual activity
What are the 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
- Thus 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
What are the risk factors for diabetic retinopathy? (8)
- Duration of diabetes
- Level of glycaemia
- Presence of high blood pressure
- Dependence on insulin
- Pregnancy
- Levels of selected serum lipids
- Nutritional
- Genetic factors
What is Hemianopia?
Is blindness in one half of the visual field
- Sight loss can be upper, lower, left or right
What is the most common cause of hemianopia?
- The loss can be caused by a variety of medical conditions - stroke being the most common
- Hemianopia is a functional defect which can affect the right or left side. Stroke patients with weakness of, for example, the right arm and leg have right sided poor vision
What are the different kinds of treatment we can give people with visual impairment?
- Treatment depends on the condition diagnosed
- Early diagnosis may be crucial
- Medical
- Surgical
- Non-invasive
What are the different forms of prevention for a visual impairment? (7)
- Regular eye exams
- Protect eyes from the sun
- Protective eyewear at work
- Know family history
- Seek treatment quickly
- Stop smoking
- Eating healthy and managing obesity
What are common misconceptions for people with a visual impairment? (7)
- 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
- They use Braille to read
- Certain activities are too difficult for them to try
- They do not look at you when they talk to you
What are difficulties that people with a visual impairment may experience when coming to the dentist? (5)
- Not being able to access printed material
- Difficulty in accessing the internet/electronic devices
- Difficulty in getting to destinations and around the environment
- Accessing unfamiliar buildings and environments
- Lack of awareness of others as to how to help
How can we maximise communication for people with a visual impairment? (11)
- 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 you’re doing before you do it
- Do not use non-verbal communication e.g. pointing in the direction of something, shrugging shoulders etc
- 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 alternative formats to be provided
- Take time to get the environment right
What can hearing be affected by? (3)
- Disease
- Disorder
- Injury
- 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 aging
How do we define someone with a hearing impairment?
- A person who is not able to hear as well as someone with normal hearing - hearing threshold of 25 dB or better in both ears - is said to have hearing loss
- Hearing loss may be mild, moderate, severe or profound
- IT can affect one ear or both ears, and leads to difficulty in hearing conversational speech or loud sounds
What are examples of functional impacts of a hearing impairment? (5)
- 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 educational assistance
- Access to suitable accommodations is important for optimal learning experience but are not always available
What is the social and emotional impact of a hearing impairment?
Exclusion from communication can have a significant impact on everyday life causing feelings of:
- Loneliness
- Isolation
- Frustration
What is the financial impact for people with a hearing impairment?
- 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
What are congenital causes of hearing loss? (5)
- 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
What are the acquired causes of hearing loss? (9)
- 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 TB, 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
What are common signs of someone with a hearing impairment? (7)
- Inactivity
- Reduced development of speech & language skills
- Deterioration of speech
- Reduced social & emotional development
- Irritability
- Autistic like behaviour
- Confusion
What are clues to identify someone with a hearing problem? (8)
- 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
How can we treat/prevent a hearing impairment? (6)
- Early detection
- Early management - surgical or medical
- Rehabilitation
- Immunisation
- Avoidance of some drugs
- Reducing occupational exposure
What are the 4 different types of hearing aid available?
- Behind the ear hearing aid
- In the ear hearing aid
- In the canal hearing aid
- Completely in the canal hearing aid
How can we maximise communication with people with a hearing impairment? (16)
- 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
- Ensure there is no echo - room with soft furnishings
- Ask people to repeat important information back to you
- Make sure hearing aids are switched on and functioning
- Reduce background noise
- Allow extra time
- Prepare an appropriate room
- Book the necessary communication support
What is a loop system?
- The loop system is an assistive listening device that works along with your hearing aid. It may also be referred to as the telecoil, or T-system. The aim of the loop system is to help overcome background noise.
