VRT EXAM Flashcards
Charles Bonnet Syndrome
Hallucination, not delusion
Stroke resulting in injury to left side of brain
Speech and language deficits
Amsler Grid
used to assess central 10 degrees of vision
recommended length of kitchen training lesson
120 minutes
Focal distance
Lower the power, further you hold away
Rehabilitation Act of ‘73 Section 504
Reasonable accommodation
4 eye conditions that are primary cause of legal blindness in elderly
Cataracts, diabetic retinopathy, ARMD, Glaucoma
Cornea
provides most refractice power to convergence of light
Convergence
Ability to search for and locate items, such as words on a page
Typoscope
Reading guide with cutout window to assist in maintaining orientation to line of print; also assists with glare
3 variables that enhace visibility for consumers with low vision
Size, color, illumination
Percent of information received through the eyes
80
As magnificaiton increases, one may experience…
…decreased field of view; increased speed of movement of objects; difficulty in control of device
benefit of a stand magnifier
alleviates the need to guess focal distance
Normal visual field
160-180 degreess horizontally, 120 degrees vertically when eyes are fixated ahead
Most common eye condition for someone of African descent
Glaucoma
Most common eye disease in children
Stargardts
Braille sequence of instruction
Dot pattern orientation, letters, tracking across line, tracking from line to line
Procedure for instruction in use of device/skill (outline):
A. General information & possible uses; B. Orientation to device; C. Setup of device/task; D. Use of device (practical applications)
Labeling playing cards
first value, then suit
AMD & Reading
It may be hard for consumer to see top of print letters; move fixation below line to view whole line of text
Behavioral objective components
Behavior, condition, criteria
Tuttle & Tuttle 7 Stages of Vision Loss
Trauma, physical or social; Shock & Denial; Mourning & Withdrawal; Succumbing & Depression; Reassessment aand reaffirmation; Coping and mobilization; Self-acceptance & Self-esteem
Livneh - 5 Stages of Adjustment to Blindness
Initial impact; defense mobilization (I don’t need); initial realization (I can’t); Retaliation (I won’t); reintegration (I can)
Lovinger - Stages of development
- Inability to distinguish oneself from others; 2. Wanting to conform & be like others (conformity); 3. Wanting to be recognized as an individual; 4. Understanding the value of others; 5. knowing one’s inner self
How do Lovinger’s stages of development affect attitude toward learning?
“1. People in conformant stage believe that others are the source of knowledge and that instructor is an authority
2. Later stages believe that the source of knowledge is own life experience, instructor is a role model or evaluator, and learner has responsibility for his or her own learning”
6 Assumptions of andragogical approach
- Self concept (individual can direct their own learning as opposed to depending on authority figure); 2. Experience (adults have reservoir of experience that is resource for continued learning); 3. Need to Know: Adults need to know why they are learning something/practical application; 4. Problem centered focus (Problem solving as avenue for learning); 5. Internal motivation (adult’s motivation is internal/self-directed); 6. Adults need to know why they should learn
4 Principles of androgogy
- Adults should have ownership of content/process of learning; 2. Learning should build on previous knowledge; 3. Learning content should focus on relevant, practical tasks related to life; 4. Focus on solving problems rather than memorizing content
Ponchilla’s strategies for instruction/communication with people with VI
”* Use analogies
* Using scale models
* Use learner’s descriptions, engage them to participate
* Hand-over-hand is the LAST resort (could use hand under
hand instead)”
Memory strategies for older adults
distraction free environment; mnemonics; chunking/classification of info; organization; repitition and practice; take breaks for processing informaiton; accommodate fatigue; simple language; identify oneself and your agency
Tips for working with individuals with hearing loss:
Face person when speaking; avoid backlighting; keep hands away from mouth when talking; turn off distracting noises; talking a normal voice (don’t shout); reword phrases the learner has difficulty understanding; lipstick can increase contrast between lips and face, beards/mustaches impede understanding
Communication strategies for visually impaired learners
use precise language; use analogies and metaphors; use auditory cues; give learner more descriptive responsibility; use tacile modeling or demonstration; present tactile or highly visible scale models; manipulating learner movements
Low vision
A degree of vision that is functional but limited enough to interfere with the ability to perform everyday activities and that cannot be corrected with standard eyeglasses or contact lenses
Visual field
The area that is visible without shifting gaze
Stage 1 Initial Impact/Trauma, Shock
VRT Response: Not many VRTs observe this stage
Stage 2: Defense Mobilization, Denial
Denial can be hopeful; intellectualization is common; VRT Response: Focus on painful losses and build lesson around this; VRT should preserve working relationship
Stage 3: Initial Realization, Mourning/Withdrawal, Succumbing/Depression
Denial/depression cycle can occur; VRT response: Monitor for suicidal ideations, try again and again until a lesson is accepted
Stage 4: Retaliation/Rebellion, Succumbing Depression
Hostility/projection stage; VRT response: avoid confrontation, sustain therapeutic relationship
Stage 5: Reintegration of reorganization/Reassessment & Reaffirmation
Behavioral adaptation and reintegration into society; VRT response: engage client more fully, client-centered care
4 major sources for assessment
case file, personal interview, performance-based assessment, direct observation
Assessment interview (Benjamin 1981):
4 sequential steps: prepartion, opening, body, closing
SMART Goals
Specific, Measurable, Attainable/Achievable?Action-Oriented, Realistic/Relevant, Timely/Time-bound
VRT Lesson Plan process
7 parts: 1. Objective (specific behavioral objective to be reached during lesson); 2. Materials; 3. Assessment (Questions/activities designed to measure adequacy of skills taught); 4. Procedure (description of sequential steps to be taught in the lesson); 5.Memoranda (Notes); 6. Evaluation (behaviors to be observed and measured at end of lesson); 7. Assignment (Practice)
VRT Lesson Plan Procedure Section
Core section on VRT Lesson Plan; 1. Perform taks analysis and prepare outline of major steps; 2. Perform Activity yourself; Write the outline to be a generic plan for average learner and modify for each students’ individual needs
SEER method use when determining adaptive techniques and devices
Safe: will not pose threat or danger when used consistently; Effective: adaptation works well and produces the intended results; efficient: assists learner in doing things using reasonable and acceptable amt of time/energy; reliable: adaptation/technique is dependable and consistent in what it does
Least restrictive adaptation theory (Jones 2004)
Category 1: Sense-shifting (changing approach to task); Category 2: altering the environment (making task easier or movement within environment easier); category 3: utilizing familiar devices (performing task with common tools/readily available items); Category 4: using a specialty product (using tool/device from a specialty company designed for particular task).
Cognitive Learning Theory (Neisser 1976)
Acquiring information and processing it internally leads to understanding & retention; strong emphasis on memory; chunking information; linking new content to previous knowledge; using real world examples; repetition; time to process activities; mnemonics to remember information
Social Learning Theory (Bandura 1977)
People learn from one another in social context through observation, imitation, modeling; group learning can lead to motivation, incidental learning and acquiring knowledge;
Medications that affect visual functioning
NSAIDs (photosensitivity); galucoma eye drops (blurring); ointments and lubricators; meds for diabetes, heart problems, arthritis, congestion can cause edema, dry eye, blurring, irritation, pupil dilation/constriction
Factors that affect low vision and ease of visibility
Illumination, contrast, color, distance, size
Illuminaton
”- amount of light reflected from the surface of viewed object into the eye
- as degree of illumination is increased, so is visibility
”
- glare
- when reflected light strikes eye at an angle or is too bright
4 categories of magnification
relative distance; relative size; angular magnification, electronic magnification
Lighting
”- quality of lighting (rather than amt of illumination) is critical
- different types of illumination can increase contrast, enhance color, increase visual comfort
- optimal visual performance - lighting that is glare free and Color Rendering Index close to 100”
Correlated Color Temperature (CCT)
”- measured by kelvin, refers to warmth or coolness.
- lower numbers indicate warmer colors
- incandescent and halogen - warmer colors
- higher numbers indicate whiter, bluer light
- flourescent - cooler colors (make objects more blue or green hued)
- LED - available across color spectrum
- rec. lights in range of 2700-3500K”
Color Rendering Index (CRI)
”- how accurate color appears under specific light
- rec. CRI of 80 for most people
- halogen - glare free light, can increase contrast”
Task lighting placement
”- Should be placed to reduce both glare and shadow
- client should not be able to see bulb directly when working on task
- positioned opposite writing hand “
- Should come from behind and not be near eyes
relative distance magnification
bring object closer to eye; ex. sitting closer to stage or whiteboard
relative size magnification
changing object size and keeping distance constant; ex large print
angular magnificaition
using lenses to change angle of light
electronic video magnifier
variable magnification, enhanced contrast, wider field for viewing ; do not require individual to hold material close to face for viewing
Magnification power
Expressed in terms of X; 2X is 2 times actual size; 3X is 3 times, etc.; affects working distance of the device
diopters
4 diopters = 1X power
Calculate diopter (dioptic power) of a lens (D)
100 cm (constant value) divided by focal distance (F) of lens in cm; D = 100cm/Fcm
calculate focal distance (F) of a lens
F = 100/D
Training for reading with low vision w/optical devices
Training should be systematic and progress measurable; should begin with higher magnification level and progress to reader’s actual magnification level; begin with single letter recognition and progress to multiple letters; letters or wpm should be documented; individuals with low vision must gain tolerance for reading w/magnification and may encounter eye strain, headache, nausea
documentation for reading training w/ optical devices
Should include device used, distance material wasa read, lighting conditions, eccentric viewing angle, reading duration
Low vision & employment: Framework for structuring services
environmental analysis of jobsite; ecological considerations (task analysis of job duties); functional low vision assessment; refer to CATIS if necessary; meet with employer; visual ergonomics assessment
Visual ergonomics in workplace for low vision
lighting (need quality illumination free from glare); reduce eye strain/fatigue; knees bent at 90 degress; monitor 16-30 inches from users eyes; top of monitor slightly below horizontal level; center of monitor 10-20 degrees below eyes.
Universal design principles
equitable; flexible; simple & intuitive; perceptible (maps, signage, signals, web page in accessible format); low physical effort; size and shape (any body type/mobility needs can comfortably utilize space)
Inverse square rule of light
The inverse square law states that every time you double your distance from the light to your subject, you lose 75 percent of the light. Losing 75 percent of your light from three feet to six feet is a very drastic change.
Teaching handwriting w adaptations- considerations
Seating; surface (contrast, ex matts or other large sheets of paper); lighting; use of low vision devices; workplace organization; instruction;
Assessment for braille
“is there a functional need for braille as a strategy for increased independence? Is the client emotionally ready and motivated? Is the client physically and cognitively able to learn braille?
- functional need for braille: determine level of usable vision; determine client’s current use of vision in daily tasks; determine long term goals of client
- determine if client is emotionally ready: does client have motivation? Current stage in vision loss processing?
- Determine if client is physically and cognitively able to learn braille: clients need to have good tactile sensitivity and ability to remember braille code; Assess tectile readiness and fine motor skills”
efficient braille reading & braille mechanics
“use two hands to track braille; index fingers sie by side; fingers slightly curled; no scrubbing
run fingers under warm water to increase sensitivity; begin lessons with tracking exercises; do not introduce new information until proper mechanics have been demonstrated”
pace of braille instruction
alternate between reading, writing, and other activities; fingers can only tolerate short periods of reading at the beginning; include writing, swing cell, contractions, or other activities in addition
Teaching word processing with speech output: instructional secquence
“1. keyboarding skills
- cursor movement by character, word, lilne, page
- basic editing commands - insert & delete by character, word, line
- basic system commands - save/open docs, print, etc
- advanced features - select blocks of text, copy/paste, underline/text attributes, spellchecl, search function, working b/w 2+ open docs
2. screen reader commands
- set speech parameters - voice, pitch, rate, volume, verbosity
- orientation to numpad
- basic speech commands - review by character, word, line, sentence, paragraph, entire doc
3. advanced system commands
- describe computer desktop elements/layout
- navigate and access to destop elements (icons, start menu, quick launch bar, system tray)
- file explorer to manage/organize files”
Screen reader features/teaching considerations
Speech parameter; JAWS cursor; “review” feature utilizing insert+numpad (ex. speak character, speak line, etc); spellcheck (alt+shift+L)
Keyboarding considerations when teaching zoom programs
Utilize built-in keyboard commands in screen reader AND zoom programs; always teach on a full-sized keyboard; determine if tactile markings or large print overlays are necessary; utilize mnemonic strategies iin teaching 6 key layout;
Assessment process for communications/information gathering instruction
“1. Where has the client been? - past experience
2. Where is the client now? - current performance
3. Where is the client going? - barriers and goals “
teaching considerations for recording devices
”- discuss uses for device
- teach device and components
- principles of recording/recording best practices
- organization - make sure files are titled/dated, unnecessary files are deleted etc.
- system for transferring recorded information to permanent place
- use to record training material “
Digital Book/reading programs
NLS BARD, Learning Ally, BookShare, LibriVox/Project Gutenburg, Audible, Kindle
areas of stovetop instruction
centering pot/pan on burner; setting appropriate temp; monitoring food in pot or pan; stirring/adding/turning foods while cooking; determining doneness of food; safe transfer to serving dishh
Centering pan on hot burner (not cold)
grasp handle with mitten hand to feel if it is sitting correctly; use wooden spoon; feel for center of heat and judge
Strategies for determinng temperature on stove
pre determined temp settings on burner control; tactile markings on stove surface/burner controls; clockface method; extend hand at chest height to determine center of heat
Turning Foods
wear long-arm gloves to prevent burns from splatters; place items in a pattern; need for ability to rotate wrist to flip item in pan; model with cold pan/foods; rotate wrist toward center of pan. Instructional sequence: use systematic search to locate food in pan; slide item to seif of pan to stabilize and slip spatula underneath; once food is in spatula (singe or double), slide spatula to 12 oclock position and flip toward body
Determining doneness
method for determining if something is done; soft sizzle sound; peak smell; touch with fork or finger to feel texture; adaptive. thermometer; visual check (not too close to pan); color of food
Oven instruction…
…for all learners, should begin with comprehensive orientation to parts when it is cold.
Functional Vision Assessment Components
History (medical, ocular, education/rehab history); interview; environmental assessment; ocular structure and reflexes; visual acuities (near, distance); visual fields (central, peripheral); ocular motility/visual skills (convergence, fixation, tracing, tracking, saccades, scanning), color screening
Hair care considerations
contrast (ex. towel behind head), lighting, magnification (lighted magnifying mirror), tactile landmarks, collaborate with hair stylist
Shaving
break face into sections; overlapping strokes; tactile check; use free finger as a guide
makeup
label makeup products; stabilize hand on cheek for eye makeup; utilize small sample size brushs; count number of strokes; use facial landmarks; use tray; use creams rather than liquids; wash hands between steps; wear apron or towel;
guidelines for VRT & insulin
work as part of teamwith physician, diabetes educator, nurse; set goal for accuracy within one unit; document cleint progress and performance levels; have client demonstrate consistency to friend, family, or medical professional
Insulin options for low vision
pre-filled syringes, insulin pump, insulin pen
ironing
“-placement of iron hot plate is away from body and cord is facing body and hanging over edge of board; trace along board until cord is located and trace cord to iron handle
-place iron on heat resistant pad
-attach cord holder to ironing board to stop cord from interfering with iron
-utilize contrast, lighting
-practice with cold iron”
eating considerations (simple to complex)
locating items in place setting; locating and identifying foos items on a plate; cutting meat and other food; spreading butter and condiemnts; using condiments; securing food onto eaing utensils; bringing food to mouth; keeping food on plate
location technique
position hands on edge of table with palms facing down; hands in c position; maintain constant contact with the table surface; move hands in a systematic pattern making note of locations of items
Most important part of managing a caseload
Documentation
Retinitis pigmentosa
“Destroys rods, causes retina to atrophy;
A progressive disorder that causes degeneration primarily of the light sensitive cells in the periphery of the retina.
Loss of peripheral vision, night blindness, tunnel vision, decreased acuity and depth perception, spotty vision because of retinal scarring, and photophobia.
Students may need to sit far away from target to increase visual field”
Macular degeneration
“Leading cause of legal blindness over age 60
Progressive or degenerat- ing damage to the central part of the retinal cones. Can be juvenile (occurring before the age of seven) or senile.
Affects central vision, photophobia, poor color vision, normal peripheral vision.
Eccentric viewing using peripheral vision, magnifi- cation to enlarge the image beyond the scotoma, diffused less intense light may permit the eyes to enlarge the pupil so more area can be viewed, telescopes for distance vision, reversed polarity on screens, adjustable lighting without glare.”
Diabetic retinopathy
“Neovascularization of the retina.
Both juvenile onset and maturity onset diabetes can cause changes in the blood vessels of the retina, causing hemorrhaging in the retina and vitreous, sensory loss in the feet and hands, and possible retinal detachment and blindness. Sensitivity to glare, double vision, fluctuating acuity, diminished color vision, defective visual fields, floating obstructions in the vitreous, retinal detach- ment. Hemorrhages recur, vision may fluctuate
Good lighting and contrast, magnification, closed circuit television.
Stress and pressure to perform can negatively affect stabilization of blood glucose.
“
MS & Vision Loss
Functional: Color distiction; fluctuating acuities; intermittent vision loss
Achromotopsia
Cone malformation, macular challenges; inability to see colors and detail; photofobia; need sunglasses, high contrast, adaptations for colors
Albanism
Total or partial lack of pigment causing abnormal optic nerve development, may or may not affect the skin color. Can be com- plete or partial albinism or ocular albinism. May be sensitive to exposure to the sun; decreased acuity; strabismus; nystagmus; photophobia
Amblyopia
“Lazy eye; Reduced visual function-
ing in one eye which
causes the student to use only one eye instead of both; need good contrast and glare reduction”
Most common vision impairment in children
Anophthalmia
Absence of the eye
Buphthalmos
Infantile Glaucoma; blindness occurs if left untreated
Cataract
Opacity or cloudiness of the lens which restricts the passage of light, Reduced visual acuity, blurred vision, poor color vision, photophobia, and sometimes nystagmus; surgical removal is recommended for mature cataracts
Most common cause of blindness worldwide
NFB (Nat. Fed. for the Blind)
Consumer organization; Provices braille and literacy resources; publishes Braille Monitor, future reflections, voice of the diabetic; support groups; legislative activism
American Foundation for the Blind (AFB)
Not a consumer organizaton; Publishes Journal of Blindness & Visual Impairment; Publishes resource directory of services for Blind and Visually Impaired; research; statistics
American Printing House for the Blind (APH)
Publishing house; shop with blindness/low vision products; textbooks; educational resources; research & development; Connect Center;
American Council of the Blind (ACB)
Advocacy organization; consumer organization; national chapters; information resource
Father Carroll & Adjusting to Vision Loss
Individual must “die” as a sighted person and self esteem be reorganized; acceptance of disability required before rehabilitation can begin
20 Losses with VI: Loss of ….physical integrity; confidence in remaining senses; reality contract with environment; visual background; light security; mobility; techniques of daily living; ease of written communication; spoken communication; informational progress; visual perception of pleasurable; visual perception of beautiful; recreation; career/vocational/job opportunity; financial security; personal independence; social adequacy; obscurity; self-esteem; personality organization
Assessment interview (Benjamin 1981):
4 sequential steps: prepartion, opening, body, closing
Assessment Interview: Preparation
Cornerstone of interview process; utilize motivational interviewing techniques (empathy, active listening, support self-efficacy); be aware of cultural and perceptual considerations