Week 13 Flashcards
Muscles that contract and relax during accommodation to view objects of varying distances
Cilia
Normal loss of near focussing that happens with age
Presbyopia.
What happens to the cilia muscles and suspensory ligament during presbyopia
Cilia muscles and suspensory ligament loose elasticity during presbyopia (difficulty with near vision)
What happens to the LENS during presbyopia?
Gradual loss of accommodation –becomes less flexible, so doesn’t change shape as easily. Important during reading
Holds lens and supports eye
suspensory ligament
What happens to the lens with age?
The lens looses flexibility with age.
What is the most common complaint with presbyopia
Arms aren’t long enough to hold out reading material (difficulty with near vision)
When does presbyopia usually happen in individuals?
May start happening about age 40-50
What is the outlook once someone has developed presbyopia ?
Progressive–worsens over time
Build up of lens leading to symptoms including cloudiness and bluriness
Cataracts
All of the following except which are symptoms of cataracts? A. Cloudiness B. Blurriness C. Bright colors D. Halos of Light
C. Bright colors. With cataracts, colors are faded
What happens after cataracts are corrected via surgery?
Person has twinkle/flicker in eye. Can usually see
T/F: Cataract surgery is very expensive and usually not covered by insurance
False. Cataract surgery should be covered, even for lower income
Age-related condition that causes central vision loss
Age-related macular Degeneration
What is the Macula important for?
Macula is crucial for central vision and seeing details sharply; activities requiring precise vision e.g., reading, sewing, driving, setting oven temperature
Part of middle eye responsible for detailed vision
Fovea
One of the leading causes of irreversible blindness…
Age-related macular degeneration
Prognosis for age-related macular degeneration?
Irreversible. One of leading causes of irreversible blindness
Genetics, exposure to the sun, and nutritional deficits are all causes of…?
Macular degeneration
Dry vs. Wet macular degeration
Dry: Insidious, creeps up slowly
-White/yellow deposits of fatty protein
-Fuzzy vision
Wet: Growth of abnormal blood vessels
-See straight lines as wavy (problem when driving, going down/up stairs)
-White out or dark outs in central vision
-Bluriness
-Where trying to focus is completely obscured
Main problems with dry macular degeneration
-Fuzzy vision
Main problems with wet macular degeneration
- Blurry vision
- See straight lines as wavy b/c abnormal blood vessel growth and leakage of fluid in eye SO
- Problem with driving, going up/down stairs
- White outs/black outs
- Where trying to focus is obscured
- Social participation affected–can’t see nonverbal cues during conversation
- distressing for life-long readers
Functional impact of macular degeneration?
- Reading
- Driving
- Safety
- Falls
Most common cause of blindness in African Americans
Glaucoma
Build-up of excess fluid that leads to pressure on the optic nerve and causes tunnel vision (peripheral blindness)
Glaucoma
T/F: Glaucoma may be reversed with time
False, Glaucoma is irreversible
Functional impacts of glaucoma?
- Driving
- Bumping into objects
- Reading
- Walking
Uncontrolled diabetes may lead to damaged retinal capillaries, causing this condition
Diabetic retinopathy
All of the following except which are symptoms of diabetic retinopathy? A. Leaking fluid into macula B. Poor blood flow C. Shrinking blood vessels D. Hemorrhaging blood vessels E. Decreased near and distance vision F. Scotomas (block outs)) in vision
C. With diabetic retinopathy, growing (not shrinking) blood vessels
Changes in vision due to diabetic retinopathy?
- Decreased near and distance vision
- Scotomas (random block outs, spots, blotchy) in vision
T/F: Type I diabetes is associated with proliferative diabetic retinopathy while Type II is associated with non-proliferative
True
Which is more common as a cause of diabetes retinopathy in OA, type I or type II diabetes?
Type II diabetes–associated with non-proliferative
Functional impacts of diabetic retinopathy ?
- Difficulty driving at night
- REading
- Preparing meds like insulin
- Testing glucose
- Mobility
Why is driving at night often problematic for OA?
They have decreased ability to adapt from darkness to lightness e.g., tunnel, shifting to bright headlights, streetlights
What suggestions can we make for OA regarding dark/light adaptation?
- Increased illumination needs–need more light to do tasks
- Areas with more light poles are better when driving
Progressive deterioration of hearing associated with aging, mainly involving higher frequencies
Presbycusis
Which types of letters/words are more difficult for OA to hear?
Higher frequencies from consonants like s, f,
Differences in sounds of vowels vs. consonants for OA?
- Vowels make loud
- Consonants sounds like mumbling (higher frequencies, more difficult to hear)
Who is more willing to use lip reading and try to use nonverbal cues (like with presbycusis), males or females?
Females more willing , but lip reading only goes so far e.g., Matt and Batt look very similar
What are often the causes of conductive loss presbycusis ?
- Often happens with blockages like ear wax
- May also be from infection
What are often the causes of sensorineural loss presbycusis?
- Loud environments
- Head trauma
- Medications
- Tumors (may have tumor in one ear and not other, but if nerves affected will affect both ears)
- HTN (hypertension)
- Diabetes
Conductive loss presbycusis vs Sensorineural loss presbycusis
Conductive loss:
-from blockages like ear wax or infection
-aboise noise and being able to conduct noise through middle or external ear
Sensorineural loss:
-Damage to inner ear and auditory vestibular nerve
-Cochlea cells may be damaged
-Loud environments often cause damange
OAs who engage in what kinds of activities/job may develop sensorineural presbycus loss
OA who mine, do construction, go to concerts may develop sensorineural presbycus loss
“Ringing in the ears” condition that affects 15% of general public
Tinnitus
Are men or women more commonly affected by Tinnitus
Men more commonly affected Tinnitus
T/F: Tinnitus can usually not be corrected
False! Can usually be corrected
T/F: Tinnitus is a symptom, not a disease
True
AT Device vs. AT Service
AT Device focuses on equipment and products
AT Services focuses on products
Both for persons with disabilities or OA
AT may be used to augment either amplification or magnification existing pathways. What do these refer to?
Amplification: hearing
Magnification: vision
When are alternative sensory pathways used?
When primary sensory path is so impaired that it can’t be used effectively
Using brail is an example of using what kind of alternative pathway?
Using brail is a tactile substitution for when visual pathway is unavailable
Using subtitles in a movie is an example of using what alternative pathway?
Visual substitution for auditory pathway
A book on tape is an example of using what alternative pathway?
Auditory substitution for visual pathway
What is the drawback to using alternative pathways for age-related sensory loss?
Alternative pathways often work at much slower rate than primary pathways.
Drawbacks to handheld magnifiers?
- May lose
- Social implications for carrying around
- May not be able to do hands free
- Decreases how much you can see at one time
Benefits and Drawbacks to eyewear field expanders
Benefits: -Widens field of view, especially for pts with tunnel vision -Looks most normal Drawback: -Not safe to be used while driving
Which of the following optical aids looks the most normal: A. Handheld magnifier B. Stand magnifier C. Field expander D. Telescope
Field expander–part of eyewear that expands field of view
Which of the following optical aids looks the least normal: A. Handheld magnifier B. Stand magnifier C. Field expander D. Telescope
Telescope. May not have great adoption rate
Nonoptical aids for vision loss include…?
- Enlarged print
- High intensity lamps
- High contrast objects
- Increase task lighting
- Minimize clutter
- Rug taped down
- Salad colors instead of patterns
Drawbacks to electronic aids for vision loss compensation
- Immobile
- Very expensive
- Have autofocus–may not be best focus for everyone
- Electronic magnifiers less expensive, but could just use smartphone (although many OA don’t have or know how to use)
What computer modifications are helpful for OA visual impairments?
- High color contrasts (helpful for color blindness too)
- Enlarged keyboards
- Screen magnifier/zoom
- Narrator
- voiceover
Automatic reading of text is what kind of alternative pathway?
- Auditory substitute for visual pathway
- May need to use with clients
- Jaws: reads out loud as someone scrolls over computer screen
T/F: There are many different kinds of hearing aids
True.
- Some in right inner ear
- Some wrap behind ear
- Sports ones available
- Some waterproof
Device that sends typed message to telephone
Teletypewriter (TTY)
-Has to be used on both ends of communication
Downfall to using Relay Services over Teletypewriters
- Takes a lot longer to communicate
- Less private
Real time translation versus closed captioning
- Closed captioning: like subtitles when watching movie
- Real time translation: Happening in real time e.g., political event, conference
Special type of sound system for use by people with hearing aids that provides a magnetic, wireless signal that is picked up by the hearing aid when it is set to ‘T’ (Telecoil) setting.
Hearing Loop. Involves mic and amplifier to help OA hear in certain room e.g., conference room
versatile portable amplifier with microphone that provides users with the ability to hear more clearly
Pocket talker
Cons to pocket talker
- Have to be very close to person
- Adoption very low
Expensive assistive listening device worn around neck
Bluetooth amplifiers
Device worn on wrist that vibrates when something happens e.g., fire alarm, doorbell rings, alarm clock rings
Alerting device
Options on computers to help with hearing loss for OA?
- Visual cues for sounds
- Closed captions
- Screen flash when email or receive text
Technology can help OA in which of the fallowing areas: A. Fall prevention B. Sleep tracking C. Disease monitoring D. Physical activity E. Financial Health F. Financial health G. Cognition maintenance H. Social participation I. Medication management J. Leisure activity
All!
In general, how to OAs feel about using technical adaptations?
May be challenges, but they are generally open to it
When introducing technological adaptations with OA, it is important to address…
- Must integrate into their life so meaningful
- Must fit in with finances
- Address privacy issues e.g., fear of info traveling in public
- Must practically fit into their routine
- Provide more care rather than less–technology not there to replace you!
Benefits to computer games for OA
- Relaxation and entertainment: sense of flow leading to sense of satisfaction and achievement
- Improvement in QOL from socialization (playing with others)
- Sharpening mind and body (physical and cognitive benefits e.g., enhanced motor skills and manual dexterity
Design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design
Universal design (original def)
What are the 7 principles of universal design?
- Equitable use: useful and marketable to people with diverse disabilities
- Flexibility in use: design accommodates a wide range of individual preferences and abilities
- Simple and intuitive use: design is easy to understand, regardless of user’s experience, knowledge, language skills, current concentration level
- Perceptible information: design communicates necessary info effectively to user, regardless of ambient conditions or sensory abilities
- Tolerance for error: design minimizes hazards and adverse consequences of accidental/unintended actions
- Low physical effort: design can be used efficiently and comfortably and with minimum of fatigue
- Size and space for approach and use: appropriate size and space provided for approach, reach, manipulation, and use regardless of body size, posture, mobility
New definition of universal design: A process that enables and empowers a diverse population by improving human performance, health and wellness, and social participation. How does the new definition of universal design differ from original?
- Feels more intuitive
- Changes from designer standpoint to consumer perspective
- Less complicated
What are the 8 goals of universal design?
- Body fit
- Comfort
- Awareness
- Understanding
- Wellness
- Social Integration
- Personalization
- Cultural Appropriateness
One of the 8 goals of universal design, accommodating a wide range of body sizes and abilities
Body fit
One of the 8 goals of universal design, keeping demands within desirable limits of body function and perception
Comfort
One of the 8 goals of universal design, ensuring that critical information for use is easily perceived
Awareness
One of the 8 goals of universal design, making methods of operation and use intuitive, clear and unambiguous
Understanding
One of the 8 goals of universal design, contributing to health promotion, avoidance of disease and protection from hazards
Wellness
One of the 8 goals of universal design, Treating all groups with dignity and respect
Social Integration
One of the 8 goals of universal design, Incorporating opportunities for choice and the expression of individual preference
Personalization
One of the 8 goals of universal design, Respecting and reinforcing cultural values, and the social and environmental contexts of any design project
Cultural appropriateness
How does universal design differ from ergonomics?
Universal design is about physical body and how it fits with the environment. Can be applied to any design process
Possible detriments to having lever-door handle?
- Easy for cat and small kids to open
- People with dementia can easily get out
- Things can get caught on
According to Liu’s research, which interventions were most effective for OA with low vision?
- Interventions that involved teaching knowledge and skills to overcome disabling processes
- Multiple sessions of training with low vision devices and special viewing skills (to have positive effect on daily activities)
- Multidisciplinary interventions that focused on personal goals
Term used in research by Liu: visual impairment that can’t be corrected by regular eyeglasses, contact lenses, medication, or surgery and interferes with ability to perform everyday activities
Low vision
In Liu’s article, four main causes of low vision in older adults
- Age-related macular degeneration
- Glaucoma
- diabetic retinopathy
- cataracts
According to Liu, what are strategies that OTs use with OA with low vision?
- teaching clients how to use low vision devices
- changing environment consistent with principles of lighting, contrast, size, pattern, organization
- promote use of sensory and cognitive fxns
Liu’s research review indicated what as the key to low vision interventions for OA?
- Multiple components and multiple training sessions so OA has time to adopt new knowledge and skills into daily activities
- Must also cover knowledge of low vision, use of low vision devices, problem-solving strategies, community resources
According to Liu, who has the potential to maintain, restore, or improve ADL and IADL performance at home in OA with low vision?
OT OT!
