Vision rehabilitation

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Vision rehabilitation (often called vision rehab) is a term for a medical rehabilitation to improve vision or low vision. In other words, it is the process of restoring functional ability and improving quality of life and independence in an individual who has lost visual function through illness or injury. [1] [2] Most visual rehabilitation services are focused on low vision, which is a visual impairment that cannot be fully corrected by regular eyeglasses, contact lenses, medication, or surgery. Low vision interferes with the ability to perform everyday activities. [3] Visual impairment is caused by factors including brain damage, vision loss, and others. [4] Of the vision rehabilitation techniques available, most center on neurological and physical approaches. According to the American Academy of Ophthalmology, "Provision of, or referral to, vision rehabilitation is now the standard of care for all who experience vision loss.." [5]

Contents

Definition

Rehabilitation (literally, the act of making able again) helps patients achieve physical, social, emotional, spiritual independence and quality of life. [6] Rehabilitation does not undo or reverse the cause of damage; it seeks to promote function and independence through adaptation. Individuals can seek rehabilitation in different domains, such as motor rehabilitation after a stroke or physical rehabilitation after a car accident. [7] Low vision can be caused by many diseases. [6]

Clinical studies and treatments

Neurological approach

There are many treatments and therapies to slow degradation of vision loss or improve the vision using neurological approaches. Studies have found that low vision can be restored to good vision. [4] [8] In some cases, vision cannot be restored to normal levels but progressive visual loss can be stopped through interventions. [6]

Chemical treatments

In general, chemical treatments are designed to slow the process of vision loss. Some research is done with neuroprotective treatment that will slow the progression of vision loss. [9] Despite other approaches existing, neuroprotective treatments seem to be most common among all chemical treatments.

Gene therapy

Gene therapy uses DNA as a delivery system to treat visual impairments. In this approach, DNA is modified through a viral vector, and then cells related to vision cease translating faulty proteins. [10] Gene therapy seems to be the most prominent field that might be able to restore vision through therapy. However, research indicates gene therapy may worsen symptoms, cause them to last longer or lead to further complications.

Gene therapy using an adenovirus vector. Gene therapy.jpg
Gene therapy using an adenovirus vector.

Physical approach

For physical approaches to vision rehabilitation, most of the training is focused on ways to make environments easier to deal with for those with low vision. Occupational therapy is commonly suggested for these patients. [11] Also, there are devices that help patients achieve higher standards of living. These include video magnifiers, peripheral prism glasses, transcranial direct current stimulation (tDCS), closed-circuit television (CCTV), RFID devices, electronic badges with emergency alert systems, virtual sound systems, and smart wheelchairs.

CCTV for low vision Closed-circuit television (CCTV) for low vision IMG 0880.JPG
CCTV for low vision

Mobility training

Mobility training improves the ability for patients with visual impairment to live independently by training patients to become more mobile. [12] For low vision patients, there are multiple mobility training methods and devices available including the 3D sound virtual reality system, talking braille, and RFID floors.

The 3D sound virtual reality system transforms sounds into locations and maps the environment. [13] This system alerts patients to avoid possible dangers. The talking braille is a device that helps low vision patients to read braille by detecting light and transmitting this information through Bluetooth technology. [14] RFID floors are GPS-like navigation systems which help patients to detect building interiors, which ultimately allow them to detour around obstacles. [15]

Home skills training

Home skills training allows patients to improve communication skills, self-care skills, cognitive skills, socialization skills, vocational training, psychological testing, and education. [16] One study indicates that multicomponent group interventions for older adults with low vision as an effective approach related to home training. [17] The multicomponent group interventions include learning new knowledge or skills each week, having multiple sessions to allow participants to apply learned knowledge or skills in their living environment, and building relationships with their health care providers. [18] The most important factor in this intervention is support from family, which includes assistance with changes in lifestyles, financial concerns, and future planning. [19]

Vision Rehabilitation Therapy

The field of vision rehabilitation therapy is made up of professionals who provide specialized services to individuals who are blind or who have a vision loss that cannot be corrected with prescription lenses, medication, or surgery. Professionals who work in this field are called Vision Rehabilitation Therapists [20] (VRTs) or Rehabilitation Teachers [20] (RTs). A vision rehabilitation therapist, VRT, is a professional who provides specialized instruction and guidance to individuals who are blind or have low vision. Best practice recommends professionals who work in this field be nationally certified. [21] To obtain certification as a VRT, professionals must complete a course of study through a university program, complete a 350-hour internship, and pass a certification examination. [22] The certifying body for VRTs is the Academy for Certification of Vision Rehabilitation and Education Professionals, ACVREP. [20] The ACVREP certification for a VRT is called Certified Vision Rehabilitation Therapist and the certified professional uses the letters CVRT indicating this credential. Scope of Practice A VRT works within the scope of practice outlined by ACVREP. [22] The VRT provides Instruction in the use of adaptive skills and strategies to help individuals with vision loss to safely meet their personal goals for employment, education, and independence in the workplace, home, and community. Training from a VRT may include:

  • Efficient use of remaining vision
  • Safe and independent management of daily living activities, including personal care
  • Reading and writing, including braille
  • Use of computers, smartphones, tablets, etc., including assistive technology like screen magnifiers and screen readers
  • Hobbies and crafts
  • Safe movement within the home
  • Workplace accommodations
  • Recommendations for environmental modifications that increase safety and independence

The VRT serves individuals of any age, whether vision loss is present at birth or if acquired later in life. Individuals with any level of visual impairment, whether partial or total, may benefit from services provided by the VRT. Services provided by a VRT are comprehensive taking into consideration visual abilities, other physical limitations, social supports, and emotional adjustment to vision loss. Instruction with a VRT often uses strategies which include other senses to complete tasks, use of devices that enhance low vision or increase accessibility, and problem-based learning.

Employment

Vision Rehabilitation Therapists are hired by state vocational rehabilitation programs, non-profit agencies, veterans’ administration (VA) hospitals, [23] or they may choose to be self-employed, working as private contractors. A VRT may provide their services one-on-one or in a group setting. Many services are provided in the home of the client with vision loss, so that environmental factors can be assessed, and specific strategies practiced in the location where tasks need to be completed. Services might also be provided in the client’s workplace or educational institution, a community center, rehab residential facility, or in the community. The vision rehabilitation therapist may also work as part of a rehabilitation team, which may include an Orientation and Mobility (O&M) Specialist (COMS), Certified Assistive Technology Instructional Specialist (CATIS), and Low Vision Therapist (CLVT) to provide comprehensive rehabilitation services.

Occupational Therapy

Occupational therapists can assess how low vision affects day-to-day function. [24] They can promote independence in daily activities through home assessments and modifications, problem solving training, home exercise programs and finding compensatory strategies. [25] [24] For example, an occupational therapist can suggest adding lighting and contrast to a room to improve visibility. [24]

Related Research Articles

<span class="mw-page-title-main">Assistive technology</span> Assistive devices for people with disabilities

Assistive technology (AT) is a term for assistive, adaptive, and rehabilitative devices for people with disabilities and the elderly. Disabled people often have difficulty performing activities of daily living (ADLs) independently, or even with assistance. ADLs are self-care activities that include toileting, mobility (ambulation), eating, bathing, dressing, grooming, and personal device care. Assistive technology can ameliorate the effects of disabilities that limit the ability to perform ADLs. Assistive technology promotes greater independence by enabling people to perform tasks they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the technology needed to accomplish such tasks. For example, wheelchairs provide independent mobility for those who cannot walk, while assistive eating devices can enable people who cannot feed themselves to do so. Due to assistive technology, disabled people have an opportunity of a more positive and easygoing lifestyle, with an increase in "social participation", "security and control", and a greater chance to "reduce institutional costs without significantly increasing household expenses." In schools, assistive technology can be critical in allowing students with disabilities to access the general education curriculum. Students who experience challenges writing or keyboarding, for example, can use voice recognition software instead. Assistive technologies assist people who are recovering from strokes and people who have sustained injuries that affect their daily tasks.

Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.

<span class="mw-page-title-main">Physical therapy</span> Profession that helps a disabled person function in everyday life

Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease prevention, and health promotion. Physical therapist is the term used for such professionals in the United States, and physiotherapist is the term used in many other countries.

Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's ability to fulfill their daily routines and roles. OTs have training in the physical, psychological, and social aspects of human functioning deriving from an education grounded in anatomical and physiological concepts, and psychological perspectives. They enable individuals across the lifespan by optimizing their abilities to perform activities that are meaningful to them ("occupations"). Human occupations include activities of daily living, work/vocation, play, education, leisure, rest and sleep, and social participation.

<span class="mw-page-title-main">Occupational therapy</span> Healthcare profession

Occupational therapy (OT) is a healthcare profession that involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to improve mental and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). While OTs and OTAs have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments.

Vision therapy (VT), or behavioral optometry, is an umbrella term for alternative medicine treatments using eye exercises, based around the pseudoscientific claim that vision problems are the true underlying cause of learning difficulties, particularly in children. Vision therapy has not been shown to be effective using scientific studies, except for helping with convergence insufficiency. Most claims—for example that the therapy can address neurological, educational, and spatial difficulties—lack supporting evidence. Neither the American Academy of Pediatrics nor the American Academy of Ophthalmology support the use of vision therapy.

<span class="mw-page-title-main">Visual impairment</span> Decreased ability to see

Visual or vision impairment is the partial or total inability of visual perception. In the absence of treatment such as corrective eyewear, assistive devices, and medical treatment – visual impairment may cause the individual difficulties with normal daily tasks including reading and walking. The terms low vision and blindness are often used for levels of impairment which are difficult or impossible to correct and significantly impact daily life. In addition to the various permanent conditions, fleeting temporary vision impairment, amaurosis fugax, may occur, and may indicate serious medical problems.

<span class="mw-page-title-main">Telerehabilitation</span> Delivery of rehabilitation services over the internet

Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.

Sensory integration therapy (SIT) was originally developed by occupational therapist A. Jean Ayres in the 1970s to help children with sensory-processing difficulties. It was specifically designed to treat Sensory Processing Disorder. Sensory Integration Therapy is based on A. Jean Ayres's Sensory Integration Theory, which proposes that sensory-processing is linked to emotional regulation, learning, behavior, and participation in daily life. Sensory integration is the process of organizing sensations from the body and from environmental stimuli.

Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury, and to minimize and/or compensate for any functional alterations resulting from it.

<span class="mw-page-title-main">American Occupational Therapy Association</span> American professional association

The American Occupational Therapy Association (AOTA) is the national professional association established in 1917 to represent the interests and concerns of occupational therapy practitioners and students and improve the quality of occupational therapy services. AOTA membership is approximately 63,000 occupational therapists, occupational therapy assistants, and students.

<span class="mw-page-title-main">Anna Jean Ayres</span> American occupational therapist and educational psychologist

Anna Jean Ayres was an American occupational therapist, educational psychologist and advocate for individuals with special needs. She became known for her work on sensory integration (SI) theory.

This article discusses occupational therapy (OT) in the United Kingdom.

<span class="mw-page-title-main">Management of cerebral palsy</span>

Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement. Much of childhood therapy is aimed at improving gait and walking. Approximately 60% of people with CP are able to walk independently or with aids at adulthood. However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors. There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level, or vice versa. Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.

When treating a person with a spinal cord injury, repairing the damage created by injury is the ultimate goal. By using a variety of treatments, greater improvements are achieved, and, therefore, treatment should not be limited to one method. Furthermore, increasing activity will increase his/her chances of recovery.

Substance use disorders (SUD) can have a significant effect on one's function in all areas of occupation. Physical and psychosocial issues due to SUD can impact occupational performance. Unfulfilled life roles and disruption in meaningful activity can result from lack of structure or routine, poor motivation, limited skills, and poor social networks. These deficits may also contribute to stress, affecting the ability to cope with challenges. While SUD can affect a client's participation in therapy and ability to follow recommendations, occupational therapists are trained to facilitate occupational participation and performance.

Video game rehabilitation is a process of using common video game consoles and methodology to target and improve physical and mental weaknesses through therapeutic processes. Video games are becoming an integral part of occupational therapy practice in acute, rehabilitation, and community settings. The design for video games in rehabilitation is focused on a number of fundamental principles, such as reward, goals, challenge, and meaningful play. 'Meaningful play' emerges from the relationship between player action and system outcome, apparent to the player through, visual, physical and aural feedback. Platforms that feature motion control, notably the Nintendo Wii, Microsoft's Xbox Kinect, Sony's Eye Toy, and virtual reality have all been effective in this field of research. Methodologies have been applied to all age groups, from toddlers to the elderly. It has been used in a variety of cases ranging from stroke rehabilitation, cerebral palsy and other neurological impairments, to tendinitis and multiple sclerosis. Researchers have promoted such technology based on the personalization of gaming systems to patients, allowing for further engagement and interaction. Additionally, gaming consoles have the ability to capture real-time data and provide instant feedback to the patients using the systems. Currently, several researchers have performed case studies to demonstrate the benefits of this technology. Repeat trials and experiments have shown that outcomes are easily replicated among various groups worldwide. Additionally, the outcomes have increased interest in the field, growing experiments beyond simple case studies to experiments with a larger participant base.

<span class="mw-page-title-main">Sensory processing disorder</span> Medical condition

Sensory processing disorder is a condition in which multisensory input is not adequately processed in order to provide appropriate responses to the demands of the environment. Sensory processing disorder is present in many people with dyspraxia, autism spectrum disorder and attention deficit hyperactivity disorder. Individuals with SPD may inadequately process visual, auditory, olfactory (smell), gustatory (taste), tactile (touch), vestibular (balance), proprioception, and interoception sensory stimuli.

<span class="mw-page-title-main">Vestibular rehabilitation</span> Form of physical therapy for vestibular disorders

Vestibular rehabilitation (VR), also known as vestibular rehabilitation therapy (VRT), is a specialized form of physical therapy used to treat vestibular disorders or symptoms, characterized by dizziness, vertigo, and trouble with balance, posture, and vision. These primary symptoms can result in secondary symptoms such as nausea, fatigue, and lack of concentration. All symptoms of vestibular dysfunction can significantly decrease quality of life, introducing mental-emotional issues such as anxiety and depression, and greatly impair an individual, causing them to become more sedentary. Decreased mobility results in weaker muscles, less flexible joints, and worsened stamina, as well as decreased social and occupational activity. Vestibular rehabilitation therapy can be used in conjunction with cognitive behavioral therapy in order to reduce anxiety and depression resulting from an individual's change in lifestyle. However, there is often confusion about whether vestibular rehabilitation falls under physical therapy (PT) or occupational therapy (OT).

Elnora M. Gilfoyle is a retired American occupational therapist, researcher, educator, and university administrator. She worked at several hospitals before accepting a professorship at Colorado State University, later serving as Dean of the College of Applied Human Sciences and Provost/Academic Vice President at that university. She is also a past president of the American Occupational Therapy Association. With research interests in child development, developmental disabilities, and child abuse, she has led studies on the state and federal levels. The co-author of two books and many articles, she was inducted into the Colorado Women's Hall of Fame in 1996.

References

  1. ↑ Brandt Jr, E. N., & Pope, A. M. (Eds.). (1997). Enabling America: Assessing the role of rehabilitation science and engineering. National Academies Press.
  2. ↑ Scheiman, M., Scheiman, M., & Whittaker, S. (2007). Low vision rehabilitation: A practical guide for occupational therapists. SLACK Incorporated.
  3. ↑ Liu, C.J., Brost, M.A., Horton, V.E, Kenyon, S.B., & Mears, K.E. (2013). "Occupational Therapy Interventions to Improve Performance of Daily Activities at Home for Older Adults with Low Vision:A Systematic Review". Journal of Occupational Therapy. 67 (3). PMID   23597685.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. 1 2 Fletcher, K., & Barton, J.J.S. (2012). "Vision Rehabilitation: multidisciplinary care of the patient following brain injury". Perception. 41 (10): 1287–1288. doi: 10.1068/p4110rvw .{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ↑ "Low Vision - American Academy of Ophthalmology". www.aao.org. Retrieved 2024-03-23.
  6. 1 2 3 Vision Rehabilitation for Elderly Individuals with Low Vision or Blindness. USA: Department of Health & Human Services. 2004. p. 20.
  7. ↑ Ponsford, J., Sloan, S., & Snow, P. (2012). Traumatic brain injury: Rehabilitation for everyday adaptive living. Psychology Press.
  8. ↑ Markowitz, S. N. (2006). "Principles of modern low vision rehabilitation". Canadian Journal of Ophthalmology. 41 (3): 289–312. doi:10.1139/i06-027. PMID   16767184.
  9. ↑ Pardue, MT; Phillips, MJ; Yin, H; Sippy, BD; Webb-wood, S; Chow, AY; Ball, SL (2005). "Neuroprotective effect of subretinal implants in the RCS rat". Investigative Ophthalmology & Visual Science. 46 (2): 674–682. doi: 10.1167/iovs.04-0515 . PMID   15671299.
  10. ↑ Strachan, T., & Read, A. P. (1999). Gene therapy and other molecular genetic-based therapeutic approaches.
  11. ↑ McGrath, C. E.; Rudman, D. L. (2013). "Factors that influence the occupational engagement of older adults with low vision: a scoping review". British Journal of Occupational Therapy. 76 (5): 234–241. doi:10.4276/030802213x13679275042762. S2CID   147277904.
  12. ↑ Jeon, B.-J.; Cha (2013). "The Effects of Balance of Low Vision Patients on Activities of Daily Living". Journal of Physical Therapy Science. 25 (6): 693–696. doi:10.1589/jpts.25.693. PMC   3804998 . PMID   24259832.
  13. ↑ Lentz, T.; Schröder, D.; Vorländer, M.; Assenmacher, I. (2007). "Virtual reality systems with integrated sound field simulation and reproduction". EURASIP Journal on Applied Signal Processing. 2007 (1): 187.
  14. ↑ Ross, D. A., & Lightman, A. (2005, October). Talking braille: a wireless ubiquitous computing network for orientation and way-finding. In Proceedings of the 7th international ACM SIGACCESS conference on Computers and accessibility (pp. 98-105). ACM.
  15. ↑ Mori, T., Suemasu, Y., Noguchi, H., & Sato, T. (2004, October). Multiple people tracking by integrating distributed floor pressure sensors and RFID system. In Systems, Man and Cybernetics, 2004 IEEE International Conference on (Vol. 6, pp. 5271-5278). IEEE.
  16. ↑ Justiss, M. D. (2013). "Occupational Therapy Interventions to Promote Driving and Community Mobility for Older Adults With Low Vision: A Systematic Review". American Journal of Occupational Therapy. 67 (3): 296–302. doi: 10.5014/ajot.2013.005660 . PMID   23597687.
  17. ↑ Berger, S.; McAteer, J.; Schreier, K.; Kaldenberg, J. (2013). "Occupational Therapy Interventions to Improve Leisure and Social Participation for Older Adults With Low Vision: A Systematic Review". American Journal of Occupational Therapy. 67 (3): 303–311. doi: 10.5014/ajot.2013.005447 . PMID   23597688.
  18. ↑ Smallfield, S.; Clem, K.; Myers, A. (2013). "Occupational Therapy Interventions to Improve the Reading Ability of Older Adults With Low Vision: A Systematic Review". American Journal of Occupational Therapy. 67 (3): 288–295. doi: 10.5014/ajot.2013.004929 . PMID   23597686.
  19. ↑ O'Connor, P. M.; Lamoureux, E. L.; Keeffe, J. E. (2008). "Predicting the need for low vision rehabilitation services". British Journal of Ophthalmology. 92 (2): 252–255. doi:10.1136/bjo.2007.125955. PMID   18227205. S2CID   206867086.
  20. 1 2 3 Lee, Helen; Ottowitz, Jennifer, eds. (2020). Foundations of vision rehabilitation therapy. Louisville: APH Press, American Printing House for the Blind. ISBN   978-1-950723-08-9.
  21. ↑ LeJeune, BJ (May 2018). "Best practices in administration of the OIB program" (PDF). Older Individuals Who are Blind Technical Assistance Center. Retrieved March 23, 2024.
  22. 1 2 "Vision Rehabilitation Therapy (CVRT) Certification Handbook, Section 2- Scope of Practice". Academy for Certification of Vision Rehabilitation Professionals (ACVREP). March 23, 2024. Retrieved March 23, 2024.
  23. ↑ "VHA HANDBOOK 1174.01" (PDF). Department of Veterans Affairs. February 19, 2016. Retrieved March 23, 2024.
  24. 1 2 3 Warren, M., & Baker Nobles, L. (2011). Occupational Therapy Services for Persons With Visual Impairment. aota.org. https://www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/low-vision.aspx
  25. ↑ Liu, Chiung-ju; Chang, Megan C. (2020-01-01). "Interventions Within the Scope of Occupational Therapy Practice to Improve Performance of Daily Activities for Older Adults With Low Vision: A Systematic Review". American Journal of Occupational Therapy. 74 (1): 7401185010p1–7401185010p18. doi:10.5014/ajot.2020.038372. PMC   7018463 . PMID   32078506.
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