ABC’s of OT: techniques to address VISION

Just like muscle tone, bone density, and vestibular function, vision diminishes as we age. Personally, I have found this to be especially true within the SNF setting.

When I assess for visual deficits, I always ask the patient if he or she has noticed any changes in his/her vision since the onset of the admitting diagnosis. I also make sure to ask if the patient uses corrective lenses.

It is obvious to say that we as OTs are not ophthalmologists. However, we can perform simple, quick assessments/screens that will provide insight into a patient’s current level of vision.

A Snellen chart is a great first step. I also like to take UNO cards to assess vision. I place them around the room at varying distances and ask the patient to identify the color and number of each card from one seated position. This strategy can quickly and easily be modified to assess peripheral vision and depth perception as well. To assess peripheral vision, I ask the patient to keep his/her head and eyes focused ahead, and then ask him/her to identify the colors of the cards on either side of the room. To assess depth perception, I ask the patient to identify the numbers and colors of each card starting with the card closest to the patient and working in order towards the farthest.

I’m going to let you in on a little secret from my OT school experience: during what seemed like every. single. adult rehab lecture. it felt like our professors would repeat the same two sentences:

“To compensate for visual deficits, we need to increase lighting, increase contrast, and decrease clutter.”

“Here’s what we see a lot in nursing homes. You get the white chicken on the white plate with the white potatoes and the white gravy. Really?!”

Now, I’m not gonna lie: my OT friends and I would sometimes {always} laugh at how frequently these two phrases were repeated during lectures. But now that I am working with older adults, I understand how true these statements are.

I am always putting bright red tape around the edges of counters, along chair armrests and toilet rails, on cabinets and drawers; any surface that a patient may have a hard time differentiating from the background. We also have red plates that enable patients to visually locate all food on the plate.

There are some instances in which a patient’s visual decline is already significantly progressed. If this is the case, then many of my sessions are used to teach the patient how to compensate for these visual deficits. This includes the use of a cane or the chair rail in the hallway to assist with obstacle negotiation within the facility. I also work on stereognosis (aka tactile object recognition) to help the patient better understand how to rely on tactile input to navigate the immediate environment.

If a patient is completely or near completely blind, a red plate will do very little to improve self feeding. This is where adaptive equipment like a plate guard or a lipped plate comes in handy. The clock method can also be used to help patients identify foods on the plate.

VISION-IMPAIRED+PATIENT
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You can always reach out to the American Foundation for the Blind to obtain further, in-depth visual evaluation or receive patient-specific adaptive equipment such as audio books, page-sized magnifiers, talking watches, and braille printers.

 

What are some ways that you address visual deficits within your treatment sessions?

 

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