Teaching/Learning Strategies for Intervention with People with Neurovisual Impairments

Abstract

This chapter presents teaching/learning strategies that can be used by occupational therapists (OTs) who provide service for people with neurovisual impairments, i.e., vision impairments related to neurological injury and illness. When to consider integrating people with neurovisual impairments into group interventions that primarily include people with adult-onset eye diseases such as macular degeneration and glaucoma is discussed. When it is probably most essential to provide individual intervention is also discussed. There is a focus on self-management and health promotion models to design and plan both group and individual interventions.

Appendices

Case Study of Kate: Participation in Occupations Following Neurovisual Impairment

Keywords: Self-management, health promotion, vision impairment

Introduction

The theme of this case study is mild to moderate neurovisual deficits that may occur following a stroke, traumatic brain injury, or other neurological illness and the teaching/learning strategies that can be used when planning individual or group interventions.

The Student’s Tasks Include

• Reviewing methods of conducting visual screening and evaluation for people with vision impairments .

• Understanding general cognitive teaching/learning strategies that can be applied to intervention for people with low vision.

• Identifying the goals and purpose of chronic disease self-management for people with low vision and reviewing the evidence for using self-management and health promotion with people with neurovisual deficits.

As a starting point, the students should use the following references to gather background information:

Important References Are

• Brody B, Roch-Levecq A, Thomas R, Kaplan RM et al (2005) Self-management of age-related macular degeneration at the 6-month follow-up: a randomized controlled trial. Arch Ophthalmol 123:46–53

• Eklund K, Sjostrand J, Dahlin-Ivanoff S (2008) A randomized controlled trial of a health-promotion programme and its effect on ADL dependence and self-reported health problems for the elderly visually impaired. Scand J Occup Ther 15:68–74

• Girdler SJ, Boldy DP, Dahliwal SS, Crowley M, Packer TL (2010) Vision self-management for older adults: a randomized controlled trial. Br J Ophthalmol 42:223–228

• Toglia JB, Roger SA, Polatjko HJ (2012) Anatomy of cognitive strategies: a therapist’s primer for enabling occupational performance. Can J Occup Ther 79:225–236

• Warren M (2013) Evaluation and treatment of visual deficits following brain injury. In: Pendleton HM, Schultz-Krohn W (eds) Occupational therapy practice skills for physical dysfunction, 7th edn. Elsevier Mosby, St. Louis, pp 590–630

• Warren M (2013) visABILITIES rehab services, inc.: The biVABA. http://www.visabilities.com/bivaba.html. Accessed 30 Oct 2013

Overview of the Content

Major Goals of the Intervention

The main goals of the intervention are engagement in occupations to enhance participation for people with neurovisual deficits and increased confidence in managing the short-term and chronic symptoms of neurovisual deficits.

Learning Objectives

By the end of this chapter, students will be able to:

• 1. Distinguish between neurovisual deficits and other low-vision eye diseases,

• 2. Discuss screening and evaluation of a person with a neurovisual deficit,

• 3. Identify appropriate teaching/learning strategies to apply to the case, and

• 4. Apply principles of self-management and health promotion for people with neurovisual deficits.

Background

Personal Information

Kate is a 65-year-old woman, recently retired from her position as an office administrative assistant, which she held for 22 years. She lives alone in a mid-sized city in a three-bedroom, one-story house. During the first 10 months following her stroke, Kate’s sister came from another city to live with Kate and help her as she recovered. With some community services having been put in place, the sister was compelled to return to her own home a few months ago. Kate’s functional abilities immediately began to decline.

Pertinent Medical History

As a child, Kate was in a bicycle accident in which she lost complete sight in her left eye. About 1 year ago, Kate experienced a left posterior cerebral artery ischemic stroke with lesions in the occipital lobe affecting vision. Remaining symptoms of the stroke were mild to moderate. Early problems with cognition were relatively resolved 3–6 months following the stroke with only minor attention and short-term memory problems remaining. Scattered visual field loss and contrast sensitivity difficulties persisted too; some sensory loss on the eyelid and surface of the eye have resulted in a drooping eyelid and some visual blurring. Neuro-ophthalmology testing revealed loss of visual acuity of 20/100 best corrected vision. A follow-up visit to her neurologist resulted in referral to occupational therapy for vision rehabilitation.

Occupational Therapy Interventions

Occupational therapy evaluation conducted in the OT clinic revealed that Kate is having difficulty reading, managing money, and finding desired heat levels on stove burners . She reported that she almost fell in her home recently, has trouble recognizing the faces of people who come to her door, and is feeling depressed because she is so isolated and unable to leave her home. Having driven prior to her stroke, Kate stated that she would like to use public transportation but knows little about it and is nervous about going outside by herself. The OT plans a home visit (see Chap. 13) to evaluate environmental conditions (see Chap. 12) and observe Kate in her daily routine. She also enrolls Kate in a group self-management program consisting of 10 weekly sessions. Among other occupations addressed, the program educates Kate about her vision problem, provides opportunities to try assistive technologies that might improve function in the home and community, explores lighting and magnification options, and addresses some home and community mobility issues through collaboration with an orientation & mobility specialist.

The Student’s Report

The following questions have been identified in developing possible solutions to Katie. These questions were generated from the references found in the reference list of this chapter:

• What measures might the OT use when conducting a screening of Kate’s vision?

• What functional abilities and routines are likely to be affected by Kate’s vision loss?

• What client-centered goals would the OT develop to address neurovision concerns in collaboration with Kate?

• How would a group self-management program benefit Kate? If she is unable or unwilling to attend a group, what self-management alternatives might the OT use to explore Kate’s issues?