Neurological Vision Impairments
20.6 million Americans report experiencing vision impairment or blindness (Blackwell, Lucas, & Clarke, 2014). It is one of the top 10 disabilities among adults over age 18 (Centers for Disease Control and Prevention, 2015). Older adults with visual impairment are three to four times more likely than adults with normal vision to experience difficulties completing instrumental activities of daily living (IADLs), such as preparing a meal, managing medications, and utilizing community mobility options (Crews & Campbell, 2004).
Occupational therapy practitioners work to ensure that older adults are able to age in place and participate in their communities despite visual impairment. Occupational therapy practitioners are also part of coordinated rehabilitation teams that enable working age adults with visual impairment to acquire or continue independent living and productive employment. As experts in activity analysis and environmental modification, occupational therapy practitioners determine how vision impairment has limited the person’s ability to complete specific daily tasks. The practitioner then modifies the task and/or the environment to minimize or remove those limitations. For example, an occupational therapy practitioner might restructure a task to remove a vision-dependent step, such as programming a telephone to speed dial emergency numbers. The occupational therapist also carefully evaluates the environments where the person completes activities to determine those things that facilitate or inhibit participation, safety, and independence, then provides recommendations and modifications. For example, the therapist may recommend adding lighting and contrast to increase visibility in the environment, reorganizing the kitchen to increase ease of accessibility and safety when preparing meals, or removing a hazard to reduce the risk of falls. Occupational therapy practitioners also apply their expertise with adaptive devices and assistive technology to enable older adults to use optical and non-optical devices to complete ADLs. The practitioner, for example, may work with the person to use a prescribed optical device such as a hand-held magnifier to complete shopping, or a non-optical device such as a talking glucometer to complete diabetes self-management. Occupational therapy practitioners also work with persons to use their remaining vision as efficiently as possible to complete ADLs. This may include teaching a person with central vision loss how to use another part of the retina to see letters more clearly when reading a medication label, or teaching a person who has lost vision on one side from a stroke to scan the environment more quickly and completely on the blind side to avoid missing objects, which may hinder safety or the ability to read print.
Traumatic Brain Injury
Occupational therapy practitioners are recognized experts in addressing the vision processing deficits that occur from traumatic brain injury (TBI). Practitioners provide interventions to improve visual attention, search and speed, and efficiency in visual processing. They work closely with optometrists and ophthalmologists to ensure that clients with TBI are able to compensate for deficits in acuity, visual field, and eye movements to complete important daily activities safely and effectively.