client education
recovery is a slow processsafety:• visual compensation• self-monitoring• environmental modification
remedial treatment
sensory reeducationsensory recovery via graded input; reduces hypersensitivityexamples:• massage• biofeedback• textures• vibration• fluidotherapy• stress loading
compensatory treatment
avoid exposure of affected area• lower water heater temperature to avoid burns• apply less force when holding equipment/tools• use larger handles to distribute pressure across gripping surface• observe skin for signs of stress from excessive force or repetitive pressure• follow daily skincare routine• use unaffected hand for tasks• scan environment to observe before moving• use AE as needed• avoid kitchen burns (pot holders, thermometers, wooden spoons, general safety practices)
PNS treatment
compensatory treatment:• safety training (avoid use of affected limb if unsafe)remedial treatment:• desensitization → sensory re-education• graded simulation (feathers, cotton, cloth)• graded sensory buckets (sand, rice, beans, popcorn kernels)
hearing:OT treatment
tools:• AE (vibrating alarm, flashing doorbell/smoke detector)• telephone devices for deaf• hearing aid care & insertion (after stroke/injury)• emergency call buttons• written/demonstrated directions/guidelines for activitiestips:• eliminate background noise• lower pitches• take turns • speak slowly & clearly• avoid unfamiliar words
smell:OT treatment
olfaction has direct link to sensory processing area of in cortex• doesn't go through thalamus• aging is primary cause of decreased sense of smellpatient education:• regular visual check of spoiled food• labeling food with dates• utility company cards to check for gas/carbon monoxide leaks
taste:OT treatment
gustation frequently decreases after stroke & with aging process• avoid spoiled, excessively salty/sweet foods• use dietary consultation
visual perception
vision receptors info is integrated with other senses info to form visual image in environment• visual• proprioceptive• kinesthetic• tactile• vestibular• olfactory• auditory
visual hierarchy
1. adaptation through vision2. visual cognition3. visual memory4. pattern recognition5. scanning6. attention (alertness & attendance)
primary visual functions
➤ visual acuity➤ oculomotor control➤ visual fields
visual acuity
complex interaction between optical system which focuses light at back of eye on retina & CNS processing that transforms light into visual images seen
oculomotor control
effective coordination of eye movements by eye muscles to maintain single visual image
visual fields
reception of complete visual information in environment; 4 quadrants
visual attention
ability to fixate gaze on object as long as needed & shifting to other objects as needed
visual scanning
ability to shift attention from 1 vision target to another in smooth succession; clear image seen no matter how much eyes move
pattern recognition
ability to identify important features of objects & environment + using features to distinguish object from surroundings & from each other
visual memory
ability to create & retain mental image of observed object in mind's eye & store visual image temporarily in STM, produce response, or store in LTM & remember from recognition or recall as needed
macular degeneration
loss of central vision associated with age related degeneration of macula. cause:• decreased blood supply • abnormal growth of blood vessels under retinaoutcomes:• some peripheral vision typically retained• increased sensitivity to glare• difficulty with light changes• may progress to total blindness
cataracts
opacity & clouding of lenscause:• changes in lens proteinsoutcomes:• gradual loss of vision (central to peripheral)• increased problems with glare• general darkening of vision• loss of acuity• distortion
glaucoma
increased intraocular pressurecause:• degeneration of optic disc• atrophy of optic nerveoutcomes:• early loss of peripheral vision (tunnel vision)
hypertensive retinopathy
cause:• hypertension• hardening of retinal blood cellsoutcomes:• gradual loss of visual acuity (identical to diabetic retinopathy)
diabetic retinopathy
complication of diabetes mellituscause:• damage to retinal capillaries• growth of abnormal blood vessels• retinal scarring & retinal detachment from hemorrhagesoutcomes:• impaired central vision• blurred vision• rarely, complete blindness
vision acuity:OT intervention
manipulate environment to make it user-friendly• background contrast• illumination• backgrounds• decluttered living areas
oculomotor control:OT intervention
address skills for eye alignment, eye ROM, speed & coordination• eye stretches• Marsden ball tasks• Brock string exercise• saccade activitiesexample:• Marsden ball is swung past visual field while patient calls out letters seen
visual fields:OT treatment
patient tendencies:• usually unaware of absence of vision• eyes do not move far enough to obtain needed visual information• may compensate with protective strategy: decreased head turning → reduced visual scanning → increased tactile & vestibular input, so brain "fills in" with illusion of seeing complete area/scenetreatment strategies:• patient education for awareness of visual loss• increase head turning• increase visual scanning (balloon volleyball, catch, Marsden ball tasks)• Dynavision to increase peripheral vision, reaction time, multitasking• line guides for reading, writing• tracing tasks• pens with feedback• activities for improving eye-hand coordination• same strategies for visual acuity for environmentexample:• Dynavision: push buttons as they light up
visual attention:OT treatment
scanning is more effective if physical environment is manipulated• scan large areas incorporating whole body movementsactivities:• matching games• sorting activities• form boards• puzzles• dominos• enlarge games• word search• checkers• Concentration• Scrabble• crafts• crossword puzzles• Sudokutips:• double-check work (self-recognition & self-correction of errors)• immediate feedback• compare predicted & actual performance• simulate in real environments to transfer skills learned in new/other contexts/environments
feeding compensatory strategies:general eating
general eating:• establish point of reference (clock method)• place plate on contrasting placemat• request assist for food location & for pouring/cutting• maintain tactile contact with table• bend forward while eating• estimate weight, temperature, & texture of food on utensil prior to placing in mouth• stabilize food with "pusher" to place on fork
feeding compensatory strategies:exploring plate contents
• use spoon (recommended)• hold fork with tines downwards• start at 12 & move clockwise• identify food by texture & smell before eating
feeding compensatory strategies:cutting food
1. locate knife & turn sharp edge towards table2. hold knife in dom hand with index finger firmly along handle with thumb on side of handle3. hold fork in non-dom hand with tines downward & index finger along top surface of handle4. use knife to locate food to be cut5. place fork 1in from outer edge of food to be cut6. cut into bite-size pieces by placing knife against back of fork tines, sawing back & forth firmly & slowly
feeding compensatory strategies:pouring cold liquids
1. use thermal cup with lid & spout or cutout & straw2. use tall glass (center container over glass)3. place glass in sink/bow to catch spills4. place index finger over lip of glass to estimate liquid level5. note changes in weight, temperature, & sound while filling
feeding compensatory strategies:buttering bread
1. use softened butter for easier spreading2. use fingers/feel of knife's weight to determine amount of butter on knife3. place bread in palm or on plate4. spread butter from top right corner to lower right corner5. turn bread 90° counter-clockwise & repeat
mobility compensatory strategies:hand trailing
• use arm closest to smooth surface• hold arm straight, not rigid, extending in diagonal• lightly touch hand on trailing surface
mobility compensatory strategies:sighted guiding
• ask to hold guide's arm• hold lightly & firmly above elbow with thumb outside & fingers inside arm• guide relaxes arm with elbow bent• guide walks in front of patient; patient at side following half step behind for safety• guide sets comfortable place, monitoring grip or pulling back to slow down
vision compensatory strategies:telling time
• magnifying glass• telescopes• talking features• large numbered time devices with contrasting backgrounds
vision compensatory strategies:money identification
bills:• identify folding systeme.g. singles flat, 5s folded in half horizontally, 10s folded in half vertically, 20s folded in half twicecoins:• identify by edges & thickness (stereognosis)
vision compensatory strategies:clothing
• color match with safety pins, french knots, iron-on patches, Braille labels• texture• identifying marks (fasteners, trimmings)• small dots of clear nail polish with Braille system inside heel of shoes to identify color