Occupational Therapy for Persons with Visual Impairment

Occupational therapy focuses on reducing the impact of disability by promoting maximal independence and participation in valued activities. Occupational therapy practitioners use the term occupation to represent activities that individuals need and/or want to do and that are meaningful to them. The broad and comprehensive educational preparation of occupational therapy practitioners enables them to address the multiple dimensions of disability, including physical, psychological, cognitive, and social, that prevent children and adults from engaging in meaningful daily occupations.

LOW VISION
Low vision is the loss of sight that is not correctable with eye glasses or surgery. Some of the most common causes of low vision include age-related macular degeneration, diabetes, and glaucoma. When low vision limits a person’s safety, independence, or engagement in daily activity, he/she may benefit from low vision services provided by an occupational therapist.
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.

VISUAL PROBLEMS AFTER STROKE
Approximately 1/3 of all people who have a stroke will suffer from post-stroke visual impairment. Hemianopsia (loss of sight in half of the visual field) is the most common symptom, but also frequent are neglect/inattention to one side, diplopia (double vision), nystagmus (involuntary eye movement), and difficulty moving the eyes smoothly, accurately, and quickly. Partial or complete recovery of visual disorders can occur, but many patients suffer permanent disability. This disability is often less evident than impairment of motor or speech functions, but can lead to a significant loss of independence in daily functioning.
Occupational therapists are trained to perform a thorough visual screening and, in collaboration with an Ophthalmologist or Optometrist, to provide intervention to restore visual function and teach compensatory strategies. For example, an occupational therapist may provide strategies to promote attention to the neglected side and to scan the environment in all directions. The therapist may prescribe exercises to improve control and coordination of the eyes. The therapist may also instruct the patient and family in strategies to compensate for vision impairment to maximize safety and independence with daily tasks.
It is important to recognize and address visual problems after a stroke so that a treatment plan can be created to promote recovery. While most recovery occurs within 6 months after a stroke, many treatments can be effective even years after the stroke occurs.

American Occupational Therapy Association, AOTA Fact Sheet: OT Services for Persons with Visual Impairment
Archives of Physical Medicine and Rehabilitation 2016;97:2021-2
National Stroke Association, www.stroke.org
American Optometric Association, www.aoa.org