Assessment and Treatment in the Outpatient Setting The follow ing is a Word file from a Pow erPoint presentation. Slide: 1 Text Assessment and Treatment in the Outpatient Setting Slide: 2 Text How To Get Started in the Field Presenters • David Slay, Blind Rehabilitation Outpatient Specialist, Los Angeles • Robert Kozel, Blind Rehabilitation Outpatient Specialist, San Antonio Slide: 3 Text A BROS IS Trustworthy, Loyal, Helpful, Friendly, Courteous, Kind, Obedient, Cheerful, Thrif ty, Brave, Clean, and Reverent… And very creative in their thinking and approach… We Want the Very Best! Slide: 4 Text w ith Picture I w ant to work in the most up to day Vision Therapy Lab in existence. With all the modern tools, etc. With an Eye Doctor who knows everything there is to know. Where is that located? Picture: Mad Scientist doing experiment. Slide: 5 Title and Picture I Want… Picture of the Taj Mahal Slide: 6 Text Where Do I Begin? Not at the Taj Mahal BROS must w ork at the setting that they are presently in, w ith an eye towards change in the future as their skills expand and as the facility better understands the needs of this patient population. Slide: 7 Text Who Do We Serve? • Polytrauma patients w ho have been to a PRC • Polytrauma patients w ho have not been to a PRC – but w ho likely w ill go • Mild – Moderate TBI, w ho may never attend a PRC Slide: 8 Text What Are the Likely Vis ion Problems • May include major vision loss bilaterally • May include things such as loss of an eye • May include ocular muscle injuries • May include convergence and accommodation problems • May include cognitive problems • May be a combination of problems Slide: 9 Text The Vet Sees 20/25, So What’s the Problem • Shrapnel remains in the eyes • Ocular muscle damage • Other potential eye problems • Headaches when he/she reads • PTSD (diagnosed) • Cognitive disorders • Physical injuries Slide: 10 Text Functional Problems vs. Clinical Problem • Functional Problem: Reading material for a PTSD veteran w ould be constructive when the he or she isolates in room. • Clinical Problem: When the veteran reads he/she develops headaches, possibly secondary to (in)effic iency of eye movement. Slide: 11 Text Functional vs. Clinical (cont.) • Functional Veteran is enrolled in Talking Books and starts using almost immediately. Family buys in, and assists. • Clinical The veteran may be prescribed glasses, eye exercises, etc, and works on efficient eye movements. Slide: 12 Text Which Is The Best Approach? • There is no “best” approach! BROS w orks w ith what is now and attempts to find the best short term and long term solutions for veterans. And, you may w ork on both simultaneously. Slide: 13 Text Where Does A BROS Start? Find out w hat services you have already in your medical center. • Do you have access to a Low Vision or other specialized eye exams? • Will this conference be an opportunity to expand on this ? Slide: 14 Text Where Does A BROS Start? (cont.) Are there other team members to work w ith? And, do they know who you are? • Eye Doctor – OD, MD, both… • Speech • OT • PT • Recreation, etc. Slide: 15 Text Where Do I Start w ith the Veteran? Listen to them and their family (especially if there are no exis ting records on vision disorders) Do your own history and a simple screening. Ask them about their vision and their problems. Have them describe what is giving them trouble, what works for them, etc. You can do simple field assessment. We do this w ith other veterans. Slide: 16 Text What is Next? Address functional needs and address clinical needs • Introduce items and strategies that might work right now to solv e problems. • Send to Low Vision exam, or the best Eye Exam available, and follow up with recommendations. Slide: 17 Text What if I do Not Know Much About Visual Disturbances? You will learn! • Through this conference • Through ongoing BROS education • Through reading material (BROS Resource list) • Through working w ith others Slide: 18 Text Additional Training • “The Eyes Have It” University of Michigan website, provides film of actual components of eye screening: http://www.kellogg.umich.edu/theeyeshaveit/screening/index.html Or do search: Eyes Have It + Ophthalmology Slide: 19 Text Please Note • There are many sources on screening The U of M w ebsite actually provides film clips to give you an indication of how things are done and the actual results. Very useful when looking at pupil responses and tropias. Slide: 20 Text What About Training? • There are many useful sites on training also The follow ing is one simple site on training for reading readiness. http://www.ta-comm.com/eyesplus/inventory.html Slide: 21 Text Am I Able to Adapt Devices I Already Use? • Yes!! Here are some examples • Lighting is a critical issue, especially with a high incidence of photophobia. BROS deal w ith task lighting, you might want to expand to the concept of dimmer sw itches (especially for HISA and other adaptations). • Concept: An ideal goal is to develop a lighting lab as part of a Vis ion Therapy Lab Slide: 22 Text Am I Able to Adapt Devices I Already Use? Cont. Computers • Offer excellent tracking and eye hand options • Offer contrast and magnification • Offer speech to supplement reading • Offer features (in ZoomText) such as Ticker Reading and Pursuit Reading, w ith w orkable settings, that may be useful in therapy. Slide: 23 Text Am I Able to Adapt Devices I Already Use? (cont). Devices may assis t in reading on a case by case basis: • Closed Circuit Television • OCR – used to augment or to read along w ith text • Low vision aids and sun filters • Note (Plus lenses are a strategy for Accommodative Insufficiency) Slide: 24 Text What is a Vis ual Therapy Lab? A Visual Therapy Lab • Includes a Low Vision component (as you might find at a Blind Rehab Center or where you currently send veterans for Low Vis ion Exams) • Includes a Visual Therapy component that deals with visual disturbances including problems w ith Accommodation and Convergence. • There is also an accent on TBI and Stroke, the events that may trigger visual disturbances. Slide: 25 Text How Do I Become the Catalyst for a Vis ion Therapy Lab? The San Antonio Experience • Start getting ideas about what you need • Meet w ith your partners – OD and OT in our case • Become a SME and get help doing it • Put it in your Business Plan • Present to your local Polytrauma Team Slide: 26 Text How Do I Become the Catalyst for a Vis ion Therapy Lab? Cont. Think out the logistics • How are referrals going to be made? • Does the OD (or MD) need a longer then normal time slot? • Who is going to be doing the training, how are you going to work the details? • How does this fit in w ith 5.0? • How do you juggle your other caseload?
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