Assessment and Treatment in the Outpatient Setting by coreymcintyre


									Assessment and Treatment in the Outpatient Setting

The follow ing is a Word file from a Pow erPoint presentation.

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Assessment and Treatment in the Outpatient Setting

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How To Get Started in the Field

•   David Slay, Blind Rehabilitation Outpatient Specialist, Los Angeles

•   Robert Kozel, Blind Rehabilitation Outpatient Specialist, San Antonio

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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!

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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.

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I Want…

Picture of the Taj Mahal

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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.

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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

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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

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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

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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.

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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.

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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.

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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 ?

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Where Does A BROS Start?

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.

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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.

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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.

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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

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Additional Training

•   “The Eyes Have It”

University of Michigan website, provides film of actual components of eye screening:

Or do search: Eyes Have It + Ophthalmology

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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.

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What About Training?
•   There are many useful sites on training also

The follow ing is one simple site on training for reading readiness.
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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

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Am I Able to Adapt Devices I Already Use? Cont.

•   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.

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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)

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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
•   There is also an accent on TBI and Stroke, the events that may trigger visual disturbances.

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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

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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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