Walter Wittich

Sensory and demographic characteristics of deafblindness rehabilitation clients in Montréal, Canada

Citation information: Wittich W, Watanabe DH & Gagné J‐P. Sensory and demographic characteristics of deafblindness rehabilitation clients in Montréal Canada. Ophthalmic Physiol Opt 2012, 32, 242–251. doi: 10.1111/j.1475‐1313.2012.00897.x

Barriers to Low Vision Rehabilitation: The Montreal Barriers Study

PURPOSE One objective of the Montreal Barriers Study was to examine demographic characteristics of people with vision impairment that may hinder their referral or decision to access rehabilitation services. METHODS Data collection was conducted in three phases, whereby during phase I, patients in ophthalmology department waiting rooms underwent a structured interview to ascertain demographic variables that may be related to their utilization of the rehabilitation process. Phase II examined variables recorded in the rehabilitation agency file of those who had made the choice to access services. Phase III examined the rehabilitation access behavior of those participants who were referred as part of phase I. RESULTS In phase I, 54% of the 702 participants had been referred to and received rehabilitation services. An additional 13% were aware of these services but chose not to access them, whereas 33% were unaware of their existence. The variables associated with positive access choice were education, diagnosis, race, acuity at the time of interview, and living situation. In phase II, it was found that acuity at agency intake was markedly better than at the study interview. Of the participants who were referred to rehabilitation services as part of the phase I protocol, it was found in phase III that only 56% had engaged in rehabilitation services. CONCLUSIONS It seems that even under ideal referral situations, there remain barriers to vision rehabilitation services that have not been specifically identified in the present study. Further research is necessary on the psychological and psychosocial contributors to this process.

Multisensory Integration Central Processing Modifies Peripheral Systems

Multisensory integration in humans is thought to be essentially a brain phenomenon, but theories are silent as to the possible involvement of the peripheral nervous system. We provide evidence that this approach is insufficient. We report novel tactile-auditory and tactilevisual interactions in humans, demonstrating that a facilitating sound or visual stimulus that is exactly synchronous with an excitatory tactile signal presented at the lower leg increases the peripheral representation of that excitatory signal. These results demonstrate that during multisensory integration, the brain not only continuously binds information obtained from the senses, but also acts directly on that information by modulating activity at peripheral levels. We also discuss a theoretical framework to explain this novel interaction.

What’s in a name: Dual sensory impairment or deafblindness?

Communications about deafblindness within the clinical and research literature are littered with several terms that have not yet been well established or defined, such as deafblindness, dual sensory loss, or combined vision and hearing impairment. Depending on the context (e.g. service delivery for children, adults, or seniors) or the user (e.g. educators, clinicians, researchers, or clients), these terms are sometimes used interchangeably; such practice, however, can be misleading and does not assist the scientific goal of precise communication. The goal of this study was to review the existing definitions of these terms and their use through a systematic review of the literature and by conducting a qualitative survey to solicit the opinions of clinicians and researchers in the field of deafblindness. A systematic review of five databases resulted in 809 references containing terms relevant to deafblindness, which were then searched using the terms, such as deafblind, deaf-blind, deaf AND blind, dual, vision AND hearing, and combined, as they appeared in the titles and/or abstracts. In addition, a survey of researchers and rehabilitation professionals in this domain was conducted. The large majority of articles using deafblind-related terminology were published in clinician-oriented journals, whereas authors of high-impact research journal articles (many outside the domain of sensory rehabilitation) were more likely to utilize terms such as dual sensory or combined impairment. This segregation was similar in the 68 responses obtained through the survey. There is a need to harmonize the interpretation of terminology, specifically across professionals and interest groups relevant to deafblindness. Through the development of comparable terminology and clarity in communication, rehabilitation professionals will find it easier to access (and translate) research findings in their respective fields. In addition, the exchange of ideas between practitioners and researchers will be easier, resulting in more practically relevant research projects.

Visual function assessment and metamorphopsia after macular hole surgery

The purpose of this study was to develop a new resolution acuity measure for patients after macular hole surgery. Fifty eyes of 44 patients who had undergone successful treatment were tested. Visual acuity was measured with the Snellen, Early Treatment of Diabetic Retinopathy Study and Landolt‐C charts. A Line Resolution Test was performed as part of their follow‐up exam where a vertical line was presented. Participants were categorized by their perception of the line as solid, bent or broken. The line could be distorted into a sine‐wave pattern in order to determine the participants’ detection threshold for the distortion. Chart acuities did not differ among the three groups, as categorized by their line perception. Only the distortion measure was sensitive enough to differentiate the solid‐ from the broken‐line group. The distortion measure assesses resolution power of the macula in smaller increments than acuity charts. This hyperacuity approach is more appropriate in the assessment of functional outcome after microsurgery.

Influence of eye position on the Schirmer tear test

INTRODUCTION The Schirmer test (ST) evaluates the volume of tears in potential dry eye candidates via a strip placed in the lower tear lake. Previously reported inconsistencies in the results may be in part due to the lack of standardization as to the methodology, e.g. the eye position during the test. The purpose of this study was to evaluate the effect of eye position on the ST score. METHODS . A ST was performed in a randomized fashion with and without anesthesia in three open eye positions (primary, superior and inferior) at 20° from each other. Palpebral aperture, age and a dry eye questionnaire (OSDI) were evaluated for correlation with the ST. RESULTS In the 20 non-dry eye volunteers (n=20, ages 18-40, mean OSDI score 10.5), the ST results were, as expected, lower overall (p < .001) with anesthesia (11.33 ± 7.78 mm) than without (19.74 ± 2.83 mm). The inferior gaze position resulted in higher values (p < .03) than the other two positions, regardless of the use of anesthesia. No correlation was noted between the palpebral aperture, age, questionnaire and the ST. CONCLUSION The ST seems to be influenced by the position of gaze. However, the mechanism for this, effect remains unclear. Further studies could focus on whether an inferior gaze of 20° compresses the tear film falsely, thereby elevating the tear volume. It is recommended that the clinician should adopt a standard eye position for the ST and that future reports provide specifics as to the methodology used.

Coping With Extended Facedown Positioning After Macular Hole Surgery A Qualitative Diary Analysis

Background: Patients undergoing facedown positioning have to overcome physical and psychological challenges; however, their perspective and experience are rarely documented in the research literature. Objectives: The objective of this study was to examine the content of a self-motivated diary written by a person who underwent 77 days of facedown positioning after macular hole surgery. Her narrative about the obstacles during this postsurgical requirement resulted in an insightful description of several core topics relevant to patient care. Methods: The diary content was summarized using qualitative description procedures. This document was selected due to its unique rich nature. Thematic analysis was used to summarize and describe main topics of importance within the diary. Additional data sources (i.e., medical file, research literature, patient follow-up, and Web sites) were consulted to provide a more comprehensive understanding of the diary content. Results: On the basis of proximity of coded quotes and richness of content, seven areas of interest emerged, including the patients emotional state, quality of sleep, nutritional considerations, visual functioning, physical status, social support, and entertainment needs. Discussion: Potential patients and their caregivers can learn from the experiences of an individual who has coped successfully with this treatment. This analysis builds the groundwork for the refinement of guidelines for overcoming prevalent physical and psychological barriers.

An adapted adult day centre for older adults with sensory impairment

The MAB-Mackay Rehabilitation Centre runs a Day Centre Programme whose objectives are to maintain or improve the seniors’ biological, psychological, and social health while delaying or avoiding institutionalization. Activities include walking groups, language courses, and memory games, supervised by an interdisciplinary team. Services include rehabilitation follow-up and referrals to community resources. The present study reports on the impact of the Day Centre on the holistic health of older adults with visual impairment. Between September 2011 and October 2012, 30 newly referred clients (age = 71–98 years, M = 85, visual acuity [VA] 20/50 to no-light-perception [NLP], M = 20/126) were evaluated at intake, and after 6 and 12 months, including the Visual Function Questionnaire-14, Hearing Handicap Inventory for the Elderly, Geriatric Depression Scale, Friendship Scale, Timed Up and Go Test, and Montreal Cognitive Assessment (MoCA). In all, 19 participants completed the 1-year follow-up and continued to live independently in the community 12 months after entering the Day Centre. Only one person was transferred into long-term care. Comorbid conditions included high blood pressure, asthma, cardiac problems, diabetes, stroke, arthritis, and osteoporosis. Participants reported statistically unchanged scores on all the measures, except for improved MoCA scores, p < .05. Considering the vulnerability of this population, the data indicate that the Day Centre contributes to prevent decline in its clients’ general well-being. The increase in cognitive scores is possibly linked to practice effects and reduced test anxiety. Participation in adapted Day Centre activities, as an integrated part of rehabilitation services, may support independent living in older adults with vision loss.

Spatial judgments in patients with retinitis pigmentosa

Previous investigations into cortical plasticity in the presence of ocular disease have focused on central retinal damage. Perceptually, patients often report distortions of visual space which can be partially explained by perceptual filling-in. The mechanisms involved could also apply to peripheral field loss. Spatial interval discrimination was tested in 28 retinitis pigmentosa (RP) patients and a control group. When stimuli were presented to both hemispheres, bias did not differ whereas threshold was poorer in RP patients. When presenting the task to only one hemifield, bias was related to field asymmetry, but only in the left visual field, r(2)=.59. Brain laterality may be an important factor when examining changes in cortical function in response to peripheral system damage.

Usability of assistive listening devices by older adults with low vision

Abstract Purpose: This study examines the performance of individuals with both hearing and vision loss when using assistive listening devices. Methods: Older adults (age 60–100) with low vision only (n = 23), combined vision and hearing loss (n = 25) and a control group (n = 12) were asked to assemble a pocket talker, and operate a talking clock and an amplified telephone. They either received minimal or no instruction. Success at using the devices properly, as well as performance speed, was recorded. Results: The proportion of individuals with sensory loss that was able to complete our naturalistic tasks without mistakes ranged from 20% to 95%, depending on the device, the task complexity and the instruction provided. Both instruction as well as simple repetition had statistically significant and separate beneficial effects; however, neither was able to bring success to 100% on any device. Speed and task success were linked in an intuitive way, whereby individuals who succeeded at a task also performed it faster. Conclusions: Even minimal explanation during the introduction of assistive listening devices to persons with low vision facilitates user success. Device visibility, cognitive and motor complexity of the task, as well as manual dexterity warrant further investigation as potential barriers to device use. Implications for Rehabilitation Hearing rehabilitation with individuals affected by vision loss requires additional attention and time to accommodate challenges with visibility and task complexity. Even minimal rehabilitation interventions can improve success and speed of device use. Repetition (practice) and instruction (strategy) have independent beneficial effects on device use. Dexterity, visibility, hand-eye-coordination, task complexity and cognitive ability need to be considered when assigning assistive devices for older adults with vision and/or hearing loss.