Blindness

Blindness?

Blindness is defined as a loss of vision in both eyes that cannot be corrected to better than 10/100 feet or 6/60 meters. The term blindness also applies to loss of peripheral vision so that visual field is restricted to less than a 20 degree angle (tunnel vision). People who had sight but lost it are referred to as adventitiously or newly blinded, whereas people born without sight are said to be congenitally blind.

Cause

There are many possible causes of blindness: a detached retina, diabetic retinopathy, puncture wounds to the eyes, multiple sclerosis, conjunctivitis, retinal hemorage, retinal fibrosis, enucleation,glaucoma, pressure ob the optic nerve, or rubella.

Assessment

Areas

People with visual impairments frequently have multiple handicaps that need to be assessed and managed to improve coping skills.

• range of motion
• hand function and skills-grasp, pinch,and release
• muscle strength
• ambulation and mobility
• postural reflexes and balance/equilibrium reactions
• sensory awareness and discrimination
• auditory localization
• perceptual skills, including directionality and laterality
• self perception
• interpersonal skills
• self-care skills, including oral motor skills
• communication skills
• productivity interests and skills
• leisure interests and skills

Instruments

• Screening for physical and Occupational Therapy Referral
• Activities of daily living scale
• Occupational histiry
• Leisure checklist

Problems

Motor

• The person loses ease of mobility.
• Hand functions that normally rely on visual input are decreased.

Sensory

• The person has a loss of acuity.
• The person ha a los of color vision.
• The person may have no awareness of the environment.
• The person may have light perception only (awareness of light and dark).
• The person may have travel vision but cannot move safely about the environment independently.

Cognitive

Learning problems may occur for persons previosly dependent on sight for gaining most

of their information.

Intrapersonal

• The person has feelings of insecurity.
• The person has feelings of helplessness and hopelessness.
• The person may be depressed .
• The person may become introverted.

Interpersonal

• The person may become dependent to others.
• The person may avoid friends and situations previously enjoyed.

Self-Care

The person may have loss of skills that depend on vision, such as grooming, telling time,

or matching socks, skirt, and blouse.

Productivity

the person may be unable to continue a former occupation or need adjustments in the

working environment.

Leisure

The person may be unable to continue some leisure interests previously enjoyed or need

adjustments to continue them, such as stamp or coin collecting and reading.

Treatment/Management

Motor

• Help the person regain mobility.
• Provide practice in using hands in activities.

Sensory

• Increase the person's skills and awareness of other sensory modalities, including hearing, touch, kinesthesia, proprioception, and vestibulum.

Cognitive

Inform the person of learning options available to the blind, including books on tape and music activities.

Intrapersonal

Improve self-perception through use of creative activities, such as crafts, drama, dance, or music activities.

Interpersonal

• Encourage the person's family to discuss role changes that may occur because of blindness and what roles the person can perform within the family structure.
• Encourage the person to participate in social activities.

Self-Care

Help the person to organize objects needed for activities of daily living, such as marking objects for easy identification and making use of Braille-coded objects, such as watches and timers.

Productivity

• Help the person determine whether previous employment or job interests are feasible with limited or no sight.
• Suggest changes that could be made in the work environment to facilitate continued employment for a person with limited sight.
• help the person explore alternate vocational interests if continuation of present emplotment is not possible.
• Help the person organize home living environment to facilitate management of it.

Leisure

Help the person explore new or redevelop old interests adapted for blind persons, including materials that can be purchased, such as Braille-marked cards.

Precautions

• Safety is a major concern. Always check equipment and the physical environment for possible hazards.
• If blindness is due to diabetic retinopathy, be aware of other problems associated with diabetes, such as poor circulation and loss of tactile sensation.

Prognosis/Outcome

• The person can demonstrate the ability to perform basic activities of daily living independently.
• The person is able to negotiate home and local community without assistance.
• The person is able to engage in productive activities as a worker, student or volunteer.
• The person participates in a variety of leisure activities.

Child Abuse and Neglect

Child Abuse and Neglect

Child abuse and neglect is defined as physical injury, emotional disturbance, sexual abuse, negligence, or maltreatment of a child under the age of 18 by a person who is responsible for the child's welfare.

Cause

Abuse is the breakdown of impulse control in the parent, guardian, or other caregiver.

there are four factors involved:

1. Personalities features-The caregiver experienced lack of affection and support as a child and thus does not know how to provide the same for his or her child, or the caregiver is out of control due to substance abuse or psychotic illness.
2. The difficult or different child- Examples include hyperactive, handicapped, premature, or sickly children or stepchildren.
3. Inadequate support- The caregiver feels isolated or abandoned by relatives or friends who could provide guidance and assistance.
4. Crisis situation- Stress overcomes the caregiver's ability to function.

Neglect is observed in families with multiple problems and disorganized lifestyles. Depression, desertion, drug or alcohol abuse, and chronic medical conditions may be seen in one or more caregivers.

Assessment

Areas

• gross motor development and skills
• fine motor skills, manipulation, dexterity, and bilateral coordination
• muscle strength
• reflex development and maturation
• postural control (use of protective and equilibrium reactions)
• muscle tone
• joint stability and mobility
• sensory registration/awareness
• sensory sensitivity/processing
• perceptual skills ( visual, auditory, tactile, and kinesthetic)
• attending behavior and concentration
• ability to follow directions/sequencing
• motivation or self-initiated activity
• mood or affect
• self-control
• coping skills
• social conduct skills
• daily living skills
• academic readiness or academic skills
• play skills

Instruments

No comprehensive or specific scale for occupational therapist to use assessing child abuse was identified. The following assessments may be useful:

• Bayley Scales of infant development
• Brazelton Neonatal Assessment Scale
• A play scale
• Child abuse potential inventory

Problems

The problems associated with child abuse can be verified and many. The list of problems should be considered as examples and not as comprehensive list.

Motor

• Developmental milestones may be delayed, especially gross and fine motor skills.
• Muscle weakness may be present if nerve or brain damage has occurred.
• Paralysis may be present if nerve or brain damage has occurred.
• Contractures may be present if condition has existed for some time.
• Reduction range of motion may be present, depending on the type of injury.
• Reflex maturation may be incomplete, with primitive reflexes continuing to be present.

Sensory

• Sensory loss may have occurred in vision, hearing, touch proprioception, or kinesthesia and less commonly in taste or smell.
• Body image may fail to develop or an impaired body image may develop.
• Sensory integrative Dysfunction may be present, including developmental dyspraxia and vestibular- bilateral disorder.
• Sensory responses may be hypo- or hyperactive.

Cognitive

• Learning disabilities may be present, including dyslexia, short attention span and hyperkinetic behavior.
• The child may have poor problem- solving skills.

Intrapersonal

• The child may have poor self-image and lack of confidence.
• The child may feel guilty for "causing so much trouble." (note: The child is not the cause but may be made to feel so by repeated statements from one or more adults.)
• The child may have blunted or flat affect.
• The child may lack self-control, such as being sensitive and aggressive or having low tolerance for frustration.
• The child may act helpless or be overly complaint or withdrawn.
• Role identity within family unit may be ill-defined or fluctuating.

Interpersonal

• Parent(s) and child may lack coping skills.
• The child may have delayed development of social interaction and conduct skills.
• the child may be delayed in acquiring speech or vocabulary.
• Bonding between parent and child may be inadequate or lacking.
• The child may lack group interaction skills.

Self-Care

• The child may be delayed in developing activities of daily living, such as dressing, tying shoes, or eating with a fork.
• The child may be unable to perform certain ADLs (activities of daily living) if motor skills are involved.

Productivity

• The child may have developmetal delays in acquiring play skills.
• the child may use less imagination in play.
• The child may be unable to organize play activities.
• The child may show little exploratory behavior in play.

Leisure

The child may have few leisure interests beyond watching television or video.

Treatment/Management

Models of treatment include sensory integration (Ayres), and neurodevelopmental therapy (Bobath).

Motor

• Promote development of groos and fine motor skills according to developmental level.
• Increase muscle strength through progressive resistive exercises.
• Maintain or increase joint range of motion through passive exercises and active involvement in activities.
• Facilitate integration of primitive reflexes.

Sensory

• If sensory loss has occurred, facilitate development of remaining senses.
• Increase body awareness and position in space.
• Is sensory dysfunction is noted, see section on the specific disorder for treatment suggestions.
• Modulate hyper- or hyporesponsiveness to stimuli.

Intrapersonal

• Improve self-image and sense of mastery through use of creative activities ,such as crafts, games, music, dance, or drama.
• Increase self-control by assisting the child to think of alternative approaches to situations and tasks.

Interpersonal

Provide an opportunity for the child to practice social conduct in a group situation.

Self-Care

• promote self-feeding skills.
• Decrease oral motor sensitivity.
• Increase skills in daily living.

Productivity

• Teach parents or caregivers the child's level of play skills and how to participate in play activities with the child.
• Promote development of play skills
• Assist in promoting academic readiness skills.

Leisure

Encourage exploration of interests and developments of leisure skills.

Precautions

Observe a child for signs of any additional abuse or neglect.

Prognosis and Outcome

• Parent or caregiver is able to interact with the child without violent or abusive behavior.
• Parent or caregiver demonstrates knowledge of the child's level of development and adjusts expectations to the child's level of performance.
• Parent or caregiver is able to manage his or her own life situation and stresses without taking anger or frustration out on the child.
• Child demonstrates improved developmental profile in motor, sensory, language, and self-care skills
• Child demonstrates improvement in play skills.