JOURNAL CLUB #2: VISION REHAB LEADERS: ERIN MCNAMARA & KATHERINE BERNARD October 9 th, 2013

SUMMARY The visual system influences the way a person produces fine motor movements Vision provides feedback, “and monitoring of the hand’s position in space, and relation to the target interest” (p. 12) One study found that when reaching for an object, we rely first on our visual system and then on propreoceptive input to complete the motor task (p. 12)

APPLICATION Two main applications for OT practice 1.“By adding an appropriate visual component, treatment for fine motor coordination deficits may be significantly enhanced” (p. 13). 2.Underlying visual deficits can impair fine motor coordination. Case Studies 1.Olivia 2.Luis 3.Peter

STRENGTHS Explain connection between visual system and fine motor coordination Inclusion of case studies Provided ideas on how to design vision rehab intervention LIMITATIONS Could have provided rationale in case studies for when to refer to other professionals Lacking clarity on OT’s role in vision rehab (vs. other professionals) STRENGTHS & LIMITATIONS

How can we incorporate vision rehab into our therapy sessions? How can we make vision rehab an occupation-based, functional activity? From your clinical experiences, how have you seen visual impairments impact your patient’s fine motor abilities? ADDITIONAL DISCUSSION QUESTIONS

COMMENTS & QUESTIONS FROM DISTANCE STUDENTS Suzanne Holm, PPOTD  Most optometrists (and opthomologists) in my experience are not considering the functional sequelea of visual deficits. So the OT in practice should consider that s/he will be the one trying to put the pieces of the puzzle together with that additional information  For example, in case study 2, it seems like a fantasy that the optometrist would identify a deficit in smooth pursuits and then would collaborate with the OT to come up with a treatment plan. I just wanted to be realistic about the current state of practice--it doesn't mean it can't happen! But the effort of a collaborative relationship will probably fall to the OT.  HOWEVER! a neuro-optometrist would be more likely to be collaborative, help put those pieces together and is a valuable resource for OTs. They are just harder to find/there are not that many specialists in that area.

COMMENTS & QUESTIONS FROM DISTANCE STUDENTS Suzanne Holm, PPOTD  The crux of the article, that vision and visual perceptual deficits do impair progress with therapy, participation, limit motor control--IS correct and often under-identified. Practitioners should prioritize at least a visual screening in their evaluations.  The client is often unable to either identify the deficits or the deficits are unclear to the "see-er" so being able to explain the "why" of doing a thorough eval and then doing the evaluation is important.

COMMENTS & QUESTIONS FROM DISTANCE STUDENTS Suzanne Holm, PPOTD  Not a part of the article focus, but when it becomes to issues related to age-related changes, like macular degeneration/cataracts--having contacts with others who specialize in this area is important.  For example, we have a low vision non-profit that primarily has assistive technology for compensation or teaches compensatory strategies - so I would want to refer a client to those folks. Not everyone will have that option, I suppose, so the OT may have to do extra reading and learning to gain the knowledge and skills required to assist those clients.

COMMENTS RELATED TO VISION REHAB ARTICLE Ketti Johnson Coffelt, PPOTD  Within the article there is support that OT’s screen for vision issues due to “integrative relationship” of vision and fine motor coordination - yea  This is so vital within school setting for student in primary grades (1-3) from my perspective as children develop their reading skills from near and far point and begin to spend more time with this learning task.

OT ROLE AND RESPONSIBILITY WITHIN SCHOOL TEAM Ketti Johnson Coffelt, PPOTD  As part of school team, our role is essential for facilitating possible vision problems that may be an indicator of the students problems with reading and writing and as indicated by article presented today, fine motor coordination  Typically a vision screen by school personnel indicate a pass/fail  In looking at research, there are few studies of vision screening effectiveness and many are outdated

REVIEW OF CHILDREN’S VISION SCREENING STUDY Ketti Johnson Coffelt, PPOTD  This study review looks at problems and concerns of types of vision screening that produce over-referral’s (false positive results) and under-referral ( false negative results) which questions the efficacy of vision screening tools, see this article that review tools and efficacy in globally (Australia)  o.12029/pdf o.12029/pdf

AGAIN, VALUABLE OPPORTUNITY FOR OT’S Ketti Johnson Coffelt, PPOTD  As stated in vision rehab article, we can provide additional vision information related to areas of performance to relay to family and school team to suggest further follow-up for vision evaluation and bring forward our concerns. Really time is of the essence – learning pace to keep up with  As a school based OT, I continually have encountered the false positive results when only relying on pass/fail from vision screening. The results of vision examination reveals a need for prescription glasses that in turn make a huge difference for children’s learning. OT’s offer much to important issue of vision and learning for preschool, and school age children