0. Occupational Therapy & Vision Rehabilitation
Presented by:
Margaret A. Waskiewicz MS, OTR/L
Unit Supervisor, Adult Outpatient OT
Special acknowledgement: Christina Finn MS, OTR/L

1. Defining Vision More than 20/20
Ability to interpret and understand what we are seeing
“It is the total ability to organize light input and recognize spatial relationships between things and to build an internal representation of reality” (Paul Harris, 1998)

2. Diagnosis CVA/Stroke **TBI** Parkinson’s Disease Multiple Sclerosis
Concussion

3. Common Vision Diagnoses
Homonymous Hemianopsia
Homonymous Quadrantonopsia
Optic Neuritis
Convergence Insufficiency

4. Common Visual Complaints
“I get tired when trying to read”
“When I turn too quickly I get dizzy”
“I feel like it is difficult to find things”
“I am seeing double”
“My vision is blurry”
“My depth is off”
“I am skipping lines when reading”

5. Impact on Functional Activities
Self-Care/ADL
Household/IADL
Reading/Computer/Work-Related Tasks
Community Mobility & Driving
Quality of Life

6. Occupational Therapy Evaluation & Vision Screen: What Do We Look At?

7. OT Evaluation: Work Related Tasks Writing, reading, computer use
Writing sample
Wold Sentence Copying
Reading sample
DEM, K-D Test
QOL: NFQ-25
**Consider quality and safety not just independent or not!
Physical Function
Basic AROM
Hand Eye Coordination:
9 hole peg test
Purdue pegboard
Grip/Pinch
Qualitative observations about posture (head tilt, rotated head, tilted pelvis)
Functional complaints
ADL:
Managing buttons/fasteners
Lower body self-care
Showering
IADL:
Community:
Grocery Shopping
Crossing the street
Navigating from home to destination
Household:
Cooking
Cleaning
Laundry
Paying bills/writing checks

8. OT Vision Screen: Basic Test of Near & Far Acuity Oculomotor:
Pursuits
Saccades
Ocular ROM (monocular and binocular)
consider if symptoms are provoked
Binocular:
Convergence/Divergence
Brock String
Stereopsis
Worth 4 Dot for Suppression
Eye Alignment:
Phoria cards
Cover/Uncover Test
Visual Fields
Visual Perceptual Testing (LOTCA, Behavioral Inattention Test, MVPT)

9. Adaptations, Interventions & Treatment

10. Adaptations to Improve Comfort with Reading and Computer Use
Line Guide
Colored Tints
Anti-Glare screen
Reduce Glare
Ergonomics/Rest Breaks

11. Adaptations for Low Vision
Increase Contrast
Reduce Glare
Reduce Clutter
Assistive Technology:
Screen Readers
Screen Magnifiers
Large button keyboards

12. OT Treatment for Oculomotor Skills
Improving visual scanning/saccades
Improving smooth pursuits/tracking
Incorporate into functional activity
Posture & use of body movements are all considered!

13. OT Treatment for Oculomotor Skills
Monocular/binocular strengthening
H, X, O
4-corners
Clock
Post-its
Crossword Puzzle
Letter cancellation
Multi-matrix
Vision coach
Biometrics

14. Management of Double Vision/Binocular Impairments in OT
Compensation
Partial Occlusion
Teach eye teaming skills and how to use in a functional context
Integration of body movements with eye movements

15. Management of Double Vision/Binocular Impairments in OT
Pencil push-ups
Straw Piercing
Brock string
Thumb/Post-it
Static
Dynamic
With environmental distractions

16. Referrals for Vision Rehab
Appropriate Referrals
Concussion with saccadic impairment
Visual Disturbance
Diplopia
Visuospatial neglect
Concussion with convergence insufficiency
TBI with impaired saccades
Dizzy patient of unknown etiology with oculomotor impairments
Inappropriate Referrals
Strabismus for several years
Elderly patient with changes in vision (ie. accommodation)
Macular degeneration
Glaucoma
Cataracts

17. Who Is Involved? Occupational Therapist Neuro-ophthalmologist
Neuro-optometrist
Physiatrist
Other rehab services PT
Vestibular PT
SLP
Neuropsychology/psychology
Nursing
Social work
Vocational rehab

18. Conclusion
The visual system allow us to make sense of our world and to be able to adapt to our ever changing environment.
Our vision is also involved in up to 85% of our perception, learning and mental acquisition of knowledge.

19. References
Brown, C., Tolefson, N., Dunn, W., Cromwell, R. & Filion, D. (2001). The adult sensory profile: measuring patterns of sensory processing. American Journal of Occupational Therapy, 55,
Ciuffreda, K.J., Kapoor, N., Rutner, D., Sucholf, I.B., Han, M.E., & Craig, S. Occurrence of oculomotor dysfunctions in acquired brain injury: A retrospective analysis (2007)
Goodrich, G.L., Flyg, H.M.,Kirby, J.E., Chea-Yo Chang, C., Martinsen, G.L. (2013). Mechanisms of TBI and Visual Consequences in Military and Veteran Populations. Optometry and Vision Science, 90,
Khan, F., Baguley, I.J., & Cameron, I.D. (2003). Rehabilitation after traumatic brain injury. MJA Practice Essentials, 178,