Category: Occupational Therapy

Why Should All Healthcare Providers Ask About Low Vision?

Blog post written by Krista Covell-Pierson, OTR/L, BCB-PMD & Owner of Covell Care & Rehabilitation, LLC.

As an occupational therapist, my job is to look at how functional things are for people. I don’t care so much if your shoulder lacks 24 degrees of range of motion as I do if you can wash your hair, reach into your cupboards and do your daily routine without hardship. I might measure your range of motion so I can track objective changes in your arm but I am primarily concerned with your quality of life. 

Because I focus on function, function, function I am often frustrated when healthcare providers of many different disciplines don’t take people’s vision into consideration for their interventions. Every single one of us from pharmacists, doctors, counselors, activity coordinators, etc need to understand different eye diseases and how they impact people we work with. An ophthalmologist or optometrist are not the only people that should ask about our eyes.  

For example, I worked with a client that told me she had seen a physical therapist months prior and was given a hand out of exercises. I said, “Perfect, let’s review those exercises.” The client referred me to her fridge where the sheet was hung up so she wouldn’t lose it. I handed her the paper asking her to show me some of the exercises. She responded, “Well, I haven’t done them in a while and I’ve forgotten a lot of them. And… I can’t see what’s on here. The pictures are too little and the writing is way too small.” 

Such a simple solution might have improved this client’s ability to maintain, or return to, her exercise program. If only the PT had enlarged the print and pictures and ensured the client could read the paper!

During my years working in a rehabilitation center I met countless residents and short-term patients with low vision and eye disease. Many times I would hear a nurse would report that a patient refused to go to meals and was isolating themselves in their room. I would often look into this with clients from an OT perspective. One particular client said, “I am so embarrassed by how I spill in the dining room. I knock things over, I can’t pour my water from the pitcher on the table and I don’t even know what I am eating until I take a bite. I can’t even tell who is sitting at the table with me because I can’t see their faces and I feel awful asking people when I should know who they are. I don’t want to ask for help because the staff is so busy already. I would rather just eat alone.” Simple modifications like contrasting plates with her place-mat and food, strategies to help her accurately pour water and see people with the remaining peripheral vision she had solved this issue. 

I could go on and on with examples of how vision impairments get overlooked and need to be a regular part of healthcare professionals’ assessments. When was the last time your doctor asked you about your eyesight? 

If a healthcare provider finds that a client struggles with vision, or lives with eye disease, not only should the client be referred to an ophthalmologist but also to an OT for an evaluation. At our practice, we provide mobile, outpatient services and can see clients in their homes rather than making them come to our office for an assessment. This is huge when it comes to low vision training! If a provider can’t find a mobile provider (and they are hard to find), a referral to a traditional outpatient clinic may suffice. Some eye doctors have OT’s on their staff which is always refreshing and supportive to comprehensive care for patients. 

For the best outcomes, therapists and patients should work together beyond the evaluation and focus on the recommendations. Leaving clients to figure out devices or integrate new ideas into routines greatly reduces the likelihood of positive carry-over. Using magnifiers, learning how to use their preferred retinal locus (PRL), problem-solving with new strategies requires SUPPORT. If you are a patient and feel like you aren’t doing well with recommendations, go back to your therapist or find a new one that will take the time to help you master your new skills. 

In order to get folks thinking about things that can help with low vision I put together a simple list of things I have used many times with clients. This is just the tip of the iceberg!

  1. Lighting: Try different light bulbs–both style and wattage. Different light affects the eyes differently. I keep a box of various light bulbs in my low vision kit. Remember that what works in the kitchen may not work in the bathroom. (And it’s ok to keep the lights on during the day if it’s helpful!) 
  2. Contrast: An onion on a white cutting board is difficult to see for someone with low vision. Buy a cutting board with a dark color on one side and a light color on the other. Cutting the onion? Use the dark contrasting color! Cutting open an avocado? Use the white side! 
  3. Establish tactile cues to help with matching clothes: For example, take tiny safety pins and pin one on the tag of all the black shirts, pants and skirts. Then take two tiny safety pins and put them on everything that is navy blue. Work together with someone to set up the system that works and then be confident that you are wearing the colors you want to! If you know you like to wear certain outfit combinations put them together on a hanger so you aren’t searching or wondering if you have the right clothing items.  
  4. Reduce strain and stress by converting to large print calendars, playing cards, books and magazines. 
  5. Buy a talking watch or clock. 
  6. Reduce glare. Bright lights can reflect off of granite counter tops or shiny floors and cause distorted or irritated vision. Older adults can tolerate 2.5 times less glare than a young adult. 
  7. Use a 20/20 pen to write in large, black ink that is less likely to leak through your paper than a Sharpie. 
  8. Integrate a large print and/or high contrast keyboard to the computer. 
  9. Use a goose-neck lamp with built-in magnifier and spotlight in order to read, see medications, and keep up with hobbies. 
  10. Paint or put high-contrast tape on the edge of steps in and out of the garage to help with depth perception.
  11. Sign up for you state’s Talking Book Library. In Colorado, people receive an electronic device and books on tape to play. It makes it really easy to navigate the buttons on the device and hear what you enjoy. Plus, it’s all free!  
  12. Add high contrast to light switches to make them easier to locate. 
  13. Keep things in the same place so people with low vision know where they are. Don’t move furniture around! 
  14. Check out different scanners that can read labels, price tags, medication bottles and differentiate between denominations of dollar bills.

Share your low-vision tips, equipment, ideas with me! We will take all of the tips and share them together before the end of the month! You can message me at krista@covellcare.com

Glaucoma & the value of Occupational Therapy

Glaucoma is a common eye disorder and there are more than 3 million cases per year in the United States alone. What is it? Pressure build up in the eye that can result in a functional visual impairment, impacting a person’s daily life.

Occupational therapists are in the business of function and purpose. They support people in most everything involved in a person’s day: bathing, driving, toileting, paying bills, working, home safety….the list goes on. The overall goal is to keep people involved and engaged in their environment, at home or in the community.

For people living with glaucoma, occupational therapy can offer modifications (i.e. equipment, lighting) for their home environment to make them safe, new techniques like visual scanning and tracking and training on low vision tools. But most off all OT’s look at things in a holistic approach to ensure people are able to participate in the things they want and need to do.

To learn more about occupational therapy and low vision support contact Covell Care at (970) 204-4331. We would love to share how we are impacting our clients’ lives.

In Home Fall Prevention Exercises and Strategies

Blog written by Galen Friesen, past Covell Care Intern and CSU Graduate.

In 2014, 28.7% of community-dwelling adults 65 years or older reported falling, resulting in 29 million falls [1]. Luckily, exercise is one of the most effective interventions for falls, and there are many modalities of exercise to pick from. The minimum requirement for exercise in elderly populations is 30 minutes a day, 5 days a week to see benefit [2]. Many individuals who have suffered a fall find themselves worried that if they engage in exercise they will fall again, however, it is more beneficial to begin a supervised exercise program than to completely avoid activity altogether.

First and foremost, always consult your primary care provider before starting a new exercise program; see if they have any recommendations as to what exercises would be most beneficial. Simple exercises that can be done at home include (use a chair or wall for extra stability if needed): single leg balancing, sit-squats, floor bridges, step-ups, bird-dogs, and planks. Explanations and pictures for these exercises can be found here: https://blog.nasm.org/fitness/exercise-tips-fall-prevention%E2%80%8E/. Another great resource would be your physical or occupational therapist, and they might even know a personal trainer or fitness class that they could refer you to.

Along with exercise, a great way to reduce the risk of falls in the home is to
reduce the number of obstacles in your environment – removing decorative rugs, keeping a clear floor, and providing space around corners and in walkways reduces the likelihood of environment induced falls. Take your time while transitioning from seated to standing and while entering rooms or turning corners to make sure you have a constant mindfulness about your center of balance.

[1 Grossman, D. C. (2018, April/May). Interventions to Prevent Falls in Community-Dwelling Older Adults US Preventive Services Task Force Recommendation Statement.
[2] Exercise – the Miracle Cure. (2016, June 16). Retrieved from http://www.aomrc.org.uk/reports-guidance/exercise-the-miracle-cure-0215/

Home Hazards…Are they related to falls?

A 2018 study titled, The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk, by Judy A. Stevens, PhD and Robin Lee, PhD, MPH estimated the prevalence of seven fall risk factors and the effectiveness of seven evidence-based fall interventions.

Stevens & Lee defined a “fall risk factor as an attribute or characteristic of an individual that increases the likelihood of a fall occurring”. They go on to say that many fall risk factors are potentially modifiable (e.g. poor balance, mobility problems, impaired vision, and insufficient vitamin D). Contributing factors increase the chance of falls such as the side effects of medications and the presence of home hazards.

Lets take a focus on home hazards. Most of us feel our homes are the place we feel most safe and comfortable. But does that mean our home is truly “safe”. Here are some questions to ask your self to determine where your home sits on the safety spectrum and some techniques you can use to enhance safety.

Can you safely enter and exit your home? 
Do you have stationary chairs with arm rests that do not rock or glide? 
Does every room have a night light? 
Can you read your medication bottles? 
Can you enter and exit your shower or tub without a loss of balance?
Can you transfer to and from your toilet without difficulty? 
Do you have clear pathways throughout the home? 
Are your kitchen goods stored between the height of your knees and your shoulders? 
Are you able to retrieve items from under your bathroom sink with ease? 
Do you have throw rugs picked up? 
Do you know how to use your microwave correctly? 
Do you remember to turn off the stove or oven when finished? 
Are cords clear from being in the walkways? 
Do you know how to use your thermostat? 
Have you been free from falling in the last year?  
Do you take your medication on time consistently? 
Is there a table next to your bed for a light and to set items on? 
Is your carpet and flooring free from tears and ripples? 

Home Safety Strategies:

  1. Remove all scatter rugs, repair frayed carpet, tape or tack down loose carpet edges.
  2. Arrange furniture to allow adequate space for safe walking between and within all rooms.
  3. When using oxygen, do not smoke or use an open flame.
  4. Do not overload circuits – unplug appliances when not in use.
  5. Wear close-fitting sleeves to prevent spills and burns that could happen with loose, long sleeves.
  6. Clean up spills immediately.
  7. Use a step stool or reacher to reach high shelves – do not stand on chairs or stools.
  8. Place safety strips or a non-skid mat in bathtub/shower and install grab bars – do not use soap dishes or towel racks for support when sitting or standing.
  9. Keep closet doors and drawers closed to prevent bruises or tripping.
  10. Keep walking aids within reach and keep a nightlight on or flashlight within reach of your bed.

If you are interested in having an occupational therapist conduct a home safety assessment in your home please contact our office at (970) 204-4331. And keep in mind, most insurance plans cover the visit.

The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk Judy A. Stevens, PhD,1 Robin Lee, PhD, MPH2

Pelvic Dysfunction & Aging

Thank you to Guest Blogger and CSU Graduate, Hailey Jungerman.

Although many believe that it is a natural part of ageing, “age doesn’t cause urinary incontinence, age-related changes may predispose an individual” (Garvey 14). Not only is it not a normal part of ageing, but “more than 50 percent of older Americans struggle with incontinence” (Reinberg). It is important to understand that bladder and bowel incontinence is an issue that can go beyond just toileting. As owner Krista Covell-Pierson OTR/L, BCB-PMD points out in her article Are You Addressing Incontinence at Home? An OT’s Guide, “Unaddressed incontinence can lead to the following additional problems: depression, social withdrawal, anxiety, fatigue, increased fall risk, restricted sexual activity, increased expenses for supplies, higher risk of infection, and skin irritation.” All of these things can lead to reduced participation in activities of daily living.

So, how can OT help address incontinence? “Occupational therapists provide a comprehensive approach that looks beyond musculoskeletal skills deficits and recognizes the need for changes in performance patterns, such as habits and routines, while also considering the context and activity demands related to the problem. Additionally, occupational therapy practitioners have the background and training to understand the related distress and provide support for the psychosocial aspects of these disorders” (Neuman et al.).

Krista Covell-Pierson OTR/L explained to me what a normal plan to manage
incontinence would look like. The evaluation will touch on bowel and bladder health. Krista says it is important to look at both as the bladder can affect the bowel and vice versa. The therapist will discuss with the patient about their diet, toileting and leave the patient with incontinence reading material and a voiding diary. From there the rest of the sessions are working on finding the issue and working on the pelvic floor muscles. The therapist will work as an investigator to solve the problem. They will recommend small changes to see if that is helping, and work in stages as to not be overwhelming for the patient. If needed, the therapist can also use a
biofeedback machine to better understand what the pelvic floor muscles are doing and to get patients working them. Though the internal biofeedback is not required, Krista said there is about an 87% rate of improvement over those that do not do the biofeedback.

Incontinence is a serious issue that can lead to a decline in quality of life. It is the number one reason why people put a loved one in an assisted living community as it is draining on the patient as well as any caregivers. Getting the issue resolved can improve the quality of life and keep our loved ones home for longer. If you have any questions regarding incontinence our owner Krista Covell-Pierson is a great resource as she is Board Certified in Biofeedback.

Please call Covell Care and Rehabilitation at (970) 204-4331 to get more information or an appointment scheduled with us to address incontinence.


Citations:
Covell-Pierson, Krista. “Are You Addressing Incontinence at Home? An OT’s Guide.” 2018 National Patient Safety Goals: Communication | MedBridge Blog, Medbridge, 20 Apr. 2018, www.medbridgeeducation.com/blog/2018/04/addressing-incontinence-home-ots-guide/. Garvey, Kathleen A. “Toileting: Making the Most of Our Time in the Bathroom.” MiOTA Conference. 12 Oct. 2015, www.miota.org.
Neumann, B & Tries, J & Plummer, M. (2009). The role of OT in the treatment of incontinence and pelvic floor disorders. OT Practice. 14. 10-1318.
Reinberg, Steven. “Over Half of Seniors Plagued by Incontinence: CDC.” Consumer HealthDay, HealthDay, 25 June 2014.