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Low Vision Assessment and Rehabilitation

Visual rehabilitation by missouri rehabilitation services for the blind

Vocational Rehabilitation

The urgency of Dr. Cole's employment difficulties was recognized. It was determined that he met the state's visual acuity criteria for services. The state agency facilitated an emergency enrollment, and a low vision assessment was authorized. He was appraised by a senior vocational counselor from the state agency in late October 1998 in an expedited review. Although he was still able to perform direct chiropractic patient care, the paperwork, documentation of medicare and medicaid billing, insurance forms, receipts, etc. were problematic. His wife had come out of retirement to help him with these tasks, but this was putting added stress on the home.

Environmental Modifications

A few modifications were necessary in both of his practice offices. The state agency purchased a talking clinical thermometer, a business envelope writing guide, and a desk top light box for use with his CCTV for reading x-rays. Ambient illumination levels were satisfactory.

Many items were purchased for Dr. Cole to function independently in the home, a prerequisite for functioning independently in the workplace. For personal care use, he was provided with a talking scale, liquid level indicator, braille watch, tel-timer, long oven mitts, easy grip cutting board, adjustable slicing knife, bold line paper, hand magnifiers, NOIR glasses for glare control, white cane, talking clock, match-makers clothing identifiers, and a double-sided spatula.

Orientation and Mobility ( O & M ) Training

Several training sessions were undertaken with a Missouri Rehabilitation Services for the Blind (RSB) O & M specialist. These training session covered four areas: sighted techniques, protective techniques, pre-cane skills, and cane skills. Dr. Cole easily learned these techniques. His mobility was enhanced with the use of a white cane and his independence rapidly improved.

Sighted Techniques

These include numerous useful skills, including the adoption of a proper body posture, use of proper hand grip, use of an arm-following method of assisted ambulation, recognition of arm signals for narrow spaces, the ascent and descent of curbs, stairs and escalators, the negotiation of revolving doors, the correct approach to chairs, and the location of vehicle door handles.

Protective Techniques

Training was required to instill both upper arm and lower arm protective techniques when walking, and face protection when stooping.

Pre-Cane Skills

Orientation was facilitated by specific training to use environmental clues, sounds, landmarks and points of reference, orientation of self to home and to new environments, and in identification of clues to the location of dropped objects.

Cane Skills

Dr. Cole was trained initially with a 54-inch foldable white cane. The correct grip and arm position were taught. He was encouraged to reach his hand out more and to widen the arc of cane travel to each side, to move the cane in rhythm with his steps, and to keep the cane tip close to the ground. Training and experience was necessary so that he could detect changes in the level and texture underfoot. The ability to walk in a straight line and the use of "squaring off" (on corners), diagonal, and "coursing techniques" rapidly improved his overall mobility. Part of his training was undertaken with the use of blindfolds (sleep shades) to remove all visual clues and thereby facilitate the learning process. He was also taught to cross suburban streets both with and without traffic control, and re-trained in the use of public transportation.

These skills quite rapidly improved as part of a mobility training program undertaken by a Missouri Rehabilitation Services for the Blind O & M specialist with one to two training sessions per month over nine months, principally at a distant location.

Diabetes Care

Dr. Cole was educated about the diabetes process and appropriate management. Some education was postponed until his residential training period.

Insulin therapy had been introduced to control his diabetes, along with an Accucheck Voice Mate. His insurance company would only pay for the standard model, and the state agency paid for the additional cost of the voice recorder. He was also trained to measure his own insulin dosages using the Count-a-Dose device, which clicks once for every two units of insulin drawn up.