20 / 20 vision
An occupational therapist ’ s journey of understanding , identifying and managing stroke-related visual dysfunction
We are a team of occupational
therapists working within the East Berkshire Earlier Supported Discharge Team ( ESD ). Last year , we were dreaming about 2020 as the perfect iconic year ( 20 / 20 ) to share and publish our learning , development and findings related to vision .
Unfortunately COVID-19 had other plans for us , and it has delayed some of our projects , but not our passion . This article intends to increase occupational
‘‘ therapy awareness and understanding about the importance of assessing and managing vision and encourage occupational therapists to appreciate and not underestimate the impact that visual impairments have on a patient ’ s recovery .
Vision and occupational therapy Vision ( including eye movement ) is a key part of a comprehensive neurological assessment , listed in the National Institute for Health and Care Excellence ( NICE ) stroke guidelines .
We believe that occupational therapists should be having a role in this field . As occupational therapists , we are best placed to understand how visual difficulties impact on a person ’ s ability to complete activities they need or want to do .
As occupational therapists , we are best placed to understand how visual difficulties impact on a person ’ s ability to complete activities they need or want to do .
Our role would include a visual screening of the visual components , visual demands analysis and the management of visual impairment following a stroke , to facilitate occupational performance , in collaboration with the eye specialist services .
Traditionally , occupational therapy input in relation to vision has focused on the highest level of visual integration ( top-down approach ) and visual perceptual function . Little attention has been paid to the bottom-up approach that looks at the acquisition and integration of basic skills ( oculomotor control , visual acuity and visual field ) as a foundation for the development of higherlevel function .
In 1993 , occupational therapist Mary Warren suggested a framework that dictates a bottom-up approach to evaluation and treatment of visual impairment . This approach emphasises the importance of identification and remediation of deficits in lower level skills in order to allow normal integration of higher-level skills .
She recommended three treatment principles and five training guidelines to manage basic skills ( Warren1993 ).
Inspired by the bottom up approach , we have increased our knowledge and understanding about how the brain processes vision , how the eyes move , and the importance of effective oculomotor control , through formal courses and independent learning .
38 OTnews February 2021
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