Orientation and mobility for older person

Presented by : Nomar B. Capoy Presented to: Prof. Pagurayan

The contexts of ageing and vision loss

Ageing and disability current anticipated life expectancy is 75 years Rehabilitation intervention

Rehabilitations role is to preserve years of active life for as long as possible, even though agerelated impairments may threaten continued independence.
Rehabilitation training among older blind persons should reduce dependency and contribute to years of active life. Age related and disease related changes classifications biological changes- changes in muscle strength and cardiac pulmonary function Normal age-related psychological changes lead to slower pace of learning and negative views regarding the ability to recover from physical losses. Social related changes include ageism that may affect the decision of health care professionals to encourage or refer to rehabilitation services.

Aging and vision loss Leading causes of blindness among older people Macular degeneration Cataracts Glaucoma Diabetic retinopathy Severe vision impairment defined as the inability to read newspaper print with best correction increases from 4.7 percent of population ages 65-74, to 9.9 percent over the age group 75-84, to 25 percent over the age of 85,, overall above 65 is 7.8 percent vision loss prevalence rate.

Normal aging and disability among elders create important frames for the issues of vision loss among elders. Normal changes the eye, including the cornea, lens, and vitreous are to be expected, and they have the effect of degrading vision, but severe vision loss cannot be dismissed as normal.

The Practice of O & M among Elders

Adapting O & M instructions for older people involves paying attention to the following four broad issues: Assessment of function Collaboration with the student and the rehabilitation team. Relevance of instruction to the students needs. Modification of instruction in response to individuals health and circumstances. Assessment addresses the following areas: Review of available medical or rehabilitation information. Quality and size of social networks Interview with the client regarding travel objectives and interest Observation of ambulation in representative environments ( indoors, residential, and small business)

Assessment should result in a plan encompassing content, sequence, pace, and length of training. The Responsibility of the O & M practitioner is assess each student's personal characteristics, needs, and desires in order to create a relevant educational experience.

Collaboration refers to instituting a routine of sharing information and making joint decisions with the student. The goal of collaboration is to provide both instructor and student an opportunity to influence the other. Approaching older students in this manner indicates the practitioner is intent upon demonstrating respect, understanding, and empathy throughout the teaching process. Collaboration also refers to the teamwork approach existing between the O & M instructor and other professionals involved in treating other health or psychosocial concerns. It may determine the effects of medications on the student's alertness, coordination, balance, or reasoning ability. Collaboration may also address social support and social integration concerns. Potential collaborators include physicians, nurses, social service providers, spouse, or family members.

Attention to relevance is necessary to ensure that training provides solutions for practical problems experienced in daily life. Adjustments can be made in presentation, emphasis, pace, and sequencing of instruction to ensure that suitability for individual circumstances is maintained. It should be a natural outgrowth of the collaborative approach.

Modification , defined as tailoring the instruction to meet the unique needs of individuals, is at the heart of the individualized instructional process. Deficits in health, balance, coordination , physical strength or endurance, psychosocial or emotional well-being, or cognitive performance are examples of factors that lead to modifying training. Other factors to be considered include amount and type of vision, living situation ( alone or with family), and type of home environment.

Case Histories Mrs. Q 63 y/o vision impairment macular degeneration Mobility problems falls, contacts with objects while moving , maintaining straight- line travel, difficulties with level change detection and step-edge detection, unreliable depth perception, variations in visual acuity in the presence of rapid lightning changes, disorientation in unfamiliar areas, and uncertainty regarding timing and safety of street crossings. Her mobility goals-- attainment of independent movement on her own property ; recreational walking on her own rural area; access to an alternate form of transportation; independent travel in residential; semibusiness, and business areas; and independent travel at her church. Collaboration involved the O & M specialist and the client, as well as the primary physician.

Relevance of Training was addressed by the referral source; Mrs Q and her rehabilitation counsellor both agreed that comprehensive O & M training was required for her to remain in her home and continue to care for her mother.

Assessment took the form of an extensive interview,conducted during the first visit. Observational portions of the assessment were conducted in small increments at subsequent meetings to limit physical exertion. It revealed both need and capacity for a comprehensive O & M training program.
Modification involved adjustments primarily in presentation, pace, and sequence. Fairly equal emphasis was placed on all outdoor skills because of the comprehensive nature of Mrs Q's stated goals.

Skills modification included extensive use of modified ( constant contact ) touch technique combined with support cane use during all outdoor travel. Presentation was enhanced by modelling techniques demonstrated by the instructor. Mrs Q acknowledged the need to use two canes because of her difficulties with ambulation, and she expressed misgivings about the appearance of using two canes at once. Pace was dictated by the client's variable strength and endurance. Due to Mrs. Q's health problems lesson times were variable in length, according to her physical capabilities on a given day. Sequence was initially dictated by the demands of Mrs Q's home environment. The skills required for her to negotiate her front steps, her home property, and the narrow gravel lane leading to her mother's house were covered first. Afterwards ,she learned to increased independence and seek out referral sources for additional services.

Conical model of the theoretical framework for mobility in older adults illustrating seven lifespace locations (ascending in order of increasing distance from the room where one sleeps), each of which is composed of mobility determinants related to cognitive, psychosocial, physical, environmental, and financial factors.

Webber S C et al. The Gerontologist 2010;50:443-450

The Author 2010. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org.

Conclusion It is likely that O & M professionals will encounter greater numbers of older people as rehabilitation organizations respond to increases in the number of elders experiencing vision loss. This increased exposure will expand and perhaps test the capacity of O & M instructors to respond to the complex, fluid needs of older people. They need to respond to the great variety presented by older people. Each student in each circumstances is worthy , and each student benefits from the therapeutic effect that increased travel skills produce. Their aim for serving older people is the same as for any consumer- to recognize the strengths and goals of each individual, and respond to those needs in a way that enhances choice, dignity, control, and quality life.

Thank you.....