The RT News
Newsletter of Division 11
March 2007
FROM THE CHAIR
Time for a Change?As promised in the last issue of the RT News, your Division Board has discussed feedback from the members, and we are proposing a name change for the Division. Current members of the Division will be receiving a ballot soon with the following By-laws proposal. The existing language is as follows:
ARTICLE I. NAME
Section 1. The name of this organization shall be the Association for Education and Rehabilitation of the Blind and Visually Impaired, Rehabilitation Teaching Division.
Section 2. The Association shall hereafter in these Bylaws be referred to as AER.
Section 3. Rehabilitation Teaching Division shall hereafter in these Bylaws be referred to as the Division.
The proposed change would replace “Rehabilitation Teaching” with “Vision Rehabilitation Therapy Division” in Article I, sections 1 and 3. The amendments will then be mailed to all voting members of the Division for vote. Ballots must be postmarked no later than 21 days after the date that the ballots were mailed by the Division. The adoption of proposed amendments shall require a quorum and affirmative vote of two-thirds of the members voting. If the amendment is adopted, then we will move on to the next steps of changing the names of the newsletter and website.
It’s up to you—make sure you exercise your right to vote on this important issue!
Mary Beth Harrison, CVRT, CLVT
OFFICERS
Mary Beth Harrison, Chair: marybeth.harrison@med.va.gov
John McMahon, Chair-elect: john.m.mcmahon@wmich.edu
Susan M. Dalton, Secretary/Treasurer: smdtvp@joltmail.net
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Beeping Eggs and other ideas
By Nancy Paskin, CVRT
This is the Spring issue of the newsletter and it dawned on me that some of you may be in positions to advise consumers and/or your agency on holding an Audible Easter Egg Hunt. So what started from a simple email question has grown into a big Internet search. I want to share the results with you. Please feel free to write or email in YOUR ideas about this topic to me and they can be shared in a future issue. By Nancy Paskin, CVRT
The Houston Lighthouse seems to hold the honor of holding the first audible Easter egg hunt in 1982. They had volunteers who have made audible eggs using components from Radio Shack and Leggs eggs. I understand that these eggs are no longer used in Leggs packaging. HL would not share their “recipe” for their eggs, but they will loan eggs to groups who want to hold an audible egg hunt and who will share statistics about the new egg hunt with Houston Lighthouse.
The Hunt: It seems that there are about three different types of hunts and they are variations on each other. The common feature, other than the audible eggs, is that the visually impaired children have a separate searching area from the other children. Both hunts, however, often take place at the same time. The children are encouraged to use their mobility aids at all times and are cheered on by friends and family.
The audible eggs are placed around the area, under bushes, near a tree, etc. When found the egg is brought back to the “Start” and is traded in for a basket of candy/toys, etc. The audible eggs are placed one each in the middle of the basket of candy/toys so that by finding the audible egg, the child also finds the basket of candy/toys. The audible egg is placed in the center of a “nest” of candy which can actually be nest-like or just that the candy is within an arm’s length of the audible egg. When the child finds the audible egg, they will need to do some further pattern searching to locate the other items and fill their basket.
The audible eggs have generally been made for either a specific child or specific agency, usually by volunteers like telephone pioneers, jaycees, police volunteers, eagle scouts, etc. Several clever parents have also made the eggs and have posted their work on the Internet. One father used the inside works of a toy cell phone and just glued the works into plastic eggs. A mother found a chirping chick in a drug store and put the little chick into a paper maché egg for her child. Another father figured out a beeping or clicking mechanism and had his co-workers make them in assembly line style and gave them to the agency where his child received services.
Other sound makers used include: a Say When with the wires touching, a car key locater, a battery operated toothbrush, etc. ILA has a locator device that has either 4 or 8 transmitters that can be attached to items frequently lost. Then by using the base piece which is color coordinated and has buttons to match the transmitters, by pushing a specific button the respective transmitter sounds off. This item could easily be used with the eggs….and for other items the rest of the year. I’m sure other small items and toys could be found to work with either the eggs or with the baskets, if too big to fit an egg. So VRTs put on your thinking caps. Lets come up with a “recipe” for more audible eggs. Let me know at nansam@peoplepc.com. Happy Spring !!!
Insulin Identification and Visual Measurement
By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L
Insulin identification and measurement are both critical to obtaining an accurate dose of the correct insulin. Individuals who require insulin may take more than one type of insulin a day and several different doses throughout the day.
By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L
Insulin Identification:
All insulin bottles are the same size and shape except for those produced by Sanofi-Aventis (Lantus and Apidra), which are taller and thinner. Several adaptations are available to distinguish between two like vials. A Rubber band can be placed around one of the vials, such as Regular or Rapid-Acting. A commercially available, color coded, large print sleeve, such as the Insuleeve, can be used although it requires removal prior to using most insulin measuring devices. One of the talking blood glucose monitors, the Voicemate, has a bar code reader, however, it will only read one of the insulin manufacturer’s bar codes, the Lilly brand.
Insulin Measurement – Syringe Basics:
The primary method of insulin delivery is the vial and syringe. The features of a syringe include: syringe/barrel size, needle gauge and needle size. For visual accuracy in dosing, the syringe size is matched to the insulin dose to be injected as follows: 0.25 cc (for doses <25 units); 0.30 cc or 3/10 cc (for doses < 30 units); 0.5 cc or 1/2 cc (for doses < 50 units) and 1 cc (for doses 50 to 100 units). The smallest syringe size should be used for the dose of insulin needed, as the measuring lines on the barrel of small syringes are farther apart and easier to see.
Needle gauge refers to the width of the needle; the higher the gauge of the needle, the thinner it is (ranging fro 28G to 31G, the thinnest). Needle size refers to the length of the needle; 1/2 inch being standard length and 5/16 inch short length. The short needle is used by individuals with normal or near-normal body mass. Concerns regarding needle length should be referred to or addressed by the client’s physician. The shorter needle length often corresponds to finer needle gauge.
The basic parts of the insulin syringe include the needle, the barrel, and the plunger. A protective cap covers the needle and a cap may often cover the plunger. The barrel is a long thin chamber that holds the insulin. The barrel is marked with lines to measure the number of insulin units. In some syringes one line is equal to one unit of insulin in others each line is equal to two units of insulin. The protrusions at the one end of the barrel are called wings or flanges.
The plunger is a long thin rod that fits snugly inside the barrel of the syringe. It slides up and down to either draw the insulin into the barrel or push the insulin out of the barrel through the needle. The end of the plunger that is within the barrel chamber is called the tip or stopper of the plunger. The top edge of the plunger tip is matched with the line or insulin dosage marking on the scale of the syringe barrel to measure the correct amount of insulin. The plunger tip also serves as a rubber seal preventing insulin leakage out of the syringe. At the other end of the plunger rod there is a small, round piece called the thumb press.
Insulin Measurement – Visual Adaptations and Devices:
Modifying the environment by adding and optimizing task lighting can be a first step in enabling a person with vision loss to use their remaining vision in insulin measurement. Some forms of head borne lighting are also now available that might provide more direct lighting. Contrast can be enhanced by placing the syringe against a solid white background, such as white piece of paper, wall or appliance like a white refrigerator. This will permit the black plunger tip and syringe barrel markings to stand out.
Optical devices can used to assist in insulin measurement. Spectacle format magnification and closed circuit televisions allow both hands to be used. A hand held magnifier can be propped up with a homemade magnifier stand or a commercially available double ended clamp can be obtained to allow hands free use.
Several magnifiers are made specifically to fit on the syringe and they may enable a person with mild vision loss to read the dose markings on the barrel. These include the Syringe Magnifer, the B-D Magni-Guide, and the TruHand. Syringe magnifiers will fit varying sizes and brands of insulin syringe. They are available directly through their manufacturers or can be purchased through low vision catalogues.
The clip on Syringe Magnifier is a small magnifier that clips firmly to the syringe barrel. The BD Magni-Guide, which provides 1.7x magnification has a groove where the syringe barrel is placed. The insulin vial is snapped into a collar at one end of the guide. The syringe needle is then guided into the rubber stopper of the insulin vial. Since the magnifying guide has an open back it can be modified with a piece of Velcro to help the user keep the syringe barrel in place.
The TruHand is a 2-piece magnifying syringe guide. The larger piece is enclosed on the sides and serves as the magnifier. The inserted piece has an insulin vial holder at one end and slots to hold the syringe flanges at the other end in order to lock the syringe in place. The two pieces are connected by a tabbed ring. The insulin vial clicks into place when inserted into the 2-piece guide. As the syringe is inserted into the guide the needle automatically aligns with the rubber stopper of the insulin vial. The TruHand provides a 2-3X magnification of the syringe scale. Insulin vials can be changed for mixing without disturbing the syringe.
Visual methods and devices for insulin vial identification and insulin measurement should be reliable even when the user’s vision is at its lowest. In addition, they should only be used if they consistently result in an accurate insulin dose measurement. However, most visual techniques and devices are only effective with persons who have relatively mild loss. The next column will address non-visual techniques and equipment frequently used to measure insulin.
Assessment: the key to quality instruction
By Brendan Tedrick, MS, CVRT
Before any instruction in daily living skills can begin, it is essential that an assessment is done first. Without an assessment, what can the rehabilitation teacher base their instruction on? It is also very important to do a holistic assessment, so that the rehabilitation teacher gets the whole picture of the person and has a good understanding of what areas the client needs instruction. Here are the areas that should be in an assessment: medical information, communication skills, home management, personal management, low vision, leisure activities, and indoor orientation and mobility. It is a good idea to ask questions in the above areas but even better to ask the client to demonstrate some of the skills. By demonstrating some of the daily living skills, the rehabilitation teacher can see for first hand if the client is fine in that area or if he/she is having difficulties in that particular area. The rest of this article is going to focus on how to do an assessment, in particular what types of questions to ask in the introduction part, communication skills, home management, personal management, low vision, orientation and mobility and leisure.
By Brendan Tedrick, MS, CVRT
In the introduction part of the assessment, the rehabilitation teacher will reaffirm the correct spelling of the client’s name, address, phone number and emergency contact information. The next part of the introduction is the medical information section. Here the rehabilitation teacher will ask for the client’s doctor’s name, address and phone number. It is also, important to get a current list of health conditions and medications. The more information that the rehabilitation teacher has the better the assessment report will be. The last part of the introduction is focused on the client’s eye condition. Here the rehabilitation teacher will ask the client who their eye doctor is, address and phone number of the eye doctor. It is also, recommended to ask the client what the name of their eye condition is and how would they explain their eye condition. In doing this the rehabilitation teacher is seeing how much the client knows about their eye condition. Before asking any health related questions, the rehabilitation teacher should explain HIPAA Privacy Rules and that their medical information is safe and will not be discussed without their permission. Communication is the next area in a rehabilitation teaching assessment.
People can communicate to each other by spoken means, written means, tactually, or by using gestures. The first thing that a rehabilitation teacher can ask a client in the communication category is if they are signed up for the Talking Book program. It is a good idea to have the Talking Book application on hand so that the rehabilitation teacher can fill out right when the rehabilitation teaching assessment is being done. If the client is signed up for the Talking Book program, ask the client to demonstrate how they operate the talking book machine. Handwriting is another communication area that needs to be assessed. The best way to assess ones handwriting is to ask the client for a sample of their handwriting. The rehabilitation teacher could ask the client to write out a food list, or fill out a sample check. Another communication area is Braille, the rehabilitation teacher could have a sample alphabet sheet and see if the client understands the concept and secondarily if the client can tactually recognize the Braille. Keyboarding is the last communication area. If a client has limited keyboarding skills, Talking Tutor is a good software program to help with keyboarding skills. Assessing client’s home management skill level is the next area in a rehabilitation teaching assessment.
Home management refers to client’s cooking ability, cleaning ability and home repairs. In assessing client’s cooking ability, the five cooking areas are: kitchen safety, food preparation, pouring, using the stove/oven, and using the microwave. Safety is extremely important when assessing a client’s cooking ability. The rehabilitation teacher should ask the client to perform the following cooking skills: cutting, regulating the flame on the stove, pouring cold and hot liquids, making a sandwich, and operating the microwave. In terms of cleaning ability, the rehabilitation teacher should ask the client the following questions: How often do you sweep? How often do you mop? and Do you do any dusting? It also, is a good idea to have the client do some of the cleaning skills so that the rehabilitation teacher can get a feel of how the client can clean their living space. In terms of the home repairs section, the rehabilitation teacher should ask the client to perform the following skills: change a light bulb, plug a cord into an outlet, and use a key to open a door. The next important area of a rehabilitation teaching assessment is the personal management section.
The seven skill areas that are assessed in the personal management section are: grooming, medicine management, clothing identification, laundry, money identification, time management, and telephone. In terms of the grooming area, the rehabilitation teacher should ask the clients if they have any problems with brushing their teeth, shaving, nail care, and taking a bath. Medicine management is very important, the rehabilitation teacher should ask the client if they know what medications they are taking, do they know when to take their medicine and do they know the specific directions for each medicine that they are taking. In terms of clothing identification, the rehabilitation teacher needs to find out how the client is identifying their clothes and what system the client is using. Laundry is another area of personal management, here the rehabilitation teacher needs to ask the client do they know how to separate whites from colors, can the client measure out the correct amount of soap, and is the washer and drier marked with client-friendly markings. The rehabilitation teacher should also, ask the client to show how they identify their money by asking the client to demonstrate their folding system. If client does not have a folding system the rehabilitation teacher should demonstrate a folding system. Time management is another personal management area; here the rehabilitation teacher should ask the client what time it is. If the client does not have an accurate way to tell the time, then the rehabilitation teacher should show the client different talking watches, low vision watches and tactual watch and allow the client to pick out a watch that works the best for him or her. In assessing telephone management, the rehabilitation teacher should ask the client to dial a number to see how the client can dial, also have the client write down a telephone number to see if the client can read back the number. It is also, important to ask clients that live by them selves if they can dial 9-1-1 in an emergency. Here are some personal management skill performance tasks: ask the client to identify different bill denominations, ask the client to dial phone numbers, ask the client what color their outfit is, and ask the client to go over the clients medicine that is in the pill box.
The next three areas that are looked at in the rehabilitation teaching assessment are: low vision, orientation & mobility and leisure activities. There are two basic questions in the low vision section. The first question is, have you had a low vision exam done and if so when was the low vision exam done? The second question in the low vision exam section is to ask the client to list any low vision devices that they are currently using. For example a client might say, I use a 3X hand held magnifier and a telescope. In terms of the orientation and mobility section of the rehabilitation teaching assessment, the rehabilitation teacher should ask the client if they have ever had orientation and mobility training and if they have had training to ask for the contact information of the O&M instructor. If the client has never had O&M training before, the rehabilitation teacher should briefly explain what O&M training is and then ask if the client is interesting in O&M training. In terms of leisure activities, the rehabilitation teacher asks the client what type of leisure activities they participate in.
The last part of the rehabilitation teaching assessment deals with client’s goals, equipment and other comments. In terms of client’s goals, the rehabilitation teacher will list the client’s goals that the client wants to work on. Here are some examples of equipment that a particular client might need: liquid level indicator, talking watch, and 20/20 Pens. Here is an example of other comments; Client is interested in joining local support groups and in some of Hadley courses.
The key to quality instruction is finding out what skill areas each client needs instruction in by doing a holistic assessment. The term holistic assessment refers to getting an accurate picture of the client in terms of their strengths, limitations and medical information. Raftary (1977) stated that, “Performance of skills is a much better basis for a rehabilitation teaching assessment than an interview” (p. 393). Here Raftary is pointing out that it very valuable to ask clients perform specific daily living tasks rather than taking there word. Rehabilitation teachers due to time constrictions can not ask clients to perform every daily living activity but they can ask the client to do some daily living skill performances. It is highly recommended that rehabilitation teachers have both interview questions and performance evaluations during the rehabilitation teaching assessment. Once a rehabilitation teaching assessment has been completed, the rehabilitation teacher can begin to plan worthwhile lessons. It is also, important to have the clients agree with the daily living skill program so that they have ownership in their own daily living skills program.
References:
Ponchillia, P., and Ponchillia, S. (1996). Foundations Of Rehabilitation Teaching with Persons Who Are Visually Impaired. AFB Press: New York: NY.
Raftary, A. (1977). Assessment of Rehabilitation Students during Initial Contact with the Teacher. Visual Impairment and Blindness, November, 392-393.
Equipment Resources:
Ann Morris Enterprises, Inc: 1-800-537-2118; Hear-More: 1-800-881-4327; Independent Living Aids: 1-800-537-2118; Learning, Sight and Sound made easier: 1-800-468-4789; Lighthouse International; 1-800-826-4200; Maxi-Aids: 1-800-522-6249
Transformation at CNIB
By Sara Bennett, CVRT
CNIB, Canada's primary source of vision rehabilitation services and vision health information, has recently become more accessible to Canadians experiencing vision loss. Formerly known as the Canadian National Institute for the Blind, this non-profit, nationwide and community-based organization is now simply "CNIB", a more inclusive name that better reflects the fact that 90% of its 100,000 clients have some degree of vision, and that it is involved in a wide range of activities related to vision and vision health. CNIB serves everyone from children to working-age adults and seniors, and also engages in vision research and public education. By re-branding itself, the agency is attempting to make its services available to everyone who needs them. By Sara Bennett, CVRT
In keeping with its efforts to be more accessible, CNIB has undertaken the digitization of its library, which offers books, textbooks, children's literature, government publications, corporate materials etc. in braille, print/braille, audio and tactile graphics. The library also circulates described videos and braille music. Since 1998 it has been converting its analogue files to digital ones, which are easier and less expensive to use than the 30-year-old technology of four track cassettes. Now, books are contained on one CD instead of numerous cassettes and sound quality is superior; the DAISY book players allow users to adjust reading speed without affecting pitch, and to navigate by specific blocks of text such as chapter or paragraph. Besides mailing titles to readers, the library also delivers them over the internet, either to be read online or downloaded. While online, readers can also access newspapers and magazines, reference materials, the library's catalogue, and the children's discovery portal that provides digital books, accessible games and the world's first accessible and moderated chat room for kids with vision loss. By the completion of the digitization project sometime this year, CNIB will have doubled its library collection to 120,000 titles. As a member of the International DAISY (digital audio-based information system) Consortium, the CNIB Library is working with 40 non-profit libraries for people with vision loss to create world standards for digital audio books.
The new CNIB Centre, a five-storey, 140,000 square foot building that opened in 2004, utilizes universal design principles to improve accessibility and navigation for visitors. The central hallway is wide enough to accommodate several people with white canes, guide dogs, wheelchairs and scooters; natural and diffused lighting reduces glare and maximizes vision; floor tiles contrast in colour and mark important areas like stairs and elevators, as well as where floor and walls meet; talking elevators speak floor numbers and whether they are going up or down; talking signs verbalize via FM receivers the location a visitor is approaching; and office signs are displayed in high-contrast large print, tactile lettering and braille. In the cafeteria, a black tactile path guides visitors through the queue and to the dining area and aromas may also direct patrons by virtue of the cafeteria's open design. Just outside the centre, a fragrant garden contains trees, shrubs and flowers selected for their distinct scents, textures and the sounds they make in the wind. As visitors leave the grounds, textured stones let guests know they are leaving the parking lot and approaching the street. From beginning to end, a visit to CNIB's head office in Toronto is an accessible one.
For more information on CNIB or its transformation, call 1-800-563-2642 or visit www.cnib.ca.
Resources from Sara
Perkins School for the Blind has recently published "Welcoming Students with Visual Impairment to Your School: A guide for training public school personnel and families about the needs of students with vision loss", multi-media modules designed to provide vision professionals with a user-friendly resource for sharing information about students with visual impairment. Modules include an overview of visual impairment, Social skills for children and youth, Orientation and Mobility, and Low Vision. Visit www.PerkinsPublications.org for more information.
A White Paper recently released by the Age-Related Macular Degeneration (AMD) Alliance International shows a strong link between AMD and decreased quality of life, and between the eye condition and depression. For further information on the report, visit:www.cnib.ca/eng/about-us/media-centre/news/amd-news-092006.htm
Bookshare.org's network of volunteers, including educators and librarians, has succeeded in scanning 30,000 books creating the world's largest accessible online library for persons with print disabilities. United States residents can download books from this subscription-based service to Braille printers, portable braille devices and via screen magnification and screen reader software. International visitors can access numerous public domain books here, which are no longer subject to copyright laws. Visit www.bookshare.org for further details.
"To the Left of Inspiration: Adventures in Living with Disabilities", written by Katherine Schneider who is a blind psychologist, highlights the warmth and humor in our struggles to be humane with each other, whether we are temporarily able-bodied or disabled. The book is available through online booksellers and in accessible format at: www.bookshare.org
The biography of Sir John Wilson (1919-1999), the force behind the Royal Commonwealth Society for the Blind (now Sight Savers International) and supporter of the merger between organizations of and for the blind to form the World Blind Union, is available from www.amazon.com in print, large print, Daisy audio and full text, Screen Reader (magnification, speech or braille) and braille. A CD-Rom accompanies each print copy. A review of Blindness and the Visionary is available at: www.disabilityworld.org/01_07/wilson.shtml
Another Excellent Braille Chocolate Bar Resource
By Mary Fleming, CVRT
Contact: Mary Fleming at mflemin3@nycap.rr.comBy Mary Fleming, CVRT
Put “Braille Chocolate” in the heading so I will open the e-mail. Each bar is $6 plus shipping They are 6 ½ X 3 ¾ - boxed Weight is approximately 7-8oz.
The greetings are: Thank You; Have a Nice Day; Love You; Happy Holiday; or Merry Christmas I have the only authorized logos for AER and NYSAER used for the chocolate bars. 10% of each order is donated to NYSAER Scholarship fund. All bars can be ordered in milk, dark or white chocolate. Sorry, NO sugar free!!
All orders must be placed 10 days in advanced NO credit cards. Mail orders to Mary Fleming, 153 Charlton Road, Ballston Lake, NY 12019