The RT News
Newsletter of Division 11
December 2006
From the Chair
Who are we?The Rehabilitation Teaching Division is its members—generally about 400 or so of us at any given time. We are Rehabilitation Teachers, many of whom are now Certified Vision Rehabilitation Therapists. Does this mean we have an identity crisis? Should we change the name of the Division to match our certification title? My opinion is that yes, we probably should. The question is, what exactly should we call ourselves? Here are some possibilities, along with the precedents to go with them:
- Vision Rehabilitation Division—this seems to coincide with the Low Vision Division and Orientation & Mobility Division names.
- Vision Rehabilitation Therapy Division—this would be similar to our current name; it says what we do (“therapy”) instead of who does it (“therapist”).
- Vision Rehabilitation Therapist Division—this matches the certification title most closely; however, it does not seem to fit in with the Division names of the other Adult Services Divisions.
ARTICLE X. AMENDMENTS
Section 1. Amendments. Amendments can be proposed by any member of Division 11.
Section 2. Amendments shall originate in one of the following manners:
- Submission by petition of at least ten voting members of the Division; or
- Submission by a majority vote of the Division Board.
Section 4. Adoption of Amendments. The adoption of proposed amendments shall require a quorum and affirmative vote of two-thirds of the members voting
CVRT® Logo Design
The ACVREP Board has not yet chosen the logo for our new Certification Pin. They are still accepting designs and would welcome your input. Send your ideas to Sharon Mikrut, ACVREP, 3333 N. Campbell Ave, Suite 11, Tucson, AZ 86719, or e-mail her at info@acverp.org.
Your Executive Team: 2004-2006
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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APH Ad: Identify Your World by Voice: Sherlock Talking Label Identifier and the Colorino Talking Color Identifier
The Sugar Blues: Insulin Management – The Basics
Basic Information:
Insulin is usually the medication most often associated with diabetes. It may be used in combination with diabetes medications (known as oral hypoglycemic agents) or by itself. An external source of insulin is required by persons with Type 1 diabetes; persons with Type 2 diabetes may take insulin if diet, exercise and oral medications are no longer effective in normalizing blood glucose levels. It is a myth that taking insulin means that a person’s diabetes has gotten worse or that they have “failed” at managing their diabetes.
According to the Centers for Disease Control about 32% of adults with diabetes are currently taking insulin. Insulin is primarily used in an injectable form. An inhaled insulin called Exubera recently entered the market and research is also focused on the development of insulin in pill, patch and nasal spray form.
What is insulin and how does it work?
Insulin is a hormone made by the Beta cells of the pancreas. Insulin acts as a key opening gates within the cells of muscle tissue. When the gates in these cells are opened, glucose in the bloodstream that resulted from food that is eaten enters the cells and provides energy to the muscles. Without insulin, glucose remains and accumulates in the bloodstream and causes hyperglycemia or high blood glucose. The normal pancreas releases a slow, steady trickle of insulin over the course of the day, to cover the glucose the body naturally makes. In addition to this “background” insulin, the normal pancreas also automatically delivers a large dose of insulin to cover the carbohydrates that are eaten within each meal or any increase in blood glucose level.
Where does insulin come from and what are it’s properties?
Currently 3 companies manufacture injectable insulin in the U.S.: Lilly (brand names Humulin and Humalog); Novo Nordisk (Novolin, Novolog, and Levemir); and Aventis (Lantus and Apidra). Insulins are classified according to their onset of action, peak effect and duration of action. The 4 classifications of insulin include rapid or fast-acting (Humalog, Novolog, Apidra), short-acting (R or regular), intermediate-acting (N or NPH) and long-acting (Lantus and Levemir). The fast and short-acting insulins are also known as mealtime insulins as they mimic the large dose of insulin the pancreas releases during a meal. The intermediate and long-acting insulins are known as basal insulins as they provide the background insulin coverage required throughout the day. Lantus, one of the newer insulins is the only “peakless” insulin. To simplify insulin administration and eliminate mixing, several premixed insulins were developed (70/30, 50/50, 75/25); these combine a rapid or short acting component with an intermediate one.
How often, when and how much?
Insulin dosing is dependent on the type of diabetes, level of insulin deficiency or resistance, timing and carbohydrate content of meals, physical activity, and waking and sleeping patterns, and overall lifestyle pattern¹. Common dosing frequencies include a single daily injection administered in the morning or at bedtime or a 2-injection regime with insulin administered in the morning before breakfast and before the evening meal or at bedtime. “Intensive insulin therapy” ranges from 3- 4 times per day with a 4-injection regime requiring one injection in the morning and 1 at each mealtime. Some persons take a “fixed” dose of insulin that is set by their physician. Others take a “variable” dose, which is a dose that can be altered by the individual taking into account their current blood glucose level and carbohydrate amounts eaten or to be eaten, among other factors.
Components of Safe Insulin Use:
Many steps are required for safe, accurate and effective insulin use. These tasks include: insulin storage, identification (if more than 1 is taken), insulin/vial preparation, measurement, mixing (if more than 1 is taken), air bubble management, administration, injection site management, determination of quality and quantity of vial contents, and sharps disposal. Incorrect storage may cause deterioration in the quality of the insulin and thus its effectiveness; incorrect identification may result in the wrong insulin at the wrong time; inaccurate measurement may result in an incorrect dose. The errors above can either lead to hypoglycemia or hyperglycemia.
Many of these steps should be taught by the client’s primary healthcare provider, physician, or diabetes educator as part of basic diabetes self-care. Vision rehabilitation therapists should be familiar with such aspects as insulin storage, preparation, etc., in order to recognize if the client may not be adhering to proper technique and might require further instruction from a healthcare professional. Each of the above tasks can pose difficulties and barriers to performance for persons with vision loss. The vision rehabilitation therapist can provide both low vision and non-visual adaptations for their completion. Each of these areas will be addressed in detail in upcoming columns. Lets begin with:
Insulin Storage and Quality of Vial Contents: Insulin expires like all other medications; refer to the package expiration date. However unlike most other medications insulin expires sooner once it is “opened;” i.e., the stopper or seal of the vial or pen has been punctured with a needle.
According to Joslin Diabetes Center², unopened insulin vials and pens should be stored in the refrigerator until expiration date. Opened insulin vials should be kept at room temperature (between 59° F and 86 ° F) and are good for 28 days. Opened insulin pens should be kept at room temperature and are good from 10 to 28 (one new insulin 42 days) days depending on the type of pen and insulin. Recommended storage guidelines can be obtained from the pharmacist, package insert, or manufacturer's web site.
Most insulins (Humalog and Novolog, Regular, Lantus and Levemir) are clear, colorless solutions, while some insulins such as NPH are suspensions and should be evenly cloudy or milky in appearance. According to the American Diabetes Association³ a clear insulin such as regular should be examined for particles or discoloration; a cloudy insulin such as NPH should be checked for "frosting" or crystals in the insulin on the inside of the bottle or for small particles or clumps in the insulin. Insulin exhibiting the above characteristics should be discarded or returned to the pharmacy if recently purchased.
Conclusion:
Vision rehabilitation therapists can insure that optical aids or sighted assistance (pharmacist, friend) are utilized in the above tasks and that information related to expiration/use by dates are placed in accessible format such as large print, Braille, or audio. Vision rehabilitation therapists should also promote an organized approach to rotating supplies and use of a reliable supplier who will consistently provide insulin with expiration dates beyond intended use. Use of bold pens and large print calendars can aid in tracking how long pens and vials have been open or placing small items such as pennies in a container, one for each day a vial or pen is “open” can also aid in tracking shelf life.
¹ White, John R. and Campbell, K.R., “Pharmacologic Therapies for Glucose Management,” from Diabetic Management Therapies, A Case Curriculum for Diabetes Education 5th Edition, 2003, American Association of Diabetes Education, p. 108.
² Joslin EZ Start™ Guiding Insulin Initiation. Joslin Diabetes Center, Harvard Medical School, Boston, MA ©2006, p. 17.
³ American Diabetes Association, viewed November 11, 2006 at http;//www.diabetes.org/type-1-diabetes/safety.jsp.
HOLIDAY Resources by Sara Bennett, CVRT
The Chocolate Experience, Inc. sells braille chocolate bars for gifts, fundraising or resale in a gift box. Messages available on the bar include: Congratulations, Good Luck, Happy Anniversary, Happy Birthday, Happy Chanuka, Happy Easter, Happy Holidays, Happy Retirement, Have a Nice Day, I Love You, Merry Christmas and Thank You. In addition to sugar-free, they do custom orders, braille business cards and a 2 lb. 3D chocolate Labrador guide dog with harness with the braille message "best friend." Call (888) 568-6665 (outside NY State only) or email Chocolates Unlimited has braille chocolate bars with messages including: Happy Birthday, Happy Holidays, Have a Nice Day, I Love You, Merry Christmas, and Thank You. They make custom logos, business cards, trade shows, fundraisers and party favors. Available in milk, dark and white chocolate with or without nuts. They also carry supplies to make your own candy and braille bars. Call them for a braille catalog. Phone (718) 359-4466 or email info@chocolatesunlimited.biz.
Greeting cards in various alternative formats are available from www.braillegreetingcards.com, www.sightedtouch.com, www.cal-s.org/braille-greeting-cards.html, www.brailleenterprises.com, and a list of greeting card sources can be found at http://blindreaders.info/cards.html. Hallmark stores also sell braille and large print greeting cards (www.hallmark.com).
Favorite Christmas Carols from National Braille Press, available in one braille volume or in PortaBook, sells for $8 and contains lyrics to 33 Christmas carols. Also now available are new selections in print-braille for children including Curious George and the Firefighters by Margret & H. A. Rey, $5; I Will Never Not Ever Eat a Tomato by Lauren Child, $6.99; and The Napping House by Audrey Wood, $5.95. Simple Ways to Control Your Weight is available in one volume for $8. It is not a diet book but rather contains the best weight management advice and tips from experts. NBP has also released Blog On: Reading and Writing Blogs with a Screen Reader. This book covers such topics as finding, reading and staying current with blogs of interest and creating and writing a blog of your own. The book is available in braille or PortaBook for $10. Call NBP toll-free (800) 548-7323 or visit www.nbp.org.
Seedlings has added a number of braille books to its collection this year, and its 2007 catalogue is now available. Additions include books by Dr. Seuss, Judy Blume and Gordon Korman, as well as books in the Arthur and Boxcar Children series. Seedlings also now offers e-braille books, for $10 each, that can be downloaded from their website and accessed via a Braille access device like a notetaker or braille embosser. Current e-braille books include Indian in the Cupboard, Matilda, The Secret Garden and A Wrinkle in Time. Call Seedlings toll-free at 800-777-8552 or visit http://www.seedlings.org/whatsnew.php.
Reader's Digest introductory offer in large print is $21.95 per year. This may be ordered by calling (800) 807-2780. American Printing House for the Blind publishes the cassette and braille editions. For large print Condensed Books call: (800) 877-5293. Great for this time of year, many organizations provide religious or faith-based materials in alternative formats for adults and/or children, either for sale, free of charge or on loan. They include: Aurora Ministries has Bibles and Bible studies on standard speed cassette free of charge in 64 languages to visually impaired persons. Call (941) 748-3031 or email tapes@auroraministries.org.
Braille Bibles International can be reached at 800-522-4253 or via email at info@braillebibles.org.
Christian Record Services has books to loan and Bible studies and religious periodicals for free for visually impaired persons. They are in large print (22 point), braille, and cassette (not all items available in all formats). They also have a lending library available to members for individuals of all ages. Phone (866) 488-0981 or email info@christianrecord.org.
Lutheran Braille Workers, Inc. provides Bibles and Bible studies in Braille and large print (18 point) free to visually impaired persons in 130 countries and over 40 languages. They also provide catalogs in large print and braille. Call (909) 795-8977 or email lbw@lbwinc.org
The Canadian Bible Society offers free Scriptures in alternative formats. Call 1-800-465-2425, email info@biblesociety.ca or visit www.biblesociety.ca.
Christian Blind Mission International Canada offers Christian literature on audiocassette for Canadians with vision loss through its Talking Book Library. For further information, call 1-800-567-2264, email cbmi@cbmicanada.org or visit www.cbmicanada.org.
The Jewish Braille Institute of America loans thousands of books of Jewish interest on audio cassette, in braille and in large print free of charge to anyone who is blind, visually impaired, physically or learning disabled. Call (800) 433-1531 or email admin@jbilibrary.org.
Various articles and books related to Judaism are available online or in audio formats free of charge from God and Jews. Visit http://www.GodAndJews.org
The Arizona Instructional Resource Center (AIRC) at the Foundation for Blind Children in Phoenix announces the completion of a braille transcription of the English translation of the Holy Koran. The braille copy is available for sale in seven volumes. For more information please call the AIRC at (602) 331-1370.
Audio versions of the Koran and related materials are available from KVisionBooks. Call 1-866-98 BOOKS, Email sales@kvisionbooks.com or visit http://www.kvisionbooks.com
Materials related to Hinduism are available online, in braille or audio formats from the Himilayan Academy. Call (1) 800-890-1008, email contact@hindu.org or visit www.himalayanacademy.com.
Mahayana Sutra and Tantra Press has brought out a braille edition of their popular translation The Principal Teachings of Buddhism. The new release can be ordered free of charge by contacting Mahayana Sutra and Tantra Press at Tel: 732-378-5898 or by emailing mstp@monmouth.com.
Braille editions of several books by the Dalai Lama, including his best seller The Art of Happiness, as well
as many other English language Buddhist classics, are available from the Talking Book Division of The National Library Service. Their complete listing, including materials related to other religions, can be found by visiting their website at www.loc.gov/nls or telephone 800-424-8567.
The Insight email newsletter is a free source of trusted vision health news and information delivered directly to your email Inbox each month. Read about tips on how to improve your vision health, the latest vision health research, common vision health questions and answers in the Ask the Expert feature, the latest consumer products and assistive technologies for living independently with vision loss, upcoming events, and profiles of those in the community who are helping to make a difference. To sign up or to read past issues, visit www.cnib.ca/eng/publications-resources/publications/newsletters/insight/index.htm.
"Living Well with Macular Degeneration" and "Macular Degeneration: The Complete Guide to Maximizing and Saving Your Sight" from CNIB provide information on causes and symptoms, as well as practical tips and personal stories. Call 1-866-659-1843 or email: store@cnib.ca
"Feeling Great, Looking Good" is a report from RNIB that draws a link between obesity and sight loss--specifically, age-related macular degeneration (AMD), diabetes retinopathy and cataracts. To download the report, visit: www.rnib.org.uk/campaigns
101 Tips to Raising Healthy Kids with Diabetes ($14.95), published in 2006 by the American Diabetes Association, helps parents teach children the facts, responsibilities, and good attitudes about diabetes while they are young. Chapters cover babyhood, toddlers, school-age and teen concerns. The book addresses medical, emotional and lifestyle issues. Learn about hypoglycemic treatment for babies, snack ideas for fussy eaters, and strategies for active school-age children and teen athletes. Tips include how to teach children about self-management and blood glucose monitoring. The index, terms, and explanation of diabetes are also helpful.
Through the Looking Glass and its National Resource Center for Parents with Disabilities are proud to announce the release of "Hands-On Parenting: A Resource Guide for Parents who are Blind or Partially Sighted", available in regular print, Large Print or CD-ROM for $40 (USD). For further details, call 1-800-644-2666 or visit: www.lookingglass.org
Upcoming courses from the Hadley School for the Blind include Glaucoma, Parenting Children with Multiple Disabilities, and Art History: The Ancient Art of Egypt. For information on course formats and programs in which they are offered, call Student Services at 1-800-526-9909 or visit: www.hadley.edu
Seminars at Hadley is a new live internet lecture series hosted by the Hadley School for the Blind. The first topic, which aired in April 2006, was "Braille: Every Day, Every Way" and the June broadcast featured author, Richard Nelson Bolles, who wrote the best-selling job-hunting book in history, "The 2006 What Color is Your Parachute?". To access recordings of these and other lectures on Hadley's website, visit www.hadley.edu and select "Events" and then "Seminars at Hadley". To receive notification of upcoming lectures, sign up for electronic news releases by selecting "Lounge" and then "Mailing List".
The Hadley School for the Blind also offers online forums related to braille, adaptive technology and general interest. There is also a forum for family members of people who are blind or partially sighted, and one for professionals who work directly with people experiencing vision loss. In addition, a feedback forum is available. Visit www.hadley.edu and select "forums".
ETO Engineering PLLC provides accessible cell phones for people who are blind, have low vision, deaf/hard of hearing, hearing aid users, physically disabled, upper-extremity amputees, and elderly persons. Phone 919-523-0205 or email: ray.gonzales@etoengineering.com.
Carroll Tech, a service of the Carroll Center for the Blind, is a Web-based distance learning service that offers instruction in access technology. The courses are either self-paced or instructor led using a chat program. Classes are available in Outlook, Excel, PowerPoint, using accessible graphing calculators, using TGD Pro, using the Duxbury Braille Translator and more. For information about the courses and associated costs, contact the Carroll Center for the Blind, 770 Centre St., Newton, MA 02458; Phone: 617-969-6200; Web site: www.carrolltech.org.
Kelvin is a voice-activated, fully programmable thermostat. It may be operated from its keypad or by voice commands. The thermostat will control heating and cooling and replaces the existing thermostat. It can be programmed to raise or lower the temperature at certain times of the day. Kelvin costs $129.95. For more information, call Independent Living Aids at 800-537-2118 or visit www.independentliving.com.
The Schwan's catalog contains a wide range of frozen foods, which may be delivered straight to your door. The catalog is available in braille or on cassette. To request a catalog, contact Schwan's Customer Service, 115 West College Drive, Marshall, MN 56258; Phone: 888-724-9267; Web site: www.schwans.com.
The Lighthouse International carries a variety of products: mirrors, magnifiers, lamps, organizer wallets, braille speaker telephones, talking calculators, writing guides, talking pagers, clocks, luggage locators, cards, games, toys, talking scales, medical aids, etc. Call (800) 829-0500 or (212) 821-9200 or email retailstore@lighthouse.org.
Independent Living Aids, Inc. has watches, clocks, canes, kitchen items, slates and styluses, household, personal and recreation items, voice activated TV remote, large button cordless phone, talking pagers, sewing aids, tools, medical devices including diabetic aids, and more. Call (800) 537 2118, (516) 937-1848 or email can-do@independentliving.com.
Ann Morris Enterprises, a division of Independent Living Aids, offers blindness-related items including kitchen aids, 4-track tape recorders, canes, safety items, magnifiers, computer games and many other talking gadgets. Call 800-537-2118.
Speak To Me Catalog of talking products can be ordered by calling (800)248-9965.
CNIB sells a variety of consumer products and technical aids for people experiencing vision loss. Visit www.cnib.ca/tech_aids/index.htm to view the catalogue online or to download a pdf version.
A new information website provides self-help techniques, resources, and basic eye medical information was launched in October 2006. It is aimed at consumers and family members who are searching for answers to dealing with new vision loss and want to know what services and techniques are available to them and/or their family member. Easy search. Experts answer questions. Screens are friendly to use with screen readers and offer magnification choices. Visit www.visionaware.org
The Alice Raftary Rising Star Award
Alice Geisler Raftary: Mother to Eight and Mentor to Many, Many More ! She was born in Detroit, Michigan in 1927. she earned a Bachelor of Science Degree in Nutrition and Institutional Management from Marygrove College in 1949. She married Raymond Raftary in 1950 and over the next eleven years they were blessed with four daughters and four sons. Shortly before the birth of her eighth child, the macular degeneration that Alice first experienced in high school caused a substantial loss of vision and she became legally blind.
This event rekindled her interest in the field of blindness. While still a full time homemaker, she returned to Marygrove College on a full grant and earned a Masters of Education Degree specializing in Blindness and Rehabilitation in 1967.
She continued her work with a Traineeship in work with the Deaf-Blind at the Industrial Home for the Blind, NYC, in 1968 (now known as Helen Keller Services for the Blind). She took additional coursework at Wayne State University in 1972 in Opthalmology and Counseling. Her career as a rehabilitation teacher began in 1968 at the Greater Detroit Society for the Blind (Upshaw Institute for the Blind). While at the Upshaw Institute she served as a rehabilitation teacher, supervisor of teaching and personal adjustment training, coordinator of rehabilitation and social services and lastly, Associate Director. She authored a number of publications and scripted and produced audio-visuals.
Throughout her career, Alice was in demand as a conference and workshop presenter on the topics of working with the deaf-blind population, insulin management, psycho-social aspects of blindness, funding sources, initial client assessment, aging and blindness, etc. etc.
Alice has been the recipient of many awards over her career. In 1982, she was given the Bruce McKenzie Award, our Division’s lifetime achievement award for all of her work and efforts in our field. The Michigan Chapter of AER named her Member of the Year in 1991. In 1992, she received the Charlyn Allen Award from MACRT for outstanding leadership and dedication to the field of rehabilitation teaching.
Alice has mentored many clients and helped numerous new professionals gain work experience, perform internships, and gain a love and respect for the field of rehabilitation teaching, which is so dear to her heart. It is only fitting that our award honoring new professionals to our field be named for her.
Information above was gained in large measure from the APH Hall of Fame and Alice’s bio on that site.
Past winners of the RT Division’s Rising Star Award include: 2004 Vacent Garcia, 2006 Sarah Heinrich.
The Elizabeth Lennon Meritorious Achievement Award
Elizabeth Marie Lennon: teacher, advocate, volunteer & world traveler. Known to most as Libby Lennon. She was born in Chicago in 1915. Her parents soon moved to Gary, Indiana where she attended the Indiana School for the Blind. By elementary school, she had surgically lost one eye and had 19/400 in the other. Education: Indiana University – journalism - 1938-1941 Teacher’s College, Columbia University – 1947 She did additional coursework at San Francisco State, North Carolina State and Butler University.
Her work history began in Boston at a school for the blind. From there she went to North Carolina and worked at the NC Commission for the Blind. From 1968 to 1978 Miss Lennon was at Western Michigan University as Assistant Professor in the Blind Rehabilitation Program from which she retired. She also did part time work in Montana in a summer program as a consultant from 1968 to 1971.
Miss Lennon has been a regular contributor to The Braille Forum, the publication of the American Council of the Blind. She often contributed resources and new items of interest.
She has been very active within Kalamazoo’s senior community. She helped start the Kalamazoo Center for Independent Living. Is a founding member of Kalamazoo’s Disability Resource Center. She is a co-founder of Shepherd’s Center of Greater Kalamazoo, ecumenical programs for homebound elderly. She is a board member of the Voluntary Action Center of Greater Kalamazoo and on the advisory committees of the City of Kalamazoo’s Advisory Committee for the Coover Recreational Center and of the Michigan Commission for the blind.
Awards that Miss Lennon has received include the Handicapped Professional Woman of the Year in 1971 and in 2002 the Irving S. Gilmore Lifetime Achievement Award.
She is also known for world-wide travel, a wry sense of humor and entertaining at the piano. She is retired from teaching and enjoys an active life in (and out of) Kalamazoo. We are so pleased to honor Miss Elizabeth Lennon by naming our division’s Meritorious Achievement Award for her.
Past winners of the RT Division’s Meritorious Achievement Award include: 1984 Patricia Bussen Smith, William Farrell, Thomas Hansen, Michael Nelipovich, Paul Ponchillia and Alvin Roberts. 1986 Juliet Bindt Esterly, Sherrie Raymond, Ruth Kaarlela (special award). 1988 Beatrice David, Dolores Fricke, Judy Matsuoka and David Search. 1990 Michelle Frazier, Lynne Luxton, Ramona Sangalli and JoAnn Search. 1992 Patty Arnonld, Lenore Dillon and Michael Nelipovich. 1994 Nancy Paskin. 1996 Cheryl Richesin. 1998 Pamela Cory, Maureen Duffy and Gretchen Good. 2000 Anntonina Adamowicz-Hummel. 2002 Barbara Hunt and Diane Weiss. 2004 Debra Solko-McKay. 2006 Jennifer Ottowitz.
Adjustment, Losses and Positive Attitude:
Dealing With Vision Impairment and Blindness
By Brendan Tedrick, MS, CVRT, LGIKnighton in Cockeyed (2006) like most newly individuals that are blind or those that have a vision impairment is showing some signs of denial to his vision loss. According to the American Foundation for the Blind, “ten million people in the United Stated are blind or visually impaired”. The major eye conditions are Cataracts, Macular Degeneration, Glaucoma, and Diabetic Retinopathy. This article will discuss the adjustment stages and how having a positive attitude will impact people that are blind or visually impaired.
Adjustment Stages
The seven phases/stages of adjustment to blindness according to Tuttle and Tuttle (1996) are: (1) Trauma, Physical or Social, (2) Shock and Denial, (3) Mourning and Withdrawal, (4) Succumbing and Depression, (5) Reassessment and Reaffirmation, (6) Coping and Mobilization, and (7) Self-Acceptance and Self-Esteem. As one goes through each phase/stage, there is no set time frame in terms of how long a client/consumer will stay in one particular phase/stage. Also, one can not over look the importance of supportive family members and friends. Now lets look at each of the seven phases/stages. In the trauma phase/stage the client may become overwhelmed of hearing the news for the first time that they are losing sight or may become blind. Clients become disbelieved in the Shock and Denial phase/stage, for example a client may say, “I can see fine and I’m not going blind”. Tuttle and Tuttle (1996), stated, “three factors that…influence the intensity and severity of the shock: 1) the significance of the loss to the individual, 2 the suddenness or unexpectedness of the event, and 3 the degree of visual loss” (p. 144). Self-pity is the main character in the mourning and withdrawal phase/stage. Clients might become very isolated during this phase/stage and stop doing activities that they once loved to participate in. Clients begin to think negative in the succumbing and depression phase/stage. Tuttle and Tuttle (1996) stated Dobson’s work on the “D’s” of depression as despair, discouragement, disinterest, distress, despondency, and disenchantment. Vision professional have to be on the look out for clients that show signs of major league depression and be able to make a referral to a professional counsel. The next phase/stage in the adjustment process is reassessment and reaffirmation, in this phase/stage the client self-examines their life and finds meaning (purpose for living). In the next to the last phase/stage (coping and mobilization), the client will go out and find information and or new skills so that they can move on with their life. As the client moves from the coping/mobilization phase/stage to the final phase of self-acceptance the client will gain in self-confidence, self-worth and begin to have closure with his/her vision loss.
Father Carroll’s Losses
Carroll (1961) stated the following about adjustment: Total adjustment might be defined as the attitude which enables the blinded person…to face the fact of his/her blindness, admitting its severity without minimizing or exaggerating it…to return as a whole personality to the society from which he/she came. (p. 232)
Here we see that clients have to face their vision loss or becoming blind but not spend too much time on negative thoughts, so that the person can re-entry into society and become a productive member of the society. Father Carroll also, came up with twenty losses that a blind person goes through and organizes these twenty losses into six major areas of loss. The six major areas of loss are: (1) Basic Losses to Psychological Security, (2) Losses in Basic Skills, (3) Losses in Communication, (4) Losses in Appreciation, (5) Losses Concerning Occupational and Financial Status, and (6) Resulting Losses to the Whole Personality.
Table 1.1 Carroll’s Losses
In looking at the table above a client could have two of the losses in one area and one loss from another area or areas. It really depends on the client in terms of what losses that they are going through and when they are going to experience that particular loss. These losses are different from Tuttle and Tuttle (1996) seven adjustment phases/stages. Positive Attitude
Do you see the glass half empty or half full? Those that go through life with a negative attitude will find it difficult to find happiness. On the other hand, those that have a positive attitude will find some happiness in living everyday. Losing vision or becoming blind is a hard thing to go through but with the right attitude clients can go through this challenge. According to Harrell (2003), “The next time you are faced with a difficult challenge, focus on staying positive. Remember that you’re set backs can be setups for even greater opportunities” (p. 9). Harrell is it is stating that having a positive attitude in a time of need can lead to advancement. Remember it took Edison 3000 attempts before he had the light bulb. The million dollar question is how does one have or create a positive attitude. The answer to this question is quite simple; Harrell suggests that people have to have a positive inner dialogue. Harrell (2003) stated, “The key to ridding yourself of this attitude of helplessness is to clear your mind of negative inner conversations and replace them with more hopeful messages” (p. 42). When training clients to deal with their adjustment to blindness important that the clients realize that they are having a negative thought/attitude disregard the negative thought and come up with a positive thought/attitude.
Conclusion
In terms of adjusting to blindness and vision impairment the two major theories that were discussed in this article were Tuttle and Tuttle seven phases of adjustment and Father Carroll’s six areas of loss. When clients go through the seven adjustment phases or any of the six areas of loss it is very important that the client stays positive and not negative. Realizing that negative thoughts/attitudes are coming on is important; so that the client can get rid of the negative and create a positive inner dialogue. Timing is also, important if clients sped too much negative though soon their disability or not enough time grieving the loss of sight then major problems can arise. This author can not instill the importance of positive thinking and the effects that it has on the client and the vision professional.
“Strangely enough, losing my sight wasn't quite as bad as you'd think, because my mom conditioned me for the day that I would be totally blind.” Ray Charles
Resources\Websites:
American Psychological Association
750 First Street, NE,
Washington, DC 20002-4242
1-800-374-2721
http://www.apa.org
Association for Education and Rehabilitation of the Blind & Visually Impaired
1702 North Beauregard Street
Suite 440
Alexandria, VA 22311
1-877-492-2708
http://aerbvi.org
Carroll Center for the Blind
770 Centre Street
Newton, MA 02458
1-800-852-3131
http://www.carroll.org
Hadley School for the Blind
700 Elm Street
Winnetka, IL 60093-2554
1-800-323-4238
http://www.hadley-school.org
Mr. Harrell (Dr. Attitude)
8374 Market Street #504
Lakewood Ranch, FL 34202
1-800-451-3190
http://www.keithharrell.com
Power Optimism
2464 Lafayette Ave.
Abington, PA 19001
(215) 855-2127
http://www.poweroptimism.com
References:
American Foundation for the Blind. Statistics and Sources for Professionals. Retrieved On July 7, 2006, From World Wide Web at http://www.afb.org/Section.asp?SectionID=15&DocumentID=1367 Carroll, T. (1961). Blindness: what it is, what it does and how to live with it. Boston, MA: Little, Brown and Company.
Harrell, K. (2003). Attitude Is Everything. New York, NY: Harper Collins Publishers. Knighton, R. (2006). Cockeyed. New York, NY: Public Affairs. Tuttle, D., and Tuttle, N. (1996). Self-esteem and Adjusting With Blindness; The Process if Responding to Life’s Demands. Springfield, IL: Charles C. Thomas.
Mentoring Opportunities Available: A Win-Win in New Online/Mentored Course by Felice Eisenegger, CVRT, COMS
A unique NIDRR-funded project* being conducted by Lighthouse International is proving beneficial for the paraprofessionals it is designed to train, and also for the Certified Vision Rehabilitation Therapists who are mentors in the project. VRA Net is using an accessible, online 38-lesson course to provide paraprofessional training in four areas: daily living skills, orientation and mobility, low vision and team skills. Students learn how to reinforce the skills and techniques initially taught by vision rehabilitation professionals. In this competency-based course, mentoring is a key element, providing students with support, guidance and supervised client contact. A series of Mentor Activities are built into the courseware, and students are required to Role Play with their mentors, to Observe their mentor or other professionals working with clients, and finally to Work with clients under their mentor’s supervision. Mentors have their own utilities in the courseware (a “Mentor Center”) allowing them to track student progress, encourage and communicate with students, and monitor and rate student performance.
I have been participating as an off-site mentor in addition to working on the project as the CVRT Consultant. As a mentor, I find the courseware extremely user-friendly. It has been easy to remain updated on my student's progress and to communicate with her. I also have found it beneficial to review the content of the individual lessons so I know what my student is learning and how to support her as needed. The lesson content has also provided me with a great review of techniques and equipment.
When VRA-Net began, project staff canvassed state agencies and private vision rehabilitation organizations across the United States to find students and mentors. ACVREP certification in Vision Rehabilitation Therapy is a pre-requisite to being eligible to mentor, as well as the ability: to provide access to people with vision impairment who are receiving vision rehabilitation services; to confer with the paraprofessional at least twice a week; and to critique the paraprofessional in periodic training sessions with clients, either onsite or via project-provided equipment. The courseware is flexible enough to allow the student and mentor to establish their own learning schedule. This flexibility makes mentoring possible even with a busy work and personal life as long as both student and mentor stay committed to the schedule they create.
Besides testing the implementation of the online and mentored course, the VRA-Net project is exploring how mentoring is delivered. The shortage of Certified Vision Rehabilitation Therapists in certain regions has resulted in diverse mentoring arrangements. Some mentors work in the same site as the students they supervise. Others work for the same organization but in geographically distant offices within a state, and still other mentors are in different states than their students. Being an offsite mentor requires some additional attention to your student's progress and provides both challenges and rewards. As an offsite mentor, I helped arrange for my student to have access to clients through other professionals within her agency. Through regular meetings with my student (2 times/week via email or phone) and contact with the participating instructors, I am able to monitor her progress, address any issues or concerns, and practice role playing with her. Although role playing over the phone can be difficult, it does provide an opportunity for the student to be precise in her/his explanations of skills.
In addition, I am pleased that all mentors are encouraged to contribute their ideas to the developing set of mentor guidelines that will be one output of this project.
I found that mentoring provides many opportunities for the professional including: the opportunity to develop supervisory and student teaching skills; opportunities to learn adaptive skills and techniques that a professional may not be aware of; and an opportunity to consider alternative means to meet client needs. It has also given me an opportunity to provide feedback on a project that is developing an efficient and dynamic training program for vision rehabilitation paraprofessionals. Most importantly, mentoring contributes to the training of much needed paraprofessionals. I have worked with several well trained VRAs and their assistance has been invaluable.
As we all know, vision rehabilitation professionals have large caseloads that promise to grow. As demands on professionals increase, trained VRAs will be able to assist in reaching out to more individuals needing vision rehabilitation services and provide more time for clients needing follow-up training. Teams of well trained professionals and paraprofessionals can work together to make the vision rehabilitation process more efficient and accessible to clients.
Mentors reap two additional benefits from participating in VRA Net. The project provides a $1000 honorarium for mentors supervising up to two students. (Students receive a $750 stipend.) Also, mentors can receive continuing education credit for mentoring students. For every four hours of supervision, mentors can earn one point up to a maximum of 50 points towards their ACVREP re-certification.
The first cohort of 15 students and 15 mentors was recruited from North Dakota, South Dakota, Nebraska, Maine, Florida, Alabama, Indiana, and Massachusetts. Their course will end in December and the reviews have been great:
Students:
“These online lessons bring to life all the components of each task – things aren’t as easy as they appear. I thought I knew a lot but I have a lot to learn.”
“I have more knowledge and can explain a lot of things in more detail than I was able to before.”
Mentors:
“I enjoy seeing my student’s progress and the joy she gets out of learning.”
“Being involved in this program has sharpened my skills.”
Recruitment is now underway for students and mentors for Group 2, scheduled to begin in January 2007. A student needs to be a high school graduate (or equivalency) with access to clients receiving vision rehabilitation services. A mentor needs to be a CVRT who can provide regular, ongoing support and supervision for up to two students either onsite or offsite. No special hardware or software is needed to access the online courseware, which is compatible with screen reader software and accessible to people who have vision impairments. If you are interested in being considered for Group 2, please contact Karen Seidman, MPA, Director of Education and International Programs, Lighthouse International; 111 East 59 Street, New York, NY 10022; (212) 821-9465; kseidman@lighthouse.org. If you have general questions about mentoring in this project, I can be reached at waterflee@earthlink.net. I look forward to welcoming you on board for Group 2!
Felice Eisenegger CVRT, COMS VRA Net Project CVRT Consultant
*Lighthouse International was awarded a three-year grant by the US Department of Education’s National Institute on Disability and Rehabilitation Research (Project # H133G050058).
CVRT® Logo Design
The ACVREP Board has not yet chosen the logo for our new Certification Pin. They are still accepting designs and would welcome your input.
Send your ideas to Sharon Mikrut,
ACVREP, 3333 N. Campbell Ave, Suite 11, Tucson, AZ 86719, or e-mail her at info@acverp.org.