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Low Vision Blog

Case Study

(05/23/2011)

Case Study: Ms. GN is a 67 year old white female who lives alone in a single story home and receives occasional assistance from family members who visit from Utah. GN has left hemonomous hemianopsia and a slight weakness of the left side of her body from a stroke suffered two years back. She also has diabetic retinopathy and a cataract in her right eye. GN's corrected visual acuities are 20/200 in the right eye and 20/160 in the left eye.

GN was referred by her local optometrist and after her initial evaluation began training at our Low Vision Services clinic 2 times per week for 6 weeks. GN had not received assistance in the area of vision rehab and was not aware of such assistance prior to her initial evaluation. GN was happily surprised to find about the types of assistance the Low Vision Clinic would assist her with. Her initial goals were: 1. be able to read her mail and favorite books. 2. be able to use the microwave, TV, radio and other home appliances. 3. be able to navigate both inside and outside her home with increased confidence, independence and safety.

One week after our initially consultation from our clinic, I visited her home and began the adaptations GN needed in order to improve her ability to function safely during meal preparation. GN explained her difficulties with food identification from both the pantry and refrigerator. Not knowing Braille, we improvised by using varying sizes of plastic containers appropriately placed in both the pantry and refrigerator. Foods she ate most often were placed towards the front and left over foods were placed in the back with puffy paint on the top of the containers to identify Day 1 and Day 2. Anything beyond Day 2 was discarded if not eaten. In pantry, can foods were labeled with rubber-bands to hold puffy paint laminated labels. S stood for Soup, with all other soup cans sitting behind the marked can. T stood for Tomato Sauce; TU stood for Tuna; B stood for Beans; P for Peanut butter and V for mixed vegetables. Client was accompanied and introduced to local market's supervisor; a schedule of shopping days were determined and both parties agreed to provide a grocery staff member to assist GN with her shopping whenever she came unaccompanied by family or friends. GN was instructed to voice record her grocery list, then use large print and 20/20 felt tip pens to write down her grocery list or use her computer to print her list and provide it to her grocery store staff member.

Once GN was able to shop and identify foods, she was instructed on the use of tactile reinforcements such as locator dots placed on microwave oven, convectional oven, stove, dishwasher, laundry-room washer and drier. A large TV remote was set-up to facilitate TV and radio use. GN has been able to successfully use all of the appliances in her home safely again.

During follow-up visits GN was instructed to use a white cane to get to/fro the mailbox and local grocery store approximately one block away from home. She was instructed on safety skills as they pertain to protective techniques and orientation and mobility. GN was able to safely perform street crossing by using scanning techniques to assist with using her remaining vision and use auditory feedback to reinforce and track traffic movements.

After teaching GN to locate her preferred retinal location and successfully performing eccentric viewing, GN was dispensed a 5X LED hand-held magnifier to help her see food labels and perform other spot checking tasks. However, she prefers to use her computer for reading newspapers and other articles so she was instructed on the use of ZoomText magnification software. GN's keyboard was replaced with one with large keys and shortcuts buttons for email and internet access. GN is an avid computer user who adapted well to the magnification software that allowed her to continue with on-line banking, communication with family and friends and leisure tasks such as accessing news and games.

GN was discharged from vision rehab after meeting all established goals and having been set-up for services such as peer-counseling, local directory assistance service, radio reading services, paratransit door-to-door transportation, and taxi discount voucher program. However, she declined books on tape.