Finding out about functional vision AAC SIG: Making Sense of AAC November 4th 2014.
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Transcript of Finding out about functional vision AAC SIG: Making Sense of AAC November 4th 2014.
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Finding out about functional vision
AAC SIG: Making Sense of AAC
November 4th 2014
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Judy Bell
Independent consultant in visual impairment & complex needs
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What the session will cover
Brief considerations of:• The nature of functional vision• The differences between functional &
clinical vision assessment • Who might carry out functional vision
assessment• The aspects of functional vision that will
impact on the choice and use of AAC• How these aspects might be assessed
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The nature of functional vision
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Functional Vision
Functional vision is the way an individual uses his or her sight in everyday situations
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Functional Vision
An individual’s level of functional vision will vary according to both internal (e.g. health, hunger, tiredness etc.) and external conditions (e.g. location, lighting etc.)
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Functional and clinical vision assessment
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Functional vision assessment
• Assessment is via observation of structured activities and interaction in everyday situations
• Assessment takes place in an environment which is familiar to the individual
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Clinical assessment of vision
• Direct clinical examinations are undertaken
• Standardised test material is used
• Assessment is usually within a clinical setting such as an optometrist’s examining room or hospital clinic
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Individuals involved in functional vision assessment
• Often co-ordinated by a QTVI or QTMSI although anyone who knows and works with the individual can undertake such an assessment
• The observations of those who know the child well contribute to the assessment
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Practitioners who may be involved in clinical vision assessment
• Ophthalmologist (eye doctor)• Optometrist (ophthalmic optician)• Orthoptist (specialist in binocular vision & eye
movements)• Paediatrician• School nurse
Usually these practitioners are not familiar to the individual
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Aspects covered by clinical vision assessment
• Appearance & health of eyes• Refraction• Eye movements• Alignment of gaze & binocular vision • Visual acuity (distance)• Visual acuity (near)• Visual field• Contrast sensitivity• Colour vision
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Aspects covered by clinical vision assessment
Visual acuity (distance)
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Visual acuity distance: Snellen
• Fraction-like figure, e.g. 6/6, 6/12, 6/18, 6/24, 6/36, 6/60
• Bottom figure refers to the distance at which an individual with normal sight would be able to perceive image clearly
• Top figure refers to distance at which the person being tested is able to perceive the image clearly
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Visual acuity distance: logMAR
Using the logMAR system, visual acuity is recorded as a decimal figure 0.0 to 1.0.
1.0 equates to Snellen 6/60
0.6 equates to Snellen 6/24
0.1 equates to Snellen 6/7.7
0.0 equates to Snellen 6/6
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Clinical vision: Assessment to threshold
• Clinical vision assessment tests to the threshold at which an individual is able to see clearly
• No individual will willingly perform to visual threshold 100% of the time
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Functional vision: Assessment of typical use of vision
• Functional assessment identifies how an individual uses his or sight in identified situations
• Functional vision assessment provides a picture of an individual’s ‘typical’ use of vision in everyday situations
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Clinical and Functional Assessment
• Functional assessment should be ongoing
• Clinical assessment needs to be undertaken on a regular basis
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Clinical and Functional Assessment
• Together, the clinical and functional assessment of vision provide a full picture of the visual needs of an individual
• Both will be required in order to determine the nature of AAC to be used.
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Aspects of functional vision that will impact on the choice and use of AAC
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AAC: Aspects of functional vision
Initial considerations:
• Willingness/reluctance to use vision
• Preferred sensory channel(s) – single or multi-channel
• Variability of vision
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AAC: Aspects of functional vision
• Near vision will be main, but not only, concern
• If signing is used, an assessment of distance vision will be important in order to establish optimal distances
• Difficulties with distance vision will affect incidental learning & subjects available for communication
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AAC: Aspects of functional vision
Near vision – consider preferred
• Lighting: – Strength – Type (natural, colour, LED, overhead,
backlighting, task etc.)
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AAC: Aspects of functional vision
Near vision – consider preferred
• Size of stimulus (bigger not always better)
• Distance of stimulus (function of size)
• Position of stimulus (direction and plane)
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AAC: Aspects of functional vision
Near vision – consider preferred
• Contrast
• Colour
• Tone
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AAC: Aspects of functional vision
Colour, tone & contrast
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Colours of a similar tone – poor contrast
Photocopy
Colour, tone & contrast
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Colours with tonal contrast
Photocopy
Colour, tone & contrast
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AAC: Aspects of functional vision
Near vision - consider
• Tracking skills: direction, speed, midline
• Scanning skills: direction, speed, midline, coverage
• Shift of attention from one stimulus to another: direction, speed, midline, coverage
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AAC: Aspects of functional vision
Near vision - consider
• Visually directed reach and grasp– Locate, look & reach or….– Locate, look away & reach
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AAC: Aspects of functional vision
Near vision - consider
• Clutter – stimulus & stimulus/background
• Visual distraction
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AAC: Aspects of functional vision
• Clutter – stimulus & stimulus/background: Visual distraction
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AAC: Aspects of functional vision
• Clutter – stimulus & stimulus/background: Visual distraction
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AAC: Aspects of functional vision
• Clutter – stimulus & stimulus/background: Visual distraction
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AAC: Aspects of functional vision
Near vision - consider
• Time taken for visual processing & response
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AAC: Aspects of functional vision
Near vision – consider preferred• Movement of stimulus
– Constant – Intermittent– Still
• Sound production related to stimulus– Nature– Duration – intermittent or constant
• Nature of images– Photographs or drawings
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How aspects of functional vision might be assessed
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Functional vision assessment
• Observation in normal environment
• Observation of structured intervention and response
• Interview with those who know individual in different settings
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Functional vision assessment
• Various schedules and profiles
• JB 2009 – Functional vision observations & assessment sheets – downloadable from website
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Contact
Judy Bell
07748 657463
www.judybellassociates.com