Blind Rehabilitation Center Research Articles

Blind rehabilitation programs teach iPhone and iPad use to improve independence in Veterans with low vision or blindness

While many individuals affected by blindness or low vision utilize accessibility applications on iPhone and iPad devices, few receive professional training on application use. Determining the impact of a smartphone and tablet-based curriculum at a Blind Rehabilitation Center (BRC) on functionality and independence can help patients and physicians understand the value of these training programs. Between January 2015 and December 2019, a pre–post initiative evaluated patient functionality and independence scores before and after exposure to a technology educational curriculum at the West Palm Beach Veteran Affairs BRC. A total of 337 patients with impaired vision or complete blindness participated in a 1-month, 35-hr iPhone and iPad learning course. This course was led by technology instructors trained in working with patients with low vision or blindness. The level of function and independence was determined before and after the educational curriculum using a modified Functional Independence Measurement (FIM) Scale from 1 to 7, with 1 indicating no independent functionality and 7 indicating complete independence. After completion of the course, patients were stratified by age, gender, ethnicity, and eye-related diagnosis. All demographic groups noted an increase in FIM score, with average improvement of 3.75 points. A factorial analysis of variance (ANOVA) revealed that younger age groups displayed a statistically significant improvement in FIM score compared to older groups with an F ratio of F(3, 295) = 4.503, p = .004. Eye diagnosis did not have an impact on FIM score change. These results suggest any patient may benefit from professional training in the use of iPhone and iPad applications with younger patients showing greater rates of initial improvement. The authors recommend increased utilization of smartphone and tablet training programs at BRCs by all individuals with low vision or blindness.

Building a Communication Model amongst the Blind: An Ethnographic Study in the Blind Rehabilitation Center ‘Wyata Guna’, Bandung, Indonesia

The reality of blindness is a unique phenomenon rarely studied in the discipline of communication. It is consequential in the absence of a special communication model for the blind. This research reveals the phenomenon and constructs a communication model amongst the blind. The qualitative research with this ethnographic tradition was conducted at the Blind Rehabilitation Center (it will hereafter be abbreviated as BRC) Wyata Guna, Bandung, West Java, Indonesia. The results show that the blind people only rely on verbal or vocal communication and nonverbal communication in the form of touch, both in sending and in receiving messages to and from their other visually challenged. The blind’s touch communication is determined by three goals, i.e. touch for mobility, touch as a friendship expression and a romantic touch for those who are dating their fellows. This research results in the communication model that exists amongst the blind as an effort to fill the void of communication models that are dominated by models with the perspective of communication of physically normal people. The model shows the dynamic of communication amongst the blind by maximising their sense organs of hearing, touch, smell and taste.

안과의사, 시각장애인에게 타자를 가르치다 ―‘맹인부흥원’과 공병우의 시각장애인 자활운동

This paper traces how Kong Pyung Woo (1907~1995), an ophthalmologist and the inventor of the Korean typewriter, was engaged with activities for the self-sustenance of the visually impaired. After gaining a reputation as the most successful Korean ophthalmologist since the Japanese occupation period (1910~1945), Kong became interested in the welfare of the blind, which led him to coduct various activities for their self-sustenance. His best known contribution was the establishment of the ‘Blind Rehabilitation Center’ in 1959, for which he donated land, buildings, and budget.BRWhat was remarkable with his engagement was that Kong recommended his own typewriter as vocational education for the self-supporting of the blind. Kong Pyung Woo was skeptical about the existing scheme of the special education for the blind, which in effect led everyone into several service sectors, such as massage and acupuncture, since the Colonial Era. Instead, Kong advocated the American model, which emphasized teaching the blind the white-collar skills, equivalent to the non-disabled. Believing that the typewriter was the right skill for the blind to secure a equal job opportuinty, he included his typewriter in the BRC education class. Unlike other Korean typewriter models that competed at the time, Kong’s typewriters could be memorized and operated without seeing the keyboard, which made it as usable to the blind as to the non-blind.BRIn 1969, however, the South Korean government announced new standard keyboards, and marginalized the Kong typewriter, although it was it then occupied more than the half of the market share. Kong’s social engagement also fell into trouble: BRC was closed in 1982. Although Kong Pyung Woo’s experiment did not fully achieve his goals, it is noteworthy that his endeavor was aimed to trailblaze new paths for the self-sustenance of the blind. Kong’s story also illustrates how the renowned intellectuals of the 1960s and 1970s recognized social responsibility and responded to it.

A MODEL OF CARE FOR OLDER ADULTS WITH IMPAIRED VISION OR BLINDNESS AT THE END OF LIFE

Our objectives were to describe unique challenges of visually-impaired patients receiving end-of-life institutional care and to propose a model for the comprehensive care of the vision-impaired patients incorporating bedside techniques and advanced assistive technology. The prevalence of visual impairment in long-term care is increasing. Collaborating with our Blind Rehabilitation Center, we have summarized a care model including the identification of patients who have impaired vision and adjustments of daily routine. Care was consistently provided by staff with voices familiar to patients. Staff is trained to introduced themselves clearly by voice when entering the room. Patients engage in hobbies that are less dependent on vision, such as music therapy. Safety measures are taken to facilitate mobility. We describe the case of a 90-year-old WWII Veteran with dementia and dysphagia who was legally blind and required extensive assistance with his ADLs. Although initially calm, the patient eventually became delirious, reliving his time as a gunner in the Navy and believing he was firing on Japanese Kamikaze planes. After his visual impairment was addressed using the approach described above, the patient became calmer. Listening to his wife’s voice and enjoying his favorite gospel music helped him cope better with the situation until he died peacefully on hospice care. In conclusion, a model of care considering visual impairment was effective at alleviating distress. More emphasis needs to be placed on evaluating and managing sensory impairment when providing care for older adults approaching the end of life.

Falls Prevention Intervention Modified for Older Adults With Low Vision: A Pilot Study

Abstract Date Presented 4/20/2018 Few falls prevention interventions for older adults are accessible for those with low vision. We pilot tested a visually accessible version of an evidence-based intervention for use with veterans receiving services in the U.S. Department of Veterans Affairs Southeastern Blind Rehabilitation Center. Primary Author and Speaker: Sarah Blaylock Contributing Authors: Mary Warren, Cynthia Brown, Donald Lein

Change-readiness of the blind: a hospital based study in a coastal town of South India.

Purpose:Blindness is a devastating condition with psychosocial and economic effects. The shortcomings result in a burden to the blind person, the family and society. Rehabilitation of the blind can transform their lives. The aim of this study was to assess the “change-readiness” of the blind to undergo a “change-management”.Materials and Methods:The study was a semi-structured pre-tested questionnaire-based study of 50 blind subjects in a medical college hospital. The blind participants were assessed for depression using the Beck Depression Inventory II, for the perceived effect of blindness on family, social life and occupation. The participants were counseled to undergo psychiatric management, vocational training, use blind aids and learn Braille. The willingness of the participants with reasons was assessed using a verbal analogue scale. Pearson Chi-square test, ANOVA and the t-test were used for statistical analysis.Results:Over two-thirds of the subjects were depressed. Family life, social life and occupation were perceived to be affected by 44%, 66% and 74%, respectively. Change-readiness scores were low for low vision and blind aids, vocational training, psychiatric management, change of job and learning Braille. The low score was due to the associated taboo, dependence, lack of skills, embarrassment, etc., The most valuable feature was the family cohesiveness.Conclusion:The results suggest that there is a need to modify health policy to include blind rehabilitation, to improve visibility of blind rehabilitation centers, to include family members and co-professionals while managing the blind so that we treat the “blind person” and not a “pair of blind eyes”.

Inclusion of CVI in Texas Tech University's Personnel Preparation Program

For a number of years, Texas Tech University's (TTU) personnel preparation programs for teachers of students with visual impairments and orientation and mobility (OM 2. the return of soldiers from war with traumatic brain injury (TBI) and CVI who are attending Department of Veterans Affairs' Blind Rehabilitation Centers; 3. the publication of textbooks and the availability of other resources like web sites and electronic bulletin boards on this topic; 4. feedback from personnel in the field of vision that they are increasingly asked to serve students with CVI; and 5. the revision of state certification examinations for teachers of students with visual impairments to include content on CVI. Biannually, the TTU faculty members review syllabi to check the required textbooks and resources that are used in the courses on visual impairment to discuss and make potential changes. All new resources are then reviewed and vetted by the faculty. A book list for all the courses is listed on the web site of the Virginia Murray Sowell Center for Research and Education in Visual Impairment at for students to purchase. Course activities using these new resources are developed by the instructor of record for each course. For example, in EDSP 5392, the Advanced Seminar in Orientation and Mobility, O&M students read Christine Roman-Lantzy's book, Cortical Visual Impairment: An Approach to Assessment and Intervention (New York: AFB Press, 2007) and write a research paper summarizing the content and its application to O&M services. Similarly, in EDSP 5389, Methods and Materials for Teaching Students with Dual Sensory Impairments, a case study of a visually impaired child with additional disabilities is given to students, who are asked to use Roman-Lantzy's range rating scale to assess this child and to develop an assessment report. CVI is also covered in EDSP 5383, Anatomy and Functions of the Visual System. The knowledge that graduate students gain about this topic prepares them to teach children with CVI with more confidence, and the students' evaluations of these children are more accurate. …

Outcomes of the Veterans Affairs Low Vision Intervention Trial (LOVIT)

To evaluate the effectiveness of a low-vision rehabilitation program. A multicenter randomized clinical trial was conducted from November 2004 to November 2006 with a 4-month follow-up. A total of 126 patients were included, 98% of whom were white and male. The patients were referred from eye or low-vision clinics and blind rehabilitation centers with a visual acuity in the better-seeing eye worse than 20/100 and better than 20/500 and were eligible for Veterans Affairs (VA) services. Telephone interviews of patients were conducted in their homes before and after participation in an outpatient low-vision program at a VA medical care facility or a (waiting list) control group. The interviewer administering questionnaires by telephone was masked to patients' assignments. Interventions included low-vision examination, counseling, and prescription and provision of low-vision devices and 6 weekly sessions provided by a low-vision therapist to teach use of assistive devices and adaptive strategies to perform daily living tasks independently. Change in patients' visual reading ability estimated from participant responses to the Veterans Affairs Low-Vision Visual Functioning Questionnaire (LV VFQ-48) reading items completed at baseline compared with 4 months after enrollment for the treatment and control groups. The secondary outcomes were changes in other visual ability domains (mobility, visual information processing, visual motor skills) and overall visual ability from baseline to 4 months estimated from VA LV VFQ-48 difficulty ratings for subsets of items. The treatment group demonstrated significant improvement in all aspects of visual function compared with the control group. The difference in mean changes was 2.43 logits (95% confidence interval [CI], 2.07-2.77; P < .001; effect size, 2.51) for visual reading ability; 0.84 logit (95% CI, 0.58-1.10; P < .001; effect size, 1.14) for mobility; 1.38 logits (95% CI, 1.15-1.62; P < .001; effect size, 2.03) for visual information processing; 1.51 logits (95% CI, 1.22-1.80; P < .001; effect size, 1.82) for visual motor skills; and 1.63 logits (95% CI, 1.40-1.86; P < .001; effect size, 2.51) for overall visual function. The program effectively provided low-vision rehabilitation for patients with macular diseases. APPLICATIONS TO CLINICAL PRACTICE: At least 10 hours of low-vision therapy, including a home visit and assigned homework to encourage practice, is justified for patients with moderate and severe vision loss from macular diseases. Because the waiting-list control patients demonstrated a decline in functional ability, low-vision services should be offered as early as possible. clinicaltrials.gov Identifier: NCT00223756.

Short- and Long-Term Effects of an Intensive Inpatient Vision Rehabilitation Program

Stelmack JA, Moran D’A, Dean D, Massof RW. Short- and long-term effects of an intensive inpatient vision rehabilitation program. Objective To assess the effects of a visual rehabilitation program on visually impaired subjects’ visual ability and ability to perform activities. Design Prospective observational study. Setting Telephone interviews of respondents in their homes the week before admission to the rehabilitation center and 3 months and 1 year after discharge from the rehabilitation center. Participants A total of 178 consecutive patients from the Hines Blind Rehabilitation Center participated in development of the 48-item Veterans Affairs Low Vision Visual Functioning Questionnaire (VA LV VFQ-48). Data were analyzed for 95 who participated in all 3 administrations of the questionnaire. Intervention Comprehensive blind rehabilitation program (mean hospital admission, 40d). Main Outcome Measure The self-report ratings of patients’ difficulty performing 48 activities on the VA LV VFQ-48. Results The increase in visual ability ± standard deviation of .981±.482 logits (equivalent to an 8-line improvement in visual acuity on an Early Treatment of Diabetic Retinopathy Study chart) at 3 months postrehabilitation decreased to .682±.485 logits (equivalent to a loss of 2.5 lines of visual acuity on the same chart) 1 year postrehabilitation. The effect sizes measured at 3 months (2.035) and 1 year (1.495) indicate large treatment effects corresponding to statistically significant differences for the increase in visual ability at 3 months and 1 year postrehabilitation (paired 2-tailed t tests, P<.001) relative to pretreatment measures. The difference in visual abilities measured at 3 months and 1 year posttreatment also is statistically significant ( P<.001). Conclusions Treatment effects decreased over the 12-month follow-up period. However, the group of patients whose data were analyzed was still statistically and clinically significantly better at their 1-year follow-up than before beginning treatment.

Measuring Outcomes of Vision Rehabilitation with the Veterans Affairs Low Vision Visual Functioning Questionnaire

To evaluate the sensitivity to change, in patients who undergo vision rehabilitation, of the Veteran Affairs (VA) Low Vision Visual Functioning Questionnaire (LV VFQ-48), which was designed to measure the difficulty visually impaired persons have in performing daily activities and to evaluate vision rehabilitation outcomes. Before and after rehabilitation, the VA LV VFQ-48 was administered by telephone interview to subjects from five sites in the VA and private sector. Visual acuity of these subjects ranged from near normal to total blindness. The VA LV VFQ exhibited significant differential item functioning (DIF) for 7 of 48 items (two mobility tasks, four reading tasks, and one distance-vision task). However, the DIF was small relative to baseline changes in item difficulty for all items. Therefore, the data were reanalyzed with the constraint that item difficulties do not change with rehabilitation, which assigns all changes to the person measure. Subjects in the inpatient Blind Rehabilitation Center (BRC) program showed the largest changes in person measures after vision rehabilitation (effect size = 1.9; t-test P < 0.0001). The subjects in the outpatient programs exhibited smaller changes in person measures after rehabilitation (effect size = 0.29; t-test P < 0.01). There was no significant change in person measures for the control group (test-retest before rehabilitation). In addition to being a valid and reliable measure of visual ability, the VA LV VFQ-48 is a sensitive measure of changes that occur in visual ability as a result of vision rehabilitation. Patients' self-reports of the difficulty they experience performing daily activities measured with this instrument can be used to compute a single number, the person measure that can serve as an outcome measure in clinical studies. The VA LV VFQ-48 can be used to compare programs that offer different levels of intervention and serve patients across the continuum of vision loss.

Timing and directions for administration of questionnaires affect outcomes measurement

We used data from two pilot studies to compare the change in patients' self-reported health-related quality of life after participation in two nearly identical Department of Veterans Affairs (VA) Blind Rehabilitation Center (BRC) programs, the Southwestern BRC in Tucson, Arizona, and the BRC at the VA hospital in Hines, Illinois. Researchers at the Southwestern BRC administered the National Eye Institute Visual Functioning Questionnaire as directed by the developer. Researchers at the Hines BRC modified the directions to consider use of low-vision devices. Interval person-ability and item-difficulty measures estimated from patient responses pre- and postrehabilitation were compared with these same measures obtained at follow-up. At the Southwestern BRC, no change was reported in either person or item measures 3 months after rehabilitation. At the Hines BRC, improvement was seen in both the person and item measures when measurements were made immediately following rehabilitation. Because a temporary halo effect may explain the higher ratings at discharge, veterans from the Hines cohort were contacted by telephone and administered the same instrument 3 years later. For these subjects, the improvement noted in the person measure disappeared at follow-up, while the improvement in the item measure was maintained.

Evaluating psychometric properties of a clinical and a self-report blind rehabilitation outcome measure

This study assessed the psychometric properties and evaluated the compatibility of two blind and low-vision rehabilitation outcome instruments, the VA-13 and the Functional Assessment of Self-Reliance on Tasks (FAST). Legally blind veterans (N = 190) from a Department of Veterans Affairs inpatient blind rehabilitation center completed the VA-13 (a retrospective pretest and posttest) at 6 weeks postdischarge. Clinicians rated veterans on the FAST at admission and discharge. The psychometric properties of the two instruments and their compatibility were evaluated with the use of a Rasch model analysis. The two instruments functioned consistently as screens and showed a ceiling effect at posttest; however, the VA-13 showed poor sensitivity to change. In contrast, the FAST showed more reliable change, but a few items changed in unexpected ways. Our conclusions show that the two instruments are currently not compatible for calibration; however, this can be improved with proper attention to scaling inadequacies, test administration times, and content coverage.

Is there a standard of care for eccentric viewing training?

A study was conducted to determine the current Department of Veterans Affairs (VA) standard of practice for eccentric viewing (EV) training. EV training is the process of teaching patients to realign the visual image away from a diseased foveal/macular region onto healthier retina. Optometrists and Visual Skills Instructors at all VA blind rehabilitation centers (BRCs) and VICTORS (vision impairment centers to optimize remaining sight) programs were asked to rate preference for EV prescription criteria, evaluation, and training techniques. Responses were received from 70% of BRCs and 67% of VICTORS. The respondents reported that all programs include EV training. The average minutes of training per patient varied from 20 minutes to nearly 24 hours, with instructors within a single center varying by as much as two orders of magnitude. Routinely, 82% of optometrists prescribe EV training, yet no consensus was found among these practitioners as to the criteria for selecting the best EV area. The results of this survey reveal an inconsistent standard of practice across VA centers and demonstrate the need for prospective studies of the efficacy, effectiveness, and cost-effectiveness of EV training.

Retinitis pigmentosa: distribution of inheritance patterns in a VA blind rehabilitation center population

Objectives: This purpose of this study was to characterize retinitis pigmentosa (RP) patients at the Southeastern Blind Rehabilitation Center (SBRC) by inheritance pattern, and compare the results with similar studies. Study Design: Records of all RP patients who were in the blind rehabilitation program at the SBRC between 1989 and 1993 were reviewed (n=50). Patients were included in the study who could be personally contacted and whose records were complete (n=43). Pedigrees were obtained through review of records and patient interviews. Results: The analysis showed 24 patients (55.8%) were simplex (no family history of RP), 8 patients (18.6%) were autosomal dominant, 4 patients (9.3%) were probable autosomal dominant, 4 patients (9.3%) were autosomal recessive, 2 patients (4.7%) were probable autosomal recessive and 1 patient (2.3%) was X-linked recessive. Conclusions: Unique trends were apparent in the distribution of inheritance patterns. Clinicians should be aware of the large number of simplex patients found in this and the majority of similar studies.

Veteransʼ Use of Low Vision Devices for Reading

This report presents the results of a 2-year study of veterans' use of low vision devices (LVDs) which were prescribed and dispensed through the Blind Rehabilitation Centers (BRCs) and Visual Impairment Centers to Optimize Remaining Sight (VICTORS) of the Department of Veterans Affairs. Two-hundred veterans using 740 LVDs were surveyed by telephone 12 to 24 months after the prescription/dispensing of the devices. Reliability (test-retest) and validity (content, criterion-related, and construct) were established for the survey. Primary analysis of the data was accomplished through tabular presentations. Because most devices were used for reading, an exploratory data analysis was completed to further investigate successful use of LVDs for this task. Relationships of 21 variables with a definition of highly successful use, use and nonuse of LVDs for reading were evaluated. Only visual acuity provided a statistically significant predictor of use of LVDs for reading. LVDs in the lowest visual acuity grouping tend to be used either highly successfully, or fall into the nonuse category. The highly successful LVDs are primarily video magnifiers; the nonused LVDs tended to be spectacle magnifiers. This population is using devices extensively for reading, reporting frequencies of use of several times per day.

Client Satisfaction with a Recreation Program in a Blind Rehabilitation Center

Client satisfaction with the recreation program at a blind rehabilitation center and views toward various aspects of recreation in general were assessed by questionnaire. The results showed that clients were highly satisfied with the center's recreation program and viewed recreation as an important aspect of blind rehabilitation. A significant change was found in their views about the appropriateness of various recreational activities for participation by visually impaired persons. Compared to pre-rehabilitation activity levels, post-rehabilitation clients planned to increase their number of recreational activities.

Retrospective Survey to Investigate Use of Distance Magnifiers for Travel

Seventy-eight subjects from the Western Blind Rehabilitation Center at the Palo Alto Veterans Administration Hospital and 34 subjects from the U.C. Berkeley Low Vision Center were surveyed to investigate the use of distance magnifiers for travel. Information is reported regarding demographic characteristics, vision characteristics, usual travel patterns, characteristics of telescopes used by the subjects, telescope training, and travel habits with telescopic devices, along with similarities and differences between the two groups.

A Family Training Program for Adventitiously Blinded and Low Vision Veterans

The family training program at the Western Blind Rehabilitation Center is an integral part of the rehabilitation process for adventitiously blinded and low vision adults. An exploratory study was conducted to assess which aspects of the training were most outstanding and to inquire how the program affected interpersonal relations and attitudes towards sight loss. Results showed a marked reduction in stated problems immediately after the training and over a three-and-a-half-year period of time. The study demonstrates similar benefits for older family members, those receiving shortened programs, and those who have been living with sight loss for many years.

Evaluating the rehabilitation process

The research methods presented here were developed for the evaluation of the CBRC (Central Blind Rehabilitation Center) at Hines. These methods are applicable to the evaluation of other blind rehabilitation programs. In addition, most of the strategies are applicable to other kinds of rehabilitation programs. The process of defining goals and of determining outcome variables is a necessary step in effective evaluation regardless of the population and program in question. It is essential to measure the influence of patient variables on treatment outcomes for all populations undergoing rehabilitation. The measures to evaluate these out-come and patient variables must be demonstrably reliable and valid. The methods used to identify and define variables, the research design and methods to produce reliable measures all can be used to evaluate a variety of programs as well as individual treatments and devices.

Optacon Skill Acquisition by Blinded Veterans

Presents data on veterans trained with the Optacon reading device at the Eastern Blind Rehabilitation Center, West Haven, Connecticut. Describes the teaching methodology and the trainees, compares the data with those from other published studies, and gives results of a follow-up questionnaire. This questionnaire provides information about Optacon use and personal feelings of the veterans involved in this pilot study. Data indicate that the veteran population is substantially older than other groups reported in the literature. Acquisition of skill is more difficult for the veteran and eventual reading rates are slower, but the majority of the veterans reported that the device still serves a vital function in allowing them access to print.