Child with Special Needs Part 2
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This document provides guidance on assessing and treating patients with special needs. It emphasizes treating patients with dignity, preparing for assessments by learning about the patient's history and abilities, using creative techniques to test visual acuity and binocular vision, and treating refractive errors and ocular health issues when possible. Comprehensive assessments include case history, acuity, refractive error, binocular vision, and ocular health evaluations. Treatment considers the patient's cognitive and motor abilities as well as therapy goals. Referrals are made for additional services beyond optometry.
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Child with Special Needs Part 2
- 1. Dominick M. Maino, O.D., M.Ed., F.A.A.O. Diagnosis and Management: Professor, Pediatrics/Binocular Vision Service Patients ith S i l N d P ti t with Special Needs Illinois College of Optometry Illinois Eye Institute 3241 S. Michigan Ave. Chicago, Il. 60616 312-949-7280 (Voice) 312-949-7358 (fax) dmaino@ico.edu www.ico.edu nw.optometry.net Diagnosis Diagnosis • Preparing for the examination Assessment Techniques for Special • greet patient by name Populations • position yourself at patient’s eye level • be on schedule Use everything you know, be creative, and • consider patient’s wishes about family/friends in exam room trust your objective evaluation skills! • direct initial comments to patient • treat patient as a person first, then as an individual with a disability Diagnosis • Preparing for the examination • speak clearly • listen carefully • use short command sentences Treat the patient the • “look here” • “do this” way you would want • “watch my light” to be treated! 1
- 2. Remember the 10 Commandments Remember the 10 Commandments 1.) Speak directly to the 4.) If you offer assistance wait 7.) Listen attentively when talking to 10.) Relax. Don’t be person rather than thru a people who have difficulty embarrassed if you use until the offer is accepted, speaking and wait for them to companion or sign language then listen and wait for common expressions that finish. interpreter. instructions. seems torelate to a person’s 8.) Place yourself at eye level 2.)Always offer to shake ) y disability. 5.) 5 ) Treat adults as adults. adults when talking to someone in a hands when introduced. 6.) Do not lean against or hand wheelchair. 3.)Always identify yourself 9.) Tap a person who is deaf on the The Ten Commandments of on someone's wheelchair or shoulder or wave your hand to and others who are with you cart. Communicating with People get their attention. when meeting someone who With Disabilities is blind. Case History Case History • Demographic Information • Medical history including their disability • typically taking many medications • Visual history • Educational history • Rehabilitation history • Vocational history • Recreational history Visual Acuity Visual Acuity •Use highest level possible •binocular before monocular testing • Snellen • Broken Wheel E •adaptive positioning • HOTV •use assistants, friends, family members • Lea Symbols FP •limited window of opportunity • Teller Acuity Cards •randomize optotypes, use reinforcers • OKN TOZ •test=game, be creative HOVT 2
- 3. Visual Acuity Visual Acuity • Snellen • Snellen • Broken Wheel • Broken Wheel • HOTV • HOTV • Lea Symbols • Lea Symbols • Teller Acuity Cards • Teller Acuity Cards • OKN • OKN Visual Acuity Visual Acuity • Snellen • Snellen • Broken Wheel • Broken Wheel • HOTV • HOTV • Lea Symbols • Lea Symbols • Teller Acuity Cards • Teller Acuity Cards • OKN • OKN Visual Acuity Visual Acuity • Snellen • Snellen • Broken Wheel • Broken Wheel • HOTV • HOTV • Lea Symbols y • Lea Symbols • Teller Acuity Cards • Teller Acuity Cards • OKN preferential looking • OKN • Cardiff Cards cards that use form discrimination with vanishing optotypes 3
- 4. Visual Acuity Refractive Error Mohindra Dynamic Retinoscopy •lens bars, 50 cm working distance , g •dark, pt looks at light •neutralize primary meridians •write in spherocyindrical form •add a (-) minus 1.25 to the sphere Refractive Error Refractive Error • Cycloplegic/Mydriatic spray • Keratometry • hand held electronic devices (Nidek) • Placido’s disk • Spray on closed lids, • keratoscope have pt blink wipe off blink, excess (.5% Cyclo, .5% Myd, 2.5% Phenyl) Binocular Vision Assessment Binocular Vision Assessment Incidence of Strabismus • Observation • Observation • Cover Test CEREBRAL PALSY 15-60% • Cover Test • Bruckner MENTAL • Bruckner RETARDATION 16-40% • Angle Kappa A l K • Angle Kappa DOWN SYNDROME 41-75% • Hirschberg • Hirschberg DEAFNESS 29% • Krimsky • Krimsky NORMAL CHILDREN 2-4% 4
- 5. Binocular Vision Assessment Binocular Vision Assessment • Observation • Observation • Cover Test • Cover Test • Bruckner • Bruckner • Angle Kappa A l K • Angle Kappa A l K • Hirschberg • Hirschberg • Krimsky • Krimsky Binocular Vision Assessment Binocular Vision Assessment • Observation • Observation • Cover Test • Cover Test • Bruckner • Bruckner • Angle Kappa A l K • Angle Kappa A l K • Hirschberg • Hirschberg • Krimsky • Krimsky Binocular Vision Assessment Binocular Vision Assessment • Lang stereotest • Lang stereotest • Random Dot E • Random Dot E • Worth 4 Dot • Worth 4 Dot • MEM Nearpoint p • MEM Nearpoint p Retinoscopy Retinoscopy • NPC • NPC • Accommodative Facility • Accommodative Facility • Saccades/Pursuits • Saccades/Pursuits 5
- 6. Binocular Vision Assessment Binocular Vision Assessment • Lang stereotest • Lang stereotest • Random Dot E • Random Dot E • Worth 4 Dot • Worth 4 Dot • MEM Nearpoint Retinoscopy p py • MEM Nearpoint p • NPC Retinoscopy • Accommodative Facility • NPC • Saccades/Pursuits http://opt.pacificu.edu/ce/catalog/14041-GO/14041-GO.html • Accommodative Facility • Saccades/Pursuits Binocular Vision Assessment Binocular Vision Assessment • Lang stereotest • Lang stereotest • Random Dot E • Random Dot E • Worth 4 Dot • Worth 4 Dot • MEM Nearpoint p • MEM Nearpoint p Retinoscopy Retinoscopy • NPC • NPC • Accommodative Facility • Accommodative Facility • Saccades/Pursuits • Saccades/Pursuits Ocular Health Ocular Health • Hand held devices • Hand held devices • Slit lamp • Slit lamp • Keeler/Tonopen/ • Tonopen/Perkins • Perkins • BIO/MIO/direct • BIO/MIO/direct http://opt.pacificu.edu/ce/catalog/14041-GO/14041-GO.html 6
- 7. Tangential Penlight Angle Ocular Health Estimation • Hand held devices • Penlight at temporal aspect of • Slit lamp • cornea Angle between 20-35 degrees to • Tonopen/Perkins the facial plane • BIO/MIO/direct • • Maximum brightness Open angle = nasal illumination at least 75% as bright as temporal illumination Special Testing Special Testing Ultrasound, B-Scan • VEP, ERG, EOG • VEP, ERG, EOG • Sweep VEP • Sweep VEP CPT 76512 (contact B-scan); Indications • Ultrasound (A/B scan) • Ultrasound (A/B scan) Examination of the posterior • TOVA • TOVA portion of the eye when direct • Visagraph • Visagraph view is precluded by media opacities. Evaluation of intraocular or orbital masses. For more info: http://www.healthgate.co.uk/dp /dph.0253.shtml Special Testing The Test of Variables of Attention Special Testing (T.O.V.A.®), a 21.6 minute computerized continuous • VEP, ERG, EOG performance test used by professionals • VEP, ERG, EOG • Sweep VEP in the diagnosis and monitoring • Sweep VEP • Ultrasound (A/B scan) of treatment of attention deficit disorder • Ultrasound (A/B scan) ( (ADD)/attention deficit hyperactivity ) yp y • TOVA disorder (ADHD) in children and adults. • TOVA • Visagraph The standardized test is well normed and • Visagraph extremely helpful in predicting responsiveness to treatment modality. More info at: http://www.tova.net/ 7
- 8. Assessment Treatment • Refractive • Working with incomplete or “fuzzy” clinical data • “Get over it!” •Patient’s cognitive level • Seek help •Patient’s motor ability • Dr. Dominick Maino •Patient’s therapy goals • 312-949-7282 •Patient’s vocational goals • dmaino@ico.edu •Patient’s self abusive behaviors •Living conditions •Past success Treatment Treatment • When Do You Correct Refractive Error? • Binocular Vision Dysfunction • Strabismus •Myopia > 1.00D • Rx, VT, surgery • Amblyopia •Hyperopia > 2.00D yp p • Rx VT Rx, •WR Astig > 2.00D • Accommodation dysfunction •AR Astig > 1.00D • Rx, VT •Oblique Astig > 1.00D • Oculomotor anomalies •Anisometropia > 1.00D • Rx, VT Treatment Treatment Ocular Health Ocular Treat as you would any other Health patient. May even be more anterior aggressive in your treatment segment: lids, lashes conjunctiva, cornea 8
- 9. Treatment Treatment • Lens • GLC • refer/treat optically • Treat/Refer • cataract • lenticonus • Many need • Fundus/Optic nerve surgical i l • diagnose/refer intervention Referral Resources Summary Developmental Disabilities Service • All deserve optometric vision care Neumann Family Services • If all you do is take a detailed case history, it’s probably of the more than any have even attempted before Illinois Eye Institute • Do not underestimate the power of glasses d i h f l • Be creative, use want you know, invent! 3241 S. Michigan Ave. • Treat (optically, functionally, medically) because we do Chicago, Il. 60616 it all! 312-949-7280 (Pediatrics) Questions? Contact: Dominick M. Maino, OD, MEd, FAAO, FCOVD-A Professor, Pediatric/Binocular Vision Service Distinguished Practitioner, Academies of Practice Leonardo da Vinci Award of Excellence in Medicine, Recipient Illinois Eye Institute Illinois College of Optometry 3241 S. Michigan Ave. Chicago, Il. 60616 312-949-7280 (phone) 312-949-7660 (fax) dmaino@ico.edu www.ico.edu www.nw.optometry.net MainosMemos.blogspot.com 9