How to Stay Calm When You Know You'll Be Stressed

Since your decrease in vision, have you lost everyday items more easily? Misplaced your wallet? Been faced with a difficult medical choice? According to neurologist Daniel Levitin, we all encounter these parts of life - not just those with vision loss. 

I recently heard an intriguing program on NPR following the theme of stress. It featured neurologist Daniel Levitin (who's TED talk is at the bottom of this post). Watch it, if you can - it's candid, funny and honest.  I'll go ahead and flesh out the points he make that are most relevant to Vision Rehabilitation Therapy. 

In the pre-mortem you look ahead and you try to figure out all the things that could go wrong, and then you try to figure out what you can do to prevent those things from happening.

I talk about this idea quite a bit on my site. It is so critical to be self-aware, and anticipate what your most difficult tasks are. By pinpointing and addressing your trickiest Activity of Daily Living, you are taking the bull by the horns, and letting yourself be the driver. Here, I believe Daniel is emphasizing moving from a passive to pro-active state. 

Around the home, designate a place for things that are easily lost. 

This is a big one. With vision loss, too. Baskets, trays, organizational dividers - these are all tools you can use to help designate places for your mail, keys, recorders, etc. 

Take a cell phone picture of your credit cards, your driver's license, your passport, mail it to yourself so it's in the cloud. If these things are lost or stolen, you can facilitate replacement.

I love this idea. Prior to watching Daniel's TED talk I had never done this before. It takes less than 5 minutes, but is so worth it. This is an important step for everyone to take. It's a good idea to take pictures of your paratransit benefit cards, medical benefits cards and other daily-use card you have. 

All of us are going to be in that position, where we have to make a very important decision about the future of our medical care or that of a loved one, to help them with a decision.

Again, here we are talking about anticipation and planning. How do you choose to communication with service providers or medical professionals? Do you prep questions ahead of time? Do you have an insurance advocate that can ensure you are getting the reimbursement you are entitled to?

Now, what is this, the NNT? It's the number of people that need to take a drug or undergo a surgery or any medical procedure before one person is helped.

One of the strongest points of Daniel's talk, was explaining the NNT (number need to treat). You can incorporate this subject into your prepped questions for medical doctors. It's an important topic that (even if it doesn't drive your decision making) will encourage transparency from the medical personnel that are serving you. 

So the idea of the pre-mortem is to think ahead of time to the questions that you might be able to ask that will push the conversation forward. 

Bringing it back around to the first point, the key here is to ANTICIPATE what situations will provide you with stress, and therefore a higher level of cortisol, fogging your thinking. This means we have to do the prep-work ahead of time. Prepare questions, places for your keys, pictures of your important documents. This is how to stay calm. 

You don't want to have to manufacture all of this on the spot. And you also want to think about things like quality of life. 

Quality of life is a big one. When we plan for stress, we ensure our quality of life stays steady. We shouldn't have to constantly improvise and fail miserably in tough situations. Taking 5 minutes, once per week, to take these small steps with help to improve your overall quaility of life. 


10 Reasons to Download "Seeing AI" for iPhone

If you have an iPhone DO NOT WAIT! 

The new Seeing AI app from Microsoft has blown much of the the scanner/OCR (optical character recognition) readers out the water. It's seamless design and virtually no wait-time have made it a must-have for users with low vision. 

I'll take a few deep breaths and (try to) deliver a more level-headed review. I genuinely love this app. Here are 10 reasons why I think you should download it and give it a test drive, stat. 

  1. It is a FREE identification app

  2. It will read short text (mail, receipt, check, etc.) just by holding up the camera to the item you want it to read

  3. It will read long text (menus, documents, letters, etc.) just by taking a picture, then quickly allowing you to navigate the document section-by-section - the best part is your camera doesn't save these photos, therefore not taking up a bunch of space on your phone!

  4. It will identify the brand and exact product of an item by simply hovering the camera over the barcode + detailed product information (if you want it)

  5. You can train it to identify specific faces and facial expressions

  6. The layout and design is simple, with one lower bar menu to toggle between the reader settings 

  7. You can easily download it from the iTunes App Store 

  8. It is compatible with VoiceOver

  9. It will soon include a built-in currency reader for bill identification

  10. Many people and clients I've worked with have been sincerely excited about the ease of use and improvement to their quality of life. No more wondering which shampoo you are buying! 

 

What aging can teach us about hard work.

Some of our passions change or evolve, while others we've maintained our whole lives. Which interests, loves or hobbies fill you up? Have you lost sight of them? 

The Center for Disease Control and Prevention just published a sophisticated checklist - built to remind us of those passions. Here are the highlights.

Research

"Research has shown that for older adults, staying engaged in enjoyable activities is associated with better physical and mental health

In addition, research has shown that learning a new activity for older people can provide some “insurance” against memory loss. However, it cannot prevent progressive diseases like Alzheimer’s and other dementias (CDC 2017)."

Re-engagement

What activities get you inspired, motivated, or downright excited? Identifying these first (without judgement!) will get you started on the right track. Have you considered volunteer work, or going back to school? Not letting societal norms define your journey is key to embracing the possibilities of personal growth.

Put Yourself Out There

You may not feel up for learning a risky new skill, but making yourself vulnerable to a new group via a theater class, Meetup group, or Silver Sneakers walking club will provide you with an unmatched psychological reward. Ready to take the plunge? 


The Beginner's Guide to Telehealth and Telerehabilitation for Low Vision

Is it difficult for you to travel to the nearest low vision clinic or private agency for vision rehabilitation therapy services? Do you find the cost, effort and stress of travel outweighs the benefits?

As health care services turn to videoconferencing, telemedicine and remote counseling, the logical next step would be to consider the effectiveness of a similar model applied to rehabilitation. 

In the last five years, the rehabilitation sector has seen an influx of research evaluating the impact and need of remote, video-based evaluation and follow-up. In this Beginner's Guide we will look closely at recent research in the fields of low vision and related therapy outcomes. Let's get up to speed. 

What is telerehabilitation?

"Telerehabilitation refers to the delivery of rehabilitation services via information and communication technologies (Brennan 2011). Clinically, this term encompasses a range of rehabilitation services that include assessment, monitoring, prevention, intervention, supervision, education, consultation, and counseling (Bittner, et al. 2015)."

It is an approach to rehabilitation that utilizes modern technology to reach people who otherwise wouldn't be able to attend therapeutic sessions. It seeks to break down the barriers that people in rural communities, or people with limited travel options, face when seeking help for their functional vision. 

Winters, J. (2002). Telerehabilitation research: Emerging opportunities.  Annual Review of Biomedical Engineering,   4 , 287-320.

Winters, J. (2002). Telerehabilitation research: Emerging opportunities. Annual Review of Biomedical Engineering, 4, 287-320.

How is telehealth and telerehabilitation applied in the medical sector and different therapies? 

Medically

Perhaps, like me, you first realized that you could access a medical doctor remotely via your health insurance app. I was SHOCKED to learn that I could get a prescription for sinusitis from my living room, in less than 20 minutes. eVisit, an online telemedicine company, offers us beginners a great overview of how telemedicine came to be. Read their Ultimate Guide here. 

"Telemedicine refers to the use of information technologies and electronic communications to provide remote clinical services to patients. The digital transmission of medical imaging, remote medical diagnosis and evaluations, and video consultations with specialists are all examples of telemedicine (eVisit)." 

Other Therapies

Occupational Therapy

Telerehabilitation, as defined by the American Occupational Therapy Association (AOTA) position paper, is the clinical application of consultative, preventative, diagnostic, and therapeutic services via two-way interactive telecommunication technology (Wakeford, Whitman, White, & Schmeler, 2005).

The Canadian Association of Occupational Therapists (CAOT) also has a position statement about tele-occupational therapy. CAOT recognizes the ongoing development of tele-occupational therapy, which will promote opportunities for effective, efficient, and accessible occupational therapy services, education and resources to all Canadians (Schmeler, et al. 2015).

Vocational Rehabilitation and Counseling

The Commission on Rehabilitation Counselor Certification (CRCC)  has published significant revision to the ethics code that contains new practice guidelines regarding the use of technology in assessment and distance counseling (Schmeler, et al. 2015).

The new code outlines that rehabilitation counselors are held to the same level of expected behavior as defined by the ethics code regardless of the technology used or its application. It offers practice guidelines on issues related to problematic use of the Internet, privacy, confidentiality and security (Schmeler, et al. 2015).

Speech Language Pathology 

ASHA uses the term “telepractice” to refer to “the application of telecommunications technology to deliver professional services at a distance” (American Speech-Language-Hearing Association, 2005). Since 1998, ASHA has studied the potential impact of telepractice on speech-language pathologists (SLPs) and audiologists and the individuals they serve (Schmeler, et al. 2015).

Physical Therapy

American Physical Therapy Association (APTA) has released a Board of Directors Position on telehealth. There are also articles explaining how physical therapists are using telehealth to overcome barriers of distance and time (Schmeler, et al. 2015). 

Winters, J. (2002). Telerehabilitation research: Emerging opportunities.  Annual Review of Biomedical Engineering,   4 , 287-320.

Winters, J. (2002). Telerehabilitation research: Emerging opportunities. Annual Review of Biomedical Engineering, 4, 287-320.

How can it be applied to Vision Rehabilitation Therapy?

"Delivering low vision rehabilitation services remotely via telemedicine has the potential to help people with vision loss maintain function and activities of daily living as well as social and psychological well-being (Bittner, et al. 2015)."

Although VRT telerehabilitation hasn't hit the mainstream yet, pockets of investigation are emerging.

AERBVI and ACVREP have not released positions on telehealth or rehabilitation at the time of this blog post, however the Journal of Visual Impairment and Blindness published the most recent study in 2016 entitled, Steps to Offering Low Vision Rehabilitation Services Through Clinical Video Telehealth. Spearheaded by the VA Buffalo VISIOR pilot clinic, they came to the following conclusions: 

"The increase in low vision clinical care at the Buffalo VA VISOR clinic, because of the addition of low vision telehealth clinics, has shown the effectiveness of access by helping more partially sighted and legally blind patients who could not schedule comprehensive low vision rehabilitation services in an outpatient or inpatient setting (Ihrig 2016)."

"Clinical video telehealth currently allows low vision rehabilitation with low vision optometrists and blind rehabilitation therapists in a manner that is timely and without the need for the patient to travel long distances to receive services (Ihrig 2016)."

How does telerehabilitation compare to in-person therapy?

In an exciting new comparative study by Baycrest Center for Geriatric Care, professionals evaluated the effectiveness of telerehabilitation strategies, and held up the results to the success of in-person therapies. Here is what they found:

"Telerehabilitation helps healthcare professionals reach more patients in need, but some worry it doesn't offer the same quality of care as in-person treatment. This isn't the case, according to recent research by Baycrest.

The study, published in the journal Aphasiology, found that patients who accessed speech language therapy over the Internet saw large improvements to their communication abilities that were similar to those of patients doing in-person therapy.

This finding encourages greater adoption of telerehabilitation to treat patients living in remote communities who are recovering from post-stroke communication disorders as a way to improve the use of limited healthcare resources (Baycrest Centre for Geriatric Care 2017)."

What is the future outlook for telehealth and telerehabilitation for low vision? 

Looking back at the Buffalo VA VISOR pilot telerehabilitation clinic, they found that most patients responded positively:

"Specifically regarding telehealth, patients noted they appreciate the low vision clinical video telehealth clinic because it allowed them to receive services they would not otherwise be able to access (Ihrig 2016)."

Overcoming the barriers of immediate intervention, transportation, geographical location, and access to VRT services, help ensure that the future of telerehabilitation is expansive. Although it is still in it's infancy, distance-based assessments, consultation and therapeutic interventions promise to broaden the availability of specialized therapies to those individuals who require support in overcoming these barriers. 


References

Baycrest Centre for Geriatric Care. (2017, July 20). Similar improvements between speech language therapy delivered online and in-personScienceDaily. Retrieved August 4, 2017 from www.sciencedaily.com/releases/2017/07/170720142332.htm

Bittner, A. K., Wykstra, S. L., Yoshinaga, P. D., & Li, T. (2015). Telerehabilitation for people with low vision. The Cochrane Database of Systematic Reviews8, CD011019. http://doi.org/10.1002/14651858.CD011019.pub2

eVisit: The Ultimate Guide to Telemedicine. https://evisit.com/what-is-telemedicine/

Ihrig, C. (2016). Steps to offering low vision rehabilitation services through clinical video telehealth. Journal of Visual Impairment & Blindness (Online), 110(6), 441. Retrieved from https://search-proquest-com.proxy.wexler.hunter.cuny.edu/docview/1847926465?accountid=27495

Schmeler, M., Schein, R., McCue, M., & Betz, K. (2015). Telerehabilitation and Clinical Applications: Research, Opportunities, and Challenges. International Journal of Telerehabilitation, 0, 12-24. doi:https://doi.org/10.5195/ijt.2008.701

Winters, J. (2002). Telerehabilitation research: Emerging opportunities. Annual Review of Biomedical Engineering, 4, 287-320.