Child with Special Needs Part 2

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Presentation given at the Vision's Impact on Learning Conference 9-11

Published in: Health & Medicine, Education

Child with Special Needs Part 2

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

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