child with special needs part 2
Post on 02-Jul-2015
276 Views
Preview:
DESCRIPTION
TRANSCRIPT
1
Diagnosis and Management:P ti t ith S i l N dPatients with Special Needs
Dominick M. Maino, O.D., M.Ed., F.A.A.O.
Professor, Pediatrics/Binocular Vision Service
Illinois College of OptometryIllinois Eye Institute
3241 S. Michigan Ave.Chicago, Il. 60616
312-949-7280 (Voice) 312-949-7358 (fax)
dmaino@ico.eduwww.ico.edu nw.optometry.net
Diagnosis
Assessment Techniques for Special Populations
Use everything you know, be creative, and trust your objective evaluation skills!
Diagnosis
• Preparing for the examination• greet patient by name• position yourself at patient’s eye
level• be on schedulebe on schedule• consider patient’s wishes about
family/friends in exam room• 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
• “look here”• “look here”• “do this”• “watch my light”
Treat the patient the way you would want to be treated!
2
Remember the 10 Commandments
1.) Speak directly to the person rather than thru a companion or sign language interpreter.
2.)Always offer to shake
4.) If you offer assistance wait until the offer is accepted, then listen and wait for instructions.
5 ) Treat adults as adults) yhands when introduced.
3.)Always identify yourself and others who are with you when meeting someone who is blind.
5.) Treat adults as adults.
6.) Do not lean against or hand on someone's wheelchair or cart.
Remember the 10 Commandments
7.) Listen attentively when talking to people who have difficulty speaking and wait for them to finish.
8.) Place yourself at eye level when talking to someone in a
10.) Relax. Don’t be embarrassed if you use common expressions that seems torelate to a person’s disability.
when talking to someone in a wheelchair.
9.) Tap a person who is deaf on the shoulder or wave your hand to get their attention.
The Ten Commandments of Communicating with People With Disabilities
Case History Case History
• Demographic Information
• Medical history including their disability• typically taking many medications
• Visual history
• Educational history• Educational history
• Rehabilitation history
• Vocational history
• Recreational history
Visual Acuity
•Use highest level possible
•binocular before monocular testing
•adaptive positioning
•use assistants, friends, family members
•limited window of opportunity
•randomize optotypes, use reinforcers
•test=game, be creative
Visual Acuity
• Snellen
• Broken Wheel
• HOTV
E• Lea Symbols
• Teller Acuity Cards
• OKN
F PT O Z
H O V T
3
Visual Acuity
• Snellen
• Broken Wheel
• HOTV
• Lea Symbols
• Teller Acuity Cards
• OKN
Visual Acuity
• Snellen
• Broken Wheel
• HOTV
• Lea Symbols
• Teller Acuity Cards
• OKN
Visual Acuity
• Snellen
• Broken Wheel
• HOTV
• Lea Symbols
• Teller Acuity Cards
• OKN
Visual Acuity
• Snellen
• Broken Wheel
• HOTV
• Lea Symbols
• Teller Acuity Cards
• OKN
Visual Acuity
• Snellen
• Broken Wheel
• HOTV
• Lea Symbols
• Teller Acuity Cards
• OKN
Visual Acuity
• Snellen• Broken Wheel• HOTV• Lea Symbolsy• Teller Acuity Cards• OKN• Cardiff Cards
preferential looking cards that use form discrimination with vanishing optotypes
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
• Cycloplegic/Mydriatic spray
• Spray on closed lids, have pt blink wipe off have pt blink, wipe off excess (.5% Cyclo, .5% Myd, 2.5% Phenyl)
Refractive Error
• Keratometry• hand held electronic devices (Nidek)• Placido’s disk• keratoscope
Binocular Vision Assessment
• Observation
• Cover Test
• Bruckner
• A l K• Angle Kappa
• Hirschberg
• Krimsky
Binocular Vision Assessment
Incidence of Strabismus
CEREBRAL PALSY 15-60%
MENTAL RETARDATION 16-40%
• Observation
• Cover Test
• Bruckner
DOWN SYNDROME 41-75%
DEAFNESS 29%
NORMAL CHILDREN 2-4%
• Angle Kappa
• Hirschberg
• Krimsky
5
Binocular Vision Assessment
• Observation
• Cover Test
• Bruckner
• A l K• Angle Kappa
• Hirschberg
• Krimsky
Binocular Vision Assessment
• Observation
• Cover Test
• Bruckner
• A l K• Angle Kappa
• Hirschberg
• Krimsky
Binocular Vision Assessment
• Observation
• Cover Test
• Bruckner
• A l K• Angle Kappa
• Hirschberg
• Krimsky
Binocular Vision Assessment
• Observation
• Cover Test
• Bruckner
• A l K• Angle Kappa
• Hirschberg
• Krimsky
Binocular Vision Assessment
• Lang stereotest
• Random Dot E
• Worth 4 Dot
• MEM Nearpoint p
Retinoscopy
• NPC
• Accommodative Facility
• Saccades/Pursuits
Binocular Vision Assessment
• Lang stereotest
• Random Dot E
• Worth 4 Dot
• MEM Nearpoint p
Retinoscopy
• NPC
• Accommodative Facility
• Saccades/Pursuits
6
Binocular Vision Assessment
• Lang stereotest
• Random Dot E
• Worth 4 Dot
• MEM Nearpoint Retinoscopyp py
• NPC
• Accommodative Facility
• Saccades/Pursuits http://opt.pacificu.edu/ce/catalog/14041-GO/14041-GO.html
Binocular Vision Assessment
• Lang stereotest
• Random Dot E
• Worth 4 Dot
• MEM Nearpoint p
Retinoscopy
• NPC
• Accommodative Facility
• Saccades/Pursuits
Binocular Vision Assessment
• Lang stereotest
• Random Dot E
• Worth 4 Dot
• MEM Nearpoint p
Retinoscopy
• NPC
• Accommodative Facility
• Saccades/Pursuits
Binocular Vision Assessment
• Lang stereotest
• Random Dot E
• Worth 4 Dot
• MEM Nearpoint p
Retinoscopy
• NPC
• Accommodative Facility
• Saccades/Pursuits
Ocular Health
•Hand held devices•Slit lamp•Tonopen/PerkinsTonopen/Perkins•BIO/MIO/direct
http://opt.pacificu.edu/ce/catalog/14041-GO/14041-GO.html
Ocular Health
•Hand held devices•Slit lamp•Keeler/Tonopen/•Perkins•Perkins•BIO/MIO/direct
7
Ocular Health
•Hand held devices•Slit lamp•Tonopen/PerkinsTonopen/Perkins•BIO/MIO/direct
Tangential Penlight Angle Estimation
• Penlight at temporal aspect of cornea
• Angle between 20-35 degrees to the facial planethe facial plane
• Maximum brightness
• Open angle = nasal illumination at least 75% as bright as temporal illumination
Special Testing
• VEP, ERG, EOG
• Sweep VEP
• Ultrasound (A/B scan)
• TOVA• TOVA
• Visagraph
Special Testing
• VEP, ERG, EOG
• Sweep VEP
• Ultrasound (A/B scan)
• TOVA
Ultrasound, B-Scan
CPT 76512 (contact B-scan);
IndicationsExamination of the posterior
• TOVA
• Visagraphportion 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
Special Testing
• VEP, ERG, EOG
• Sweep VEP
• Ultrasound (A/B scan)
• TOVA
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 • TOVA
• Visagraph
( ) yp ydisorder (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/
Special Testing
• VEP, ERG, EOG
• Sweep VEP
• Ultrasound (A/B scan)
• TOVA• TOVA
• Visagraph
8
Assessment
• Working with incomplete or “fuzzy” clinical data
• “Get over it!”
• Seek helpSeek help• Dr. Dominick Maino• 312-949-7282• dmaino@ico.edu
Treatment
• Refractive
•Patient’s cognitive level•Patient’s motor ability•Patient’s therapy goals•Patient’s vocational goals•Patient’s self abusive behaviors•Living conditions•Past success
Treatment
• When Do You Correct Refractive Error?
•Myopia > 1.00D•Hyperopia > 2.00Dyp p•WR Astig > 2.00D•AR Astig > 1.00D•Oblique Astig > 1.00D•Anisometropia > 1.00D
Treatment
• Binocular Vision Dysfunction• Strabismus
• Rx, VT, surgery• Amblyopia
• Rx VT• Rx, VT• Accommodation dysfunction
• Rx, VT• Oculomotor anomalies
• Rx, VT
Treatment
Ocular Health
Treat as you would any other patient. May even be more aggressive in your treatment
Treatment
Ocular Healthanterior segment:
lids, lashes
conjunctiva, cornea
9
Treatment
• Lens• refer/treat optically• cataract• lenticonus
• Fundus/Optic nerve• diagnose/refer
Treatment
• GLC•Treat/Refer•Many need
i l surgical intervention
Referral Resources
Developmental Disabilities Service
Neumann Family Services of the
Illinois Eye Institute3241 S. Michigan Ave.
Chicago, Il. 60616
312-949-7280 (Pediatrics)
Summary
• All deserve optometric vision care
• If all you do is take a detailed case history, it’s probably more than any have even attempted before
d i h f l• Do not underestimate the power of glasses
• Be creative, use want you know, invent!
• Treat (optically, functionally, medically) because we do it all!
Questions? Contact:
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Professor, Pediatric/Binocular Vision ServiceDistinguished 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
top related