o and m for older persons

7/28/2019 O and M for Older Persons

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Orientation and

mobility for olde

personPresented by : Nomar B. Capoy

Presented to: Prof. Pagurayan


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The contexts of ageing and vision loss

Ageing and disability current anticipated life expectancy is 75 years

Rehabilitation intervention

Rehabilitations role is to preserve years of active life for as long as possible, even though ag

related impairments may threaten continued independence.

Rehabilitation training among older blind persons should reduce dependency and contribu

years of active life.

Age related and disease related changes classifications

biological changes- changes in muscle strength and cardiac pulmonary function

Normal age-related psychological changes lead to slower pace of learning and negative vie

regarding the ability to recover from physical losses.

Social related changes include ageism that may affect the decision of health care professi

to encourage or refer to rehabilitation services.


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Aging and vision loss

Leading causes of blindness among older people

Macular degenerationCataracts

Glaucoma

Diabetic retinopathy

Severe vision impairment defined as the inability to read newspaper print with best correct

increases from 4.7 percent of population ages 65-74, to 9.9 percent over the age group 75-8

25 percent over the age of 85,, overall above 65 is 7.8 percent vision loss prevalence rate.

Normal aging and disability among elders create important frames for the issues of vision loamong elders. Normal changes the eye, including the cornea, lens, and vitreous are to be

expected, and they have the effect of degrading vision, but severe vision loss cannot be dism

as normal.


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The Practice of O & M among Elders

Adapting O & M instructions for older people involves paying attention to the following fou

issues:

Assessment of function

Collaboration with the student and the rehabilitation team.

Relevance of instruction to the students needs.

Modification of instruction in response to individuals health and circumstances.

Assessment addresses the following areas:

Review of available medical or rehabilitation information.Quality and size of social networks

Interview with the client regarding travel objectives and interest

Observation of ambulation in representative environments ( indoors, residential, and sma

business)


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Assessment should result in a plan encompassing content, sequence, pace, and length of t

The Responsibility of the O & M practitioner is assess each student's personal characteristic

needs, and desires in order to create a relevant educational experience.

Collaboration refers to instituting a routine of sharing information and making joint decisio

the student. The goal of collaboration is to provide both instructor and student an opportu

influence the other. Approaching older students in this manner indicates the practitioner is

upon demonstrating respect, understanding, and empathy throughout the teaching proces

Collaboration also refers to the teamwork approach existing between the O & M instructor

other professionals involved in treating other health or psychosocial concerns. It may deter

the effects of medications on the student's alertness, coordination, balance, or reasoning a

Collaboration may also address social support and social integration concerns. Potential

collaborators include physicians, nurses, social service providers, spouse, or family member


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Attention to relevance is necessary to ensure that training provides solutions for practical

problems experienced in daily life. Adjustments can be made in presentation, emphasis, pa

sequencing of instruction to ensure that suitability for individual circumstances is maintain

should be a natural outgrowth of the collaborative approach.

Modification , defined as tailoring the instruction to meet the unique needs of individuals,

the heart of the individualized instructional process. Deficits in health, balance, coordinatio

physical strength or endurance, psychosocial or emotional well-being, or cognitive perform

are examples of factors that lead to modifying training. Other factors to be considered inclu

amount and type of vision, living situation ( alone or with family), and type of home enviro


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Case Histories

Mrs. Q 63 y/o vision impairment macular degeneration

Mobility problems falls, contacts with objects while moving , maintaining straight- line tr

difficulties with level change detection and step-edge detection, unreliable depth perceptio

variations in visual acuity in the presence of rapid lightning changes, disorientation in unfam

areas, and uncertainty regarding timing and safety of street crossings.

Her mobility goals-- attainment of independent movement on her own property ; recreatio

walking on her own rural area; access to an alternate form of transportation; independent

residential; semibusiness, and business areas; and independent travel at her church.

Collaboration involved the O & M specialist and the client, as well as the primary physician


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Relevance of Training was addressed by the referral source; Mrs Q and her rehabilitation

counsellor both agreed that comprehensive O & M training was required for her to remain

home and continue to care for her mother.

Assessment took the form of an extensive interview,conducted during the first visit. Observ

portions of the assessment were conducted in small increments at subsequent meetings t

physical exertion. It revealed both need and capacity for a comprehensive O & M training p

Modification involved adjustments primarily in presentation, pace, and sequence. Fairly eq

emphasis was placed on all outdoor skills because of the comprehensive nature of Mrs Q's

goals.


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Skills modification included extensive use of modified ( constant contact ) touch technique

combined with support cane use during all outdoor travel.

Presentation was enhanced by modelling techniques demonstrated by the instructor. Mr

acknowledged the need to use two canes because of her difficulties with ambulation, and

expressed misgivings about the appearance of using two canes at once.

Pace was dictated by the client's variable strength and endurance. Due to Mrs. Q's health

problems lesson times were variable in length, according to her physical capabilities on a g

day.

Sequence was initially dictated by the demands of Mrs Q's home environment. The skills r

for her to negotiate her front steps, her home property, and the narrow gravel lane leadinmother's house were covered first. Afterwards ,she learned to increased independence an

out referral sources for additional services.


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Conical model of the theoretical framework for mobility in older adults illustrating seven

space locations (ascending in order of increasing distance from the room where one sle

each of which is composed of mobility determinants related to cognitive, psychosoci

physical, environmental, and financial factors.

Webber S C et al. The Gerontologist 2010;50:443-450

The Author 2010. Published by Oxford University Press on behalf of The GerontologicalSociety of America. All rights reserved. For Permissions, please e-mail:[email protected].


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Conclusion

It is likely that O & M professionals will encounter greater numbers of older people as

rehabilitation organizations respond to increases in the number of elders experiencing visio

This increased exposure will expand and perhaps test the capacity of O & M instructors to r

to the complex, fluid needs of older people. They need to respond to the great variety pres

by older people. Each student in each circumstances is worthy , and each student benefits f

the therapeutic effect that increased travel skills produce. Their aim for serving older peop

same as for any consumer- to recognize the strengths and goals of each individual, and resp

those needs in a way that enhances choice, dignity, control, and quality life.


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Thank you.....

o and m for older persons

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