Macular Degeneration solutions, for Richard & others.

Macular Degeneration is a debilitating disease process, inwhich people lose their central visual field. It is progressive and can severely inhibit independence especially in areas such as: driving, reading, recognition of faces, money and medication management and instrumental activities of daily living.

In our case study this week we studied an interview with Richard who was experiencing the isolating effects of this disease. The primary limitations that concerned him, included 1) difficulty reading and 2) difficulty in social situations - primarily because he was unable to identify faces.

1) To begin to find solutions for the reading difficulties he was experiencing, I found this article about an Electronic Magnifier. In this article one of the solutions to enable reading with macular degeneration is discussed - that of magnification. It discusses the PRIMER, a more cost effective CCTV, electronic magnifier which can be used even in the late stages of macular degeneration, with upto 15 times the magnification. This could be used for people, such as Richard, as he is able to do some reading, but when he has to strain to read it exhausts him and makes the process less enjoyable.

The PRIMER, is able to magnify items that are three dimensional, such as medication bottles, cans of food, recipe books, newspapers and reading materials such as books, newspapers and magazines. This would be very beneficial to Richard as he is determined to remain as independent as possible and the magnification of these items would allow him to remain so.

The biggest drawback to this device, is that it is static and requires a TV or computer screen to plug it into. It would therefore not be useful in a grocery store for example. One benefit however is that it only costs $295.00.

Although this device would be useful to Richard, it still necessitates that he read, which he finds difficult. As an alternative to this, I found another device in a catalogue sent to me. It is Simon - The Affordable Reading Machine. This was not found on the Closing the Gap site but elsewhere on the web. Although it claims to be affordable I doubt that Richard would think that $2,295.00 was affordable, if his finances are anything like mine!

I would still bring this suggestion to him as an Assistive Technology provider however, as it sounds like the perfect fit to his problem. He could scan any written material and the content would be verbally spoken back to him. If this was a very important area for him he might find a way to afford him. I would not want to make the assumption that he wouldn't want/ couldn't pay for this device just because I would have a hard time doing so.

Both of these devices would enable Richard to become more independent in his reading, whether he chose to read the larger print or have the information read to him.

2) A device to enable him to see faces of people speaking to him would be glasses with behind the lens telescope. These would not draw too much attention to him, which is one of his personal concerns (within his cultural context), and yet he could see the faces of those speaking to him, which would enable him to attend social situations where there are crowds, such as church, and therefore not be so isolated.

Therefore through the use of these simple devices, Richard and others with macular degeneration could participate actively in their roles, routines and responsibilities more independently and feel that they are contributing members of our society.

Mounting 101

The Challenge: Eric Blackstock was an 84 year old, active man, who was injured whilst working - cutting the grass on his riding lawn mower, when he lost control and drove it into a parked truck. He sustained a C5-6 incomplete, central cord lesion, which permanently left his legs stronger than his arms, and yet ineffective for functional ambulation.

The Process: After extensive therapy, Eric could transfer functionally but was unable to walk more than 10 feet, at which time fatigue made him unsafe to continue. The inpatient rehabilitation team - including Mr. Blackstock, decided that a power wheelchair, with a tilt-in-space function (for pressure relief), would be an important assistive technology device for him to use, for maximum functional independence.

The Problem: Most power wheelchairs are turned on with a button, which requires good fine motor coordination and strength to push. They are then controlled with a joystick, operated by the upper extremities. In Eric's case, however, his upper extremities were less functional than his lower extremities, and therefore it was necessary to place the controls in such a way that his lower extremities could control the mobility and tilt-in-space functions of his wheelchair. This is a real patient (name changed to protect identity) that I treated, and the real issues that we faced with him, and this is the reason I chose this article: Mounting 101. Had I know about the variety of methods to mount wheelchair controls, the solutions we devised for Eric, might have been very different - and would have taken a lot less time.

In this article by Edward Hitchcock, the importance of mounting solutions is discussed, and I couldn't agree more. The process of having identified an individuals strengths (and weaknesses), and then having found a solution for maximum functioning capacity can be thwarted by not being able to mesh these two together. The solution often lies in mounting the controls to a device, close enough and in correct proximity to, the individual, so that they can operate it safely, independently, and with minimal energy expenditure.

The article also gives some excellent problem solving tips for challenging wheelchairs, such as: wheelchairs without exposed tubing; tilt-in-space models; or bariatric models - to prevent increasing their already-wide width. One of my patient had fingers amputated because his wheelchair was too wide to fit through his doorways and he kept catching his fingers, so keeping controls within the width of the chair is an important consideration.

To supplement this article, I have a link to the Daedalus site:
Pictures of Daedalus mounting options, in which some pictures of the "s" shaped mounts attached to casters and frame clamp, can be more clearly seen.

Our Solution: Although with this new found knowledge, my solution today would have included the Daedalus locking swing away mount - which can be moved out of the way during transfers, I will conclude by telling you what our team devised. We positioned an on/off switch (with velcro) to the outside of Eric's right thigh (attached to the inside of his arm rest in his wheelchair), with which he could turn his power chair on/off (he had to abduct his right thigh). He had shoulder protraction/retraction, so with a wrist cock-up splint (to stabilize his wrist), and forearm support he was able to steer the wheelchair, using a "T-shaped" control.

Another switch was velroed to the inside of his left armrest, and he used abduction of his left thigh for the tilt-in-space controls of the chair (as he was unable to use his arms for pressure relief, due to his injury).

I am pleased to say that I now have better solutions for future patients!

Helen Houston's Rehabilitation Resources

Rehabilitation Resources

I plan for this site to be a digital resource that I can access at work to act as a resource for the patients I treat in the Inpatient Rehabilitation of Pitt County Memorial Hospital (PCMH), Greenville, NC.

I have worked at PCMH for 7 years: 2 years as a float in acute and 5 years on the General Rehabilitation II team. We treat a variety of patients with some of the following diagnoses: diabetes, brain injuries, spinal cord injuries, cardiac disorders, amputations, neurological disorders, debility and oncology. Most of the patients I treat are adults (primarily geriatrics), but on weekends I cover on the pediatric unit too.

I love what I do and continually strive to be a resource for my patients and their families to enable them to be as independent as they can be!