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Introduction to OT 677

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Title: Introduction to OT 677


1
Introduction to OT 677
  • Foundations in Low Vision Rehabilitation I

2
Instructors Information
  • Mary Warrens contact information
  • Email address warrenm_at_uab.edu
  • Phone number 934-1800
  • Office Hours by appointment
  • Office 340
  • Beth Barstows contact information email
    addressbarstow_at_eyes.uab.edu
  • 325-8115

3
Class Materials
  • Required Books
  • Understanding Low Vision Jose
  • Macular Degeneration The Complete Guide to
    Saving and Maximizing Your Sight Mogk
  • Additional Readings
  • Required readings will be posted in Resource File
    on WebCT
  • Must obtain copy of the following free catalogs
  • Independent Living Aides (800) 537-2118
    www.independentliving.com
  • LSS Group (800) 468-4789 www.lssgroup.com
  • Maxi-aids (800) 522-6294 www.maxi.aids.com
  • Ruler with cm markings

4
Lectures/Class Assignments
  • Lectures will be posted in WebCT at least one day
    before the class
  • Out of Class Learning Activity Assignments must
    be typed and submitted in WebCT
  • Forms will be posted on the website in word
    format
  • Due dates for Learning Activities are listed on
    the topic outline
  • In class learning activities will be due at the
    end of class

5
Submission of Class Assignments
  • Must be type written and submitted in the
    required format in WebCT
  • .5 deduction for all mis-spellings, grammatical
    errors
  • 10 point deduction for turning in a late
    assignment

6
Absences
  • Notify me by phone or email if you will need to
    miss a class. Because this class relies on class
    lecture and demonstration with little outside
    reading, attendance is very important.
  • One excused absence is allowed
  • Additional absences result in 15 pt deduction
    from test grade
  • In the case of bad weather (ice, snow) class will
    be cancelled-( I will send an email out to the
    class via WebCT) although the information you
    will be taught is very important it doesnt
    warrant risking life, limb and car.

7
Learning Activities
  • 1. Complete the eye anatomy coloring book.
  • 2. Select 2 eye diseases from the list provided
    complete a written summary on each disease using
    the form provided to describe the etiology of the
    disease, population affected, visual functions
    affected by the disease and occupational
    performance limitations.
  • 3. Spend one day without driving cannot be a
    Sunday or a day with few activities to complete.
    Write up experiences obtaining transportation

8
Learning Activities cont
  • 4. Design male and female signage for restrooms
    that can be reliably identified by a person with
    20/200 visual acuity at a distance of 10 feet.
    Can be completed with a partner
  • 5. Observe a low vision examination by an
    optometrist or ophthalmologist in either the low
    vision service at the Optometry school or at the
    UAB Center for Low Vision Rehabilitation and
    complete the summary form describing the
    evaluation process and the results of the
    evaluation.
  • Observations must be scheduled through
  • Lee Test at 488-0736
  • Identify yourself as an OT student taking Marys
    class
  • Only one student may observe at a time

9
Learning Activity 6
  • Observe 4 hours of occupational therapy
    intervention provided at the UABCLVR
  • A minimum of 3 patients must be observed
  • Complete a written summary on each patient using
    the format provided
  • Observations must be scheduled through Beth
    Barstow
  • 1 student may observe a pt session at a time
  • Observations will be scheduled as pt/therapists
    are available-you may not be able to observe at
    the time you want
  • This assignment can be completed this semester or
    during 679
  • 20 points will be added to your total in the
    semester it is completed
  • 20 points will be deducted from your point total
    in 679 if the learning activity is not completed
    by the final.

10
Observing in Low Vision Clinic
  • Clinic is located on the third floor of the
    Callahan Eye Foundation Hospital
  • Directly across the street from RMSB
  • Suite 380
  • Schedule OT clinic observations with Beth
  • Schedule Physician observations with Lee
  • 488-0736
  • Sign in and out on the clipboard each time you
    observe

11
Dress Code/Behavior
  • A professional dress code is enforced at the
    Center
  • No jeans, sandals, flip flops, excessive jewelry,
    non professional clothing
  • Cover tatoos
  • If your grandmother would be embarrassed to see
    you wearing that-dont wear it in the clinic!
  • Display respect for patients, staff at all times
  • HIPPA guidelines are enforced

12
Student Evaluation
  • Two written exams 60
  • Short answer, multiple choice
  • One practical exam 20
  • Demonstrate correct test procedure
  • Demonstrate understanding of test mechanics
  • Demonstrate understanding of test modifications
  • Learning Activities 20
  • 5 outside learning activities
  • 3 in class learning activities
  • Learning Activity 6 20 points

13
Grading Scale
  • A 90-100
  • B 80-89
  • C 70-79
  • F 69 or below

14
Dates
  • Exams
  • Exam 1 February 4th
  • Practical Exam March 4th
  • Exam 2 March 10th
  • Exam 3 April 21st
  • NO Class March 24th

15
Lecture One
  • Introduction to Low Vision Rehabilitation

16
Learning Objectives
  • Understand the role of vision in occupational
    performance
  • Understand the framework for evaluation and
    treatment of persons with visual impairment
  • Understand the characteristics and demographics
    of low vision
  • Understand how low vision rehab services are
    provided in the US

17
What does vision contribute to occupational
performance?
  • Lecture Objective 1

18
The Role of Vision in Occupational Performance
  • The overall function of the brain is to filter,
    organize and integrate sensory information to
    make an adaptive response to the environment.
  • All neural structures of CNS are devoted to
    taking in sensory input, analyzing it and
    responding to it

19
Vision is the primary sensory system used to
acquire information about the environment
  • 80-90 of all learning occurs through the visual
    channel
  • 90 of all sensory information supplied to the
    CNS is visual

20
Vision is the primary system because it is our
most far reachingsensory system
  • First to alert us to danger or pleasure
  • See a car coming straight at you
  • See your food before you taste it
  • Enables us to be anticipatory
  • Looks like its going to rain
  • And plan for situations
  • Guess Ill take along an umbrella

21
Contributions of Visual Input
  • Supplies information needed for cognitive
    processing problem solving and decision making
  • Use vision to size up situations
  • First impressions ARE important
  • Avoid persons who are acting strangely or oddly
    dressed
  • Use vision to make decisions
  • Where to sit at a meeting, what to eat at a salad
    bar
  • Facilitates problem solving
  • Want to see the problem so we can solve it
  • Visual memory of a previous event helps solve a
    new one

22
Contributions of Visual Input
  • Supplies information needed to interpret social
    interactions
  • Facial expressions convey a lot of subtle
    information
  • Supplies input for motor and postural control
  • Impetus for motor development
  • Child sees a toy and attempts to reach it
  • Warns of upcoming challenges to postural control
  • Surveys the line of travel and prepares the
    person to navigate around objects
  • Rarely collide with objects (and always surprised
    when you do)

23
Contribution of Visual Input
  • Supplies speed in information processing
  • Instantly identify objects with vision
  • Can identify with your other senses too but not
    as quickly
  • Information supplied instantly by one image on
    television would take several minutes to describe
    in print or over the radio and never have the
    same impact
  • Example Challenger or Columbia explosions, fall
    of the world trade towers

24
Contribution of Visual Input
  • That speed is critical to the ability to adapt to
    dynamic environments
  • Move in two types of environments
  • Static environment
  • Nothing moving but person
  • Must make spatial but not temporal adaptation
  • Person decides when to start and stop movement
  • Dynamic environment
  • objects are in motion independent of the person
  • Must make both spatial and temporal adaptation
  • Must match movement to movement of other objects

25
To Summarize Contributions of Vision to
Occupational Performance
26
To Summarize Contributions of Vision to
Occupational Performance
  • Anticipates/plans
  • Drives decision making
  • Interprets social interactions
  • Supplies speed in information processing
  • Dictates motor actions
  • Early warning system for postural control

27
Visual Impairment Can Occur From
  • Disease
  • Trauma
  • Aging
  • Combination of any or all of the above

28
When Visual Impairment occurs it
  • Alters the quality and quantity of visual input
    to CNS OR alters CNS ability to use incoming
    visual input
  • The result is a decrease in the ability to use
    vision for occupational performance
  • Observe deficiencies in activities dependent on
    vision for completion
  • Reading, driving etc.
  • Observe a decrease in speed of information
    processing

29
Visual Impairment.
  • Alters cognitive performance
  • Errors made because person doesnt get enough
    input and/or accurate input for decision making
  • Can cause changes in way person responds to their
    environment and daily activities
  • Anxiousness and uncertainty
  • Decreased confidence
  • Increased passivity

30
If vision is so important to occupational
performance, why is visual impairment so often
overlooked in evaluation and treatment?
31
A Because it is a hidden disability and its
symptoms are often attributed to other
causes Unless person has a white cane or a dog
guide you cant tell h/she has a visual
impairment
32
Because of the importance of vision to
occupational performance, a person with vision no
matter how limited will attempt to use vision to
adapt
33
  • Therefore it is more natural to train a person to
    use his/her available vision more efficiently
    than to learn to use sensory substitution

34
Framework for Evaluation and Treatment
  • Lecture Objective 2

35
General Approach
  • In working with patients, vision must be viewed
    as part of a unified process used by the CNS to
    adapt to the environment and circumstances
  • Not a singular, simple modality
  • Not just the ability to see the letter on an eye
    chart
  • Used with motor, cognitive, auditory, verbal,
    vestibular, memory etc to produce an adaptive
    response

36
Viewed as part of a unified process
  • A patients visual performance is not significant
    in terms of how it deviates from the norm but how
    it interferes with occupational performance
  • Whether or not a patient has a visual deficit
    that requires remediation depends on his/her life
    demands

37
  • A patient has a visual deficit if his/her ability
    to obtain and/or process visual information has
    been altered to the extent it prevents completion
    of a necessary activity of daily living
  • Viewing it from this perspective helps determine
    medical necessity
  • Determine if treatment intervention is required
    and justified

38
OT Evaluation has 4 Purposes
  • Identify the limitation in occupational
    performance
  • Link the performance limitation to the presence
    of an impairment
  • Determine if treatment is necessary
  • Identify the most appropriate treatment
    intervention

39
Criteria for Treatment Intervention
  • A person has a visual impairment that merits
    treatment intervention ONLY if it interferes with
    completion of a necessary activity of daily
    living
  • Therefore observation of the patients functional
    performance is the cornerstone of evaluation

40
Two Treatment Approaches
  • Person centered approach
  • Emphasis is on changing the person
  • Improving ability to take in and process visual
    information
  • Environment centered approach
  • Emphasis is on altering the environment to
    achieve a better person-environment fit
  • Enable the person to respond with remaining
    capabilities

41
Education of Patient and Family is a Critical
Component of Treatment
  • Education is critical to success because insight
    is critical to persons ability to adapt
  • Education is particularly important for persons
    with visual impairment because we dont typically
    question the accuracy of our vision
  • One reason why it takes a long time for persons
    in their 40s to realize that they need reading
    glasses for presbyopia

42
Goal never changes.
  • Goal is always occupational performance
  • Same as for any disability
  • Only the method changes
  • Instead of treating a patient with function
    limitations from a motor deficit, youre treating
    limitations from a visual deficit
  • You will continue to provide occupational therapy
  • This is NOT vision therapy and you are NOT a
    vision therapist or a low vision therapist
  • No such category for insurance purposes
  • Vision therapy is equated with treatment provided
    for learning disability

43
What criteria dictate whether visual impairment
will be addressed in therapy?
44
What criteria dictate whether visual impairment
will be addressed in therapy?
  • A whether visual impairment has caused a
    limitation in occupational performance

45
What is the purpose of the O.T. evaluation?
46
What is the purpose of the O.T. evaluation?
  • A To link the presence of a visual impairment to
    a limitation in occupational performance

47
What are the characteristics and demographics of
the low vision population?
  • Lecture Objective 3

48
Definition of Low Vision
  • A visual impairment severe enough to interfere
    with occupational performance but allowing some
    usable vision

49
Definition of Legal Blindness
  • Term coined by federal government to describe
    visual impairment criteria qualifying persons for
    benefits and services
  • Best corrected visual acuity of 20/200 or less in
    the better eye or
  • A visual field of 20 degrees or less in the
    better eye

50
To Experience Low Vision Place Your Low Vision
Simulator Over Your EyesBefore Viewing the Next
Slide
  • Without removing the simulator see if you can
    identify the following faces

51
(No Transcript)
52
Use of the Term Legal Blindness Creates Confusion
Regarding Low Vision
  • Persons who are defined as legally blind have
    varying degrees of vision loss ranging from
    ability to read print to no vision at all
  • Individuals who are blind are also included in
    the definition of legal blindness
  • But blindness is NOT synonymous with legal
    blindness
  • Many persons who have low vision but who are not
    legally blind have significant limitations in
    occupational performance

53
Instead of Legal Blindness
  • In an effort to establish more precise
    descriptions of visual impairment the world
    health organization established a range of visual
    impairment
  • IDC 9 codes are assigned to each level and used
    for diagnostic and billing purposes

54
WHO Visual impairment Levels ( for medical
coding)
  • Normal vision 20/20 - 20/30
  • Near normal 20/30 - 20/60
  • Moderate impairment 20/80 - 20/160
  • Severe impairment 20/160 - 20/400
  • Profound impairment 20/400 - 20/1000
  • Near blindness 20/1000 - 20/2500
  • Blind no light perception

55
What is the difference between low vision and
legal blindness?
56
  • Low vision describes the visual functioning of
    someone for whom regular eyeglasses or medical
    procedures cannot correct vision to within the
    normal range
  • Legal blindness is eligibility criterion used to
    qualify persons for services

57
Low vision is primarily an acquired condition
  • Most persons with low vision grew up, worked,
    reared their families and retired as sighted
    persons

58
Three Diseases Account for 90 of Referrals to
Low Vision Clinics
  • Macular degeneration
  • 60-90 of all referrals
  • Glaucoma
  • 13 of referrals
  • Diabetic retinopathy
  • 9, leading cause of blindness adults

59
Macular Degeneration
  • Also called
  • Senile macular degeneration
  • Age macular degeneration (AMD)
  • Age related macular degeneration (ARMD)
  • Primarily seen in Caucasians
  • NEVER results in blindness
  • At best takes only 20 of vision
  • But central vision is damaged significantly
    reducing visual acuity

60
Glaucoma
  • Often most feared because it can result in
    blindness
  • But usually can be better controlled
  • So less vision loss occurs
  • Higher incidence in African Americans

61
Diabetic Retinopathy
  • Side effect of diabetes
  • Caused by elevated and fluctuating blood glucose
    levels
  • Most dangerous
  • Can quickly lead to blindness
  • Higher prevalence in African Americans, Native
    Americans, Hispanics, Pacific Islanders

62
These Diseases Share Common Characteristics
  • Age related
  • Incidence of the disease increases with age
  • 1 out of 4 in the plus 80 age group
  • Vision loss is permanent
  • Treatment consists of management NOT cure

63
What is the leading cause of low vision in the US?
64
What is the leading cause of low vision in the
US?A Macular Degeneration
65
What population cohort makes up the majority of
people with low vision?
66
What population cohort makes up the majority of
people with low vision?A Adults over 65 years
of age
67
Low Vision Demographics
  • For persons over 70, vision loss ranks 3rd among
    chronic conditions causing a need for assistance
    in ADL
  • 2/3rds of low vision elderly have a secondary
    chronic physical impairment that affects
    occupational performance

68
Vision loss is
69
Vision loss is a womans issue
70
Vision loss is a womans issue
  • Ratio of women to men with vision loss is 21
  • Reason women outlive men vision loss is age
    related
  • Women with vision loss are more likely than men
    to live alone without in-home support available
    to them
  • Reason women outlive men

71
Vision loss is
72
Vision loss is a race/ethnicity issue
73
Vision loss is a race/ethnicity issue
  • African Americans, Hispanic, Native Americans,
    Pacific Islanders experience higher rates of age
    related vision loss than the overall population
  • African Americans are 5x more likely to
    experience glaucoma and 6x more likely to
    experience blindness from this condition
  • Experience higher rates of diabetes and as a side
    effect experience
  • Diabetic retinopathy
  • And elevated rates of glaucoma

74
Vision loss is
75
Vision loss is a socioeconomic issue
76
Vision loss is a socioeconomic issue
  • Diabetic retinopathy and glaucoma can be held in
    check with good access to quality health care and
    eye care
  • Lack of preventative care can lead to severe
    vision loss

77
Most older adults with low vision live in their
own homes
  • Despite age and impairment 70 live in their own
    home
  • The goal of O.T. is to help them age in place

78
Lecture Objective 4What two systems provide
low vision rehabilitation services in the United
States?
79
Professions Providing LVR
  • Ophthalmologists
  • Optometrists
  • Orientation and Mobility Specialists
  • Rehabilitation teachers
  • Certified Low Vision Therapists
  • Vision Teachers
  • Occupational Therapists

80
  • These professionals provide services through two
    distinct and separate systems
  • Blindness system
  • Healthcare system

81
Blindness System
  • Traditional provider of low vision services to
    older adults
  • Well developed network of private, state and
    federal services
  • Has been in existence for over 100 years with
    comprehensive services beginning after WWII
  • Uses an educational/vocational framework
  • Most appropriate for retraining veterans and
    preparing children

82
Primary Service Providers
  • Rehabilitation teachers
  • Degree in rehabilitation teaching
  • Certified by Academy for Certification of
    Rehabilitation and Education Professionals
  • Address ADLs affected by vision loss
  • Often experts in Braille, assistive technology,
    diabetic management, blind technique
  • Orientation mobility specialists
  • Masters degree in orientation mobility
  • Certified by Academy for Certification of
    Rehabilitation and Education Professionals
  • Address travel needs of persons with visual
    impairment and blindness
  • Long cane technique, dog guide
  • Some OTs obtain this masters and hold dual
    certification

83
Primary service providers
  • Certified Low Vision Therapist (CLVT)
  • Certification recently introduced and granted by
    Academy for Certification of Rehabilitation and
    Education Professionals
  • Rehab professionals with various backgrounds can
    take the exam for certification (given 2x yearly)
  • Including OT
  • Not required for OT and not a benefit to practice
  • Vision Teacher
  • Have special education degree and additional
    certification in vision
  • Work with children who have visual impairment on
    issues of literacy and inclusion in the classroom

84
Reimbursement Sources
  • Private Sector
  • Local charitable organizations will provide
    services for a certain state, city or region
  • Example Lighthouse International and Jewish
    Guild for the Blind in New York, Alphapointe in
    Kansas City etc.
  • Some have a more national agenda
  • American Foundation for the Blind
  • Services provided vary
  • Most concentrate on younger and severely visually
    impaired

85
Reimbursement Sources
  • Veterans Administration
  • Following WWII, VA played a pivotal role in the
    development of vision rehabilitation services
    especially orientation and mobility
  • Has its own network of comprehensive services
  • 5 blind residential tx centers
  • 3 blind rehab clinics
  • 3 low vision rehab centers-VICTORS
  • Services are restricted to veterans

86
Reimbursement Sources
  • State Vocational System
  • Established with Rehabilitation Act of 1973
  • Created one system for persons with disabilities
    and a separate system for blind and visually
    impaired
  • State commissions or divisions for blind
  • Focus is on working age adults, competitive
    employment
  • 1978 amendment added independent living stream of
    funding
  • Covers older adult homemaker
  • Funded at 11 million dollars for entire nation
  • Approximately 250,000 per state

87
Healthcare System
  • Services reimbursed through medical insurance
  • Requires physicians and licensed health care
    providers
  • OT, PT, Social Services, Nursing, etc.
  • Restorative not educational
  • New player in low vision field
  • Service delivery is not yet as comprehensive as
    blindness system

88
Primary Service Providers
  • Ophthalmologists
  • Medical doctors (M.D.)
  • Trained to diagnose and medically manage
    conditions causing visual impairment
  • May specialize
  • Retina
  • Glaucoma
  • Cornea
  • Vitreous
  • Neuro
  • Often have very little awareness or understanding
    of rehabilitation
  • Largely function in consultative role providing
    information on diagnosis and prognosis

89
Primary Service Providers cont..
  • Optometrists
  • 4 years of post graduate training in optometry
  • Graduate with doctorate of optometry
  • Not physicians but instead healthcare providers
    who diagnose, treat and manage conditions causing
    visual impairment
  • Provide almost 2/3rds of primary eye care
    services in the US
  • Led the development of the field of low vision
    rehabilitation
  • Occupational Therapists
  • Have always treated persons with low vision
  • Formally re-entered low vision field in 1991
  • Educational preparation is sporadic

90
Reimbursement Sources
  • Medical insurance
  • Since most persons with low vision are over age
    65, Medicare is the primary reimbursement source
  • Medicare Part B covers physicians, occupational
    therapists in private practice and employed by
    outpatient clinics
  • Medicare Part A covers home health OTs
  • Other insurances may cover depending on
    conditions for coverage
  • Workmans compensation
  • May cover services on case by case basis

91
Provision of comprehensive low vision
rehabilitation services through the healthcare
system has been occurring for just over 10 years
92
Critical Milestones in Development of LVR in the
Healthcare System
  • Prior to 1991
  • Primary providers
  • Ophthalmologists
  • Diagnosed and medically managed the diseases
    causing low vision
  • Did not provide treatment or rehab
  • Optometrists
  • Prescribed optical devices for persons with low
    vision
  • Did not receive reimbursement for training and
    had difficulty obtaining coverage for evaluation

93
in 1991..
  • HCFA (now CMS) unofficially acknowledged visual
    impairment as a physical impairment meriting
    rehabilitation
  • Enabled reimbursement for services provided by
    licensed health care providers when prescribed by
    physicians
  • Brought O.T. into the field
  • Coverage of OT services was interpreted on a case
    by case basis by regional Medicare fiscal
    intermediaries (FIs)
  • Some FIs imposed very restrictive guidelines,
    others were more lenient and generous
  • Did not cover orientation and mobility
    specialists or rehabilitation teachers
  • Not classified as licensed health care providers
  • Optometrists were not allowed to refer patients
    to OT as they were not recognized by Medicare as
    physicians

94
Between 1991 and 2002
  • Hospital based outpatient clinics opened using
    occupational therapists to provide rehabilitation
    services
  • Ophthalmologists interested in low vision served
    as the medical directors of the clinics and other
    ophthalmologists provided referrals
  • Optometrists were minimally involved because they
    could not make direct referral to OT
  • A few OTs provided services as independent
    practitioners and others provided services
    through home health agencies
  • Coverage for services varied by state depending
    on the regional Medicare fiscal intermediary
  • 26 regional fiscal intermediaries had established
    guidelines for coverage of OT services by spring
    2002.

95
May 29, 2002
  • CMS issued a memorandum outlining conditions for
    coverage of services provided by licensed
    healthcare providers
  • Set official national policy that supercedes
    guidelines imposed by regional FIs
  • Placed low vision rehabilitation services under
    the umbrella of physical medicine and
    rehabilitation services
  • Must follow the same requirements for physician
    referral and certification
  • Classified optometrists as physicians for the
    purpose of referral and certification of OT
    services
  • Set down the ICD-9 codes needed to justify
    referral for rehabilitation services
  • Suggested CPT codes for OT procedures

96
March 2003
  • CMS eased restrictions and permitted occupational
    therapists to be employed by physician practices
    and bill under their own Medicare provider number
  • OT assigns reimbursement for services over to the
    practice and is paid by practice

97
Which system is better prepared to work with
older adults with low vision?
98
Healthcare vs. Blindness System
  • Chronic shortages in funding and manpower have
    created a situation in the blindness system where
    rehabilitation services for older adults are not
    based on need but availability of resources
  • Services are generally restricted to urban areas
    (get the biggest bang for the buck)
  • Services are often limited to 1-2 show and tell
    sessions, providing person with resources and
    tips rather than comprehensive treatment
    intervention

99
Healthcare vs. Blindness cont
  • Services for older adults with vision loss are
    more easily provided for through the healthcare
    system and are the primary focus of this system
  • Funding is automatic from Medicare
  • Multiple sessions can be provided
  • Referral pattern is already established
  • Services are disseminated widely throughout the
    U.S. (compared to urban concentration for
    services provided by blindness system)

100
To SummarizeHealthcare vs. Blindness
  • Consistent, adequate funding
  • Adequate manpower
  • Elderly are primary consumer
  • Widely distributed services
  • Funding limited and often sporadic
  • Manpower shortages
  • Working age and children are primary consumers
  • Services limited to urban areas

101
Challenges Treating Elderly Through Either System
  • Elderly have multiple disabilities
  • Complicates provision of services
  • Vision issues make them appropriate for the
    blindness system but professionals in that system
    are not trained to address other physical
    disabilities
  • Their physical disabilities make elderly more
    appropriate for the aging and healthcare systems
    but professionals in that system are not trained
    to address their vision issues
  • As a result, elders with low vision often fall
    through the cracks of the two systems

102
How OT Can Bridge the Gap
  • OTs are trained to address issues of aging and
    disability
  • With training in visual impairment, OTs can meet
    the diverse needs of elders with low vision
  • Bridging the gap between the two systems
  • This ability creates the potential for great
    demand for services from OTs trained in LVR

103
OTs Entrance into LVR
  • OT has not been embraced by traditional blindness
    professionals
  • David vs. Goliath scenario
  • 2,500 traditional providers vs. 95,000 OTs
  • Afraid of losing jobs to OT
  • Has prompted traditional providers to seek better
    reimbursement and standing
  • Optometry obtained physician status for medical
    referral through technical amendment to the
    Balance Budget Refinement Act of 1999
  • Later superceded by 2002 Medicare Memorandum

104
  • Other rehab professionals, under the leadership
    of Lighthouse International (NY) persuaded Rep
    Capuano to introduce the Medicare Vision
    Rehabilitation Services Act in 1999
  • Original bill excluded OT from service provision
  • AOTA worked to have the bill rewritten
  • New bill (HR 2484)re-introduced in 2001 left OT
    coverage alone and sought coverage of O/M and
    Rehab Teachers, CLVT under supervision of
    physician
  • Bill died in committee twice before being
    reintroduced this year in both the House and
    Senate

105
November 2003
  • Bill was passed as an amendment to the Medicare
    Prescription Act
  • Orientation Mobility Specialists, Rehab Teachers
    and Certified Low Vision Therapists are now
    permitted to receive Medicare reimbursement
  • Must now qualify to receive reimbursement
  • Licensure and facility issues will have to be
    addressed
  • Will significantly alter provision of services to
    persons with low vision

106
Current OT Structure in LVR
  • No specific restrictions on treatment settings
  • Can be provided in all settings covered by
    Medicare and third party payers
  • Most programs are outpatient, hospital based but
    employment of OTs by physician practices is
    expected to increase
  • Ophthalmology is the primary referral source
  • Also expected to change as more optometrists (now
    that they can refer) begin to partner with OTs

107
OT Programs continued
  • Older adults still make up the majority of
    referrals for OT services
  • Most programs using OTs see both brain injury and
    age related diagnosis
  • Persons with visual impairment from brain injury
    are also more likely to fall between the cracks
    of the two systems
  • Medicare is currently the primary payer source
  • Will continue as long as older adults are the
    largest group of consumers
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