Ocupational performance and quality of life: interrelationships in daily life of visual impaired individuals / Desempenho ocupacional e qualidade de vida: inter-relações no cotidiano de pessoas com deficiência visual

ABSTRACT Objective: Identify levels of self-perception of occupational performance and quality of life of individuals with visual impairment and subsequent analysis of the interrelationship between the indices found. Methods: Descriptive cross-sectional survey with people with visual disabilities enrolled in visual rehabilitation program. COPM was applied to measure the self-perception of occupational performance, the SF-36 for quality of life measurement and a socio-demographic questionnaire to describe personal characteristics. Results. Twentythree subjects were included in the sample: 74% with low vision, 52.2% were female and mean age of 46.7 years. The self-perception of performance and emotional aspects domains of participants with low vision were better than those with blindness. The greater the time of visual impairment, worse was the self-perception of pain. The vitality domain showed statistical significant relationship with the domains general health, performance and satisfaction as well as the mental health domain were related to general health, pain, performance and vitality. Conclusion: The best were the mental health index, the better were the evaluations of physical, functional and social areas, a fact that indicates the importance of considering mental health in visual rehabilitation programs. The COPM and the SF-36 address the issue of functionality in different ways and their results are not compatible.

Objetivo: Identificar níveis de autopercepção de desempenho ocupacional e qualidade de vida de indivíduos com deficiência visual e posterior análise de inter-relação entre os índices encontrados. Métodos: Estudo descritivo de corte transversal junto a pessoas com deficiência visual inscritas em programa de reabilitação visual. Foram utilizados os questionários COPM para mensuração da autopercepção de desempenho ocupacional, SF-36 para mensuração de níveis de qualidade de vida e questionário de investigação sociodemográfico e perfil dos sujeitos. Resultados: Vinte três sujeitos compuseram a amostra, sendo 74% com baixa visão, 52,2% do gênero feminino e média de idade de 46,7 anos. A autopercepção de desempenho e aspectos emocionais dos participantes com baixa visão foram melhores do que os com cegueira. Quanto maior era o tempo de deficiência visual, pior era a avaliação da dor. O domínio vitalidade apresentou relação estatisticamente significativa com os domínios estado geral de saúde, desempenho e satisfação, assim como o domínio saúde mental apresentou relação com estado geral de saúde, dor, desempenho e vitalidade. Conclusão: Quanto melhores foram os índices de saúde mental, melhores foram as avaliações dos domínios físicos, funcionais e sociais, fato que indica a importância de considerar a saúde mental em programas de reabilitação. A COPM e a SF-36 abordam a questão da funcionalidade de maneiras distintas e seus resultados não são compatíveis.

Habilidades funcionais na criança com cegueira congênita: um estudo de caso / Functional abilities in children with congenital blindness: a case study

Considerando os atrasos que a ausência da visão acarreta, o trabalho de intervenção precoce torna-se um mediador essencial para que a criança com cegueira possa se desenvolver da melhor forma possível. Esta pesquisa objetivou avaliar e comparar o desempenho e a necessidade de assistência nas habilidades funcionais de uma criança cega antes e após um período de intervenção terapêutica ocupacional. Participou do estudo uma criança de um ano e seis meses, do sexo feminino, com cegueira congênita, atendida em um programa de habilitação e reabilitação em deficiência visual. Utilizou-se o Inventário de Avaliação Pediátrica de Incapacidade antes e após um período de três meses de atendimento para avaliar o desempenho das habilidades funcionais. A análise descritiva dos dados foi realizada de forma quantitativa, comparando os escores obtidos nos dois momentos de avaliação, e qualitativa pela observação dos vídeos. Houve melhora em todas as áreas das habilidades após o período das sessões, sendo possível concluir a eficácia do atendimento terapêutico ocupacional em intervenção precoce com crianças com cegueira congênita.

Considering possible delays that the absence of vision can result, the work of early intervention becomes anessential mediator for the child with blindness can develop the best possible way. This study objectived to evaluate and to compare the performance and the aid for perform the funcional habilities of a blind child before and after the treatment of occupacionaltherapy. Participated in the study a child of one year and six months, female, with congenital blindness, that receiving care in a habilitation and rehabilitation program in visual impairment. The Inventory Pediatric Evaluation of Disability has been usedbefore and after a period of three months of treatment to assess the performance of functional abilities. The descriptive analysis was performed quantitatively comparing the scores obtained in the two moments of evaluation, and qualitative in the observation of the videos. There was improvement in all areas of skills after a period of sessions, that is possible to conclude the effectiveness of occupational therapy services in early intervention with children with congenital blindness.

Visual impairment, rehabilitation and International Classification of Functioning, Disability and Health / Deficiência visual, reabilitação e Classificação Internacional de Funcionalidade, Incapacidade e Saúde

Objetive: To describe the characteristics of people with visual impairment who participated in the Visual Rehabilitation Groups, according to the ICD-10 and the International Classification of Functioning, Disability and Health (ICF). Methods: Quantitative, cross-sectional survey, developed in a university rehabilitation research center between october and december 2012. The users from the Visual Rehabilitation Groups were invited; 13 of them agreed to participate. We performed an occupational therapy evaluation – with anamnesis, performance evaluation and functional vision assessment – an analysis of medical charts and patient description with the use of the ICF Results: The major causes of visual impairment were diabetic retinopathy, glaucoma, optical neuritis and keratoconus. Some functions and structures of the body, performance and capabilities in activities and participation, environmental factors facilitators or limiters were highlighted in this study, allowing the description of the characteristics of each participant through the functionality and the improvement of the therapeutic planning. Assistive technologies, optical and non-optical aids used and their everyday benefits were presented. Conclusion: Visual loss, at any level, led to functional impairments, limiting and restricting the participation and performance in everyday activities, interfering with the individuals’ independence, autonomy and quality of life. However, the use of optical aids, non-optical aids and environmental adaptations proved to be beneficial for increasing the functionality, showing the influence of external factors on the performance. Knowing and recognizing the existence of diversities within the visual impairment universe allows us to understand who the treated individual is, avoiding the generalization by the visual condition. The ICF showed to have a fundamental role in this context. .

Objetivo: Descrever as características das pessoas com deficiência visual participantes de Grupos de Reabilitação Visual, segundo a CID-10 e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Métodos: Pesquisa quantitativa de corte transversal, desenvolvida em um centro universitário de pesquisas em reabilitação entre outubro e dezembro de 2012. Usuários de Grupos de Reabilitação Visual foram convidados, sendo 13 os que aceitaram participar. Foi realizada avaliação de terapia ocupacional – com anamnese, avaliação de desempenho e avaliação funcional da visão – consulta aos prontuários e a classificação dos participantes utilizando a CIF. Resultados: As principais causas de deficiência visual foram retinopatia diabética, glaucoma, neurite óptica e ceratocone. Algumas funções e estruturas do corpo, desempenho e capacidades em atividades e participação, fatores ambientais facilitadores ou limitadores foram destacados neste estudo, possibilitando descrever as características de cada participante por meio de sua funcionalidade e auxiliando no planejamento terapêutico. Tecnologias assistivas, auxílios ópticos e não ópticos utilizados e seus benefícios cotidianos foram apresentados. Conclusão: A perda visual, em qualquer nível, levou a prejuízos funcionais, limitando e restringindo a participação e o desempenho em atividades cotidianas, interferindo na independência, autonomia e qualidade de vida dos sujeitos. Entretanto, o uso de recursos ópticos, não ópticos, auxílios e adaptações ambientais mostraram-se benéficos para a ampliação da funcionalidade, evidenciando a influência de fatores externos no desempenho do indivíduo. Conhecer e reconhecer a existência da diversidade dentro do universo da deficiência visual possibilita entender quem é o sujeito atendido, evitando a generalização pela condição visual, tendo a CIF papel fundamental nesse contexto. .

Sokoto blind beggars: causes of blindness and barriers to rehabilitation services

To determine the causes of blindness and the barriers to accessing rehabilitation services [RS] among blind street beggars [bsb] in Sokoto, Nigeria. A cross-sectional survey of 202 bsb [VA < 3/60] using interviewer administered questionnaire. The causes of blindness were diagnosed by clinical ophthalmic examination. There were 107 [53%] males and 95 [47%] females with a mean age of 49 years [SD 12.2]. Most bsb 191 [94.6%] had non-formal education. Of 190 [94.1%] irreversibly bsb, 180/190 [94.7%] had no light perception [NPL] bilaterally. The major causes of blindness were non-trachomatous corneal opacity [60.8%] and trachoma corneal opacity [12.8%]. There were 166 [82%] blind from avoidable causes and 190 [94.1%] were irreversibly blind with 76.1% due to avoidable causes. The available sub-standard RS were educational, vocational and financial support. The barriers to RS in the past included non-availability 151 [87.8%], inability to afford 2 [1.2%], unfelt need 4 [2.3%], family refusal 1 [0.6], ignorance 6 [3.5%] and being not linked 8 [4.7%]. The barriers to RS during the study period included inability of 72 subjects [35.6%] to access RS and 59 [81.9%] were due to lack of linkage to the existing services. Corneal opacification was the major cause of blindness among bsb. The main challenges to RS include the inadequate services available, societal and users factors. Renewed efforts are warranted toward the prevention of avoidable causes of blindness especially corneal opacities. The quality of life of the blind street beggar should be improved through available, accessible and affordable well-maintained and sustained rehabilitation services.

Autonomia pessoal e social de pessoas com deficiência visual após reabilitação / Personal and social autonomy of visually impaired people who were assisted by rehabilitation services

Objetivo: O objetivo deste estudo visou identificar e analisar criticamente a autonomia pessoal e social de pessoas com deficiência visual (cegueira) após passarem por serviços de reabilitação em uma única instituição especializada. Métodos: O método utilizado na pesquisa possuiu enfoque qualitativo, através da organização de questionários e entrevistas para a coleta dos dados. Foram sujeitos deste estudo pessoas com deficiência visual (cegueira), que passaram pela reabilitação, e os respectivos familiares que acompanharam o processo. O estudo envolveu seis pessoas com deficiência visual, egressos da Unidade para Reabilitação de Deficientes Visuais - URDV entre os anos de 2002 a 2009, além dos seis familiares, correspondendo um para cada pessoa com deficiência visual. Resultados: Os resultados da pesquisa indicam que a reabilitação proporcionou alternativas para mudanças determinantes para as pessoas com deficiência visual em seu contexto social. Conclusão: A pesquisa evidenciou que a conquista, ou a reconquista da autonomia pessoal e social dessa população foi alcançada, propiciando, consequentemente, uma melhor qualidade de vida.

Objective:This study aims to identify and critically examine the personal and social autonomy of visually impaired people (blindness) after undergoing rehabilitation services in a single specialized institution. Methods: The method used in the study possessed qualitative approach, by organizing interviews and questionnaires to collect data. Study subjects are visually impaired people (blindness), who went through rehab, and their family members who accompanied the process.. The study involved the six people with visual impairments, graduates of the Unit for Rehabilitation of the Visually Impaired - URDV between the years 2002 and 2009, and six family members, one member to each person with visual impairment. Results: The survey results indicate that rehabilitation provided alternatives for determining changes to people with visual impairments in their socialcontext. Conclusion: This research showed that the conquest or reconquest of personal and social autonomy of this population was reached, providing thus a better quality of life.

The economic burden of blindness in Pakistan: A socio-economic and policy imperative for poverty reduction strategies.

State and nonstate health programs in developing countries are often influenced by priorities that are defined in the Millennium Development Goals (MDGs). In the wake of recessionary pressures, policy makers in the health sector are often seen to divert significant budgets to some specific health programs and make only token allocations for other health problems that are important but do not fall under the traditional MDG box of health priorities. This paper illustrates the economic argument for investment in one such program: The eye health program and employs a country case study of Pakistan to demonstrate that there are significant economic gains that are being foregone by not addressing the needs of the blind in poverty reduction strategies. By applying appropriate growth and discounting factors and using the average wage rate, the paper estimates the total productivity gains that are realizable over a period of 10 years if the blind population in Pakistan is rehabilitated and their carers released to participate in the mainstream economic activity. Our findings indicate that significant productivity gains accumulated over 10 years, range from 61 billion (US$ 709 million) to 421 billion (US$ 4.9 billion) depending upon whether the entire blind population or only those affected by a specific cause are rehabilitated. The per annum productivity gains of rehabilitating the entire blind population represents 0.74% of the current gross domestic product of Pakistan, which is higher than the total public spending on health. In order to reap these benefits, the subsequent absorption of the rehabilitated blind and their carers into mainstream economic activity is as important as their effective rehabilitation.

Diabetic retinopathy and visual disabilities among patients in a rehabilitation program / Retinopatia diabética e deficiência visual entre pacientes de programa de reabilitação

OBJECTIVE: To assess the prevalence of diabetic retinopathy and to evaluate the management of patients with visual disabilities attending at the CEPRE Rehabilitation Program of University of Campinas. METHODS: A retrospective study was carried out based on medical records of patients with visual disabilities attending a vision rehabilitation program. The following variables were studied: gender, age, marital status, level of schooling, social security status, origin, type and cause of visual disability and vision rehabilitation actions. RESULTS: The sample consisted of 155 patients, 55.5 percent males, aged between 12 and 88 years, mean age 41 years old, 34.8 percent were blind and 65.2 percent with low vision disability. Of those blind patients, 81.8 percent reported acquired blindness, and the leading cause was diabetic retinopathy (33.3 percent), followed by glaucoma (16.6 percent), and retinal detachment (15.0 percent). Of those patients with low vision disability, 14.9 percent had diabetic retinopathy, 14.9 percent hereditary syndromes, and 10.9 percent age-related macular degeneration. Vision rehabilitation therapy included interdisciplinary team consultations helping patients go through the mourning process for the loss or impairment of vision, and promoting the enhancement of their skills for performing activities of daily living independently. The management of patients with low vision was also focused on vision rehabilitation. CONCLUSION: The health of the eyes of patients with chronic diseases such as diabetes is at risk. The prevalence of diabetic retinopathy was found to be a cause for visual disability, suggesting the need to assess these patients' access to health care and rehabilitation and promote health education for changing habits and improving quality of life.

OBJETIVO: Verificar a prevalência da retinopatia diabética e as condutas desenvolvidas entre deficientes visuais atendidos pelo Programa de Reabilitação no CEPRE da Universidade Estadual de Campinas. MÉTODOS: O estudo retrospectivo transversal foi desenvolvido a partir da análise de prontuários de pacientes que participaram do programa de reabilitação de deficientes visuais, considerando-se as variáveis: sexo, idade, estado civil, escolaridade, situação de seguridade, procedência, tipo e a causa da deficiência visual e condutas reabilitacionais. RESULTADOS: A casuística constou de 155 pacientes, 55,5 por cento do sexo masculino, faixa etária entre 12 e 88 anos, média de idade de 41 anos, 34,8 por cento cegos e 65,2 por cento com baixa visão. Dos cegos, 81,8 por cento tinham cegueira adquirida, sendo a retinopatia diabética (33,3 por cento) a causa prevalente da cegueira, seguida por glaucoma (16,6 por cento) e descolamento de retina (15,0 por cento). Dos pacientes com baixa visão, 14,9 por cento apresentavam a retinopatia diabética e síndromes hereditárias somaram 14,9 por cento, seguido pela degeneração macular associada à idade (10,9 por cento). As condutas reabilitacionais desenvolvidas para os pacientes com deficiência visual constaram de atendimentos com equipe interdisciplinar propiciando a elaboração do luto pela perda ou diminuição visual, potencializando as habilidades para o desempenho independente e autônomo nas atividades do cotidiano. Entre os pacientes com baixa visão, as condutas enfocaram a reabilitação visual. CONCLUSÃO: Doenças crônicas como o diabetes constituem risco para a saúde ocular. Destacou-se a prevalência da retinopatia diabética entre as causas da deficiência visual, indicando a necessidade de se avaliar o acesso ao atendimento médico e às ações de reabilitação e educação em saúde favorecendo as mudanças de hábitos e qualidade de vida dos pacientes.

Ocular status and functional adaptation of visually challenged children of a special school in Oman

We assessed the ocular status and visual adaptation among children studying at a school for visually disabled children in Muscat, Oman. This descriptive study was conducted in 2009-2010. We assessed the visual and ocular status of the participants. They were interviewed to elicit the past history of eye problems and management. They also expressed their visual adaptation in their 'day-to-day' life, and their ambitions. We examined and interviewed 47 participants [29 male and 18 female]. The mean age of the participants was 19.7 years [Standard deviation 5.9 years]. Twenty-six of them were blind since birth. Phthisical eyes, disfigured eyes and anophthalmic sockets were noted in 19, 58, and six eyes of participants. Twenty-six [55.5%] participants had visual disabilities due to genetic causes, since birth. In 13 participants, further investigations were needed to confirm diagnosis and determine further management After low vision training, 13 participants with residual vision could be integrated in the school with normal children. One participant was recommended stem cell treatment for visual restoration. Five children were advised reconstructive orbital surgery. The participants were not keen to use a white cane for mobility. Some participants, 16 / 28 [57%], with absolute blindness, were not able to read the Braille language. Singing and playing music were not very well-accepted hobbies among the participants. Nineteen participants were keen to become teachers. Children with visual disabilities need to be periodically assessed. The underlying causes of visual disabilities should be further explored to facilitate prevention and genetic counseling. Participants had visual adaptation for daily living and had ambitions for the future

Are current guidelines for categorization of visual impairment in India appropriate.

Context: Visual disability in India is categorized based on severity. Sometimes the disabled person does not fit unambiguously into any of the categories. Aims: To identify and quantify disability that does not fit in the current classification, and propose a new classification that includes all levels of vision. Settings and Design: Retrospective chart review of visual disability awarded in a teaching hospital. Materials and Methods: The last hundred records of patients who had been classified as visually disabled were screened for vision in both eyes and percentage disability awarded. Data were handled in accordance with the Helsinki Declaration. Results: Twenty-one patients had been classified as having 30% disability, seven each had 40% and 75%, and 65 had 100% disability. Eleven of them did not fall into any of the current categories, forcing the disability board to use its own judgment. There was a tendency to over-grade the disability (seven of 11; 63.6%). The classification proposed by us is based on the national program for control of blindness' definition of normal vision (20/20 to 20/60), low vision (<20/60 to 20/200), economic blindness (<20/200 to 20/400) and social blindness (<20/400). It ranges from the mildest disability (normal vision in one eye, low vision in the other) up to the most severe grade (social blindness in both eyes). Conclusions: The current classification of visual disabilities does not include all combinations of vision; some disabled patients cannot be categorized. The classification proposed by us is comprehensive, progresses logically, and follows the definitions of the national program.

O oftalmologista e o paciente deprimido: situações frequentes e condutas / The ophthalmologist and the depressive patient: common situations and it's management

Os objetivos deste trabalho foram os de alertar o médico oftalmologista para os sintomas da doença depressiva e dos quadros oculares que podem se associar a ela, principalmente, de lembrar a import6ancia do encaminhamento de pacientes deprimidos portadores de cegueira ou com baixa visão para os centros de resdaptaçào. Nesses centros procura-se reabilitar o paciente em sua profissào anterior ou orientá-lo para uma nova atividade visando reintegrá-lo no convívio social. O trabalho revela ainda como a depressão interferena readaptação desses pacientes.

Quality of life after community-based rehabilitation for blind persons in a rural population of South India.

This study aimed to determine the impact of community-based rehabilitation on the quality of life of blind persons in a rural south Indian population. We performed a population-based survey followed by clinical examinations to identify blind persons in a rural south Indian population. Pre-and-post rehabilitation quality of life of 159 blind persons aged 15 years or above was ascertained through a questionnaire previously validated for use in this population. Post-rehabilitation quality-of-life scales showed some improvement for 151 (95.0%) subjects. The additional benefit from rehabilitation was greatest for the self-care and mobility subscales, ranging from 24.6% to 30.0% for the self care subscale and 37.6% to 44.3% for the mobility subscale with effect sizes of 21.5 and 2.38 respectively. Overall quality of life scores were not significantly different between those who did and did not receive economic rehabilitation (P = 0.1). Blind persons in this rural population benefited considerably from rehabilitation services even if economic rehabilitation is not provided. Initiatives against blindness need to consider rehabilitation of the blind as a priority.

Campanha nacional de prevencao de cegueira e reabilitacao visual do idoso: 1996 / Health promotion of blindness prevention and visual rehabilitation in aged: 1996

A catarata e considerada a principal causa de cegueira nos paises em desenvolvimento e a cirurgia e o unico meio de reabilitacao visual. A Campanha Nacional de Prevencao de Cegueira e Reabilitacao Visual do Idoso (1996) foi organizada em duas etapas: a fase Preventiva, onde mais de 2000 oftalmologistas, voluntariamente, proferiram palestras sobre cuidados em saude ocular para 10 milhoes de pessoas, em cerca de 500 cidades brasileiras; e a fase Reabilitacao Visual, onde foram triadas 452 mil pessoas com mais de 50 anos e 30 mil pessoas reabilitadas com prescricao e doacao de oculos e com cirurgias de catarata. O objetivo da Campanha e promover a reintegracao do idoso na sociedade e ressaltar a importancia da realizacao de projetos desta finalidade

Causas e características do trauma ocular perfurante em Botucatu - SP / Causes and characteristics of perfurant ocular traumas in Botucatu - SP

O trauma ocular perfurante é importante causa de cegueira prevenível. Há necessidade de conhecer suas causas para tomada de medidas preventivas. Para tal, avaliamos os traumas perfurantes atendidos no H.C. da FMB-UNESP, nos últimos 5 anos. Observamos que a maioria dos caos ocorreu em indivíduos masculinos 73 (por cento), crianças e adultos jovens, em atividades domesticas 77,92 (por cento), geralmente provocados por objetos metálicos 40,54 (por cento), sendo mais frequente a perfuraçäo corneoescleral 46,75 (por cento). A gravidade do trauma perfurante é constatada pelo número expressivo de cegos (AV menor que 0,1) no final do tratamento

Imprensa Braille / Braille Press

Artigo histórico sobre a invençäo do método Braille para escrita e leitura destinado a cegos

O papel do oftalmologista numa equipe multidisciplinar para a habilitaçäo de crianças deficientes visuais / The role of the ophtalmologist in the children's visual rehabilitation

Em virtude da grande necessidade da criaçäo de serviços voltados para o atendimento de pacientes com baixa visäo, e da crescente conscientizaçäo dos profissionais das áreas da saúde e educaçäo relacionadas à deficiência visual a participaçäo do oftalmologista em equipes multidisciplinares é cada vez mais urgente. Diagnósticos e avaliaçöes completas forneceräo dados de extrema importância aos habilitadores, assim como a melhora da utilizaçäo da visäo residual e a análise das verdadeiras necessidades visuais da criança, complementam a conduta do médico