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Vision Rehabilitation Therapists Awareness Week Commemorates Anne Sullivan’s Birthday

by Steve Kelley, CVRT

New Date for Celebration of Vision Rehabilitation Therapists Awareness Week

This year marks a change of date for Vision Rehabilitation Therapist (VRT) Awareness Week. In the past, the week of Helen Keller’s birthday, June 27th was the highlight of this commemoration. For 2015 VRT Awareness Week will take place, April 12-18, the week of Anne Sullivan’s birthday, which was April 14.

Helen Keller and Anne Sullivan Macy formal portrait. Keller is seated in front of Macy. With her left hand, Keller holds her teacher's right hand, circa 1893

Commemorating Anne Sullivan

Commemorating Anne Sullivan, Helen Keller’s teacher, as part of VRT Awareness, is a natural fit for the profession. Ironically, it’s been my observation that most individuals outside our profession have no idea what a Vision Rehab Therapist does, yet most people, of all ages, know that Anne Sullivan was a great teacher for her pupil, Helen Keller who became deaf-blind following a serious illness when she was 19 months old.

Teacher Preparation

In 1887, Anne Sullivan was a recent graduate from the Perkins Institute for the Blind (now called Perkins School for the Blind or Perkins International) in Watertown, Massachusetts when she traveled to the Keller home in Tuscumbia, Alabama. At that time, she may have been considered a "Home Teacher" for her new student, 7 year-old Helen. “Home Teacher” was one of the earliest occupational titles for vision rehabilitation professionals, and were individuals who traveled to consumer’s homes to teach skills related to vision loss, such as Braille, reading embossed books, crafts, and other activities we might call Adapted Daily Living skills today.

Often, home teachers were blind or visually impaired themselves, as was the case with Anne Sullivan. Sullivan herself lost much of her vision in early childhood from an eye disease called Trachoma. As an adolescent, she regained enough vision from a surgical procedure to read print again, but would remain visually impaired the rest of her life.

Professional preparation for VRTs is much different today, than in Sullivan’s time, often including a Master’s Degree and national certification through the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP). Sullivan’s preparation for teaching included her 6 years of schooling at Perkins, and studying the successful work Dr. Howe (former director of Perkins) undertook with another Perkins student, Laura Bridgman, who was also deaf-blind. Bridgman was a resident at Perkins during the time Sullivan was a student so she was experienced communicating with her. Perhaps even more important experiences for teacher training, however, were the life lessons Sullivan learned growing up in profound poverty. The eldest child of Irish immigrants who fled the potato famine, she found herself at 10 years old caring for her younger brother Jimmie after her mother died and father abandoned the family. Nearly blind, and with no formal education, she and Jimmie were taken to the Tewksbury Almshouse (Massachusetts), where her brother died shortly after their arrival. It was surely these lessons that helped Sullivan develop her persistence, creativity, and efficacy as a teacher.

Setting the Precedent for Vision Rehabilitation Professionals

Over the years, there has been considerable debate about some of the facts surrounding Helen’s acquisition of skills and the details of Sullivan’s teaching methods. Much of this has to do with abridged letters in Keller’s autobiography from Sullivan to her former teacher and mentor Mrs. Sophia Hopkins, and Perkins Director Michael Anagnos. Regardless of the specifics it is evident that Sullivan’s efforts as a teacher were creative and focused on the goals of the student.

In the following quote from the Perkins History Museum page on Anne Sullivan, it is clear that Sullivan set a precedent for the vision rehabilitation professionals who followed, that recognized the importance of meeting the student wherever they are and focusing on their goals: "It was not long before Sullivan realized that the rigid routine did not suit her exuberant and spontaneous young pupil. Never one to be limited by rules, Sullivan abandoned the prescribed schedule and shifted the focus of her teaching. Sullivan decided to enter Helen's world, follow her interests and add language and vocabulary to those activities"

No doubt, the specifics of this debate will have some historical merit, but will not influence our recognition of Anne Sullivan's great teaching ability and lifelong dedication to her student, Helen Keller. It is for this reason that the VRT Recruitment and Retention Committee has selected the week of Sullivan's birthday to further recognize one of the pioneer teachers in vision rehabilitation therapy!


Topic:
Personal Reflections

Preparing for the 2015 White House Conference on Aging: Highlights of the Phoenix Conversation on Aging and Vision Loss

picture of group of people of all ages and cultures

On April 8, 2015, a large group of older individuals with vision loss, family members, service providers, eye care specialists, policy makers, and researchers gathered in the same room in Phoenix, Arizona, during the American Foundation for the Blind Leadership Conference. The purpose of the gathering was to hold a “conversation about aging and visual impairment” to discuss issues to be raised at the upcoming White House Conference on Aging (WHCOA) to be held in July, 2015.

White House Conference to Be Held July, 2015

How fitting that the conference will be held in July, the month that symbolizes independence in this country. How sad that what the conversation in Phoenix highlighted was the lack of independence that older persons with visual impairment experience on a daily basis and in a variety of ways. Even sadder is the fact that these same concerns were voiced at a similar meeting one decade ago.

Highlights of the Phoenix "Conversation on Aging and Vision Loss"

At the Phoenix meeting, a representative of the Department of Health and Human Services, Melissa Stafford Jones, was on hand to speak about the White House Conference and its purpose. She stayed to hear some of the comments brought up from the presenters and the audience.

Rebecca Sheffield, policy researcher from AFB, led the meeting and reviewed the overall themes, garnered from an online survey that AFB structured to gather input on the issues that the WHCOA will be addressing.

Cross-cutting Themes from Survey Input

Quality of Life

Older Americans want to be sure that policies and programs are designed to prioritize not just the years in one’s life, but also the life in one’s years.

Supports to Age-in-Place

Most older Americans prefer to live in their homes and their home communities to the greatest extent possible.

Transportation and Pedestrian Access

Vision and health issues for aging Americans often mean that they need new options for transportation. Public transportation and walkable communities are important for ensuring that older Americans maintain the freedom to travel when and where they want.

General Accessibility of Commonly Used Items

Consumer electronics are increasingly relying on touch-screen and flat-screen displays. Manufacturers and designers should consider the needs of older Americans, including older people with vision loss, and should design products with accessible features and options.

Public Awareness

The general public needs to be better informed about vision loss, the rights of people with visual impairments, and the possibilities and preferences of older Americans with vision loss.

More Trained Professionals

As the population of older Americans with vision loss is growing, there is a pressing need for professionals, including orientation and mobility specialists, vision rehabilitation therapists and teachers, gerontology specialists, etc.

Supports in Rural Areas

All of the above-listed issues are even more difficult for people in rural areas. Access to programs and services, especially transportation, is a major limiting factor in many rural areas of the United States.

Themes Voiced at the Phoenix Meeting

Head shot of Dr. John Crews

The audience also heard from Dr. John Crews, Health Scientist at the Centers for Disease Control, who laid out a bleak picture about the numbers of people who will be experiencing eye conditions such as macular degeneration as well as the additional types of health issues they will be having. Dr. Vladimir Yevseyenkov, a low vision optometrist and associate professor at Midwestern State University, presented his concerns about the lack of coordinated service delivery between eye care professionals and the rehabilitation field and how that affects his patients in robbing them of low vision devices that can help them carry out everyday tasks such as reading. Deborah MacIlroy, Assistant Program Manager, Arizona Rehabilitation Services Administration, discussed the issues and concerns that older clients of her agency experience related to all aspects of independence from managing medications, to transportation to economic security.

Consumers with vision loss brought up personal concerns related to both independence and interdependence. Themes were similar to those raised by online survey respondents reported above. To summarize: A major area of concern was obtaining reliable assistance with managing financial and other concerns, managing medications, obtaining transportation for social, shopping, and medical needs. Financial considerations raised included having to retire early due to vision problems and having enough money to make ends meet. Participants also expressed concerns about obtaining low vision and equipment that make living with vision loss more manageable, waiting lists for services and lack of trained personnel, lack of funding for services, lack of coordination between the medical community and rehabilitation services, lack of understanding on the part of the eye medical community including doctors who discount patient concerns because they do not understand the impact of vision loss, and the need for public education and education of service providers such as assistive living staff and other aging service providers.

Dr. Crews summed up the frustrations of the participants observing, "Support systems value everyday things." The feedback at the conference and through the survey brought home the fact that we are sadly lacking in “valuing everyday things” when it comes to our nation’s older population with vision loss.

Tell Us What You Think

What do you think? Do any of these concerns resonate? Please take time to complete AFB’s online survey. AFB will be compiling all of the survey data and results in the meeting in Phoenix to send to the White House Conference on Aging for their consideration. We need your voice and your advocacy.


Topics:
Planning for the Future
Personal Reflections
Aging

Diabetes and the Significance of the A1C Test

Editor's note: This post is the second in a series that Audrey Demmitt, R.N., is writing on diabetes. Her first addressed the importance of diabetes education in lowering your A1C and the risk of diabetic retinopathy.

How Diabetes Is Diagnosed

When teaching people with diabetes, I encourage them to 'know their numbers' and use them to better manage their diabetes. Let's take a look at the A1C and why it is an important number. Diabetes is a complex condition to diagnose and manage. In the early stages there are no symptoms and in the long term, there can be devastating effects on every system in the body. Prevention, early detection, and vigilant management are key factors in reducing diabetes complications such as blindness and blood vessel disease. The A1C blood test, also known as glycated hemoglobin, hemoglobin A1C and HbA1c, is the primary tool used to diagnose diabetes and pre-diabetes and to monitor blood glucose control in people with type 1 and type 2 diabetes. This test enables health care providers to diagnose diabetes and treat it before complications occur and to diagnose pre-diabetes so as to prevent or delay the development of type 2 diabetes. Below are the established A1C levels used to diagnose diabetes and pre-diabetes:

Diagnosis A1C level
Normal below 5.7 percent
Pre-diabetes5.7 to 6.4 percent
Diabetes 6.5 percent or above

lab tech examines vial of blood image credit to National Eye Institute

What Does the A1C Measure?

The A1C test reflects a person’s average blood glucose, or sugar in the blood for the past three months. When glucose enters the bloodstream, it attaches itself to hemoglobin, a protein in red blood cells. The A1C test measures what percentage of your hemoglobin is coated with sugar or "glycated." A normal A1C is below 5.7 percent. This number represents an average of all the ups and downs in blood glucose levels as if recorded on a video camera over the past many weeks. The higher the A1C, the higher the blood glucose levels have been over time and the higher your risk is for diabetes complications.

How Does the A1C Compare to Other Blood Glucose Tests?

There are several other traditional blood glucose tests which are used to diagnose and manage diabetes: the fasting and random blood glucose tests, the glucose tolerance test, and the self-monitoring home glucose test. These can be thought of as snapshots, measuring the blood sugar level in a moment of time or day to day. Normal blood glucose levels range from 80-100mg/dL (milligrams per deciliter), fluctuating throughout the day in response to food, activity, medication, illness and stress. Daily readings are interpreted in the short term to monitor blood sugar changes. It is helpful to do daily testing and record the values to reveal patterns and responses so that corrective actions can be taken and adjustments can be made to the daily care plan.

In contrast, A1C is a long term average of blood glucose levels and gives a "big picture" perspective on how well you are doing in controlling daily blood sugars. It can be useful in evaluating the overall success of the treatment plan, your daily efforts and the efficacy of medications.

How Does the A1C Relate to My Daily Blood Sugars?

Your A1C can be converted to a number that is expressed in the same terms as your daily blood glucose readings. This is called "estimated average glucose" or eAG. For example, an A1C of 7 percent is equivalent to an estimated average glucose (eAG) of 154 mg/dL, reflecting blood sugars that may have ranged between 180 and 140 mg/dL over the past three months. The A1C/eAG is not the same as the average blood glucose you may see on your meter since it is an average of all the blood sugar levels - not just the ones you may have recorded on your meter. The average blood glucose reported on your meter is likely to be lower than your actual A1C/eAG. Maintaining blood sugars as close to normal range as possible is the goal to reduce risks and complications of diabetes. When daily blood sugars are kept in optimal range, the corresponding A1C will also be optimal. Below is a table with conversions of A1C levels to eAG.

A1C in percent eAG in mg/dL
6 126
7 154
8 183
9 212
10 240
11 269
12 298

(Source: Adapted from American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37(Supp 1):S14–S80, table 8.)

How Often Should my A1C be Tested?

The American Diabetes Association (ADA) recommends you have the A1C test twice a year if your blood sugars are stable and you are meeting your treatment goals. Health care providers may repeat the A1C test as often as four times a year if there are changes in treatments or you are not meeting your A1C target. The A1C is like a report card on how well you are managing your diabetes.

What Should My Target A1C Be?

People will not have the same A1C target. It will depend on your individual diabetes history and general health. You and your doctor need to discuss this and set goals that are appropriate for your situation. The ADA suggests a target A1C below 7%. Research shows that keeping A1C levels below 7 percent can reduce complications of diabetes. But an A1C of 7 percent or below may not be safe or realistic for everyone. Less strict control may be suitable for the elderly, those who experience severe hypoglycemic (low blood sugar) episodes or those who already have advanced diabetes complications, for instance. People who are younger and have had diabetes for a shorter time may have a target A1C of 6.5% or below, according to the ADA recommendations. The key is to make sustained daily efforts to achieve the target that is best for you.

How Can I Meet My A1C Target?

Managing diabetes requires a lifestyle of healthy self-care practices. The keys to bringing down A1C levels are the same as for bringing down blood sugar levels. The essentials are:

  1. Taking the right medications at the right times and in the proper doses. Work with your doctor to evaluate your medications periodically so they can be adjusted when needed. Since diabetes is a progressive disease, it is likely that you will need to increase and/or add to your glucose-lowering medications over time.
  2. Eating the right portions of fruits, vegetables, whole grains, low-fat dairy and healthy fats. A diet rich in fiber has been linked to lower blood sugar levels. You may want to learn more about counting carbohydrates and portion control. Eat about the same amount of carbs at each meal and at the same times each day. Ask a dietician to help you create a meal plan that will help control your weight and A1C.
  3. Increasing daily physical activity. Engage in at least 30 minutes of moderate exercise like brisk walking 5 days a week and strength training 2 days a week. Find ways to move more and incorporate activities you enjoy into your day.
  4. Managing stress and depression. Negative emotions, depression and diabetes burnout can make following your treatment plan difficult. If you are finding it hard to cope with diabetes, let your doctor know and enlist the support of a loved one. There are many resources to help you.

Additonal Resources

By making daily efforts to stick to your treatment plan and making healthy lifestyle changes, you can achieve your A1C goal, avoid long term complications, and live well with diabetes. Here are some additional resources:

American Diabetes Association Living with Diabetes

National Institute of Diabetes and Digestive and Kidney Disease A1C Test

Mayo Clinic Tests and Procedures

Diabetic Living Online

Information about Diabetic Retinopathy

Diabetes Guides Following Seven Self Care Behaviors


Topic:
Diabetes and diabetic retinopathy

Don't Let Consumer Fraud Fool You

This is not an April Fool's joke! April is Financial Literacy Month as well as that time of year that we think of (shudder) paying taxes! Speaking of taxes, IRS has put out a list of 2015 scams of which you need to be aware. Among them are phone, phishing, and identify theft. You may also be interested in VisionAware's tax guide.

AFB's Partnership with the Consumer Financial Protection Bureau

To help consumers, family members, and professionals in the field, the U.S. Consumer Financial Protection Bureau (CFPB) has partnered with the AFB eLearning Center to provide a free webinar on tools you can use to protect yourself from financial fraud. Their tools include information and help for consumers and professionals. Below are a few of the tools and services they offer, but be sure to listen to this free, archived webinar. A transcript and accessible slide show accompany it. You will need to sign up to take the webinar, but there is no fee. Note: You can sign up as a guest to avoid using a credit card.

Office for Older Americans

This office helps consumers aged 62 and older get the financial education and training they need, basically for two purposes:

  1. First, to prevent unfair, deceptive, and abusive practices aimed at seniors such as financial exploitation and scams and
  2. Second, to help seniors make sound financial decisions as they age
money smart guide cover

One of the products that this office offers in conjunction with the Federal Deposit Insurance Corporation (FDIC) is a guide entitled: "Money Smart for Older Adults." The guide is offered to consumers and as a training program as well for providers of senior services. It is also available in Spanish. There are seven segments:

  • Common Types of Elder Financial Exploitation
  • Scams Targeting Veterans
  • Identity Theft
  • Medical Identity Theft
  • Scams that Target Homeowners
  • Planning for Unexpected Life Events
  • How to Be Financially Prepared for Disasters

Another important initiative of this office is the creation of a set of four, user-friendly, how-to guides for fiduciaries (people named to manage money or property for someone else). There are four types with a separate guide for each: agents under powers of attorney; court-appointed guardians of property; trustees under what we call revocable living trusts; and then government fiduciaries—and those would include Social Security representative payees and VA fiduciaries.

Office of Financial Empowerment

The Bureau's Office of Financial Empowerment has a toolkit "Your Money, Your Goals", that contains financial education modules and tools that are specifically geared to meet the needs of low-income and underserved populations. It is primarily to train social services workers and others who work directly with low-income and economically vulnerable consumers.

Consumer Complaints

CFPB has built a very robust set of resources and tools that are available at their website. There you can check out their computer complaint database, and Ask CFPB. You can also Tell Your Story, which is a way to help CFPB spot issues in the financial markets, illustrate challenges people are having, uncover insights into the products and services you depend on, and identify and fix problems before they become major issues.

Another great service is the ability to submit a consumer complaint online, or by calling 855-411-2372. When complaints come in CFPB checks them for completeness and confirm whether or not it's within our jurisdiction.

Companies have 15 days to provide a substantive response to CFPB. We're expected to close all but the most complicated complaints within 60 days. When that initial response is received from the company, consumers can then provide feedback about the company's response and either accept it or dispute it.

Again, here is the information for signing up for the webinar.

Have you been the victim fraud? Comment below.

Additional Resources

Money Management

Dealing with Identify Theft. This is a three-part series.

How I Keep My Hands on My Money


Topic:
Public Policy

National Reading Month: Reading with Visual Impairment, Part II

by Steven Kelley, CVRT, VisionAware Contributor

Books flying into a tablet (metaphor for ebooks).

Continuing our discussion of reading options, let’s look at some of the reading alternatives available today.

Lighting

If you have low vision, lighting is a critical component of reading. VisionAware has lots of information on this topic, including a video series entitled Better Lighting for Better Sight. This series by Bryan Gerritsen, CLVT, covers types of lighting as well as proper positioning of lighting. Positioning of the light source is as important as the type of light you use for a task

Magnification

You may find that regular size print, such as newspaper print, is readily accessible again with some magnification. There is a much greater choice and strength of magnifying devices (optical or electronic) than what you find in the local pharmacy or big box store. Before buying anything, consider getting an vision assessment from a low vision doctor, certified low vision therapist (CLVT) or certified vision rehabilitation therapist (CVRT) to help determine which device might be most useful for your reading needs.

A good quality handheld magnifier with LED light is just one possible solution for magnification. Desktop and handheld video magnifiers (CCTVs) are also very useful particularly if changing the color of text from black on white to white on black or other color combinations makes it easier to read. Additionally, some of the newer video magnifiers incorporate text-to-speech, permitting the device to read printed material out loud. Also, a comprehensive list of resources for magnification may be found on the Library of Congress website.

Talking Books

If you have a loss of vision, or other disability that affects your ability to read, you may qualify for the National Library Service (NLS) Talking Book Program. Applications may be requested over the telephone by calling 1-888-657-7323 or on the NLS website. Consumers eligible for NLS Talking Books receive an easy-to-use digital audio player, and audio books are mailed to subscribers through postal delivery. Each delivery contains a reusable shipping box with return postage provided. Books and magazines may be ordered based on a preferred genre such as westerns or romance, or by a specific title. One of the best features of this program is that there is no cost to eligible consumers!

The NLS Talking Book program does not require access to a computer to use. If, however, consumers have access to a computer or Apple iDevice (iPad, iPod, or iPhone) books and magazines may be downloaded directly from the National Library of Congress BARD website.

If you are an Apple iDevice user, the free app called BARD Mobile will allow you to download and listen to books within minutes. The controls on the app look very similar to what you use on the actual NLS Talking Book player, so it is an easy app to learn to use. And, for other tablet and smartphone users, a BARD app will be coming for Android devices very soon!

Newspapers

  1. One of the simplest ways to regain access to the newspaper may be through a local or state Radio Reading Services. Typically, this type of service is accessed through a radio receiver provided by the reading service or through a secondary audio channel available from a local cable service. Increasingly though, consumers may access reading services through a computer or tablet connected to the Internet. Newspapers and magazines are often read by human readers, and listeners tune in at a specific time to hear the broadcast of their favorite newspaper or section, such as editorials or obituaries. For more information about a reading service in your area, contact the International Association of Audio Information Services online or by calling 1-800-280-5325.
  2. Using a computer or tablet connected to the Internet, two services in particular offer great access to a wide variety of publications: AIRS LA, and iBlink Radio. AIRS LA offers a number of national newspapers and magazines archived as audio files or "podcasts" that may be downloaded and played on a variety of devices. iBlink Radio offers a menu selection titled "Reading Services" with a comprehensive listing of state reading services that may be played using a Mac, tablet or smartphone. Both AirsLA and iBlink Radio offer free apps that will work with both Apple iDevices or Android devices.
  3. Another option for newspaper reading in many states is the National Federation of the Blind (NFB) Newsline. NFB Newsline provides access to newspapers for both high tech, and low tech consumers with a vision loss. There is no cost to the subscriber as costs are covered by grants,donations, or state rehabilitation funding. At the most basic level subscribers may use a landline telephone (no smartphone required!) to dial a local number or toll free number. The dialing pad on the phone is used to select reading options, such as the newspaper, section, reading speed, etc. Unlike the radio reading services, however, most of the newspapers on Newsline are read by text-to-speech computer voices. This has the advantage of speeding up the reading to skim through articles if you wish, but lacks the quality and intonation of a good human reader. One of the greatest features of Newsline, is the flexibility the service offers for consumers who are computer users. With a computer or tablet, users may access newspapers using a Web browser, or through an app on their tablet or smartphone. In this way, text can be enlarged to read visually, read by a screen reader, emailed, or converted to an audio file that may be downloaded to another portable reading device. In a nutshell, Newsline offers many different ways to customize how a subscriber chooses to access their newspaper and take it with them on the go. You can even access

Bookshare

Bookshare is a rapidly growing library of over 300,000 books and magazines available for subscribers with a vision loss or other print disability. A subscription to Bookshare is free for any US student and student status includes Adult Education such as courses in the community or distance education such as Hadley School for the Blind. Non students pay a one-time registration fee of $25, and annual subscription rate of $50. A free or paid subscription entitles subscribers to download hundreds of books annually at no additional cost. Books are formatted into an electronic format called DAISY (an acronym that stands for Digital Accessible Information SYstem) that may be read using a wide variety of electronic devices. Bookshare may also be read using the NLS Talking Book player, a computer, tablet, smartphone, stand-alone DAISY player like a Victor Reader Stream, or a device with a braille display. Bookshare has a very comprehensive resource on how to play DAISY books. You can sign up for Bookshare online or call 1-650.352.0198.

Two popular apps for Apple iDevices to read Bookshare books include Read2Go and Voice Dream. Both offer many options for reading, including increasing the text size, color and background of text, voices used for reading text, etc. In addition, users may highlight and bookmark text.

Other Options for Reading

A relative newcomer to the iPad is an app called Spotlight Text, which focuses on ease-of-use. Text may be read in a single line scrolling across the screen (Marquee mode) or as several lines of large print scrolling from bottom to top (Teleprompter mode). Users may choose the size of the text, the speed it moves across the page, and whether or not the text is read out loud. The user interface on Spotlight Text is simple to use with large buttons, making it a good choice for users new to using an iPad or reading electronic books.

For Android tablets and smartphones, GoRead and Darwin Reader are two popular apps that work with Bookshare titles. GoRead is a free app with basic features most suited for reading with text-to-speach. Darwin Reader offers more flexibility with text settings for the low vision user who prefers to read with large print.

This is by no means intended to be a comprehensive list of the many ways individuals experiencing vision loss might return to reading or expand reading options. The focus here is really on low cost and ease of access. Choose any one of these suggestions and you will begin reading again, or increase your many options.

Additional Resources

Reading and Writing

Top Book Reading Apps for Braille Users

Impact of Talking Books

Low Vision Optical Devices

Common Non-optical Devices

Voice Dream Reader


Topic:
Reading

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