In This Issue:
Editor's Note.
The President's Message
Taking the Fear Out of Research
The Medical vs. Rehabilitation Model
Using Excel for Simple Record Keeping
A Little Pixie of a ……………Dot
College Reviews: Universities of Arkansas
Poetry Feature: Hello Mr. Dave
Birnimghan, Alabama: Our Next Conference Site
Membership Renewal for 2008
Editor's Note
Zeze Miller; Older Blind Program Manager; State of Missouri,
Deadline for Newsletter Articles
The deadline for the next MACRT newsletter is Friday, April 18, 2008.
If you have suggestions or ideas, please contact Zeze Miller via e-mail at zeze.o.miller@dss.mo.gov or by phone at 573-751-8903. Thank you in advance for your contribution.
You can have your newsletter e-mailed which will cut down on the cost for postage and paper. If you are interested in a newsletter via e-mail please contact Sue Dalton or Lucille Dolan at transvis@mc.net.
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The President's Message
By: Latisha Houston
Hello MACRT members:
2007 was a great year for MACRT. Check out some of highlights of the past year included below:
The MACRT/ASERT Conference "CSI: Creating Skills for Independence" was held in Las Vegas, Nevada at the Stratosphere Hotel on November 9-11, 2007. In addition, a pre-conference day, developed by the MACRT Professional Standards Committee, took place on November 8th. The conference was attended by rehabilitation teachers and professionals from over twelve states and one foreign country.
Various topics presented at the Conference included:
- - The code of ethics for rehabilitation teachers
- - Working with deaf-blind consumers
- - Exciting program models from several agencies
- - Updates on new adaptive products and technology
- - Low vision/eye disorders
- - Resources/community services for consumers
- - Research in the rehabilitation teaching field!
The conference was another example of our continuing efforts to provide quality training to equip teachers across the land. The conference in Nevada, hit the jackpot! We would like to thank Suzanne Martin and the committee from Las Vegas for hosting an outstanding conference and for all their hard work!
The 2007 MACRT scholarship recipients were Jeri Cooper and Elaine
Samuels. Congratulations to Nancy Parkin-Bashizi who was awarded the 2007 Charlyn Allen Award. The board would like to thank Rachel Clarkson for her past two years of service as a board member. Due to some unforeseen circumstances Ms. Clarkson had to resign from the board and Lenore Dillon has been appointed to take her place. Mrs. Dillon will be chairing the planning committee for the upcoming 2008 Conference. We would like to welcome Lenore Dillon to the Board!
We would also like to thank Jennifer Ottowitz for editing the MACRT newsletter for the past several years. Mrs. Ottowitz has turned over the position of editor to Zeze Miller. The MACRT newsletter is published quarterly. We welcome you to submit articles and other information to Zeze Miller to be included in the publication.
Take care and best wishes for a happy, healthy, and productive 2008!
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Taking the Fear Out of Research
By:Jennifer Ottowitz
At the 2007 MACRT/ASERT annual training/professional development conference in Las Vegas, a one day pre-conference session was held on the topic of research. The presenters did an excellent job making the basic elements of research understandable and encouraging us to contribute to the existing body of work. They stressed the need to conduct research within the field of vision rehabilitation citing an emphasis on evidence-based practices and the need to identify effective teaching strategies as well as develop better consumer outcomes.
Dr. Tad Kosanovich, OD, opened the day with some updates on current areas of research in the vision field. General categories included image enhancement, pharmaceutical, diagnostics, and the psycho-physics of reading.
Jane Thompson from the American Printing House for the Blind , presenting on behalf of Elaine Kitchel, involved us in a "Research Autopsy" to help understand what we can do to become involved in research as well as how to understand the basics. In true Elaine-style, this presentation was very fun, educational, and came complete with "interesting" autopsy photos and graphics. The research theme was further carried out by B.J. LeJeune, CVRT, CRC, from Mississippi State University who presented a framework for conducting research that was clear and unintimidating. The day concluded with case study presentations by Terrie (Mary T.) Terlau, PhD from the American Printing House for the Blind, B.J., and Dr. Kosanovich.
Our deepest thanks go to Lenore Dillon and the members of the MACRT Professional Standards committee who planned the pre-conference workshop. The presentations themselves went into much greater scope and detail. We hope that others who attended the presentations as well as the presenters themselves will continue the discussion of the topic of research in future newsletters as it is a critical part of maintaining the vision rehabilitation profession.
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The Medical vs. Rehabilitation Model
By: Zeze Miller
What is the Ideal Model that will optimize mobility and independence for individuals who experience vision loss?
There has been an ongoing debate among professionals in the field of low vision regarding the ideal system of rehabilitation for individuals with low vision. Should these individuals pursue medical treatments? Should they seek low vision therapy? Or do they forget using their remaining residual vision and learn adaptive techniques and new skills in order to regain their independence? And if they sought out the medical model, would they have access to the necessary low vision aids? Quite often, low vision aids aren't even included in the medical model much less low vision rehabilitation. Ophthalmologists do not think in terms of what they themselves cannot fix, surgical or otherwise, and they are not set up to provide low vision aids or rehabilitation.
No matter where one stands with this issue, there are some facts that the majority of us in the rehabilitation field agree upon. For example:
- Low vision conditions can result from a variety of ophthalmologic and neurological disorders.
- As the incidence of age-related eye diseases increases, more seniors with vision loss will need help dealing with their loss and the quality-of-life issues that affect them.
- Rehabilitation is needed to help these individuals regain their independence and improve their quality-of-life.
- Rehabilitation services may include medical or surgical therapy, environmental measures, or social and financial support services.
- Drug therapy and surgical procedures may help in preventing vision loss or stopping the progression of diseases; such as macular degeneration and glaucoma.
- Ophthalmologists tend to undervalue the effect of poor vision on one's quality of life, and the need for rehabilitation. And most importantly,
- The ultimate goal of vision rehabilitation is to recapture, reinforce and preserve self-confidence, positive self-esteem and safe independent functioning.
So how do we as rehabilitation professionals help our clients achieve this significant goal?
In many cases, clients are confronted with a diagnosis of an eye disease without the proper education about the effects the disease has on their lives, and how they can live with decreased vision. Very few ophthalmologists do anything to counsel their patients about living with low vision. Their main concern is to deal with the medical problem and do not take the time to notice the depression their patients are experiencing. Although many are aware of the rehabilitation services that are available, referrals are not being made for rehabilitative services. Furthermore, since the dispensing of low vision rehabilitation is not a medical problem, insurance companies refuse to cover the service and therefore, ophthalmologists do not make the referrals to low vision specialists. Likewise, if by sheer luck the client does reach an optometrist, they may receive the low vision devices but not the training. As such, the devices end up in a drawer, forgotten and unused.
The lucky client who has received the needed medical treatment, the prescribed low vision devices, and has been referred to an agency for training may still be faced with some contentious opinions on the rehabilitation approach. The issues surrounding the effectiveness of low vision rehabilitation are often controversial and inconsistent concerning evidence-based practices and acceptable standards of practice.
It appears that there are different opinions as to what low vision rehabilitation means. One school of thought believes that low vision rehabilitation addresses the needs of clients through the use of low vision aids, education and training, techniques for increasing visual functioning and performing every day activities. Its goal is to increase independence, reduce stress, increase mobility, and ultimately, design a plan of action to maintain a stable quality of life, when treatments are not an option.
Another group of professionals believe that the emphasis should not be placed on the use of low vision devices, but that their quality of life would be greatly improved if the focus is on skill training; such as the use of the long cane, Braille, ADL skills, etc. In fact, some rehabilitation professionals take the position that every legally blind person needs to learn the skills of blindness, and should learn them while blindfolded, in spite of the fact that countless individuals with low vision may not need or want to be blindfolded or the use the methods of blindness during the rehabilitative process or in daily life. However, depending on individual needs, a large number of clients may benefit from special education and rehabilitative services if they are to become efficient users of their low vision, learn non-visual methods if they are more efficient or comfortable, and obtain jobs that allow for reasonable accommodations. Fortunately, there is a paradigm shift in the educational services for individuals with visual impairments. We are now using functional vision assessments, learning media assessments, and clinical evaluations, Braille, print, or a dual media approach for students.
Vision loss among the older population on the other hand, could be managed in a medically oriented rehabilitation setting, if ophthalmologists would routinely send patients with vision loss for help. Even if they do however, patients with some residual useful vision who are referred for low vision care usually just receive aids and devices minus the training. This approach usually falls short for older patients who have both visual impairments and other medical problems that need to be managed in order to maintain or restore a safe, independent living environment. Therefore, I believe that an interdisciplinary team approach would be the most holistic method for serving our clients, particularly seniors.
Dr. Tad Kosanovich said it best when he used the following analogy. To paraphrase, when a client falls, the most logical action one takes is to pick them up and place them on a table that has four legs to help support their weight. He further explains, the first leg is the Ophthalmologist who addresses the medical issues. The second leg represents the Optometrist who conducts the low vision assessment and dispenses the low vision devices. The third leg represents the vision rehabilitation therapist who provides the training in the use of the devices. The rehabilitation teacher who addresses the mental health issues and provides the training in the use of adaptive techniques and teaching new skills is the fourth leg.
Many people with low vision, especially seniors, feel more comfortable using a combination of visual and auditory methods when performing every day tasks. Consequently, they need to learn new skills to carry out activities of daily living, reading and writing skills, environmental adaptations, contrast enhancement, glare control, help with functional mobility, and learn to deal with the psychosocial aspects of their vision loss. To accomplish such a goal requires a team approach which should include the ophthalmologist, the optometrist, a low vision therapist, and a rehabilitation teacher.
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Using Excel for Simple Record Keeping
By: Terrie (Mary T.) Terlau
-From the 2007 MACRT/ASERT Conference
This document is geared toward the use of Microsoft® Excel 2000 and beyond with a screen reader, not with a mouse. Use this approach with consumers who struggle to read the computer screen with magnification.
This document focuses on keystrokes that are part of Microsoft Excel and therefore are valid regardless of which screen reader is used. However, a few Jaws® keystrokes will be noted. Window-Eyes has equally helpful keystrokes; however, Terrie primarily uses Jaws with Excel and cannot yet speak accurately about Window-Eyes® keystrokes.
Excel can be used simply and easily by persons who have recently lost significant vision. It may fill the gap in record keeping until people acquire new skills --- or it may provide a viable long-term solution. Use Excel to:
- Create easily-accessible address and phone books
- Set up weekly calendars to keep track of appointments
- Maintain financial records
- Keep medical records
- And much more.
Screen Reader Issues: Window Eyes 6.1 and Jaws 7 and beyond have good support for Office 2000 and later, with best support for Office 2003 and later. Window-Eyes default Excel settings work well. Terrie recommends, however, that one option should be changed. In the Window-Eyes window, go to verbosity menu, alt-v, and arrow down to Excel. Tab through options and uncheck:
"Speak Position Before Contents." With this option checked as it is by default, cell coordinates are read before contents. When unchecked, cell contents are read before coordinates.
Very Basic Excel
- Each individual piece of information is stored in a cell.
- A cell exists in a grid pattern or spreadsheet of 256 columns and 65536 rows.
- The coordinates of the cell are its column letter and row number.
- Excel column positions are shown by letters A through IV.
- Excel row positions are shown by numbers 1 through 65536.
- Position A3 is the first cell in the third row.
- Z15 is the 15th cell in the 26th column.
- AA5 is the fifth cell in the 27th column.
- An Excel file, called a Workbook, has three spreadsheets, though more can be added and one or two of the initial three can be deleted.
- Type words, letters, numbers, or a combination in any cell.
- Often, the first row of a sheet has headings for columns and the first column of a sheet has headings for rows.
- Headings tell you something about what kind of information you will find in each cell.
- Move with left and right arrows or by tab and shift tab across a row of cells.
- Move with up and down arrows vertically through a column.
- Screen readers read the information in each cell and then usually say the cell's coordinates.
- To edit information after you have entered it in a cell, press f2. Press escape to cancel the edit or enter to accept it.
- To move between pages of a spreadsheet, press control + page up and control + page down.
- To go to a particular cell, press control + G, enter the coordinate, and press enter.
Hint: When using Jaws, read a row head with shift + control + R.
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A Little Pixie of a …………Dot
By: Rekha Nanchal
I am so excited! We are getting ready for our Christmas Party. I want to smell good, look good, and dress in my best clothes. Oh! It is always so hard to decide on such occasions! I have closets full of dresses but nothing seems right! AHAAAA... I know what I want! I want this baby blue dress with sequins and lace! Now I need a pair of lingerie to go with it. Darn it! This needs washing. Ok, here is the washing machine. And here you go!
"Mama!! Mama! Come here!! Look what happened to my lingerie!! It's all crumpled and torn!! I set the dials on this cycle."
"Oh! Dear!! You washed your lingerie on linen cycle. No wonder it got damaged!!"
OH! For that "Little Pixie of a DOT". Tanya moaned.
This "disaster" occurred in the absence of bump dots on Tanya's washer and drier.
All Rehabilitation teachers know the importance of tactile sensitivity and for that matter bump dots take the front seat. But do other people also recognize and appreciate their importance? I have always been surprised during sensitivity and in-service trainings that the knowledge a Rehabilitation Teacher thinks is very basic, actually has a greater impact on other people who know nothing about it.
Perhaps, Rehabilitation Teachers take too much for granted. Marking appliances is very simple and easy to them. Place two dots and match them up. And that is all. The recognition of how complex it can be for others came to me the other day when three Rehabilitation teachers in our office tried to train some of our colleagues on marking appliances. There were so many questions to be answered that two hours just flew away. Questions about neuropathy, color and size of dots, using them visually, leaning over the stove, surfaces to be marked, gadgets to be marked, effectiveness of Hi-Marks against bump dots, training people to use them, digital gadgets etc. All safety issues were talked about in the process. We even put them under sleep shades to give them first hand experience.
Some questions that came up might interest you also:
Q1. Can a person having some residual vision use it to match bump dots instead of doing it tactilely?
A: If a person has distortion in his vision it may not be possible as the actual placing of the dot may be different than where he is seeing it as is the case with people having macular degeneration and diabetic retinopathy.
Q2. Can people having neuropathy use small bump dots?
A: It depends on what they can feel. If they are not able to feel the small dots then medium or large ones may work for them.
Q3. How can it be hazardous to lean over to look at the bump dots to match?
A: The flame or heat may come up suddenly as soon as the dots are matched, clothing or hair may catch fire, and the person may bump their head against the hood.
Q4. Is it as easy to mark an appliance with Hi-Mark as the bump dot?
A: No and yes. No, because one has to be very careful in squeezing the liquid out not to make a blob or smudge it. Secondly, it takes time for it to dry up. But once it is dried and nicely set it works great as it is more permanent than a bump dot.
There were questions asked about flat top stoves. A suggestion was made that bump dots could be put on the side of the cooking range to indicate the exact location of the back and front burners. Marking keys, mail boxes, cell phones and measuring cups were some other things discussed.
We tried to add some punch to it by enacting the damaged lingerie part and cooking eggs where they got burnt in the absence of bump dots. This was received very positively and everyone enjoyed it. At the end we had a "Test Your Knowledge" session. I am sure you will enjoy it too. Some of the questions may seem very silly and funny. But if you ponder over them, they all have relevance, even the question about "Protective Hat". The purpose was to send a message about the safety issues.
Test your Knowledge
True or False?
- 1. Bump dots will adhere to a greasy surface.
- 2. Bump dots will adhere well to rough surfaces.
- 3. Only one bump dot is required for labeling the stove.
- 4. Too many bump dots will confuse the consumer.
- 5. Bump dots only come in one color.
- 6. People with neuropathy need bigger bump dots.
- 7. Once you place a bump dot on a surface you can never remove it.
- 8. Bump dots require prior approval from your DS to purchase.
- 9. If bump dots are needed for an additional time for a consumer then an exception to the policy is required.
10. Hi-marks dry instantly after applying to a surface.
11. Only a round dot should be made with the Hi-Mark on any surface.
12. Hi-Mark is easily washable when it gets on clothes.
13. Hi-Mark makes a great snack for holiday events.
14. Every appliance can be marked the same way with Hi-Mark or bump dots.
15. In order to match the dots up with bump dots, you must stand at an angle.
16. The consumer must always use residual vision when using bump dots and Hi-Mark.
17. The family must be present when applying bump dots or Hi-Mark so they can also learn of the safety risks involved with these adaptive aids.
18. The trained professional must use a protective hat while training a consumer with bump dots or Hi-Mark so he/she does not bump their head on the overhead stove hood.
19. Bump dots can be used to mark keys/mail boxes.
20. Bump dots should always be considered using over Hi-Mark.
Essay
Compare and contrast the difference and similarities between bump dots and Hi-Mark.
This all made me realize the importance of sensitivity trainings and little things in life that can make all the difference. A red dot on my forehead had great importance in my life as a Hindu but I never knew that another little pixie of a "DOT" shall also play such an important role in my own life.
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College Reviews: University of Arkansas t
By Ann Laughlin
I decided it is important to find out and share information on which colleges in the United States offer rehabilitation teaching or related courses; therefore, this is the first of many articles describing various colleges and universities who offer Rehabilitation Teaching degrees. This first article features the University of Arkansas at Little Rock, Arkansas (UALR). UALR provides three programs: master's degree programs in Rehabilitation Teaching and Orientation and Mobility, and a master's degree program in Rehabilitation Counseling as well as a Ph.D. program.
The Rehabilitation Teaching Program is 42 credit hours, some of which are offered as online courses. Those already employed in the Rehabilitation field are afforded the added opportunity of using their work experience to meet their practicum requirements.
To be accepted into the program a student must have a GPA of 2.75 in their undergraduate work, or a master's degree in any other field. Applicants are required to submit a 500 word essay which may be relayed via telephone, with the Rehabilitation Teaching program coordinator. Other qualifications include graduate school application with official transcripts, computer literacy, and possess independent living skills. Please note that the full detail of admission requirements can be found at http://ualr.edu/rehdept/admission.shtml.
The cost for the Rehabilitation Teaching program is $840.00 per required course, which are three credit hours each, which averages out to $11,760.00 per year. This does not include textbooks, course project materials, computers, room and board for workshops, or travel to workshops. Requirements for financial assistance include U. S. citizenship, having maintained good standing with previous government loans, maintain required GPA for the program, have some prior experience in the field, and you must have previously completed six credit hours successfully.
The required courses for a Rehabilitation Teaching degree are:
Braille and Relevant Formats,
Principles of Rehabilitation Teaching,
Medical Aspects of Blindness and Associated Disabilities
Methods of Teaching Adaptive Communications Skills to Persons with Impaired Vision,
Methods of Teaching Adaptive Living Skills to persons with Impaired Vision
Implications of Low Vision
Techniques of the Counseling Interview
Psychological Aspects of Disability,
Basic Independent Living Skills for Persons with Visual Impairment
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Poetry Feature: Hello Mr. Dave
By: David Buhl
Hello Mr. Dave
I know this boy who had a stroke
He told stories and loved to tell jokes
I know a boy who never complains
About his struggles and all his new pains.
He walks with two canes and a smile so bright
I wish him well with his daily fight
He taught me to look at life differently now
My life has changed I can't explain how.
I know a boy who has become a man
His favorite motto is "Yes I can"
I am proud to have helped this young man out
He is now on his way with a new plan "He shouts."
He is on his way to start a new life
He said he would call when he meets his new wife
He came in a boy and left a grown ass man
Go out into the world and change the land.
Sometime in the future I will pick up a phone
I will hear "Hello Mr. Dave" this is Tyrone
I was his teacher and he came here to learn
He is on his way now it is time to adjourn.
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Birmingham, AlabamaOur Next Conference Site
By: Carol Braithwaite
Our next conference site, hosted by ASERT (Association of South Eastern Rehabilitation Teachers), will be held in Birmingham, Alabama. Once at the center of the Civil Rights Movement in the 1960s, Birmingham now bristles with activity and cultural events. The Birmingham Civil Rights Institute, located across the street from the infamous 16th Street Baptist Church, chronicles the role Birmingham played in the civil rights movement and serves as a forum for understanding the universal problem of racism
Birmingham has many other attractions in the way of cultural points of interest. One such place is the Birmingham Museum of Art, which has a guided tour designed specifically for people who have visual impairments. Selected works of art displayed throughout the museum are represented tactilely so that comprehension of what the docent is explaining can be enhanced. Background music is coordinated with each exhibit.
Other attractions include: The Birmingham Zoo, home of Chip the Llama, Birmingham's colorful zoo mascot; the Alabama Jazz Hall of Fame, an attraction that contains numerous exhibits on Alabamians such as Erskine Hawkins and Sun Ra who have made international contributions to the world of jazz; and the Alabama Sports Hall of Fame, a museum that pays tribute to sports heroes with ties to the state of Alabama.
The Alabama Symphony Orchestra will be performing at the Alys Stephens Center, the University of Alabama at Birmingham's concert hall. You will be able to catch a play at the historic Virginia Sanford Theatre or a performance at the 1920's vintage Alabama Theatre.
Southern cuisine abounds. Grump's Great Grill will serve a barbecue lunch "to die for" if you want to follow up a tour of the Museum of Art with something tasty before starting our opening Thursday afternoon session. Joe's Crab Shack and the Alabama Fish Market both have seafood brought in from the Gulf daily. If you prefer Greek or Lebanese, Japanese or Thai, Mexican or down-home "soul food," we've got it.
Y'all come on down to Sweet Home Alabama!
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Membership Renewal for 2008
We are trying something new this year! All of our members were sent an invoice for $25.00 to renew their MACRT membership. If you didn't receive yours or if you no longer wish to be a member (I don't know why), then call 815-923-7545 or email us at transvis@mc.net.
Please encourage others to join this professional organization and receive informative newsletters, participate in outstanding educational and networking opportunities (a.k.a. the annual training conference), and to demonstrate your pride in and commitment to the profession of rehabilitation teaching.
Thank you for your support.
Mail your dues to:
Susan Dalton
20009 IL Route 176
Marengo, IL 60152
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