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Copy of The Eye

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Melissa Lobkovich

on 5 November 2015

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Transcript of Copy of The Eye

Pathophysiology
Measurement
Limitation or loss in visual capacity due to disease, trauma, or congenital or degenerative condition
Chapter 52: Visual Impairment
Incidence and Prevalence Rates
Effects of VI on Exercise Response

Why is this a concern?
LeSeanda Willis
Melissa Lobkovich

Definition
Classification
Etiology and Risk Factors
Total: 6,636,900
Women: 3,665,200
Men: 2,971,600
Age 18-64: 3,372,400
Age 65 or older: 2,743,600
1.
Legal
- vision of 20/200 or less with corrective lenses

2.
Visual blindness
- visual field less than 10 feet of central vision

3.
Total Blindness
- lack of visual perception
500,000 persons in the USA are legally blind
In 95% of individuals who are defined as blind have some residual vision
 2nd least common disability in children (1st is deaf-blind)
 Increasingly prevalent with advanced age

Visusal impairment cannot be corrected by lenses, medication or surgery
Measurement is through a visual exam which results in vision of 20/200 or less
o
Younger individuals
- cause due to birth defects,
(congenital cataracts and optic nerve disease) uncommon cause retinopathy of prematurity.
o
Adult
- tumors, injuries, infectious diseases
o
Elderly
- diabetes, macular degeneration, glaucoma, cataracts (leading causes)
o
Additional
- VI can occur concomitantly in people with cerebral palsy and mental retardation

VI generally does not affect exercise response from a single session
Acute Response
o Verbal cues essential to testing
o Loss of visual field, peripheral vision, affect mobility

Functional Consequences and Co-Morbidities (Effect on ADLs)
o Poor balance, forward head posture, low cardiovascular fitness, obesity, lack of confidence, timidity, self-stimulatory behaviors (rocking), fewer social skills
Long Lasting Response
Less need for assistance due to familiarity with the environment
Effects of Exercise Training
o VI individuals produce the same positive psychological and physiological benefits as those without VI’s
o Additional benefits include:
 Increased opportunities for improvement of socialization skills
 Balance skill improvement and practice
Increased self-image, confidence
Spatial orientation
Decreased obesity

Body Structure and Fuction
Anatomical
Physiological
Macular Degeneration
Cataract
Glaucoma
Age related disease that destroys central vision
Two types:
Wet
Dry
Macular Degeneration
Cellular death of the macular cells
a clouding on the lens of the eye
Cataract
decreased blurred vision and visibility due to the clouding on the lens
Glaucoma
A group of diseases that damage the optic nerve
is caused by increase in fluid pressure from damaging of the optic nerve.
causes a person to loss peripherial vision and progressively decreases total vision
Alleviate or Cause additional problems?
Physical exercise will not cause addtional problems if done safety
Exercise will not cure VI's but does have positive effects on the overall body
Management and Medication
Management: sunglasses may be worn for sunlight sensitivity
There are no commonly prescribed medications for those just with VI
For those who additionally suffer from glaucoma eye drops before and after exercise are used
VI suffers with other primary problems (coronary artery disease or diabetes) should note special medications for these specific diseases and follow proper testing and training

Management
Medication
o Standard Exercise testing protocols can be used.
o When other primary conditions are also involved follow respective assessment and treatment
o Additional guidelines:
 Instructions given verbally or audio tape
 Allow the individual to describe or demonstrate the test before beginning
 Give tactile and verbal reinforcement
 Allow the tester to be close to the individual to use residual vision, or to have access to touch handrails or tester if necessary

Recommendations for Exercise Testing
Assessment and Diagnostic Techniques
In and Out-of-Scope Procedures
What is seen on the physical exam?
Aerobic:
Naughton Protocol Test
Flexibility:
Sit and Reach Test
Anerobic:
Forced Velocity Test
Naughton Protocol test
increased aerobic capacity
Sit-and-Reach
increased flexability
Forced Velocity Test
shows current anaerobic capacity
Exercise Programming Components
Article
Narrative
Bibliography
Standard ACSM exercise recommedations
At least 150 minutes of moderate exercise intensity per wk
Can split into 30-60 min of moderate exercise 5 days/wk or 20-60 min of vigorous exercise 3 days/wk

Resistance Training
-Train each major muscle group 2-3 days/wk

-2-4 sets of each exercise to improve strength and power

-8-12 reps: young adults

-10-15 reps: middle aged and older adults

-15-20 reps to improve muscle endurance

- wait at least 48 hours between resistance training sessions

-2-3 days /wk to improve ROM

-hold stretch 10-30 seconds

-repeat 2-4 time to accumulate 60sec per stretch

-do static, dynamic, ballistic, and PNF stretches

-do flexibility exercise when muscles are warm



Flexibility Training
Exercise Cautions
Functional Training
-do 2-3 days/wk; 20-30min/day

-exercise to improve motor skills: balance, coordination, and gait

-improve proprioception: ex. Tai chi or yoga; do to prevent falls




8. Keep doors closed or wide open

9. Keep equipment in the same place at all times

10. Keep area safe from clutter

11. Mark changes in the building with white tape or paint; eg. Stairs, exits, entrances

12. Keep area well lit

13. Keep radio or some form of audio at one end of the room or shallow end of the pool for direction orientation

14. Individuals with aphakia, detached retina, or high myopia should not do high impact physical activities such as jumping

Individual can participate in activities such as swimming, weight training, dance, track and field, goal, and bell ball.

1. Verbal/physical cues to prevent boredom

2. Keep instructions in Braille or large print

3. Avoid activities that involve visual tracking such as tennis

4. Make sure glasses are secured to face

5. Allow person to exercise or run with a partner

6. Consider offering goal ball

7. When patients are being oriented with the facility make sure the person is aware of the location
Take Home Message
Visually impaired individuals can have normal exercise testing and programming with consideration on the severity of the impairment.
Silvia
et al
. 2013 conducted a study entitled Sports Injuries in Elite Paralympic Swimmers with Visual Impairment. This was a descriptive, observational, epidemiological study (Silvia
et al
. 2013). The purpose of the study was to determine characteristics, prevalence, clinical incidence, and incidence rated of injuries sustained from swimming competitively (Silvia
et al
. 2013). The participants were 28 elite swimmers from the Brazilian Paralympic Team (Silvia
et al
. 2013). Eleven were classified as blind and 16 were classified as low vision (Silvia
et al.
2013). The injuries were documented on a standardized injury report form completed by the orthopaedist classifying the type of injury and the location the injury occurred (Silvia
et al.
2013). The injuries were recorded during the International competitions from 2004-2008 (Silvia
et al.
2013). The results of the study showed that 18 of the athletes reported 41 sports injuries (Silvia
et al.
2013). The prevalence of injuries was 64%, clinical incidence 1.5 per athlete, and incidence rate was 0.3 injured per athlete per competition (Silvia
et al.
2013). Eighty percent of the injuries were from overuse and the other 20% were traumatic (Silvia
et al
. 2013). There was no statistical significance between the visual class or sexes (Silvia
et al
. 2013). Most of the injuries occurred in the trunk at 46.34% (Silvia
et al
. 2013). The upper body sustained 3.15% of the injuries reported (Silvia
et al
. 2013). Within the trunk the shoulders received the most injuries (Silvia
et al.
2013). The shoulders had 29.27% injuries, while the trunk had 21.95% (Silvia
et a
l. 2013). The lumbar spine had the least amount of injuries, consisting of 17.07% (Silvia
et al
. 2013). About 36.59% of the injuries were diagnosed as spasms and 26.83% were diagnosed as tendinopathy (Silvia
et a
l. 2013). The article suggested that swimming competitively reduced shoulder instability by increasing the shoulder’s range of motion (Silvia
et al
. 2013). The shoulder also experienced an increase in internal rotation and adduction strength (Silvia et al. 2013). Injuries also resulted from fatigue as a result of prolonged training and swimming in the competition (Silvia
et al
. 2013).
Durstine
et al.
, 2009
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et al.
, 2009
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et al.
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Blindness Statistics, 2014
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et al.
, 2009

American College of Sports Medicine. (n.d.). American College of Sports Medicine. Retrieved June 8, 2014, from http://acsm.org
Blindness Statistics. (n.d.). National Federation of the Blind. Retrieved June 8, 2014, from http://nfb.org/blindness-statistics
Cataract. (n.d.). Medline Plus. Retrieved June 7, 2014, from http://www.nlm.nih/gov/medlineplus/cataract.html
Durstine, J. L., Moore, G. E., Painter, P. L., & Roberts, S. O. (2009). Osteoporosis. ACSM's Exercise Management for Persson's with Chronic Diseases and Disabilities (pp. 368-374). Champaign: Human Kinetics. (Original work published 1997)
Ehrman, J. K., Gordon, P. M., Visich, P. S., & Keteyian, S. J. (2009). Clinical Exercise Physiology (2003 ed.). Champaign: Human Kinetics.
Glaucoma: MedlinePlus. (n.d.). U.S National Library of Medicine. Retrieved June 8, 2014, from http://www.nlm.nih.gov/medlineplus/glaucoma.html
Linossier, M., Dermois, D., Fouquet, R., Geyssant, A., & Denis, C. (1996). Use of Force-Velocity Test to Determine the Optimal Braking Force for a Sprint Exercise on a Friction Leaded Ergometer. European Journal of Applied Physiology, 74, 420-427.
Macular Degeneration: MedlinePlus. (n.d.). U.S National Library of Medicine. Retrieved June 8, 2014, from http://www.nlm.nih.gov/medlineplus/maculardegeneration.html
Quinn, E. (2014, May 28). Sit and Reach Test. Sit And Reach Flexibility Test - What Is the Sit And Reach Flexibility Test. Retrieved June 7, 2014, from http://sportsmedicine.about.com/od/fitnessevalandassessment/SitandReach.htm
Quinn, E. (2014, May 28). Sit And Reach Flexibility Test - What Is the Sit And Reach Flexibility Test. About.com. Retrieved June 7, 2014, from http://www.sportsmedicine.about.com/od/fitnessevalandassessment/SitandReach.htm
Silvia, M. M., Bilzon, J., Durate, E., Gorla, J., & Vital, R. (2013). Sports Injuries in Elite Paralympic Swimmers withVisual Impairment. Journal of Athletic Training, 48(4), 493.
Visual Impairment. (n.d.). Medline Plus. Retrieved June 7, 2014, from http://www.nlm.nih/gov/medlineplus.visualimpairment.html




Measurement:
Legally blind individuals only have the ability to see up to 20ft, whereas, normal field vision is the same at 200ft (Durstine et al. 2009). Legally blindness exhibits a lack of visual acuity or keenness (Durstine et al. 2009). Visual field blindness can be described as tunnel vision, caused by retinitis pigementosa (Durstine et al. 2009). Individuals with total blindness don’t have the ability to recognize a strong light when it is shone directly in the eye (Durstine et al. 2009). Total blindness has no light perception (Durstine et al. 2009).
Etiology:
Retinopathy of prematurity is caused by excessive O2 in incubator (Durstine et al. 2009).
Exercise Response:
Low cardiovascular fitness and obesity may be due to the inability to perform vigorous exercise, sedentary lifestyle, or related to comorbidities such as coronary artery disease or diabetes (Durstine et al. 2009). This may also be due a lack of self-esteem (Durstine et al. 2009). Individuals with this impairment may tend isolate themselves because of their visual limitation and lack of social skills (Durstine et al. 2009). Visual impairment is also associated with self-stimulatory behaviors, such as rocking, and effected mobility which resulting from loss of peripheral vision (Durstine et al. 2009).
Anatomical and Physiological Analysis:
Visual impairment can be caused by age-related diseases such as macular degeneration, cataracts, and glaucoma (Visual Impairment, 2014). The eye has a structure called the macula that allows you to see fine details (Visual Impairment, 2014). The macula is responsible for central vision (Visual Impairment, 2014). Central vision is needed to read, drive, and see objects (Visual Impairment, 2014). Wet degeneration occurs rapidly (Visual Impairment, 2014). The early symptom is blurred vision (Visual Impairment, 2014). Dry macular degeneration is a slow breakdown of the macular cells (Visual Impairment, 2014). This causes a person to see straight lines as crooked (Visual Impairment, 2014). Macular degeneration can be diagnosed with regular eye exam (Visual Impairment, 2014).

Cataracts can occur in both eyes; however, it does not spread from one eye to the other (Visual Impairment, 2014). Symptoms include blurred vision, faded colors, glare, double vision, poor vision, and frequent changed in prescription for eye glasses (Visual Impairment, 2014). It can initially be helped with the use of sunglasses, corrective lenses, and a magnifying glass (Visual Impairment, 2014) Surgery can also be done to replace the lenses with artificial lenses (Visual Impairment,2014).

Glaucoma is the leading cause of blindness (Visual Impairment, 2014). There are no early symptoms and no cure (Visual Impairment, 2014). Glaucoma causes one to lose peripheral vision (Visual Impairment, 2014). Treatment includes eye drops and surgery (Visual Impairment, 2014). People that are at risk include African Americans over the age of 40, elderly greater than 60 years, and a person with a family history (Visual Impairment, 2014).
Exercise Test:
Naughton Protocol Test: This is a graded exercise test that is performed on a treadmill (Ehrman et al. 2009). The test advances in 1 and 2 minute stages with increments of 1 MET or less (Ehrman et al. 2009).This test has 7 stages and usually last for f8 to 12 minutes. It is used to measure the aerobic capacity (Erhman et al. 2009). The person starts walking on the treadmill a 1.0 mph with 0% grade (Ehrman et al. 2009). In the second stage the speed increases to 2.0 mph and remains at this stage until the 7th stage (Ehrman et al. 2009). The grade increases from stage 3 to 7. If the patient has completed the test when the person can no longer walk or had completed all of the stages (Ehrman et al. 2009).

Sit and Reach Test: Use a testing box of 30-cm tall. Have the individual remove their shoes and sit on the floor with their legs stretched out in front of them. Make sure their knees are straight and their feet are flat against the end of the test. The person will slowly lean forward from the hip and slide the ruler as far as they can. Repeat this test three times and take the average. This will be the flexibility number. (Quinn, 2014).

Forced Velocity Test: This test measure the anaerobic capacity (Lenossier et al. 1996). This test measures short maximum sprints on a bike (Lenossier et al. 1996). It is a friction loaded cycle ergometer test (Lenossier et al. 1996). The individual sits on a bike and put their feet on the pedals (Lenossier et al. 1996). The pedals have straps to make sure the feet do not slide off (Lenossier et al. 1996). Then the individual will cycle as fast as they can for 5-7 seconds (Lenossier et al. 1996). The level will start at 10N and increase by 10 or 20 after a five minute recovery (Lenossier et al. 1996). This is done until the person no longer have the power to perform the test (Lenossier et al. 1996).
Aerobic Exercise:
The individual can do one continuous session or multiple shorter sessions of at least 10 minutes to accumulate to 60 minutes. Participant must gradually progress duration, frequency, and intensity. (American College of Sports Medicine, 2014)

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