Download Home Modification Strategies for the Visually and Hearing Impaired

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Independence Empowers People
HOME MODIFICATION STRATEGIES FOR THE VISUALLY AND HEARING IMPAIRED
WHAT HAPPENS WHEN WE LOOK AT AN OBJECT?
The light rays reflect from the object to the cornea (the focusing surface)light travels thru the aqueous fluid thru the pupil (that dilates and constricts to control light entering the eye)
Light ray travels thru the vitreous (jelly like substance that gives the eye form and shape).
Light reaches the back of the eye to the retina. The retina contains the macula that lets us see detail and
central vision; and the fovea for reading driving and watching TV. The rest of the retina gives us periphral vision.
After age 40 there is less transmission of the ocular media, increased light scatter, decreased retinal
sensitivity and decreased pupil size. Perceptual changes include visual ambiguity, decreased depth
perception and visual memory.
AS A RESULT:
there is an increased risks of falls, depression and altering of the visual world.
colors may be perceived differently
loss of contrast-light or dark objects blend into similarly colored backgrounds or objects
decreased depth perception and visual acuity
increased glare sensitivity
more sensitivity to adverse lighting/harder to adjust to light levels
decreased pupil size limits light that enters the eye (need more light to see)
pupil constriction causes decreased reactivity to light changes. As a result, you need longer adjustments
when moving from bright to darker areas
decrease in elasticity of lens and increased opacity makes objects up close hard to see and alters
accommodation by light scattering that causes difficulty with night driving (because of the glare of headlights)
thicker lens limits light and causes the retina to have diminished ability to see yellow, green and blue
changes in consistency of vitreous fluid from egg white to thinker liquid results in flashing lights, blurred
images and floaters.
THE MOST COMMON CAUSES OF VISION LOSS:
AGE RELATED MACULAR DEGENERATION is the leading cause of vision loss for those 60+ years of age.
it causes the loss of sharp central vision, makes it hard to read, sew, drive and see faces,
there is decreased detail discrimination and straight on viewing.
when the cone cells are damaged you cannot see colors
there is no problem with peripheral vision so people rely on it to detect shape and movement.
it makes it very difficult to do ADL tasks and recognize faces.
DRY MD is the most common form- gradual and mild.
WET MD is the most severe-moves faster, causes blind spots, distorted images and makes straight lines look wavy.
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RISK FACTORS: 60+ years old, women, obesity, race (white) smoking, diet low in antioxidants, exposure to
ultraviolet rays and family history.
CATARACTS: the most common cause of low vision in ages 60+.
Causes light scatter, cloudy vision,
produces glare and decreased vision
changes color values.
It can cause slight to profound blur, making it difficult to perceive color and light sources. (can get denser with time.)
RISK FACTORS: smoking, diet, alcohol diabetes, exposure to ultraviolet radiation
SURGERY: removes clouded lenses and replaces it with plastic intraocular lens. If it can’t be removed use low
vision magnification devices/filters and use hats or visors for glare strategies
GLAUCOMA: (primary open angle) permanent vision loss without warning or symptoms.
damage to ganglion layer of retina;
atrophy of optic nerve;
high pressure is more risk than cause;
nerve cell damage/cell death causes primarily peripheral vision loss.
central vision is spared until the end stages of the disease.
Treatment slows the process; medication and laser surgery relieve the pressure but does not cure or re
store vision.
LOW/NORMAL TENSION GLAUCOMA you have the symptoms of optic nerve damage and loss of
visual field but have normal eye pressure
CLOSED ANGLE GLAUCOMA-fluid at front of eye that cannot reach exit angle- because it is blocked by iris
ACUTE SYMPTOMS: severe pain, nausea, redness, blindness
DIABETIC RETINOPATHY: leading cause of blindness.
Blood vessels are malformed and weakened due to the disease.
SYMPTOMS: floaters, distortion, scotomas, degree of vision problems fluctuates-blurring, distortion
changes in refraction, edema
ALZHEIMER’S: visual problems may be due to the interpretation of the senses because of neurological impairment.
Damage to the parietal cortex may cause poor visual acuity: alexia (unable to understand the written word); agnosia
(inability to process sensory information-loss of ability to recognize objects, persons, sounds, etc.) spatial disorientation,
depth perception, glare, visual misinterpretation, deficit in contrast sensitivity(( function needed to perceive a stimulus from
its background -similar color, patterned, dark contrasting color). May jump or step over borders.
HEMIANOPIA-loss of half of visual field due to stroke, head injury, TBI
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DIPLOPIA-double vision-one eye turns out.
Makes it hard to find the beginning of a line, bump into objects, half of visual field is black but brain shifts visual field to
what is actually a trajectory off to one side (depending on the side of the brain affected) and is perceived as straight ahead.
HEARING LOSS: 3rd most common physical condition after arthritis and heart disease
At 60+ years 1 of 3 people; ½ of people 85 + years
HOW DO WE HEAR?
outer ear-pinna or auricle collect sounds that travel into auditory canal to the ear drum and tympanic membrane.
canal is curved to protect the eardrum;
ear wax keeps dirt and dust out
eardrum is sensitive-placed at the beginning of the middle ear;
middle ear turns sound waves into vibration and is delivered to the inner ear-needs eardrum to do this function;
vibrations are moved with hammer, anvil and stirrups to connect to the membrane that covers the
entrance to the cochlea in the inner ear.
sound waves move through the inner ear, thick fluid transmits pressure through the cochlea,
cilia pick up the sound vibrations and create impulses in the auditory nerve to the brain to translate sound.
Hearing loss is caused by the malformation of the ear, disease processes, fluid, impacted wax, exposure to
loud noises and aging. Loud atmospheres today cause loss much earlier than 30+ years ago.
TYPES OF HEARING LOSS:
CONDUCTIVE- sound is not conducted properly through the outer ear canal to the eardrum to ossicles(bones)
of middle ear.
caused by impacted wax, infection, fluid in the ear, perforated drum, benign tumors, absence in
malformation of outer ear, middle or canal.
difficulty with hearing faint sounds.
can be medically or surgically corrected.
SENSORINEURAL-damage to the cochlea (inner ear) or to nerve pathways to the brain.
it is permanent and there is no cure.
difficult to hear faint sounds and understand speech.
caused by disease, injury at birth, toxic meds, genetic syndromes, noise exposure, viruses, tumors, aging.
MIXED HEARING LOSS-combination of both-damage to outer ear and in the auditory nerve at the same time.
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PRESBYCUSIS-changes in inner ear with aging or from changes in middle ear or in pathways leading to the brain.
it is the same or similar with everyone;
lose high pitch first, middle then lower;
same degree for both ears; happens gradually
BACKGROUND NOISE-LOW FREQUENCY. Seniors hear low frequency easier than high so they hear
background noise better than conversations. Complain of people mumbling, “if only people would speak more
clearly”. Helped with hearing aid.
PEOPLE WITH HEARING LOSS:
use extra energy to communicate;
avoid social situations;
feel more stressed;
feel less independent;
worry about safety
are less satisfied with life;
not as content in retirement.
Older adults that do not wear hearing aids report more depression and sadness, have more worry, anxiety
and paranoia, are less socially active and have increased emotional turmoil and insecurity. Those that do wear
hearing aids report better relationships with friends and family, better feelings about themselves, improved
mental health, greater independence and security.
GOALS FOR HOME MODIFICATIONS FOR THE VISUALLY AND HEARING IMPAIRED ARE TO
REDUCE DEMANDS ON THE IMPAIRED SYSTEM AND TO COMPENSATE FOR THE IMPAIRMENTS
BY USING INTACT SKILLS AND PRESERVED ABILITIES OF OTHER SENSORY SYSTEMS.
HOW DO WE REDUCE DEMANDS ON IMPAIRED SYSTEMS?
increase light levels
control glare
increase contrast-light background with dark letters or dark background with light objects
stay away from all white or colored paper with colored letters
decrease unnecessary patterns on carpet: they can be stressful to the visual system and a safety hazard
keep surfaces level-no gravel or bumpy walkways, throw rugs, loose tiles or abrupt changes in grade
use lighting systems and vibration at night when sleeping
increase loudness of doorbells
have codes for lights to flash
have 911 lights strobe outside window to alert rescue people
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HOW CAN WE COMPENSATE FOR IMPAIRMENTS?
use auditory, tactile or automatic signals to alert you and compensate for lack of visual interpretation.
reduce background noise
reduce reverberation (echoes/sounds) because they diminish the benefit of hearing aids and make speech
reading harder
make at least one room a quiet go to room if you cannot do a large area of your home.
increase loudness for alert systems, use flashing lights or vibration. People who are hard of hearing prefer
increasing loudness; deaf people prefer flashing lights
Use lighting to convey information to alert person to different sounds-simple codes help identify the
sound….3 quick for doorbell, 3 slow for telephone, on/off for baby crying.
AREAS OF CONSIDERATION FOR HOME MODIFICATION STRATEGIES
MOBILITY AND TRANSFERS:
in and out of the house;
moving around the house;
getting to different levels of the house
PERSONAL CARE/HYGIENE
CHORES/ACTIVITIES
MOBILITY AND TRANSFERS:
Remove clutter for clear path of travel in/out of house and throughout the house
Increase light levels
Use shear curtains to avoid glare from windows
Control glare with night lights, easy to use lights, long lasting light bulbs
Avoid use of metal blinds
Cover sky lights if light falls on paths or seating areas
Label doors with large signs
Leave doors open
Have flush thresholds
Light keyholes and doorbells
Avoid globe fixtures outside-they have tremendous glare and prevent you from seeing beyond them.
Walkway lights should be low enough to light the surface evenly without allowing light rays to be
diffused to eye level
Have distinctive cues to mark paths-use different floor textures in each room
Have telephones and thermostats with large numbers
Have distinctive on/off positions for switches
Add decals to sliding glass doors
Secure carpet and tile on stairs
Have handrails on both sides of the stairs that extend beyond the top and bottom steps
Add adhesive or felt at top and bottom of the railing so you are aware that you are at the beginning or end
of the staircase
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USING CONTRAST:
Make doors/frames/thresholds different colors
Red/yellow/orange are more easily distinguishable
Change doorknob colors
Have a resting place to help adjust to light changes from inside to outside
Paint outside steps with textured paint of use abrasive strips
Use colored tape, paint or carpeting to contrast edges of steps
PEERSONALCARE/HYGEINE:
Increase lighting/contrast. Look at bathroom with dark sunglasses to check lighting
Have a ceiling light over toilet/tub
Put colored tape on the edge of the tub
Contrast color of grab bars
Use a bright toilet seat or more contrast in background
Use an illuminated magnifying mirror (7-10x the best)
Have a mirror on extended arm for grooming
SAFETY:
Lower the water temperature
Have an anti-scald valve
Reinforce towel rods/use grab bars
Use non-skid mats with contrast to cue for depth
For filling tub-line with bright toy or put a bright toy that floats
There are not a lot of modifications for the hearing impaired for hygiene
CHORES/ACTIVITIES
Use audible signals when pouring liquids-an audible device will beep when you reach the level you want
Use contrast to trim edges or drawers or doors
Place mirrors so light does not reflect off of them and cause glare
Paint cupboard shelves to contrast with doors
Use contrast colors for outlet covers
Have light switches at all entrances
Contrast dishes with table top
Have burners that contrast with stove top
Have large buttons on dishwasher
Control stove with raised markings
Use Velcro on smooth surfaces/switches on microwave
Mark often used temperature settings on stove with permanent marker
Have good lighting over appliances
Add lighting to underside of cabinets
Add shields to keep light away from your eyes
Remind people who are visually impaired that light should always be aimed at the work you are doing, not at the eyes.
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Arrange furniture in small groups for easy conversation
When purchasing furniture select upholstery with texture for tactile clues for identification.
Use brightly colored vases and lamps to make furniture easier to locate.
Using warm/fluorescent/compact fluorescent bulbs reduces glare
Try to avoid fluorescent lights-they hum and seniors are sensitive to that
Use swing arm or gooseneck lamps near appliances
Use nonskid, non-glare products to clean floors
Use a pegboard for pots and pans
Use pull out drawers for storage
Have a toilet overflow alarm or anyplace that can flood (alarm is triggered when water touches it)
MORE CONSIDERATIONS FOR THE HOME FOR HEARING IMPAIRED POPULATION:
Do not have large areas of tile, glass or mirrors
Tighten window seals to prevent outdoor noise
Use wall carpet, double paned windows, lined drapery or acoustical panels to reduce reverberation
Some deaf people use hardwood or linoleum on floors so they can rely on floor
vibration for information
Use amplified alarm clocks, flashing light, pillow vibrator
Consider smoke alarms with flashing light
Used closed caption on TV. It-may be hard to follow at first or can be a challenge with diminished vision or illiteracy.
Use TDD/Teletypewriter for telephone conversations. Conversation appears in print. Most are portable
lightweight and powered by household current. Some are computer compatible. When contacting someone
who does not have a TTY a message relay is required. The national number for relay is 711.
Use amplified ringers that change volume, pitch or pattern of ring
Some doors have vibration sensors that activate when knocked on
Have spring loaded handles or motion detectors for faucets
Have wrist watches and timers with vibrations
INFORMATION SOURCES:
www.visionaware.org
www.ideasconsultinginc.com Specialty Course in Home Modifications
www.amd.org- Macular Degeneration Partnership
www.homemods.org Executive Certificate in Home Modifications
www.cbvi.org
Independence Empowers People
Stephanie Rauscher - Owner
315.867.4331
[email protected]
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