Jaime is a 30-year-old Mexican American who loves soccer, brewing his own beer, and spending time with family. He is a successful real estate agent, and he and his wife are expecting their second child. They own their four-bedroom colonial style home in the upper eastern United States. He woke up one morning late for work with a splitting headache, the kind where your eyes hurt. He popped some pain pills and hurriedly got in the shower. As the day progressed, the headache wouldn’t go away. About lunch time, he started vomiting. Thinking he had the flu, he cancelled his appointments and went home to lie down. He felt better that evening but was seeing rainbow colors around the lights in the house, and they seemed so bright. Jaime’s right eye became blurry. His wife looked, and the white of his eye was red and the pupil large. They decided to go to the emergency room. The emergency room doctors learn that Jaime has experienced acute angle closure crisis. After some medical history, it was determined that Jaime has a family history of glaucoma and was not aware. He had not been to an eye doctor in years. Jaime undergoes treatment for both eyes and works with the American Federation for the Blind to adapt to his changing lifestyle.After four years, Jaime has adapted to his loss of sight in his right eye. He is rapidly losing vision in his left eye and doctors are becoming more aggressive with treatment. Items appear blurry, and Jaime uses a screen reader to help with his computer work. An enlarger assists with written documents and the voiceover feature on his phone is a mainstay. Jaime has been matched with a guide dog, Shadow, and he is becoming more confident in his recreational activities. Jaime wants to be more active as he has gained weight since his diagnosis and has just signed up for a snow skiing trip through the special recreation association. You are the CTRS who is leading the trip specifically designed for skiers with blindness and low vision. Jaime provides the following information on his registration form
Significant past medical history: Acute angle closure crisis causing glaucoma right eye total blindness. Left eye increasing in pressure 20/200. Family history of high blood pressure and glaucoma.
Medications: Eye drops, beta blocker
Cognition/perception: Excited to try skiing!
Physical examination: Right eye, no vision. Left eye, 20/200.
Client Goals
1.Increase the types of
.Enjoy activities from before vision loss
3.Increase independence4.Increase physical activity
1. Create an inclusion plan for Jaime, using evidence-based practice to guide your decision on appropriate adaptations following the DENT problem-solving method.
a. Define the problem: Clearly identify and articulate the specific problem or challenge that needs to be addressed. This involves understanding the current situation, desired outcomes, and any constraints or limitations (1 paragraph)
b.Explore possible solutions: Generate a range of potential solutions or approaches to solving the problem. Encourage creative thinking and consider different perspectives or alternative options.(1 paragraph)
c. Narrow down options: Evaluate the potential solutions and select the most feasible and effective ones. Consider the advantages, disadvantages, and potential risks associated with each option.(1 paragraph)
d. Take action: Implement the chosen solution or solutions. Develop a plan, allocate resources, and set specific goals and timelines for execution. (1 paragraph)
3.What assessment would be most appropriate for you to give to Jaime? (1 paragraph: Question 2 and Question 3)
3.What factors must be considered when planning Jaime’s adaptations?
4. What is your PICO question? (1 paragraph: Question 4 and Question 5)
5.What outcomes do you anticipate from your plan?
6.How will you evaluate the outcomes of your plan? (1 paragraph: Question 6 and Question 7)
7.What contraindications should you consider in Jaime’s inclusion?
8.What other recreational activities would be appropriate considering Jaime’s interests, goals, and current functioning level? (1 paragraph)
9.How would you communicate your recommendations to Jaime?” (1 paragraph)
- Inclusion Plan for Jaime:
a. Define the problem: The specific problem is to create an inclusion plan for Jaime, a visually impaired individual with acute angle closure crisis-induced glaucoma and decreasing vision in his left eye, to enable him to participate in a snow skiing trip for individuals with blindness and low vision. The goal is to address his desire to engage in recreational activities, increase his independence, and enhance physical activity while ensuring his safety and enjoyment.
b. Explore possible solutions: Some potential solutions for Jaime’s inclusion on the skiing trip could include:
- Providing adaptive skiing equipment, such as a visually impaired skiing guide, modified skis with additional stability features, and communication devices to ensure safety and guidance on the slopes.
- Offering orientation and mobility training specific to skiing, including techniques for navigating slopes, recognizing auditory cues, and understanding the environment.
- Conducting pre-trip orientation sessions to familiarize Jaime with the skiing resort, ski instructors, and other participants.
- Partnering Jaime with an experienced skiing guide who can provide verbal cues, navigation assistance, and support throughout the trip.
- Ensuring clear communication channels between Jaime and the trip leaders to address any concerns, adapt activities as needed, and monitor his well-being.
c. Narrow down options: Evaluate the potential solutions and select the most feasible and effective ones. Consider the advantages, disadvantages, and potential risks associated with each option. For Jaime’s inclusion plan, the chosen solutions could include:
- Providing adaptive skiing equipment tailored to Jaime’s needs, such as a guide dog harness designed for skiing, to enhance safety and mobility.
- Conducting a thorough assessment of Jaime’s skiing skills and capabilities to determine the appropriate level of assistance and support required.
- Collaborating with skiing instructors who have experience working with visually impaired individuals to ensure effective instruction and guidance during the trip.
- Implementing a buddy system where Jaime is paired with a fellow participant or instructor who can provide additional support and assistance.
- Incorporating regular breaks and rest periods during skiing activities to prevent fatigue and allow Jaime to manage any discomfort related to his eye condition.
d. Take action: Implement the chosen solutions by developing a comprehensive plan that outlines the adaptations, resources needed, and specific goals and timelines for execution. Assign appropriate staff or volunteers who are trained in working with visually impaired individuals to support Jaime during the trip. Continuously monitor Jaime’s progress and make adjustments as necessary to ensure his safety, enjoyment, and achievement of desired outcomes.
- The most appropriate assessment for Jaime would be a comprehensive orientation and mobility assessment. This assessment would evaluate his current skills and abilities related to independent travel and mobility, as well as his understanding of auditory cues, spatial awareness, and environmental navigation. It would help identify any specific challenges or areas requiring additional training and adaptation, especially in the context of skiing activities.
- When planning Jaime’s adaptations, several factors must be considered:
- The extent of his visual impairment and specific challenges he faces due to his condition.
- Safety concerns and the need for adaptations to ensure his well-being during skiing activities.
- Jaime’s physical capabilities and limitations, taking into account his previous experience with skiing and any potential impact on his balance, coordination, or stamina.
- The availability of adaptive equipment and resources to support his participation in skiing.
- Consideration of his personal preferences, interests, and goals to tailor adaptations and activities to his specific needs.
- PICO question: In visually impaired individuals with glaucoma-related vision loss, does participation in adaptive skiing programs lead to increased physical activity, improved quality of life, and enhanced social integration compared to those who do not participate?
- Anticipated outcomes from the inclusion plan for Jaime:
- Increased participation in recreational activities, specifically skiing.
- Improved physical fitness and weight management.
- Enhanced sense of independence and self-confidence.
- Expanded social connections and opportunities for interaction with others.
- Increased overall enjoyment and quality of life.
- Evaluation of plan outcomes will involve:
- Assessing Jaime’s subjective feedback and satisfaction with the skiing experience.
- Monitoring any improvements in his physical fitness and weight management.
- Evaluating his ability to adapt to skiing techniques and navigate the slopes safely.
- Assessing the impact of the skiing trip on Jaime’s sense of independence, self-confidence, and social integration.
- Collecting feedback from trip leaders, instructors, and fellow participants on Jaime’s progress and contributions during the trip.
- Contraindications to consider in Jaime’s inclusion:
- Medical contraindications: Consult with Jaime’s healthcare provider to ensure that skiing and physical activity are safe for him considering his glaucoma and overall health status.
- Environmental contraindications: Evaluate weather conditions, slope difficulty, and potential hazards to ensure they are suitable for visually impaired individuals and align with Jaime’s abilities.
- Personal contraindications: Take into account any personal preferences, limitations, or discomfort that may affect Jaime’s participation in skiing activities.
- Other recreational activities appropriate for Jaime’s interests, goals, and current functioning level could include:
- Tactile sports such as goalball, where he can engage in team-based competition.
- Outdoor activities like hiking or nature walks with the assistance of a guide or his guide dog.
- Audio-described theater or movie experiences to enjoy cultural and entertainment activities.
- Adaptive indoor sports like bowling or table tennis that can be easily modified for visually impaired individuals.
- Recommendations to Jaime can be communicated by:
- Providing a comprehensive written plan that outlines the adaptations, resources, and goals for the skiing trip.
- Scheduling a meeting or phone call to discuss the plan in detail and address any questions or concerns.
- Offering visual aids or materials in accessible formats, such as braille or large print, if needed.
- Ensuring a clear and open line of communication throughout the planning process and the trip itself, allowing Jaime to provide feedback and express any additional needs or preferences.