[Neurosensory, aesthetic and dental late effects of childhood cancer therapy]

Oncologic management in pediatric patient may be associated with a high risk of neurosensory deficit, such as taste, olfaction, vision and hearing. These neurosensory deficits can be linked to chemotherapy toxicity or to a direct deleterious effect of local radiotherapy or surgical management in case of craniofacial cancers. Neurosensory deficit may be temporary but are usually irreversible and frequently progress after the completion of treatment. Taste and olfaction deficits expose to high risk of nutritional complications and quality of life alteration. Hyposialia, as a result of irradiation of the salivary glands, increases taste changes and the risk of dental caries. The risk of cataract is present in patients who received high dose corticosteroids and/or brain or orbital irradiation. When hearing is affected, a risk of impaired intellectual or academic performance is increased with an impact on the quality of life in absence of specific care. Finally, there are some cosmetic consequences of therapy such as alopecia and scarring that alter the image of the patient. Early detection of these problems in order to limit medical, psychological, educational and social impact is mandatory. Moreover, high risk of worsening of these deficits after completion of therapy support long-term follow-up children treated for cancer, especially with head and neck primary.

Do problem-solving interventions improve psychosocial outcomes in vision impaired adults: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of problem-solving interventions on psychosocial outcomes in vision impaired adults.

METHODS

A systematic search of randomised controlled trials (RCTs), published between 1990 and 2013, that investigated the impact of problem-solving interventions on depressive symptoms, emotional distress, quality of life (QoL) and functioning was conducted. Two reviewers independently selected and appraised study quality. Data permitting, intervention effects were statistically pooled and meta-analyses were performed, otherwise summarised descriptively.

RESULTS

Eleven studies (reporting on eight trials) met inclusion criteria. Pooled analysis showed problem-solving interventions improved vision-related functioning (standardised mean change [SMC]: 0.15; 95% CI: 0.04-0.27) and emotional distress (SMC: -0.36; 95% CI: -0.54 to -0.19). There was no evidence to support improvements in depressive symptoms (SMC: -0.27, 95% CI: -0.66 to 0.12) and insufficient evidence to determine the effectiveness of problem-solving interventions on QoL.

CONCLUSION

The small number of well-designed studies and narrow inclusion criteria limit the conclusions drawn from this review. However, problem-solving skills may be important for nurturing daily functioning and reducing emotional distress for adults with vision impairment.

PRACTICE IMPLICATIONS

Given the empirical support for the importance of effective problem-solving skills in managing chronic illness, more well-designed RCTs are needed with diverse vision impaired samples.

Intra-session test-retest reliability of magnitude and structure of center of pressure from the Nintendo Wii Balance Board™ for a visually impaired and normally sighted population

Individuals with visual impairment (VI) have irreparable damage to one of the input streams contributing to postural stability. Here, we evaluated the intra-session test-retest reliability of the Wii Balance Board (WBB) for measuring Center of Pressure (COP) magnitude and structure, i.e. approximate entropy (ApEn) in fourteen legally blind participants and 21 participants with corrected-to-normal vision. Participants completed a validated balance protocol which included four sensory conditions: double-leg standing on a firm surface with eyes open (EO-firm); a firm surface with eyes closed (EC-firm); a foam surface with EO (EO-foam); and a foam surface with EC (EC-foam). Participants performed the full balance protocol twice during the session, separated by a period of 15min, to determine the intraclass correlation coefficient (ICC). Absolute reliability was determined by the standard error of measurement (SEM). The minimal difference (MD) was estimated to determine clinical significance for future studies. COP measures were derived from data sent by the WBB to a laptop via Bluetooth. COP scores increased with the difficulty of sensory condition indicating WBB sensitivity (all p<0.01). ICCs in the VI group ranged from 0.73 to 0.95, indicating high to very high correlations, and the normal group showed moderate to very high ICCs (0.62-0.94). The SEM was comparable between groups regardless of between-subject variability. The reliability of the WBB makes it practical to screen for balance impairment among VI persons.

A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services

OBJECTIVE

To investigate the effectiveness of a low vision self-management programme (LVSMP) in older adults.

METHODS

Participants (n=153) were existing clients of a national low vision rehabilitation organisation randomly allocated to usual services (n=60) or usual services plus LVSMP (n=93). The LVSMP was an 8-week group programme facilitated by low vision counsellors. The primary outcome was vision-specific quality of life (QoL) measured using the Impact of Vision Impairment (IVI) questionnaire. Secondary outcomes emotional well-being, self-efficacy and adaptation to vision loss were measured using the depression, anxiety, stress scale (DASS), general self-efficacy scale (GSES), and short form adaptation to age-related vision loss scale (AVL12).

RESULTS

At one and six month follow-up assessments, no significant between-group differences were found for vision-specific QoL, emotional well-being, adaptation to vision loss or self-efficacy (p>0.05). Univariate and multivariate analyses revealed no impact of the intervention on outcome measures.

CONCLUSIONS

In contrast to previous work, our study found limited benefit of a LVSM programme on QoL for older adults accessing low vision services.

PRACTICE IMPLICATIONS

When implementing self-management programmes in low vision rehabilitation settings, issues of client interest, divergence of need, programme accessibility and fidelity of intervention delivery need to be addressed.

Seroepidemiology of Toxocara infection in patients with vision impairment and blindness in durango, Mexico

Background

Toxocara infection is a cause of vision impairment and blindness. We aimed to determine the seroprevalence and correlates of Toxocara infection in patients suffering from vision impairment and blindness in Durango City, Mexico.

Methods

Through a cross-sectional seroprevalence study, 204 patients with vision impairment and 19 blind patients were studied for the presence of anti-Toxocara IgG antibodies in Durango City, Mexico. Seroprevalence association with socio-demographic, housing, clinical, and behavioral characteristics of participants was also investigated.

Results

Five (2.5%) of the 204 patients with vision impairment, and none of the 19 patients with blindness were positive for anti-Toxocara IgG antibodies. In total, five of the 223 (2.2%) patients were positive for anti-Toxocara IgG antibodies. Seropositivity to Toxocara was not associated with age, sex, educational level, socio-economic status, presence of underlying diseases or behavioral characteristics of the patients. In contrast, multivariate analysis showed that Toxocara seropositivity was associated with living in a house with soil floor (odds ratio (OR) = 11.14; 95% confidence interval (CI): 1.57 - 78.74; P = 0.01).

Conclusions

This is the first report of Toxocara exposure in patients with vision impairment and blindness in Mexico, and of an association of Toxocara exposure with living in a house with soil floors. Results suggest a low Toxocara exposure in these patients in Durango, Mexico. The risk factor associated with Toxocara exposure identified in this study warrants for further investigation.

Documentation of Dual Sensory Impairment in Electronic Medical Records

PURPOSE OF THE STUDY

To examine the documentation of sensory impairment in the electronic medical records (EMRs) of Veterans with both hearing and vision losses (dual sensory impairment [DSI]).

DESIGN AND METHODS

A retrospective chart review of the EMRs of 20 patients with DSI was conducted. Providers' documentation of the presence of sensory impairment, the use of assistive technology during clinical appointments, and the content of notes mentioning communication issues were extracted from each chart note in the EMR for the prior 6 years.

RESULTS

Primary care providers documented DSI in 50% of EMRs, vision loss alone in 40%, and hearing loss alone in 10% of EMRs. Audiologists documented vision loss in 50% of cases, whereas ophthalmologists/optometrists documented hearing loss in 15% of cases. Examination of two selected cases illustrates that care can be compromised when providers do not take note of sensory impairments during planning and provision of clinical care.

IMPLICATIONS

Sensory impairment is poorly documented by most providers in EMRs. This is alarming because vision and hearing affect patient-physician communication and the use of medical interventions. The results of this study raise awareness about the need to document the presence of sensory impairments and use the information when planning treatment for individuals with DSI.

Enabling positive work outcomes for people with low vision: two case studies

This paper will focus on work-based environments, assistive technology solutions and compensatory strategies for people with low vision (that is, when vision cannot be satisfactorily corrected by spectacles/lenses). It presents two case studies to illustrate how functional capacity within a workplace can be maximized for individuals with vision impairment through a range of interventions. Each case study will demonstrate how the provision of a holistic suite of services delivered by a multidisciplinary team achieves positive and sustainable work outcomes for this cohort. One case study features an individual in a manual work role and the other in an office-based role. The following aspects of service delivery will be illustrated by each case study: Importance of comprehensive workplace and low vision assessment. Vocational planning. Compensatory strategies for job/task specific duties. Assistive technology and workplace modifications. Independent and safe travel skills to, from and within the workplace. Employer and co-worker training.

Change in psychological control in visually impaired older adults over 2 years: role of functional ability and depressed mood

OBJECTIVES

The life-span theory of control is applied to study change in vision-specific control strategies in visually impaired older individuals, depending on performance in instrumental activities of daily living (IADL) and depressed mood.

METHOD

Longitudinal data from visually impaired individuals (at baseline: N = 364; mean age = 82.8 years; visual acuity less than 20/60) measured at three occasions with 1-year intervals in-between were analyzed. A newly established vision-specific control scale to assess selective primary control (SPC), selective secondary control (SSC), compensatory primary control (CPC), and compensatory secondary control (CSC) was used. Linear and nonlinear (quadratic and piecewise) generalized mixed models with gamma response distribution to fit the skewed data were applied.

RESULTS

CPC progressively increased as IADL capacity decreased up to a turning point, at which CPC plateaued, whereas all other strategies declined linearly with IADL decrease. Controlling for depressed mood did not change these relationships for CPC, SPC, and SSC but absorbed IADL-related decline of CSC. Higher depression was associated with less SPC, SSC, and CSC, but only slightly with less CPC.

DISCUSSION

IADL plays an important role triggering a shift in adaptational strategies from selective control to CPC in visually impaired older adults and possibly other disabled populations.

Severe vision and hearing impairment and successful aging: a multidimensional view

PURPOSE

Previous research on psychosocial adaptation of sensory-impaired older adults has focused mainly on only one sensory modality and on a limited number of successful aging outcomes. We considered a broad range of successful aging indicators and compared older adults with vision impairment, hearing impairment, and dual sensory impairments and without sensory impairment.

DESIGN AND METHODS

Data came from samples of severely visually impaired (VI; N = 121), severely hearing-impaired (HI; N = 116), dual sensory-impaired (DI; N = 43), and sensory-unimpaired older adults (UI; N = 150). Participants underwent a wide-ranging assessment, covering everyday competence, cognitive functioning, social resources, self-regulation strategies, cognitive and affective well-being, and 4-year survival status (except the DI group).

RESULTS

The most pronounced difference among groups was in the area of everyday competence (lowest in VI and DI). Multigroup comparisons in latent space revealed both similar and differing relationship strengths among health, everyday competence, social resources, self-regulation, and overall well-being, depending on sensory status. After 4 years, mortality in VI (29%) and HI (30%) was significantly higher than in UI (20%) at the bivariate level, but not after controlling for confounders in a multivariate analysis.

IMPLICATIONS

A multidimensional approach to the understanding of sensory impairment and psychosocial adaptation in old age reveals a complex picture of loss and maintenance.

Life satisfaction and quality of life of older New Zealanders with and without impaired vision: a descriptive, comparative study

A study involving older New Zealanders (aged 65+) explored levels of life satisfaction reported by groups with and without impaired vision as well as factors contributing to and detracting from quality of life (QOL). Those with impaired vision (n = 135) had a visual acuity of 6/24 (i.e., 20/80) or worse in the better eye with corrective lenses, or a field of vision not greater than 20° at its widest diameter and had a mean age of 82.3 (SD = 6.76). Those with no significant impairment of vision (n = 425) were able read newsprint and legally drive and had a mean age of 74 (SD = 6.49). Overall, those with impaired vision reported a significantly lower level of life satisfaction in comparison to their sighted peers. There was a significant interaction effect of vision status and age, such that those with impaired vision aged 85+ reported life satisfaction scores higher than those reported by their sighted peers. Family and friends emerged as most important contributors to QOL for the vision-impaired group, where good health was the primary contributor to those with sight. Detractors to QOL reported by those with impaired vision included poor vision, inability to drive and poor health. Those with no significant impairment of vision reported poor health, physical impairment and poor finances detracted from QOL. Results could enable ageing and rehabilitation service providers to design rehabilitation programmes addressing areas reported to be most important to older adults with and without impaired vision.