Community rehabilitation of disabled with a focus on blind persons: Indian perspective

Barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa within a global context

Low vision is an uncorrectable form of visual impairment that affect millions of people worldwide. Low vision care and rehabilitation are essential to improving the independence of affected individuals. Even though sub-Saharan Africa has one of the highest burdens of low vision globally, there are inadequate care and rehabilitation services in most countries and in some cases they are non-existent This scoping review aimed to identify the barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa and assess these within the global context. The review was conducted using the five-step Arksey and O'Malley framework. Search terms were formulated based on the research questions and a search strategy was designed to search for eligible research articles from electronic databases; Pubmed, Ovid, Medline, and Embase. The data was screened by two members of the research team in accordance with set inclusion and exclusion criteria. Twenty-five out of 260 articles satisfied the inclusion criteria for the study. Inadequate low vision care infrastructure and supplies, non-standardised training of low vision care providers, health system failure and poor awareness of low vision care were the main barriers noted by eye care practitioners. Patients living with low vision cited the cost and availability of low vision aids, societal stigma, and poor awareness of services as the main barriers. No direct enablers were identified in sub-Saharan Africa; however, practitioners suggested improved training in low vision as a potential enabler. The barriers to low vision care and rehabilitation services identified were not unique to sub-Saharan Africa when viewed within a global context. Adopting and adapting solutions from other countries may therefore assist in improving low vision care and rehabilitation in sub-Saharan Africa.

Impact of special software training on quality of life among people with visual impairment

Purpose

To evaluate the impact of special software training in computer and smartphone apps as a form of rehabilitation to improve the quality of life of individuals with visual impairment (VI).

Methods

The study utilized a one-group pretest-posttest design. A total of 50 individuals aged 15 years and older with VI participated in the training, which included special software (NVDA) and mobile app training for 60 hours at the Visual Rehabilitation Center. The Low Vision Quality of Life Questionnaire was administered before the start of training and six months after completion. The questionnaire covered the following domains: (1) mobility, distance vision, and lighting; (2) reading and fine work; (3) social well-being; (4) economic impact; (5) attitude toward life; and (6) activities of daily living. Statistical software STATA 14.0 (Texas, USA) was used for data analysis. Paired t-tests and Wilcoxon signed-rank tests were conducted to compare the mean differences before and after training.

Results

Significant improvements were observed in five dimensions, namely mobility, distance vision and lighting, reading and fine work, and attitude toward life, at a highly significant level of 1% probability. The dimensions of social well-being and economic impact showed significant improvement at a 5% level of probability.

Conclusion

Visual impairment, whether congenital or acquired later in life, affects independence in all aspects of life. To the best of our knowledge, this is the first study to investigate the impact of special software training on the quality of life of visually impaired individuals. The authors suggest that this form of rehabilitation enhances accessibility to mainstream living, promotes independence, and ultimately improves quality of life. Participants experienced an improved quality of life through increased access to mainstream resources, enhanced ability to navigate and manage daily activities independently, and reduced reliance on multiple low vision aids or assistance from sighted individuals.

Use of subjective and objective criteria to categorise visual disability

CONTEXT

Visual disability is categorised using objective criteria. Subjective measures are not considered.

AIM

To use subjective criteria along with objective ones to categorise visual disability.

SETTINGS AND DESIGN

Ophthalmology out-patient department; teaching hospital; observational study.

MATERIAL AND METHODS

Consecutive persons aged >25 years, with vision <20/20 (in one or both eyes) due to chronic conditions, like cataract and refractive errors, were categorized into 11 groups of increasing disability; group-zero: normal range of vision, to group-X: no perception of light, bilaterally. Snellen's vision; binocular contrast sensitivity (Pelli-Robson chart); automated binocular visual field (Humphrey; Esterman test); and vision-related quality of life (Indian Visual Function Questionnaire-33; IND-VFQ33) were recorded.

STATISTICAL ANALYSIS

SPSS version-17; Kruskal-wallis test was used to compare contrast sensitivity and visual fields across groups, and Mann-Whitney U test for pair-wise comparison (Bonferroni adjustment; P < 0.01). One-way ANOVA compared quality of life data across groups; for pairwise significance, Dunnett T3 test was applied.

RESULTS

In 226 patients, contrast sensitivity and visual fields were comparable for differing disability grades except when disability was severe (P < 0.001), or moderately severe (P < 0.01). Individual scales of IND-VFQ33 were also mostly comparable; however, global scores showed a distinct pattern, being different for some disability grades but comparable for groups III (78.51 ± 6.86) and IV (82.64 ± 5.80), and groups IV and V (77.23 ± 3.22); these were merged to generate group 345; similarly, global scores were comparable for adjacent groups V and VI (72.53 ± 6.77), VI and VII (74.46 ± 4.32), and VII and VIII (69.12 ± 5.97); these were merged to generate group 5678; thereafter, contrast sensitivity and global and individual IND-VFQ33 scores could differentiate between different grades of disability in the five new groups.

CONCLUSIONS

Subjective criteria made it possible to objectively reclassify visual disability. Visual disability grades could be redefined to accommodate all from zero-100%.

Realizing the potential of accessible ICTs in developing countries

PURPOSE

To raise the awareness of policy makers, economic development practitioners, and service providers about the importance of making information and communication technology (ICT) based international economic development in low- and middle-income countries inclusive of people with disabilities and to discuss the role and importance of addressing the complete ICT and assistive technology (AT) ecosystem to ensure sustainable, scalable, and affordable access to ICTs and ICT-based programs.

METHOD

This commentary piece draws upon recent literature and practice cases to examine the role of accessible ICTs in international development.

RESULTS

Accessible ICTs can enhance economic participation and prevent exclusion from participation in international development programs. Access to and use of accessible technologies are largely determined by the ecosystem in which they exist and can be enhanced or hindered by government policy and legislation and the quality of the service delivery systems and financing mechanisms.

CONCLUSIONS

People with disabilities in developing countries face daunting barriers to socioeconomic participation. Accessible ICTs can eliminate or mitigate some of these barriers. However, technology advancements do not solely promote penetration, affordability, or scalability of ICT-based development for persons with disabilities. A comprehensive ecosystem approach can help in developing sustainable mechanisms for access, affordability, and availability.