Home lighting assessment for clients with low vision

A Study of Environmental Factors in Low Vision Rehabilitation

Healthcare has the past decades shifted from a narrow medical perspective to a more holistic, biopsychosocial perspective. Disability understood as a contextual condition constituted by the relation of the individual to their social and physical context. The disability model of the International Classification of Functions (ICF) contextualizes activity, participation, body functions and structure by including environmental and personal factors. However, illustrated by the consideration of the environmental factors as a neutral dimension, the dynamic interrelation of the individual parts of the system is rather unchartered. In 2017–2019, a lighting assessment was developed and tested on 60 participants in low vision rehabilitation. An action research project accompanied the pilot study from 2018. Ethnographic participatory observations of the low vision consultants in 15 consultations, semi-structured interviews, and a document analysis of the project material of the pilot project has been analyzed using the theoretical framework of science and technology studies. Mapping the physical environment showed a range of factors from spatial organization to luminaires and light bulbs. Moreover, in relation to specific activities, relevant factors were identified and assessed, and in the intervention adjusted to relevant personal and social factors. Identifying overlapping personal, environmental, and professional spheres illustrates the complexity of practicing rehabilitation in people's everyday lives. Acknowledging and coordinating different versions of lighting enabled low vision consultants to work across these spheres relationally. ICF was embedded in the practice of low vision consultants as a frame of reference, however, implementing this framework occurred through an assemblage of tools from different fields. The focus on lighting as an active element in low vision rehabilitation demonstrated a way to work across the personal and environmental to reduce the gap that caused disability. In everyday life, the physical environment was pivotal in the person–environment relationship and in enabling or disabling the individual. However, the physical environment was also key to the rehabilitation process, facilitating the individual's learning and change processes and reconfiguring their understanding and use of the environment. Consequently, the physical environment was not a neutral background to the other factors but rather enabling the rehabilitation and recovery processes.

An Investigation of the Implications of Visual Impairment for Illumination Requirements

Introduction

The present contribution mainly focuses on the evaluation of the visual performance of people with impaired vision and, for comparison purposes, individuals with typical vision under different lighting conditions. Methods: A monitor with adjustable brightness facilitated various test runs to determine the visual performance as a function of the adaptation luminance and glare. In addition, the subjective impressions of the participants with impaired vision were queried via interviews. The study included 98 people with impaired vision and 38 people without visual impairments. Results: The interview results suggest that most people with visual impairments require special lighting conditions. An increased lighting requirement is observed amongst 50% of this group. Moreover, 75% of this group display increased glare sensitivity. Likewise, adaptation problems and critical issues related to nonuniform lighting are manifest. Individuals with impaired vision included in this study display a greatly reduced contrast threshold and a higher subjective level of discomfort compared to individuals with typical vision.Discussion: Most visually impaired participants state that they require a higher degree of brightness to achieve their maximum personal visual performance. However, about a quarter of the participants reported that they achieve a better visual performance at lower brightness, while displaying an increased sensitivity to glare. In general, glare has a decisive influence on the visual performance of the participants with impaired vision in our study. Implications for Practitioners: The study reconfirms the essential importance of glare-free and uniform general lighting strategies (e.g., via predominantly indirect lighting) as well as avoiding abrupt spatiotemporal luminance changes (e.g., via provision of a transition zone between locations with very different luminance levels).

Impact of Lighting Assessment and Optimization on Participation and Quality of Life in Individuals with Vision Loss

This pilot study was designed to investigate the effects of a holistic lighting intervention on the quality of life for individuals with low vision. Sixty participants (44 women; median age 69 years) with visual impairment received lighting interventions, including a home visit and consultation in a lighting lab. Assisted by low vision consultants, participants evaluated their performance using the Canadian Occupational Performance Measure (COPM) before and after the intervention. Improvements in visual functioning and quality of life were evaluated using the 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39), the Groffman Visual Tracing Test, and the Farnsworth Dichotomous Test (D15). Following the lighting intervention, scores improved for all activities in the COPM (p < 0.01), for near activities and vision-specific role difficulties in the VFQ-39 (p < 0.05), and overall in the D15 test (p < 0.05). These results suggest the intervention provided an effective method for improving the participants' quality of life and performance.

Assessing optimal colour and illumination to facilitate reading: an analysis of print size

PURPOSE

This study examined how optimal colour/illumination conditions and the efficacy of the iPad, LuxIQ and Smart Bulb varied as a function of print size in younger, older and visually impaired adults.

METHODS

Participants with visual impairments and simulated low vision (SLV) read the MNRead using the iPad, LuxIQ and Smart Bulb.

RESULTS

In the impairment condition at 1.20 logMAR, the iPad (M = 9.49, 95% CI [3.18, 19.42]) and LuxIQ (M = 15.95, 95% CI [9.54, 24.86]) improved the reading speeds. At 0.80 logMAR (SLV), all devices improved reading speeds of older adults (iPad (M = 28.70, 95% CI [14.65, 42.51]); LuxIQ (M = 49.63, 95% CI [30.04, 69.68]); Smart Bulb (M = 23.11, 95% CI [3.33, 42.11])), but in younger adults only the LuxIQ (M = 13.04, 95% CI [3.21, 21.27]) did so. In the impairment condition, the iPad (M = 5.54, 95% CI [0.31, 12.13]) and LuxIQ (M = 13.90, 95% CI [7.88, 23.49]) improved reading speeds. In the SLV condition, age was a significant predictor of reading speed at 1.20 logMAR (F_3,164  = 10.74, p < 0.001, Adj. R²  = 0.16). At 0.80 logMAR, age and luminance, but not colour, were significant predictors (F_3,164  = 52.52, p < 0.001, Adj. R²  = 0.49). In the impairment condition, both age and lux were significant predictors of reading speed at 1.20 (F_3,85  = 7.14, p < 0.001, Adj. R²  = 0.20) and 0.80 logMAR (F_3,85  = 7.97, p < 0.001, Adj. R²  = 0.22), but colour was not.

CONCLUSIONS

Light source effectiveness and optimal colour/illumination vary as a function of print size. It appears that print size is the most important factor for improving reading speed. As print size decreases, luminance becomes crucial, and only at the smallest print sizes does the effect of colour become useful.

Comparison of Two Lighting Assessment Methods when Reading with Low Vision

SIGNIFICANCE

Lighting assessments are an important component of low-vision rehabilitation but are rarely studied systematically. Our study indicates that preferred lighting levels support improvements in reading ease and enjoyment, independently of the evaluation technique. To determine preferred illumination level and color temperature, the LuxIQ is quicker to administer and covers broad options of settings.

PURPOSE

The purpose of this study was to determine if preferred lighting, as assessed by the LuxIQ versus a standard lighting assessment, leads to better reading outcomes in individuals with low vision.

METHODS

Preferred lighting was assessed at home with visually impaired persons (mean age, 75.3 years), using the LuxIQ (n = 18) or a standard technique based on trying out light bulbs of various intensity and color temperature (n = 16). Maximum reading speed and reading acuity were measured before the lighting intervention and then under the preferred lighting conditions. A 1-month telephone follow-up evaluated the (1) compliance with the lighting recommendations and, for those who modified their lighting, (2) their level of satisfaction with the length of reading time and eye strain felt during reading.

RESULTS

Compared with usual lighting conditions, most participants preferred a cooler temperature at a higher illuminance level. Neither lighting assessment type appeared to lead to substantially improved objectively measurable reading outcomes. At the 1-month follow-up, 56% of the participants had modified their lighting, having a significant effect on satisfaction (P < .01), independent of assessment method. Of 18 respondents, 16 (87.5%) mentioned that reading was more enjoyable or easier with the lighting modifications.

CONCLUSIONS

Both lighting assessment methods lead to comparable results, but the LuxIQ is easier and faster to use. More research is needed to determine whether the LuxIQ is suitable to be incorporated into clinical practice.

Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study

BACKGROUND

Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer's disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health.

OBJECTIVE

The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation.

METHODS

We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision & hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health).

RESULTS

The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again.

CONCLUSIONS

Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19931.

Assessing optimal colour and illumination to facilitate reading

PURPOSE

This study examined the effectiveness of the LuxIQ, the Apple iPad and a smart bulb in assessing optimal colour and illumination to facilitate reading in younger, older and visually impaired adults.

METHODS

Participants read standardised texts at baseline (normal lighting/no device), then using the Apple iPad, LuxIQ and smart bulb, with their normal vision (20/20 condition) and using a simulated reduction in visual acuity/contrast sensitivity (20/80 condition). Visually impaired participants followed the same procedure used in the 20/80 condition.

RESULTS

There was a significant interaction between condition and device in younger, F(1.5, 43.51) = 30.41, p < 0.001, ω²  = 0.34 and older, F(1.5, 4.51) = 4.51, p = 0.03, ω²  = 0.05 adults with normal vision, and there was a significant effect of device, F(2, 58) = 5.95, p = 0.004, ω²  = 0.12 in visually impaired adults. In the 20/20 condition, age and colour predicted reading speed, F(3, 176) = 36.25, p < 0.001, Adj. R²  = 0.37, whereas age, lighting and colour predicted reading speed, F(3, 176) = 36.25, p < 0.001, Adj. R²  = 0.37 in the 20/80 condition. In the visual impairment condition, lighting, colour and impairment severity predicted reading speed, F(3, 85) = 10.10, p < 0.001, Adj. R²  = 0.24.

CONCLUSIONS

The clinical implications of this study are that reading speeds improve in individuals with low vision under improved lighting conditions, specifically, with higher levels of luminance and colour temperature. The effectiveness of the devices varied across groups; however, the LuxIQ was the only device to improve reading speeds from baseline in older adults with visual impairments.

Understanding Older Adults' Perception and Usage of Indoor Lighting in Independent Senior Living

The main purpose of this research is to examine the lighting condition and residents' perception of lighting in a senior retirement community in order to understand various environmental issues related to lighting. Also, this research aims to suggest a new lighting solution to compensate for older adults' vision impairment and challenges at home for a successful aging place. In the normal aging process, more than 30% of older adults have a vision impairment, which negatively affects health and well-being of older adults such as limited activities, falling, loneliness, depression, anxiety, and a sense of control. Via a mixed method study design, residents in senior living communities were asked to describe the adequacy of light levels and specific tasks and needs related to lighting at their home. In addition to the survey and interview, indoor lighting assessments were conducted during the in-home session. The research findings highlighted older adults' experience and perception of lighting in their homes. Paired-sample t test indicated that there were statistically significant differences in light levels between normal conditions and full capacity conditions in all spaces. In order to address various challenges which older adults have been experiencing in their home for a long time, this research suggests new smart lighting platform which provides a proper level of illumination in older adult's homes. Such a smart platform is proactive and can dynamically adjust the smart devices or lighting fixtures in situ, while older adults are performing certain tasks.

A Novel Adaptive Lighting System Which Considers Behavioral Adaptation Aspects for Visually Impaired People

The number of visually impaired people and elderly people groups are significant, but the current lighting system used in buildings, which is based on the current standard, cannot provide the necessary lighting comfort for them. The lighting system should provide the correct illuminance for every activity and even pattern of light. This research presents the work in progress in developing the novel adaptive lighting system tailored for visually impaired people, which becomes the solution to the problem. The behavioral adaptation aspects and the experience and memory principle are taken into account in the system design. It also makes use of the latest independent adjustable artificial light (LED) technology, to get an even pattern of lighting, while still considering efficient energy usage. The proposed system structure uses a wireless sensor network (WSN), big data processing, and the Artificial Intelligence (AI) sub-system, which can predict and adaptively regulate the illumination level based on the occupant’s needs and routines. The initial simulation of the lighting model is presented in this paper. The simulation uses five scenarios in different seasons and daylight. The simulation shows satisfactory results for illuminance values 200, 250, 300, 500, and 750 lux, needed by the occupants.

Impact of circadian tuning on the illuminance and color uniformity of a multichannel luminaire with spatially optimized LED placement

Potential advantages offered by multichannel luminaires with regards to spectral tuning are frequently overshadowed by its design challenges, a major one being the non-uniformity in illuminance and color distribution. In this paper, we present a formulation using genetic algorithm (GA) to optimize the Light Emitting Diode (LED) placement, yielding 40% superior uniformity in illuminance and color distributions compared to existing analytical formulations, substantially reducing the reliance on optical design for this purpose. It is specifically shown that our approach is employable for circadian tuning applications, even when heavily constrained by industry specifications on panel size and minimum LED separation.

Test-retest Variability of a Standardized Low Vision Lighting Assessment

SIGNIFICANCE

Systematic lighting assessments should be part of low vision evaluations. The LuxIQ has gained popularity as an assessment tool, but its reliability has not been examined independently and is necessary for evidence-based vision rehabilitation.

PURPOSE

Besides magnification, improved lighting levels are a common intervention in reading rehabilitation for individuals with low vision. Determining the appropriate lighting can be a complex and time-consuming task. The LuxIQ is a portable lighting assessment tool that can be used to systematically measure lighting preferences; however, there is little independent evidence to support its reliability in low vision rehabilitation.

METHODS

One hundred nine control subjects (age, 18 to 85 years) and 64 individuals with low vision (age, 27 to 99 years) adjusted both the luminance and color temperature parameters on the LuxIQ while viewing a sentence on the MNREAD at their preferred print size for continuous reading. After 30 minutes, they were asked to repeat the same measurements.

RESULTS

Using Bland-Altman plots, test-retest variability was calculated using the limits of agreement (LOAs). For illuminance, the LOA width was 2806 lux for control subjects and 2657 lux for visually impaired participants. For color temperature, the LOA width was 2807 K for control subjects and 2364 K for those with a visual impairment. Difference scores were centered near zero, indicating overall accuracy.

CONCLUSIONS

The measurement of lighting preference lacks the precision necessary for clinical utility, given that the LOA for luminance ranged more than 2600 lux, with normally sighted and low vision participants. Such variability translates into a range of approximately ±40 or 50 W in an incandescent light bulb, depending on the luminance level, making it clinically difficult to narrow down the options for evidence-based lighting recommendations. Next steps are to examine whether the reading behavior of low vision clients is positively affected by interventions that are based on LuxIQ recommendations.

Lighting as a Compensatory Strategy for Acquired Visual Deficits After Stroke: Two Case Reports

OBJECTIVE. The objective of this article was to explore the effects of enhanced lighting on the function of people with an acquired visual deficit resulting from cerebrovascular accident (CVA) in an inpatient rehabilitation facility (IRF).

METHOD. An ABAB design was used with two cases to assess how a short-term intervention involving lighting changes affected clients’ grooming performance in an IRF. Analysis consisted of scores on the grooming section of the FIM®, times for each grooming task, and light meter readings.

RESULTS. Both participants demonstrated improvements in function as measured by the FIM and in time to complete grooming tasks with enhanced lighting.

CONCLUSION. These results suggest that individualized lighting can lead to improved grooming function in clients with CVA.

The everyday lives of older adults with visual impairment: An occupational perspective

Introduction

In order to live in a world created for the sighted, older adults with visual impairment must adapt to complete vision-dependent activities that require reading, writing, and object identification. The objective of this study was to explore the occupational lives of three older adults with visual impairment.

Method

A qualitative study with four interviews each and two observation sessions each was conducted with older adults with visual impairment. Data were analyzed by participant and across participants using open, axial, and selective coding. Codes were refined throughout the process yielding the themes of the study.

Results

Three themes emerged from the analysis: an occupational life of doing, an occupational life rich with well-being, and an occupational life filled with motivation for independence. Participants were highly motivated to complete their occupations and activities independently. Participation in activities in the home and community environments provided participants with life satisfaction and happiness. Through problem-solving skills, adaptations, and support of family and friends, participants successfully completed their desired occupations.

Conclusion

This study highlights the importance of motivation and support to facilitate participation in occupations in the home and community environments.

The Clinimetric Properties of Instruments Measuring Home Hazards for Older People at Risk of Falling: A Systematic Review

Home hazards are associated with falls among older people living in the community. However, evaluating home hazards is a complex process as environmental factors vary according to geography, culture, and architectural design. As a result, many health practitioners commonly use nonstandardized assessment methods that may lead to inaccurate findings. Thus, the aim of this systematic review was to identify standardized instruments for evaluating home hazards related to falls and evaluate the clinimetric properties of these instruments for use by health practitioners. A systematic search was conducted in the Medline, CINAHL, AgeLine, Web of Science databases, and the University of Sydney Library CrossSearch Engine. Study screening, assessment, and quality ratings were conducted independently. Thirty-six studies were identified describing 19 instruments and three assessment techniques. The clinimetric properties varied between instruments. The Home Falls and Accidents Screening Tool, Home Safety Self-Assessment Tool, In-Home Occupational Performance Evaluation, and Westmead Home Safety Assessment were the instruments with high potential for evaluating home hazards associated with falls. Health practitioners can choose the most appropriate instruments for their practice, as a range of standardized instruments with established clinimetric properties are available.

Screening for sensory impairment in older adults: Training and practice of occupational therapists in Quebec

BACKGROUND

The goal of occupational therapy education is to train generalists who can refine their knowledge after graduation according to the requirements of the professional environment. However, it is currently unclear to what extent sensory screening should be included in the educational curricula.

PURPOSE

The purpose of this study was to examine the sensory screening education for and practice by occupational therapists working with older adults.

METHOD

A cross-sectional survey was used to collect data from members of the Quebec Order of Occupational Therapists. Descriptive statistics were used in the analysis.

FINDINGS

Data from 102 respondents indicated that training on sensory impairment-related topics was minimal and in stark contrast to the proportion who reported serving clients with a visual (92%), hearing (84%), or combined impairment (53%).

IMPLICATIONS

Occupational therapy considers numerous aspects of physical, cognitive, and emotional well-being. The question remains as to what extent vision and hearing health should take their place among these priorities.

Update on productive aging research in the American Journal of Occupational Therapy, 2013, and overview of research published 2009-2013

In light of the Centennial Vision charge of supporting practice through evidence, this article reviews productive aging research published in the American Journal of Occupational Therapy (AJOT) in 2013 and as a whole from 2009 to 2013. Thirteen such articles were published in 2013, consisting of 4 systematic reviews that identified effective occupational therapy interventions for older adults with low vision; 1 randomized controlled trial that examined changes in occupational therapists' mental health practices with DVD training; and 8 descriptive articles addressing instrument development, practitioner decision making, patient management of medications, and effects of task activities on pain and participation levels. From 2009 to 2013, the quantity and quality of AJOT articles on productive aging increased; 63 articles were published, including 24 effectiveness studies, 14 basic research studies, 15 articles on instrument development and testing, 1 article linking occupational engagement and health, 6 articles on professional education, and 3 articles addressing professional questions.

Systematic Review of Studies on Measurement Properties of Instruments for Adults Published in the American Journal of Occupational Therapy, 2009–2013

OBJECTIVE. We describe the methodological quality of recent studies on instrument development and testing published in the American Journal of Occupational Therapy (AJOT).

METHOD. We conducted a systematic review using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist to appraise 48 articles on measurement properties of assessments for adults published in AJOT between 2009 and 2013.

RESULTS. Most studies had adequate methodological quality in design and statistical analysis. Common methodological limitations included that methods used to examine internal consistency were not consistently linked to the theoretical constructs underpinning assessments; participants in some test–retest reliability studies were not stable during the interim period; and in several studies of reliability and convergent validity, sample sizes were inadequate.

CONCLUSION. AJOT’s dissemination of psychometric research evidence has made important contributions to moving the profession toward the American Occupational Therapy Association’s Centennial Vision. This study’s results provide a benchmark by which to evaluate future accomplishments.

State of the Journal, 2013

The American Journal of Occupational Therapy (AJOT) has developed into a solid research journal, increasingly disseminating evidence-based research able to inform practice.