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Blind Rehabilitation Service
Services for Blind and Visually Impaired Veterans
Blindness is considered one of the most devastating disabilities that can affect an individual, striking people of all ages and walks of life. The term legal blindness is, however, a deceiving one. The generally accepted definition of legal blindness is either central visual acuity of 20/200 or worse in the better eye with the use of corrective glasses; or, central visual acuity better than 20/200 in the better eye with visual field deficits in which the widest diameter of peripheral fields is 20 degrees or less. The definition of low vision used to generate estimates of veterans with low vision is central visual acuity equal to or less than 20/70 but greater than 20/200 in the better seeing eye with the use of corrective glasses. |
In the
The impact of blindness is very individualized and includes a wide range of eye conditions, from the older veteran whose vision gradually worsens due to macular degeneration or some other age-related eye problems, to the serviceperson who is totally blind from traumatic injury. Veterans who must cope with a significant loss of vision require individualized, specialized care and treatment suited to their specific cause of blindness. Physical and medical condition, age, ability to cope with frustrating situations, learning ability, and the overall needs and lifestyle of the veteran are important considerations.
A person confronted with blindness may feel limited and frustrated in performing everyday activities previously taken for granted. Tasks such as dressing, eating, writing, reading, and traveling may become difficult to perform independently. Communication with other people by ordinary means is often hampered, as is the ability to keep up with the daily news and current events. Social interaction, recreation, and hobbies may also be limited or curtailed as a result of vision impairment.
Frequently a person may be forced into premature retirement because of vision loss, often resulting in loss of income and financial security. As a result of the numerous negative outcomes, it is not uncommon for the newly blinded individual to undergo a period of personal stress. Individuals facing blindness and vision impairment may lose self-esteem, or believe the future holds little promise. Spouses, families, and loved ones may experience pressure, strain or uncertainty.
Loss of sight affects each person differently and may hinder overall functioning, including employment, recreation, communication, and social, and family life. To help the veteran cope with these problems the Department of Veterans Affairs established the Blind Rehabilitation Service to provide a wide variety of rehabilitation programs and services to veterans who are blind. The rehabilitation program is designed to improve quality of life for veterans who are blind or severely visually impaired through the development and enhancement of skills and capabilities needed for personal independence, adjustment, and successful reintegration into the community and family environment. Elements of the blind rehabilitation program include: 10 Blind Rehabilitation Centers, Visual Impairment Services Teams (VIST) and VIST Coordinators located at many VA Medical Centers and VA Outpatient Clinics, Blind Rehabilitation Outpatient Specialist (BROS), National Consultants, and a Computer Access Training (CAT) Program. In addition, there are a variety of low vision services and blind rehabilitation programs within the Department of Veterans Affairs system including: Visual Impairment Services Outpatient Rehabilitation (VISOR) programs, Visual Impairment Centers to Optimize Remaining Sight (VICTORS) programs, Intermediate Low Vision Clinics, Advanced Ambulatory Low Vision Clinics and Advanced Hoptel Outpatient Blind Rehabilitation Programs. The VA Blind Rehabilitation Service is committed to a continuum of care model that extends from the veteran’s home environment to the local VA care site and regionally-based inpatient training programs encompassing an array of alternative rehabilitative services. The following will describe in detail the programs offered in Blind Rehabilitation Service, as well as low vision services available at local VA Medical Centers and Outpatient Clinics.
The Blind Rehabilitation Centers
In 1948 the first
The Blind Rehabilitation Centers provide rehabilitation to legally blind veterans. Comprehensive, individualized blind rehabilitation services are provided in an inpatient VA Medical Center environment by a multidisciplinary team of rehabilitation specialists. A Computer Access Training Program (CAT) is offered as part of the comprehensive training or as a specialized inpatient or outpatient rehabilitation option. Attendance in a rehabilitation program requires that all veterans participate in ongoing daily activities, and veterans must meet specific travel requirements in order to attend. All medical conditions that a veteran may currently have, in addition to visual impairment, must be stable enough to permit participation in rehabilitation activities. The management of chronic medical conditions is addressed as part of the training regimen, with many veterans experiencing improvement during their stay.
VA’s Blind Rehabilitation Program has many years of experience and has found that comprehensive rehabilitation is usually the best course to follow for those who are legally or totally blind. Highly qualified professional staff members guide the individual through a rehabilitation process that leads to maximum adjustment to the disability, reorganization of the person’s life, and return to a contributing place in the family and community. To achieve comprehensive rehabilitation, the Blind Rehabilitation Centers offer a variety of skill courses to the veteran, each of which is designed to help achieve a realistic level of independence. The veteran is also assisted in developing a healthy attitude toward himself, blindness, and the future.
Training Provided at Blind Rehabilitation Centers
Orientation and Mobility
Principles of independent travel (often referred to as Orientation and Mobility) are taught using a cane.” Maximum use of any remaining vision to assist travel is evaluated, and in many cases low vision devices are provided and made an integral part of mobility training. Sensory training classes teach the veteran how to more effectively use remaining senses, particularly hearing, as an aid in travel. In addition, exercises in mental mapping serve to enhance the veteran’s orientation while traveling through different kinds of environments.
Orientation and Mobility instruction in relatively simple routes to increasingly complex routes builds the veteran's confidence in the ability to travel independently. By the completion of the instruction the veteran should have a realistic understanding of his or her travel capacity, and the ability to travel safely and independently in both familiar and unfamiliar areas.
Living Skills
This phase of the rehabilitation program includes communication, activities of daily living, and independent living.
Communication: Instruction is designed to enhance and restore abilities in written and spoken communication. Opportunities to learn and use strategies and tools for communication are provided to the veteran, such as typing, handwriting, telling time, management of financial records, Braille, recording devices and other electronic equipment. These courses help the veteran to keep up with current events, correspondence and personal files, and help to maintain a normal means of communication with other people.
Activities of Daily Living: Strategies are provided to the veterans to help them accomplish tasks ranging from routine (managing money, making a cup of coffee) to complex activities such as arranging an entire wardrobe, shopping, kitchen organization, and preparation of complete meals. The emphasis is on learning by doing; techniques and methods are taught and then integrated into the veteran's daily routine. By the completion of the program the veteran should be capable of handling daily living tasks with complete or greatly enhanced independence. Family members often experience a reduction in the burden of care they have been providing to the visually impaired family member.
Independent Living Program: Each
The Living Skills Instructors also arrange consultations with the VA Medical Center dietetic service so veterans have the opportunity to meet with a dietitian. This is particularly important for those veterans who may require special diets and who may require education concerning these diets. Detailed instructions in preparation of special diets can be provided and daily nutrition can be monitored.
Manual Skills
This program area provides the veteran who has little or no vision with the means to develop and improve organizational skills, awareness of the environment, safe and efficient work habits, spatial relationships, and an understanding and mastery of tactual ability. The manual skills training focuses on the sequential development of skills and builds confidence. Training is generally presented to the veteran in several areas, and may include (but is not limited to) handcrafts, home mechanics, woodworking, metalworking, leatherwork, weaving and ceramics.
The initial training area consists of hand crafting objects in order to develop the individual’s confidence in their non-visual senses. The home mechanics training is an introduction to the tools and organizational techniques that allows an individual to perform simple repairs and assembly. Advanced training focuses on the use of adaptive measuring devices, hand tools and power equipment typically used in woodworking.
The manual skills training is not vocational, although some veterans have developed vocational interests or hobbies after participating in this training. Manual skills training may enable a veteran to resume performing home repairs or other related activities at home, further adding to the person's self-confidence and motivation. Veterans who enter blind rehabilitation with minimal abilities in manual skills or those who are slightly skilled in aspects of mechanics or woodworking find this training very beneficial.
Visual Skills
Approximately 85 percent of all veterans who enter a rehabilitation program possess some level of vision that may be useful in many situations. Each veteran attending the program is given a comprehensive eye examination, and a thorough visual skills assessment is performed.
Visual skills training addresses the needs of veterans with remaining vision and helps these individuals gain a better understanding of their eye problems through therapy. Instruction focuses on effective use of remaining vision through the development and use of visual motor and visual perceptual skills. Assessment and instruction with special optical and electronic devices that are designed to meet the needs of people who are visually impaired is provided. Ergonomic equipment such as special lighting and positioning devices are provided to assist veterans in using vision effectively. Lessons may employ the use of visual and ergonomic equipment and visual skills that address near, intermediate and distance tasks. This approach allows veterans who have vision to accomplish a variety of tasks, such as reading printed material, and to use their vision to perform routine activities of daily life, independent travel, etc.
An important goal of the visual skills area is to help the veterans to develop a realistic assessment and understanding of their visual capabilities and limitations so that they may better use their vision in daily life.
Computer Access Training Section (CATS)
The CATS program provides specialized services to eligible veterans including: a comprehensive adaptive computer needs assessment, recommendation of appropriate computer equipment, training on recommended equipment, issuance of equipment upon successful completion of training, and follow-up technical support as required. Eligible veterans may be able to receive local training and issuance if there are local qualified providers in the veterans’ communities.
The equipment issued by CATS is state-of-the-art computer technology with all necessary peripherals and accessible hardware/software to meet the veterans’ identified needs. Training encompasses comprehensive instruction on accessible hardware/software, computer literacy, familiarization to computer keyboard, fundamentals of disk operating systems and fundamentals of word processing, internet access and email. Exceptions to this training regimen are determined on a case-by-case basis.
Physical Conditioning
The onset of vision loss may severely disrupt exercise or recreational activities that many veterans have incorporated into their daily lives, causing a decrease in muscular tone and stamina. Each
Exercises and activities can range from relatively moderate to relatively vigorous, depending on the ability and needs of the veteran. Even a moderate program of regular exercise can assist veterans in management of complicated medical situations. Although many veterans are uncertain at first of their ability to perform regular exercise or participate in leisure activities, they are often surprised at how much they can accomplish with time and patience.
Recreation
Just as the pattern of normal exercise and activity can be affected by blindness, so can recreation that brings pleasure and enjoyment to a person's life. Recreational activities are offered for groups as well as for individuals. Opportunities to attend sporting events, theaters, movies, concerts, as well as social gatherings of various kinds are planned for all patients. The aim of the recreation program is to renew interest in activities that have been enjoyed in the past, and to stimulate new interests. Possible social and recreational activities that may be available in the veteran's home area are discussed and strategies for realistic involvement are explored.
Adjustment to Blindness
Emotional and behavioral adjustment to blindness is often one of the most challenging issues faced by the veteran, and is a primary focus of our Clinical Psychologist, Social Worker and the rehabilitation team.
Through individual counseling sessions and group meetings, veterans are taught coping and adaptation strategies. The rehabilitation program provides a therapeutic environment where the entire staff assists the veteran in developing their own strategies.
A Clinical Psychologist is assigned to each
The Social Worker provides assistance to veterans and designated family members in evaluating and solving social, emotional, or family problems affecting treatment. In many situations problems may be related to the adjustment to blindness, family/interpersonal relationships, financial difficulties, housing/living arrangements, and other issues. Often solutions to the multifaceted dilemmas may require linking with community resources in the veteran's home area to assure that necessary services are available and used following discharge.
Family Program :
The purpose of the family program is to involve the veteran's family in the rehabilitation process, and to demonstrate the changes the veteran has made. The family program is a very important aspect of rehabilitation, because it enlightens and educates the family member and helps to reinforce rehabilitation lessons once the veteran returns home. Moreover, the family program assists family members in their own adjustment to the veteran’s vision loss by identifying problems or misconceptions they have that may negatively affect the veteran’s adjustment.
The Social Worker designs a family program as indicated by the recommendation of the rehabilitation team and veteran's needs. In many situations the family program can be a very important aspect of rehabilitation. If a family program is recommended and approved, the veteran selects a family member with whom he/she lives to visit the
Group Meetings
One major strength of the residential
Team Coordinator Concept
The staff assigned to work with a particular patient forms the rehabilitation team, with the veteran as the most important member. One staff member serves as the coordinator or case manager of the team. The team coordinator follows the progress of the veteran from the day of admission until the day of discharge, assists the veteran in any way possible and monitors the veteran’s progress towards their goals. This allows one person to serve as the focal point for the veteran's rehabilitation program, so the veteran knows who is available for advice, consultation, and discussion concerning the rehabilitation program. The team is delegated responsibility for planning the details of the veteran's rehabilitation program and making adjustments as necessary. As an important part of the team approach, the veteran is involved as much as possible in the planning of the program; just as staff may suggest changes or modification to the rehabilitation plan, so may the veteran provide input to the team. In this way, the veteran becomes a member of the team and is a party to all aspects of the rehabilitation program, particularly the setting of goals and objectives. This team approach to rehabilitation is at the heart of the rehabilitation concept and helps assure accountability for the quality of patient care.
Life at the
Eligible blinded veterans may apply for admission to a
Rehabilitation training activities at the
Comfortable, casual clothing is the rule for most classes. Clothing should be appropriate to the particular facility, the time of year, and the climate of the geographic area. Linens and towels are provided. Veterans are expected to wash their personal laundry in the laundry room after instruction in the use of the washer and dryer. Veterans need not bring such things as radios, tape recorders, talking book machines, and other items of that nature, as they are available. Veterans are encouraged to open an account with the VA Medical Center's Agent Cashier for the deposit of personal funds. This will allow the veteran to make withdrawals as needed.
Each
Length of the Rehabilitation Program
The length of the rehabilitation program varies from veteran to veteran. In addition to severity of vision loss, the veteran's general health, emotional condition, learning ability, and motivation determine the length of stay. The first week of the rehabilitation program is spent evaluating the veteran's overall condition and assessing the veteran's general and specific needs. After a team assessment, which includes the veteran, intensive rehabilitation begins and a projection of duration of training made. This projection can be updated as warranted by circumstances and the veteran's needs. A typical duration of stay ranges from 4 to 8 weeks.
Rehabilitation is a dynamic process and cannot be rushed. A sufficient duration of rehabilitation should be provided so that veterans thoroughly learn skills and incorporate them into their lifestyles. We ask veterans to be willing to give sufficient time to adequately complete their rehabilitation programs. Time passes very quickly at the Blind Rehabilitation Centers and we are confident that each veteran will consider their program an investment in their future.
Prosthetic Appliances and Sensory Aids for Persons Who are Legally Blind
The Chiefs of the Blind Rehabilitation Centers have been authorized to provide various devices for the legally blind veterans who undergo rehabilitation training. Each veteran is evaluated with, and taught the use, of appropriate devices. Issuance of devices to veterans is based upon need, the demonstrated ability to use them, and adherence to clearly defined criteria. All devices issued to veterans assist them in overcoming the disability of blindness and permit them to function effectively and efficiently after rehabilitation is completed.
Special Programs at Blind Rehabilitation Centers
Over the years, innovative technology has been developed for persons who are blind and visually impaired. Many of these devices are available at the Blind Rehabilitation Centers, along with assessment and training in their use. Qualified veterans may apply for programs providing assessment and training in the use of these specialized devices. Specific criteria for admission and for issuance of the devices have been established. Questions concerning eligibility and suitability for training, as well as issuances of devices, should be directed to the Chief of the appropriate
Special programs for training in the use of innovative technology generally fall into the areas of visual skills, communication and orientation and mobility. Visual skills devices included special electronic viewing devices that supplement optical low vision devices. Communication devices include electronic reading machines for the blind, computers, and other similar specialized devices. Electronic orientation and mobility devices are designed to supplement the usual protective travel devices such as the long cane. As new and innovative devices are developed, special programs in their use may become available. Training in the use of these devices is complex; they require a great deal of hard work and persistence, and may not be suitable for every veteran. While these devices should in no way be viewed as a substitute for basic blind rehabilitation training, or for the usual devices frequently issued to many veterans, they can serve an important role in the lives of many veterans.
Special programs are usually 2 to 4 weeks in length and deal specifically with one device. Several hours per day are spent working on that device, so only limited involvement with the regular rehabilitation program is possible. Veterans participating in the full rehabilitation program are assessed using the devices and may wish to return for a detailed program at a later date.
Additional Information Concerning Blind Rehabilitation Centers
Research and Clinical Evaluation Programs
The VA has consistently been a leader in development of sensory and prosthetic research and each
Most
Affiliations
Each of the Blind Rehabilitation Centers provides teaching and internship opportunities for students from affiliated universities. The VA Medical Centers housing the Blind Rehabilitation Centers are affiliated with nationally recognized medical schools, further ensuring the highest level of medical care for each blinded veteran.
Visual Impairment Services Team (VIST) Coordinators
The Visual Impairment Services Team (VIST) Coordinator is a case manager who has primary responsibility for the coordination of services for visually impaired veterans and their families and are the first contact for blind rehabilitation services. VIST coordinator duties include providing and/or arranging for the provision of appropriate treatment in order to enhance a blind veteran's functioning (for example referrals to
Visual Impairment Services Outpatient Rehabilitation (VISOR) Program
The VISOR Programs are outpatient, intermediate nine-day rehabilitation programs. They provide comfortable, safe, overnight accommodations for veterans who are visually impaired and require temporary lodging. The program offers skills training, orientation and mobility, and low vision therapy. It is staffed with Blind Rehabilitation Specialists (BROS) and Visual Impairment Service Team (VIST) Coordinators, Social Workers, and Certified Low Vision Therapists. Veterans who attend VISOR must be able to perform basic activities of daily living independently, including the ability to self-medicate.
Visual Impairment Centers to Optimize Remaining Sight (VICTORS) Program
In the late 1970s VHA recognized that there were a growing number of veterans who were not yet legally blind who needed rehabilitation services. The Directors of Blind Rehabilitation, Social Work, Psychology, and Optometry Services developed the Visual Impairment Center to Optimize Remaining Sight (VICTORS) program to address this unmet need. The initial VICTORS program started in 1979 at the Kansas City VA Medical Center. Over the years, VICTORS services have expanded to the Chicago VA Medical Center (Westside campus), and the Northport VAMC (
National Consultants
The Regional Consultants serve as advisors to the VA Medical Center-based rehabilitation programs for the blind and visually impaired. Each regional consultant has oversight of VA facilities in the geographic area served by the
Blind Rehabilitation Outpatient Specialist (BROS) Program
BROSs are multi-skilled professionals who perform a wide array of blind rehabilitation services including assessments and visual skills, living skills and orientation and mobility training. BROS services are provided to veterans in the most appropriate setting, for example, home, VA, college, nursing home or assisted living environments (and in rare instances at the work site). The BROS offer pre/post
Referral Procedures and Application Requirements
The Visual Impairment Services Team (VIST) Coordinator is the first contact for referrals for the Blind Rehabilitation Centers, VISOR, VICTORS and BROS Programs as well as some Low Vision Clinics. They are case managers who has primary responsibility for the coordination of services for visually impaired veterans and their families.
Any VA health care facility may make a referral to a
The application package for the blind rehabilitation center should include the following:
1. A fully completed VA form 10-10 Application for Medical Benefits, the related VA form 10-10M Medical Certificate and History, and VA form 10-1 OF, Financial Worksheet when necessary.
2. A cover letter briefly stating the events leading to the referral.
3. A current and complete physical examination, detailing all conditions that may affect progress in rehabilitation, including a detailed statement of physical capacities and tolerance, as well as pertinent radiology and laboratory reports.
4. A complete ophthalmological report, containing corrected and uncorrected near and distance visual acuities and measurements of peripheral and central visual fields.
5. A social work report, outlining the veteran's military, family, educational, social, and work history and other relevant information.
6. An audiological report.
7. VA benefits rating sheet.
8. Psychiatric and/or psychological report, if necessary.
The application package will be reviewed by the staff at the
Travel Information
Transportation to and from the
Conclusion
Although partial or total loss of vision can be overwhelming, the problem is not insurmountable. Rehabilitation can be the start of a new life. It is the beginning, the training ground, the base that prepares the blinded veteran to assume or continue a meaningful place in the family and in society. Rehabilitation assists the blinded veteran in building the strength, skills, and self-confidence to live a normal, happy, well-rounded life.
Blind Rehabilitation Centers
VA
(253) 582-8440
VA
(706) 733-0188
Edward Hines, Jr. Hospital
5th &
Phone: (708) 202-8387
VA
Phone: (203) 932-5711
(787) 641-8325
Southeastern
VA
(205) 933-8101
Southwestern
(520) 629-4643
VA
(254) 297-3755
VA
(650) 493-5000
VA
7305 N. Military Trail
Phone: (561) 422-8425
Department of Veterans Affairs
Veterans Health Administration
Blind Rehabilitation Service
202-273-8483
VA website Address: http://www.va.gov/blindrehab
Please e-mail Wanda Washington or Mike Williams in Blind Rehab Service for questions or comments relating to this website.
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Reviewed/Updated Date: March 4, 2009