Tuesday, May 7, 2013

Seeing Clearly

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Nece is sitting in her wheelchair in her doorway when I pass. Her face lights up. "Hey! When will you be working with me?"

(Our computer system, Rehab Optima, is down and we don't have scheduled patient treatments the way we normally do.)

"You're not on my list today!" I exclaim. "Let me see what I can do."

I hear her call out, "I love you!" as I head down the hall to my next treatment.

She warms my heart with every interaction!

"I love you, too, Nece." I really do. She's a precious soul.

We have an awesome travel COTA in our building right now. I know he and I will have to do some switching, which sometimes feels like the trading post - "I'll give you (so and so) if you give me (so and so).... 

after all, we like all our patients, don't we....but we do resonate with some more than others!!

Nece experienced an occipital CVA which has impacted her physical body with mild left-sided weakness, but the real deficits are cognitive and visual.

It came up early in our working relationship when she said, "I just can't see anything in my right eye!" After testing her, I find that the field cut deficit is only in the lateral part of the right eye. So, in the photo below, it would be like only the right side of #2.

I realize how important vision is in the therapeutic process, but I've rarely been in buildings where there was a full-scale vision rehab program, and I have never taken a vision CEU. Shame on me.

If any of you therapists out there love vision rehab and would like to contribute to this post, please write me!

I am motivated to do a bit of study, and here is what I find. I already know that Nece has hemianopsia. On www.hemianopsia.net, I find a mention of the description of Nece's impairment under the title Brain Injury with only a Visual Field Defect: 

Some patients present with damage localized to a specific area of one lobe... The most common being a small area of stroke isolated to the occipital lobe.

I know about scanning (aka saccadic eye movement training) as a treatment option, thus the word search. I read about training hemianoptic reading skills (building on scanning) as well as optical visual field expanders

and something called Vision Restoration Therapy, which uses computer stimulation along the border of the visual field loss to restore vision. Its efficacy is currently being researched.


Note to self: research local vision specialists and get a referral for a visual field expander for Nece.

I get to Nece in the afternoon. She wheels into a small OT room up to the table where I have placed a word search with the clue page enlarged as much as possible. I have discovered a Chicken Soup for the Soul word find book when cleaning the OT room the other day.

The clue page includes these words:

Sensible people

never either desire it
for themselves

or care about it in others.

If mind be but well cultivated,

and the heart well disposed,

No one ever

cares for

the exterior.

Anne Bronte
She reads the page with cuing, and she stops, looks up at me, and she gets tears in her eyes. "That is so beautiful! Thank you so much for sharing that with me today." We go on to talk about what that saying means to her, and I find that she is a deep and beautiful thinker.

I give her directions to highlight every E that she sees on the search page, as she requires a simpler task than finding words at this point. She works diligently and looks up when she is finished.


She has marked only the left five rows of the page, leaving the other 10 vertical rows unmarked. There is her field deficit right in front of me.

We then work on strategies to scan to the right until she gets to the end of each row. It takes much concentration for her to focus, and she requires breaks to close her eyes.

During her scanning work, I am providing Jin Shin Jyutsu as an adjunct to her occupational therapy treatment.

What I am finding about JSJ is that really wonderful things occur in the healing process that are not always "seen." Nece begins to talk about the recent loss of her sister. She is the last one left in a family of 8 children. She has not had time to grieve because of her recent stroke and rehab process.

I have five amazing sisters, three by birth and two by marriage, and cannot imagine losing any one of them. I can only imagine her pain.

She goes on to talk about her sadness of the emotional distance of her son, who is married a woman she does not like. All the while she is sharing, she is still such a positive person. She talks about how much she loved her husband, with whom she shared 50 years.

"I'm feeling so emotional! I feel like I need to cry." And we stop for a moment. This is such an important part of our therapy process. She comes to acknowledge realizations about her life, her relationships, her future.

How lucky am I to have the privilege to experience this with her?!

She finishes the session, having found all the "E"s in the word search, and she has even found some words.


as important, this session was not just about seeing clearly in the physical sense. It was about peering into many moving parts of life that needed healing.

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