1 of 63

Supporting

clients with

Low Vision

through

Art Accessibility

2 of 63

We’d love to know...

Your name
Who you work with
Where you practice
Why you’re interested in this topic��

Jeff Hanson has been visually impaired since childhood due to an optic tumor. Born in 1993, he began undergoing chemotherapy at age 12. Proceeds from his artwork benefit the Children's Tumor Foundation to fund optic tumor research.�Image obtained online from www.jeffhansonart.com

Tuscan Stroll, Jeff Hanson

3 of 63

APRIL SAWYER

Recent grad from UNC-CH, working at Triumph Therapy in Early Intervention and currently working towards a specialization in Cortical Visual Impairment�
Background and personal interests: Special Education, Intercultural Studies, Early Intervention�
Personal Interests: Family coaching, natural environments, cross-cultural partnerships�
Why am I interested in this topic? Art Accessibility empowers our communities to widen their doors to clients and families that have experienced great loss in their occupations. It invites husbands, wives, mothers, fathers, sons, and daughters to share meaningful memories when so much of the world feels closed off and or uninviting.

4 of 63

AILSE O’NEILL

UNC graduate, UAB - Graduate Certificate in Low vision, Worked with people with low vision and visual impairments for over six years. Started Therapy Insight, PLLC�
Background and personal interests: low vision, environmental modifications in home/community, aging-in-place, advocacy�
Personal Interests: gardening, crafts, soccer, being outdoors, reading�
Why am I interested in this topic? Vision affects all ADL/IADL. The meaning of art does not change even when a person’s vision decreases. Finding ways to help support co-occupations is important as well.

5 of 63

OUTLINE

Welcome!
Introduction to Low Vision and Advocacy
Lessons Learned Along the Way
Group Activity
Closing

6 of 63

LOW VISION AND BLIND

Low Vision

Vision that cannot be corrected with glasses, medication or surgery;
Participation in valued life activities are affected - reading, cooking, mobility, etc (NEI, 2016), (Warren, 2011)
Age is the best predictor (NEI, 2016)
Have some usable vision

Blind - legally Blind vs. Blind

Legal Blindness is defined as visual acuity less than 20/200 in the better seeing eye with correction or a visual field limitation of 20 degrees or less (American Foundation for the Blind, 2017)

7 of 63

STATISTICS

⅔ of adults with LV are over 65 years of age (NEI, 2016)
⅔ of older adults with LV also have at least one other chronic condition (Crews, Jones, & Kim, 2006)
Adults aged 75 and over ~ appr. 26%

Self-reported vision impairment (Leonard, 2002)

Persons with low vision and/or blindness is expected to double by 2030 to 7.7 million in the US (Leonard, 2002)
Approximately 11% of Americans aged 20 year and older with diabetes have some sort of visual impairment (Centers for Disease Control and Prevention, 2015)

8 of 63

Macula/Fovea

9 of 63

COMMON VISUAL IMPAIRMENTS

Age-Related Macular Degeneration
Glaucoma
Diabetic Retinopathy
Retinal disorders
CVA or stroke
Cortical Visual Impairment

10 of 63

Lighting

11 of 63

Contrast

12 of 63

Glare

https://commons.wikimedia.org/wiki/File:Shelves_in_a_Ralphs_grocery_store.jpg

https://www.shutterstock.com/search/looking+at+computer+screen

13 of 63

Social and Cultural Environment

http://time.com/4741005/arts-programs-children-nea/

14 of 63

Advocacy and Occupational Therapy

“Efforts directed toward promoting occupational justice and empowering clients to seek and obtain resources to fully participate in daily life occupations. The outcomes of advocacy and self-advocacy support health, well-being, and occupational participation at the individual or systems level (OTPF, p. S30, 2017).

Goal for outcomes - OTPF (2017):

Occupational Performance
Prevention
Health and wellness
Quality of life
Participation
Role competence
Well-being
Occupational Justice

15 of 63

WHAT YOU OFTEN SEE...

16 of 63

WHAT WE PROPOSE...

17 of 63

“Nothing About Us Without Us”

Need direct representation from persons with disabilities regarding any changes
Better if they lead the process

OT as supporting role

Image obtained online from: https://archpaper.com/2018/02/house-vote-roll-back-ada-protections/

18 of 63

19 of 63

LESSONS LEARNED ALONG THE WAY

Keith Salmon's eyesight diminished quickly after being diagnosed with diabetic retinopathy. This change in vision led him to develop new ways of painting. He states, "I have tried to explore my new and changing view, recording, (using oil paint and pastel) not what I see, but rather how I now see my surroundings."

Cloud breaking from Cir Mhor, Glen Rosa, Isle of Arran; Keith Salmon�Image obtained online from http://www.keithsalmon.org/

20 of 63

“You can’t lead someone to a place

you aren’t willing to

go yourself.”

�-April’s wonderfully wise friend

that she unfortunately cannot

remember the name of

Lesson #1

21 of 63

Embrace any lack of knowledge or experience. Acknowledge anything that causes you to feel ill-equipped.

These voids provide a road map of what to do next.

Lesson #2

22 of 63

Takeaways from Lesson #2

You don’t have to be an artist to support Art Accessibility, being an OT practitioner is more than enough. �
do·cent(noun): a person who acts as a guide, typically on a voluntary basis, in a museum, art gallery, or zoo (thanks Google)

23 of 63

There are TONS of pre-existing local and national programs that can provide you with innovative resources and direction (aka you don’t have to reinvent the wheel).

Lesson #3

24 of 63

Initial meeting @ the Ackland

(Chapel Hill)

Meeting w/ Beth McGuire @ NCMA (Raleigh)

Meeting w/ Betsy Ludwig @ Arts Access (Raleigh/Wake Forest)

Meeting @ SAAM (Washington DC)

Back to the Ackland!

Back to the Ackland again :)

25 of 63

CONTACTS

Beth McGuire, Coordinator of Tours & Docent Education, NCMA

beth.mcguire@ncdcr.gov

Betsy Ludwig, Executive Director, Arts Access

betsy@artsaccessinc.org

Geoffrey Cohrs, Docent Coordinator | Education Office, SAAM

cohrsG@si.edu

Edmond Bronder, Docent, SAAM

ebronder@verizon.net

Pat Greenfield, Docent, SAAM

phgreenfield1@gmail.com�

26 of 63

BETH MCGUIRE @ NCMA: RESOURCES

Tactile Tours - scheduled upon request

1 to 1.5 hours, tactile explorations, audio descriptions, “service animals welcome”
http://ncartmuseum.org/visit/tours

Tip: Neon colored paper or tactile bump in front of pieces that can be touched
Training material for docents (see below) - click here for entire file

27 of 63

BETH MCGUIRE @ NCMA: INSPIRATION

Philadelphia Museum of Art

https://www.philamuseum.org/accessibility/

MOMA

https://www.moma.org/visit/accessibility/

Denver Art Museum

http://denverartmuseum.org/accessibility
“VERY audience centered” | PDFs online
GREAT storage benches

Minneapolis Institute of Art

https://new.artsmia.org/visit/services-for-visitors-with-disabilities/

Metropolitan Museum of Art

Programs for people w/ Alzheimer's and med school students

NC Natural Science Museum

Low sound, ADA coordinator - specializes in programs for specific audiences

28 of 63

BETSY LUDWIG @ ARTS ACCESS: RESOURCES / TRAINING

29 of 63

BETSY LUDWIG @ ARTS ACCESS: INSPIRATION

Guidelines for large print documents

American Council for the Blind - http://www.acb.org/large-print-guidelines

VAE Creative incubator

vaeraleigh.org/accessibility/

Lighthouse - non-profit dedicated to promoting accessibility through effective print and media design, use of AT, or well-thought-out floor plan

http://www.lighthouseguild.org/

The Kennedy Center - webinars (free)

education.kennedy-center.org/education/vsa/resources/webinars.cfm

MET - “one of the best programs for museum access”

30 of 63

InSight Verbal Description �Tours - 4x/month
Tactile Tours
Newsletters
Theme lists

Smithsonian for American Art Museum

31 of 63

DOCENT TRAINING: ENVIRONMENT

Navigation / Wayfinding

“In front of the art is a one inch lip” �
“We are approaching a bench on the right”�
“We are transitioning from a marble surface to carpet”�
“We are entering the elevator, there are no people inside”

32 of 63

Baseball at Night by Morris Kantor

Tactile resources: cut out of boomerang- shaped foam paper
Music / sounds

33 of 63

The Janitor Who Paints by Palmer Hayden

What would you describe first?
Describe size? Rectangle shape?
3 figures, apartment, pipes in ceiling
Color of dress, flowers, brush tips (red, white, blue)
“His profession vs. his work”

Question for visitors: Have you experienced a pallette? Eisel?

Possible tactile resources: pallette

34 of 63

Southern Gate by Eldzier Cortor

Where would you start?
Possible connection: Are visitors aware of this specific location in Richmond?
How would you describe the fabric?
“Clothed in honor”
“Clothed in virtue”
What do the colors communicate?
How would you describe her face?

35 of 63

SAAM: Intro to Verbal Descriptions

36 of 63

Art Accessibility begins long before you get to the museum.

Lesson #4

37 of 63

MESO

MICRO

MACRO

MICRO LEVEL BARRIERS

Intrapersonal

Depression, anxiety, isolation, fear
Motivation

Interpersonal

Community mobility
Finances
Social support
Time constraints

38 of 63

MESO

MICRO

MACRO

MESO LEVEL BARRIERS

Local programming

What exists?
How is it advertised?
Accessible websites?
Volunteer training?
Are community members involved in planning? Evaluating?

Building structure

Stairs, flooring
Windows / glare
Wayfinding

39 of 63

ENVIRONMENTAL ANALYSIS: STAIRS

40 of 63

ENVIRONMENTAL ANALYSIS: BARRIERS

41 of 63

ENVIRONMENTAL ANALYSIS: BARRIERS

“They go around the most precious / rare pieces … it’s low tone, doesn’t distract from the art.”

-SAAM security guard

42 of 63

ENVIRONMENTAL ANALYSIS: WAYFINDING

43 of 63

ENVIRONMENTAL ANALYSIS: LIGHTING

44 of 63

MESO

MICRO

MACRO

MACRO LEVEL BARRIERS

Policies or programs that can help with funding and transport

What exists
How is it advertised?
Accessible websites?

What are facilitators that can address some of these barriers?

45 of 63

Art Accessibility promotes occupational maintenance, recovery, and discovery. �

Clients are empowered to

maintain meaningful leisure occupations
recover occupations that have been prematurely surrendered
experience new modalities of occupational participation, at times during seasons of great loss.

Lesson #5

46 of 63

Initial meeting @ the Ackland

(Chapel Hill)

Meeting w/ Beth McGuire @ NCMA (Raleigh)

Meeting w/ Betsy Ludwig @ Arts Access (Raleigh/Wake Forest)

Meeting @ SAAM (Washington DC)

Back to the Ackland!

Back to the Ackland again :)

47 of 63

Remember that the institution you’re working with (museum, gallery, school, etc.) and the people supporting it, come with client factors, backgrounds, and contexts that impact the advocacy process.

ALSO, remember you’re an OT practitioner, this is what you trained for.

Lesson #6

48 of 63

TIPS FROM THE ACKLAND

Not everyone knows what Occupational Therapy is. You can tell them about ...

Your training and experience
How you can help them communicate with various audiences
How they can gather info nonverbally

Body language
Field of vision clues

How to anticipate safety needs or barriers
How to construct feedback measures that incorporate the strengths and skills of various audiences.

When emailing, avoid “I need you to…” Instead, use phrases like:

“I’m looking for connections or ideas.”
“I’d like to organize a visit for a client with __________.”
“I’d like to host a group and I’d like to talk to you about how to plan for that.”

Mid-size to large museums often have a “Visitor Services” person that may be helpful when coordinating visits�
We appreciate hands-on experiences and broad applications for personnel (i.e. program developers, docents, student volunteers, security, etc.).

49 of 63

QUESTIONS?

50 of 63

GROUP ACTIVITY

4 case studies, 4 groups�
Take turns wearing the goggles and guiding each other.�
As a group, read the case study.�
Practice sighted guide techniques. Safety is paramount!

Collaborate with each other to conduct an environmental analysis of your assigned area.�
Choose a reporter to describe your experience.

51 of 63

Case study 1: Macular Degeneration�Leading cause of vision impairment among adults in the US �(Prevent Blindness America, 2015)

RISK FACTORS: Age (60+), genetics, caucasian, lighter eyes, smoking, cardiovascular disease, excessive light exposure, decreased nutrition (Mogk, 2011)

RESULTS: Cells of the macula deteriorate within the central 20 degrees of visual field; wet or dry (Mogk, 2011) :�-decreased central vision�-difficulty with detailed tasks (recognizing faces, reading)�-difficulty with glare and seeing in low contrast situations�-impacted driving and mobility, fall risk�-Abnormal color vision (Tripp, 2017)

-Rate of depression - around 30% (Rovner et al., 2007)

Maggie is a 75 year old woman who was diagnosed with Wet Macular Degeneration, arthritis, and she has had bilateral knee replacement. She is a retired teacher and has an extremely supportive family who live five miles away. She has always enjoyed cooking for others and traveling to see her sisters in Indiana. As her MD has progressed, cooking has become more difficult; she specifically has difficulty with pouring, measuring, and identifying spices and items in the refrigerator. She loves being around others but has become more and more apprehensive about leaving the house. Prior to her diagnosis, she often enjoyed attending events with her friends; such as music, art, and entertainment. She is extremely sensitive to glare and often misses the cracks or uneven pavement in the sidewalk. She has always loved the trees in her yard but they cast several shadows that make mobility difficult. She has had to give up driving and is now fully dependent on her family to provide transportation. She was attending book club but reading has become more difficult when the font is not enlarged. Her friends often tell her that they miss her and comment that she “isn’t as happy-go-lucky” as she has always been. Maggie’s daughter is worried about her ability to manage her medications as the small print size is difficult and Maggie often drops her medication. Maggie also previously took great pride in applying her makeup and coordinating her clothes. She feels insecure as this has become difficult, especially differentiating between navy and black. She recently expressed that she feels “bored and alone.”

Acuity: 20/160 in both eyes.

52 of 63

Macular Degeneration

What anxiety do you think Maggie has about visiting an art museum?

What would be helpful for Maggie? What would make her feel welcome?

Thinking about mobility, what might be difficult for Maggie?

How could art be therapeutic for Maggie?

53 of 63

Case study 2: Glaucoma�A leading cause of blindness in the US

Many people that have glaucoma don’t realize they have it; painless and few noticeable symptoms until it is very advanced (NEI, 2017)��RISK FACTORS: 60+, African American or Hispanic, genetic component, (NEI, 2017), other conditions - diabetes, hypertension (Mayo clinic, 2017)

RESULTS: Too much pressure inside the eye causes damage to the optic nerve; begins with peripheral vision loss (“tunnel vision”) but can progress into central vision loss (Mogk, 2011).�-Difficulty with mobility, glare, scanning, avoiding obstacles, detecting motion (Holsten & Fischer, 2017)�-May experience collisions, falls, disorientation, decreased participation in community, difficulty seeing detailed objects (Holsten & Fischer, 2017)

Burt is a 63 year old man who has advanced primary open angle glaucoma. In addition to this, Burt has a history of hypertension, heart disease, carpal tunnel syndrome, and chronic back pain. Burt’s visual field is about eight degrees. His central acuity is 20/70. This impacts his ability to scan, avoid obstacles, and detect moving objects. Burt recently retired from working as a college economics professor as his eye condition was drastically impacting both his productivity and stress levels at work. He has always enjoyed reading the newspaper, hiking with his wife, riding his bicycle, participating in a local trivia group, and watching football on TV. As his eyesight has declined, he reports that he has frequently bumped into objects, experienced blurred vision and eye fatigue, and has become increasingly sensitive to light and glare. As a result, Burt has stopped driving. He is only able to participate in his weekly trivia group if his wife can give him a ride. Burt finds reading arduous and he does not find as much enjoyment anymore. In unfamiliar places, Burt often bumps into objects. He used to love hiking but now finds it difficult to see roots and objects on the ground that may cause him to fall. He reports that he has not gone hiking with his wife for several months. Burt’s wife is concerned about his lack of opportunity to leave the house and is worried about his transition to retirement. She is still working full time but tries to make time to drive him to his doctor’s appointments and to his trivia nights when she can. Burt recently confessed that he is struggling to find “purpose” and that he misses his co-workers. He feels isolated during the day and is unsure how to fill his days.

Acuity: Visual field 8 degrees, central vision 20/70

54 of 63

Glaucoma

What anxiety do you think Burt has about visiting an art museum?

What would be helpful for Burt? What would make him feel welcome?

Thinking about mobility, what might be difficult for Burt?

How could art be therapeutic for Burt?

55 of 63

Case study 3: Diabetic Retinopathy

According to the CDC (N.D.), “diabetes is the leading cause of new cases of blindness in adults. . . as the number of individuals with diabetes increase, so does the number of those with impaired vision”

Dark spots, scotomas, floaters
blurry vision that fluctuates
light sensitivity, halos or flashing lights
diminished peripheral vision
decreased acuity; Difficulty with fine details (reading/watching TV) and outdoor travel
poor night vision, double vision

Results:

Pancreas creates insulin
PWD have insufficient amounts of insulin or inefficient use of insulin
Glucose levels remain high in bloodstream
Damage to small blood vessels in eye/body (Mogk, 2011).

Rate of Depression:

Twice as high as for persons without DR (Anderson et al. 2001)

(Mogk, 2011)

Will is a 62 year old man who was diagnosed with Diabetic Retinopathy. Will has a history of kidney replacement and peripheral neuropathy. Additionally, Will has a history of detached retina in his left eye. It wasn’t caught early enough and, although surgery was completed, he never regained full vision in his left eye. Will lives with his wife and his son, daughter-in-law, and grandchildren live nearby in Carrboro. Will’s hobbies include being a part of a local antique car club, reading political biographies, walking his dog, playing poker with his friends, and attending shows at the DPAC with his wife. Will and his wife opened an office supply store 25 years ago in Durham and manage it with the help of their son. Both Will and his wife were born and raised in Durham and love being a part of the community. Will has recently admitted that it is becoming more difficult for him to manage the financial statements, read emails, and check the inventory. Both his diabetic retinopathy and peripheral neuropathy have impacted his coordination; leading to 2 recent falls at work and in his backyard. He has occasionally reported tingling and burning feelings in his feet and upward into his legs. Due to these concerns, Will has stopped walking his dog around the neighborhood. Will reports that reading has also become more and more difficult as the letters on the page often appear “rippled.” Will and his wife have season tickets to the DPAC; however, they missed the last several shows. The low lighting and crowded seats make it difficult for Will to safely navigate to his seat. Occasionally a well-meaning stranger has attempted to help guide Will to his seat but this makes Will feel uncomfortable and often causes him to feel “out of control.” Will’s wife reports that Will is becoming more averse to crowded rooms as it is often difficult for him to see others unless they are directly in front of him. Will’s son is concerned that his father has appeared increasingly stressed at work.

Acuity: last measured at Duke Eye Center at 20/160 in both eyes.

56 of 63

Diabetic Retinopathy

What anxiety do you think Will has about visiting an art museum?

What would be helpful for Will? What would make him feel welcome?

Thinking about mobility, what might be difficult for Will?

How could art be therapeutic for Will?

57 of 63

Case study 4 - diagnosed with Congenital Cataracts�

What anxiety do you think Melanie has about visiting an art museum?�

What would be helpful for Melanie? What would make her feel welcome?�

Thinking about mobility, what might be difficult for Melanie?�

How could art be therapeutic for Melanie?

Melanie is an 16 year old girl that was born with congenital cataracts. Her mother and grandmother have a history of cataracts as well. Melanie had cataract removal surgery at 3 months old but was diagnosed with glaucoma 5 years ago. As a child she used eye drops 3 times a day to control the pressure but 2 years ago, as a result of the glaucoma, she experienced a detached retina. She has had surgery to replace the retina but she states that the eyesight in her right eye “still isn’t the same.” Melanie previously enjoyed playing soccer but as her sight was diminished it has become more difficult. She has begun running cross country and enjoys that. She also enjoys oil painting, ceramics, spending time with her friends, attending girl scouts, and singing in her school choir. Melanie occasionally complains that she struggles to read new music in choir. At school she has a personal computer where she can utilize accessibility features for her assignments; these include voiceover, zoomtext, and high contrast options but all of this takes more time with the advanced classes she is taking. She is also able to listen to her textbooks online. She has begun experiencing extreme light sensitivity in her right eye and often complains of glare. Her parents report that she is generally a happy person but that she does feel self-conscious about the adaptations she has at school.

ACUITY: 20/250 in both eyes

58 of 63

GROUP REPORTS

ALSO: How to make LV goggles using materials from your scrap and the dollar store.

59 of 63

Would you like a copy of some of the resources we talked about today?

Smithsonian for American Art video
Sighted Guide Techniques
NCMA training material for docents
Contact list

We are HAPPY to share resources and corresponding links. Please make sure your name is on our sign up sheet if you would like to receive access to these files.

60 of 63

References

American Foundation for the Blind. (2017). State-Specific Statistical Information: North Carolina. Retrieved from http://www.afb.org/info/blindness-statistics/state-specific-statistical-information/�north-carolina/235

American Foundation for the Blind. (2017). Key definitions of statistical terms. Retreived October 23, 2018 from http://www.afb.org/info/blindness-statistics/key-definitions-of-statistical-terms/25

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1– S48. http://dx.doi.org/10.5014/ajot.2014.682006

Anderson, R., Freedland, K., Clouse, R., & Lustman, P. (2001). The prevalence of comorbid depression in adults with diabetes. Diabetes Care: Jun; 24(6): 1069-1078

Centers for Disease Control and Prevention. (2015). Vision Health Initiative (VHI): Data & Statistics. Retrieved December 02, 2017, from https://www.cdc.gov/visionhealth/data/national.htm

61 of 63

References (cont.)

Centers for Disease Control and Prevention (N.D.). Diabetic retinopahty. Retrieved December 03, 2017 from: https://www.cdc.gov/visionhealth/pdf/factsheet.pdf

Crews, J. E., Jones, G. C., & Kim, J. H. (2006). Double jeopardy: the effects of comorbid conditions among older people with vision loss. Journal of Visual Impairment & Blindness, 100, 824.

Holsten, C. and Holland Fischer, L. (2017). Making One's Future Bright Again. NCOTA conference, Raleigh, NC.

Leonard, R. (2002). Statistics on vision impairment: A resource manual (5th ed.). New York: Lighthouse International.

Mayo clinic (N.D.). Glaucoma: Symptoms and causes. Retrieved December 3, 2017 from, https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839

Mogk, L. (2011). Eye conditions that cause low vision in adults. In M. Warren and E. Barstow (Eds.). Occupational therapy interventions for adults with low vision. American Occupational Therapy Association: Bethesda, MD.

62 of 63

References (cont.)

National Eye Institute (2016). Living with low vision. Retrieved November 11, 2017, from https://nei.nih.gov/sites/default/files/health-pdfs/LivingWithLowVisionBooklet.pdf

National Eye Institute. Glaucoma, did you know? Retrieved December 3, 2017, from https://nei.nih.gov/glaucoma/content/english/doyouknow

Rovner B., Casten R. (2007). Neuroticism predicts depression and disability in age-related macular degeneration. J Am Geriatr Soc 2001;49 (8) 1097- 1100

Tripp, Fay. (2017) Technological Advances in Low Vision Rehabilitation for the Geriatric Client. NCOTA conference, Raleigh, NC.

Warren, M. (2011). An overview of low vision rehabilitation and the role of occupational therapy. In M. Warren and E. Barstow (Eds.). Occupational therapy interventions for adults with low vision. American Occupational Therapy Association: Bethesda, MD.

63 of 63

Thanks

for coming!

Have questions

or comments?

We’d love to hear from you!��ailse@therapy-insight.com

april@triumphtherapy.com

Evening in Portofino by Jeff Hanson