# Low Vision Rehabilitation/Amelia Schwartz

Amelia Schwartz is 6 months old. She lives in foster care with a loving family and attends See Well Australia with her foster mother, Jenny. Amelia was born with Fetal Alcohol Syndrome (FAS) and her facial features are typical of a baby with this problem. They include: small eye openings, thin upper lip and smooth philtrum (philtrum is the vertical groove between the nose and upper lip). The amount of alcohol drunk and how often it is drunk throughout the pregnancy is biggest factor associated with an increased risk of FAS. Jenny reports that Amelia's birth mother had a history of frequent binge drinking during pregnancy. Through Amelia and other case studies you will be able to discuss the key characteristics of commonly seen congenital and developmental anomalies associated with vision complications, how they impact on childhood development and be able to adapt standard vision tests to meet the needs of children with multiple handicaps.

## Question

How does FAS impact Amelia's development (both physical and visual) and how can you perform a low vision assessment on her? Use Amelia's case and the additional resources and case studies to formulate your own response to this question. You will need to apply this question to a variety of disorders, not just FAS.

## Activities
### Task 1

Start with the Congenital and Developmental Anomalies Power Point presentation which will introduce you to a variety of disorders.

### Task 2

You should undertake further research into the following disorders:
* Autism Spectrum Disorders
* Cerebral Palsy
* Down Syndrome
* Hydrocephalus
* Fetal Alcohol Syndrome
For each disorder, consider the developmental and visual impact. You will also need to apply your knowledge of the impact of the disorder in order to consider how you would modify your low vision assessment.
The Modified Vision Assessment presentation is a good starting point for you.

### Task 3

In your group, work through the following paediatric case studies. Deeper discussion of these cases will take place face to face in week 9 of semester.

### Case 1 - Jenny

You meet Jenny whilst performing school vision screening. She is a very happy and affectionate child. Jenny is a short chubby little girl with short stubby fingers, you notice she has narrowed and slanted palpebral fissures. The teacher tells you she is a slow developer; she is several years older than the class average. She was delayed in her developmental milestones such as walking and talking.
1. At what age would you expect a child to:
a) Follow a target with their eyes
b) Sit unaided
c) Walk independently
d) Follow simple instructions 2. Explain Down Syndrome for Jenny’s teacher, include the key features and the likely vision problems.
3. What might you need to consider in assessing Jenny’s vision?

### Case 2 - Ben

Ben has cerebral palsy of the athetoid type. He also has global delay and functions at the level of a 4 year old whilst he is actually 7.
1. What will you need to consider in assessing Ben’s vision?
2. Choose appropriate tests from those you are aware of, justify your choice.
3. Explain how you will administer each test and describe the type/s of response/s you would expect.

### Case 3 - Melissa

Melissa is a 5 year old child referred to you by her school for assessment of vision. Melissa does not seem to respond to other children or the teacher. She does not demonstrate visual responses and the teacher thinks she may be blind. On questioning her mother says she was not a very affectionate baby compared to her younger sister. She is very easily upset even when the teacher changes to a new activity. Melissa is very quiet but when she does talk she tends to repeat what you have said.
1. Discuss the variations of Autism Spectral Disorders.
2. Do you think Melissa has a vision problem, justify your response?
3. How might you attract her attention to assess her and gain her cooperation in management?

### Case 4 - Plum

Plum’s kindergarten teacher reports she is a very antisocial child, she prefers to play on her own and can be aggressive toward the other children. She has a small head and microphthalmia in addition to some intellectual disability. Plum’s mother is a recovering alcoholic.
1. Explain Fetal Alcohol Syndrome to Plum’s kindergarten teacher.
2. Outline other drugs that you have found out about that can cause birth defects?
3. Would you expect Plum to have other ocular problems? If so what would you look for?

### Case 5 - Harry

Harry was a very unhappy baby, he cried a lot and was constantly vomiting. His head appeared enlarged and he had a strabismus.
1. Explain the causes and implications of hydrocephalus.
2. What further consequences of hydrocephalus might Harry exhibit as he gets older?
3. Would you expect to find ocular problems? If so explain the ocular investigation you would undertake to find out.

### Case 6 - Katie

A child is referred to See Well Australia who has bilateral retinopathy of prematurity. Katie is five years old and about to start school. Her vision is thought to be about 6/24. 1. Explain the impact you might expect her vision impairment to have had on her social and physical development to date?
2. How will you assess her visual function to determine her functional performance for school activities?
3. How will you explain her functional performance to her teachers?

### Case 7 - Jake

You and your mentor from See Well Australia are assessing children in a special development school. Jake is referred to you because he has a history of birth trauma and staff are unsure if he has any sight.
1. Explain the possible problems relating to vision?
2. Develop a testing protocol to determine if Jake has cortical vision impairment or permanent vision loss such as optic atrophy?

### Case 8 - Michelle

Melissa was born with oculo-cutaneous albinism. She is an active healthy 12 year old about to move from primary to secondary school.
1. What impact will albinism have on Melissa’s visual functioning?
2. What issues might arise for her with the transition to secondary school?
3. What assistance can you offer as an orthoptist?
4. Explain to Melissa’s teachers the impact of albinism on her visual function and therefore daily function.