CH 59: Patient with a Sensory Impairment

DH201 Clinician SciencesLisa Mayo, RDH, BSDH

“You have two hands, one to help yourself and the second to help

others.”?

CH 59: Patient with a Sensory Impairment

DH201 Clinician SciencesLisa Mayo, RDH, BSDH

“You have two hands, one to help yourself and the second to help

others.”?

1. Visual Impairment2. Hearing Impairment

Objectives

Definition: person with a disability who has a physical or mental impairment that substantially limits major life activities

Hearing & Visually impaired fall under this act

Business’s must provide services & devises

Americans with Disabilities Act

Visually Impaired

Cover a broad spectrum from the slightly affected to the completely blind with no perception of light

Many cases: blindness is secondary to a primary condition that may have been the cause of the blindness (ex: diabetes)

Legally blind: legal term, not medical Central vision (or acuity) of not more than 20/200

in the better eye with correction (glasses) Peripheral fields (side vision) of no more than 20

degrees diameter or 10 degrees radius

Visual Impairment

Causes of blindness: Leading cause: diabetic retinopathy, age-

related macular degeneration, senile cataracts, glaucoma, vascular disease, trauma, infections

Children: ½ is of prenatal origin, particularly resulting from maternal infections (rubella, syphilis, toxoplasmosis)

Visual Impairment

Which of the following is a visual impairment? A) DiplopiaB) Otitis mediaC) VertigoD) TinnitusE) Sensorineural loss

Review

A) Diplopia

Diplopia is double vision. The other choices are all conditions that affect hearing.

Answer

Legally blind is defined as central visual acuity of 20/100. This means that the person who has received the best optical correction can see at 100 feet what a normal-visioned person can see at 200 feet.

a. The first statement is true, and the second statement is false.

b. The first statement is false, and the second statement is true.

c. Both statements are false.

d. Both statements are true.

NBQ

Legally blind is defined as central visual acuity of 20/100. This means that the person who has received the best optical correction can see at 100 feet what a normal-visioned person can see at 200 feet.

a. The first statement is true, and the second statement is false.

b. The first statement is false, and the second statement is true.

c. Both statements are false.

d. Both statements are true.

NBQ

All but one of the following may be a problem for an 85-yr old woman with a vision problem. Which one is the EXCEPTION?

a. Glare from the dental lightb. Heavy shag rug in the waiting roomc. Changes in color between the tile floor and the

carpetd. Raised door thresholdse. Signs on the receptionist’s desk

NBQ

All but one of the following may be a problem for an 85-yr old woman with a vision problem. Which one is the EXCEPTION?

a. Glare from the dental lightb. Heavy shag rug in the waiting roomc. Changes in color between the tile floor and the

carpetd. Raised door thresholdse. Signs on the receptionist’s desk

NBQ

Assistance in completing the personal questionnaire Relay on your tone of voice more heavily than others

(cannot see your facial expressions or body language) Lower chair before bringing pt to the op & move all

barriers out of the way Explain why you are leaving the room and when you

will be back Guide dogs: do not distract the dog, do not touch the

dog, ask pt where best place is for the dog (usually lie in the corner of the tx room)

DH Care for the Totally Blind Patient

Clinical procedures Describe each step in detail of your appt Explain instruments, materials, flavors, etc… Let children touch and hold non-sharp instruments so

they can feel it and become familiar with it Prepare pt for power instruments, water, prophy cup,

ect… Speak before touching patient

DH Care for the Totally Blind Patient

Escorting a Blind Patient

You

Pt

When being escorted, a blind client holds the arm of the person acting as the escort just below the escort’s wrist. Then the client walks beside and slightly behind the escort.

a. The first statement is true, and the second statement is false.

b. The first statement is false, and the second statement is true.

c. Both statements are false.d. Both statements are true.

NBQ

When being escorted, a blind client holds the arm of the person acting as the escort just below the escort’s wrist. Then the client walks beside and slightly behind the escort.

a. The first statement is true, and the second statement is false.

b. The first statement is false, and the second statement is true.

c. Both statements are false.d. Both statements are true.

NBQ

Failure of the liquid in the eye to drain resulting in increased pressure and optic nerve destruction defines:

a. Cataractb. Retrolental fibroplasiac. Retinitis pigmentosad. Glaucoma

NBQ

Failure of the liquid in the eye to drain resulting in increased pressure and optic nerve destruction defines:

a. Cataractb. Retrolental fibroplasiac. Retinitis pigmentosad. Glaucoma

NBQ

Chair position: supine may bother a pt with glaucoma (increase pain & pressure)

Light: avoid light in pt eye’s = increased sensitivity to light

OHI: position pt for best vision Ex: glaucoma = no peripheral vision, so sit directly in

front of pt Cannot see fine detail (small radiograph)

DH Care forPartially Sighted

Hearing Impaired

Deaf: When hearing is impaired to the extent that it has no practical value for the purpose of spoken communication

Hard of hearing: defective but functional w/ or w/out hearing aid

Causes of hearing impairment Outer, middle, inner ear mechanisms Heredity, prenatal infection in the mother

(rubella), birth trauma are significant in the earliest years

Hearing Impairment

Marlee MatlinGolden Globes

Academy AwardOscar

http://www.youtube.com/watch?v=xSXaWa-brlc

Types1. Conductive hearing loss: Outer or middle ear

involvement of the conduction pathways to the inner ear

2. Sensorineural hearing loss: damage to sensory

3. Mixed hearing loss: combo4. Central hearing loss: Damage of the nerves

or nuclei of the central nervous system in the brain or the pathways to the brain

Hearing ImpairmentWilkins p.912

Conductive hearing loss is defined as damage to the:

A) outer or middle ear conduction pathways to the inner ear

B) sensory hair cells of the inner ear or the nerves of the inner ear

C) nerves or nuclei of the central nervous system in the brain or the pathways to the brain

D) inner, middle, and outer ear pathways

Review

A) Outer or middle ear conduction pathways to the inner ear

Conductive hearing loss is defined as damage to the outer or middle ear conduction pathways to the inner ear. Sensorineural hearing loss is damage to the sensory hair cells of the inner ear or the nerves that supply the inner ear. Central hearing loss is damage of the nerves or nuclei of the central nervous system in the brain or the pathways to the brain.

Answer

Hearing Impairment

Hearing aids Electronic device that amplifies & shapes sound

waves that enter the external auditory canal In-the-ear model or Canal aid model

Cochlear implants Small electronic device that helps provide a

sense of sound to a child or adult who is profoundly deaf or severely hard of hearing

Does not restore normal hearing

Hearing Impairment

American Sign Language (ASL) Fingerspelling in the air – combined w/ALS Speech-reading (lip reading) Write down instructions

Clipboard with a marker-type pen attached and large paper, at least 8-1/2 x 11 inches

Modes of Communication

(Reprinted with permission from Lange LG. The Gallaudet survival guide to signing. Washington: Gallaudet University Press; 1990.)

(Adapted with permission from Lane LG. The Gallaudet survival guide to signing. Washington, DC: Gallaudet University Press; 1990.)

(Adapted with permission from Lane LG. The Gallaudet survival guide to signing. Washington, DC: Gallaudet University Press; 1990.)

(Adapted with permission from Lane LG. The Gallaudet survival guide to signing. Washington, DC: Gallaudet University Press; 1990.)

Patient with hearing aid Do NOT touch a hearing aid when it is

turned on Turn off when using a power-driven

dental instrument Patient with partial hearing ability

Speak clearly and distinctly Face the patient Eliminate interfering noises: suction

Dental Hygiene Care

Speech-reader Face them straight on, do not turn to side Speak in normal tone, do not exaggerate words Slow the pace of speech, pause more frequently

than usual Do not raise voice, raising voice can distort lip

movements and make lip reading more difficult

Dental Hygiene Care

General suggestions Written appointment card Telecommunication Relay Service (TRS)

to call a deaf patient directly with appointment reminders

Dental Hygiene Care

A patient with a hearing aid may need which modification in delivery of dental hygiene therapy?

A) Remove eyeglassesB) Cover ear canal with gauzeC) Speak very loudly and slowly so the patient can hear you over other noiseD) Remove or turn off hearing aid when using a power-driven

scaler

Review

D) Remove or turn off hearing aid when using a power-driven scaler

It is important to ask patients with hearing aids to turn them off or to take them out when using a power-driven scaler. The noise can be amplified many times, making it uncomfortable for patients. All other modifications listed are unnecessary.

Answer

Mr. Smith is 90 years old and wears a hearing aid. Which of the following will be important when communicating with Mr.Smith?

a. Speak as loud as you canb. Speak slowly and enunciatec. Don’t communicate with himd. Communicate only with his spouse

NBQ

Mr. Smith is 90 years old and wears a hearing aid. Which of the following will be important when communicating with Mr.Smith?

a. Speak as loud as you canb. Speak slowly and enunciatec. Don’t communicate with himd. Communicate only with his spouse

NBQ