November is National Diabetes Month
Providing Occupational Therapy and Assistive Technology for Persons with Diabetes and Visual Impairment
November is National Diabetes Month, and for OT’s providing services to adults and children, diabetic care may be part of your therapy interventions. As a chronic health condition, diabetics can cause complications of the skin, eyes, nervous system, kidney, heart when uncontrolled (Diabetes Complications, 2019). Diabetic complications may require additional treatment considerations, or adaptive or assistive technology in therapy interventions.
While diabetes complications can affect many bodily functions, vision is one of the systems that can be impaired if diabetes is not controlled. According to the Center for Disease Control (Diabetes Public Health Resource, 2012), in 2011, 20 % of individuals aged 45 years and older diagnosed with diabetes reported visual impairment. Diabetic retinopathy is also reported as the leading cause of blindness in working aged adults (Program, 2018) along with a higher risk of early cataracts, glaucoma and other visual impairments associated with the diabetes (Kleinbeck, 2013). Given the complications of visual impairment with patients with diabetes, treatment may require familiarity with adaptive tools, assistive technology and modifications to support OT intervention of patients with diabetes.
The American Association of Diabetic Educators (AADE) identifies 7 Self Care Behaviors for individuals with diabetes (Resources for People Living with Diabetes, 2019). Each of these self-care areas fall within the scope of occupational performance skills assessed and treated by OT’s. The 7 Self Care Behaviors, as defined by the AADE align with OT scope of practice as listed below:
- Healthy Eating (Health Management, Shopping, Meal preparation)
- Being Active (Health Management)
- Monitoring (Health Management; Personal Hygiene and Grooming; Personal Device Care)
- Medication Administration (Health Management,
- Problem Solving (Health Management)
- Risk Reduction (Health Management; Personal Hygiene and Grooming)
- Healthy Coping (Health Management; Social Participation in Community; Education)
National Diabetes Month, OT and Assistive/Adaptive Technology and Resources
Given the incidence of visual impairment with patients OT’s treat, the need for assistive and adaptive devices to compensate for their sensory impairment may need to be explored. So, what assistive technology, adaptive equipment or modifications are available for diabetic patients with visual impairment to help them with health management and maintain independence with their self-care?
While some devices are medically prescribed by the patient’s diabetic team, there are many devices and modifications Occupational therapists that can be considered to support diabetic health management and patients’ occupational goals. Listed below are few assistive/adaptive technology tools and resources that might be considered to support OT intervention of the diabetic in the 7 Self Care areas:
| AADE 7 Self Care Behaviors / OT Occupations | Assistive or Adaptive Devices
(Low to high tech tools) |
Resources to Support OT Interventions in the 7 Self Care Behaviors |
| Healthy Eating / Health Management, Shopping, Meal preparation
|
|
The Diabetes Food Hub website has recipes, a meal planning tool and other healthy eating tips for diabetics
MyPlate program provides a visual guide for healthy eating, food and quantity management. Carb counting apps or forms aid learning and tracking daily carb intake: Mayo Clinic’s Diabetic Meal Plan Recipes Provides a list of foods and recipes for diabetic meal planning and preparation Large Print Activity and Food Log (free) from American Diabetes Association |
| Being Active / Health Management |
|
Some Medicare Insurances have a Fitbit community to aid motivation for staying active (e.g. AARP Advantage plan Fitbit community)
The Silver Sneaker Program provides online line and community health/fitness programs geared to seniors. Check client eligibility at Silver Sneaker.com. American Diabetes Association has Fitness Information for Diabetics. The National Council on Aging provides a wealth of evidenced based practices on fitness programs for older adults. A Workout Program for Diabetics from the Verywell Health website offers information and fitness training for Diabetic Type 2 clients. VisionAware has information on Exercise for People who are Blind or Low vision. |
| Monitoring / Health Management; Personal Hygiene and Grooming; Personal Device Care |
MiBest Talking BP monitor^ has a large, high contrast LCD, offers English and Spanish and saves up to 90 records for 2 users.
|
The American Diabetes Association website Device Technology section has an overview of basic devices used for diabetic management.
VisionAware website provides diabetics step by step instructions for monitoring sugar levels in print format and also audio versions. Information on what to look for in glucose meters is also provided. Information on monitoring blood pressures is also included in this topic which can be found at VisionAware: Monitoring your Blood Glucose when you have Visual Impairment Large Print blood glucose and blood pressure log sheets are available: |
| Medication Administration
/ Health Management |
VisionAware website offers information on Products and Devices to Help Identify Medication including a list of adaptive medication identification systems including talking options. A few medication devices listed:
Other labeling systems:
|
The American Diabetes Association has information on medication management for diabetics and caregivers.
VisionAware website has specific medication management suggestions and tools for diabetics with visual impairment – Diabetes: The Basics Taking Medication . VisionAware website is accessible with magnification tools and audio formatted information for individuals with visual impairment.
|
| Problem Solving /
Health Management |
Problem Solving tools can include apps to organize and review diabetes data:
|
VisionAware Diabetes: The Basics: Problem Solving: Suggestions for productive problem solving is the focus of the information presented on VisionAware website for individuals with visual impairment. Magnification tools and information in audio recordings offer accessible formats.
National Diabetes Education Program – Lifestyle Change Program providing education, support groups are available through National Diabetes Education Program. The Diabetic Council.com offers a listing of support and educational groups by state. |
| Risk Reduction / Health Management; Personal Hygiene and Grooming
|
Monitor and record BP, BG and Cholesterol levels using apps and/or diabetic monitoring forms. Maintaining records can help the diabetes team identify medical needs.
|
VisionAware website Diabetes: The Basics: Risk Reduction offers information on reducing risks including the following topics:
|
| Coping Strategies / Health Management; Social Participation in Community; Education
|
Apps for calming, deep breath or meditation can be help as a coaching tool for anxieties or depression
|
The Diabetic Council.com offers a listing of support and educational groups by state. Support groups, activity groups and educational groups are known resources to help with well-being. Some program costs may be covered by insurance.
VisionAware – Diabetes: The Basics: Coping Strategies offers information regarding healthy coaching for diabetics with low vision. Accessible print and audio format of the information is available. Coping with Your Emotions – University of California – SF offers online suggestions for copying with diabetes. |
^ Amazon Affiliate Link
Reading and Writing Assistive Technology Tools for Individuals with Visual Impairment**
A wide range of reading and writing assistive tools and modifications are available to support access and production of print for individuals with visual impairment. These aids can help diabetics with visual impairment maintain independence in their health management. A few of the reading or writing aids to support low vision might include devices as listed below with many more varieties available on the market depending on patients needs and resources:
- Modifying print and writing tools with large text, high contrast, bold and clean fonts (san serif fonts) as Arial, Tahoma, increased spacing, use bold pens, writing guides can increase visibility for individuals with low vision. A few tools to consider:
- Increased lighting, such as task lighting, flashlights directed to the viewed text or object and comfortable to the client aids visibility. Flexible task lights such as:
- Big Eye Magnifier and Light offers a flexible neck lamp and magnifier.
- Stella Light^ offers a flexible stand lamp with adjustable light and brightness levels
- Magnification of objects or print using handheld magnifiers, video magnifiers or CCTV’s provide adjustable spot and stationary reading aids. Video magnifiers offer illumination, multiple magnification levels, contrast settings and reading lines for reading print. A few such magnification systems to consider (but not limited to) include:
- Handheld video magnifiers of different sizes for near and or far distance viewing:
- CCTV’s:
- Life Style CCTV – HD CCTV offers a stationary monitor and video camera for reading print magnified on a large monitor.
- Go Vision CCTV – The Go Vision CCTV provides video magnification and OCR with reading aloud capabilities. Contrast, magnification and connectivity with phones, computers, tablets are among its features.
- Patriot Voice Plus – A non-visual device that reads aloud text placed under the camera. Simple tactile controls provide easy access to the Patriots features for individuals with blindness or significant visual impairment
- Computer programs that magnify and computer information also may support clients in accessing health management information. Programs such as:
- Accessibility options in Windows and Mac operating systems offers magnification, text to speech, high contrast, enlarged pointers/cursors for individuals with visual impairment.
- ZoomText Magnification/Reader or Fusion software are dedicated magnification programs to access computer print as well as screen reading access (JAWS) in the expanded version of Fusion.
- JAWS – Job Access with Speak program offers access to Windows computer for individual with blindness.
- NVDA– Non-Visual Desktop Access is a free screen reader for Windows operating system allowing access to the computer to individual who are blind.
Summary
Occupational therapists working with patients with diabetes can support their health management, self-care and iADL skills following the 7 Self-Care Behaviors identified by the American Association of Diabetic Educators. For patients with diabetes who have a visual impairment, there are many assistive and adaptive tools and resources OT’s can consider to support patients in the 7 Self Care Behaviors to help with health management and well-being.
More for your OT eTool Kit as well as other adaptive devices!
OT & AT for Persons with Diabetes and Visual Impairment PDF
Carol- OT’s with Apps & Technology
References
Diabetes Complications. (2019). Retrieved from American Diabetes Association: https://www.diabetes.org/diabetes/complications
Diabetes Public Health Resource. (2012, September 21). Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/diabetes/statistics/visual/fig3.htm
Diabetes: The Basics Overview. (2019, November 22). Retrieved from VisionAware: https://www.visionaware.org/info/your-eye-condition/diabetic-retinopathy/diabetes-guides-with-lessons-following-seven-self-care-behaviors/the-basics-about-living-with-diabetes-7-lessons-in-audio-and-print/1234
Kleinbeck, C. (2013, July 25). Diabetes Self Management. Retrieved from Tools and Techniques for Visual Impairment: https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/tools-and-techniques-for-visual-impairment/
Program, N. D. (2018). Guiding Principles for the Care of People with or at Risk of Diabetes. Retrieved from National Institute of Health: https://www.niddk.nih.gov/health-information/communication-programs/ndep/health-professionals/guiding-principles-care-people-risk-diabetes
Resources for People Living with Diabetes. (2019, November 22). Retrieved from American Association of Diabetes Educators: https://www.diabeteseducator.org/living-with-diabetes/aade7-self-care-behaviors
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