Abstract
Welcome to 2015 and this January issue of the BJVI
As you know there are many things that we take for granted and often until someone raises your awareness, you do not realise the importance or the significance of this event or action. I think this is typified in the first article by Marquès-Brocksopp who investigated the well-being of a guide dog owner, after a dog attack on a guide dog. This research conducted in the United Kingdom through 20 in-depth interviews of participants whose guide dog had been attacked found many negative consequences of the attack. The main findings that stood out for me in this research were the quotes from the participants that stressed the feelings of helplessness, a loss of empowerment, and fear. Almost every participant reported this, and this loss of empowerment can be something that is extremely difficult to rebuild and to develop further resilience. The concept of connectedness that is explored in the article is a very important one, and the report of a participant almost feeling a complete loss of connectedness with society is very worrying and concerning for all of us working in the field as practitioners. As such, the further advice offered in the article is something I believe we should then take notice and for those who work with guide dogs and their owners to pay particular focus on the emotional social and well-being of the person whose dog has been recently attacked.
One of the benefits of this multidisciplinary journal I feel is that we are able to focus on a wide variety of issues that effect those with visual impairment. Our next article concentrates on whether older adults with age-related macular degeneration who experience Charles Bonnet syndrome (CBS) are at a higher risk of developing depression and mild cognitive impairment. Although the article by Boxerman Wittich and Overbury showed that the participants with CBS did not statistically show a higher likelihood of developing depression than those without CBS. The risk of depression (30%) was consistent with previous studies, and in their sample of 42 participants with visual impairment, they noted how these participants were at risk of cognitive decline. There is also an interesting discussion which I draw your attention to regarding the importance of identifying people in rehabilitation centres with CBS as this can lead to a decrease in the occurrence of hallucinations which will have an important impact of the relationship between client and clinician.
How do we know that the changes we implement as practitioners and researchers have real effective impact? This is becoming one of the questions we are all asking ourselves. In the article by Bloeming-Wolbrink and her colleagues, they address this question straight on, by investigating whether a change (and this is a dramatic change – the intervention as it were) in the living accommodation for people with congenital deafblindness and intellectual disability will improve their own interactions and communication as well as the interactions of the caregiver and professional. It is important to measure and to evaluate our interventions and to understand how and why changes occur, and this is exactly what is reported in the article. I was particularly drawn to the findings that new accommodation brought about an increase in variety and level of communicative behaviours of the people with congenital deafblindness but that this increase does take time but stressing the importance of a specific and identified tailored approach.
The issue of school vision screening can be a contested and debatable one particularly in the United Kingdom and certainly in Scotland, having completed a study on the effectiveness of school vision screening myself. Some of the arguments under consideration about school vision screening can be based around the identification and determining the exact number of children who had unknown (and uncorrected) vision difficulties within their school career. Certainly, the research that I was involved with identified very few children who had unreported significant visual difficulties in secondary school. All children who had significant visual impairment were known to educationalists, ophthalmologists, and paediatricians, thus calling into account the need for school vision screening but perhaps to focus on parental and child education and disseminating the importance of children getting their eyes examined regularly by their local optometrist. However, as I say, this is still a contested area and no doubt will continue to be. However, all of us agree to stress the importance of regular eye examinations for children; the debate is how this should be done?
The issue, though, of school vision screening in some countries is a very different matter to that of the United Kingdom. Children are not able to simply attend their local optometrist, and many vision services are poor, thus resulting in many children with preventable visual impairment and/or with refractive errors are not known to educationalists and health workers. So, school vision screening becomes very important as this is the only mechanism for examining the child’s vision. The paper by Abu and colleagues in Ghana stresses this need, for the article highlights the epidemiology of ocular disorders among junior high-school children in the Cape Coast area of Ghana. Abu details that only 20% of the 1029 children who were examined had a previous eye exam. The implications of the importance of school vision screening are rightly discussed in this article.
Carrying on the theme based around guide dogs, it is interesting to note in the article by Bohan and Chan how difficult it has been for the acceptance of Guide Dogs within Singapore, with guide dog owners with their dogs being refused entry onto buses, into restaurants and so on. I also noted with great surprise that there are only two guide dog owners in Singapore, of which this article utilising a case study design explores the lived experiences of one of the guide dog owners. The article for me brings home not only the issues of mobility and rehabilitation but one of inclusion, respect, and acceptance, as well as incorporating a different culture. There are many fascinating aspects to this article which I will now look to follow with great interest and will be interested to see how change occurs within Singapore for the guide dog and for the guide dog user.
Assessing children with visual impairment is not easy; it requires training, education, experience, and patience. Assessing children with multiple disabilities and cerebral visual impairment (MDVI) requires even more education, training, and experience, and so anything that helps in the assessment of children with MDVI is of great interest. The last Commentary by Little and Dutton describes the effect a construction of diffusely coloured tents that enclosed the child and therapist had on the attention, engagement, and understanding on children with MDVI. What for me is of interest in the article is not so much ‘how’ to construct the tent, although this is obviously important, but the response of the child, and the practitioner, to clearly identify for each child their working thresholds. This is extremely important when working with children with MDVI and children with visual impairment. One cannot of course ignore the final quote by a parent in this article. On an editorial note may I just thank the Children and the Parents themselves for giving consent to allow photographs of them to illustrate the tents’ functional use; this will really aid the dissemination of this practice. Thank you.
Have a great 2015, and I look forward to receiving your new and interdisciplinary research/practice articles this year.