Orientation and Mobility

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Principles of independent travel (often referred to as Orientation and Mobility) are taught using a cane.” Maximum use of any remaining vision to assist travel is evaluated, and in many cases low vision devices are provided and made an integral part of mobility training. Sensory training classes teach the veteran how to more effectively use remaining senses, particularly hearing, as an aid in travel. In addition, exercises in mental mapping serve to enhance the veteran’s orientation while traveling through different kinds of environments.

Orientation and Mobility instruction in relatively simple routes to increasingly complex routes builds the veteran's confidence in the ability to travel independently. By the completion of the instruction the veteran should have a realistic understanding of his or her travel capacity, and the ability to travel safely and independently in both familiar and unfamiliar areas.

Living Skills

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This phase of the rehabilitation program includes communication, activities of daily living, and independent living.

Communication:  Instruction is designed to enhance and restore abilities in written and spoken communication. Opportunities to learn and use strategies and tools for communication are provided to the veteran, such as typing, handwriting, telling time, management of financial records, Braille, recording devices and other electronic equipment. These courses help the veteran to keep up with current events, correspondence and personal files, and help to maintain a normal means of communication with other people.

Activities of Daily Living: Strategies are provided to the veterans to help them accomplish tasks ranging from routine (managing money, making a cup of coffee) to complex activities such as arranging an entire wardrobe, shopping, kitchen organization, and preparation of complete meals. The emphasis is on learning by doing; techniques and methods are taught and then integrated into the veteran's daily routine. By the completion of the program the veteran should be capable of handling daily living tasks with complete or greatly enhanced independence. Family members often experience a reduction in the burden of care they have been providing to the visually impaired family member.

Independent Living Program: Each Blind Rehabilitation Center has established an independent living program that is designed primarily for those veterans who will be living alone following their rehabilitation. After extensive instruction, the veteran is given an opportunity to practice newly acquired skills. The veteran can experience countless tasks typically encountered when living independently, and the veteran can devise solutions to many of these problems before returning home.

The Living Skills Instructors also arrange consultations with the VA Medical Center dietetic service so veterans have the opportunity to meet with a dietitian. This is particularly important for those veterans who may require special diets and who may require education concerning these diets. Detailed instructions in preparation of special diets can be provided and daily nutrition can be monitored.

Manual Skills

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This program area provides the veteran who has little or no vision with the means to develop and improve organizational skills, awareness of the environment, safe and efficient work habits, spatial relationships, and an understanding and mastery of tactual ability. The manual skills training focuses on the sequential development of skills and builds confidence. Training is generally presented to the veteran in several areas, and may include (but is not limited to) handcrafts, home mechanics, woodworking, metalworking, leatherwork, weaving and ceramics.

The initial training area consists of hand crafting objects in order to develop the individual’s confidence in their non-visual senses. The home mechanics training is an introduction to the tools and organizational techniques that allows an individual to perform simple repairs and assembly. Advanced training focuses on the use of adaptive measuring devices, hand tools and power equipment typically used in woodworking.

The manual skills training is not vocational, although some veterans have developed vocational interests or hobbies after participating in this training. Manual skills training may enable a veteran to resume performing home repairs or other related activities at home, further adding to the person's self-confidence and motivation. Veterans who enter blind rehabilitation with minimal abilities in manual skills or those who are slightly skilled in aspects of mechanics or woodworking find this training very beneficial.

Visual Skills

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Approximately 85 percent of all veterans who enter a rehabilitation program possess some level of vision that may be useful in many situations. Each veteran attending the program is given a comprehensive eye examination, and a thorough visual skills assessment is performed.

Visual skills training addresses the needs of veterans with remaining vision and helps these individuals gain a better understanding of their eye problems through therapy. Instruction focuses on effective use of remaining vision through the development and use of visual motor and visual perceptual skills. Assessment and instruction with special optical and electronic devices that are designed to meet the needs of people who are visually impaired is provided. Ergonomic equipment such as special lighting and positioning devices are provided to assist veterans in using vision effectively. Lessons may employ the use of visual and ergonomic equipment and visual skills that address near, intermediate and distance tasks. This approach allows veterans who have vision to accomplish a variety of tasks, such as reading printed material, and to use their vision to perform routine activities of daily life, independent travel, etc.

An important goal of the visual skills area is to help the veterans to develop a realistic assessment and understanding of their visual capabilities and limitations so that they may better use their vision in daily life. 

Computer Access Training Section (CATS)

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The CATS program provides specialized services to eligible veterans including: a comprehensive adaptive computer needs assessment, recommendation of appropriate computer equipment, training on recommended equipment, issuance of equipment upon successful completion of training, and follow-up technical support as required. Eligible veterans may be able to receive local training and issuance if there are local qualified providers in the veterans’ communities.

The equipment issued by CATS is state-of-the-art computer technology with all necessary peripherals and accessible hardware/software to meet the veterans’ identified needs. Training encompasses comprehensive instruction on accessible hardware/software, computer literacy, familiarization to computer keyboard, fundamentals of disk operating systems and fundamentals of word processing, internet access and email. Exceptions to this training regimen are determined on a case-by-case basis.

Physical Conditioning

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The onset of vision loss may severely disrupt exercise or recreational activities that many veterans have incorporated into their daily lives, causing a decrease in muscular tone and stamina. Each Blind Rehabilitation Center offers a program of physical training under medical supervision. Not only does this training improve the physical condition of the veteran, but it also teaches the veteran exercises that may be completed at home to maintain good health.

Exercises and activities can range from relatively moderate to relatively vigorous, depending on the ability and needs of the veteran. Even a moderate program of regular exercise can assist veterans in management of complicated medical situations. Although many veterans are uncertain at first of their ability to perform regular exercise or participate in leisure activities, they are often surprised at how much they can accomplish with time and patience.

Recreation

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Just as the pattern of normal exercise and activity can be affected by blindness, so can recreation that brings pleasure and enjoyment to a person's life. Recreational activities are offered for groups as well as for individuals. Opportunities to attend sporting events, theaters, movies, concerts, as well as social gatherings of various kinds are planned for all patients. The aim of the recreation program is to renew interest in activities that have been enjoyed in the past, and to stimulate new interests. Possible social and recreational activities that may be available in the veteran's home area are discussed and strategies for realistic involvement are explored.

Adjustment to Blindness

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Emotional and behavioral adjustment to blindness is often one of the most challenging issues faced by the veteran, and is a primary focus of our Clinical Psychologist, Social Worker and the rehabilitation team.

Through individual counseling sessions and group meetings, veterans are taught coping and adaptation strategies. The rehabilitation program provides a therapeutic environment where the entire staff assists the veteran in developing their own strategies.

A Clinical Psychologist is assigned to each Blind Rehabilitation Center . The Psychologist's duties include an evaluation of the veteran's adjustment strengths and limitations and counseling in individual and group sessions on various aspects of blindness and emotional adjustment. The Psychologist routinely consults with the staff of the Blind Rehabilitation Center to assure that the veteran's psychological needs are addressed in the program of rehabilitation. Planning can include vocational rehabilitation, education, job retraining, or development of a vocational interest. Vocational planning is coordinated with Veterans Benefits Administration (VBA) counseling and rehabilitation staff for veterans eligible for those services. Non-eligible veterans may be referred to the appropriate state agency for additional services, if available.

The Social Worker provides assistance to veterans and designated family members in evaluating and solving social, emotional, or family problems affecting treatment. In many situations problems may be related to the adjustment to blindness, family/interpersonal relationships, financial difficulties, housing/living arrangements, and other issues. Often solutions to the multifaceted dilemmas may require linking with community resources in the veteran's home area to assure that necessary services are available and used following discharge.

Family Program

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The purpose of the family program is to involve the veteran's family in the rehabilitation process, and to demonstrate the changes the veteran has made. The family program is a very important aspect of rehabilitation, because it enlightens and educates the family member and helps to reinforce rehabilitation lessons once the veteran returns home. Moreover, the family program assists family members in their own adjustment to the veteran’s vision loss by identifying problems or misconceptions they have that may negatively affect the veteran’s adjustment.

The Social Worker designs a family program as indicated by the recommendation of the rehabilitation team and veteran's needs. In many situations the family program can be a very important aspect of rehabilitation. If a family program is recommended and approved, the veteran selects a family member with whom he/she lives to visit the Blind Rehabilitation Center . The family member stays for several days, approximately three-quarters of the way through the veteran's program. Costs of travel, lodging, and meals are sometimes defrayed by the VA facility where the Blind Rehabilitation Center is located, depending on local policy.

Group Meetings

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One major strength of the residential Blind Rehabilitation Center is that it brings together people from many varied backgrounds, educational levels, and occupations who, as veterans, share one thing in common - blindness. Through interaction with other people who are experiencing the same difficulty, the group itself can frequently support individuals as they struggle with their feelings. To aid in this process, group meetings are scheduled that allow expression of feelings concerning blindness.

Team Coordinator Concept

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The staff assigned to work with a particular patient forms the rehabilitation team, with the veteran as the most important member. One staff member serves as the coordinator or case manager of the team. The team coordinator follows the progress of the veteran from the day of admission until the day of discharge, assists the veteran in any way possible and monitors the veteran’s progress towards their goals. This allows one person to serve as the focal point for the veteran's rehabilitation program, so the veteran knows who is available for advice, consultation, and discussion concerning the rehabilitation program. The team is delegated responsibility for planning the details of the veteran's rehabilitation program and making adjustments as necessary. As an important part of the team approach, the veteran is involved as much as possible in the planning of the program; just as staff may suggest changes or modification to the rehabilitation plan, so may the veteran provide input to the team. In this way, the veteran becomes a member of the team and is a party to all aspects of the rehabilitation program, particularly the setting of goals and objectives. This team approach to rehabilitation is at the heart of the rehabilitation concept and helps assure accountability for the quality of patient care.