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PALO ALTO VA IS SETTING NEW SIGHTS, LITERALLY --
Blind Rehabilitation Center transforms its
services to meet
needs of veterans from Iraq War as well as World
War II.
Marine Corporal Robert Williams, who
lost his left eye in Iraq in 2005, works with a neuro-vision
technology machine while Scott Johnson, program coordinator, helps
him to understand his vision more consistently. (Photo by Marjan
Sadoughi / Palo Alto Weekly.) |
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Story here...
http://www.paloalto
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Story below:
-------------------------
Setting new sights
Blind Rehabilitation Center at VA
transforms its services to meet needs of vets from Iraq War as well as
WWII
by Sue Dremann
Palo Alto Weekly Staff
The hallways were busy with veterans tapping their white canes.
Sliding the red-tipped staffs along polished floors, the men felt their
way to rehabilitation therapy, computer classes — and wood shop — at the
VA Palo Alto Health Care System's Western Blind Rehabilitation Center.
Marine Corporal Robert Williams sat squarely in front of a light panel,
his nose only 11.8 inches away from touching its black surface. Colored
lights in rows flashed in preprogrammed sequences before him: red, white,
blue, green and amber.
Partially blinded in the Iraq War, Williams counted, comparing the
flashing patterns or sorting out the colors, trying to discern the
differences.
Williams, 23, has deep-blue eyes and boyish good looks. An avid hunter and
fisherman, he lost sight in his left eye in August 2005 after a roadside
bomb attack in Iraq. The blast damaged his depth perception.
"I can see flying bugs and can point at them, but I don't know how far
they are. I guess my career as a wide receive is completely squashed," he
said jokingly with a smile.
 The
light panel is helping Williams to learn to scan his environment, training
his neck and head to turn and to create a visual list. Williams is
learning to gather that information in sync with his brain's ability to
process it. The Western Blind Center is the first hospital in the U.S. to
have a vision board, rehabilitation specialists said. It is part of a
litany of technologies being developed or adapted by researchers at the
center.
Adaptive devices such as computers, smart phones, specialized scanning
equipment and GPS navigation are helping blind and visually impaired
veterans to live independently with greater facility. And younger vets,
who are plugged into the digital world, are demanding prosthetics that are
tailored for individual needs and ages, such as devices that scan and read
menus and interpret them by voice, specialists said.
The center used to focus on eye diseases such as macular degeneration and
glaucoma and served an aging population of veterans. It used to only take
patients who were legally blind or fit certain criteria. But the wars in
Afghanistan and Iraq have brought in new, young soldiers whose injuries
are changing the way the center treats blindness. Young vets have
functional impairments — neurologically based visual problems — caused by
stroke, aneurysm and polytraumatic injury, according to Harriet Straus,
the center's nurse manager.
In some cases, no injury to the eye is apparent. The veterans can see
well, but how the brain interprets what they see isn't the same, according
to Scott Johnson, coordinator of the Comprehensive Neurological Vision
Rehabilitation Program.
The causes are often improvised exploded devices (IEDs). Some soldiers are
being exposed to two, three, four or even seven IED explosions causing
repetitive "closed-head" brain trauma from the concussive force, Johnson
said. And the center is bracing for an increase in patients whose visual
impairment could come later in life as a result of their head trauma.
"When this war is over we will have a program in place. We will have a ton
of people with strokes. [Before] a lot of people with strokes didn't have
vision rehabilitation," he said.
The center has a "basic training" program that teaches core skills, such
as use of optical aids, independent travel, daily living skills,
alternative methods of communication, sensory awareness and manual-skill
development, and training family members to interact with the veteran at
home, according to Lila Jaffray, clinical coordinator. Special programs
include computer-access training, GPS, power-wheelchair or power-scooter
programs.
Blind Center researchers were forerunners in the development of a
power-mobility program, and the center has been a testing site for
electronic travel aids and other devices, Jaffray said. The center houses
26 in-patients and in a year 200 are served. The length of stay varies,
depending on each veteran's needs, she said.
"The polytrauma patients have totally changed how the VA does business,"
Straus said. "They are doing cutting-edge therapy with patients. ... It's
a pretty phenomenal thing. I've been a rehab nurse for more than 20 years,
and I've never seen a place like this for the blind."
Robert Williams messed around in the recreation room, tussling with Mae, a
6-month-old black Labrador retriever that is a seeing-eye dog in training.
The dog is blind-rehabilitation specialist Laura Kaehler's tenth dog in
training. Williams has become attached to the dog, which was chasing a
rope toy as Williams traced it along the floor.
"The biggest part of her training is socialization. ... She had to learn
to not be afraid of the automatic door," Kaehler said.
Williams is missing 30 percent of his field of view. He has been at the
center since mid-July, picking up the tales and wisdom of older vets from
older wars.
The recreation room has a pool table and big-screen television.
"I love the irony of walking into a blind school and finding a big-screen
TV. It's like taking deaf people to a ventriloquist," he said.
But Williams is learning to function again the same as any young man his
age: He can drive his truck with the use of bubble mirrors. And the
vehicle is equipped with a back-up sensor and GPS navigation to aid
backing out of parking spaces, he said.
Williams wants prosthetics that will help further his education. A
Petaluma resident, Williams plans to attend Santa Rosa Junior College and
wants to become a physical therapist, he said.
He works with Dan Nakamura, a blind-rehabilitation specialist in
computer-access training, to learn how to use the Kurzweill 3000 program,
which scans printed text and can read aloud to Williams. Although he has
some sight, his vision tires easily. The program can coach him along the
way when he becomes too fatigued to read on his own.
Smart phones are another valuable innovation with widespread applications
for the blind, Nakamura said.
"Robert doesn't have to carry seven different things. He's carrying one
thing that does everything for you," Nakamura said.
Smart phones have GPS, Windows and voice-recording capabilities. The
phones are being tested on the completely blind, Nakamura said.
He held up a small black box the size of a point-and-shoot digital camera.
"It can take a picture of a menu and read it back to you. It can observe
and read a street sign and read it back," he said.
Williams is excited about the freedom of hand-held technology. "Dan will
hook me up with Powerpoint, word processing, Google and Wikipedia," he
said.
Minh-Tri Van, a gentle and soft-spoken 29-year-old man, was a Navy sonar
technician stationed in San Diego when his roommate found him unconscious
in his barracks. He developed brain damage in 1998 due to a mysterious
episode that caused anoxia — a lack of oxygen.
Van picked at his salad during lunch in the mess hall. A painting of a
veteran walking with a white cane adorned the wall. A series of white
canes hung from pegs on the back of the mess-hall door as their owners
chatted during lunch.
Part of Van's brain has died as a result of the episode, causing speech,
memory and mobility problems, he said. "My vision is 20/200. Everything is
blurry. I can distinguish colors, and I have depth-perception problems."
Since coming to the center, he has been camping, swimming and playing
billiards. But he also engages in hard work: training to use a
book-scanning device that can read aloud, having speech therapy and
learning to clap his hands and punch. Much of that occupational therapy
takes place at the polytrauma center. Van tends to fall, so he still uses
a walker, but he has made much progress.
Since coming to the Blind Center on July 8 from his parents' home in
Columbus, Ohio, he has learned to use a white cane and how to cross a
street safely. He wants a GPS system so he can navigate by himself around
neighborhoods and will have more independence. He likes Palo Alto, and
living here independently is a goal, he said.
"When I came here, I couldn't walk backwards or speak loudly," he said.
Nakamura said devices that enhance communication are crucial for older
blind veterans, too, who will rely on computers for communication with
children and grandchildren who are part of the digital generation.
"Sometimes they say they're too old. You're never too old. We had a
99-year-old man here. He was running around here better than I am,"
Jaffray said.
Older vets can also be the primary caregiver of a spouse, Jaffray said,
noting the importance of retaining independence as eye problems from
disease rob sight.
Most patients have macular degeneration, glaucoma and retinitis pigmentosa.
"But the really big one is diabetic retinopathy," Straus said. Fifty
percent of patients have the disease and the center is seeing more Vietnam
veterans. Those veterans are more prone to getting diabetes as a result of
the war and post-traumatic stress disorder, which can lead to alcohol
abuse and depression, she said.
Among older veterans, "one of the biggest problems is reading — just to
read a newspaper or look at family photos," Jaffray said. Older veterans
use adaptive devices to get mail or to go to the end of the block. "For
some, that's a goal," she said. Others want to travel or return to work.
The center offers training in touch typing and creating a business plan,
she said.
Ron Caravello, 75, a retired New York City police officer and Korean War
veteran in the Air Force, lost sight in his left eye 12 years ago to
macular degeneration. His other eye lost sight 1 1/2 years ago, he said.
"I can't see straight ahead, but I can see on the side," he said.
Gregarious and energetic, Caravello loves to take visitors to his room to
see a portrait taken with his wife, a stunning 68-year-old woman who looks
45. Last year, they celebrated their 50th anniversary, he said.
Caravello arrived at the Blind Center in late June.
"This place is absolutely unbelievable. The attention you get from the
start: They teach you how to cross streets; how to cross safely. It's very
difficult without training for the things to listen for. They teach you
how to use peripheral eyesight," he said, strolling briskly down the hall,
his white cane scanning the terrain ahead of him.
He fingered a finely tooled leather belt he learned to make himself.
Halfway through, he learned to work it without looking, he said. With the
use of closed-circuit television, he can read newspaper articles.
"It's the first time I've read in 10 years," he said with satisfaction.
Caravello is learning to type again and wants to learn computer skills so
that he can get a job working on a computer, he said.
"They teach you so well you can almost do what a person who can see can
do," he said.
While hospital spokeswoman Kerri Childress and a visitor rode the
elevator, Caravello took the stairs beating them to the woodshop. Table
tops and shelves are laden with wooden toys, boxes, frames and candlestick
holders, all made by blind veterans. Caravello opens a drawer filled with
hammered copper pictures: praying hands and American eagles. He is
learning to make frames for each of the craftworks, he said.
Irving Gold, 92, is turning a wooden block on a lathe, turning it into a
fine writing pen under the watchful eye of El Gray, a blind-rehab
specialist and manual-skills instructor.
"The tools are outfitted differently and set up in ways where they can't
hurt themselves," Childress said.
In the manual-skills lab, veterans are doing leather work, creating
identification folders or learning basic skills such as threading laces
and using restrooms.
A board mounted with several keys, door knobs and latches provides a
platform for learning how to open and close various kinds of door
fixtures.
The hallway is lined with photographs and descriptions of different types
of visual impairments, each image a reminder of just exactly how veterans
with each kind of vision loss really see.
For Anita Stone, a blind-rehabilitation specialist and living-skills
instructor, her own blindness is a constant reminder of what her clients
experience. Stone was in Navy communications and intelligence. Eight years
ago, she developed retinitis pigmentosa and went through a similar
rehabilitation program in Tucson, Ariz. She has light perception but is
functionally blind, she said.
"I know what it's like. I've been privileged to be on both sides. I tell
them it's OK to be scared. They are out of their comfort zone. I tell them
by the second week, they'll be owning the place," Stone said.
"The biggest frustration is transportation. When you lose your vision,
it's difficult to cope," she said.
Someone's seeing-eye dog loped around Stone's cramped office. She ate
lunch with her husband, Dale Honhoinewa, who has low vision and works in
the hospital's intensive-care unit. Both have experienced the frustrations
of the public's often well-meaning misconception of blindness, they said.
"When you travel, going to destinations and being in public, a lot of
people want to help you. But some people overstep their boundaries. They
get angry when you refuse their help. ... Trying to convey to the public
that you are OK is especially difficult," she said.
Stone said she assesses each veteran's issues and tries to figure out what
they need. For some, it's typing and Braille, for others, it's about money
and identification safety. Some people have health problems. They lose
spouses and families and friends due to blindness and many become
isolated. "'The best thing,' I tell someone, 'is when you lose vision, is
to find others,'" she said.
Tuesday morning is graduation day. It's the time when veterans line up to
receive diplomas and speak about their achievements. Each week the ritual
is renewed, with a new crop of graduates making their way out into the
world — independently.
"When people graduate and they get their certificate, it means the world
to them, and it meant the world to me," Stone said.
Last year, the Western Blind Rehabilitation Center celebrated its 40th
anniversary. The center is the second oldest in the country, and is one of
11 regional facilities nationwide. When the Palo Alto VA undergoes a
makeover in the next few years, the Blind Center will have a new
64,000-square-foot facility that will nearly double the current amount of
space and will possibly include an outpatient center reflecting the
changing needs of veterans, Jason Nietupski, facilities manager said.
Stone said the center's new direction and continuing research take a
tremendous effort but are necessary to make the center more challenging.
The ultimate goal is how to best serve veterans in a changing world.
"We had a young man who sat in his house for three years and never went
outside. He came here and in a short time he was volunteering and going
out. This place saved his life," she said.
-------------------------
posted by Larry
Scott
Founder and Editor
VA Watchdog dot Org
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