Sydney East Region: (02) 9412 9300

Sydney West Region: (02) 9891 4914

Low Vision Clinic: (02) 9412 9342

Guide Dogs Centre: (02) 4579 7555

ACT: (02) 6285 2988

Albury: (02) 6041 5201

Wollongong: (02) 4225 9247

Or contact us at www.guidedogs.com.au/contact-us

Ballina: (02) 6681 1667

Newcastle: (02) 4925 3066

Orange: (02) 6362 6625

Tamworth: (02) 6761 3152

Wagga Wagga: (02) 6925 3559

Coffs Harbour: (02) 6652 7424

Guide Dogs NSW/ACT provides all of its services, including mobility aids, free of charge.

To refer someone to us, with their permission, please phone your nearest Guide Dogs office on:

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permission from Guide Dogs NSW/ACT. You can view our privacy statement on our website at www.guidedogs.com.au.

Reducing fallsVision loss can be a major contributing factor to falls. A fully sighted person is still at risk of having a fall, but this risk increases significantly with a reduction in vision or visual field changes.

Glaucoma, Macular Degeneration, Cataracts, Diabetic Retinopathy, Retinitis Pigmentosa, Strabismus, Anisometropia, significant refractive error, Retinal Dystrophies - the list is endless - are all conditions or ocular situations that may affect field, contrast and depth perception. Every individual manages differently and there is a different challenge each time.

Some people find that dealing with reduced visual field is common sense and make adaptations to move their head and carefully check all around them before walking, crossing roads, or using stairs. Other people may find that dealing with loss of contrast is far more challenging and find determining the end of a step far more difficult to manage.

Depth perception is difficult to manage as our brains do not adapt quickly, when older, to changes that in childhood would have almost gone unnoticed with such rapid adaptations.

Caution, common sense, and slowing down, are all sensible measures for an individual to help prevent falls. However, in the circumstances of vision loss or visual impairment, they are even more necessary and other factors on top of these, should be considered, investigated and advice given.

Bigger, Bolder, Brighter is the rule of thumb with low vision, and can be applied when it comes to fall prevention also. Bigger - this may mean updating glasses so visual acuity is as good as possible.

Small items should be moved up or out of the way if possible.

Bolder - the outline of steps and pathways should be bolder if possible.

Darker objects on a lighter background (eg. light carpet) are always much easier to see than pale items on light carpet.

Brighter - increase lighting where possible to make the area lighter, brighter and easier to see. Pathways and corridors should be well lit.

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he uideIssue 5 | Autumn 2012

T GStepping On is a

community based falls prevention program that reduces falls for the elderly. The program is suitable for independent older people who have fallen or are worried about falling, and have no memory issues. The program runs two hours a week for seven weeks.

Guide Dogs was part of the initial research

that was undertaken in 2000 by Professor Lindy Clemson. The research showed the program reduced falls by 31% in older people.

The Stepping On program is based on a sound conceptual basis and allows older people to change their behaviour whilst becoming aware of their own falls risk. The latest falls prevention

thinking is used in the program and one session focuses on vision and falls.

Guide Dogs NSW/ACT has a marvellous Orientation and Mobility Department and their instructors have always been wil l ing to help us. The Orientation and Mobility instructors talk to the group of 12-14 people about the need to have your eyes checked each year to prevent and manage age-related vision conditions.

Walking aids, anti-glare glasses and ways of managing safely with low vision are discussed. The session is very empowering and informative. This has led to many referrals for Guide Dog’s Orientation and Mobility team.

As the program has expanded to country areas, instructors from Guide Dogs have always been very wil l ing to present.

This partnership has been based on strong community development principles. I want to thank the organisation for their support.

Vision loss and falls prevention

Megan Swann Guest Contributor

Vision loss prevents healthy and independent ageing and is associated with the following:

• Risk of falls increased two times

• Risk of hip fractures increased four to eight times

Source: “Clear Focus”, Vision 2020 Australia and Access Economics, June 2010.

The Stepping On program is facilitated by a trained health professional, usually an OT or Physiotherapist, and a team of content experts including an Orientation and Mobility Instructor from Guide Dogs NSW/ACT. Sessions empower participants to make better decisions, learn falls prevention techniques and make behavioural changes.

More information

www.steppingon.com

www.activeandhealthy.nsw.gov.au/nsw_falls_prevention_network

Facebook link – Stepping On Falls Prevention

For more information about practical options to increase safety and reduce falls risks related to vision loss, contact your local Guide Dogs office.

When it comes to falls prevention, many people have not adapted to their changing age or reduced vision. Guide Dogs Orientation and Mobility Instructors provide individually tailored solutions, after having a chat and observing the person in their home environment. The aim is not necessarily to change all that a person is doing, but to make suggestions and increase their attention to tasks and environments where there is greater risk of having a fall. It is these simple ideas that make a world of difference; simple ideas like washing prescription glasses on a regular basis.

In working with an older person, Orientation and Mobility Instructors aim to limit risk, increase independence and safety, and decrease accidents and their consequences.

Older people with vision loss are encouraged to consider:• Contrast and lighting - step nosings can provide useful visual clues to alert a person to the presence of steps.

• Road crossings - strategies to alert drivers of a person’s intention to cross the road.

• Problem solving - make appointments at a time that is best for the client’s vision and avoid busy times.

• Positioning of tasks – Is there a better place to be reading, or chopping food?

• Public transport - when getting off the bus, stop, collect your thoughts and then go on your way; don’t go into auto pilot which can increase your risk of falling.

• Reducing trip hazards in the home – do power points and cords need to be moved out of walkways?

• Glare reduction options – have they tried a window blind, UV Shields or changing their position? Do you they need a special light for some tasks?

As with all Guide Dogs’ training, Orientation and Mobility Instructors encourage clients to use what works best for them.

Stepping On – in the central westGuide Dogs in the Central West region has been actively involved in the falls prevention program “Stepping On” for at least 4 years. Staff from the Orange office have presented on this subject at Gulargambone, Coonamble, Dubbo, Mudgee and Bathurst.

Instructors work in collaboration with either physiotherapists or occupational therapists within the allied health sector. Groups can vary in size from as low as three up to ten.

Whilst the majority of participants may not need mobility training from Guide Dogs, many report being pleasantly surprised by the breadth of services we offer.

If nothing else, they have learnt not to be members of the “sloppy slipper” club! The participants are now able to take an inventory of their home which enables them to list and remedy potential trip / slip factors, particularly in poorly lit areas such as shaded back steps or poorly contrasted areas like an all-one-colour bathroom.

Falls prevention research

Shirley and her Instructor Elaine Neal

At age 45, Doreen was diagnosed with PXE. PXE or Pseudoxanthoma elasticum is a rare condition which can affect, among other things, the skin and central vision. Over the following years her vision slowly deteriorated. At age 56 Doreen had to give up work and at age 62, she was declared legally blind. Doreen is now 77.

Doreen attended a Stepping On program in 2011 where she found out about the Miniguide, a small handheld device which sends out ultrasonic beams. When it detects an object the Miniguide provides feedback, either vibration or an auditory beep, depending on the model. The closer you are to an object, the more feedback the Miniguide provides. Doreen now uses the Miniguide regularly in conjunction with her support cane.

Doreen also has an ID cane, which she uses when travelling, but mostly she gets around with her support cane and Miniguide. The Miniguide has increased her confidence significantly.

“I often go walking by myself and the Miniguide enables me to locate objects, such as poles, at eye level. It is a very, very good gadget. I really can’t live without my support cane. Everywhere I go, so does my cane”, commented Doreen.

Alexander Technique trialThe main inputs to postural stability are from the somatosensory (chiefly proprioception), vestibular and visual systems. Nerve conduction speed and central nervous system integration slows with age, forcing older adults to rely less on proprioception and more on visual input, especially for dynamic balance control.

For older adults with vision impairments this pushes them to the edge of their ability to maintain their balance under challenging conditions. People with vision impairments are at increased risk of falls. A trial of older people with significant vision impairments found that a home safety program successfully reduced falls but exercise intervention, which had been shown to benefit the general population, did not.

The Alexander Technique uses everyday movements to re-educate an individual‘s ability to balance effectively in activity. Researchers from the George Institute, in collaboration with Guide Dogs NSW/ACT, are conducting a randomised controlled trial to evaluate the Alexander Technique. Participants will be assessed at baseline, 3 months and 12 months by assessors masked to participant status.

Balance and mobility impairments are key risk factors for falls and if this study shows an effect on balance and mobility, future studies could assess the effect of the Alexander Technique on the rate of falls.

Doreen’s story

In 2006/07, it was estimated that over 251,000 individuals aged 65 years or older (or 27% of the older NSW population) fell at least once. In total, there were an estimated 507,000 falls and, of these, almost 143,000 (28%) resulted in injuries requiring some form of medical treatment (NSW Health).

Doreen and her Instructor Fiona Henwood