Abstract
In March 2020, the Italian Government declared a state of lockdown to curb the spread of the COVID-19 pandemic. This led to many challenges in the provision of rehabilitation services to people with disabilities. Consequently, there was a transition to the telematic provision of healthcare as an adaptive approach to the constraints posed by the pandemic. In the visual rehabilitation field, the lack of international guidelines for telematic rehabilitation led to pioneering interventions, which were challenged by difficulties in the use of technological devices by visually impaired individuals. The purpose of this chapter is to identify the peculiar features that could enable the provision of visual telerehabilitation during the pandemic by analyzing the procedures followed in the implementation of a visual telerehabilitation protocol in Italy and the outcomes thereof.
TopIntroduction
An international report on visual impairment prevalence (Bourne et al., 2020) shows that in 2020 49.1 million people all over the world were blind, 33.6 million people presented a severe visual impairment (VI), and 221.4 million people presented a moderate visual (VI) impairment. The prevalence of blind people increased by 42.8% from 1990 (34.4 million) to 2020 (49.1 million) (Bourne et al., 2020). Globally, the main causes for blindness and visual impairment are cataract, uncorrected refractive error, glaucoma, age-related macular degeneration, corneal opacity, trachoma, diabetic retinopathy (Ackland et al., 2017). Specifically, among the worldwide population, a significant increase in blindness percentage has risen between 2015 and 2020: 38.5 million individuals have acquired blindness from a previous cataract (from 13 million to 70 million), 13 million from uncorrected refractive error (2 million to 16 million), and 3 million from glaucoma (4 million to 11 million) (Flaxman et al., 2017).
In this field, rehabilitation protocols are addressed at preventing patients’ vision loss and at supporting their autonomy and psychosocial wellbeing (Bittner et al., 2020). The spectrum of visual rehabilitation includes protocols to strengthening individual adaptive synaptic responses in terms of cortical plasticity (Karmarkar & Dan, 2006; Trauzettel-Klosinski, 2011) through training visual attention (Pilz et al., 2006), compensatory eye movements (White & Bedell, 1990), and eccentric fixation (Nilsson et al., 2003). Visual rehabilitation is a powerful tool to advocate for people with visual impairment social inclusion and autonomy (Shadrick, 2020), even during the Covid-19 pandemic and related socio-behavioral restrictions.
From March 2020, the healthcare system was globally challenged by the Covid-19 crisis to continue to provide rehabilitation for individuals with disabilities, notwithstanding lockdown and restrictive measures (Martinez et al., 2020). Professionals from many different rehabilitation areas and across different diagnoses needed to adapt their rehabilitation protocols to the telematic environment (Das & Christy, 2021; Salgueiro et al. 2021; Varela-Aldás et al., 2021). In the visual rehabilitation field, this was particularly challenging given the lack of international guidelines and the difficulties in the use of technology and digital devices by visually impaired or blind individuals (Murphy et al., 2008; Saltes, 2018; Senjam et al., 2021).
In that context, healthcare needed to find strategies to be resilient. Resilience is the capacity to bend without breaking, but also to gain hints for enrichment and growth from distressing events. In this sense, the chapter is focused on telemedicine and telehealth as tools to avoid breaking rehabilitation patterns. Firstly, it is targeted at understanding which peculiar features could enable the healthcare system to conduct visual telerehabilitation resiliently and successfully during the pandemic by analyzing the procedure and the outcomes of an Italian implementation experience. The chapter illustrates the procedure proposed for the visual telerehabilitation protocol developed during the first lockdown in Italy. During the first wave of the Covid-19 pandemic, Italian healthcare was not prepared to face the emergency and telematic rehabilitation of visually impaired people passed from being an utopistic project to be a necessary daily resource. The chapter offers a dual perspective on the intervention through two main methodologies: a quantitative and empirical study and a qualitative investigation. The chapter presents an empirical investigation to explore the protocol’s successful outcomes among visually impaired children and adults, bringing knowledge about the application of ICTs in the telematic rehabilitation of visually impaired individuals. Subsequently, the chapter offers a qualitative perspective from orthoptists’ point of view of the experience of visual telerehabilitation during the Covid-19 lockdown months in Italy (i.e., from March to May 2020).
Key Terms in this Chapter
Activities of Daily Living (ADLs): Activities of daily living are all the activities performed by individuals to take care of themselves and adapt to the environment. This label encompasses Basic ADLs and Instrumental ADLs. Basic ADLs include ambulating, dressing, feeding, personal hygiene, toileting, continence. Instrumental ADLs require more complex skills to interact with the environment: transportation and shopping, meal preparation, house cleaning, managing communication, managing finances, managing medications.
Speech Synthesizers: Speech synthesizers are computerized tools that elaborate textual inputs and translate them in audible language outputs. These devices use a text-to-speech system (TTS) and symbolic-linguistic transcriptions to elaborate and convert inputs into outputs.
Video Magnifier: Video magnifier is an electronic device provided with a camera and display screen (LCD or CRT). The camera captures the printed stimuli (e.g., a book page) and the display allows to enlarge them. It can include a lamp to lighten the material that has to be magnified.
Assistive Technology (AT): Assistive or adaptive or rehabilitative technologies are devices and tools for elderly individuals or individuals with a disability, that help them to perform ADLs. Screen readers, braille pads, video magnifiers, tactile keyboards, wearable technologies, are examples of AT applications.
Orthoptist: Orthoptists are experts in the diagnosis and treatment of visual impairments. Orthoptists work with a various range of diagnoses and conditions as they are trained in procedures to correct visual deficits and help patients using their residual vision as best as possible.
Residual Vision: Residual vision is a subjective parameter measuring the remaining ability of the patient to see. It is quantified by perimetry testing.
Visual Impairment (VI): Visual impairment is the term used to describe total or partial vision loss. The entity of the deficit is not fixable by using glasses. A visual impairment becomes legal blindness when a person’s better eye—under the use of corrective lens—has 20/200 or lower central visual acuity and 20 degrees or lower field of vision.
Rehabilitation: Rehabilitation is a set of actions aimed at reducing psychophysical deficits, optimizing residual functioning, simplifying daily life, and the adaptation to the environment. It is tailored to individuals with congenital or acquired disability, or on individuals who underwent injury, surgery, illness, or on elderly people whose functioning declines with age.
Telerehabilitation: Telerehabilitation or e-rehabilitation is the process of delivering rehabilitation through the use of telecommunications and the Internet. This method consents healthcare providers to remotely assist and train the patients. Telerehabilitation is commonly used in occupational therapy, psychology, audiology, speech-language rehabilitation, physical therapy. It includes sessions of exercises structured towards a goal. Video-calling applications, phone-calling, webcams, screen sharing make remote rehabilitation possible. However, the range of activities to practice in remote is more limited than the one professional in-person. Combined modalities (i.e., in-person and telematic therapy) are often used in the healthcare field.
Optical Character Recognition (OCR): The terms optical character recognition or optical character reader (OCR) indicate electronic devices aimed at the mechanical conversion of images input (e.g., presenting printed or handwritten text) in the machined encoded text. The image inputs are scanned or photographed.