Re-establishing reading skills of elderly low vision patients : : studies on Swedish low vision clinic clients

Abstract: This thesis is based on the project "Reading skills, reading training and technology for the visually handicapped - Prospects for the 1990s," carried out at the Department of Educational Research of the Stockholm Institute of Education 1988-1993. All data were collected in connection with this project. Quantitative and qualitative methods and objective and subjective measures were used. The overall aim of the thesis is to evaluate short- and long-term outcomes of reading rehabilitation of elderly low vision patients, as reflected in the practice of low vision clinics. Other aims are to introduce a Three-stage model for training reading skills at different levels, to find possible interactions of cognitive capacity, age and visual deficits with influence on restoring reading ability, to evaluate the impact of low vision reading rehabilitation on life satisfaction, and to describe the outcome of intensive and extended reading training. The theoretical framework for the thesis is an interactive model of the reading process. Visual acuity was the strongest determinant of reading achievements with optical devices. Visual acuity was also a good predictor of outcome as measured by the reading performance index. A polarization of reading proficiency was found over a three-year period. Patients using optical devices as their reading media had decreased, but patients who adhered to optical devices had further improved their reading skills. Changes in visual ability did not explain the alterations. Other factors, especially aging and its consequences, were more influential. Results supported the theory of other researchers that predictors of successful outcome of low vision reading rehabilitation are to be found in interactive effects of cognitive capacity and visual deficits. Low vision clinics measured outcomes mainly at the sensory level which is not enough. Low vision affected elderly patients differently compared to other ages. The more the visual/reading ability was reduced, the greater the risk for patients to become passive. Patients with the best reading skills were found to be the most active media consumers. Restored reading ability was a clear contributor to an independent life and a promoter of retained or improved quality of life. The overall conclusion is that prescription of optical reading devices must always be accompanied by a strong educational support, i.e. low vision reading training, specifically for elderly patients with the most reduced visual ability. Training with clear objectives related to the patients' interests and high motivation are indicators of a positive outcome. Attention should be paid to patients' cognitive capacity and comprehension training. Low reading rates are not an obstacle for patients' appreciation of the training. Criteria of acceptable results should be set differently for different categories of patients. A limited and modest progress could make the difference between dependence/dissatisfaction and independence/satisfaction. A high prioritized area for future research should be studies on measuring short- and long-term outcomes in order to define reliable predictors of successful low vision (reading) rehabilitation.