Joshua Robinson, OD, FAAO, director of Low Vision Rehabilitation at the Vanderbilt Eye Institute (VEI), put it succinctly when he said, “This is a big deal.” “Even I probably don’t understand right now how big of a deal it could end up being. It’s potentially a game changer,” he said.
The “this” Dr. Robinson is talking about is a pilot program developed and implemented by Salus University's Blindness and Low Vision Studies (BLVS) department in partnership with Vanderbilt University Medical Center in Nashville, Tennessee, specifically for Vanderbilt’s on-staff Physical Therapists (PTs), that provided Orientation and Mobility (O&M) skills-based training PTs could offer their patients.
“Unfortunately, there is frequently a dearth in the number of O&M instructors available, so people would wait long times to have their immediate needs met,” said Jamie Maffit, MS, COMS, CLVT, director of Salus University’s O&M program. “So the idea was to provide skills-based training on selected indoor O&M skills for the physical therapists who are often the first rehabilitation professional to meet with the person post-low vision exam and have them provide those first-line basic level skills. And, then refer for further O&M if needed.”
She added that for some patients, PTs might be able to provide all of the skills necessary, making the wait to see an O&M specialist unnecessary.
The idea to teach PTs to offer basic O&M instruction to patients was the brainchild of Carlene Lebous, a retired CEO and founder of vision rehabilitation facilities and former O&M specialist. Through her experience in both the rehabilitation and healthcare areas, she realized there was a tremendous gap between healthcare providers and the awareness of and referrals for vision rehabilitation services. This was primarily because many of these specialists have trained in the colleges of education, not allied health, and have not been recognized as a part of the healthcare reimbursement system.
“My vision a number of years ago was to look at how we could bridge this gap so that people with vision loss do not fall between the cracks. It’s been something that has been a part of my life for decades,” said Lebous. She is a member of the VEI advisory board, where she met Dr. Robinson, who had been brought in to expand low vision services. With Dr. Robinson’s knowledge base and Lebous’ engagement on the advisory board, the two began talking about how to expand O&M services.
Lebous began reaching out to a number of people in the low vision and blindness field and connected with VisionServe Alliance, an organization of CEOs of major vision rehabilitation facilities across the country. It was VisionServe Alliance members who suggested Lebous contact Salus, where she approached Fabiana Perla, EdD, COMS, CLVR, chair of the University’s BLVS department, and Maffit to collaborate in the development of this described pilot project.
“Salus is a very innovative and creative university when it comes to looking at new approaches to providing services. Fabiana and Jamie were more than receptive to continuing the conversation,” said Lebous. “We then engaged Salus along with Vanderbilt and began discussing how could we develop a pilot project that would truly have an impact on expanding and building the quality of services provided for people with low vision and severe vision loss.”
It took about a year for the program to come to fruition. The eight-week course started in August 2021 and combined online and in person instruction. Dr. Perla and Maffit traveled to Nashville to provide two days of hands-on training to seven Vanderbilt PTs, who received a micro-credential, a certificate and PT continuing education credits for their participation. Another key component to the success of the project was the support of Salus’ Department of International and Continuing Education (DICE).
Part of the unique partnership was that Salus worked directly with Dr. Robinson at the VEI — whose entire patient base consists of people with permanent vision impairment — and was able to design the program with his referrals in mind.
“It’s well understood in this field, and in the field of rehabilitation and vision impairment in general, that there is a shortage of certified orientation and mobility specialists to whom I can refer,” said Dr. Robinson. “So, when I have a patient who needs these services, it’s often limited by the manpower out there providing the services and in some instances the out-of-pocket costs associated. There is such a low supply and high demand and it’s hard to get the patients what they need in a timely manner.”
PT and Occupational Therapy are disciplines Dr. Robinson heavily uses in his referral patterns to help his patients.
“Home health PT seems like a natural bridge because of the work that they’re already doing when they go into a patient’s home and are assessing ambulation and thresholds and safety in general,” he said. “It seemed like a smooth connection to also add basic introductory mobility skills training into PT.”
Some of the Vanderbilt PTs who participated had never heard of blindness and low vision rehabilitation services. That included Alessandra Cannon, who works for Vanderbilt Home Care Services and has been a physical therapist for 30 years. “O&M is a whole field that I never knew when I was in college,” she said mainly because it is a specialty not covered by insurance.
Cannon said she had a personal reason for wanting to participate in the program. Her mother has macular degeneration — an eye disease that causes loss in the center of the field of vision — and it’s hereditary in her family.
“If the possibility exists that I’m going to lose my sight, I would be interested in learning more about O&M,” she said. “What O&M does is keep you as independent as possible and you’re not in a position of being helpless. Having those services can make you more independent and feel good about yourself. It’s wonderful to have those services available and we have been referring our patients to some of the rehab specialists in the area.”
Cannon was also particularly impressed with the hands-on training from the Salus contingent. “It was essential to have the hands-on training. You have to learn the proper techniques and practice them,” she said. “There are some things that might be in a book and you can read them, but you have to see it and practice it. This is now a tool for us to use with our patients.”
Since this program was the first of its kind and the results were so positive, Lebous said Vanderbilt will continue to evaluate the referral base from Dr. Robinson to the PTs in order to continue to validate the importance of the project. In turn, she believes the next step will be to look for other sites where the program can be instituted, an initiative that she hopes will continue to include Salus and Vanderbilt. “I have been so impressed with the collaboration. Salus stepped up to the plate to create an innovative program," she said. She also hopes the pilot project and collaboration is just the first step to expanding limited O&M services nationwide to individuals experiencing low vision and blindness.
“What I observed as a former O&M specialist during the hands-on training was qualified, seasoned physical therapists that had been working with individuals with vision loss for a number of years, but who realized how much this training allowed them to be more effective with these patients,” said Lebous. “It truly opened a door for them to be able to provide better services to more individuals in need.”
