Orthoptic Home Visits for Stroke Survivors: Results from a UK Professional Practice Survey.

AimOrthoptists are perhaps the only allied health profession without a standard home visits service in the UK, although it could arguably be of benefit to many orthoptic patients. The aim of this survey was to identify whether home visits are being offered, or have the potential to be offered, within the orthoptic profession.MethodA survey of the orthoptic professional body (BIOS) for the UK and Ireland was developed and data collected between January and March 2016. Descriptive analysis was used to report the quantitative findings. A thematic analysis approach was undertaken for the written responses within the free-text boxes of the survey.Results461 BIOS members responded to the survey (response rate of 30.7%). Ten hospital sites (3.7%) reported offering home visits, and 444 members (96.3%) reported that they do not offer home visits, with little desire or perceived need for such a service. Only certain patients reportedly meet requirements for an orthoptic home visit, including those unable to attend the hospital due to poor health, transport issues, reduced cognition, stroke and learning difficulties. Implementation barriers were reported including staff safety, assessment quality and cost.ConclusionHome visits are infrequently conducted within the orthoptic profession. However, where offered, certain patient groups were suggested to benefit from this service when they cannot attend hospital and thus, home visits could present a viable means of providing equitable visual care. Future research is required to explore orthoptic home visits compared to other forms of rehabilitation, and address concerns from the orthoptic professional body

A conceptual framework for circular design

Design has been recognised in the literature as a catalyst to move away from the traditional model of take-make-dispose to achieve a more restorative, regenerative and circular economy. As such, for a circular economy to thrive, products need to be designed for closed loops, as well as be adapted to generate revenues. This should not only be at the point of purchase, but also during use, and be supported by low-cost return chains and reprocessing structures, as well as effective policy and regulation. To date, most academic and grey literature on the circular economy has focused primarily on the development of new business models, with some of the latter studies addressing design strategies for a circular economy, specifically in the area of resource cycles and design for product life extension. However, these studies primarily consider a limited spectrum of the technical and biological cycles where materials are recovered and restored and nutrients (e.g., materials, energy, water) are regenerated. This provides little guidance or clarity for designers wishing to design for new circular business models in practice. As such, this paper aims to address this gap by systematically analysing previous literature on Design for Sustainability (DfX) (e.g., design for resource conservation, design for slowing resource loops and whole systems design) and links these approaches to the current literature on circular business models. A conceptual framework is developed for circular economy design strategies. From this conceptual framework, recommendations are made to enable designers to fully consider the holistic implications for design within a circular economy

Vergence Neural Pathways: A Systematic Narrative Literature Review.

Research in the neural pathway for vergence is less understood in comparison to the other four visual eye movements. The aim of this study was to review the literature on vergence neural pathways and associated disorders. A review of previous published literature though to March 2016 was conducted. Intracranial pathologies that affect entire neural functioning were found to cause convergence insufficiencies. In contrast, pathologies with a more localised intracranial lesion cause more specific vergence disorders. There is debate as to the potential presence of a "divergence centre." Detailed information on the divergence pathway is lacking and warrants further research

Measurement of fusional vergence: protocol for a systematic review

Introduction - No validated protocol exists for the measurement of the prism fusion ranges. Many studies report on how fusional vergence ranges can be measured using different techniques (rotary prism, prism bar, loose prisms and synoptophore) and stimuli, leading to different ranges being reported in the literature. Repeatability of the different methods available and the equivalence between them it is also important. In addition, some studies available do not agree in what order fusional vergence should be measured to provide the essential information on which to base clinical judgements on compensation of deviations. When performing fusional vergence testing the most commonly accepted clinical technique is to first measure negative fusional vergence followed by a measurement of positive fusional vergence to avoid affecting the value of vergence recovery because of excessive stimulation of convergence. Von Noorden recommend using vertical fusion amplitudes in between horizontal amplitudes (base-out, base-up, base-in, and base down) to prevent vergence adaptation. Others place the base of the prism in the direction opposite to that used to measure the deviation to increase the vergence demand. Objectives - The purpose of this review is to assess and compare the accuracy of tests for measurement of fusional vergence. Secondary objectives are to investigate sources of heterogeneity of diagnostic accuracy including: age; variation in method of assessment; study design; study size; type of strabismus (convergent, divergent, vertical, cycle); severity of strabismus (constant/intermittent/latent)

Self-Management of Chronic Fatigue Syndrome in Adolescents

Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a condition of unknown aetiology that commonly follows an infection. There are no known predictors for recovery or established treatments. At the Royal Children’s Hospital (RCH) in Melbourne, Australia, the majority of young people with CFS are provided with symptom management and lifestyle guidance in an outpatient setting. However, for some, educational or social issues preclude progress and for those who request this assistance, since 2012, the Victorian Paediatric Rehabilitation Service has offered an Intensive Self-Management Program. For this program, participants engage in both group and individual sessions, attending 3 days per week for 4 weeks in small groups of 3–4. Interdisciplinary input is from Occupational Therapy, Physiotherapy, Education and Psychology to assist with goal setting and strategies. Outcome measures are obtained at initial assessment, 6 weeks and 6 months post-program. Support is offered for 12 months post-program. For both the outpatient program and the intensive program the outcomes and feedback from patient and family has influenced the approach and focus. This chapter outlines the current approach and how it has evolved over time