Feasibility of telerehabilitation to address the orientation and mobility needs of individuals with visual impairment: perspectives of current guide dog users.

OBJECTIVE: To assess guide dog users' perspectives on the feasibility of telerehabilitation for their O&M needs. METHOD: An online survey gathered insights from 56 guide dog (GD) users (Mean age = 59, Mean GD used = 4, Mean duration of use = 22 years). Thirteen GD users further participated in interviews or focus groups to explore survey responses. Data were analyzed using content analysis. FINDINGS: Most (40) were blind, and 16 had low vision, with intermediate (25) and advanced (25) communication technology proficiency. Most GD users (46) underwent residential training, and 10 received one-on-one visits. Qualitative analysis revealed acceptance of telerehabilitation services, citing accessibility as an advantage. However, GD users expressed concerns about safety, potential loss of behavioral observation, and social contact loss. Success depended on the type of technology, service type, and personal attributes. CONCLUSION: While feasible, telerehabilitation services may not be universally suitable for all training stages. Flexibility and applicability in service design are necessary to accommodate individual preferences and experience levels.

Telerehabilitation of Orientation & Mobility (O&M) services for individuals that are blind or have low vision potentially offers a hybrid service delivery mode, reducing wait time and travel costs.A remote O&M service offer could allow rehabilitation professionals to provide services across borders, to rural and remote regions, and reach a broader client base.Rehabilitation professionals should collaborate with technology companies to improve remote rehabilitation service delivery and address clients' concerns.Rehabilitation professionals should ensure that their approach to utilizing this telerehabilitation services is flexible and patient-centered, accommodating the client's need for in-person services.

Are rehabilitation professionals familiar with visual impairments? A survey of professional orders in Quebec, Canada.

SIGNIFICANCE: The number of patients with mild to moderate visual impairments (MVIs) is increasing as the average age of the population increases. Thus, it is important to understand the training and resources available for rehabilitation practitioners to provide adequate care to these patients within their scope of practice. PURPOSE: This study explores rehabilitation professionals' perceptions of their competence in screening and treating patients with MVI, and identifying the tools and resources needed to increase these professionals' comfort level in managing these patients. METHODS: Data collection was carried via an online questionnaire to Quebec rehabilitation professionals and student-trainees who are members of their respective professional orders. The questionnaire consisted of 29 to 30 questions (open- and close-ended) related to demographics, service provision to MVI patients, education in MVI and future training, and future service delivery to MVI patients. RESULTS: Data were collected from 96 professionals, with 52 fully completing the questionnaire, with all the responses included in the analysis. Most respondents had little or no confidence in adequately screening or treating patients with MVI and mentioned that they knew little or nothing about the range of services offered by vision rehabilitation centers in Quebec (81%), whereas 55% at least occasionally offer services to these patients. The majority felt that their profession would benefit from continuing education on MVI (73%), with a marked interest in online training. CONCLUSIONS: Rehabilitation professionals in Quebec are not confident in identifying or treating patients presenting MVI but express an interest in attending continuing education courses given by optometrists, low vision professionals, or a member of their own profession. Numerous barriers account for this problem, including a lack of experience and competence in the assessment and treatment options for MVI, as well as a lack of informational and human resources available in their workplaces.

The roles of ionotropic glutamate receptors along the On and Off signaling pathways in the light-adapted mouse retina.

Although the locations of glutamate receptors along the On and Off pathways have been determined, how these receptors modulate the retinal outputs--the light-evoked and spontaneous activities of individual ganglion cells--is not fully understood in the mouse retina. Specifically, how these receptors mediate On and Off responses of retinal ganglion cells in mouse retina under light adaptation remains unknown. Since mouse retina has become a powerful model for vision research, the functions of glutamate receptors along the On and Off pathways in mouse need to be determined. In the current study, the light-evoked and spontaneous excitatory postsynaptic currents (light-evoked EPSCs and sEPSCs) from On, Off and On-Off retinal ganglion cells (RGCs) were recorded using whole-cell patch-clamp recordings to assess how NMDA and AMPA/KA receptors modulate the retinal outputs of RGCs in the light-adapted mouse retina. We found NMDA and AMPA/KA played different roles in light-evoked EPSCs along On and Off pathways in light-adapted mice retinas. Both NMDA receptor antagonist DL-2-amino-5-phosphonopentanoic acid (AP-5) and AMPA/KA receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) acted on RGCs to reduce On responses of ganglion cells while they acted on Off-cone bipolar cells and/or ganglion cells to mediate Off responses of RGCs. Co-application of AP-5 and CNQX completely eliminated the Off responses in majority of RGCs, indicating that both NMDA and AMPA/KA receptors are critical for light signaling along the cone-driven Off pathways in the light-adapted mouse retina.

Inhibition of nitric oxide synthase desensitizes retinal ganglion cells to light by diminishing their excitatory synaptic currents under light adaptation.

The effect of inhibiting nitric oxide synthase (NOS) on the visual responses of mouse retinal ganglion cells (RGCs) was studied under light adaptation by using patch-clamp recordings. The results demonstrated that NOS inhibitor, l-NAME, reduced the sensitivity of RGCs to light under light adaptation at different ambient light conditions. These observations were seen in all cells that recordings were made from. l-NAME diminished the excitatory synaptic currents (EPSCs), rather than increasing the inhibitory synaptic currents, of RGCs to reduce the sensitivity of RGCs to light. Cones may be the sites that l-NAME acted to diminish the EPSCs of RGCs.

Differential effects of charybdotoxin on the activity of retinal ganglion cells in the dark- and light-adapted mouse retina.

Patch-clamp recordings were made from retinal ganglion cells in the mouse retina. Under dark adaptation, blockage of BK(Ca) channels increases the spontaneous excitatory postsynaptic currents (EPSCs) and light-evoked On-EPSCs, while it decreases the light-evoked Off inhibitory postsynaptic currents (IPSCs). However, under light adaptation it decreases the light-evoked On-EPSCs, the spontaneous IPSCs and the light-evoked On- and Off-IPSCs. Blockage of BK(Ca) channels significantly altered the outputs of RGCs by changing their light-evoked responses into a bursting pattern and increasing the light-evoked depolarization of the membrane potentials, while it did not significantly change the peak firing rates of light-evoked responses.

The sensitivity of light-evoked responses of retinal ganglion cells is decreased in nitric oxide synthase gene knockout mice.

We have shown previously that increasing the production of nitric oxide (NO) results in a dampening of visual responses of retinal ganglion cells (G. Y. Wang, L. C. Liets, & L. M. Chalupa, 2003). To gain further insights into the role of NO in retinal function, we made whole-cell patch clamp recordings from ganglion cells of neural type nitric oxide synthase (nNOS) gene knockout mice. Here we show that in the dark-adapted state, the sensitivity of retinal ganglion cell to light stimulation is decreased in nNOS knockout animals. The lowest light intensities required to evoke optimal responses and the average intensities that evoked half-maximal responses were significantly higher in nNOS knockouts than in normal mice. Retinal histology and other features of light-evoked responses of ganglion cells in nNOS mice appeared to be indistinguishable from those of normal mice. Collectively, these results, in conjunction with our previous work, provide evidence that increasing levels of NO dampen visual responses of ganglion cells, while a lack of nNOS decreases the sensitivity of these neurons to light. Thus, NO levels in the retina are capable of modulating the information that ganglion cells convey to the visual centers of the brain.