第五章功能性視力和助視器的訓(xùn)練及使用ChapterFiveFunctionalVisionandT

第五章功能性視力和助視器的訓(xùn)練及使用ChapterFive

FunctionalVisionandTrainingfortheUseofVisionAids一、功能性視力的定義I.

DefinitionofFunctionalVision為了有目的的行為而去使用的視力Visionusedforpurposefulbehavior低視力康復(fù)是為了使視覺(jué)損害的影響降至最小Rehabilitationforlowvisionaimstominimizetheimpactofvisualimpairment,enablingpatientstobetterandmoreeffectivelyusetheirresidualvision.第一節(jié)功能性視力SectionOneFunctionalVision二、功能性視力的模式II.

ModelofFunctionalVision功能性視力是一個(gè)有靈活性的三維結(jié)構(gòu)Functionalvisionisaflexiblethree-dimensionalstructurecomprisingvisualcapabilities視覺(jué)能力VisualCapabilities個(gè)體可利用的儲(chǔ)備IndividualAvailableReserves環(huán)境線(xiàn)索EnvironmentalClues第一節(jié)功能性視力SectionOneFunctionalVision三、功能性視力訓(xùn)練的目的和意義III.

PurposeandSignificanceofFunctionalVisionTraining（1）提供各種看的機(jī)會(huì)，鼓勵(lì)低視力患者更好地使用視力。（1）Toprovidevariousopportunitiesforvisualengagement,encouraginglowvisionpatientstomakebetteruseoftheirvision（2）幫助低視力患者掌握視覺(jué)技巧，學(xué)會(huì)視覺(jué)操作，提高患者利用自身殘余視力的能力。（2）Toassistlowvisionpatientsinmasteringvisualtechniques,learningvisualoperations,andenhancingtheirabilitytoutilizetheirresidualvision.眼病類(lèi)別與視覺(jué)損害時(shí)間的不同，形成低視力患者對(duì)視覺(jué)技巧的掌握人皆不同，而患者的年齡、文化層次及職業(yè)的不同，也使他們對(duì)視力的需求不盡相同。Differenteyeconditionsanddurationsofvisualimpairmentformationamonglowvisionpatientsresultinvaryingdegreesofmasteryofvisualtechniques.Moreover,differencesinage,culturalbackgrounds,andprofessionsamongpatientsleadtodiversedemandsfortheirvision.第一節(jié)功能性視力SectionOneFunctionalVision認(rèn)識(shí)和注視訓(xùn)練RecognitionandFixationTraining視覺(jué)辨認(rèn)訓(xùn)練VisualRecognitionTraining視覺(jué)追蹤訓(xùn)練VisualTrackingTraining視覺(jué)搜尋訓(xùn)練VisualSearchTraining01030204功能性視力訓(xùn)練的基本內(nèi)容BasicContentsofFunctionalVisionTraining05視覺(jué)記憶訓(xùn)練VisualMemoryTraining第一節(jié)功能性視力SectionOneFunctionalVisionAC

個(gè)性化訓(xùn)練PersonalizedTraining適合患者實(shí)際的訓(xùn)練材料AppropriateTrainingMaterials啟發(fā)誘導(dǎo)式的訓(xùn)練Induction-BasedTrainingB訓(xùn)練的組織與指導(dǎo)OrganizationandGuidanceofTraining第一節(jié)功能性視力SectionOneFunctionalVision第二節(jié)

助視器的訓(xùn)練和使用SectionTwoTrainingandUseofVisualAids一、遠(yuǎn)用助視器的訓(xùn)練I.TrainingforFarVisualAids首先應(yīng)該熟悉以下基本情況Itisimportanttobefamiliarwiththefollowingkeyaspects①在訓(xùn)練開(kāi)始前，應(yīng)知道低視力患者視功能情況①Beforecommencingthetraining,theinstructorshouldbeawareofthelowvisionpatient'soculardiagnosis,visualacuity,fieldofvision,contrastsensitivity,andotheraspectsofvisualfunction.②應(yīng)該了解助視器的特殊功能、優(yōu)缺點(diǎn)及光學(xué)原理等②Instructorsshouldhaveknowledgeaboutthespecificfeatures,advantages,disadvantages,andopticalprinciplesofvisualaids.③知道低視力患者使用助視器要達(dá)到的主要目的與要求③Understandtheprimarypurposesandrequirementsforwhichlowvisionpatientsareusingvisualaids.④訓(xùn)練的原則是先簡(jiǎn)單后復(fù)雜，訓(xùn)練的目標(biāo)應(yīng)該是先靜止后活動(dòng)。④Thetrainingprincipleinvolvesstartingwithsimplertasksandprogressingtomorecomplexones.Thetrainingobjectivesshouldshiftfromstatictodynamictasks.⑤低視力患者可能需要放大倍數(shù)較大的助視器，但在開(kāi)始訓(xùn)練時(shí)應(yīng)該用低倍助視器，訓(xùn)練用的目標(biāo)也應(yīng)該大一些⑤Whilelowvisionpatientsmayrequirevisualaidswithhighermagnification,it'srecommendedtostartthetrainingwithlowermagnificationaidsandlargertargets,⑥在訓(xùn)練初期，時(shí)間要短一些⑥D(zhuǎn)uringtheinitialstagesoftraining,keepthedurationshorter(一)訓(xùn)練前準(zhǔn)備及訓(xùn)練中注意事項(xiàng)(Ⅰ）PreparationbeforeTrainingandConsiderationsduringTraining作為訓(xùn)練的房間應(yīng)該安靜、簡(jiǎn)單、整潔，可以利用人工或自然照明Thetrainingroomshouldbequiet,simple,andneat,witheitherartificialornaturallightingavailable.指導(dǎo)者進(jìn)行訓(xùn)練時(shí)遵循一個(gè)合理的順序It'scrucialfortheinstructortofollowalogicalsequenceduringtraining.門(mén)診或康復(fù)點(diǎn)進(jìn)行訓(xùn)練時(shí)，低視力患者使用某種助視器感到不滿(mǎn)意，可以隨時(shí)更換其他助視器Whentrainingisconductedinclinicsorrehabilitationcenters,ifalowvisionpatientisunsatisfiedwithaparticularvisualaid,theycanchangetoanotheraidatanytime.第二節(jié)

助視器的訓(xùn)練和使用SectionTwoTrainingandUseofVisualAids(二)訓(xùn)練方法(Ⅱ）TrainingMethods

目標(biāo)定位訓(xùn)練

Targetlocalizationtraining:

注視訓(xùn)練

Fixationtraining

定位注視聯(lián)合訓(xùn)練

Combinedpositioningandfixationtraining

跟蹤訓(xùn)練

Trackingtraining:

追蹤訓(xùn)練

Pursuittraining

搜尋訓(xùn)練

Searchtraining

實(shí)地訓(xùn)練

Practicaltraining

圖

患者使用望遠(yuǎn)鏡觀(guān)察的姿勢(shì)Thepictureshowsthepatient'spostureusingatelescope

第二節(jié)

助視器的訓(xùn)練和使用SectionTwoTrainingandUseofVisualAids搜尋練習(xí)圖形Searchingexercises第二節(jié)

助視器的訓(xùn)練和使用SectionTwoTrainingandUseofVisualAids二、近用助視器的訓(xùn)練II.

TrainingforMyopiaAids1.近用助視器的基本原則1.Basicprinciplesfornearvisionaids2.注視2.Fixatio3.定位3.Locating4.搜尋或掃描

4.SearchingorScanning5.追蹤5.Tracking6.視覺(jué)技術(shù)的有效應(yīng)用6.Effectiveapplicationofvisualtechniques7.演示近用助視器的光學(xué)特點(diǎn)7.Demonstratetheopticalcharacteristicsofnearmagnifiers第二節(jié)

助視器的訓(xùn)練和使用SectionTwoTrainingandUseofVisualAidsA.放大鏡和閱讀材料接觸時(shí)，幾乎沒(méi)有放大作用；A.Thereisminimalmagnificationwhenthemagnifierisincontactwithreadingmaterial第二節(jié)

助視器的訓(xùn)練和使用SectionTwoTrainingandUseofVisualAidsB.放大鏡置于恰當(dāng)?shù)奈恢?，可獲得理想的放大作用。B.Anidealmagnificationisachievedwhenthemagnifierispositionedcorrectly.三、閉路電視助視器的訓(xùn)練III.Closed-CircuitTelevision(CCTV)AidsTraining1.使用CCTV的閱讀距離1.ReadingdistancewithCCTVPatients2.讓患者熟悉儀器2.Familiarizepatientswiththedevice3.了解水平-垂直軸(X-Y軸)閱讀平臺(tái)的運(yùn)動(dòng)范圍3.Understandtherangeofmovementforthehorizontal-verticalaxis(X-Yaxis)readingplatform4.對(duì)于比較厚的書(shū)本壓平

以便于攝像頭的清晰對(duì)焦4.Forthickerbooks,flattenthebookandfacilitateclearfocusingbythecamera.5.低放大率狀態(tài)下瀏覽整個(gè)閱讀物，然后在高放大率的狀態(tài)下閱讀你所感興趣的段落

5.Browsetheentirereadingmaterialinlowmagnification,thenfocusonspecificparagraphsofinterestinhighermagnification.6.養(yǎng)成借助顯示屏看著自己的手和筆的習(xí)慣6.Developthehabitofwatchingtheirhandandpenonthedisplayscreen第二節(jié)

助視器的訓(xùn)練和使用SectionTwoTrainingandUseofVisualAids四、改善視野的助視器的訓(xùn)練IV.

ImprovingPeripheralVisionwithAidsTraining在臨床低視力康復(fù)中改善周邊視野的助視器處方開(kāi)得很少I(mǎi)nclinicallowvisionrehabilitation,prescriptionsforimprovingperipheralvisionassistivedevicesarelimited對(duì)于倒置的望遠(yuǎn)鏡，患者主要是用它們來(lái)幫助進(jìn)行定位Inthecaseofinvertedtelescopes,patientsprimarilyusethemfororientationassistance.擴(kuò)大視野的另一種方法是通過(guò)三棱鏡來(lái)看物體，指導(dǎo)患者通過(guò)棱鏡來(lái)觀(guān)察物體Anothermethodforexpandingthefieldofviewinvolvesusingprismstoobserveobjects.Guidethepatienttoobserveobjectsthroughtheprism.通過(guò)三棱鏡成像的清晰度將下降Imageclaritydecreasesthroughtheprism:棱鏡移位Prismdisplacement:第二節(jié)

助視器的訓(xùn)練和使用SectionTwoTrainingandUseofVisualAids第三節(jié)

影響助視器成功使用的因素SectionThreeFactorsInfluencingSuccessfulUseofVisionAids臨床常見(jiàn)的影響低視力助視器能否成功使用的因素：Commonclinicalfactorsaffectingthesuccessfuluseoflowvisionaidsareasfollows:1.視力1.Visualacuity

2.視力低下的持續(xù)時(shí)間2.Durationofvisualimpairment3.動(dòng)機(jī)3.Motivation

4.患者是否容易接受新事物(靈活性)4.Acceptanceofnovelty(flexibility)5.視野5.Fieldofvision

6.病情的穩(wěn)定性

6.Stabilityofconditions7.導(dǎo)致視力損害的病因7.Causesofvisualimpairment

8.色覺(jué)8.Colorvision

9.年齡9.Age

10.對(duì)眼病的了解程度10.Understandingofeyediseases

11.自我形象11.Self-image

實(shí)訓(xùn)

遠(yuǎn)用助視器的使用訓(xùn)練Training

TrainingfortheUseofHypermetropiaVisualAids1.操作前BeforetheOperation(1)用物準(zhǔn)備：各種類(lèi)型遠(yuǎn)用助視器、各種遠(yuǎn)距離視標(biāo)、磨砂鏡片、白板、標(biāo)記筆、視覺(jué)訓(xùn)練圖譜。（1）PreparationofMaterials:Varioustypesofhypermetropiavisualaids,differentdistance

visioncharts,frostedlenses,whiteboard,markerpen,visualtrainingcharts.

（2）檢查者和被檢查者準(zhǔn)備：兩兩一組，分別作為檢查者和受試者，交換進(jìn)行助視器訓(xùn)練，用磨砂鏡

片模擬低視力患者。用望遠(yuǎn)鏡進(jìn)行視覺(jué)訓(xùn)練，練習(xí)定位、注視、調(diào)焦、跟蹤以及追蹤功能，記錄視覺(jué)訓(xùn)練

的要點(diǎn)，體會(huì)如何使用望遠(yuǎn)鏡提高視覺(jué)效率。

（2）Preparationofexaminerandexaminee:Pairedintwos,designatedasexaminerandexaminee,they

switchrolesforvisualaidtraining,simulatinglowvisionusingfrostedlenses.Engageinvisual

training

usingbinoculars,practicingtargeting,focusing,tracking,andtracingfunctions,notingthekeypointsof

visualtraining,understandinghowtousebinocularstoenhancevisualefficiency.

1)指導(dǎo)者先以患者為目標(biāo)，兩者之間距離為2～3m，調(diào)節(jié)焦距，直到看清患者為止。1）Theinstructorfirstbecomesthetargetforthepatient,standing2-3mapart,accommodatethefocallengthuntilthepatientcanclearlyseetheinstructor.

2）將已經(jīng)調(diào)好焦距的望遠(yuǎn)鏡遞給患者，兩人之間相對(duì)位置不變，首先讓患者在不配戴望遠(yuǎn)鏡的情況下看指導(dǎo)者，并保持視線(xiàn)不動(dòng)，緩慢將望遠(yuǎn)鏡放在眼前并清晰地看到指導(dǎo)者。重復(fù)數(shù)次，直到可以熟練定位。2）Thebinoculars,settotheaccommodatedfocallength,arethenhandedtothepatientwithoutalteringtherelativepositions.Initially,thepatientlooksattheinstructorwithoutwearingthebinoculars,keepingthegazesteady,andslowlybringsthebinocularstotheeyestoclearlyseetheinstructor.Repeatthisprocessseveraltimesuntilproficientinlocatingthetarget.

3）注意事項(xiàng)：如果尋找目標(biāo)有困難，可用一紙簡(jiǎn)放在眼前，然后進(jìn)行定位、注視等練習(xí)。因?yàn)榧埻驳目讖奖容^大，易于獲得成功。紙筒訓(xùn)練無(wú)困難以后，再戴望遠(yuǎn)鏡進(jìn)行訓(xùn)練。3）Note:Ifthere’sdifficultyinfindingatarget,apapertubecanbeusedinfrontoftheeyesforpracticeinlocatingandfocusing.Thelargerapertureofthepapertubemakesiteasiertoachievesuccess.Oncecomfortablewiththepapertubeexercises,proceedtotrainingwithbinoculars.

各種訓(xùn)練方法均不滿(mǎn)意時(shí)，應(yīng)使用較大視野的望遠(yuǎn)鏡(比如降低倍率)。Whendissatisfiedwithvarioustrainingmethods,largerfieldofviewbinoculars(e.g.,reducingmagnification)shouldbeused

(1)目標(biāo)定位訓(xùn)練：(1)Targetlocalizationtraining:2.操作步驟2.OperationSteps

(2)目標(biāo)注視及調(diào)焦功能訓(xùn)練：(2)Targetfixationandfocusingfunctiontraining:

1)已做到望遠(yuǎn)鏡下準(zhǔn)確定位。1）Accuratepositioningunderthetelescopehasbeenachieved.

2)若望遠(yuǎn)鏡下目標(biāo)不清晰，可以捏住望遠(yuǎn)鏡鏡筒兩端，左右慢慢旋轉(zhuǎn)鏡筒進(jìn)行調(diào)焦，直到目標(biāo)最清晰為止。2）Ifthetargetisunclearunderthebinoculars,graspbothendsofthebinocularsandslowlyrotatethelensesleftandrightforfocusinguntilthetargetisatitsclearest.

3)注意事項(xiàng)：調(diào)焦一定是建立在可以熟練定位基礎(chǔ)之上的。3）Note:Focusingmustbebuiltuponafoundationofproficienttargetlocalization.

若患者的望遠(yuǎn)鏡通常只在固定距離下使用，比如座位相對(duì)固定的學(xué)生，用望遠(yuǎn)鏡看黑板，則一般調(diào)好焦之后下次就無(wú)需再次調(diào)焦了。Forpatientswhousuallyusebinocularsatfixeddistances,suchasstudentssittinginafixedseatusingbinocularstoviewablackboard,afterfocusingadjustment,theymightnotneedtorefocusforthenextuse.

有些視力障礙患者自幼視力低下，并沒(méi)有清晰像的概念，如果碰到此種情況，需要讓患者明白什么是清晰像或是模糊像，可通過(guò)投影放大的方法讓其有感性認(rèn)識(shí)。Somevisuallyimpairedpatientshavehadlowvisionsincechildhoodandlackaclearconceptofaclearorblurryimage.Insuchcases,it'simportanttohelpthepatientunderstandwhataclearorblurryimageis,whichcanbeachievedbyusingmagnificationprojectionmethodsforasensoryunderstanding.

不能學(xué)會(huì)調(diào)焦者，可以試用非調(diào)焦望遠(yuǎn)鏡。Thoseunabletolearnfocusingtechniquescantryusingnon-focusingbinoculars.

(3)定位注視聯(lián)合訓(xùn)練：(3)Positioningandfixationjointtraining:

1)在不使用望遠(yuǎn)鏡的情況下找到目標(biāo)。1）Findatargetwithoutusingatelescope.

2)保持視線(xiàn)不動(dòng)，緩慢將望遠(yuǎn)鏡放至眼前，使用望遠(yuǎn)鏡尋找目標(biāo)，并鎖定目標(biāo)不動(dòng)。2）Keepyourgazefixed,slowlybringthebinocularsclosetoyoureyes,usethemtolocatethetarget,andlockontothetargetwithoutmoving.

3)對(duì)望遠(yuǎn)鏡進(jìn)行調(diào)焦，直到看清楚目標(biāo)為止。3）Focusthebinocularsuntilthetargetisclearlyvisible.(4)跟蹤訓(xùn)練(靜止目標(biāo))：(4)Trackingtraining(stationarytarget):

1)在黑板上或紙板上畫(huà)一條連續(xù)的短直線(xiàn)，此線(xiàn)全部在患者視野內(nèi)，先不用望遠(yuǎn)鏡看到此線(xiàn)，然后使用望遠(yuǎn)鏡看清此線(xiàn)。1）Drawashortcontinuousstraightlineonablackboardorcardboard,entirelywithinthepatient‘sfieldofview.Initially,withoutusingthebinoculars,

seethisline,andthenusethebinocularstoclearlyviewit.

2)再畫(huà)一條更長(zhǎng)的連續(xù)直線(xiàn)，練習(xí)從線(xiàn)的一端開(kāi)始看，沿著線(xiàn)看下去，直到線(xiàn)的末端，患者控制自己的頭部與望遠(yuǎn)鏡“連在一起”緩慢勻速移

動(dòng)，在運(yùn)動(dòng)過(guò)程中望遠(yuǎn)鏡不能偏離眼部。先不戴望遠(yuǎn)鏡做此訓(xùn)練，然后戴望遠(yuǎn)鏡再做上述訓(xùn)練。2）Next,drawalongercontinuousstraightline.Practicestartingfromoneendoftheline,followingituntiltheotherend,whilecontrollingyourheadto

movesmoothlyandsteadily,keepingit“connected”tothebinocularswithoutdeviation.Dothisexercisewithoutthebinocularsfirst,thenrepeatitwhileusingthem.

3)熟練之后改用虛線(xiàn)，采用同樣的方式繼續(xù)訓(xùn)練。3）Onceproficient,switchtodashedlinesandcontinuetraininginthesamemanner.

4)熟練使用線(xiàn)條圖訓(xùn)練之后可改用幾何圖形，患者從圖的一邊看起，逐漸看完全圖，說(shuō)出圖的形狀。4）Afterbecomingskilledwithlineexercises,progresstogeometricshapes.Startwiththepatientlookingatonesideoftheshape,graduallyprogressingtoviewingtheentireshapeandverballyidentifyingitsform.

5)熟練使用幾何圖形之后改用不規(guī)則圖形，患者從圖的一邊看起，逐漸看完全圖，并說(shuō)出圖的形狀。圖上的每一條線(xiàn)都標(biāo)明號(hào)碼，號(hào)碼字要小些，只有使用望遠(yuǎn)鏡才能看清。線(xiàn)的顏色各不相同。讓患者練習(xí)看清各條顏色的線(xiàn)及其號(hào)碼，說(shuō)明為直線(xiàn)、斜線(xiàn)、實(shí)線(xiàn)或虛線(xiàn)等。5）Onceproficientwithgeometricshapes,transitiontoirregularshapes.Thepatientbeginsbyviewingonesideoftheshape,graduallyprogressingtoviewingtheentireshapeanddescribingitsform.Eachlineontheshapeisnumberedwithsmaller-sizeddigits,visibleonlythroughthebinoculars.Thelinesarealsodifferentcolors.Practiceinvolvesidentifyinganddescribingeachcolor-codedlineanditscorrespondingnumber,distinguishingbetweenstraight,diagonal,solid,ordashedlines.

6)注意事項(xiàng)：訓(xùn)練難度由淺入深，采用短線(xiàn)、長(zhǎng)線(xiàn)條、虛線(xiàn)、規(guī)則圖形、不規(guī)則圖形等逐漸復(fù)雜的圖形進(jìn)行訓(xùn)練。

先固定訓(xùn)練距離，比如在黑板上的各種線(xiàn)或圖形做訓(xùn)練，基本上望遠(yuǎn)鏡調(diào)焦一次即可跟蹤或看清全部圖形。然后用一條彩色帶或繩，放在地板上，旁標(biāo)有號(hào)碼，低視力患者從條帶的一端看起，然后跟蹤此條帶到其末端。這樣就要不斷地定位、注視、調(diào)焦，才能完成上述訓(xùn)練。6）Note:Trainingdifficultyshouldincreasegraduallybystartingwithsimplerformssuchasshortlines,longlines,dashedlines,regularshapes,andthenmovingtoirregularshapes.(5)追蹤訓(xùn)練：跟蹤訓(xùn)練是跟蹤靜止的目標(biāo)，而追蹤練習(xí)是追蹤運(yùn)動(dòng)的目標(biāo)。因此，后者比前者更難一些。可以先在室內(nèi)訓(xùn)練，看指導(dǎo)者手中的目標(biāo)，而目標(biāo)可以做各種運(yùn)動(dòng)。待熟練之后可改為至外訓(xùn)練，比如練習(xí)追蹤一個(gè)玩耍的小孩，騎自行車(chē)者或一個(gè)移動(dòng)的汽車(chē)等。(5)Trackingtraining:Trackingtraininginvolvesfollowingstationarytargets,whereaspursuitexercisesinvolvetrackingmovingtargets.Thelatteristhereforeslightlymorechallengingthantheformer.Initially,thiscanbepracticedindoorsbyobservingatargetheldbyaninstructorthatcanmoveinvariousways.Onceproficient,thisexercisecantransitiontooutdoorsettings,suchastrackingaplayingchild,acyclist,oramovingvehicle.

(6)搜尋訓(xùn)練：是用望遠(yuǎn)鏡搜尋周?chē)h(huán)境中的某一目標(biāo)的練習(xí)方法。(6)Searchtraining:Thismethodinvolvesusingbinocularstosearchforaspecifictargetinthesurroundingenvironment.

1)患者帶上望遠(yuǎn)鏡，面對(duì)黑板，黑板上面一個(gè)搜尋用實(shí)線(xiàn)圖形，在實(shí)線(xiàn)上沿著箭頭方向標(biāo)記不同的號(hào)碼，注意號(hào)碼是無(wú)序排列的。練習(xí)時(shí)，告知患者嘗試沿著箭頭方向，找到某一個(gè)號(hào)碼，重復(fù)訓(xùn)練，直至患者能夠熟練找到號(hào)碼。1)Thepatientwearsbinocularsfacingablackboardwithasolid-linefiguredrawnonit.Alongtheline,differentnumbersaremarkedinarrowdirection,withnumbersplacedinarandomsequence.Duringpractice,instructthepatienttoattempttolocateaspecificnumberalongthearrowdirection,repeatingtheexerciseuntilthepatientcanproficientlyfindthenumber.2)當(dāng)感者能熟練在實(shí)線(xiàn)上搜尋以后，改用和上述實(shí)線(xiàn)圖類(lèi)似的虛線(xiàn)圖，用同樣的方法練習(xí)，待患者能熟練找到目標(biāo)號(hào)碼以后，繼續(xù)加大難度，將虛線(xiàn)的線(xiàn)段變短、線(xiàn)間間隔加長(zhǎng)，最后線(xiàn)條全部消失，僅存留原線(xiàn)旁的號(hào)碼。2)Oncethepatientbecomesproficientinsearchingalongthesolidline,transitiontoadashed-linefiguresimilartothepreviousexercise.Usethesamemethodforpracticeuntilthepatientcanproficientlylocatethetargetnumbers.Graduallyincreasethedifficultybyshorteningthedashes,increasingthegapbetweenthem,eventuallyeliminatingthelinesaltogetherandleavingonlythenumbersbesidetheiroriginallinepositions.

3)當(dāng)患者掌握水平搜尋技術(shù)以后，再練習(xí)垂直搜尋技術(shù)，方法同上。然后再加長(zhǎng)患者與黑板間的距離，線(xiàn)變細(xì)，號(hào)碼變小，照明降低等，繼續(xù)進(jìn)行訓(xùn)練。3)Afterthepatientmastershorizontalsearchtechniques,proceedtoverticalsearchtechniquesusingthesameapproach.Then,increasethedistancebetweenthepatientandtheblackboard,makethelinesthinner,reducethesizeofthenumbers,lowerthelighting,etc.,tocontinuethetraining.4)最后實(shí)地訓(xùn)練，練習(xí)在擁擠的人群中搜尋患者熟悉的人，搜尋十字路口的紅綠燈、街道牌、各種不同的建筑物(如商店、政府辦公機(jī)構(gòu)、影劇院等)，以及天空中的飛鳥(niǎo)等。4)Finally,FieldTraining:Practicesearchingforfamiliarindividualsincrowdedplaces,identifyingtrafficlightsatintersections,streetsigns,variousbuildings(suchasshops,governmentoffices,theaters,etc.),andbirdsinthesky.3.復(fù)習(xí)思考題3.ReviewExercise

(1)在配戴望遠(yuǎn)鏡的基礎(chǔ)上，先對(duì)眼前50cm的目標(biāo)進(jìn)行調(diào)焦，然后對(duì)無(wú)窮遠(yuǎn)的物體進(jìn)行調(diào)焦，為了能看清無(wú)窮遠(yuǎn)的物體，這時(shí)需要如何轉(zhuǎn)動(dòng)望遠(yuǎn)鏡？(鏡筒拉長(zhǎng)還是縮短？)。答案：縮短(1)Withbinocularsworn,focusinitiallyonatarget50cmaway,thenfocusonanobjectatinfinity.Toseedistantobjectsclearly,howshouldyouadjustthebinoculars?(Shouldthebarrelbeextendedorshortened?)

(2)分別在黑板兩端水平對(duì)應(yīng)的位置上隨機(jī)標(biāo)出數(shù)字(在左邊)和字母(在右邊)，每邊各10個(gè)，數(shù)字和字母要小到只能戴放大鏡才能看清的程度，在配戴望遠(yuǎn)鏡的基礎(chǔ)上，運(yùn)用上述的視覺(jué)訓(xùn)練技巧，分別讀出相對(duì)應(yīng)的數(shù)字和字母，并由搭檔記錄漏讀或錯(cuò)讀的數(shù)字或者字母，以及讀完所有字母和數(shù)字所花的時(shí)間，總的錯(cuò)誤數(shù)(包括漏讀、錯(cuò)讀以及其他情況)。(2)Randomlymarknumbers(ontheleft)andletters(ontheright)atcorrespondingpositionsonbothendsofablackboard,with10oneachside.Thesenumbersandlettersshouldbesmallenoughtorequiremagnificationtoreadclearly.Withbinocularsworn,usetheaforementionedvisualtrainingtechniquestoreadthecorrespondingnumbersandletters.Haveapartnerrecordanymisreadoromittednumbersorlettersandthetimetakentoreadallthenumbersandletters,includingtotalerrors(omissions,misreads,andothermistakes).

實(shí)訓(xùn)

近用助視器的使用訓(xùn)練Training

TrainingfortheUseofHypermetropiaVisualAids

1.操作前

1.BeforetheOperation

(1)用物準(zhǔn)備：各種類(lèi)型近用助視器、各種不同字體大小的閱讀材料、漢字兩對(duì)比閱讀視力表、視覺(jué)訓(xùn)練圖譜。(1)Materialsneeded:Varioustypesofnear-visionaids,readingmaterialsindifferentfontsizes,Chinesecharacterreadingacuitycharts,visualtrainingcharts.

(2)檢查者和被檢查者準(zhǔn)備：兩兩一組，分別作為檢查者和受試者，交換行助視器訓(xùn)練，用磨砂鏡片模擬低視力患者。用近用助視器進(jìn)行視覺(jué)訓(xùn)練，練習(xí)定位、注視、調(diào)焦、跟蹤以及追蹤功能，記錄視覺(jué)訓(xùn)練的要點(diǎn)，體會(huì)如何在使用近用助視器情況下提高視覺(jué)效率，測(cè)試使用不同字號(hào)閱讀材料、不同閱讀距離下的閱讀速度。(2)Preparationofexaminerandexaminee:Inpairs,oneactsastheexaminerandtheotherastheexaminee,exchangingrolesforvisionaidtraining,simulatinglowvisionwithfrostedlenses.Conductvisualtrainingusingnear-visionaids,practicinglocalization,fixation,focusing,tracking,andtracingfunctions.Recordkeypointsofvisualtraining,understandhowtoenhancevisualefficiencywhileusingnear-visionaids,andtestreadingspeedswithdifferentfontsizesandreadingdistances.

2.操作步驟

2.OperationSteps

(1)調(diào)焦訓(xùn)練：在使用手持放大鏡時(shí)，需要調(diào)焦訓(xùn)練。(1)Focusingtraining:Whenusingahandheldmagnifyingglass,focusingtrainingisnecessary.

1)用遮蓋板遮住患者視力較差眼，讓患者通過(guò)放大鏡看目標(biāo)。1）Covertheeyewithpoorervisionusinganshadeorcover,andallowthepatienttoviewthetargetthroughthemagnifyingglass.

2)將放大鏡放在閱讀材料上，緩慢向上移動(dòng)放大鏡，調(diào)整放大鏡與閱讀資料之間的距離，使得通過(guò)放大鏡看到的字體變清晰并變大，且再往上移動(dòng)放大鏡時(shí)，閱讀資料反而變模糊，往回移動(dòng)放大鏡直至清晰為止，在此距離上可清晰閱讀。重復(fù)練習(xí)幾次，熟練掌握調(diào)焦技術(shù)。2）Placingthemagnifyingglassonthereadingmaterial,slowlymovethemagnifyingglassupwards,adjustingthedistancebetweenthemagnifyingglassandthereadingmaterial.Ensurethatthetextseenthroughthemagnifyingglassbecomesclearandlarger.Asyoucontinuemovingthemagnifyingglassupwards,thereadingmaterialwillbecomeblurry.Movethemagnifyingglassbackuntilthetextbecomesclearagain.Repeatthisexerciseseveraltimestobecomeproficientinfocusingtechniques.3)注意事項(xiàng)：若對(duì)上述調(diào)焦練習(xí)有困難，可考慮使用閱讀架，也可使用帶距離控制罩的放大鏡。當(dāng)患者使用手持放大鏡難以控制焦距時(shí)，可用立式放大鏡代替。3）Notes:Iftherearedifficultieswiththeabovefocusingexercise,considerusingareadingstandoramagnifyingglasswithdistancecontrol.Ifthepatientstrugglestocontrolthefocallengthwithahandheldmagnifyingglass,astandingmagnifiercanbeusedasanalternative.

需要讓患者明白焦距或景深的含義，將目標(biāo)離開(kāi)焦點(diǎn)，即離眼很遠(yuǎn)或很近時(shí)，患者便無(wú)法看清目標(biāo)。It'simportanttohelpthepatientunderstandtheconceptoffocallengthordepthoffield.Whenthetargetmovesawayfromthefocuspoint,meaningit'stoofarortooclosetotheeyes,thepatientwon'tbeabletoseethetargetclearly.

如果患者的較差眼對(duì)閱讀帶來(lái)干擾，建議遮蓋該眼，如果沒(méi)有明顯干擾，可以雙眼直接開(kāi)放，使用好眼閱讀。Ifthepoorereyecausesinterferenceduringreading,itisadvisabletocoverthateye.However,ifthere'snosignificantinterference,botheyescanbeusedforreading.

(2)定位訓(xùn)練：在閱讀開(kāi)始時(shí)，需要找到每一行的開(kāi)始處、文章的題目或圖表等，必須使用定位技術(shù)。(2)Locationtraining:Atthestartofreading,it'simportanttofindthebeginningofeachline,thetitleofthearticle,oranycharts.Thisrequiresprecisepositioningtechniques.

1)給患者一本書(shū)，讓他找到某頁(yè)左上或右上角的第一個(gè)字，左下或右下角最末一個(gè)字。1）Givethepatientabookandaskthemtofindthefirstwordinthetopleftorrightcornerofacertainpageandthelastwordinthebottomleftorrightcorner.

2)讓患者手持讀物，或?qū)⒆x物放在閱讀架上，用示指指向文章的開(kāi)頭處，或指向文章的標(biāo)題，沿著一行一行的文字內(nèi)容，找到頁(yè)面最后一個(gè)字。2)Havethepatientholdthereadingmaterialorplaceitonareadingstand.Usetheindexfingertopointatthebeginningofanarticleorindicatethetitle.Followthetextlinebylineandlocatethelastwordonthepage.

3)在使用助視器的情況下重復(fù)上述練習(xí)，直至手眼協(xié)調(diào)，能熟練找到開(kāi)篇第一個(gè)字以及最后一個(gè)字。3）Repeattheexerciseusingassistivedevicesuntilthepatientdevelopshand-eyecoordinationandcanproficientlyfindthefirstandlastwordsofapassage.

4)注意事項(xiàng)：如做上述練習(xí)有困難，指導(dǎo)者可以在紙上寫(xiě)幾行字，如前所述做定位練習(xí)，或在桌子上擺一些小東西(成行)，讓患者做定位練習(xí)。指導(dǎo)者要觀(guān)察患者的體位、頭部及眼位，并向患者提供合適的照明與對(duì)比度。4）Notes:Iftheaforementionedexercisesarechallenging,theinstructorcanwritewordsinrowsonpaperforpositioningexercises,aspreviouslydescribed.Alternatively,placesmallobjects(linedup)onthetableforthepatienttopracticepositioning.Theinstructorshouldobservethepatient’sposture,head,andocularposition,andprovideappropriatelightingandcontrast.

如患者仍有定位困難，可設(shè)法增加目標(biāo)與背景的對(duì)比度。讓患者在不用助視器的情況下，使用其視網(wǎng)膜最敏感區(qū)對(duì)目標(biāo)進(jìn)行定位，然后將助視器移到眼前，進(jìn)行定位及調(diào)焦。Ifthepatientstillfacesdifficultiesinpositioning,considerincreasingthecontrastbetweenthetargetandthebackground.Havethepatientlocatethetargetusingthemostsensitiveareaoftheirretinawithoutusingassistivedevices,thenmovethedeviceinfrontoftheireyesforpositioningandfocusing.如患者定位有困難，應(yīng)考慮換用低倍助視器，以增大視野，降低閱讀定位難度。Ifthepatientstruggleswithpositioning,considerswitchingtolower-magnificationassistivedevicestoincreasethefieldofviewandreducereadingpositioningdifficulties.

遠(yuǎn)用助視器訓(xùn)練時(shí)的定位相對(duì)容易，近距離助視器使用時(shí)除大致定位材料段落位置之外，在閱讀過(guò)程中仍需要實(shí)時(shí)定位，否則容易串行。Positioningduringtrainingwithhypermetropiavisualaidsisrelativelyeasier.However,whileusingnear-rangeassistivedevices,apartfromgenerallypositioningthematerialorparagraph,real-timepositioningisstillrequiredduringthereadingprocess,otherwise,itmightresultinasequentialreading.

(3)搜尋訓(xùn)練：指導(dǎo)患者應(yīng)用系統(tǒng)搜尋法尋找目標(biāo)，閱讀即是典型的近處搜尋功能體現(xiàn)。(3)Searchtraining:Instructpatientstousesystematicsearchmethodstofindtargets,asreadingisatypicalmanifestationofnear-rangesearchfunction.

1)閱讀時(shí)，慢慢從左向右讀，讀完一行，從原行末尾回到第一個(gè)字，然