Adapting the ACL for those with Vision Impairment

Question:

I have a question re: ADM-2 for an individual who is deaf blind. They completed the LACLS-5 and scored around 4.2-4.4. I was wondering if the card-making assessment could be used. I believe they could have enough vision to determine difference in the coloured ribbon. Do you have any insights?

Response:

The first thing to consider is whether the deaf blindness is a new disability or not. If longstanding (most likely), you can proceed with the assessment, provided the person can distinguish between the ribbons. If they can do it visually then fine, but you may need to provide ribbons with a high colour contrast. Alternatively you could use ribbons with a strong tactile contrast such as grosgrain vs satin. Check that they can feel or see the slits in the card. 

For clients with a new disability, you can still use the assessment if they can distinguish between the ribbons and identify the slits. It is more likely that their Allen Cognitive Level will be higher rather than lower than the task score due to increased cognitive demand of the task. My clinical experience leads me to believe that we will get accurate results but given the lack of research evidence to guide us, I would look at score 2 modes above and below the assessed score.

We have done the ACLS with a profoundly vision impaired client, from birth, by letting her "feel" the demonstration. It worked well. Validating the screening scores takes a bit more effort. 

There is no research evidence to help us; we need to use our clinical reasoning and be explicit about this in reports. We need someone to do an honours project about it.