Amélie Desnoyers, Rehabilitation specialist for the visually impaired

What is your training?

I have a bachelor’s degree in psychology and a graduate diploma in specialized studies (DESS) from the School of Optometry at Université de Montréal, completed in 2012. This program has since been transformed into a professional Master’s program.

What is your work experience to date?

Since 2012, I’ve had the good fortune to work at the Nazareth and Louis Braille Institute, a specialized rehabilitation centre for an older clientele with visual impairment who come from the Montérégie and Montréal East.

The services are designed for whom, and what is the process for receiving services?

I am assigned to a specific department for seniors aged 65 and over. As soon as they have difficulty performing their daily activities, they can apply directly to the Nazareth and Louis Brail Institute or be referred to an optometrist, an ophthalmologist or a health professional working in a CLSC, another rehabilitation centre or a hospital centre.

Seniors are first briefly assessed over the phone by intake-assessment-referral personnel to confirm their eligibility and establish their level of priority. I then make contact with them to arrange a home visit to gather the initial information. Who are they? What is their surrounding environment? What are their needs and daily habits? What difficulties do they encounter because of their loss of sight? What expectations do they have regarding rehabilitation? This gives me an opportunity to present rehabilitation for visual impairments, reframe the available services in terms of clients’ expectations, and work out rehabilitation objectives together. We also set our game plan and identify potential needs for a specialized response.

Describe your day-to-day work.

If I’m not at the Nazareth and Louis Brail Institute doing follow-up work, planning, or reports, I am at a client’s home, developing a response plan. In my role as a pivot-professional, I monitor changes in objectives as part of the holistic approach to rehabilitation advocated by the Institute. My role as rehabilitation specialist for the visually impaired also leads me to work directly with service users. The two roles are separate at the Institute, but throughout the province, direct work with clients predominates.

The majority of seniors who come to see us still have some sight to offset their handicap. Visual re-education involves helping them be aware of their loss of vision and make optimal use of their remaining sight. For example, most people lose their central vision. The exercises that we propose help them develop what we call eccentric fixation. This is a way of looking that is completely different from what they’re used to; it takes practice and encouragement as it is quite complex.

To meet a need often evoked by seniors who want to regain some degree of independence, we focus our work on reading or on certain communication activities. Compensatory optical aids are proposed. We also assess lighting to reduce glare and discomfort. Parallel to that, we work on preventing falls and reducing risks in the environment. The Nazareth and Louis Brail Institute gives priority to fairly targeted actions, but the work of my colleagues elsewhere in Québec focuses on all daily living habits in the home or workplace, or at school if young people are involved.

What are you most passionate about in your work?

A number of things. First, exploring the psychosocial and human dimension. After that, analysing and summarizing each case… and the expertise that emerges from teamwork. I feel privileged to rub shoulders with so many qualified professionals who pool their skills.

How do you make a difference in peoples’ lives?

Older people already face a whole host of difficulties and it’s a great shock if they lose their sight as well. When I arrive, they are discouraged and fearful that they’ll lose their independence. Our goal is to help them regain their ability to take action in their daily lives and change their perception of their own abilities. They can still do a lot of things. We help them resume their activities, manage their finances, access their mail and overcome their isolation. In return, they express their gratitude.

What are the challenges you face in your profession?

The challenges have to do with the clientele itself. The complexity of assessments is a challenge. It’s important to distinguish what is related to vision loss from what is part of the normal aging process, and to zero in on existing strategies. Older people have less energy and are already mourning a number of losses. They may be dealing with their own health problems or be serving as natural caregivers for a friend or relative. It’s important to try to understand their experience without imposing our ways of doing things. The challenge is to adapt or adjust our response, and we sometimes have to suspend rehabilitation.

Interdisciplinary work is also a challenge. It’s important to exchange information, co-ordinate and communicate with our colleagues, so we have to set up effective ways of working in concert.

Lastly, because of our specificity, we have to raise the profile of our profession. A professional association was recently created to make other professionals and the public more aware of visual impairments and our work. In Québec as a whole, a very low percentage of those grappling with a visual impairment consult us. People think they have to live with major impairment or complete blindness before they contact us, whereas that’s not the case at all. The population is aging and it’s better to take early action before people’s independence is substantially eroded. We have to intervene in a timely way to help people retain their independence.

Technological developments require constant adaptation but are very promising. The tools at our disposal such as adapted computer equipment are changing and transforming at a rapid pace, and are opening new horizons.

How has your work changed since you began your career?

I’d say we’re doing better now than we used to.

Now that I know exactly how the health and social system works, I can fully play my role as a pivot-professional. Social workers are also more aware of our realities and are quicker to refer patients to us.

In the digital age, communication materials are more and more effective in serving our clients. People now have access to phones with text-to-speech synthesis that replaces the need for vision. There is also a function that helps send text messages.

Since very recently, there are visual implants for people who have very low vision. We have to acquire new skills to help clients take advantage of these new developments.

Lastly, the creation of a Master’s degree in rehabilitation for the visually impaired promotes recognition of the profession by fostering applied research, a better network, and continuing training.