As I have talked about previously in this blog, many brain injury survivors recovering from traumatic brain injuries will experience visual scanning difficulties as a result of those injuries. This can be due to a direct loss of visual ability (often called a visual field cut) or due to an attentional issue such as left neglect. One convenient and practical way to work on scanning is for the survivor to practice with a telephone book or supermarket circular.
The idea is pretty straightforward: the survivor is tasked with locating various items found in the advertisements of the telephone book’s yellow pages or in a supermarket circular. You’ll want to pick items in a random order so as to prevent the survivor from figuring out where each correct item is without really working on the skills. For example, if you are using restaurant ads in the yellow pages, you may first have the survivor find the hours of operation from an Arby’s ad in the top left corner, then the address of a Taco Bell advertised on the bottom left of the page, followed by the Domino’s Pizza fax number down at the bottom right. The supermarket circular can be used in the exact same manner. As example, you could ask the survivor for the cost of the Oscar Meyer bologna in the top right corner of the page, then the size packaging of the Frosted Flakes cereal in the bottom left corner, followed by having the survivor point to the Hebrew National hot dogs back up towards the top right.
You do not want to tell the survivor where on the page each item is located, but allow the survivor to naturally search on his or her own. All parts of the page, including the center, should be used during this activity. If the survivor cannot find the material, the survivor (often with the help of a loved one) should be prompted to conduct a slow, organized search for the item in question. If the survivor has left neglect, such a search should always begin on the left side, using a slow up-down search rather than side to side. If the survivor has a visual field cut, the search should always begin on whichever side has suffered the cut, again using an up-down search. If the survivor is missing the right visual field in both eyes, the search should always begin on the right side and if he or she is missing the left visual field in both eyes, the search should always begin on the left. Missing both the right or both the left visual fields is known as homonymous hemianopsia.
There are a few things you want to keep in mind to help this task go smoothly. You will want to check and ensure that the information can be easily seen by the survivor. Sometimes the writing in phone books and circulars may be quite small and the survivor may need to use reading glasses or perhaps need only to work with the bigger items on the page. When working with the yellow pages, it is generally better to pick pages with lots of display ads rather than just listings. I do not advise using the white pages since the writing is small, placed very close together and is always in an obvious alphabetical order. Supermarket circulars are generally much better for this task than department store circulars since they will tend to list more items. If the survivor has left neglect, it may be helpful to highlight the left side of the page or put a bright object (such as a strip of paper) on the left side. Additionally, some survivors benefit from the use of a line reader (such as ruler) to help with their ability to focus on one section of information at a time.
Here are a few previous blog posts on home-based visual scanning activities:
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