The following materials are published and used by CDA as outlines for conducting continued education clinics.

Visual Impairments and Blind Skiers / Snowboarders

December 2003

MEDICAL INFORMATION

Disabilities and medication will affect the physical (fitness, strength, mobility, balance, etc.) and physiological (behavior, cognition, memory, communication, etc.) condition if the student.

Visual impairment is most often described in terms of acuity and range. The legal definition of blindness is a corrected visual acuity of 20/200 or less, or a peripheral field restriction to a diameter of 20 degrees or less, in the better eye. Thus, long distances, short distances or fields of vision may be affected. Since 90 % of people who are legally blind have some residual eyesight, it is important to determine the amount of vision your student has and ensure that your teaching strategy takes full advantage of any residual vision.

Common Types and Causes of Visual Impairments

Retinis Pigmentosa - is a progressive hereditary disorder that usually appears in childhood and causes slow degradation of the light receptors in both eyes. The rods (for black and white vision) are affected most, usually resulting in night blindness. Peripheral vision decreases progressively, leading to "tunnel vision." No satisfactory treatment for this disease is currently available.

Glaucoma - this condition occurs when the fluid inside the forward part of the eye fails to drain properly, thereby causing an increase in intraocular pressure. This eventually causes nerve damage and loss of vision. It is more common in adults over the age of 40. The initial symptoms are a blurred or foggy vision, with eventual loss of vision. These at risk of developing chronic glaucoma are people over the age of 35 who have had diabetes, myopia, or a family history of glaucoma. The treatment is somewhat limited, and includes eye drops for early forms of glaucoma and occasionally surgery may be effective.

Cataracts - are opaque or clouded areas on the lens that block passage of light into the eye. Initial symptoms include blurred or double vision and sensitivity to light. The likelihood of developing cataracts increases with age but the condition can also be hereditary, congenital or caused by chemical burns. Treatment consists of surgery.

Detached retina - is a condition in which the retina, which contains the light-receiving rods and cones, becomes separated from the back of the eye. Although the detachment is painless, it results in loss of vision in the detached area and, if severe, can cause total blindness of the affected eye. Treatment consists of surgery to reattach the retina.

Macular degeneration - is a progressive disease that affects the central part of the retina, known as the macula. Although more common in the elderly, macular degeneration can occur at any age, resulting in loss of vision in the center of the field of view that gradually worsens. Treatment options are limited, and surgery is used to halt the process of the disease.

Optic nerve disease - ranges from mild loss of acuity to an enlarged blind spot or total loss of vision. Causes include congenital disease, multiple sclerosis (most common), tumors, glaucoma, high blood pressure, diabetes, nutritional deficiencies, or chemical poisoning.

Diabetic Retinopathy - is caused by a weakening of the lining of the blood vessels in the eye. This causes hemorrhage and scaring on the retina. This tissue then contracts and pulls the retina away from the back of the eye. The degree of retinopathy seems more related to the duration of the diabetes than its stability (that is, control of the blood sugar). It usually occurs after the person has had diabetes for 10 years or more.

DISABILITY RELATED CONCERNS

The instructor must assess and anticipate any complications related to a specific disability and the environment, especially medication variations, due to environmental, physiological or psychological changes.

Secondary Disability Issues

Secondary disability issues are most important with VI clients because while we are focused on the primary concern (vision) we must also look at the cause of the vision loss and what complications could arise during your lesson (i.e., diabetes).

EVALUATION AND EQUIPMENT SETUP

A medical history should contain a written evaluation of a student's abilities. Using this as a guideline, an on-site, practical assessment is completed prior to skiing or snowboarding. Appropriate equipment may then be selected.

Practical Assessment

Student Evaluation allows the instructor to get an idea of general and current vision. Things to look for in the assessment:

Does the student have any useable vision? Observe your student.
If the student does have useable vision, is it in one eye or both and how does it differ?
Can the student distinguish colors and shapes?
How near or far can the student see? Acuity, depth perception and angle of vision.

Equipment

Use the above evaluations to choose the appropriate equipment. Equipment needs will vary with each individual.

Ski Bra	Helps with lateral stability and muscle control. A metal device that clamps onto the tips of the skis to keep errant ski tips together. A variation, the trombone ski bra, is useful for maintaining the skis in a parallel position. It can slide back and forth to allow for walking and independent leg movement while skiing.
Bamboo Poles	Used when guiding, the instructor holds one bamboo pole in each hand, and a student is either directly behind or in front of the instructor, holding the opposite ends of the poles at hip level. They also allow student and instructor to ski side by side.
Reins	Lengths of one-inch webbing with clasps on one end. We use them from behind the student to help control speed and turns. They can be attached to a ski bra or around boot cuffs at the ankle. Reins can also be used to pull your student through the lift line or flat terrain.
"Blind Skier and "Blind Skier Guide" bibs	We use these bibs while skiing or snowboarding to alert other Powderhorn guests of your student's presence on the slopes. Must be worn while on the mountain.
Two-Way Radios	They eliminate the need to yell and provide you with a backup signaling system.

TEACHING AND COMMUNICATION TACTICS

A written and practical assessment can help determine teaching technique. Use appropriate teaching styles for the student's learning style. Establish emergency commands, "slow down," "sit down" (to the side), or "stop" immediately when you call out the emergency command. These commands are used when an out-of-control skier or snowboarder is rapidly approaching, if your student takes a wrong turn, or if you fall. Voice inflection is very important. Use a firm, confident tone to establish a trusting bond.

Directional Commands are used to move the student from point to point.

Clock System relates to numbers on a clock face. Good to use in static situations, such as when in lift line.
Grid System is a good way for student to visualize the slope.
Auditory cues are represented by tapping of poles in front of the student (or a tambourine).
Verbal commands. Most frequently used "right turn', "left turn" or "and turn" cadence are important in establishing the rhytm. "Dip", "flats", "steeps", "rut", etc. are good in describing the approaching terrain. Short commands also will help you avoid a constant stream of non-essential chatter.

Guiding Techniques

Once you and student have established commands and emergency procedures then you should decide on a guiding technique.

Inside the lodge - let your student stand next to you and hold on to your elbow. Where your elbow goes, your student will follow (left, right, forward). This is a non-auditory communication.
Corrals and lift lines. The student places one hand on your shoulder and you glide through the maze as a unit.
Catwalks and transitional terrain - use a pole lead to guide the student. Applying minimal pressure to the right or left (coupled with some verbal directions) will assist the student in moving in the desired direction.
Guiding from the front while skiing backwards. This is a very good method with beginner skiers because it is reassuring for the student. Always be very careful when skiing backwards.
Guiding from the side - used with students with peripheral vision. It is a difficult method to implement on a crowded slope.
Guiding from behind - allows student to easily hear your voice and you can easily observe and view the slope ("horse and buggy technique").
Guiding from the front while skiing forward should be reserved only for the advanced skiers and snowboarders. Used on race courses.

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