Gaps in Physical Medicine and Rehabilitation for Blindness and Low Vision: The Imperative of Rehabilitation for Visual Disability.

Abstract

Persons with blindness and low vision experience increased fall and injury risk beyond atypical biomechanics and balance impairments. Falling risk doubles with blindness, and more than triples with depth perception losses. Despite this, physical therapy focuses on musculoskeletal injuries postevent rather than taking a proactive and preventative approach for persons with blindness and low vision. We posit that physical therapy implemented preinjury, alongside orientation and mobility training of adapted movement protocols could positively affect injury avoidance and severity for persons with blindness and low vision. The global VISION 2020 initiative seeks increased access to rehabilitation services and treatments to enhance quality-of-life for persons with blindness and low vision. In support, this article reviews research studies in rehabilitation science that promote physical health and well-being, and stresses preventative skilled mobility and therapeutic exercise to mitigate injury. To reduce the personal, financial, and societal costs associated with blindness and low vision, as well as position patients for better outcomes, we review an evidence base that may generate immediate impact in this area. While these recommendations provide an initial framework, the role of physical therapy in prehabilitative care remains a critical gap that must be addressed. It is imperative that interventions, guidelines, impairment/severity-specific practices, and overall health promotion are re-evaluated and redesigned for persons with blindness and low vision, affording equity for health and mobility.