1. Naccarato, Alicia BS, SPT
  2. Wilson, Christopher PT, DPT, DScPT

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Sensory conditions acquired through the aging process negatively impact the ability to live alone and are often associated with depression, dementia, or delirium (Fischer et al., 2016). Conditions such as cataracts, glaucoma, and macular degeneration can impact health-related quality of life (Lee et al., 2009). Age-related hearing loss (presbycusis) has been linked to impaired cognition, impairment in activities of daily living, and decreased mobility contributing to depression (Sharma et al., 2021). Screening to identify sensory conditions along with interventions that mitigate the impact of these deficits can be implemented by rehabilitation professionals, resulting in earlier and more effective management and compensatory strategies, potentially reducing healthcare costs and improving quality of life.


Audiology and ophthalmology are highly specialized areas of clinical practice. The measures described below are brief screenings used to determine if further evaluation is warranted by a specialist. These assessments can be performed with corrective lenses or hearing aids to determine their effectiveness.


Hearing: The most basic hearing test is the Whisper Test (Strawbridge & Wallhagen, 2017). The patient occludes their contralateral ear with a finger or earplug. Stand at arm's length behind the person on one side and whisper a combination of letters and numbers (e.g., 2, G, 4) into their ear. The sequence is repeated with a new series of letters and numbers. If the patient accurately repeats three or more out of the six letters, the test is negative in that ear. The process is repeated on the opposite ear.


The Weber and Rinne tests require a tuning fork (Wahid et al., 2022). For the Weber test, strike the tuning fork and place the base on the patient's forehead or top of their head (Figure 1). The sound should be perceived equally in both ears. If the sound is heard more loudly in one ear, it may suggest a sensorineural hearing loss in the other ear (heard more loudly in the better ear) or a conductive hearing loss in the affected ear (heard more loudly in the poorer ear).

Figure 1 - Click to enlarge in new windowFigure 1. Weber TestPhoto courtesy of Alicia Naccarato. Printed with permission.

For the Rinne test, after striking the tuning fork, place the base on the person's mastoid bone to assess bone conduction (Figure 2). When the person is no longer able to hear the sound, ask them to raise their hand. Then move the tines of the tuning fork to their ear to assess air conduction. Ask the person to raise their hand when the sound is no longer heard. The sound should be heard longer through air conduction than bone conduction. Repeat the test on both sides. When bone conduction is longer than air conduction, it suggests a conductive hearing loss on that side.

Figure 2 - Click to enlarge in new windowFigure 2. Rinne TestPhoto courtesy of Alicia Naccarato. Printed with permission.

Vision: The Rosenbaum Card (Figure 3) is held 14 inches from the person's eye (Tiraset et al., 2021). Test each eye separately in a well-lit area with the other eye occluded with the individual wearing their normal eyewear (if applicable). Ask the person to select the smallest line that they think they can read and have them read out loud each number, directional E, or OXO letter sequence. Next, prompt the person to try progressively harder lines until mistakes are made. Once mistakes are made on a line, document the Jaeger score indicated on the card used during the test, or distance equivalent value for the prior line that was completed correctly. Repeat on the other eye.

Figure 3 - Click to enlarge in new windowFigure 3. Rosenbaum Pocket Vision Screening Card

The Amsler grid is a 10 cm by 10 cm black and white grid printed on paper (Figure 4) used to assess visual field disturbances (Tripathy & Salini, 2019). It consists of black lines printed on white paper. The person should wear their corrective lenses and the Amsler grid should be held at the same distance the person would normally read printed materials. The person then covers one eye and focuses on the dot in the center of the grid. Prompt them to judge if any of the lines look blurred, wavy, or distorted. The person should note whether they see the entire grid or if there are missing or dark areas of the grid (including whether all corners or sides are visible). Mark any areas on the grid that are irregular or not visible. The process should be repeated with a new Amsler grid for the other eye. These marked pages can be delivered with a referral to a vision specialist if indicated.

Figure 4 - Click to enlarge in new windowFigure 4. Amsler GridJmarchn. Amsler Grid. <

Early detection of age-related sensory impairments may be beneficial in promoting independent functioning in the home, preventing cognitive decline, and preventing the onset of mental health conditions such as depression. Rehabilitation professionals can identify potential sensory impairments in older adults and assess the individual's ability to remain safe and independent in their home.




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