Deaf-BlindDeaf-Blind

OverviewOverviewMARCH 21, 2013MARCH 21, 2013

Introductions

CARLA BECK & KAREN CARLA BECK & KAREN WINDYWINDY

PROJECT REACH: ILLINOIS PROJECT REACH: ILLINOIS DEAF-BLIND SERVICESDEAF-BLIND SERVICES

Project Reach: Illinois Deaf-Blind Services

• Federal Grant

• Serving Children and youth, ages birth-21, who have a combined vision-hearing challenge

• Free services throughout state of Illinois

Goals for today• Learn common causes of deaf-

blindness

• Learn vision and hearing concerns related to deaf blindness, and their developmental and educational implications

• Learn ways to help

What does Deaf-Blind mean?

• Combined vision-hearing challenge

• Cannot rely on hearing to accommodate for vision concerns, cannot rely on vision to accommodate for hearing concerns

• In Illinois, 446 youth considered to be deaf-blind (2011) and 5,624 persons of all ages (1995)

Are all people who are deaf-blind born deaf-blind?

Congenital• Both losses occur at birth (syndromes,

prenatal causes, causes at birth)

Adventitious• One at birth and one later (syndromes,

accidents, illnesses and medical treatments) • Both may occur later in life (syndromes,

accidents, aging, illnesses, medical treatments)

What is the range of abilities and needs among people who are deaf-

blind?

• Depends on age of onset• Depends on additional disabilities• Depends on individual personalities• People who are deaf-blind are receptionists,

vending service employees, proofreaders, teachers, college instructors, homemakers and parents, agency directors, computer programmers…

In all cases, the major disability for persons who are deaf- blind is

the challenge of GATHERING

INFORMATION

Common causes of deaf-blindness

• Age

• Anoxia

• CHARGE

• Down Syndrome

• Encephalitis

• Meningitis

• Prematurity

• Syndromes

• Traumatic Brain Injury

• Usher Syndrome

Primary Identified Etiology of Children Who Are Deaf-Blind

(ages birth through 21)

• Hereditary Syndromes/Disorders

• CHARGE association 824

• Usher Syndrome (I,II,III) 263

• Down syndrome (Trisomy 21 syndrome) 226

• OTHER: Hereditary/ Syndrome Disorders 2375

Primary Identified Etiology (Cont’d.)

• Pre-Natal/Congenital Complications

• Cytomegalo-virus (CMV) 332

• Microcephaly 275

• Hydrocephaly 248

• Congenital Rubella 72

• OTHER: Pre-Natal/ Congenital Complications 652

Primary Identified Etiology (Cont’d.)

• Post-Natal/ Non-Congenital Complications

• Asphyxia 235

• Severe Head Injury 193

• Meningitis 188

• Encephalitis 70

• OTHER: Post-Natal/ Non-Congenitall 590

Primary Identified Etiology (Cont’d.)

• Complication of Prematurity 1108

• No Determination of Etiology 1736• Source: National Consortium on Deaf-

Blindness. (2012.) The 2011 national child count of children and youth who are deaf-blind.

http://www.nationaldb.org/documents/products/2011-Census-Tables.pdf

Primary condition listed on 2011 Census:

• Intellectual Disability – 17% • Visually Impaired – 6%• Hard-of-hearing or Deaf – 13%• Other Health Impaired – 10% • Orthopedic Impairment – 1% • Deaf-Blind – 6% • Physical challenges = 70% • Intellectual disability = 67% • Complex medical needs = 40%

Types of Visual Impairments

• Acuity Loss

• Visual Field Loss

• Oculomotor Problems

• Cortical Visual Impairment

Acuity Loss

• Blurriness of Vision AFTER best correction

• May be measured as 20/20

• Legal Blindness begins at 20/200

• Many medical causes lead to acuity loss

Visual Field Loss

• Peripheral Field Loss

• Central Field Loss

• Scattered Scotomas (Islands of Vision)

Visual Field Loss

• Peripheral Field Loss–Unable to see what is coming from

the sides, above and below

–If have a hearing loss, it would be difficult to know if something is coming in that field of vision

Visual Field Loss

• Central Field Loss–Unable to see items directly in front,

only see things to the side

–If there is a hearing loss, may not realize that someone is in front of you talking or signing

Visual Field Loss

• Scattered Scotomas (Islands of Vision)–Patches in all fields of vision are

affected

–If there is a hearing loss may have an even greater chance of missing something or someone

OCULOMOTOR PROBLEMS• Strabismus is one type of

oculomotor problem• It may be constant, or intermittent• Constant strabismus from an early

age may lead to amblyopia (lazy eye)

• May include nystagmus (involuntary shaking of eyes)

Cortical Visual Impairment

• Inability of the brain to process visual information

• Effects can vary from specific visual inabilities (unable to identify people by looking at their faces) to overall visual impairments of acuity or field

Functional Implications of eye conditions

• Eye conditions can vary from no impact on vision to no light perception

• Different diseases can have the same functional impact (acuity, field, etc.)

• A person can have more than one condition and more than one functional implication

TYPE OF HEARING LOSS

• A conductive or sensorineural hearing loss, with amplification, in the better ear

• An auditory processing disorder

• Unable to use hearing for education, as determined by educational team

CONDUCTIVE vs. SENSORI-NEURAL HEARING LOSS

Conductive Hearing Loss

- Medical intervention is sometimes possible

- Amplification will often improve

Sensori-neural Hearing Loss

- Nerve damage is permanent

- Amplification will not improve clarity

What a person might hear:

• Normal: Freddie thought he should find a whistle.

• Mild loss: Freddie though- -e -ould -ind a whi-le.

• Moderate loss: -reddie -ough- -e -ould -i-- a -i--le.

• Profound loss: LOUDsoft LOUDsoft soft LOUD soft LOUDsoft

Other types of hearing loss besides

conductive and sensorineural

• Auditory neuropathy

• Auditory processing disorders

Auditory Neuropathy

• A simple explanation: – Think about listening to some music on a

CD player, but there is a frayed wire somewhere between the radio and the speaker system. The sound is entering the perfectly operational player but is not able to get through the wire and into the speaker in the correct way. Now replace the words radio, wire, and speaker in that sentence with the words cochlea, nerve and brain.

Auditory Processing Disorder

• A simple explanation: – Think about listening to your CD player,

but you have a DISTORTED/IMPAIRED SPEAKER. The sound is entering the perfectly operational player and is able to get through the wire and into the speaker in the correct way but the speaker cannot properly take in that information which leads to poor output. Now replace the words radio, wire, and speaker in that sentence with the words cochlea, nerve and brain.

Auditory Processing Disorder

• An example of what it may sound like.– Imagine watching TV with the volume turned

way down and noise in the background as loud or louder.

– Imagine trying to watch a foreign language movie without subtitles.

– Easy to see how a person becomes distracted, disruptive, tired, irritable.

– Misdiagnosis can occur.

What is daily life like for people who are deaf-blind?

• Challenges with communication• Challenges getting around• Challenges to learn new things• Challenges in daily living• These challenges are often

compounded with additional disabilities

Effects on Development

• Social/Emotional

• Cognitive

• Motor

• Communication/Language

Effects on Social Emotional

• Bonding and Attachment

• Trust vs. Mistrust

• Independence

• Self Concept

Effects on Cognitive

• Cause and Effect• Object Permanence• Understanding entire process of activities• General Constructs (classification, conservation,

visual concepts like color, perspective)• Balance information with excessive verbalism

Effects on Motor• Different timelines

• Delay greater for mobility milestones than for stationary motor milestones

• Decreased motivation to move

Effects on Communication/Language

• Need to have tactile life experiences to attach so language attaches to meaning

• May have delayed speech• May use Augmentative and Alternative

Communication Systems• Need to make visual and tactile

accommodations to systems

What can we do to help?

• Accommodations for communication

• Accommodations for vision

• Accommodations for hearing

Communication without completevision and hearing

May use residual vision and hearing

May use different techniques in different settings and situations (multimodal or total communication)

May need one system for receptive information, another for expressive information

May need tactile communication

Possible communication strategies

• Body Language

• Touch Cues

• Objects Cues

• Tangible Symbols

• Sign

• Speech

• Print

• Braille

Critical Receptive Messages

• Hello! I am here!

• My name is….

• Activity

• Touching

• Movement

• Time to finish

• Goodbye!

OBJECT AND TOUCH CUES

Object Cues– Showing/helping to touch an item to give

information about activities, expectations, and choices.

Touch (or Body) Cues

- Touching a person’s body in a systematic way to give information about activities, expectations, and choices. Used when there is no logical object to use for an object.

SCRIPTING

1) A step-by step description of movements and words used while doing something, like the script of a play.

2) Ensures caregivers do daily routines exactly the same way.

3) Starts as a receptive communication technique

4) After a while, insert pauses before favorite event of routine.

5) Student learns to move in anticipation of favorite part of routine.

6) This movement becomes a home sign for the activity.

Accommodations for vision

• Help people use the remaining vision they have

• Help people get around safely

• Replace visual information with auditory/tactile information

What might help people see better?

• Glasses/contacts

• Surgery

• Correct lighting

• Reducing glare

• Special devices (magnifiers, CCTVs, telescopes)

• Position, position, position!

How can we adapt materials to help people

use vision better?

• Size/distance

• Contrast/color

• Clutter/background

ORIENTATION & MOBILITY

• May require the use of more than just a cane

• Crossing streets are more difficult because cannot use hearing to determine if it is safe to cross

What about people who use wheelchairs or walkers?

• Canes or adapted mobility devices can be added to walkers and wheelchairs

• Persons who do not push their own chairs can be taught to feel for “landmarks” to know where they are

Replacing vision with hearing and touch

• Interpret the visual environment with sign or voice

• Remember touch and object cues• Replace pictures with tangible symbols• Hand UNDER hand exploration

sometimes works best

ACCOMMODATIONS FOR HEARING

• Help people use the remaining hearing they have

• Replace auditory information with visual/tactile information

Things that may help hearing

• Hearing aids

• Personal Listening Systems

• FM Systems

• Cochlear Implants

Auditory Accommodations

• Get close to what is important to listen to

• Turn off unneeded sound (if possible)

• Add acoustic features to room (tennis balls on chair feet, carpets, curtains, acoustic tile)

• Use prescribed amplification

Guidelines for Working and Playing with Deaf-

Blind People

• Courtesy

• Guiding

• Communication

• Interpreting

Summary

• Know levels of vision and hearing

• Use prescribed vision and hearing accommodations

• Be sure to give critical messages

• Try alternative communication if typical vision or hearing systems is not enough

• Wait for information to get in, and wait for a response to get out

THANK YOU!

• QUESTIONS?