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Impact of Hearing and Vision Loss on Independent Living Tracy Bell Koster Jan Radatz Deaf and Hard of Hearing Services. 2007 Age and Disabilities Odyssey Conference August 21, 2007 Duluth, Minnesota. What you’ll learn today. - PowerPoint PPT Presentation
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2007 Age and Disabilities Odyssey Conference August 21, 2007 Duluth, Minnesota
Impact of Hearing and Vision Loss on Independent Living
Tracy Bell KosterJan Radatz
Deaf and Hard of Hearing Services
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
2
What you’ll learn today• Impact that hearing and vision loss
have on independent living, self-determination, and community integration
• Technology and service resources
• Tools and resources that can be used in the support planning process
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study
1) Background about “Larry”2) Determining what was needed to
enable Larry to live more independently
3) Getting the needed supports in place
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
4
Case Study1) Background about “Larry”
DeafBlindPrimary language: American Sign LanguageHome and educationWork historyHow he came to live in nursing home
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Diversity of Hearing Loss
• Born Deaf
• Born Hard of Hearing
• Becomes Deaf later
• Becomes Hard of Hearing later
• What if vision loss added?
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Terminology
• Deafblindness
• Dual sensory loss
• Combined hearing and vision loss
• Deaf, hard of hearing & vision impairment
• “I don’t hear so good or see that well anymore”
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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What isn’t deafblindness?
Not deafness plus blindness
Why not?Usual compensation for hearing loss = visionUsual compensation for vision loss = hearingExponential effect
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Larry’s Hearing and Vision
• Usher Syndrome• Born profoundly deaf • Began losing his vision around
age 12• Significant vision loss likely by
age 25
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study1) Background about “Larry”
DeafBlind
Primary language: American Sign LanguageHome and educationWork historyHow he came to live in nursing home
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Primary Language
English (spoken / written language)
• Language of American mainstream society
• Common language with hearing / sighted people
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Primary Language
American Sign Language
• Language of Deaf Culture; not the language of mainstream American society
• Visual, spatial; not written
• English is second language
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Primary Language
• Hearing loss makes it difficult to access spoken language and sound
• Visual means of communication required
• Age of onset and degree of hearing loss influence primary language
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Alternative English ModesEnglish (spoken / written language)
• Lipreading / speechreading
• Writing
• Writing in large print
• Braille
• Print-on-Palm
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Alternative Sign Language Modes
American Sign Language
• Tactile signing
• Close vision signing
• Limited signing space
• Fingerspelling
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Larry’s Communication
• American Sign Language
• Limited signing space
• Learning tactile signing
• Home signs with family
• White board with black marker
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study1) Background about “Larry”
DeafBlindPrimary language: American Sign
Language
Home and educationWork historyHow he came to live in nursing home
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study
• Raised on a remote farm in rural Minnesota
• Parents, sister, other relatives hearing
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study
• Attended Minnesota State Academy for the Deaf (MSAD) in Faribault
• Immersed in American Sign Language and Deaf Culture
• Graduated from MSAD
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study1) Background about “Larry”
DeafBlindPrimary language: American Sign
LanguageHome and education
Work historyHow he came to live in nursing home
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study• Gainfully employed in a blue collar
job in a large metropolitan area until age 28
• Then moved back to family farm; worked in small towns near farm
• Developed alcoholism
• Treatment program at RTC
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study
• Upon completing treatment, moved back to family farm
• Worked odd jobs (building, roofing, laying brick, peeling corn, etc.)
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study1) Background about “Larry”
DeafBlindPrimary language: American Sign LanguageHome and education Work history
How he came to live in nursing home
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
23
Case Study• Larry became dependent on his
mother as he became legally blind and could no longer work
• Father passed away in 1985, sister passed away in 1993
• Mother’s health deteriorated and she was moved to nursing home in 1996
2007 Age & Disabilities Odyssey Conference
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Case Study• Larry had no opportunity to develop
independent living skills as a deafblind person
• He could not manage family farm; moved to nursing home with mother
• Mother passed away in 2001; Larry remained in nursing home
2007 Age & Disabilities Odyssey Conference
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Case Study• Larry did not meet criteria of being
full-time nursing home resident
• Staff at the nursing home did not know sign language
• Larry’s routine consisted of smoking, eating, watching TV, laying in bed, sleeping
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study
• Attempts to move Larry to live with nephew or uncle in Kansas unsuccessful
Fearful of leaving known environment
Nephew, uncle did not know ASL
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study1) Background about “Larry”
2)Determining what was needed to enable Larry to live more independently
3) Getting the needed supports in place
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Understanding the loss of distance senses
• “The world becomes the size of an outstretched arm”
• Difficulty seeing or hearing people or objects or traffic approaching
• Difficulty identifying individuals if not in close proximity
2007 Age & Disabilities Odyssey Conference
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• Greatest comfort level is in known surroundings with familiar people
• New environments are frightening• Limited or no distance vision to “get
your bearings”• Safety
Understanding the loss of distance senses
2007 Age & Disabilities Odyssey Conference
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• No motivation to meet new people; communication barriers
• Language• Mode of communication
• Depression, trust issues, inadequate coping strategies dues to extreme isolation
Understanding the loss of distance senses
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Isolation of hearing loss and deafblindness
• Isolates individuals from:
PeopleEnvironment
Communication
Information
2007 Age & Disabilities Odyssey Conference
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Effect on Self-Determination
• Difficulty accessing information; determining choices
• Limited world knowledge
• Self-determination requires cognitive ability and information/knowledge
• Limited life experiences
2007 Age & Disabilities Odyssey Conference
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The “Unpredictability” Effect
• Illness effects functional use of vision & hearing
• Vision or hearing changes day to day
• Lack of sleep effects ability to concentrate
• Communication techniques that worked yesterday may not work today
2007 Age & Disabilities Odyssey Conference
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Impact on Larry
• Comfortable only within the nursing home and spent most of his time within his room
• Very limited communication with staff
• Very limited exposure to outside environment sources of information
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Impact on Larry
• High level of fear to travel outside the nursing home, even with assistance
• No instruction on alternative communication modes to accommodate his deteriorating vision
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Determining what was needed first
• Before Larry could consider moving out of the nursing home, he needed to:
• Learn to use his remaining vision
• Learn to use tactile sign language
• Learn techniques for independent travel, independent living
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Determining what was needed first
• Larry also needed to:
• Resolve his depression
• Experience new environments
• Develop confidence in his ability to do more than was expected in the nursing home
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Determining what was needed first
• Larry needed access to information
• General opportunities for more independent living
• Specific options
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Case Study
1) Background about “Larry”2) Determining what was needed to
enable Larry to live more independently
3)Getting the needed supports in place
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
40
Partners in Planning
• Guardian
• Deaf and Hard of Hearing Services Regional Office
• State Services for the Blind
• Nursing home
• County
2007 Age & Disabilities Odyssey Conference
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Types of Supports
• Services• Assistive Technology
• Home Modifications / Learning New Techniques for Daily Routines
2007 Age & Disabilities Odyssey Conference
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Larry’s Support Services
• Support Service Provider• Deaf• Fluent in American Sign Language
Purpose• Exposure to language & communication• Access to environment & information
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Larry’s Support Services
• Orientation & Mobility Instructor• Expert in deafblindness• Fluent in American Sign Language
Purpose• Teach navigation skills• Develop confidence and trust for
independent travel
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Larry’s Support Services
• Psychologist• Deaf• Fluent in American Sign Language
Purpose• Address depression, anxiety,
fearfulness• Build self-confidence
2007 Age & Disabilities Odyssey Conference
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Types of Supports
• Services
• Assistive Technology
• Home Modifications / Learning New Techniques for Daily Routines
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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ARRAY OF TECHNOLOGY
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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ARRAY OF TECHNOLOGY
2007 Age & Disabilities Odyssey Conference
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Common products for vision loss:•Large-print wristwatches •Large-print check registers •Large-print playing cards/crossword puzzles •Large-print kitchen timer •Extra-long oven mitts •Large-print computer software
ARRAY OF TECHNOLOGY
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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Common products for hearing loss:•Hearing aids•Assistive listening devices•Amplified telephones•Loop or infrared listening systems•Alerting systems (doorbell, baby-cry, smoke alarms) with amplification or flashing lights
ARRAY OF TECHNOLOGY
2007 Age & Disabilities Odyssey Conference
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Types of Supports
• Services
• Assistive Technology
• Home Modifications / Learning New Techniques for Daily Routines
2007 Age & Disabilities Odyssey Conference
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Deaf & Hard of Hearing Serviceswww.dhhsd.org
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TIPS FOR THE HOME• Workstations can be set up in each room. Gather together
the most frequently used items so they’re handy. • Puffy paint and raised bump dots are handy for marking
thermostat settings, security system keypads, radios or TV stations settings or other controls that may be hard to see.
• Color contrast makes items more visible (for example, put dark placemats under white plates).
• Maximize lighting in all rooms. Direct the light at the
State Services for the Blindwww.mnssb.org
2007 Age & Disabilities Odyssey Conference
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Types of Supports
• Services
• Assistive Technology
• Home Modifications / Learning New Techniques for Daily Routines
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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New Daily Routines - Resources
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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New Daily Routines - Resources
2007 Age & Disabilities Odyssey Conference
Impact of Hearing & Vision Loss on Independent Living
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New Daily Routines - Resources
Orientation & Mobility(O&M)
Deafblind-specificindependent living skills training
SupportServiceProviders(SSPs)
Interpretingservices, real-timecaptioning (CART)
DHHSD DeafBlindConsumer DirectedServices program
2007 Age & Disabilities Odyssey Conference
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Resources forTechnical Assistance
• Deaf & Hard of Hearing Services Divisionwww.dhhsd.org
• DeafBlind Services Minnesotawww.dbsm.org
• Duluth Lighthouse for the Blindwww.lighthousefortheblind-duluth.org
2007 Age & Disabilities Odyssey Conference
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Resources forTechnical Assistance
• MN State Services for the Blindwww.mnssb.org
• MN Dept of Ed. DeafBlind Projectwww.dbproject.mn.org
• Vision Loss Resources – Minnesotawww.visionlossresources.org
2007 Age & Disabilities Odyssey Conference
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Where is Larry Today?
• Moved from small town nursing home to group home in large metropolitan area
• Lives with 3 other individuals who are deaf and use sign language• Staff fluent in sign language
• Works part-time in sheltered workshop
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Where is Larry Today?
• Built a birdhouse in woodworking class that teaches special techniques for people who are blind
• With Support Service Provider, traveled to another state to visit nephew
• Participates in social events with other deafblind people
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Thanks For Coming!