THE DUAL SENSORY CHALLENGE

The many sides of deaf-blindness

© MECDHH 2018

Kristen Shorey, MEdkristen.shorey@mecdhh.org

THE DUAL SENSORY CHALLENGE

Presenters

© MECDHH 2018

Donna Casavant, MED, CASdonna.casavant@mecdhh.org

OBJECTIVES• Recognize the range of individuals that meet this

classification of deaf-blindness.

• Describe the impacts of dual sensory challenges for students with deaf-blindness.

• Identify key principles and strategies for interacting with individuals with deaf-blindness.

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THE DUAL SENSORY CHALLENGE

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Distant Senses• Visual (sight)• Auditory (hearing)

THE SENSES

Near Senses• Tactile (touch)• Gustatory (taste)• Olfactory (smell)• Kinesthetic/Proprioception (body

position & muscle movement)

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OUR DISTANCE SENSES

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OUR NEAR SENSES

HEARING LEVELS

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HEARING ISSUES RELATED TO THE EAR

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Conductive• Outer ear

* Canal* Ear drum

• Middle ear* Ossicles (bones)* Eustachian tube

Ø InfectionsØ PerforationsØ DrainageØ Fluctuating or Permanent

Sensorineural• Inner ear

* Cochlea* Auditory nerve

Ø StableØ ProgressiveØ Permanent

HEARING ISSUES RELATED TO THE BRAIN

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Auditory processing Auditory neuropathy

VISION LOSS

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WAYS VISION CAN BE AFFECTED

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Acuity loss

Contrast loss

Field loss

WAYS VISION CAN BE AFFECTED

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Loss of color sensitivity

Oculomotor problems

OCULAR VS. CORTICAL VISION IMPAIRMENT

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OCULAR refers to EYE(cornea, pupil, lens, iris, retina, eye muscles)

CORTICAL refers to BRAIN and how the brain processes visual information

COMBINED VISION AND HEARING LOSS

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COMBINED VISION AND HEARING LOSS

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WHAT IS DEAF-BLINDNESS?

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Deaf-blindness means concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness.

34 CFR 300.8 (c) (2)

WHAT DOES THAT MEAN?

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“Combined hearing and vision loss presents unique challenges that are greater than the

sum of those parts.”

Deafblindness >>> Deaf + Blind

LOWEST OF THE LOW INCIDENCE DISABILITIES

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THE EDUCATIONAL AND FUNCTIONAL IMPACT OF COMBINED LOSSES WILL VARY DEPENDING UPON:

• Degree and type of vision and hearing concerns • Stability of hearing and vision• Age of onset • Presence or absence of additional disabilities • Quality of educational services provided

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DEVELOPMENTAL IMPACT OF COMBINED SENSORY LOSS

• Communication and language • Movement and motor • Cognitive • Emotional and social • Body image and self-concept

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FormsofExpressiveCommunication FormsofReceptiveCommunication

OralMotorOutput VisualInput•Vocalizations(cry,coo,babble,gurgle,grunt,laugh,whine,scream)•Vowelsounds,consonant-vowelpairs,word-likejargon•Spokenwords

•Facialexpressions•Gestures•SignLanguage•Objectsymbols•Picturesymbols•Printedwords

Motor-GesturalOutput AuditoryInput•Bodymovements(head,limb,posturalchange,changeinbodytone)•Facialexpressions•Gestures•Eyegaze•SignLanguage

•Environmentalsounds•Intonation/registerofspeech•Spokenwords

Augmentative/AlternativeOutput TactileInput•Tactilesymbols•Picturesymbols•Objectsymbols•Writtenwords•“High-tech”communicationdevicesorAppsoniPads

•Handling/touch/movement•Specifictouchcues•Objectsymbols•Tactile(hand-in-hand)signs•Brailled words

FORMS OF COMMUNICATION

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FUNCTIONS OF COMMUNICATION (ROWLAND, 2007)

express discomfort, protest, refuse or reject something

express comfort, continue action, obtain more of something, request more of an action or object, request a new action or object, make choices, request absent object

express interest in other people, attract or request attention, show affection, greet people, offers things or shares, direct someone’s attention to something, uses polite social forms

answer yes/no questions, ask questions, names things or people, makes comments

Refuse:

Obtain:

Social:

Information:

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7 LEVELS OF EXPRESSIVE COMMUNICATION (ROWLAND, 2007)

LevelsofCommunication

Description Examples

Pre-Intentional: Reflexiveorpre-intentionalbehaviorsthatreflectthechild’sgeneralstate

Fussingwhenhungry,wet,sleepy

Intentional: Intentionalbutnotintentionallycommunicative

Pushingawayanemptycup.

Unconventional: Intentionaltoexpressneeds,ofteninawayuniquetothechild,butnotsymbolic.

VocalizationsFacialexpressionsPullsyouovertodesiredobjectReachesfordesiredobject

ConventionalCommunication:

Gesturesareusedwithintentofaffectingcaregiversbehaviors

BeckonsforyoutocomePointsatdesiredobjectNodshead

UseofConcreteSymbols: Limiteduseofconcretesymbolstorepresentspecificitems

Pointstoobject/photo/drawingfordesiredobjectMimicssoundofobject

AbstractSymbols: Limiteduseofabstractsymbolstorepresentitems. Usedoneatatime.

Spoke,sign,written,brailedword–“More”,“ball”

Language: Rule-bounduseofsymbolsystem.Orderedcombinationsof2-3symbolsaccordingtosyntacticalconventions.

“Moreball”“Doitagain”“Givemeball”

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ACCESS: CONCEPT DEVELOPMENT

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ACCESS: INCIDENTAL LEARNING

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ACCESS: MOTOR

• Motor milestones reached later than might be expected • Tendency to extend play on the body

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MOTOR FEATURES COMMON FOR CHILDREN WITH DEAF-BLINDNESS

• Low muscle tone• Static/dynamic balance challenges• Non-purposeful movement• Gait pattern deviations • toe walking• toe-out gait pattern• pronation

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KEY PRINCIPLES AND STRATEGIES

• Accessibility: Visual, auditory, physical

• Availability: Readiness to learn

• Modality: Communication choices

• Utility: Routines and calendars

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MAXIMIZE VISUAL ACCESS

Access to learning materials and media (size, distance, field, etc)

Reduce visual clutter

Correct amount and position of light

Maximize visual contrast

Team support from the teacher of the visually impaired and orientation and mobility specialist

Use of prescribed lenses

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MAXIMIZE AUDITORY ACCESS

Use of prescribed personal listening equipment and remote microphones

Minimize auditory distractions

Team support from the teacher of the deaf and hard of hearing

and speech language

pathologist

Acoustic treatments

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MAXIMIZE PHYSICAL ACCESS

Physical positioning to access materials Positioning for best visual access

Team support from occupational therapist, physical therapist, orientation and mobility specialist

Positioning to minimize fatigue

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ACCESS TO LEARNING EXPERIENCES

Learning for a Child with Deaf-

blindness

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ACCESS TO NATURAL ENVIRONMENTS

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ACCESS THROUGH TOUCH

“My hands are my eyes, my voice, my heart.”

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AVAILABILITY FOR LEARNING TRUST AND RECIPROCAL INTERACTIONS

TRUST BONDING

RECIPROCAL INTERACTIONS

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• Health factors• States of arousal• Stress level• Likes and dislikes• Strongest sensory channel(s)

AVAILABILITY FOR LEARNING INTERNAL AND EXTERNAL FACTORS

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• ASL/Total Communication/Spoken Language• Verbal/Visual/Tactile cues• Simultaneous vs single sense

LANGUAGE MODALITY CHOICES

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UTILITIES FOR LEARNING: CALENDARS AND ROUTINES

ANY QUESTIONS OR COMMENTS?

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Thank you for joining us!

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THE DUAL SENSORY CHALLENGE

Donna Casavant, MED, CASdonna.casavant@mecdhh.org

Kristen Shorey, MEdkristen.shorey@mecdhh.org

© MECDHH 2018

• Catholic Charities Maine: Education Services for the Blind and Visually Impaired at https://www.ccmaine.org/education-services-for-blind-and-visually-impaired-children

• communicationmatrix.org

• Helen Keller National Center at https://www.helenkeller.org/hknc

• Intervener.org

• Maine Educational Center for the Deaf and Hard of Hearing at http://www.mecdhh.org/governor-baxter-school-for-the-deaf/

• Morrison Center at http://morrison-maine.org/

• National Center on Deaf Blindness at https://nationaldb.org/

• New England Consortium for Deaf-Blind Projects at http://www.nec4db.org/

• Perkins School for the Blind at www.perkins.org

• TicTalk: Touch Initiated communication at https://www.tictalk.org/about.html

RESOURCES

REFERENCES• Alsop, et.al. (2012) A family’s guide to interveners for children with combined vision and hearing loss. Logan, UT: SKI-HI Institute.• Blaha, R. (2001). Calendars for students with multiple impairments including deaf-blindness. Austin: Texas School for the Blind and

Visually Impaired. • Casavant, D. and Duncan, K. (2017) The significant impact of a tiny hearing loss: Minimal and mild hearing loss in school aged children.

[Power Point Slides]. Maine Educational Center for the Deaf and Hard of Hearing.• 34 CFR 300.8 (c) (2) retrieved on 01-16-2018 from https://www.law.cornell.edu/cfr/text/34/300.8• Heydt, K. et al. (2004). Perkins activity and resource guide: A handbook for teachers and parents of students with visual and multiple

disabilities. Watertown (MA): Perkins School for the Blind. • Luiselli, T.E. (2015) NEC Maine Part 2 [PowerPoint Slides]. Maine DeafBlind Project, New England Consortium of DeafBlind Projects. • Miles & McLetchi. (2004) Developing concepts with children who are deafblind. Monmouth (OR): National Consortium on Deafblindness

DB-Link.• Miles B. (2003). Talking the language of the hands to the hands: The importance of hands for the person who is deafblind. Monmouth

(OR): National Information Clearning House on Children Who are Deafblind. DB-Link.

• Miles, B. and Riggio, M. (1999). Remarkable conversations: A guide to developing meaningful communication with children and young adults who are deafblind. Watertown (MA): Perkins School for the Blind.

• National Center on DeafBlindness. Open Hands Open Access: Deaf-Blind intervener learning modules. Retrieved on 01-06-2018 from https://nationaldb.org/ohoa/modules.

• Texas School for the Blind. Some common features in the development of children with deaf-blindness. Retrieved on 01-16-2018 from http://www.tsbvi.edu/deafblindness-items/2172-some-common-features-in-the-development-of-db-children

• Voelker, S. (2018) What is Deaf-Blindness [PowerPoint Slides]. Retrieved from http://slideplayer.com/slide/8631582/.

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IMAGE CREDITS• http://images.slideplayer.com/26/8631582/slides/slide_10.jpg

• http://www.hearingreview.com/2015/10/new-study-shows-hearing-aids-reduce-risk-of-cognitive-decline-in-older-adults/

• https://www.healthline.com/hlcmsresource/images/imce/visual-acuity-test_thumb.jpg

• https://w3c.github.io/low-vision-a11y-tf/requirements.html

• http://www.matossianeye.com/doylestown/cataract-surgery.htm

• http://braintenance.blogspot.com/2010/09/quick-vision-test-1-are-you-colorblind.html

• https://ilslearningcorner.com/2016-06-oculomotor-dysfunction-why-my-child-skips-words-cant-cross-the-midline-experiences-double-vision/

• http://yogaformodernage.com/changing-vision-eyes-vs-heart/

• https://spaceplace.nasa.gov/sound-cone/en/

• http://blog.burdgecooper.com/2013/09/haptics-the-desire-to-touch/

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IMAGE CREDITS• https://www.pinterest.com/pollyannaflower/deafblind/

• http://www.prweb.com/releases/2011/12/prweb9030315.htm

• https://www.pinterest.com/aphfortheblind/deafblind-resources/?lp=true

• https://audiologyblog.phonakpro.com/maximizing-outcomes-for-children-who-are-hard-of-hearing/

• https://www.acousticlab.com/acoustic-in-schools.html

• https://www.pinterest.com/pin/495044184018348767/?lp=true

• http://www.pathstoliteracy.org/blog/calendar-boxes-and-schedule-systems-literacy-tools

• http://www.pathstoliteracy.org/sites/pathstoliteracy.perkinsdev1.org/files/adventure-flower.jpg

• http://www.copdaz.org/clientservices.htm

• https://www.pinterest.com/cadbs/deaf-blind-organizations-agencies-projects/?lp=true

• http://www.pathstoliteracy.org/blog/reach-out-and-touch-picture-concrete-abstract-thinking

• https://www.wilkes.co.uk/reminder-of-key-principles-tupe-and-service-provision-change-transfers/

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