Total Communication and its EffectOn Communicative Habilitation of

Deafblind Children

ByAmal Ezzat Aly

Ph.D Program in psychologyLanguage &Speech therapist

Consultant for deafblind personsNida Society

Deafblidness is an extreme disability as regards lack of access to the physical and human environment because of the serious impairment of both distance senses. Deafblindness is considered more than a visual impairment and a hearing impairment. This is because hearing cannot compensate for loss of vision and vice versa . This means that you have to compensate for the dual sensory loss by using the other senses such as tactile and smell. (Andreassen & Rodbroe, 2007).

• Deafblind children are exposed to many problems because they cannot communicate, and they cannot share their feelings, needs and ideas with others. They cannot feel secure, which leads to maladjustment and can appear in passivity, withdrawal, self stimulation, stereotypic behavior, dependency, decrease in self initiations for exploration, interaction and communication, difficulty in building social relationship, destroyed perception for world and low learning motivation. So we should be design an appropriate communication programs help deafblind children to achieve personal and social adaptation.

Aim- Study the effectiveness of using a program

supports a total communication philosophy to develop communication of deafblind children and help them to decide which method or methods of communication can be used with comfort and confidence.

Congenitally Deafblind person

The Nordic definition of deafblindness (2006)• Deafblindness is a distinct disability.

Deafblindness is a combined vision and hearing disability. It limits activities of a person and restricts full participation in society to a degree, which requires that society compensates by means of specific services, environmental alterations and/or technology.

Who should treated as Deafblind? • Sometimes we notice that a deafblind person can see when he

comes directly to someone or when he hear and answer although his hearing impairment.

• Deafblind person does not need much vision to see a big moving blob, nor does he require acute hearing to identify a repeated explosive familiar sound.

SO A limited ability to use some residual vision and/or hearing does not indicate the person does not have to be supported as deafblind.

CATEGORIES OF DEAFBLINDNESS

•There are four groups of deafblind people:

1.Totally deaf and totally blind.2.Totally deaf and has residual vision.3.Totally blind and has residual hearing.4.Has residual vision and residual hearing.

Statistics of deafblind persons

• In U.S there are approximately roughly 45,000 to 50,000 individuals who are deafblind. According to the 2007 National DeafBlind Child Count, over 10,000 are children under the age of 21.

• In Egypt there are not any statistics about deafblind children.

Total Communication•Total communication is the philosophy of supporting the right of

person who is deafblind to communicate in whatever way is most effective. It allows the individual to use all available sensory and communication abilities so he or she will be equipped to decide which method or methods can be used with comfort and confidence. •Total communication is using all or any means of communication such

as sign language, spoken language, fingerspelling, lip reading, written language, gesture, pictures, braille, objects of reference and augmentative communication system. Total communication acknowledges that the means of communication may need to be adjusted based on the situation. Sometimes signing is the right method to use; other times, it may be speech. In other situations, writing may be the best method to use.

• Total communication acknowledges that the means of communication may need to be adjusted based on the situation. Sometimes signing is the right method to use; other times, it may be speech. In other situations, writing may be the best method to use.

• Total Communication is a help to establish the dynamic process of communication where both partners are active and contribute to the process. It is used in an individual way, depending on the residual senses of the person.

• One way of communication is not more valuable than other. We have to respect and accept all means of communication.

The overall aim is to understand and to be understood.

Total Communication

Total Communication

Tactile sign language

Tadoma

Sign language

Writing

Finger spelling

Body language

Speech Braille PictogramObject of reference

Drawing

Photographs

Natural expressions

Facial expressions

Gestures

Parts of Total CommunicationNatural Expressions (Pre- Linguistic communication)Support System (Augmentative System)Language

Natural Expressions (Pre- linguistic communication)

Natural ExpressionsGestures

Body movement

Smile

Embodied signs

Smell cues

SoundsPointing Touch Happy

voicesLaughing

Go back to places

Rolling

Yawing

Happiness

Jumping

Support System (Augmentative System)

Support System

(Augmentative System)

Object of reference

Photos

DrawingsPictogram

Tadoma

Language

Language

Spoken Language

Sign Language

Writing Language

Hand alphabet ,

Finger spelling

Braille

Tactile Sign

Language

Method• This paper focus on using total communication to support the

communicative habilitation and to help the deafblind children to choose the proper method of communication. It introduces 3 models for children who are congenitally deafblind, with the aim of identifying communicative strategies that support their potential for language. The sessions was observed by video record and video analysis.

Participants•The participantes were 3 deafblind children:1- A boy was 12 years old. His left eye is totally blind and he had light

perception in right eye. He also had bilateral moderate hearing impairment and he use digital hearing aids.

2- A girl was 9 years old. She is totally deaf, her right eye is totally blind, she has visual impairment in her left eye and she use glasses. She was diagnosed as ADHD and she has autistic features.

3- A boy was 8 years old. He is totally blind and has bilateral severe hearing impairment.

Core strategies of communicative habilitation

1. Creating a natural context for communicative developmentNatural learning characterized as follows:• They are initiated and controlled by the child.• The partner of interaction is observant, reactive, and

responsible for the expansion.• The natural way of learning is to play. Play is chractarized by

shared affections, curiosity, and discovery through exploration.

2- Use the strong channels and try to instrument the residual senses.

• The most efficient channels in the case of deafblindness are movement, touch, airflow, vibration, smell, and taste.

• Our goal is to make functional use of every possible channel, however weak it might be.

• The more channels that the person will be able to use the more flexible he will be in new and complex situation.

3- Sensitivity and child- directed intervention• Both partner in communication must be aware of the

contribution of the other partner and ready to react to them in a way that keeps the interactional exchanges going.

• The partner of the deafblind person is responsible for expansion and further development.

4- Repetition and novelty• On one hand, we have to make use of recognition by use of

repetition to create conditions that help the deafblind person to have an overview and to support the cognitive development. On the other hand, we have to add novelty to a well- known act in order not to make it dull and thereby loose the interest of deafblind person.

• The development of a relationship between the partner and child is essential (attachment).

• The base of communication and language is the social interaction, the social/ emotional attachment and the ability of joint attention to a (third element).

• Social interaction go along parallel with the development of communication.

• Anticipation is very important, by means of structuring the daily activities around `highlights', the child may anticipate the coming events. In this anticipatory situation the child might initiate a signal himself

• It is more appropriate to start with the communication gestures within the motoric competence of the individual child.

• In the development from signal to symbol it is important that the child discovers the similarity between the gesture and what it depicts, e.g. between `hands making a sliding movement' and the activity of playing on the slide. Whether or not the child discovers this similarity is largely dependent on his intelligence.

Imitation• To facilitate the use of gestures by the child, emphasis

his expressions by imitation, especially of body movements.. The attention of the child is directed towards the movements the partner makes.

Results

• Results indicated that total communication allows the individual to use all available sensory and communication abilities so he will be equipped to decide which method or methods can be used with comfort and confidence.

التخاطب بدءStarting Communication

اللفظي األسئلة) التخاطب على اإلجابةوالضمائر(

الجلسة نهاية في

التأهيل قبل

والكتابة اإلشارة بلغة التخاطب

بأنه يشعر أن في الحق4 له إنسان الكفيف األصم الطفلومفهوم ومرئي مسموع