Unit 3: Deaf-blindness

3.1 Definition, causes, classification, prevalence and characteristics of deaf-blindness

3.2 Effects and implications of deaf-blindness on activities of daily living and education
3.3 Screening, assessment, identification & interventional strategies of deaf-blindness
3.4 Fostering early communication development: Methods, assistive devices and practices
including AAC.
3.5 Addressing orientation, mobility & educational needs of student with deaf-blindness.

3.1 Definition, causes, classification, prevalence and characteristics of deaf-blindness

Definition of Deaf-Blindness:
Multiple Disabilities (more than one specified disabilities) including deaf blindness which means
a condition in which a person may have combination of hearing and visual impairments causing
severe communication, developmental, and educational problems. (RPwD Act, 2016).

Causes of Deaf Blindness

There are many causes of deaf-blindness. Those that are present or occur around the time a child
is born include prematurity, childbirth complications, and numerous congenital syndromes, many
of which are quite rare. Deaf-blindness may also occur later in childhood or during adulthood
due to causes such as meningitis, brain injury, or inherited conditions.
1. Deaf-blindness is Usher’s Syndrome, Congenital Rubella Syndrome, CHARGE Association
and Old Age.
2. Severe head injuries, traumas, sexually transmitted diseases, such as syphilis and AIDS, drug
overdosing, medical errors and self-inflicted injuries.
3. Four primary causes of vision and hearing loss:
a. Hereditary/Chromosomal Disorders.
b. Prenatal viral/bacterial diseases or harmful chemicals (Teratogens).
c. Complications at birth.
d. Postnatal injuries and/or illnesses.

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Classification of Deaf-blindness

1. Congenitally Deaf with Acquired Blindness

2. Congenitally Blind with Acquired Deafness

3. Acquired Deaf and Acquired Blind

4. Congenitally Deaf and Congenitally Blind

The number of variables includes the etiology of the vision and hearing loss, the degree of the
vision and hearing loss, the timing of the vision and hearing loss & the level of stability of the
vision and hearing loss.

Types of acquired deaf blindness

1. ADAB – Acquired vision loss and acquired hearing loss: commonly happens to the elderly.
For example when an elderly person loses their hearing as they get older and then they begin to
lose their sight.

2. CDAB - Congenitally deaf and acquired vision loss: to be born deaf but then becomes blind at
some point due to a prevailing condition or brought on by something else.

3. CBAD - Congenitally blind and acquired hearing loss: to be born blind but then becomes deaf,
which can happen at any time by a prevailing condition or brought on by something else.

Prevalence of deaf-blindness

Prevalence is the proportion of a population who have a specific characteristic in a given time
period.

For a representative sample, prevalence is the number of people in the sample with the
characteristic of interest, divided by the total number of people in the sample.

There are several ways to measure and report prevalence depending on the timeframe of the
estimate.

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Point Prevalence:

Point Prevalence is the proportion of a population that has the characteristic at a specific point in
time.

Period prevalence:

Period prevalence is the proportion of a population that has the characteristic at any point during
a given time period of interest. “Past 12 months” is a commonly used period.

Lifetime prevalence:

Lifetime prevalence is the proportion of a population who, at some point in life has eve has the
characteristic.

Characteristics of Students with Deaf-Blindness

According to the Deaf Blind Services Division, Utah Schools for the Deaf and the Blind (N.D.),
depending on the age of onset, deaf blindness can affect learning in the areas of cognition,
communication, social interaction, motor skills, and motivation. Indicators of Deaf-Blindness
include:
1. The student has difficulty with communication
2. The student may have distorted perceptions. It is difficult to see the whole picture or
relate one element to the whole.
3. The student may have difficulty anticipating what is going to happen. Clues from the
environment or from the faces/actions of others may be difficult to read.
4. The student-may be somewhat unmotivated. Things may not be seen or heard enough to
be desirable.
5. The student needs to learn mainly through first hand experiences.
6. The lack of vision and hearing make it hard to learn through incidental or group learning
experiences.
7. Problems communicating
8. Problems navigating the environment

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Characteristics for children with deaf-blindness based on the cognitive, communication,
behavior and physical:
A. Cognitive
1. Inability to perform basic academic tasks
2. Difficulty in performing functional life skills
B. Communication
1. Difficulty with spoken language (nonverbal in some instances)
2. Limited vocabulary
C. Behavior
1. Exhibits low frustration tolerance
2. Difficulty in demonstrating age-appropriate behavior
3. Exhibits problems in adjusting to change
4. Exhibits self-stimulatory behaviors such as body rocking, an attraction to light and
hyperactivity
5. Exhibits inappropriate behaviors in touching and smelling objects and/or people
D. Physical
1. Difficulty with environmental mobility
2. Difficulty with vision
3. Difficulty with hearing
4. Difficulty with physical ambulation (motor problems/ orthopedic problems/cerebral
palsy)
5. Displays seizure activity
6. Difficulty with eating
7. Difficulty with bowel and/or bladder control
8. Difficulty in administering self-care

3.2 Effects and implications of deaf-blindness on activities of daily living and education

All persons who interact with learners who experience deaf-blindness must learn basic
interaction skills (e.g., using a cautious approach, touch, object and/or picture cues, name signs
in the learners language).

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Hand-under-hand is an important for shared experiences, exploration of the objects, and to model
and demonstrate concepts.

Always consider providing adequate time for processing information while also reducing
competing sensory information.

Consider individual information about the learner’s hearing and vision loss and any other
disabling conditions or factors complicating education.

Environmental and instructional considerations as well for both hearing and vision loss may
improve or allow the learner with deaf-blindness to gather information or learn from residual
vision or hearing.

Assessment of the skills of these learners requires a multidisciplinary team approach.

Assessment requires formal and informal tools and can be gathered during daily interactions and
routines.

These same routines can be a powerful tool in the building of skills for learners.

With careful thought and consideration, learners who experience deaf-blindness, can make
progress in any educational setting

3.3 Screening, assessment, identification & interventional strategies of deaf-blindness

Assessment of vision function and functioning:

 Visual behavior:
Special head posture
Child uses both the eyes / prefer to see one particular eye
Sensitivity to light/better vision in a day
Reaction to a sudden movement in front of the eyes
Child use glasses during the assessment.
 Eye Movements:
Nystagmus, strabismus, non-coordinated eye movements, smooth coordinated
movements and convergence to the near.
 Visual Attention:

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 To light, shiny object, contrast colored object, faces etc..
 Localization and Fixation:
Indicate object , its size, distance of the object, length of fixation.
 Following Moving Object:
Follow over central line, move eyes and head or only eyes.
 Eye hand coordination:
Follows the hand during activity.
Looks first, then grasps without eye control.
Search things only by touch or vision or both.
 Recognition:
Recognizes photographs, pictures of real objects.
Recognizes geometric shapes, pictograms, symbols separately.
Hearing Assessment

Hearing is the main sensory pathway through which speech and verbal communication
develop. If a child hears imperfectly, he is likely to speak incorrectly. Again, hearing also
influences learning and other aspects of maturation. Early detection of hearing impairment is
important for the overall development of the child. Hearing impairment reduces our knowledge
of the world around us. Children with auditory impairment may have difficulty in hearing in
either one or both ears or no power of hearing at all.

Screening procedures
1. Behaviour Observation: This technique involves presentation of known fixed intensity
sound at various frequencies.
2. Cribogram Technique: It is an instrument used for early testing of hearing impaired
infants. It comprises a crib to the sides of which speakers are connected which are in turn
connected to sound source. Whenever, the sound is produced the child makes a
movement. The movement is recorded with the help of a recorder kept below the child’s
bed. The high frequency sound is presented at known interval of time and the child’s
movement as a response to the given sound is recorded and measured.

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 3. Objective Measurement: Brainstem Auditory Evoked Responses are used for screening
of infants at intensive care units, using the electro encephalograph recording. This is used
for not only the severely or profound hearing infants but also mildly affected infants.
4. Impedance Audiometry could be used both for middle ear screening.
Interventional Strategies of Deaf-Blindness
Early intervention services for children who are deaf blind maximizes the potential for
growth and development, and support families and careers.

 Early intervention services can improve developmental, social, and educational

gains.
 Reduce feelings of isolation, stress and frustration that families may experience.
 Help alleviate and reduce behaviors of concern by using positive behavior
strategies and interventions.
 Help children with deaf-blindness disabilities grow up to become productive,
independent individuals.
 Reduce the future costs of special education, rehabilitation and health care needs.
Early intervention includes the using Assistive technology, Audiology, Deaf-blind Education
Team, Family training, Medical services, Nursing services, Nutrition/Dietetics services,
Occupations therapy and Physiotherapy.

3.4 Fostering early communication development: Methods, assistive devices and practices
including AAC

Three Levels of Communicative Abilities

Level 1 Emerging Communicators

These are pre-symbolic communicators who may display reflexive/reactive behavior (laughing,
crying) which is interpreted by the observer as communicative, and this level extends on through
individuals who exhibit intentional goal-directed behavior (not necessarily directed towards
another person), and finally on through those who exhibit intentional communicative behavior
(goal directed behavior directed towards another individual) using gesture or natural non-
symbolic means.

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Level 2 Beginning Symbolic Communicators might be using some symbols: manual sign or
sign approximations, vocalizations, stylized gestures (including pointing), and verbalizations or
verbal approximations. They use the symbols one at a time and have not started combining them
together much, if at all. They might use (or have tried) picture based communications strategies,
or a single or double-message speech generating device to indicate a simple greeting, the desire
for reinstatement of a preferred activity or a choice between two activities.

Level 3 Intermediate Symbolic Communicators may be using a number of symbols: manual

signs or sign approximations, vocalizations, verbalizations one at a time, they may be combining
the symbols at least in a rudimentary syntax or word order, e.g., I want.... I like... I don’t like... I
go... etc.

Tadoma Method

Tadoma is a way to understand what someone is saying by touch. This is why it is also
known as “tactile lip-reading”. You place your thumb on the speaker's lips, your three middle
fingers along the jawline and your little finger on the throat.

Hand-Under-Hand Interactions
The hands of a child who is deaf-blind are precious. Like the eyes and ears of a hearing-
sighted child, the hands allow a child who is deaf-blind to explore, communicate, and make
sense of the world around them.

Using hand-under-hand interactions appropriately,

teachers and related service providers can gently encourage a child’s learning by placing their
hands under the child’s to help guide the child’s tactile exploration. In this manner, practitioners

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can introduce, demonstrate, and explore objects and surroundings as well as follow along where
the child shows interest and curiosity.

Tactile Learning Strategies

Vision and hearing are the primary senses through which education occurs for
most children. When these senses are absent, distorted, or diminished, educators
and families must use alternative strategies to support learning.

These strategies include tactile modeling, mutual tactile attention, and the use of a
hand-under-hand approach to interactions.

Maximizing the Use of Hearing and Vision

There are many ways to maximize hearing and vision for a child with deaf-blindness.

These include medical devices like glasses and hearing aids, assistive technology, and
individualized educational accommodations. The foundation for determining the best devices
and accommodations for a particular student is a careful, thorough assessment.

Educational personnel play an essential role in helping students use accommodations and
devices and making observations about how well they work. Making the most of (maximizing)
any vision or hearing that a student with deaf-blindness has, will help them be as successful as
possible in school and life.

Assistive Devices

Definition

Any item, piece of equipment, or product system, whether acquired commercially off the shelf,
modified, or customized, that is used to increase, maintain, or improve the functional capabilities
of a child with a disability. The term does not include a medical device that is surgically
implanted, or the replacement of such a device. (IDEA, 2004)

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Assistive devices and services can be of great value in providing infants and young children with
disabilities opportunities to learn and interact with their environment in ways that might not
otherwise be possible. For example, assistive technology can help a child to:

 participate more actively in family, school and community activities

 play successfully with toys and other children
 communicate his or her needs and ideas
 make choices
 move independently
 “Access to literacy begins at the prelinguistic stage, as with typically developing infants
and toddlers...Access to books can be enhanced through modifications of physical,
linguistic, and cognitive properties.”
 Modifications of learning environments can provide the “door” to all children to
participate and to learn together
 Early intervention is needed to allow children with disabilities to have opportunities to
develop critical skills for continued learning and development
 Research to date supports the use of AT in early intervention to increase participation
and mastery of pre-academic skills.

AAC: Augmentative or Alternative Communication (AAC) is any device, system, or method

that improves the ability of a child with communication impairment to communicate effectively.

Augmentative and Alternative Communication is a multimodal method enabling children to use

gesture, vocalization, sign, and speech to enhance their communication. (Adapted from ASHA,
2005)

AAC is introduced when the student does not develop communication in the typical fashion, or
experiences significant delays, and is used to AUGMENT (add to) whatever communication the
student possesses, as part of a “multimodal” system.

Multimodal communication is our natural means of expressional of us use different

modes of expression constantly and are able to “read body language” when we are interacting
with others. An Assistive Technology Communication Evaluation can be conducted formally or

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informally, by school-based teams, private therapists, or clinics. The AAC tool needs to be
positioned properly so that the student can access it consistently and intentionally. Direct
selection is a method of access in which the individual specifically indicates the desired item in
the selection set without any intermediary steps.

3.5 Addressing orientation, mobility & educational needs of students with deaf-blindness
Orientation and Mobility (O&M) instruction provides students who are deaf-blind with a
set of foundational skills to use residual visual, auditory and other sensory information to
understand his or her environment. For the child who is deaf-blind, movement is an opportunity
to gather sensory information, to communicate, and to make choices. O&M instruction provides
opportunities and skills that can broaden the student’s awareness of the environment, resulting in
increased motivation, independence and safety.

Orientation skills allow us to know where we are, where we are going, and how to think
about and plan strategies for getting to a destination. Mobility involves the actual movement
from place to place. Along with communication skills and daily living skills, O&M skills are
essential for all children who are deaf-blind. The ability to understand the environment and to
move safely within it is an important component of future development, success, and
independence.

O&M instruction for individuals who are deaf-blind is designed to teach them to move as
independently and as purposefully as they are able. For some children who are deaf-blind, it is
reasonable and desirable to expect that they will move about independently in both indoor and
outdoor environments. This independence may mean using a long white cane to cross streets
successfully and learning to use city transportation systems. For others, O&M instruction will
provide the skills necessary to allow independent movement within the classroom or within the
home. At a more basic level, and for children with limited motoric capabilities, increased
independence will mean that they have better developed residual senses and can more fully
understand and interpret information from their environments. They may come to understand
where an object is located and where the object is in relation to their own bodies. They will have
the ability to move with purpose, perhaps to extend an arm or roll to obtain that object.

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 It is necessary to consult with an O&M specialist who can help to refine and individualize
specific mobility skills appropriate for a particular child, develop individualized instructional
programs, and recommend additional resource information.

 Guided Travel
Using this technique, the deaf blind child maintains a constant grip on the
guide’s arm while following the guide around obstacles as they travel
through the environment.
 Protective techniques
Protective techniques allow students to travel
independently, yet safely, in familiar places, enabling them
to locate objects while protecting their bodies. Protection
skills are primarily used in familiar indoor environments
and are designed to provide information about the
environment during travel.
 Trailing
While trailing, a student will extend the arm at about 45
degrees, holding the arm to the side and slightly in front of the
body while maintaining contact with a surface, such as a wall.
This technique can provide a student with a method of
maintaining alignment.
 Mobility Devices
There are many mobility devices that can, when properly used provide a student with the
means for independent, safe, efficient travel. The most commonly recognized mobility device is
the long white cane.
 Dog Guides
Some individuals who are deaf-blind prefer to use dog guides rather than canes. Dog guide
use is taught at special dog guide schools. Most of the schools work primarily with adults who
are blind or visually impaired, but there are several that offer their services to individuals who
are deaf-blind as well. Individuals who are considering a dog guide must also understand that
there are additional responsibilities in caring for their dog, including the daily feeding, grooming,
and toileting issues.

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 Electronic Travel Aids
Electronic Travel Aids (ETAs) are portable devices that emit sonar or laser signals that are
reflected back to the user during travel, and are converted to auditory and/or tactile signals. The
devices are hand held, or chest, head, wheelchair, or cane mounted, and usually serve to provide
supplementary information during travel. Individuals using ETAs can learn to interpret
information they receive from the device about obstacles that may be in their direct path, about
“openings” in hallways, and about drop-offs or inclines in the travel surface. They may also be
used to enhance trailing abilities.
 Wheelchair Mobility
Any O&M program for students using wheelchairs must be highly individualized and must
take into account the student’s residual senses, his or her ability to operate a chair with one hand,
and the potential use of a motorized wheelchair. In addition to the O&M specialist, the student’s
physical therapist and occupational therapist must be actively involved in all decisions regarding
mobility for wheelchair users.
Educational needs
Communication and language instruction is the cornerstone of educational programming
for children who are deaf blind. Deaf blindness severely limits access to models of
communication and language and to the general curriculum. Many children who are congenitally
deaf blind struggle to develop symbolic communication.
Tactile sign language, tactile finger spelling, methods of speech reading, use of object symbols,
print on palm, finger braille, or braille communication cards rely upon the student’s tactile sense
for receptive communication with partners. Close range sign language, sign language in the
student’s field of vision, lip reading, picture symbols, large print communication boards, or
regular print rely on residual vision. Speech relies on residual hearing and vision. A constellation
of variables should be considered when teaching and supporting the acquisition of symbolic
forms.
Children who are deaf blind should have an Individualized Educational Program (IEP) or
an Individualized Family Service Plan (IFSP) developed and implemented by a team that
includes at least one member who has expertise, knowledge, and skills in deaf blindness.
Teachers who have preparation in the educational specialty of deaf blindness are necessary to
provide optimal programming

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References
1. https://www.nationaldb.org/info-center/educational-practices/maximizing-hearing-vision/

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