Deaf Blindness

Think about this:

A child who is deaf or hard of hearing– Learns through vision.

A child who is blind or visually impaired– learns through hearing.

A child who is Deaf Blind– Learns through touch.

What is deaf blindness?

According to the IDEA, Deaf Blindness is defined as concomitant (simultaneous) hearing and visual impairment, the combination of which cause 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.

Deaf-blindness is a unique and complex disability!

• Individuals are characterized as having blind, if they have
  • Low vision in the better eye
  • Legally blind with light perception
  • Critical visual impairments
• Hearing impairments can range from mild loss to severe and profound loss
• Communication and mobility are the two areas most affected by a loss of sight and hearing.

Characteristics of Deaf Blindness

Common characteristics:

• Having a problem in communication with his/her environment in a meaningful way.
• Appear to withdrawn and isolated.
• Lack of curiosity and deprived of motivations.
• Have medical problems.
• Unusual sleep patterns.
• Have develop unique learning style.
• Feelings of vulnerability; generally, the learner will experience feelings of greater security / safety in a seated position.
• Difficulty developing skills for communicating with others in a meaningful way.
• Trouble learning object permanence (i.e. knowing objects and people still exist when they cannot be directly seen or heard) Not fully understanding object permanence greatly impacts learning.
• Inconsistent responses to sounds or visual images (i.e., developing functional use of remaining sensory skills can be difficult)
• Developing a distorted perception of the world (i.e due to a lack of non-distorted information from the distance senses); they typically perceive time very differently i.e time seems to pass much more slowly.
• Unusual responses via the impact senses (e.g., tactile sensitivity or tactile defensiveness, particularly around the face)
• An overactive startle response.
• Difficulty interacting with things in the environment in a meaningful way and / or generalizing information.
• Stereotype (because of fear, confusion, and / or sensory deprivation)
• Delayed motor skills, such as crawling and reaching (because these are motivated and further developed by the use of vision and hearing); difficulties interpreting movement.
• Problems in maintaining and restoring balance.

Referral characteristics:

A. Cognitive

• Inability to perform basic academic tasks.
• Difficulty in performing functional life skill

B. Communication

• Difficulty with spoken language
• Limited vocabulary.

C. Behavior

• Exhibits problems in adjusting to change.
• Exhibits self-stimulatory behaviors.
• Exhibits low frustration tolerance.

D. Physical

• Difficulty with environment mobility.
  • Difficulty with vision.
  • Difficulty with hearing.
  • Difficulty with physical ambulation (motor problem).
  • Difficulty in eating.
  • Difficulty in administering self-care.

Screening and Identification

The earlier deaf blindness is diagnosed, the better. All babies are offered hearing screening just after they’re born. These tests can pick up many hearing impairments.

If you’re worried about your child’s vision or hearing as she gets older, first see your General Physician. Your GP will refer you to an Audiologist and/or Ophthalmologist. These specialists will look at your child’s ears and eyes, ask you questions about how your child acts, and do tests. At the end of this, the specialists should be able to say exactly what the problem is.

Procedures and Assessment Measures used to diagnose Deaf Blindness

If a student is suspected of having Deaf-Blindness, an evaluation for both a visual impairment and hearing impairment shall be conducted:

• Evaluation for a visual impairment should include the following:
  • Evaluation by an ophthalmologist or optometrist, which documents the eye condition with the best possible correction
  • A written functional vision assessment, completed or compiled by a licensed teacher of students with Visual Impairments, which includes:
    • Observation of visual behaviors at school, home, or other environments
    • Educational implications of eye condition based upon information received from eye report
    • Assessment and/or screening of expanded core curriculum skills (orientation and mobility, social interaction, visual efficiency, independent living, recreation and leisure)
• Evaluation for a hearing impairment should include the following:
  • An audiological assessment by an audiologist licensed by a State Board of Examiners in Speech Pathology and Audiology;
  • A medical statement or a health assessment statement indicating whether the hearing loss, if conductive, is treatable and whether the use of amplification is contra-indicated;
  • Assessments to determine the impact of the suspected disability:
  • A developmental history, if needed
  • An assessment of intellectual ability
  • Other assessments of the characteristics of speech and language impairments if  any
  • Assessments to determine the impact of the suspected disability: On the student’s educational performance when the student is at the age of eligibility for kindergarten through age 21 On the student’s developmental progress when the student is age three through the age of eligibility for kindergarten.

Causes of Deaf-Blind

Deaf blindness is not caused by a single condition. People can be born deaf blind, possibly as a result of infection, a genetic syndrome or birth trauma. This may result in congenital deaf blindness. Acquired deaf blindness refers to instances where a person becomes deaf blind later in life, as a result of a progressive condition or through infection, accident or due to the process of ageing.

Four primary causes of vision and hearing loss:

• Hereditary/Chromosomal Disorders.
• Prenatal viral/bacterial diseases, or harmful chemicals(Teratogens).
• Complications at birth.
• Postnatal injuries and/or illnesses

Some of the most common causes of deaf blindness are

1. Usher’s Syndrome,
2. Congenital Rubella Syndrome,
3. CHARGE Association and
4. Old Age.

 Other causes are

• Severe head injuries;
• Traumas;
• Sexually transmitted diseases, such as syphilis and AIDS;
• Drug overdosing; medical errors and
• Self-inflicted injuries.
• Fetal alcohol syndrome
• Hydrocephaly and Microcephaly
• Maternal drug abuse

Infections

• Rubella contacted during pregnancy
• Other infections, affecting the fetus, include Cytomegalovirus (CMV) or Toxoplasmosis.
• Meningitis
• Rubella and Congenital Rubella Syndrome

Syndromes

• CHARGE Association
• Goldenhar Syndrome
• Usher Syndrome

CHARGE Syndrome

• C – Coloboma (hole in the eye structure),
• H – Heart defects,
• A – Choanal Atresia(nasal passages are blocked),
• R – Retarded growth,
• G – Genitalia anomalies,
• E – Ear anomalies.

Usher Syndrome

• It is named after Dr. Charles H. Usher, who noticed the correlation between the two conditions, hearing loss combined with retinitis pigmentosa. Usher Syndrome affects between 3 and 6 percent of the deaf community. Currently, the following three types of Usher Syndrome are recognized:
• Type I :Born profoundly deaf, has balance problems, Night blindness in early childhood.
• Type II :Born hard of hearing, has no balance problems. Blind spots by teens. Legally blind in early adulthood.
• Type III: Born with good hearing or mild hearing loss, has some balance problems. Night blindness in childhood, blind spots by early adulthood, legally blind by middle age.

Goldenhar syndrome also known as oculo-auriculo-vertebral (OAV) syndrome is a rare congenital defect characterized by incomplete development of the ear, nose, soft palate, lip and mandible

Classification and types of deaf blind

The two broad types of deaf blindness are:

• Congenital deaf blindness is a term used if a person is born with a sight and hearing impairment. This may be due to infections during pregnancy, premature birth, birth trauma and rare genetic conditions.
• Acquired deaf blindness is a term used if a person experiences sight and hearing loss later in life. Anyone can become deafblind at any time through illness, accident or as a result of ageing.
• Usher Syndrome

Types of deaf-blind

Deaf-blind individuals do not all acquire their combined vision and hearing impairment in the same way. An individual may be:

• Born both deaf and blind
• Born blind(or acquire blindness first) and later become deaf
• Born deaf (or acquire deafness first) and later become blind
• Acquire both deafness and blindness later in life

Degree of deaf blind

• Moderate to profound auditory and significant visual impairment.
• Moderate to profound auditory and significant visual impairments and other significant disabilities.
• Central processing problem of vision and hearing.
• Progressive sensory impairment.
• A significant visual impairment; and a possible loss of auditory processing mechanisms(associated with severe physical disabilities or severe cognitive disabilities) and severe communication delay.

IMPACT OF DEAF BLINDNESS

ON LITERACY

Literacy is nothing but the ability to read and write. Children with deaf-blindness face the following challenges:

• Reduced incidental opportunities for language development through observation and listening to people around them as they cannot see or listen and perceive the things.
• Reduced materials in appropriate literacy mode as reading and writing materials may not be accessible.
• Difficulty obtaining appropriate literacy related equipment. For e.g., visually impaired children may not have easy access to braille’s, large print materials, etc.
• Challenges of picture related learning especially visually impaired children may have problems in learning through pictures.
• Reduced experiences due to added disabilities. The presence of additional disabilities like hearing/vision impairments with cognitive delays, cerebral palsy etc. creates further challenges in reading and writing.
• Lack of appropriate educational intervention. Children with deafblindness/multiple disabilities often do not receive early and appropriate intervention that leads to delays in the acquisition of literacy skills.
• They may face many challenges in acquiring language, concepts and reading/writing skills.

ON COMMUNICATION

• Communication skills are interactive skills that help you to exchange information with others.
• The child who is deafblind has reduced opportunities to interact with objects and people, significantly and negatively affecting language development.
• The child who is deafblind is dependent upon people in the environment to not only create interaction opportunities but also to label objects, people, and experiences.
• From infancy, the isolation of deaf blindness affects communication by negatively impacting the infant/caregiver relationship.
• Bonding is difficult for the parents and other primary caregivers of infants who are deafblind because of their limited responses.
• Children who are deafblind receive dramatically less input. Input must be thoughtful and planned.

ADAPTATIONS, ACCOMMODATIONS AND MODIFICATIONS FOR CWDB

Children with deaf-blindness requires considerable modifications to teaching content and different teaching strategies. They cannot learn from what they see like the deaf children does. they cannot learn from listening like the blind children does they learn only by what they do.

• A person who is deaf-blind has a unique experience of the world. For people who can see and hear, the world extends outward as far as his or her eyes and ears can reach.
• For the young child who is deaf-blind, the world is initially much narrower. If the child is profoundly deaf and totally blind, his or her experience of the world extends only as far as the fingertips can reach.

These four categories include learners who are:

• Totally deaf and totally blind;
• Totally deaf, but able to use vision to some degree;
• Totally blind, but able to use hearing to some degree; and
• Able to use some residual hearing and some residual vision.

DEFINING THE TERMS

• Adaptations are changes permissible in educational environments which allow the student equal opportunity to obtain access, results, benefits, and levels of achievement.
  • Adaptations are changes made to the environment, curriculum, instruction and or assessment practices in order for student to be a successful learner.
  • Adaptations include both Accommodations and Modification
  • They are based on the individual students Strength and Needs.
  • Meaning of Adaptation- Changes suitable for a purpose, Modifications, Alterations, Reshaping, Accommodations
• Accommodations: Some curricular adaptations do not alter or lower standards or expectations in either the instructional or assessments and designated as Accommodations.
• Modifications: Some adaptations do alter or lower standards or expectations and can be termed Modifications.

ACCOMMODATIONS AND MODIFICATIONS

• Test should be taken orally rather than totally relying on written tests.
• Large print text books are to be provided.
• Additional time should be provided to take Tests.
• Additional locker/desk/shelves to keep their equipment.
• Peer support for note taking.
• Tactile or printed graphics for better understanding.
• Total Communication strategies must be used which include signed, oral, auditory, written and visual aids.
• Hands on experiences (actually doing a particular thing)
• Contrast must be used which can be helpful for students who have visual challenges. Contrast is about how much something appears to stand out from its background. It’s harder to see things that are similar in color to the background.

PRINCIPLE COMMUNICATION SYSTEM

• Tactile representations: Through the sense of touch of pictures, maps, graphs, diagrams, and other images. A person with a visual impairment can feel raised lines and surfaces in order to obtain the same information that people who are sighted get through looking at pictures or other visual images.
• Touch cues: Touch cues are physical cues that are used in a consistent manner on the child or adult’s body to give a specific message about what is about to happen to the person.
• Object cues: A real object or part of an object used to represent an activity, place, or routine. Examples: Spoon= time to eat; Cup= time to drink
• Picture symbols
• Sign language
• Finger spelling
• Braille writing and reading
• Large print writing and reading
• Lip-reading speech

ASSISTIVE TECHNOLOGY

• Hearing aids / FM Systems (Auditory Trainers)
• Glasses / Low vision devices (magnifiers, monocular, CCTV, etc.)
• Alerting devices (vibrating alarms, watches, etc.)
• Captioning (TV and Video)
• TDD, Tele braille or relay services for making phone calls
• Calendar system
• Calculators
• Intervener, interpreter or interpreter-tutor

INSTRUCTIONAL

• Reactive Environment
• Hands on experiences
• Total communication strategies
• Anticipation strategies
• Sensory Integration strategies
• Clear directions
• Experimental learning
• Verbalization of writing
• Oral Description or Narration
• Note taker
• Extra time for responses in class
• Models

CHALLENGES IN EDUCATING DEAF BLINDNESS IN INCLUSIVE SETUP

• “Inclusion is a dynamic approach of responding to pupil diversity and seeing individual differences not as a problem, but an opportunity for enriching learning.” (UNESCO 2004)
• Lack of experience in an inclusion setting is a challenge. Some teachers have not been exposed to special needs classrooms and this can be a disadvantage. Educators need to coordinate efforts and understand the needs of the classroom in terms of developing skills and lesson plans.
• Students with deaf blindness may have poor posture and poor hand control. They may easily bump into furniture, equipment and people in and around the classroom.
• They may also have difficulties in learning to read and write.
• They may be unable to read the blackboard, projected materials, print and diagrams of small sizes. As each child’s problem is unique, strategies to cope with problems are highly individual.
• As there is little or no imitative learning through vision, their learning will also be slow and their attention span short. They may require more time to complete a task.
• With limited mobility, they may encounter difficulties when participating in classroom activities, games and other outdoor activities.
• Some can benefit from good sources of light; while others are hindered by bright light.
• Partially sighted students will usually need extra time on their test, especially if they are reading the test by themselves.
• The learning difficulties of hearing-impaired children lie primarily in their difficulties in speech and language, which may in turn vary according to their degrees of hearing loss.
• The impact of hearing loss can cause delays in receiving learning material.
• Language plays an important part in the higher intellectual development, especially in problem solving. Deafness may cause a language deficit, which in turn affects progress in learning.