Deaf-Blindness

By: Carmen Willings
teachingvisuallyimpaired.com

Deafblindness refers to a combination of hearing and vision loss. Most students who are deafblind are not completely deaf or blind, but have some degree of hearing and vision loss. The combined effects of the two sensory losses can have a very significant affect on the student's learning.

There is an added challenge for students who are deafblind to make sense of their world. As with other areas of visual impairments, it is essential to maximize the students use of their remaining hearing and vision, along with other senses and provide concrete methods of communicating in order to help them gain information and learn about their world.

Types of Auditory Impairments

1. Hearing loss is the loss of sound sensitivity (partial or complete) produced by abnormality anywhere in the auditory system.
2. Central auditory processing impairment occurs when there is no loss of sound sensitivity but sensory information is processed inadequately or not at all.

Degrees of hearing loss

• Normal (0-15 decibels and the student is able to detect and discriminate all speech sounds)
• Borderline Normal (the loss is 16-25 decibels and the student has some difficulty hearing conversational speech)
• Mild (the loss is 26-40 decibels and the student may have difficulty hearing quiet speech/sounds),
• Moderate (the loss of 41-55 decibels and the student may have difficulty hearing normal conversations),
• Moderate to Severe (the loss of 56-70 decibels and the student has difficulty understanding speech in most situations),
• Severe (the loss of 71-90 decibels and the student may be able to identify environmental sounds, but is unable to hear conversational speech), and
• Profound (the loss of 91+ decibels and the student may hear loud sounds and feel vibrations).

Forms of Communication

There are different forms of communication that a student who is deafblind may use. The Hearing Impairment Teacher and/or Speech and Language Pathologist will provide input in selecting a method for communication. The method may be modified over time as the student's developmental level changes or if there is a change in the students hearing or vision. The following are the primary communication options:

Sign Communication

• Manually Coded English. This type of sign communication uses signs in exact English word order.
• Simultaneous-Communication. This type of sign involves the simultaneous use of speech and manually coded English.
• American Sign Language (ASL). This manual language has its own syntax and grammar. It consists of hand signs, body movements, facial expressions and gestures.
• Contact Signing. This sign system uses ASL signs in approximate English word order and is used as a form of communication between users of ASL and English.
• Bi-Lingual & Bi-Cultural Communication. This uses a combination of ASL and spoken/written English and Cued Speech.

Aural Modes

• Auditory-Oral. This method maximizes a students use of hearing through amplification (hearing aids; cochlear implant). Speech reading (deciphering lip, cheek and throat movements along with gestures and context clues to understand spoken communication) is encouraged in this method.
• Cued Speech. This method combines speech reading with a system of hand shapes placed near the mouth to help students differentiate words that look similar on the lips or are hidden from view.

Total Communication

Total communication includes the use of any form of communication that is appropriate in meeting the unique needs of the student in a given situation, including signs, finger spelling, speech, speech reading, and amplification. If the student demonstrates strengths in using hearing and/or touch to communicate, the following are options:

• Auditory-Verbal. This emphasizes auditory skills and listening for communication, with aided hearing alone; no manual communication is used and the use of visual cues is discouraged.
• Tactile Signing. This uses signing under a student's hands or on a student's body so the signs can be felt by the student.
• Tadoma. In this technique, the student uses their hands to feel another person's mouth and throat in order to understand spoken language.

Amplification Options

• Ear-level aids fit behind the ear and are attached to a soft earmold placed in the bowl of the ear.
• Body aids are used with students with limited head control.
• Cochlear implants are electronic hearing devices that are implanted in a student's inner ear. They are designed to produce useful hearing sensations to those with severe to profound nerve deafness by electrically stimulating nerves inside the cochlea of the inner ear.

Deafblindness refers to a combination of hearing and vision loss. Most students who are deafblind are not completely deaf or blind but have some degree of hearing and vision loss. The following resources can help learn more about deaf-blindness and instructional strategies. If you are aware of other helpful resources, please let me know so I can add them here! Links are embedded in the titles of organizations whose websites are identified as secure. 

Deafblind Online Resources

• ​​A to Z of Deafblindness is a web resource that provides resources specific to deafblindness. Resources include web resources, mailing lists, unique equipment, poetry, videos, and listservs for people who are blind and deaf.
• ​​The Alabama Institute for Deaf and Blind (AIDB) is a comprehensive education, rehabilitation, and service system serving children and adults who are deaf, blind and multi-disabled. Alabama Institute for Deaf and Blind (AIDB) has a wealth of resources and expertise to share related to services and information about hearing and vision loss.  The Reference Desk has online resources available.
• The American Association of Deaf-Blind (AADB) ​​​​The American Association of Deaf-Blind (AADB) is a nonprofit national consumer group of, by and for deaf-blind persons and their supporters.
• ​​Deafblindinfo.org ​​​The American Association of Deaf-Blind (AADB) is a nonprofit national consumer group of, by and for deaf-blind persons and their supporters.
• ​​Helen Keller National Center for Deaf-Blind Youths and Adults ​Helen Keller National Center for Deaf-Blind Youths and Adults provides rehabilitation services, employment services, services for students, low vision services, as well as services for seniors and those with developmental disabilities.
• ​Intervener Intervener provides information on interveners, those who work with students who are deafblind. In addition to information on interveners, it provides information on deafblindness, training, intervention, and additional resources.
• ​​Listenclear Listenclear has put together an American Sign Language Resource Guide that includes several helpful resources.  ​
• ​National Center on Deaf-Blindness This is a national technical assistance center funded by the federal Department of Education. It works to improve the quality of life for deaf-blind children and their families.
• ​National Coalition on Deafblindness​. This is an organization of parents, professionals, persons who are deafblind and agencies that advocate for children who are deafblind. They run a discussion group on legislative and policy issues related to education.
• ​National Consortium on Deaf-Blindness​. The National Consortium on Deaf-Blind is a federally funded, national information clearinghouse that identifies, coordinates, and disseminates information related to children and youth who are deaf-blind.  It provides publications, databases, and other resources for deaf-blindness.
• ​​National Family Association for Deaf-Blind (NFADA). This national non-profit membership organization strives to empower and advocate for families of individuals who are deaf-blind.
• ​​The SKI-HI Institute ​is a unit of the College of Education’s department of communicative disorders and deaf education at Utah State University, Logan. Outreach programs to Utah citizens and families and professionals in nearly all 50 states and Canada are a part of their focus. The Institute’s primary purpose is to identify and respond to the real needs of young children who are deaf/hard of hearing, blind/visually impaired, deafblind, multi-disabled, or who have any special needs.

Additional Resources

Deafblindness: Educational Service Guidelines by Marianne Riggio provides a framework for creating a program for students who are deafblind. The guidelines, developed by a group of educators and family members, identify the knowledge and skills educators need to assist students who are deafblind reach their full potential and become successful contributing members of society.

Signing Savvy is a great web resource to use with students who are learning sign. It provides a searchable web dictionary and a video of how to sign the word or phrase!

Compensatory Skills

Concept Development

• Demonstrates awareness of objects
• Demonstrate understanding of object permanence
• Plays with toys – takes adv. of characteristics
• Open container to locate noisemaker
• Demonstrate interest in toys
• Object identification
• Match/Classify objects by shapes
• Match/Classify objects by size
• Time awareness and concepts
• Spatial awareness
• Quantity Concepts

Alternative Communication

• Body responses & gestures for communication
• Choice Board (object/tactile/picture)
• Communication system (calendar boxes)
• Sign language/tactile sign (deafblind)

Emergent Literacy

• Explore pictures/objects from story
• Explore & turn pages
• Proper care of books
• Awareness of environmental print/braille
• Pretend to read/write print/braille

Access Print

• Use low vision tools to access near print
• Use low vision tools to access distance print
• Use technology to access digital print
• Use screen sharing to access print at distance
• Access variety of print formats
• Identify print size needed

Pre-Braille

• Tactile discrimination of symbols
• Identify spatial position of dots in braille cell
• Identify the dot number in a braille cell
• Track a line of dots from left to right
• Track a row of dots
• Identify beginning/end/breaks on a braille line
• Tactually explore a braille page
• Track braille sentences when read aloud by adult
• Orients braille book correctly
• Turn pages in a braille book one at a time
• Locates the first braille line on a page
• Locate the page number in a braille book
• Use two hands to track braille
• Use pointer finger as lead finger
• Use pinky finger to detect the end of a line
• Use light touch
• Use two hands separately to track and return
• Locate name in braille
• Identify same/different braille shape
• Identify the braille alphabet
• Identify the literary braille numerals 0-10

Braille Code

• Read/write the alphabet
• Read/write whole-word alphabet contractions
• Read/write whole and part word contractions
• Read/write short form words
• Read/write lower signs
• Read/write part word signs
• Read/write whole word signs
• Read/write initial letter signs
• Read/write final letter signs
• Read and produce literary numbers
• Read and produce braille indicators
• Read and produce symbols and punctuation
• Braille Reading Fluency
• Read back personal writing and edit
• Access a variety test & worksheet formats
• Apply rules for contractions, punctuation, comp.
• Use alternate braille codes (ex. Language, music, etc)

Braille Formatting

• Locate beginnings of paragraphs
• Writes paragraphs, indenting two spaces
• Read/write lists
• Locates and read transcriber’s notes, picture captions
• Locates headings/subheadings in a text
• Reads/write columned materials and tables
• Read/write format for poetry and plays
• Write outlines in correct (literary/textbook) format
• Locate preliminary pages, special symbols page
• Use table of contents, glossary and index
• Locate/read words and definitions in dictionary
• Use a multi-volume textbook

Braillewriter

• Locate/name parts on a braillewriter
• Make random braille dots
• Insert/remove paper from braillewriter
• Operate line advance/carriage return
• Operate backspace
• Use correct fingers on keys
• Produce uniform dots using correct finger strength
• Erase errors with a braille eraser
• Use spacebar appropriately
• Set margin stops on braille writer
• Change margin for various format needs (ex. column)
• Spatially arrange math problems
• Proofread writing and make corrections

Slate & Stylus

• Identify the dot numbers in cell on a slate
• Load paper in the slate
• Create legible, uniform dots
• Skip space on a slate
• Create letters, words, and numbers
• Use slate & stylus to complete tasks
• Proofread writing and make corrections

Tactile Graphics

• Explore Tactile graphics
• Locate/identify title, key and symbol
• Identify meaning of various textures on globe/map
• Interpret graphical information (e.g. graphs & charts)

nemeth code

• Read/write numerals in Nemeth Code
• Read/write signs of operation (+, -, x, /)
• Read/write linear mathematical equations
• Read/write horizontal mathematical equations
• Read/write symbols of comparison (<,>, =)
• Read/write symbols money using signs: $, ¢, .)
• Read/write fractions
• Read/write mixed numerals
• Read/write temperatures using sign for degrees
• Read/write percent
• Read/write grouping symbols ( , ) , [ , ] , { , }
• Read/write Nemeth punctuation (, -, : )
• Read/write modifier signs for lines, arrows, rays, bars
• Read/write shape indicator (circle, square, etc.)
• Read/write signs/format for parallel & perpendicular
• Read/write signs for angles
• Read/write adv. symbols of comparison (i.e. ≠, = )
• Read/write square roots
• Read/write subscripts/superscripts
• Read/write algebraic expressions
• Read/write chemical equations
• Read/write braille clock/watch
• Write time
• Measure to the nearest centimeter, ½”
• Construct/draw measure geometric figures & label
• Use braille/tactual tools to measure
• Display data on tactual graph
• Interpret data in various tables and graphs
• Read/write standard/metric measurements
• Read/write advanced Nemeth code symbols
• Apply rules to complete grade level problems

Access Classes

• Use of charts, graphs, maps
• Measurement tools
• Handwriting (legibility)
• Develop a consistent signature
• Use signature writing guide
• Use of needed accommodations
• Interpretation of Tactile graphics

Abacus

• Identify all parts of the abacus
• Demonstrate understanding of set, clear and count
• Set numbers in the ones column
• Set numbers in the tens column
• Set and read whole numbers according to place value
• Demonstrate understanding of 0/9 exchange
• Add/subtract 0-4 on the abacus
• Add/subtract numbers 0-19 on abacus
• add/subtract 1-4 digit # to/from a 2-5 digit #
• Add 1-4 digit # to a 2-5-digit numeral on abacus
• Set and read decimal numbers to place values
• Subtract decimals using abacus
• Add decimals using abacus
• Multiply decimals on abacus
• Set/read mixed fractions using 1 or 2 abacus
• Set/read complex fractions using 1 or 2 abacus
• Add/subtract simple fractions using 1 or 2 abacus
• Add/subtract mixed/complex fractions using 1 or 2
• Multiply/divide [simple; mixed; complex] fractions
• Set and read multiplier and multiplicand
• Multiply/divide 1-3 digit #s to 2-5 digit #s
• Compute ratios on the abacus
• Compute percent on the abacus

Organization

• Put items away where they belong
• Organize Items in backpack/desk
• Independently store and retrieve personal items
• Label or mark personal care items
• Trial a variety of labeling & filing materials
• Trial a variety of office supplies
• Maintain personal address/phone directory
• Organize information & documents

Study Skills

• Take and read back notes
• Search and scan written materials
• Use reference materials
• Research Skills
• Demonstrate map, chart, graph reading skills
• Use scanning techniques in primary reading medium
• Use library on level commensurate with peers
• Take notes and access them
• Ident. Key words, dates, def. in text and in lectures
• Use of live reader

Time Management

• Ready on time
• Is prepared as activities begin
• Follow daily schedule
• Create daily to do list
• Access recreational materials in unstructured time
• Demo. ability to use a watch/clock
• Keep schedule of activities for day, week, month

Listening Skills

• Respond to oral instructions
• Follow along during oral reading
• Organize oral info. into retrievable medium
• Repeat words/phrases just heard
• Identify word missing
• Follow 1 or multiple step commands
• Identify likeness or diff. between sounds
• Discriminate Words of different or similar sounds
• Discrim. between emotions (angry, happy, sad, etc)
• Identify dominant sound
• Follow directions among background noise
• Identify direction of environmental sounds
• Repeat sounds in sequential order
• Repeat 1-4+ letters/words/#s in order
• Remember and repeat familiar phrases or rhymes
• Repeat and follow 1-3 step verbal commands
• Recall facts from information given
• Recall details from a story heard within time intervals
• Ident. sim./diff between words/sentences/paragraph
• Attend to speaker and select information required
• Select items of info which are pertinent and respond
• Identify what information heard was pertinent