MN DeafBlind



Are All Five Major Senses Working?

The chart below is not based on any reliable data. Estimates are quoted in the literature that the percentage of information that we take in via our eyes is anywhere from 60 to 90%. Of course, if you are listening to an audio tape, vision doesn’t matter at all. If you are watching a film strip, hearing is of no consequence. In addition, some people are visual learners and some people are auditory learners. It is well-known that two people with identical audiograms may have strikingly different abilities to understand speech and other sounds. Perhaps the one who understands speech better is actually an auditory learner. But even that person misses information. If he/she uses speech-reading extensively, then a vision impairment on top of a hearing impairment will cut down on understanding as well.

Figure 1: Full access to information from all senses.

However, consider what happens if a child is visually impaired AND hearing impaired. If a child has moderate visual impairment, the Vision bar might be half as high. If the child is moderately hard of hearing, the Hearing bar would be shortened by half. Relatively speaking, then, the other senses become more important.

Figure 2

Graphic: Vision & Hearing loss
Figure 3

Figures 2 and 3: Compare the differences when half of either vision or hearing is gone.

Now consider how less information is available when half of BOTH the vision and the hearing are missing. Notice how much more important the senses of touch and smell become.

Figure 4: Combined vision/hearing loss with half of each gone.

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What is DeafBlind?

Definition: Any combination of hearing and vision loss that interferes with access to communication and the environment and requires interventions beyond those necessary for hearing or vision loss alone. For educational purposes in most states, the child needs to meet the criteria for deaf/hard-of-hearing as well as for blind/visually impaired. Contact the DeafBlind Project for more information.

DeafBlind rarely means totally deaf and totally blind. No other succinct term has been found that fits all of the conditions listed in the table below. Dual sensory loss, Hard of Hearing/Visually Impaired, etc. are cumbersome. Most parents and educators have finally settled on DeafBlind even though that term is a somewhat inaccurate and, often, a scary term.

The importance of having a DeafBlind label, however, cannot be underestimated. The educational needs are truly different when both senses are affected. It is not enough to have the consultants come in and give their input without considering the effect of the other sensory loss. The reason is that the techniques used to compensate for vision loss often involve hearing and those used for hearing loss frequently involve vision. Note in the table below that the term DeafBlind is used even if the child is found to be just visually impaired and hearing impaired. The combination makes a HUGE difference in the way information should be presented.

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What Combination of Vision and Hearing is Present?

When one or more senses are impaired, additional education consultants are needed, even (or perhaps especially) during the Early Childhood phase of development. Research out of Denver shows that, if a communication system is established BEFORE six months of age, a deaf child can develop completely normal language. Even if they learn to read sign language, they do not fall behind their hearing peers in expressive language and reading. The implications are staggering. Even though medical issues in CHARGE syndrome occupy the thoughts and minds of parents and caretakers during the first 2 years of life, it would appear to be very important to start some form of communication as early as possible.

The table below introduces the kinds of special educational consultants needed to address the vision and hearing issues. However, physical therapists, occupational therapists and a variety of other consultants may also be needed (just like in the hospital and clinic). Note that the kinds of modifications given depend on the nature of sensory input.

Sensory StatusConsultant NeededModificationsComments
Hearing + SightedNone  
Hearing + Visually impairedB/VI teacher
+/- O&M
Large print, contrast, placement of student 
Hearing + BlindB/VI teacher
+O& M
Braille, O&M, audio tapes & instruction 
Hard of Hearing + SightedD/HH teacher +/-SPLHearing aids, +/- FM or other amplification, noise reduction, classroom placement 
Deaf + SightedD/HH teacher +/- Interpreter Hearing aids, +/- FM or other amplification, noise reduction, classroom placement 
Hard of Hearing + Visually ImpairedB/VI, O&M, D/HH, SPL, DBP consultantAmplification, large print, be within the "Communication Bubble" 
Hard of Hearing + BlindB/VI, O&M, D/HH, SPL, DBP consultantAmplification, Braille, O&M, +/- sign languageDeaf-Blind
Deaf + Visually ImpairedB/VI, O&M, D/HH, DBP consultant Modified sign language, O&M, large print, be within the "Communication Bubble"Deaf-Blind
Deaf + BlindB/VI, O&M, D/HH, DBP consultant Modified sign language (possibly tactile), Braille, O&MDeaf-Blind

B/VI = Blind/Visually Impaired
D/HH = Deaf/Hard of Hearing
SPL = Speech/Language
O&M = Orientation & Mobility (learning how to know where you are and move safely with low or no vision)
DBP = DeafBlind Project

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The Need to Establish A Communication Bubble

Establishing what Susan Smith, the parent of two children with CHARGE Syndrome, calls the "Communication Bubble" is essential if you want to make sure the child knows you are there and are trying to communicate. The concept of a "bubble" is a good one because you can imagine the space within which you need to be. As Eric Kloos says, you need to be "on the child’s radar." If you are outside the bubble, you might as well not exist. Too many times, we think the child is tuned out, not paying attention, or is too "retarded" to answer when, in fact, he/she may not even know that you are trying to say something.

How to establish the bubble is found in a separate section. Each parent should know how far a child can see, what kinds and colors of objects, with or without movement, in different lighting conditions and against different shaded backgrounds. The eye doctor will usually not be able to tell you this except by guessing, though some do this kind of testing. A vision teacher, however, can do a Functional Vision Evaluation to help establish these visual abilities. Figuring out what the child hears clearly, at what distance and on which side is also important. Neither of these is easy to determine so parents and team members will likely have to engage in a continuing evaluation process.

What Types Of Communication Systems Are Available?

Emerging languageTouch cues 
Object cues 
Formal languageOral LanguageAuditory/Verbal
Oral Language supported manuallyCued Speech
Sign LanguageSigned English
ASL, Auslan, etc. (the native sign language of a given country)
Total CommunicationCombination of oral and sign languages
Total Communication - combination of all

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How Do You Choose the Right Method?

There is no one right answer to this question. Too often, however, the confusion results from passionate arguments for one method of communication, like spoken English or American Sign Language, without fully understanding the effects of dual sensory loss. The most important thing is to get language into that developing brain in a form that can be consistent and effective. What that form takes will likely be determined by a team meeting of the parents and professionals. We learn any language by receiving it and then repeating it. We learn it fastest and best by total immersion. Learning it for an hour in the classroom twice a week or in bits and snatches with a word or sign here or there is simply not enough to become fluent. This means that whatever method is chosen needs to be woven into everything the child does, from getting up in the morning to going to bed at night. Keep in mind that perfectly good language by whatever method is useless to the child unless it is delivered within the communication bubble.

The other very important point is that a lot of communication precedes formal language. Every mother can "read" her child’s communication regardless of whether that child uses any formal language. Sometimes it is guessing, but the child will let the mother know when she’s got it right. Therefore, it is important to lead up to formal communication step by step. We use sight cues and verbal cues like outstretched arms with some encouraging words to let a hearing/sighted child know what we want to do next. For a child without good vision or hearing, concrete object cuesOpen in new window. Link to a different web site. and touch cuesOpen in new window. Link to a different web site. are used instead. DeafBlind project staff can help the regular and special education staff learn how to use these methods. As parents and educators we may get hung up on wanting our children to speak our own language using the method we use. That is as natural as immigrants wanting their children to continue speaking their language and remembering their culture. However, the issue is not the form but the substance. The child needs to learn that an object, touch, picture, word or sign is a symbol that stands for a thought. Many of them strung together convey complex ideas or stories. They include naming of objects, actions, remembering the past, anticipating the future and, later, getting into abstract thoughts and discussions.

So, above all, just get to it! COMMUNICATE, COMMUNICATE, COMMUNICATE.

prepared by
Sandra L.H. Davenport, M.D.
Sensory Genetics/Neuro-development
5801 Southwood Drive
Bloomington MN 55437-1739
952-831-0381 Fax

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