Sessions 7 Reading

Summary of "Deaf-blindness: Implications for Learning"
 Understanding the Effects of Deaf-Blindness

A. The loss of vision and hearing create even more challenges when combined than a loss of either of these senses does when looked at individually.

1. Deaf-blindness effects motor skills. (e.g., the ability to walk and move, etc.)

Deaf-blindness effects communication. (e.g., the ability to ask for things, let others know how he or she feels, the ability to show discomfort, etc.)
2. Deaf-blindness effects general development (i.e., lack of movement increases the possibility of low muscle tone and development, lack of language decreases choice making, etc.)

B. Sensory Information Access

1. Near Senses: Taste, touch, smell (you can only taste what you put in your mouth, you can touch only as far as you can reach, and you can smell things that give off an odor that reaches your nose.)

2. Distance Senses: Vision, hearing (You can see as far as the horizon when you are outside and you can hear sounds that may be several blocks away- siren!)

C. Vision and hearing loss can vary greatly within individuals

Some individuals may have a slight hearing loss and be totally blind. Someone else might have a slight vision loss, but be totally blind. Yet someone else might have only a slight loss of both senses or be totally deaf and blind.

D. Accessing information for learning

1. Information is not learned incidentally (without intent or by chance as in learning

2. Information is gained through direct instruction (one to one instruction)

3. Information received through distance senses can be very inconsistent (for example, if a child has a history of ear infections, one day the child may hear everything but when the ear is infected, he or she may only hear loud sounds. In the case of Usher's Syndrome vision is progressively lost.)

4. Motivation to interact with the environment can be reduced due to the effect of vision and hearing loss (If you don't know what's out there, why seek it out. In the case of the "fairy syndrome" things magically appear out of no-where. This is when the child or student receives an object without an introduction or physical explanation of where the object came from. For example: a child sits at the table ready to eat and the plate of food magically appears from no-where. The child should be guided through the process of removing the plate from the cabinet, allowed to serve food from the pot and assisted with the plate to the table. Once the child has eaten, the plate should be carried by the child, washed, dried, and returned to the cabinet. The next time the child is presented with a plate, he or she might have a place of reference as to where the plate came from. This may take several sessions for the child to make the association, but the end result is worth it. This process should be addressed for all objects utilized in a child's day.)

E. Communication and Movement

1. a. Communication and movement are closely linked, stimulating each other to continue to develop.

2. b. Impaired vision and hearing interfere with the individual's ability to understand and respond to the communication and movement of others in their environment.

F. Incidental Learning

Vision is the organizing sense. It synthesizes large amounts of information very quickly thus allowing an individual to learn without much effort. (Remember 80% of our information in gathered through vision!)

G. Concept Development

Concrete to abstract

1. Build on concrete experiences and previous learning. (Concrete means "real" experience--not something that is read, imagined, etc. A student with deaf-blindness must experience all situations.)

2. Provide language to label new concepts. (The language can take on many forms: verbal, tactile, touch cues, object cues associated with an activity, etc.)

3. Help individual to generalize learning and use new information. (Carryover is important to help the child make associations effective and faster. Activities should be consistent between home and school.)

Examples: To help a child associate an object such as a spoon to the functional activity of eating, every time it is time to eat a spoon should be presented prior to going to the dining area. All modes of communication should be utilized (verbal, tactile (holding and feeling the spoon) smelling of food in the distance, and hearing the sounds typical in the kitchen or cafeteria). Presenting an object that is somehow related to the activity should be the beginning point. Once the child/student anticipates the activity by demonstrating (vocalizing, smiling, etc.) he or she understands or if you are not sure, use a mismatch. Give the child a different object for the activity and observe to see if the child demonstrates confusion or an unsure response. Then go back to the original object to verify the association.

H. Mental Imagery

1. Begin by exploring the whole item to develop an image of the item. (For example, children at a very young age learn that McDonalds has a Playland. They quickly associate the sound of the word "McDonald's with the Playland and are able to think or make a mental image of the McDonald's Playland!)

2. b. Use of models if the child/student understands symbolism. When the student understands an association, the teacher can use other symbols to identify an activity.

I. Emotional Development

1. Bonding behaviors: interactive dialogue (When working with an individual who is deaf-blind it is important to introduce yourself using a touch sign, particular smell (perfume), distinct hair, etc. to facilitate the bonding behavior. Over time you become a familiar person to this individual and trust can be developed.

2. Attachment behaviors

J. Sense of Self and Body Image

Refer to "Theory In Practice," page 34, of Hand-In-Hand "Ideas for Enhancing Awareness of Body Image.

K. Perception of Safety

1. Over protectiveness by others (Families may be over protective of a child who is deaf-blind. Different cultures have different viewpoints about a child who is deaf-blind. In some cultures, having a child with a disability is considered a gift, while others may view the birth of a child with a disability as a punishment. A teacher needs to understand the perspective of the parent(s).

2. Comfort level of individual with routine and environment (If a child/student with deaf-blindness is fearful or uncomfortable, everyone involved with this child must think through each task or activity and take each step gradually never overwhelming the individual. The comfort level will increase with consistency and repetition.)

3. Safety verses allowing natural possibilities for learning (Safety issues should always be first and foremost for all involved in the development of a plan for an individual with deaf-blindness, including the individual. Example: How would you teach a child that is deaf-blind to avoid a dangerous object in the home, school, etc.? (Stove, heater, etc)

L. Learned Helplessness

1. Due to limited access to information: vision and hearing of individuals who are deaf-blind may be unaware of their impact on their environment.

2. Individuals who are deaf-blind may become victims of the "fairy-godmother syndrome:" Things they wish for, may just magically appear or disappear. (To avoid learned helplessness, the individual must be involved in every step of the activity. Everyone must learn to "support" rather than "do" for the individual who is deaf-blind.)

M. Isolation

Reflect on how it felt to be blindfolded and hard-of-hearing. Did you feel "isolated?"

N. Four critical factors that effect an individual with deaf-blindness.

a. Age of onset of vision and hearing loss.

1. The earlier one is affected, the more significant (critical developmental periods.

2. Individuals who are older at the time of their loss have a foundation to build on.

b. Degree and type of vision and hearing loss.

1. Even a small amount of residual vision or hearing allows access to some environmental information.

c. Stability of each sensory loss.  (Look at "Help at a glance" section on pages 41-42 of Hand-In-Hand for vision and hearing loss.)

1. Progressiveness of the loss requires the individual to constantly adjust to how they obtain and use information and can be frustrating. Look for behavior changes in children with deaf-blindness with limited communication skills. This may be a cue to a change in their vision or hearing.

d.  Educational intervention

1. Amount and type of intervention depends on the child's vision and hearing loss.

2. The amount and type of intervention depends depends on the families skills and needs for support.

3. Consistency is a key to the development of independence.

O. Forms of Deaf-Blindness

a. Early onset

1. Vision and hearing loss before age 2.

2. Severe to profound losses of both senses.

3. Lack environment input beyond arms reach.
   

b. Early onset, but less severe losses (mild to moderate)

1. Sometimes glasses and hearing aids do not completely restore vision and hearing and many factors can interfere with information gathering.

2. Can use some environmental information for learning and development of language.

3. Benefit from multi-sensory approaches to learning to fill in gaps.

c. Early hearing disability with later vision loss

1. Hearing impaired before age 2.

2. Can usually master daily living activities at early age

3. Usher syndrome (Hand-In-Hand page 47, "Theory In Practice: Usher Syndrome."

d. Later sensory losses

1. Lose vision and hearing as young adults.

2. Have already mastered mobility and communication using vision and hearing.

3. Can use previously learned information to adjust to losses.

4. Will need to relearn academic or job skills without the use of vision or hearing.

P. Additional disabilities and their effect on the individual with deaf-blindness

a. Common Causes

1. Rubella (German Measles)

2. Cytomegaloviris (CMV)

3. Prematurity

b. Types of additional disabilities

1. Motor (example: cerebral palsy)

2. Cognitive

3. Neurological

Q. Special Health Care Needs

1. Often referred to as medically fragile.

2. Often are technology dependent and limited in their movement and experiences.

3. Benefit from being in instructional settings with the proper medical support.

4. Often are absent due to illness/hospitalizations.

5. Benefit most when school and medical personnel and family work closely together.

R. Suggestions for learning

1. Individuals with deaf-blindness are unique, so one must get to know each individual and his or her unique strengths and needs.

2. Observation is one of the best ways to learn about each individual: observe his or her exploration of the environment and especially how he or she communicates.

3. Information the individual with deaf-blindness receives may be distorted, limited, or incomplete.

4. Needs:

1. To be taught what others learn incidentally.

2. Provided the opportunity for direct experiences and repetition.

3. Allowed to apply his or her learning in a variety of situations.

4. Provided with multi-sensory learning opportunities to fill in what is missing from his or her vision and hearing..

5. Maximize tactile information.

6. Shown how to examine things systematically.

7. To be taught what others learn incidentally.

8. Provided the opportunity for direct experiences and repetition.

9. Allowed to apply his or her learning in a variety of situations.

10. Provided with multi-sensory learning opportunities to fill in what is missing from his or her vision and hearing..

11. Maximize tactile information.

12. Shown how to examine things systematically.