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Needs Of Children With Deafblindness

When a child is deaf or hard of hearing, his access to information and interaction relies heavily on the visual channel. Since sign language, fingerspelling, speechreading, and cued speech are intensely visual in nature, vision loss affects the child's ability to access these communication forms. For this reason, it is important to address any vision loss, which might impact the student's ability to access educational information.

The effect of the student's vision loss on the acquisition and use of visual communication forms needs to be evaluated so that appropriate adaptations can be implemented that insures access to his method of communication. Because deafblindness is a low incidence disability, the communication assessment, functional vision evaluation (FVE), or learning media assessment (LMA) do not routinely address this issue. Pre-service programs for teacher of the visually impaired and teachers of the deaf and hearing impaired do not typically teach strategies which are commonly associated with deafblindness.  In addition, the classroom interpreter is trained to provide services to individuals who are deaf or hard of hearing, but may be unfamiliar with the adaptations needed for the child with deafblindness to access these forms of communication. Assessment of vision must be carefully planned for and carried out related to receptive communication.

Working with educators in Texas, we have developed an approach to evaluating the impact of vision loss on the child's ability to access and learn information through these communication forms. We wanted to share this information, hoping it might be useful to others facing the same task.

Assessing the Student's Needs

Step 1: Assemble the assessment team

Obtaining the information that is needed requires a team approach. The evaluation process requires someone who can understand what the child is signing, what is being signed to the child, and what specific visual obstacles must be overcome for the child to detect and interpret these forms of communication. Specifically, the team needs to include both a teacher of the visually impaired and a teacher of the deaf and hard of hearing. Both these teachers have critical information that the other lacks, requiring collaboration between them. Additional team members should include such people as the family, the student, the educational interpreter, intervener, teacher and/or the instructional aide.

Ideally, the team will have support from a professional with a background in deafblindness. Specific training on the assessment and development of programming for students with deafblindness is not typically covered in training programs for teachers of the visually impaired or for teachers of students who are deaf and hard of hearing. This information belongs to the separate field of deafblindness

Step 2: Conduct standard screenings/assessment

The process of evaluating the effects of vision loss on recognizing and using visual forms of communication is tied to the functional vision evaluation (FVE) and the learning media assessment (LMA). Conducting these assessments is the primary responsibility of the teacher of the visually impaired in collaboration with the team. As a team you should determine how to gather this information. The teacher of the visually impaired can report the impact of the student's vision loss on signing, fingerspelling, speechreading, and cued speech in either the FVE or LMA.

There may also be a need to make a referral to a low vision specialist. Many times a child may benefit from the use of such devices as a monocular, telescope, special lightings, or to learn specific strategies to help him access his preferred communication form(s). The teacher of the visually impaired should make this recommendation to the ARD committee if he or she feels it would be beneficial.

Step 3: Compile information

After the functional vision evaluation is completed, the team needs to compile some specific information.

Consider the child's etiology

There are a number of syndromes having both a vision and hearing loss component. This may have bearing on the best educational approaches to use with the child or give direction to long-term medical follow-up. For example, Usher Syndrome brings about a visual field loss. Children with Congenital Rubella syndrome have a risk of developing cataracts and glaucoma. Resources such as the National Organization for Rare Diseases (NORD) and D-B Link can be very helpful in obtaining this important information. There are other etiologies besides syndromes that can cause vision loss. An example of such a condition is spinal meningitis. Cortical visual impairment (CVI) can be associated with this condition and results in fluctuating vision and possible perceptual problems.

Consider the communication system or methodology being used with the child

There are several manual communication methodologies or systems being used in Texas classrooms at this time. Speechreading is used by a number of students. Cued speech is also an option for some children as a communication form. A sentence or thought can be expressed in different ways, depending on which communication methodology or system is used, resulting in different visual demands on the child. Chart 1 gives some very simple definitions of these methodologies or systems. (Chart 1 is not comprehensive and only meant to introduce you to these terms. It is not meant to be an endorsement or criticism of any of these methodologies or systems.)

CHART 1 - Manual Communication Systems and Methodologies

American Sign Language: (ASL): "the native language of thousands of Deaf people who have Deaf parents. For them, it is not only a first language but also carries with it the culture of generations of Deaf people in America. Like other foreign languages, it has its own history, idiomatic expressions, structure and grammatical rules." It is a highly sophisticated visual language and it is not based on nor is it derived from English.-- (Humphries, et al 1980.)

Signing Exact English (S.E.E. signs): A sign system developed in the early 1970's which is based on the English Language. "The most important principle in Signing Exact English is that English should be signed in a manner that is as consistent as possible with how it is spoken or written...." (Gustason, et al 1993.)

Fingerspelling: Individual letters of the alphabet are produced manually by the dominant hand through specific handshapes. In this country, we typically use the American One Hand Manual Alphabet. It is usually used in conjunction with sign language.

Total Communication (TC): English is spoken and signed simultaneously using English syntax and grammar.

Speechreading: Includes lipreading, but also capitalizes on gestures and body language, facial expressions, situational clues, linguistic factors and any auditory input that is available to the individual (Kaplan, H. (1996).

Cued Speech: is a visual communication system which, in English, uses eight hand shapes in four locations ("cues") in combination with the natural mouth movements of speech to make all the sounds of spoken language look different. Cued Speech identifies each distinctive speech sound. Shapes of one hand identify consonant sounds; locations near the mouth identify vowel sounds. A hand shape and a location together cue a syllable. (Discover Cued Speech 2002)

Step 4: Observe the child

There are tests designed to check for receptive sign vocabulary. However, these tests typically give the student the advantage of seeing one sign at a time, from a consistent distance, and with a limited number of responses. The results may accurately indicate the signs that the child knows in a clinical environment, but tell you nothing about his ability to recognize them in other environments or situations. His vision loss may impede his "functional" comprehension of these communicative forms, especially if lighting conditions are poor, there is glare, he is across the room for the person signing (with an acuity problem) or very near a person (with a field loss).

Tests to determine the child's ability to speechread also may not take into consideration the impact of a less than perfect visual setting for the student. A child, depending on his or her visual functioning, may do very well in a close one-on-one situation. That same child may not be able to use speechreading at all or only marginally in a typical classroom setting.

Therefore, if you are evaluating a child with deafblindness's ability to use signs, fingerspelling, speechreading or cued speech, you must observe the child in these real environments and situations. Typically, we have taken the assessment questions, which follow, and let these guide our observations of the child in a variety of interactions throughout his regular day. These observations are carried out over the course of several days so that we can get a broad sample of the child's functioning.

A note of caution about what you observe: It is possible to overestimate a child's receptive communication skills. For instance, the student may be able to tell that someone is signing without actually discriminating discrete segments of the sign or signs. For example, the teacher holds up a yellow art folder and signs "Time for art". Twenty feet away, he can see the art folder, note the teacher was signing, and guess that she was telling him to go to art. That does not mean this child can discriminate all signs at twenty feet. Likewise, a child may observe your lips move at the time of day when you typically tell him to go to lunch and be able to guess what comes next in his schedule. He may not have actually been able to tell that you were saying, "time to eat" because he was at a distance of four feet from you and his visual acuity only allows him to see faces clearly at one foot.

Since this guessing method works best in familiar routines, you might expect to observe a significant drop in the child's comprehension of sign language in new situations and environments. He may require different instructional distances to read signs, fingerspelling, speechreading or cued speech without contextual cues or when presented with novel information.

Step 5: Interview the Team

As the next step in the process be sure to interview team members who have the most experience with the child in communicative interactions. This should include such people as the family, the educational interpreter, intervener, teacher and/or the instructional aide. The assessment questions that follow can guide these interviews.

If the student is at a level where he can participate in the interviews, be sure to include him. In many cases he may be the best person to tell the team about problems he is having. However, it is important to remember that some children are not aware that they are missing information in certain situations. Remember, you don't know what you missed, if you missed it.

Step 6: Validate Your Observations

Your observations and interviews should help you formulated a theory about how the child is using his vision. Devise some situations to test your theory. For example, if you think the child may have night vision problems, set up some situations to see how the child using his vision in darkened hallways, in the early evening hours, or when lights are turned off for overhead use.

The results may suggest the specific adaptations you want to try. These adaptations are likely to be very individualized, not only from child to child, but from situation to situation for an individual child. This occurs because one individual may be affected by different lighting conditions, the degree of familiarity with the situation, the number of other visual demands being made, etc. If the child has a progressive or a fluctuation vision loss, then the adaptations he requires may also vary over time or within a short period of time.

Step 7: Document the Findings

It is necessary to document the team's findings. For this reason it is important to amend the learning media assessment (LMA) and functional vision evaluation (FVE) as needed to address the impact of vision loss on the student's ability to access his method of communication. The impact of his vision and hearing loss may require your team to update any communication assessment that may have already been done. Make sure the impact of the vision loss on these assessments has been factored into any of the results. A new assessment may be necessary after appropriate accommodations or adaptations have been made for the student. Specifically, your team should make a determination that a change in the method of communication does or does not need to be made to address the visual impairment. For example, the student may not be able to efficiently use speechreading in most settings as a receptive communication form because of vision problems and may need a different communication method.

Step 8: Convene the ARD/IEP Committee to Update the IEP

The IEP committee should convene to update the changes needed to address the findings. The teacher of the visually impaired's recommendation for modifications, adaptations, and accommodations should be discussed and agreed upon. Additional related and supplemental services may be required, too. The team then needs to consider changes that may be necessary to implement the IEP.

Many of the necessary changes are unique to the field of deafblindness. Training on deafblindness is not typically provided at the preservice or inservice level for either professionals or paraprofessionals in most parts of Texas. For this reason, there may be a need for family and staff training. There are a number of resources for training, including the deafblind specialists at the regional education service centers and the Texas Deafblind Project. The Project also offers training for paraprofessionals serving a child with deafblindness through the Intervener Training Program. For more information on these resources visit the Texas School for the Blind and Visually Impaired website at Intervener Resources

Another possible change is the need for additional staff. The necessary modifications for any student may place such a demand on the existing staff that there is a risk that the IEP will not be implemented. For example, taking the additional time to let the child study pictures or to use a slower pacing of signs necessary to include the child with deafblindness will frequently break up the momentum of a group lesson. Consistently making these changes, while conducting group instruction, may be impossible. As a result, it is easy to deny the same level of instruction to the child with deafblindness. The need for an additional staff person may be needed.

All of these agreed upon changes should be documented in the IEP so that everyone will know what is needed for the student to access communication. Your team may wish to reference these articles, Documenting Modifications in the IEP for the Student with Deaf-Blindness and IEP Quality Indicators, developed by Texas Deafblind Project and available on the Texas School for the Blind and Visually Impaired website at

Assessment Questions And Possible Adaptations

What follows is the list of questions that guide the observations along with possible instructional modifications, adaptations, accommodations or teaching strategies that may be considered. This list is by no means comprehensive. There may be other questions your team wants to address. The ones you select for any child are highly individualized and should be based on his or her vision and communication preferences.

1) What is the best space, placement, and distance of communication forms for the child related to his visual fields?

As a rule of thumb, manual communication takes place within a two-foot cubic area. Speechreading and cued speech requires the student to be able to see the face of the speaker, his finger positions for cueing, body expressions and facial expressions. Students with field losses (blank spots) in their vision can have considerable difficulty in seeing some of this information depending on the location and size of their field loss. Missing parts of the message can greatly affect comprehension. It is important to know the child's best area for viewing these communication forms. In order to make this determination, you will need to know the best placement (e.g., central, upper, left, or right quadrant) for signing or cueing space (e.g., a diameter of ten inches) for that child. If the student has a field loss, moving further away from the signer, allows him to see more of their body and provides him more of the information provided by the hands and the body. When a child has both an acuity problem (blurred vision) and a field loss, finding the best distance becomes a much more complex issue. If the child moves far enough away to capture the face, body, and hands in his fields of vision, he may lose clarity of the image. If he gets up close to see features of the hands and face clearly, he may lose information that falls out of his fields of vision.

Be sure to utilize the information you have gathered about the student's fields from the ophthalmologist's report and the functional vision evaluation when determining the space, placement, or distance of the communication forms you want the child to access. In your observations, take note of a student who keeps backing up, when you try to sign to him. He may be trying to see more of you in his reduced fields. Also watch for students who touch your wrist or hand, reach out to reposition your hand, pull their head back or use eccentric viewing positions (e.g., always turns head down and to the left to use their peripheral vision). Teachers may report having trouble getting the child's attention from a particular side. Try systematically signing or gesturing from different distances and locations within a quadrant.

Children who are using cued speech or speechreading may need to sit close to be able to see the speakers face. Does the child struggle to keep the speaker's face in his field of vision? Check to see if this student's comprehension drops dramatically when the speaker is more than a few feet away or if he is in a group discussion situation.

Possible adaptations, accommodations, and modifications:

  • Present signs consistently in the same quadrant, at the same distance and within a precise signing space.
  • Reduce signing space. (e.g., The sign "country" could be signed between the wrist and the elbow rather than at the elbow.) This may be helpful to students with field losses because it moves the sign into their visual field.
  • Fingerspell (rather than sign) some words if the movement of the sign takes it out of the child's field of vision (e.g., "Russia" which is signed by placing the hands on the hips).
  • Substitute a sign which requires a smaller signing space as long as the meaning is not changed.
  • Alter the signing or speaking distance (based on the type of field loss) between you and the person with deafblindness.
  • Consider the use of low vision aids to increase the amount of information the child is receiving (e.g., expanded field telescopes).
  • Allow the child to turn his head to use eccentric viewing positions if needed.
  • Use tactual signing or (tactual) tracking in some situations.
  • Position oral interpreter or speaker so the student can easily see within his/her field of vision.

2) What is the best rate and distance of communication forms for the child related to his acuity?

The appropriate distance and rate for various communication forms can vary according to the complexity of the exchange, the amount of contextual support to aid in guess work, and the characteristics of the individual sign, letter, cue, or facial and body expressions. Some signs are very concrete and have big, clear movements (e.g., "brush teeth"). Others are more abstract and have subtle, less discernible movements (e.g., "seven"). Signs may also resemble each other (e.g., "purple" and "green"). When fingerspelling, the hand stays in one place eliminating the types of cues many signed words provide. For example, "king" is distinctive because of the movement from shoulder to hip. Also, some fingerspelled letters are remarkably similar for people with acuity losses (e.g., a, t, n, m, o, s, e). The typical rate for fingerspelling is a rapid 3-4 letters per second and this may present a problem for the child who is visually impaired. Hand cues used in cued speech do not contrast very well against the face. Information carried by the body and face that is critical to a speechreader may be lost if everything gets blurry. For some students with deafblindness, their best distance vision is only usable up to a foot away.

If the student has acuity problems, he will have to be close enough to his partner to bring the person's hands, face, and torso into focus. When you put any number of signs (and/or fingerspelled words) together, you may need to sign more slowly and distinctly. Cued speech and speechreading may become impossible for a child with acuity problems under less than ideal conditions. Making changes in the rate and distance of your signs, fingerspelling, and hand cues, or accommodating the child's needs when he is speechreading may be very difficult when you have other students to consider. However, you must find the appropriate distance and rate for any of these forms based on the child's rate of comprehension and can vary across settings.

Adaptations you might consider:

  • Vary the rate of signing, fingerspelling, speech or cues according to the situation such as when the information is complex or novel (however, always keep your signing pace predictable).
  • Work individually with the child to improve his comprehension of signs, fingerspelling, speechreading, and cued speech through receptive drills.
  • Make specific determinations about the best receptive distance for him in a variety of situations.
  • Use tactual signing and/or fingerspelling when necessary (see tactual signing question).
  • Consider the use of low vision aids to increase the amount of information the child is receiving (e.g., a monocular distance aid).
  • Consider the use of additional staff if the distance and rate differs significantly from that required by the other students in the class.

3) Can the student visually discern nonmanual signals that give meaning to the signs or spoken words?

American Sign Language (ASL) utilizes an intricate combination of manual sign and non-manual signals. These must be viewed simultaneously because the non-manual signal affect the grammatical outcome of what is being expressed. A few examples of non-manual signals are: pursed lips, puffed cheeks, a raised eyebrow. When specific signals combine with the manual sign for a word, the meaning changes (Baker & Cokely, 1980). The child can perhaps see the large hand movements, but not be able to see the more subtle movement of the eyebrow. Therefore, he is unable to receive the entire message and misunderstands. A child who uses speechreading or cued speech also needs to be able to distinguish and interpret these non-manual signals at times to fully understand what is being conveyed.

Look at the child's overall comprehension of information that is being presented. Also consider the child's ability to read peoples' moods or intents communicated through body language. Try some imitative games that require the child to be able to attend to facial movements and hand or body movements at the same time. Does he see both movements at a variety of distances?

Adaptations you might consider:

  • Providing this information in some other form. For example, instead of relying on your facial expression use additional manual signs or words to convey the meaning (e.g., sign or say "suspicious" as well as narrowing your eyes).
  • Teach that feelings are expressed through body language. The child with a vision impairment may be unaware of this information.
  • Try exaggerating non-manual signals slightly in order to convey them.

4) Does lighting affect a student's ability to visually access information?

For some children, dim or very bright lighting may present challenges. As one friend who has visual impairments put it, "Light can either be my best friend or worst enemy."

Observe the child's ability to understand and respond to manual communication, speechreading or cues in different lighting conditions. Watch for changes in skills as he moves indoors and outdoors, under fluorescent lights and incandescent lights, in shaded or dimly light areas, etc. Some information should be gathered in twilight or at night.

Adaptations you might consider:

  • Have the child shift to tactual signing. For example, when the lights are dimmed for a video tape, a child with peripheral field loss may need this support.
  • Use area lighting. Lamps or overhead spotlighting on the person communicating can be very helpful. Position the light so that shadows don't fall on the signer's or speaker's hands or face (cross-lighting is best).
  • Use visors, hats, and sunglasses to reduce glare. For students with Usher Syndrome or other visual conditions, glare is a big obstacle.
  • The person signing or speaking should not stand with their back toward a light source (e.g., standing in front of a window).
  • Information from overhead transparencies should be provided in another form.

5) Does the visual background affect the child's comprehension?

Professional sign language interpreters wear dark solid colors when interpreting because it provides good contrast to their hands. This makes their signs clearer and easier to read.

The child with visual impairments has to work harder to pick out visual information when there is a "busy" visual background. Watch to see if the child's comprehension skills increase or decrease when decoding signs against different visual backgrounds.

Adaptations you might consider:

  • Dressing in contrasting, solid colors to make signs easier for the child to discriminate. If the teacher's wardrobe does not contain many solid colors, they might consider wearing a smock.
  • Selecting the best color to improve background contrast. (e.g., Some children may be able to see better with purple as the background color rather than black.)

6) Can a student follow signed conversations in group settings?

Group instruction poses different demands on a child's functional use of vision than when he is in one-on-one situations. In a group lesson a teacher may start signing a sentence directly to the student at 6"-12" and then turn to another child to finish the statement. Suddenly the teacher's hands have moved to a distance of 30" from the child. When this occurs, the student with a vision loss misses part of the sign(s) simply because it has moved out of visual range. Likewise, a teacher sitting very close to the child may be accessible visually if he is speechreading, but should she turn her head or step away to address another student, the child misses what is being said.

The distance and angle of the manual communication, cued speech or speechreading continually changes as different people in the group take part in the discussion. The student constantly has to locate the person signing or speaking and refocus to see what is being signed or said. He may even need to physically reposition himself to bring that person into view.

(Note: Taking the additional time to provide even the most basic adaptations necessary to include the child with deafblindness will frequently break up the momentum of a group lesson. A teacher may know the child needs additional time to study pictures, needs other people to sign more slowly, needs to be close by to see her face, or has trouble tracking the movement of hands. However, consistently making these changes, while conducting group instruction, may be impossible. As a result, it is easy to deny the same level of instruction to the child with deafblindness. The same problem arises in always being available to provide tactual support when the child needs it. Because of these things, additional staff may be warranted to address group activities.)

Adaptations to consider include:

  • Consider the use of additional staff to assist in informational access when the child is included in group activities.
  • Point to the person who will sign or speak next, and allow the child time to visually locate them.

7) Would the student benefit from supplemental experience work to assist in understanding the concepts behind the signs or spoken word?

Children who are deaf or hard of hearing have a wealth of incidental visual information to serve as a basis for language. This may not be the case for a child with deafblindness. Significant amounts of this critical information are distorted or missing altogether for a child with a concurrent visual loss. For example, this child may never be able to see a bird flying or sitting in a tree, or for that matter see a "bird" at all. Showing him a picture or giving him a sign for bird assumes he knows not only what the symbol represents, but has a concept of "bird." This may not be true for him.

New information should not be introduced via speech (even with cues), a picture, or sign if the child does not have a firm experiential base to relate to the picture or sign. Even though he may have the ability to understand or remember information, if he is not getting all the information in the first place, it is virtually impossible for him to understand. This is an access issue. Children with deafblindness need extensive, organized experiences with real objects and actions before they can truly understand pictures, spoken word, fingerspelling, or signs which represent these objects and actions. Their sensory losses have denied them this experience.

Even if the child has a good experiential base, there still may be a need for supplemental experience. Demonstrations and modeling are used extensively with deaf or hard of hearing students. If the student cannot see the demonstration, he needs to do the action himself. For students with field restrictions, who can see the demonstrations, watching demonstrations while simultaneously attending to signing or spoken word requires rapid shifts of gaze. In the process, parts of information from both sources may be lost. Objects may need to be examined tactually and visually before they can be recognized when viewed at distance. The child with acuity loss may also miss information or receive distorted information. Class demonstrations may prove equally difficult for him.

Adaptations you might consider:

  • Provide supplemental experience work to build his overall conceptual base.
  • Allow the child to go through the demonstration individually before he participates in the demonstration with the group.

8) Is the child's vision such that he would benefit from the technique of coactive signing when learning new signs or speech cues?

Coactive signing is a technique that teaches expressive sign skills to students who are visually impaired and unable to see the instructor model the sign. When teaching a sign, the instructor takes the students hand(s) and helps the student form the sign correctly. This technique can also be used with students who have visual perceptual problems because these children may not be able to learn to produce signs just by watching others. This technique could also be used with speech cues. While coactive signing or cuing teaches the child to make signs and cues, he will still need to learn to read signs and cues when others produce them. Therefore, it is important to give the child an opportunity to see (or tactually read) you make the sign or cue if they are to learn them receptively.

9) Does the child initiate or benefit from (hand) tracking?

(Hand) tracking when used in reference to signing occurs when the person with deafblindness places his hand(s) on the wrist(s) area of the signer. This technique enables a person with a visual impairment to know where the signer's hand is moving so that he can direct his gaze accordingly. He may also get enough information from the plane or general location of the hand to recognize the sign without seeing it clearly. (Hand) tracking can also be used in conjunction with the other adaptations mentioned in question #1.

Some children initiate this technique on their own. This is usually an indication that they need more information than they are getting visually. Sometimes this can be a tip-off to a field loss. (Hand) tracking should be on this child's lists of strategies since there are some situations where the strategy of moving further from the speaker is impractical (e.g. sitting next to a friend on the bus when his optimum distance for viewing is 4 feet). The child should be allowed to shift to (hand) tracking when he chooses. In some instances, this technique will need to be taught to the child.

10) Does the child initiate or benefit from tactual signing?

Note: This is an abbreviated discussion of the important issues involved with tactual signing. Tactual signing, a receptive skill, should not be confused with coactive signing which is used to teach expressive signing.

Tactual signing is used by a person who understands sign language, but cannot visually read signs and fingerspelling. To receive information, "the deafblind person places one or both hands on the hand(s) of the signer in order to read signs and fingerspelling through the tactual sense. (It is) ...a direct adaptation of a communication system originally intended for the tactual sense." (Reed, et al 1995.) For students who learn sighs visually and then undergo a significant vision loss, there will be a process of relearning signs tactually. Signs feel different than they look. There may also be emotional issues to face in switching to tactual sign because it is an admission of vision loss. This is an extremely stressful change for a person who is hard of hearing or deaf.

In order to be a skilled reader of tactual signs a person must do more than just learn how the signs feel. He will need to learn how to place his hands to get the most information without interfering with the speaker's ability to sign. Typically, the student uses both hands in the beginning. As his skills increase or if he is very familiar with his partner, he may use only one hand. The student will need to "keep it light" in terms of how much weight he puts on the hands of the person who is signing to him. The partner can fatigue very quickly, and over time, injuries like Carpal Tunnel Syndrome can occur if adequate breaks are not allowed. The person with deafblindness may also become fatigued because holding his hands in place for long periods of time is tiring, and reading signs tactually takes a great deal of concentration.

Much of the information conveyed in sign language is expressed through facial expressions, eye gaze, a slight shrug, etc. With tactile signing, every attempt should be made to find alternate ways to convey the meaning tactually.

While tactual signing is most often used by individuals whose vision loss is total, it is also used by people who have vision but are not able to see the signs and fingerspelling clearly enough to understand them. If a student with low vision initiates this modification, it should be respected as an attempt to gain necessary information. The child should be given the opportunity to receive signs tactually. Some students may need to use tactual signing in some situations and not in others. For example, a student may need to rely on tactual signs in very dim light, but be able to get by without it under good lighting conditions.

In some instances, utilizing tactual signing can allow a child to follow a discussion with his hands while he uses his vision to regard the item or situation under discussion. He doesn't have to choose what to look at. When a child becomes more sophisticated in signing, having to read longer sentences, he may no longer be able to get by on his vision alone. He may move to tactual signing because of a change in the level of demand upon vision. In another student, self-initiation of tactual signing could indicate a problem with the child's vision.

11) Does the student need additional environmental information provided to him?

When conversing with or interpreting for a person who is deafblind, additional environmental information should be supplied along with the conversation or lecture. For example, who is in the room, a description of the furnishings, an unexpected noise, etc. Without this information some comments may not make sense if people are referring to things that the person with deafblindness cannot see or hear. Have each person say their name before making a comment and provide the interpreter with a seating chart that contains the names of the others in the group.

12) If a student will benefit from braille, are there English acquisition issues associated with students who are deaf or hard of hearing which should be addressed?

When determining whether print or braille should be used for a student who is deaf or hard of hearing, teachers will need to keep in mind that slow reading rates and problems with comprehension may be related to acquiring English rather than to a vision problem. In many ways, these students' learning needs are similar to those students who are learning English as a second language. A change in literacy medium from print to braille may not improve reading performance for students experiencing English acquisition issues.

The following item might be helpful to braille students acquiring English:

  • Modify the language level to match the child's ability to read and understand English.
  • Generate stories and text based on the child's actual experiences or interests will help them understand the English represented by the braille.
  • The ability to fingerspell has been useful in supporting the learning of the braille alphabet.

13) Are there instructional strategies, materials, and tools typically used with students who are deaf or hard of hearing that may present problems for the students with deafblindness?

  • Pointing, facial expressions, gestures, demonstrations, and modeling. These methods require shifting gaze from signs to some other reference.
  • Pictures of signs/fingerspelling used to teach signs or of faces to teach cues and speechig. If these are used it is important to determine the best presentation: color or black line drawings, high contrast, figure-ground clarification, perspective, etc.
  • When working on the floor, teachers frequently place pictures or objects on the floor and then sign at chest level or speak. Visual demands are being presented in two places and at two distances requiring gaze shifting and refocusing.
  • Holding two pictures or objects side by side and bobbing them up and down in a modification of the sign for "which". The child with a vision loss is faced with the problem of trying to interpret moving pictures.
  • Captioning. Subtitles are displayed on a screen so that a person who is deaf or hard of hearing can follow the sound track of a program. The size of print (the subtitles are about one half inch high on a nineteen inch screen) and rate of presentation may be problems for a student with a vision problem. There are versions of decoders that produce the information in braille.
  • Computer aided real time (CART). Students with vision problems may have difficulties with the size of print and rate of presentation.
  • TDD (telecommunications device for the deaf). May need adaptations to the keyboard such as larger and/or higher contrast labeling of the keys. Specially modified TDDs that come with an external large visual display are available. A device such as the Telebraille may be appropriate if the student is a braille user.
  • Alerting devices utilizing light or visual displays may need to be replaced with devices that are vibrotactile.

14) Are there modifications to standard interpreting arrangements or signed classroom instruction that need to be addressed?

Note: this is an abbreviated discussion of the important issues involved with appropriate interpreter services. Not all interpreter arrangements are discussed.

It is possible that a person with deafblindness may need a completely different interpreting arrangement than other hearing impaired students in the same classroom. Even in an environment where everyone is signing, you may need additional support. For example, at a recent conference we had four participants who requested sign language interpretation. One of the participants could see the platform interpreter who stood by the speaker. Two of the participants required a tactile interpreter. The fourth person used a close vision interpreter. Three different interpreting arrangements were needed simultaneously, in order to make the information accessible to all participants.

Adaptations about interpreter arrangements:

  • Platform interpreting. The interpreter is positioned near the speaker. They can be too close or too far away from the student with deafblindness.
  • Small group interpreting. The interpreter sits within two or three feet of a small group of students. This is an adaptation provided for those whose vision prohibits them from seeing a platform interpreter.
  • Close vision (1 on 1) interpreting. This type of interpreting is provided when an individual's vision loss requires specialized placement of the signed information. This is frequently the case when a person has restricted visual fields or other visual impairments that require signs to be delivered within a particular space or from a particular distance. This also occurs when a person needs to use tactual signing.
  • Visual descriptions. When interpreting for a person who is deafblind (or conversing with him), the interpreter includes descriptions of what he can't see or hear.
  • Tactual Interpreting (see question #11)
  • Feedback Interpreting. Used in situations where a presenter with deafblindness needs to know what is happening in the audience e.g. laughter, questions, remarks.
  • Oral Interpreting. Used by speechreaders, the interpreter mouths the words that are being said by the speaker at a distance where the deaf/hearing impaired person can read his/her lips.

15) Does the student have skills to advocate for the modifications he needs?

Many children, even at a very young age, will let you know when they cannot see what you are signing or saying. They may pull away from tasks or refuse to look. The older child may move your hands so they will be in his field of vision or become critical of your signing. He or she may comment that you are speaking too fast or that a mustache is reducing the visibility of the lips for speechreading. Note how well the child can assess his ability to see in any given situation and how well he can communicate visual difficulty to others. Ultimately, only the individual with deafblindness knows what really aids him in accessing communication and he must be able to advocate for these adaptations throughout his life.

Adaptations you might consider:

  • Work individually with the child to teach him to tell you what adjustments he needs.


Making the appropriate modifications and adaptations for a child with deafblindness is critical to their educational achievement. If his unique needs are not met, the child, no matter where he is placed, is in the most restrictive environment. He is cut off from any opportunity to learn. Unfortunately, these supports are not always easy or inexpensive to provide.

By conducting a thorough assessment of the child's visual functioning in accessing manual forms of communication, speechreading and cued speech, you can determine the supports that are necessary. This will help you and your team to develop the type of programming which has the most benefit for the child educationally and make that program accessible to him.

We would like to thank Millie Smith, Education Specialist, Texas School for the Blind and Visually Impaired Outreach Dept. for her assistance in writing this article.


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