Sensory_Loss

1. What is sensory impairment' Sensory impairment or sensory loss – what does it mean' ‘Sensory impairment’ or ‘sensory loss’ are umbrella terms used to describe loss of the distance senses i.e. sight and hearing. The term ‘sensory impairment’ is commonly used by professionals rather than ‘sensory impaired’ individuals themselves who may be more likely to use the terms below. There are three very distinct groups within sensory impairment: • visually impaired people • deaf people • deafblind people ------------------------------------------------- ------------------------------------------------- People with a sensory impairment will have experienced life with their individual impairment in a completely different way to others who may be classed as belonging to the same group – no two people will be exactly the same and services should not be delivered as if they were. Causes of sensory impairment The largest cause of sensory impairment is the ageing process with over 65s more likely to experience some level of sensory loss. The following is a list of some common causes, of course, this list is not comprehensive … Blindness/partial sight Ageing process, e.g. age-related macular degeneration Disease, e.g. diabetes Infection, e.g. meningitis Genetics e.g. retinitis pigmentosa (RP) Injury or physical trauma Cataract Glaucoma Deafness Ageing process Infection, e.g. meningitis, mumps, measles Disease, e.g. Ménière’s disease Physical trauma Exposure to loud noise Genetics Deafblindness Ageing process Maternal infection, e.g. rubella Genetics, e.g. Usher Syndrome Other congenital causes, e.g. premature birth Combination of causes of deafness and blindness ------------------------------------------------- ------------------------------------------------- The largest cause of visual, hearing and dual sensory loss is the ageing process ------------------------------------------------- Sensory loss and age Recognising sensory impairment At times it may be obvious that a person is either deaf, blind or deafblind, however, many people have developed coping strategies which may unintentionally conceal their impairment. Indications that impairment may be present could include one or a combination of the following … Loss of hearing Wear a hearing aid Use sign language Fail to react to voices behind him/her Have difficulties joining in a group Turn up the volume on the TV/radio Fail to respond to a doorbell, etc Lean forward and look intently into the speaker’s face Give inappropriate responses Ask for repetition of what was said Loss of sight Wear dark glasses Use a white cane Use a guide dog Fail to react to visual clues/motions Bump into people/objects or trip over items on the ground Move around tentatively, perhaps walking close to walls Fail to see documents, cups, objects placed near them Have to hold something very close to read it Not look directly at you Loss of both sight and hearing Display any of the above … plus Use a red and white cane Find it difficult to ‘hear’ when the light is dim 2. Visual Impairment What does it mean' The term ‘visual impairment’ is used to refer to anyone who is blind or partially sighted. Blind – what does it mean' The current definition of blindness which is 60 years old states that the person can be registered blind when they are: “substantially and permanently handicapped by defective vision, caused by congenital defect or illness or injury” (National Assistance Act, section 29, 1948) Partially sighted – what does it mean' People can also be registered as Partially Sighted. People who are registered partially sighted have some useful vision and are sometimes referred to as having ‘low vision’. The majority of blind and partially sighted people have a little or some useful vision. Depending on the visual impairment individuals will see things very differently. ------------------------------------------------- Some common conditions: ------------------------------------------------- Age-related Macular Degeneration (AMD) ------------------------------------------------- Cataract ------------------------------------------------- Glaucoma ------------------------------------------------- Diabetic Retinopathy ------------------------------------------------- Retinitis Pigmentosa (RP) - Tunnel vision Statistics - visually impaired people How many people in the UK are blind or partially sighted' The Royal National Institute of Blind People (RNIB) state that around 2 million people in the UK have a significant sight loss. ------------------------------------------------- Of those people with a visual impairment, approximately ------------------------------------------------- 85% are aged over 65. (RNIB, 2006) Communication and access difficulties Here I highlight some problems experienced by blind/partially sighted people with communication and/or accessing information. • Not being able to access printed material • Difficulty in accessing the Internet / electronic devices • Difficulty in getting to destinations and around the built environment • Accessing unfamiliar buildings and environments • Lack of awareness of others as to how to help What can I/we do' Taking ‘positive’ action is always better than trying to ‘repair’ communication breakdowns. Maximising communication for blind/partially sighted people - Always identify myself even in known surroundings - Always use names to identify people – especially in a group situation - Keep the visually impaired person informed of people moving around and/or leaving the room/table etc. - Don’t be concerned about using phrases such as “did you see Alice yesterday'” - Do not use non-verbal communication e.g. pointing in the direction of something, shrugging shoulders, pulling faces - Provide information in alternative formats: extra large print, audio tapes, electronic formats Braille, moon, large print CD, email, etc I/we may also need to: - Allow extra time - Prepare an appropriate room - Arrange for the alternative formats to be provided - Take time to get the environment right - Look at providing the equivalent of a ramp for wheelchair users 3. Deaf/deafness What does it mean' There is no formal definition of deafness. It could be described using the medical model or terms that focus on the individual. Terms used to describe when a person became deaf: acquired hearing loss or born deaf (post-natal / pre-natal) People may describe themselves or be described as: Hard of hearing Deafened/profoundly deaf Sign language users Partially deaf Partially hearing Hearing impaired Terms that also describe the level of hearing loss may be used (along with measurement in decibel loss - dB) Mild 20 – 40 decibels Moderate 41 – 70 decibels Severe 71 – 95 decibels Profound 95+ decibels ‘Normal’ conversation at a distance of 1 metre is between 50-60dB ------------------------------------------------- Some common conditions: ------------------------------------------------- ------------------------------------------------- Age related deafness ------------------------------------------------- Cochlea Ostosclerosis ------------------------------------------------- Drugs (ototoxic deafness) ------------------------------------------------- Maternal Rubella ------------------------------------------------- Meningitis ------------------------------------------------- Measles ------------------------------------------------- Noise Induced deafness ------------------------------------------------- Presabyacusis ------------------------------------------------- What we hear' Deafness is not only about volume. Frequencies of sound have to be considered as well. It is more common for people to have a little useful hearing, particularly with the help of appropriately issued hearing aids. The following chart highlights what a person hears (or not hears) plotted on an audiogram. Most deaf people will have a bi-lateral hearing loss which is similar in both ears. This chart shows a person who hears differently from ear to ear. In the most basic terms, this person will not hear clearly the speech sounds above each line at the given frequencies. Statistics How many people in Scotland are deaf' As there is no central register of deafness, it is difficult to say accurately how many deaf people there are in the UK, however a number of estimates exist: Action on Hearing Loss (The Royal National Institute for Deaf People - RNID) estimates that 1 in 6 people in the UK have a hearing loss. ------------------------------------------------- ------------------------------------------------- The incidence of deafness increases sharply with age, so the older we are the more likely we are to have a hearing loss. ------------------------------------------------- Estimated 75% of over 70s will have a hearing loss ------------------------------------------------- Communication and access difficulties Here I highlight some problems experienced by deaf people with communication and/or accessing information. • Lack of awareness of others as to how to help • Not being able to access spoken material • English as a second language • Difficulties with lip-reading • Difficulty in accessing BSL interpreters or other appropriate communication professional • Diffi culty in accessing loop systems • Lack of awareness of others as to how to help What can I/we do' Taking ‘positive’ action is always better than trying to ‘repair’ communication breakdowns. Maximising communication for deaf people - Ask if they want to use a loop system - Try to establish the person’s preferred communication method - If necessary book BSL interpreters, lip speaker, note taker etc well in advance - Face the person - Use clear speech, normal lip pattern, don’t shout - Use finger spelling - Speak at ear level - Repeat, rephrase - Write things down - Ensure there is no echo - room with soft furnishings - Quiet situation I/we may also need to: - Allow extra time - Prepare an appropriate room - Book the necessary communication support - Take time to get the environment right - Look at providing the equivalent of a ramp for wheelchair users Hearing aids - benefits and limitations Hearing aids come in many shapes and sizes (and colours!). The most common being the ‘behind-the-ear aid’. Others include body worn aids which can be kept in a shirt/jacket pocket, an in-the-ear aid which fits snugly into the outer part of the ear canal (becoming more common), hearing aids attached to spectacles, radio aids etc. Virtually all hearing aids (especially behind-the-ear aids) have 3 switches: O - off, M - microphone (on) and T – telecoil (loop). Some just have a button for the Loop option. The T switch allows the user to use an Inductive Loop System, where only the sound from an external microphone is received by the hearing aid via magnetic signals transmitted through a wired ‘loop’ which can surround a table, room, theatre etc., thus, cutting out background noise etc. Hearing Aids: - enable some deaf people to understand speech more easily - either on its own or with a Loop system - are a miniature amplifying system - do not restore ‘normal’ hearing - benefits of hearing aids depend on the individual (i.e. type, degree of deafness) - make all sounds louder - take time to get used to - are not suitable for all people - some people have to re-learn sounds - profoundly deaf people may derive little or no benefit from hearing aids Some people may find hearing aids unsightly and/or the ‘dawning’ of old-age. Just because a person is wearing a hearing aid - I do not assume they can hear clearly. Cochlear Implants Technology is advancing and there are many developments in the area of ‘aids to hearing’ including cochlear implants, bone anchored hearing aids and middle ear implants. A popular misconception is that an implant is a cure for deafness, this is not the case. A Cochlear Implant is a surgically implanted device which stimulates the nerve of hearing and is usually only offered to people who do not derive any benefit from conventional hearing aids. Implants do not restore or ‘give the gift of hearing’, however, they do offer the chance to hear everyday sounds and sounds of speech. Sounds heard have to be learnt. 4. Deafblind/Dual sensory loss What does it mean' The generally accepted definition of deafblindness across Europe is: ‘Persons are regarded as deafblind if they have a severe degree of combined visual and auditory impairment, resulting in problems with communication, information and mobility’. “Breaking Through” Report, 1988 The terms dual sensory loss, dual sensory impairment and deafblind are used interchangeably. There are two recognisably very distinct groups within deafblindness: Congenitally deafblind having been born with a dual sensory impairment or having developed it in early childhood. Acquired deafblindness having been born with vision and/or hearing and having lost one or both some time after childhood, normally in later life. Person who is born deaf and later lose their sight Person who is born blind and later lose their hearing Person who loses both sight and hearing in later life This group includes those who have Usher Syndrome. Usher Syndrome is an inherited condition which results in hearing loss and a progressive loss of vision from Retinitis Pigmentosa (RP). The hearing loss is congenital, and ranges from moderate to profound. RP can occur without hearing loss. ------------------------------------------------- Important to remember ------------------------------------------------- ------------------------------------------------- People may describe themselves differently, for example: ------------------------------------------------- Deaf person with a visual impairment ------------------------------------------------- Dual sensory impaired ------------------------------------------------- Hard of hearing with a sight loss ------------------------------------------------- Blind with hearing impairment ------------------------------------------------- Etc Communication and access difficulties Here we highlight some problems experienced by deafblind people with communication and/or accessing information. All of the above points raised under blind, partially sighted and deaf people plus: • Not having access to guide/communicator service or communication support • Lack of awareness of the possibility of dual sensory loss being present • Lack of awareness of others as to how to help What can I/we do' Taking ‘positive’ action is always better than trying to ‘repair’ communication breakdowns. Maximising communication for deafblind people Follow all the guidelines for blind and deaf people and then additionally: - Good lighting is essential - Plain background - Light on the person speaking and coming from behind the deafblind person - Distance and positioning is important, check their preferred distance. - Use a whiteboard, or paper with black felt tip pen - Provide a guide/communicator to help deafblind person prepare for an appointment I/we may also need to: - Allow extra time - Prepare an appropriate room - Book the necessary communication support - Arrange for the alternative formats to be provided - Take time to get the environment right - Look at providing the equivalent of a ramp for wheelchair users ------------------------------------------------- ------------------------------------------------- Important to remember - what works for one deafblind person may not work for another - always check with the person. ------------------------------------------------- Practical communication Two-handed fingerspelling In general deaf people who use sign language use two-handed finger spelling. Some hard of hearing/deafened people may use finger spelling to initialise similar looking/sounding words (for example; ‘c’ for ceiling and ‘s’ for selling) Deafblind manual Some deafblind people (including deaf people who become blind) rely on a ‘tactile’ form of the alphabet. Deafblind manual is based on the two-handed fingerspelling as above, but with the obvious difference of the letters being spelled onto the hands of the deafblind person. Some of the letters are produced slightly different from the two-handed version (for example; ‘p’ is the pinching of the recipient’s index finger so it is not confused with ‘e’). Block alphabet Some deafblind people may not have learned either two-handed or deafblind manual and prefer to receive letters ‘drawn’ on the palm of the hand. These shapes resemble capital letters of the written alphabet. It is important to note hat each letter has a number of strokes to ‘draw’ out the letter shape (for example the letter ‘A’ has 2-stokes and not three as you may expect - if it had, it may be confusable with ‘H’). Using forefinger I can trace BLOCK CAPITAL letters on the palm of the deafblind person’s hand - each letter on top of the last. Quick signs: Two taps on the palm for ‘Yes’ Rubbing out movement accros the palm for ‘No’ or for erasing an error. Points for good communication * Keep my face in good light and face the person who’s deaf. A light source will cast a shadow on my face making lip-reading difficult * Keep my face clear at all times. Hands, pens also make lip-reading difficult. Masks or visors may hinder clear communication * Speak clearly. Do not exaggerate my mouth movements and do not shout, this distorts your lip-patterns * Cut out as much background noise as possible, e.g. close windows, doors, turn off radios etc. Hearing aids pick up and amplify all sounds. Remember, ‘visual noise’ has to be considered as well! * Use the most common form of words and do not change from one topic of conversation to another as this confuses a lip-reader. * If I am not understood, I will try re-phrasing what I said or write it down * If another person joins the conversation, I will indicate to the deaf person who is now speaking by a hand gesture or a nod in the direction of the new speaker * It may also be useful to use some gestures when I am explaining things. I remember, gestures and normal facial expressions form part of good communication * I am aware that laminated notices/posters may be affected by glare from lighting * Printed material may need to be changed – type size, colour of paper * Contrasting colours to indicate furniture such as low tables, doorways etc assist visually impaired people in getting around * Remove any obstacles which may be a risk – waste/recycling bins for example * Ask the person! Guiding awareness There is no one correct way to guide a deafblind person. Each deafblind person experiences deafblindness in their own unique way, and this affects their mobility and guiding needs. One way to introduce myself and ask the person if she/he needs assistance I must always be just in front; the blind / deafblind person will follow. Offer them my elbow then keep my elbow at the side of my body - this will automatically mean I am in front Don’t look at their feet, look ahead Take their hand and gently put it on the chair/door/cup Never push them backwards into a chair, take their hand and gently put it on the back of the chair A person born with a visual impairment may have undergone mobility training and be confident being guided A person with acquired blindness/deafblindness may require different techniques (e.g. firmer hold) Communication services 1 - British Sign Language/English Interpreter What do they do' Interprets from one language to the other (usually simultaneously) e.g. English to British Sign Language (BSL) & BSL to English Who would use them' BSL users Born or became deaf in early childhood Sign language may be their main means to communication 2 - Electronic Notetaker / Speech to Text Reporter What do they do' Writes or types (conventional or palantype keyboard) almost verbatim. Palantype operator – 200 wpm Who would use them' Deafened or hard of hearing people Became deaf after acquiring spoken language - spoken/written may be their main means to communication 3 - Lip Speaker What do they do' Repeats what is being said without voice (only lip movements), almost verbatim and with appropriate facial expressions and gestures Who would use them' Hard of hearing people Born or became deaf (partially/severe) - spoken/written may be their main means to communication 4 - Communicator Guide with Deafblind People What do they do' The tasks they carry out will vary, depending on the individual deafblind person, their level of residual hearing and vision and the