Nevada Dual Sensory Impairment Project University of Nevada, Reno MaryAnn Demchak, Ph.D. Project Director Deafblindness: An Introduction

Contact Information MaryAnn Demchak Nevada Dual Sensory Impairment Project/299 University of Nevada, Reno Reno, NV Toll-free: Website:

Purpose of this Presentation Participants will understand: What deafblindness, or a dual sensory impairment, is The diverse nature of deafblindness Critical factors influencing the effects of deafblindness The challenges or impact of dual sensory impairments

What is Deafblindness?-- The Legal Definition Deafblindness, or dual sensory impairment, refers to the concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and education problems that the individual cannot be accommodated in programs solely for individuals who are deaf or blind (2004, IDEA)

The Diversity of “Deafblindness” Although “deafblind” implies a total absence of vision and hearing, this is not the case Most children who are deafblind have residual hearing and vision There is no single profile of a child who is deafblind

How Might Vision Be Impacted? Low vision (visual acuity of 20/70 to 20/200) Legally blind (visual acuity of 20/200 or less or field restriction of 20 degrees or less) Light perception only Totally blind Diagnosed progressive loss Cortical visual impairment

How Might Hearing Be Impacted? Mild loss (26-40 dB loss) Moderate (41-55 dB loss) Moderately severe (56-70 dB loss) Severe (71-90 dB loss) Profound (91+ dB loss) Diagnosed progressive loss Auditory neuropathy

Degree of Vision Normal Vision Low Vision (best corrected to 20/70) Blind - legally,light perception, field loss, totally) Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Low Vision (best corrected to 20/70) Blind - legally,light perception, field loss, totally) Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Low Vision (best corrected to 20/70) Blind - legally,light perception, field loss, totally) Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired (HI) Low Vision (best corrected to 20/70) Blind - legally,light perception, field loss, totally) Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired (HI) HI Low Vision (best corrected to 20/70) Blind - legally,light perception, field loss, totally) Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired (HI) HIDepends on degree Low Vision (best corrected to 20/70) Blind - legally,light perception, field loss, totally) Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired (HI) HIDepends on degree HI Low Vision (best corrected to 20/70) Blind - legally,light perception, field loss, totally) Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired (HI) HIDepends on degree HI Low Vision (best corrected to 20/70) Visually impaired (VI) Blind - legally,light perception, field loss, totally) Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired (HI) HIDepends on degree HI Low Vision (best corrected to 20/70) Visually impaired (VI) Blind - legally,light perception, field loss, totally) VI Progress ive Loss CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Blind - legally,light perception, field loss, totally) VI Progress ive Loss Depends on degree CVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Blind - legally,light perception, field loss, totally) VI Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB Blind - legally,light perception, field loss, totally) VI Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI DB

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI DB

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI DB

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI DB

Degree of Hearing Degree of Vision Normal Hearing Hard of Hearing (mild-moderate) Deaf (severe to profound) Progres- sive Loss Auditory Neuro- pathy Normal Vision Normal for both Hearing impaired Depends on degree Hearing impaired Low Vision (best corrected to 20/70) Visually impaired (VI) Identified as DB DB Blind - legally,light perception, field loss, totally) VI DB Progress ive Loss Depends on degree DB CVIVI DB

What Might You See & Hear Simulations DVD: Sensory Perspectives (from SKI-HI)

Critical Factors that Influence the Impact of Deafblindness Age at onset of loss Accompanying disabilities Degree, type, and stability of vision and hearing loss

Critical Factors that Influence the Impact of Deafblindness Age at onset of loss –Congenitally deafblind –Adventitiously deafblind –One sense congenitally impaired; other loss acquired Accompanying disabilities Degree, type, and stability of vision and hearing loss

Critical Factors that Influence the Impact of Deafblindness Age at onset of loss Accompanying disabilities –Cognitive impairments –Physical impairments –Complex health care issues

Critical Factors that Influence the Impact of Deafblindness Age at onset of loss Accompanying disabilities Degree, type, and stability of vision and hearing loss –Progressive losses

Impact of Deafblindness on Development Limited access to information Movement Learning Emotional development Communication –Receptive –Expressive

Accessing Information Vision and hearing are our distance senses Even a mild loss can have a serious effect Hearing is our only sense that can “bend around corners” Vision takes in more information all at once than any other sense Fragmented or distorted information often acquired with a dual sensory loss

Movement Seeing objects and hearing sounds influences motivation to interact with the environment When vision and hearing impaired, motivation is diminished

Learning Incidental learning  More likely to require formal instruction on “topics” others acquire incidentally Concept development  Abstract concepts more difficult to learn Mental imagery  Challenging to construct mental images of simple objects

Emotional Development Bonding and attachment behaviors Sense of self and body image Motivation Perception of safety Isolation

Communication Early communication involves movement Infants gain experiences in using their actions to influence people and objects in their environments, form of early communication They may not understand their actions influenced those around them or caused something to happen

Communication They do not have the same opportunity to acquire symbols to represent their communication They do not have repetitive, meaningful exposure to incidental use of objects, pictures, sign language, speech May have difficulty finding communication partners May have difficulty finding common topic

Communication & “Problem” Behaviors “Problem” behaviors serve a purpose for the child All behavior can be communicative Behavior does not have to be intentional to be communicative Behavior is influenced by events in the setting Understanding the message behind “problem” behaviors can be difficult

It Is Important to Remember: Children who are deafblind--  Require thoughtful and unique educational approaches  Can participate in almost any activity  Communicate in a variety of ways

What if you are working with a child who is deafblind and would like assistance? Contact the Nevada Dual Sensory Impairment Project

Information about the project How do you refer a child? What happens after a child is referred? What assistance can be provided? How does a family or service provider get assistance? Where is assistance provided? Is there a cost? What are the benefits?

Remember Who is Eligible for the Project Vision and hearing impairments Can also have other disabilities: –Cognitive impairments –Physical impairments –Complex health care needs –Speech / language / communication delays –Behavior disorders Most of the time do have other disabilities in addition to impairments in both vision and hearing

How to refer to the project? Complete a referral packet and fax or mail to MaryAnn Call MaryAnn and discuss referral over phone or request packet

Why refer to the project? Project newsletter & other TA documents (e.g., Tip sheets) Print or video resources Parent-to-parent network Family-to-family network and listserv (western states) Project sponsored trainings Help in finding resources Home and/or school visits Annual parent conference

What happens after referral? Referral packet reviewed Potential phone calls for clarification on some questions Intro binders mailed to parent and service provider: –TA request forms, all tip sheets, newsletter & more Introductory phone call and/ or visit

Questions