Understand. sensory loss. Unit SS MU 3.1. In this unit you will learn about:

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1 Unit SS MU 3.1 Understand sensory loss It is essential that you understand the differing needs of people with sensory loss and how you can improve on your work practices to support and empower them. There are significant numbers of people in the UK who have a sensory loss. This can mean sight loss, hearing loss or dual sensory loss. This unit will introduce you to the impact of sensory loss on the person. With a single sensory loss, the person normally relies on the other senses to compensate. However, people missing both senses have a unique disability which requires specialist communication skills alongside ongoing support. Throughout this unit, you will encounter many terms for sensory loss. The Royal National Institute for Deaf People (RNID) suggest that when talking about a person with a hearing loss, it is good practice to use the terms Deaf, hard of hearing or having a hearing loss. British Sign Language (BSL) users use a capital D in Deaf to highlight that they belong to the Deaf community. The Royal National Institute for the Blind (RNIB) use the terms blind or partially sighted, and Sense advise that hearing and vision loss is termed deafblindness. In this unit you will learn about: the factors that impact on an individual with sensory loss the importance of effective communication for individuals with sensory loss the main causes and conditions of sensory loss how to recognise when an individual may be experiencing sight and/or hearing loss and actions that may be taken. 1

2 Level 3 Health & Social Care Diploma 1. Understand the factors that impact on an individual with sensory loss Approximately 95 per cent of the information about the world around us comes from our hearing and sight. We read books, magazines and correspondence, we talk to each other face to face or on the telephone and we listen to our music on the television or the radio. The environmental information lets us know what is going on body language and facial expressions, conversations, computer keys tapping, lawn mowers being used in gardens and so on. To understand the world around us we rely a great deal on our senses. When people have any sensory loss, then their mobility and communication are greatly affected. This can lead to increased loneliness and even isolation in some cases. Activity 1 Your sensory awareness Take ten minutes and write down everything you see and hear How many times did you use your hearing? How many times did you use your sight? How many times did you use your other senses? Try to imagine the impact of sensory loss on your day-to-day life. 1.1 How a range of factors can impact on individuals with sensory loss Impact on communication Sensory loss can often be a hidden disability which can frequently lead to isolation and frustration at not being able to communicate efficiently with other people. With hearing loss, day-to-day activities such as hearing a doorbell, using the telephone, watching television or taking part in conversations can produce feelings of inadequacy. Conversely, not being able to distinguish faces, read the time on a clock or drive can produce the same feelings in a person who has vision loss. Having a dual sensory loss compounds the frustration and isolation a person feels when trying to communicate effectively. Many blind and partially sighted people lose the ability to see gestures and facial expressions, which are important parts of communication. It becomes difficult for them to know when someone is speaking to them or even when the other person has walked away. Written communication can be difficult for a person with low vision. Sometimes a larger font is needed, a differentcoloured paper for colour contrasting or the information on a disk or tape. Communication by or text can be accessed by having speech programs installed on a computer or mobile telephone. Activity 2 Sight loss Sit on a chair in a crowded room and observe what is going on around you Do you hear people talking? Can you see people walking across the room? Is the television or radio on? Close your eyes and sit in the same chair. 4. Now what can you see? 5. What can you hear? 6. Do you recognise people s voices or the way they walk across a room? 7. How different do you feel when you can not see? 8. Would you be able to walk around the room safely? Hearing loss interferes with face-to-face communication and can often cause older people to lose interest in everyday activities and in turn make them more likely to miss information given by their doctor, carer or family member. Older people who are losing their hearing often rely on their eyesight to compensate for this. In conversation, they will watch the other person s face and lips, and use clues about the context to try to respond appropriately. 2

3 Understand sensory loss Unit SS MU 3.1 Activity 3 Hearing loss Try turning the volume down very low on the TV, so you can just hear a murmur. Now try to follow what is going on in the programme. 1. How frustrating was it not to be able to hear what was happening? 2. What help did you need to follow what was going on? However, people who are losing both their hearing and their vision will find it difficult to look for clues in the conversation. This will be particularly severe with a person who has central vision loss, as this then may completely remove the ability to read lips or to see faces. To avoid deafblind people becoming devoid of knowledge about the outside world or having a limited contact with a variety of other people, support should be obtained from a range of sources, such as health services, social services, specialist organisations and support groups. Impact on information One of the needs of people with a sensory impairment is to be able to obtain information. Whether it is written, spoken or signed information, it needs to be in an accessible format. A person who has vision loss wants to be able, for example, to look at their own bank statement, to know what is available on a menu, to be able to participate in local activities or events or to be able to read/write a personal letter. Additionally, someone else reading their written communication in the form of lists, appointments and private correspondence has a detrimental effect on maintaining the person s dignity and confidentiality. Access to written information specifically for people with a vision loss is not readily available and information is not forthcoming. Furthermore, people with a hearing loss may need access to information that is not in a written format by telephone, face-to-face and signed information. The impact on information is greatly enhanced when a person has a dual sensory loss. It is important for all of us to be able to access information independently and not to have to rely on someone else. This removes or reduces independence and privacy. Everybody has the right to be able to access information and should be afforded the opportunity to do so privately and independently. Impact on familiar layouts and routines Sight plays a major role in maintaining orientation and people can lose a sense of what is around them and where they are. Although listening to sound can be useful, it can move and then echo off surroundings; therefore it is not as confined or exact as vision. People with vision loss may no longer be sure where things are. A feeling of being separate and an increasing sense of isolation can occur because the brain is receiving less stimulation. People who are sighted have an immediate sense of what is in the environment beyond the task taking place. Without vision, hearing can provide some information, but only about people or objects producing sound. Also, peripheral vision gives people no indication that there are other people and objects around, which can cause confusion when they come into the visual area. An extensive loss of vision can result in: an inability to negotiate the environment a loss of sense of freedom a loss of security a loss of control in their environment. These effects can make people feel very dependent on others. Hearing loss causes its own problems with difficulty hearing information, following conversation or asking for directions. This can be very isolating for somebody if their usual routine is to listen to a programme on the radio, talk to people on the telephone or go for coffee with friends in a noisy restaurant. Hearing loss impacts greatly on gathering information and making informed choices. People need to have confidence in moving safely around their own homes and immediate local area, and also to go further afield. This may be with or without a recognised mobility aid, such as a white cane, red and white cane (to signify dual sensory loss) or guide dog. The cost and lack of transport will be added obstacles for many people. For some people, the need to have assistance in the form of sighted guiding is essential. 3

4 Level 3 Health & Social Care Diploma Activity 4 Guiding techniques You should refer to sighted guiding techniques and practise with a colleague how to guide a person correctly. You can download a how-to guide from 1. How did you feel putting your confidence in another person to guide you? 2. How safe did you feel being guided? 3. How confident were you in guiding someone? Impact on mobility Good design in homes and buildings can help with finding your way around more easily if you have sensory loss. It is recommended that good colour contrasting is used throughout the premises. This ensures that people who have some useful vision can see door frames, edges of cupboards, where the walls start and end. This all helps with navigating around buildings including the doctor s surgery, bank or supermarket. Normal changes in sight due to aging include: general reduced acuity (seeing detail) reduced accommodation reduced peripheral vision the need for increased lighting problems with glare problems adapting to light changes problems with depth perception reduced colour and contrast sensitivity. It is therefore important to have good consistent lighting throughout the building. Key term Accommodation the process by which the eye changes optical power to focus on an object as its distance changes Some local authorities have Communicator Guides or Guide-help schemes, which enable a deafblind person to benefit from a better quality of life with greater independence. Communicator Guides act as a conduit, allowing the deafblind person to interact with the outside world. Tasks include helping with reading letters and paying bills, escorting on excursions outside of the home to doctors, banks or leisure activities. They enable the person to make use of their remaining sight and hearing, and play an important role in reducing stress and increasing confidence. Remember there are no hard and fast rules on how to guide people with sight problems, but these are the guidelines the RNIB offers because they are safe and sensible. You may find the person you are guiding does not follow these guidelines, choosing instead to do something different that works for them. The practical advice and information given here will help you feel confident about guiding people with sight problems. Your offer to guide will usually be welcomed; however, many people with sight problems prefer to keep their independence. Also remember that for some people, physical contact may be a problem due to their culture or gender, or because they are protective of their personal space. Doing it well Guiding Give instructions where necessary, but do not overdo it, and be careful not to push or pull the person you are guiding. Match your pace to that of the person you are guiding. Give them time to hold your arm securely before you start walking. Remember to give adequate room round obstacles. Watch out for hazards at head height, especially if the person you are guiding is taller than you. It is very easy to walk someone into an overhanging tree or shop canopy. Watch out for lamp posts and bollards too. You may find people you are guiding prefer to walk on the pavement edge to avoid such obstacles. Explain loud noises that may alarm, such as roadworks or alarms. Explain changes in ground surface, for example, if you are walking from a pavement on to grass or gravel, or if paving slabs and road surfaces are particularly uneven. Keep your guiding arm still and relaxed. Do not wave it about or point at things. Remember that older people or those with other disabilities may need extra consideration. 4

5 Understand sensory loss Unit SS MU 3.1 When you meet someone with a white cane or a guide dog, remember they are not always totally blind. In fact many people have some useful vision but they might welcome your help at times for example, in an unfamiliar place or at night time. If someone is carrying a white cane with red bands on it or has a guide dog with a red and white harness, this indicates they are deafblind (that is, they have both a sight and hearing loss) and may be experiencing difficulties in particularly noisy or busy environments. You may have to ascertain how much useful hearing or sight the person has, and adapt your help accordingly. You may have to use the deafblind alphabet to communicate, or encourage the person to lipread. Try to give precise verbal instructions it does not help to point and say, It s over there. And remember to say when you go away, or you might leave someone talking to an empty space! Activity 5 Factors impacting on sensory loss Take some time to analyse other factors which may impact on a person with sensory loss for example, health, happiness. In your own work role, highlight the areas where you can improve your practice to ensure that barriers to communication, information, familiar layouts and routines and mobility are addressed. Develop an action plan which will encourage people to maintain their independence. Functional Skills English: Writing When writing your action plan, ensure that an appropriate layout is used. Proofread your work to check that spelling, punctuation and grammar is accurate. 1.2 The impact of societal attitudes and beliefs Any type of sensory loss can cause people to experience the ways in which society treats them differently. People often believe that any type of sensory loss also reduces people s capacity to understand. How many times have you heard people speak slowly and loudly to someone who is blind? Have you ever done it? There are many simple things that people do without thinking of the impact on someone with a sensory loss. How often have you parked a car half on the pavement to make more space on a narrow road? Someone who cannot see it may be walking down the pavement expecting to be able to take their usual route. Another major risk is the parking of vans and lorries because mirrors are at face and head height, so even if someone has a guide dog that guides them around the vehicle, the mirrors will still stick out far enough to cause injuries. Society is better than it used to be at recognising the needs of deaf people; there are more public buildings such as cinemas, theatres and conference facilities that have loop systems so that people who can use hearing aids are able to listen to what is being said or performed. There some events that now have signers to translate speeches and performances. Many television programmes now have access to subtitles and some have signers, although these tend to be late at night. People with any kind of sensory loss can have difficulties in finding employment. Even though the Equality Act and the Disability Discrimination Act mean that employers cannot discriminate, it is hard to convince an employer that a sensory loss does not necessarily mean that someone is unable to do a job. Attitudes such as these can make it difficult for people to maintain self-esteem and can destroy confidence, with the result that they will attempt less, rely on others more and potentially lose their independence. However, there have been some major shifts in attitudes as initiatives such as Our Health Our Care Our Say, Putting People First and Valuing People are changing how we look at disability and making people aware that all disabled people have the right to take a full part in society and to make choices about how they want to live. Major lobbying from disabled rights organisations over a period of many years has finally begun to change how society views people with a sensory loss. 5

6 Level 3 Health & Social Care Diploma Case study Recognising the signs of sensory loss Doreen Jones is 85 and lives in a residential home, having moved from her own home a year ago after falling and breaking her hip, although she fully recovered from the hip replacement. Doreen s son informed staff that his mother had reading glasses and sometimes chose to ignore people who were speaking to her. She had been to the optician, who had told her that she might develop a problem later on, but the son could not elaborate on this. As the optician s notes were not forwarded to the home, staff are unaware that Doreen might have an eye condition. At the time of her arrival at the home, she was happy to join in activities and was a member of the residents association. She regularly went on outings with the home and enjoyed the regular Friday night chip suppers. During the last three months, Doreen has refused to attend any activities as she says she cannot be bothered. She has also asked for her meals to be served in her bedroom away from everyone else and also changes her clothing after every meal. A member of staff has tried to ask Doreen if she has any problems; she refuses to answer, instead asking, What are you saying? or just telling them to go away. A second member of staff has said she thinks Doreen seems depressed, while another member of staff says she is just being awkward or has dementia. 1. What are the possible reasons for the change in Doreen s behaviour? 2. Who would need to be involved in making an assessment of her? 3. How would you go about getting an assessment for Doreen? Functional Skills English: Reading You will need to read and understand both straightforward and complex texts, and use the information in an appropriate way. In this case you will need to use the text to answer questions using the information within it. 1.3 The impact of attitudes on service provision The social model of disability supports the idea of person-centred services. For people with sensory loss, this means that services are planned in a way that gives people control over the services they need to support them. Most people are now offered a personal budget that enables them to work out a support plan based on what they are able to do for themselves, the informal support they have and identifying where paid support is needed to fill the gaps. The changes in attitudes brought about by new initiatives such as those mentioned above have resulted in the huge shifts in how services are delivered. Services are no longer based on a gift model where professionals decide what services will best suit someone; person-centred service planning and delivery now put people at the heart of everything and give them choice and control over their lives. Personal budgets give people the chance to decide: what support they need how they want the support delivered whom they want to deliver the support when they want support. This is in total contrast to earlier models where services were delivered in the way most convenient for the organisation providing them and people were expected to fit in. 6

7 Understand sensory loss Unit SS MU Understand the importance of effective communication for individuals with sensory loss There are many ways of communicating, including, for example: talk face to face talk telephone, mobile, radio gestures formal, such as sign language gestures informal hand movements body language eye contact reading and writing ing and text messaging. 2.1 The methods of communication used by individuals with sight loss, hearing loss and deafblindness Sight loss There are many ways that somebody with sight loss can communicate. Some examples of communication can be seen in print, using information technology, recording on to tape or disk, Braille or a specially adapted telephone. The RNIB produces Clear Print guidelines which you can access from Use large printed words rather than joined-up writing. Print should not be all capitalised, as this makes distinguishing between different letters/words difficult. Using a felt tip or marker pen produces a vivid dark image which is easier to read. You can magnify print using a low vision aid or you can enlarge text on a photocopier. When reading, it may help to use a ruler or piece of card to mark the line and reduce glare coming from the page. Computers, scanners, software and electronic magnifiers can frequently enable the person to read or write, while some staff find it beneficial to record information on to disk. A big button telephone enables people with sight loss to access the telephone. Braille is a tactile language, read/felt through the fingertips. Have you seen Braille books or notices? Doing it well Supporting people with vision loss Say who you are. Say what you are going to do and be specific. Talk directly to the person and use their name. Stand in a place where you can be seen. If necessary, touch for attention. Take the time to answer questions. Tell the person that you are leaving them do not just walk away. Functional skills English: Speaking and listening Speaking and listening skills can be practised by completing the task above. When communicating verbally, it is important to present information clearly using appropriate language and to be able to adapt your contribution to suit the situation you are in. It is also important to be aware of your body language. Ensure you take an active part in the discussion and that you show effective listening skills. 7

8 Level 3 Health & Social Care Diploma British Sign Language (BSL) is the language of choice for a significant number of deaf people in the UK. It is a visual/spatial language, which has its own grammatical rules using hand shapes, hand movements and facial expressions to convey meaning. The grammatical rules of BSL are completely different to the rules of English. straight text-to-text conversation which does not need the help of an operator to translate speech to text. The use of hearing aids greatly enhances communication for some people who are hard of hearing. There are many types of hearing aids, induction loops and conversers on sale at present and some hearing aids are still available from the NHS. The letters A and B from the fingerspelling alphabet. Where have you seen this symbol? Hello (formal) and I m sorry. Hearing loss A number of people who are deaf or hard of hearing sometimes prefer to communicate using lipspeakers. These follow the conversation and repeat what is said but without using their voice; this in turn makes it easier for some people to lipread. People who are deaf or hard of hearing may access a speech-to-text reporter. This uses a special keyboard to produce a verbatim (word for word) report, which is displayed on a computer screen or a large screen, via a data projector, for the deaf person to read. This is an entirely different system to having a notetaker who will provide summary notes, not a verbatim account of what is being relayed. A telephone relay service is used by many people with a hearing loss who wish to communicate by telephone. The message is relayed to an operator, who sends the message by text to the person with hearing loss. If there are no hearing people involved in the call, then it is a This symbol indicates a loop system is present. Switching a hearing aid to the T setting engages the telecoil. This shuts out background noise because the microphone has been switched off, and ordinary acoustic sound around you is no longer picked up by your hearing aids. Only sound coming from a nearby magnetic induction loop is being picked up. You can look at for more advice on communication. Doing it well Supporting people with hearing loss A quiet, well-lit room is best. Ensure the light is on the speaker s face. Face the person you are speaking to. Stay in their field of vision. Speak a little louder than usual. Do not shout, as this distorts the voice and lip patterns. Speak a little more slowly than usual but not so slowly as to destroy the speech rhythm. If something is not understood, rephrase rather than repeat. Avoid distracting clothes or dangly earrings, or a beard if you are male, as this may cover the lips. 8

9 Understand sensory loss Unit SS MU 3.1 Functional skills English: Speaking and listening Speaking and listening skills can be practised by completing the task on the previous page. When communicating verbally, it is important to present information clearly using appropriate language and to be able to adapt your contribution to suit the situation. It is also important to be aware of your body language. Ensure you take an active part in the discussion and that you show effective listening skills. Deafblindness People who are deafblind communicate using their remaining sight and hearing. They can also use touch with objects, known as tactile communication, or by using touch with people, known as tactual communication. Communicating with people who have a dual sensory loss is greatly enhanced by using clear speech and clear print. People who have a vision loss after using signs for communication can still follow the signs being used by putting their hands over those of the person who is signing. The Deafblind Manual Alphabet is similar to BSL fingerspelling, but all of the manual alphabet is concentrated on the person s hand in which you point to different finger positions on the deafblind person s hand, or draw letter shapes. Tactile communication Braille is a system of raised dots which can be read by touch. The Moon alphabet consists of embossed shapes which can be read by touch. Objects of Reference are objects that have special meanings assigned to them. They stand for something in the same way that words do. Tactual communication Tadoma is a form of tactual communication whereby direct contact is made between the hand of the deafblind receiver and the face of a talker to monitor the various articulatory actions that occur during speech. Key term Articulatory relating to articulation (vocal expression) Activity 6 Tactile communication Use the information in the unit to find out more about different forms of tactile communication. Consider how it could benefit any of the people you support. Reflect Take all your communications for just one day. Think about which of your senses you used for each of them; did you use hearing, touch, sight or a combination? Spend some time reflecting on how difficult it may be to communicate without one or more of your senses. 2.2 How the environment facilitates effective communication for people with sensory loss Earlier in this unit, you looked at how making small changes to an environment, such as moving furniture or reducing noise, can make a positive difference to people with sensory loss. Supporting people to maintain their independence through managing their day-to-day environment is a vitally important part of your role. There some quite simple changes that can make communication more effective for people. By using colour, it is possible to create a visual contrast between surfaces to help people differentiate between them. It can also be used to highlight key and safety features. An effectively contrasted environment will reduce the risk of injury, enabling people to see edges between surfaces and perceive depth and difference more easily. 9

10 Level 3 Health & Social Care Diploma The RNIB suggests making things bigger, brighter and bolder. Bigger Making things bigger usually makes them easier to see. Using easy-to-see products could help people in their daily lives. Some examples of these are: clocks and watches with large numbers big button telephones large print books and calendars thick black felt-tip pens to write notes with. People can also try moving things closer to their eyes this will not damage their eyes, just make things appear bigger. For example, they could sit closer to your television to make the picture bigger. Using a magnifier can also make things look bigger. Choosing the right magnifier is very important and people should visit their low vision service, where they will receive a full assessment so that they can get the best magnifier for them. Brighter Making things brighter by using better lighting can help to make things easier to see. You should make sure that people have as much light as they feel comfortable with for each task that they do. It is often easier to see things if people shine a light directly on to what they want to see. For example, when reading, it may be easier to see the text if they use a lamp that can be adjusted to shine directly on the page that they are reading. This is called task lighting. Everyone is different and needs to find the amount of light that they are comfortable with. Bolder It is harder to see things that are similar in colour to the background that they are on. Contrast is about how much something appears to stand out from its background because of its colour or tone. Things can be made easier to see by putting them on a contrasting background. You can use different colours or tones to make them stand out. For instance, a dark purple plate on a dark purple tablecloth may be difficult to see. It would be easier to see a white plate on a purple tablecloth or a light purple plate on a dark purple tablecloth. The best contrast is black and white. One of the key beneficial changes for people with a hearing loss is to reduce background noise along with good lighting so that people s faces can be clearly seen when they are speaking. It may be difficult to reduce background noises when people are living in a group setting, but being aware of noise levels and remembering to suggest that people move into a quieter room for important communication can be a great help. Using task lighting can be a help if the general light levels in a room are low. If people have well-lit faces, it is so much easier for people to lip-read and to make maximum use of non-verbal communication through facial expression. People are also an important part of an environment; so reminding others to think about the communication needs of people with a sensory loss and encouraging everyone to have consideration and respect for each others particular needs is a useful contribution to a supportive and communication friendly environment. 2.3 How effective communication may have a positive impact on individuals with sensory loss Consider your feelings when you could not see or hear properly in the activities earlier in this unit. You will need to explain how adapting the environment, staff training and guidance can all contribute to having a positive impact on people with a sensory loss. In January 2006, the White Paper Our health, our care, our say: a new direction for community services (see was published, and included the following outcomes: improved health and emotional well-being improved quality of life making a positive contribution choice of control freedom from discrimination economic well-being personal dignity. 10

11 Understand sensory loss Unit SS MU Understand the main conditions and causes of sensory loss 3.1 The main causes of sensory loss Main eye conditions Cornea Pupil Iris Vitreous A cross-section of the eye. Lens Macular degeneration Macula Retina Optic nerve To the brain The eye is shaped like a ball. The pupil, close to the front, is the opening, which allows light to enter the eye. Just behind the pupil is the lens, which focuses the light on the retina at the back of the eye. The retina is a delicate tissue, which converts the light into images, and sends them to the brain. The macula is a small area at the very centre of the retina (see Table 1). The macula is very important and is responsible for what we see straight in front of us, allowing us to see fine detail for activities such as reading and writing, as well as allowing us to see colour. Sometimes the delicate cells of the macula become damaged and stop working, and there are many different conditions which can cause this. If it occurs later in life, it is called age-related macular degeneration (AMD). Broadly speaking, there are two types of macular degeneration or AMD, usually referred to as wet and dry. This is not a description of what the eye feels like but what the ophthalmologist (eye specialist) can see when looking at the macula. Dry AMD is the most common form of the condition. It develops very slowly, causing gradual loss of central vision. Many people find that vision slowly deteriorates by gradual central blurring, and that the colours fade away like in an old photograph. There is no medical treatment for this type of AMD. However, aids such as magnifiers can be helpful with reading and other small detailed tasks. Part Cornea Iris Pupil Lens Retina Macula Optic nerve Vitreous Description Clear front window of the eye that transmits and focuses light into the eye Coloured part of the eye that helps regulate the amount of light that enters Dark aperture in the iris that determines how much light is let into the eye Transparent structure inside the eye that focuses light rays on to the retina Nerve layer that lines the back of the eye, senses light, and creates electrical impulses that travel through the optic nerve to the brain Small central area in the retina that contains special light-sensitive cells and allows the eye to see fine details clearly Connects the eye to the brain and carries the electrical impulses formed by the retina to the visual cortex of the brain Clear, jelly-like substance that fills the middle of the eye Table 1: Parts of the eye. 11

12 Level 3 Health & Social Care Diploma Wet AMD results in new blood vessels growing behind the retina; this causes bleeding and scarring, which can lead to sight loss. Wet AMD can develop quickly and sometimes responds to treatment in the early stages. It accounts for about ten per cent of all people with AMD. Glaucoma Glaucoma is the name for a group of eye conditions in which the optic nerve is damaged at the point where it leaves the eye. This nerve carries information from the light-sensitive layer in your eye, the retina, to the brain where it is perceived as a picture. The eye needs a certain amount of pressure to keep the eyeball in shape so that it can work properly. In some people, the glaucoma damage is caused by raised eye pressure. Others may have an eye pressure within normal limits but damage occurs because there is a weakness in the optic nerve. In most cases, both factors of high pressure and weakness in the optic nerve are involved, but to a varying extent. Pressure is controlled in the eye through a layer of cells behind the iris (the coloured part of the eye) which produces a watery fluid, called aqueous. The fluid passes through a hole in the centre of the iris (called the pupil) to leave the eye through tiny drainage channels. These are in the angle between the front of the eye (the cornea) and the iris, and return the fluid to the blood stream. Normally the fluid produced is balanced by the fluid draining out, but if it cannot escape, or too much is produced, then the eye pressure will rise. If the optic nerve comes under too much pressure, then it can be injured. How much damage there is will depend on how much pressure there is and how long it has lasted, and whether there is a poor blood supply or other weakness of the optic nerve. A really high pressure will damage the optic nerve immediately. A lower level of pressure can cause damage more slowly, and then a person would gradually lose their sight if it was not treated. Please note: People over the age of 40 years with an immediate family member diagnosed with glaucoma parents, children or siblings are entitled to a free sight test every year under the NHS. Diabetic eye disease Diabetes can start in childhood, but more often begins in later life. It can cause complications which affect different parts of the body, the eye being one of them. There are two different types of diabetes mellitus. Type 1 diabetes commonly occurs before the age of 30 and is the result of the body producing little or no insulin. Type 1 diabetes is controlled by insulin injections. Type 2 diabetes commonly occurs after the age of 40. In this type of diabetes the body does produce some insulin, although the amount is either not sufficient or the body is not able to make proper use of it. Type 2 diabetes is generally controlled by diet or tablets, although some people in this group will use insulin injections. If someone has diabetes, this does not necessarily mean that their sight will be affected, but there is a higher risk. If the diabetes is well controlled then they are less likely to have problems, or they may be less serious. However, if there are complications that affect the eyes, then this may result in loss of sight. Most sight loss due to diabetes can be prevented, but it is vital that it is diagnosed early. It can only be detected by a detailed examination of the eye. Therefore, regular annual eye examinations are extremely important, as a person may not realise that there is anything wrong with their eyes until it is too late. Diabetes can affect the eye in a number of ways. The most serious eye condition associated with diabetes involves the retina, and, more specifically, the network of blood vessels lying within it. The name of this condition is diabetic retinopathy. This is usually graded according to how severe it is. The three main stages are shown in Table 2. With treatment, sight-threatening diabetic problems can be prevented if caught early enough. However, laser treatment will not restore vision already lost. Cataract A cataract is a clouding of part of the eye called the lens. The lens is a clear tissue found behind the iris, the coloured part of the eye. The lens helps to focus light on the retina at the back of the eye to form an image. To help produce a sharp image, the lens must be clear. Vision becomes blurred because the cataract is like a frosted glass, interfering with sight. It is not a layer of skin that grows over the eye. Cataracts can commonly give rise to blurry sight; sight appears blurred or misty, or as if glasses are dirty or scratched. People with 12

13 Understand sensory loss Unit SS MU 3.1 Stage Description Background diabetic retinopathy Maculopathy Proliferative diabetic retinopathy Very common in people who have had diabetes for a long time. Vision is normal with no threat to sight. Blood vessels in the retina are very mildly affected; they may bulge slightly (microaneurysm) and may leak blood (haemorrhage) or fluid (exudate). Macula area of the retina remains unaffected. Central vision gradually gets worse (this varies from person to person); it becomes difficult to recognise distant faces or to see detail such as small print. Peripheral vision is preserved. This is the main cause of loss of vision and may occur gradually but progressively. It is rare for someone with maculopathy to lose all their sight. This is rarer than background retinopathy. Blood vessels in the retina may become blocked. New blood vessels form in the eye, but are weak and in the wrong place growing on the surface of the retina and into the vitreous gel. These blood vessels can bleed very easily and cause scar tissue to form in the eye. The scarring pulls and distorts the retina. When the retina is pulled out of position, this is called retinal detachment. The new blood vessels rarely affect vision, but the bleeding or retinal detachment may cause vision to get worse. Eyesight may become blurred and patchy as the bleeding obscures part of the person s vision. Visual loss in this stage is often sudden and severe. Without treatment, total loss of vision may happen. Table 2: Stages of diabetic retinopathy. cataracts may also be dazzled by lights, such as car headlamps, and sunlight, and experience their colour vision becoming washed out or faded. Cataracts can form at any age. The most common type of cataracts are age-related cataracts. These develop as people get older. Many people over 60 have some cataract and the vast majority can be treated successfully. Early cataracts may not affect sight and do not need treatment. Although researchers are learning more about cataracts, no one knows for sure what causes them. There may be several causes and some studies have linked smoking, excessive exposure to sunlight and poor diet with cataract development. In younger people cataracts can result from conditions such as diabetes, certain medications and other long-standing eye problems. Cataracts can also be present at birth. These are called congenital cataracts. The only effective treatment for cataract is an operation to remove the cloudy lens. Main ear conditions The ear consists of three main parts: the outer (the part you can see), middle and inner ear. The outer ear opens into the ear canal. The eardrum separates the ear canal from the middle ear. There are small bones in the middle ear which help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain. Vibrations or sound waves are sent into the air when they are confronted by any kind of sound. These channel their way through the ear opening, down into the ear, the canal, and then hit your eardrum, causing it to vibrate. The vibrations are then passed to the small bones of the middle ear, which transmit them to the auditory nerve in the inner ear whereby vibrations develop into nerve impulses and go directly to the brain, which interprets the impulses as sound (voices, traffic, crying and so on). 13

14 Level 3 Health & Social Care Diploma Pinna Anvil Hammer Eardrum A cross-section of the ear. Semicircular canals Stirrup Conductive hearing loss Cochlea Round window Auditory nerve Many people have problems with their ears when they are children and as adults. This can usually result from an obstruction in the outer or middle ear for example, an increase in ear wax or an ear infection producing fluid. Conductive hearing loss is caused by anything that stops sound moving from your outer ear to your inner ear. Other possible causes of conductive hearing loss are: middle ear infections otosclerosis, a condition where the ossicles (three tiny bones) of the middle ear harden and become less able to vibrate damage to the ossicles, for example, by serious infection or head injury a perforated eardrum, which can be caused by an untreated ear infection, head injury or a blow to the ear, or from poking something in your ear. A person with a conductive hearing loss will complain of not being able to hear properly as the sounds are too quiet. The ensuing hearing loss can be permanent or temporary, and can often be corrected with minor surgery or medication from a healthcare professional. Sensorineural hearing loss This type of hearing loss is sometimes referred to as sensory, cochlear, neural or inner ear hearing loss. Damage to the hair cells within the cochlea or the hearing nerve can cause sensorineural hearing loss. As part of the ageing process the cochlea can become damaged and the condition is known as presbycusis. However, there are several ways to cause sensorineural hearing loss, including frequent exposure to loud sounds. This can be listening to very loud music on headphones, or sitting next to music speakers at a concert. Temporary hearing loss can happen when a person is exposed to loud sounds like a motorbike backfiring, a jet plane or fire alarm bells. An ototoxic hearing loss happens when someone takes or is given a drug that causes hearing loss as one of its side effects. These can be some types of antibiotics, chemotherapy drugs or anti-inflammatory drugs. Sometimes the drug-induced hearing loss is temporary and can be reversed or stopped. Other times it is permanent. People with hearing loss need to be especially aware of the potential for ototoxic effects, as an ototoxic drug can make an existing hearing loss worse. Rubella is now a rare infectious disease due to vaccinations as a baby or at school. The virus, if caught in early pregnancy, passes through the placenta to the unborn baby and has been known to cause damage to a baby s sight, hearing, brain and heart. There can be many other causes of sensorineural hearing loss for example, a head injury, benign tumours or a genetic predisposition. A person with sensorineural hearing loss will have difficulty hearing quiet sounds with the sounds becoming relatively indistinct, leading to difficulty understanding speech. The Control of Noise at Work Regulations 2005 were set up to ensure that workers hearing is protected from excessive noise at their place of work, which could cause them to lose their hearing and/or to suffer from tinnitus. See for more information. 14

15 Understand sensory loss Unit SS MU Congenital sensory loss and acquired sensory loss Sensory loss may be congenital or acquired. For example, cataracts can form at any age, but they can also be present at birth (congenital cataracts). Key terms Congenital present at birth Acquired anything that is not present at birth but develops some time later Demographic the characteristics of a human population or part of it, especially its size, growth, density, distribution, and statistics regarding birth, marriage, disease, and death 3.3 Demographic factors that influence the incidence of sensory loss in the population As you will have identified previously, there are many demographic factors that influence the incidence of sensory loss in the population. As people age it is a common thought that losing some sight or hearing, or both, is a normal part of ageing rather than being potentially disabling. With rising numbers of people over the age of 60 and growing life expectancy, the percentage of older people who experience both sight and hearing loss is also escalating. In particular, there has been a major increase in the number of people living to old old age (85+), when it is now thought that deafblindness is most likely to be challenging. Activity 7 Congenital or acquired? Look up the following sensory conditions and decide if they are congenital or acquired. Otitis Media Blepharitis Best s Disease Charles Bonnet Syndrome Tinnitus Retinitis Pigmentosa Meniere s Disease Stargardts Disease. Functional skills English: Reading When researching, you will be practising reading skills to pick out relevant information from the text to use for other purposes. 15

16 Level 3 Health & Social Care Diploma 4. Know how to recognise when an individual may be experiencing sight and/or hearing loss, and actions that may be taken 4.1 Indicators and signs of sight loss, hearing loss and deafblindness Sight loss It is important that you are aware if someone you support is showing signs of developing sight loss. Some of the signs you may notice are as follows. Moving about cautiously. Holding books or reading material close to the face or at arm s length. Overcautious driving habits. Finding lighting either too dim or too bright. Frequent eye glass prescription changes. Squinting or tilting the head to see. Difficulty in recognising people. Changes in leisure activities. Changes in personal appearance. Bumping into objects. Appearing disoriented or confused. Hearing loss It is also important that you can identify if someone you are supporting is developing hearing loss. Some of the signs you may notice are as follows. Not responding when you speak to them from behind. Often asking people to repeat what they have said. Not hearing when someone knocks at the door or rings the bell. Complaining that people mumble or speak too quickly. Having difficulty hearing when several people are present. Needing the TV/radio/stereo to be louder than is usual for others. Having difficulty following speech with unfamiliar people or accents. Having problems using the telephone. Deafblindness When people experience a loss of both vision and hearing, you may notice a combination of any of the signs from the lists. 4.2 What to do about signs of sensory loss If you notice changes in the ability of someone you support, you need to talk to them about what you have noticed. For example, if you think that someone s sight is deteriorating, you need to check with them that they have noticed too. For example: Margaret you seem to be having trouble reading the newspaper recently is that right? If you have concerns, it is important that you talk to the person you support and explain what can be done to check out what is happening. Go through the options for investigating the cause of the loss and ensure that you have the person s agreement to contacting the relevant health professional. The initial contact is likely to be the GP, who can arrange for further specialist tests. If the person you support has family or informal carers as part of their support network, you should also talk to them if the person agrees. You may need to provide additional support depending on the outcome of any tests and decisions about the specialist equipment or treatment that may be offered. 16

17 Understand sensory loss Unit SS MU Sources of support for sensory loss There may be specialist sensory support workers available in your local authority, or sensory support may be offered through a general adults service. Some primary care trusts also have sensory support teams who may be able to provide support or to offer advice on good practice. Specialist organisation such as RNIB and RNID have a wealth of information and specialist advice; they should also be able to provide information about local facilities in your area. The local Council for Voluntary Service or Citizens Advice Bureau will have a list of any specialist support organisations or regular activity groups in the area. Activity 8 Sources of support How do you find someone who knows how to use British Sign Language? Legislation Care Standards Act 2000 Control of Noise at Work Regulations 2005 Disability Discrimination Act 1995 Local Authority Social Services Act 1970 Further reading and research (the Thomas Pocklington Trust) (the Royal National Institute for the Blind) (the Royal National Institute for Deaf People) (the Social Care Institute for Excellence; you can find research papers here which highlight the research topic on population) (information on population statistics that may help with research on demographics) Look on the Internet to find out which sensory organisations offer emotional support. Do you know if your area has Communicator Guides? Getting ready for assessment LO1 You need to understand the Fair Access to Care (FACS) eligibility framework and the subsequent grading into four bands of critical, substantial, moderate and low needs. LO2 You should write a report on your findings and explain how effective communication has a positive impact on people with a sensory loss. Your assessor may ask you questions on your contribution to effective communication. You need to be able to inform your assessor of the aids and adaptations you know about and how to look at the environment taking into consideration sensory loss. LO3 You will need to research the demographic factors that influence the incidence of sensory loss in the population and also be able to define congenital and acquired sensory loss. It will be beneficial to you to go through all of the activities for this particular section and keep your research notes to show your assessor. LO4 You should be able to identify indicators and signs that someone may be experiencing a sensory loss. You should be able to show your assessor that you know which people you support have sensory loss and that you have a plan in place to adapt the support plans to show this. You will also be able to show your assessor that you know where to go for sources of support and that you have compiled a list of support in your local area. Your assessor will want to know what actions (if any) you have taken when you discovered that a person is experiencing a sensory loss. 17