Presented by Ed Gervasoni, Ed.S. COMS, CVRT

Transcription

1 2017 SWOMA Conference Region 4 Education Service Center Houston, TX October 20-21, 2017 O & M Assessment & Instructional Strategies for Individuals Who Are DeafBlind or Have Combined Vision & Hearing Losses (CVHL) Presented by Ed Gervasoni, Ed.S. COMS, CVRT gervasonied@gmail.com

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3 O & M Assessment & Instructional Strategies for Individuals Who Are DeafBlind or Have Combined Vision & Hearing Losses (CVHL) Ed Gervasoni, Ed.S. COMS, CVRT gervasonied@gmail.com Introduction Background & Educational Experiences Professional Experiences Personal Experiences Underlining Philosophy Deafblindness: Disability of Access to Information, which causes various challenges for: Community Travel Access to Surrounding Auditory & Visual Information Interacting & Communicating with Others Figure 1 Sign that reads "Access" and has keys on it. Functional Impact of Combined Vision and Hearing Losses NOT: vision + hearing loss RATHER: vision X hearing loss Figure 2 Graph showing the function f(x)=2 x Effects Are Multiplied & Exponential! 2

4 Access Barriers for the Deaf-Blind Fall into 3 Major Categories: Communication Access: Face-to-face One-on-one situations Group situations Tele-communications Using Assistive Technologies Interacting with Automated Technologies Figure 3 Image of two heads in profile facing each other above the words Verbal Communication. Access Barriers for the Deaf-Blind Fall into 3 Major Categories: Information Access: In the home or indoor controlled environments (much progress has been made for the person with literacy skills) Outside of the home (non-controlled environments) Figure 4 icon for "information" with the words "right to information" 3

5 Access Barriers for the Deaf-Blind Fall into 3 Major Categories: Environmental Access: o Regularly traveled routes o Community-at-large Static environments Dynamic Environments Disability of Deaf-Blindness - Going from parts to whole All information is received within arms reach Hands must act as eyes, ears, voice, and tool user sometimes all at once Olfactory, proprioceptive and various types of tactile information are used more often Figure 5 a weird hand with hands on top of each finger. Disability of Deaf-Blindness Filling in the Pieces Environmental information is received in parts (Fractional Details) Fractional details with other knowledge is pieced together to make the whole. (a lot of guess work involved) Lack any connection to the distance without BRIDGES Figure 6 Puzzle pieces Figure 7 Drawing of two people on cliffs above a body of water with a chasm between them. 4

6 Sub-groups of the Population Congenitally CVHL/deaf-blind Congenitally deaf/hh who became blind/lv Congenitally blind/lv who became deaf/hh Born with hearing and vision - became CVHL/deafblind (age, trauma, tumors, etc.) Those with additional disabilities (cognitive, physical, health impaired, speech impaired, etc.) Figure 8 A young deafblind boy holds hands with an adult. Figure 9 A young man with deafblindness holds the wrist of his interpreter so he can control the size and location of signs to read them easier. Assessment: Client Histories Occurrence of Vision Loss - Stable or Progressive Occurrence of Hearing Loss - Stable or Progressive Communication Methods Used Previous Travel Experience Conceptual Understandings of Travel Environments Assessment: Client Histories (continued) Comfort Levels Regarding Touch Tactile Observation Skill Levels Personal/Family Goals Educational Needs of Significant Others in His/Her World Other Factors: Mental Health, Physical Limitations, Environments, etc. 5

7 Assessment: Communication Methods Communication Methods & Strategies Currently Using? Communication Methods & Strategies Needing to Incorporate WHEN & WHERE Use of Multi-Modal Approaches? Knowledge & Use of Communication Technologies both High & Low? Assessment: Assistive Technologies Being Used Communication Purposes Information Purposes Environmental Access Purposes Figure 10 Man with a hearing aid and other piece of assistive technology Assessment: Communication Systems Sign Varieties Adaptive Manual Types Written & Oral Combining Methods Assistive Communication Technology Figure 11 Someone reading signs tactually. 6

8 Sign Varieties American Sign Language (ASL) Contact Sign Language (formerly Pidgin Signed English - PSE) Signing In English Sign Language Adaptations o Low Vision o Restricted Fields o Tracking o Tactual Reducing Visual Complexity & Enhancing Contrast Figure 12 Clipart showing the letter "A" in print and fingerspelling Adaptive Manual Types Fingerspelling o Manual Alphabet (under palm) from outer side of the hand fingers directly into palm British Alphabet Print on Palm Finger Braille Tactile Feedback Methods Figure 13 Picture of someone reading print-on-palm 7

9 Written & Oral Communication Communication cards/books Lip-reading speech (visually) Large print writing & reading Braille writing & reading Texting & ing Technologies Figure 14 Plaque done in braille How We Use Our Hearing Hearing-Sighted Communication Alerting purposes To gather & receive information Entertainment purposes Blind & Severely Visually Impaired Detection of things in travel path Presence & location of people, places and things o Identification o Recognition of particular qualities and features Street crossing purposes 8

10 Auditory Behaviors Observed in Blind Travelers Duck under tree branches just before encountering (without any outside forewarnings) Changes pitches and rhythms with self- generated sound sources to locate and observe things Identify known locations by exclusively using auditory features Safely ride a bike on familiar roads by mainly observing the environment through auditory feedback Small groups of Blind students traveling together matched the exact veering pattern/routes of peers 3 to 5 minutes after the peer had completed his turn General Principles of Hearing for the Blind (Wiener, W. & Lawson, G. 1997) Hearing Is a distance sense It helps one to appreciate depth o by identifying the existence of space o and the distance through space to a reflecting surface and/or sound emitting object Enables comprehension of some characteristics of environments (residential vs. business areas, etc ) Figure 15 image of someone holding their hand up to their ear in the gesture meaning "I can't hear you" Figure 16 Drawing of parts of the ear 9

11 Types of Hearing Loss Sensorineural permanent; individuals benefit from hearing aids or assistive listening devices Conductive loss can usually be corrected; often occurs from otitis media Mixed combination of sensorineural and conductive loss Auditory processing disorder auditory pathway and/or auditory cortex are damaged; difficulty analyzing, understanding, and remembering sounds Types of Auditory Testing Testing is mainly done for Communication purposes Pure Tone Tests (Audiometer) Speech Discrimination Tests Masking - adding white noise & background sounds (Audiometer) Sound Field Discrimination (Audiometer) Auditory Brainstem Response (ABR) Otoacoustic Emissions (acoustic emissions in the cochlea) Tympanometry (middle ear pressure, eardrum mobility & related bones, eustachian tube function, acoustic reflex thresholds) Identifying Hearing Loss on Audiograms From Handout 2K Alabama State Outreach and Technical Assistance Center (SOTAC) & Postsecondary Education Consortium (PEC). (n.d.). How to read an audiogram. Retrieved April 27, 2004, from Figure 17 Audiogram 10

12 Audiogram Figure 18 Audiogram showing the various speech frequencies, the "speech banana" Interpreting Audiograms Audio Gram Notations X = left ear = right ear A = with hearing aids S = sound field M = masking Decibels = loudness Frequency = pitch Types of Testing Pure Tone Tests Speech Discrimination Tests Sound Field Discrimination Auditory Brainstem Response (ABR) Otoacoustic Emissions (Acoustic emissions in the cochlea) Tympanometry (middle ear pressure, eardrum mobility & related bones, Eustachian tube function, acoustic reflex thresholds Masking - adding white noise & background sounds 11

13 Audiogram Figure 19 Audiogram showing a high frequency hearing loss Hearing Loss Variation Unilateral Loss = Hearing loss in one ear Bilateral Loss = Hearing loss in both ears Mid-Range Frequency Loss Environmental Influences Audiogram 12

14 Hearing Loss Categories Minimal Hearing Loss may miss 10% of info (difficulty detecting tree branches and chair link or rod iron gates when there are competing sounds) Mild Hearing Loss may miss auditory fragments that could lead to misinterpretation of = 25-40% of = up to 50% of info (pedestrian crossing signal poles, bus stop signs, subtle doorways, etc) Moderate Hearing Loss will typically miss fragments of auditory information without appropriate amplification 40dB = 50+% of info 50dB = up to 80% of info (easily detectable doorways, idling cars, large obstacles will see greater waiting and analyzing times) Moderate/Severe Hearing Loss (55 70dB) hears loud noises, most likely will not localize where sound is coming from, may hear people talking- but not understand words, will not use hearing for street crossing purposes. Severe Hearing Loss (71-90dB) very hard to discriminate sounds Profound Hearing Loss (91+dB) may hear some environmental sounds based on configuration of loss and auditory complexity levels of the environment. Unilateral Hearing Loss (one normal ear and one ear with permanent loss) can t localize, will benefit from human guide being on the side of the better ear 13

15 Figure 20 Audiogram showing a severe-profound hearing loss Hearing Aids & Hearing Technologies Digital Aids - computer chip is programmed to boost pitches just right and to filter out background noise Bi-Cross Hearing Aids - Microphone is at one ear transmission is sent to opposite ear FM (Frequency Modulated) Systems = transmitter and microphone + receiver and direct connect to hearing aid or neck loop Cochlear Implant - device which is meant to provide a person with the sensation of sound (traditionally installing one device on one side) Programmable Hearing Aids - Can have separate programs that can be changed remotely by the individual based on the hearing requirements of the situation. Auditory Factors That Will Influence How Well Sound Can Be Used Acoustic properties of an object or place Distance between traveler and objects in the environment Sound sources used for detection Competing sound sources Sound volumes Complexity levels that stem from the combination of all things listed above 14

16 Givens with Hearing Loss Changes in any one of the listed factors may have an impact on desired outcomes Someone who has hearing loss will need more time to successfully analyze auditory information Auditory information can be less reliable than visual information When hearing is used in combination with other senses information is gained more completely and efficiently Someone who is severely visually impaired and has a hearing loss will most likely need specific O & M instruction and support to safely and successfully cross at an unfamiliar intersection on a regular basis Baseball hats/visors protects the face and becomes a close range warning device Assessment Strategies Frequency of opportunities Environmental variations Knowing sound source qualities Determining previous experiences Demonstration through hand gestures Simple to complex Complex to simple With and without self-generated sound sources Access to Information Access to Media Forms Signs, Symbols, Images Alerting & Signs & Signals Emergency Alerting: Strobes, Sirens, Vibration, People Visual Displays, Auditory Output, Physical Objects & Tactile Markers Auditory Information Behaviors Observed In The Environment Activity of People Activity of Things 15

17 Access to the Environment Figure 21 Clipart showing a man carrying a brief case walking across the tops of skyscrapers What are the desired outcomes? What are the challenges & barriers to success? Which type of tools & strategies will be needed for purposes of O& M Communication Information Access Self-determination Under which conditions do alternative strategies need to be used How accurately can the client determine where access issues occur and do they have strategies and tools to resolve them O & M Techniques Specific to Deaf-Blindness Adaptive Sighted Guide Techniques Cane Techniques Orientation to Environments Using Adaptive Technologies Street Crossings Communication With the General Public Problem Solving Skills 16

18 Guidelines for Instruction Establishment of Procedures Regarding: process for familiarization to environments and demonstration of orientation procedures levels of touch that will be incorporated signals/signs for direction (straight, crossing over, turning, etc.) distance between instructor and client signal to request instructors assistance X on back for emergencies giving feedback & reinforcement Special Considerations consistently identifying self & providing additional information need for additonal processing and instructional time Adaptive Human Guide Techniques Variations for simultaneous walking & talking hand of guiding arm is in opposite hand of the person being guided (good for tactile observations and communication) guiding with hand under hand (left arm of guide is under right arm of person being guided - has limitations for safety) guiding in way that puts the guide on the side of the person s better ear Cane Techniques Constant Contact Technique with a Rolling Tip Checking for Obstacles in the Environment First Time Users Storing the Cane for Tactual Observations & Tactual Communication Purposes Techniques for Driveways & Street Crossings Sharing Mutual Attention via the Cane 17

19 Communication With the General Public Using Public Transportation Private Ride Services For Soliciting Aid Handling Interactions One-to-one One to many Multi-Tasking Figure 22 Clipart depicting a person speaking to another person and not being understood Orientation to Environments Establishing Object to Object Relationships Following Shorelines Using Feet & Cane Incorporating Visual, Auditory, Olfactory Proprioceptive, Kinesthetic and Tactile Information Providing Additional Information About Variables Within the Environment Using Maps - tactile, large print, auditory Incorporating Technologies Landmarks & Clues Street Crossing Strategies Soliciting Aid o Street Crossing Signs o Auditory Street Crossing Requests o Businesses & Residences Vibration/Tactile Pedestrian Crossing Signals Low Vision & Adaptive Technologies Raised Crosswalk Lines & Truncated Domes 18

20 Technology & The Deaf-Blind Person: Fundamental Assumptions Typically Have The Use of Two Hands Which May Act As The Eyes, Ears, Voice and Hands SIMULTANEOUSLY Current Technologies Barriers: o Specific to a cluster of tasks o Often require more than one piece of equipment to be effective o Solutions are often geared towards a portion of an access issue o Very expensive with limited to no funding sources o Fails based on a few factors Required Skills for AT Discrimination and problem-solving abilities Literacy skills and ability to access appropriate reading medias and other forms of informational input. Ability to navigate between various functions and information levels Ability to function without help of assistive technologies Tactile Observations, Exploration & Learning Building Sophisticated Tactile Vision Hand Under Hand Approach o Promotes Active Learning o Gives Student More Control o Works Best With Additional Processing Time o Enhances Mutual Tactual Attention Multi-Modal Approaches = Integration of Touch, Vision, Hearing, Smell, Taste & Kinesthetic Information Simultaneously Mutual Tactile Attention is crucial to observational, social and language development Additional Safety Devices Flashing strobe safety lights Brightly colored clothing orange safety vests Bus hailing cards some are specific for Deaf-Blind users Individual tracking devices Identification buttons/labels 19

21 Additional Safety Devices Radio Frequency ID Applied Digital Solutions--which is trademarking the phrase "Get Chipped!"--has big plans for its little device. In the next few years, it wants to add sensors that will read your vital signs--pulse, temperature, blood sugar and so on--and a satellite receiver that can track where you are. The company makes a pager-like gadget called Digital Angel that does both those things, and its engineers are doing their darnedest to cram Digital Angel's functions into a package small enough to implant Figure 23 Fluorescent Safety Vest Working with Students Who Have Ushers Syndrome Additional Factors Observe balance and gait changes as progress into darker environments (especially for those with Type 1) Communication issues o Sign language usage - under what lighting conditions can they see signs (distance from signer, ideal environments, are they comfortable using tactile sign if needed?) o Reading lips (distance, hearing-aid modifications, etc) o Cell phone texting/im & o Writing & reading notes 20

22 O & M Assessment Outline for Travelers Who are DeafBlind or CVHL Occurrence of Vision Loss - Stable or Progressive Occurrence of Hearing Loss - Stable or Progressive Communication Methods Used Previous Travel Experience Conceptual Understandings of Travel Environments Comfort Levels Regarding Touch Tactile Observation Skill Levels Personal/Family Goals Educational Needs of Significant Others in His/Her World Other Factors: Mental Health, Physical Limitations, Environments, etc. Communication Methods & Strategies Currently Using? Communication Methods & Strategies Needing to Incorporate WHEN & WHERE Use of Multi-Modal Approaches? Knowledge & Use of Communication Technologies both High & Low? Communication Purposes Information Purposes Environmental Access Purposes Sign Varieties Adaptive Manual Types Written & Oral Combining Methods Assistive Communication Technology Access to Media Forms o Signs, Symbols, Images Alerting & Signs & Signals o Emergency Alerting: Strobes, Sirens, Vibration, People o Visual Displays, Auditory Output, Physical Objects & Tactile Markers o Auditory Information 21

23 Behaviors Observed In The Environment o Activity of People o Activity of Things What are the desired outcomes? What are the challenges & barriers to success? Which type of tools & strategies will be needed for purposes of o O & M o Communication o Information Access o Self-determination Under which conditions do alternative strategies need to be used How accurately can the client determine where access issues occur and do they have strategies and tools to resolve them Which Technologies (assistive and non-assistive) are being used and under what conditions Which Technologies, (assistive and non-assistive0 can be learned and used to benefit the situations 22

24 SWOMA Sponsors Region 4 Education Service Center (ESC), Houston Figure 24 Region 4 ESC logo. Texas School for the Blind & Visually Impaired Outreach Programs Figure 25 TSBVI logo Figure 26 IDEAs that Work logo and OSEP disclaimer. 23