Impact of Hearing and Vision Loss on Independent Living Tracy Bell Koster Jan Radatz Deaf and Hard...
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Transcript of Impact of Hearing and Vision Loss on Independent Living Tracy Bell Koster Jan Radatz Deaf and Hard...
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2007 Age and Disabilities Odyssey Conference August 21, 2007 Duluth, Minnesota
Impact of Hearing and Vision Loss on Independent Living
Tracy Bell KosterJan Radatz
Deaf and Hard of Hearing Services
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What you’ll learn today• Impact that hearing and vision loss
have on independent living, self-determination, and community integration
• Technology and service resources
• Tools and resources that can be used in the support planning process
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Case Study
1) Background about “Larry”2) Determining what was needed to
enable Larry to live more independently
3) Getting the needed supports in place
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Case Study1) Background about “Larry”
DeafBlindPrimary language: American Sign LanguageHome and educationWork historyHow he came to live in nursing home
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Diversity of Hearing Loss
• Born Deaf
• Born Hard of Hearing
• Becomes Deaf later
• Becomes Hard of Hearing later
• What if vision loss added?
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Terminology
• Deafblindness
• Dual sensory loss
• Combined hearing and vision loss
• Deaf, hard of hearing & vision impairment
• “I don’t hear so good or see that well anymore”
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What isn’t deafblindness?
Not deafness plus blindness
Why not?Usual compensation for hearing loss = visionUsual compensation for vision loss = hearingExponential effect
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Larry’s Hearing and Vision
• Usher Syndrome• Born profoundly deaf • Began losing his vision around
age 12• Significant vision loss likely by
age 25
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Case Study1) Background about “Larry”
DeafBlind
Primary language: American Sign LanguageHome and educationWork historyHow he came to live in nursing home
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Primary Language
English (spoken / written language)
• Language of American mainstream society
• Common language with hearing / sighted people
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Primary Language
American Sign Language
• Language of Deaf Culture; not the language of mainstream American society
• Visual, spatial; not written
• English is second language
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Primary Language
• Hearing loss makes it difficult to access spoken language and sound
• Visual means of communication required
• Age of onset and degree of hearing loss influence primary language
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Alternative English ModesEnglish (spoken / written language)
• Lipreading / speechreading
• Writing
• Writing in large print
• Braille
• Print-on-Palm
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Alternative Sign Language Modes
American Sign Language
• Tactile signing
• Close vision signing
• Limited signing space
• Fingerspelling
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Larry’s Communication
• American Sign Language
• Limited signing space
• Learning tactile signing
• Home signs with family
• White board with black marker
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Case Study1) Background about “Larry”
DeafBlindPrimary language: American Sign
Language
Home and educationWork historyHow he came to live in nursing home
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Case Study
• Raised on a remote farm in rural Minnesota
• Parents, sister, other relatives hearing
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Case Study
• Attended Minnesota State Academy for the Deaf (MSAD) in Faribault
• Immersed in American Sign Language and Deaf Culture
• Graduated from MSAD
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Case Study1) Background about “Larry”
DeafBlindPrimary language: American Sign
LanguageHome and education
Work historyHow he came to live in nursing home
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Case Study• Gainfully employed in a blue collar
job in a large metropolitan area until age 28
• Then moved back to family farm; worked in small towns near farm
• Developed alcoholism
• Treatment program at RTC
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Case Study
• Upon completing treatment, moved back to family farm
• Worked odd jobs (building, roofing, laying brick, peeling corn, etc.)
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Case Study1) Background about “Larry”
DeafBlindPrimary language: American Sign LanguageHome and education Work history
How he came to live in nursing home
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Case Study• Larry became dependent on his
mother as he became legally blind and could no longer work
• Father passed away in 1985, sister passed away in 1993
• Mother’s health deteriorated and she was moved to nursing home in 1996
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Case Study• Larry had no opportunity to develop
independent living skills as a deafblind person
• He could not manage family farm; moved to nursing home with mother
• Mother passed away in 2001; Larry remained in nursing home
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Case Study• Larry did not meet criteria of being
full-time nursing home resident
• Staff at the nursing home did not know sign language
• Larry’s routine consisted of smoking, eating, watching TV, laying in bed, sleeping
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Case Study
• Attempts to move Larry to live with nephew or uncle in Kansas unsuccessful
Fearful of leaving known environment
Nephew, uncle did not know ASL
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Case Study1) Background about “Larry”
2)Determining what was needed to enable Larry to live more independently
3) Getting the needed supports in place
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Understanding the loss of distance senses
• “The world becomes the size of an outstretched arm”
• Difficulty seeing or hearing people or objects or traffic approaching
• Difficulty identifying individuals if not in close proximity
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• Greatest comfort level is in known surroundings with familiar people
• New environments are frightening• Limited or no distance vision to “get
your bearings”• Safety
Understanding the loss of distance senses
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• No motivation to meet new people; communication barriers
• Language• Mode of communication
• Depression, trust issues, inadequate coping strategies dues to extreme isolation
Understanding the loss of distance senses
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Isolation of hearing loss and deafblindness
• Isolates individuals from:
PeopleEnvironment
Communication
Information
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Effect on Self-Determination
• Difficulty accessing information; determining choices
• Limited world knowledge
• Self-determination requires cognitive ability and information/knowledge
• Limited life experiences
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The “Unpredictability” Effect
• Illness effects functional use of vision & hearing
• Vision or hearing changes day to day
• Lack of sleep effects ability to concentrate
• Communication techniques that worked yesterday may not work today
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Impact on Larry
• Comfortable only within the nursing home and spent most of his time within his room
• Very limited communication with staff
• Very limited exposure to outside environment sources of information
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Impact on Larry
• High level of fear to travel outside the nursing home, even with assistance
• No instruction on alternative communication modes to accommodate his deteriorating vision
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Determining what was needed first
• Before Larry could consider moving out of the nursing home, he needed to:
• Learn to use his remaining vision
• Learn to use tactile sign language
• Learn techniques for independent travel, independent living
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Determining what was needed first
• Larry also needed to:
• Resolve his depression
• Experience new environments
• Develop confidence in his ability to do more than was expected in the nursing home
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Determining what was needed first
• Larry needed access to information
• General opportunities for more independent living
• Specific options
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Case Study
1) Background about “Larry”2) Determining what was needed to
enable Larry to live more independently
3)Getting the needed supports in place
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Partners in Planning
• Guardian
• Deaf and Hard of Hearing Services Regional Office
• State Services for the Blind
• Nursing home
• County
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Types of Supports
• Services• Assistive Technology
• Home Modifications / Learning New Techniques for Daily Routines
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Larry’s Support Services
• Support Service Provider• Deaf• Fluent in American Sign Language
Purpose• Exposure to language & communication• Access to environment & information
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Larry’s Support Services
• Orientation & Mobility Instructor• Expert in deafblindness• Fluent in American Sign Language
Purpose• Teach navigation skills• Develop confidence and trust for
independent travel
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Larry’s Support Services
• Psychologist• Deaf• Fluent in American Sign Language
Purpose• Address depression, anxiety,
fearfulness• Build self-confidence
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Types of Supports
• Services
• Assistive Technology
• Home Modifications / Learning New Techniques for Daily Routines
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ARRAY OF TECHNOLOGY
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ARRAY OF TECHNOLOGY
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Common products for vision loss:•Large-print wristwatches •Large-print check registers •Large-print playing cards/crossword puzzles •Large-print kitchen timer •Extra-long oven mitts •Large-print computer software
ARRAY OF TECHNOLOGY
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Common products for hearing loss:•Hearing aids•Assistive listening devices•Amplified telephones•Loop or infrared listening systems•Alerting systems (doorbell, baby-cry, smoke alarms) with amplification or flashing lights
ARRAY OF TECHNOLOGY
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Types of Supports
• Services
• Assistive Technology
• Home Modifications / Learning New Techniques for Daily Routines
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Deaf & Hard of Hearing Serviceswww.dhhsd.org
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TIPS FOR THE HOME• Workstations can be set up in each room. Gather together
the most frequently used items so they’re handy. • Puffy paint and raised bump dots are handy for marking
thermostat settings, security system keypads, radios or TV stations settings or other controls that may be hard to see.
• Color contrast makes items more visible (for example, put dark placemats under white plates).
• Maximize lighting in all rooms. Direct the light at the
State Services for the Blindwww.mnssb.org
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Types of Supports
• Services
• Assistive Technology
• Home Modifications / Learning New Techniques for Daily Routines
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New Daily Routines - Resources
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New Daily Routines - Resources
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New Daily Routines - Resources
Orientation & Mobility(O&M)
Deafblind-specificindependent living skills training
SupportServiceProviders(SSPs)
Interpretingservices, real-timecaptioning (CART)
DHHSD DeafBlindConsumer DirectedServices program
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Resources forTechnical Assistance
• Deaf & Hard of Hearing Services Divisionwww.dhhsd.org
• DeafBlind Services Minnesotawww.dbsm.org
• Duluth Lighthouse for the Blindwww.lighthousefortheblind-duluth.org
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Resources forTechnical Assistance
• MN State Services for the Blindwww.mnssb.org
• MN Dept of Ed. DeafBlind Projectwww.dbproject.mn.org
• Vision Loss Resources – Minnesotawww.visionlossresources.org
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Where is Larry Today?
• Moved from small town nursing home to group home in large metropolitan area
• Lives with 3 other individuals who are deaf and use sign language• Staff fluent in sign language
• Works part-time in sheltered workshop
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Where is Larry Today?
• Built a birdhouse in woodworking class that teaches special techniques for people who are blind
• With Support Service Provider, traveled to another state to visit nephew
• Participates in social events with other deafblind people
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Thanks For Coming!