Deaf-Blindness

According to Individuals with Disabilities Education Act(IDEA) the term Deaf-

Blindness means a concomitant(simultananeous) hearing and visual impairement, tge
combination of which causes such severe communication and other developmental and
educational needs that they cannot be accommodited in a special educational programs
solely for children with deafness of children with blindness (Newark, 2015).
 History
(Worldview)
Date Events
1789-1832 Victorine, Morisseau, first deaf-blind woman to receive formal education is
taught in Paris, France.

1837 Laura Bridgeman, first deaf-blind person educated in the United States, is
admitted to Peridas School for the Blind.

1887 Ann Sulivann sent to Tuscumbia, by the director of Perkins School for the
Blind, Michael Anagnos to teach Helen Keller. Helen’s life created a
worldwide interest in the education of deaf-blind children.
 History
(Worldview)
Date Events
1900-1950 A few school to teach the deaf-blind child were established in
Europe.The most notable of this are Condover Hall in the United
Kingdom.
1962-1964 A worldwide epidemic of rubella resulted in the birth of thousands
of deaf-blind children.
1968 Congress passed P.L. 90-230,which legislated the creation of
centers and services for Deaf-Blind children and Youth(Title VI-
C).
 Characteristics
• difficulty bondingwith caregivers and establishing/maintaining interpersonal relationships.
• feelings of vulnerability;generally, the learner will experience feeling of greater
security/safety in seated position.
• trouble learning object permanence(knowing object and people still exist when they
cannot be directly seen or heard).
• Delayed understanding that there are consequence to actions(i.e “causality”) because
learners with Deaf-Blindness are not able to see or hear “what happens”.
• inconsistent responses to sound or visual image(i.e. Developing functional use of
remaining sensory skills can be difficult).
 Characteristics
• developing a distorted perception of the world(due to lack of non-distorted information from the distance
senses), they typically perceive time very differently(times seems to pass much more slowly).
• unusual responses via the impact senses(tactile sensitivity or tactile defensiveness, particularly around the
face).
• an overactive startle response.
• difficulty interacting with things in the environment in a meaningful way and/or generalizing information.
• stereotype(because of fear, confusion and/or sensory deprivation).
• delayed motor skills(such as crawling and reaching(because these are motivated and furthur developed by
use if vision and hearing;(difficulties interpreting movement;problems and maintaining and restoring
balance(Geary, 2010).
 Possible referral characteristics
for children with deaf-blindness
may consist of the following;
A. Cognitive.
• inability to perform basic academic tasks.
• difficulty in performing functional life skills.
B. Communication
• difficulty with spoken language(non-verbal in some intances).
• limited vocabulary. .
Possible referral characteristics for children with
deaf-blindness may consist of the following;
C. Behavior
• exhibits low frustration tolerance.
• difficulty in demonstrating age-appropriate behavior.
• exhibits problems in adjusting to change.
D. Physical
• difficulty with environmental mobility.
• difficulty with vision.
• difficulty with eating.
• difficulty with hearing.
 Screening and Diagnosis
• The red reflex test.
• The pupil reflex text.
• Attention to visual object.
• Snellen and LogMAR charts.
• Range of movement tests.
• Refraction test.
• Color vision defenciency test.
 No. of different eye problem affecting babies and children
that can be detected during eye test including;

• Childhood cataracts-cloudly patches in the lense of the eye that are present from birth.
• Lazy eye(amblyobia)-where the vision in one eye does not develop properly(All about
Vision,2000).
• Squint(Strabismus)-where the look eyes look in different direction(Optomistrists Network 1996).
• Short-sightedness(myopia)-where distant objects appear blurred, while close objects can be seen
clearly(National Eye Institute, 2016).
• Long-sightedness(hyperopia)
• Astigmatism
• Color vision deficiency(color blindness)
 Newborn babies can be screened for any potential
hearing problems using two quick and painless test;
• Automated oto accoustic emission(AOAE)test – a soft earpiece is placed
in the baby’s ear and quiet clicking sounds are played through it.
• Automated auditory brainstem response(AABR)test-three small sensors
are placed on the baby’s head and neck, and soft headphones use to play
quiet clicking sounds.
 These are usually undertaken at an Audiology
department, some of this test are describe below;

• Visual Reinforcement Audiometry.

• Play Audiometry.
• Pure tone Audiometry.
• Bone conduction test.
• Speech perception test.
• Tympanometry.
 Reasons why a child may have a hearing
problem;
• Glue ear-a build- up of fluid in the middle ear, which is common in young children(Otovent).
• Infections that develops in the womb or at birth, such as rubella or cytomegalovirus, which
can cause progressive hearing loss(Baby center, 1997).
• Inherited conditions, such as otosclerosis which stop the ears or nerves from working
properly(National Institute of Deafness and Other Communication Disorders, 2015).
• Damage to the cochlear or auditory nerves, which transmit hearing signals to the brain.
• Being starved of oxygen at birth(birth asphyxia) (Seattle children’s, Hospital 1995).
• Illnesses such as meningitis and encephalitis, which both involves swelling brain(National
Institute of Neurological Disorder and Stroke, 2016).
 Causes?
A causes a certain individual to have death-blindness?
There could be many high risk factors leading to Deaf-Blindness. Based on the module
addressing special education and teacher education made by Rebecca Obold-Geary in
2010, a variety known causes exist for Deaf-Blindness; these include congenital
conditions and a wide variety of condition that occure or manifest after birth(due to
adventitious causes).
Etiologist of Deaf-Blindness Mechanism/Cause Associated Sensory Conditions
Down Syndrome(center of Genetic pattern Myopia,hyperopia,strabismus,
disease control and prevention mild to moderate hearing loss.
Syphilis,toxoplasmosis,cytonega Infection Various degrees of vision and
lovirus(CMV),herpes and hearing loss.
human immunodificiency
virus(HIV)
(Baby center, 1997).
Etiologies of Deaf-Blindness Mechanism/Cause Associated Sensory Conditions
Usher Syndrome (Types I, II, III Heriditary Syndrome Sensorineural hearing loss,
USA.gov, 2016 retinitis pigmentosa
CHARGE Syndrome(coloboma, Genetic pattern Sensorineural hearing loss due
heart detect,retarded growth, to malform cochlea,coloboma.
henital abnormalities, ear
abnormalities(CHARGE
Syndrome Foundation, 2016).
Retinopathy of Prematurity(The Birth prior to full-term Optic atrophy, cataracts,
nemours Foundation, 1995). glaucoma,under develop
ears(causes sensorineural loss).
 Problems,Challenges and Struggle
• People with special learning needs
Having deaf-blindness disability may result uncomfortable interacting non-verbally with others need for preparation
to receive some form of symbolic communication as a part of those and interaction.
In the study of Bodsworth, Clare, and Simblett and DeafBlindUK(2011) entitles Deaf Blindness and Mental
health:Psychological distress and unmet need among people with Deaf Blindness: 1) Mental distress affects many
people with Deaf Blindness. They found that almost half of men and women in their sample (45.8% of 439
respondent reported high levels of anxiety, depression,physical symptoms and/or social impairement.
• Family and School
The most important challenge for parents, caregivers, and teachers is to communicate meaningfully with the child
who is deaf blind. Continual good communication will help foster his or her healthy development.
The National Consortium on Deaf Bindness explain that the Education for the child or youth with Deaf Blindness
needs to be individualized:the limited channels available for learning necessitate organizing a program for each child
that will address the child unique ways of learning and his or her own interests.
 Problems, Challenges and Struggle
• Teachers
Teachers are challenge with this question:What would a teacher of students with deaf-
blindness do? In the United States of America, many states have interant teacher of
students visual impairements and interant teacher of students with hearing
impairement.
Teachers are challenge to provide both direct and consultative services. Direct
instruction may include activities incorporating the following:vision awareness or
vision efficiency activities, auditory awareness, or training, activity routines which
facilitate use of object symbol.
 TRAUMATIC
BRAIN INJURY
• The individuals with Disability Education Act (2004) defined Traumatic
Brain Injury as an acquired injury to the brain caused by an external
physical force, resulting in total or partial functional disability or
psychological impairment, or both that adversely affects a child's
educational performance.It applies to open or closed head injuries
resulting in impairments in one or more areas such as: cognition,
language, memory, attention, and reasoning , abstract thinking, judgment,
problem solving, sensory , perceptual and motor abilities, psycholological
behavior , physical functions, informal processing and speech.
 HISTORY:
• According to Zasier, Katz, Zafonte, Arciniegas, Bullock, and Kreutzer
(2012) the many advances in acute care of head injuries since WWII are
built on priciples derived from military experiences and expressed
through modern scientific, technological , and organizational progress.
• In the early 1970s the group that formed around Bryan Jennett in
Glasgow, drew attention to the importance of secondary ischemuc brain
damage- which occurs in the hours and days following the initial
trauma, rather than as a direct result of it-
 CHARACTERISTICS:
• The Ohio Center for Autism and Low Incidence (2016)characterized
Traumatic Brain Injury In terms of severity with the following categories:
mild , moderate and severe Traumatic Brain Injury.
• Mild Traumatic Brain Injury:
• According to Kay, Harrington, Adams, Anderson, Berrol, Cicerone,
Dahlberg, Gerber, Goka, Harley, Hilt, Horn, Lehmkuhl, Malec (1993)The
following are the criteria of a person with mild Traumatic Brain Injury
that may have induced physiological disruption of brain function:
• 1.Loss of consciousness less than 30 minutes;
• 2. Loss of memory for events immediately before or after accident;
• 3. Alteration of mental state at time of accident; and
• 4. Focal neurological deficit (s) that may or may not be transient.
 In connection to the criteria of Kay et al ( 1993), the
Ohio Center for Autism and Low Incidence (2016)
gave more specific symptoms, including:
📍Fatigue 📍Dizziness / loss of balance
📍Headaches 📍Irritability
📍Visual disturbances 📍Feelings of depression
📍Memory loss 📍Seizures
📍Poor attention/concentration
📍Sleep disturbances
 Moderate Traumatic Brain Injury
It causes unconsciousness lasting more than 30 minutes.Symptoms of Moderate
TBI are similar to those of mild TBI but more serious and longer-lasting
( Alheimerz n.d) The Ohio Center for Autism and Low Incidence (2016) gave
the following symptoms:
• Coma
• Confusion
• Difficulty with thinking skills
• Blurred vision/loss of vision
• Change in hearing acuity
• Slurred speech.
 Severe Traumatic Brain Injury
• Severe brain injury is usually defined as being a condition where the
patient has been in an unconscious state for 6 hours or more, or a post-
traumatic amnesia of 24 hours or more. These patients are likely to be
hospitalised and receive rehabilitation once the acute phase has passed.
• Specifically , there are several long lasting deficits after severe TBI that
can be divided into three categories: physical, cognitive and behavioral.
Physical deficits after severe traumatic brain injury include:

• Paralysis (quadriplegia) or weakness (quadriparesis) in both the arms and

legs.
• Paralysis (hemiplegia) or weakness ( hemiparesis) on one side of the body.
• Impaired fine motor skills, sometimes with tremors.
• Poor overall body coordination ( Ataxia)
• Double vision( diplopia)
• Visual field cuts
• Motor speech disorders like dysarthria and difficulties in oral speech
planning ( oral apraxia)
• Inability to carry out learned movements( apraxia).
 Cognitive deficits after severe traumatic
brain injury include:
• Impaired attention and concentration
• Memory impairement for learning and recall of new information.
• Impaired problem-solving and decision-making skills.
• Blurred information processing speed.
• Impulsive thinking without regard for consequences.
• Poor organization, planning and sequencing abilities.
 Cognitive deficits after severe traumatic
brain injury include:
• Impaired concept formation and abstract thinking.
• Inflexible thinking and mental rigidity.
• Poor judgment, especially in social situation.
 Behavioral deficits after severe traumatic brain injury include:

Inability to engage in purposeful activity

📌Disinhibition 📌Denial of deficits
📌Inability to respond appropriate to environmental cues
📌Socially inappropriate behavior
📌Social skills deficits. 📌Poor self-esteem.
📌Impulsivity
📌Poor initiation and apathy
📌Lack of insight into behavior and it's consequences.
📌Inability to profit from experience.
 DePompei and Blosser( 1987) had enumerated all the possible
characteristics that can occur to an individual with Traumatic Brain
Injury.

• Communication:
• Language Abstraction
• Writing Reading
• Articulation
• Computation
• Word finding (anomia)
 DePompei and Blosser( 1987) had enumerated all the possible
characteristics that can occur to an individual with Traumatic Brain
Injury.

• Physical
• Look for impairements in:
• Mobility
• Vision
• Strength
• Hearing
• Coordination
 Cognitive
Watch for difficulty in :
• Memory- short and long term.
• Thought processes
• Conceptual skills
• Problem Solving
 Perceptual Motor
Think about involvement in:
• visual neglect
• visual field cuts
• motor apraxia
• motor speed
• motor sequencing
 Behavior
Be aware that brain damage may account for:
• impulsivity
• depression
• poor judgment
• emotional ability
• disinhibition
• apathy
 Social
-Sensitize yourself to know the child with a brain injury may:

• Have difficulty learning from peers.

• Have difficulty learning from social situations.
• Behave like a much younger child withdraw.
• Become distracted in noisy surroundings .
• Become lost ever in familiar.
• Causes
Traumatic brain injury is usually caused by a blow or other traumatic
injury to the head or body. The degree of damage can depend on several
factors, including the nature of the injury and the force of impact.
 Common events causing traumatic brain
injury include the following:
• Falls. Falls from bed or a ladder, down stairs, in the bath, and other falls are the
most common cause of traumatic brain injury overall, particularly in older adults
and young children.
• Vehicle-related collisions. Collisions involving cars,motorcycles or bicycles —
and pedestrians involved in such accidents — are a common cause of traumatic
brain injury.
• Violence. Gunshot wounds, domestic violence, child abuse and other assaults are
common causes. Shaken baby syndrome is a traumatic brain injury in infants
caused by violent shaking.
 Common events causing traumatic brain
injury include the following:
• Sports injuries. Traumatic brain injuries may be caused by injuries from a
number of sports, including soccer, boxing, football, baseball, lacrosse,
skateboarding, hockey, and other high-impact or extreme sports. These are
particularly common in youth.
• Explosive blasts and other combat injuries. Explosive blasts are a common
cause of traumatic brain injury in active-duty military personnel. Although how
the damage occurs isn't yet well understood, many researchers believe that the
pressure wave passing through the brain significantly disrupts brain function.
 Traumatic brain injury also results from penetrating
wounds, severe blows to the head with shrapnel or
debris, and falls or bodily collisions with objects
following a blast.
• Risk factors:
• The people most at risk of traumatic brain injury include:
• Children, especially newborns to 4-year-olds
• Young adults, especially those between ages 15 and 24
• Adults age 60 and older
• Males in any age group.
 Degenerative brain diseases:

• The relationship between degenerative brain diseases and brain injuries is still
unclear. But some research suggests that repeated or severe traumatic brain injuries
might increase the risk of degenerative brain diseases. But this risk can't be
predicted for an individual — and researchers are still investigating if, why and
how traumatic brain injuries might be related to degenerative brain diseases.
• A degenerative brain disorder can cause gradual loss of brain functions, including:
• Alzheimer's disease, which primarily causes the progressive loss of memory and
other thinking skills.
• Parkinson's disease, a progressive condition that causes movement problems, such as tremors, rigidity and
slow movements.
• Dementia pugilistica — most often associated with repetitive blows to the head in career boxing — which
causes symptoms of dementia and movement problems.

• Prevention
• Follow these tips to reduce the risk of brain injury:

• Seat belts and airbags. Always wear a seat belt in a motor vehicle. A small child should always sit in the back
seat of a car secured in a child safety seat or booster seat that is appropriate for his or her size and weight.
• Alcohol and drug use. Don't drive under the influence of alcohol or drugs, including
prescription medications that can impair the ability to drive.

• Helmets. Wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or

all-terrain vehicle. Also wear appropriate head protection when playing baseball or
contact sports, skiing, skating, snowboarding or riding a horse.

• Pay attention to your surroundings. Don't drive, walk or cross the street while using your
phone, tablet or any smart device. These distractions can lead to accidents or falls.
 Problems,Challenges and Struggles.
• People with Special Learning Needs
The researcher journal getting my Bearings,Returning to School:
Issues facing adolesence with Traumatic Brain Injury by Schilling anad
Getch (2012),the authors discuss three issues facing adolesence with TBI.
Cognitives effects just as with many students with disabilities,students
with TBI have unique challenges.
 Problems,Challenges and Struggles.
• Family
In the study of Brown, Whittingham,Sfronoff & Boyd(2013) entitled
“Presenteng a child with traumatic brain injury: Experiences of parents
and health professionals”,reported that they beyond the impact of the
injury on the child.
The researchers concluded that parenting interventions may provide
essential support for parents in adjusting to and managing their child
difficulties and the effiacy of existing programmes needs evaluation.
 Problems,Challenges and Struggles.
• Teachers
To address educational needs of students who have experienced a traumatic brain
injury(TBI),educators are challenge to clear three hurdles: 1) Identification,often
the school is unaware that child has been brain injured or that this will have serious
implications for meeting the child education needs.
Appropriate methods for identifying students with TBI need to be adopted with
schools.2) Assessment,when assessing children with TBI,the assessment goals
must be expanded to delineating the specific cognitive challenges each child faces.