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

2. Contact Information MaryAnn Demchak Nevada Dual Sensory Impairment Project/299 University of Nevada, Reno Reno, NV 89557 Toll-free: 1-877-621-5042 Email: mad@unr.edumad@unr.edu Website: http://www.unr.edu/educ/ndsip/http://www.unr.edu/educ/ndsip/

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

53. How to refer to the project? Complete a referral packet and fax or mail to MaryAnn Call MaryAnn and discuss referral over phone or request packet 1-877-621-5042 mad@unr.edu

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

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

56. Questions