Deafblind people, communication, independence, and isolation

Australian Hospital Experiences of People Living with Deafblindness or Dual Sensory Impairment: The Report Card

Gaps abound in the literature about what happens when people living with deafblindness or dual sensory impairment (DBDSI) go to the hospital. Anecdotally, from my lived experiences and professional work, as well as from within communities, stories are told about how hazardous it is to be a patient in an Australian hospital for those living with DBDSI. This paper outlines a quantitative component of a mixed-methods study examining the intricacies of these experiences. The research objective was to discover what hospital interactions looked like for patients living with DBDSI. A constrained question set was used, namely, the Australian hospital experience question set (AHPEQS 2017). It asked patients about key factors in their hospital interactions. The results form a distressing snapshot of care and communication interactions. Experiences of flouting protective conventions, dehumanisation, neglect, discrimination, disparate care, inaccessible consent forms, and a lack of communication predominate. The participants reported experiences from multiple different hospitals, so these findings suggest a broad culture of failing to provide patient-centred care and accessible-to-the-patient communication. The findings showcase the urgency for more research and remedial actions to be undertaken by both professionals and institutions.

Caeski: an assistive technology for the communication of persons with deafblindness

PURPOSE

Caeski is a keyboard with 12 vibrating keys that connects to an application via smartphone. This assistive technology aims to facilitate the communication of persons with deafblindness in presential contexts or with people who can be anywhere in the world. The purpose is to present this assistive technology and analyse the viability of its use through tests with eleven persons with deafblindness.

MATERIALS AND METHODS

The study design consisted of ten days of testing with eleven persons with deafblindness and five interpreters who had the function of passing the information about the content of the tests.

RESULTS

The tests showed that most participants were able to communicate through Caeski. In addition, the tests showed the need to add the function of repeating the reception of information via vibration to confirm the understanding. The results demonstrated the need for more training time to improve the learning of accented words and long sentences. Therefore, training time and previous contact with technological devices are factors that influence the result of the tests.

CONCLUSION

The use of Caeski is feasible and as future perspectives, this assistive technology can be used in association with similar assistive technologies such as Perkins Machine and Braille Line, preventing possible tactile overloads. In addition, can be applied in the educational context, from literacy to university. Studies with longer training time should be conducted to confirm the results. The implications for rehabilitation:Social interactions, presential and online, with deafblind and non-deafblind persons anywhere in the world.Literacy and cognitive development of persons with deafblindness.Digital inclusion for occupational, school or academic contexts.

Social participation in older people with hearing impairment in Chinese community: A latent profile analysis

OBJECTIVES

Hearing impairment may lead to increased communication difficulties for older people, making their social participation less optimistic. However, there is little research on the social participation of older people with hearing impairment, especially based on the characteristics of their social participation. This study aimed to identify different social participation profiles in older people with hearing impairment and to explore sociodemographic characteristics, disease-related characteristics and psychosocial factors with different social participation profiles.

METHODS

A cross-sectional study of 300 older people with hearing impairment using the sociodemographic questionnaire, the Impact on Participation and Autonomy Questionnaire, the Lubben Social Network Scale-6, Medical Outcomes Study Social Support Survey and Geriatric Depression Scale-15 from May to August 2023 in a community of Beijing, China. Latent profile analysis was used to analyse the latent profiles of social participation in elderly with hearing impairment. Multiple logistic regression was used to explore the predictors of different profiles.

RESULTS

The social participation of older people with hearing impairment in the community can be classified into three potential profiles: Profile 1 - high social participation group (76.05 %), Profile 2 - moderate social participation group (17.34 %), Profile 3 - low social participation group (6.61 %). Age, types of chronic diseases, self-reported health, severity of hearing impairment, social network, social support and depression were predictors of different profiles.

CONCLUSIONS

Nurses should pay attention to the characteristics, depression, social network and support of older people with different hearing impairment to improve social participation in different profiles.

IMPLICATIONS AND RECOMMENDATIONS

This was the first study exploring latent profiles of social participation in older people with hearing impairment. Insights from this study are useful for gerontological nursing to distinguish different profiles and further identify the characteristics of different profiles in older people with hearing impairment by characterizing the level of social participation in the community and better implement interventions according to profiles.

Skin-Integrated Wireless Odor Message Delivery Electronics for the Deaf-blind

Deaf-blindness limits daily human activities, especially interactive modes of audio and visual perception. Although the developed standards have been verified as alternative communication methods, they are uncommon to the nondisabled due to the complicated learning process and inefficiency in terms of communicating distance and throughput. Therefore, the development of communication techniques employing innate sensory abilities including olfaction related to the cerebral limbic system processing emotions, memories, and recognition has been suggested for reducing the training level and increasing communication efficiency. Here, a skin-integrated and wireless olfactory interface system exploiting arrays of miniaturized odor generators (OGs) based on melting/solidifying odorous wax to release smell is introduced for establishing an advanced communication system between deaf-blind and non-deaf-blind. By optimizing the structure design of the OGs, each OG device is as small as 0.24 cm3 (length × width × height of 11 mm × 10 mm × 2.2 mm), enabling integration of up to 8 OGs on the epidermis between nose and lip for direct and rapid olfactory drive with a weight of only 24.56 g. By generating single or mixed odors, different linked messages could be delivered to a user within a short period in a wireless and programmable way. By adopting the olfactory interface message delivery system, the recognition rates for the messages have been improved 1.5 times that of the touch-based method, while the response times were immensely decreased 4 times. Thus, the presented wearable olfactory interface system exhibits great potential as an alternative message delivery method for the deaf-blind.

Understanding the perceptions and experiences of the deafblind community about digital games

PURPOSE

Participation and accessibility issues faced by gamers with multi-sensory disabilities are themes yet to be fully understood by accessible technology researchers. In this work, we examine the personal experiences and perceptions of individuals with deafblindness who play games despite their disability, as well as the reasons that lead some of them to stop playing games.

MATERIALS AND METHODS

We conducted 60 semi-structured interviews with individuals living with deafblindness in five European countries: United Kingdom, Germany, Netherlands, Greece and Sweden.

RESULTS

Participants stated that reasons for playing games included them being a fun and entertaining hobby, for socialization and meeting others, or for occupying the mind. Reasons for stop playing games included essentially accessibility issues, followed by high cognitive demand, changes in gaming experience due their disability, financial reasons, or because the accessible version of a specific game was not considered as fun as the original one.

CONCLUSIONS

We identified that a considerable number of individuals with deafblindness enjoy playing casual mobile games such as Wordfeud and Sudoku as a pastime activity. Despite challenging accessibility issues, games provide meaningful social interactions to players with deafblindness. Finally, we introduce a set of user-driven recommendations for making digital games more accessible to players with a diverse combination of sensory abilities.IMPLICATIONS FOR REHABILITATIONDigital games were considered a fun and entertaining hobby by participants with deafblindness. Furthermore, participants play games for socialization and meeting others, or for occupying the mind.Digital games provide meaningful social interactions and past time to persons with deafblindness.On top of accessibility implications, our findings draw attention to the importance of the social element of gaming for persons with deafblindness.Based on interviews, we introduce a set of user-driven recommendations for making digital games more accessible to players with a diverse combination of sensory abilities.

Is there a correlation between sensory impairments and social isolation in middle-aged and older Chinese population? Cross-sectional and longitudinal evidence from a nationally representative survey

Purpose

The aim of this study is to investigate the cross-sectional and longitudinal associations between sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI), and dual sensory impairments (DSI) with social isolation in the middle-aged and older Chinese population.

Methods

Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 11,674 Chinese older adults aged over 45 were included at baseline 2011, and 6,859 participants who accomplished all four interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and social isolation measurements including social disconnectedness and self-perceived loneliness were collected. Assessment of social disconnectedness included the number of types of social activities in which they participated and the frequency of such participation. Loneliness referred to the subjective perception of loneliness. Other covariates included socio-demographic characteristics, medical conditions, and lifestyle-related factors. The impacts of baseline sensory status on social disconnectedness and loneliness were assessed using univariate and multivariate generalized linear models. A generalized linear model with generalized estimation equations (GEE) was used to assess the association between time-varying sensory statuses with social disconnectedness or loneliness over 8 years after being adjusted with multi-confounding factors.

Results

Participants with SIs had significantly higher levels of social disconnectedness and self-perceived loneliness, compared to those who were free of SI. All kinds of SIs were significantly associated with loneliness according to both cross-sectional and longitudinal data. The correlations between DSI and social disconnectedness or loneliness at baseline and over 8 years were also noticed. SHI was found to be significantly associated with both frequency and types of social activities according to cross-sectional data and with the frequency of social activity participation in longitudinal analysis. SVI was only associated with the types of social activities at baseline (all p-values < 0.05).

Conclusion

Sensory impairments, especially dual sensory impairments, have explicitly detrimental effects on social isolation among the older Chinese population. Over time, single hearing impairment specifically jeopardizes their frequency rather than types of social activities participation.

Acquired Combined Vision and Hearing Loss: Awareness and Perceptions of Australian Aged Care Workers

Introduction: Understanding the attitudes, competency, and awareness of those supporting older people who have an acquired combined vision and hearing loss is an important endeavor for this population. It can help guide aged care policy makers, leaders, and managers in the allocation of resources and training. This Australian study investigated the awareness and perceptions of aged care workers on supporting older adults with acquired combined vision and hearing loss. Methods: Twenty-four participants who were employed in aged care services participated in semistructured interviews that were thematically analyzed. The interviews explored the participants’ awareness of this disability, identification within their service, adaptation strategies, and their access to relevant information. Results: Several themes emerged, including lack of identification and recording of acquired combined vision and hearing loss in this population, lack of awareness of this disability, and lack of available information or training to support aged care workers within their care setting. Discussion: Aged care workers have little understanding of the prevalence of acquired combined vision and hearing loss in an older population. Care plans are key documents for individuals, which outline their needs and any sensory losses; however, this information is not well recorded. Aged care workers have little awareness of how to effectively support this population. When encountering an individual with an acquired combined vision and hearing loss, however, an aged care worker will develop strategies to support the individual. Individuals with this acquired dual-sensory loss, as well as dementia, pose a significant challenge to aged care workers, and dementia is often the primary focus of intervention. Implications for Practitioners: It appears that older individuals living in aged care settings who have acquired combined vision and hearing loss are not adequately identified, nor are aged care workers adequately trained to support individuals with this unique disability.

Experiences of rehabilitation services from the perspective of older adults with dual sensory loss – a qualitative study

Purpose

Methods

Results

Conclusions

Interventions for adults with deafblindness - an integrative review

PURPOSE

To compile the current research on interventions for rehabilitation aimed at adults (aged 18-65 years) with deafblindness.

MATERIALS AND METHODS

A comprehensive search was conducted in eight databases. An additional manual search was also carried out. A total of 7049 unique references were initially identified, and after screening, 28 original scientific articles were included. The results from these articles were categorized based on limiting consequences of deafblindness: communication, orientation and to move around freely and safely and access to information, as well as to psychological adaptation to deafblindness.

RESULTS

Fourteen of the included articles had their main focus on access to communication, ten on orientation and the ability to move around feely and safely, three on the opportunity to gain access to information, and one related to psychological adaptation to deafblindness. Most articles focused on technical devices, of which one-third were single case studies.

CONCLUSION

There is a limited number of evaluated interventions for people with deafblindness. Most of the existing studies involved one to five participants with deafblindness, and only few studies involved a larger number of participants. More research with a larger number of participants are needed, which could be facilitated by international cooperation between practitioners and researchers.

Mental health impact of COVID-19 on Saudi families and children with special educational needs and disabilities in Saudi Arabia: A national perspective

Introduction

The COVID-19 pandemic revealed a multidimensional impact on mental health due to health concerns, social distancing and lockdowns, job loss, and limits in institutional support. Accordingly, COVID-19 may disproportionally impact families with special educational needs and disabilities (SEND) due to the already high prevalence of mental health conditions in children with SEND and their parents. Hence, it is essential to determine the short-term impact of the pandemic on the mental health of families with SEND to identify their ongoing health, including psychological wellbeing and support needs. The current study examines the anxiety level and concerns of children with SEND and their parents living in Saudi Arabia.

Methodology

A cross-sectional national study design was utilized as a part of an international consortium using an online Arabic survey. Data were collected from the Ministry of Human Resources and Social Development beneficiaries from May to July 2020. The sample consisted of 1,848 parents of children with SEND aged between 1 and 18 years (mean = 9.66; SD = 4.31). A descriptive and bivariant analysis is reported.

Results

Parental worries on all those concerns when the pandemic started were significantly higher than before the pandemic, p < 0.050. Parental-perceived general anxiety had risen significantly across time, p < 0.001, and their perceived anxiety when the pandemic started exceeded their anxiety before the pandemic, p < 0.001. The general anxiety of children with SEND had risen significantly across time (from before the pandemic to when it had started to during the pandemic), p < 0.001. The children's general worries at the start of the pandemic had correlated significantly and positively with their anxiety, adaptive, maladaptive, and coping efficacies, and parental anxiety scores, p < 0.010 each.

Conclusion

Anxiety levels were high in SEND and their caregivers before and during COVID-19. At the start of the pandemic, the anxiety, adaptive, maladaptive, coping efficacies, and parental anxiety scores of children with SEND were significantly and favorably correlated. These findings support the notion of SEND-specific anxiety and patterns of coping in SEND and their caregivers. The notion also attests to the institutional support required for this specifically vulnerable population during epidemics.

Implementation of UN Convention on the Rights of Persons with Disabilities in public and private schools in three districts of Uganda

Background

The study was grounded in the recent developments of implementing the United Nations Convention on the Right of Persons with Disabilities (UNCRPD) in schools in Uganda, leading to a renewed interest in the questionings about inclusive education.

Objectives

The inclusive approach was evaluated in terms of: (1) how public or private schools in Uganda understand inclusive education; (2) how schools implement inclusive education under the influence of the UN Convention; and (3) what determines the course of action and school routine of private and state schools.

Methods

This exploratory qualitative research included interviews with six schools purposively selected in Mukono, Wakiso and Kampala districts of Central Uganda. The selected schools comprised three private and three state schools (i.e. representing primary and secondary schools and a vocational training institute).

Results

The research demonstrated that ‘inclusive education practice’ that was upheld by all the schools, was ironically stained with exclusion, for example, by non-admission of students with visual and hearing impairment, inaccessible physical environment, inadequate funding and separation of students according to abilities. However, whilst all schools followed the regular curriculum, some schools developed their own ways of teaching learners with diverse learning needs.

Conclusion

Some schools in Uganda have developed meaningful approaches of including students with disabilities but there are still many challenges for many. Enforcing Uganda’s disability policies adapted from the CRPDs could enable learners with disabilities to enjoy their legal rights.

Contribution

Since the intention of inclusion of students with disabilities stands in contrast to the reality of practice found in many schools, there seems to be a need to carry out regular assessments and measures of support for a sustainable inclusive school development.

Working Memory-Based Cognitive Rehabilitation: Spoken Language of Deaf and Hard-of-Hearing Children

This research examined the effect of the Working Memory-based Cognitive Rehabilitation (WMCR) intervention on the spoken language development of deaf and hard-of-hearing (DHH) children. In this clinical trial study, 28 DHH children aged between 5 and 6 years were selected by random sampling method. The participants were randomly assigned to experimental and control groups. The experimental group participated in the WMCR intervention involving 11 sessions. All participants were assessed pre-and postintervention. Data were collected by the Newsha Development Scale and analyzed through MANCOVA. The results revealed a significant difference between the scores of the receptive and expressive language of the experimental group that were exposed to the WMCR intervention compared with the control group. The receptive and expressive language skills of the experimental group indicated a significant improvement after the intervention. Therefore, the WMCR intervention is an effective method that affects the spoken language skills of DHH children. These findings have critical implications for teachers, parents, and therapists in supporting DHH young children to develop their language skills.

Quality of Life in Deafblind People and Its Effect on the Processes of Educational Adaptation and Social Inclusion in Canary Islands, Spain

Deafblindness is a unique and complex disability. Research on the needs and quality of life are scarce; as well as the lack of adequate knowledge, training and lack of qualified professionals to serve this group. All this justifies the sense and interest of this study. This study is derived from the project with reference 2020EDU04. Design: The study is descriptive, cross-sectional and quantitative-qualitative research design was conducted. Objectives: Know and analyze the needs of adult deafblind people in order to contribute to improving their quality of life. Method: Sample of 16 adults with double sensory loss (hearing and vision) residing in the Autonomous Community of the Canary Islands (Spain) was used. Instruments: The FUMAT Scale was used to measure personal development; self-determination; interpersonal relationships; social inclusion; rights of deafblind people; emotional well-being; physical well-being and material well-being. In addition, a semi-structured interview is conducted. Results by dimensions: Personal development: The professionals did not have specialized training to provide an educational response. Physical well-being: 68% of the sample had other health problems associated with deafblindness. Interpersonal relationships: 100% of the sample reported communication problems in the family environment. Social inclusion: They reported difficulties in accessing educational and leisure activities. Material well-being: In general, they stated that they have the material resources necessary for their daily lives. Self-determination: they consider that they have decision-making capacity in basic aspects of daily life. Rights: Deafblind people state that they have limitations in exercising their rights. Based on the interviews, it was observed that the people with the greatest difficulties in daily life are those who presented the greatest visual commitment. Conclusion: The etiology does not determine the quality of life of deafblind people, but communication conditions interpersonal relationships and personal development, and therefore their quality of life.

A salutogenesis approach to ageing with impairment: the managing and coping experiences of older people ageing with deafblindness

An understanding of the psychosocial impact of deafblindness on older people is impoverished by a dearth of research in the field. Particularly limited are studies adopting a salutogenesis perspective, in which older deafblind people's coping capacities are explored. Much research focuses on vulnerability to unfavourable outcomes, which may perpetuate negative stereotypes of deafblind people as passive and dependent. Identifying deafblind people as a vulnerable group gives rise to misunderstanding of the impairment, perceptions of incapability and neglect of deafblind people's agency. This paper draws on data from the first United Kingdom-based study of vulnerability from the perspectives of older adults ageing with deafblindness. Findings presented here relate to participants’ experiences of managing and coping with their felt vulnerability and ageing with deafblindness. The study adopted interpretative phenomenological analysis (IPA) as its qualitative approach. In-depth semi-structured interviews were undertaken between October 2014 and July 2016 with eight participants, aged between 48 and 83 years. Data were analysed using an iterative six-step IPA process. Three superordinate themes were identified: taking action to protect self; psychological coping strategies; and accessing and using care and support. Participants’ managing and coping strategies, and the care and support they value, respond to elements identified as generating felt vulnerability. Professionals should seek to bolster coping capacity and provide support in ways valued by those ageing with deafblindness.

Factors that influence the participation of individuals with deafblindness: A qualitative study with rehabilitation service providers in India

Evidence to inform rehabilitation service delivery for individuals with deafblindness, especially in the Indian context, is inadequate. Rehabilitation professionals often find it challenging to design rehabilitation interventions that promote participation for those with deafblindness. Therefore, our purpose was to understand the contextual factors that influence the participation of individuals with deafblindness in India from the perspectives of those who are involved in providing rehabilitation services to them. Using the International Classification of Functioning, Disability, and Health (ICF) as a framework, we conducted two focus group discussions with 16 rehabilitation service providers in India. We used a content analysis approach to examine the data. Rehabilitation service providers perceived participation barriers to be linked primarily to the social environment. Specifically, participants identified four major factors acting as barriers, including (a) lack of awareness about deafblindness; (b) negative attitudes and stigma associated with disability; (c) lack of access to resources such as assistive technology and interpreter support; and (d) communication challenges associated with severe impairments. Facilitators include accessibility of the built environment for multisensory impairments, affordable technology, provision of an interpreter and personal support worker, and training on deafblindness for professionals. The participation of individuals with deafblindness could be enhanced by identifying and removing environmental barriers and improving knowledge about deafblindness among rehabilitation professionals for proper identification, assessment, and access to rehabilitation services.

The consequences of deafblindness rules the family: Parents’ lived experiences of family life when the other parent has deafblindness

Deafblindness is a combined vision and hearing disability that restricts communication, access to information, and mobility, thus limiting a person’s activities and full participation in society. Literature on how this might affect the lives of family members is sparse. The aim of this study is to describe the lived experience of family life from the perspective of one parent when the other has deafblindness. Six partners of deafblind parents, four men and two women, agreed to participate. Three were deaf and communicated in Swedish sign language. Qualitative interviews were conducted and analysed using interpretative phenomenological analysis. Seven themes were identified during the analysis. When one parent has deafblindness, communication within the family and with people outside the family is affected. The non-deafblind partners tried to integrate deafblindness into everyday family life and constantly strove to compensate for the losses caused by deafblindness. They tried to enhance participation and engagement in everyday family life for the parent with deafblindness by facilitating communication and taking a greater part in some areas of their shared responsibilities at home. The results reveal that these partners often put themselves in second place. They and their families needed support to manage family life. Deafblindness affects the life of the entire family, and the non-deafblind partner has to take considerable responsibility for everyday life. Everyday life can be facilitated by an adapted environment and appropriate support, which should be offered to the entire family.

A cross-sectional study of prevalence and correlates of self-harm and suicidal ideation in older adults with dual sensory loss

BACKGROUND

Loss of vision and hearing (dual sensory loss: DSL) presents risk factors for self-harm and/or suicidal ideation, although this has rarely been examined for older adults.

OBJECTIVES

This study estimated the prevalence of thoughts about self-harm and suicide ideation in a national sample of adults with DSL in Denmark.

METHODS

All 513 people aged 50 years or older who were registered with the national provider of service for people with DSL in Denmark were eligible to participate. Surveys were returned by 290 participants. Participants were mostly female (70%) and aged 50-100 years (M = 81). Surveys contained questions related to thoughts of self-harm and suicide as well as physical, mental, and social wellbeing.

RESULTS

In total, 17% of participants reported thoughts of self-harm and/or suicide in the past two weeks. Not participating in social activities, poorer self-rated health, and presence of more depressive symptoms were associated with self-harm and suicidal ideation. Factors that were associated with self-harm and suicidal ideation were lower levels of emotional support, non-participation in social activities, and symptoms of depression.

CONCLUSIONS

These finding highlight the importance of ongoing mental health screening and support for older adults with DSL, especially in ensuring accessible mental health services.

Numerosity Identification Used to Assess Tactile Stimulation Methods for Communication

Finger-Braille is a tactile communication method used by people who are Deafblind. Individuals communicate Finger-Braille messages with combinations of taps on three fingers of each of the hands of the person receiving the communication. Devices have been developed to produce Finger-Braille symbols using different tactile stimulation methods. Before engaging in communication studies based on technologically-mediated Finger-Braille, we evaluated the relative efficacy of these methods by comparing two devices similarly constructed; the first based on widely employed eccentric rotating-mass vibrating motors and the other using specifically designed tapping actuators. We asked volunteers to identify the numerosity of presented items and for each device we measured (1) error-rate, (2) reaction time, (3) confidence ratings, and (4) a comparison of confidence ratings to actual performance. The four measures obtained for each device showed a net advantage of the tapping stimulation method over the method of vibrations. In this article, we conclude that the tapping stimulation method is recommended for use in the design of tactile communication devices based on Finger-Braille and fingerspelling methods reliant on finger tapping actions. The results did not demonstrate clear evidence for tactile subitising with passively experienced stimulation on the fingers.

Informed Consent or Assent Strategies for Research With Individuals With Deafblindness or Dual Sensory Impairment: A Scoping Review

OBJECTIVE

To synthesize evidence on existing informed consent/assent strategies and processes that enable the participation of individuazls with deafblindness or dual sensory impairment in research.

DATA SOURCES

Five scientific databases (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health, Web of Science, and PsycINFO) and other sources such as Google Scholar, Journal of Visual Impairment and Blindness, and British Journal of Visual Impairment were hand-searched from January 2015 until July 2020.

STUDY SELECTION

Studies were selected using a priori inclusion criteria of sensory and cognitive disabilities and focused on consent/assent strategies and processes in research within this population. Articles related to the medical or sexual consent processes were excluded.

DATA EXTRACTION

An Excel spreadsheet was used to extract data from the eligible sources. Discrepancies were resolved in discussion with team members.

DATA SYNTHESIS

A total of 2163 sources were screened, and 16 articles were included in the review. Seven sources only examined consent strategies, whereas the remaining 8 included a combination of consent/assent and dissent strategies. Using thematic analysis, 3 key themes emerged: consent/assent strategies, researcher capacity, and capacity to consent tools. Key identified strategies included the accessibility of the consent/assent process, building relationships with participants and caregivers, identifying behavioral cues, and communication training for researchers.

CONCLUSIONS

Despite the absence of literature on consent/assent strategies within the population with deafblindness, the review found promising strategies applied to individuals with other cognitive or sensory disabilities that researchers can adopt. Researchers are encouraged to use best practices in creating an inclusive research environment to include individuals with deafblindness.

GoCC4All a pervasive technology to provide access to TV to the deafblind community

Considering the importance of communication and independence for the deafblind community, this work presents findings of the use of technology to address the lack of information due to communication challenges among the deafblind community. Over time, many investigations have been carried out regarding this matter, but very few providing solution, which is why this study emerged, looking to making all the information broadcasted through television accessible for this community. The work team designed a technology (GoCC4All) to address the needs of the deafblind community. GoCC4All provides access to captions available on TV through braille displays and mobile devices. Our research process and results outline the path for creating, adapting, and adopting new technologies for people with disabilities who have the right to access the information just as their peers without disabilities. The information in this paper is based on two surveys, an initial beta testing (BT) and a final survey among a group of 14 users (UT) who tested the GoCC4All application. Our findings support the positive impact of the iterative creation of assistive technology based on users' experience and users' recommendations to better serve the needs of the deafblind community.

Impact of COVID-19 on people with physical disabilities: A rapid review

BACKGROUND

The COVID-19 pandemic caused drastic changes in the lives of the general population. People with physical disabilities, who commonly encounter daily challenges such as barriers to community mobility, reduced access to healthcare services and higher risk of suffering from depression, may face additional challenges in the context of the pandemic.

OBJECTIVE

This study aims to review the impact of the COVID-19 pandemic, and associated isolation and protective measures, among people with physical disabilities.

METHODS

A rapid review of the published literature was conducted on August 10, 2020 through a search in six online databases to synthesize results from original studies regarding the impact of the COVID-19 pandemic on people with physical disabilities. The International Classification of Functioning, Disability and Health was used to describe the population and the personal and environmental factors with a unified and standard health language.

RESULTS

Eleven records were extracted from 1621 individual papers retrieved from the search strategy. Various impacts on daily functioning such as a decrease in access to healthcare have been noted during the pandemic. Changes in social and lifestyle habits, mood changes and decreased levels of physical activity were also noted.

CONCLUSIONS

Our results highlighted the lack of early research about the impacts of COVID-19 experienced by people with physical disabilities. Future studies should focus on specific consequences and needs of this vulnerable population to ensure their inclusion in public health recommendations and consideration by policy makers.

Similarities and Differences in Health, Social Trust, and Financial Situation in People With Usher Syndrome, a Bio-Psychosocial Perspective

Purpose

The primary aim was to describe the similarities and differences among the general health, physical health, psychological health, social trust, and financial situations of people with Usher syndrome (USH) types 1, 2, and 3. A second aim was to explore whether age, gender, clinical diagnosis, visual field, visual acuity, and degree of hearing impairment were associated with the general health, physical health, psychological health, social trust, and financial situations of people with USH.

Methods

In this study, 162 people with USH living in Sweden were included, and all three types of the disease were represented. Data concerning vision, hearing, and genetics were retrieved from the Swedish Usher database. Group comparison using frequencies, χ²-tests and Kruskal-Wallis tests for group comparison were used. To examine the effect of independent variables on poor health outcomes, a logistic regression analysis was conducted.

Results

Problems with poor health, social trust, and finances were found for all three types; however, more similarities than differences were found. The results of the regression model were ambiguous; it is not clear which independent measures contributed the most to poor outcomes. People with USH3 tended to report the most problems regarding the dependent outcome measures.

Conclusion

The observations of the associations between the independent variables and poor health, social trust and finances made in the present study are important to bear in mind in a rehabilitation setting; however, they do not fully explain how people with USH actually feel or rate their health. More research is needed to confirm the knowledge that exists within the clinical setting and the life stories told by the people with USH to merge existing knowledge into a rehabilitation setting based on evidence.

Mental Maps and the Use of Sensory Information by Blind and Partially Sighted People

This article aims to fill an important gap in the literature by reporting on blind and partially sighted people's use of spatial representations (mental maps) from their perspective and when travelling on real routes. The results presented here were obtained from semi-structured interviews with 100 blind and partially sighted people in five different countries. They are intended to answer three questions about the representation of space by blind and partially sighted people, how these representations are used to support travel, and the implications for the design of travel aids and orientation and mobility training. They show that blind and partially sighted people do have spatial representations and that a number of them explicitly use the term mental map. This article discusses the variety of approaches to spatial representations, including the sensory modalities used, the use of global or local representations, and the applications to support travel. The conclusions summarize the answers to the three questions and include a two-level preliminary classification of the spatial representations of blind and partially sighted people.

Challenges of teaching the deaf-blind learner in an education setting in Johannesburg: Experiences of educators and assistant educators

BACKGROUND

Evidence suggests that educators of deaf-blind students in the South African context have specific challenges in the educational setting because of their lack of adequate knowledge on deaf-blindness and a lack of sufficient training on communication, teaching and learning strategies.

OBJECTIVES

The aim of this study was to describe the challenges experienced by educators and assistant educators of children with deaf-blindness.

METHOD

Ten educators and assistant educators were selected purposively to participate in the study (Male = 3; Female = 7; age range 31-49 years). Participants were recruited from a school for the deaf-blind in Johannesburg. Participants completed semi-structured interviews on the challenges that they experienced when educating learners who are deaf-blind.

RESULTS

Findings from the data after inductive thematic analysis suggested the following: (1) under-preparedness of educators and assistant educators, (2) communication challenges, (3) challenges related to the diversity of deaf-blind learners and (4) lack of support structures for educators and assistant educators.

CONCLUSION

There is a need for ongoing educator training on communication strategies, cultural diversity and inclusive strategies. A collaborative model of delivering training and inclusive education that will encompass educators and therapists as a means of supporting both the educator and the learner who is deaf and blind is needed. Such a collaboration may result in positive outcomes for both the educator and the deaf-blind learner.

Is it Usher syndrome? Collaborative diagnosis and molecular genetics of patients with visual impairment and hearing loss

Background: Usher syndrome is the most common hereditary syndrome combining deafness and blindness. In the 2017 National Child Count of Children and Youth who are Deaf-Blind, Usher syndrome represented 329 of 10,000 children, but there were also at least 70 other etiologies of deaf-blindness documented. The purpose of this study was to analyze the work-up and ultimate diagnoses of 21 consecutive families who presented to the Genetic Eye-Ear Clinic (GEEC) at the University of Iowa. Our hypothesis was that most families referred to the GEEC would have initial and final diagnoses of Usher syndrome.Materials and Methods: Patients were identified through an IRB approved retrospective chart review of referrals to the GEEC between 2012 and 2019. Details about each patient's history, exam, and clinical and genetic work-up were recorded.Results: From 2012 to 2019, 21 families (25 patients) were referred to the collaborative GEEC. Overall molecular diagnostic rate in this cohort was 14/21 (67%). Evaluation resulted in a change of diagnosis in 11/21 (52%) families. Ultimately, there were eleven unique diagnoses including hereditary, non-hereditary, and independent causes of combined visual impairment and hearing loss. The most common diagnosis was Usher syndrome, which represented 6/21 (29%) families.Conclusions: Providing a correct diagnosis for patients with visual impairment and hearing loss can be challenging for clinicians and their patients, but it can greatly improve clinical care and outcomes. We recommend an algorithm that includes multidisciplinary collaboration, careful clinical evaluation, strategic molecular testing, and consideration of a broad differential diagnosis.

Life strategies of people with deafblindness due to Usher syndrome type 2a - a qualitative study

Purpose: To explore life strategies in people with Usher syndrome type 2a. Background: There are no studies on life strategies in people with Usher syndrome. People with deafblindness are often described in terms of poor health and low quality of life, or as being vulnerable. From a clinical point of view, it is of importance to balance this picture, with an increased knowledge of life strategies. Methods: The study had a qualitative explorative design. Fourteen people aged 20-64 years (4 women, 10 men) with USH2a in Sweden participated in focus group interviews, which were transcribed and analysed by qualitative content analysis. Results: The content analysis resulted in seven categories; remaining active, using devices, using support, sharing knowledge, appreciating the present, maintaining a positive image and alleviating emotional pain. Two sub-themes: resolve or prevent challenges and comforting oneself was abstracted forming a theme "being at the helm". Conclusion: The findings show that people with USH2a have a variety of life strategies that can be interpreted as highlighting different aspects of psychological flexibility in a life adjustment process. The study demonstrates that people with USH2a manage in many ways, and metaphorically, by "taking the helm", they strive to actively navigate towards their own chosen values.

Using the ICF to Identify Contextual Factors That Influence Participation of Persons With Deafblindness

OBJECTIVE

To identify and describe the contextual factors that influence the participation of people with deafblindness in India.

DESIGN

Qualitative study, using directed content analysis approach and the International Classification of Functioning, Disability and Health (ICF) as a framework to analyze the data.

SETTING

Community and social participation settings.

PARTICIPANTS

Community-dwelling individuals with deafblindness (N=16). Age ranges from 18-45 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Personal and environmental factors that influence the participation of individuals with deafblindness using the ICF framework.

RESULTS

Results indicate that the age of onset and nature of impairment (deafblindness) and willingness to explain the condition (functional consequences of deafblindness) emerged as important personal factors. Access to resources such as assistive technology, social support, and deafblind-specific services were found to be enablers of participation. Lack of services, systems, and policies specific to deafblindness along with negative societal attitude toward disability were highly perceived environmental barriers that influence participation of people with deafblindness in India.

CONCLUSIONS

Professionals must acknowledge aspects of the environment in conducting assessments and delivering interventions and understand the dynamic interactions between environment of the individual and his/her concurrent vision and hearing impairments. Approaches to enable participation require rehabilitation professionals to work with those with deafblindness to advocate for removal of environmental barriers and ensure provision of appropriate resources from the government to facilitate their participation. Social policy and government must ensure emphasis on awareness about deafblindness, access to deafblind-specific services, positive societal attitude, and opportunities for full participation for people with deafblindness in society.

Relational strain in close social relations among older adults with dual sensory loss

Objectives:

The loss of both hearing and vision (dual sensory loss) affects communication and potentially challenges the ability to maintain healthy social relations. The aim of this study was to examine the association between severity of sensory loss and relational strain among older adults with acquired dual sensory loss.

Method:

Data were collected through a national cross-sectional questionnaire survey and an administrative database. A total of 302 individuals with functional dual sensory loss ⩾50 years of age participated (66% response). Relational strain was measured as the perceived experience of excessive demands, worries, and conflicts with children, other relatives, or the personal support worker. Data were analyzed by multivariate logistic regression.

Results:

No associations between severity of dual sensory loss and excessive demands from or worries for children, other relatives, or personal support workers were found. Participants with total blindness and profound deafness had significantly higher odds for experiencing conflicts with children (odds ratio [OR] = 3.09, 95% confidence interval [CI] = [1.02, 9.38]) and the personal support worker (OR = 4.18, 95% CI = [1.23, 4.28]) compared to participants with residuals of both senses.

Discussion:

Individuals with total blindness and profound deafness might require special attention in rehabilitation to support them in maintaining healthy social relations.

Meaning and experiences of participation: a phenomenological study with persons with deafblindness in India

Purpose: Deafblindness, also known as dual sensory loss, creates a distinct condition more disabling than either deafness or blindness alone. The participation experiences of persons with deafblindness have not been understood well. This phenomenological study aims to understand the meanings of participation for persons with deafblindness and identify the domains of life that are important to them.Methods: We used the International Classification of Functioning, Disability and Health as a guiding framework. Sixteen adults with deafblindness were interviewed between March and May 2017 in India using a qualitative interview guide.Results: Findings suggest participation as a dynamic, individualized construct that is not just an end outcome. Rather, it is a means to achieve other goals important to the participants such as gaining respect, autonomy, independence, support and relationships, to fulfill aspirations and responsibilities, and to feel included and recognized in society. Life domains that they deemed important for participation were communication and access to information, mobility, relationships, education and productivity, and recreation and leisure.Conclusions: In order to enhance societal participation of people with deafblindness, a significant change in the focus of rehabilitation services is required which involves professionals viewing participation as both a means and an end outcome while designing interventions.

Overcoming barriers to the involvement of deafblind people in conversations about research: recommendations from individuals with Usher syndrome

PLAIN ENGLISH SUMMARY

Usher syndrome is the most common cause of deafblindness worldwide and is estimated to affect between 3 and 6 people in every 100,000. Children are born with hearing loss and develop sight loss in their early years of life. A barrier to the involvement and participation of deafblind people in research is access to information in appropriate formats. The degree of sight and hearing impairment experienced by individuals is variable, so there is not a one size fits all solution. We held a research discussion group, that included five people with Usher syndrome, to consider people's accessibility needs for an upcoming research project involving this condition.We have identified a number of considerations for including deafblind people in conversations about research: i) using appropriately sized meeting rooms which offer control over lighting, layout and sound; ii) where appropriate, ensuring written/printed materials are high contrast (e.g. black text with a yellow background) and in large (18 point and above), sans-serif fonts (e.g. Arial); iii) identifying the relevant communication support for the individual whether that be sign language interpretation, lip reading, hearing loop, speech to text reporting or a combination; iv) ensuring that there is access to emotional support for both people who are deafblind and their families before, during and after the research.The outcome of this work is a checklist of considerations when planning to hold a research conversation with someone who is deafblind and hinges on earlier interactions to identify the appropriate support needs for the individual.

ABSTRACT

Background Usher syndrome is the most common cause of deafblindness worldwide. Children are born with hearing loss and develop sight loss in their early years of life. It is estimated to affect between 3 and 6 people in every 100,000. A barrier to the involvement and participation of deafblind people in research is access to information in appropriate formats. Individuals have varying degrees of sight and hearing impairment meaning there is not a singular solution to supporting all people's communication needs. There is evidence that severe sight and hearing impairments are used as exclusion criteria in some research studies. This exclusion may extend into involvement activities. Methods Eight people, including five people with Usher syndrome, attended a research discussion group. Through this activity, we identified what to consider when looking to improve the experience of taking part in a discussion about research for deafblind individuals. Results Among contributors two people made use of standard British Sign Language interpretation and one communicated using hands-on signing. Contributors highlighted the limitations associated with signing and lip reading such as exhaustion and clear lines of sight as well as the need for additional formats such as speech to text reporting, and high contrast (e.g. black text with a yellow background) printouts with large (18 point and above), sans-serif fonts (e.g. Arial). A large proportion of discussions were on the importance of wrap around emotional support for people who are deafblind and their family throughout the research pathway. This includes counselling, peer support and sensitive and mindful facilitators of involvement activities. Conclusions The range and specific nature of the communication methods and support offerings that deafblind people depend on are broad and require researchers and involvement practitioners to reach out to deafblind contributors earlier on, in order to appropriately tailor approaches and put the most suitable support in place. Informed by this discussion group, we have developed a checklist of key considerations to support the inclusion of deafblind individuals in research conversations, supplemented with input from the sensory disability charity Sense.

Participation experiences of people with deafblindness or dual sensory loss: A scoping review of global deafblind literature

Background

Deafblindness, also known as dual sensory loss, is a varying combination of visual and hearing impairment in the same individual. Interest in this topic has increased recently due to evidence suggesting an increase in prevalence of this condition among older adults. Persons with deafblindness frequently experience participation barriers and social isolation. Developing an understanding of their experiences can inform the design of programs and policies to enhance participation of people with deafblindness in society.

Objective

To identify and summarize available research literature on participation experiences of people with deafblindness or dual sensory loss.

Methods

A comprehensive literature search of eight databases (CINAHL/EBSCO, Embase, ERIC, Global Health, MEDLINE, ProQuest, PsycINFO, PubMed) was performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) during January 2017 and last updated in June 2017. In addition, non-peer reviewed (grey) literature was also retrieved in the form of online published reports of research projects by 16 deafblind-specific organizations across the globe. To be included, sources had to be published after 1990, had persons with deafblindness as the focal population, and focused on their participation experiences.

Results

A total 1172 sources were identified of which 54 studies were included. The findings reveal that persons with deafblindness, regardless of origin of their impairment, experience difficulty in communication, mobility, daily living functioning, and social interactions. While these experiences may vary between individuals with congenital versus acquired conditions, they generally feel socially isolated, insecure and uncertain about their future.

Conclusion

Participation experiences of persons with deafblindness are shaped by dynamic interactions between personal factors (such as onset and type of impairments) and environmental influences (such as attitude, technology, and supports). A better understanding of participation experiences may help professionals in placing emphasis on affected participation domains to design services to enhance participation of people with deafblindness.

Health, work, social trust, and financial situation in persons with Usher syndrome type 1

BACKGROUND

Research has demonstrated that persons with Usher syndrome type 1 (USH1) have significantly poorer physical and psychological health compared to a reference group.

PURPOSE

To explore the relation between work, health, social trust, and financial situation in USH1 compared to a reference group.

MATERIAL

Sixty-six persons (18-65 y) from the Swedish Usher database received a questionnaire and 47 were included, 23 working and 24 non-working. The reference group comprised 3,049 working and 198 non-working persons.

METHODS

The Swedish Health on Equal Terms questionnaire was used and statistical analysis with multiple logistic regression was conducted.

RESULTS

The USH1 non-work group had a higher Odds ratio (95% CI) in poor psychological and physical health, social trust, and financial situation compared to the USH1 work group and reference groups. Age, gender, hearing, and vision impairment did not explain the differences. The relation between the USH1 work and non-work groups showed the same pattern as the reference groups, but the magnitude of problems was significantly higher.

CONCLUSIONS

Both disability and unemployment increased the risk of poor health, social trust and financial situation in persons with USH1, but having an employment seemed to counteract the risks related to disability.

One of society's most vulnerable groups? A systematically conducted literature review exploring the vulnerability of deafblind people

The vulnerability of deafblind people is considered axiomatic; they are seen not only as a vulnerable group but also as one of the most vulnerable. This paper aims to synthesise existing knowledge to determine what is known about such vulnerability. A comprehensive literature search was undertaken between April 2013 and May 2014. The review method was informed by systematic review principles. An approach based on a 'hierarchy of evidence' would have reduced the amount of literature reviewed significantly, to the point where synthesis would not be possible. Included material was appraised and an interpretative rather than aggregative approach to synthesis adopted. Drawing on principles of critical interpretive synthesis, rather than being a determiner of whether material should be included or excluded, a critique of the literature is offered within the synthesis. Twenty-eight references were identified for inclusion, originating from the UK, USA, Australia, Continental Europe and the Nordic Countries. No empirical studies specifically examining the experience of vulnerability of deafblind people were found. However, deafblind people describe feelings of vulnerability in studies exploring their experiences more generally, and in personal accounts of living with the impairment. Literature produced by practitioners and specialist organisations also explores the topic. Deafblind people are identified as a population 'at risk' of various adverse outcomes, particularly when compared to the non-deafblind majority, and deafblind people describe being and feeling vulnerable in various situations. The literature largely relates to negative outcomes and includes significantly less exploration of positive risk taking, coping capacity and resilience. Deafblind people do not appear to describe themselves as being vulnerable as a permanent state, suggesting a need for greater exploration of the experience among all sections of this heterogeneous population, with consideration of the concepts of resilience and coping capacity.

The Influence of Need-Supportive Teacher Behavior on the Motivation of Students with Congenital Deafblindness

Introduction

Research has indicated that need-supportive learning environments positively influence students’ motivation. According to self-determination theory, a need-supportive learning environment is one in which teachers provide structure, autonomy support, and involvement, and thereby support their students’ psychological needs for competence, autonomy, and relatedness. In this study, we aimed to explore whether teachers of students with congenital deafblindness provide such an environment and how they adjust their need-supportive teaching to these students.

Methods

We conducted an in-depth analysis of teacher-student interactions using a multiple-case-study design. We analyzed videos of teacher-student interactions from the perspective of self-determination theory.

Results

We found that successful need support for this group requires careful adjustments for each individual student. Only if the provision of structure, autonomy support, and involvement is tailored to the student can a positive influence on motivation be noticed. Another important finding is that teachers provide more structure and involvement than autonomy support.

Discussion

This study showed that need-supportive teaching is important in the education of students with congenital deafblindness. By using video analysis, we were able to point out teaching strategies that led to greater motivation for these students.

Implications for practitioners

Motivation is a prerequisite for learning, and teachers’ behavior might add to that motivation. This study showed that need support leads to enhanced motivation in students with congenital deafblindness. We provided practical insights that teachers can use to create need-supportive learning environments for these students.

Problems identified by dual sensory impaired older adults in long-term care when using a self-management program: A qualitative study

OBJECTIVE

To gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care.

METHODS

A qualitative study was conducted in parallel with a cluster randomized controlled trial. Dual sensory impaired older adults in the intervention group (n = 47, age range 82-98) were invited by a familiar nurse to identify the problems they wanted to address. Data were taken from the semi-structured intervention diaries in which nurses noted the older adults' verbal responses during a five-month intervention period in 17 long-term care homes across the Netherlands. The data were analyzed using descriptive statistics and qualitative content analysis based on the Grounded Theory.

FINDINGS

The 47 dual sensory impaired older adults identified a total of 122 problems. Qualitative content analysis showed that the older adults encountered participation problems and problems controlling what happens in their personal environment. Three categories of participation problems emerged: (1) existential concerns of not belonging or not being able to connect with other people, (2) lack of access to communication, information and mobility, and (3) the desire to be actively involved in care delivery. Two categories of control-in-personal-space problems emerged: (1) lack of control of their own physical belongings, and (2) lack of control regarding the behavior of nurses providing daily care in their personal environment.

CONCLUSIONS

The invasive problems identified indicate that dual sensory impaired older adults experience great existential pressures on their lives. Long-term care providers need to develop and implement policies that identify and address these problems, and be aware of adverse consequences of usual care, in order to improve dual sensory impaired residents' autonomy and quality of life.

Psychosocial well-being and health-related quality of life in a UK population with Usher syndrome

OBJECTIVES

To determine whether psychosocial well-being is associated with the health-related quality of life (HRQOL) of people with Usher syndrome.

SETTING

The survey was advertised online and through deafblind-related charities, support groups and social groups throughout the UK.

PARTICIPANTS

90 people with Usher syndrome took part in the survey. Inclusion criteria are having a diagnosis of Usher syndrome, being 18 or older and being a UK resident.

PRIMARY AND SECONDARY OUTCOME MEASURES

All participants took part in a survey that measured depressive symptoms, loneliness and social support (predictors) and their physical and mental HRQOL (outcomes). Measured confounders included age-related, sex-related and health-related characteristics. Hierarchical multiple linear regression analyses examined the association of each psychosocial well-being predictor with the physical and mental HRQOL outcomes while controlling for confounders in a stepwise manner.

RESULTS

After adjusting for all confounders, psychosocial well-being was shown to predict physical and mental HRQOL in our population with Usher syndrome. Increasing depressive symptoms were predictive of poorer physical (β=-0.36, p<0.01) and mental (β=-0.60, p<0.001) HRQOL. Higher levels of loneliness predicted poorer mental HRQOL (β=-0.20, p<0.05). Finally, increasing levels of social support predicted better mental HRQOL (β=0.19, p<0.05).

CONCLUSIONS

Depression, loneliness and social support all represent important issues that are linked with HRQOL in a UK population with Usher syndrome. Our results add to the growing body of evidence that psychosocial well-being is an important factor to consider in people with Usher syndrome alongside functional and physical impairment within research and clinical practice.

Tactile short-term memory in sensory-deprived individuals

To verify whether loosing a sense or two has consequences on a spared sensory modality, namely touch, and whether these consequences depend on practice or are biologically determined, we investigated 13 deafblind participants, 16 deaf participants, 15 blind participants, and 13 matched normally sighted and hearing controls on a tactile short-term memory task, using checkerboard matrices of increasing length in which half of the squares were made up of a rough texture and half of a smooth one. Time of execution of a fixed matrix, number of correctly reproduced matrices, largest matrix correctly reproduced and tactile span were recorded. The three groups of sensory-deprived individuals did not differ in any measure, while blind and deaf participants outscored controls in all parameters except time of execution; the difference approached significance for deafblind people compared to controls only in one measure, namely correctly reproduced matrices. In blind and deafblind participants, performance negatively correlated with age of Braille acquisition, the older being the subject when acquiring Braille, the lower the performance, suggesting that practice plays a role. However, the fact that deaf participants, who did not share tactile experience, performed similarly to blind participants and significantly better than controls highlights that practice cannot be the only contribution to better tactile memory.

Theory of Mind and Cognitive Function in Adults with Alström or Usher Syndrome

Objective

Theory of mind (ToM) refers to the ability to impute mental states to one's self and others. ToM was investigated in adults with Usher syndrome type 2 (USH2) or Alström syndrome (AS). Both syndromes cause deafblindness, but differ with regard to onset and degree of sensory loss. Individuals with AS, furthermore, display additional physical diseases. Comparisons were made with individuals with typical hearing and vision.

Methods

Thirteen people with USH2, 12 people with AS, and 33 people with typical hearing and vision performed tests of working memory capacity and verbal ability. ToM was tested via Happé's Strange Stories, assessing ability to understand the emotions and actions of story characters. The test also included matched physical stories to evaluate understanding of the logical outcomes associated with everyday situations.

Results

Significant differences were identified in problem solving regarding physical conditions, with higher scores for the typical hearing and vision group, H(2) = 22.91, p < 0.01. The two groups with deafblindness also demonstrated poorer ToM than the typical hearing and vision group, H(2) = 21.61, p < 0.01, and the USH2 group outperformed the AS group, U(34), z = 2.42, p = 0.016. Intra-group variability was related to working memory capacity, verbal ability, visual status, and to a minor extent auditory capacity. The prevalence of the additional physical diseases was not related to ToM performance.

Conclusions

Limited access to information due to visual loss may have reduced the degree of social experience, thereby negatively affecting the development of ToM. That working memory capacity and verbal ability displayed an impact implies that hearing also contributes to ToM development. Differences between the two groups might be a function of genetic conditions, in which the gene causing USH2 only affects the ears and the eyes, whereas AS has a multisystemic pathology.

Implications for practitioners

Advice and support technology should emphasize ease of communication and boost the development of the communication required to develop ToM.

Ageing with a unique impairment: a systematically conducted review of older deafblind people's experiences

Little is known about the experiences of people ageing with impairments; social gerontology has largely focused on those ageing into disability rather than those ageing with disability. This paper synthesises existing knowledge to determine what is known about the experiences of those ageing with deafblindness. A comprehensive literature search was undertaken between April 2013 and May 2014. The review method was informed by systematic review principles. A total of 24 references were identified for inclusion. No studies examining deafblind people's experience of ageing and old age specifically were found, suggesting that those ageing with deafblindness are an under-studied sub-group within the deafblind population. However, deafblind people describe ageing experiences in studies exploring their lives generally, and in personal accounts of living with the impairment. Practitioner-authored material also explores the topic. Similarities in experience were identified between those ageing with deafblindness and those ageing with other impairments: ongoing change and consequent need for adaptation; a particular relationship between ageing and impairment; a sense that whilst one can learn adaptive strategies having lived with impairment for many years, it does not necessarily get easier; and a particular relationship with care and support services. These experiences illustrate the unique nature of ageing with impairment, and challenge gerontologists to engage in further research and theorising in the field of disability in later life.

Implications of Deafblindness: The Physical and Mental Health and Social Trust of Persons with Usher Syndrome Type 3

Introduction

The aim of this study was to describe health and social trust in persons with Usher syndrome type 3 (USH3) in relation to hearing and visual impairment.

Methods

Participants were recruited from the Swedish Usher database. Twenty-one persons with USH3 received two questionnaires, which covered a wide range of domains related to health and social trust. Fifteen individuals, 4 men and 11 women aged 19–71 years, responded. Each outcome measure within every domain reported by the individual was structured into a matrix, which included auditory and visual findings.

Results

Severe problems with health and social trust were apparent for persons with USH3. Differences in the number of reported problems were suggested. Three persons had cochlear implants, and they reported far fewer problems with physical health, mental health, and social trust than the others.

Discussion

Three major patterns emerged. The first was that the group was heterogeneous with regard to the problems reported in the biopsychosocial dimensions; that is, general health, physical health, and mental health, as well as social trust. The second was that none of the biopsychosocial dimensions could be disregarded when describing health among persons with USH3. The third major pattern was that a cochlear implant might benefit the health of persons with USH3.

Implications for practitioners

The results suggested poor physical and mental health and severe social trust problems for people with USH3. Interdisciplinary strategies are required to facilitate the rehabilitation of persons with USH3 throughout their lifespan.

Physical and psychological health, social trust, and financial situation for persons with Usher syndrome type 1

The article describes physical health, psychological health, social trust, and financial situation in persons with deafblindness due to Usher syndrome type 1 (USH1) in comparison with a cross-section of the Swedish population. Persons with USH1 were recruited through the Swedish Usher database. Totally, 87 adults received the Health on Equal Terms (HET) questionnaire. The HET was adjusted, thus the questions were translated into Swedish sign language, and a large font size, better contrast, and a structure compatible with the Braille script reader were also provided. The questionnaire comprises a wide range of domains related to health and wellbeing. In all, 60 persons responded (60% women, mean age: 49 years, range: 21–79 years). The persons with USH1 were compared to a cross section of the Swedish population that included 5738 individuals (56% women, mean age: 49 years, range: 16–84  years). Significant differences in physical health, psychological health, social trust, and financial situation as well as the odds ratio adjusted for sex and age, and its 95% confidence interval are reported. The psychological health, social trust, and financial situation of persons with USH1 were significantly poorer compared to the reference group although this was not the case for physical health. Persons with USH1 only expressed significantly more problems with headache compared to the cross section of the Swedish population. The respondents revealed major problems with fatigue, loss of confidence, and suicide thoughts and attempts. Major social trust and financial problems were reported in terms of refraining going out alone, not receiving help, having no one with whom to share thoughts, and confide in and being unable to obtain 15.000 SEK (approximately US$1.724 or €1.544) in the case of an unforeseen situation. To identify factors associated with physical health, psychological health, social trust, and financial situation is important in the design of future rehabilitation strategies for persons with USH1. The high level of psychological distress and lack of social trust reported could be related to ontological insecurity, as well as lack of recognition from others. Special attention must be devoted to suicide behavior.

Psychological Stress in People with Dual Sensory Impairment through Usher Syndrome Type II

Introduction

Due to their dual, sensory impairment, people with Usher syndrome are assumed to have a high risk of stress. The purpose of this study was to assess stress in people with Usher syndrome type II (USH2) and the influence of personal variables such as age, gender, and employment on stress.

Methods

Two questionnaires were used: A self-developed questionnaire (SQ) to investigate the frequency and intensity of stress by external stressors within six life domains and the German standardized stress questionnaire Trierer Inventory of Chronic Stress (TICS) to compare frequency of stress between the USH2 sample group and a reference group ( n = 604). The questionnaires were filled in by an ad hoc sample of 262 persons with USH2 (response rate: 93%), mainly recruited from self-help groups (ages 17–79, mean age = 51; 53% female; 32% employed). Differences were determined by using methods of classical test theory.

Results

The evaluated SQ shows good indices in terms of item and factor analysis. The greatest stress was seen in the factor “Orientation and Mobility”; in TICS it was in the scale “Chronic Worry.” In TICS the USH2 sample showed significantly higher stress on scales that indicate a lack of social-emotional need fulfillment and less stress in those with high expectations ( p = .05). In both questionnaires, stress was dependent on personal variables.

Discussion

The results indicate the need for rehabilitation arrangements to reduce stress in people with USH2, especially in the areas of orientation and mobility, chronic worry, and social isolation. In intervention, particular attention should be paid to older, female, and unemployed people.

Implications for practitioners

Internal and external resources for people with dual sensory impairment need to be strengthened and systematic programs for learning how to cope with stress need to be established in order to provide clients with successful problem- and emotion-focused coping strategies.