people inclusion sens limit lesson

Chapter 18 – People, Inclusion, and Sensory Limitations: On-Line Lesson

The focus of this lesson is to present information on the causes and treatments for visual and hearing impairments and offer suggestions for inclusion into leisure services.

INTRODUCTION

Visual and hearing impairments which are also referred to as sensory impairments can be congenital, or acquired at any time in one’s life. These impairments can have an effect on the individual’s leisure lifestyle because without leisure options they may become isolated from others.

ABOUT VISUAL IMPAIRMENTS

According to The American Foundation for the Blind the terms blind and blindness should be reserved for persons who have no usable sight at all. The words visually impaired, partially sighted, or low vision describe "a serious loss of vision that cannot be corrected by medical or surgical procedures, or with conventional eyeglasses".

Definition of terms

Acuity – This describes the amount of detail an individual sees compared to what a person with normal vision sees. It is the measurement taken of the best eye with the best correction to determine what the individual can see at 20 feet, compared to what a person with unimpaired vision sees. The phrase "20/20 vision" means the individual’s sight does not need correction. The larger the second number, the less vision a person has. A person with 20/70 vision is said to have low vision.

Visual field – This includes the entire area that can be seen at one time with the fixed eye. The normal visual field is 180 degrees while looking straight ahead. You should see an equal area on each side of the nose. The central 1/3 of the visual field is seen by both eyes. The definition of field used for legal blindness is 20 degrees.

Legal blindness – This occurs when a person’s visual acuity is 20/200 or less in the better eye with correction and/or the visual field is 20 degrees or less at the widest point. 72% of those identified as legally blind are 65 or older. 80% of those who are legally blind have some light and dark perception.

Low vision – This is having a severe visual impairment where a person’s visual acuity can range between 20/70 and 20/200 or 30 degrees or less visual field. There are five times as many people with low vision as there are people who are legally blind.

Causes of visual impairments

Trachoma – This is an infectious disease caused when a bacterium-like microorganism spread by flies enters the eye. This causes infection and scarring of the cornea or eyelid. It is the major cause of blindness in the world, but rare in the U.S.

Congenital – Some visual impairments can be present at birth as opposed to being acquired later.

Rubella – This is an infectious disease also known as German measles that can cause multiple disabilities, including blindness, in the fetus if contracted during the first trimester of pregnancy. This is completely preventable with immunizations.

Accidents – Pieces of flying metal cause more eye wounds than any other type of object, a good argument for safety glasses. Children ages 5-14 acquire sports-related eye injuries which could be prevented with proper eyewear or headgear. Preschool children sustain eye injuries from cigarettes, cigars and pipes.

Retinopathy of prematurity – ROP is blindness that occurs when premature infants are exposed to 100% oxygen for prolonged periods of time. Brain damage often occurs also.

Detached retina – This occurs when the retina which is the sensory tissue upon which the lens image is formed, detaches and rips a hole in the outer wall. This creates a blind spot and can be surgically repaired using laser technology. This condition is associated with trauma and more common with young males.

Diabetic retinopathy – This is a vascular disease that is the leading cause of blindness in the U.S. for people ages 20-74. An imbalance of insulin causes the retinal blood vessels to degenerate. There is no cure for this disorder but it can be slowed through laser technology.

Glaucoma – This is a blinding disease caused by increased pressure in the eye. It may be acute but usually is progressive and causes the loss of peripheral vision otherwise known as tunnel vision.

Cataracts – This condition decreases vision very gradually as the fogging of the lens blocks light needed for vision. It is more commonly found in infancy and advanced age. Artificial lenses can be implanted to replace the opaque natural lens. Infants born with cataracts must have them removed before reaching 8 weeks of age for best hope of normal vision.

Macular degeneration – This is a malfunction of the pigment epithelium which removes waste from the inner fluid of the eye. It tends to run in families in people who have blue, gray or green eyes. There is little treatment, but it usually does not cause total blindness.

Retinitis pigmentosa – This is a condition where, over time, receptor cells grow shorter, resulting in night blindness, tunnel vision, and loss of central vision. It is an inherited disease that leads to blindness in adolescence or young adulthood. There is no cure or treatment.

Considerations for Inclusion

Provide an orientation to the environment.
Consider balance by pointing out handrails, counters and other features that can lend support.
Act as a sighted guide by allowing the individual with a visual impairment to grasp your bicep, while walking about a half step behind.
Understand methods of mobility such as the use of canes or guide dogs.
Use teaching methods that are geared to the individual such as lighting, colors, textures, size of objects, boundaries, etc.
Use techniques to assist such as using more detailed verbal instruction or touch (always ask first).
Purchase adaptive equipment that would be helpful.
Modify activities when necessary or pair them up with a sighted partner.
Facilitate integration by demanding equal opportunity to use existing services and facilities instead of segregating areas for only people who are blind.
Advertise programs on radio stations or taped information if Braille is too costly.
Include people with visual impairments in the planning process.

ABOUT HEARING IMPAIRMENTS

A hearing impairment is an invisible condition that affects 21 million people in the U.S. It can range from total congenital deafness to mild partial deafness. 50% of those people 75 years or older have some hearing loss.

Deafness is defined as the state occurring when a person is unable to understand speech through the ear alone, with or without a hearing aid.

Hard-of-hearing – This is mild to moderate hearing loss resulting in decreased perception of conversational speech, but sufficient hearing to permit understanding under optimal circumstances. This is the term preferred by members of the deaf community; however hearing impaired is the term of choice by the general public.

The categories by degree of hearing loss in one or both ears include:

Mild hearing loss (loss of some sound)
Moderate hearing loss (ability to understand environment is affected)
Bilateral loss (both ears have loss, the better ear has difficulty hearing)
Severe loss (many sounds are not heard including speech)
Profound loss (inability to hear almost all sounds)

Hearing is measured by units of sound intensity called decibels (dB). Zero decibel is the softest sound that can be heard by individuals with normal hearing.

From 0-25 dB and up is considered normal hearing (20dB is at a level of a whisper).

From 25-40dB is considered to be mild hearing loss.

From 40-55dB is moderate loss.

From 55-70dB is moderately severe (50-60dB is typical conversation level).

From 70-90dB is severe loss (80dB is the volume of alarm clock at two ft. away).

90dB or above is termed a profound hearing loss.

Beyond 90dB would be called deaf.

Stereo headphones (100dB) and concert speakers (120dB) are dangerous to one’s hearing that increases with exposure.

Hertz (Hz) – This is the unit of measurement of the frequency of sound waves and describes pitch. Some people have losses of high or low pitches when having difficulty understanding speech.

There are three basic types of hearing impairments:

Conductive loss - Sound waves are blocked as they travel through the auditory canal or middle ear and cannot reach the inner ear.

Sounds seem muffled and an earache may be present.

It can be caused by wax blocking the ear canal, infection, or punctured eardrum.

It affects both children and adults.

Another cause is Otosclerosis, a disorder where the bones of the middle ear soften, do not vibrate well and then calcify.

This hearing loss can be treated with surgery or other procedures.

Sensorineural hearing loss – This loss involves the inner ear and is the result of damage to the hair cells, nerve fibers, or both. It is more commonly called "nerve deafness."

Sounds are distorted and high tones are not heard.

Ringing or buzzing sounds may be present (tinnitus).

Speech is heard but not easily understand.

This type of loss is permanent and irreversible.

This is caused by genetics, birth injury, or damage to the fetus by maternal infections such as rubella, herpes, or other viral diseases.

Other causes include high fevers, excessive noise, heredity, adverse reaction to drugs, diseases such as meningitis, head injuries and aging.

Central hearing loss – Sound levels are not affected, but understanding of language becomes difficult because the pathways to the brain or the brain itself are damaged. Causes include excess exposure to loud noises, head injuries, high fever, or tumors.

Considerations for Inclusion

Use meaningful communication such as using a normal tone of voice, speaking in complete sentences, speaking slowly and distinctly, looking at the person when speaking, and maintaining face to face contact.
Be aware of the technology that is available to assist individuals with hearing impairments such as hearing aids.
Understand methods of assistance such as speech reading and sign language, which are available to persons with severe hearing loss.
It is important to understand the classification of hearing impairments: prelingual deafness occurs before language skills have been acquired; postlingual deafness occurs after language has been acquired.
American Sign Language

ABOUT DEAF-BLINDNESS

Most people who are deaf-blind are over 65.
Most are women due to longer life span.
The majority of children with deaf-blindness are as intelligent as children without disabilities.
Some 250-300 children are born deaf-blind each year due to accidents, diseases, and genetic problems.
Children who are born deaf-blind can learn but at a different pace and in different ways.

Considerations for Inclusion

The family is the greatest resource for information.
Learn how you can best communicate with the individual to discover their leisure preferences.
As with all visual impairments, ensure a barrier free environment.
Teach through demonstration.

CONCLUDING STATEMENTS

One of the goals of leisure services providers is to facilitate meaningful recreation opportunities for all participants. People with sensory impairments deserve the same opportunities. Avoid assuming incorrectly that they have limited skills and cognitive abilities. It is the leisure services provider’s responsibility to figure out the best way to communicate with each individual.

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