The evaluation of functional vision involves communication and comprehension of both signed and spoken language and of everything else that is happening in the classroom. This differs substantially from the evaluation of hearing students who have similar visual problems. For the most part, the orientation and mobility teacher or the vision education specialist has had no previous preparation for this task which includes knowledge and expertise from the fields of both blindness and deafness.
The specialist must evaluate the ability of students with restricted fields of vision to maintain an adequate level of comprehension of the classroom dialogue. This is particularly important for student's with Usher syndrome, Type 1. As that student's already restricted field of vision continues to decrease, the ability to compensate visually by modifying scanning techniques becomes increasingly more difficult. At a certain point, the student is no longer able to scan effectively and follow both the teacher's signs and the signs of other students in the class. If the student has to continue to depend upon scanning alone, he or she will experience visual fatigue, diminishing comprehension and will demonstrate decreased academic performance.
The student may be able to attend to the teacher without a problem, but when there is interaction between students and teacher or among students, students with Usher syndrome, Type 1 have a hard time locating the person who is talking or signing.
When conducting a vision evaluation of a student with Usher syndrome in a school for the deaf, it is imperative that the assessment not be restricted to the students' viewing of the teacher's stationary signs. An evaluation of active scanning and simultaneous comprehension of class dialogue is vital as well.
Ideally, this evaluation would be conducted by a vision or orientation and mobility specialist who is fluent in American Sign Language (ASL). Realistically, however, there are very few specialists with this skill. It should be emphasized that a specialist without ASL skills or with only some familiarity with sign language should not be conducting this part of the evaluation alone.
It is more realistic to have an ASL-fluent member of the vision/education team (possibly the primary advocate or safe person) join the vision or orientation and mobility specialist with this part of the assessment. This person should first develop an understanding of the student's residual vision characteristics, perhaps in consultation with the vision specialist, before attempting any joint assistance.
The first step is to determine the best possible placement of the student in the classroom, to find the place from which scanning techniques can be most easily and efficiently applied.
Other factors to consider are: distance from the signer, teacher or blackboard, the location and type of lighting source, the appropriate size and contrast of printed classroom and hand-written blackboard materials, the background and clothing contrast of signer, and the position of the student relative to the lighting source. Once these variables of position, lighting, environment, size of materials, and contrast are addressed, the specialist can observe the student following classroom dialogue and interaction over a period of time.
A deaf student with retinitis pigmentosa (RP) experiences more eye fatigue trying to follow classroom information than does a hearing student with RP. It is through visual scanning alone that he or she receives information all day long.
By comparison, hearing students with RP can still follow classroom information through sound. If they choose to rest their eyes, they can do so easily and without sacrificing comprehension or attention to the class lecture or dialogue. This is not so for the student with Usher syndrome, whose struggle to follow class dialogue is analogous to a spectator at a tennis game watching the match through a straw. It is inevitably a tiring experience, and as visual fields decrease, it may eventually be futile.
Once the actual difficulties of visual participation are understood, the gradually decreasing academic performance of students with Usher syndrome comes as little surprise. Exceptions to this would include students with Usher syndrome, Type 2 or 3 who have sufficient residual hearing to follow voice instruction with amplification equipment or other assistive devices. Taking the above factors into consideration, evaluators should schedule various times during the day and week to make observations.
If scanning techniques and other strategies to maximize visual efficiency (such as position of the student, lighting and background contrast of the signer) fail to bring the student to a point of reasonably full participation in the classroom, then it is important to explore specialized and individualized interpreting services.
Ideally the Usher syndrome student should be able to communicate comfortably and efficiently with both users and non-users of sign language, even as the student's vision loss becomes more advanced.
A variety of skills can be taught to the student with recommendations to teachers and family members to help solve difficulties. Examples might include:
Some suggestions in the above list are only for those who use American Sign Language and some are for both signing and oral students.
As a general rule, tactile sign language, for those using sign language, should be introduced to students with Usher syndrome at the earliest opportunity. In most cases, this a skill that the student already needs to use in evening environments and with family members under various lighting conditions.
Although individual assessment always needs to be done to determine the student's readiness to accept instruction in these areas, training in tactile sign language skills for those using sign, protective and trailing skills and sighted guide skills can all be introduced in a non-threatening way under very comfortable conditions.
Occasionally students are uncomfortable discussing vision loss, or their parents have refused to give permission to discuss the subject. In such situations, an instructor can pair students with each other (or with the instructor) and play simple games with blindfolds, all structured to facilitate the development of various necessary skills without pressuring the student. For those older students or more mature students, the teacher can use a direct approach doing training sessions under actual evening conditions.
Individualized interpreting may require a range of methods, including signing at some distance from the student in a small physical space, using tactile tracking, using fully tactile sign language, or a combination of these methods. A selective and varying use of these three methods will be needed as the student's visual fields narrow (and involve central field and acuity loss). At this stage of vision loss, the student's visual condition and corresponding needs may fluctuate as they are influenced by health, stress, fatigue, available lighting and other factors.
Exposure to orientation and mobility instruction and instruction in tactile communication methods are of primary importance. After these needs have been met, the school vision consultant should introduce the student to Braille to see what it looks like and how it works. Students should see a Perkins brailler and should learn as they get older that computers can be operated with refreshable Braille output.
The authors support early exposure to Braille so that it is done at a time of relative stability and strength in the life of the student. Adolescents with the ability to use abstract reasoning will already be wondering how they will use a computer, go to college, or read a book if they lose their remaining vision. The goal is to avoid having the student become dependent and despondent when they experience further vision loss. Students need to know there are ways of managing their lives successfully. They need to be in control and not constantly be place in dependent situations requiring the assistance of hearing/sighted adults. Early exposure to and acquisition of skills in Braille will contribute to the development of a person who believes they can take care of themselves. It is for these reasons that early exposure to Braille is supported.
from Ilene Miner, CSW & Joe Cioffi, M. Ed.: Usher Syndrome in the School Setting
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Original address of this page:
www.tr.wosc.osshe.edu/dblink/usher-VIII.htm
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