Dual sensory impairment is the combination of both visual impairment and hearing impairment. It does not mean that the individual has no hearing or sight. In fact the majority of dual impaired people have some hearing and/or sight.

Dual sensory impairment occurs when the combination of both impairments intensifies the impact of both disabilities. The impact is not uniform and the educational needs of the learner must be delivered on an individual basis.

The dual impaired learner will find it difficult if not impossible to fully benefit from the support usually given to visual or hearing impaired people. A dual impairment approach is therefore needed.

Characteristic difficulties of a dual sensory impaired learner

• To develop communication skills the learner will often require adapted or augmented forms of communication
• The development of mobility and orientation skills will often require specialised learning programmes and modifications to the physical environment
• The integration of information received through other senses will require individual activity based programmes which have been differentiated to meet the individual’s specific needs
• Specific programmes will be necessary, and woven into the curriculum, to develop

1. Social skills
2. Independent living skills 

Curriculum and strategies

An individual needs led approach to education and development is required. Individual need cannot be assumed or generalised.

• Based on an individual assessment an individual curriculum is required to include specific age appropriate intervention in

1. Communication skills
2. Accessible information

3. Mobility and orientation
4. Social skills
5. Independent living skills

• Awareness training in dual sensory impairment is necessary for all staff coming into contact with the learner to include non sensory impaired peers. Ongoing staff training is also necessary to develop specialist knowledge and skills

Physical environment

An environmental audit should be carried out to ensure the learner’s individual needs are being met.

• The learning environment needs to be well lit, without glare to ensure the learner can lip-read, follow signing, read print facilitate mobility and maximise the reading of facial expressions and body language where possible
• The learning environment should be consistently laid out and clutter free to help access
• Lighting should be controllable e.g.

1. Dimmer switches fitted
   1. Blinds over windows

• Colour and textural contrast can help the learner differentiate surrounds e.g. highlight,

1. The leading edge to steps
2. Door handles
3. Door frames
4. Personal storage spaces

• Mobility trails should be provided where necessary to aid independent travel
• Communal spaces like toilets and storage spaces should be marked so the individual can access them independently
• Communal notice boards should be accessible
• Carpeted rooms are preferred to hard floors as they tend to reduce echoing
• Incidental noises should be kept to a minimum e.g. learning environment noise kept to  minimum with rooms positioned away from busy and noisy roads
• Suitably positioned induction loops for hearing aid users should be provided
• Don’t try and communicate with the dual impaired learner whilst trying o do something else – you may turn your face away
• Make sure you have the learner’s attention before attempting to communicate
• Give the learner time to respond
• Constantly bear in mind the learner’s level of vision i.e. speak and sign within the learner’s visual field and at the level of the hearing aid.
• Support physically disabled learners in a comfortable relaxed position so that they can concentrate on listening and looking rather than keeping their balance.
• Always use speech when signing. Use a conversational voice with varied information patterns. Speech that is too loud will distort sound and speech patterns with speech that is too quiet will be difficult to discriminate.
• Use normal speech patterns i.e. sentences with clear phrases rather than single word utterances.
• A learner picks up information from many sources during communication to include facial expressions, body language and gestures. Constantly consider the information a sight impaired learner might therefore miss.

Communication

The communication needs of the learner will be highly individual. Communication can be presented in different forms

• Multiple communication – the use of

1. Voice
2. Objects of reference
3. Textured communication
4. Symbols
5. Pictures
6. Etc

• Finger spelling or deaf-blind manual
• Visual sign language – British Sign Language (BSL) or hands on signing
• Lip reading, voice
• Portable communication aids

A 1-1 learner support ratio is needed. An intervener will support the learner to access the curriculum. Time is also needed for someone to prepare accessible learning resources, attend meeting with staff delivering programmes to ensure materials are suitable and prepared on time.

Someone is also needed to coordinate delivery and ensure all who are involved with the learner are aware of the individual’s needs. That is, with time available to coordinate input from,

• Specialist teacher – Qualified Teacher of the Visually Impaired, Qualified Teacher of the Hearing Impaired, Multi Sensory Impairment Teacher
• Therapists – physiotherapist, occupational therapist and speech and language therapist
• Specialist tutors – regarding mobility, touch typing, ICT, signing

Time will be needed for someone to deliver specialist programmes like social skills and independent living skills. This person will also need training although programmes should be devised and monitored by qualified people.

Specialist resources which may be required

• Tactile material e.g. Braille or Moon and tactile diagrams, large print text, low vision aids to include CCTV and audio tape recorder.
• Tactile or audible equipment e.g. talking scales or tactile rulers
• ICT with a magnification display, speech synthesizer and/or Braille display
• Braille printers, scanner and tongue switches to operate computers and induction loop systems

Social needs

Dual sensory impairment is isolating. The social needs of the learner are therefore an important element regarding developmental need. Constant consideration is required regarding,

• Communication
• Mobility
• Environmental awareness
• Social skills
• Independent living skills

A guide to facilitate communication and act as eyes and ears for the learner might be necessary to facilitate two way communication when accessing the community to include shops, banks and when generally socialising. Ideally the facilitator will be age appropriate.

All of the above should be clearly set out, specified and quantified, in the learner’s Statement of Social Educational Needs or Education Health and Care Plan with Objectives and Outcomes informing the targets

The acoustic environment

A good acoustic environment is just as important to a child who is just becoming aware of sound as it is to a child who is beginning to attach meaning to sound. Small increases in background noise and reverberation will have a disproportionate effect on the amount of auditory information the hearing impaired child is able to use.

For the hearing impaired child with an additional visual impairment the problems are even greater as they are less able to use visual clues to supplement the auditory information.

Amplification

Many dual impaired children need amplification to give then any chance to respond to the sounds in their environment. Hearing aids must be in good working order. Ear moulds should be clean, batteries adequately charged, leads in good working order and appropriately connected.

People and hearing

People with normal hearing learn selective listening to sounds in a generally noisy background. Hearing impaired children have to develop this skill and be trained to recognise meaningful sounds e.g. a door opening when someone walks into a room.

Children who hear normally learn about sources of sounds and their meanings by integration of vision and hearing i.e. they hear a sound and look for its source. Dual impaired learners with poor or confused vision may not make these connections incidentally and require specific learning to compensate.

People can therefore alter the acoustic environment to enhance the quality of sound and also contribute to sound levels. 

The learning environment

Hearing aids do not cure hearing loss. They amplify all sounds in the environment and may present a mass of noise of which the learner may have to make sense. It is essential therefore to keep background noise to a minimum and to present the learner with a clear a signal as possible.

For people with normal hearing, if speech is to be heard, it must be at a 5 – 10 db intensity louder than background noise. For a hearing impaired learner the ratio needs to be 20 – 30 db greater. If this ratio is not achieved, research indicates that ‘listening’ is too difficult.

Consideration therefore must be given to ways in which background noise can be kept to a minimum.

Classroom noise can come from,

• Moving furniture
• Footsteps
• Machinery
• Central heating
• Traffic outside the room

Noise can be minimised by,

• Avoiding direct air paths between classrooms and corridors for example through cracks or around pipes
• Door frames should make a good seal and perhaps be lined with felt or rubber
• Temporary thin partitions, folding doors and sliding doors are not recommended. They are often of insufficient weight to serve as good insulators and leave gaps between floor and ceiling through which sound can be transmitted
• Carpeting the floor is advisable or if potential staining is an issue then cushion vinyl is an alternative
• The legs of moving chairs and tables should be rubber tipped
• Others in the room should be encouraged to wear soft soled shoes
• Acoustic tiles on the ceiling or walls can absorb 60% – 70% of sound waves as opposed to 5% by a smooth plastic surface. Acoustic tiles reduce the effect of reverberation when sound travelling from the sound surface bounces around the room, striking different surfaces. These reflected sounds interfere with the pure signal transmitted between the speaker and learner, speaker and hearing aid.

Quiet area

It may not be economically viable to fit carpet tiles, fix acoustic tiles to walls and ceiling and fit curtains to windows in the classroom or even whole school. However, it should be possible to produce a quiet room or area. For example

• An off-cut piece of carpet will cover the floor
• A blanket or thick cardboard can cover the wall

The area must be well lit to aid communication with lighting which is controllable.

It should only be used for one learner at a time in order to provide the optimum learning conditions to develop residual hearing. It should be used regularly for short periods.

Working in the quiet area should be a fun time when a dual impaired learner can explore various sounds and games. Sounds can be produced using rattles and by clapping and laughing or by simply using the voice.

This area may also be useful for assessment purposes or the gradual introduction of amplification.

Outside the classroom

External noises are not always under the control of the school. For example from busy roads, factories next door and even from flight paths. Awareness of the difficulties however may help to minimise their negative effects. Noise levels in communal areas for example in cloak rooms, dining areas, assembly rooms and corridors can be reduced. This can be achieved by:

• Fitting rubber shoes to furniture
• Cloths on tables
• Small areas carpeted

It should however be remembered that some noises are good location clues and are useful for orientation, mobility and to generally raise awareness of the environment.

If an environment becomes too noisy the removal of hearing aids is an option and especially if the noise becomes painful. Refusal to wear a hearing aid may be a justifiable response to unacceptable noise levels.