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PubMed2002

Inequalities in access to healthcare faced by women who are deaf.

The Cheshire Deaf Women's Health Project undertook a research study to assess the access to healthcare of women who are deaf in Cheshire, UK. Group discussions took place with 13 women who were hard of hearing and 14 women who were Deaf Sign Language users. Questionnaires were distributed to a stratified random sample of 103 women taken from the social services register, 38 of which were returned. In order to reach more women whose first language was British Sign Language, 129 questionnaires were distributed to the leaders of various clubs and organizations for people who are deaf, and 100 of these were returned. The data revealed inequities in access to healthcare. For example, women who are deaf face a lack of awareness by health staff of how to communicate with them. The survey confirmed that these problems are of major importance to the majority of women who are deaf. For example, fewer than one in 10 deaf women said that they usually fully understand what the doctor says to them when they visit the doctor on their own. There are many other difficulties faced by women who are deaf, leading to inequalities when they are compared with hearing people. Almost half the respondents said that they would be more likely to use health services if help and/or services for deaf women were available. The introduction of various relatively simple measures would greatly help to reduce the inequalities of access to healthcare faced by deaf women. Under the terms of the Disability Discrimination Act 1995, such action is essential if providers are to avoid facing possible legal action.

Adult↗

PubMed2004

Understanding 'not': neuropsychological dissociations between hand and head markers of negation in BSL.

Simple negation in natural languages represents a complex interrelationship of syntax, prosody, semantics and pragmatics, and may be realised in various ways: lexically, morphologically and prosodically. In almost all spoken languages, the first two of these are the primary realisations of syntactic negation. In contrast, in many signed languages negation can occur without lexical or morphological marking. Thus, in British Sign Language (BSL), negation is obligatorily expressed using face-head actions alone (facial negation) with the option of articulating a manual form alongside the required face-head actions (lexical negation). What are the processes underlying facial negation? Here, we explore this question neuropsychologically. If facial negation reflects lexico-syntactic processing in BSL, it may be relatively spared in people with unilateral right hemisphere (RH) lesions, as has been suggested for other 'grammatical facial actions' [Language and Speech 42 (1999) 307; Emmorey, K. (2002). Language, cognition and the brain: Insights from sign language research. Mahwah, NJ: Erlbaum (Lawrence)]. Three BSL users with RH lesions were specifically impaired in perceiving facial compared with manual (lexical and morphological) negation. This dissociation was absent in three users of BSL with left hemisphere lesions and different degrees of language disorder, who also showed relative sparing of negation comprehension. We conclude that, in contrast to some analyses [Applied Psycholinguistics 18 (1997) 411; Emmorey, K. (2002). Language, cognition and the brain: Insights from sign language research. Mahwah, NJ: Erlbaum (Lawrence); Archives of Neurology 36 (1979) 837], non-manual negation in sign may not be a direct surface realisation of syntax [Language and Speech 42 (1999) 143; Language and Speech 42 (1999) 127]. Difficulties with facial negation in the RH-lesion group were associated with specific impairments in processing facial images, including facial expressions. However, they did not reflect generalised 'face-blindness', since the reading of (English) speech patterns from faces was spared in this group. We propose that some aspects of the linguistic analysis of sign language are achieved by prosodic analysis systems (analysis of face and head gestures), which are lateralised to the minor hemisphere.

Aged↗

PubMed1995

Communication with deaf patients. Knowledge, beliefs, and practices of physicians.

OBJECTIVE: To assess physicians' knowledge and beliefs regarding communication with deaf people and compare their knowledge and beliefs with their methods of communicating with deaf patients in their practices. DESIGN: Survey. SETTING: University medical center. SUBJECTS: Attending physicians in an internal medicine department. INTERVENTIONS: Physicians were surveyed regarding prior contacts with deaf patients and with deaf people outside the medical setting, and regarding their knowledge and beliefs concerning methods of communicating with deaf people. Physicians were asked to estimate the fraction of encounters in which they communicated with deaf patients by lipreading, writing, translation by a relative or friend, a sign language interpreter, or other methods. RESULTS: Writing was the method used most frequently in communicating with deaf patients. Although 63% of physicians knew that signing should be the initial method of communicating with deaf patients who sign, only 22% used sign language interpreters more frequently than other methods in their practices. Past contact with deaf people (P = .05), belief that communication by signing was the best means of communication (P = .04), and knowledge of the inefficiency of lipreading (P = .04) were predictors of the use of sign language interpreters for deaf patients. Physicians who used sign language interpreters more frequently than other methods believed that much more time and effort were involved in caring for deaf than for hearing patients compared with those who used interpreters less frequently (P = .08). CONCLUSION: Although most physicians believed that use of sign language interpreters was preferable, only a minority used them in their practices. Greater recognition of the advantages of signing over other methods and greater availability of sign language interpreters should lead to more effective communication between deaf patients and physicians.

Adult↗

PubMed1988

Training social skills to severely mentally retarded multiply handicapped adolescents.

Three severely mentally retarded, multiply handicapped, adolescents were treated in a classroom setting for social skills deficits. Two of these children exhibited symptoms of autism including periods of echolalia, and fascination with tactile and visual stimulation. One of the pair was deaf. The third child was profoundly mentally retarded and had minimal expressive language skills. All had received sign language training to facilitate communication. Treatment focused on increasing the frequency of eye contact, in seat and response to verbal prompt behaviors, skills deemed necessary to facilitate use of sign language communication and to increase social interaction. Baseline and treatment were evaluated in a multiple baseline, alternating treatment design across children. Baseline was taken on responses to 10 standard questions, asked by the teacher, based on verbal presentation and sign language. This same procedure was then continued during the initial treatment phase following training sessions. During training, the children received social reinforcement, performance feedback and edible reinforcement, in the form of candy, for appropriate performance. Physical and verbal prompts as well as pictorial cues were employed to shape appropriate behavior. In the second treatment phase, training was implemented in the classroom in which baseline data had been collected. Improvement in target behaviors, via training sessions held four days a week, was noted. These data suggest that use of a combination of visual stimuli, operant and social learning methods can remediate social skills deficits in children with multiple psychological and physical deficits. The implications of these findings for current and future research are discussed.

Achievement↗

PubMed1999

Early dissociation of verbal and nonverbal gestural ability in an epileptic deaf child.

Studies of sign language aphasia in deaf adults have provided the evidence for two separable verbal and nonverbal manual gesture systems. We report a congenitally deaf child with a idiopathic focal epilepsy of childhood who showed specific language impairment in French sign language. The child's amazing performances in miming or sketching pictures she was unable to sign support the notion of an early dissociation of the two gestural systems.

Adult↗

PubMed1992

Dissociation between linguistic and nonlinguistic gestural systems: a case for compositionality.

This paper addresses the issue of the separability of disorders of sign language from disorders of gesture and pantomime. The study of a left-lesioned deaf signer presents one of the most striking examples to date of the cleavage between linguistic signs and manual pantomime. The left-hemisphere lesion produced a marked sign language aphasia disrupting both the production and the comprehension of sign language. However, in sharp contrast to the breakdown of sign language, the ability to communicate in nonlinguistic gesture was remarkably spared. This case has important implications for our understanding of the neural mediation of language and gesture. We argue that the differences observed in the fractionation of linguistic versus nonlinguistic gesture reflect differing degrees of compositionality of systems underlying language and gesture. The compositionality hypothesis receives support for the existence of phonemic paraphasias in sign language production, illustrating structural dissolution which is absent in the production of pantomimic gesture. Understanding the neural encoding of compositional motoric systems may lead to a principled anatomical account of the neural separability of language and gesture. This case provides a powerful indication of the left hemisphere's specialization for language-specific functions.

Aphasia↗

PubMed1984

Visual-spatial processing in deaf brain-damaged signers.

Sign language displays all the complex linguistic structure found in spoken languages, but conveys its syntax in large part by manipulating spatial relations. This study investigated whether deaf signers who rely on a visual-spatial language nonetheless show a principled cortical separation for language and nonlanguage visual-spatial functioning. Four unilaterally brain-damaged deaf signers, fluent in American Sign Language (ASL) before their strokes, served as subjects. Three had damage to the left hemisphere and one had damage to the right hemisphere. They were administered selected tests of nonlanguage visual-spatial processing. The pattern of performance of the four patients across this series of tests suggests that deaf signers show hemispheric specialization for nonlanguage visual-spatial processing that is similar to hearing speaking individuals. The patients with damage to the left hemisphere, in general, appropriately processed visual-spatial relationships, whereas, in contrast, the patient with damage to the right hemisphere showed consistent and severe visual-spatial impairment. The language behavior of these patients was much the opposite, however. Indeed, the most striking separation between linguistic and nonlanguage visual-spatial functions occurred in the left-hemisphere patient who was most severely aphasic for sign language. Her signing was grossly impaired, yet her visual-spatial capacities across the series of tests were surprisingly normal. These data suggest that the two cerebral hemispheres of congenitally deaf signers can develop separate functional specialization for nonlanguage visual-spatial processing and for language processing, even though sign language is conveyed in large part via visual-spatial manipulation.

Adult↗

PubMed2003

Space is special in Sign.

Following groundbreaking work by linguists and cognitive scientists over the past thirty years, it is now generally accepted that sign languages of the deaf, such as ASL (American Sign Language) or BSL (British Sign Language), are structured and processed in a similar manner to spoken languages. The one striking difference is that they operate in a wholly non-auditory, visuospatial medium. How does the medium impact on language processing itself?

Journal Article↗

PubMed1999

Differentiating the use of gaze in bilingual-bimodal language acquisition: a comparison of two sets of twins with deaf parents.

Signed languages make unique demands on gaze during communication. Bilingual children acquiring both a spoken and a signed language must learn to differentiate gaze use for their two languages. Gaze during utterances was examined for a set of bilingual-bimodal twins acquiring spoken English and American Sign Language (ASL) and a set of monolingual twins acquiring ASL when the twins were aged 2;0, 3;0 and 4;0. The bilingual-bimodal twins differentiated their languages by age 3;0. Like the monolingual ASL twins, the bilingual-bimodal twins established mutual gaze at the beginning of their ASL utterances and either maintained gaze to the end or alternated gaze to include a terminal look. In contrast, like children acquiring spoken English monolingually, the bilingual-bimodal twins established mutual gaze infrequently for their spoken English utterances. When they did establish mutual gaze, it occurred later in their spoken utterances and they tended to look away before the end.

Child Language↗

PubMed1988

Functional demands and consequences of manual communication.

Sign language is the fourth most commonly used language in the United States. Despite the frequent need for this unique upper limb function, little is known regarding the demands and consequences of signing. This article (1) reviews 15 signers with upper limb abnormalities to determine how the abnormalities affect their signing, and (2) explores overuse syndromes in six sign language interpreters. Because of the way the sign language is constructed, only the most severe, bilateral limb abnormalities affect signing, and no extraordinary measures beyond standard, high quality hand care is required to improve function. To treat overuse syndromes in sign language interpreters, customary conservative treatments have generally been useful, but prevention is greatly preferable to treatment.

Adolescent↗

PubMedDate not supplied

Evaluating changes in the communication skills of deaf children using vibrotactile stimulation.

Results of a 9-mo longitudinal study designed to evaluate the efficacy of a vibrotactile aid, the SRA-10, with four profoundly deaf preschool children are reported. During the study the subjects were enrolled in 30-min triweekly language therapy sessions, and changes in communication skills in connected discourse (vocalization only, sign language only, and vocalization plus sign language) were measured using a computer-based observation system. Changes in structural and semantic aspects of language were also measured. The four subjects were evaluated during one 16-week phase in which the aid was used (aid-on condition) and another 8 weeks in duration in which the aid was not used (aid-off condition). Communication skills improved in the aid-on condition and decreased in the aid-off condition. The changes were found to be significant for the communication involving the vocalization plus sign language (Total Communication) measure, indicating that the vibrotactile stimulation was positively associated with the communicative act.

Child, Preschool↗

PubMed1998

Influence of communication mode on speech intelligibility and syntactic structure of sentences in profoundly hearing impaired French children implanted between 5 and 9 years of age.

OBJECTIVE: The purpose of this study was to examine the speech production in French profoundly hearing impaired children, focusing on word intelligibility, sentences syntax, and sentence pattern stages, by incorporating direct comparisons between speech production skills and communication modes in the same children. DESIGN: The design of the study incorporated a within-subject, repeated measures design for assessing speech production intelligibility and syntax. SETTING: Montpellier Pediatric Cochlear Implant Center. SUBJECTS: Twelve prelingually deafened French children who received a Nucleus multichannel cochlear implant (mean age at the time of implantation was 7 years 2 months) served as subjects for the speech production assessment. MAIN OUTCOME MEASURES: Speech production intelligibility, syntax, and sentence pattern stages were assessed at 1, 2 and 3 years postimplant. Speech production skills were related to the communication mode of the children (auditory-oral, four children; cued-speech, four children; sign-language, four children). RESULTS: Scores on word intelligibility steadily improved with increased experience with the implant, ranging from 18% before implantation to 54.5% at 36 months postimplantation in the overall population. The highest scores were found in the cued-speech group with an averaged score of 66.8% at 36 months postimplant. The number of syntactic elements increased over time with implant experience. Children receiving cued-speech education had higher scores by 3 years postimplantation than children receiving either auditory-oral or sign-language modes of communication. Language level (sentence pattern stages) also improved with increased experience with the device. By 3 years postimplantation, children receiving auditory-oral or cued-speech instruction were able to produce sentences; however, the sign-language children failed to do so at a rate comparable to the other children. Language level was significantly higher in the oralist or cued-speech educated children than in the sign-language group. CONCLUSIONS: Speech production skills improved with increased experience using a cochlear implant. Word intelligibility, syntactic structure of sentences, sentence pattern stages improved gradually over time. Production skills were greater in the cued-speech educated children group than in the auditory oral or sign-language groups. Statistically better sentence pattern stages were found in the auditory oral and sign-language groups.

Child↗

PubMed1998

Speech-language pathologists in schools for the deaf. A survey of scope of practice, service delivery, caseload, and program features.

Analyses of surveys of speech-language pathologists (SLPs) in schools for the Deaf across the United States enable a profile of SLPs' scope of practice, caseload size and characteristics, and delivery of services, as well as features of programs through which they serve students. The findings are compared to previous results of surveys, both large and small, of SLPs in local school programs. Results point favorably to the services provided by SLPs in schools for the Deaf in terms of SLPs' proficiency in sign language, their smaller caseloads, the amount of time they spend in direct services, and a broad range of practice that focuses on written language, sign language, and functional communication.

Deafness↗

PubMed1999

Music and Deaf Culture: Images from the Media and Their Interpretation by Deaf and Hearing Students.

The purpose of the study was threefold: (a) to examine how the visual media have portrayed the subject of music and the deaf, (b) to verify the validity of these portrayals with members of the deaf community, and (c) to compare and contrast deaf and hearing audiences' impressions of these portrayals. An additional purpose of the research was to examine the results in light of possible misconceptions that may be construed by music therapists and music educators based upon the media's representation of the relationship between music and deaf culture. Since music therapists and music educators are the primary persons responsible for the music instruction of students in school programs for deaf and hard-of-hearing students, it is particularly important that they receive accurate messages about the relationship of music to deaf culture. Fifty deaf (n = 25) and hearing (n = 25) undergraduate college students individually viewed motion picture and television excerpts related to music and the deaf. Subjects were instructed to take notes as needed regarding the content of each excerpt and their impressions. Students were then interviewed in their native language, English or American Sign Language, as to their interpretations and perceptions regarding these excerpts and their accuracy. Interviews of the deaf students were translated into English from American Sign Language by trained interpreters. Written transcriptions were then made of the interpreters' English translations of the interviews with deaf students and of the verbal interviews with hearing students. Interview transcripts from both groups were coded and analyzed for recurring themes and patterns using content analysis. Data analysis revealed cultural patterns for the two groups, impressions specific to individual subjects, and trends in communication style and content for the two groups. Implications for music therapists and music educators are given regarding the influence of the media, characteristics of deaf culture, and teaching music to deaf students.

Journal Article↗

PubMed1989

Evaluating the success of deaf parents.

Nineteen parent-child pairs completed the Parental Strengths and Needs Inventory (PSNI) and were interviewed about their relationships. Parent and child scores on the PSNI were above average, with parents expressing high interest in information about childrearing. Interviews revealed issues specific to deaf parents, such as using children as interpreters and frustration when children had poor sign language skills. Children with good sign language skills said they were generally willing to interpret for their parents, except during conflict situations. Children also reported advantages to having deaf parents: they enjoyed being bilingual and their parents tolerated noise and loud music. Study results underscore the importance of triangulation strategies in cross-cultural research.

Adolescent↗

PubMed1993

"Signing tics"--insights into the pathophysiology of symptoms in Tourette's syndrome.

We describe the case of a young woman with Tourette's syndrome who incorporated sign language into her tic behavior. Sign language was used in complex "phonic tics" such as swearing, echoing what others said, or repeating what she said, read, or thought. We suggest the descriptive terms "coprolaliopraxia," "echolaliopraxia," and "palilaliopraxia" to denote these symptoms. The incorporation of such complex, learned movements into the repertoire of hyperkinesias further emphasizes the complicated association between purposeful and automatic execution of movements comprising tic behavior. This case also provides strong evidence against the suggestion that obscenities vocalized in Tourette's syndrome are due to a random generation of high-probability sequences of letters or phonemes.

Adult↗

PubMed2002

Functional magnetic resonance imaging studies of language.

Functional neuroimaging of language builds on almost 150 years of study in neurology, psychology, linguistics, anatomy, and physiology. In recent years, there has been an explosion of research using functional imaging technology, especially positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), to understand the relationship between brain mechanisms and language processing. These methods combine high-resolution anatomic images with measures of language-specific brain activity to reveal neural correlates of language processing. This article reviews some of what has been learned about the neuroanatomy of language from these imaging techniques. We first discuss the normal case, organizing the presentation according to the levels of language, encompassing words (lexicon), sound structure (phonemes), and sentences (syntax and semantics). Next, we delve into some unusual language processing circumstances, including second languages and sign languages. Finally, we discuss abnormal language processing, including developmental and acquired dyslexia and aphasia.

Aphasia↗

PubMed1990

Bottlenosed dolphin and human recognition of veridical and degraded video displays of an artificial gestural language.

2 bottlenosed dolphins proficient in interpreting gesture language signs viewed veridical and degraded gestures via TV without explicit training. In Exp. 1, dolphins immediately understood most gestures: Performance was high throughout degradations successively obscuring the head, torso, arms, and fingers, though deficits occurred for gestures degraded to a point-light display (PLD) of the signer's hands. In Exp. 2, humans of varying gestural fluency saw the PLD and veridical gestures from Exp. 1. Again, performance declined in the PLD condition. Though the dolphin recognized gestures as accurately as fluent humans, effects of the gesture's formational properties were not identical for humans and dolphin. Results suggest that the dolphin uses a network of semantic and gestural representations, that bottom-up processing predominates when the dolphin's short-term memory is taxed, and that recognition is affected by variables germane to grammatical category, short-term memory, and visual perception.

Animal Communication↗