Communicative Strategy – Including Transfer to Tactile Mode

Plenumforelæsning holdt på den fjerde europæiske konference om døvblindhed, Madrid, Spanien, juli 1997 af Live Fuglesang, Norge og Ole E. Mortensen, Videnscentret for Døvblindblevne, Danmark

How do people with acquired deafblindness communicate

There are a wide range of possible ways to communicate, and hopefully people with acquired deafblindness have a variety of strategies to use in different circumstances, according to:

which strategy/method they have learned
their preference of method
with whom they speak
light conditions
acoustic conditions
temperature! (Coming from Norway, I know something about outdoor, tactile communication when it's 20 degrees below zero. Woollen mittens and few words! )
their well-being, physical conditions. (How does their residual sight/hearing function today? It differs, we know.)
need for variations, physical strain.

The majority of persons with acquired deafblindness have been normally sighted and hearing persons from childhood and for most of their adulthood, too. - They want to use their normal way of communication as long as possible - and even longer! - They'll stick to a hearing aid and hope it'll work out OK - and for great many, it does!

One of the great frustrations for someone who is becoming deafblind over a period of time is that they have to keep adapting their methods of communication.

Today we'll focus upon those who can't benefit from a hearing aid, or from written communication with block letters or from signing in a visual frame or from visually reading a manual alphabet. We'll focus upon those who have to learn a tactile strategy to communicate directly with their fellows.

What's left then?

Different manuals to understand by using touch.
Most countries have their own manual or at least their own way to use a manual.
Hands on signing / tactile sign language
Tadoma (this will be explained later.)
Different technical aids.

In this paper we'll present some of the main points of the research in the field of tactual communication. - We will also present the results of a survey we have carried out of deafblind persons own experience with tactile communication.

Tactual communication

People with acquired deafblindness use many different communication methods. In this plenary we will focus on the methods, that are used tactually. Acquired deafblindness means that the person moves from one way of functioning to another, and that he or she has to change his/her habits and methods in a number of areas. One of them is communication. In this plenary we will look at the tactual methods of communication that are used by people with acquired deafblindness, and look at the transfer to tactile mode.

Tactile/tactual communication is communication that is received by the deafblind person through the tactile-kinaesthetic sense. The tactile sense is the sense that receives input from the surface of the skin The kinaesthetic sense receives input from the muscles, joints etc. i.e. regarding the position of the hands, fingers, arms etc.

There is one very important essential difference between tactile communication and other types of communication I would like to mention:

Spoken and signed languages that are received through the ears or eyes may make use of more than one expressive dimension at the same time. For instance, in oral language one dimension is the actual words and what they mean. Another dimension is the tone of voice, another is the quality/timbre of the voice, yet another is the volume and speed of speech etc. All these dimensions carry meaning in themselves, or carry parts of meaning, and when used together they convey information about attitudes, emotions, the nature of the sentence (is this a statement, question or what) and how to understand it correctly.

Sign language consists of dimensions such as the hand shapes and their spatial location, movement etc. together with facial expression, body posture etc. These elements may be present at the same time. The two hands may also produce different signs at the same time, for instance in "That car is mine" in Danish sign language: Left hand points to the car, while the right hand points possessively to myself, and the meaning of a whole sentence is conveyed at one and the same time.

This is called simultaneous multidimensionality. It is also found in written language – o a smaller extent – where typographical features such as italics, bold face, underlining, different fonts etc. are used to communicate something in addition to the literal meaning of the words, for example, emphasis. When writing the sentence "He killed her dog" you can by using typographical features emphasise that "He killed her dog" or that "He killed her dog", for instance.

The possibilities for simultaneous multidimensionality in tactual communication are limited. The eyes and the ears are capable of receiving much more complex information than the tactile sense. The speed and distinction/firmness with which the input is made in tactual communication (be it sign language or finger spelling) can carry some meaning along with the words, but to a much smaller extent. Information has to be transferred linearly, which limits the amount of information that can be transferred during a given period of time.

Tactual sign language

We will now look at three methods of tactual communication, starting by focusing a little on tactual sign language.

There has not been very much research into tactual sign language, or tactual communication for people with acquired deafblindness at all. We conducted a search in the three largest databases of relevant professional literature without finding anything published about tactual sign language for people with acquired deafblindness apart from the projects that we already knew of. They are:

Denmark, Center for Sign Language and Sign Supported Communication: A study on different aspects on tactual communication for deafblind sing language users. (1997)
UK, Doreen E. Woodford: Losing touch: A survey of sign language reception and modification for deaf people who are losing their sight (1987)
UK, Leena Hassinen from Finland in association with Bencie Woll: A preliminary study of tactile forms of communication (1990)
USA, Charlotte M. Reed, Lorraine A. Delhorne, Nathaniel I. Durlach (MIT) and Susan D. Fischer (NTID): A study of the reception of tactual sign language (1995)
Sweden, Johanna Mesch: A pilot study on the sign language of the deafblind (1994)

In the following we want to briefly present a few of the main points of the two most comprehensive works, focusing on different aspects of the use of tactual sign language.

Reed, Delhorne, Durlach and Fischer

Charlotte M. Reed, Lorraine A. Delhorne, Nathaniel I. Durlach (MIT) and Susan D. Fischer (NTID) made a study in 1995 of the effectiveness of tactual sign language, measured as accuracy in the perception compared to the communication speed rate. 10 experienced users of tactual sign language were tested for their ability to receive both isolated signs and whole sentences.

Results

Isolated signs: 122 isolated signs, both one hand and two hands and both symmetrical and asymmetrical were received with an average accuracy of 87 % correct, with scores ranging from 75 % to 98 % for the 10 individuals.

Sentences: 100 sign language sentences, representative of normal conversation, were adapted to tactual sign language taking into consideration the lack of possibilities for perception of visual elements such as facial expression, head- and body posture etc. The average score was here 78 % correct perception, with individual scores ranging from 60 % to 85 %. The production rate, i.e. the speed of signing, ranged from slow to normal and the results were more or less independent of the speed.

It seems that isolated signs were easier to receive than sentences, contrary to what is true for reception of for instance speech, where the context helps the understanding. The study showed that the largest part of the errors in perceiving isolated signs were due to a misperception of the sign's location. Two signs can be identical with the exception of location, i.e. the place where the signs are articulated.

This indicates that one of the major difficulties in receiving tactual sign language for a deafblind person lies in determining exactly where near the signer's body the sign is produced. In Leena Hassinen's study at Bristol University she describes a deafblind person who had developed a special communication technique with his family. Signs that would normally be articulated near the signer's body were articulated near the receiver's body in stead. This made it much easier for the deafblind person to determine the exact location of the sign.

Johanna Mesch

Johanna Mesch from the University of Stockholm notes in her study that deafblind people use fewer pointing gestures and make less use of the communication space in front of them in connection with nouns and as person deiksis. This might also be related to the same difficulty of determining exact locations of signs.

In her Swedish pilot study "Dövblindas teckenspråk" from 1994 - in English "The sign language of the deafblind" - at University of Stockholm Johanna Mesch analysed different elements in tactual sign language. Her material was video recordings of a deafblind person in three different situations: communicating with another deafblind person, communicating with a deaf person and communicating with a professional sign language interpreter. (This report is only available in Swedish).

Johanna Mesch focuses on some areas, where tactual sign language differs from visually received sign language. Her conclusion in this study is that communication is more effective between two deafblind persons than between a deafblind person and a deaf person or an interpreter, because they do not pay enough attention to the special communication needs of the deafblind person. For instance they may use facial expression too much and forget to adapt these sign language elements into a form that can be received by the deafblind person.

When two deafblind persons talk together using four hands, one hand – typically the left one – functions the receiving hand while the right one functions as the signing hand. Both the speaker and the receiver use simultaneously one hand as listening hand and one hand as speaking hand. This hand position provides possibility for efficient transfer of discourse structuring elements in connection with turn taking and feedback during the communication.

If for instance the listener wants to take the word, he might just start signing with his own signing hand at a favourable moment. It is also possible for the listener to give feedback to the speaker by squeezing his listening hand with his own speaking hand to signal that he understands, agrees, etc. or that he doesn't understand. (The most frequent sign for this negative feedback seems to be the sign "what")

When the deafblind person talks to a seeing person, he lets go of his hands and therefore has fewer possibilities of receiving continuous feedback, as we saw in the video example. Some people therefore give feedback to the deafblind person by patting his or her leg or arm when there is no hand contact.

Johanna Mesch also looked at the use of pointing gestures. These pointing gestures – for instance used in connection with nouns and person deixis makes reception difficult for the deafblind person. Deafblind people themselves use fewer pointing gestures and possessive markers and use in stead for instance nouns or name signs.

Another example of adaptation of the sign language to tactual use in this study was marking of questions, that is making clear that this is a question. In sign language this marking in most cases is indicated with facial expression. The signs may be presented in the same order in both a question and a statement, and the distinction between a question and a statement then is in the facial expression. Johanna Mesch found that deafblind people use different strategies for marking questions in lack of access to receiving facial expressions.

Questions were marked this way:

By using question signs (who, what, where etc.)
By freezing the last sign of the sentence (thereby showing that you are waiting for an answer)
By changing body or head posture, leaning back or forward
By using the sign for "question" before the question. This is most frequent when two deafblind people are talking together.

We have looked briefly at some main points from the research until now on tactual sign language. The findings until now are very interesting and useful, which I hope that you will agree with. But all researchers, whose work we have seen, express the need for further research and development work in the field of tactual sign language, and deafblind communication in general. We shall get back to this at the end of this plenary.

Manuals

There are lots of different manuals to be used by touch, but there has been carried out few studies so far on finger spelling. We'll focus on "A study of tactual and visual reception of finger spelling". This was a co-operation between MIT (Massachusetts Institute of Technology) and National Technical Institute for the Deaf, Rochester, NY., by Reed, Delhorne, Durlach and Fisher.

The purpose of the study was to examine the ability of experienced deafblind subjects to receive finger spelled materials, including sentences and connected text through the tactual sense. A parallel study of the reception of finger spelling through the visual sense was also conducted using sighted deaf subjects. Accuracy of reception was examined as a function of rate of presentation.

In the tactual study rates were limited to those that could be produced naturally by an experienced interpreter. - In the tactual reception of finger spelling, the hand ( or hands) of the receiver is placed on the hand of the sender to monitor the hand shapes and movements associated with the letters of a manual alphabet.

The subjects of this study were 5 deafblind individuals who were highly experienced in the tactual reception of the American One-Hand Manual Alphabet, using it for 10-40 years. - A certified interpreter finger spelled directly into their palms or the deafblind wrapped their fingers and palm around the side and back of the interpreter's hand. The subjects responded orally. - There were lists of sentences, some representative of everyday conversation, and some more difficult. This lists were finger spelled at various rates ranging from "slow" to "very fast".

Results

Concerning the everyday sentences, the subjects scored 80-100%, but lower for the more difficult sentences. There was also a tendency for a gradual decrease in performance with increasing presentation rate.

In general, the reception of tactual finger spelling appears to be accurate at normal rates of presentation that are considered to be comfortable for the finger speller (i.e. roughly 5 letters/s.).

The results with sped-up finger spelling suggests that sighted deaf subjects can understand substantial amounts of information at rates as high as two or three times normal finger spelling rates!

Is the tactual reception of finger spelling possible at a higher rate than proved today? This might be, perhaps by using artificial devices in the future?

Knowing this, you might think the same way as we do. What would the results be using another manual, for instant The British Manual? - Faster? More accurate? Who knows? - Are some manuals more suitable for tactual communication than others? We have not been able to find a comparative study!

The natural communication rate for both tactual and visual reception of finger spelling is roughly four to five times slower than for normal speech or for sign language. - Do we take this into consideration? Are we willing to do that, or do we ignore this fact?

What to be aware of then using any manual?

The manuals are different, but when we use one of those, we are facing some of the same possibilities and problems anyhow. In tactile communication we disclose information we want to keep for ourselves, and we are struggling with information we want to share.

A completely deaf and blind person has to rely solely on touch. As we know, it's a time-consuming activity, but the only way. The communication develops as it is intended to do, when there are enough clues concerning speech, non-verbal communication , the context and the culture.

How to deal with the words when using a manual? Is it like speaking or like writing, which are quite different! According to a Russian psychologist, Vygotsky, there are obvious differences between these two aspects.

When we talk with someone:

usually both are at the same spot and know the subject of the conversation
it's a dialogue with turn taking
we don't think of how to build a word or a sentence
want to say something, are motivated
abbreviations and uncompleted sentences
use gests, mimic and intonation.

When we write:

we are not together in the same location
we are not occupied with the same subject
requires a higher level of abstraction
not using words but symbols of words
monologue
have to use a lot of words to describe what you mean.

When analysing what the situation is like when we use a manual, it's neither like talking or like writing but somehow in between!

The context of the situation (where, who, how and so on.) is of utmost importance and a necessity to know, if the deafblind person shall have a fair chance to grasp the intention of the words we are finger spelling. The intention of an utterance does only exist within the right context.

Looking at speech/writing and known/unknown context we get four different settings:

1. Speech and known context: OK, both are familiar with what’s going on. You meet a friend with whom you have a date the following day. You part, saying: «See you tomorrow!» - No-one says where or why, it’s all prearranged. - Or: you call your spouse, saying: «It’s me, I’ll have to tell you that...». The context is well known by both.

2. Writing and known context: Might be dull, redundant. Some of the information are not needed. We all know persons who are too detailed when telling a story or joke. Even when originally it’s an amusing one, it appears to be kind of dull, destroyed by the way it’s been presented.

3. Speech and unknown context: Hopeless, plenty of misunderstandings. A person, unfamiliar to you, approach you on the street, mistaking you for an old friend to be. He starts talking about something you don’t have the slightest idea about. - You’ll try to end this situation as soon as possible, because it’s absurd.

4. Writing and unknown context: OK, but requires at lot of time, often more than you actually have. Someone tells you about an interesting journey, and you really want to get this information. Then a detailed story is OK.

What to be aware of then?

In which of these four situations you are.
Try to avoid number 3!
Move as close to the conditions for writing as possible remembering how
How much time you have at your disposal.
Give information about the context and changes in it.
Emphasise the importance of the primary word of a sentence and the first letters of any word.
Try to add some gests or put into words some of the non-verbal clues.
All these aspects are of importance whether you use one manual or another.

Tadoma

This is a very rarely used method of communication. But since it is a conventional method of tactual communication, we want to include it very briefly in this presentation.

In this method the deafblind person holds his hand on the face and neck of the talker. By feeling the movement of the mouth and the jaw, feeling the air from the mouth and the vibrations on the neck and so on, normal speech can be received through the sense of touch.

As far as we know, only very few persons in the world are using the Tadoma method today. About 20 people in USA and maybe the same number in the rest of the world, according to our information.

Although there is some discussion about this, the method is generally believed to have been developed by a Norwegian teacher at the end of the 19th century. My colleague, Live Fuglesang, found it important to mention this. She is from Norway, by the way…

Around 1920 two children called Tad and Oma were the first to be trained successfully in this method in the USA, and the method was named after them.

Tadoma can be a fairly accurate method of speech perception. Reception of about 40 % of isolated words, and about 80% of sentences can be achieved by experienced users. The method is fairly well documented, by the work of Charlotte Reed and colleagues (once again), who have done several studies on Tadoma.

Communication speed

According to Charlotte Reed and colleagues the natural speed of tactual communication – Tadoma, finger spelling and sign language – ranges from one fourth to three fourths that of normal speech and visually received sign language. (The normal communication speed of speech and visually received sign language is the same with regards to the time that it takes in the two codes to transfer the same information, for instance a sentence.)

The slowest speed but most accurate reception was obtained in finger spelling with near perfect reception at a natural speed approximately one fourth of that of normal speech and sign language.

For both the use of Tadoma and tactual sign language the average score is around 80 % reception, at a speed of approximately three fourths of normal speech and visually received sign language.

It should be stressed that these figures are averages from the results obtained in the different studies. Individual users of these methods may accomplish results different from these! They are examples to show the correlation between speed and accuracy.

Transition to tactile mode

Among the questions still relevant is the following:

How do people with acquired deafblindness experience the transition to tactile mode?

What about:

physical contact with strangers
the lack of speed using a new method
accuracy
hard
difficult to learn

Due to lack of literature on this topic, we made a questionnaire to ask those who knew, deafblind persons themselves:

Questionnaire about tactile communication

The questionnaire included the following questions:

Which communication method did you use before you were deafblind?
Which communication method do you use now?
How comfortable for you is your method of communication (i e how tired do you get when using the method)?
How fast is your method of communication?
How precise and accurate do you think your method of communication is, are there many misunderstandings when you communicate?
How do you feel having to have physical contact to communicate, i.e. having to touch the one you communicate with?
How did you learn this method of communication: By yourself or did someone teach you?
If you had teaching, who was your teacher?
How difficult did you think it was to learn this communication method?
How long did it take to learn this communication method so you could use it automatically, or without thinking very much about it?
When you were learning your new tactile communication method, how did you feel having to have physical contact to communicate, i.e. having to touch the one you communicated with?

Most of the questions had four different alternatives with boxes where to tick in the answers, like very positive , a bit positive, a bit negative, very negative. Some were open alternatives.

We sent this questionnaire to our colleagues in The Acquired Deafblind Network in Europe, and to a few others, all together 20 countries. Asked them to translate the questions into their mother tongue and distribute this to persons with acquired deafblindness using a tactile mode of communication, collect and pass the answers to us.

78 persons from 11 countries gave us a reply.

On one hand, this is not a scientific approach, we do know that! No sample drawn, but we will not make revolutionary conclusions either! This is what we were able to get, straight forward answers from deafblind persons who were willing to participate. For those who answered, it's representative, but not for the whole deafblind population in Europe! Were our questions good enough to get the answers we were looking for?

On the other hand, we have not seen a survey like this done before. Let's look upon this questionnaire as a beginning of getting to know this area better?!

Our 78 responders gave the following answers:

Mode of communication previous of their deafblindness:

23 both sign language and oral communication
21 sign language
34 oral communication

Mode of communication afterwards:

31 both tactile sign language and tactile manual alphabet
15 tactile sign language
29 tactile manual
3 other tactile methods

When you were learning your new tactile communication method, how did you feel having to have physical contact to communicate, i.e. having to touch the one you communicated with?

44 said: It didn't bother me at all, or it bothered me very little.
28 said: It bothered me some.
2 said: It bothered me very much.

How do you feel having to have physical contact to communicate, i.e. having to touch the one you communicate with (now)?

More than 1/2 of the responders think it's OK now. ( It doesn't bother me at all or it bothers me very little.)
1 out of 4 answers that it bothers them a little. Some add that it's OK when they speak with their family or other deafblind persons, but.....

How fast is your method of communication?

7 Much too slow
16 Not quite fast enough
38 Fast enough
17 Very fast

Which means: 7 out of 10 think it's fast enough or very fast!

We were taken aback, astonished, realizing these answers! Our presumption, or was it prejudice, was that lots of people would have complained about the speed or rather lack of speed.

They were satisfied! Our responders seem to have an acceptable speed on their tactile communication. Or maybe the ones with an adequate communication method were the only ones with energy and willingness to answer our questionnaire?

Who are to say if the communication method is not fast enough or good enough? Or fast compared to what?

their capability of comprehension?
their daily need/ situation?
for any situation?

We are still a bit puzzled about these answers!

How precise and accurate do you think your method of communication is, i.e. are there many misunderstandings when you communicate?

Approximately 7 out of 10 evaluate this as accurate enough or very accurate! They are satisfied!

Then the next question to ourselves is: Is your way of communication both accurate and fast or are these two parameters contraindications? We looked at communication speed a little earlier and now we'll look at what our responders answered:

Tactile sign language: 13 out of 15: fast enough or very fast and 8 out of these 13 answered accurate enough or very accurate!
Tactile sign language + manual:20 out of 31: fast enough or very fast and 19 out of these 20 answered accurate enough or very accurate!
Manual (finger spelling): 20 out of 31: fast enough or very fast and 19 out of these 20 answered accurate enough or very accurate!

To the majority of our responders neither the speed nor the accuracy of the communication was a problem. Some added that the speed might be a problem at meetings but not in daily living.

56 out of 78 have had teaching to some extent. The teachers were usually professionals, and still 1/2 of our responders had more or less difficulty in learning a new method! What can we do about that? Looks like an area which needs further development! Does it have to be so difficult?

We don't think it's wise to exaggerate the difficulty in having to learn new tactile methods, but underestimating the problems are not good either. Those who experience the transition as difficult, should have access to a helping hand!

Are some manuals more suitable for tactile communication than others?
Are some manuals more suitable when you have to combine with tactile sign language?
Do we as professionals use Hands on Sign Supported English when English Sign Language is the appropriate?
Caused by our lack of competence?
How do we try to overcome the problem of having to present all information linearly, one piece at a time? Can we develop systems for communicating both the spoken information and the context in a given situation?
When people has to make a transfer to a tactile mode of communication, it is extremely important that they can get the most qualified advice and training. Which communication method should be recommended?

There are lots of questions to be asked! Few answers have been articulated! It's an exciting area, but a fairly new one.

Ending

There are three major research projects going on in Europe at the moment, that we know of:

UK, Sarah Reed: "Communication through touch". This project has two aims: To gain a better understanding of the changes that take place in adapting from visual to tactual perception of sign language and to pilot a training programme in tactual sign language. At the meeting of the European Usher Syndrome Study Group here in Madrid just before this conference started Sarah Reed presented a paper on the latest work in the project. Should be finished March 1998
Denmark, Center for Sign Language and Sign Supported Communication: A study on tactual sign language continuing the work they have just completed. The exact topic of this study has not yet been determined. Should be finished in 1999.
Sweden, Johanna Mesch: A study continuing her pilot study focusing on discourse structuring elements such as turn-taking and marking of questions. Doctoral thesis that should be finished at the beginning of 1998.

These research projects will produce valuable new insight and knowledge, and we look forward to the results of them. But there is also a need for development work at other levels as part of the work to document and analyse tactual communication used by people with acquired deafblindness.

This work may very well be in the form of the documentation of the practical knowledge and personal experience that practitioners in the field have accumulated through their daily work. In Denmark and in Finland, for instance, interpreters for the deafblind have conducted their own small studies in the field of communication with the deafblind, based on their daily practice work.

In Finland there is also a project going on regarding development of tactile supporting signs for persons, who in some situations can not use their residual hearing for communication. Development work like this is important for the continuing work to build a base of knowledge, theoretical framework if you will, regarding the communication of people with acquired deafblindness.

With a greater understanding of the conditions for communication, professionals will be better equipped to offer – for instance – highly qualified communication training, advice and counselling in the difficult transition period that many deafblind people go through.

As one of the deafblind responders wrote in a comment to our questionnaire:

"For any deafblind person being able to fluently communicate, is the doorway to life itself, and as individuals we need to have a choose in the communication methods that suit us best as individuals."