Unit SS MU 3.1 Understand sensory loss
It is essential that you understand the differing needs of people with sensory loss and how you can improve on your work practices to support and empower them. There are significant numbers of people in the UK who have a sensory loss. This can mean sight loss, hearing loss or dual sensory loss. This unit will introduce you to the impact of sensory loss on the person. With a single sensory loss, the person normally relies on the other senses to compensate. However, people missing both senses have a unique disability which requires specialist communication skills alongside ongoing support. Throughout this unit, you will encounter many terms for sensory loss. The Royal National Institute for Deaf People (RNID) suggest that when talking about a person with a hearing loss, it is good practice to use the terms ‘Deaf’, ‘hard of hearing’ or ‘having a hearing loss’. British Sign Language (BSL) users use a capital ‘D’ in Deaf to highlight that they belong to the Deaf community. The Royal National Institute for the Blind (RNIB) use the terms ‘blind’ or ‘partially sighted’, and Sense advise that hearing and vision loss is termed ‘deafblindness’.
In this unit you will learn about:
the factors that impact on an individual with sensory loss the importance of effective communication for individuals with sensory loss the main causes and conditions of sensory loss how to recognise when an individual may be experiencing sight and/or hearing loss and actions that may be taken.
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1. Understand the factors that impact on an individual with sensory loss
Approximately 95 per cent of the information about the Many blind and partially sighted people lose the ability world around us comes from our hearing and sight. We to see gestures and facial expressions, which are read books, magazines and correspondence, we talk to important parts of communication. It becomes difficult each other face to face or on the telephone and we listen for them to know when someone is speaking to them or to our music on the television or the radio. The even when the other person has walked away. Written environmental information lets us know what is going on communication can be difficult for a person with low – body language and facial expressions, conversations, vision. Sometimes a larger font is needed, a different- computer keys tapping, lawn mowers being used in coloured paper for colour contrasting or the information gardens and so on. To understand the world around us on a disk or tape. Communication by email or text can we rely a great deal on our senses. When people have be accessed by having speech programs installed on a any sensory loss, then their mobility and communication computer or mobile telephone. are greatly affected. This can lead to increased loneliness and even isolation in some cases. Activity 2
Activity 1 Sight loss Sit on a chair in a crowded room and observe what is Your sensory awareness going on around you. Take ten minutes and write down everything you see 1. Do you hear people talking? and hear. 2. Can you see people walking across the room? 1. How many times did you use your hearing? 3. Is the television or radio on? 2. How many times did you use your sight? 3. How many times did you use your other senses? Close your eyes and sit in the same chair.
Try to imagine the impact of sensory loss on your 4. Now what can you see? day-to-day life. 5. What can you hear? 6. Do you recognise people’s voices or the way they walk across a room? 1.1 How a range of factors can 7. How different do you feel when you can not see? 8. Would you be able to walk around the room impact on individuals with safely? sensory loss Hearing loss interferes with face-to-face communication Impact on communication and can often cause older people to lose interest in Sensory loss can often be a ‘hidden’ disability which can everyday activities and in turn make them more likely to frequently lead to isolation and frustration at not being miss information given by their doctor, carer or family able to communicate efficiently with other people. With member. Older people who are losing their hearing hearing loss, day-to-day activities such as hearing a often rely on their eyesight to compensate for this. In doorbell, using the telephone, watching television or conversation, they will watch the other person’s face taking part in conversations can produce feelings of and lips, and use clues about the context to try to inadequacy. Conversely, not being able to distinguish respond appropriately. faces, read the time on a clock or drive can produce the same feelings in a person who has vision loss. Having a dual sensory loss compounds the frustration and isolation a person feels when trying to communicate effectively.
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able to access information and should be afforded the Activity 3 opportunity to do so privately and independently. Hearing loss Impact on familiar layouts and routines Try turning the volume down very low on the TV, so you can just hear a murmur. Now try to follow what is Sight plays a major role in maintaining orientation and going on in the programme. people can lose a sense of what is around them and where they are. Although listening to sound can be useful, 1. How frustrating was it not to be able to hear what it can move and then echo off surroundings; therefore it is was happening? not as confined or exact as vision. People with vision loss 2. What help did you need to follow what was may no longer be sure where things are. A feeling of being going on? separate and an increasing sense of isolation can occur because the brain is receiving less stimulation. However, people who are losing both their hearing and People who are sighted have an immediate sense of their vision will find it difficult to look for clues in the what is in the environment beyond the task taking place. conversation. This will be particularly severe with a Without vision, hearing can provide some information, person who has central vision loss, as this then may but only about people or objects producing sound. Also, completely remove the ability to read lips or to see peripheral vision gives people no indication that there are faces. To avoid deafblind people becoming devoid of other people and objects around, which can cause knowledge about the outside world or having a limited confusion when they come into the visual area. An contact with a variety of other people, support should extensive loss of vision can result in: be obtained from a range of sources, such as health •• an inability to negotiate the environment services, social services, specialist organisations and •• a loss of sense of freedom support groups. •• a loss of security •• a loss of control in their environment. Impact on information These effects can make people feel very dependent on One of the needs of people with a sensory impairment others. is to be able to obtain information. Whether it is written, spoken or signed information, it needs to be in an Hearing loss causes its own problems with difficulty accessible format. hearing information, following conversation or asking for directions. This can be very isolating for somebody if A person who has vision loss wants to be able, for their usual routine is to listen to a programme on the example, to look at their own bank statement, to know radio, talk to people on the telephone or go for coffee what is available on a menu, to be able to participate with friends in a noisy restaurant. Hearing loss impacts in local activities or events or to be able to read/write greatly on gathering information and making informed a personal letter. Additionally, someone else reading choices. their written communication in the form of lists, appointments and private correspondence has a People need to have confidence in moving safely around detrimental effect on maintaining the person’s dignity their own homes and immediate local area, and also to and confidentiality. Access to written information go further afield. This may be with or without a specifically for people with a vision loss is not readily recognised mobility aid, such as a white cane, red and available and information is not forthcoming. white cane (to signify dual sensory loss) or guide dog. The cost and lack of transport will be added obstacles Furthermore, people with a hearing loss may need for many people. access to information that is not in a written format – by telephone, face-to-face and signed information. The For some people, the need to have assistance in the impact on information is greatly enhanced when a person form of sighted guiding is essential. has a dual sensory loss. It is important for all of us to be able to access information independently and not to have to rely on someone else. This removes or reduces independence and privacy. Everybody has the right to be
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home to doctors, banks or leisure activities. They enable Activity 4 the person to make use of their remaining sight and Guiding techniques hearing, and play an important role in reducing stress and increasing confidence. You should refer to sighted guiding techniques and practise with a colleague how to guide a person Remember there are no hard and fast rules on how to correctly. You can download a how-to guide from guide people with sight problems, but these are the www.rnib.org.uk guidelines the RNIB offers because they are safe and sensible. You may find the person you are guiding does 1. How did you feel putting your confidence in not follow these guidelines, choosing instead to do another person to guide you? something different that works for them. 2. How safe did you feel being guided? 3. How confident were you in guiding someone? The practical advice and information given here will help you feel confident about guiding people with sight problems. Your offer to guide will usually be welcomed; however, many people with sight problems prefer to Impact on mobility keep their independence. Also remember that for some Good design in homes and buildings can help with people, physical contact may be a problem due to their finding your way around more easily if you have sensory culture or gender, or because they are protective of their loss. It is recommended that good colour contrasting is personal space. used throughout the premises. This ensures that people who have some useful vision can see door frames, Doing it well edges of cupboards, where the walls start and end. This all helps with navigating around buildings including the Guiding doctor’s surgery, bank or supermarket. •• Give instructions where necessary, but do not overdo it, and be careful not to push or pull the Normal changes in sight due to aging include: person you are guiding. •• general reduced acuity (seeing detail) •• Match your pace to that of the person you are •• reduced accommodation guiding. •• reduced peripheral vision •• Give them time to hold your arm securely before •• the need for increased lighting you start walking. •• problems with glare •• Remember to give adequate room round obstacles. •• problems adapting to light changes •• Watch out for hazards at head height, especially if •• problems with depth perception the person you are guiding is taller than you. It is •• reduced colour and contrast sensitivity. very easy to walk someone into an overhanging It is therefore important to have good consistent lighting tree or shop canopy. Watch out for lamp posts and throughout the building. bollards too. You may find people you are guiding prefer to walk on the pavement edge to avoid such Key term obstacles. •• Explain loud noises that may alarm, such as Accommodation – the process by which the roadworks or alarms. eye changes optical power to focus on an object as its •• Explain changes in ground surface, for example, if distance changes you are walking from a pavement on to grass or gravel, or if paving slabs and road surfaces are Some local authorities have Communicator Guides or particularly uneven. Guide-help schemes, which enable a deafblind person •• Keep your guiding arm still and relaxed. Do not to benefit from a better quality of life with greater wave it about or point at things. independence. Communicator Guides act as a conduit, •• Remember that older people or those with other allowing the deafblind person to interact with the disabilities may need extra consideration. outside world. Tasks include helping with reading letters and paying bills, escorting on excursions outside of the
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When you meet someone with a white cane or a guide 1.2 The impact of societal dog, remember they are not always totally blind. In fact many people have some useful vision but they might attitudes and beliefs welcome your help at times – for example, in an Any type of sensory loss can cause people to experience unfamiliar place or at night time. the ways in which society treats them differently. If someone is carrying a white cane with red bands on it People often believe that any type of sensory loss also or has a guide dog with a red and white harness, this reduces people’s capacity to understand. How many indicates they are deafblind (that is, they have both a times have you heard people speak slowly and loudly sight and hearing loss) and may be experiencing to someone who is blind? Have you ever done it? difficulties in particularly noisy or busy environments. There are many simple things that people do without You may have to ascertain how much useful hearing thinking of the impact on someone with a sensory loss. or sight the person has, and adapt your help How often have you parked a car half on the pavement accordingly. You may have to use the deafblind to make more space on a narrow road? Someone who alphabet to communicate, or encourage the person cannot see it may be walking down the pavement to lipread. expecting to be able to take their usual route. Another Try to give precise verbal instructions – it does not help major risk is the parking of vans and lorries because to point and say, ‘It’s over there.’ And remember to say mirrors are at face and head height, so even if someone when you go away, or you might leave someone talking has a guide dog that guides them around the vehicle, to an empty space! the mirrors will still stick out far enough to cause injuries. Activity 5 Society is better than it used to be at recognising the Factors impacting on sensory loss needs of deaf people; there are more public buildings such as cinemas, theatres and conference facilities that Take some time to analyse other factors which may have loop systems so that people who can use hearing impact on a person with sensory loss – for example, aids are able to listen to what is being said or health, happiness. performed. There some events that now have signers to In your own work role, highlight the areas where you translate speeches and performances. Many television can improve your practice to ensure that barriers to programmes now have access to subtitles and some communication, information, familiar layouts and have signers, although these tend to be late at night. routines and mobility are addressed. Develop an action People with any kind of sensory loss can have plan which will encourage people to maintain their difficulties in finding employment. Even though the independence. Equality Act and the Disability Discrimination Act mean that employers cannot discriminate, it is hard to convince an employer that a sensory loss does not Functional Skills necessarily mean that someone is unable to do a job. Attitudes such as these can make it difficult for people English: Writing to maintain self-esteem and can destroy confidence, When writing your action plan, ensure that an with the result that they will attempt less, rely on appropriate layout is used. Proofread your work to others more and potentially lose their independence. check that spelling, punctuation and grammar is However, there have been some major shifts in attitudes accurate. as initiatives such as ‘Our Health Our Care Our Say’, ‘Putting People First’ and ‘Valuing People’ are changing how we look at disability and making people aware that all disabled people have the right to take a full part in society and to make choices about how they want to live. Major lobbying from disabled rights organisations over a period of many years has finally begun to change how society views people with a sensory loss.
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Case study Recognising the signs of sensory loss Doreen Jones is 85 and lives in a residential home, During the last three months, Doreen has refused to having moved from her own home a year ago after attend any activities as she says she cannot be bothered. falling and breaking her hip, although she fully She has also asked for her meals to be served in her recovered from the hip replacement. bedroom away from everyone else and also changes her clothing after every meal. Doreen’s son informed staff that his mother had reading glasses and sometimes ‘chose to ignore people A member of staff has tried to ask Doreen if she has who were speaking to her’. She had been to the any problems; she refuses to answer, instead asking, optician, who had told her that she might develop a ‘What are you saying?’ or just telling them to ‘go away’. problem later on, but the son could not elaborate on A second member of staff has said she thinks Doreen this. As the optician’s notes were not forwarded to the seems depressed, while another member of staff says home, staff are unaware that Doreen might have an eye she is just being awkward or has dementia. condition. At the time of her arrival at the home, she 1. What are the possible reasons for the change in was happy to join in activities and was a member of the Doreen’s behaviour? residents’ association. She regularly went on outings 2. Who would need to be involved in making an with the home and enjoyed the regular Friday night assessment of her? ‘chip suppers’. 3. How would you go about getting an assessment for Doreen?
The changes in attitudes brought about by new Functional Skills initiatives such as those mentioned above have resulted in the huge shifts in how services are delivered. English: Reading Services are no longer based on a ‘gift’ model where You will need to read and understand both professionals decide what services will best suit straightforward and complex texts, and use the someone; person-centred service planning and delivery information in an appropriate way. In this case you will now put people at the heart of everything and give them need to use the text to answer questions using the choice and control over their lives. information within it. Personal budgets give people the chance to decide:
•• what support they need 1.3 The impact of attitudes on •• how they want the support delivered service provision •• whom they want to deliver the support •• when they want support. The social model of disability supports the idea of person-centred services. For people with sensory loss, This is in total contrast to earlier models where services this means that services are planned in a way that gives were delivered in the way most convenient for the people control over the services they need to support organisation providing them and people were expected them. Most people are now offered a personal budget to fit in. that enables them to work out a support plan based on what they are able to do for themselves, the informal support they have and identifying where paid support is needed to fill the gaps.
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2. Understand the importance of effective communication for individuals with sensory loss
There are many ways of communicating, including, for Braille is a tactile language, read/felt through the example: fingertips.
•• talk – face to face •• talk – telephone, mobile, radio •• gestures – formal, such as sign language •• gestures – informal hand movements •• body language •• eye contact •• reading and writing •• emailing and text messaging. 2.1 The methods of communication used by individuals with sight loss, hearing loss and deafblindness
Sight loss Have you seen Braille books or notices? There are many ways that somebody with sight loss can communicate. Some examples of communication Doing it well can be seen in print, using information technology, recording on to tape or disk, Braille or a specially Supporting people with vision loss adapted telephone. •• Say who you are. •• Say what you are going to do and be specific. The RNIB produces Clear Print guidelines which you can •• Talk directly to the person and use their name. access from www.rnib.org.uk •• Stand in a place where you can be seen. If •• Use large printed words rather than joined-up necessary, touch for attention. writing. •• Take the time to answer questions. •• Print should not be all capitalised, as this makes •• Tell the person that you are leaving them – do not distinguishing between different letters/words just walk away. difficult. •• Using a felt tip or marker pen produces a vivid dark image which is easier to read. Functional skills •• You can magnify print using a low vision aid or you can enlarge text on a photocopier. English: Speaking and listening •• When reading, it may help to use a ruler or piece of Speaking and listening skills can be practised by card to mark the line and reduce glare coming from completing the task above. When communicating the page. verbally, it is important to present information clearly Computers, scanners, software and electronic magnifiers using appropriate language and to be able to adapt can frequently enable the person to read or write, while your contribution to suit the situation you are in. It is some staff find it beneficial to record information on to also important to be aware of your body language. disk. A big button telephone enables people with sight Ensure you take an active part in the discussion and loss to access the telephone. that you show effective listening skills.
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British Sign Language (BSL) is the language of choice straight text-to-text conversation which does not need for a significant number of deaf people in the UK. It is a the help of an operator to translate speech to text. visual/spatial language, which has its own grammatical The use of hearing aids greatly enhances rules using hand shapes, hand movements and facial communication for some people who are hard of expressions to convey meaning. The grammatical rules hearing. There are many types of hearing aids, induction of BSL are completely different to the rules of English. loops and conversers on sale at present and some hearing aids are still available from the NHS.
The letters A and B from the fingerspelling alphabet.
Hello (formal) I’m Sorry
Where have you seen this symbol?
This symbol indicates a loop system is present. Switching a hearing aid to the T setting engages the telecoil. This shuts out background noise because the microphone has been switched off, and ordinary acoustic sound around you is no longer picked up by your hearing aids. Only sound coming from a nearby magnetic ‘Hello’ (formal) and ‘I’m sorry’. induction loop is being picked up. Hearing loss You can look at www.rnid.org.uk for more advice on communication. A number of people who are deaf or hard of hearing sometimes prefer to communicate using lipspeakers. These follow the conversation and repeat what is said Doing it well but without using their voice; this in turn makes it easier Supporting people with hearing loss for some people to lipread. •• A quiet, well-lit room is best. People who are deaf or hard of hearing may access a •• Ensure the light is on the speaker’s face. speech-to-text reporter. This uses a special keyboard to •• Face the person you are speaking to. produce a verbatim (word for word) report, which is •• Stay in their field of vision. displayed on a computer screen or a large screen, via a •• Speak a little louder than usual. data projector, for the deaf person to read. This is an •• Do not shout, as this distorts the voice and lip entirely different system to having a notetaker who will patterns. provide summary notes, not a verbatim account of what •• Speak a little more slowly than usual but not so is being relayed. slowly as to destroy the speech rhythm. A telephone relay service is used by many people with a •• If something is not understood, rephrase rather hearing loss who wish to communicate by telephone. than repeat. The message is relayed to an operator, who sends the •• Avoid distracting clothes or dangly earrings, or a message by text to the person with hearing loss. If there beard if you are male, as this may cover the lips. are no hearing people involved in the call, then it is a
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Functional skills Key term English: Speaking and listening Articulatory – relating to articulation (vocal Speaking and listening skills can be practised by expression) completing the task on the previous page. When communicating verbally, it is important to present information clearly using appropriate language and to Activity 6 be able to adapt your contribution to suit the situation. Tactile communication It is also important to be aware of your body language. Use the information in the unit to find out more about Ensure you take an active part in the discussion and different forms of tactile communication. Consider that you show effective listening skills. how it could benefit any of the people you support.
Deafblindness People who are deafblind communicate using their Reflect remaining sight and hearing. They can also use touch Take all your communications for just one day. with objects, known as tactile communication, or by Think about which of your senses you used for each using touch with people, known as tactual of them; did you use hearing, touch, sight or a communication. combination? Spend some time reflecting on how Communicating with people who have a dual sensory difficult it may be to communicate without one or loss is greatly enhanced by using clear speech and clear more of your senses. print. People who have a vision loss after using signs for communication can still follow the signs being used by putting their hands over those of the person who is 2.2 How the environment signing. facilitates effective The Deafblind Manual Alphabet is similar to BSL fingerspelling, but all of the manual alphabet is communication for people concentrated on the person’s hand in which you point to different finger positions on the deafblind person’s hand, with sensory loss or draw letter shapes. Earlier in this unit, you looked at how making small changes to an environment, such as moving furniture or Tactile communication reducing noise, can make a positive difference to people •• Braille is a system of raised dots which can be read with sensory loss. Supporting people to maintain their by touch. independence through managing their day-to-day •• The Moon alphabet consists of embossed shapes environment is a vitally important part of your role. which can be read by touch. There some quite simple changes that can make •• Objects of Reference are objects that have special communication more effective for people. meanings assigned to them. They stand for By using colour, it is possible to create a visual contrast something in the same way that words do. between surfaces to help people differentiate between them. It can also be used to highlight key and safety Tactual communication features. An effectively contrasted environment will Tadoma is a form of tactual communication whereby reduce the risk of injury, enabling people to see edges direct contact is made between the hand of the deaf- between surfaces and perceive depth and difference blind receiver and the face of a talker to monitor the more easily. various articulatory actions that occur during speech.
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The RNIB suggests making things bigger, brighter and One of the key beneficial changes for people with a bolder. hearing loss is to reduce background noise along with good lighting so that people’s faces can be clearly seen Bigger when they are speaking. Making things bigger usually makes them easier to see. It may be difficult to reduce background noises when Using easy-to-see products could help people in their people are living in a group setting, but being aware of daily lives. Some examples of these are: noise levels and remembering to suggest that people •• clocks and watches with large numbers move into a quieter room for important communication •• big button telephones can be a great help. Using task lighting can be a help if •• large print books and calendars the general light levels in a room are low. If people •• thick black felt-tip pens to write notes with. have well-lit faces, it is so much easier for people to lip-read and to make maximum use of non-verbal People can also try moving things closer to their eyes communication through facial expression. – this will not damage their eyes, just make things appear bigger. For example, they could sit closer to your People are also an important part of an environment; so television to make the picture bigger. reminding others to think about the communication needs of people with a sensory loss and encouraging Using a magnifier can also make things look bigger. everyone to have consideration and respect for each Choosing the right magnifier is very important and others’ particular needs is a useful contribution to a people should visit their low vision service, where they supportive and communication friendly environment. will receive a full assessment so that they can get the best magnifier for them. 2.3 How effective Brighter communication may have a Making things brighter by using better lighting can help positive impact on individuals to make things easier to see. You should make sure that people have as much light as they feel comfortable with sensory loss with for each task that they do. Consider your feelings when you could not see or hear It is often easier to see things if people shine a light properly in the activities earlier in this unit. You will directly on to what they want to see. For example, need to explain how adapting the environment, staff when reading, it may be easier to see the text if they training and guidance can all contribute to having a use a lamp that can be adjusted to shine directly on the positive impact on people with a sensory loss. page that they are reading. This is called task lighting. In January 2006, the White Paper ‘Our health, our care, Everyone is different and needs to find the amount of our say: a new direction for community services (see light that they are comfortable with. www.official-documents.gov.uk) was published, and included the following outcomes: Bolder •• improved health and emotional well-being It is harder to see things that are similar in colour to the •• improved quality of life background that they are on. Contrast is about how •• making a positive contribution much something appears to stand out from its •• choice of control background because of its colour or tone. •• freedom from discrimination •• economic well-being Things can be made easier to see by putting them on a •• personal dignity. contrasting background. You can use different colours or tones to make them stand out. For instance, a dark purple plate on a dark purple tablecloth may be difficult to see. It would be easier to see a white plate on a purple tablecloth or a light purple plate on a dark purple tablecloth. The best contrast is black and white.
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3. Understand the main conditions and causes of sensory loss
3.1 The main causes of and sends them to the brain. The macula is a small area at the very centre of the retina (see Table 1). sensory loss The macula is very important and is responsible for Main eye conditions what we see straight in front of us, allowing us to see fine detail for activities such as reading and writing, as well as allowing us to see colour.
Retina Sometimes the delicate cells of the macula become Cornea damaged and stop working, and there are many Lens different conditions which can cause this. If it occurs Optic later in life, it is called ‘age-related macular Pupil Macula nerve degeneration’ (AMD). Iris Broadly speaking, there are two types of macular degeneration or AMD, usually referred to as ‘wet’ and ‘dry’. This is not a description of what the eye feels like To the Vitreous but what the ophthalmologist (eye specialist) can see brain when looking at the macula. A cross-section of the eye. Dry AMD is the most common form of the condition. It Macular degeneration develops very slowly, causing gradual loss of central vision. Many people find that vision slowly deteriorates The eye is shaped like a ball. The pupil, close to the by gradual central blurring, and that the colours fade front, is the opening, which allows light to enter the away like in an old photograph. There is no medical eye. Just behind the pupil is the lens, which focuses the treatment for this type of AMD. However, aids such as light on the retina at the back of the eye. The retina is a magnifiers can be helpful with reading and other small delicate tissue, which converts the light into images, detailed tasks.
Part Description Cornea Clear front window of the eye that transmits and focuses light into the eye Iris Coloured part of the eye that helps regulate the amount of light that enters Pupil Dark aperture in the iris that determines how much light is let into the eye Lens Transparent structure inside the eye that focuses light rays on to the retina Retina Nerve layer that lines the back of the eye, senses light, and creates electrical impulses that travel through the optic nerve to the brain Macula Small central area in the retina that contains special light-sensitive cells and allows the eye to see fine details clearly Optic nerve Connects the eye to the brain and carries the electrical impulses formed by the retina to the visual cortex of the brain Vitreous Clear, jelly-like substance that fills the middle of the eye
Table 1: Parts of the eye.
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Wet AMD results in new blood vessels growing behind different parts of the body, the eye being one of them. the retina; this causes bleeding and scarring, which can There are two different types of diabetes mellitus. lead to sight loss. Wet AMD can develop quickly and • Type 1 diabetes commonly occurs before the age sometimes responds to treatment in the early stages. It • of 30 and is the result of the body producing little or accounts for about ten per cent of all people with AMD. no insulin. Type 1 diabetes is controlled by insulin Glaucoma injections. •• Type 2 diabetes commonly occurs after the age of Glaucoma is the name for a group of eye conditions in 40. In this type of diabetes the body does produce which the optic nerve is damaged at the point where it some insulin, although the amount is either not leaves the eye. This nerve carries information from the sufficient or the body is not able to make proper use light-sensitive layer in your eye, the retina, to the brain of it. Type 2 diabetes is generally controlled by diet where it is perceived as a picture. or tablets, although some people in this group will The eye needs a certain amount of pressure to keep the use insulin injections. eyeball in shape so that it can work properly. In some If someone has diabetes, this does not necessarily people, the glaucoma damage is caused by raised eye mean that their sight will be affected, but there is a pressure. Others may have an eye pressure within higher risk. If the diabetes is well controlled then they normal limits but damage occurs because there is a are less likely to have problems, or they may be less weakness in the optic nerve. In most cases, both factors serious. However, if there are complications that affect of high pressure and weakness in the optic nerve are the eyes, then this may result in loss of sight. involved, but to a varying extent. Most sight loss due to diabetes can be prevented, but it Pressure is controlled in the eye through a layer of cells is vital that it is diagnosed early. It can only be detected behind the iris (the coloured part of the eye) which by a detailed examination of the eye. Therefore, regular produces a watery fluid, called aqueous. The fluid annual eye examinations are extremely important, as a passes through a hole in the centre of the iris (called the person may not realise that there is anything wrong with pupil) to leave the eye through tiny drainage channels. their eyes until it is too late. These are in the angle between the front of the eye (the cornea) and the iris, and return the fluid to the blood Diabetes can affect the eye in a number of ways. The stream. Normally the fluid produced is balanced by the most serious eye condition associated with diabetes fluid draining out, but if it cannot escape, or too much is involves the retina, and, more specifically, the network produced, then the eye pressure will rise. of blood vessels lying within it. The name of this condition is diabetic retinopathy. This is usually graded If the optic nerve comes under too much pressure, then according to how severe it is. The three main stages are it can be injured. How much damage there is will shown in Table 2. depend on how much pressure there is and how long it has lasted, and whether there is a poor blood supply or With treatment, sight-threatening diabetic problems can other weakness of the optic nerve. A really high be prevented if caught early enough. However, laser pressure will damage the optic nerve immediately. A treatment will not restore vision already lost. lower level of pressure can cause damage more slowly, and then a person would gradually lose their sight if it Cataract was not treated. A cataract is a clouding of part of the eye called the lens. The lens is a clear tissue found behind the iris, the Please note: People over the age of 40 years with an coloured part of the eye. The lens helps to focus light immediate family member diagnosed with glaucoma on the retina at the back of the eye to form an image. – parents, children or siblings – are entitled to a free To help produce a sharp image, the lens must be clear. sight test every year under the NHS. Vision becomes blurred because the cataract is like a Diabetic eye disease frosted glass, interfering with sight. It is not a layer of Diabetes can start in childhood, but more often begins skin that grows over the eye. Cataracts can commonly in later life. It can cause complications which affect give rise to blurry sight; sight appears blurred or misty, or as if glasses are dirty or scratched. People with
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Stage Description
Background diabetic •• Very common in people who have had diabetes for a long time. retinopathy •• Vision is normal with no threat to sight. •• Blood vessels in the retina are very mildly affected; they may bulge slightly (microaneurysm) and may leak blood (haemorrhage) or fluid (exudate). •• Macula area of the retina remains unaffected.
Maculopathy •• Central vision gradually gets worse (this varies from person to person); it becomes difficult to recognise distant faces or to see detail such as small print. •• Peripheral vision is preserved. •• This is the main cause of loss of vision and may occur gradually but progressively. It is rare for someone with maculopathy to lose all their sight.
Proliferative diabetic •• This is rarer than background retinopathy. retinopathy •• Blood vessels in the retina may become blocked. •• New blood vessels form in the eye, but are weak and in the wrong place – growing on the surface of the retina and into the vitreous gel. •• These blood vessels can bleed very easily and cause scar tissue to form in the eye. The scarring pulls and distorts the retina. When the retina is pulled out of position, this is called retinal detachment. •• The new blood vessels rarely affect vision, but the bleeding or retinal detachment may cause vision to get worse. Eyesight may become blurred and patchy as the bleeding obscures part of the person’s vision. •• Visual loss in this stage is often sudden and severe. Without treatment, total loss of vision may happen.
Table 2: Stages of diabetic retinopathy. cataracts may also be dazzled by lights, such as car Main ear conditions headlamps, and sunlight, and experience their colour vision becoming washed out or faded. The ear consists of three main parts: the outer (the part you can see), middle and inner ear. The outer ear opens Cataracts can form at any age. The most common type into the ear canal. The eardrum separates the ear canal of cataracts are age-related cataracts. These develop as from the middle ear. There are small bones in the people get older. Many people over 60 have some middle ear which help transfer sound to the inner ear. cataract and the vast majority can be treated The inner ear contains the auditory (hearing) nerve, successfully. Early cataracts may not affect sight and which leads to the brain. do not need treatment. Vibrations or sound waves are sent into the air when Although researchers are learning more about cataracts, they are confronted by any kind of sound. These no one knows for sure what causes them. There may be channel their way through the ear opening, down into several causes and some studies have linked smoking, the ear, the canal, and then hit your eardrum, causing it excessive exposure to sunlight and poor diet with to vibrate. The vibrations are then passed to the small cataract development. In younger people cataracts bones of the middle ear, which transmit them to the can result from conditions such as diabetes, certain auditory nerve in the inner ear whereby vibrations medications and other long-standing eye problems. develop into nerve impulses and go directly to the brain, Cataracts can also be present at birth. These are called which interprets the impulses as sound (voices, traffic, congenital cataracts. crying and so on). The only effective treatment for cataract is an operation to remove the cloudy lens.
13 Level 3 Health & Social Care Diploma Understand sensory loss Unit SS MU 3.1
Semicircular Sensorineural hearing loss canals This type of hearing loss is sometimes referred to as Anvil sensory, cochlear, neural or inner ear hearing loss. Hammer Cochlea Damage to the hair cells within the cochlea or the Auditory nerve hearing nerve can cause sensorineural hearing loss. As part of the ageing process the cochlea can become damaged and the condition is known as presbycusis. However, there are several ways to cause sensorineural hearing loss, including frequent exposure to loud sounds. This can be listening to very loud music on headphones, or sitting next to music speakers at a concert. Temporary hearing loss can happen when a person is exposed to loud sounds like a motorbike Stirrup Pinna backfiring, a jet plane or fire alarm bells. Eardrum Round window An ototoxic hearing loss happens when someone takes or is given a drug that causes hearing loss as one of its A cross-section of the ear. side effects. These can be some types of antibiotics, chemotherapy drugs or anti-inflammatory drugs. Conductive hearing loss Sometimes the drug-induced hearing loss is temporary and can be reversed or stopped. Other times it is Many people have problems with their ears when they permanent. People with hearing loss need to be are children and as adults. This can usually result from especially aware of the potential for ototoxic effects, an obstruction in the outer or middle ear – for example, as an ototoxic drug can make an existing hearing loss an increase in ear wax or an ear infection producing worse. fluid. Conductive hearing loss is caused by anything that stops sound moving from your outer ear to your Rubella is now a rare infectious disease due to inner ear. Other possible causes of conductive hearing vaccinations as a baby or at school. The virus, if caught loss are: in early pregnancy, passes through the placenta to the unborn baby and has been known to cause damage to a •• middle ear infections baby’s sight, hearing, brain and heart. •• otosclerosis, a condition where the ossicles (three tiny bones) of the middle ear harden and become There can be many other causes of sensorineural less able to vibrate hearing loss – for example, a head injury, benign •• damage to the ossicles, for example, by serious tumours or a genetic predisposition. A person with infection or head injury sensorineural hearing loss will have difficulty hearing •• a perforated eardrum, which can be caused by an quiet sounds with the sounds becoming relatively untreated ear infection, head injury or a blow to the indistinct, leading to difficulty understanding speech. ear, or from poking something in your ear. The Control of Noise at Work Regulations 2005 were A person with a conductive hearing loss will complain set up to ensure that workers’ hearing is protected from of not being able to hear properly as the sounds are too excessive noise at their place of work, which could quiet. The ensuing hearing loss can be permanent or cause them to lose their hearing and/or to suffer from temporary, and can often be corrected with minor tinnitus. See www.hse.gov.uk for more information. surgery or medication from a healthcare professional.
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3.2 Congenital sensory loss and 3.3 Demographic factors that acquired sensory loss influence the incidence of Sensory loss may be congenital or acquired. For sensory loss in the population example, cataracts can form at any age, but they can As you will have identified previously, there are many also be present at birth (congenital cataracts). demographic factors that influence the incidence of sensory loss in the population. As people age it is a Key terms common thought that losing some sight or hearing, or Congenital – present at birth both, is a normal part of ageing rather than being potentially disabling. Acquired – anything that is not present at birth but With rising numbers of people over the age of 60 and develops some time later growing life expectancy, the percentage of older people Demographic – the characteristics of a human who experience both sight and hearing loss is also population or part of it, especially its size, growth, escalating. In particular, there has been a major density, distribution, and statistics regarding birth, increase in the number of people living to ‘old’ old age marriage, disease, and death (85+), when it is now thought that deafblindness is most likely to be challenging.
Activity 7 Congenital or acquired? Look up the following sensory conditions and decide if they are congenital or acquired. •• Otitis Media •• Blepharitis •• Best’s Disease •• Charles Bonnet Syndrome •• Tinnitus •• Retinitis Pigmentosa •• Meniere’s Disease •• Stargardts Disease.
Functional skills English: Reading When researching, you will be practising reading skills to pick out relevant information from the text to use for other purposes.
15 Level 3 Health & Social Care Diploma Understand sensory loss Unit SS MU 3.1
4. Know how to recognise when an individual may be experiencing sight and/or hearing loss, and actions that may be taken
4.1 Indicators and signs of sight Deafblindness loss, hearing loss and When people experience a loss of both vision and hearing, you may notice a combination of any of the deafblindness signs from the lists. Sight loss 4.2 What to do about signs of It is important that you are aware if someone you support is showing signs of developing sight loss. Some sensory loss of the signs you may notice are as follows. If you notice changes in the ability of someone you support, you need to talk to them about what you have •• Moving about cautiously. noticed. For example, if you think that someone’s sight •• Holding books or reading material close to the face or at arm’s length. is deteriorating, you need to check with them that they have noticed too. For example: ‘Margaret – you seem to •• Overcautious driving habits. be having trouble reading the newspaper recently – is •• Finding lighting either too dim or too bright. that right?’ •• Frequent eye glass prescription changes. •• Squinting or tilting the head to see. If you have concerns, it is important that you talk to the •• Difficulty in recognising people. person you support and explain what can be done to •• Changes in leisure activities. check out what is happening. Go through the options for •• Changes in personal appearance. investigating the cause of the loss and ensure that you •• Bumping into objects. have the person’s agreement to contacting the relevant •• Appearing disoriented or confused. health professional. The initial contact is likely to be the GP, who can arrange for further specialist tests. Hearing loss If the person you support has family or informal carers It is also important that you can identify if someone you as part of their support network, you should also talk to are supporting is developing hearing loss. Some of the them if the person agrees. signs you may notice are as follows. You may need to provide additional support depending •• Not responding when you speak to them from behind. on the outcome of any tests and decisions about the •• Often asking people to repeat what they have said. specialist equipment or treatment that may be offered. •• Not hearing when someone knocks at the door or rings the bell. •• Complaining that people mumble or speak too quickly. •• Having difficulty hearing when several people are present. •• Needing the TV/radio/stereo to be louder than is usual for others. •• Having difficulty following speech with unfamiliar people or accents. •• Having problems using the telephone.
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4.3 Sources of support for Legislation sensory loss •• Care Standards Act 2000 There may be specialist sensory support workers •• Control of Noise at Work Regulations 2005 available in your local authority, or sensory support may •• Disability Discrimination Act 1995 be offered through a general adults service. Some •• Local Authority Social Services Act 1970 primary care trusts also have sensory support teams who may be able to provide support or to offer advice on good practice. Further reading and research Specialist organisation such as RNIB and RNID have a •• www.pocklington-trust.org.uk (the Thomas wealth of information and specialist advice; they should Pocklington Trust) also be able to provide information about local facilities •• www.rnib.org.uk (the Royal National Institute in your area. The local Council for Voluntary Service or for the Blind) Citizens Advice Bureau will have a list of any specialist •• www.rnid.org.uk (the Royal National Institute support organisations or regular activity groups in the for Deaf People) area. •• www.scie.org.uk (the Social Care Institute for Excellence; you can find research papers here Activity 8 which highlight the research topic on population) Sources of support •• www.statistics.gov.uk (information on population How do you find someone who knows how to use statistics that may help with research on British Sign Language? demographics)
Look on the Internet to find out which sensory organisations offer emotional support.
Do you know if your area has Communicator Guides?
Getting ready for assessment LO1 and also be able to define congenital and acquired You need to understand the Fair Access to Care’ (FACS) sensory loss. It will be beneficial to you to go through all eligibility framework and the subsequent grading into of the activities for this particular section and keep your four bands of critical, substantial, moderate and low research notes to show your assessor. needs. LO4 LO2 You should be able to identify indicators and signs that You should write a report on your findings and explain someone may be experiencing a sensory loss. You how effective communication has a positive impact should be able to show your assessor that you know on people with a sensory loss. Your assessor may ask which people you support have sensory loss and that you questions on your contribution to effective you have a plan in place to adapt the support plans to communication. You need to be able to inform your show this. You will also be able to show your assessor assessor of the aids and adaptations you know about that you know where to go for sources of support and and how to look at the environment taking into that you have compiled a list of support in your local consideration sensory loss. area. Your assessor will want to know what actions (if any) you have taken when you discovered that a person LO3 is experiencing a sensory loss. You will need to research the demographic factors that influence the incidence of sensory loss in the population
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Index
Key words are indicated by bold page numbers. A H accommodation 4 hearing aids 8 acquired hearing loss 15 hearing loss age-related macular degeneration 11–12 acquired 15 articulatory 9 communication, impact on 2 assessment requirements 17 communication methods 8 attitudes and beliefs 5–6 congenital 15 ear conditions 13–14 C and familiar layouts and routines 3 cataracts 12–13 information access 3 causes of sensory loss 11–15 recognising signs of 16 communication societal attitudes and beliefs 5 environmental changes to improve 9–10 impact on 2–3 I methods 7–9 information, access to 3 positive impact of effective 10 conditions of sensory loss 11–15 L conductive hearing loss 14 legislation 17 congenital hearing loss 15 lipspeakers 8 loop systems 8 D deafblindness M communication, impact on 3 macular degeneration 11–12 communication methods 9 mobility, impact on 4–5 recognising signs of 16 deafness. see hearing loss R demographic factors 15 recognition of signs of sensory loss 16 diabetic eye disease 12, 13 S E sensorineural hearing loss 14 ear conditions 13–14 service provision and attitudes and beliefs 6 employment 5 sight loss. see vision loss English skills 5, 6, 7, 9 signs of sensory loss 16 environment and communication 9–10 societal attitudes and beliefs 5–6 eye conditions 11–12 speech-to-text reporters 8 support for sensory loss 16–17 F familiar layouts and routines, impact on 3 T functional skills, English 5, 6, 7, 9 tactile communication 9 further reading 17 tactual communication 9 telephone relay service 8 G glaucoma 12 guiding people 4
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V vision loss communication, impact on 2 communication methods 7 eye conditions 11–12 and familiar layouts and routines 3 guiding people 4 information access 3 mobility, impact on 4–5 recognising signs of 16 societal attitudes and beliefs 5–6
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