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Society and culture

Sign language

Main article: Sign language

Sign languages convey meaning through manual communication and body language instead of acoustically conveyed sound patterns. This involves the simultaneous combination of hand shapes, orientation and movement of the hands, arms or body, and facial expressions to express a speaker's thoughts.

The history of sign language

The history of sign language was full of frustration and confusion for individuals in the deaf society. In the mid-1960s, William Stokoe, a hearing scholar from Gallaudet University worked alongside his deaf colleagues to develop a new sign language dictionary that used the internal structure of sign language, including hand shapes and their specific movements to define words. As a result, some came to view sign language as a human language that could be analyzed and understood as like any other. The majority of deaf people, however, felt offended and angered by such a creation. Professor Gilbert Eastman at Gallaudet was shocked that someone would present his language through a collection of bizarre squiggles and symbols. Both members of the deaf and hearing society struggled to name "the sign language", contemplating whether or not it should have even been considered an actual form of language to begin with. The deaf community worried if such a language would contribute to their state of minority. Evidently, the recognition of American Sign Language brought more conflict and anxiety instead of the expected excitement and joy assumed to occur from the development of a new language. The basis of their anxiety came from their exposure to the public and the thought of exactly how they were to develop their own deaf culture. The combination of language and culture promised equity and opportunity to their minority group and they needed to learn how to develop both. In the 1970s and 1980s, the National Theatre of the Deaf hosted many who were poets and expressed their deaf culture through sign language on stage. Dorothy Miles was one of the first poets to generate ASL poetry. Throughout her career, she went from creating poetry where she precisely matched signs with words to performing poetry where she manipulated the signs themselves to create new forms of meaning that were beyond words themselves. Forms of art, like this one, brought the deaf community together to experience language through performance, which sparked the development of their culture.

Multiple types of sign language

There is no single "sign language". Wherever communities of deaf people exist, sign languages develop. While they use space for grammar in a way that oral languages do not, sign languages exhibit the same linguistic properties and use the same language faculty as do oral languages. Hundreds of sign languages are in use around the world and are at the cores of local deaf cultures. Some sign languages have obtained some form of legal recognition, for example the American Sign Language within the United States and Canada, while others have no status at all. Deaf sign languages are not based on the spoken languages of their region, and often have very different syntax, partly but not entirely owing to their ability to use spatial relationships to express aspects of meaning. The expression of the deaf language differentiates with the time era in which those with hearing loss live.

Communication methods

Hearing loss can affect an individuals acoustics during speech and delay the development of expressive and receptive spoken language. This can result in the limit of academic performance and the extent of an individuals vocabulary. The early detection of hearing loss in children can help maximize the development of auditory skills and spoken language. Once a family is aware of their children’s hearing loss, they can decide what communication approach they would like to implement for their child. There are several different types of sign language/communication options which hearing impaired individuals can use in their everyday language. The following communication options can be considered along a spoken and visual language continuum.

Auditory-Verbal (AV)

Communication is developed through the use of a hearing aid and the integration of hearing impaired individuals into a community of individuals who have hearing and use spoken language. During therapy, the individual is not permitted to view facial expressions and the lips of the speaker. Since the goal of this communication method is complete integration in the mainstream, the individual is not at all exposed to sign language.

Auditory-Oral

The auditory-oral approach to communication is similar to auditory-verbal in the sense a hearing aid is used and the individual is integrated in a spoken language community. Unlike auditory-verbal, the individual is permitted to use facial expressions, lip reading and gestures to receive messages and communicate.

Cued Speech

Cued speech is a visual type of communication. It is made up of eight hand shapes and four different hand locations around the face (at the lips, side of lips chin and throat). Each handshake represents a group of constanants. Constants in each group can be distinguished through lipreading. Vowels are expressed by positioning the hand to one of the four locations around the lower face. Cued speech helps improve lipreading skills and understanding of speech of individuals who do not cue. It is said that people can learn cued speech in 18 hours.

Manually Coded English (MCE)

MCE is a close representation of spoken english. MCE uses signs and finger spelling. MCE’s syntax follows the rules of spoken english and lexical items which have no specific signs are finger spelled. Morphemes are represented by certain gestures or finger spellings.

Total Communication (TC)

Individuals who use TC combine signs, gestures, lip reading, auditory speech and hearing aids to communicate. In schools, TC is the most common communication method.

Simultaneous Communication (SimCom)

SimCom is very similar to TC, except amplification from a hearing aid isn’t used.

American Sign Language (ASL)

ASL is a language completely separate from English and is purely visual. It is considered by deaf culture it’s own language. ASL has its own rules for grammar, word order and pronunciation. The syntax of ASL differs from English because sentence structure begins with the subject, followed by a predicate. Individuals communicate using hand shapes, direction and motion of the hands, body language and facial expressions. While English speakers normally use an upward inflection in their tone to ask a question, ASL users ask a question by raising their eyebrows or scrunching their forehead. Magnification and exaggeration of certain signs can convey different meanings. For example, exaggerated movement of the sign for “happy” would mean “very happy.” ASL varies regionally.

School

The first deaf schools

Abbé Charles-Michel de l'Épée was the first person to open a deaf school, in Paris. Épée taught French Sign Language (LSF) to children, and started the spread of many deaf schools across Europe. The American Thomas Gallaudet, who had traveled to England to learn methods of teaching deaf children in order to start a deaf school in the US, witnessed a demonstration of deaf teaching skills from Épée's successor Abbé Sicard and two of the school's deaf faculty members, Laurent Clerc and Jean Massieu. Gallaudet studied under these French masters and perfected his own teaching skills; then, accompanied by Clerc, he returned to the United States, where in 1817 they founded the first successful American deaf school, in Hartford, Connecticut. American Sign Language, or ASL, started to evolve from primarily LSF, and other outside influences.

Communication barriers

The most predominant forms of communication barriers originate from one's own personal self and they are directly the result of the hearing loss condition. These barriers are associated specifically with speech and language. In terms of speech, hearing loss has an effect on speech sound production, for example distortion caused by the omission of various letters from words. The pitch of their voice may sound too high or low and their volume may be louder or quieter than is intended. Resonance of voice is also affected, as it can be hypernasal or denasal. Prosody, which represents the patterns of stress and rhythm in the voice, will often become irregular. As a result of such changes to speech, the receiver during a conversation is likely to deem the communicator's speech unintelligible. The placement of improper stresses on syllables makes it more difficult for the receiver to clearly perceive and hear the intended words. Three major problems in terms of language are present for those with hearing loss. First, there are problems with language formation, where individuals may overuse nouns and verbs and they may improperly place words within a sentence. Second, the actual content of the language is troubling, for example the interpretation of synonyms and antonyms. This results in a limited vocabulary. The third major problem is associated with Pragmatics, which includes the inability of individuals to recognize that a message has been delivered to them, therefore resulting in inappropriate questions being asked. All of these speech and language barriers make it difficult for those with hearing loss to control their own speech and understand what others have to say, therefore making it quite hard to hold a conversation altogether.

Communication with family

The communication limitations between people who are deaf and their hearing family members can often cause difficulties in family relationships, and affect the strength of relationships among individual family members. It was found that most people who are deaf have hearing parents, which means that the channel that the child and parents communicate through can be very different, often affecting their relationship in a negative way. If a parent communicates best verbally, and their child communicates best using sign language, this could result in ineffective communication between parents and children. Ineffective communication can potentially lead to fights caused by misunderstanding, less willingness to talk about life events and issues, and an overall weaker relationship. Even if individuals in the family made an effort to learn deaf communication techniques such as sign language, a deaf family member often will feel excluded from casual banter; such as the exchange of daily events and news at the dinner table. It is often difficult for people who are deaf to follow these conversations due to the fast paced and overlapping nature of these exchanges. This can cause a deaf individual to become frustrated and take part in less family conversations. This can potentially result in weaker relationships between the hearing individual and their immediate family members. This communication barrier can have a particularly negative effect on relationships with extended family members as well. Communication between a deaf individual and their extended family members can be very difficult due to the gap in verbal and non-verbal communication. This can cause the individuals to feel frustrated and unwilling to put effort into communicating effectively. The lack of effort put into communicating can result in anger, miscommunication, and unwillingness to build a strong relationship.

Communication with peers and in the community

People who have hearing impairments can often experience many difficulties as a result of communication barriers among them and other hearing individuals in the community. Some major areas that can be impacted by communication barriers in the community are involvement in extracurricular activities and social relationships. For young people, extracurricular activities are vehicles for physical, emotional, social, and intellectual development. However, it is often the case that communication barriers between people who are deaf and their hearing peers and coaches/club advisors limit them from getting involved. These communication barriers make it difficult for someone with a hearing impairment to understand directions, take advice, collaborate, and form bonding relationships with other team or club members. As a result, extracurricular activities such as sports teams, clubs, and volunteering are often not as enjoyable and beneficial for individuals who have hearing impairments, and they may engage in them less often. A lack of community involvement through extracurricular activities may also limit the individual’s social network.. In general, it can be difficult for someone who is deaf to develop and maintain friendships with their hearing peers due to the communication gap that they experience. They can often miss the jokes, informal banter, and “messing around” that is associated with the formation of many friendships among young people. Conversations between people who are deaf and their hearing peers can often be limited and short due to their differences in communication methods and lack of knowledge on how to overcome these differences. Deaf individuals can often experience rejection by hearing peers who are not willing to make an effort to find their way around communication difficulties. Patience and motivation to overcome such communication barriers is required by both the hearing impaired and hearing individuals in order to establish and maintain good friendships.

The way one’s emotional and psychological stance is effected is dependent on the individual’s life experiences, customary ways of dealing with challenges and the extent to which one socializes. Outgoing individuals place more of an emphasis on interpersonal contact, while private people feel more comfortable in an isolated setting. Technology, for example the use of hearing aids, also affects one’s sociability. Some may refuse to use one because they feel it is embarrassing and weird, which further is relative to one’s self-esteem. In comparison, others feel they cannot live without one, as it is the only thing that keeps them engaged with the public. Interactions with people who have the same disability (ex. Through support groups) often have the same experiences, which can relieve social anxieties and stress and help one to develop a healthy identity and sense of well-being.

Many people tend to forget about the difficulties that deaf children encounter, as they view the deaf child differently from a deaf adult. Deaf children grow up being unable to fully communicate with their parents, siblings and other family members. Examples include being unable to tell their family what they have learned, what they did, asking for help, or even simply being unable to interact in daily conversation. Hearing impaired children have to learn sign language and to read lips at a young age, however they cannot communicate with others using it unless the others are educated in sign language as well. Children who are hearing impaired are faced with many complications while growing up, for example some children have to wear hearing aids and others require assistance from sign language (ASL) interpreters. The interpreters help them to communicate with other individuals until they develop the skills they need to efficiently communicate on their own. Although growing up for deaf children may entitle more difficulties than for other children, there are many support groups that allow deaf children to interact with other children. This is where they develop friendships. There are also classes for young children to learn sign language in an environment that has other children in their same situation and around their same age. These groups and classes can be very beneficial in providing the child with the proper knowledge and not to mention the societal interactions that they need in order to live a healthy, young, playful and carefree life that any child deserves.

Lee Meyerson, a Professor of Psychology at Arizona State University created three adjustment patterns that can help adults with hearing loss. The first one is to remain withdrawn into your own self. This provides a sense of safety and familiarity which can be a comforting way to lead your life. The second is to act “as if” one does not even have hearing loss. A positive attitude will help people to live a life with no barriers and thus, engage in optimal interaction. The final and third pattern is for the person to accept their hearing loss as a part of them without undervaluing oneself. This means understanding that one is forced to live life with this disability, however it is not the only thing that constitutes life’s meaning. Furthermore, many feel as if their inability to hear others during conversation is their fault. It's important that these individuals learn how to become more assertive individuals who do not lack fear when it comes to asking someone to repeat something or to speak a little louder. Although there is much fatigue and frustration that is produced from one’s inability to hear, it is important to learn from personal experiences in order to improve on one’s communication skills.

Communication in the workplace

In most instances, people who are deaf find themselves working with hearing colleagues, where they can often be cut off from the communication going on around them. Interpreters can be provided for meetings and workshops, however are seldom provided for everyday work interactions. Communication of important information needed for jobs typically comes in the form of written or verbal summaries, which do not convey subtle meanings such as tone of voice, side conversations during group discussions, and body language. This can result in confusion and misunderstanding for the worker who is deaf, therefore making it harder to do their job effectively. Additionally, deaf workers can be unintentionally left out of professional networks, informal gatherings, and casual conversations among their collogues. Information about informal rules and organizational culture in the workplace is often communicated though these types of interactions, which puts the worker who is deaf at a professional and personal disadvantage. This could sever their job performance due to lack of access to information and therefore, reduce their opportunity to form relationships with their co-workers. Additionally, these communication barriers can all affect a deaf person’s career development. Since being able to effectively communicate with one's co-workers and other people relevant to one's job is essential to managerial positions, people with hearing impairments can often be denied such opportunities. avoid these situations in the workplace, individuals can take full-time or part-time sign language courses. In this way, they can become better able to communicate with the hearing impaired. Such courses teach the American Sign Language (ASL) language as most North Americans use this particular language to communicate. It is a visual language made up of specific gestures (signs), hand shapes, and facial expressions that contain their own unique grammatical rules and sentence structures By completing sign language courses, it ensures that hearing impaired individuals feel a part of the workplace and have the ability to communicate with their co-workers and employer in the manner as other hearing employees do.

Communication in health care

Not only can communication barriers between deaf and hearing people affect family relationships, work, and school, but they can also have a very significant effect on a deaf individual’s health care. As a result of poor communication between the health care professional and the hearing impaired patient, many patients report that they are not properly informed about their disease and prognosis. This lack of or poor communication could also lead to other issues such as misdiagnosis, poor assessments, mistreatment, and even possibly harm to patients. Poor communication in this setting is often the result of health care providers having the misconception that all people who are hearing impaired have the same type of hearing impairment, and require the same type of communication methods. In reality, there are many different types and range of hearing loss, and in order to communicate effectively a health care provider needs to understand that each individual with hearing loss has unique needs. This affects how individuals have been educated to communicate, as some communication methods work better depending on an individual’s severity of hearing loss. For example, assuming every hearing impaired patient knows American Sign Language would be incorrect because there are different types of sign language, each varying in signs and meanings. A patient could have been educated to use cued speech which is entirely different from ASL. Therefore, in order to communicate effectively, a health care provider needs to understand that each individual has unique needs when communicating.

Although there are specific laws and rules to govern communication between health care professionals and people who are deaf, they are not always followed due to the health care professional’s insufficient knowledge of communication techniques. This lack of knowledge can lead them to make assumptions about communicating with someone who is deaf, which can in turn cause them to use an unsuitable form of communication. Acts in countries such as the Americans with Disabilities Act (ADA) state that all health care providers are required to provide reasonable communication accommodations when caring for patients who are deaf. These accommodations could include qualified sign language interpreters, CDIs, and technology such as Internet interpretation services. A qualified sign language interpreter will enhance communication between a deaf individual and a health care professional by interpreting not only a health professional’s verbal communication, but also their non-verbal such as expressions, perceptions, and body language. A Certified Deaf Interpreter (CDI) is a sign language interpreter who is also a member of the Deaf community . They accompany a sign language interpreter and are useful for communication with deaf individuals who also have language or cognitive deficits. A CDI will transform what the health care professional communicates into basic, simple language. This method takes much longer, however it can also be more effective than other techniques. Internet interpretation services are convenient and less costly, but can potentially pose significant risks. They involve the use of a sign language interpreter over a video device rather than directly in the room. This can often be an inaccurate form of communication because the interpreter may not be licensed, is often unfamiliar with the patient and their signs, and can lack knowledge of medical terminology.

Aside from utilizing interpreters, healthcare professionals can improve their communication with hearing impaired patients by educating themselves on common misconceptions and proper practices depending on the patient’s unique needs. For example, a common misconception is that over exaggerating words and speaking loudly will help the patient understand more clearly. However, many individuals with hearing loss depend on lip-reading to identify words. Over exaggerating words and raising your voice can distort the lips, making yourself even more difficult to understand. Another common mistake health care professionals make are the use of single words rather than full sentences. Although language should be kept simple and short, keeping context is important because certain homophonous words are difficult to distinguish just from lip-reading. Health care professionals can further improve their own communication with their patients by eliminating any background noise and positioning themselves in a way where their face is clearly visible to the patient. The healthcare professional should know how to use body language and facial expressions to properly communicate different feelings.

Management

Hearing aids

Hearing aids are devices that work to improve the hearing and speech comprehension of those with hearing loss. It works by magnifying the sound vibrations in the ear so that one can understand what is being said around them. The use of this technological device may or may not have an effect on one's sociability. Some people feel as if they cannot live without one because they say it is the only thing that keeps them engaged with the public. Others dislike hearing aids very much because they feel wearing them is embarrassing or weird. Due to their low-esteem, they avoid hearing aid usage altogether and would rather remain quiet and to themselves in a social environment.

Assistive devices

• A person with hearing loss cannot always hear the phone or distinguish their own ringtone from another. A signalling transmitter can be attached to a phone that will cause a light or a vibration device to activate. Transmitters can also be used to activate visuals cues to represent fire alarms.
• Individuals with hearing loss require phones with amplifiers that have a higher power of amplification compared to a regular phone. The Hearing Aid Telephone Interconnect System is a hands free amplification which allows people amplify sound when using telephones, cell phones, computer and pay phones by the attachment of a portable unit.
• Individuals can communicate by telephone using telephone typewriters (TTY). Other common names are textphone, minicom and telecommunications device for the deaf (TDD). These devices look like typewriters or word processors and transmit typed text over regular telephone lines. This allows communication through visual messaging. TTYs can transmit messages to individuals who don’t have TTY by using the the National Relay service which is an operator that acts as a messenger to each caller.