What is Sensory Impairment? Explained

1. Introduction
2. Concepts and Definition
3. Identification and Assessment
4. Causes and Types
5. Intervention 
6. Summary

Introduction

Concepts and Definition

• Hearing: Hearing is the process of identifying, understanding, and recognising sounds.
• Hearing Impairment: Any deviation or worsening of either auditory anatomy or function is considered a hearing impairment. Any hearing defect brought on by inherited traits or environmental circumstances may fall under this category. Due to this handicap, the child is unable to use their hearing for everyday activities.
• Hearing disability: Hearing disability is characterised as an auditory issue that a person experiences and complains about. A hearing impairment turns into a disability when it limits the child's functional potential and performance level.
  The persons with Disabilities Act, 1995, recognizes having impairment as a disability, defining it as a loss of sixty decibels or more in the better ear in the conversational range of frequencies.
• Hearing Handicap: A hearing handicap is a disadvantage that an individual experiences as a result of an impairment or disability that restricts or makes it impossible for them to perform a typical role, depending on their age, sex, and cultural background. The effectiveness of the person's daily existence is impacted by the restriction imposed on or acquired by them. An eardrum flaw is one type of disability. It hinders the regular process of message transfer to the middle ear and alters the process of sound vibration. Due to the inability to perceive sounds normally as a result of this distortion, hearing is impaired. The outcome is a decline in life quality.

Visual Impairment

• Low vision: Low vision refers to a person's significantly diminished functional vision. Magnifiers and large print books may be necessary for those with low eyesight to read. Children with low vision now have better learning possibilities because to recent technology advancements. Even after receiving treatment, a person with limited vision still has impaired visual functioning. The Persons with Disabilities Act of 1995 acknowledges low vision as a type of disability and classifies a person as having low vision if they continue to have visual impairments despite receiving basic refractive therapy.
• Blindness: Blindness is characterised by total loss of vision, a severely restricted field of vision, visual acuity that is less than 6/600 or 20/200 in the better eye even with corrective lenses, or restrictions on the field of vision that extend an angle of 20 degrees or more.

Deaf-Blindnes

• History of high risk factors, 
• Absence of normal response to various sounds, 
• Language development not seen even after one to two years of age, 
• Attention on the lips of the speaker, 
• Liquid discharge from ears, and 
• Constant itch in the child’s ear.

• Lack of linguistic skills, normal for ones age, 
• Difficulty in comprehension, 
• Specific problem in reading and speaking, 
• Slow mastering of language skills, and 
• Asking for repetition frequently

1. Auditory Brainstem Response (ABR): Electrical impulses are transported from our ears to the brainstem at the base of the brain via nerves in order to process sounds. An auditory brainstem response (ABR) measures the brainstem's physiological reaction to sound. The health of the hearing system from the ear to the brainstem is examined. The infant is subjected to a variety of sounds through earbuds after having four to five electrodes fixed to their head for the test. The brain receives the sound stimulus as the hearing nerve fires. The electrodes can capture the electrical activity that the nerve produces, and the waveforms that result are displayed on a computer screen. The audiologist can then play each sound at a variety of volumes in order to find the baby's maximum audibility. Only one sound, generally referred to as a click, is utilised to evaluate hearing in infant screening procedures. The click is a collection of sounds that tests a larger portion of the hearing organ simultaneously. The click is often delivered at both a loud and gentle level. The infant has passed the hearing test if a normal reaction is captured.
2. Automated Auditory Brainstem Response (AABR):  Another unbiased method of assessing hearing is the automated auditory brainstem response. The majority of newborn screening programmes employ it. The device is automated and designed to produce a pass or fail report. There is no need for an audiologist to interpret the test.
3. Otoacoustic Emission Test (OAE):  In response to a sound stimulus, the inner ear (cochlea) produces an acoustic response that is measured by the otoacoustic emission test. A little probe with a microphone and speaker is inserted into the baby's ear to conduct the test. Sounds are produced by the probe while the baby is dozing off, and the cochlea's reactions are then recorded. Neural impulses are transmitted to the brainstem after the cochlea has processed the sound. Additionally, there is a second, distinct sound that does not pass along the nerve but rather emerges from the baby's ear canal. The otoacoustic emission constitutes this "byproduct". After that, the emission is captured on tape by the microphone probe and shown graphically on a computer screen. The strength of the responses and the noises that elicited them can be determined by the audiologist. The baby has passed the hearing test if there is an emission for the sounds that are essential for understanding speech.

Six Months to Two Year:

Visual Impairment:

• Child tilts her or his head to locate the light source, 
• Pain and irritation in the eyes, 
• Bumps into objects in the environment, 
• Unable to write from the blackboard, takes help from peers to copy from the blackboard, 
• Poor performance in the class, 
• Unable to read in poor lighting conditions, 
• Unable to see during night, 
• Depends too much on oral information, 
• Rubs eyes excessively, 
• Watery eyes, 
• Eyelids are often red,
• Holds objects and the book too close to eyes, 
• Squints or blinks when looking at something, 
• Blinks more frequently, and 
• Regular headaches.

• Child tilts her or his head to locate the light source, 
• Pain and irritation in the eyes, 
• Bumps into objects in the environment, 
• Unable to write from the blackboard, takes help from peers to copy from the blackboard, 
• Poor performance in the class, 
• Unable to read in poor lighting conditions, 
• Unable to see during night, 
• Depends too much on oral information,
• Rubs eyes excessively, 
• Watery eyes, 
• Eyelids are often red,
• Holds objects and the book too close to eyes, 
• Squints or blinks when looking at something,
• Blinks more frequently, and
• Regular headaches

• Confident movement in school environment, 
• Visual orientation to the new stimuli, 
• Light gazing, 
• Avoidance response to shadows, 
• Interested in visual games, 
• Avoidance of large obstacles, 
• Unusual head tilt, 
• Flickering, 
• Distracted by movement in the environment, 
• Troubled responses to suddenly approaching objects, 
• The child experiences difficulty in identifying small details in pictures or illustrations, 
• The child frequently complains of dizziness after reading a passage or completion of assignments involving vision, and 
• The child frequently complains of headache, infection in eye, or the child uses one eye more than the other.

• Light perception of difference between sunlight and dim light,
• Light perception of difference between good light and poor light in a class, 
• Tracking of light, 
• Detecting hand movement, 
• Distance of detecting hand movement, 
• Finger counting: Fingers raised one at a time, 
• Finger counting: fingers spread apart, 
• Finger counting (General): Fingers closed together, 
• Finger counting inside the classroom with good lighting condition,
• Finger counting inside the classroom with poor lighting condition, 
• Visual background,
• Colour detection, 
• Visual closure, 
• Form constancy, 
• Eye-hand coordination, 
• Eye-foot coordination, 
• Print size preference without magnifiers, 
• Print size preference with magnifiers, 
• Time taken to read a passage in mother tongue or English, 
• Ability to write, and 
• Writing speed.

• Maddox Rod Test: When fusion is disturbed, this test is performed to detect the postural position of the eyes. This test can be used to identify hetrophoria and provides excellent measurements of heterophoria. Each eye must simultaneously get a separate image as part of the treatment. 
• Allied Muscle Balance Test: This test involves having the youngster use a projector to place a red dot inside of a rectangle that is projected on a screen while donning special lenses. Some kids may find it challenging to learn how to take this test, which calls for eye-hand coordination and fine motor control. 
• Tests for Distant Vision: The youngster with hyperopia or farsightedness will be identified by the tests for distant vision. The youngster with hyperopia normally has good distance vision but needs to make adjustments for tasks requiring near vision.
• Plus Lens Test: It is a better method to identify hyperopia. While the youngster is wearing plus lenses placed in a small, affordable frame, his vision is evaluated using a binocular device or the Snellen chart. If the youngster is using these lenses and is able to see the 20-foot line with both eyes at 20 feet from the chart, they should be sent.
• Near Vision Testing: Children with low eyesight should have their near visual acuity assessed. For children with pathological problems when merely distance visual acuity may not be sufficient, near vision information is of particular value. A variety of reading cards with printed symbols, numerals, or characters are used to assess close vision. The reading distance and lighting for kids with low eyesight should be noted

Deafblindness: 

1. Outer ear,
2. Middle ear, and
3. Inner ear

• Mild hearing loss (26 to 40 Db HL): A child with mild hearing loss will have trouble hearing and understanding soft speech in a noisy background. 
• Moderate hearing loss (41 to 55 Db HL): A Child with moderate hearing loss have difficulty in hearing conversational speech. 
• Moderately severe hearing loss (56 to 70 Db HL): A child with moderately severe hearing loss will have difficulty in hearing conversational speech even at close distances. 
• Severe hearing loss (71 to 90 Db HL): A child with severe hearing loss may only hear loud environmental sounds. 
• Profound hearing loss (91 Db HL and above): A child with profound hearing loss may only hear very loud environmental sound

1. Conductive hearing loss: Conduction hearing loss can result from any outer ear or middle ear issue that causes hearing loss.
2. Sensory neural hearing loss: Sensory-neural hearing loss is a general term for hearing loss brought on by issues with the inner ear, auditory nerve, or both.
3. Mixed hearing loss: Mixed hearing loss refers to hearing loss brought on by any issue with the outer, middle, or inner ear.
4. Central hearing loss: Central hearing loss is the phrase used to describe hearing loss brought on by errors in the central auditory processing. The child can hear the sound, but he or she has difficulty comprehending and interpreting spoken language.
5. Functional hearing loss: Hearing loss occurs when a youngster has difficulty hearing because to pretending or psychological issues but there are no anatomical or physiological abnormalities in the auditory system.

• Cataract: It is the leading factor among the major causes of blindness and refers to a clouding of the crystalline lens of the eye. There are currently an estimated 20 million blind persons worldwide. Although cataracts can't usually be prevented, a significant majority of persons who have them can have their vision nearly restored with the surgery that is currently available. 
• Trachoma: The most frequent preventable cause of blindness in the world continues to be trachoma. Trachoma is prevalent in places of the world, including India, that are socioeconomically deficient in basic necessities for housing, health, water, and sanitation. 
• Childhood blindness: Vitamin A deficiency, measles, infant conjunctivitis, congenital cataract, and retinopathy of prematurity are the leading causes of childhood blindness (ROP).

1. Congenitally deafblind: Individuals who are born with vision and hearing losses. 
2. Congenitally deaf, Adventitiously blind: Individuals who are born with deafness and later acquire blindness. 
3. Congenitally blind, adventitiously deaf: Individuals who are born with blindness and later acquire deafness. 
4. Adventitiously deafblind or acquired deafblind: Individuals who are born with hearing and vision senses but later lose both the senses in varying degrees and at different times.

1. Sensory Training: Contrary to popular belief, people without sight do not possess supernatural skills to use their senses. Without specific training, the senses will not develop their capacities. A visually impaired person is forced to use other senses, whereas sighted people typically rely primarily on their eyesight and do not utilise their other senses to their fullest potential. Consequently, it is crucial to receive good instruction in how to employ the other senses. As concepts like landmark, clue, etc. that we use in the mobility training allow the kid to grasp the environment better, the ability to use the senses increases the child's orientation and mobility skills as well. As a result, systematic sensory development becomes a crucial component of educating a kid who is visually impaired.
3. Orientation and Mobility: There are visually impaired people who are incredibly competent of moving independently in a recognisable world without any physical support. These people have total control over the environment, and their perceptions of the size, direction, and other attributes of objects as well as how they relate to themselves can be impressive. Teachers and mobility specialists train visually impaired youngsters in safe, secure, and graceful mobility techniques. People who possess these skills can move independently in a familiar environment. Although this is admirable, it is important to urge the visually impaired person to utilise a mobility device because it grants independence even in a strange place. A person who is born blind and a person who becomes blind later in life have different skill sets.
   
   
   To improve the mobility, visually impaired persons use the following:
   > Sighted guide travel: Additionally, we encounter people who are blind and prefer to travel with a seeing companion. Both the guide and the visually impaired person need to use certain sighted guide skills. This method has advantages and drawbacks. In the company of the sighted guide, the blind person might feel secure and move gracefully. On the other hand, if the sighted guide is the only one to assist with transportation, the visually impaired person will start to become dependent, which is not good for their overall development.
   > Long cane technique: Visually impaired people frequently utilise the long cane, sometimes known as the "white cane." The cane can be used to locate stairs, surfaces with various textures, etc. A visually impaired individual using a long cane for independent travel should make use of specific landmarks and hints.
4. Daily Living Skills: Basic survival skills can be thought of as everyday living abilities. These skills give visually impaired youngsters the ability to go about their daily lives independently or with little help. The development of these skills gives the kids the self-assurance they need to interact with typically developing kids. It's a common misconception that losing one's sight entails life in the dark and being powerless. Research investigations overwhelmingly support the idea that it is untrue. Individuals only acquire daily life skills through practise, thus it is important to provide the child with enough of it.
   
   
   People encounter a wide variety of events every day. Even while preparing a full meal and combing your hair may seem like small tasks, they each have their own significance. It is a crucial and difficult responsibility to teach such things to a blind individual. If the standard procedures are unsuccessful, alternative strategies must be developed. Criteria for performance evaluation are also required in addition to the tactics and instructional techniques. Therefore, it is equally vital to diagnose problems, establish strategies, and assess how well one is doing daily living skills.
   
   
   Children who are vision handicapped do not require any unique daily life skills. A visually impaired individual is expected to possess the same abilities as someone who is seeing. Therefore, using sighted children's skills as a benchmark can help in developing more effective teaching methods for visually impaired youngsters. Following are possible examples of the six-stage technique for teaching everyday life skills:
   i. Observation of the daily living skills exhibited by sighted children at various grade levels,
   ii. Diagnosing the difficulties faced by visually disabled children in acquiring those skills in a natural manner,
   iii. Designing pre-requisite skills after necessary diagnosis of difficulties encountered by visually disabled children,
   iv. Teaching those readiness skills which lead to the learning of daily living skills,
   v. Preparing evaluation criteria to measure the level of acquisition of daily living skills, and
   vi. Evaluating the performance of the children in daily living and suggesting appropriate remedial measures.
   
   
   An individual's daily life skills are essential components for appropriate social development. The abilities should be in line with any society's norms. The visually impaired person's inability to see places limitations on their ability to naturally gather information about the outside environment. The overall curriculum for visually impaired students in schools and in rehabilitation programmes needs to be strengthened in this area. Children who are vision impaired can learn these abilities, however it may be challenging.

1. Pharmacotherapy: Physicians can recommend the appropriate medicine to the child after considering the condition of the child. 
2. Therapeutics: Physicians can play a vital role in guiding the therapists like physiotherapist, occupational therapist and or speech therapist. They can suggest the therapists about the condition of the child, the prognosis, risks for associated disabilities and the effect of continuing drugs thereby affecting therapy decisions.
3. Clinical assessment: Doctors must provide assistance to families of children with multiple disabilities in the area of clinical evaluation. All family members require accurate information on the child's precise status that is presented in an understandable manner. For families to manage the daily demands of kids with multiple impairments, accurate diagnosis for sensory issues, epilepsy, degenerative disorders, operations, biochemical reactions, and other conditions is crucial. Families frequently lack knowledge about what to anticipate from their child going forward or their role in the child's medical treatment after a comprehensive examination and diagnosis. The parents will be better able to plan according to the child's medical requirements if the diagnosis is interpreted simply and directly.
4. Genetic counseling and family counseling: For medical practitioners, this is a specialist field, especially when it comes to numerous disabilities. The majority of causes of disability are inherited. Children who have numerous disabilities are less common, and the condition will be slowed down even more with timely genetic testing, analysis, and counselling.

Summary