D., Downing, J., & Rodriguez-Gil, G. (2001) Tactile Strategies
for children who are deaf-blind: Considerations and concerns from
Project SALUTE. Deaf-Blind Perspectives, 8 (2), 1-6.
Learning Strategies for Children who are Deaf-Blind:
Concerns and Considerations from Project SALUTE
June Downing, Ph.D.
Gloria Rodriguez-Gil, M.Ed.
California State University, Northridge
reliable access to clear visual and auditory information, children
who are deaf-blind must rely on additional modes of learning,
such as learning through touch. For many of these children, touch
is a primary mode of communication. Although a variety of tactile
strategies are frequently used with children who are deaf-blind,
there is little re search-based evidence that validates their
use. Identifying effective tactile strategies for deaf-blind children
who also have cognitive or physical disabilities is particularly
challenging. Project SALUTE (Successful Adaptations for Learning
to Use Touch Effectively), a federally funded model demonstration
project, is addressing the need for a more informed approach to
the use of these methods. The goal of the project is to identify,
develop, and validate tactile instructional strategies for children
who have hearing loss and no functional vision, plus additional
cognitive and physical disabilities.
article discusses key is sues and concerns regarding the use of
tactile strategies based on Project SALUTEs initial activitiesa
review of publications and input from focus groups. This preliminary
examination has identified that there are large gaps in what is
known about tactile methods and has revealed more questions than
answers regarding the use of touch with children who are deaf-blind.
For example, what are the most effective ways to present information
in this mode? How should children be taught to use their hands
for exploration, learning, and communication? What adaptations
are needed for the child who requires tactile information, but
has severe physical disabilities and can not easily control hand
following literature review and focus group findings serve as
a basis for the work of the remaining three years of Project SALUTE.
We hope that it also stimulates discussion and sharing of ideas
and resources among families and professionals who are interested
in this topic and encourages those who are using tactile strategies
to analyze their use in a systematic way.
identified a number of tactile strategies commonly used with children
who are deaf-blind by reviewing publications in the areas of visual
impairment and blindness, deaf-blindness, occupational therapy,
developmental and biological psychology, and related topics. For
the most part, these strategies are not based on research, but
rather on the experiences or opinions of the authors or on anecdotal
reports. Few re search studies have focused on tactile adaptations
for children who are blind with additional disabilities (one exception
is Rowland & Schweigert, 2000). Consequently, there is little
empirical evidence validating tactile strategies that are used
frequently with children who are deaf-blind. The specific strategies
we identified are discussed below.
guidance. Hand-over-hand guidance
is a common strategy in which an adult puts his or her hand over
a childs hand to help the child explore an object, act on
an object, or make a gesture or sign (Free man, 1985; McInnes
& Treffry, 1982). This "hand-over-hand" Volume 8,
Issue 2 Winter 2000/2001 strategy should be used only when necessary
and with sensitivity to the childs reactions. Some children
dislike having their hands manipulated and feel threatened by
the lack of control. Others become passive and prompt-dependent.
They learn to wait for an adults hand on their own as a
prompt to initiate an action (Downing, 1999; Miles, 1998). However,
hand-over-hand guidance may be an essential strategy for children
who have severe physical disabilities be cause they of ten need
assistance to manipulate and explore objects.
This is an alternative to hand-over-hand guidance. Using this
method, an adult places his or her hand slightly under the childs
as they explore objects together (Dote-Kwan & Chen, 1999;
MacFarland, 1995; Miles, 1998). The adult may also gently rest
a hand underneath the childs and wait for the child to initiate
an interaction. One strategy for introducing unfamiliar objects
u ing the hand-under-hand method involves plac ing the childs
hand on top of the adults hand while the adult grasps an
object. The adult then slowly rotates his or her hand so that
the child is gradually introduced to the shape of the object.
Another strategy involves gradually with drawing the adult hand
until the childs fingers touch the surface of the object
or texture being explored (Dote-Kwan & Chen, 1999). In order
for hand-under-hand strategies to be effective, the child must
be willing and able to keep his or her hand on top of the adults
Adapted signs are tactile adaptations of visually-based manual
signs (Chen, 1995). Adaptations involve how the sign is made (hand
shape, orientation of the hands in relationship to the body, movement
of the hands from one point to another, and area of the body where
the sign is produced) and received by a child who is deaf-blind.
This is a developing area of knowledge and the terminology can
be confusing. Some methods of adapting signs include the following:
signing. The receiver places his or her hands on the
signers hands in order to perceive the signs (Reed, Delhorne,
Durlach, & Fisher, 1995). This is a hand-under-hand method.
It is also called interactive signing (Alsop, 1993; Watkins
& Clark, 1991). Tactile or interactive signing provides
a means of communication in put (receptive communication) for
the child who is deaf-blind.
signing. A type of adapted signing in which an adult
physically guides the child to produce signs using a hand-over-hand
method (Watkins & Clark, 1991). This is a means of communication
out put (expressive communication).
signing. The signer produces signs on areas of the childs
body other than the hands (Joint, 1998). For ex ample, the sign
for EAT may be placed against the lips. Body signs are based
on manual signs that are symbols or words. The child may perceive
the sign as a touch cue, how ever, and not recognize a particular
sign as a word.
The use of selected signs (e.g., nouns and verbs) to communicate
main ideas or mes sages (Chen, 1999). Many children who are
deaf-blind with additional disabilities have very short attention
spans and limited communication. The majority of hearing adults
who communicate with them are usually limited in their sign
language skills unless they have a back ground in deafness.
For these reasons, most children who are deaf-blind who have
additional disabilities are ex posed to key word signs rather
than to American Sign Language (with its own grammar) or manually
coded English (uses English syntax). For example, WANT PLAY
are key word signs for "Do you want to play?"
common terminology and systematic study of the methods used to
adapt manual signs for children who are deaf-blind is needed.
Questions that need to be answered include: How should manual
signs be adapted to encourage receptive and expressive communication?
What criteria should guide decision-making when considering whether
adapted signs are an effective communication option for a particular
representations must make sense to a child in order to convey
meaning (Downing & Eichinger, 1990; Rowland & Schweigert,
1998). For example, using a toy car to represent "going for
a ride in a car" may be completely nonsensical from a childs
tactile point of view. A seatbelt may be a more meaningful association
based on the childs experience. Adults should think from
a tactile rather than a visual perspective when selecting tactile
cues or tactile signals are an important communication strategy
to use with young children who are deaf-blind during the early
stages of communication development (Klein, Chen, & Haney,
2000; Rowland, Schweigert, & Prickett, 1995). The intended
meaning of a touch cue is derived from the specific context and
situ ation. The use of touch cues should be consistent. A child
will not be able to decipher the meaning of a touch cue if different
people use it for a variety of messages. For example, patting
or tapping a child on the shoulder may express any of the following:
feedback ("Great job")
request or directive ("Sit down")
or reassurance ("Dont cry, youre OK")
child will not be able to discriminate the meaning of a touch
cue if there is competing tactile in put or if he or she does
not like being touched. For example, touching a childs lips
while patting his or her hand is confusing if the message is "
here is your drink." Touch cues should be used selectively,
conservatively, and consistently so that the child can develop
an understanding of what they represent. Our literature re view
and focus group discussion raised a number of questions regarding
touch cues. What is the difference between a touch cue and an
object cue from the childs perspective? Is touching the
child with the nipple of a bottle a "touch cue" or an
"object cue" if what the childs perceives is pressure
on the lip? What is the difference between a "touch cue"
and a "body sign" from the childs perspective?
Is making the sign for CANDY on the childs cheek a "body
sign" or a "touch cue" if what the child perceives
is pressure on the cheek? How should touch cues or body signs
be made (place on the childs body, type, and duration of
touch) to help the child associate a cue with its meaning?
Object cues are objects or parts of objects used in activities
or associated with a particular person. They are used to give
information, make requests, and provide feed back. Initially object
cues should be used during activities and selected so that the
child can easily make an association between an object and the
activity it represents (Chen, 1995; Rowland, Schweigert &
Prickett, 1995). For example, a small card board container of
juice may be used to rep re sent "time for snack." As
the child learns to associate an object with an activity, object
cues can be come smaller and more abstract. An object other than
the one used in the activity (e.g., an empty juice container),
a piece of the object (e.g., lid of the container), a partial
representation of the object (e.g., piece of card board), an associated
object (e.g., a straw), or a model of the object (e.g., a miniature
juice box) may be used instead.
ject cues are meaningful only if the child can recognize what
they represent. For example, miniatures usually provide visual
representations that can not be seen by a blind child. In addition,
very small objects provide limited tactile information and may
be more difficult for a child who has a physical disability such
as cerebral palsy to handle and explore. Some times arbitrary
object cues are used if there is no logical object related to
a specific activity. For example, if a child changes from one
class room to an other every day, a piece of felt on the class
room door may be used as an arbitrary object cue. With experience,
the child learns to associate the piece of felt as a land mark
for that particular class room (Rowland, Schweigert & Prickett,
considerations in selecting object symbols or tangible symbols
(Murray-Branch & Bailey, 1998) include the following:
saliency (ease of recognition)
of objects preferred by the child (encourages exploration)
the objects or tangible symbols can be reduced in size so that
they are portable and can be used in a variety of settings
easily the object or texture can be discriminated from others
used in a group of tangible symbols
materials such as sandpaper or bubblewrap, are often used as abstract
tangible symbols to promote communication with nonverbal children
and adults who are blind or deaf-blind (Murray-Branch & Bailey,
1998; Rowland, Schweigert, & Prickett, 1995). These tangible
symbols are used on communication boards to give information,
elicit requests, and provide choice making opportunities. Selection
of materials is typically based on the saliency of tactile characteristics.
Little is known about effective strategies for assisting a child
who is deaf-blind with additional disabilities to associate meaning
with abstract tactile symbols.
Group Findings: Current Practices and Issues
focus group meetings were conducted in Califor. The 33 participants
included English-speaking and Spanish-speaking family members
and service providers (both English-speaking and bilingual) of
children who were deaf-blind or blind with additional disabilities.
Although SALUTE focuses on children who are deaf-blind with additional
disabilities, we also wanted to learn from individuals who interact
with children who are to tally blind and have cognitive or physical
were asked to identify the tactile strategies that they use and
to discuss their successes, challenges, and needs. Many of the
strategies and issues identified by the literature review were
also raised during the focus group meetings. In addition, the
participants shared their own experiences and suggestions for
enhancing tactile methods of teaching and communication. They
also identified areas where more information, guidance, and clarity
regarding this topic are needed.
Each child who is deaf-blind has unique needs and preferences.
Participants stressed the importance of using an individualized
approach when determining the best teaching practices and when
selecting specific activities and materials. Several reported
that children preferred tactile input that had a functional purpose,
a simple design, and a concrete form (e.g., a wooden box with
a lid or uncooked beans). Many reported that in general, their
children tended to dislike tactile input that was unpredictable,
in distinct, complex in form, light, sticky or that was extreme
in temperature or texture (e.g., sand, feather dusters, water
paint). On the other hand, a few indicated that their children
liked to handle these types of materials. Over all, participants
said that they used a trial and error approach to determine what
works best for a particular child. They identified a need for
the development of guide lines and other tools to help them determine
effective tactile strategies.
The importance of meaningful instruction emerged as another overriding
theme. Participants felt that children who are deaf-blind learn
most effectively when instruction occurs within familiar routines,
activities, and environments. The use of real items that have
a useful purpose in stead of fabricated or artificial ones (e.g.,
a real orange rather than a plastic one) was mentioned repeatedly
as essential for enhancing concept and language development.
and positive instruction. The
importance of using a very positive and respectful approach when
interacting with children who are deaf-blind was also emphasized.
Participants felt that children should not be forced to manipulate
objects or engage in other tactile learning activities. They should
be approached with sensitivity and given ample time to receive
tactile information. Repeated use of words such as "rapport
building" and "non-intrusive" under scored the
importance of this approach.
of what motivates a child and how to pair that motivation with
an unfamiliar tactile item was identified as an effective strategy.
For example, some children are motivated by an activity such as
music or movement, in which the tactile exploration of objects
could be encouraged. Preschoolers who have some hearing and enjoy
music may cooperate with handling playdough if the adult sings
"This is the way we roll the playdough, roll the play dough,
roll the playdough . . . " Consideration regarding the type
of touch and where on the body the child likes to receive tactile
information was also stressed. Instead of demanding that a child
hold and examine an item, participants felt that they should follow
the childs lead, offer opportunities for the child to come
into contact with materials, and invite the child to handle items
in shared activities.
stressed the importance of routines and repetition to support
learning. Consistency in the presentation of information across
different settings (e.g., both at home and at school) enable children
to generalize concepts and skills. They seem to better understand
activities that have a clearly marked beginning, middle, and end.
Participants also indicated that the use of instructional prompts
(e.g., holding the child by the wrist to encourage exploration
of an o ject) and cues (e.g., touching the childs hand with
an object) help children use tactile strategies. Prompts should
be with drawn gradually as the child learns to respond to natural
from the visual to the tactile mode. Despite their acknowledged
expertise, comments from most participants suggested that adapting
visual materials is very challenging. It is difficult to convey
adequate information about many concepts or objects through tactile
adaptations alone. For example, information about objects that
are very large (e.g., a car) or very small (e.g., an ant) or that
move quickly (e.g., a bird flying), require explanation. Participants
indicated that in these cases they provided a spoken or signed
explanation about the tactile adaptation to the child.
that are easy to understand when seen, such as identifying facial
expressions or recognizing feelings, are much more difficult to
recognize through touch. The imitation of physical actions is
an other visually-based learning strategy that is difficult to
adapt to a tactile mode. Typical tactile adaptations in these
situations are to guide the child through specific actions or
movements (hand-over-hand guidance) or to let the child feel another
persons movements or actions (hand-under-hand guidance).
At best, these strategies provide tactile modeling or demonstration.
Imitation requires that the child use tactile information to mimic
what he or she has experienced.
Although tactile learning often refers to the use of ones
hands to learn, focus group participants viewed this as a very
narrow interpretation. They advocated an expanded definition to
include the use of the feet, chest, stomach, face, and the whole
body in addition to hand use. While this may be particularly critical
for children with significant limitations in hand use, participants
also indicated that learning through other body parts was helpful
for children whose hands were hypersensitive to tactile input.
Through out the focus group meetings, participants used many different
terms to describe tactile strategies. Some terms such as tactile
signals, touch cues, motoring, physical prompting, and tactile
signing were defined in different ways. This variety and confusion
in terminology also emerged from the literature review. For example,
as broadly defined by Rowland and Schweigert (2000) the term "tangible
symbols" includes both two- and three-dimensional symbols
(pictures, textures, and objects). How ever, in the traditional
augmentative and alternative communication literature, "tangible
symbols" are restricted to those symbols that can be discriminated
on the basis of shape, texture, or other tangible properties;
therefore excluding pictures and other two-dimensional symbols
(Beukelman & Mirenda,1998; Downing, 1999). The use of vocabulary
from multiple disciplines has produced similar terms with different
meanings and multiple terms with similar meanings. This is an
area where standardization is needed.
review of the literature and comments from focus group participants
have raised complicated questions regarding the use of touch with
children who are deaf-blind. In the next three years, SALUTE will
address these questions through the systematic use of individualized
tactile learning strategies with children who are deaf-blind and
have additional disabilities. We would like to invite readers
to share their questions, concerns, and resources related to the
use of tactile strategies with children who are deaf-blind.
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with a National Advisory Committee, focus groups and selected
children in California, Project SALUTE staff will identify, develop,
document, and validate tactile learning strategies for children,
infants through elementary school age. One focus group was conducted
with Spanish-speaking families in order to produce materials that
are culturally responsive. Materials will include a manual and
videos (closed captioned and in English) demonstrating activities
in both home and school environments. The video of home activities
will also be in Spanish. Project SALUTE is a model demonstration
project funded by the U.S. Department of Education grant #H324T990025
to California State University, Northridge.
Deborah Chen, Ph.D.
June Downing, Ph.D.