Project SALUTE
Successful Adaptations for Learning to Use Touch Effectively

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Chen, 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.

Tactile Learning Strategies for Children who are Deaf-Blind:
Concerns and Considerations from Project SALUTE

Deborah Chen, Ph.D.
June Downing, Ph.D.
Gloria Rodriguez-Gil, M.Ed.
California State University, Northridge

Without 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.

This article discusses key is sues and concerns regarding the use of tactile strategies based on Project SALUTE’s initial activities—a 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 movements?

The 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.

Literature Review

We 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.

Hand-over-hand guidance. Hand-over-hand guidance is a common strategy in which an adult puts his or her hand over a child’s 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 child’s 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 adult’s 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.

Hand-under-hand guidance. This is an alternative to hand-over-hand guidance. Using this method, an adult places his or her hand slightly under the child’s as they explore objects together (Dote-Kwan & Chen, 1999; MacFarland, 1995; Miles, 1998). The adult may also gently rest a hand underneath the child’s and wait for the child to initiate an interaction. One strategy for introducing unfamiliar objects u ing the hand-under-hand method involves placing the child’s hand on top of the adult’s 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 child’s 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 adult’s hand.

Adapted signs. 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:

  • Tactile signing. The receiver places his or her hands on the signer’s 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.
  • Coactive 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).
  • Body signing. The signer produces signs on areas of the child’s 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.
  • Key word signing. 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?"

A 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 child?

Tactile representation. Tactile 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 child’s tactile point of view. A seatbelt may be a more meaningful association based on the child’s experience. Adults should think from a tactile rather than a visual perspective when selecting tactile representations.

Touch cues. Touch 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:

  • positive feedback ("Great job")
  • a request or directive ("Sit down")
  • information ("Your turn")
  • comfort or reassurance ("Don’t cry, you’re OK")

A 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 child’s 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 child’s perspective? Is touching the child with the nipple of a bottle a "touch cue" or an "object cue" if what the child’s perceives is pressure on the lip? What is the difference between a "touch cue" and a "body sign" from the child’s perspective?
Is making the sign for CANDY on the child’s 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 child’s body, type, and duration of touch) to help the child associate a cue with its meaning?

Object cues. 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.

Ob 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, 1995).

Essential considerations in selecting object symbols or tangible symbols (Murray-Branch & Bailey, 1998) include the following:

  • Tactile saliency (ease of recognition)
  • Types of objects preferred by the child (encourages exploration)
  • Whether the objects or tangible symbols can be reduced in size so that they are portable and can be used in a variety of settings
  • How easily the object or texture can be discriminated from others used in a group of tangible symbols

Textured 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.

Focus Group Findings: Current Practices and Issues

Four 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 disabilities.

Participants 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.

Individualized approach. 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.

Meaningful instruction. 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.

Supportive 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.

Awareness 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 child’s lead, offer opportunities for the child to come into contact with materials, and invite the child to handle items in shared activities.

Systematic instruction. Participants 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 child’s hand with an object) help children use tactile strategies. Prompts should be with drawn gradually as the child learns to respond to natural cues.

Adapting 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.

Concepts 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 person’s 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 one’s 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.

Confusing terminology. 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.


Our 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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          Beukelman, D.R., & Mirenda, P. (1998). Augmentative and alternative communication: Management of severe communication disorders in children and adults (2nd ed.). Baltimore: Paul H. Brookes.
          Chen, D. (1995). Guiding principles for instruction and program development. In D. Chen & J. Dote-Kwan (Eds.), Starting points. Instructional practices for young children whose multiple disabilities include visual impairment (pp.15-28). Los Angeles: Blind Childrens Center.
          Chen, D. (1999). Beginning communication with infants. In D. Chen (Ed.), Essential elements in early intervention: Visual impairments and multiple disabilities (pp.337-377). New York: AFB Press.
          Dote-Kwan, J. & Chen, D. (1999). Developing meaningful interventions for infants whose multiple disabilities include visual impairments. In D. Chen (Ed.), Essential elements in early intervention: Visual impairments and multiple disabilities (pp.287-336). New York: AFB Press.
          Downing, J. (1999). Teaching communication skills to students with severe disabilities. Baltimore: Paul H. Brookes.
          Downing, J., & Eichinger, J. (1990). Instructional strategies for learners with dual sensory impairments in integrated settings. Journal of the Association for Persons with Severe Handicaps, 15, 98-105.
          Freeman, P. (1985). The deaf-blind baby: A programme of care. London: William Heinemann Medical Books.
          Joint, S.A. (1998). Body signing: A functional strategy for introducing language to students who are deaf-blind. DBI Review, 21, 10-11.
          Klein, M.D., Chen, D., & Haney, M. (2000). Promoting learning through active interaction. A guide to early communication with young children who have multiple disabilities. Baltimore: Paul H. Brookes.
          MacFarland, S.Z.C. (1995). Teaching strategies of the van Dijk curricular approach. Journal of Visual Impairments & Blindness, 89, 222-228.
          McInnes, J.M., & Treffry, J.A. (1982). Deaf-blind in fants and children: A developmental guide. Toronto: University of Toronto Press.
          Miles, B. (1998). Talking the language of the hands to the hands. Monmouth, OR: DB-LINK, The National Information Clearinghouse on Children who are Deaf-Blind.
          Murray-Branch, J. & Bailey, B.R. (1998). Textures as
Communication symbols.
Blumberg, IN: Blumberg Center for Interdisciplinary Studies in Special Education, Indiana State Uni versity.
          Reed, C.M., Delhorne, L.A., Durlach, N.I., & Fischer, S.D. (1995). A study of the tactual reception of sign language. Journal of Speech and Hearing Research, 38, 477-489.
          Rowland, C. & Schweigert, P. (2000). Tangible symbols, tangible outcomes. Augmentative and Alternative Communication,16, 61-78.
          Rowland, C. & Schweigert, P. (1998). Enhancing the acquisition of functional language and communication. In S.Z. Sacks & R.K. Silberman (Eds.), Educating students who have visual impairments with other disabilities (pp.413-438). Baltimore: Paul H. Brookes.
          Rowland, C., Schweigert, P.D., & Prickett, J.G. (1995). Communication systems, devices, and modes. In K.M. Huebner, J.G. Prickett, T.R. Welch, & E. Joffee (Eds.), Hand in hand: Essentials of communication and orientation and mobility for your students who are
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          Watkins, S., & Clark, T.C. (1991). A coactive sign system for children who are dual sensory impaired. American Annals of the Deaf, 136, 321-324.

Project Information

Working 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.

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SALUTE is a model demonstration project funded by the U.S. Department of Education grant #H324T990025 to California State University, Northridge from September 1, 1999 to August 30, 2004.