(a) American Sign Language (ASL) - ASL is the natural language of the culturally deaf and is comprised of specific gestures (signs), hand shapes and facial expressions. ASL is a highly visual language with its own syntax and grammar. It is not a manual form of English. Signs are made by either one or both hands assuming distinctive shapes in particular locations and executing specified movements. ASL grammar uses spatial relation visually displayed with the signing frequency, direction and orientation of the hands to indicate singular or plurality, subject vs object etc. This language is the preferred primary mode of communication of the adult deaf-blind population. Deaf-Blind persons using ASL are primarily persons born deaf and who lose their vision later in life. ASL can be used by deaf-blind persons both visually and tactually with adaptations.

(b) Signed Exact English (SEE) - SEE is a communication system of visually represented English in a manual form. Signs are arranged in English word order and invented forms are given meaning corresponding to English grammar (ing, ed, was, be). SEE is most often used by deaf-blind persons who have not associated with the culturally deaf community. It is also employed with those who have acquired deafness later in life or those who are involved with educational facilities. SEE can be used by deaf-blind persons both visually and tactually with adaptations.

(c) Adapted Interactive Tactual Sign Language (AITSL) (formerly called Manipulated or Modelled Sign Language) - The deaf-blind person receives communication with his hands resting on the speaker's hand while the message is signed. The speaker next manipulates the deaf-blind person's hands, followed by a partial communication accompanied with prompts or cues to allow the deaf-blind person to respond independently. Questions or choices may be presented by the speaker using the same method to ensure that the deaf-blind person understands the message. This communication system is used primarily with congenitally deaf-blind persons.

(a) American Fingerspelling - Letters of the English alphabet are formed by manipulating the fingers of one hand into specific positions and motions. Each letter of each word is spelled. Most often seen visually, the deaf-blind person can also place their hand on the speaker's hand to tactually receive the spelled message. It is used by literate deaf-blind persons who may or may not also know a sign language system.

(b) Two Hand Manual - Letters of the English alphabet are formed by a speaker's hand positions which are placed upon a recipient's open relaxed palm. This combination of hands form the alphabet. Each letter of each word is spelled. This is a tactual communication method that is also adapted for some visual use. It is used by the majority of deaf-blind adults in Canada as their preferred primary mode of communication (it also demands literacy).

(a) Print on Palm (POP) - Using the palm as a writing surface, the speaker holds the deaf-blind person's hand with the palm up. The speaker's index finger is used like a pencil to print each capital letter successively, and in the same palm location, to form a word. This system demands literacy. It is most often used as a common way to interact with the community and or within the deaf-blind community. The letter X drawn on a deaf-blind person's back, from shoulders to waist, is recognized as the standard for indicating an emergency.

(b) Print on Paper - This system uses black felt marker on flat (non-glossy) white paper with good spacing and clear standard print shape and size. It is used by many older deaf-visually impaired seniors who (are literate) as their preferred primary method of communication. It requires no learning of alternate systems and is effective with the general public. Also used on portable white and black boards.

(c) Telephone Devices for the Deaf, and Telephone Devices for the Deaf-Blind (referred to as TDD, TDD-B or TTY) - A small key board device with a modem for telephone and visual display is used to send the message by code over the telephone to a similar machine. A large print screen is available to accommodate those who have very limited vision. These devices allow access to the telephone for deaf-blind people. With the introduction of the special Bell Relay Service in Canada, deaf-blind people and those who are deaf can communicate with their TTY via special operators to relay messages to any one in the community (i.e., doctor, store, etc.)

(a) Braille - This is a system of touch reading for the blind. It uses six raised dots. These are referred to as "one cell". The six raised dots when arranged in various combinations, form the letters of the alphabet, punctuation and word contractions. Braille is used by deaf-blind persons wishing to read who cannot access print. Various forms include grades 1 and 2 braille, jumbo and computer braille. Braille is produced by a mechanical embosser (the Perkins model is most popular), a slate and stylus (easily portable) and computer driven embossers.

(b) TellaTouch - a device used by persons who know braille. One side of the mechanical device is a standard typewriter keyboard and has six keys similar to a brailler for braillists to use. The person who is deaf-blind places his finger on the braille cell and feels the letter as it is produced. This communication system is most commonly used by congenital blind persons who know braille but who have lost their hearing. It is also used by travellers or patients in hospital who are deaf-blind to communicate.

(c) TeleBraille - The TeleBraille is a braille access telephone device for persons who are deaf-blind. It is comprised of two pieces; a braille display and a keyboard with model. The TeleBraille is used by braille readers to access the phone and for face to face communication between someone in the community and a person who is deaf-blind. This device is no longer being manufactured. Alternative models are being developed.

(d) Moon Print - This raised print system retains many letters of the English alphabet in their original forms. Moon uses an alphabet of nine characters placed in various positions. Moon reads alternately from left to right, then right to left with guide lines to indicate direction. This system is still primarily used only in England but is an alternative for persons who have difficulty with the fine tactile dots of braille.

(e) Morse Code - This is an international system that consists of dots and dashes presented systematically to represent the letters of the alphabet. It is familiar to amateur radio operators (HAMs) and the armed forces. It is used by HAMs who are deaf-blind with a vibrating receiver and for computer in-put by some physically disabled deaf-blind people.

(a) Objects are presented in a predetermined repetitive order to communicate and/or solidify concepts, ideas and tasks to a person who is deaf-blind. Object referencing is used as a communication system to provide description, anticipation and aspects of recall. It is used to allow structure, initiation and decision making. Object reference systems use visual, tactual, olfactory and concrete symbols, pictures and art to convey a message. This system is most often used by persons who are congenitally affected and are learning other communication systems, or with persons who have been unable to learn other methods effectively. It is also used in part with deaf-blind persons who have intellectual disabilities as a result of being institutionalized for many years.

(b) Communication Boards - This system is used to convey a message usually in an environmentally specific manner. The board can have display of English words or alphabet tactile symbols, art, pictograph symbols, etc.

(a) FM Systems - This device provides a personal receiver worn by the hearing impaired-blind person and a transmitter worn by the speaker. This amplification device allows one to participate in a large audience setting as the speech is transmitted directly to the user's receiver blocking out environmental sounds.

(b) Speech Reading - Deaf-Blind persons who have some vision can use speech reading. It is a complex process that involves the association of visual symbols with spoken language through the decoding and piecing together of visual pattern. The technique of speech reading for the most skilled communicator is only at best 30% accurate and accuracy is further reduced by such things as lighting condition, language fluency of the speaker, visual impairment, etc.

(c) Tadoma - The Tadoma method is a system of receiving speech through the sense of touch. The person who is deaf-blind places his hand on the face of the speaker, the thumb gently touching the lips and the other fingers spread over the cheek, jaw and throat. This technique takes specialized teaching and years of practice to perfect.

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