Introduction

The participation of a student with Deaf-Blindness (DB) in recess can often be both challenging and rewarding for the student and teacher. This paper addresses common characteristics of students with DB and present basic solutions to improve the experience of these students in the recess setting. Initially the definition, characteristics, and prevalence of DB will be presented. The paper will then address recommendations for children with DB in recess.

Definition, Characteristics and Prevalence of Deaf-Blindness

The Individuals with Disabilities Education Act (IDEA) states that children who are determined to have disabilities receive special education if the condition negatively affects the educational performance of the child. One such category, which includes a variety of specific disabilities, is deaf-blindness. The definition of DB in IDEA is as follows:

...concomitant [simultaneous] hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness. [[section]300.8(c)(2)] (IDEA, 2004).

Important characteristics of DB include the following:

* Does not mean total deafness and total blindness for the individual

* Is a combined vision and hearing loss that impacts an individual's learning, communication, and interaction with the world

* Impacts the way an individual accesses information

* Requires special modifications and supports that go beyond what is typically needed with a hearing loss alone or a vision loss alone

* Individuals with combined vision and hearing loss cannot rely on vision or hearing to effectively compensate for the lack of the other sense (Supporting Parent Access to Resources, * Knowledge, Linakage, and Education, 2005).

In terms of prevalence, a child count is conducted each year to supplement the Office of Special Education Programs (OSEP). This data is collected for each disability in isolation. As an example, data is collected for children with (DB) in isolation and occurs when DB is their single disability. Since nearly 90% of the children with DB have one or more additional disabilities, it is virtually impossible to determine the figure of children who have DB. These children may be classified under OSEP categories. (National Center on Deaf-Blindness, 2015)

Causes of Deaf-Blindness

There are a variety of causes to an individual having DB. The most common of these causes, about 50%, is Usher Syndrome. Usher Syndrome is a condition where a person is born deaf or hard of hearing, or with normal hearing, and loses his or her vision later on in life from retinitis pigmentosa. (American Association of the Deaf-Blind, 2013). Other common causes of DB include:

* Problems associated with premature birth (birth before 37 weeks of pregnancy)

* An infection picked up during pregnancy, such as rubella (German measles), toxoplasmosis or cytomegalovirus (CMV)

* Genetic conditions, such as Down's syndrome

* Cerebral palsy--a condition dealing with the brain and nervous system that mainly affects movement and co-ordination

* Fetal alcohol syndrome--health problems caused by drinking alcohol during pregnancy. (National Health Services, 2015).

Some children may be born with both hearing and visual impairments but loose these senses through birth trauma or other rare reasons. (American Association of the Deaf-Blind, 2013).

Deaf-Blindness Related to Education

Combined hearing and vision loss--the two senses that are relied on most in education--is very disrupting to the learning, communication, and interaction of a child with the world. Important characteristics of individuals with DB that are related to learning include the following:

* Impacts the way an individual accesses information

* Requires special modifications and supports that go beyond what is typically needed with a hearing loss alone or a vision loss alone

* Cannot rely on vision or hearing to effectively compensate for the lack of the other sense

* Difficulty developing concepts

* Being withdrawn, inwardly focused, or preoccupied with their bodies

* Difficulty communicating and interacting with others

* Can benefit from routine and systematic instruction (Supporting Parent access to Resources, Knowledge, Linakage, and Education, 2005).

As noted earlier, the difficulty in communication often makes learning more of a challenge for children with DB. The communication methods for each individual are varied depending on a variety of items including their combined vision and hearing ability (the degree of each), their background, and their education. Common methods of communication for people with DB include:

* Sign language (adapted to fit their visual field)

* Tactile sign language

* Tracking

* Tactile fingerspelling

* Print on palm

* Tadoma (a method where the individual with DB uses his/her hand to feel the lips and cheeks of speaker)

* Braille

* Speech reading. (American Association of the Deaf-Blind, 2013).

Benefits of the Recess Setting for Children with Deaf-Blindness

Simply stated, the benefits of the recess setting are high for all children. Included in these benefits are both physical and social benefits. In terms of physical benefits, recess has been shown to lead to:

* Improvement of out-of-school activity levels--children usually are involved in physical activities on days in which they participate in in-school physical activities. (Dale, Corbin, & Dale, 2000)

* Improvement of general fitness and endurance levels for children. (Kids Exercise, 2009).

As stated, it is also important to note that the social benefits gained from recess for children with DB are also high. Social benefits of recess include an opportunity to engage in peer interactions and play in which they learn valuable communication, negotiation, cooperation, sharing and problem solving skills. These interactions and learning opportunities promote social and emotional development, especially when adult supervision is provided to guide learning and practice of pro-social skills. (About.com Health's Disease and Condition, 2013)

Recess Recommendations for Children with Deaf-Blindness

Safety is the most important item to consider when children are participating in recess. Safety is of vital importance for children with DB as injury is more possible. Listed below are some beneficial active recess choices for the child with DB. Each item should be carefully assessed in regards to the individual student to ensure safety. It should be remembered that total blindness and total deafness are atypical for children with DB.

* Swinging on a swing set with a safe professionally developed adaptive modified swing

* Using a seesaw with assistance as needed

* While seated, rolling balls with a partner a few feet (ball with a bells)

* Using a sand table with a variety of objects with a partner (probably for lower grade children)

* Assisting with long jump roping by being a turner

* Jumping back and forth over a jump rope (with assistance as needed)--an item such as a poly spot can be used to provide feedback for the child

* Jump roping--with probably a large amount of instruction/ assistance

* Walking on a low balance beam with assistance as needed

Conclusion

The participation of a student with DB in recess can often be both challenging and rewarding for both the student and teacher. The rewards can manifest themselves in the ability of the teacher to guarantee the safety of all students in an instructionally sound environment. This paper has hopefully addressed some basic concerns and solutions to improve the recess setting of students with DB.

References

About.com Health's Disease and Condition. (2012). Recess--An important part of the school day for all students. Retrieved March 5, 2013 from http://add.about.com/od/schoolissues/a/ Recess-An-Important-Part-Of-The-School-Day-For-All-Students.htm.

American Association of the Deaf-Blind. (2013). Frequently asked questions about deaf-blindness. Retrieved March 5, 2013 from http://www.aadb.org/FAQ/faq_DeafBlindness. html#communication

Dale, D., Corbin, C. B., & Dale, K. S. (2000). Restricting opportunities to be active during school time: Do children compensate by increasing physical activity levels after school? Research Quarterly for Exercise and Sport, 71(3), 240-248.

Individuals with Disabilities Education Act (IDEA), Pub. L. No. 108-466. (2004).

Kids and exercise: The many benefits of exercise. (2009). Retrieved August 4, 2010 from http://kidshealth.org/parent/fitness/general/exercise.html

National Center on Deaf Blindness. (2015). The 2014 National Child Count of Children and Youth who are Deaf-Blind. Retrieved June 11, 2016 from https://91372e5fba0d1fb26b7213cee80c2bfb23b1a8fcedea15638c1f.ssl.cf1.rackcdn.com/ cms/2014_NationalDeaf-Blind_Child_Count_Report_ v112015_641.pdf

National Health Services (UK) (2015). Causes of deaf-blindness. Retrieved June 11, 2016 from fhttp://www.nhs.uk/Conditions/ Deafblindness/Pages/Causes.aspx

Supporting parent access to resources, knowledge, linakage, and education. eaf Blindness (2005). Retrieved March 5, 2013, from http://www.sparkle.usu.edu/Topics/deafblindness/

Matthew D. Lucas, Ed.D, C.A.P.E., Associate Professor, Longwood University

Tracy M. Frye, Student, Physical and Health Education Teacher Education, Longwood University