In January 2020 I got an interview invitation from Health Hearing to talk about “Living with Dual Sensory Impairment”. Answering the interview questions helped me sort out my perspectives about the adaptation, rehabilitation, and research needs for people with dual sensory loss.
To read the published interview, please go to https://accuquest.com/what-is-dual-sensory-impairment/
1) Can you give our readers a brief overview of dual sensory impairment? Is there a particular age demographic which is more likely to experience it?
A: Dual sensory loss is the co-occurrence of vision and hearing loss. As we age, it is not uncommon to have both vision and hearing issues. Survey studies based on different communities and countries all show that the prevalence of dual sensory loss increases with age. In the United States, the prevalence is estimated to exceed 20% for adults older than 70. The most common causes of vision loss in older adults include age-related macular degeneration, glaucoma, cataracts and diabetic retinopathy.Hearing loss in older adults can result from a variety of causes, such as presbycusis, noise, or even from medicine commonly used by older adults that have toxic side effects on hearing. Compared to people with single sensory loss, the combined loss can make everyday tasks more difficult. But it is important to recognize that the majority of people with dual sensory loss still have functional vision and hearing, and timely and effective rehabilitation can help maintain their functional independence and quality of life.
2) Besides the aging process, what other factors can be attributed to causing this condition?Are there ways to prevent it?
A: Some genetic deceases can also cause dual sensory loss; the most common one is Usher syndrome. Usher syndrome causes hearing loss and a visual condition called retinitis pigmentosa, which affects night vision and causes loss of peripheral vision. Dual sensory loss can also occur after traumatic brain injury and blast exposure, which is frequently reported in veterans.
It is hard to control a family history of inherited eye diseases such as glaucoma or macular degeneration, but recent research shows that a healthy lifestyle, such as not smoking, a healthy diet and regular exercise, can reduce the risk of developing eye conditions. Similarly, scientists don’t yet know how to prevent age-related hearing loss, but we can prevent noise-induced hearing loss by staying away from damaging noises throughout our lifetime .
3) What symptoms might indicate an older person is developing dual sensory impairment? How quickly should they seek medical attention once these symptoms occur?
A: When an older person complains about difficulties in seeing and hearing, it is possible that they are developing dual sensory loss. Different vision and hearing pathologies can cause different symptoms. The most common symptoms of vision loss include reduced acuity, reduced contrast sensitivity, and visual field loss. As a result, an older person might show difficulties in reading small print and recognizing faces, and might bump into things more often.The most common symptoms of hearing loss include difficulties in speech perception and sound localization. In noisy or reverberant environments, an older person with hearing loss might find it very difficult to keep track of conversations.
Since sensory loss is often a slow process, a problem might not be detected until the symptoms are advanced. There are many reasons why it is good to be sensitive to behavioral changes and seek medical attention as soon as possible. The behavior changes and difficulties in everyday life can cause anxiety and self-doubt in the older individuals. Without knowing the causes, they might make inappropriate assumptions about their cognitive state. The ophthalmologists and otolaryngologists can help find out whether there are vision and hearing problems before assuming a cognitive impairment.
Vision and hearing loss both affect communications. The unmet needs for glasses and hearing aids can push older persons further away from social activities. There are actually studies showing that people with dual sensory loss are less likely to participate in social activities and more likely to develop depression symptoms. Rehabilitation therapists can help with adaptation and accommodation after sensory loss. They will prescribe assistive devices and teach coping strategies, which will make everyday tasks and communications much easier.
4) What are the biggest challenges facing those with acquired dual sensory impairment? How can family members help them navigate the diagnosis?
A: Sometimes dual sensory loss is perceived as “double trouble”, but the challenge of dual sensory loss is really not just an additive effect of vision and hearing loss. People with vision loss can rely on their hearing, and people with hearing loss can rely on their vision. This “sensory compensation” is a natural reaction to sensory loss, but it is not as useful for people with dual sensory loss. For example, audiobooks can help vision-impaired people in their reading, and closed captioning can help hearing-impaired people while watching videos. These aids are less helpful for people with dual sensory loss. Moreover, since people with dual sensory loss are often older in age, it is very likely that they also have other health issues. The combined health issues can be overwhelming and make them unable to cope with the vision and hearing loss, or even unaware of the changes in vision and/or hearing.
Family support is crucial for older people who are dealing with dual sensory loss. As family members, we can be observant of the behavioral signs of sensory loss. Do they watch TV at a very loud volume? Do they have to lean forward in conversations? Do they have to hold newspapers very close or at a weird angle? Detecting these changes in the early stages can help the elders get timely medical advice. We need to be patient when elders have communication problems, and can encourage and create opportunities for them to engage in social interactions. Moreover, it can be very helpful if family members are attentive in the rehabilitation process. Some assistive devices are very useful but can take time to get used to. For example, handheld magnifiers are frequently prescribed to assist reading, but the patients need to figure out how to position the book and move the magnifier in a less tiring way. Therapists can teach practical strategies but it rests upon the patients themselves to practice on a regular basis. In another example, therapists might teach patients how to move their head and eyes to search for targets or to avoid bumping into people or objects, and require the patients to practice on a daily basis. Family members can help with the use of the assistive devices and keep track of the training routine.
5) Once an individual is diagnosed with this condition, what types of treatment and/or education is recommended? Does treatment differ for those who have congenital dual sensory impairment as opposed to those who acquire it?
A: When it comes to treatment, ophthalmologists and otolaryngologists are the experts. Although treatment might not necessarily cure the vision and hearing conditions, they can often slow down deterioration, stabilize the conditions, and relieve discomforts. Optometrists and audiologists prescribe vision and hearing aids to magnify the use of the residual senses, and therapists teach practical coping strategies in daily living situations. For example, orientation & mobility therapists can teach how to safely navigate public spaces. Occupational therapists can teach skills in activities such as cooking, reading, and managing bills, and they can also help optimize the patients’ living environment in ways such as modifying the lighting and marking the staircases.
People who have congenital dual sensory loss start learning coping strategies when they are very young, and often become very proficient through a lifetime of practice. People who acquire dual sensory loss in their older age, however, are often unprepared for these changes. Moreover, for them, learning new strategies is not as easy since they have to get rid of their “old habits”.
In my perspective, patient education is almost as important as treatment. Understanding the association between the figures and numbers on the medical records and the difficulties in everyday life is often the first step towards developing coping strategies. For example, people who have peripheral vision loss might frequently miss ramps and steps, and bump into objects. They can learn why this is the case by a very simple explanation of their visual field test results. For older persons with dual sensory loss, it is important to educate them about the safety and social difficulties that they might experience due to the combined loss, and to make them aware of the changes in vision and hearing during the day and in different environments. For the majority of people with dual sensory loss, another crucial point to learn is that they still have functional vision and hearing, which can serve them to a greater extent with proper rehabilitation strategies. Maintaining the use of residual vision and hearing is a great exercise for the brain, and with time we become more and more efficient in using the visual and auditory information.
6) As a fellow at ERI, what do you hope your research will provide clinicians who work with dual sensory impaired patients?
A: I noticed the high co-occurrence of vision and hearing loss through my communication with the older participants who volunteered in my research projects. After that I combed through the literature only to find that there has been very little research devoted to this large population. People with dual sensory loss are in urgent need of assistive devices that can accommodate both vision and hearing loss, coping strategies that can optimize the use of residual vision and hearing, and public navigation systems that can provide rich visual and auditory information.
My research in Envision Research Institute focuses on developing a clinical test to evaluate functional vision and hearing. Different from conventional assessments for diagnostic purposes, this test focuses on vision and hearing abilities that are more relevant to everyday functions, such as localizing and tracking moving targets (like cars or people) in the environment. Another innovation that is particularly important for people with dual sensory loss is that this test will provide information about vision and hearing both individually and in combination. From development to validation, I am working closely with the clinicians and patients in the Envision Vision Rehabilitation Center to ensure that this test is feasible and valuable. I hope that this test can help clinicians educate patients about their own limitations, and to develop customized rehabilitation strategies accordingly. In the long term, I hope that my research can contribute to the rehabilitation of people with dual sensory loss, and bring more researchers to this field.
7) Are there any new solutions on the horizon and, if so, when might they be rolled out to the public?
A: An “integrated rehabilitation approach” has been proposed recently to address the special needs of people with dual sensory loss. This approach proposes that we need to address dual sensory loss within the context of the whole individual, taking into account the combined loss so that we can develop assessments, accommodations, and strategies to optimize the residual capacities. Although the specifics of this approach are still under investigation, there are emerging efforts and growing awareness devoted to this population. Dual sensory loss is a unique topic which by its nature requires collaborations between vision and auditory scientists, between vision and hearing clinicians, and between the scientists and clinicians. Bringing this population into public awareness is crucial for boosting the development of an integrated rehabilitation approach.