Acquired Deafblindness

Adapting the Environment

In the Home

Improve Lighting

When our eyes are not functioning properly light does not focus on the retina as it should. As we age our eyes need more lightning than we did when we were younger. Increasing illumination for people with low vision can make it easier for them to see to navigate their environment, with specific lighting being useful for reading and close tasks.

Poor lighting and shadows can increase the risk of falls, particularly on stairs and uneven surfaces. The need to adjust to different light levels when moving between rooms can be alleviated by keeping lighting levels in the home consistent wherever possible.The lighting needs of people with vision impairment will vary depending on the condition affecting their sight. For most people, additional lighting will improve their ability to see enough to navigate their environment or carry out daily tasks. However, we can never make an assumption, as increase lighting can cause glare for some and will cause considerable discomfort.

For people whose vision is limited to light perception, a light source can act as a useful navigational cue if it is a consistent light source.

As light travels from its source it will spread and weaken. By bringing the light source closer to a task or having additional lighting illumination levels will increase. Although increasing the voltage of a lamp is an alternative that can be beneficial , care must be taken to ensure that the voltage is not too powerful for the light fitting and the light shade.

Fluorescent strip lights fitted with a diffuser distributes light more evenly. Alternatively spotlights positioned to direct light in all directions are options for the kitchen, laundry or bathroom, however, although functionally useful some may not be pleasing to the decor in other areas of the home.

Other options such as down lights that are available to use with fluorescent, incandescent or halogen lamps positioned at even intervals can allow for an even spread of light.

Consider bringing light sources closer to a task such as positioning strip lighting under kitchen cupboards that can provide a more even and direct spread of light on countertops when preparing food etc. Additional lighting in the pantry directed over shelves can assist with identifying food items. Standard floor lamps and table lamps can add further illumination to a room.

Lighting tips in the home:
  • Walls painted with pastel colours will reflect light
  • Make use of natural daylight
  • Net curtains can obstruct natural light
  • Reduce glare from strong sunlight with vertical/horizontal blinds
  • Add more wall lights to spread light evenly
  • Choose a light shade that will not restrict spread of light
  • Add lighting to stairwells and entrances
  • Consider fluorescent strip lights with diffusers
  • Add strip lighting under cupboards
  • Don’t increase voltage of lamps/globes without checking they are compatible
  • Don’t use high gloss paintwork, this may cause too much reflection and glare

Improving Contrast

Creating contrast is another way to make it easier for a person with vision impairment to navigate their environment and carry out daily tasks.

Doors and/or doorframes that contrast in shade or colour to the door, wall and floor colourings will stand out more. With preferences often leaning towards neutral colour schemes; depending on the taste in décor the contrast can be a definite dark against light, however this does not need to be case, darker and lighter shades of the same colour can give similar effects. The aim is to create some contrast together with adequate lighting to provide maximum visual information.

Similarly, where furniture is the same or a similar colour or shade to the background, for a person with low vision or severe vision impairment the furniture will blend into the background making it more difficult to distinguish particularly for a person who also has difficulties with depth perception.

Living Areas

Above, a light airy room, however, with white furnishing against a white wall and light coloured flooring it would make it very difficult to see the lounge suite.Contrast could be improved by having darker flooring.The lamp stand would also stand out better on floor covering that is contrasted. A darker coloured mat could be an option, however, the risk of a mat being a trip hazard would need to be considered.Painting the wall in a colour that provides some contrast does not necessarily need to be a very dark colour but would benefit from being dark enough to make the lounge suite stand out against it.  A picture or print on the wall above the lounge suite could be an option if there is a preference not to re-decorate and could provide a visual cue in navigating the room.Having contrasting wall and flooring would also be an option, two shades of the same colour that contrast with the lounge suite could be considered.

Some scatter cushions in darker colours would provide some contrast for the lounge suite.  Walls in contrasting shades can also help, however, if cost is an issue for re-decorating a picture on the wall can also give some contrast and act as a visual cue in a room.

Kitchens, laundry rooms, bathrooms

Although lighting is reasonable in the kitchen (pictured directly beneath) there is no contrast and the dark décor makes this kitchen look dark.  Added to that the shiny surface of the countertop shows light reflections that can cause distortion.

kitchen-poor-contrast

The kitchen (pictured directly below) shows a bright kitchen with good  lighting, however,  the  white cupboards against a white wall provide no contrast and are difficult to see.  Some utensils here are contrasted so would be easy enough to locate.

white-kitchen

When choosing appliances look for contrast on controls so that setting the dials is easier.  Some control dials are contrasted to the appliance itself. Check wither the dial also has visible markings for setting. Alternatively, contrasting visual markers such as bump-ons or Velcro dots can be applied on  appliance controls.

Cooking

kitchen-contrastOrganisation plays a key part in cooking, and creating contrast can assist to make cooking equipment and food easier to locate.  Different coloured chopping boards, such as those in the example to the right, shows carrots contrasted on a yellow chopping board, a white bowl contrasted against the red chopping board. Coloured knives and other cooking utensils can be purchased that can also be used in a way the contrasts against a background.

contrast-non-slip-matsNon-slip mats (pictured left) are available in a range of colours and can have a dual purpose in providing contrast but also as a safety measure in preventing slippage of any items placed on them. Oven proof mats in contrasting colours can also be useful to highlight where to place hot pans, avoiding accidents and preventing damage to counter tops.

Likewise when serving up meals, think about the dishes that are being used and the food being served.  For instance white fish, mashed potatoes and cauliflower on a white plate will not be visible, whereas the same meal on a darker colour plate again offers contrast.  It will be difficult to see the liquid rise when making a cup of coffee using a dark coloured cup, change to a lighter colour or white cup and you have some contrast.

Clear transparent dishes will become invisible and water in a glass is easily missed with a risk of knocking over and breaking.

Hall, stairs and landing

Good lighting in entrance halls, particularly around stairs and landings is important to reduce risk of falls. The example below left, offers little contrast. For a person with low vision it is  likely to be difficult to judge the depth of the stairs.

In addition to good illumination contrast on steps and stair risers (eg below right) will make it safer and easier to negotiate. Likewise contrasting sturdy hand rails will be more visible for a person with low vision ensuring they are extended to the last steps or beyond at the top and bottom of flight.

Bedrooms

stairs-good-contrastSimilarly for bedrooms contrasting décor can be an advantage eg with bed linen in a contrasting shade to the bed frame, likewise for bedroom furniture.  Full length mirrors may also benefit from visual indicator stickers. Clothing and footwear can be organised in drawers , cupboards and wardrobes for easier identification. Sorting clothing by colours is one way or hanging up outfits that are regularly worn together.  Pairing socks in colours is also a useful tip.Think about contrast when placing everyday items on bedroom furniture.  A black comb will be difficult to find on furniture that has a dark finish. If furniture is dark an option could be using a contrasting mat in a lighter colour on top of a bedside table or chest of drawers and placing the black brush/comb or other dark items on the light mat for better visibility.

stairs-poor-contrast

How to improve contrast

Depending on the décor

  • Door handles in a contrasting colour
  • Pictures on cupboard doors will provide contrast
  • Contrasting coloured tape (electrical tape) on shelf edges
  • Contrasting coloured tape on the bottom edge of cupboard doors
  • Line shelves with contrasting non-slip mat
  • Contrasting non-slip mat on counter top
  • Contrasting visual markers such as bump-ons or velcro dots on appliance controls
  • Mark appliance controls for frequently used  temperature settings
  • Add visual indicators such as stickers with static cling that are available in a variety of designs including colourful pictures to glass doors and glass shower cubicles

AVOID:

  • shiny surfaces for countertops and flooring  that will reflect light and cause glare
  • glass doors and glass shower enclosures become invisible, reflect light causing glare and can be a hazard unless marked clearly

contrasting-door-handles

Tactile

For people who have severe vision impairment or who are blind it is more important to ensure everything has its place and is not moved without consulting with the person.   With little or no vision, organising the home will assist in locating items and navigating in the home.

Large open spaces can be more difficult to negotiate.  It is important to keep open plan areas free from clutter to avoid risk of falls. Some people are able to use a “mental map” to set out in their mind where everything is located in a room.  Some people will use pieces of furniture, walls and fixtures as cues when moving from one part of a room to another or to other parts of the home. Moving items of furniture can be frustrating and cause a person to become disorientated. In some cases a person’s safety is affected when items of furniture are placed within their usual path.

Handrails or decorative rails on a free wall in some parts of the home can be a tactile cue to follow when moving from one area to another, however, too many rails will make each room feel the same and defeat the objective. When using fixtures or items as tactile cues it is important that they are stable and consistent in positioning otherwise they do not play a role in the “mapping” system.

When setting up tactile cues they need to have different textures, sizes etc. to provide enough difference for a person to be able to identify it and associate with a different part of the home.

Other examples to distinguish between areas of a room or home are different textured walls, decorative tiles with varying textures positioned in different patterns or fixed wall plaques. A variety of wind-chimes can be set up within reach in a room, and, when touched, their unique sounds and vibrations can be used as an indication of being in a specific part of the home.

Different floor surfaces can act as a cue when moving between rooms, with carpeting and vinyl flooring having a softer feel under foot in comparison to wooden flooring or ceramic tiling. A person with dual sensory loss can gain a perception of the size of the room from the type of furnishings. Each will provide a different sound and feel to a room with sounds being absorbed by carpet, vinyl floor covering and soft furnishings reducing noise and echo, whereas sounds will bounce off harder flooring and furnishings causing the opposite effect.

Hazards in the Home

The following are some hazards we are all familiar with and affect everyone, however they are more of a risk to people who have little or no vision and with an awareness and some consideration, can be alleviated or minimised significantly:

  • Doors ajar – leave a door either shut or fully open. A half-open door is easy to bump into.
  • Cupboard doors should not be left open, they are often at eye level presenting additional risk of damaging any remaining vision.
  • If visiting a person in their home and you have brought a bag or any items of equipment make sure you do not place them in a position where they will become a hazard for the individual to trip or fall over.  If in doubt ask the person where you should place your items.
  • When sitting at a dining table, make a note of where the chairs are positioned and replace them before you leave, a chair is easy to bump into or fall over.
  • Rounded edges on tables, work surfaces in a kitchen or bathroom and other furniture will cause less of an impact if bumped into than sharp corners.
  • Pot handles left unattended and protruding on counters or oven tops can be knocked causing burns or scalding.
  • Trailing wires and rugs with curled edges again can become a trip hazard.

Reduce hazards to reduce risk.

Equipment

Adapting for Deafness or hearing loss

People who have limited or no hearing may benefit from adaptations in the home which may include the installation of equipment.

Phones adapted for individuals with low vision and hearing loss with large contrasting buttons, visual alerts and adjustable ringers and volume/amplification may be useful for some people, whereas others may use a TTY or use IT solutions to communicate.

Other solutions for situations where we rely on our hearing to know when:

  • someone is knocking at our door or ringing the doorbell
  • the telephone or fax machine is ringing
  • the smoke alarm is activated
  • a baby is crying or in distress

To overcome these difficulties items such as extra loud doorbells or extra loud ringers for telephones are available for purchase in large department stores. Some telephones have visual alerts inbuilt, although if a person is not in the room and unable to hear the phone ring they may not be aware the phone is ringing.

When this is insufficient specialist alerting systems are an alternative which can be explored and can come with visual options depending on the person’s level of vision too. A vibrating pager for people who have dual sensory loss or are deafblind may be helpful.

Visual alerting systems can be installed to be used with a portable receiver that flashes when the telephone rings. The receivers are often portable and can be moved between rooms or set up with more than one receiver.  Some systems are available that can be linked with the electrical system within the home and will cause room lights to flash. For a person with severe vision impairment the flashing light may not be sufficient even when they are in the room.

These systems can also be installed to work together with doorbells, alarm clocks, fax machines and baby alarms with the light flashing in a different pattern so the person can distinguish which alert is being activated.

People who are Deaf or have hearing loss may be at risk should there be a fire and be unable to hear the traditional smoke alarm. Smoke alarms can be set up with an extra loud ring or a flashing visual alert. However, people who wear hearing aids will leave them off during the night, therefore extra loud or visual alert functions may not be useful. An additional feature of these alerting systems is to have the smoke alarm connected to a vibrating pad placed under the pillow that will vibrate should the smoke alarm be activated.

The vibrating pillow pad is also useful to work with an alarm clock alerting the user should they need to be up for work or an appointment.

For people who have severe vision loss and are unable to see the flashing alert the option would be a vibrating pager worn on the clothing. In the same way the visual alert system flashes different signals for each function, likewise the pager will vibrate different signals to alert to callers at the door and the smoke alarm etc.

Listening to conversations with family and/or carers in the home can become difficult and frustrating for everyone concerned. Alleviate some of this frustration by reducing background noise and having soft furnishings to reduce echo and reverberation in a room.

For hearing aid users, installation of a room loop or use of a portable look may assist to improve communication. A room loop is only effective for people who have hearing aids programmed with Telecoil.

Listening to music or to the television can also present problems, loop systems can be linked to audio sources amplifying sound and eliminating background noise.  These systems will depend on the level of hearing loss. Another alternative is to use headphones that connect to the audio source with some of these being able to operate wirelessly or through infrared.

Please refer to the section on Equipment and Assistive Devices for further information of types of equipment and devices that may be useful.