RE:view, volume 37, Number 3, pages 109-116, Fall 2005.
Reprinted with permission of the Helen Dwight Reid Educational Foundation.
Published by Heldref Publications, 1319 Eighteenth St., NW, Washington, DC 20036-1802.
Copyright 2006.

RE:view - Fall 2005

Teaching Deaf-Blind People to Communicate and Interact With the Public
Critical Issues for Travelers Who Are Deaf-Blind

Eugene Bourquin and Dona Sauerburger

Travelers with dual sensory losses present the rehabilitation professional with additional tasks and responsibilities that expand the instructional curriculum. Effective instruction in rehabilitation and orientation and mobility includes teaching strategies and tools for dealing with unfamiliar people through communication (conveying information) and interaction (knowing when and how to use specific communication techniques). Incorporated in those two skills are acknowledging the public’s typical lack of awareness of the nature of deaf-blindness, understanding that the traveler knows his or her own needs better than others do, and being able to assert one’s needs effectively. Teaching effective techniques for communication and interaction, skills that are critical elements for the quality of everyday life, is a necessary component of comprehensive rehabilitation. Unless instructors address these additional needs of students who are deaf-blind (see note), comprehensive rehabilitation is not possible.

Although travelers who are deaf-blind present challenges because dual sensory loss may affect many interpersonal transactions, professionals can and should design instruction that addresses real-world circumstances and assist travelers in overcoming barriers found in everyday activities. The past several decades have seen the development of various approaches to addressing many of these challenges (DeFiore & Silver, 1988; Florence & LaGrow, 1989; Franklin & Bourquin, 2000; Gervasoni, 1996; Lolli & Sauerburger, 1997; Sauerburger, 1993; Sauerburger & Jones, 1997). In this article, we assume knowledge of these strategies and methods and will not present a detailed review of those approaches. Rather, we consider the communication and interaction of people who are deaf-blind with the public and the teaching techniques that we have found effective. The techniques we present are the results of our collective experiences with people who are deaf-blind, including several decades of instructing these travelers in community-based and residential settings.

Effective Communication Strategies

Basic Considerations

Choosing which communication strategy to use depends on the person's hearing, vision, and language skills; cognitive abilities; comfort; and assessment of the risk. The more methods that the person can use skillfully, the easier communication with the public will be. People who are deaf-blind can communicate with the public through gestures, in writing (prepared or ad hoc), orally (spoken or prerecorded), or by presenting symbols and pictures. The public can respond to the person who is deaf-blind by tapping the person on the arm or shoulder, some form of written messages (e.g., printing on the palm of the hand, using devices such as an alphabet card, writing on paper), speaking, presenting yes or no signals, and exhibiting actions or behaviors.

Generic cards and tools are not always effective. The design of the communication should match the physical and cognitive needs and skills of the person who is deaf-blind and provide the public with quick and easy ways to respond. For example, cards may be made that assist a person who is deaf-blind to arrive at certain destinations; that guide him or her to the counter at a store or business, to a certain bus, across a street; or that provide certain assistance on a train or airplane. The variety of cards and messages that can be created is as endless as the list of specific needs of these travelers. Some situations require a communication tool that provides the public with a limited choice of responses: for the person who is deaf-blind and has limited understanding of English or to communicate with people who have limited time, such as bus drivers or salespeople.

Communication cards can be developed for multiple purposes. A card may have a variety of labels that can be attached with Velcro to complete a sentence, such as "Please guide me to the (insert the name of a store or business)" or "I would like to order (insert a food item)." In Seattle, people who are visually impaired can flag buses by using tools in which the number of the bus is inserted into a clear plastic sleeve.

FIGURE 1. Tag for a specific purpose. Along the top of the card are columns saying 'NO TRACK YET, TRACK 1, TRACK 2, TRACK 3, TRACK 4.'  Below the columns are instructions saying 'Please move the paper clip to the track number of the next departing train, and return the card to me. Thank you. I am deaf and blind.' Examples of Tools Created for Specific Purposes FIGURE 2. Example of a fill-in-the-blanks card.

Keep the Communication Simple and Focused

Effective Strategies for Interaction With the Public

In addition to knowing how to communicate with the uninitiated public, people who are deaf-blind need to know how to interact with them: how to get someone’s attention; how to assert their needs. Probably the most common problem that occurs when interacting with the public is for the person who is deaf-blind to assume that the other person knows they are deaf-blind and knows how to help and communicate with them. When other people do not act as expected, the person who is deaf-blind often assumes it is because those people are rude or do not like people who are deaf-blind. They do not realize that the people have no ability to interpret this typical situation properly. People who are deaf-blind sometimes begin to mistrust the public and avoid traveling when and where they must interact with other people. Understanding the following principles for successful interaction can help people who are deaf-blind interact effectively: Figure 3. The current street-crossing card of the Helen Keller National Center for Deaf-Blind Youths and Adults. Actual size is 8 in. x 4 in.
  The card has a drawing of one person guiding another, and says: 'Please help me to -- CROSS STREET -- TAP ME -- IF YOU CAN HELP -- I am deaf and blind.' Getting the Public's Attention

To communicate effectively with the public, people who are deaf-blind need to get people's attention and convey that they want to communicate or receive assistance. To do this, it is best for them to stand where they are most visible and where others are likely to be, at locations such as a bus stop or store entrance. More people are likely to be at street corners than at midblock. People who are deaf-blind should make certain not to stand behind a bush or pole where they cannot be seen. They can use an electronic travel aid to recognize when people are passing, go into stores or businesses to find people to help, or perhaps even approach people's homes, if they are not concerned about the safety of doing this.

Having gotten people's attention, travelers who are deaf-blind must make it clear that they want assistance, or the public will simply pass by (Sauerburger & Jones, 1997). The following strategies may be effective for this purpose: Building Backup and Fail-Safe Tools

A fail-safe strategy is one that reliably informs the user when techniques are not working; a backup plan handles situations when the original strategy does not work or unpredictable situations occur. Developing several ways to communicate and interact increases the probability of a successful interaction. Devising backup procedures for the various situations that may arise puts decision making into the hands of the individual who is deaf-blind. Incorporating them into travel plans may circumvent frustrating and unsuccessful experiences and give the traveler confidence and security.


We believe that this area of inquiry is rich with potential and mostly unexplored. Insufficient published research exists concerning the many communication and interaction possibilities for travelers who are deaf-blind. Many of those individuals navigate simple and complex communication situations daily, and probably many of their strategies and successes are as yet undocumented.

We have found that the following procedure has proven highly effective for communicating and interacting with the public.

Preparing for Experiences With the Public Before Going out on Each Session Trying the Communication Techniques With the Public

It is best if the traveler first practices simple situations that eventually become more unstructured. An example of the hierarchical order to follow for lessons starts with getting help to cross streets (very structured communication). The next steps are shopping in small stores, shopping in large department stores, riding a bus, and, finally, soliciting aid to reach an unfamiliar destination or when lost.

The instructor does not prepare the public for the interaction ahead of time. During the interaction, the instructor observes unobtrusively and does not intervene. Thus, the person who is deaf-blind can experience actual interaction and learn the effectiveness of her or his communication skills. After the experience, the instructor provides objective feedback about what he or she observed, brainstorms with the student about why the interaction did or did not work, and suggests new ideas to improve the interaction.

Instructors should be aware that the level of acceptable risk and benefits of communication and interaction with the public must be decided only by the person who is deaf-blind. Although the instructor can teach strategies and explain possible consequences, individuals who are deaf-blind must judge each situation for themselves and make the final determination of whether to incorporate or reject techniques. What might be a simple task for one individual may be untenable for another person. As part of instruction, rehabilitation professionals should include self-assertiveness and self- advocacy as a primary component to the greatest degree possible.


We have chosen to use the term deaf-blind. This is the nomenclature of the major consumer organization in the United States, American Association of the Deaf-Blind (AADB), and the largest rehabilitation agency, the Helen Keller National Center for Deaf-Blind Youths and Adults. It was also the preference of individuals who are deaf-blind in a survey conducted by AADB.


Cioffi, J. (1996). Orientation and mobility and the usher syndrome client. Journal of Vocational Rehabilitation, 6, 175-183.

DeFiore, E. N., & Silver, R. (1988). A redesigned assistance card for the deaf-blind traveler. Journal of Visual Impairment & Blindness, 82, 175-177.

Florence, I. J., & LaGrow, S. J. (1989). The use of a recorded message for gaining assistance with street crossings for deaf-blind travelers. Journal of Visual Impairment & Blindness, 83, 471-472.

Franklin, P., & Bourquin, E. (2000). Picture this: A pilot study for improving street crossings for deaf-blind travelers. RE:view, 31, 173-179.

Gervasoni, E. (1996). Strategies and techniques used by a person who is totally deaf and blind to obtain assistance in crossing streets. RE:view, 28, 53-58.

Lolli, D., & Sauerburger, D. (1997). Learners with visual and hearing impairments. In B. B. Blasch, W. R. Wiener, & R. L. Welsh (Eds.), Foundations of orientation and mobility (2nd ed., pp. 513–529). New York: AFB Press.

Sauerburger, D. (1993). Independence without sight or sound: Suggestions for the practitioner working with deaf-blind adults. New York: AFB Press.

Sauerburger, D., & Jones, S. (1997). Corner to corner: How can deaf-blind people solicit aid effectively? RE:view, 29, 34-44.

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