A woman tilts her head down, covers her ears and closes her eyes.

Multisensory impairment

Multisensory impairment (MSI) is any combination of sight loss and hearing loss. MSI is also known as dual sensory loss or deafblindness.

MSI represents a wide range of conditions; it can be anything from relatively minor impairments to complete loss of both senses. So if you have MSI, you may experience something very different from another person with MSI.

Types of MSI

There are two different kinds of MSI: acquired and congenital.

Acquired MSI is the most common form of this condition. If you have acquired MSI, it means you developed at least one of your sensory impairments over time. Fortunately, you will probably keep some degree of one (or both) of your senses if you are diagnosed with acquired MSI.

Acquired MSI is more common amongst older people. It affects about 4% of people over the age of 60. If you're in this age group and experience acquired MSI, you may notice that both your sight and hearing will worsen as part of the normal ageing process. MSI can also happen when you take certain medications or have other health conditions.  

Congenital MSI happens when—for one reason or another—you are born with some degree of hearing loss or sight loss.

MSI management

There are three overall types of MSI management: prevention, treatment and support.

Prevention

Prevention aims to stop sensory impairments from developing or worsening. For instance, to prevent hearing loss, you should use hearing protection if you are regularly exposed to loud noises.

There are some manageable medical conditions that can impact your vision or hearing too. Lifestyle changes are the most proactive form of prevention, but treatment may be required. Diabetes, glaucoma and vascular problems are common examples, particularly when ignored. So if you have been diagnosed with one of these conditions, you should seek treatment quickly to reduce the chance of further sensory loss.

Certain medications can cause sensory loss as well. If you are required to take a new medication, check with your doctor to find out if sensory loss could be one of the possible side effects of the treatment.  

Treatment

Depending on the type of hearing or sight loss you experience, treatment may be available.

Sight loss. Opticians can tell you what options would be most effective. Glasses or contact lenses may help you if you have limited vision, but some visual problems can also be treated surgically. Cataracts, retinal detachment or keratoconus are conditions where surgery might make sense.

Hearing loss. Audiologists can help you with hearing loss. Hearing loss technology like hearing aids are the most common solution, but in some cases, cochlear implants might be more appropriate.

Support

Often the most important aspect of managing MSI is getting the support you need. There are several ways to do this, but you may discover that you require help from many sources. Healthcare professionals, support organisations and your loved ones can all play a vital part.

You may need additional support if you have severe MSI. Long cane training can help you navigate the streets, and guide dogs—specifically trained by Guide Dogs UK for people with sight loss or Hearing Dogs for Deaf People—may also be an option. Just keep in mind that you may have to wait quite a long time for a guide dog to become available.

When you create your customised support package, one of your key goals should be to maintain as much of your independence as possible. An occupational therapist can assess your home so you can make adaptations to support your independence. Adjustments—such as removing trip hazards, improving lighting and installing flashing fire alarms—can be minor, but they can make a big difference.

Major adaptations (such as kitchen remodelling) might also be necessary in order for you to be able to cook for yourself and stay independent. And if you work, your occupational therapist can suggest adaptations that will help you in the workplace too.

Communicating with friends, family and carers

If you have MSI, you will need to select your preferred method of communication. Even simple suggestions can really help!

For instance, if you still have some degree of your hearing, just ask people to speak clearly and directly during a conversation. Finding a quiet space to chat is an even better idea.

But if you can't hear or speak, inexpensive aids (like picture charts or photographs) can be useful. And if your vision is good enough, a notepad and pen are vital tools.

However, you might decide to learn sign language instead. There are several different kinds of sign language to consider:

  • Visual frame sign language is a form of sign language that is helpful if you have visual field loss (e.g. tunnel vision). It involves performing signs in an area that you can see.
  • Hands on sign language can be helpful if you have both severe visual and hearing loss. This involves signing where you can feel what signs are being made.
  • The deafblind manual alphabet allows similar hands on communication and is also useful if you have severe visual and hearing loss.

Being able to communicate with family members and loved ones is vital to maintaining relationships. It also allows family members to act as emergency interpreters, if you need them.

Reading

When you have MSI, large text may be helpful if your visual impairments are minor. However, if your sight loss is more severe, you may prefer another form of reading. Talking newspapers (like the Jewish Care Connect service) and talking books (offered for free through the Royal National Institute of Blind People) can be very valuable.

However, you may decide to learn braille, which uses raised bumps on a page to replicate letters (or sounds). Around for nearly 200 years, braille is frequently found in public places and on signs and other common items.

Technology in action

Technology is another way for you to stay in touch with people and keep up to date with current events and the news. Newer braille technology has been adapted to create screens, so you can read electronic text and use a computer. Text-to-speech synthesizers (included with most modern computers) are great as long as your hearing is adequate.

Consider this example of how technology can help you if you live with MSI. Dan, who is 30 years old, was born with limited sight. Over time, his sight has deteriorated. Meanwhile, when he was a child, an eardrum injury left him with long-term hearing problems. Dan uses one hearing aid and a cane, but he says his phone is his lifeline.

“You wouldn’t believe just how useful my iPhone is these days," Dan says without hesitation. "I can do everything with my phone—from reading post and identifying items of food to using Facebook, Twitter, email, music and just about anything else you can think of. It’s kind of become an extension of my right arm these days.”

Still, Dan advises others with MSI to embrace technology. He says, "As someone with multiple disabilities, I feel incredibly fortunate to be living in the time I’m living in. With the advent of devices like my iPhone, it has become much easier for disabled people to be more self-reliant and independent than they have ever been. I feel incredibly lucky to be living in 2018, and not 1978.”

Where to find out more

Dan has additional advice for anyone living with MSI (or the people that wish to support them): “Investigate any local services/charities that have been set up for them depending on their condition. I am a member of the RNIB, and a member of Cardiff Institute for the Blind. And I often find that local services/charities do a better job at catering for people than national services/charities."

If you or a loved one have this condition, there are several organisations which can support you. The following resources can help you get started.

  • Deafblind Enablement is dedicated to providing skill development for people who live with sight and hearing loss.
  • Deafblind Scotland strives to protect the rights of this community and offers a range of services.
  • Deaf and Deafblind Community is a resource from the JDA (Jewish Deaf Association) that is designed for people who mainly use British Sign Language to communicate.
  • Deaf Blind UK offers definitions, articles and medical information about deafblindess.
  • Information about multi-sensory impairment is a downloadable document that primarily concentrates on children and young people, although the general information can apply to people with MSI of any age.
  • Kent Association for the Blind has a section of its website that specifically covers deafblindness.
  • Lesser-known things about being deafblind by Liz Ball explains some of the sensory observations that take place when you live with deafblindness.
  • NHS Choices has an overview of deafblindness along with practical advice regarding signs of deafblindness, causes and support.
  • Sense is an organisation that describes itself as "a national disability charity that supports people with complex communication needs".
  • Sensory Learning Hub from the National Sensory Impairment Partnership is a collection of documents and other resources for those who work with people (particularly young people) who live with sensory impairments. Registration is free, but it is required for full access to the site.
  • Signature is an organisation that teaches people how to communicate with people who have MSI.

Jewish Care Interact has specific information on living with sight loss or living with hearing loss if you are looking for more on individual sensory changes. Jewish Care Interact also has general information about age related sensory changes as well.

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