Telephone Accessibility for Individuals with Dual Sensory Impairments: A Case Study

Rehabilitation efforts for children with congenital dual sensory impairments, or deaf-blindness, have a long-standing history. Rehabilitation for older people with acquired dual impairments has recently moved to center stage because of the increasing number of clients who require such services (Saunders & Echt, 2007). For both these groups of clients, service delivery follows already established pathways. However, it has been our experience that a third group of rehabilitation clients, namely, those who are affected by slowly progressive and early-onset impairments, often require individually tailored unique interventions that need to remain flexible over long periods. This Practice Report describes one such process in which a client's (and the rehabilitation agency's) rehabilitation goal was to make telephone services accessible in the presence of a progressive sensory-and-motor impairment that was due to Charcot-Marie-Tooth (CMT) syndrome. CMT syndrome is one of the most commonly inherited neurological disorders (Garcia, 1999; see also ). Discovered in 1886 by three physicians, Jean-Martin Charcot, Pierre Marie, and Howard Henry Tooth (Charcot & Marie, 1886; Tooth, 1886), CMT affects an estimated 2.6 million people worldwide. Symptoms usually begin in late childhood or early adulthood. The neuropathy of CMT affects both motor and sensory nerves. Persons with CMT slowly lose the use of their extremities, and some lose sensory nerve function, thereby impairing their hearing and vision. CMT is caused by mutations in genes that produce proteins that are involved in the structure and function of either the peripheral nerve axon or the myelin sheath. Consequently, these nerves slowly degenerate and lose the ability to communicate with their target cells. CMT usually does not affect life expectancy, but can cause severe disability. Even though there is no cure, physical or occupational therapy or both may be beneficial. CASE STUDY Access to the dossier information was approved by the Centre de recherche interdisciplinaire en readaptation de Montreal metropolitaine, the institutional ethics review board for rehabilitation agencies in the Montreal region. The person who benefited from this specific technological collaboration is John (a pseudonym), a 59-year-old man who was diagnosed with CMT syndrome at age 16. has a master's degree in English literature and is a passionate poet, which was also his main motivation for pursuing the use of assistive technology. At age 42, John was diagnosed with Type 1 diabetes mellitus; he used a manual wheelchair and lived independently until age 56, at which point he moved into a long-term assisted living environment. is possibly best described with a quote from his neurologist: He leads a remarkably full and active life. His visual impairment began during high school, at which time he began to develop his current skills in the use of assistive technology, such as his video magnifier, full view AOLITE spectacles (high-power reading glasses), and large-print computer software. John also uses a large-print watch and a large-print clock. attempted to learn and use braille, but he was unsuccessful because of sensory-and-motor deficits in his hands that were related to both CMT and diabetes. At the time of this rehabilitation intervention, his visual status was OD acuity 20/1500 (6/ 420), field diameter (Octopus) 22 degrees horizontal x 25 degrees vertical; OS acuity 20/1900 (6/480), 35 degrees horizontal x 35 degrees vertical. His hearing impairment began during adolescence; he has had only perceived static noise in his left ear since age 15 and continues to experience constant binaural tinnitus. John received a cochlear implant on his left side at age 56 and on his right side at age 58, in 2010. It is unclear to what extent the vision loss is related to his Type 1 diabetes mellitus or to complications related to CMT. …

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