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Case Study – Physiotherapy and Auditory Difficulties

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Source: “I See Your Voice: Practicalities, Problems and Possible Solutions for Deaf Students Accessing Learning Within a Health Profession Course, with Specific Reference to Physiotherapy.” Student Essay. http://www.ltsn.ac.uk/Members/marianne/studentessays/veritygreen/view.

Introduction

To introduce the setting of this essay I am putting forward an explanation of why I qualify to write under such a title. I am a final year physiotherapy student who is severely deaf in the right ear, profoundly deaf in the left. I speak with near perfect speech and usually only those who are musical are able to notice any slight differences when I speak. I am fluent in British Sign Language (BSL), though English is my first language due to being brought up in a hearing family and going to a mainstream school. BSL is my preferred language due to the greater amount of space and movement used when communicating with BSL compared to a pair of lips when lip-reading! Being a deaf student within a course that relies immensely on communication has presented many challenges to myself, and I suspect for my lecturers also.

Throughout my three years at University, each year has been an improvement on the last, leading to an extremely enjoyable but challenging final year. I believe the improvements were gained through both a greater understanding between my lecturers and myself. The lecturers vastly increased their knowledge and awareness of problems I may encounter, whilst I matured substantially with my own perceptions of my deafness. I have become more upfront in uncomfortable situations and have dealt with any self-prejudices I held as a person with a ::’Deaf identity’:: achieving the same as my hearing counterparts.

The Deaf Identity

The last comment may seem irrelevant if you do not understand the ::’Deaf identity’::, which sees deafness as a cultural and linguistic minority rather than a disability (Corker, 1993, British Deaf Association, 2002). This identity refers to a group of people who have their own language, values, social and political structure (Swanson, 1997). Harmer (1999) suggests that unlike other cultural and linguistic minorities, like Asians for example, deaf people are unlikely to be able to find a deaf health professional that they can relate to in their own language and who has an understanding of their culture. I therefore feel that I have a lot to contribute to both the raising of awareness in the hearing community as well as in the deaf to help create a health service that is accessible to all. Writing essays such as this will enable a larger number of people to be reached about disabled people going to university to train in one of the health professions.

My University Experiences

Year 1

This year was the most difficult with the variety of accents that were spoken from the lips of my new course mates and lecturers. This led me to selectively choose my learning environments based on what I could understand rather than what was best for me. Several students spoke of their respect for me and expressed their wish to have more integration within our year so that they could learn from me (our year was split into two groups that did not have much interaction with the other). This would have been beneficial from my point of view in that I would learn to understand those who were not in my group, and they could also learn from me. Strong and Shaver (1991) suggest that attitudes and awareness are improved when deaf people are mixed with hearing people within positive experiences and I do agree with such integration. However, I do not think that this should be routinely applied to everyone as it depends on the disabled persons’ personality and the amount of work that occurs on the course i.e. the amount of work in the first year of physiotherapy was immense and tiring for everyone, let alone someone who has to lip-read.

The lecturers made the occasional mistake, but nothing was such that made me feel they were not trying hard enough for my inclusion e.g. their positioning in lectures. Some were more approachable than others, usually those who I was more familiar with. I rarely felt left out in terms of being lectured to, with the exception of videos, none of which had subtitles. I also struggled with all the new medical terminology, as I did not hear the terms mentioned as much as my course mates would, and so the pronunciation and true meaning of many words often remained elusive until the second or third year of my degree. This links to a problem I often find with being deaf. People either may not notice or overlook any mistakes I make and assume it is due to something else and not my deafness. Due to being deaf from the age of two, my concept of the world is ::’normal’:: for me, therefore I do not realise what I miss or how I do things differently. When things are pointed out to me (as they were in the final year) I was able to change, but this affected my confidence as it could have been picked up earlier.

Year 2

In this year the prospect of clinical placements left me very worried such as auscultation on intensive care and communicating with patients on Neurology. The specialist modules I had in each area went well and any occasional lapse in positioning in lectures by the lecturers was swiftly corrected by themselves, my course mates, or if someone had not corrected it by this point then I would interject! The awareness within the course was much higher and this made me feel better due to not having to constantly correct people myself and feeling like ::’the constant disabled person’::. My confidence slowly came up as I had extremely good clinicians who never assumed anything of me and asked me questions about my deafness, which I felt helped our working relationship.

Year 3

What amused me this year, along with the second year, is that the first strength that all my clinicians wrote down on my marking form was ::’communication’::. I have now realised that I am able to get the best out of patients by adapting my many ways of communicating. Having to lip-read also gives the impression of constant eye contact, which one lecturer visiting me on placement thought was particularly good!

My main problems this year related to a clinician and my writing style. The latter issue was tackled after yet another assignment was returned to me (from the second year) with a comment on my writing. I took the assignment to the lecturer who marked it and asked for an explanation so that I could prevent it occurring in my final year work. It was fortunate that this lecturer was very aware of disabilities and had watched the programme for deaf people called ::’See Hear’:: (BBC2). He mentioned that reading my essay was like listening to the simplified language on this programme. He used two examples from my work to explain his point. I had used the word ::’right’:: instead of ::’correct’:: and talked about a persons’ ::’way’:: rather than their ::’manner’::. The infuriating matter was that I knew what these words meant, but for some reason I did not use them. I then realised that in BSL I would not use these words. Also, I would have been exposed to the former words earlier in my life and they were easier to pronounce and lip-read. Being exposed to a limited amount of English i.e. Pidgin English every day (which occurs when you cannot hear everything), has spread into my spoken and written language, particularly now I have less time to read books. Books, when I have time to read them, are in essence my main access to the English language.

The second issue this year was with a clinician who could not identify nor understand for most of my placement that I would use books to learn, and criticised my approach of using books. It was only when she queried how I revised for exams from GCSE’s through to University that she realised that I could not revise for my exams in groups with other people, due to not being able to follow conversations easily in groups. She then stated that the University had missed this ::’extremely serious issue’:: and it became an issue of the University failing me as a deaf person. Anger and low confidence prevailed from this placement, as did a long talk with my course leader. Through this talk I realised that even though I can now be aware of using conversations with other people as a way of learning, in this day and age of evidence based clinical work, my base knowledge from books will help me in my physiotherapy.

Although my lecturers have been extremely supportive and aid me in my pro-active approach to my problems, I believe that clinicians also come under the umbrella of a ::’teacher’:: within higher education. This is based on the fact that in physiotherapy a student has to undertake 1000 hours of clinical experience before qualifying. I therefore argue that clinicians need to be trained in the different types of learning styles, particularly for disabled students so as to encourage more integration.

Recommendations for change

Recommendations for change that the University could undertake to help overcome some of the above problems include:

  • Lecturers should receive deaf awareness training as custom on all courses that are due to have a deaf student e.g. tactics to aid communication. Beyond this however, lecturers need to think about how deafness will shape a life e.g. their English might be affected when they move onto university from school, as they are not being spoken to in a formal setting as much. No matter how well a student is doing, assignments/exams etc. should be checked for common themes of errors that may be due to their deafness.
  • Deaf awareness training should also be received on the course itself by the students, not just if there is a deaf student, but also for all the deaf NHS users as there have been several studies raising the issue of lack of access to the NHS for deaf people (Harris, 1994, Dye et al, 2001, Harris and Bamford, 2001 and Ubido, Huntingdon and Warburton, 2002). My final year project (unpublished) questions the issue of gaining informed consent when most final year students from two schools of physiotherapy could not identify that BSL was not the same as English when written down.
  • Last of all, clinicians should be given awareness training. The question arises of who should provide the training as it can be argued that it is the university’s responsibility to provide the learning experience for the students. I put forward the argument that the Chartered Society of Physiotherapy (CSP) should be the first port of call for everyone involved, the clinicians, universities and the students themselves. At present the CSP does not have any publications on how to communicate with deaf people.

All of the above comments can be modified to fit any a lot of other disabilities. What is required is some lateral thinking beyond the basic awareness training that can be received, to make a specific course accessible to all people.

References

British Deaf Association (2002) DEAFinitions. British Deaf Association Factsheet. (Internet) Available at: http://www.britishdeafassociation.org.uk. Accessed on:13/03/03

Corker, M., (1993) Integration and deaf people: the policy and power of enabling environments. In Disabling Barriers – Enabling Environments Swain, J., Finkelstein, V., French, S., Oliver, M., eds. Sage.

Dye, M., Kyle, J., Allsop, L., Dury, A., Richter, J., (2001) Deaf People in the Community. Health and Disability Bristol. Deaf Studies Trust.

Harmer, L.M., (1999) Health Care Delivery and Hearing-Impaired People: Practice, Problems and Recommendations for Change. Journal of Hearing-Impaired Studeis and Hearing-Impaired Education 4:2 pp73-110

Harris, J.A., (1994) The Cultural Meaning of Deafness. PhD Theses. Lancaster University. Department of Applied Social Sciences

Harris, J., Bamford, C., (2001) The Uphill Struggle: services for Deaf and hard of hearing people – issues of equality, participation and access. Disability and Society 16:7 pp969-979

Strong, C.J., Shaver, J.P., (1991) Modifying Attitudes towards persons with hearing impairment. American Annals of the Deaf 136:3 pp252-260

Swanson, L., (1997) Cochlear Implants: The Head-On Collision With Medical Technology and the Right to be Deaf. Canadian Medical Association Journal 157 pp929-932

Ubido, J., Huntingdon, J., Warburton, D., (2002) Inequalities in access to health care faced by women who are deaf. Health and Social Care in the Community. 10:4 pp247-253

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