This poster is titled, Overcoming Acute Inpatient Rehabilitation Challenges in Deaf and Blind Patients, a Case Series, and was prepared with Dr. Rebecca Freeman and Dr. Avneil Klein. Movement disorders resulting from stroke can be debilitating for any patient. However, it is particularly devastating to the deaf community, many of whom communicate through American Sign Language or other forms of sign language. On review of the literature, we found several studies have investigated aphasia in the deaf after stroke, but few have investigated hemiparesis or the communication and rehabilitation challenges deaf patients face after stroke. This series reviews two cases of deaf patients who use sign language as their primary communication strategy and who suffered strokes resulting in motor deficits impairing their ability to sign. Neither had a distinct deficit in processing sign language. We aim to demonstrate the impact of stroke on language abilities for sign language users and the challenges faced during rehabilitation. Our first patient is a 64-year-old male with deafness who suffered a stroke which resulted in right-sided hemiplegia that impaired his ability to sign with his dominant hand. Communication was made more challenging because he spoke a Haitian Sign Language, had low education level with poor literacy which made written communication ineffective, and had poor carryover. Therapy sessions required video interpretation services for the Haitian Sign Language to give detailed instructions to the patient. Initially, the patient adapted using single hand signs with his fully functional non-dominant hand, but had difficulty in speed and dexterity. Each therapy focused on using a communication board to express needs when a video interpreter was unavailable or impractical, however, he had poor carryover which made this challenging. As he gradually regained motor function of his dominant hand, therapy focused on fine motor control and developing his ability to sign. He was able to communicate in a modified Haitian Sign Language on the time of discharge. Our second case is a 61-year-old male with congenital hearing loss since birth and recent blindness due to glaucoma who suffered a stroke with resultant left-sided hemiplegia. The patient presented particular communication challenges because the vision loss prevented the use of video interpreter services which added additional barrier to communication. Therapy sessions were conducted with two interpreters in person, one who translated the therapist's instructions into American Sign Language to a deaf interpreter, and then the deaf interpreter then translated ASL into tactile sign to the patient. Some signs were done in the patient's hands so he could feel the sign, and other gestures were made by guiding the patient's hands through the sign. Interpreters were present for all therapy sessions to assist in giving instructions, and therapy tasks were explained by tactile sign prior to initiation, and tactile cues were used during the activities. Images of needs-based signs were posted above the patient's bed, and staff were taught simple tactile signs to redirect and assess needs when the interpreters were not present. Some of these images demonstrating these tactile signs are available in the center of the poster for your reference. The patient had insight to his deficits, and he was intuitively able to understand some tactile cues that were not signs. An example of this would be placing a stethoscope in his hands, he would feel it, recognize that it was the physician wanting to examine him, and then he would lean forward and breathe in and out during lung auscultation. Therapies focused on ambulation and aggregating his environment safely, and he was discharged home with family who knew tactile sign. Motor deficits resulting from strokes are extremely debilitating for the deaf who primarily communicate through sign language, and additional impairments such as blindness, education level, and different types of sign language add an additional barrier to traditional strategies used to communicate with the deaf. We know that the neural processes and hemispheres used to understand and perform sign language are similar to those used in spoken language, and deficits resulting from stroke are well studied in the general population. However, there is a paucity of literature that exists on the effects of stroke in the deaf or blind. While several studies have investigated aphasia in the deaf after stroke, few of them have investigated how hemiparesis impacts communication both during rehabilitation and upon discharge to the community. In conclusion, deaf patients with hemiplegia or blindness affecting their ability to use sign language require specialized rehabilitation services where more research is needed to identify optimal rehabilitation modalities.

deaf and blind patients

acute inpatient rehabilitation

stroke

communication barriers

specialized rehabilitation services