American Sign Language Interpreter Research Articles

UNDERSTANDING CHALLENGES AND SOLUTIONS FOR DEAF OLDER ADULTS

Abstract The Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) project explores everyday activity challenges and solutions experienced by U.S. older adults as they age with a lifelong disability involving vision, motor, or hearing. Here, we report our findings from our community-engaged research with older adults who self-identify as members of the U.S. Deaf Community and who use American Sign Language (ASL) as their primary language. Using trained Deaf interviewers, we conducted semi-structured interviews in ASL with 60 Deaf participants (age 60-79 years) to understand their challenges performing various everyday activities (e.g., doing things around the home, activities outside the home, transportation, and managing health). Overall, our thematic analyses revealed that Deaf older adults navigate everyday tasks quite well. However, they experience particular challenges with technology, communication, and accessibility; specifically, fragile or inaccessible technology systems. For instance, technology alerting systems at home (e.g., smoke alarms) or airports (e.g., gate change announcements) are typically auditory. Accessibility is also poor when healthcare or wellness providers fail to provide an ASL interpreter. When probed about their responses to these challenges, Deaf older adults often reported frustration or resignation when experiencing barriers; the need for constant vigilance and self-advocacy; or reliance on hearing family members when systems fail them. Improving communication access and technologies that Deaf older adults rely on is critical and requires the inclusion of individuals from the Deaf community to identify the challenges and potential avenues for solutions.

Flipping the Interpreter Script: Perspectives on Accessibility

In this positional essay, Jessica A. Scott, G. Sue Kasun, and Stephanie J. Gardiner-Walsh discuss their experiences and frustrations around American Sign Language interpreters in higher education settings. They draw from their intersecting experiences as researchers of language and/or deaf education to call for a “flipping of scripts” around how we frame who is being interpreted for in signed language contexts. They argue that the majoritarian, ableist mindset in higher education needs to shift to remember that hearing/abled individuals also need to learn from disabled individuals and that the field of multilingual education needs to better engage signed language in the broader field.

Self-Reported Accommodation Needs for Patients with Disabilities in Primary Care

People with disabilities experience barriers to engaging with health care due to inaccessible social and physical environments at primary care clinics. Despite legal mandates, identification and provision of necessary accommodations for this population at primary care clinics are poor. The objective of this cross-sectional study was to assess patient-reported disability status and accommodation needs among patients at a primary care clinic. An electronic health record-based Disability and Accommodations Questionnaire assessing disability status, types, and accommodation needs was developed by subject matter experts at Michigan Medicine and the University of Michigan Council for Disability Concerns. The questionnaire underwent multiple rounds of reviews and revisions before its use in clinical settings. A paper-based questionnaire was administered to all patients presenting for a wellness-based visit at an academic health system primary care clinic in southeast Michigan. Data were collected between March 2022 and August 2022. Approximately 13% of the 541 patients self-reported a disability, with 54.2% indicating at least one needed accommodation. The most commonly reported disabilities were mental health and hearing-related disabilities, by 4.8% and 4.6% of patients, respectively. The most frequently requested accommodations were communication- or language-based (for example, presence of an American Sign Language interpreter, assistive listening devices), cognitive-based (for example, inclusion of a support person with care decisions), and mobility-based (for example, assistance with transfers). The Disability and Accommodations Questionnaire helped identify the presence of a disability, its types, and any requested accommodations requested at a primary care health center.

American Sign Language Recognition and its Conversion from Text to Speech

Abstract: Speech impairment is a complicated condition that impairs a person's capacity for verbal and audible communication. Those who are impacted frequently use sign language and other alternate forms of communication. While sign language has gained popularity, bridging the communication gap between those who sign and those who don't remains a challenge. Our project endeavors to address this issue by developing an innovative application that offers real-time sign language-to-text translation. This technology aims to facilitate seamless communication between those who use sign language and those who do not. To achieve this, we have constructed a cutting-edge sign language recognition system as part of our project. Our system primarily utilizes American Sign Language (ASL) as its foundation. To accurately detect gestures, we employ a Convolutional Neural Network (CNN) with Inception V3 as the underlying model. This project's core objective is to harness Machine Learning Techniques for converting ASL hand gestures into text and vice versa. We go beyond mere translation by enabling real-time American Sign Language interpretation through single-hand gestures. Furthermore, our system can recognize ASL words, converting them into text before rendering them into audible speech.

Mixed Abilities and Varied Experiences: A Group Autoethnography of a Virtual Summer Internship

The COVID-19 pandemic forced many people to convert their daily work lives to a "virtual" format, in which they connected remotely from home. In this new, virtual environment, accessibility barriers changed, in some respects for the better (e.g., more flexibility) and in other aspects, for the worse (e.g., problems including American Sign Language interpreters over video calls). Microsoft Research held its first cohort of all virtual interns in 2020. We, the interns, full-time members, and affiliates of the Ability Team, a Microsoft research team focused on accessibility, report on our experiences navigating the challenges of working remotely. We constituted a variety of abilities, positions, and levels of seniority. Using an autoethnographic method, we provide a nuanced view of how the virtual setting affected the experiences of our mixed-ability team, the strategies we used to improve access, and areas for further improvement. We close by presenting guidelines for future virtual mixed-ability teams to improve workplace accessibility.

570-P: Designing the Deaf Diabetes Can Together Intervention

Deaf individuals who communicate using American Sign Language (ASL) are 3 times more likely to have diabetes than hearing people, yet experience challenges obtaining diabetes education due to a multitude of systematic barriers. One barrier is communication breakdown between the Deaf patient, an ASL interpreter, and clinician. Due to a lack of unified diabetes medical terms in ASL, confusion can occur when different ASL interpreters are used at diabetes appointments. In collaboration with an all-Deaf Community Advisory Board, a Certified Deaf Interpreter, Deaf health professionals, a universal access designer, and experts in Diabetes care, we co-designed an ASL Glossary of diabetes terms. The ASL Glossary confirmed, clarified, updated, and/or developed new signs and explanatory expansions during a 5-phase process. The ASL Glossary include 42 videos of diabetes terms and 28 explanatory expansions. New signs were developed for the term, ‘insulin’ to help distinguish insulin made within the body and exogenous insulin. A sign clarification was needed to establish the seriousness of prediabetes. The terms ‘diet’ and ‘fat’ were modified to be more politically correct. Technology, such as continuous glucose monitoring, insulin pumps, and smart pens required new signs and/or expansions. The ASL Glossary of diabetes terms addresses systemic barriers that exist in working with Deaf patients and research participants. The ASL Glossary of diabetes terms will support diabetes self-management education and support videos that are being created for the next phase of the Deaf Diabetes Can Together single-arm pilot study. Additionally, the ASL Glossary of diabetes terms will be used to support a future ASL interpreter training. Disclosure M.L.Litchman: None. N.A.Allen: Consultant; Diathrive Health, Dexcom, Inc. E.Iacob: None. N.A.Miller: None. M.Henderson: None. S.M.Canela: None. S.Lee: None. Funding Gordon and Betty Moore Foundation (GBMF9048); Margolis Foundation

Considerations for practitioners using applied behavior analysis therapy with autistic deaf/hard of hearing clients

AbstractThere is scarce research on adapting evidence‐based practices, such as Applied Behavior Analysis (ABA)‐based therapy, for Deaf/Hard of Hearing (DHH) children diagnosed with autism spectrum disorder (ASD). The current case involved delivering intensive ABA‐based intervention for improving communication skills to a 5‐year‐old child, Lilly, with dual diagnoses of DHH and ASD. Teaching procedures were modified to include consideration of deaf cultural norms, incorporation of American Sign Language (ASL)‐specific instructional procedures, and consultation with an ASL interpreter within all intervention sessions. Outcome data measured by the Verbal Behavior Milestones Assessment and Placement Program (VB‐MAPP) reflected rapid skill acquisition across multiple verbal operants within a 7‐month admission. Recommendations on how to deliver intensive ABA‐based intervention services to children with dual diagnoses of DHH and ASD are provided for further research and discussion. Utilizing modified behavior analytic procedures can provide increased access to needed services for this population.

In Situ Co‐transformation of Reduced Graphene Oxide Embedded in Laser‐Induced Graphene and Full‐Range On‐Body Strain Sensor

AbstractOn‐body strain information provides various indicators such as heart rate, physiological pulse, voice waveform, respiratory rate, and body motion status. Recent advances in wearable strain sensors using nanomaterials have significantly enhanced sensor performance with regard to sensitivity, detectable range, and response time. However, it is still challenging to obtain all types of body strain information, from small vibrations to joint movements, using one type of sensor. Herein, a full‐range on‐body strain (FROS) sensor covering ultrasmall‐to‐large strains such as vocal vibration and joint movement is reported. To achieve an ultrawide detectable range, reduced graphene oxide (rGO)‐embedded laser‐induced graphene (LIG) is synthesized by laser engraving on a graphene oxide (GO)‐embedded polyimide (PI) complex film. An rGO‐LIG homostructure based on sp2‐carbons is photothermally reconstructed from the GO‐PI heterostructure in a complex film by in situ co‐transformation and then transferred to an elastomer substrate. The fabricated FROS sensor successfully performs on‐body strain monitoring of various indicators, such as physiological pulse, vocal sound waveform, and body movement, as well as American sign language translation. Furthermore, it is believed that this rGO‐LIG homostructure‐based material synthesized by in situ co‐transformation can potentially provide novel functionalities in fields such as wearable electronics, humanoid, soft robotics, and intelligent prosthetics.

Considerations in the Management of Functional Neurological Disorders in Patients with Hearing Loss.

Adam is a 14-year-old adolescent boy with hearing loss who presented to the pediatric neurology clinic accompanied by his father for evaluation of new-onset left hand tremor for a duration of 1 month. An American Sign Language interpreter was present and used throughout the visit.Adam has bilateral sensorineural hearing loss related to premature birth at 28 weeks' gestation. He uses sign language and attends a school for the hearing impaired. He has been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and a nonspecific learning disorder. His ADHD symptoms are well controlled with a stimulant medication. He is independent in activities of daily living, and there is no concern for intellectual disability. His father is concerned that Adam may have anxiety, but this has not been evaluated.After careful history, it is found that the tremor was first noted the day after burglars broke into his home and stole precious belongings. Current stressors include difficulties with schoolwork and a strained relationship with an extended family member. There is no family history of tremor.The tremor was intermittent initially, with episodes lasting around 30 minutes. Over time, the tremor became more persistent. Adam is left-handed, and the tremor is now interfering with handwriting, eating, and other fine motor skills. The tremor worsens when Adam is tired or stressed and improves with relaxation. No tremor has been noted in other body parts. Adam denies any other neurological symptoms, including headache, vision changes, or gait abnormalities.On examination, Adam seemed anxious but showed no significant distress and had normal vital signs. His general examination was unremarkable. His neurological examination showed intact cranial nerves, apart from the hearing impairment. He had normal muscle tone, intact strength and coordination, and a normal casual gait. Rhythmic shaking of the left upper extremity was present with action, while maintaining posture. Using specific examination techniques, the examiner was able to alter the rhythm of the tremor, and the tremor was noted to subside when the patient was engaged with the examiner. These findings in addition to signs of suggestibility and variable frequency/direction were consistent with a functional etiology.The diagnosis of a functional neurological disorder manifesting in the form of functional tremor was discussed with the patient and his father with assistance from the sign language interpreter. Counseling regarding management consisting mainly of cognitive behavioral therapy and evaluation of possible coexisting conditions, such as anxiety, was discussed.What factors would you consider in diagnosis and management of functional neurological disorder in a hearing-impaired child/adolescent?

Whole-food plant-based Jumpstart for a Deaf and Hard of Hearing cohort.

Deaf and Hard of Hearing (DHH) patients are at high risk of developing chronic illness, and when they do, are at higher risk of poor outcomes than in a hearing community. Rochester Lifestyle Medicine Institute adapted its online, Zoom-based, medically-facilitated 15 Day Whole-Food Plant-Based (WFPB) Jumpstart program, to give DHH participants knowledge, skills, and support to make dietary changes to improve their health. Adaptations included having a medical provider present who is fluent in American Sign Language (ASL), is board-certified in Lifestyle Medicine, and has a Master of Science in Deaf Education; spotlighting participants when asking a question during the Q&A session; using ASL interpreters; utilizing closed captioning/automatic transcription during all Zoom meetings; and employing a Success Specialist to provide outreach via text and email throughout the program. Participants had significant positive changes in their eating pattern. They reported improvements in biometric measures as well as in how they were feeling. They all reported that they planned to continue to eat a more WFPB diet than they did prior to Jumpstart. All either agreed or strongly agreed that they learned important information, were confident that they knew the best eating pattern for health, and gained the skills they needed to make changes. Although this was a small pilot program, it suggests that this model can be used to provide education and support for behavior change that will lead to improved health in a DHH community.

Experiences of pregnancy and perinatal healthcare access of women who are deaf: a qualitative study.

Women who are deaf experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared with their peers who can hear. This study explores the pregnancy experiences of women who are deaf to better understand their barriers to and facilitators of optimal pregnancy-related health care. Qualitative study using thematic analysis. Semi-structured, individual, remote or in-person interviews conducted in the USA. Forty-five women who are deaf and communicate using American Sign Language (ASL) and gave birth in the USA within the past 5 years participated in the interviews. Semi-structured interviews explored how mothers who are deaf experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. Barriers and facilitators related to a positive experience of perinatal care access among women who are deaf. Three major themes emerged: (1) communication accessibility; (2) communication satisfaction; and (3) healthcare provider and team support. Common barriers included choosing healthcare providers, inconsistent communication access and difficulty accessing health information. However, when women who are deaf were able to use ASL interpreters, they had more positive pregnancy and birth experiences. Self-advocacy served as a common facilitator for more positive pregnancy and healthcare experiences. Healthcare providers need to be more aware of the communication and support needs of their patients who are deaf, especially how to communicate effectively. Increased cultural awareness and consistent provision of on-site interpreters can improve pregnancy and birth experiences for women who are deaf.

Collaging as Embodied Method: The Use of Collage in a Study of American Sign Language (ASL) Interpreters' Experiences

This methodological essay describes the generativity of collaborative collaging in a qualitative inquiry project with American Sign Language (ASL) interpreters who serve D/deaf students within a public university. Sign language interpreting is a demanding profession requiring physical endurance, creativity, and quick mental processing to switch between spoken and sign language. Interpreters’ visual communicative culture aligns conceptually with the embodied arts-based, visual, and tactile research technique of collaging. We first introduce collaging scholarship to ground our discussion of using collaging as a method within this case study of ASL interpreters. We then provide an overview of ASL interpreter research and our case study to situate the collaging method used alongside other approaches, asking, “How was collaging a productive method for exploring interpreters’ understanding of their work experiences?” We describe the use of the method and the productivity of interpreters’ collaging for surfacing embodied experiences, fueling collaborative meaning-making, and showing rather than telling aspects of interpreters’ labor in another expressive language. We conclude by identifying the value of collaborative collaging in this case study and for other researchers, issues, and contexts.

American Sign Language Translation Using Wearable Inertial and Electromyography Sensors for Tracking Hand Movements and Facial Expressions.

A sign language translation system can break the communication barrier between hearing-impaired people and others. In this paper, a novel American sign language (ASL) translation method based on wearable sensors was proposed. We leveraged inertial sensors to capture signs and surface electromyography (EMG) sensors to detect facial expressions. We applied a convolutional neural network (CNN) to extract features from input signals. Then, long short-term memory (LSTM) and transformer models were exploited to achieve end-to-end translation from input signals to text sentences. We evaluated two models on 40 ASL sentences strictly following the rules of grammar. Word error rate (WER) and sentence error rate (SER) are utilized as the evaluation standard. The LSTM model can translate sentences in the testing dataset with a 7.74% WER and 9.17% SER. The transformer model performs much better by achieving a 4.22% WER and 4.72% SER. The encouraging results indicate that both models are suitable for sign language translation with high accuracy. With complete motion capture sensors and facial expression recognition methods, the sign language translation system has the potential to recognize more sentences.

The Self-Determination Inventory: Student Report American Sign Language Translation.

Research literature and community narratives both emphasize the importance of self-determination in the lives of deaf youth. This paper describes the development, initial validation, and potential applications of a translated measure of self-determination for deaf youth, the SDI:SR ASL Translation (SDI:SR ASL). A sample of 3,309 young people who completed the SDI:SR, of whom 392 were deaf, was used in this validation study. Results provide preliminary support for the use of SDI:SR ASL with deaf youth. Findings also indicate that deaf youth who take the SDI:SR ASL score more similarly to youth without disabilities taking the SDI:SR than youth with disabilities. The SDI:SR ASL can be an important tool for researchers and practitioners to better understand self-determination among deaf youth and facilitate continued development of self-determination skills.

Opening the Pathway: An Example of Universal Design for Learning as a Guide to Inclusive Teaching Practices.

Universal Design for Learning (UDL) provides a flexible framework for supporting a wide variety of learners. We report here on a conference that presented the UDL framework as a way to increase success of deaf and hard-of-hearing (deaf/hh) students in introductory biology courses. The Opening the Pathway conference was an NSF Advanced Technological Education project focusing on raising awareness about careers in biotechnology and student success in introductory biology, a key gateway course for careers in biotechnology. The participants were professionals who work with deaf/hh students at pivotal points in students’ educational pathways for raising awareness of biotechnology career options, including community college faculty, high school faculty at schools for the deaf, and American Sign Language (ASL) interpreters. The conference goal was to provide an effective, meaningful professional development experience in biology instruction. The conference explicitly addressed the role of a UDL approach in building accessible, inclusive, productive learning environments, particularly for deaf/hh students, and demonstrated how to make effective pedagogical practices, specifically case-based learning, inclusive and UDL-aligned in an introductory biology context. We describe the conference, conference outcomes for participants, and in particular the application of the UDL framework to create an inclusive experience.

Is It Reasonable? Reasonable and Unreasonable Accommodations for Occupational Therapy Students in Clinical Settings

Despite the growing number of graduate students with disabilities, little is known about what accommodations are considered reasonable in various occupational therapy fieldwork settings. This study explores which accommodations fieldwork educators perceive as reasonable or unreasonable for occupational therapy students with disabilities. Snowball sampling methodology was used to distribute a virtual survey, using a descriptive design. One hundred and sixty-two occupational therapists and occupational therapy assistants answered questions relating to demographic information, clinical experience supervising fieldwork students, and their clinical judgement regarding commonly requested accommodations. Using a quantitative approach, the accommodations deemed most reasonable were allowing the use of adaptive equipment (n = 156, reasonable: 96.3%) and permission to excuse oneself from the unit to maintain health (n = 152, reasonable: 93.83%). The accommodations considered the most unreasonable were the use of an intermediary to perform physical tasks (n = 82, unreasonable: 50.62%) and the use of an American Sign Language interpreter (n = 42, unreasonable: 24.93%). Clinicians in rehabilitation most often responded “reasonable” in response to an accommodation (n = 24, reasonable: 80.20%), while those who worked in outpatient pediatrics selected “unreasonable” most often (n = 4, unreasonable: 13.51%). This preliminary data provides stakeholders information about accommodations, creating opportunities to support students with disabilities in their pursuit of becoming clinicians. This will help to better fulfill American Occupational Therapy Association's vision of inclusivity and equitability.

“None of it was especially easy”: improving COVID-19 vaccine equity for people with disabilities

ObjectivesOur study aimed to (1) identify barriers to equitable access to COVID-19 vaccines for Canadians with disabilities and (2) present recommendations made by study participants to improve immunization programs in terms of inclusivity and equitable access.MethodsWe invited Manitobans living with disabilities to participate in online focus groups. Focus groups were conducted across multiple disability experiences, although one focus group was advertised explicitly as offering simultaneous American Sign Language interpretation to encourage people who are d/Deaf or hard of hearing to participate. Participants were asked about their perspectives on the management of COVID-19 public health measures and vaccination program rollout. Participants were also asked about barriers and facilitators of their vaccination experiences and if they had recommendations for improvement.ResultsThe participants identified three areas where they encountered routine barriers in accessing the COVID-19 vaccines: (1) vaccine information and appointment booking, (2) physical access to vaccination clinics, and (3) vaccination experience. While participants identified specific recommendations to improve vaccine accessibility for people with disabilities, the single most crucial advice consistently identified was to involve people with disabilities in developing accessible immunization programs.ConclusionMeaningful engagement with people living with disabilities in immunization program planning would help ensure that people with disabilities, who already face significant challenges due to COVID-19, are offered the same protections as the rest of the population. These recommendations could be easily transferred to the administration of other large-scale immunization campaigns (e.g., influenza vaccines).

Augmented Reality ASL for 11:11 at Theatre Passe Muraille

In November 2020, Theatre Passe Muraille produced a workshop as a part of their Accessibility Labs (funded through the Toronto Arts Council’s Open Door Project). This workshop connected the development of Samson Bonkeabantu Brown’s play 11:11, directed by Tsholo Visions Khalema and choreographed by Mafa Makhubalo, with a collaboration between technology collectives Toasterlab and Cohort to experiment with the use of augmented reality to support the American Sign Language interpretation and live captioning in consultation with Courage Bacchus, Marcia Adolphe, and Carmelle Cachero, Jenelle Rouse, and Gaitrie Persaud. The collaborators spent a week building an interpretation distribution system that used affordable technology to create a proof-of-concept experiment to see what it would look like to move both text and sign interpretation from just offstage into the visual field of the performance. Using Cohort’s media distribution app developed for the synchronous delivery of media to mobile devices, this project explored live and pre-recorded versions of performance interpretation for a Deaf audience. These were displayed on the audience’s phone screens and in simple augmented reality headsets. The goal was to explore expanding the opportunities for an audience to access interpretation, making the experience more customizable through different forms of engagement, and seeking to provide more universal access across all performances by making a recorded alternative available. The workshop also explored the dramaturgical and scenographic implications of adding this information into the direct visual field of an audience member. This article, in the form of a compiled oral history of the workshop, documents the process, the findings, and the follow-up questions that the team identified over our short time together to provide a baseline for further exploration into the use of mixed-reality technologies in support of accessible performance spaces. It considers situated identity and Deaf culture in relationship to translating interpreted performance to a technological solution as it both outlines the practical steps that allowed this to happen and explores artist, interpreter, and technologist perspectives on what was learned.

Assessing the Availability of Foreign and American Sign Language Interpreting Services in Community Pharmacies.

Objective To determine community pharmacists' experience with foreign language and American Sign Language (ASL) interpretation services. Design A survey was drafted to gather information about pharmacists' familiarity with ASL and foreign language interpreting services as well as the frequency with which pharmacists encountered patients who needed these services. Setting Independent and chain community pharmacies in Spokane County, Washington, USA. Participants Fifty-two community pharmacies were identified using a provider-credential search. Fifty-one pharmacists (98%) agreed to participate and completed the survey. Interventions Surveys were initially conducted in person, but after the COVID-19 pandemic began data collection was halted and restarted via phone in accordance with the Washington State University Office of Research Support and Operations. Results Four out of 51 pharmacists surveyed (7.84%) indicated that they were fluent in a language besides English. Pharmacists reported encountering patients who spoke Spanish (31%), Russian (31%), ASL (8%), Arabic (5%), Mandarin Chinese (5%), Vietnamese (5%), Marshallese (5%), and Ukrainian (2%). Some pharmacists (8%) reported not encountering patients who spoke other languages besides English. Most pharmacists (72.5%) indicated their company offered interpreting services for foreign languages, but less than half of pharmacists surveyed (43.1%) had experience using these services. Forty-five percent of pharmacists surveyed did not know whether their company offered an interpreting service for ASL, and only 23.5% indicated that they had experience using ASL interpreting services. Conclusion Pharmacists are less familiar with services for patients who speak ASL and are less likely to have experience with ASL interpretation services than they are to have assisted foreign-language-speaking patients.

Consider staffing options for ASL interpreters

Since 1990, when the Americans with Disabilities Act was enacted into law by President George H.W. Bush, more students with disabilities have had the opportunity to attend college. Since then, a growing number of deaf or hard of hearing students have enrolled in higher education. The National Deaf Center on Postsecondary Outcomes reported that, as of 2019, 5% of the deaf or hard of hearing population in the U.S. were enrolled in college. Of these students, most prefer lip reading or voicing, despite the availability of tools such as live captioning and closed captioning. Still, an American Sign Language interpreter helps students who are deaf or hard of hearing navigate the challenges of completing a postsecondary degree.