Hard Of Hearing Individuals Research Articles

Hearing Impairment: Reduced Pupil Dilation Response and Frontal Activation During Degraded Speech Perception.

A relevant aspect of listening is the effort required during speech processing, which can be assessed by pupillometry. Here, we assessed the pupil dilation response of normal-hearing (NH) and hard of hearing (HH) individuals during listening to clear sentences and masked or degraded sentences. We combined this assessment with functional magnetic resonance imaging (fMRI) to investigate the neural correlates of the pupil dilation response. Seventeen NH participants (Mage = 46 years) were compared to 17 HH participants (Mage = 45 years) who were individually matched in age and educational level. Participants repeated sentences that were presented clearly, that were distorted, or that were masked. The sentence intelligibility level of masked and distorted sentences was 50% correct. Silent baseline trials were presented as well. Performance measures, pupil dilation responses, and fMRI data were acquired. HH individuals had overall poorer speech reception than the NH participants, but not for noise-vocoded speech. In addition, an interaction effect was observed with smaller pupil dilation responses in HH than in NH listeners for the degraded speech conditions. Hearing impairment was associated with higher activation across conditions in the left superior temporal gyrus, as compared to the silent baseline. However, the region of interest analysis indicated lower activation during degraded speech relative to clear speech in bilateral frontal regions and the insular cortex, for HH compared to NH listeners. Hearing impairment was also associated with a weaker relation between the pupil response and activation in the right inferior frontal gyrus. Overall, degraded speech evoked higher frontal activation than clear speech. Brain areas associated with attentional and cognitive-control processes may be increasingly recruited when speech is degraded and are related to the pupil dilation response, but this relationship is weaker in HH listeners. https://doi.org/10.23641/asha.27162135.

Developing a capacity-building intervention for healthcare workers to improve communication skills and awareness of hard of hearing and D/deaf patients: results from a participatory action research study

BackgroundHealthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals’ experiences in healthcare and improve their capacity to communicate with these populations.MethodsThis study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention.ResultsMain qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients.ConclusionsFindings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs’ perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment.

A Deep Learning Approach for ASL Recognition and Text-to-Speech Synthesis using CNN

Abstract: Sign language is a visual language that is used by the deaf and hard-of-hearing community to communicate. However, sign language is not universally understood by non-signers, which can create communication barriers for the deaf and hard-ofhearing individuals. In this paper, we present a novel application for American Sign Language (ASL) to text to speech conversion using deep learning techniques. Our app aims to bridge the communication gap between hearing-impaired individuals who use ASL as their primary mode of communication and individuals who do not understand ASL. The app comprises three main components: a hand gesture recognition module that detects and recognizes ASL signs, a text-tospeech synthesis module that converts recognized ASL signs to text, and a speech synthesis module that converts the text to speech

Longing to Belong: Hard of Hearing Young Adults' Experiences of Social Identity and Group Membership.

Studies on hard of hearing (HH) individuals have focused mostly on children's experiences in school. However, their lives as young adults have not received much attention. The present study therefore examined HH young adults' experiences of social identity and group membership. Semistructured interviews were conducted with 16 individuals (10 males, 6 females) with severe to profound hearing loss. They were from diverse cultural backgrounds. A qualitative content analysis was performed with a manifest analysis. Two categories emerged: Belonging to a Social Environment and Engaging in Important Communication. The results indicate that the HH individuals, either deliberately or unconsciously, chose to be with other HH individuals because of their longing for group membership and desire to avoid being misunderstood. The participants longed for inclusion, acceptance, and opportunities to create an inclusive social environment and to communicate with others.

The role of experience and language gap on depression and aggression in hard of hearing individuals

Hard of hearing individuals having language and communication problems might be prone to experience psychopathology just like every individual using phonic languages. This study tested a structural equation model in which aggression mediated the relationship between perception of gap between experience and language representation and depression in hard of hearing sample. Although previous research gave evidence that language deterioration is closely related to depression, the research on intervening variables in the relationship has been limited. The main aim of the present study was to provide additional knowledge about the mediatory processes through which language relates to depression. Two-hundred hard of hearing individual participated in the study. The Beliefs about the Functions of Language Scale was used to measure personal perception of the gap between experience and language; Buss Perry Aggression Questionnaire was used to measure aggression level and Beck Depression Inventory was used to measure depression levels of the participants. The model proposed by the current investigation was tested using structural equation modelling using LISREL 8.80. Although the results supported that aggression plays a potentially mediatory role between GAP and depression, the alternative model considered to be better where depression was taken as a mediator variable. Under the light of previous research and current findings, suggestions for prevention and treatment strategies for aggression will be provided, especially for the hard of hearing people.

Frequency of Severity and Types of Hearing Impairment In Children of Age 5 to 10 Years in Audiology Department

Hearing impairment also known as hearing loss is a total or partial incapability to hear. Hard of hearing individuals have difficulty understanding speech sounds. The hearing tribulations in children could have an effect on the ability to learn spoken language as well as in adults it could be able to generate difficulty with social communication in addition to at work.
 Objective: To determine the Frequency of severity level along with its types of hearing loss in children age 5 to 15 years coming to the Department of Audiology in Children Hospital and ICH, Lahore.
 Methods: The Descriptive cross-sectional study was performed in the Audiology Department of Children Hospital and ICH in Lahore District, Punjab Province, Pakistan. Children of age limit between 5 to 15 years were had screened and examine for hearing impairment according to the World Health Organization (WHO) protocols. A purposive sampling technique was used. The Case-control analysis of the audiometric test had performed to find out the type and degree of Hearing loss, follow by Chi-Square analysis.
 Results: The total of 175 children comprised the study population, in which 51.4% (n=90) children belong to the age group of 10-12 years, had Moderate to Severe SNHL due to Birth complications and lack of awareness about Preventable hearing loss especially in rural areas of Pakistan, 28.5% (n=50) children belong to the age group of 13-15 years, had Severe to Profound SNHL due to Consanguineous marriages, 20% (n=35) children belong to the age group of 7-9 years, had Mild to Moderate CHL due to Ear Discharge and other complications like Tonsillitis and Adenoids, etc.
 Conclusions: This study concluded that a total of 175 children participated in that research, in which 90 children had Moderate to Severe SNHL, 50 children had Severe to Profound SNHL and 35 children had Mild to Moderate CHL. 

Evaluation of an American Sign Language co-curricular training for pharmacy students

Background and purposeWith a prevalence of about one million d/Deaf and Hard of Hearing (HOH) patients that utilize American Sign Language (ASL) and the strong potential for communication barriers to adversely influence patient care outcomes, strategies must be developed to support health care professionals and students in learning to better care for d/Deaf and HOH patients. The primary objective of this project was to implement and assess a co-curricular course focused on helping student pharmacists become more confident and comfortable in communicating with d/Deaf and HOH patients. Educational activity and settingThe co-curricular course (ASL for the Pharmacy Professional) consisted of four 90-min classes, each covering different words/phrases and Deaf cultural competence. Students were taught basic ASL including the alphabet, numbers, vocabulary, and sentence structure. Deaf culture and d/Deaf patient interaction was also covered. Students interacted with a Deaf physician over Skype and with d/Deaf and HOH individuals from the local community. FindingsPre- and post-surveys that contained an identical set of questions were administered before and after course completion. Surveys assessed confidence and level of comfort of first- and second-professional year student pharmacists surrounding Deaf culture and interacting with d/Deaf and HOH patients. Following the course, students reported significantly improved confidence in communicating with d/Deaf patients directly and with a translator. SummaryFollowing completion of a co-curricular ASL course, doctor of pharmacy students perceived an increase in confidence in working with d/Deaf and HOH patients. Program logistics were simplified through collaboration with an outside entity.

The Input Matters: Assessing Cumulative Language Access in Deaf and Hard of Hearing Individuals and Populations

Deaf and hard-of-hearing (DHH) children present several challenges to traditional methods of language assessment, and yet language assessment for this population is absolutely essential for optimizing their developmental potential. Whereas assessment often focuses on language outcomes, this Conceptual Analysis argues that assessing cumulative language input is critically important both in clinical work with DHH individuals and in research/public health contexts concerned with DHH populations. At the individual level, paying attention to the input (and the person’s access to it) is vital for discriminating disorder from delay, and for setting goals and strategies for reaching them. At the population level, understanding relationships between cumulative language input and resulting language outcomes is essential to the broader public health efforts aimed at identifying strategies to improve outcomes in DHH populations and to theoretical efforts to understand the role that language plays in child development. Unfortunately, several factors jointly result in DHH children’s input being under-described at both individual and population levels: for example, overly simplistic ways of classifying input, and the lack of tools for assessing input more thoroughly. To address these limitations, this Conceptual Analysis proposes a new way of characterizing a DHH child’s cumulative experience with input, and outlines the features that a tool would need to have in order to measure this alternative construct.

Deaf and hard of hearing in the United Arab Emirates interacting with Alexa, an intelligent personal assistant

BACKGROUND: Intelligent Personal Assistants have been booming around the world since 2014, allowing millions of users to interact with different cloud-based software via speech. Unfortunately, the Deaf and Hard of Hearing individuals have been left out without recognizable accessibility to such technologies, although it might be used to make their daily life routine easier. OBJECTIVE: In this research, the researcher studies the interaction and perception of Amazon’s Alexa among the Deaf and Hard of Hearing in the United Arab Emirates in its current set up (Tap-to-Alexa accessibility option) in addition to Sign Language as an input method. The researcher expands on the Technology Acceptance Model to study the acceptance of Alexa as an assistive technology for the Deaf and Hard of Hearing. Additionally, the researcher discusses more suitable input methods and solutions to allow Alexa, and other Intelligent Personal Assistants, be more accessible for the Deaf and Hard of Hearing. METHODS: The mixed method is used in this research in terms of collecting primary data through hands-on experiments, surveys, and interviews with the Deaf and Hard of Hearing participants. RESULTS: The researcher found that the Deaf and Hard of Hearing in the United Arab Emirates perceive that Sign Language combined with a Live interpreter is better than the accessibility option “Tap-to-Alexa”, which is a solution provided by Amazon. The researcher also found that Sign Language combined with a Live interpreter is the most suitable input method to make the device accessible for the Deaf and Hard of Hearing, in addition to translating the “Tap-to-Alexa” to different languages. Finally, the researcher proposes a modification to the Technology Acceptance Model to suit the research study of the Deaf and Hard of Hearing perception of Alexa. CONCLUSIONS: The researcher concludes that the ideal scenario for the Deaf and Hard of Hearing to interact and benefit the most from Amazon’s Alexa, and IPAs in general, is to include Sign Language as an embedded input method in the device and provide live interpreters; this sheds light on the importance of the interpreters’ jobs around the world. Additionally, “Tap-to-Alexa” must be translated into different languages for a better perception of the input method.

الوظائف الدلالية للغة الإشارة في السياق القرآني والنبوي وصور استخداماتها : دراسة نوعية = The Semantic Functions of Sign Language in the Quranic and Prophetic Context and the Images of Its Uses : A Qualitative Study

الوظائف الدلالية | لغة الإشارة | السياق القرآني | السياق النبوي | الأفراد الصم وضعاف السمع | Semantic Functions | Sign Language | Quranic Context | Prophetic Context | Deaf and Hard of Hearing Individuals

Genetic Testing for Deaf and Hard of Hearing Individuals: Genetic Counseling

More than half of human deafness or hard of hearing is attributable to genetic causes. There are over one hundred genes that individually contribute to cochlear function and the absence or alteration of a single gene can result in deafness, making deaf/hard of hearing genetically heterogeneous. This review will cover the genetic heterogeneity of human deafness, the clinical utility of currently available diagnostic testing for deafness, targeted parallel sequencing modalities, as well as challenges to interpretation of testing. As clinical genetics providers, our counseling approach should be future oriented due to the dynamic nature and expanding knowledge of genetic sequence variation.

Developing Consumer and System-Level Readiness for Effective Self-Advocacy: Perspectives from Vocational Rehabilitation Counselors Working With Deaf and Hard of Hearing Individuals in Post-Secondary Settings

Effective self-advocacy skills have been shown to positively influence lifetime outcomes of d/Deaf and Hard of Hearing (DHH) individuals. The literature suggests that many DHH individuals may be underprepared to effectively self-advocate in post-secondary settings due to a lack of effective training and opportunity. Vocational rehabilitation counselors (VRCs) who work with and serve DHH consumers are in a unique position to support their clients’ self-advocacy skill building, especially during the transition into the workforce and other post-secondary settings. The purpose of this qualitative study was to explore how VRC’s promote the self-advocacy knowledge and skills of their DHH consumers within post-secondary employment and educational contexts. Additionally, this study explored how VRC’s facilitated self-advocacy opportunities for their clients at broader systems-levels. Utilizing a grounded theory approach, data from semi-structured interviews with 10 VRCs working specifically with DHH clients was analyzed. Selective coding procedures revealed sixteen thematic strategies used by VRCs at both the individual and systems level, including defining of necessary self-advocacy skills, linguistic skill building, provision of full communication access, comprehension monitoring, both informal and formal self-advocacy assessments, direct modeling of advocacy skill, self-advocacy skills programming and counseling, an overall gauging of client ‘readiness to advocate’, identification of advocacy opportunity at the system-level, and employer education. Implications and future directions are discussed.

Addressing Intersections in HIV/AIDS and Mental Health: The Role of Organizations for d/Deaf and Hard of Hearing Individuals in South Africa

Like south africans generally, d/Deaf and hard of hearing South Africans are at risk of HIV/AIDS and mental disorders resulting from barriers to communication and care. In interviews and a focus group, members of South African organizations for d/Deaf and hard of hearing individuals all gave priority to HIV/AIDS education and prevention, citing risks resulting from language and communication barriers, inadequate schooling, and insufficient information in South African Sign Language. Participants gave varied descriptions of HIV/AIDS programs in schools for d/Deaf and hard of hearing students and described school initiatives they had directed. Some participants gave mental health problems lesser priority; others said susceptibility to mental disorders may result from communication difficulties and therefore warrants specialized services. Others, seeing a need to address mental health in HIV/AIDS prevention, had designed programs accordingly. Such prevention efforts merit support, as do activities to reduce communication barriers.

Constraints in Access to Assistive Technologies - and Communication - for Hard-of-Hearing People in the Russian Federation and in Germany

Keywordsassistive listening devices, accessibility, hard of hearing, hearing aid, communication, procedures, rehabilitationAbstractThis paper is an attempt to shed light on the specific constraints faced by hard of hearing (HoH) people in accessing assistive listening devices that are vital to their communication capability, functionality and participation in the society. It will focus on the situation of HoH people in such countries as Germany and the Russian Federation – the countries that were part of the first international research project "Hard of Hearing Young People in Europe: developing strategies on access to equal participation, social inclusion and protection of human rights." The project, the only of its kind, has been conducted by IFHOHYP, the International Federation of Hard of Hearing Young People, and was supported by the Council of Europe. The research was conducted through analysis of the results of the a) quantitative questionnaires on access to information, education, employment, communication, governmental support and knowledge of national protective legal framework – the questionnaires were disseminated amongst HoH individuals in several European countries; b) qualitative semi-structured interviews with the experts in the field (policy experts, leaders of the non-profit organizations of/for people with hearing loss, government representatives).

Enhancing Our Community of Inquiry: Thoughts on Principles and Best Practices in Research With Deaf and Hard of Hearing Individuals

The beginning of a new editorship for the Annals provides a good opportunity to re-engage contributors and the readership in a conversation about the principles and standards for manuscripts submitted to the Annals. In turn, the hope is that this conversation might help to enhance our research community and therefore the Annals' contributions to knowledge and understanding across an array of research and areas of inquiry focused on d/Deaf and hard of hearing individuals.

A New Era: “What Can I Know? What Ought I to Do? What May I Hope?”

Can I Know? What Ought I Do? What May I Hope? The above quote is taken from Immanuel Kant's (1787/1901) book, Critique of Pure Reason (p. 583), and reflects-at least on my intellectual level-my demeanor on becoming the new editor of the American Annals of the Deaf (January 1, 2011). First published in 1847, the Annals is purported to be the oldest continuously published English-language journal in North America. It is an honor to assume the responsibility of editorship. Although a good demeanor is crucial for success, it is daunting, but challenging, to follow the footsteps of Donald Moores, the outgoing editor (20+ years!). I thank Dr. Moores for working with me during the transition process. The major focus of this editorial is to present my vision for the Annals . Along the way, new members of the Editorial Board will be listed. Finally, I provide a few brief remarks on conducting and reporting high-quality research, which is also the topic of the invited article in this issue by John Ryan, 'Enhancing our Community of Inquiry: Thoughts on Principles and Best Practices in Research with d/Deaf and Hard of Hearing Individuals.' In conjunction with members of the Editorial Board, I expect to continue the mission of the Annals ; that is, to ensure that it is accessible to a wide audience, especially theorists, researchers, educators, and other relevant professionals invested in the welfare of individuals who are d/Deaf or hard of hearing. It is also critical for us to understand the need to be meticulous, courteous, and prompt with our reviews of submitted manuscripts from authors and to ensure the timely publication of the Annals issues. The most important goal is to ensure that the Annals remains a cutting-edge, high-quality, high-impact journal. Having stated the above, it is pertinent to welcome the new members of our Editorial Board (in addition to Don Moores, who assumes his 'new' role as reviewer): * Erik Drasgow (University of South Carolina) * Janet Jamieson (University of British Columbia) * Robert Kretschmer (Teachers College/Columbia University) * Carol LaSasso (Gallaudet University) * John Ryan (University of Vermont) * Beverly Trezek (DePaul University) * Ye Wang (Missouri State University) * Cheri Williams (University of Cincinnati) I am confident that these new members, along with our continuing crew, will enhance the rigorous and quality of the review process. There is a need to recruit additional individuals to increase our diversity and areas of expertise, given the range of topics in manuscripts submitted to the Annals . To accomplish this goal, I am open to recommendations (including self nominations) and will also solicit others, as needed, to serve as guest or invited reviewers to evaluate their potential to become members of the board. Maintaining high standards for the Annals requires the collaboration of the editor and members of the Editorial Board. In articulating my vision for the Annals , the intent is to raise the bar . Although it is necessary to appeal to a wide audience, we must ensure that the Annals remains a prestigious scholarly journal with rigorously reviewed articles involving theory and research across a broad range of topics. I propose the following ideas to be considered by the Annals community and stakeholders. Associate Editorship Nearly all major journals with a robust readership and substantial number of submissions employ the voluntary services of associate editor(s). Associate editors, who are 'action editors' for selected manuscripts, assist the editor in upholding quality, enhancing visibility, and in meeting deadlines. They can also serve as reviewers in special cases as needed. The initial proposal is for the selection of two associate editors, one of whom will function predominantly as a methodologist. That is, one associate editor should have a strong background in the field of deafness with ample scholarly and research publications. …

Has Public Policy Affected the Employment of Deaf and Hard of Hearing Individuals? Results of a National Survey

When Congress passed the Americans with Disabilities Act in 1990, economists expressed the concern that, rather than help disabled workers, ADA mandates to accommodate workers would make it harder for disabled workers to find jobs. Due to relatively high costs of accommodation, deaf workers may be most at risk under the provisions of the ADA. In this paper, we report the results of a survey of individuals familiar with the deaf population - vocational rehabilitation counselors and others who serve deaf and hard of hearing clients across the United States. On the positive side, respondents indicate that the ADA has improved working conditions for deaf and hard of hearing individuals who already have jobs. On the negative side, most notable is the perception among many of those who work with deaf individuals that costly ADA requirements have discouraged employers from hiring deaf workers.

A Comparative Perspective on the Experiences of Deaf and Hard of Hearing Individuals as Students at Mainstream and Special Schools

Integration of individuals categorized as having special educational needs in mainstream schools has become a dominant policy in many countries. Changes in recent years in the field traditionally called "special education" have significantly influenced the education of deaf and hard of hearing individuals. The movements against segregation and toward integration and, more recently, inclusion, have created the conditions for educational changes, not only in mainstreaming but in special education. The article brings to light the views and experiences of deaf and hard of hearing people as students at special schools and mainstream schools, in order to compare the two systems from the viewpoints of those involved and to explore the possible implications of these views and experiences for the development of the educational system in Cyprus regarding inclusive education. Particular attention is given to improvement of the education of deaf and hard of hearing children.

A Scattered Approach to Critical Issues

This book contains a selection of articles written by educational researchers, legal experts, test developers, an interpreter, and other professionals in the deafness field who have experience related to equal standards and fair assessment of deaf and hard-of-hearing individuals. The editors organized 15 chapters into five sections: (a) the context, (b) test development issues, (c) administrative issues, (d) cases from specific professions, and (e) summing up. The tests and evaluations that are the focus of these chapters are related to Educational Testing Service (ETS) tests, such as Scholastic Aptitude Tests, Graduate Record Examinations, and licensing tests. One chapter does address the psychometric properties of intelligence tests as related to deaf and hard of hearing. Neuropsychological, social emotional assessment, and other assessment methods of collecting data such as interviews, self-report measures, and behavioral checklists are not the scope of this book. The majority of the authors of the seven chapters that fall in the test development and administrative issues sections introduce their respective chapters with discussions of the historic background of educational assessment with deaf and hard-of-hearing individuals and an overview of the language confounds related to the use of standardized tests with deaf and hard-ofhearing individuals. The authors then make suggestions of possible test accommodations. Some of the language issues that are highlighted are idiomatic English, vocabulary, grammar, multiple meanings, inadequate context, and multiple embedded dependent clauses. Even though a few of the authors of these chapters do take different angles on the subject (e.g., examining whether the test construct is the same for deaf and hearing through differential item functioning) the repetitiveness of the content in these seven chapters makes the reading of the book tedious. This collection of chapters does orient the reader to the relevant ETS testing issues and how to maximize accessibility to ‘‘fair’’ testing and provides criteria regarding how to review test item structure and psychometric properties such as validity issues. The editors explain that ‘‘this book is about difficult choices which face persons who are deaf or hard of hearing and decision makers who must make decisions about their qualifications and futures.’’ For an individual who is unaware of the basic issues regarding assessing deaf and hard-of-hearing individuals, this book may be a good entry point; however, for a professional who is familiar with assessing deaf and hard-ofhearing professionals, this book is redundant.

Using Focus Groups to Create Culturally Appropriate HIV Prevention Material for the Deaf Community

The Washington, DC Department of Health and the HIV/AIDS Administration in collaboration with Deaf-REACH, a Washington, DC community service center for Deaf and Hard of Hearing (HOH) individuals, sponsored a qualitative research study to develop HIV and AIDS prevention materials specifically targeted for the deaf and HOH community. This article describes the process of creating a prevention poster and condom card targeted for Deaf and HOH individuals who use American Sign Language. This study utilized a series of five focus groups with members of the deaf community. The focus groups targeted three areas: (1) assessment of needs; (2) designs for prevention materials in terms of language appropriateness, graphics, and cultural relevance; and, (3) final choice of design and evaluation of language, graphics, and cultural relevance. Results of the initial focus groups indicated that there was a lack of general knowledge about HIV and a lack of culturally specific prevention and education materials, especially for subgroups within the deaf community. In the second phase, group members provided suggestions for character placement, setting, and cultural cues for prevention materials. Finally, an HIV prevention poster and brochure were chosen, produced, and disseminated at places deaf individuals frequent. Practitioners who provide HIV services to the deaf community must be aware that traditional methods of educating and outreach to members used in the hearing community may not be effective in the deaf community. Consideration should be given to the unique cultural and linguistic needs of the deaf community.