Dr. Sandra Cummings:

I am Dr. Sandra Cummings. I am an audiological scientist at the Beacon Hospital and I represent the Irish Society of Hearing Aid Audiologists. As my colleague has mentioned, deafblindness is a singular impairment that can present concomitantly different degrees of vision and hearing loss. Recognising deafblindness as a singular impairment has a number of advantages for the patients involved as well as the clinicians whom I represent.

First, recognition is vital in terms of developing a care pathway for individuals with a bimodal disability or deafblindness. A care pathway is defined as "a complex intervention for the mutual decision-making and organisation of care processes for a well-defined group of patients during a well-defined period". The defining characteristics of a care pathway include an explicit statement of the goals and key elements of care based on evidence, best practice and patients' expectations and characteristics; the facilitation of communication among the team members and with patients and families; the co-ordination of the care process by co-ordinating the roles and sequencing the activities of the multidisciplinary care team, the patients and their relatives; the documentation, monitoring and evaluation of variances and outcomes; and the identification of the appropriate resources. Only once deafblindness is recognised as a disability can a care pathway be developed and implemented. The aim of a care pathway is, therefore, to enhance the quality of care across the continuum by improving risk-adjusted patient outcomes, providing patient safety, increasing patient satisfaction and optimising the use of resources.

Second, early and correct management of deafblind individuals is the responsibility of many professions and specialties. Otolaryngologists, audiologists and ophthalmologists as well as other specialists from the rehabilitation teams should co-operate closely to achieve the best results. From an audiological perspective, the liaison with the ophthalmology representation is particularly important when considering appropriate rehabilitation of the hearing impairment. It is important that the audiologist be made fully aware of the deteriorating visual acuity, as this has important implications regarding the decision of when to refer for a cochlear implant should the vision be deteriorating quicker than the decline in auditory acuity. Therefore, decisions on when to provide traditional amplification or when to refer for cochlear implantation should depend on the ongoing assessment of the multidisciplinary team.

Third, the recognition of deafblindness will allow for support at a national health care and remuneration level, particularly in terms of aids and appliances submissions and assessment of need submissions. This has particular relevance for hearing aid and cochlear implant assistive technology like FM systems, sound field systems or any assistive technology that enhances the deafblind individual's communicative needs.

Fourth, the appropriate training of professionals who specialise in the rehabilitation and support of the deafblind will be implemented and facilitated by having deafblindness recognised as a singular impairment.

Deafblind people need specific means of communication to have access to education, career opportunities, leisure and social life. Knowledge about the communication abilities and difficulties that a deafblind person has can guide public policies to create measures aimed at improving access to communication and information and, therefore, independence of deafblind people.