From the Fourth Rochester conference on Human Rights and Responsibilities:
“Communicating among Nations and Peoples”
M. Prosser and K. Sitaram (Eds.)

The Duality of Communication as a Barrier Between People who Hear and People who Don’t

The Deafened People Project

Hearing loss has conventionally been addressed with a rehabilitation approach, which views it as a defect to be remedied by treating and training the individual. More progressively, and with a greater sensitivity to the cultural view of deafness, an access perspective has been taken which externalizes the problem in environmental/situational barriers. This paper observes that both approaches take an information-processing view of communication that deals with content to the exclusion of relationship between sender and receiver.

As an alternative, the relational communication approach fits the situation of communication between people of different hearing abilities well, and provides additional insights that the content-centred perspective does not. People with hearing loss are as entitled access to the relational elements of communication they are to the information content, thus relational communication must be considered in developing and evaluating assisted/mediated communication. The priority, when it is not possible to accommodate both, should be determined by the communicators, not by professionals oriented to value one or the other aspect.

1. Background

This paper originated from the first author’s combined experience as an ergonomist/human factors engineer and a deaf person. In the latter capacity, considerable feedback has been received from deafened, deaf, and hard-of-hearing people about both the communication and assistive device options available to them and the cooperation they have enjoyed—or not—from their family, friends, and colleagues. This has been supplemented by the research of the second author specifically addressing interpersonal relations involving deafened people. Recent literature has been sampled to illustrate the breadth and diversity of views on the topic. Although each perspective offers something valid, the lack of coordination among the orientations and conflicting preferences confound genuinely equal interaction between people of different hearing abilities.

2. Communication loss through hearing loss: culture/defect and rehabilitation/access

Hearing is a critical element of communication. Hearing is essential to most face-to-face communication, to conventional telephone communication and voice-mail, to receipt of public emergency information, alarm signals, and announcements, access to mass media including radio, films, and conventional television and broadcast advertising. When people are deaf or become deaf, considerable focus is placed on restoring to them access to information that is conventionally transmitted in the auditory channel.

A cultural perspective is sometimes taken. The Deaf culture has by now been widely recognized as a culture with its own values and a distinct language (e.g. Sacks, 1990). The participation of deaf people in society can take an inter-cultural approach. Cooperation of non-deaf people to sign has been used as a measure of the success of mixed social interactions, e.g. “The ideal bicultural working place would be a place where everyone, hearing associates and supervisors as well, knew sign language,…” (Backenroth, 1997, p. 89) although “the use of sign language does not automatically lead to a positive attitude between the deaf and the hearing.” (p. 90).

Deaf culture provides a fulfilling setting for meeting all human needs—for some deaf people. Other than deaf adults who marry other deaf adults, work among deaf colleagues and with deaf clients, most deaf and deafened adults and children live in a world populated with hearing people. Deaf parents tend to have hearing children and most deaf children have hearing parents (Padden & Humphries, 1988). Anyone can become deaf at any time, through disease and treatment of disease, adverse reaction to medication, head injury, overexposure to loud noise, and heredity, among other factors (Deafened People Page, 1999). In addition to those who become deaf, there are many more who are or become hard of hearing. The hearing loss of normal aging (presbycusis) typically leaves some residual hearing until an advanced age, but affects a large majority of the elderly population. See Table 1.

Unfortunately, most people who are hard-of-hearing, deafened, or oral deaf—at least 3/4 of those who are audiometrically deaf and almost all of those who are hard of hearing—did not become deaf in childhood and may not belong to the culture[1]. Since the majority of deaf people have hearing parents, the inter-generational propagation of the culture is centred in the deaf residential school system rather than in the family, and thus age of onset is an inevitable determinant of cultural membership. Some of these people do “dabble” in both cultures, for instance those who work with deaf clients, or those who have acquired sign language skills although preferring on balance to remain in the non-signing world. For those who do not know how to sign, social refuge among deaf people does not exist. Communication with non-deaf people is essential because the alternative is no communication.

Even those who do have deaf family, colleagues, and clients, there are still the chores of daily living to achieve: health care, shopping, financial transactions, and so forth, which cannot all be done among only deaf people. This situation makes it necessary to address communication among people of different hearing abilities, whether through ‘rehabilitation’ or provision of ‘access’.

Rehabilitation addresses the deficit of the individual, thus those who view deafness as a difference rather than a defect are troubled by the “rehabilitation” concept. There are those who believe that deafness is a natural state and requires no rehabilitation. The semantics of “access” are more acceptable, referring to adjusting the setting so barriers to participation are removed. Both rehabilitation (support and training) and access (modifying the environment) are considered to comprise “empowerment” from the community social work perspective (Itzhak & Schwartz, 1998). The cultural perspective largely demands an access approach, accomplished by sign language interpreting, and as noted above, benefits merely a fraction of those with hearing loss sufficient to disrupt communication.

Those who are not served by that medium are usually recipients of rehabilitation efforts. Rehabilitation technology includes fitting hearing aids to augment residual hearing and cochlear implantation. Rehabilitation also includes teaching the person how to lipread, how to arrange a face-to-face conversation so that lipreading is optimized and how to interpret residual hearing. Aural rehabilitation also can include maintenance of expressive communication skills (speech articulation). These people are encouraged to use written communication, receiving, for example, assertiveness training to request a message in writing, or the use of notetakers (Aguayo, 1999). Rehabilitation from the psychological perspective may include acceptance of the loss of the sense of hearing, which normally provides cues for personal security as well as communication, and acknowledging the finality of not hearing music. Group-oriented rehabilitation customarily involves ensuring that the group realizes that the deaf or hard-of-hearing member may require repetition, first choice of seating (to avoid glare while lipreading), tips for speaking “lipreadably”, and the like.

Access technology includes providing information in visible media: text transcription, directional signage, written instructions, provision of mediated communication such as captioning for television, and text telephones (TTYs), self-serve channels such as web pages and automatic banking machines, visible and tactile signals e.g. doorbells, telephone ring, alarm clock. Most access interventions are environmental, external to the deaf person, however there are elements of skills acquisition to ensure that the deaf person is able to use the access provided. New text centred technologies are also touted as solutions for this communication problem: e-mail, online chat, fax as alternatives to the spoken word, and automatic speech recognition (Stuckless, 1994)—purported to transform spoken words into text.

Technology is an indefinite source of salvation. As soon as one new technology emerges which is text-based, another emerges which is confounded by lack of hearing. While new technology brings us Internet websites through which deaf people can access text information on demand, it also brings the touch-tone telephone actuated fax-on-demand technology, which cannot be accessed directly by deaf people.

For all the disputes over whether deafness is a culture or a disability, whether the remedies should be in the person (rehabilitation) or in the environment (access), all of the communication enhancement interventions are directed towards maintenance of content of communication.

3. Relational communication: dominance and affiliation

The communication discipline has recognized relational communication since the late 1960s (the observation having been credited to Watzlawick, Beavin & Jackson, 1967, as cited by Dillard, Solomon, & Palmer, 1999). The relational approach recognizes that communication is a relational event between two people, not merely the transmission of some specific content. Studies of relational communication have suggested that the relationship aspect contains two main dimensions: dominance (or submission) and affiliation although each may have a number of constituent dimensions (Dillard et al, 1999). Relational “uses and gratifications” influence choice of communication channel. A channel must be available and effective, but it must also be perceived as appropriate, given the specific communication goals, such as desires to give or receive inclusion, control, affection, or to experience pleasure, escape, or relaxation, and who the communication partner is (Westmyer, DiCioccio, & Rubin, 1998). The Sender-Receiver-Message information-processing model of communication omits these elements of dominance and affiliation, or inclusion, control, and affection, unless they form a specific ‘bit’ of the message content.

While development of rehabilitation and access interventions has proceeded largely “unhindered” by relational communication considerations, the relevance of relational communication in the situation of hearing loss has not been ignored. Studies of communication involving elderly people with presbycusis have been reported (Villaume, Brown, Darling et al, 1997, and other studies by Villaume and colleagues cited therein). Frequent adjustment to the loss of content become a matter of relational concern, although as long as the listener can discern the emotional reaction of the partner, the conversational adjustment is manageable. The nature of their studies of presbycusis made it impossible to separate the contribution of hearing loss from deterioration in the central processing of language due to aging.

A recent qualitative study of deafened adults observed that none of the subjects were referred for any relationship centred rehabilitation by any of the medical practitioners and service agencies they contacted (Aguayo, 1999), although they received an average of three referrals to medical or allied health practitioners. Villaume and colleagues (1997) also noted that prior research in that area had addressed only the content dimension. They called for research into practical remediation of the effect of presbycusis on relationships.

Relational aspects of communication were highlighted in an ergonomic analysis of the application of automatic speech recognition for deaf and hard-of-hearing users (Woodcock, 1997), which identified relational aspects as the greatest weakness of such a technology. Ergonomics requires task analysis. Defining the task as the transmission of content and the maintenance of role, within constraints that may be imposed by format, it was immediately apparent that ‘communication’ was too diverse to analyse as a single task. Analysis was facilitated by use of a matrix relating communication format (one to one, one to many, many to many, etc.) and role, e.g. intimates, family, strangers. In breaking down the communication settings, differences between combinations of format and role are more apparent e.g. one-to-one talk among intimates (“pillow talk”) versus one-to-many disembodied voice (PA system), and naturally made relational aspects explicit.

Confronted with the prospect of complete failure of communication through hearing loss, the priority to preserve information transfer is understandable, but it reveals a foregone conclusion that information is more important than relationships. As a matter of “Human Rights and Responsibilities”, this presumption must be challenged.

4. Re-examining deafness communication obstacles relationally

It may seem self-evident that communication is important but the point bears making explicit. Communication, or the absence of ready communication, is a barrier to full professional/vocational achievement of deaf people. The barrier of deafness to educational attainment is cited as a factor, as is the importance of speech skills. Both educational and training interventions and speech therapy are given much emphasis in employment preparation for deaf people. However, anecdotal evidence including personal experience suggests that these may merely be masking the effect of discrimination, albeit not necessarily deliberate discrimination. While many retired politicians can expect to enjoy steady income as lobbyists and consultants, a deaf retired politician who uses sign language to communicate finds his employment options limited to the ‘sheltered workshop’ of a service agency (Edmonds, 1999). Studies in the deaf culture in Canada have identified a 62.5% employment rate, but even this low rate includes 42% working below the level of their qualifications and ability (Canadian Association of the Deaf, 1999). The rate varies from province to province, as low as 14% employed in Ontario, Canada’s most populous province. Backenroth (1997) also found among deaf people a marked impression of not making full use their abilities and skills, compared to non-deaf respondents in the same organizations. Removing barriers to communication is essential for deaf people to achieve an appropriate social role, which for most people includes full employment.

Having found employment, an optimal working life and good psychosocial work environment require the ability to express oneself and one’s competence, to feel needed, to feel important to the job (Backenroth, 1997). The same are clearly needed in personal life. Within personal life, communication is the foundation for healthy family relationships, and friendships are also important to well being. When people become deaf, communication is disrupted. The disruption may be fatal to the relationship (Aguayo, 1999). The relational aspects of communication contribute significantly to the sense of affiliation and inclusion that this entails. When deaf people interact with hearing people, hearing ability usually allows hearing people to dominate, and results in dis-affiliation. Withdrawal is commonly reported as a result (Aguayo, 1999). Even those not affected by the adjustment to the loss of hearing report negative effects. These include a sense of isolation, lack of feeling of community, lack of feedback, unconfirmed identity, insufficient inspiration at work, missing important information given at work, missing opportunities for further training, a lack of respect from hearing associates, psychic fatigue, and psychic imbalance. This dysfunctional level of integration drives deaf people to socialize predominantly among deaf people (Backenroth, 1997, citing 1993 research in Swedish).

Interpreting certain natural communication behaviours also provides clues. People becoming hard of hearing may continue to telephone family and friends long after speech stops making sense, just for the relationship value of hearing the other person’s voice and transmitting their own. Chit-chat has very little function on the content level, yet if it was not important for fostering rapport, local newscasts, for example, would discontinue anchor banter. Chit-chat is lost when there is no relationship to sustain the extra effort of, for instance, writing notes. There was some indication that elderly people with hearing loss adopted the pattern of taking fixed turns in conversation as they became older, alternating stretches of passive and active roles in conversation (Villaume et al, 1997). As the majority of conversations could best be described as “chit-chat”, this is apparently a relational phenomenon, achieving affiliation/inclusion or affection through being a good listener. Distinctive communication patterns have been noted (anecdotally) among deafened adults lacking signing abilities; we have observed these deafened people exploit the busy-ness of social gatherings to achieve a rapid turnover of conversational partners and obviate meaningful conversational response. They could be seen as achieving a high quantity of total relational communication in terms of inclusion and control, despite lack of information transmission.

5. Options and paradoxes

The absence of genuine empowerment or human-rights orientation to communication enhancement could explain the pervasive wariness of the deaf culture to yet another well-meaning hearing person trying to teach the deaf to hear and speak, regardless of the impact on psyche and health (Sneed & Joss, 1999). Relational communication provides a key to understanding the needs and past failures, and evaluating options for the future.

The main means for assisting and mediating communication are converting or replacing speech with text, use of gestural communication, and aural rehabilitation including lipreading, amplification, cochlear implantation and related interventions.

5.1     Text

Text includes transcription by humans (real time reporting, computer-input and handwritten notetaking) and automatic speech recognition. Other than real-time transcription by skilled stenographer, all forms of transcription including computerized notetaking (QWERTY) and handwriting entail summarization. It is simply impossible to enter text at the rate of speech (Stuckless, 1994). Under time pressure, the operator will focus invariably on the mission-critical elements of the speech, inevitably perceiving the mission to be content. Thus inflections and tone of voice are not transcribed. Adjectives are the first to go. Understanding nuance is critical for effective participation in society; the person who misses the point behind sarcasm, who fails to note the emotional overtones of others, or who responds to the nouns without the adjectives loses relational ground. Inclusion and control suffer, and little pleasure is realized.

The main limitation of computerized automatic speech recognition for deaf and hard of hearing users[2] is the present inability of any one system to handle all three of the key elements of spoken information: continuous speech, unlimited vocabulary, and infinite speakers. Computerized speech recognition entails errors. For it to be effective, the speaker must monitor the transcription and make corrections; the recipient cannot judge what is accurate and what is not. Certainly this is possible, and has been reported, but this burden requires high motivation and assumption of responsibility by the speaker. Hearing loss is commonly considered to be the responsibility of the person who has the hearing loss, not those interacting with him/her. Imposing this responsibility on the speaker could well destabilize the accepted control or dominance balance in the relationship. In another view (Crocker, 1999), this could constitute a disruption of the social experience and elicit an ascription of stigma even though the other person has no established prejudice against deaf or hard-of-hearing people. It is not the hearing loss itself that elicits this reaction, but rather the unseemly dominance required to stay abreast of the content. Further, the response, rejection of that need, is detrimental to affiliation.

The sense of vision does not entirely substitute for hearing. Hearing is omnidirectional, while vision is unidirectional. For a text channel to deliver the Message, the Receiver must be looking at it. However, much communication is non-verbal. Turn taking, for instance, which is an important part of relational communication, is conveyed in part by gaze, gesture, and intonation (Fox, 1999). When hearing people talk to Deaf people using a sign language interpreter, the interpreter’s role includes conveying non-verbal cues such as the tone and register of the communication. This omission is a problem in the synchronous speech-to-text solution. [The asynchronous nature of email does not have this problem, while online chat and TTY conversations have technology-centred solutions, such as separate windows or other ways to display overlapping threads, or the GA (go ahead) protocol.] The resulting delayed responses of the text-dependent participant will seem like interruptions (rude, dominant, inappropriate). Alternatively, in avoiding this, the deaf participant will suppress responses, and seem aloof or unintelligent. Eye contact is such a fundamental component that infants begin, from the earliest age, learning communication through eye contact.

Although they provide high potential content transmission, subject to the performance of the technology and operator, text modes lack the social presence of face to face communication, and are a poor medium compared to the richness of vocal inflection, facial expression, body language, immediacy, added to the words themselves. Face to face communication is chosen as more appropriate for almost every type of message, with written messages much less preferred (Westmyer et al, 1998).

5.2     Sign Language

The importance and value of sign language to communication is signified by the model Swedish law mandating parents of deaf children to learn sign language (Sneed & Joss, 1999).

The ability to learn sign language is subject to interpersonal differences. Sign language acquisition is difficult for many people, with diminishing returns for a given amount of effort as exposure progresses (Kemp, 1998). Persistence depends in part on whether the learning was begun with instrumental or integrative motivations. Once the goal has been attained, even if it falls short of fluency, instrumental learners lose their incentive. As illustrated by the insouciant advice: if you want to really learn French, take a French lover—integrative motivations foster fluency. The person with a hearing loss may come to have an integrative motivation, if signing is seen as a key to rich social interaction, but the family is somewhat less so, since the objective may merely be to ensure Mom knows what time soccer practice lets out. Thus there may be adverse impact on affiliation and inclusion when effort drops off and fluency plateaus.

Acquisition of sign language, and any language, can be hindered by deterioration in the central language processing of the brain in aging, and as a result, elderly people becoming deaf may not be able to learn sign language. Gestural communication is still an option, however, as the family can adopt the “home signs” or intuitive gestures produced by the elderly member(s). The language problem may be a last-in-first-out situation, with long term memory intact. Some elderly informants have reported recollection of fingerspelling acquired some 60 or 70 years earlier, and the regret that they had not learned more signs then. The too-old-to-learn objection to gestural communication really does not differentiate between the suitability of text versus gestural channels. The same central language processing barriers that apply to learning signs will make it difficult to read text scrolling up a display at the speed of speech, particularly if the display is in any other way difficult for older eyes to read. “Too old” could be a euphemistic way to object to perceived inappropriateness, for instance, of gesturing at all.

Although this provides little help to people deafened today, it may be a good investment in future communication after acquired hearing loss if all people learned sign language in childhood. There are examples of isolated communities where high prevalence of deafness has led to sign language being accepted in the mainstream, and deaf people being accepted as full members of the community (Groce, 1985; Sneed & Joss, 1999). Paradoxically, perhaps, the Deaf culture is ambivalent about sharing sign language with hearing parents and deafened people, for fear that the language will become watered down, more like the spoken language, and they will lose control over it (Kisor, 1990).

Sign languages and even home signs provide the opportunity for eye contact at least, and at best a fully functional, grammatically complete, visually accessible language. Depending on the existing relationships, imposing a change to sign language might represent an unacceptable increase of control.

5.3     Aural rehabilitation

Lipreading is not a skill everyone can perform (Kisor, 1990). It can cause emotional discomfort, frustration, anger, and impatience with misunderstandings and ambiguities (Sneed & Joss, 1999). Undue persistence in this approach may provide little more than a second medium of communication failure. Amplification and cochlear implantation is acceptance of the dominance of people who do hear. This is likely a realistic decision, but it may be a discomfort for someone accustomed to being dominant. The imperfect hearing that results from these interventions must be reconciled with the decision that instigated their acquisition, that communication would adapt to the preference of the dominant hearing people. This may undermine reclamation of some control, to oblige partners to adopt gestural communication for example, to make up the shortfall in benefits derived from the device. Adding hearing aid or implant to a choice of sign language would represent the same net collection of techniques, yet relationally may be quite different.

If only it was effective, lipreading would be an ideal approach, because it maintains approximate eye contact (looking at the face) and requires less imposition of control than sign language. Certain environmental changes might be needed and communication partners might need to talk in a contrived way in order to achieve comprehension, but less so than other media. Unfortunately, most of lipreading performance comes from mind-reading, with a minimal amount[3] of language actually readable on the lips, thus it is weak on the content dimension. Lipreading is often practiced for relational reasons (with the companion practice of ‘faking’ comprehension).

5.4     Who chooses?

This duality of communication makes each communication a challenge of choosing a channel appropriate to the parties, the goal, and the message. In some cases, relational aspects are more important (I don’t really want to know about the attire of the other wedding guests, I just want to interact with my friend), while in others content is more important (if I parked with my headlights on, I really do want to know). None of the communication channels is universally superior. Empowerment entails supporting the individual to make his or her own choices. With communication, there are two or more individuals. However, the person who does not hear has fewer options, and experiences the barriers to communication continuously, and merits priority consideration for making this choice. Empowerment does not entail merely assigning the prerogative of the decision, but facilitating a well-formed decision. An empowered decision will have worked through such hazards as attempting to second-guess those perceived as dominant. We have heard many cases, anecdotally, of deafened people discounting a sign language option just presuming that family and friends will never learn, and that employers will never provide interpreting.

A person with a hearing loss often defers to rehabilitation professionals, and their professional models are oriented to communication as transmission of content. Achievement of the transfer of content is amenable to specification and performance is readily quantified, and this may be consistent with the orientation of the professional practitioners involved in this rehabilitation or access for deaf people, such as speech-language pathologists/audiologists, surgeons, and rehabilitation/biomedical engineers. This may also exist because professionals are rarely deaf themselves: while a Sender may consider text to be acceptable on the basis that content is effectively transmitted, a Receiver will be more inclined to judge acceptability in terms of the appropriateness of the medium in the context of the relationship (Westmyer at al, 1998). Most professionals fail even to recognize that their advice, “just tell your family how they need to communicate to you,” requires precisely the relationship dominance that the person with family communication problems does not have. The person with the hearing loss may perceive the relationship aspects as a loss, but doubt this perception when professionals all emphasize content. Relationship-centred counselling to reconstruct communication is usually warranted and desired by the deafened person, but rarely obtained (Aguayo, 1999).

In judging communication media, people generally prefer social presence and richness over content, and both reports and our own observation of certain natural behaviours of people with hearing loss show that they too try to preserve relationships. However their conscious choices about communication are often content-centred, probably because that is the orientation of the advice they receive. It seems inappropriate for professionals to guide people with hearing loss towards restoration of content over maintenance or reconstruction of relationships. At the very least, the trade-offs between the two should be explained. If the content-centred emphasis continues to prevail in resolving this duality (or out of oblivion to relational communication), then deaf and hard-of-hearing people will continue to find assistive and mediated communication interventions often being barriers themselves.

5.5     Paradoxes and conflicts

Perhaps the largest contribution this paper can make is personal observation from the my (KW) position as an ergonomist and engineer and a deaf person and advocate. While the field of communication has been conscious of the relational aspects of communication, my training as an engineer defined communication in information-theory terms. No relationship was expressed or implied. My experience as a consumer of audiological and hearing rehabilitation services indicating hearing-rehabilitation professionals as practitioners of ‘applied communication’ gave me no indication that relationship was important, and this supports the reports (anecdotal and research) of other deafened adults.

Presented with the limitations of the automatic speech recognition option, many people have said, “yes, I understand, but I still wish to do it anyway.” These people have invariably been People Who Hear. Empathy and the best of intentions notwithstanding, these people are not expressing the direct preferences of the People Who Do Not Hear. This tends to be supported not only by the absence of the intent-to-pursue on the part of average deaf people toward ASR, but also by their comments on their disaffiliation and frustration with their own significant People Who Hear. Resistance toward change in the modes of communication characterizes those relationships, and ASR represents a perceived opportunity to preserve the prior or mainstream mode of communication rather than adopt a new mode.

Another common response to the fallibility of ASR is the request for a position on “what error rate would be acceptable?” Usually this is couched in the let’s-be-realistic framework of the expense of interpreting. The fallacy of the question lies first in the assumption that any one position could be binding on a user population as diverse as deaf people, undertaking a wide spectrum of activities. The second fallacy is the assumption that minimizing the error rate is merely to enhance the deaf person’s enjoyment of the communication. If the deaf person was a cardiologist taking your history in the Emergency Department, any ASR error rate greater than zero is likely to be cause for concern to you. Commonly discussed in the classroom context, if a non-zero error rate is acceptable for ASR for deaf students, are they to be graded out of some standard less than 100%? Which answers are they permitted to get wrong? A further oversight is the fact that users of a fallible system do not know which information is correct and which is incorrect. Knowing that the error rate is 10% is of little use. Each bit of information has a 10% chance to be wrong, and some errors are errors of omission, so all of it is suspect. Deaf and hard-of-hearing people can readily make inferences about how much their participation is really valued, how included they really are, when the decision is taken to let them sink or swim in a stream of unreliable transcription, and dis-affiliation would be an unsurprising response.

The barriers to effective participation of deafened, oral deaf, and hard-of-hearing people are complex because they consist not only of breakdown in transmission of content, but in adverse impacts on relationships of the very efforts undertaken to restore content. A counselling approach must be developed that empowers deaf and hard-of-hearing people to weigh these two factors and make informed trade-offs. Development of assistive and mediated communication approaches needs to consider the relationships between and among users of different hearing abilities, so that the relationship impact of deafness is minimized, and certainly not worsened by introduction of the aid.

6.     References

Aguayo, M. (1999) Rehabilitation of deafened adults: a puzzle with missing pieces. Unpublished MSW thesis. Waterloo ON Canada: Wilfrid Laurier University. [Available July 1999: http://webhome.idirect.com/~deafened/research.htm]

Backenroth, G.A.M. (1997) Social interaction in deaf/hearing bicultural work groups. International Journal of Rehabilitation Research, 20:85–90.

Canadian Association of the Deaf, [Available 27 July, 1999: http://www.cad.ca/release.employ.pdf].

The Deafened People Page, [Available 27 July, 1999: http://www.deafened.org].

Dillard, J.P., Solomon, D.H., Palmer, M.T. (1999) Structuring the concept of relational communication. Communication Monographs, 66:49–65.

Edmonds, S. (1999) Deaf say they need jobs. The Associated Press/Canadian Press. Canoe: CNews Top Stories 26 March 1999.

Fox, B. (1999) Directions in research: language and the body. Research on Language and Social Interaction., 32:51–59.

Groce, N.E. (1985) Everyone here spoke sign language. Cambridge MA: Harvard University Press.

Kemp, M. (1998) Why is learning American Sign Language such a challenge? American Annals of the Deaf. 143:255–259.

Kisor, H. (1990) What’s that Pig Outdoors? A Memoir of Deafness. New York: Hill and Wang.

Padden, C. & Humphries, T. (1988) Deaf in America: Voices from a Culture. Cambridge MA: Harvard University Press.

Sacks, O. (1989) Seeing Voices: a Journey into the World of the Deaf. Berkeley CA: University of California Press.

Santos, K.D. (1995) Deafness. The Encyclopedia of Social Work (19 ed.) [CD-ROM] Silver Springs, MD: The National Association of Social Workers Press.

Stuckless, E.R. (1994) Developments in real-time speech-to-text communication for people with impaired hearing. In: Ross, M. (Ed.) Communication access for persons with hearing loss. Baltimore MD: York Press, pp. 197–226.

Villaume, W.A., Brown, M.H., Darling, R., Richardson, D., Hawk, R., Henry, D.M., Reid, T. (1997) Presbycusis and conversation: elderly interactants adjusting to multiple hearing losses. Research on Language and Social Interaction, 30:235–262.

Westmyer, S.A., DiCioccio, R.L., & Rubin, R.B. (1998) Appropriateness and effectiveness of communication channels in competent interpersonal communication. Journal of Communication, (Summer 1998):27–48.

Woodcock, K. (1997) Ergonomics and automatic speech recognition applications for deaf and hard-of-hearing users. Technology and Disability, 7:147–164.

[1]Unfortunately, the salience of deaf culture in the deaf spectrum has all but obliterated recognition of the access needs of the non-signing majority. As evidence of this orientation, the subject of much anecdotal frustration among hard-of-hearing and deafened adults, one may consult references for social workers (Santos, 1995) and occupational therapists (Sneed & Joss, 1999), and indeed the amount and availability of funding for hearing-loss related research, development, resources etc.

[2]  For a fuller analysis, see Woodcock (1997).

[3]Most figures published for this have dubious empirical origins, but lipreadability figures for English tend to be in the range of 30%.