Communication changes and Usher

As already discussed, many people with Usher will need to adopt new communication methods as their vision and hearing changes.

Usher Type 1

Typical features of communication: Sign language, hearing aids, cochlear implants.

An adult with Usher type 1 is typically from a generation who attended Deaf schools and use either Sign Supported English (SSE) or British Sign Language (BSL) and did not have Cochlear Implants (CI) at a young age, although they may have CIs later in life. They tend to have some useful vision and may be able to access the ‘full’ picture of someone using SSE or BSL.

When the individual’s vision becomes ‘narrow’, they will be able to see sign language produced on a smaller scale, as it might appear if you take a photo through a camera lens. This is called Visual Frame Sign Language. Also the distance they can see may change, perhaps within about a distance of four feet, i.e. the signer cannot stand too close or too far from the person with Usher.

Over the years, this person’s vision may become narrower or they may struggle to see people, faces, expressions, or lips for lip reading so this may lead them to start using what is called ‘Hands On’ sign language. They can start to place their hands over the signer’s hands to ‘feel’ hand shapes and directions to better understand the communication. They may also be open to using Social Haptic communication for environmental information. 

Young people with Usher Type 1 are more likely to have had Cochlear Implants (CI) as babies, toddlers or at a very young age.  Their communication methods are different compared to older adults with Usher. Their CI will have helped their hearing and ability to communicate through speech, and they are more likely to attend mainstream schools. Some do not use any form of sign language and function in a similar way as people with Usher Type 2. 

Usher Type 2

Typical features of communication: Clear speech, lip reading, hearing aids

People with Usher type 2 usually speak well and tend not to use sign language. However, there are some people with Usher type 2 who choose to use sign language so they can communicate with signing deaf friends and colleagues. When their sight deteriorates, they may struggle to lip read and listen to someone talking which may result in them mov-ing their head closer to the person so they can hear what they are saying.

When a person with Usher struggles with lip reading or is no longer be able to ‘see’ shapes of lip reading and facial expression as clues, they may turn to learning Deafblind Manual fingerspelling as a communication method.  Alternatively, they can opt for Block written on hands and Social Haptic communication.  

Usher Type 3

Typical features of communication: Hearing, speech, cochlear im-plants

People with Usher type 3 communicate through speech. Because both their sight and hearing deteriorate roughly at the same time, it can be challenging trying to find ways to compensate for both.

Many will have Cochlear Implants to support their hearing loss and most will still rely on listening/receiving verbal communication without looking at a person’s face if their sight deteriorates. A person with Usher type 3 may not be used to lip reading and will, where appropriate, need to learn this new skill with cued speech. When a person with Usher struggles with lip reading or is no longer able to ‘see’ shapes of lip-reading and facial expression as clues, they may turn to learning Deafblind Manual fingerspelling as a communication method.  Alternatively, they can opt for Block written on hands and Social Haptic communication.   

Adapting Writing and Text styles

People with Usher will have their own preferences when it comes to reading text and writing, depending on their Usher and specific eye conditions.

Examples of adaptations

From a young age, people with Usher who have had good vision and been able to read text for many years, may be able to see written text in normal light.  As they get older however, they may discover they can no longer read text in font sizes 8, 10 or 12 and their preferred size will increase.  They may request large print and font sizes of 14, which could again increase to 16, 18 or 24 and so on.

Many people with Usher like Arial as their preferred font style for its clarity.  However this may not be the case for all those with Usher and they will have their own preferred font style.  When writing on paper, they may no longer be able to read writing using normal ball point pens. Thus, they may prefer to use black felt pens, or thick pens on white papers, or other light coloured paper. 

Many people with Usher will find it difficult to see writing from red or green pens and prefer the use of black or dark blue pens, as these are easier to read due to the greater colour contrast. Some people will use a magnifying aid in order to read as they are finding it difficult to simply use larger print.  When a person with Usher struggles to read with all of the above adaptations they may opt to use Braille or Moon. These are best learnt before their sight changes to make the transition easier and to ensure they are prepared should their sight change.  However, it is never too late to learn Braille or Moon, but it will take longer once their sight has deteriorated. 


Created: February 2016

Review due: February 2018

First published: Wednesday 2 December 2015
Updated: Monday 16 January 2017