PP1510 - Fall Prevention in Older Deaf Adults Who Use American Sign Language

CDC data published in 2020 shows a higher self-reported fall rate among older adults who responded yes to, “Are you deaf or do you have serious difficulty hearing?” What is not known from current data is what the fall frequency is in older adults who use ASL. In this pilot study, we use VEMP, vHIT, balance control assessments, and self-reported scales to determine vestibular function in this population. We will begin to (1) describe the frequency of vestibular impairment among older Deaf adults; and (2) assess the associations between fall history and vestibular impairments in older Deaf adults. 

Summary:

The CDC’s BRFSS 2020 dataset shows a higher self-reported fall rate among older adults who responded “Yes” to the question, “Are you deaf or do you have serious difficulty hearing?” What is not known from the BRFSS dataset is whether the fall frequency applies to older adults who use ASL, especially given that the data were collected over telephone. There are both physiological and cultural/behavioral bases to distinguish ASL-users from non-ASL users. Physiologically, most adults who use ASL have done so since childhood; they have been affected by hearing loss etiologies that cause congenital or early-onset hearing loss and potentially vestibular impairment. Most adults who acquire hearing loss later in life choose to pursue hearing aids and cochlear implantation to allow them to continue spoken communication. Culturally/behaviorally, use of the visual-manual language likely impacts many facets of functionality (e.g., walking and signing).

The functional impacts of the physiological and cultural/behavioral differences in older Deaf adults require close examination. Deaf adults appear to function well when young, even with objectively measurable vestibular impairment, perhaps due to life-long adaptation. Yet, the aging process may have a more significant impact on Deaf individuals than on others. The age-related decline in the ability to multi-task may also have a greater impact in older Deaf adults, especially when such multi-tasking must occur using a limited set of sensory modalities.

The large-scale surveys infer vestibular functions from reported symptoms that are associated with physiologic vestibular impairments; but the association between the physiologic impairment and the reported symptoms is not straightforward. Not all physiologic impairment results in significant symptoms, and many symptoms that are associated with vestibular impairments are also symptoms of other pathologies. Specific assessment of each vestibular organ clarifies the actual vestibular organ functions in this population.  

In this project, we will (1) describe the frequency of vestibular impairment among older Deaf adults by the affected organs and any impairment patterns that can be observed; and (2) assess the associations between fall history and vestibular impairments as well as between fall history and balance control abilities in older Deaf adults. The knowledge of vestibular and balance control characteristics will inform if and which exercise strategies can be specifically tailored for this population.

A typical VEMP and vHIT procedure will be utilized. The limits of stability, modified clinical tests of sensory integration of balance, 5-times sit-to-stand, and timed up-and-go were selected to address different balance control functions and how they might impact risk of falls. Lastly, the Activities-specific Balance Confidence scale asks the respondents to rate their confidence level in being able to maintain their balance.

IRB approval has been obtained and data collection has begun. We aim to collect data from 15 participants for this pilot study before February 10, 2023. It is expected that approximately half of the participants will present with significant vestibular impairment. It is expected that those with a history of falls will present with greater incidences of vestibular impairment and limitations of balance control functions. Such confirmation will support the use of vestibular-targeting rehabilitation components into preventative exercise programs.