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A CASE STUDY OF A PHYSICALLY IMPAIRED DEAF CHILD Rosslyn Gaines Roy Meals An Interesting parallel We present the case of "Mary Anne" because it has some parallel with the case of deaf children born into hearing families. In the present instance, a deaf child born into a seventh generation deaf family cannot communicate with her family because, as in the hearing family, there is not a readily shared mode of communication available to both child and family members. Mary Anne, born without thumbs, could not sign in a way that was understandable to most signing persons. A deaf child in a hearing family is, of course, in a more restricted position, because she, or he, cannot understand the family vocal communication and cannot respond. From another viewpoint, Mary Anne was much like a child whose speech impairment is so severe that only the mother can understand some of what the child says and strangers cannot follow the line of speech at all. Mary Anne could understand the family's manual communication but could not express herself clearly. Most fortunately, it was possible, after five years, to create thumbs surgically for Mary Anne.' If she became able to manipulate these thumbs, then her expressed communications could be better understood by others. Our investigation pursues not only the post operative communication changes but the associated corollary psychological differences possible with such a change. Did her intelligence level change as a result of her increased participation in communication? Did her emotional adjustment show a change in response to her more adequate communication? Were there unexpected 1 See: Functional demands & consequences of manual communication, The Journal of Hand Surgery 13A (1988), 686-691 (by R. A. Meals, M.D., R., W. Payne, M.D. &R.Gaines, Ph.D.). Q 1990 by Linstok Press, Inc. See note inside front cover. ISSN 0302-1475 245 Gaines &Meals differences in her school performance? Last, the extent of gains in associated activities, such as perceptual skill and eye-hand coordination, were examined. Answers to the above questions may seem obvious to some readers; yet it is not certain which psychological and performance changes could occur in response to increased communication. This case could give some insight into the generalizable psychological benefits of such an enormous change in physiological status. Briefly, Mary Anne was given a pretest battery prior to surgery at 5 years, 10 months. She was operated on at 6 years, 1 month and post-tested with the same battery at 6 years, 8 months. The seven month interval allowed for surgical recovery and a practice period in using the new thumbs. The report is organized as follows: First, the details of the case and family history are given; second, the importance of the use of thumbs in sign language are described; third, the tests used pre- and post-operatively and the reasons for their selection are presented; last, comparison of the test results and conclusions are offered and the possible effects of maturation on the test results are discussed. Case description Perhaps the most ironic part of Mary Anne's history is that she was born into a family where deafness is a seventh generation autosomal dominant, thus insuring her of excellent familial communication and acceptance of her auditory deficit. In addition to this autosomal dominant gene, Mary Anne was born with bilateral ulnar, fibular dimelia, and no thumbs but 6 digits on one hand and 5 on the other. Everyone in the family, including hearing members, like the maternal grandmother, are fully versed in total communication (speaking vocally and using signed English simultaneously) and American Sign Language (ASL). When Mary Anne was 5 years old she was brought to UCLA. The second author determined that reconstructive surgery to create thumbs for both hands was possible. The medical procedures are more fully described elsewhere (See footnote 1). Sign language In all sign languages used by deaf people, the thumb is frequently used as an independent digit on several facial locations: for example, GIRL SLS 68 Sign production disorder and TOMORROW require contact on the cheek (Fig. 1). If the first finger is used instead of the thumb, these signs can be confused with other signs; e.g...


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