Some Facts about Sign Language and Interpreting

This short description of sign language and interpreting is written by an ophthalmologist for colleagues to keep the language devoid of the many fine expressions that linguists are apt to use. My knowledge of American Sign Language (ASL) is minimal, but I have had exposure to sign languages and deaf culture in other countries.

Sign language may seem to be a haphazard collection of gestures when looked upon by a person who does not see the minute differences in the movements of hands and fingers, and who does not understand the spatial and visual structure of signed information.

A rather common misconception about sign language is that it is visualized English. American Sign Language (ASL), the mother tongue of deaf communication, is a distinctly different language. There are also different ways of presenting English manually, either by fingerspelling (visual handshapes of the manual alphabet, Figures 1A and 1B) or by Signing Exact English (SEE). There is also Pidgin Signed English (PSE) which uses signs but is closer to English than ASL in its syntax. Sometimes we see families that use homemade signs and gestures that do not fulfill the definition of any formal sign language.

Figure 1A. One-handed manual alphabet. Pocket-size copies of the manual alphabet card are available. (Finnish)		Figure 1B. Two-handed manual alphabet. (Australian)

The existence of several different forms of manual communications means that we must remember to ask the patient what type of sign language should be used during interpretation, or which interpreter the patient would prefer in medical communication. Physicians need to know that sign language is far more logical and structured than our spoken language. When a new concept, person, object, is mentioned for the first time, it is described and "placed" in a certain location in the visual space. When the concept is referred to later, it is pointed to in the signing space. It does not need to be defined each time it is used.

The use of a specific location in space to specify a person or function makes signed information often very quick and therefore hard to translate into speech (reverse interpretation). For example, the left hand of the signer may be used to speak for the signer himself and the right hand for another person. It then becomes possible for the signer to describe an argument between these two persons with one hand saying "yes" and the other hand almost simultaneously saying "no"! Another example of effectiveness of signed information is when the patient signs with two small movements "bilateral cataract extraction with lens implants", the first small vertical movement in front of both eyes depicting the surgery and the other movement depicting how the implant is put in place. On the other hand, there are numerous situations where the interpreter has to sign for quite some time to cover something that can be expressed by just a few spoken words.

Figure 2. The patient describes three persons and defines their locations to be used during that part of the conversation. Later, the verb signs movefrom the location of the "doer" to the location of the person who is the object of the action.

Quite often the interpreter has to ask the patient to slow down or pause in order to catch up with the tidal wave of signed information. Similarly, the doctor may sometimes be asked to wait for a while so that the interpreter can catch up. We have to learn to accept the interpreter as the communication's supervisor.

Interpretation from spoken language into sign language and vice versa can be either simultaneous or consecutive. In medical examinations it is most often consecutive until the doctor and the interpreter have worked together sufficiently long that the examination situation and the phrases used are mastered by both persons.

Due to the fact that deaf people pay particular attention to the detailed description of each person or object to be discussed, we should learn to define each new subject carefully and make sure that the patient knows what we are talking about. If the concept is new and there is no commonly used sign for that concept, it first has to be finger spelled and then clarified, using signs. This is the responsibility of the interpreter, but the doctor has to be aware of the need for extra time and has to wait patiently until the end of the signed message. In some cases, the interpreter may need to ask the doctor for help in formulating the clarification.

Another typical feature of sign language is the use of actual, sequential time order in describing a series of events. In ASL the focal point of the comment is placed at the end of a statement, rather than at the beginning as is common in English. For example, in spoken language we can say "Does your visual field get smaller when you enter a dimly-lit room?". In sign language the event that happens first is signed first. Thus, in ASL the statement would be "When you enter a dimly-lit room, does your visual field get smaller?". If we can remember this simple example we will make the interpreter's work a lot easier, since the interpreter cannot start the sentence before the doctor has described the event that happens first.

The speed at which a patient can easily perceive signing is related to both his competence in sign language as well as the nature of his visual impairment. Our current tests used in assessment of impaired vision do not reveal the degree of loss of temporal resolution, changes in motion perception, or the perception of exact positions of fingers and arms which probably are quite important in the communication of deaf persons. Since we cannot measure the degree of communication impairment, we have to carefully ask the patient whether signing with normal gestures is acceptable and use that information in our reports.

Although sign language is visual, it is not visual in the word's usual meaning. Our visually impaired patients whose visual fields are limited to a few degrees perform their signing in a space that does not visually exist for them. When we try to sign with smaller signs to make them fit in the small tubular field of new patients, these persons often dislike it and would rather sit at an unusually long communication distance, in order to retain more ordinary signing. This might be related to the fact that signs have well known relationships with different body parts. If removed from its normal location in space the sign also becomes detached in its meaning. When a deafblind person with a small tubular field comes in contact with other similarly affected deaf persons, the use of smaller signs is often accepted rapidly.

Lip reading or speech reading is often thought to be an essential part of sign language and deaf people are often expected to be able to lip read so well that they can use it as their sole means of communication. The ability to lip read is very individual, and it is never a hundred per cent correct when uncommon vocabulary, such as medical terminology, is used. Lip movements are fast and short; they can be perceived if the person has perception at the needed high frequencies.

Motion perception may be lost due to retinal changes in retinitis pigmentosa. It may disappear when the visual field is still 30–40 degrees in diameter and the person must start using cane to warn the people around him/her about vision loss. Since motion perception is not measured as a part of clinical examinations, it is difficult to have acceptance of the diagnosis of severe vision loss when the visual field is still quite large and visual acuity is also “too good”. However, a person who does not perceive the speed of movement of other people, cannot calculate how to void bumping into them, is functionally blind in crowds and traffic.

Any new language that we learn means exposure to a new culture since language and culture are intimately interrelated. Therefore we have to be prepared to deal with cultural and attitudinal differences, too. There are a few things that many deaf persons experience as insulting, more so than hearing persons can imagine. One common mistake is to assume that the patient has the ability to lipread and to want to measure it as a part of the assessment of visual functioning. Lipreading tests should be introduced only if the deaf person uses lipreading in communication. Another insulting request is to ask a deaf person who uses ASL to talk. This seems to occur in medical institutions even in situations where there is no need for the patient to talk since there is an interpreter present. The request for speech makes no sense and only serves to alienate the patient from the medical specialists.

Among the many publications related to sign language the research report "Language Research: New Views of How the Brain Works" from the Salk Institute for Biological Studies, P.O. Box 85800, San Diego, California 92138 is particularly relevant to an ophthalmologist.