By Malloree Rice, MS, ACSM-CEP, CCRP

Cardiopulmonary rehabilitation professionals work with people from all walks of life. Beyond the physiological diversity, we also get to learn about different cultures, ethnicities, religions, and abilities. Every participant provides an opportunity to expand our skills in exercise prescription and education. Two populations we may infrequently see are those who are hard of hearing or deaf and those who have low vision or are blind. Neither community accepts the term “impaired,” which is viewed negatively because it focuses on what people cannot do. When in doubt, ask patients how they identify themselves. Our facility has had the pleasure of working with both of these patient populations. Here, we share our takeaways to help support your team in providing accessible, adaptable care.

Individuals Who Are Deaf or Hard of Hearing

One of the main takeaways from working with patients who are hard of hearing or deaf is that, if available, an in-person interpreter is preferred. Although audio/video technology can be a huge benefit overall, it’s not always the best option for these participants. They typically would rather have an in-person interpreter due to the ease of explaining exercises without having to maneuver a device to see the interpreter on a screen. We recommend reaching out to your interpretive services department to see what resources are available at your hospital.

Beyond the education and health improvements that we offer, cardiopulmonary rehab can provide patients with a sense of community. An in-person interpreter allows these patients to experience this feeling of togetherness. Staff should encourage others to utilize the interpreter as well. His or her physical presence may encourage participants to engage with a patient who may be hard of hearing or deaf.  

When utilizing an interpreter, make sure you are talking to the patient and not the interpreter. Make eye contact; and stand where the patient can see you, as some people who are deaf are able to lip-read and/or interpret body language and facial expressions. Be cognizant of what equipment the patient is using, as they need their hands to communicate. When they are using a treadmill or arm ergometer, this may not be the best time to communicate. For programs able to secure the same interpreter for sequential visits, consider providing that individual with your educational material ahead of time. This allows them to study the education and know a little about what you are going to say, as these topics and verbiage might be unfamiliar.

If a patient does not require an interpreter but is hard of hearing, remember to speak clearly, enunciate, and communicate in a tone that is easy to understand. With hearing loss, a patient is more likely to understand if you deepen the tone of your voice rather than yell. Be sure to ask which side you should stand on when giving education, so that it makes it easier for the patient to hear you. Inquire about the easiest way to contact them and for them to contact you.  Many patients with hearing needs have specialized phones or rely on family members to communicate care. Utilizing the electronic medical record messaging for communication is also a great option. Ask the interpreter to teach you numbers or simple greetings in American Sign Language (ASL) in order to communicate blood pressure and heart rate without the interpreter. Show the patient that you care. 

Individuals Who Are Blind or Have Low Vision

We must sometimes be creative when it comes to providing cardiopulmonary rehab to participants with low vision or blindness, who may require extra assistance when transferring surfaces. Simple actions like turning on the cardiac monitor, reading the number on the scale, or seeing the level on a machine can be difficult. If you provide handouts with your education, edit those materials so that the font is large enough for patients with low vision to read. Do the same with the RPE/RPD (rate of perceived effort/rate of perceived discomfort) scale: bring a scale to the patient, or read the scale to him or her. If the participant has better vision on one side, be mindful of demonstrating exercises, showing scales, and providing education to the patient on that side. When assisting with equipment, it is usually best to guide by the elbow and use descriptive words to convey the environment and where the equipment is in relation to the patient. Be conscious of tripping hazards that may be in the path. Be sure to ask the patient if he or she needs assistance, and if so, what is the best way for you to provide that.

Importantly, cardiopulmonary rehabilitation program staff must get familiar with the Americans with Disabilities Act. The federal law requires medical care professionals to provide individuals with disabilities full and equal access to their health care services and facilities as well as reasonable modifications to policies, practices, and procedures. The best thing we can do for these patients is to care for them just as we would anyone else seeking our help.