












































MANUSCRIPT TYPE


PATIENT-CENTERED CARE COMMENTARY  

 

65 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

Providing Athletic Training Resources to Deaf and Hard-of-Hearing 
Persons 
Molly M. Osborn, MS, LAT, ATC*; Courtney M. Meyer MS, SCAT, ATC‡; Zachary K. Winkelmann, PhD, SCAT, ATC, CHSE‡ 
*Florida International University, Miami, FL; ‡University of South Carolina, Columbia, SC 
 

 
Correspondence 
Dr. Zachary Winkelmann, 1300 Wheat Street, Columbia, SC 29208. 
E-mail: winkelz@mailbox.sc.edu   
Twitter: @zachwinkelmann 
 
Full Citation 
Osborn MM, Meyer CM, Winkelmann ZK. Providing athletic training resources to deaf and hard-of-hearing persons. Clin 
Pract Athl Train. 2023;6(2): 65-70. https://doi.org/10.31622/2023/0006.02.11.  
 

 
INTRODUCTION 

Athletic trainers are responsible for the care and health of active individuals in various settings, leading 
them to interact with diverse patient populations characterized by unique personal backgrounds, 
socioeconomic status, culture, physical ability, and medical disabilities. The people often overlooked in the 
realm of sports and recreation is the Deaf community. Approximately nine percent of the total world 
population is a member of the Deaf or Hard of Hearing community (See Table 1 for definition).1 Some 
Deaf athletes have other comorbidities; for example, approximately 1 in 4 Special Olympic athletes with 
intellectual disabilities have failed a hearing screening.2 On the other hand, many Deaf individuals often 
have no other bodily disorder or condition requiring the removal from regular sports participation or 
athletic competition. Many high-profile Deaf athletes have shared their stories and advocated for the 
acceptance of their fellow Deaf or hard of hearing athletes. Several National Football League players, 
like Bonnie Sloan, Larry Brown, Kenny Walker, Flozell Adams, and Derrick Coleman, either acquired 
deafness slowly throughout their careers or were deaf before successful participation in the league.3 With 
the increase in participation and the necessity of equitable medical care among all athletes, athletic 
trainers need additional education, resources, and support to assist Deaf athletes when they experience an 
injury or illness during their athletic participation.  

Table 1. Deaf Terminology4 
Deaf Refers to a person with complete or profound hearing loss; the capital D is often 

used to describe the community or culture. 
deaf  Refers to the medical condition of having complete or near complete hearing loss 
Hard of Hearing  Refers to a person who has mild or moderate hearing loss 
Hearing Impaired  Refers to any degree of hearing loss 

 

BARRIERS TO CARE 

One significant barrier to Deaf athletes' sports participation is their ability to seek medical care like their 
peers. Communicating with patients is a large part of patient education and honoring a patient’s beliefs, 
experiences, and wishes in a patient-centered care model. Healthcare providers should facilitate the care 
of Deaf athletes, empowering their ability to choose their healthcare options.5  Interpreters that were 
interviewed as part of a previous study made statements like, “Many patients just don’t even know their 
communication rights. So on top of feeling disempowered, they may not even know what they can 

mailto:winkelz@mailbox.sc.edu
https://doi.org/10.31622/2023/0006.02.11


Providing Athletic Training Resources to Deaf and Hard of Hearing Persons 

 

66 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

advocate for”.6 Without proper modes of communication, misdiagnosis or medical errors are more likely to 
occur. Therefore, Deaf individuals are more at risk than hearing individuals for misdiagnosis, 
misunderstanding, and coercive medical care.1 While there is a lack of data relating to communication with 
and the care of Deaf patients in athletic training, studies have been conducted on communication barriers 
in other healthcare settings.  

During a study on issues related to providing care for Deaf individuals who use American Sign Language 
(ASL), nurse practitioners noted three critical levels at which barriers occurred (intrapersonal, interpersonal, 
and organizational).5 Barriers across each of these levels included language barriers/not knowing ASL, 
lack of access/presence of an interpreter, little experience with Deaf individuals, and a lack of means to 
communicate with Deaf individuals.5 Only a small portion of healthcare professionals are fluent in ASL or 
know basic terms, thus creating a communication gap between providers and patients.5 Similar barriers 
exist in the athletic environment and undoubtedly pose an equally impactful barrier to medical care.  

Previous research identified that while healthcare providers recognize the role of interpreters as a 
facilitator of reasonable care, they did feel that using an interpreter was a “…last resort when all other 
means of communication failed.”5 While it may be new and uncomfortable for the provider, interpreters 
are essential healthcare team members when the patient and provider use different languages for their 
primary communication. In the absence of a formal interpreter, a family member may be available for 
ease of communication. However, using a patient-centered approach may pose a threat to unbiased 
patient education. The parent, sibling, spouse, or other family member may intentionally or unintentionally 
bias the information or patient responses due to personal beliefs or biases about the medical care. For this 
reason, the most reliable method of communication in the absence of a hired interpreter may be to write 
down important information and consent for all procedures. A final barrier addressed by the nurse 
practitioners in the study was the rarity of Deaf patients in their practice.5 With any situation, familiarity 
with procedures and resources and comfort level with different cases increases with regular review and 
use. Since many healthcare providers do not encounter Deaf patients regularly, they do not have this in 
routine practice.  

INTERPRETERS AS A MEMBER OF THE MEDICAL TEAM 

In the absence of a healthcare provider trained in medical ASL, interpreters are the gold standard of 
medical care. The healthcare provider must recognize the value interpreters bring to their practice and the 
care team.7 The Americans with Disabilities Act (ADA) describe situations where an interpreter may be 
necessary to ensure effective healthcare communication.8 These situations include obtaining consent for 
treatment, taking a medical history, explaining therapeutic interventions and procedures, and providing a 
diagnosis.8 In a study by Chatzidamianos et al., researchers interviewed ASL interpreters in the mental 
health setting.9 They found that the triangle of care between the patient, interpreter, and healthcare 
provider was the most important theme in caring for a Deaf patient.9 As Deaf individuals do not 
communicate verbally, their non-verbal cues and body language are, by necessity, more important and 
more prominent. ASL interpreters are responsible for conveying not only the signed words but also the 
patient's non-verbal emotional cues.7,9 It is important when using an interpreter to continue conversing with 
the patient as if the interpreter is not there and mainly speaking with the interpreter to provide clarifying 
information.1 Maintaining eye contact with the patient and allowing them to read any facial expressions or 
body language is important to building trust with them.7 It is also important to avoid using third-person 
language or having side conversations with the interpreter during the appointment.7 If needed, a post-
encounter debrief can be scheduled with the interpreter to improve communication or further explain 
concepts.7  



Providing Athletic Training Resources to Deaf and Hard of Hearing Persons 

 

67 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

Consistent use of a single interpreter may be important in ensuring all relevant information is communicated 
in both directions. This also builds the trust essential for the foundation of the triangle of care. Without trust 
created between all three team members, trust cannot exist between any two members.9 As healthcare 
providers, athletic trainers can integrate this triangle of care by building a relationship with interpreters 
within the community before working with Deaf patients. Whether that is through accessibility resource 
offices, community resources, or private interpreter services, athletic trainers should build relationships with 
ASL interpreters before the need for their services. This can help develop that triangle of care with the 
patient more quickly by already having one strong side in the triangle.  

OTHER STRATEGIES TO IMPROVE CARE 

Another option for increasing the efficiency and availability of health care for Deaf individuals has 
emerged and gained prevalence in recent years: telemedicine. Telemedicine allows the provider, 
interpreter, and patient to access the appointments remotely.10 This option allows athletic trainers in rural 
areas to access care for their Deaf patients if their area does not have any medical interpreter for ASL. 
Telemedicine systems designed for the triangle of care have been deemed acceptable for healthcare use 
on simulated patient interactions for most medical appointments.10 Also, if an interpreter is unavailable for 
an appointment, many telemedicine modalities have closed captioning functions. However, it should be 
noted that the closed captioning function is imperfect due to errors in the software captions, lack of ability 
to interpret non-verbal cues, and unreliability of the technology. Telemedicine can offer a low-cost 
alternative to schedule appointments with an interpreter on the call, even if the appointment is last 
minute.11 

Patient education via brochures, pamphlets, and printed materials about their appointment, health 
conditions, or treatments should be incorporated to ensure continuity of care and informed decision-
making.12 When choosing effective patient education strategies, athletic trainers must consider each 
patient's means, access, resources, and goals. Some individuals respond better to spoken word versus 
written materials, making presentations, podcasts, videos, and peer-to-peer discussion a more effective 
pathway for information and education. However, written communication is one of the most accessible 
ways to convey medical information without an interpreter present for Deaf patients. It can represent a 
way to clarify any words that are not translated well through ASL, even with the help of a medical 
interpreter.1 Special care should be given to providing Deaf athletes with an encounter note reviewing 
everything covered in their appointment and whom to contact with questions.  

In a blog post by an ASL using Deaf individual,1 she outlines many small things healthcare providers can do 
to provide a better patient experience. One simple thing to do that hearing people only sometimes 
consider is getting their attention before signing, speaking, writing, or performing any examination or 
treatment.1 Deaf people cannot orient to sound the way hearing people do, so healthcare providers should 
tap the arm or flicker lights to alert them to you. It is also important to face them directly and not stand 
straight in front of the light source.1 This will allow the Deaf person to see and interpret the provider's 
body language and facial expressions, whereas a hearing person may focus on speech tone instead. Some 
Deaf individuals are proficient in reading lips, so wearing a mask will inhibit communication in these 
situations. See Table 2 for more communication practices to incorporate in patient care. It is important to 
note that most Deaf persons cannot proficiently lip read, so assuming that you will be able to communicate 
this way with ease is inappropriate.1 Even in ideal situations, lip reading only yields 30-40% 
understanding, so its use as the sole method of communication should be discouraged.11 Additionally, 
provider time constraints and rushing appointments have been described as barriers to proper 
communication and patient education when an interpreter is absent.6 Prior to the appointment or providing 



Providing Athletic Training Resources to Deaf and Hard of Hearing Persons 

 

68 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

athletic training services, a conversation about the preferred method of communication and the patient's 
need for additional resources should occur. Medical interpreters, including those fluent in ASL, are legally 
required to be available if requested by a patient under the ADA.13 While not all patients will elect to 
have a medical interpreter present, it is essential to establish relationships with community partners in 
advance to ensure access to these resources should they be needed. If an emergent situation arises and an 
interpreter is not readily available, athletic trainers should implement strategies for communicating with 
Deaf or hard-of-hearing individual. Table 3 provides recommendations for resources for the provider to 
learn more about. 

Table 2. Best Practices in Communication14 

Positioning  

 Avoid standing in front of bright light. 
 The face should be visible. 

Speech  

 Speak at a typical speed. 

 Refrain from over-enunciating. 

 Verbalize one idea at a time. 
 Ask only one question at a time. 
Non-verbal Cues  
 Maintain eye contact. 
 Use typical facial expressions to guide ideas. 
 Introduce the patient to the location of information being discussed on any 

visual aids by pointing. 
Environment  
 Avoid discussions in areas with visual distractions. 

 

CONCLUSIONS 

Deaf individuals are members of physically active populations that athletic trainers work with regularly. 
Athletic trainers should work with these individuals to provide thorough care while allowing them the same 
autonomy as hearing patients. Interpreters provide a great resource in healthcare and function as a part 
of the healthcare team, just as many other professions do. For this reason, athletic trainers should seek out 
ASL interpreters before requiring their services and build a professional relationship. In addition, written 
notes explaining their diagnoses, options, and current treatment should be provided. Overall, extra care 
should be taken to incorporate any accommodations Deaf athletes need to be satisfied with their medical 
care and ability to communicate with their healthcare provider.  

  



Providing Athletic Training Resources to Deaf and Hard of Hearing Persons 

 

69 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

Table 3. Resources For Athletic Trainers 

Resource 
Hyperlink 

Description Price Time 
Commitment 

Signing Online15 This educational online course consists of 4 courses 
of 10 classes each. 

$300 
total 

24 Months 

Basic Medical 
Sign 
Language16 

This pamphlet teaches basic signs needed for 
communicating in a medical setting. 

Free N/A 

Language Line 
Telehealth 
Interpreting17 

This website provides on-demand medical 
interpreters 

$4.95 
per 
minute 

Must pre-
purchase 
package 

Deaf Athletes- 
How to Provide 
Care Podcast18 

This is a podcast made by and for ATs. In this 
episode, two ATs who have experience with Deaf or 
hard-of-hearing athletes answer questions and 
discuss care.  

Free 1 hour 5 
minutes 

Handling Relay 
Service Phone 
Calls…19 

This pamphlet has tips for using relay services via 
phone with patients who are deaf or hard of 
hearing. 

Free N/A 

 

REFERENCES 

1. Little KJ. Healthcare and the deaf: The Healthcare Experience from a Deaf Perspective. LifePrint. 
https://www.lifeprint.com/asl101/topics/healthcare_and_the_deaf02.htm.   

2. Hild U, Hey C, Baumann U, Montgomery J, Euler HA, Neumann K. High prevalence of hearing disorders 
at the Special Olympics indicate need to screen persons with intellectual disability. J Intellect Disabil 
Res. 2008;52(Pt 6):520-528. https://doi.org/10.1111/j.1365-2788.2008.01059.x.  

3. von Büren J. 4 deaf NFL players you probably didn’t know about. Hearing Like Me. May 16, 2019. 
https://www.hearinglikeme.com/4-deaf-nfl-players-you-probably-didnt-know-about/.   

4. ConnectHear. The difference between d/deaf, hard of hearing and hearing-impaired. ConnectHear. 
August 18, 2020. Accessed 2022. https://www.connecthear.org/post/the-difference-between-d-
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5. Pendergrass KM, Nemeth L, Newman SD, Jenkins CM, Jones EG. Nurse practitioner perceptions of 
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9. Chatzidamianos G, Fletcher I, Wedlock L, Lever R. Clinical communication and the 'triangle of care' in 
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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 6 – Issue 2 – September 2023 

10. Hughes G, Hudgins B, MacDougall J. Using telehealth technology to improve the delivery of health 
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18. Jackson J. Deaf Athletes – How to provide care. The Sports Medicine Broadcast. 2021. Accessed May 
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19. Hearing DoSftDaHo. Handling relay srice calls with patients that have Hearing Loss. In: Services 
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http://dx.doi.org/10.1109/IEMBS.2004.1403871
https://doi.org/10.1097/01.npr.0000445956.21045.c4
https://doi.org/10.1016/j.anai.2016.08.029
https://doi.org/10.1097/00001888-199407000-00001
https://doi.org/10.1097/01.nurse.0000435197.65529.cd
https://signingonline.com/
https://www.ellismedlibrary.org/uploads/9/1/9/0/91901496/asl.pdf
https://www.languageline.com/
https://sportsmedicinebroadcast.com/caring-for-deaf-athletes/#:%7E:text=Talking%20slower%20or%20louder%20does,Have%20empathy
https://sportsmedicinebroadcast.com/caring-for-deaf-athletes/#:%7E:text=Talking%20slower%20or%20louder%20does,Have%20empathy
http://www.ncdhhs.gov/dsdhh2020

