The research, led by Helena Ami Delali Heymann of the Ashanti Regional Hospital in Kumasi, together with colleagues at Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital and the Department of Nursing at KNUST, set out to determine nurses’ knowledge, attitudes and practices regarding sign language usage with Deaf patients. The team used a cross-sectional design, recruiting 140 nurses and midwives at Kumasi South Hospital through simple random sampling. Data were analysed in STATA version 16.0 and Excel, with results presented using descriptive statistics and logistic regression to identify the factors that predicted high knowledge and use of sign language.

The headline numbers tell a story of awareness without action. A large majority of participants, 128 of the 140 surveyed, or 91.4 percent, were aware of the importance of sign language in caring for Deaf patients. Even more emphatically, 96.4 percent agreed that sign language is essential for delivering quality care. Yet when the researchers asked about actual clinical practice, only 31.4 percent reported having used sign language with patients. In other words, roughly two out of three nurses who believed in the necessity of signed communication had never deployed it at the bedside, a discrepancy the authors describe as a gap between positive attitudes and low application in practice.

The statistical modelling added nuance to that picture. Logistic regression showed that nurses aged 21 to 25 years had significantly higher odds of possessing high sign language knowledge, with an adjusted odds ratio of 3.42 and a 95 percent confidence interval of 1.24 to 9.45, and a p value of 0.018. Experience, by contrast, worked in the opposite direction: nurses with 7 to 10 years of professional experience had lower odds of high knowledge, with an adjusted odds ratio of 0.15, a 95 percent confidence interval of 0.03 to 0.65, and a p value of 0.010. The most powerful predictor of high knowledge, however, was attitudinal. A positive attitude toward sign language carried an adjusted odds ratio of 18.57, with a 95 percent confidence interval of 7.26 to 48.28 and a p value below 0.001, making it by far the strongest factor associated with knowing about and understanding signed communication.

These demographic patterns invite careful interpretation. The finding that younger nurses, those in the 21 to 25 age bracket, showed greater sign language knowledge may reflect changes in nursing curricula or generational exposure to disability inclusion, though the study reports the association without attributing a cause. The inverse relationship with mid-career experience is equally intriguing, suggesting that knowledge does not simply accumulate over time on the job. Whatever the mechanism, the implication for workforce planning is clear: sign language competence cannot be assumed to develop spontaneously with seniority, and targeted training may be needed across every career stage, not only for new entrants to the profession.

The stakes of this knowledge gap are far from abstract. Deaf patients face significant challenges accessing healthcare compared with other people with disabilities, precisely because of communication barriers, and those barriers often result in misdiagnoses, inadequate treatment and overall poorer health outcomes. A patient who cannot describe the onset of chest pain, the location of abdominal discomfort or an allergy to a medication is a patient at risk. Nurses are typically the health professionals with the most continuous patient contact, which makes their communicative capacity a critical determinant of safety for Deaf individuals. When signed communication is unavailable, care often proceeds through improvised gestures, written notes or family interpreters, each of which introduces the potential for error and loss of privacy.

The study’s implications for practice, as outlined by the authors, point toward strengthening nurses’ sign language competencies as a route to reducing communication errors, cutting medical mistakes and enhancing patient-centred care for Deaf individuals. They recommend that healthcare facilities integrate structured sign language training and supportive policies to ensure equitable and inclusive nursing practice. The distinction between structured training and informal exposure matters here. Ghanaian Sign Language, abbreviated GSL in the study, is a full language with its own grammar and vocabulary, not a spontaneous system of gestures, and meaningful clinical competence in it requires deliberate instruction, practice and assessment rather than occasional contact with Deaf colleagues or patients.

The institutional context of the research underscores its credibility and its ethical grounding. The study was conducted in accordance with the principles of the Declaration of Helsinki, and ethical clearance was obtained from the Committee on Human Research, Publication and Ethics at Kwame Nkrumah University of Science and Technology under reference number CHRPE/AP/194/25. All participants who agreed to take part signed consent forms, were assured of confidentiality and privacy, and were identified only by generically generated codes known to the principal investigator. The work appears in BMC Nursing as an open-access article, published on 25 September 2026, with the corresponding author listed as Bright Ofori of the Department of Health Promotion and Disability Studies at KNUST.

What makes the findings resonate beyond Kumasi is how faithfully they mirror a global pattern. The authors note that knowledge and use of sign language by nurses worldwide is quite poor, with many healthcare providers lacking essential training to communicate in any sign language. Ghana is not an outlier so much as a sharply documented case of a systemic shortfall. The Ghana National Association of the Deaf, referenced in the study’s abbreviations, represents a national community whose members routinely navigate a health system that speaks a language they cannot hear. For a country committed to universal health coverage, the arithmetic is unforgiving: an attitude that is 96 percent positive but a practice rate of 31 percent leaves a large share of Deaf patients facing their most vulnerable moments without an effective channel of communication.

The path forward suggested by the data is unusually well signposted. Because attitude was the strongest predictor of knowledge, with an odds ratio approaching nineteen, interventions that cultivate positive dispositions toward signed communication are likely to pay dividends in competence as well. Because actual use lags far behind belief, however, attitude alone is insufficient; structured training, institutional policy and accountability must convert goodwill into clinical practice. The authors’ conclusion is measured but firm: most nurses recognise the importance of sign language and hold positive attitudes toward it, yet its application in practice remains low. Closing that gap, they argue, will contribute to reducing medical errors and enhancing patient-centred care for Deaf individuals, turning a near-universal conviction into a daily reality on the hospital ward.

Subject of Research: Nurses' knowledge, attitudes and practices regarding sign language use with Deaf patients in Ghana

Article Title: Nurses’ knowledge, attitudes and practices regarding sign language use with deaf patients in Ghana

Article References: Heymann, H. A. D., Ofori, B., Issaka, Z., Abaya-Kotey, E., & Poku, C. A. (2026). Nurses’ knowledge, attitudes and practices regarding sign language use with deaf patients in Ghana. BMC Nursing. https://doi.org/10.1186/s12912-026-05427-9

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05427-9

Keywords: sign language, Deaf patients, nursing, Ghana, communication barriers, healthcare access, cross-sectional study, logistic regression, patient safety, nursing education, health equity, BMC Nursing

The study, published in the journal iScience, was led by Xiaoyi Zuo, Gantang Li, Zhengye Wang, Peng Peng, Chenjie Dong, and Suiping Wang, who pooled neuroimaging data from forty-seven studies comprising 801 deaf participants and 880 hearing controls. Most of the deaf participants had severe-to-profound hearing loss, 88 percent had lost hearing before the age of three, and 91 percent were sign language users. Rather than relying on qualitative narrative reviews, which have struggled to reconcile heterogeneous experimental paradigms, brain morphology, and activation patterns across studies, the team used activation likelihood estimation, or ALE, a coordinate-based meta-analytic technique that models each reported brain activation peak as a three-dimensional Gaussian probability distribution and tests whether activation converges across experiments more than chance would predict.

The first finding confirmed what single studies had long suggested: across all forty-seven studies, deaf participants consistently showed greater activation than hearing participants in the bilateral superior temporal gyri, the cortical ridge on each side of the brain that houses the primary and association auditory areas. Crucially, the researchers did not simply trust anatomical landmarks, a common shortcut in this literature that only about 11 percent of prior studies avoided. Instead, they defined the auditory cortex functionally, using auditory task activations in hearing participants combined with large-scale functional masks from the Neurosynth database. The result was striking: 82 percent of the voxels that lit up cross-modally in deaf participants fell within the functional auditory mask, confirming that the recruitment genuinely targets the deprived hearing cortex rather than adjacent, unrelated tissue.

The heart of the study lay in splitting the literature into two categories. Linguistic tasks, such as sign language comprehension and lipreading, made up 49 percent of the studies and probe domain-specific language processing. Non-linguistic tasks, such as tracking moving dots or judging faces, made up 38 percent and probe a broad range of visual processes without any linguistic content. If the functional change principle governed cross-modal plasticity, both task types should recruit the same auditory subregions. If functional preservation ruled, the two task types should engage distinct subregions. The data delivered a third, hybrid answer that supports a differential model of cross-modal plasticity.

Contrast analyses revealed that the left anterior superior temporal gyrus was recruited selectively during linguistic tasks. This region is a core node of the left-lateralized language network in hearing people, and its exclusive engagement by sign language and lipreading in deaf individuals suggests that its linguistic specialization survives auditory deprivation intact, merely switching its input channel from sound to sight. The laterality analysis reinforced this interpretation: linguistic tasks produced significantly left-lateralized cross-modal recruitment, with an average laterality index of 0.28, mirroring the left-hemisphere dominance for language seen in hearing brains. In other words, the auditory cortex of a deaf signer appears to keep doing language, just in a visual language.

In contrast, the left posterior superior temporal gyrus and the right superior temporal gyrus were recruited by both linguistic and non-linguistic tasks, and non-linguistic tasks alone produced strongly right-lateralized recruitment, with a laterality index of minus 0.75. These regions appear to have undergone a genuine functional shift toward domain-general visual processing, handling everything from object matching and motion perception to spatial attention and visual working memory. The researchers suggest this versatility may reflect the multifunctional profile of these regions in hearing people, where the right superior temporal gyrus contributes to acoustic-phonetic encoding, prosody perception, and spatial processing alike, giving it a flexibility that lends itself to repurposing when sound disappears.

The team went to unusual lengths to rule out confounds, running five separate control analyses. Because sign language and lipreading involve dynamic visual stimuli while many non-linguistic tasks use static images, they repeated the analysis restricted to dynamic stimuli and found the same pattern. They reclassified studies by task demands rather than stimulus type, again with the same result. Restricting the dataset to prelingual deafness, defined as hearing loss before age three, also replicated the findings. A leave-one-out jackknife analysis showed the clusters were robust to the exclusion of any single study, with an average robustness of 99 percent, and fail-safe N analyses indicated the results could withstand the addition of substantial numbers of unpublished null studies. The lone exception was reduced activation in the left inferior occipital gyrus, which showed susceptibility to publication bias and should be treated cautiously.

Parallels with blindness make the pattern more compelling. In blind individuals, the fusiform face area and the visual word form area preserve their specializations through touch or sound, while the primary visual cortex becomes a domain-general workhorse recruited for Braille reading, speech processing, and even mathematics. The deaf brain appears to follow the same logic in reverse: some temporal regions act as scaffolds that keep their original jobs through alternative senses, while others become flexible generalists. The authors note that preserved functions tend to be those that naturally operate across multiple senses, such as identity recognition and rhythm processing, which may be maintained by strengthening or unmasking pre-existing connections between auditory regions and multisensory cortices.

The findings carry real clinical weight. Cross-modal recruitment is known to influence outcomes after cochlear implantation, and the new framework offers a way to predict which patients might benefit. One hypothesis is that functionally preserved regions, such as the left anterior superior temporal gyrus, act as scaffolds that support auditory and speech rehabilitation, and activity in some cross-modally recruited areas has indeed been found to positively predict auditory outcomes. Conversely, regions that have undergone functional change toward domain-general visual processing may be associated with maladaptive outcomes, suggesting that targeted auditory training tailored to specific functions may be needed to restore their original roles. Longitudinal studies tracking cross-modal recruitment before and after implantation are the logical next step.

The authors also acknowledge limits. Coordinate-based meta-analyses of fMRI data identify converging BOLD signals but cannot map the fine-grained computational architecture underneath, and the broad linguistic versus non-linguistic taxonomy may partly reflect differences in attentional demand or cognitive load rather than pure domain specificity. The control analysis for dynamic non-linguistic tasks rested on only eleven experiments, below the recommended threshold of seventeen for robust ALE inference. Still, the central message stands and is likely to reshape how the field thinks about sensory deprivation: the deaf brain is neither a story of wholesale reorganization nor of rigid preservation, but a mosaic in which neighboring patches of the auditory cortex simultaneously hold onto language and reinvent themselves for vision, revealing an interplay between cortical architecture, sensory loss, and language experience that no single principle could capture alone.

Subject of Research: Cross-modal functional plasticity of the auditory cortex in deaf individuals

Article Title: Differential cross-modal functional plasticity in deaf individuals: A meta-analysis of neuroimaging studies

Article References: Zuo, X., Li, G., Wang, Z., Peng, P., Dong, C., & Wang, S. (2026). Differential cross-modal functional plasticity in deaf individuals: A meta-analysis of neuroimaging studies. iScience, 29(10), Article 117610. https://doi.org/10.1016/j.isci.2026.117610

Image Credits: AI Generated

DOI: 10.1016/j.isci.2026.117610

Keywords: cross-modal plasticity, deafness, auditory cortex, superior temporal gyrus, meta-analysis, neuroimaging, fMRI, sign language, brain plasticity, cochlear implantation, language processing, visual processing