Deaf-blind manual is a modified form of the BSL fingerspelling alphabet, where written English letters are signified by specific hand configurations. The deaf-blind manual communication method involves spelling out words on the deaf-blind client's hand. However, this communication method is only effective if the deaf-blind client has a good level of English, as the deaf-blind manual alphabet relies on spelling out English words. For example, deaf-blind manual may be used with clients who acquired sight or hearing loss consecutively, and so have been able to acquire English.
Hands-on signing involves using normal BSL while the deaf-blind client holds on to the interpreter's hand (hence the term 'hands-on'). The BSL needs to be significantly modified. As natural BSL relies on facial expression and non-verbal cues to express meaning, deaf-blind Interpreters need to ensure that information normally conveyed non-verbally is expressed verbally for the deaf-blind user. For example, negation is normally expressed by shaking the head (a non-verbal signifier) and so negation would need to be encoded differently, e.g. by using additional signs.
Visual frame tends to be the preferred communication method for people with Usher's syndrome, which results in 'tunnel vision'. This requires the deaf-blind interpreter to use normal BSL but within a particular signing space. The normal signing space for natural BSL is anywhere from above the waist to above the head, but visual frame users may require this to be restricted around the face area, for example. Visual frame users may also require the deaf-blind interpreter to sit in a specific position, e.g. a specific distance from the deaf-blind user.