This is the medium of communication being used by the majority of severe-to-profound hearing-impaired persons. All natural sign languages have a unique syntax, so that even though sign languages in different communities have their own conventional syntax rules, hearing-impaired communities in different localities can still communicate with each other through sign language because natural sign language is strongly pictographic and ideographic.

It is also known as grammatical sign language, and as Chinese Sign Language in Hong Kong. At the present school it is known as Sign-supported Chinese. It is a mode of communication used by hearing people in Hong Kong whereby speech and signs are used at the same time. The syntax used is similar to that of spoken Chinese.

It is variously known as the manual alphabet, spelling sign language, phonetic sign language, or writing through finger spelling in different countries. In some countries, words and phrases can be shown through the use of finger spelling. Borrowings from the American manual alphabet have been incorporated into Hong Kong Sign Language. However, as people in the streets do not know how to spell Cantonese, Chinese words and phrases cannot be finger-spelt.