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This article examines the social and interactional foundations of sign-creation among DeafBlind people in Seattle, Washington. Linguists studying signed languages have proposed models of sign-creation that involve the selection of an iconic gestural representation of the referent which is subjected to grammatical constraints and is thereby incorporated into the linguistic system. Drawing on 18 months of ethnographic fieldwork and more than 190 hours of video recordings of interaction and language use, I argue that a key interactional mechanism driving processes of sign-creation among DeafBlind people in Seattle is deictic integration. Deictic integration restricts the range of contextual values that the grammar can retrieve by coordinating systems of reference with patterns in activity. This process brings language into alignment with the world as it is perceived by the users of that language, making a range of potentially iconic relations available for selection in the creation of new signs.