Disability Conditions and Instructional Strategies

Approximately 500,000 Americans have vision impairments to the extent that they are considered "legally blind." There are three degrees of vision loss:

1. Visual acuity of 20/200 - the legally blind person can see at 20 feet what the average sighted person can see at 200;
2. Low vision - limited or diminished vision that cannot be corrected with standard lenses; and
3. Partial sight - the field of vision is impaired because of an illness, a degenerative syndrome, or trauma. Only two percent of the people with vision impairments are totally blind: most blind people have some amount of usable vision.

Some considerations

• Some students with vision loss use canes or guide dogs for mobility purposes; however, many navigate without them.
• Like anybody, students with vision impairments appreciate being asked if help is needed before it is given. Ask a student if he or she would like some help and then wait for a response before acting.
• Words and phrases that refer to sight, such as "I'll see you later," are commonly used expressions and usually go unnoticed unless a speaker is particular self-conscious. Students with vision loss can still "see" what is meant by such expressions.
• When talking with or greeting a student with vision impairment, speak in a normal voice; most people with vision impairments are not deaf. Speak to the student, not through a third party or companion, and use the student's name when directing the conversation to him or her. When entering a room, identify yourself to the student.
• When giving directions, say "left" or "right," "step up" or "step down." Convert directions to the vision impaired student's perspective. When guiding a student (into a room, for example) offer your arm and let him or her take it rather than pulling the person's sleeve.
• If a student has a harnessed guide dog, it is working and should not be petted.
• Common accommodations for students with vision impairments include alternative print formats, magnification devices, bright incandescent lighting, raised lettering, tactile cues, adaptive computer equipment, and readers for exams, print scanners, early syllabus, priority registration, taped lectures, and lab or library assistants.

Instructional Strategies

The following strategies are suggested to enhance the accessibility of course instruction, materials, and activities. They are general strategies designed to support individualized reasonable accommodation.

• Include a Disability Access Statement on the syllabus.
• Have copies of the syllabus and reading assignments ready three to five weeks prior to the beginning of classes so documents are available for taping or Braille transcription.
• Provide vision impaired students with materials in alternative formats at the same time the materials are given to the rest of the class. The student must advise as to the format: large print, Braille, or tape.
• Repeat aloud what is written on the board or presented on overheads and in handouts.
• Pace the presentation of material: if referring to a textbook or handout, allow time for students to find the information.
• Allow students to tape-record lectures.
• When appropriate, ask for a sighted volunteer to team up with a student with vision-­impairment. A corner seat is especially convenient for a student with a guide dog.
• Assist the student with finding an effective note taker or lab assistant from the class (see Student Accessibility Services).
• Make arrangements early for field trips and ensure that accommodations will be in place on the given day (e.g., transportation, site accessibility).
• Be flexible with deadlines if assignments are held up by the document conversion process.
• When in doubt about how to assist the student, ask him or her.
• Allow the student the same anonymity as other students (i.e., avoid pointing out the student or the alternative arrangements to the rest of the class).

The causes and degree of hearing loss vary across the deaf and hard of hearing community, as do methods of communication and attitudes toward deafness. In general, there are three types of hearing loss:

• Conductive loss affects the sound conducting paths of the outer and middle ear. The degree of hearing loss can be decreased through the use of a hearing aid or by surgery. People with conductive loss might speak softly, hear better in noisy surroundings than people with normal hearing, and might experience ringing in their ears.
• Sensor neural loss affects the inner ear and the auditory nerve and can range from mild to profound. People with sensor neural loss might speak loudly, experience greater high­ frequency loss, have difficulty distinguishing consonant sounds, and not hear well in noisy environments.
• Mixed loss results from both a conductive and sensor neural loss.

Given the close relationship between oral language and hearing, students with hearing loss might also have speech impairments. One's age at the time of the loss determines whether one is pre-lingually deaf (hearing loss before oral language acquisition) or adventitiously deaf (normal hearing during language acquisition). Those born deaf or who become deaf as very young children might have more limited speech development.

Some consideration

• The inability to hear does not affect an individual's native intelligence or the physical ability to produce sounds.
• Some deaf students are skilled lip readers, but many are not. Many speech sounds have identical mouth movements, which can make lip reading particularly difficult. For example, “p”, “b”, and “m” look exactly alike on the lips, and many sounds (vowels, for example) are produced without using clearly differentiated lip movements.
• Make sure you have a deaf student’s attention before speaking. A light touch on the shoulder, a wave, or other visual signal will help.
• Look directly at a person with a hearing loss during a conversation, even when an interpreter is present. Speak clearly, without shouting. If you have problems being understood, rephrase your thoughts. Writing is also a good way to clarify.
• Make sure that your face is clearly visible. Keep your hands away from your face and mouth while speaking. Sitting with your back to a window, gum chewing, cigarette smoking, pencil biting, and similar obstructions of the lips can also interfere with the effectiveness of communication.
• Common accommodations for deaf or hard of hearing students include sign language or oral interpreters, assistive listening devices, TTYs, volume control telephones, signaling devices (e.g., a flashing light to alert individuals to a door knock or ringing telephones), priority registration, early syllabus, note takers, and captions for films and videos.

Modes of Communication

Not all deaf students are fluent users of all of the communication modes used across the deaf community, just as users of spoken language are not fluent in all oral languages. For example, not all deaf students lip read; many use sign language - but there are several types of sign language systems. American Sign Language (ASL) is a natural, visual language having its own syntax and grammatical structure. Finger spelling is the use of the manual alphabet to form words. Pidgin Sign English (PSE) combines aspects of ASL and English and it’s used in educational situations often combined with speech. Nearly every spoken language has an accompanying sign language.

In addition to sign language and lip reading, deaf students also use sign and oral language interpreters. These are professionals who assist deaf or hard of hearing persons with understanding communications not received aurally. Interpreters also assist hearing persons with understanding messages communicated by deaf or hard of hearing individuals.  Sign language interpreters’ use highly developed language and finger spelling skills; oralinterpreters silently form words on their lips for speech reading. Interpreters also voice, when requested. Interpreters will interpret all information in a given situation, including instructor's comments, class discussion, and environmental sounds.

Instructional Strategies

The following strategies are suggested to enhance the accessibility of course instruction, materials, and activities. They are general strategies designed to support individualized reasonable accommodation.

• Include a Disability Access Statement on the syllabus.
• Circular seating arrangements offer deaf or hard of hearing students the best advantage for seeing all class participants.
• When desks are arranged in rows, keep front seats open for students who are deaf or hard of hearing and their interpreters.
• When appropriate, ask for a hearing volunteer to team up with a deaf or hard of hearing student for in class assignments.
• Assist the students with finding an effective note taker or tab assistant from the class (see Student Accessibility Services).
• If possible, provide transcribers of audio information.
• Face the class while speaking; if an interpreter is present, make sure the student can see both you and the interpreter.
• If there is a break in the class, get the deaf or hard of hearing student's attention before resuming class.
• Be flexible; allow a deaf student to work with audiovisual material independently and for a longer period of time.
• When in doubt about how to assist the student, ask him or her.
• Allow the student the same anonymity as other students (i.e., avoid pointing out the student or the alternative arrangements to the rest of the class).
• Do not over enunciate or exaggerate mouth movements.

Mobility impairments range in severity from limitations in stamina to paralysis. Some mobility impairments are caused by conditions present at birth while others are the result of illness or physical injury. Injuries cause different types of mobility impairments, depending on what area of the spine is affected. Quadriplegia, paralysis of the extremities and trunk, is caused by a neck injury. Students with quadriplegia have limited or no use of their arms and hands and often use electric wheelchairs. Paraplegia, paralysis of the lower extremities and the lower trunk, is caused by an injury to the mid-back. Students often use a manual wheelchair and have full movement of arms and hands. Below are brief descriptions of other causes of mobility impairments.

• Amputation is the removal of one or more limbs, sometimes caused by trauma or another condition.
• Arthritis is the inflammation of the body's joints, causing pain, swelling, and difficulty in body movement.
• Back disorders can limit a student's ability to sit, stand, walk, bend, or carry objects. They include, but are not limited to degenerative disk disease, scoliosis, and herniated disks.
• Cerebral palsy is the result of damage to the brain prior to or shortly after birth. It can prevent or inhibit walking and cause a lack of muscle coordination, spasms, and speech difficulty.
• Neuromuscular disorders include a variety of disorders, such as muscular dystrophy, multiple sclerosis, and ataxia that result in degeneration and atrophy of muscle or nerve tissues.

Some considerations

• Many students with mobility impairments lead lives similar to those without impairments. Dependency and helplessness are not characteristics of physical disability.
• A physical disability is often separate from matters of cognition and general health; it does not imply that a student has other health problems or difficulty with intellectual functioning.
• People adjust to disabilities in a myriad of ways; students should not be assumed to be brave and courageous on the basis of disability.
• When talking with a wheelchair user, attempt to converse at eye level as opposed to standing and looking down. If a student has communication impairment as well as mobility impairment, take time to understand the person. Repeat what you understand, and when you don't understand, say so.
• A student with a physical disability may or may not want assistance in a particular situation. Ask before giving assistance, and wait for a response. Listen to any instructions the student may give; by virtue of experience, the student likely knows the safest and most efficient way to accomplish the task at hand.
• Be considerate of the extra time it might take a student with a disability to speak or act. Allow the student to set the pace walking or talking.
• A wheelchair should be viewed as a personal assistance device rather than something one is "confined to." It is also part of a student's personal space; do not lean on or touch the chair, and do not push the chair, unless asked.
• Mobility impairments vary over a wide range, from temporary (e.g., a broken arm) to permanent (e.g., a form of paralysis). Other conditions, such as respiratory conditions, affect coordination and endurance. These can also affect a student's ability to perform in class.
• Physical access to a class is the first barrier a student with mobility impairment may face, and this is not only related to the specific accessibility of the building or classroom. An unshoveled sidewalk, lack of reliable transportation, or mechanical problems with a wheelchair can easily cause a student to be late.
• Common accommodations for students with mobility impairments include priority registration, note takers, accessible classroom/location/furniture, and alternative ways of completing assignments, lab or library assistants, assistive computer technology, exam modifications and conveniently located parking.

Instructional Strategies

The following strategies are suggested to enhance the accessibility of course instruction, materials, and activities. They are general strategies designed to support individualized reasonable accommodation.

• Include a Disability Access Statement on the syllabus.
• If necessary, arrange for a room change before the term begins.
• If possible, try not to seat wheelchair users in the back row. Move a desk or rearrange seating at a table so the student is part of the regular classroom seating.
• Make arrangement early for field trips and ensure that accommodations will be in place on the given day (e.g., transportation, site accessibility).
• Make sure accommodations are in place for in-class written work (e.g., allowing the student to use a scribe, to use assistive computer technology, or to complete the assignment outside of class).
• Be flexible with deadlines; assignments that require library work or access to sites off campus will consume more time for a student with mobility impairment.
• When in doubt about how to assist the student, ask him or her.
• Allow the student the same anonymity as other students (i.e. avoid pointing out the student or the alternative arrangement to the rest of the class).

Systemic Disabilities are conditions affecting one or more of the body's systems. These include the respiratory, immunological, neurological, and circulatory systems. There are many kinds of systemic impairments, varying significantly in their effects and symptoms; below are brief descriptions of some of the more common types.

• Cancer is a malignant growth that can affect any part of the body. Treatment can be time­ consuming, painful, and sometimes result in permanent disability.
• Chemical dependency is considered to be a disabling condition when it is documented that a person has received treatment for a drug or alcohol addiction and is not currently using. Chemical dependency can cause permanent cognitive impairments and carries with it a great deal of stigma,
• Diabetes mellitus causes a person to lose the ability to regulate blood sugar. People with diabetes often need to follow a strict diet and may require insulin injections. During a diabetic reaction, a person may experience confusion, sudden personality changes, or loss of consciousness. In extreme cases, diabetes can also cause vision loss, cardiovascular disease, kidney failure, stroke, or necessitate the amputation of limbs.
• Epilepsy/seizure disorder causes a person to experience a loss of consciousness. Episodes, or seizures, vary from short absence or "petit mal" seizures to the less common "grand mal." Seizures are frequently controlled by medications and are most often not emergency situations.
• Epstein Barr virus / chronic fatigue syndrome is an autoimmune disorder which causes extreme fatigue, loss of appetite, and depression. Physical or emotional stress may adversely affect a person with this condition.
• Human immunodeficiency virus (HIV+), which causes AIDS, inhibits one's ability to fight off illness and infections. Symptoms vary greatly. People with HIV or AIDS are often stigmatized.
• Lyme disease is a multi system condition which can cause paralysis, fatigue, fever, dermatitis, sleeping problems, memory dysfunction, cognitive difficulties, and depression.
• Lupus erythematosis can cause inflammatory lesions, neurological problems, extreme fatigue, persistent flu-like symptoms, impaired cognitive ability, and connective tissue dysfunction, and mobility impairments. Lupus most often affects young women.
• Multiple chemical sensitivity (MCS) often results from prolonged exposure to chemicals. A person with MCS becomes increasingly sensitive to chemicals found in everyday environments. Reactions can be caused by cleaning products, pesticides, petroleum products, vehicle exhaust, tobacco smoke, room deodorizers, perfumes, and scented personal products. Though reactions vary nausea, rashes, lightheadedness, and respiratory distress are common to MCS.
• Multiple sclerosis (MS) is a progressive neurological disease with a variety of symptoms, such as loss of strength, numbness, vision impairments, tremors, and depression. The intensity of MS symptoms can vary greatly; one day a person might be extremely fatigued and the next day feel strong. Extreme temperatures can also adversely affect a person with MS.
• Renal disease failure can result in loss of bladder control, extreme fatigue, pain, and toxic reactions that can cause cognitive difficulties. Some people with renal disease are on dialysis and have to adhere to a rigid schedule.

Some considerations

• Students affected by systemic disabilities differ from those with other disabilities because systemic disabilities are often unstable. This causes a person's condition to vary; therefore, the need for and type of reasonable accommodations may also change.
• Some common accommodations for students with systemic disabilities include conveniently located parking, note takers, extended time to complete a task, modified course or workload, flexible deadlines, relocation of a meeting or class, early syllabus, priority registration, and exam modifications.

Instructional Strategies

The following strategies are suggested to enhance the accessibility of course instruction, materials, and activities. They are general strategies designed to support individualized reasonable accommodation.

• Include a Disability Access Statement on the syllabus.
• When in doubt about how to assist the student, ask him or her.
• Allow the student the same anonymity as other students (i.e., avoid pointing out the student or the alternative arrangements to the rest of the class.
• Systemic disabilities often require instructional strategies similar to those listed for other disability conditions. The use of such strategies will depend on how the disability is manifested. If a faculty member would like more information about instructional strategies for students with systemic disabilities, he or she should contact Student Accessibility Services.

Students with psychiatric disabilities have experienced significant emotional difficulty that generally has required treatment in a hospital setting. With appropriate treatment, often combining medications, psychotherapy, and support, the majority of psychiatric disorders are cured or controlled. The National Institute of Mental Health estimates that one in five people in the United States have some form of psychiatric disability, but only one in five persons with diagnosable psychiatric disorder ever seeks treatment due to the stigmatization involved. Below are brief descriptions of some common psychiatric disabilities.

• Depression is a major disorder that can begin at any age. Major depression may be characterized by a depressed mood most of each day, a lack of pleasure in most activities, thoughts of suicide, insomnia, and feelings of worthlessness or guilt.
• Bipolar disorder (manic depressive disorder) causes a person to experience periods of mania and depression. In the manic phase, a person might experience inflated self-esteem and a decreased need to sleep.
• Anxiety disorders can disrupt a person's ability to concentrate and cause hyperventilation, a racing heart, chest pains, dizziness, panic, and extreme fear.
• Schizophrenia can cause a person to experience, at some point in the illness, delusions and hallucinations.

Some considerations

• Trauma is not the sole cause of psychiatric disabilities; genetics may play a role.
• Psychiatric disabilities affect people of any age, gender, income group, and intellectual level.
• Disruptive behavior is not an attribute of most people with psychiatric disabilities.
• Eighty to ninety percent of people with depression experience relief from symptoms through medication, therapy, or a combination of the two. Depression is a variable condition that may fluctuate during a person's lifetime.
• There are not more people with psychiatric disabilities, just more people seeking treatment outside the walls of state mental health institutions.
• Common accommodations for students with psychiatric disabilities are exam modifications, alternative ways of completing assignments, time extensions, taped lectures, early syllabus, and study skills and strategies training.

Instructional Strategies

The following strategies are suggested to enhance the accessibility of course instruction, materials, and activities. They are general strategies designed to support individualized reasonable accommodation.

• Include a Disability Access Statement on the syllabus.
• Spend extra time with the student, when necessary, and assist the student with planning and time management.
• Be flexible with deadlines.
• Allow the student to tape-record lectures.
• Assist the student with finding an effective note taker or lab assistant from the class (see Student Accessibility Services).
• Clearly define course requirements, the dates of exams, and when assignments are due; provide advance notice of any changes.
• When in doubt about how to assist the student, ask him or her.
• Allow the student the same anonymity as other students (i.e., avoid pointing out the student or the alternative arrangements to the rest of the class).

Learning disabilities are neurologically based conditions that interfere with the acquisition, storage, organization, and use of skills and knowledge. They are identified by deficits in academic functioning and in processing memory, auditory, visual, and linguistic information. The diagnosis of a learning disability in an adult requires documentation of at least average intellectual functioning along with deficit in one or more of the following areas:

• auditory processing
• abstract and general reasoning
• reading skills
• visual spatial skills
• executive functioning (planning)
• memory (long-term, short-term, visual, auditory)
• visual processing
• information processing speed
• spoken and written language skills
• mathematical skills
• motor skills

Some considerations

• A learning disability is not a disorder that a student "grows out of." It is a permanent disorder affecting how students with normal or above-average intelligence process incoming information, outgoing information, or both.
• Learning disabilities are often inconsistent. They may be manifested in only one specific academic area, such as math or foreign language. There might be problems in grade school, none in high school, and again in college.
• Learning disabilities are not the same as mental retardation or emotional disorders.
• Common accommodations for students with learning disabilities are alternative print formats, taped lectures, note takers, alternative ways of completing assignments, course substitutions, early syllabus, exam modifications, priority registration, and study skills and strategies training.

Attention Deficit / Hyperactivity Disorder (ADHD)

While ADHD is a separate condition, students with ADHD use some of the same accommodations and instructional strategies as those with learning disabilities. ADHD is a persistent pattern of inattention or hyperactivity/impulsivity manifested in academic, employment, or social situations. It is marked in school settings by careless mistakes and disorganized work. Students often have difficulty concentrating on and completing tasks, frequently shifting from one uncompleted activity to another. In social situations, inattention may be apparent by frequent shifts in conversation, poor listening comprehension, and not following the details or rules of games and other activities. Symptoms of hyperactivity may take the form of restlessness and difficulty with quiet activities. ADHD arises during childhood and is attributed neither to gross neurological, sensory, language, or motor impairment nor to mental retardation or severe emotional disturbance.

Instructional Strategies

The following strategies are suggested to enhance the accessibility of course instruction, materials, and activities. They are general strategies designed to support individualized reasonable accommodation.

• Include a Disability Access Statement on the syllabus.
• Keep instructions brief and as uncomplicated as possible.
• Assist the student with finding an effective note taker or lab assistant from the class (see Student Accessibility Services).
• Allow the student to tape-record lectures.
• Clearly define course requirements, the dates of exams, and when assignments are due; provide advance notice of any changes.
• Provide handouts and visual aids.
• Use more than one way to demonstrate or explain information.
• Have copies of the syllabus ready three to five weeks prior to the beginning of classes so textbooks are available for taping.
• Break information into small steps when teaching many new tasks in one lesson (state objectives, review previous lesson, summarize periodically).
• Allow time for clarification of directions and essential information.
• Provide alternative ways for the students to do tasks, such as dictations or oral presentations.

Though not always visible and sometimes seemingly minor, brain injury is complex. It can cause physical, cognitive, social, and vocational changes that affect an individual for a short period of time or permanently. Depending on the extent and location of the injury, symptoms caused by a brain injury vary widely. Some common results are seizures, loss of balance or coordination, difficulty with speech, limited concentration, memory loss, and loss of organizational and reasoning skills.

Some considerations

• A traditional intelligence test is not an accurate assessment of cognitive recovery after a brain injury and bears little relationship to the mental process required for everyday functioning. For example, students with brain injuries might perform well on brief, structured, artificial tasks but have such significant deficits in learning, memory, and executive functions that they are unable to otherwise cope.
• Recovery from a brain injury can be inconsistent. A student might take one step forward, two back, do nothing for a while, and then unexpectedly make a series of gains. A "plateau" is not evidence that functional improvement has ended.
• Common accommodations for students with brain injuries are exam modifications, time extensions, taped lectures, instruction presented in more than one way, alternative ways of completing assignments, early syllabus, note takers, course substitutions, priority registration, study skills and strategies training and alternative print formats.

Instructional Strategies

The following strategies are suggested to enhance the accessibility of course instruction, materials, and activities. They are general strategies designed to support individualized reasonable accommodation.

• Include a Disability Access Statement on the syllabus.
• When in doubt about how to assist the student, ask him or her.
• Allow the student the same anonymity as other students (i.e., avoid pointing out the student or the alternative arrangements to the rest of the class.
• Traumatic Brain Injury often requires instructional strategies similar to those listed for other disability conditions. The use of such strategies will depend on how the disability is manifested. If a faculty member would like more information about instructional strategies for students with traumatic brain injury, he or she should contact Student Accessibility Services.