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66
1
1
2
CITY OF ASHEVILLE
AMERICANS
WITH DISABILITIES ACT
SENSITIVITY
TRAINING
MAY 1995
PRESENTERS:
Cindy Lou Daniel - USDA - US Forest Service
People with Disabilities Program
Diane T. Ducharme - Americorps
Recreation Accessibility Coordinator
ADA TRAINING DIRECTOR:
Lyle Willis - City of Asheville ADA Coordinator
DOCUMENT CREDITS
Research, Writing, and Preparation
Diane T. Ducharme, Americorps member -
Recreation Accessibility Coordinator
Contributions
Cindy Lou Daniel - USDA - Forest Service
People with Disabilities Program Manager
Printing
City of Asheville Print Shop
P.O. Box 7148
Asheville, NC 28802
(704) 259-5687
CONTENTS
THE AMERICANS WITH DISABILITIES ACT
PAGE NO.
I. Introduction to ADA
An Overview
1
Glossary of Terms
4
Access Statement
8
The New Facts About Disability
9
Ten Dos And Don'ts
11
Ten Commandments of Etiquette
13
II. Various Disabilities
Taking the Handicap out of Disability
14
Who Are the Handicapped: A Clarification of Terms
18
Types of Physical Limitations
34
What are Learning Disabilities
36
Guidelines & Tips for Dealing With Various Disabilities
38
122 Work Survival Signs for Dealing With Deaf Persons
42
III. Positive Communication with People with Disabilities
Barriers
43
What are Attitudinal Barriers
44
Words That Empower
45
Unhandicapping Our Language
46
Providing Effective Communication
50
Visual
Hearing or Speech Disabilities
Cognitive Disabilities
CONTENTS
Let's Communicate
58
Basic Signs & Tips for Communicating
with Deaf People
Guidelines & Tips for Communicating with Deaf Persons
64
Through an Interpreter
Guidelines for Hiring A Sign Language Interpreter
68
Considerations When Working With Interpreters
78
Access To Arts Programs : Being There
80
Communicating with Persons with Disabilities
in Programs
Technical Assistance Guide
88
TTY for Deaf Persons
Hard-of-Hearing
Hearing Impaired
Open-Captioning of Film
IV. Accessible Documentation
Advertising Accessibility
110
Options for Producing Documents in Accessible Formats
114
Guidelines for Reporting and Writing About People with
Disabilities
120
Examples of Poor & Good Signage
124
Disability Access Symbols Project
126
National Association for Visually Handicapped Standards
and Criteria for Large Print Publications
132
V. Additional Information for Programs, Services, and Activities
Creating Peer Acceptance
134
Awareness Activities
136
Activity Adaptation
140
CONTENTS
Basketball Activities
146
Crab Soccer
148
Rhythms and Dance Activities
150
Soccer Activities
153
Swimming Activities
155
Tennis Activities
158
Equipment Modifications
160
General Guidelines
For Including Persons With Disabilities
in Your Programs
169
Bridging the Gap
170
Planning A Field Trip
171
Methods to Modify Games
172
Assisting Individuals with Mobility Impairments
173
Guiding Individuals with Visual Impairments
176
Integrating People with Visual Impairments
177
Visual Impairments
178
Integrating Persons with Hearing Impairments
180
Hearing Impairments
184
Integrating Persons who are Developmental Disabled
186
Mental Retardation
187
Learning Disabilities
189
Emotionally Recovering
191
Strokes
194
Spinal Cord Injuries
196
Muscular Dystrophy
198
Alzheimer's
199
Multiple Sclerosis
200
Cerebral Palsy
202
AIDS - ARC
204
Autism
206
CONTENTS
VI. Personal Issues
Technical Assistance Manual - Personal Services
209
Example of a Suggested "Personnel Policy"
210
Services for People With Disabilities -
Local Agencies
212
Administrative Requirements
213
Sensitivity and Etiquette - Helpful Hints
219
Qualified Individuals With Disabilities
222
AN
INTRODUCTION
TO
THE
AMERICANS
WITH
DISABILITIES
ACT (ADA)
THE AMERICANS WITH DISABILITIES ACT OF 1990
AN OVERVIEW
I. INTRODUCTION
The Americans with Disabilities Act of 1990 (ADA) was signed into public
law (101-336) on July 26, 1990. It is a sweeping civil rights law that is
intended to eliminate discrimination against people with disabilities in all
aspects of American life. This law includes provisions regarding employment,
state and local government services, public transit services, public
accommodations, and communications.
In other words, this law gives civil right protections similar to those
provided to individuals on the basis of race, color, sex, national origin, age,
and religion. City of Asheville, as a public provider of leisure services, is
subject to compliance with this law.
II. TITLE I - EMPLOYMENT
EFFECTIVE DATE : July 26, 1992 - 25 or more employees
*July 26, 1994 - 15 or more employees
Any employer is prohibited from discrimination on the basis of disability in
any employment action. Employers should develop a job analysis to
determine the essential functions of each job. When an individual with a
disability meets legitimate educational, skill, and experience qualifications for
a position, and can perform the essential functions of a job, the employer must
make a reasonable accommodation. Reasonable accommodations include, but
are not limited to, reassignment of non-essential tasks, providing auxiliary aids
or services, removing architectural barriers in the work place, changing the
individual's work schedule, permitting supplemental unpaid leave, or
reassignment of an employee to a vacant position.
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II. TITLE II - PUBLIC SERVICES
STATE AND LOCAL GOVERNMENT SERVICES -
SUBTITLE A
EFFECTIVE DATE : January 26, 1992
State and local governments shall not exclude an individual with a
disability, from participation in, or the benefits of, programs, services, and
activities, who with or without a reasonable accommodation, meet essential
eligibility requirements. Units of local government must conduct self-analysis
to identify discriminatory practices and barriers, and shall remove all
structural barriers within three years of January 26, 1992 or as expeditiously
as is possible.
III. TITLE II - PUBLIC SERVICES
PUBLIC TRANSIT - SUBTITLE B
EFFECTIVE DATE : August 26, 1992
State and local governments which provide public transit systems must
assure that all services are readily accessible to and usable by individuals with
disabilities. Public transit systems include fixed route systems, demand
responsive systems, para-transit systems, and rapid rail systems. Certain
requirements are phased in over a period of time because of anticipated
difficulty in funding for massive structural changes.
IV. TITLE III - PUBLIC ACCOMMODATIONS AND SERVICES
OPERATED BY PRIVATE ENTITIES
EFFECTIVE DATE : January 26, 1992
All private, non-profit, and general businesses which provide goods,
services. or facilities for the public is prohibited from discrimination on the
basis of disability in the provision of those services. Entities must provide
reasonable accommodations for those individuals with disabilities. Where
removal of a barrier will require structural change, removal must be readily
achievable. If not, alternative methods of accommodation must be
considered.
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V. TITLE IV - TELECOMMUNICATIONS
EFFECTIVE DATES: July 26, 1993
Telephone companies must provide telephone systems and other
communication services that are available to people with hearing impairments
and people with speech impairments all day, every day.
VI. TITLE V - MISCELLANEOUS PROVISIONS
In general, this title depicts the ADA' S relationship to other laws, explains
insurance issues, prohibits state immunity, provides congressional inclusion,
sets regulations by the Architectural and Transportation Barriers Compliance
Board (ATBCB), explains implementation of each title, notes amendments to
the Rehabilitation Act of 1973, and gives alternative means for dispute
resolutions.
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GLOSSARY TERMS
FOR AMERICANS WITH DISABILITIES ACT
03/16/95
1. ADA - Americans with Disabilities Act signed into law by President
George Bush on July 26, 1990. See Overview for more details of this law.
2. PUBLIC ENTITY - as covered by title II is defined as:
a). any State or local government;
b). any department, agency, special purpose district, or other
instrumentality of a State or local government; or
c). certain commuter authorities as well as AMTRAK.
3. DISABILITY - an individual with a disability is a person who -
a). has a physical or mental impairment that substantially limits one or
more of the major life activities;
b). has a record of such an impairment; or
c). is regarded as having such an impairment.
4. PHYSICAL OR MENTAL IMPAIRMENT -
A). Physical impairments include physiological disorders or conditions;
cosmetic disfigurement; or anatomical loss. Specific examples of
physical impairments include orthopedic, visual, speech, and hearing
impairments, cerebral palsy, epilepsy, muscular dystrophy, multiple
sclerosis, cancer, heart disease, diabetes, HIV disease (symptomatic or
asymptomatic), tuberculosis, drug addictions, and alcoholism.
B). Mental impairments include mental or psychological disorders, such as
mental retardation, organic brain syndrome, emotional or mental
illness,and specific learning disabilities.
5. MAJOR LIFE ACTIVITIES - include such activities as caring for one's
self, performing manual tasks, walking, seeing, speaking, breathing,
learning, and working.
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6. RECORD OF A PHYSICAL OR MENTAL IMPAIRMENT THAT
SUBSTANTIALLY LIMITED A MAJOR LIFE ACTIVITY - this
protected group includes:
a). a person with a history of an impairment that substantially limited a
major life activity by who has recovered from the impairment.
Examples might be persons with histories of mental or emotional
illness, drug addiction, alcoholism, heart disease, or cancer.
b). a person who have been misclassified as having an impairment.
7. REGARDED AS HAVING AN IMPAIRMENT - protects certain
persons who are regarded by a public entity as having a physical or mental
impairment that limits a major life activity, whether or not that person
actually has an impairment. Three typical areas are covered here:
a). an individual who has a physical or mental impairment that does not
substantially limit major life activities, but is treated as if it would;
b). an individual who has a physical or mental impairment that
substantially limit major life activities only as a result of the attitudes
of others towards the impairment;
c). an individual who has no impairments but who is treated by a public
entity as having an impairment that substantially limits a major life
activity.
8. QUALIFIED INDIVIDUAL WITH A DISABILITY - refers to an
individual with a disability who, with or without reasonable
accommodations to rules, policies, or practices, the removal of
architectural, communication, or transportation barriers, or the provision of
auxiliary aids and services, meets the essential eligibility requirements for
the receipt of services or the participation in programs or activities
provided by a public entity.
9. ESSENTIAL ELIGIBILITY REQUIREMENTS - will depend on the
type of service or activity involved. The minimum criteria for essential
eligibility is likely to include: capacity, charges, and conduct required.
There are four additional factors which may modify essential eligibility:
residency, relative skill, safety, and age. For some activities, such as State
licensing programs, the ability to meet specific skill and performance
requirements may be "essential".
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10. REASONABLE ACCOMMODATIONS - are those accommodations
made for a person with a disability who could meet the essential eligibility
requirements for a program. It is the responsibility of the departments to
make these reasonable accommodations for people with disabilities when
assistance is needed because of the disability. Five types of reasonable
accommodations were specifically named as follows:
a). Change policies, practices, or procedures
b). Remove transportation barriers
c). Provide auxiliary aids or services
d). Remove architectural barriers
e). Remove communication barriers
11. MOST INTEGRATED SETTING - is one which enables interaction
between people with and without disabilities to the maximum extent
feasible. Integration of individuals with disabilities into the mainstream of
society is fundamental to the purposes of the ADA. An essential obligation
exists to provide equivalent opportunities, but does not oblige a parks and
recreation department to guarantee successful participation. Public entities
may not provide services or benefits to individuals with a disabilities
through programs that are separate or different, unless the separate
programs are necessary to ensure that the benefits and services are equally
effective.
12. UNDUE BURDEN - is when an accommodation would result in a
substantial economic or administrative burden, or result in a fundamental
alteration of the nature of the service, an agency may refuse to make the
accommodation. In any case, documentation must follow the decision.
13. SUBSTANTIAL ECONOMIC BURDEN - an analysis of the following
factors might be considered in order to substantiate economic burden: total
operating budget of the department; the budget of the division or unit
where the accommodation is being considered; the cost of the
accommodation; the number of individuals to benefit from the
accommodation; the availability of the funds within the current operation
of capital budget of the department.
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14. ADMINISTRATIVE BURDEN - is very much like economic burden, but
factor to consider might include: number of employees in the department;
number assigned to the division where the accommodation is being
considered; number of employees required to make the accommodation;
whether the assignment of employees to make the accommodation will
result in a failure in completion of other tasks.
15. FUNDAMENTAL ALTERATION - an understanding of the nature of
the program, service, or activity where the accommodation will occur is
essential. If an accommodation results in a fundamental alteration of the
program, the department need not make the accommodation. Some
questions to be considered might include asking does the accommodation:
a). require "massive change" in the program
b). endanger a program's viability
c). "jeopardize the effectiveness" of the program
d). require a "major restructuring" of a program, or
e). require the creation of a new program
16. ALTERNATIVES METHODS - in this instance, refers to readily
accessible non-structural means of program accessibility. These include:
a). redesign of equipment;
b). reassignment of services, programs, and activities to accessible
buildings;
c). assignment of aids to beneficiaries;
d). home visits;
e). delivery of services to alternative accessible sites;
f). alteration of existing facilities or construction of new facilities;
g). use of accessible "rolling stock" or other conveyances;
h). or any other methods that result in making it services, programs, or
activities readily accessible to and usable by individual with
disabilities.
Sources:
McGovern, John The ADA Self Evaluation (1992) National Recreation and
Park Association Resource Development Division
Codes of Federal Register Part 35-36, Public Law 101-336, ADA 1990
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ASHEVILLE
Interoffice Memo
TO:
Parks and
FROM: Lyle Willis, City
RE:
New Access Statement
DATE: March 20, 1995
Below is the new Access Statement, which has been reviewed by the legal department. It is the responsibility of all
Parks and Recreation staff to see that this Access Statement is displayed on the inside front cover of any brochure,
flyer, registration or other promotional information, including co-sponsored events. Appropriate access symbols are
to be used where applicable. Also, this statement should be displayed in a standardized large font (at least 14 pt.).
By incorporating this Access Statement, the City of Asheville is taking the first step to publicize its commitment and
willingness to work on accessibility issues.
If you have any questions concerning this matter, contact Lyle Willis.
1. Use the statement below for general information and on small brochures, per M. McGlohon:
SMALL STATEMENT
The Parks and Recreation Department of the City of Asheville does not
discriminate on the basis of race, sex, color, age, national origin, religion or
disability in its employment opportunities, programs, services, or activities.
2. Use the statement below for flyers, brochures or pamphlets advertising a City of Asheville or Parks and
Recreation Department event, or to advertise a public hearing, per M. McGlohon:
LARGE STATEMENT
The Parks and Recreation Department of the City of Asheville does not
discriminate on the basis of race, sex, color, age, national origin, religion or
disability in its employment opportunities, programs, services, or activities.
Auxiliary aids and services are available with advance notification. Please let us
know how we can best meet your needs in accessing any of our facilities or
programs. Contact us at the Asheville Parks and Recreation Department
at 259-5800. The City of Asheville's TYY number is 259-5548.
*At the asterisk, insert the appropriate city department if this statement is used by other departments. In the Large
Statement, add the appropriate phone number.
PARKS AND RECREATION
First Nationally Accredited Municipal Recreation Department
CITY OF ASHEVILLE
POST OFFICE BOX 7148
ASHEVILLE, NC 28802
8
(704) 259-5800
TEN DOs AND DON'Ts
WHEN YOU MEET A PERSON WITH A DISABILITY
1. Offer assistance as you would to anyone else, for example, to push a
wheelchair or to guide a blind person. The person will indicate whether or
not the help is needed, and a "No, thank you" must be respected. Most
people with a disability will not hesitate to ask for needed help and will be
specific as to how it should be given: for example, the blind person usually
prefers to take your arm rather than to have you grab his/hers.
2. Noticing an obvious disability is not rude; however, asking personal
questions about it is inappropriate.
3. Always talk directly to the person with the disability rather than to the
person who may be accompanying him or her. Never talk about the person
with the disability to the person he or she is with as if the person does not
exist. This includes an interpreter for a deaf person.
4. Do not be concerned if you use the words walking or running when talking
to a person in a wheelchair, or "Do you see?" when talking to a blind
person. People with disabilities use these words themselves and think
nothing of it.
5. Do not avoid using words like blind or deaf when associating with people
with these disabilities. They know that they have these disabilities and do
not need to be shielded from the facts.
6. When talking with a person in a wheelchair for any length of time, it is
better to sit down in order to be at the same eye level. It is very tiring for a
person to look up for a long time.
7. Be sensitive to architectural barriers in your facility. Be aware of federal
and state laws that may apply to eliminating architectural barriers in your
establishment. Everyone must be concerned and alert to this very real
problem.
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8. Remember that if a person does not turn around in response to a call, it may
be that he or she is deaf. A light tap on the shoulder to get a person's
attention would be appropriate.
9. Never gesture about a blind person to someone else who may be present.
This will inevitably be picked up and make the person who is blind feel
that you are "talking behind his or her back".
10. Lip reading by deaf persons can be aided by being sure that the light is on
your face and not behind you and by taking all obstructions such as pipes,
cigarettes or gum out of the mouth, keeping the lips flexible, and speaking
slowly. Additional communication could include body language,
pantomime and gestures of all kinds, and written communication if
necessary.
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10
The NEW Facts About Disability
General Information
There are 48.9 million Americans with a disability. This represents 19.4% of the total
population of the United States. In other words, nearly 1 in 5 Americans has some
type of disability.
24.1 million have a severe disability, which represents 9.6% of the total population.
Age
There are 29.5 million Americans with disabilities who are between the work ages of
15 to 64.
13.2 million of these individuals have a severe disability.
2.9 million children have a disability, and 16.5 million adults 65 and older have a
disability.
The 65 and older group is the most severely disabled. Of the 16.5 million adults in
this age range with a disability, 10.4 million have a severe disability.
Employment and Earnings
For persons without a disability, the employment rate is 80.5%. For those with a
severe functional limitation, however, the employment rate is only 27.6%.
The mean earnings for people between the ages of 35 to 54 who have no disability
is $2,446 per month. Those in the same age range with a non-severe disability have
an average monthly earning of $2,006. For those with a severe disability, the aver-
age monthly wage is $1,562.
Functional Limitations of Persons 15 to 64
The following were the most commonly cited functional limitations for persons be-
tween the ages of 15 and 64.
Climbing
8.1 million
Walking
7.9
Lifting
7.8
Hearing
5.5
Seeing
4.8
Speaking
1.5
11
Disabling Conditions of Persons 15 to 64
Of the nearly 29.5 million persons between the ages of 15 to 64 who reported the
cause of their disability, the following represent the most common causes:
Back or spinal problems
3.9 million
Arthritis or rheumatism
2.7
Heart problems
1.5
Lung or respiratory problems
1.4
Limb disorders
1.2
High blood pressure
1.0
Diabetes
0.8
Insurance Coverage of Persons 15-64
Of the 29.5 million Americans with disabilities between the ages of 15 to 64, 18.4
million are covered by private insurance. Of the 11.1 million not covered by private
insurance, 4.4 million are covered by Medicaid, and 5.1 million have no form of
health insurance.
For those with a severe disability (13.2 million), 6.3 million are covered by private
insurance. Of the 6.8 million not covered by private insurance, 3.6 million are COV-
ered by Medicaid and 2.1 million have no health insurance.
Years of School Completed for Persons Between 25 and 64
For the 26.0 million adults between the ages of 25 and 64 who have a disability, 7.8
million have not finished high school. Another 10.1 million have completed high
school, but have had no college education. The remaining 8.1 million have had at
least some college education.
For the 12.0 million adults between the ages of 25 and 64 who have a severe dis-
ability, 5.0 million have not finished high school; 4.3 million have completed high
school, but have had no college education; and 2.7 million have had at least some
college education.
Source:
McNeil, J. M. (1993). Americans with Disabilities: 1991-92. U.S. Bureau of the Cen-
sus Current Population Report P70-33. Washington, DC: U.S. Government Printing
Office.
12
EMPLOYMENT
COMPLETED
PEOPLE
INDIANA
President's Committee on Employment
of People with Disabilities
TEN COMMANDMENTS OF ETIQUETTE FOR COMMUNICATING WITH
PERSONS WITH DISABILITIES
1. When talking with a person with a disability, speak directly to that person rather than
through a companion or sign language interpreter.
2. When introduced to a person with a disability, it is appropriate to offer to shake hands.
People with limited hand use or who wear an artificial limb can usually shake hands.
(Shaking hands with the left hand is an acceptable greeting.)
3. When meeting a person with a visual impairment, always identify yourself and others
who may be with you. When conversing in a group, remember to identify the person
to whom you are speaking.
4. If you offer assistance, wait until the offer is accepted. Then listen to or ask for
instructions.
5. Treat adults as adults. Address people who have disabilities by their first names only
when extending the same familiarity to all others. (Never patronize people who use
wheelchairs by patting them on the head or shoulder.)
6. Leaning or hanging on a person's wheelchair is similiar to leaning or hanging on a
person and is generally considered annoying. The chair is part of the personal body
space of the person who uses it.
7. Listen attentively when you're talking with a person who has difficulty speaking. Be
patient and wait for the person to finish, rather than correcting or speaking for the
person. If necessary, ask short questions that require short answers, a nod or shake of
the head. Never pretend to understand if you are having difficulty doing so. Instead,
repeat what you have understood and allow the person to respond. The response will
clue in and guide your understanding.
8. When speaking with a person in a wheelchair or a person who uses crutches, place
yourself at eye level in front of the person to facilitate the conversation.
9. To get the attention of a person who is hearing impaired, tap the the person on the
shoulder or wave your hand. Look directly at the person and speak clearly, slowly and
expressively to determine if the person can read your lips. Not all people with a
hearing impairment can lip read. For those who do not lip read, be sensitive to their
needs by placing yourself so that you face the light source and keep hands, cigarettes
and food away from your mouth when speaking.
10. Relax. Don't be embarrassed if you happen to use accepted, common expressions such
as disability. "See you later." or "Did you hear about that?" that seem to relate to a person's
Reprinted with permission of:
NATIONAL CENTER FOR ACCESS UNLIMITED
155 North Wacker Drive
Suite 315
Chicago, Illinois 60606
13
(312) 368-0380 V (312) 368-0179 TDD
VARIOUS
DISABILITIES
Taking the HANDICAP out of DISABILITY
Introduction
In recent years, much attention has been given to the
HANDICAP
rights of people with disabilities. Legislation such as the
Americans with Disabilities Act and efforts of many con-
sumer groups have spurred ramp construction, affirmative
action to increase employment opportunities and television
programming to include realistic role portrayals for people
with disabilities.
These developments - resulting from the recognition
that people with disabilities are, indeed, valuable and equal
Communication: the two-way street
members of society - have helped people with disabilities
lead more productive lives.
If you are not used to communicating
However, many people still view individuals with
with a person with a disability and have any
disabilities as lesser people - to be pitied, feared or ignored.
hesitations or concerns, here are a few tips:
These attitudes may arise from fear of someone who is
different in any way or simply from a lack of knowledge
USE COMMON SENSE -- People with
about disabilities. Despite good intentions and education
disabilities want to be treated the same way as
programs, negative stereotypes and callous behavior remain.
everyone else.
This brochure gives suggestions on how to relate to
people with disabilities, how to look beyond the disability
BE POLITE -- Show the person the same
and look at the ability and the personality - the things that
respect that you would expect to be given to
make each of us unique and worthwhile.
you.
Attitudes & barriers
BE CONSIDERATE -- Be patient, take time
and try to understand the problem or need of
the individual.
A person with a disability is - first and foremost - a
person. While a particular disability may limit certain types
OFFER ASSISTANCE Do not hesitate to
of activities or abilities, it does not make the individual any
offer assistance. However, do not automati-
less a person. Ten to 15 percent of the population has a
cally give help unless the person clearly needs
disability such as blindness, deafness, paralysis, cerebral
help or asks for it. If the person declines your
palsy, neurological disorder, mental illness, arthritis or
offer, do not insist on helping. Ask the person
mental retardation.
if assistance is needed and how it should be
An attitude is a feeling or emotion which a person has
given.
towards a fact, situation, or person. Awareness is the knowl-
edge or perception about a situation, object or person. Attitu-
COMMUNICATE Talk directly to the
dinal barriers are a way of thinking or feeling that blocks or
person. It is not difficult to communicate with a
limits people's perception of the potential of people with
person with a disability. In some cases, it may
disabilities to be capable, independent individuals. Attitudi-
take a little time, depending on the person's
nal barriers include prejudice, ignorance, fear, insensitivity,
disability.
bigotry, stereotyping, misconception, discrimination, dislike,
insecurity, discomfort, tension and intolerance.
EMERGENCY ACTION -- Know the
Positive attitudes and awareness help people in their
location of people with disabilities in your
contacts and relationships with people with disabilities.
building to help with evacuation, if necessary,
Attitudes which are insensitive and prejudical produce poor
during an emergency.
relationships. A person may not be aware of biases or nega-
tive attitudes and may express them in words or actions.
14
Helpful Hints
While the following list is not inclusive of all disabilities, it does give some tips to use when meeting people with
some common disabilities. Each persons particular disability may vary in how it affects them compared to how it affec+-
another person. Sometimes a person may have more than one disability. While the following hints may be useful whe
applied in general, each person is affected by a disability in an individual way.
*Hearing Impairments*
A person's failure to respond to a spoken request or warning may be the result of an inability to hear. Gestures and
gutteral sounds made by a person with deafness and or hearing impairments are not signs of anger, belligerance or intoxi-
cation. They may be the individual's only method of communication. However, many individuals with hearing impair-
ments have very clear speech.
When communicating with a person with a hearing impairment:
Be considerate and try to make the person feel comfortable and confident in dealing with you.
Look directly at the person to whom you are speaking. Speak slowly - the person may wish to lip read. If a sign
language interpreter is present, talk directly to the person with deafness - not the interpreter.
Be flexible with your language. If a word is not understood, try another word rather than simply repeating
yourself.
Be aware of false interpretations (a nod of the head does not necessarily mean "I understand").
Do not shout. Hearing aids make sounds louder, not clearer.
Use of sign language, miming, gesturing, etc., is encouraged in augmenting lip reading abilities. Even minimal
sign language skills can make lip reading easier.
If all else fails, use a pad and pencil to communicate.
*Blindness or visual impairments*
People with blindness or visual impairments rely on their other senses to perceive the world around them. When
you are with a person with blindness or a visual impairment:
Speak directly to the person, using a normal tone of voice. Blindness does not affect a person's hearing.
Do not be afraid to use terms such as" See you soon." Everyday words relating to vision are used by people
with blindness themselves.
Offer assistance but be guided by the individual's response.
Be specific in giving directions. It is useless to point or give visual landmarks. If the individual must make a
turn, state whether it should be left or right.
Walk alongside and slightly ahead of a person with blindness or a visual impairment when you are assisting.
Never hold the person's arm while walking. Let him or her hold your arm. The motion of your body tells the
person what to expect.
Avoid escalators or revolving doors, if possible. These can be disconcerting and dangerous.
Assist the individual on stairs by guiding a hand to a banister. If there is no banister tell them whether you are
going up or down and when you are at the end of the staircase or at a landing.
When giving assistance in seating, place the person's hand on the back or arm of the seat.
Never leave a person with blindness in an open area. Instead, lead the person to the side of a room, to a chair or
some landmark from which you or another person can provide them a direction for travel.
Do not leave a person with blindness abruptly after talking, without saying that you are leaving. Otherwise, be
or she may try to continue the conversation with you when no one is listening or present.
Do not pet a guide dog. The dog has an important job to do and petting may be distracting.
*Mental retardation*
People with mental retardation have limited ability to learn and sometimes have difficulty in using what they have
learned. Through education and training, however, many people with mental retardation can learn to be self-sufficient
When communicating:
Do not use complex sentences.
Make instructions clear and concise.
Do not be condenscending. Talk to the person as a person: talk to adults as adults, not as children. Each person
deserves the same respect as anyone else.
15
Individuals use wheelchairs, crutches, or leg braces as a result of a variety of disabilities including spinal cord
njury, multiple sclerosis, muscular dystrophy, arthritis, cerebral palsy or polio. Wheelchairs provide mobility for persons
ith paralysis, muscle weakness, lack of coordination, nerve damage and stiffness of joints. When you are with a person
using a wheelchair:
*
Talk directly to the person using the wheelchair, rather than to somcone else. People using wheelchairs are fully
capable of speaking for themselves.
Push a wheelchair only after asking the person if assistance is needed.
When assisting someone using a wheelchair to go up or down a curb, ask if the person perfers to go forward or
backward.
In guiding a wheelchair down an incline, hold the push handles so that the chair does not go too fast.
Learn the location of wheelchair-accessible ramps, restrooms, elevators and telephones.
For more than one step, keep the chair tilted back at all times while descending or ascending.
Cerebral Palsy*
Cerebral palsy is not a disease but a condition that affects the muscles and, in some cases, the senses. The effects
of cerebral palsy vary from mild to severe, depending on which part of the brain is affected. In some instances, the condi-
tion is barely noticable, while in others, the person may be unable to speak, may not have use of hands or may be unable
to walk. When with a person with cerebral palsy:
*
Be yourself.
*
Speak directly to the individual, not to a friend or companion.
Try to give your whole, unhurried attention if the person has difficulty speaking.
*
Do not complete the speaker's sentences. Let the person finish.
*
Do not be afraid to ask the person to repeat something.
Mental illness*
People with mental illness are people whose emotional or mental abilities to cope with life are impaired, usually
only for a short time. Mental illness is not the same as mental retardation. Most people recover from a mental illness just
as most people recover from a physical illness or disease. Usually, you will not know that a person ever had a mental
illness. However, if you come in contact with someone who is having a mental or emotional crisis:
Ask if anything is the matter and offer to talk.
Offer to get the help of a friend, relative or clergy.
Offer to obtain the services of a psyciatrist, psychologist or trained counselor.
Do not call the police or an ambulance unless there is a clear indication that the person is potentially harmful to
others or to him/herself.
*Epilepsy*
Epilepsy is a hidden disability and is a disorder of the nervous system. Seizures are a primary characteristic of
epilepsy, but they can be controlled or prevented by the use of medication. Most seizures last only a few minutes and
many individuals receive enough of a warning to avoid falling or other injury. If an individual has a seizure:
*
Keep calm. You cannot stop a seizure once it has started. Do not restrain the person.
Clear the area of hard, sharp or hot objects which could injure the person. Place a pillow or a rolled-up coat
under the person's head.
Keep crowds away.
Do not force anything between the teeth.
Loosen tight clothing but do not interfere with movements.
Remember that the person does not breathe well and skin color may be affected.
After the seizure, the person may be confused and should not be left alone.
Medical help may be needed only if breathing stops, the person continues to have seizures one after another or
becomes seriously injured.
16
"No" Words
Just as some well known, four letter words are offensive, so are some words used in referring to
people with disabilities. Here are some to avoid when speaking to or about people with disabilities.
Afflicted - It is negative and suggests hopelessness.
Cases - Sounds like something to be filed away and institutionalized.
Cerebral palsied Sounds like an inanimate object instead of a person. The correct discription is "person
with cerebral palsy."
Confined to a wheelchair - A person uses a wheelchair.
Courageous - People with disabilities are not unusually brave and do not want to be regarded as super
heroes. Like everyone else, they have the will to live and enjoy life's pleasures.
Crippled This paints a mental picture of a person who can't do anything, someone whom people would
rather ignore.
Deaf and dumb or deaf mute - These out-of-date terms were used to describe a person with deafness who
also could not speak. Many individuals with deafness or hearing impairments can speak, although their
speech may be hard to understand. Deafness does not make a person dumb or ignorant.
Disease - Describes a contagious condition. Most people with disabilities are as healthy as anyone else.
Epileptic - Individuals with this condition prefer to be referred to as persons with epilepsy.
Gimp - This out-of-date word was once used to describe someone who walked with a limp. It is a putdown.
Normal - Refers to numbers, not people. When used to describe a non-disabled person, it suggests that a
person with a disability is abnormal or subnormal.
Patient - Hospitals and doctors have patients. Most people with disabilities are not in hospitals or regularly
cared for by doctors. Rather they are self-relient members of the community.
Poor - Describes a person who lacks money or one to be pitied.
Retard, retardate or retarded - Because some people with disabilities are at times considered awkward, this
does not mean that they are retarded. Individuals with mental retardation prefer to be called by their own
names.
Spastic - Some people with disabilities lack coordination but this is only a product of the physical disability
and should not be ridiculed.
Suffering - To say that someone suffers from a disability means that he or she is in constant pain as a result
of the disability. This is rarely the case.
Unfortunate - This implies unlucky, unsuccessful or social outcast. Whether or not luck had anything to do
with a person becoming disabled, he or she wants to be regarded as a real, likable person.
Victim - Victims are people sacrificed by an uncontrollable force or agent. People with disabilities do not
want to be considered as helpless victims but as people - with many worthwhile attributes.
Reprinted with permission from the New York State Advocates for the Disabled, Albany, New York
State of Ohio
Governor's Council on People with Disabilities
400 E. Campus View Blvd.
Columbus, OH 43235-4604
(614) 438-1391
Catalog Number G-12
toll-free in Ohio 1-800-282-4536, ext. 1391 (both V/TDD).
Revised 4/92
17
WHO ARE THE HANDICAPPED: A CLARIFICATION OF TERMS
The terms impaired, disabled, and handicapped are often used synony-
mously and interchangeably. Society imposes labels, particularly upon
individuals with various physical, mental, emotional, and social conditions.
There are important differences among the terms impaired, disabled, and
handicapped, and different degrees of affliction. These terms are differen-
tiated in the way individuals with various conditions look upon themselves,
not in ways that have been culturally imposed by society and by persons with-
out any of these conditions.
Impaired individuals have identifiable organic or functional
conditions; some part of the body is actually missing, a portion
of an anatomical structure is gone, or one or more parts of the
body do not function properly or adequately. The condition may
be permanent, as in the case of amputation, congenital birth de-
fect, cerebral palsy, brain damage, or rectolinial fibroplasia.
It may be temporary--functional speech defects, some learning
disabilities, various emotional problems, certain social mal-
adjustments, or specific movement deficiencies.
Disabled individuals, because of impairments, are limited or
restricted in executing some skills, doing specific jobs or tasks,
or performing certain activities. Individuals with certain impair-
ments should not be automatically excluded from activities because
the condition makes it appear that they cannot participate safely,
successfully, or with satisfaction. Some impaired persons attain
high levels of excellence in activities in which they are not sup-
posed to be able to perform or participate.
Handicapped individuals, because of impairment or disability, are
adversely affected psychologically, emotionally, or socially. Handi-
capped persons reflect an attitude of self-pity. Some individuals
with impairments and disabilities are handicapped, some severely.
Others with severe impairments or disabilities adjust extremely well
to their conditions and live happy and productive lives. In their
eyes they are not handicapped even though society continues to label
them handicapped. Undoubtedly many persons in society with neither
an impairment nor a disability are handicapped!
Source: Making Workshops Work in Physical Education and Recreation
for Special Populations, AAHPERD, 1900 Association Drive,
Reston, VA 20043, March 1976.
18
Since many persons may only rarely come into contact with a handi-
capped individual, their reactions may be based upon stereotypes or mis-
conceptions about a particular condition. Because people often tend to
fear or avoid contact with what they do not understand, it is important
that clear, factual information concerning handicaps be given. That is
the purpose of this unit.
While discussing the characteristics of some of the more common handi-
caps, please remember that a handicap cannot be understood or regarded
simply as a medical problem. It is also a social concern. The handicapped
person does not exist in a vacuum. Society greatly affects the self-concept
of the handicapped individual and the attitudes and responses of individuals
around him. As a member of society, you can learn to "THINK OF THE ABILITIES
RATHER THAN THE DISABILITIES."
People have devoted years of study and experience to understanding and
treating individuals with handicaps. The results cannot all be included in
one unit; but a summary of the characteristics of handicapping conditions
gives background for reaching out to handicapped persons. And remember--
do not be afraid to ask questions--of parents, teachers, medical professionals,
recreation professionals, social workers, and especially, of the handicapped
person, who may be the best source of information on what he/she is or is not
able to do.
There are many handicapping conditions but those most often found in
people are included in this chapter. Many characteristics of these handicaps
do overlap. Also, some individuals may have more than one handicap. Consider
these thoughts as you use this section. Following is a list of the contents
to assist you. Let's look at
Physical Handicaps
Visually Impaired
Hearing Impaired
Hearing and Visually Impaired
Amputation
Spinal Cord Injuries
Crippling and Neurological Disabilities
Cerebral Palsy
Muscular Dystrophy
Spina Bifida
19
Mental Handicaps
Mental Retardation
Emotional Disabilities
Behavior Problems
VISUALLY IMPAIRED
Vision ranges from severely limited to totally absent. The definition
used for legal purposes, 20/200 vision or less in the better eye after
correction, indicates that the person sees at 20 feet what a sighted person
sees at 200 feet. Partially sighted people have vision between 20/70 and
20/200. Although some people perceive only large objects or shadows, some
function very well using corrective lenses.
For the individual who is meeting a visually impaired person for the
first time, there are a few simple guidelines to follow, based primarily
upon common sense and the same basic sensitivity and politeness shown towards
any individual.
When meeting a visually impaired person, begin by introducing yourself
and making sure that he is aware that you are talking to him. Likewise, when
you leave, tell him that you are going. Never make visually impaired people
guess who you are or wonder whether you are still there. Speak directly to
him in a normal tone of voice. If he is with friends, do not use a third
person as an interpreter. Do not shout at someone who is visually impaired
as if they were hearing impaired. When talking to a visually impaired person
use the words you normally use: do not try to avoid words like "look" and
"see" that are part of everyone's vocabulary, including the visually impaired
person's.
When offering to act as a guide, ask the person to take your arm, just
above the elbow, and walk about half a step ahead of the person. Never grab
the person's cane and do not insist upon helping someone who does not want
assistance. When a guide dog is being used for travel, do not distract the
dog from his job by petting or talking to him.
When interacting with a visually impaired person, think of him in the
same way you would think of any other person. Remember he is just like other
people except he depends upon hearing, touching, tasting, and smelling instead
20
of seeing. He needs all the experiences any person would have, but
because he cannot see, he will need a lot of encouragement to experiment
with new things. Of course, you must help him avoid some dangerous places
and things, but try not to overprotect him.
When you are with a visually impaired person, make an effort to des-
cribe things, and let him touch, taste, or smell if possible. Let him
touch you--your face, your clothes, your watch, etc. Talk about the things
he explores. When you visit a different place, guide him around, explaining
what you see and letting him feel key items.
Visually handfcapped people may use certain devices to help them. They
read and write using a touch system of raised dots called Braille. Record-
ings of books and magazines ("Talking Books") are also available. Partially
sighted people may be able to read using a magnifying glass or enlarged print.
HEARING IMPAIRED
True deafness is defined as a hearing loss in both ears severe enough to
prevent communication through the ear, even with amplification. Hearing losses
can vary from mild, when the person has difficulty hearing faint or distant
speech, to severe, when the person only feels vibrations. Some people have a
combination of types of hearing losses. Many people with deafness due to
erve or brain damage may have associated handicaps.
The hearing impaired person is usually eager to communicate and knows
is own best ways to succeed at it. Regardless of the communication method
sed, remember to establish and keep eye contact throughout the conversation.
ou, as the hearing partner, should accept the choice of the deaf person.
Oral Speech
Speech is easy for you and most difficult for the hearing impaired
person. This story of three hearing impaired ladies on a shopping
trip shows some difficulties encountered when conversing by speak-
ing and lip reading. The first lady says to the others, "Windy
today, isn't it?" The second says, "No, it's Thursday." The third
says, "I'm thirsty too. Let's go and have a drink." As you can
see, the person choosing speech and lip reading faces a real
challenge. Lots of encouragement is needed. When talking with a
hearing impaired person, face the light, so that your mouth can be
seen, and speak slowly and clearly. Do not exaggerate or raise
your voice. Try to be expressive; facial expressions are an
important clue to what you are trying to convey. When explaining
21
directions, a demonstration may be more helpful than a verbal
explanation. Keep your language at the person's level. Accept
repetitions until the person gives up, but never pretend to
understand if you do not.
Finger Spelling
Finger spelling is a good choice for people with inadequate
speech, since the majority of them have mastered this skill.
It consists of spelling the letters of each word in the air
and is easy to learn, the only difficult part being to read
it back from the partner. Keep in practice, and ask the person
to go slowly at first.
Sign Language
Signing involves the combining of larger units of utterance into
manual symbols. Taking a course in signing or having an inter-
preter available will assist communication between deaf and
hearing persons.
Simultaneous Means
Combinations of the possibilities previously mentioned make
communication possible.
Writing
This should be the last resort.
If the person wears a hearing aid, be sure he has it on at all times,
except swimming. Hearing aids have various settings; ask the person to
show you how to adjust it. Not all people who wear hearing aids can under-
stand speech with the aid. Many still rely on other forms of communication.
In any case, always speak clearly and directly without raising your voice.
Except for activities which involve hearing and speaking, there is
little difference in the way you should treat hearing-impaired people from
the way you would treat any other person. Like any person, hearing-impaired
people need opportunities to be independent and self-confident in their
own abilities.
HEARING - VISUALLY IMPAIRED
The combination of hearing and visual impairment results in a severe
handicap. Some people may still have some residual vision or hearing. The
hearing-visually impaired person who has lost all his vision or hearing has
only his senses of touch, taste, and smell. With only these senses to learn
about his world, he needs a great deal of guidance. He needs opportunities
to "see" things through touching, tasting, and smelling. Give him oppor-
tunities to feel what you are doing--taking off your coat, eating with a
spoon, washing the dishes, sweeping, watering the flowers. When he is
ready, you can show him how to do these things by helping him imitate your
motions. A hearing-visually impaired person may even need to learn how to
play.
Even though the hearing-visually impaired person you are caring for
cannot hear you, continue to speak to him just as you would to any other
22
person. You will find yourself more relaxed and able to relate to him.
Let him feel your mouth or throat if he seems interested.
Remember that the hearing-visually impaired person may take longer
to learn to do things than the non-handicapped person. Although this con-
dition is often associated with mental retardation, it does not necessarily
mean there is any intellectual deficit. He will always need time and
patience in learning a new skill. All people need the security of being
loved. Since the hearing-visually impaired person cannot see a smile or
hear your praise, you must make an effort to show affection physically. A
kiss or a hug not only conveys affection, but also promotes self-confidence.
AMPUTATION
An amputee has experienced the partial or total loss of one or more
limbs. Amputations exist, or are performed, for a wide variety of reasons.
The adjustment is often easier for a person born without a limb, and may be
more difficult when the amputation occurs when the person is several years
old and accustomed to use of the limb. Some terms used to identify amputa-
tions are:
Unilateral - one arm or one leg
Bilateral - two arms or two legs
Double - one arm and one leg
Multiple - more than two extremities
Above Elbow(A/E) Below Elbow(B/E)
Above Knee(A/K) Below Knee (B/K)
In most cases an artificial device, a prosthesis, is fitted to the
stump(s) to replace the missing limb(s). The amputee will have clear in-
structions relating to the care of the stump, which is crucial. Exercise,
massage, and conditioning of the unamputated limbs is essential. Also,
special care is in order at the earliest possible moment if skin troubles
develop. If abrasions occur, they should be washed gently, covered with
antiseptic and sterile gauze, and the prosthesis should be given special
attention to assure that it is clean and dry. Small blisters may be treated
in this manner but large blisters should have immediate medical attention.
During the period of relearning and adjustment, the amputee may require
support and encouragement not only from those who are directly involved in
his training, but also from his family, peers, and counselor. Effective
training will give attention to the physical activities and psychological
needs of the amputee. There is no amputee personality as such. The reaction
23
of the amputee to his loss can be predicted to some degree on the basis
of how he has reacted to stress in the past.
Although there are wide variations in the manner in which amputees
are able to accept their loss and make satisfactory and satisfying adjust-
ments, amputees in general may be helped to--
develop new and attainable goals in the various areas of
Living--personal, social, educational, and vocational.
form plans for reaching these goals.
include their changed bodies in a relatively satisfying
self-concept.
seek out and use a wide range of personal and community
resources in the realization of hopes and expectations.
Functional limitations which should be considered for upper extremity
amputees are:
climbing
throwing
crawling
pushing
reaching
handling
lifting
pulling
carrying
fingering
foot-eye-hand coordination
Functional limitations which should be considered for lower extremity
amputees are:
walking
twisting
lifting
jumping
standing
carrying
running
turning
balancing
stooping
climbing
crouching
crawling
kneeling
SPINAL CORD INJURIES
Spinal cord damage is usually a consequence of some type of trauma to
the spine although it may also be caused by disease. This can result in both
motor and sensory impairments. The degree of impairment is determined by the
level at which the trauma occurred and the severity of the damage to the spinal
cord. The two major resulting impairments of the spinal cord are termed
paraplegia or quadriplegia. As in other impairments, the degree to which a
24
person has adjusted to his specific impairment will determine the extent
of mobility achieved. Therefore, people with the same level of spinal
damage and severity will be able to do many different activities with differ-
ing degrees of success.
Paraplegia
Paraplegia refers to partial impairment or paralysis and consequent
loss of the use of both legs and lower part of the body. This occurs as
a result of damage to the spinal cord at the thoracic or lumbar level. In
addition to traumatic paraplegia, impairment may also result from cerebral
palsy, muscular dystrophy, and multiple sclerosis.
Because of the length of the spine involved in paraplegia, there will
be a vast difference in the degre of mobility found in individudals that
are considered to be paraplegic. Generally, the lower the spinal cord
damage occurs, the greater the upper body strength, lateral stability, and
functional mobility there will be. In more severe cases, there is still
full function of the arms, neck, shoulders and hands.
Depending upon the level of damage, the paraplegic will need the use
of (or combinations of) assistive mobility devices such as a wheelchair,
crutches, and/or braces. The paraplegic should be encouraged to use a wheel-
chair (if needed) as a functional machine in which to travel and not as an
embarrassing reminder of an impairment. The desire is to achieve the highest
degree of mobility possible and the wheelchair is an effective device toward
this end.
When developing activities involving paraplegics you should keep several
things in mind. The person should be encouraged to use as much of the remain-
ing function in the body as he can. Twisting, turning, reaching, pushing,
pulling and throwing type activities are important for keeping the upper body
in shape. Cardiovascular needs are also important to overall fitness. Swim-
ming is an excellent activity for these considerations. It is also extremely
important to prevent excessive weight gain which can easily happen as a re-
sult of inactivity. Practicing good nutrition and maintaining a regular
exercise program will help achieve this aim and allow the paraplegic to pur-
sue an active life in all areas.
25
Quadriplegia
Quadriplegia occurs when there is impairment or paralysis involving
all four extremities and the trunk. This is a result of damage to the
spinal cord at the cervical level, which is basically the neck area. This
damage usually will occur near the base of the neck because that is the
area of the greater amount of neck movement and it is, therefore, more sus-
ceptible to injury because of this.
Quadriplegics will nearly always require some attendant care; the amount
depending on the actual level and extent of trauma and also the adjustment of
the person to the resulting impairment. In any case, the upper extremities
and neck are never totally paralyzed and some function, however small, can
be expected. Some very high level paraplegics may also show similar charac-
teristics as quadriplegics, but without sedentary activity deficiencies, and
may make planning easier if included with quadriplegics.
When considering activities for quadriplegics, it is again important to
encourage and stress using whatever bodily functioning remains. Ambulation
is a severe problem. Varying degrees of wheelchair locomotion can be achieved
and should be developed in order to decrease the amount of attendant care
necessary in the house. Whatever neck, shoulder, hand, and arm movements
that are possible should be stressed and exercises developed accordingly to
keep these areas functioning. Quadriplegics may have respiratory problems so
this should be considered when developing activities. Pressure sores (bed
sores) are also a potential problem due to a loss of sensation at the level
of spinal cord injury. Finally, a regular diet and plenty of fluid intake
are extremely important to quadriplegics.
CEREBRAL PALSY
Cerebral palsy is a condition resulting from injury to the brain.
"Cerebral" refers to the brain and "palsy" to lack of control over the mus-
cles. In cerebral palsy, the muscles are not paralyzed, but uncoordinated.
There are many different types of cerebral palsy, and in many cases
there will be a combination of two or more types. Common types of CP are:
Spastic - Characterized by tense contracted muscles with inability
to move smoothly. A person may be spastic only in his legs, on one
side of his body (arm and leg) or in all four limbs.
26
Athetoid - Characterized by constant uncontrolled motion, even
at rest. Athetoid movements intensify with excitement.
Ataxic - Damage in the area of the brain concerned with balance
which leads to many falls.
Tremor - Constant shaking, especially in the arms and hands,
limits abilities.
Because the brain controls all bodily functions, damage to brain cells
can result in impairments in other areas besides muscle function. In addi-
tion to lack of motor control, there may be seizures, spasms, mental retar-
dation, abnormal sensation and perception, or impairment of sight, hearing,
or speech, all in varying degrees.
Because of the complex nature of cerebral palsy, you will have to rely
on the teacher or parent to teach you the best way to handle the child. A
CP person may use specialized equipment. If he wears braces, be sure to
watch how they are put on and removed. If he uses a wheelchair, know how
to position the person properly in the chair, how to operate the brakes,
how to maneuver up and down curbs, and how to open or fold the chair. Dif-
ferent people will require different adaptations on their wheelchairs. Some
people with cerebral palsy walk with crutches, some wear corsets to help
them sit upright, and some wear braces or casts at night to prevent defor-
mities. The teacher or parent should explain how to use these devices.
MUSCULAR DYSTROPHY
The term muscular dystrophy refers to a group of diseases which are
characterized by weakness and wasting of the voluntary muscles (those over
which there is conscious control of the body). The most common, and most
serious type of MD (Duchenne's) usually affects young boys between the ages
of 2 and 6. Fat replaces the muscle fibers and weakness progresses rapidly.
Deformities may develop and a child with this type of dystrophy is usually
confined to a wheelchair in early teens. In the last stages of MD, when the
muscles are completely wasted, the child is often extremely thin. Children
with this form of MD rarely live past 20 as they are unable to cope with
respiratory infections.
Exercise is vitally important for the child with MD. By keeping the
remaining muscles as functional as possible, avoiding or slowing down the
development of complications that come from the progressive loss of muscle
activity is possible. When you are caring for a child with MD, be aware
27
of his/her capabilities. Take care not to overtire the child. Do not
allow the child to become chilled following swimming or strenuous activity.
A slight cold can result in hospitalization for a child with MD.
Because the dystrophic child is less mobile than the non-handicapped
child, gaining weight is a common occurence. Some children will eat as a
substitute for the many things they cannot do. Many MD children have diet
restrictions that you should be aware of, as an increase in fat intake can
speed up the weakening process.
The child with MD may use various devices including braces, crutches,
corsets, wheelchair, or specialized aids for feeding or dressing. A special
toilet seat may be necessary; however, MD children usually retain bowel and
bladder control. Encourage the child to use equipment, as it will enable
him to be more active and self-sufficient.
In advanced states of MD, the bones become very fragile. You must
take great care in handling such children as they are prone to fractures.
It is important to realize in lifting a child with MD, the muscles are like
jelly and you cannot get a good hold on the child. Special lifting devices
may be necessary. A teacher or parent should explain to you what assist-
ance the child may need in getting from one place to another.
You will find that many MD children are afraid to try new things.
They become discouraged as they watch their bodies weaken with no hope for
recovery. You can help these children by encouraging them to develop hob-
bies using remaining abilities. The small muscles of the hands are often
the last to be affected by MD. Even severely weakened children can often
enjoy drawing, finger painting, or simple board games. Muscular dystrophy
does not lead to mental retardation. Severely affected children often spend
a great deal of time reading.
SPINA BIFIDA
Spina bifida is a birth defect in which part of the backbone that
covers the spinal cord fails to develop, leaving the spinal cord exposed
in one spot. There are five major types of spina bifida. Many children
with spina bifida have no symptoms and require no treatment. Some babies
are born with a thin walled sack called a meningocele protruding from their
back. When this sack contains a part of the defective spinal cord which
has slipped through the abnormal opening in the spine, it is called my-
elomeningocele. The cause of this malformation, which occurs during the
28
end of the first month of pregnancy, is unknown.
The child with myelomeningocele is likely to have a number of
problems: paralysis of lower limbs, loss of sensation, lack of bowel
and bladder control, deformities, susceptibility to infection, and/or
hydrocephalus.
When caring for a boy or girl with spina bifida, there are several
factors to consider. In each case, check with a teacher or parent about
the correct procedures for each child. Eating, communicating, urinating,
and mobility may be special concerns for the spina bifida child.
In many children, lack of coordination of the muscles of the face
may result in uncontrolled grimacing, especially when attempting to speak.
Tightness and poor coordination of the muscles of the jaw, mouth, and
tongue lead to swallowing problems. The child may drool excessively, espe-
cially when concentrating on a task requiring effort. Tongue thrust,
reverse swallow, and bite reflex are all problems which make eating diffi-
cult. In addition, many children do not have enough coordination to hold
a spoon and bring it to their mouth or to drink from a cup, so adaptations
must be made. A good sitting posture is vital; be sure to find out what
supports are necessary. Know what problems you may encounter. Know how
to assist the child, allowing as much independence as possible. Find out
if there are any restrictions of the child's diet.
Urination can be managed in several ways. Some children wear urine
collecting devices. Other children may learn to empty the bladder at
regular intervals and press the abdomen to expel as much urine as possible
from the bladder. Regular toileting is very important as urinary infec-
tions are common, due to fluid remaining in the bladder.
With extensive bracing, some children are able to stand daily at a
specially designed standing table. Using braces and a walker or crutches,
some children are able to walk. Many use wheelchairs.
When you are caring for a child with myelomeningocele, you must rely
on the teacher or parent to show you how to use the equipment that the
child requires. Because many of these children are not using their legs as
non-handicapped children do, their leg bones are extremely fragile and apt
to break. Take care in moving the child with floppy legs, especially when
the braces are off. Never try to get the child to stand without the brace
At all times, remember to concentrate on what the child can do, and
give assistance only when needed. When you do things for him that he can
29
do himself, you actually handicap the child more. If you are patient
and supportive, you can be an important factor in helping the child
overcome the disability. With all this in mind, try to remember that
although myelomeningocele is a complex disability requiring numerous dif-
ferent types of specialized care, the child needs attention other than
just medical care. Encourage the child to use his abilities and develop
confidence in himself. All children need to feel good about their
accomplishments.
MENTAL RETARDATION
Mentally retarded persons are those who develop at a below average
rate and experience unusual difficulty in learning, social adjustment, and
economic productivity. Mental retardation should not be confused with
mental illness or emotional disturbance, although a retarded person may--
like anyone else--become emotionally disturbed. Mentally retarded people
simply have a learning problem; they learn slower than others.
Just as there are different levels within the range of normal intelli-
gence, there are different levels of mental retardation. The levels and
general characteristics of each level are:
Mild
Mental Age 8-9 yrs.
IQ 50-69
Moderate
Mental Age 5-7 yrs.
IQ 40-49
Severe
Mental Age
3-4 yrs.
IQ 20-39
Profound
Mental Age
0-2 yrs.
IQ 0-19
General Characteristics
Mildly Retarded
Can take care of self and they are educable
1) Often appears normal to casual observer.
2) May achieve academic skills to fourth grade level.
3) Can benefit from vocational training.
4) Can be self-supporting, unskilled employee.
Moderately Retarded
Slow, trainable under sheltered conditions
1) Generally progresses from kindergarten to first grade.
2) Tends to be self-sufficient under supervision.
3) May become self-supporting in service occupation.
Severely Retarded
Custodial--need constant supervision
1) Can usually learn to talk, though limited.
2) Can be trained in most basic self-help skills.
3) Can do simple tasks under supervision.
/.\ celf-cunnortino in a sheltered envi ronment.
30
Profoundly Retarded
Custodial--need constant supervision
1) Less intellectual ability than the average three-year old.
2) Might develop regular toilet habits.
3) Might be trained to feed and dress self.
4) Often cannot talk or communicate.
5) Requires continued care through life.
A slightly different classification system is used in the education
system. Educators refer to Educably Mentally Handicapped (EMH) children
and Trainable Mentally Handicapped (TMH) children. EMH roughly approximates
the Mild and Moderate IQ range while the TMH categorization for educational
purposes is more similar to the Severe and Profound range.
A mentally retarded person often acts younger than he or she actually
is. In more severely retarded people, the gap between abilities and age
is even greater. When you are with a mentally retarded person, keep in
mind his abilities, not his age; although be careful not to provide/offer
extreme age inappropriate activities.
Mentally retarded people do not necessarily need special equipment and
treatment in order to play and learn. They need varied experiences just
like any other person. Every person learns about himself and his environ-
ment by feeling, seeing, hearing, and moving about. The mentally retarded
person learns the same way, but slower.
It is important to structure the activities of the mentally retarded
person. He is apt to have a very short attention span so that he is unable
to concentrate on one activity for more than a few minutes. He needs
numerous activities, active and quiet, easy and challenging, but always
suggested with his abilities in mind. Directions may need to be repeated
or broken down into simple steps or basic concepts. Give him plenty of
time to complete a task. His reactions may be very slow and he may become
frustrated easily. Be sure to praise all his efforts, however small.
Mentally retarded people may need firm and consistent limits. However,
one must remember that the mentally retarded person's abilities and level
of comprehension are lower than would be expected for his age, so expec-
tations for his behavior must be adjusted accordingly. This doesn't mean
that mentally retarded people are never naughty. They need a lot of praise
and affection, but they also need discipline. Be caring but firm.
As with any handicapped person, the parents or guardian of a mentally
retarded person will probably be your best source of information. Mentally
31
retarded people are apt to be less flexible than other people, so become
familiar with the person's daily routine as well as any special equipment
or medication he may require. Prepare him ahead of time for any changes
or new experiences.
BEHAVIOR PROBLEMS
There are many times when children display behaviors which are not
socially acceptable. Temper tantrums, excessive crying, screaming or
holding the breath are a few examples. Unacceptable behavior may be the
result of fears, frustrations, or the failure to satisfy the child's basic
needs for love and security. As the child develops, how he learns to deal
with his fears, frustrations, and unmet needs is very important to the
child and his personality. If a child feels so much stress and anxiety
that it interferes with normal daily functioning, he is likely to express
his anxieties through inappropriate behavior. Then it can be said that
the child has a behavior problem. Given this definition, all children at
times have behavior problems, some for only a week, or a month, but others
continuously throughout their lives. Children who have repeated behavior
problems may require professional assistance. Each child is unique; within
limits, what is inappropriate and unacceptable behavior for one might be
acceptable behavior for another.
There are various techniques for dealing with behavior problems, most
of which stress structure and consistency. It is very important to recog-
nize who the child is and then to provide him with the assistance and
support necessary for the development of his potential.
MEETING COMMUNICATION NEEDS OF INDIVIDUALS WITH HANDICAPPING CONDITIONS
Before you can be of much help to the disabled person in communication,
or in any other dimension, you must have developed a healthy attitude
toward that person and to the role you can play with him. It involves,
among other things, a sincere acceptance of him as a person, and an equally
sincere attitude on your part of rendering service without "do-gooder"
overtones.
Each person will have a channel or channels of communication which
work best. Channels may be verbal, auditory, gesture, or written. Your
responsibility will be to learn to communicate with individuals through their
most effective channel. The process will require time and effort on your part,
but you will be amply rewarded. It will open the door to any other approach
you wish to make -- in recreation, in socialization, in stimulating new
knowledge.
32
Because each person will have individual problems and characteristics,
we can only make general suggestions which can then be adapted to specific
instances. However, considering the many things which can affect the normal
development of speech, there are several points which are important to
think about when you work with a particular person. For example, you may
find that you can be much more easily understood if you speak more slowly
and simply. Rapid speech may simply confuse and discourage individuals with
handicapping conditions. Also, communication should be easygoing and relaxed.
Further, you may find it desirable to ask questions so that responses can be
simple and yet definite. A "yes" or "no" or even a simple nod can convey
much meaning if preceded by an appropriate question. In any event, give
ample time for the person to respond. Communication should involve the use
of a fairly limited vocabulary, simple sentence structure, and also the
introduction of items of information which most of us take for granted.
Repetition and reinforcement will hasten the learning experience. In summary,
remember to:
Have a healthy attitude.
Learn individual channels of communication.
Establish a reason for communication.
Structure the situation for successful communication.
Work at their language level.
Be patient.
Source: Adapted from 4-H Leader's Guide:
Lets Look at 4-H and Handicapped Youth"
Cooperative Extension Service
The Pennsylvania State University
University Park, PA 16802
33
TYPES OF PHYSICAL LIMITATIONS
The following describes six major types of physical
limitations or involvement, which refers to a portion
or portions of the human anatomy and or physiology
that have a loss or impairment of normal function as
a result of genesis, trauma, disease, inflammation,
or degeneration. The six basic categories of involve-
ment in this report are:
(1) Non-ambulatory disabilities are those impairments
that, regardless of cause, confine individuals to
wheelchairs;
(2) Semi-ambulatory disabilities are those impairments
that cause individuals to walk with difficulty or
insecurity; examples include individuals with
cardiac and pulmonary ills, those who require the
use of braces, crutches, or canes, as well as per-
sons who are arthritics, amputees, or spastics;
(3) Incoordination disabilities include faulty coordi-
nation or palsy due to brain, spinal, or peripheral
nerve injuries;
(4) Aging disabilities are those manifestations of the
aging process that significantly reduce mobility,
flexibility, coordination, and/or perceptiveness;
(5) Sight disabilities range from total blindness to
impairments affecting sight so that the individual
functioning in public areas is insecure or exposed
to danger;
(6) Hearing disabilities include deafness or hearing
problems which might make an individual insecure
in public areas because he/she is unable to communi-
cate or hear warning signals. 1
1 National Society for Crippled Children and Adults,
American Standards Association Specifications for
Making Buildings and Facilities Accessible to, and
Usable by the Physically Handicapped, Chicago National
Society for Crippled Children and Adults, 1961 (reaf-
firmed 1971), page 6.
34
When considering the six basic types of involvement, it
must be realized that all six groups will not need nor
necessarily want the same standards to provide increased
usability. However, it can be assumed that if the design
meets the requirements of the most severely disabled, it
should also work for the less disabled as well as able
bodied individuals.
Before getting into the actual criteria themselves,
there are general principles and considerations relating
to the non-ambulatory and semi-ambulatory categories
which must be presented.
35
WHAT ARE LEARNING DISABILITIES?
Although individuals with learning disabilities usually have average to above
average intelligence and the potential for achieving in a wide variety of areas
of adult life, they may be characterized as lazy, irresponsible and
unmotivated. Generally the term "learning disabilities" refers to a broad
spectrum of processing disorders that arise from inaccurate information
received through the senses, an inability to remember or integrate
information, or difficulty with oral, written, and nonverbal expression. The
description used by the Learning Disabilities Association of America (1986) is
as follows:
"Specific learnig disabilities is a chronic condition of presumed
neurological origin which selectively interferes with the
development, integration, and/or demonstration of verbal and/or
nonverbal abilities. Specific learning disabilities exists as a
distinct handicapping condition which varies in its manifestations
and in degree of severity. Throughout life the condition can
affect self-esteem, education, vocation, socialization, and/or daily
living activities."
This description points out that learning disabilities are naturally part of of
the individual and not a set of behaviors that have been acquired. It also
points out that no specific area will be affected in every individual; in other
words, each individual with learning disabilities has a unique set of learning
difficulties and those difficulties will always be present. Individuals,
however, can learn to cope with those difficulties. As indicated, learning
disabilities affect all aspects of life and can cause problems with
self-esteem, interpersonal relationships, and independent living skills. As
mentioned earlier, a learning disability is indicated by problems in taking in,
storing, retrieving or expressing information. As research and experience have
shown, learning disabilities are not related to mental retardation in any way.
Rather, learning disabillities reflect a discrepancy between an individual's
ability and performance levels and the assumption is usually that the
individual has at least average intelligence. The measurement of ability and
performance, either in formal testing or in the instructional setting, can be
particularly frustrating in that results will most likely be inconsistent.
That is, in one area, the individual with a learning disability will
demonstrate high to very high aptitude and achievement, while, in another area,
results will indicate below average to very low performance.
36
Guidelines & Tips for Dealing With Various Disabilities
GENERAL
1.
People with handicapping conditions have the desire, determination, and
ability to participate with everyone else. All they need is the chance
to be included and that comes from you.
2.
Treat the participant as a person, just like anyone else in your program.
3.
Have a positive attitude toward the person. Let this be a model for other
program participants.
4.
You may need to spend extra time allowing the person to get things said
or done.
5.
Be sure to address the person directly, instead of through another member
of the group.
6.
Try to foresee and eliminate unexpected barriers or conditions that may
result in problems.
7.
Choose activity areas that allow all people to participate.
8.
By providing a barrier-free environment you are encouraging participation
by all members of the group.
SPECIFIC DISABILITIES
Physical Disabilities
Ask a disabled member what help is preferred. Assist only as needed. Be
courteous, use common sense, and communicate concern.
Examples of Physical Handicaps:
Blind
Speak in a normal voice using normal vocabulary words.
Demonstrate by touch, taste, and smell.
Describe the surrounding environment--location, shapes, and distances of
objects.
Remove/minimize all hazards in the area.
Capitalize on all remaining sensory receptors in activities. Add a bell to
the ball and play circle dodge ball. Run relays in roped-off lanes. Train
for mobility through dance movements or rhythm bands.
Contact an agency serving the blind. Many games have been adapted in braille
and are commercially available.
38
Deaf
Maintain eye contact. "V" or "U" shaped and semicircles are the best
seating formations.
Speak slowly and distinctly at the person's language level.
Demonstrate explanations.
Know about a hearing aid--its operation, care, and wearability.
Deaf-Blind
Make your presence known by a simple touch that conveys friendly interest.
Work out special communication signals between member and leader. Learn
and use whatever communication method is known by the member. Be sure to
understand each other.
Encourage use of voice.
Always orient the member to the surrounding environment.
Let the member take your arm when walking.
Swimming is enjoyed most in warm water.
Amputation
Functional limitations depend upon amputee.
Activities should exercise muscles surrounding affected body parts to avoid
stiffness.
Watch for falls as balance is a problem when body weight is not equally
distributed.
Encourage the individual to think of adapted methods.
Contact a physical therapist or agency serving physically disabled persons.
Special adaptive devices are available to help with some skills.
Crippling and Neurological Disabilities
Cerebral palsy
Coordination is a problem. Motor activities such as running, jumping, or
throwing are great. Fine motor activities using eye-hand coordination or
delicate finger movements can be frustrating.
Watch for falls--the sense of balance is not even.
Avoid excessively loud sounds and sudden, unexpected movements. These in-
crease uncontrollable spastic movements.
Muscular dystrophy
Watch for signs of fatigue due to muscular weakness and respiratory
difficulties.
Watch for falls due to impaired sense of balance.
Plan activities involving movement, as these exercise muscles. Activities
such as climbing stairs which involve affected muscles require assistance.
39
Participation in activities of all types is desired because youth eventual-
ly become wheelchair bound due to the nature of the disease.
Once wheelchair bound, continue all activities manageable by the individual.
Increase mental activities that use the imagination--the brain does not tire,
only the muscles!
Spina bifida
Know specifics about the extent of spinal cord injury and paralyzed body
parts.
Watch for signs of fatigue as endurance level is lower.
Watch for falls since sense of balance is uneven.
Specialized equipment often helps mobility and functioning--know specifics
about use and care.
Braces enable full participation but may slow movement.
There is no sensation in injured areas. Watch for injury to the skin from
burns (fire, too hot water) or scrapes. Watch for reddened areas resulting
from pressure sores. Change sitting/lying position frequently. Watch for
swelling and color changes due to circulation problems.
Wheelchairs will be necessary for some.
Physical Handling Is An Important Consideration
Wheelchairs
Be sure all straps are fastened securely. Sense of balance is not always
good.
Use arms and shoulder muscles when pushing wheelchaired participants up
ramps.
Guide a wheelchair down a ramp backwards.
Use small foot bars to tilt wheelchairs backwards when going up/down low
curbs.
Change the position of the members in wheelchairs often to prevent sores and
make them comfortable.
Be sure brakes are positioned when member leaves the chair.
Crutches
Ask what help is needed.
Know how to hand crutches to a handicapped member.
Hold at the waistline when assisting a person on crutches up an incline.
Braces
Know when and how the braces are used.
Know how to maintain the braces.
40
Falls
Catch hold of the hips of a falling handicapped member to help regain
lost balance.
Try to break a fall to prevent much injury.
Wait for a fallen handicapped member to indicate a need for help; allow
a few minutes for rest.
Check for serious injury and keep your eyes open.
Mental and Emotional Disabilities
Mental retardation
Full participation in all recreational activities promotes interaction in
an increasingly mature manner. Participants can do anything; their limits
relate only to slower learning rates.
Recognize that each individual has a chronological age, a mental age, an
emotional age, a social age, and a certain degree of physical ability.
Plan activities so that everyone has a chance to be good at something and
to experience success.
Be quick to praise.
Break an activity into parts and present the most simple feat first.
Alternate active and quiet games to avoid overstimulation and to compensat
for short attention spans.
Repeat well-liked activities.
Include only one new activity in a meeting.
Ease new members into the program gradually.
have a youth advocate
accompany the mentally handicapped youth to the first few meetings. The
child feels relaxed and the leader gets first-hand information of the
child's special needs.
Be firm and take a positive leader role.
Behavior Problems
Structure activities so that everyone participates in an organized manner.
Vary the type of activity.
Plan extra activities to fill a time slot completely.
Be consistent in what you say and do.
Focus on the individual and support self-development.
Source: Project INSPIRE Resource Guide
David Austin, Lou Powell (eds.)
Department of Recreation and Park Administration
Indiana University
Bloomington, Indiana 47401
41
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Joyce Media. Inc.
8753 Shirley P.O. Box 4440
are
Northridge, CA 91328
(213) 885.7181 (TTY & V(