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Transcript
Lecture 3
Impairments and Cen Guide 6
The levels of disability linked to
three different levels of intervention.
Impairments






Sensory impairments
Physical impairments
Developmental impairments
Cognitive impairments
Learning impairments
Mental Health impairments
National Disability Survey
Prevalence of each type of disability
Number
of
people
mobility & dexterity
184,000
pain
152,800
remembering & concentrating
113,000
emotional, psychological & mental
health
110,600
breathing
71,500
intellectual & learning*
71,600
hearing
57,600
diagnosed with intellectual
disability
50,400
seeing
50,600
speech
35,300
Visual Impairments

Visual impairment represents a continuum, from people with very
poor vision, to people who can see light but no shapes, to people
who have no perception of light at all.

For general discussion it is useful to think of this population as
representing two broad groups: those with low vision and those
who are legally blind.


About 51,000 have impaired vision About 1.2% of the
population
21,000 “a lot of difficulty”, 2,300 cannot see at all
•
There are an estimated 8.6 million people with visual impairments
(3.4% of the U.S. population).

In the elderly population the percentage of persons with visual
impairments is very high.
Visual Impairments



A person is termed legally blind when their visual
acuity (sharpness of vision) is 20/200 or worse after
correction, or when their field of vision is less than
20 degrees; in the best eye after correction.
Low vision includes problems (after correction) such
as dimness of vision, haziness, film over the eye,
foggy vision, extreme near- or farsightedness,
distortion of vision, spots before the eyes, colour
distortions, visual field defects, tunnel vision, no
peripheral vision, abnormal sensitivity to light or
glare, and night blindness.
There are approximately 1.8 million people in the
U.S. with severe visual impairments who are not
legally blind.
Visual Impairments









Some of the more common difficulties a person
with sight loss may experience include:
Judging the position and depth of steps
Reading standard print
Seeing the time on their watch
Using the telephone
Identifying money
Carrying out everyday routine tasks at home such
as writing a shopping
list
Crossing the road during the day or at night
Recognising faces
Visual Impairments


Many diseases causing severe visual impairments
are common in those who are aging (glaucoma,
cataracts, macular degeneration, and diabetic
retinopathy).
With current demographic trends toward a larger
proportion of elderly, the incidence of visual
impairments will certainly increase
Causes of Sight Loss
Causes of Sight Loss
 A person with sight loss is seeing much less or may see
nothing at all.
 Different eye conditions create different difficulties.
 Very few people are totally blind. A few have
perception of light only; some have a loss of vision in
the centre of their eye, others have no side vision.
Some see everything as a blur while others have blank
spots.
 Some people with sight loss have enough vision to read
but may have difficulty with night vision. Don’t assume
that a person, who has enough vision to do one thing,
can see enough to do everything.
 In Ireland, some of the most common eye conditions
are macular degeneration, glaucoma, detached retina,
diabetic retinopathy and cataracts.
Macular degeneration
This condition causes a
loss of vision in the
centre of the eye.
Reading, writing and upclose work can become
difficult. Sometimes the
person may experience a
problem with recognising
colours. Daylight vision
may be affected so
increased lighting may be
required. The person
may have some side
vision so they usually will
be able to see to move
about. It is a more
common cause of sight
loss among older people.
Glaucoma
A person with glaucoma may experience
loss of side vision.

Early onset glaucoma causes a subtle
loss of contrast, for example,
difficulties with seeing steps on a stairs
or the herb on the pavement.

For a person with advanced glaucoma,
moving around can be difficult,
especially at night when vision is more
reduced.

There may be a small central area
where the person can still see to read
and do up close work but side vision
has been lost. This is also called tunnel
vision.

You are more at risk of developing
glaucoma if a member of your family
has this condition, or if you are
shortsighted or if you are of African or
Asian origin.
Detached Retina




Detached retina will result
in a loss of vision where
the retina has been
damaged. A person’s retina
may detach for many
reasons.
Retinal detachment is more
common among middle
aged people and short
sighted people.
Detached retina may
appear like a dark shadow
over part of the eye or the
person may experience
bright flashes of light or
showers of dark spots
called floaters.
In many cases, the
damage can be repaired.
Diabetic Retinopathy



This condition causes a
partial blurring of vision or
patchy loss of vision. Near
vision may reduce and a
person may have difficulty
with up close reading. Vision
levels may vary on a daily
basis.
Diabetic retinopathy is a
complication of advanced
diabetes. Not all people with
diabetes will develop this
condition.
Damage to the back of the
eye can often be repaired if
detected at an early stage.
Cataracts




Cataracts make things look
blurred and misty. Some people
may have double vision.
As a cataract develops its
centre becomes more and more
yellow, giving everything the
person sees a yellowish tinge.
Colours may become dulled and
the person may see little detail.
People with cataracts can be
very sensitive to light and
glare, light scatters and
produces a ‘halo’.
Bright light or very sunny days
can dazzle the person while too
little light can make it difficult
to see
Hearing impairment


Hearing impairment means any degree
and type of auditory disorder, while
deafness means an extreme inability to
discriminate conversational speech
through the ear. Deaf people, then, are
those who cannot use their hearing for
communication.
People with a lesser degree of hearing
impairment are called hard of hearing.
Usually, a person is considered deaf when
sound must reach at least 90 decibels (5
to 10 times louder than normal speech) to
be heard, and even amplified speech
cannot be understood
National Disability Survey




About 58,000 with hearing
impairments
About 1.4% of population
21,000 “ a lot of difficulty”, 1,800
can’t hear
About 95% of onset is in adulthood,
at older ages
Hearing impairments
Hearing impairments can be found in all age
groups, but loss of hearing acuity is part of
the natural aging process. 23% of those
aged 65 to 74 have hearing impairments,
while almost 40% over age 75 have hearing
impairments. The number of individuals
with hearing impairments will increase with
the increasing age of the population and
the increase in the severity of noise
exposure.
Hearing impairments


Hearing impairment may be sensorineural
or conductive. Sensorineural hearing
loss involves damage to the auditory
pathways within the central nervous
system, beginning with the cochlea and
auditory nerve, and including the brain
stem and cerebral cortex (this prevents or
disrupts interpretation of the auditory
signal).
Conductive hearing loss is damage to
the outer or middle ear which interferes
with sound waves reaching the cochlea.
Causes include heredity, infections,
tumors, accidents and aging (presbycusis,
or "old hearing")9
Ear
Causes of Hearing Loss

Conductive hearing loss






Cholesteatoma
(noncancerous tumour
in the middle ear
caused by an ear
infection)
Chronic middle ear
fluid (otitis media with
effusion)
Middle ear infection
(otitis media)
Obstruction of external
ear canal (for
example, with wax, a
tumour, or pus from
an infection)
Otosclerosis (bony
overgrowth of the
ossicles)
Perforated eardrum













Sensorineural hearing loss
Aging
Brain tumors
Certain drugs
Childhood infections (mumps,
meningitis)
Congenital infection (toxoplasmosis,
rubella, cytomegalovirus, herpes,
syphilis)
Congenital abnormality
Demyelinating diseases (diseases
that destroy the myelin sheath
covering nerves)
Genetic
Loud noise
Meniere's disease
Sudden pressure changes caused
by flying, diving, and strenuous
exercise
Viral infection of the inner ear
(labyrinthitis)
What Is a Cochlear Implant?


A cochlear implant is a surgically implanted device
that helps overcome problems in the inner ear, or
cochlea. The cochlea is a snail-shaped, curled tube
located in the area of the ear where nerves are
contained.
Its function is to gather electrical signals from sound
vibrations and transmit them to your auditory nerve
(or hearing nerve). The hearing nerve then sends
these signals to the brain, where they're translated
into recognizable sounds.
Measurement of Loudness

Loudness is measured on a logarithmic
scale. This means that an increase of 10
decibels (dB) represents a 10-fold increase
in sound intensity and a doubling of the
perceived loudness. Thus, 20 dB is 100
times the intensity of 0 dB and seems 4
times as loud; 30 dB is 1,000 times the
intensity of 0 dB and seems 8 times as
loud.
Decibels Example
0 Faintest sound heard by human ear
30 Whisper, quiet library
60 Normal conversation, sewing machine, typewriter
90 Lawnmower, shop tools, truck traffic (8 hours per day is
the maximum exposure without protection)
100 Chainsaw, pneumatic drill, snowmobile (2 hours per
day is the maximum exposure without protection)
115 Sandblasting, loud rock concert, automobile horn (15
minutes per day is the maximum exposure without
protection)
140 Gun shot, jet engine (noise causes pain, and even brief
exposure injures unprotected ears; injury may occur
even with hearing protectors)
180 Rocket launching pad
Hearing Devices
Physical Impairments
•
Problems faced by individuals with physical
impairments include poor muscle control,
weakness and fatigue, difficulty walking, talking,
seeing, speaking, sensing or grasping (due to
pain or weakness), difficulty reaching things, and
difficulty doing complex or compound
manipulations (push and turn).
•
Individuals with spinal cord injuries may be
unable to use their limbs and may use
"mouthsticks" for most manipulations.
Twisting motions may be difficult or impossible for
people with many types of physical disabilities
(including cerebral palsy, spinal cord injury,
arthritis, multiple sclerosis, muscular dystrophy,
etc.).
•
National Disability Survey

160,000 have walking difficulties







83,000 use walking aids
31,000 use wheelchairs
160,000 can’t walk for 15 minutes
About 80,000, nearly 2% of the population, have
problems using hands or fingers
About half of these are aged over 65
About 31,000 have a lot of difficulty and about
14,000 can’t use their hands at all
Practical difficulties in everyday activities like
cooking, dressing, writing, opening doors, turning
taps
Nature and Causes of Physical
Impairments

Neuromuscular impairments include:







paralysis (total lack of muscular control in part or most of
the body),
weakness (paresis; lack of muscle strength, or pain), and
interference with control, via spasticity (where muscles
are tense and contracted),
ataxia (problems in accuracy of motor programming and
coordination), and
athetosis (extra, involuntary, uncontrolled and
purposeless motion).
http://www.neuromuscular-disease.com/neuromuscular-disorders/
Skeletal impairments include joint movement
limitations (either mechanical or due to pain), small
limbs, missing limbs, or abnormal trunk size.
Physical Impairments




A major causes of these impairments are:
Arthritis. Arthritis is defined as pain in
joints, usually reducing range of motion
and causing weakness.
Rheumatoid arthritis is a chronic
syndrome. Osteoarthritis is a
degenerative joint disease. 31.6 million
people in the U.S. suffer from rheumatic
disease.
The incidence of all forms of arthritis is
now estimated at 900,000 new cases per
year
Cerebral Palsy (CP).




Cerebral palsy is defined as damage to the motor
areas of the brain prior to brain maturity (most
cases of CP occur before, during or shortly
following birth).
CP is a type of injury, not a disease (although it
can be caused by a disease), and does not get
worse over time; it is also not "curable." Some
causes of cerebral palsy are high temperature,
lack of oxygen, and injury to the head.
The most common types are: (1) spastic, where
the individual moves stiffly and with difficulty, (2)
ataxic, characterized by a disturbed sense of
balance and depth perception, and (3) athetoid,
characterized by involuntary, uncontrolled motion.
Most cases are combinations of the three types
Neurological disorder

A neurological disorder is a
disorder that involves the nervous
system, by definition. A neurological
disorder can be caused by either a
disease, such as multiple sclerosis,
or a trauma or injury to the nervous
system. Neurological disorders can
be remarkably difficult to treat and
are often debilitating

Symptoms of neurological disorders can
include the slow loss of coordination,
balance, or ability to speak clearly. Often
symptoms start with a mild and
intermittent twitching or numbness in one
extremity. Tremors, rigid muscles, slowed
motion, difficulty swallowing, loss of
automatic movements such as blinking,
swinging the arms, and unconscious acts,
and eventually dementia.

Diagnosing some neurological
disorders may very well depend on
symptoms evaluation alone.
Parkinson’s for example, has no
definitive test and is more likely to
be diagnosed through physical
examination well after the initial
onset of symptoms.
Acquired Neurological Conditions







Motor Neurone Disease
Parkinson’s Disease
Multiple Sclerosis
Spinal Cord Injury
Stroke
Traumatic Brain Injury
Head & Neck Cancer
Spinal Cord Injury
. Spinal cord injury can result in paralysis or paresis
(weakening). The extent of paralysis/paresis and
the parts of the body effected are determined by
how high or low on the spine the damage occurs
and the type of damage to the cord.
• Quadriplegia involves all four limbs and is
caused by injury to the cervical (upper) region of
the spine;
• paraplegia involves only the lower extremities
and occurs where injury was below the level of
the first thoracic vertebra (mid-lower back).
•
In the US, 47% of spinal cord injuries result in
paraplegia; 53% in quadriplegia. Car accidents
are the most frequent cause (38%), followed by
falls and jumps (16%) and gunshot wounds
(13%).
Spinal Cord
Levels of Injury in SCI




Cervical SCI's usually cause loss of function in the arms
and legs, resulting in quadriplegia.
The first thoracic vertebra, T-1, is the vertebra where the
top rib attaches. Injuries in the thoracic region usually
affect the chest and the legs and result in paraplegia.
The vertebra in the lower back between the thoracic
vertebra, where the ribs attach, and the pelvis (hip bone),
are the Lumbar Vertebra. The sacral vertebra run from the
Pelvis to the end of the spinal column. Generally result in
some loss of functioning in the hips and legs.
Paraplegia
http://www.spinalinjury.net/html/_spinal_cord_101.html
Specific Loss of Body Functions

Injuries above the C-4 level may require a ventilator for the person to
breathe.

C-5 injuries often result in shoulder and biceps control, but no control at
the wrist or hand.

C-6 injuries generally yield wrist control, but no hand function.

Individuals with C-7 and T-1 injuries can straighten their arms but still
may have dexterity problems with the hand and fingers. Injuries at the
thoracic level and below result in paraplegia, with the hands not affected.
At T-1 to T-8 there is most often control of the hands, but poor trunk
control as the result of lack of abdominal muscle control.
Specific Loss of Body Functions

Lower T-injuries (T-9 to T-12) allow good truck control and good
abdominal muscle control. Sitting balance is very good.

Lumbar and Sacral injuries yield decreasing control of the hip flexors and
legs.


Besides a loss of sensation or motor functioning, individuals with SCI also
experience other changes. E.g., they may experience dysfunction of the
bowel and bladder,. Sexual functioning is frequently with SCI may have
their fertility affected, while women's fertility is generally not affected.
Very high injuries (C-1, C-2) can result in a loss of many involuntary
functions including the ability to breathe, necessitating breathing aids
such as mechanical ventilators. Other effects low blood pressure, inability
to regulate blood pressure effectively, reduced control of body
temperature, inability to sweat below the level of injury, and chronic pain
National Disability Survey




About 153,000 people experience
chronic pain
About 3.6% of population
Fairly common among those of
working age
About 78,000 experience a lot of or
extreme difficulties in performing
normal, everyday activities
Head Injury (cerebral trauma).



The term "head injury" is used to describe a wide
array of injuries, including concussion, brain stem
injury, closed head injury, cerebral haemorrhage,
depressed skull fracture, foreign object, anoxia,
and post-operative infections.
Like spinal cord injuries, head injury and also
stroke often results in paralysis and paresis
(partial), but there can be a variety of other
effects as well.
Currently about one million Americans (1 in 250)
suffer from effects of head injuries, and 400,000 600,000 people sustain a head injury each year.
However, many of these are not permanently or
severely disabled
http://www.emedicinehealth.com/head_injury/article_em.htm#ov
erview
US figures re Head Injuries
National Disability Survey Memory/Concentration



113,000 people, about 2.7% of
population
About 55,000 have moderate
difficulty
Difficulties include:



remembering important things
concentrating for ten minutes
performing normal daily activities
Stroke (cerebral vascular accident;
CVA).


The three main causes of stroke are:
thrombosis (blood clot in a blood vessel
blocks blood flow past that point),
haemorrhage (resulting in bleeding into the
brain tissue; associated with high blood
pressure or rupture of an aneurysm), and
embolism (a large clot breaks off and blocks
an artery).
The response of brain tissue to injury is similar
whether the injury results from direct trauma
(as above) or from stroke. In either case,
function in the area of the brain affected either
stops altogether or is impaired
What are the risk factors of stroke?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
high blood pressure
diabetes
heart disease
cigarette smoking
history of transient ischemic attacks (TIAs)
history of cerebrovascular accident (CVA)
high red blood cell count
high blood cholesterol and lipids
lack of exercise, physical inactivity
obesity
excessive alcohol use
drug abuse (certain kinds)
abnormal heart rhythm
cardiac structural abnormalities
age
race
history of prior stroke
heredity/genetics
where a person lives
temperature, season, and climate
socioeconomic factors
MD and MND




Motor Neuron disease (MND) is a fatal degenerative
disease of the central nervous system characterized by
slowly progressive paralysis of the voluntary muscles.
The major symptom is progressive muscle weakness
involving the limbs, trunk, breathing muscles, throat
and tongue, leading to partial paralysis and severe
speech difficulties.
This is not a rare disease (5 cases per 100,000). It
strikes mostly those between age 30 and 60, and men
three times as often as women. Duration from onset to
death is about 1 to 10 years (average 4 years).
Muscular Dystrophy (MD). Muscular dystrophy is a
group of hereditary diseases causing progressive
muscular weakness, loss of muscular control,
contractions and difficulty in walking, breathing,
reaching, and use of hands involving strength. About 4
cases in 100,000 are reported
Motor Neurone Disease (MND)




Degenerative disease involving motor
neurones of the brain and spinal cord
75% of people are unable to speak by the
time of their death
14-39% of patients survive for 5 years
from first symptoms, 10% for 10 years.
Patients who present with bulbar
symptoms (speech, swallowing) have
rapid progression with average 2.2 years
survival rate from first symptoms
Multiple Sclerosis


Degenerative disease of white matter of
central nervous system
Disease course involves 5 different
classes (relapsing and remitting / chronic
progressive / combined /benign /
malignant)
Specific factors in MS




Age of clients. Often diagnosed 2030’s
Cognitive issues- 50% of people
experience short term memory
issues
Sensory issues- 16-30% of people
experience optic neuritis (acute loss
of central vision), diplopia also
common
Motor skills- varies widely among
people, intention tremor (ataxia)
Diplopia
Traumatic Brain Injury




Closed head injury results in more diffuse
damage than e.g. stroke/tumour
Open head injury/penetrating injury (e.g.
gun-shot) tends to result in focal damage
Have to consider the effects of
complications of trauma e.g. intracranial
haemorrhage/raised intracranial pressure
etc.
Different effects in children and adult
Traumatic Brain Injury
CHILDREN
 Causes damage at a time when language
and cognition is still developing
 Attention and concentration difficultiesaffects processing of verbal and written
language
 Memory for new vocabulary, new
language learning
 Responding to social cues can be affected
due to frontal lobe damage
 Over time, damage can become more
apparent
Head & Neck Cancer



30 different sites in ‘head and neck’
cancer group including lips, tongue,
mouth, pharynx, larynx
In Ireland approx 500 people per year are
diagnosed with laryngeal cancer. 80% of
people are male, 70% are over 60 years
old
Around 650 people in Ireland are
diagnosed with oral cancers. More
common in men than women (ratio
decreased from 5:1 in 1950’s to 2:1
presently)
National Disability Survey - Breathing




About 72,000 people,
about 1.7% of the population
Vulnerability to smoke
May create problems in walking
About 27,000 experience serious or
extreme difficulties in performing
normal, everyday activities
Cognitive impairments







Cognitive impairments are varied, but may be categorized as
memory,
perception,
problem-solving, and
conceptualizing disabilities.
Memory problems include difficulty getting information from
short-term storage, long term and remote memory. This
includes difficulty recognizing and retrieving information.
Perception problems include difficulty taking in, attending to,
and discriminating sensory information.
Cognitive impairments Con’d



Difficulties in problem solving include recognizing the
problem, identifying, choosing and implementing solutions,
and evaluation of outcome.
Conceptual difficulties can include problems in sequencing,
generalizing previously learned information, categorizing,
cause and effect, abstract concepts, comprehension and skill
development.
Language impairments can cause difficulty in comprehension
and/or expression of written and/or spoken language.
Cognitive/Language Impairments




Cognitive Disability. A person is considered to have a
cognitive disability if they have an IQ below 70
(average IQ is 100) and if they have difficulty
functioning independently.
The cause is unknown, although infections, premature
birth, birth trauma, or lack of oxygen may all cause
cognitive impairment.
Those considered having a mild impairment (80-85%)
have an IQ between 55 and 69 and are considered to
be able to achieve primary level education. They
usually function well in the community and hold down
semi-skilled and unskilled jobs.
People with moderate impairment have an IQ between
40 and 54 and can attain educational skills and
independence. They can learn to recognize symbols
and simple words, achieving approximately a junior
primary level.
National Disability Survey

About 50,000 with intellectual disabilities,
1.2% of population




14,000 with mild intellectual disability
24,000 moderate intellectual disability
12,000 severe intellectual disability
Research designs which are confined to
private households may miss those who
are living in institutional care (c. 4,000).
Intellectual Disability Stats Ireland
27,000 people with intellectual disability registered on the National
Intellectual Disability Database in Ireland.
That is a prevalence rate of 7.38 per 1,000 of the total population.
Of those registered on the database, approximately 41% are registered
as having a mild intellectual disability,
36% as having a moderate intellectual disability,
15% as having a severe disability and
4% as having a profound disability.
There are another 4% whose level of disability is not verified.
Impact of Intellectual Disability
About 87% will be mildly affected and will only be a little slower than
average in learning new information and skills.
As young children, their disability is not readily apparent and may not be
identified even after they enter school, without formal testing.
As adults, many will be able to lead independent lives in the community and
will no longer be viewed as having an intellectual disability.
Impact of Intellectual Disability
The remaining 13% of people with intellectual disability have serious
limitations in functioning. Some may also have physical disabilities.
However, with early intervention and with appropriate education and
supports as adults, they can lead satisfying lives in the community,
working in open, supported or sheltered employment.
1 or 2% of this group will require a highly structured environment, with
one to one support from a caregiver, for optimal development.
The following factors have been identified as causes of the Impairment
1. Prenatal: affecting the baby before birth e.g. alcohol and
substance abuse by the pregnant mother (there are guidelines
available on alcohol intake during pregnancy and mothers should
discuss these with their doctors); bleeding during pregnancy and
illness or injury of the mother during pregnancy. Recent research
has implicated smoking for an increased risk of prematurity.
2. Perinatal: affecting the baby at birth e.g. extreme prematurity,
low birth weight and brain injury.
3. Postnatal: affecting the baby after birth e.g. meningitis,
encephalitis, measles, pertussis (whooping cough), head injuries
and other traumas to young children.
4. Genetic/Inherited causes: e.g. Down Syndrome, the most
common genetic condition associated with intellectual disability
or Fragile X Syndrome, the most common identifiable inherited
cause of intellectual disability.
5. Environmental: e.g. cultural deprivation and extreme poverty,
which can result in malnutrition, inadequate medical care or
environmental hazards.
Severe and Profound
People with severe and profound disability are the most vulnerable
among disabled persons. Often they are persons with multiple disability,
with a severe or profound intellectual disability associated to a motor
and/or sensorial disability, causing a restriction of autonomy as well
as of perception, expression and relating capacities. These restrictions
cause complex needs and the danger of social exclusion from society.
Language and Learning Disabilities


Specific learning disabilities are chronic
conditions of presumed neurological origin
which selectively interfere with the
development, integration, and/or
demonstration of verbal and/or nonverbal abilities.
Many people with learning disabilities are
average intelligent aside from their
specific learning disability. 1-8% of
school-aged children and youth have
specific learning disabilities
Age-Related Disease



Alzheimer's disease is a degenerative
disease that leads to progressive
intellectual decline, confusion and
disorientation.
Dementia is a brain disease that results in
the progressive loss of mental functions,
often beginning with memory, learning,
attention and judgment deficits.
The underlying cause is obstruction of
blood flow to the brain. Some kinds of
dementia are curable, while others are
not
Seizure Disorders




A number of injuries or conditions can result in seizure
disorders.
Epilepsy is a chronic neurological disorder. It is
reported that approximately 1 person in 15 has a
seizure of some sort during his life, and between .5%
and 1.5% of the general population have chronic,
recurring seizures.
A seizure consists of an explosive discharge of nervous
tissue, Except at those times when this electrical storm
is sweeping through it, the brain is working perfectly
well in the person with epilepsy.
Seizures can vary from momentary loss of attention to
grand mal seizures which result in the severe loss of
motor control and awareness. Seizures can be
triggered in people with photosensitive epilepsy by
rapidly flashing lights, particularly in the 10 to 25 Hz
range
Mental Health
There are many different theories, and much disagreement, about what
causes mental health problems. Possible causes of mental health problems
in people with a learning disability may include:
•genetics
•damage to the brain that has caused the learning disability
•traumatic events in childhood, for example abuse
•traumatic events in adulthood
•misuse of alcohol or illicit substances
•not having enough control over their own lives
•not having enough stimulating things to do in their own lives
•social isolation
•bullying and discrimination
•difficulty expressing emotions, or not having anyone to express them to.
National disability Survey




Almost 111,000 people, about 2.6% of
population
About 1 in 4 of us has an episode at
some stage of our life
About 75,000 are of working age
Depression is the most common




About
About
About
About
31,000 have depression
14,000 have anxiety disorders
5,000 have schizophrenia
3,000 have bipolar disorder
CAN/CENELEC GUIDE 6
Guidelines for Standards developers
to address the needs of older
people and persons with disabilities
Why standards






Provide a tool which will identify
factors that will effect the use of a
product, service or environment
Inclusive reasons but also economic
Addressing the needs in early
stages of design
Safety & Ergonomic reasons
Risk assessment
Consideration for AT
CAN/CENELEC Guide 6



CEN ( European Committee for
Standardisation)
CENELEC (European Committee for
Electrotechnical Standardisation)
Guide 6 prepared by ad hoc
ISO/TAG (Technical Advisory Group)
based on work by ISO/COPOLCO
(Committee on Consumer Policy)
Guide 6



Describes process by which needs
of older persons or persons with
disabilities may be considered in the
development of standards
Provides tables of factors to be
considered
Descriptions of body functions
Overview of CEN Guide 6



Clause 6 briefly describes a process that allows
technical committees to consider the needs of
older persons and persons with disabilities. It
divides the standardization process into five
steps; for each step, the Guide lists one or more
issues that need to be addressed.
Clause 7 and 8 provide tables that relate several
types of clauses in a standard (for example, on
packaging, the user interface and the built
environment) to factors that need to be
considered when addressing disabilities.
Clause 9 provides descriptions of body functions
or disabilities and their implications when using
products and services.
STAND4ALL EU Project http://ftb-esv.de/stand4all/index.html
The seven design fields in clauses 7 and 8 are:
information on how a product or service should be
used;
 packaging, including labels, the materials used, the
opening and the disposal of packaging;
 the materials used in a product;
 the installation of a product;
 the user interface;
 the maintenance, storage and disposal;
 the built environment (for example, wider doors and
corridors for wheelchairs, and access for working
dogs).
Transport and transportation services are not mentioned
in clause 7.

Ease of handling includes aspects such as the required
strength, the angle of rotation of a person’s joints, the
frequency of actions, and the precision required for certain
movements.
Sensory/Physical




Seeing
Hearing
Touch/Smell
Balance





Dexterity
Manipulation
Movement
Strength
Voice
Cognitive / Allergy


Intellect
Memory



Contact
Food
Repertory
1: Factors re Information
2: Factors for Packaging
3: Factors regarding Materials:
4: Factors regarding Installation
5:
User Interface
6:Factors to consider in clauses on maintenance, storage
and disposal
7: Built Environment
Develop Standard for a Photocopier
Clauses 1-6






Table 1: clauses on information.
Table 2: clauses on packaging (for persons
who package the machine in a factory and
for persons who unpack it before
installation).
Table 3: clauses on materials.
Table 4: clauses on installation (for persons
who install a photocopier).
Table 5: clauses on the user interface.
Table 6: clauses on maintenance, storage
and disposal (for staff in charge of these
tasks).