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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).