Speech and Language Impairment

Speech and Language Impairment — Speech impairment may influence speech in a general way or only certain aspects of it, such as fluency or voice volume. Language impairment may be associated with a more general intellectual impairment.

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Language impairment — An impairment in the ability to understand and/or use words in context, both verbally and non-verbally. Some characteristics of language impairment include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur those who are affected by language learning disabilities or developmental language delay. The person may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

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Non-Verbal — Persons who cannot communicate through the use of voice. Persons who are non-verbal must communicate through Augmentative or Alternative Communication Devices.

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Speech and Language Impairment (all types) —

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Speech impairment — The impairment of speech articulation, voice, fluency, or the impairment language comprehension and/oral expression or the impairment of the use of a spoken or other symbol system. Might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay. They may say see when they mean ski or they may have trouble using other sounds like l or r. Listeners may have trouble understanding what someone with a speech disorder is trying to say. People with voice disorders may have trouble with the way their voices sound.

Mobility Impairment

Mobility Impairment — Reduced function of legs and feet leads to users depending on a wheelchair or artificial aid to walking. In addition to people who are born with a disability, this group includes a large number of people whose condition is caused by age or accidents.

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Cannot walk without aid — It is important that these persons are given proper workstation ergonomics because problems in the legs often cause poor posture which put the person at risk of developing other problems such as back strain.

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Mobility Impairments (all types) —

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Wheelchair user — An employee who uses wheelchairs often requires a modified workstation. The keyboard height, desktop and monitor height need to be adjusted to assure proper ergonomics.

Learning Disability

Learning Disability — A specific learning disability results from problems in one more of the central nervous system processes involved in perceiving, understanding and/or using concepts through verbal (spoken or written) language or nonverbal means. It manifests itself with a deficit in one or more of the following areas: attention, reasoning, processing, memory, communication, reading, writing, spelling, calculation, coordination, social competence and emotional maturity.

It affects:

INPUT

• How information is taken in.
• Perception (How it is perceived)
• Auditorily (How well information is heard)
• Visually (How well information is seen)
• Tactually (How well information is input by touch)

INTEGRATION

• How new information is taken in, understood and linked to old information.
• Concept formation.
• How multiple ideas are combined.

OUTPUT

• How information that has been learned and assimpilated is shown to others.
• Written expression
• Organization of thoughts and understanding of Logical Progression.
• Oral expression (A speech or explanation of what has been learned)
• Organization of thoughts and understanding of Logical Progression.
• Demonstration (A project demonstrating what they have learned)
• Organization of thoughts and understanding of Logical Progression.

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Attention Deficit (Difficulty Focusing) — Attention Deficit Disorder is a biologically based condition causing a persistent pattern of difficulties resulting in one or more of the following behaviors:

• inattention
• hyperactivity
• impulsivity

Inattention: difficulty attending or focusing on a specific task. People with Attention Deficit Disorder may become distracted within a matter of minutes. Inattentive behavior may also cause difficulties with staying organized (e.g. losing things), keeping track of time, completing tasks and making careless errors.
Hyperactivity: difficulty inhibiting behavior. These people are in constant motion. They may engage in excessive fiddling, leg swinging and squirming in their chair.
Impulsivity: difficulty controlling impulses. These people do not stop and think before they act. They say and do whatever comes into their mind without thinking about the consequences. They might say something inappropriate and regret it later, blurt out a response to question before a person is done speaking to them or have difficulty waiting for their turn in line.

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Dyscalculia — Difficulty performing math calculations. A learning disability which affects math.

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Dysgraphia — Difficulty expressing thoughts in writing. It is used to refer to extremely poor handwriting.

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Dyslexia — Dyslexia is a learning disability that involves reading. Other similar terms include Dysgraphia (writing disability) and Dyscalculia (math disability). Dyslexia is probably the most common LD term which the general public hears. The word "dyslexia" simply means difficulty understanding written words.
The following are some common signs of Dyslexia:

• trouble expressing verbal language
• poor reading comprehension
• poor spelling
• difficulty reading — trouble identifying individual words
• trouble expressing thoughts in written form
• difficulty listening to or following directions — may hear words incorrectly
• confusion about directions in space and time, (e.g. left from right, up from down, months of the year)
• letter reversals (e.g. writing b for d or vice versa), trouble sequencing letters, (e.g. "left" for "felt").
• may see words as upside down, blurred or distorted
• difficulty with handwriting
• difficulty with mathematics — using mathematical symbols,
• sequencing steps to solve a mathematical problem

Dexterity Impairment Arms Hands Fingers

Dexterity Impairment (Arms/Hands/Fingers) — Reduced function of arms and hands makes activities related to moving, turning or pressing objects difficult or impossible. This does not influence speech communication itself but makes it hard to make a phone call or use a wide range of other equipment.

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Cannot use fingers — This can seriously affect a person's ability to use a computer keyboard and mouse.

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Cannot use one arm — Causes difficulty in typing. The constant reaching for a mouse and increased demands on the useful arm puts persons in this category at high risk of developing Repetitive Strain Injury in the working arm. A person in this category must be provided with the best possible workstation ergonomics as well as the appropriate assistive device.

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Dexterity Impairments (all types) —

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Hand Tremors — Causes difficulty in writing, keyboarding, mouse use etc.

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Reduced co-ordination — Hand/eye coordination is necessary on traditional computers. Cursor movement on the screen responds to minute movements of the mouse by the hand. Typing also requires a certain amount of coordination and dexterity.

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Reduced strength — Refers to persons who have disabilities that affect depressing computer keys, mouse clicks, lifting reference material etc. May require adaptations to the workstation that allow for low or no impact computing as well as other workstation modifications.

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Reduced Strength—Arm — Persons who have disabilities that affect depressing computer keys, mouse clicks, lifting reference material etc. May require adaptations to the workstation that allow for low or no impact computing as well as other workstation modifications.

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Reduced Strength—Hand — Persons who have disabilities, which affect depressing computer keys, mouse clicks, lifting reference material etc. May require adaptations to the workstation that allow for low or no impact computing as well as other workstation modifications.

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Repetitive Strain Injury (RSI) — Extremely prevalent in recent years due to the intensive computer use. It is a separate category even though many of the symptoms are covered in other categories. RSI is a result of repetitive procedures that gradually affect the user. It sometimes becomes so severe that the person cannot even pick up a pencil. Risk of RSI can be reduced dramatically through ergonomically designed work stations and prevention training. All computer users should take frequent short breaks and vary physical activities during the day. A saying among health professionals is, It is much harder to get RSI than it is to get rid of it. Prevention is key. Treatment can last up to a year or longer and may include surgery. There are assistive devices designed to aid persons with RSI work in a more natural position and put less strain on the body.

Disability Studies

Disability studies is a relatively new interdisciplinary academic field focusing on the roles of people with disabilities in history, literature, social policy, law, architecture, and other disciplines. Although it has many antecedents, disability studies began to flourish toward the end of the twentieth century. The first PhD program in disability studies in the United States was established in 1998 at the University of Illinois at Chicago.

Definitions

Disability theorists have debated at length how disability should be defined. The theoretical roots for these debates reside in the medical, structural, and minority models. The medical model views disability as equivalent to a functional impairment; the minority model sees a lack of equal rights as a primary impediment to equality between able and disabled populations; and the structural model looks to environmental factors as the cause of disability.

Mission

The field of academic study of disability is growing worldwide; one of its major backers, the transnational Society for Disability Studies, took up the task in the mid-1990s to create an official "definition" for what the field involves. It offers the following working guidelines for any program that describes itself as 'Disability Studies':

• It should be interdisciplinary/multidisciplinary. Disability sits at the center of many overlapping disciplines in the humanities, sciences, and social sciences. Programs in Disability Studies should encourage a curriculum that allows students, activists, teachers, artists, practitioners, and researchers to engage the subject matter from various disciplinary perspectives.

• It should challenge the view of disability as an individual deficit or defect that can be remedied solely through medical intervention or rehabilitation by "experts" and other service providers. Rather, a program in disability studies should explore models and theories that examine social, political, cultural, and economic factors that define disability and help determine personal and collective responses to difference. At the same time, Disability Studies should work to de-stigmatize disease, illness, and impairment, including those that cannot be measured or explained by biological science. Finally, while acknowledging that medical research and intervention can be useful, Disability Studies should interrogate the connections between medical practice and stigmatizing disability.

• It should study national and international perspectives, policies, literature, culture, and history with an aim of placing current ideas of disability within their broadest possible context. Since attitudes toward disability have not been the same across times and places, much can be gained by learning from these other experiences.

• It should actively encourage participation by disabled students and faculty, and should ensure physical and intellectual access.

• It should make it a priority to have leadership positions held by disabled people; at the same time it is important to create an environment where contributions from anyone who shares the above goals are welcome.

However, the actual scope of disability studies differs from country to country in spite of its common core. Some, such as the United Kingdom, tend to see the field primarily as primarily belonging only to disabled people and the disability activism they might tend to promote; in the United States, by contrast, a much wider range of professions, such as sociology and social work more generally, which involves both able-bodied and disabled people, may be involved.^{[citation needed]} One of the earliest academic publications in the area was 'Deformity as Device in the Twentieth-Century Australian Novel' (1991), a PhD thesis, at the University of Tasmania, by CA. Cranston.

Criticism

Disability studies is not without its critics. It has been suggested that the dominant social model it uses, which developed in the 1970s and served its purpose well through that era, has now been outgrown, and needs major developments. One major area of contention is the frequent exclusion of the personal experience of impairment, cognitive disability, and illness, which is often left out of most discussion in these circles in the name of "focused" academic discourse. Another concern is the ever-present possibility of a drift towards identity politics in the discipline and also within the disability rights movement as a whole. The social model of disability separates physical impairment from social disability, and in its most rigid form does not accept that impairment can cause disability at all. Scholars are increasingly recognizing that the effects of impairment form a central part of many disabled people's experience, and that these effects must be included for the social model to still be a valid reflection of that experience. Slogan "the personal is political" has been particularly influential in these developments.
Disability studies has also been criticised for its failure to engage with other forms of sociopolitical oppression, such as racism, sexism or homophobia, both as they may apply to disabled people in these oppressed groups, and also in disability studies' ability (or lack thereof) to "unite" with these other movements in common struggle. As a relatively new discipline, critics allege disability studies seems to have made very little progress in this area, in spite of new published writings which deal with these very topics.

Nonvisible Disabilities

Main article: Invisible disability

Several chronic disorders, such as diabetes, asthma or epilepsy, would be counted as nonvisible disabilities, as opposed to disabilities which are clearly visible, such as being confined to a wheelchair.

Developmental Disability

Main article: Developmental disability

Developmental disability is any disability that results in problems with growth and development. Although the term is often used as a synonym or euphemism for intellectual disability, the term also encompasses many congenital medical conditions that have no mental or intellectual components, for example spina bifida.

Mental Health And Emotional Disabilities

Main article: Mental disorder

A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which are not a part of normal development or culture. The recognition and understanding of mental health conditions has changed over time and across cultures, and there are still variations in the definition, assessment, and classification of mental disorders, although standard guideline criteria are widely accepted.

Intellectual Disability

Main article: Intellectual disability

Intellectual disability is a broad concept that ranges from mental retardation to cognitive deficits too mild or too specific (as in specific learning disability) to qualify as mental retardation. Intellectual disabilities may appear at any age. Mental retardation is a subtype of intellectual disability, and the term intellectual disability is now preferred by many advocates in most English-speaking countries as a euphemism for mental retardation.

Balance disorder

Main article: Balance disorder

A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by symptoms of being giddy, woozy, or have a sensation of movement, spinning, or floating. Balance is the result of several body systems working together. The eyes (visual system), ears (vestibular system) and the body's sense of where it is in space (proprioception) need to be intact. The brain, which compiles this information, needs to be functioning effectively.

Somatosensory Impairment

Main article: Somatosensory disorder

Insensitivity to stimuli such as touch, heat, cold, and pain are often an adjunct to a more general physical impairment involving neural pathways and is very commonly associated with paralysis (in which the motor neural circuits are also affected).

Olfactory and gustatory impairment

Impairment of the sense of smell and taste are commonly associated with aging but can also occur in younger people due to a wide variety of causes.

Further information: Olfaction#Disorders of olfaction

There are various olfactory disorders:

• Anosmia – inability to smell
• Dysosmia – things smell different than they should
• Hyperosmia – an abnormally acute sense of smell.
• Hyposmia – decreased ability to smell
• Olfactory Reference Syndrome – psychological disorder which causes the patient to imagine he has strong body odor
• Parosmia – things smell worse than they should
• Phantosmia – "hallucinated smell," often unpleasant in nature

Further information: Taste#Disorders of taste

Complete loss of the sense of taste is known as ageusia, while dysgeusia is persistent abnormal sense of taste

Hearing Impaired Disability

Today the hearing impaired disability is not a rarity. In fact, a research done recently or hearing impaired disability has shown that one out of every eight people become disabled in one or the other every year. For men normally in their thirties, this is a ratio of one in every five and for women in their thirties; this becomes one in every three. Although most of the people suffer from hearing impaired disabilities as a result of heart conditions or some other ailments, but as the years set on or due to some sort of accident or disease, many people develop a hearing impairment.

A hearing impairment disability is the full or partial decrease in the ability of an individual to detect and understand sounds. For people who suffer from hearing impairments, there are certain benefits available from Social Security that are provided and granted by the Social Security Law. A hearing impairment disability is a qualified disability and confers on the people the right to receive certain benefits. These benefits are the legal right of the disabled people and they should make the necessary research to file for them. There are a number of law firms that deal specifically with the Social Security Laws and know all the requirements. There are some common causes why most of the people applying for hearing impairment befits filed with Social Security are rejected, these are; inaccurate application of the Social Security laws; incomplete application for Social Security disability benefits, unsupported claims of incapacity to work or find a job; incorrect and/or insufficient medical records.

But in case people have filed for benefits under Social Security for their hearing impairment and have had their application turned down, it is not the end of the line. The application of the disabled people is not turned down for good and they can re-file. Of course this time people should make sure their own research and paper work is complete. Also people should consult with a lawyer or social worker who specializes in the area of disability benefits and hearing impairment disability. Filing for benefits for the hearing impairment disability is the legal right; it also establishes the impairment as a legal fact, and helps in insurance claims as well as any employment opportunities that people may be seeking. Such disability benefits can also help people to cover any cost of treatment that they may subsequently incur. There are some physical ailments that may cause the impairment to the hearing, if people have gone through any of these they should opt for a behavioral audiogram.

Some of the more common conditions or diseases that can lead to hearing impairment are; measles which may result in auditory nerve damage; meningitis may damage the auditory nerve or the cochlea; autoimmune disease has only recently been recognized as a probable cause for cochlear damage. Although probably unusual, it is possible for autoimmune processes to target the cochlea specifically, without symptoms affecting other organs; Wegener's granulomatosis is also one of the autoimmune conditions that may precipitate hearing loss; mumps or Epidemic parotitis may result in profound sensorineural hearing loss.

visual impairment disability

Introduction Millions of people in the United States and around the world are inflicted by some type of disability, whether it be a hearing loss, a visual impairment, a mobility impairment, or a learning disability. Despite laws that have been passed that have improved the lifestyles of persons with disabilities, these people face difficult challenges in their everyday lives.
"Visual impairments are divided into two general categories: blindness and low vision. Individuals with blindness have absolutely no sight, or have so little that learning must take place through other senses. Only 10-15% of the visually impaired population is totally blind. People with low vision have severe impairments and need special accommodations, but are still able to learn through vision." (Office for Students with Disabilities)
The term visual impairment has a broad spectrum. It may mean a person has difficulty reading, but can still see things pretty well as a whole. The person may not be able to discern shapes or colors, while others may have vision which fluctuates due to a particular disease.
For a person to be considered legally blind, he/she must have a "visual acuity of 20/200 or worse in the better eye with correction (glasses), or a visual field which subtends to an angle of not greater than 20 degrees. While a low vision person has a visual acuity above 20/200 but worse than 20/70 in their better eye with correction." (Visual Impairment)
Issues
Typically in a school setting a student is considered visually impaired if the student's learning is affected by their vision. Generally, the biggest challenge that visually impaired students face in school and in the outside world is the huge mass of printed materials. In a classroom, a visually impaired person can be hindered if they are unable to use standard print materials such as textbooks, handouts and tests. To accommodate these students special provisions must be made. These could be as simple as providing the student with audio books, large type books and handouts, or providing materials printed in Braille. In addition to the problem of printed materials, the visually impaired student must also deal with the teacher's use of a blackboard, overhead, and audio-visual equipment. These obstacles can typically be overcome by providing the student with a writer or note take or an audio recorder. Also, the 'typical' classroom has become more accessible to the visually impaired student due to the advances made in technology. Visually impaired students are able to utilize one or more of these tools, sometimes called assistive technologies, to help overcome their impairment. Some examples of assistive technologies used in everyday classroom activities include the following:

• Enlarger or Closed Circuit Television (CCTV) - a magnification device that enlarges and projects printed materials onto a television screen.
• Braille 'n Speak - an input/output device that acts as a Brailler. The student can use the Braille 'n Speak for things such as note taking, writing papers, or doing assignments. The Braille 'n Speak can be hooked to a computer to be used with various software programs or to print to a Braille Printer. The Braille 'n Speak is also capable of being bilingual if the student is taking a foreign language.
• Braille Printer - an embosser that prints in Braille. Examples include VersaPoint , Juliet , and Blazer .
• MegaDots and Duxbury Braille Translator - Braille translator software programs to input and translate text. These programs can also make printed text accessible through the use of a scanner.
• Scanner - provide access to printed materials in order to bridge the gap between print and computer. May be used in conjunction with screen magnifiers, screen readers, and voice input devices. Specific software programs such as VisAbility and OmniPage can bee used to simplify and expedite the process of scanning.

The 'typical' classroom has also changed as a result of technology. Teachers and students are both using computers more and more to complete everyday functions. Teachers are using computers for various assignments, activities and projects, while students are using computers for things such as writing papers (word processing) and doing research (via the Internet). To accommodate visually impaired students' use of computers, there are various hardware and software programs available. Some examples include the following:

Screen Magnification / Enhancement Software - People with low vision typically need to magnify or enhance the screen. Large monitors and software application programs can provide minor magnification and simple adjustment of font sizes, where screen magnification software provides higher levels of magnification and contrast and color enhancement.

• ZoomText Xtra
• MAGic
• inLarge for Macintosh Screen Reading Software - Most blind computer users need visual information to be spoken or presented in Braille. Screen Reading software can be used to translate information shown on the screen and translate it into spoken words using a speech synthesizer.
  
• JAWS for Windows
• Window-Eyes
• Window Bridge
• Vocal Eyes Voice Input - A keyboard/mouse alternative that can be used for typing words and sentences into a word processor and for operating program controls like menus and buttons.
  
• DragonDictate
• VoiceType and ViaVoice

One increasing problem for the visually impaired is access to the Internet. As the Internet continues to rapidly expand, so does the complexity of web sites. Most have eye catching graphics and a variety of different designs a . See how far you will get." (Campbell)

• Keep the screen uncluttered. People with low vision impairments may have trouble reading what is on the web page if it is cluttered, while a blind person using screen reading software may have trouble because the information on the page could get jumbled if it is not presented in an orderly fashion, because typically screen readers read the page from left to right.
• Avoid placing multiple hyperlinks on any one line. It is easier for the user to find the links if each one is on a line of its own. It also makes it easier to click on the right link.
• Avoid having a tiled background. People with low vision may have difficulty reading information on sites with a tiled background or a background image because the text may become obscured.
• Avoid backgrounds that are dark or light in color. People with low vision or color blindness may have difficulty reading text if the background and text colors do not contrast well.
• Space out items on the page. Providing space around items will make the site neater and cleaner. This may help avoid any confusion for the visually impaired user.
• Provide an alternative page that is text-only . Text only v ore accessible to all visitors.
• Include descriptions of graphics and images . If the graphics are critical to the content of the page it is good to provide a caption for the graphic for those people using screen reading software.
• Use the ALT attribute with images. The ALT attribute provides alternative text for the user that is intended to help the user understand the graphics on the page.
• Provide "speech" using options such as Talker or Real Audio . These are software programs that can be downloaded to make a web page talk.
• Include menu alternatives when using image maps. An image map is a picture on which part of the picture can be clicked on to find a link to another page. Providing menu alternatives for image maps ensures that the embedded links are accessible.
• Make links descriptive. Nondescriptive phrases like 'click here' when used as a link present problems for those people using screen readers. Screen reading software typically allows the user to tab through the page to all links, so the words the user look different in different web browsers. One should try to test their web page with at least one text-based browser such as Lynx .
• Use an accessibility validation site. These sites run a diagnostic test on a web page and point out the parts of the page that are inaccessible.
  • BOBBY as many of the guidelines as possible his/her pages should be more accessible to all users.
  
  

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  Conclusion
  • Although our country and the world as a whole have made tremendous strides in improving access to those with disabilities, their is still room for improvement. In the booming age of technology, access to computers, the Internet and other technologies is steadily improving for those with disabilities. If we all consider this audience in our teaching practices and in designing web pages, access will improve that much more

Sensory Disability

If you are Deaf, visually impaired, hearing impaired or have a significant combination of hearing and sight loss, we can provide support and advice to you and, if appropriate, your carer, that may help you to live more independently.
The Devon Strategic Partnership for People with Physical and Sensory Disabilities and Acquired Brain Injury is responsible for overseeing the planning of services for adults with:

• Physical Disabilities
• Sensory Disabilities (including Deaf people who use sign language)
• Acquired Brain Injury

Physical Disabilities

A. Basic Information

Physical impairment refers to a broad range of disabilities which include orthopedic, neuromuscular, cardiovascular and pulmonary disorders. People with these disabilities often must rely upon assertive devices such as wheelchairs, crutches, canes, and artificial limbs to obtain mobility. The physical disability may either be congenital or a result of injury, muscular dystrophy, multiple sclerosis, cerebral palsy, amputation, heart disease, pulmonary disease or more. Some persons may have hidden (nonvisible) disabilities which include pulmonary disease, respiratory disorders, epilepsy and other limiting conditions.

B. Considerations

Although the cause of the disability may vary, persons with physical disabilities may face the following difficulties:

Access Issues:

• Inability to gain access to inaccessible building or room.
• Decreased eye-hand coordination.
• Impaired verbal communication.
• Decreased physical stamina and endurance.

Considerations:

• If a person uses a wheelchair, conversations at different eye levels are difficult. If a conversation continues for more than a few minutes and if it is possible to do so, sit down, kneel, or squat and share eye level.
• A wheelchair is part of the person's body space. Do not automatically hang or lean on the chair; it is similar to hanging or leaning on the person. It is fine if you are friends but inappropriate otherwise.
• Using words like "walking" or "running" are appropriate. Sensitivity to these words is not necessary. People who use wheelchairs use the same words.
• When it appears that a person needs assistance, ask if you can help. Most persons will ask for assistance if they need it. Accept a "no thank you" graciously.
• Accept the fact that a disability exists. By not acknowledging this fact is the same as not acknowledging the person.
• People with physical disabilities are not "confined" to wheelchairs. They often transfer over to automobiles and to furniture. Some who use wheelchairs can walk with the aid of canes, braces, crutches or walkers. Using a wheelchair some of the time does not mean an individual is "faking" a disability. It may be a means to conserve energy or move about more quickly.
• If a person's speech is difficult to understand, do not hesitate to ask him/her to repeat.

Provide assistance if you are asked. Never come up behind a person who uses a wheelchair and push them. Always ask first while facing the person. Never take the door out of a person's hand to assist them in opening it, they may be using the door for balance. Always ask if you can help first.

What is being done to improve the daily lives of people with disabilities

Q: What is being done to improve the daily lives of people with disabilities?
A: About six hundred million people live with disabilities of various types due to chronic diseases, injuries, violence, infectious diseases, malnutrition, and other causes closely related to poverty. This number is increasing. Of this total, 80% of people with disabilities live in low-income countries; most are poor and have limited or no access to basic services, including rehabilitation facilities.
The Fifty-eighth World Health Assembly has adopted a resolution aimed at improving the daily lives of people with disabilities. It calls on WHO and its Member States to work towards ensuring equal opportunities and promoting the rights and dignity of people with disabilities, especially those who are poor. Countries are requested to strengthen national policies and programmes on disability, including community-based rehabilitation services. WHO is requested to support these efforts, and to collect more reliable data on all relevant aspects of disability, including the cost-effectiveness of interventions.
Specifically, the resolution calls upon the following:

• Promoting early intervention and identification of disability, especially for children
• Supporting the integration of community-based rehabilitation services into the health system
• Facilitating development and access to appropriate assistive devices, including wheel chairs, hearing aids, orthoses, prostheses, etc. which help to ensure the inclusion and participation of people with disabilities in their societies
• Strengthening collaborative work on disability across the United Nations system and with Member States, academia, private sector and nongovernmental organizations, including disabled people's organizations
• Production and dissemination of a World report on disability and rehabilitation based on the best available scientific evidence.

Disability and health

Key facts

• Over a billion people, about 15% of the world's population, have some form of disability.
• Between 110 million and 190 million people have significant difficulties in functioning.
• Rates of disability are increasing due to population ageing and increases in chronic health conditions, among other causes.
• People with disabilities have less access to health care services and therefore experience unmet health care needs.

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Disability and health

The International Classification of Functioning, Disability and Health (ICF) defines disability as an umbrella term for impairments, activity limitations and participation restrictions. Disability is the interaction between individuals with a health condition (e.g. cerebral palsy, Down syndrome and depression) and personal and environmental factors (e.g. negative attitudes, inaccessible transportation and public buildings, and limited social supports).
Over a billion people are estimated to live with some form of disability. This corresponds to about 15% of the world's population. Between 110 million (2.2%) and 190 million (3.8%) people 15 years and older have significant difficulties in functioning. Furthermore, the rates of disability are increasing in part due to ageing populations and an increase in chronic health conditions.
Disability is extremely diverse. While some health conditions associated with disability result in poor health and extensive health care needs, others do not. However all people with disabilities have the same general health care needs as everyone else, and therefore need access to mainstream health care services. Article 25 of the UN Convention on the Rights of Persons with Disabilities (CRPD) reinforces the right of persons with disabilities to attain the highest standard of health care, without discrimination.

Unmet needs for health care

People with disabilities report seeking more health care than people without disabilities and have greater unmet needs. For example, a recent survey of people with serious mental disorders, showed that between 35% and 50% of people in developed countries, and between 76% and 85% in developing countries, received no treatment in the year prior to the study.
Health promotion and prevention activities seldom target people with disabilities. For example women with disabilities receive less screening for breast and cervical cancer than women without disabilities. People with intellectual impairments and diabetes are less likely to have their weight checked. Adolescents and adults with disabilities are more likely to be excluded from sex education programmes.

How are the lives of people with disabilities affected?

People with disabilities are particularly vulnerable to deficiencies in health care services. Depending on the group and setting, persons with disabilities may experience greater vulnerability to secondary conditions, co-morbid conditions, age-related conditions, engaging in health risk behaviors and higher rates of premature death.

Secondary conditions

Secondary conditions occur in addition to (and are related to) a primary health condition, and are both predictable and therefore preventable. Examples include pressure ulcers, urinary tract infections, osteoporosis and pain.

Co-morbid conditions

Co-morbid conditions occur in addition to (and are unrelated to) a primary health condition associated with disability. For example the prevalence of diabetes in people with schizophrenia is around 15% compared to a rate of 2-3% for the general population.

Age-related conditions

The ageing process for some groups of people with disabilities begins earlier than usual. For example some people with developmental disabilities show signs of premature ageing in their 40s and 50s.

Engaging in health risk behaviours

Some studies have indicated that people with disabilities have higher rates of risky behaviours such as smoking, poor diet and physical inactivity.

Higher rates of premature death

Mortality rates for people with disabilities vary depending on the health condition. However an investigation in the United Kingdom found that people with mental health disorders and intellectual impairments had a lower life expectancy.

Barriers to health care

People with disabilities encounter a range of barriers when they attempt to access health care including the following.

Prohibitive costs

Affordability of health services and transportation are two main reasons why people with disabilities do not receive needed health care in low-income countries - 32-33% of non-disabled people are unable to afford health care compared to 51-53% of people with disabilities.

Limited availability of services

The lack of appropriate services for people with disabilities is a significant barrier to health care. For example, research in Uttar Pradesh and Tamil Nadu states of India found that after the cost, the lack of services in the area was the second most significant barrier to using health facilities.

Physical barriers

Uneven access to buildings (hospitals, health centres), inaccessible medical equipment, poor signage, narrow doorways, internal steps, inadequate bathroom facilities, and inaccessible parking areas create barriers to health care facilities. For example, women with mobility difficulties are often unable to access breast and cervical cancer screening because examination tables are not height-adjustable and mammography equipment only accommodates women who are able to stand.

Inadequate skills and knowledge of health workers

People with disabilities were more than twice as likely to report finding health care provider skills inadequate to meet their needs, four times more likely to report being treated badly and nearly three times more likely to report being denied care.

Addressing barriers to health care

Governments can improve health outcomes for people with disabilities by improving access to quality, affordable health care services, which make the best use of available resources. As several factors interact to inhibit access to health care, reforms in all the interacting components of the health care system are required.

Policy and legislation

Assess existing policies and services, identify priorities to reduce health inequalities and plan improvements for access and inclusion. Make changes to comply with the CRPD. Establish health care standards related to care of persons with disabilities with enforcement mechanisms.

Financing

Where private health insurance dominates health care financing, ensure that people with disabilities are covered and consider measures to make the premiums affordable. Ensure that people with disabilities benefit equally from public health care programmes. Use financial incentives to encourage health-care providers to make services accessible and provide comprehensive assessments, treatment, and follow-ups. Consider options for reducing or removing out-of-pocket payments for people with disabilities who do not have other means of financing health care services.

Service delivery

Provide a broad range of modifications and adjustments (reasonable accommodation) to facilitate access to health care services. For example changing the physical layout of clinics to provide access for people with mobility difficulties or communicating health information in accessible formats such as Braille. Empower people with disabilities to maximize their health by providing information, training, and peer support. Promote community-based rehabilitation (CBR) to facilitate access for disabled people to existing services. Identify groups that require alternative service delivery models, for example, targeted services or care coordination to improve access to health care.

Human resources

Integrate disability education into undergraduate and continuing education for all health-care professionals. Train community workers so that they can play a role in preventive health care services. Provide evidence-based guidelines for assessment and treatment.

Data and research

Include people with disabilities in health care surveillance. Conduct more research on the needs, barriers, and health outcomes for people with disabilities.

WHO response

In order to improve access to health services for people with disabilities, WHO:

• guides and supports Member States to increase awareness of disability issues, and promotes the inclusion of disability as a component in national health policies and programmes;
• facilitates data collection and dissemination of disability-related data and information;
• develops normative tools, including guidelines to strengthen health care;
• builds capacity among health policy-makers and service providers;
• promotes scaling up of CBR;
• promotes strategies to ensure that people with disabilities are knowledgeable about their own health conditions, and that health-care personnel support and protect the rights and dignity of persons with disabilities.

Disabilities

Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.
Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.

World report on disability

About 15% of the world's population lives with some form of disability, of whom 2-4% experience significant difficulties in functioning. The global disability prevalence is higher than previous WHO estimates, which date from the 1970s and suggested a figure of around 10%. This global estimate for disability is on the rise due to population ageing and the rapid spread of chronic diseases, as well as improvements in the methodologies used to measure disability. 
 
The first ever WHO/World Bank World report on disability reviews evidence about the situation of people with disabilities around the world. Following chapters on understanding disability and measuring disability, the report contains topic-specific chapters on health; rehabilitation; assistance and support; enabling environments; education; and employment. Within each chapter, there is a discussion of the barriers confronted, and case studies showing how countries have succeeded in addressing these by promoting good practice. In its final chapter, the report offers nine concrete recommendations for policy and practice which if put in place could lead to real improvements in the lives of people with disability.