Disability descriptors - The Open University



Disability descriptorsThese notes are designed to provide guidance on a variety of disabilities, conditions and specific learning difficulties.Contents TOC \o "1-3" \h \z \u Agoraphobia PAGEREF _Toc462922202 \h 1Anxiety and depression PAGEREF _Toc462922204 \h 3Asperger syndrome and autism PAGEREF _Toc462922206 \h 5Asthma PAGEREF _Toc462922208 \h 7Adult attention deficit/hyperactivity disorder (AD(H)D) PAGEREF _Toc462922210 \h 9Bipolar disorder PAGEREF _Toc462922212 \h 11Cerebral palsy PAGEREF _Toc462922214 \h 14Crohns disease and ulcerative colitis PAGEREF _Toc462922216 \h 16D/deaf PAGEREF _Toc462922218 \h 18Diabetes PAGEREF _Toc462922220 \h 21Epilepsy PAGEREF _Toc462922222 \h 23Heart and circulatory disease (cardiovascular disease) PAGEREF _Toc462922224 \h 25Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) PAGEREF _Toc462922226 \h 27Myalgic encephalopathy (ME), chronic fatigue syndrome (CFS) and post-viral fatigue syndrome (PVFS) PAGEREF _Toc462922228 \h 29Multiple sclerosis (MS) PAGEREF _Toc462922230 \h 31Obsessive compulsive disorder PAGEREF _Toc462922232 \h 33Parkinson’s disease PAGEREF _Toc462922234 \h 35Physical disabilities and dexterity difficulties PAGEREF _Toc462922236 \h 37Rheumatic disorders PAGEREF _Toc462922238 \h 39Schizophrenia PAGEREF _Toc462922240 \h 41Speech and language difficulties PAGEREF _Toc462922242 \h 43Specific learning difficulties (including dyslexia) PAGEREF _Toc462922244 \h 45Tinnitus PAGEREF _Toc462922246 \h 48Tourettes syndrome (TS) PAGEREF _Toc462922248 \h 49Visual impairment PAGEREF _Toc462922250 \h 51AgoraphobiaThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationThe literal meaning of agoraphobia is ‘fear of open spaces’, which is an incomplete and possibly misleading definition of the condition. Agoraphobia is a complex group of interrelated phobias which includes a mild fear of going out, a fear of crowds, of being ‘trapped’ in a social situation, of being alone, of using public transport, of being in an unfamiliar place, or any situation in which the individual does not feel safe. Not having an immediate exit is characteristic of many of these situations. A person with agoraphobia experiences feelings of panic or severe anxiety and a strong desire to escape to a safe place, usually their home. Many people suffer from more than one phobia at a time.Social phobia?can result in avoidance behaviour, but is characterised by a generalised fear of behaving in an embarrassing or humiliating way in public, of being the focus of attention in a social situation, of being observed to be anxious and of being judged. A person with social phobia may be quite comfortable relating to other people on an individual basis and participating as part of a group, but experience feelings of panic and extreme embarrassment in a situation where attention is drawn to them.Possible effectsSome people with agoraphobia may be able to travel reasonable distances from their homes, particularly if they are accompanied by a friend or family member, but others are completely confined to the home.Social phobia can also result in feeling unable to leave the safety of home because the fear of public humiliation or embarrassment is so great, while others cope reasonably well with social activities and only fear a situation where they become the focus of attention. This could include anything from having to give a presentation at a tutorial, to writing a cheque for a shop assistant. A person with social phobia can experience panic attacks or may display symptoms of extreme embarrassment such as shaking, sweating, blushing, or being unable to speak when confronted with a situation they find challenging.Implications for learning and teachingAlthough a student with agoraphobia is unlikely to attend tutorials, some may feel able to do so if accompanied by a friend, family member or support worker. If so, they may prefer to sit close to the door so they would be able to exit the room with minimum embarrassment and disruption to the group.Students with agoraphobia who do not feel able to attend tutorials may appreciate the offer of special session support by telephone or email. A student with social phobia is more likely to attend tutorials, but could find them stressful if put ‘on the spot’ in any way. For example, by being asked to introduce themselves to the rest of the group or write on a flipchart. Careful consideration should be given when planning icebreakers and group activities. However, social phobia does not normally prevent people from relating to others individually and participating in general group activities.External linksAnxiety UKNo PanicThe Anxiety Panic Internet Resource (tAPir)Mental Health Foundation?Anxiety and depressionThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationAnxiety can take many forms, such as phobias, which are the intense though irrational fears of clearly identifiable things or situations, and panic attacks. A more general form of anxiety is referred to as ‘free-floating’ and results in panic attacks occurring for no apparent reason. Anxiety can lead to the ‘fight or flight reaction’ to occur without a trigger. Panic attacks are extremely distressing, and the more frequently they occur the greater the likelihood of a recurrence, so that they can come to trigger themselves.Anxiety may be either an outcome of or a cause of depression, which is why so many people have both and it is not unusual to classify anxiety and depression together. Both conditions have symptoms are so many and varied that they are often not recognised as such – and sometimes not recognised at all by the person who has them. There is also a reluctance to mention or discuss symptoms and effects.Unfortunately, the terms ’anxiety‘ and ’depression‘ are often used with reference to less serious and more common feelings, whereas the conditions are extremely distressing and debilitating.Possible effectsAnxiety may cause muscular tension, leading to discomfort and headache. Rapid breathing often results in light-headedness and shakiness, as well as pins and needles. The effects on the digestive and nervous systems manifest themselves in nausea, sickness, butterflies in the stomach and diarrhoea. An inexplicable fear that something terrible is about to happen is another symptom of anxiety and during a panic attack a dread of imminent insanity or heart attack is common. A feeling of unreality is often experienced; a strange, unpleasant separation of self and surroundings.Avoiding things, places and situations, especially those associated with a previous distressing experience such as panic attack, is also a typical effect of anxiety.Depression has many symptoms, which includepoor self-esteem and self-confidencedifficulty in concentrating and making decisionsuncharacteristic irritability and impatienceirregular sleep patternreduced energy, enthusiasm and activity.Implications for learning and teachingStudents with anxiety and/or depression may not be enthusiastic about attending group tutorials, but may respond well to encouragement. For some students attendance will demand a great effort or be impossible, and if the importance and benefits of attending is too greatly stressed the result will be detrimental.Providing handouts and, where possible, special sessions will help reassure students that their participation on the course is valued and that they are not falling behind. Those who do attend may have difficulty interacting with other students and the tutor. It may be advantageous to make others aware of their condition, but this, of course, must be the decision and action of the student, not the tutor.Anxiety and depression can lead to low self-esteem and negative feelings. Being overly self-critical is characteristic, as is striving excessively to conform to the expectations of others. It is therefore be essential to mark a student’s work positively, focusing on its strengths and indicating the improvements that can be made, rather than highlighting weaknesses alone.Medication such as tranquilisers, which may be prescribed for anxiety and depression, typically cause sluggishness and reduced concentration. Students may, therefore, require some flexibility with deadlines. Treatment such as cognitive behavioural therapy is likely to have little or no impact on the student’s concentration and focus.External linksDepression AllianceMind publicationsStudents Against DepressionMental Health Foundation?Asperger syndrome and autismThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationAsperger syndrome is a lifelong developmental disability that affects the way a person communicates and relates to the people around them. It is on the autistic spectrum. The effects of the condition vary and interact with other factors, such as personality, ability and personal experience.People with autism or Asperger syndrome have difficulties with social interaction and may not understand the social and cultural norms that most people take for granted. This can mean that they misinterpret the intentions, behaviour and conversation of others. They generally want to be sociable and enjoy human contact, but their difficulties in reading non-verbal signals, including facial expressions, can make it difficult for them to form and maintain social relationships with people unaware of their needs. They also find it difficult to understand abstract concepts and tend to take jokes and metaphors literally.People with Asperger syndrome are at the higher functioning end of the autistic spectrum and therefore may well progress into higher education. Many people with autism have accompanying learning disabilities which make it unlikely that they will be able to access higher education.?Implications for learningThe most common effects of Asperger syndrome include problems withsocial interactionsocial relationshipsaccommodating changedeveloping a broad range of interestsStudents with Asperger syndrome may have particular strengths invisual memory.an exceptional talent or skill.visual and spatial skillslong-term memoryintellectual capacityvocabulary relating to specific interests?Implications for teachingIt is important to see the individual not the syndrome. Communication may be more impaired than it first appears, and some acquired skills may mask the fact that other social skills have not been learned. However, students cope well if adequately supported.Be prepared to offer regular, proactive support, and give direct instructions, particularly relating to social skills.Don’t promise and under deliver. It is better to state what can be reasonably offered, rather than what might be the ideal.Offer clear timetables and ensure adequate notification of changes.To avoid misunderstanding in communicationavoid jokes and sarcasm, or making assumptionsgive direct explanations – often very direct advice which describes the impact of an action on the student and does not contain a great deal of emotional content is requiredambiguous language such as ‘to take a leaf out of his book’ can create confusion and is best avoided.External linksThe National Autistic Society?(NAS)BRAIN.HEAsthmaThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationAsthma is a condition that affects the airways of the lungs and can vary from mild to severe depending on the individual. Triggers such as stress, exercise, colds and viral infections, dust, certain foods and animals may cause the lining of the airways to swell and the airways to become narrower, leading to symptoms such as coughing, wheezing or breathlessness. The condition is often controlled and treated by using aerosol inhalers or by drugs and steroids.Attacks are often unpredictable even when triggers are known and anticipated, and can be frightening and distressing, and leading to anxiety.. The student may not be able to breathe properly, may become panicky, and will be left feeling fatigued. A severe attack may last for several days and can require hospitalisation.The symptoms of chronic asthma, wheezing, coughing and breathlessness, are present for much of the time, causing such fatigue and lack of energy that even minor tasks cost a tremendous effort. All people with asthma, but especially chronic cases, are particularly vulnerable to attacks during the night, disrupting rest and sleep. Chronic asthma increases in incidence in middle age and later years, when it can become so severe that daily activity and mobility are restricted. In some cases people become confined to the home during the winter months, with resulting feelings of isolation.Implications for learning and teachingMost asthma sufferers are aware of their triggers and carry the necessary treatment.In the event of a severe attack, try to help the student relax and slow and deepen their breathing. If an inhaler has no effect at first, then try again. Seek medical help if no improvement occurs within 10 minutes. The student may wish to rest at home after an attack.Study may be interrupted by severe attacks, and the student may require flexibility with cut-off dates or support sessions to make up for missed tutorials. It may be helpful to have a tutorial session outline and main points available for the student to look over, allowing them to catch up on any missed information.External linksAsthma UKAdult attention deficit/hyperactivity disorder (AD(H)D)The following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationAttention deficit disorder (ADD) is a recognised neurological condition, which may be accompanied by hyperactivity (ADHD). It is commonly experienced by students who have other specific learning difficulties, such as dyslexia, dyspraxia or dyscalculia.Possible effectsAdults with ADHD experience challenges in three core areas: inattention, hyperactivity and impulsivity, and may experience difficulties with some or all of the following.Managing their work loadMaintaining attentionTime managementListening effectively and ignoring distractionAttention to detailSitting stillThe need to talk excessivelyImpulsiveness?Many students develop strengths such asthinking holistically and creativelythe ability to contribute ideasthe ability to initiate activityImplications for learning and teachingThe student may need toask for instructions to be repeatedfind a quiet area in which to work, away from distractionsbe given reminders of the priorities for the day or the weekhave tasks broken down into manageable chunksExternal Bipolar disorderThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationBipolar disorder, or manic depression as it is also known, is a mental health condition that affects roughly one per cent of the population. It is characterised by polarised extremes of mood, including profound periods of depression and periods of exhilarating euphoria, known as mania. However for much of the time moods are within the range experienced by the majority of people, so the condition is not evident.It is a common misconception that people with bipolar disorder are highly volatile and likely to have sudden, unpredictable mood changes within any singe day. The majority of people with this condition are more likely to have periods of several days, weeks or even months when their mood is in a constant state, which might, however, be fairly extreme.Talking therapies and drug therapies are effective in reducing the symptoms of bipolar disorder, and many people with the diagnosis learn to manage the condition.Possible effectsMost people who have a diagnosis of bipolar disorder experience a severe depression at some time, if not on a recurring basis. Usually this follows an episode of mania where the trauma of the manic episode may compound the depression. For some people the depression is more likely during the winter months.Symptoms of depression include changes in appetite, loss of energy and motivation, changes in sleep pattern, impaired concentration, loss of confidence, withdrawal from social contact, feelings of worthlessness, self-loathing and even suicidal thoughts.Someone experiencing mania may not recognise that it is happening, although the change in their behaviour will often be evident to other people who know them. In the less severe form of mania (hypomania) an individual may be highly creative and productive, and behave in a very extroverted way. They might have increased energy levels, lose appetite and interest in food, and need fewer hours of sleep than usual. Hypomania may not adversely affect a person’s work or social life and it is unusual for someone to be hospitalised due to a hypomanic state. In its more severe form, mania can extend to delusional (often grandiose) thinking, paranoia, visual and oral hallucinations and unusual or apparently irrational behaviour. A serious manic psychosis can be very distressing for the individual and may require hospital treatment.Implications for learning and teachingThe impact of bipolar disorder on study depends on its severity and on how well it is managed. Where the symptoms are recognised and coped with there will be very little impact on study. However, if the student experiences severe bouts of mania or depression that are difficult to control, the impact could be considerable.In a state of hypomania a student may work copiously and to a very high standard. They may find it difficult to maintain the same standard if their mood drops, and then might be reluctant to submit work that they are not satisfied with, which may be confusing to the tutor. If this seems to be the case, encourage the student to submit a piece of work even if they feel it is not up to their usual standard. Give reassurance that it is better to try to stay abreast of the course work than to turn in just a few excellent assignments.A hypomanic student might also be overly enthusiastic about their course and may tend to dominate tutorial discussions. In this situation good group management skills are needed. Thanking them for their input, but suggesting that it would be interesting to get other students’ views, too, is one way of dealing with the situation, or perhaps discussing it with the student before or after the tutorial may be effective.A student in a delusional state of mania may find it very difficult to apply themselves to study. If they attend sessions, they may behave in a strange way or say apparently inappropriate things. It is extremely unlikely that they would ever present a threat to their tutor or other students, but even so it can be difficult to know how to respond. Usually the best course of action is to demonstrate acceptance and understanding, and to continue as usual. Other students in the group may also feel unsure of how to deal with the student, and will be guided by the tutor’s behaviour.In a depressed state, a student will lack motivation, concentration and confidence and may require reassurance and encouragement to stop them from withdrawing from their course. They might stop attending sessions and find it difficult to produce written work. If the student is eligible for Disabled Students’ Allowances (DSA) they may be able to fund a non-medical helper to support them with these motivational difficulties and in organising their work. In some cases, however, it might not be in the interests of the student’s health to continue study, and withdrawal might be the most appropriate course of action.External linksManic Depression FellowshipManic Depression Fellowship WalesMINDMental Health Foundation?Cerebral palsyThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationCerebral palsy is a diverse and complex condition resulting from injury or poor development to part of the brain. The cause is often impossible to identify, but is invariably associated with circumstances before, during, or within a few years after birth.The affected area of the brain is usually concerned with muscle control and certain body movements. Cerebral palsy jumbles messages between the brain and the muscles. The effects of cerebral palsy may be barely noticeable or quite severe. Cerebral palsy is not progressive; it does not become more severe.There are three types of cerebral palsy, depending on the part of the brain affected.Spastic?means ‘stiff’. This form of cerebral palsy permanently stiffens muscles and decreases the range of movement in joints. This tightness is perpetual. This is the most common form of cerebral palsy and affects various areas of the body.Athetoid?cerebral palsy causes muscles to tighten and relax rapidly and uncontrollably, leading to involuntary movements. There may be speech difficulties* because of inability to control the tongue, breathing and vocal cords, and hearing* may be affected too.Ataxic?cerebral palsy affects balance and spatial awareness in the whole body. Most people with ataxic cerebral palsy can walk but they will probably be unsteady. They may also have shaky hand movements causing dexterity difficulties*, and jerky speech.Other parts of the brain may also be affected, which may have an impact on sight, hearing, perception and learning.*?See other guidance notes in this series for further informationImplications for learning and teachingThe difficulties can be mild, moderate or severe, but do not affect intelligence.No two people experience cerebral palsy in the same way. The impact may be seen inspecific problems with reading, drawing or arithmeticthe ability to express ideasunderstanding the spoken wordvisual perceptionmobility difficultiesDue to the highly individual nature of cerebral palsy, it is always advisable for a tutor to make early contact with the student to discuss their study needs. The tutor can then plan how to manage challenges such as ensuring the student’s full participation in tutorials. The tutor’s behaviour will influence that of other students in the group. Creating an atmosphere in which the student with cerebral palsy is given the time needed to express their thoughts is essential.External linksScope ResponseCapability ScotlandCrohns disease and ulcerative colitisThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationCrohn’s disease causes an inflammation of the gastrointestinal (GI) tract, often in the lower part of the small intestine. Ulcerative colitis causes ulcers and inflammation along the lining of the colon and rectum. Both are better known as inflammatory bowel disease (IBD). These conditions are not the same as the more common irritable bowel syndrome (IBS), though symptoms are similar. It is not fully known what causes IBD; treatments to manage the symptoms include special diet, anti-inflammatory and anti-diarrhea medications, although there is no cure.Symptoms differ in type and severity between individuals, and may lead to hospitalisation. They may includesevere abdominal paindiarrhoea/urgent need to go to the toiletnausealack of appetiteweight losspain in the jointsgeneral fatigueTreatments for these symptoms may incur side-effects such reduced concentration, tiredness, mood swings and exhaustion. Due to the potential embarrassment and unpredictability of IBD, emotional and mental strain must not be underestimated.Implications for learning and teachingIBDs such as Crohn’s disease and ulcerative colitis are serious conditions that pose challenges in a learning environment, especially as the physical and mental pressure involved in OU study may be aggravating factors. The student may miss significant parts of a session, or suddenly be unavailable for a prearranged meeting. In these cases it is useful to have an electronic or hard copy of the session outline and main points for the student to use to help them catch up.Attendance at tutorials may be sporadic due toa need to rest after long sessions (e.g. at day school)a bout of debilitating symptomssurgical interventionRecording equipment or a note taker may be approved to help fill in any gaps in missed sessions.External linksIBDD/deafThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationDeafness varies considerably in type and effect from one individual to another. These guidance notes inevitably include some generalisations due to their relatively limited scope. For more detailed information about hearing loss, please refer to the ‘Further information’ section at the end of this document.Possible effectsDeafness is as much about loss of tonal differentiation as loss in volume. An individual might discern background noise quite easily but have great difficulty in picking up the sounds of human speech.A common feature is the inability to hear consonant sounds, which can be caused by a combination of their quietness in comparison with vowels and the fact that they tend to be high-tone sounds. Other people may have difficulty hearing low tones, which means particular problems with vowel sounds, but have reasonable hearing for high tones.In addition to the type of hearing loss, the age of onset is an important factor. Deafness in the very early years affects the acquisition of language and presents a different set of difficulties from those associated with hearing loss in later life.Tinnitus* is a form of hearing difficulty that causes the sensation of ringing, whistling or buzzing noises in the ears when there is no external sound. It can affect a student’s concentration and learning, but it varies from person to person, depending on their general health and mood and on external factors at times.Implications for learning and teachingFor profoundly deaf students, using interpreters may be the most effective form of communication in tutorials. A qualified interpreter can be employed by utilising Disabled Students’ Allowances (DSA) or the OU Disabled Resources Team, who provide for communication support at tutorials.Many deaf people develop lip-reading skills and are heavily reliant on these to aid communication. For effective lip reading it is important that the speaker is in a good light, faces the person, speaks clearly, avoids distracting hand gestures and does not move around the room. As much understanding comes from awareness of the context, preparation on the part of the student is helpful, as are notes or an outline of the content of the session provided in advance by the tutor, and visual references to the subject, such as the use of a blackboard or presentation materials. Trained lip speakers can be funded through DSA.Some students use hearing aids, which in a tutorial situation work most effectively in conjunction with an induction loop if used with the hearing aid switched to the ’T‘ position. In this system the speaker talks into a radio microphone, which amplifies the sound and transmits it to the listener’s receiver via an induction loop wire. The induction loop amplifies only what is spoken into the microphone, thus eliminating background sound. Not every hearing-aid user benefits from this, but for the majority it can enhance residual hearing significantly.There are two types of induction loop available to OU students: the room loop, which can be extended around a room so all those within it will benefit; or a personal system with a neck loop. Room loops are not available in all study centres, but personal loops can be provided through DSA or borrowed from the Disability Resources Team.If the student is using a radio microphone or loop system, remember that all contributors to the discussion should speak into the microphone. This can be achieved either by passing the microphone from speaker to speaker or by using a conference microphone.Lip reading, listening to auditory clues (rather than whole words) and working through contextual guesswork is tiring and demanding. Rest breaks and moments of informality that offer opportunity for relaxation, however, may be more socially challenging for a deaf student than the structured atmosphere of the tutorial or lecture.The following suggestions promote good practice in tutorials.When speaking, face the student and speak clearly without shouting. Keep your hands and other items away from the mouth so your face and lips can be clearly seen.Stop talking if you turn away from the student, e.g. to write on the board.Do not stand in front of a window when speaking as this will prevent the student from seeing your face clearly. Try to ensure that lighting is as even as possible so that everyone’s face is well lit.If using video or slides in a darkened room, find a way to ensure that the deaf student can see the speaker or interpreter (e.g. leave a curtain open).Students who lip read or watch an interpreter will not be able to take notes or read handouts at the same time. Copies of notes and OHTs should be given to the student, preferably in advance.Interpreters and communication support workers should receive copies of learning materials in advance in order to provide a more fluent delivery.Be aware of the acoustic quality of the room, as this affects people relying on residual hearing. Classrooms with no soft furnishings are usually resonant, which emphasises unwanted noise such as chairs scraping or coughing.When introducing unfamiliar vocabulary, ensure that the spoken and written word, as well as the sign (if used) are understood. New vocabulary can be very difficult to lip read. Write the word on the board and check that the student has grasped the concept before moving on.When managing group work, encourage other students to indicate with a gesture when they are about to speak. Passing a microphone might help.Be aware that the grammar of spoken language is different to that of sign language. Try to use short, clear statements which avoid abstract terms and double negatives. If the student does not understand at first, don’t repeat the statement but think of a different way of explaining the same idea.If an interpreter is used, allow for time lags involved in the interpreting process. Give the interpreter and the deaf student an opportunity for short breaks.Unless addressing the interpreter directly, act as if she or he is not there; always look at the student to acknowledge that you have heard any comment made by the student via the interpreter.External linksAction on hearing lossHearing ConcernTinnitisDiabetesThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationDiabetes affects the body’s ability to produce or respond to insulin. Insulin is a hormone that allows blood glucose (blood sugar) to enter the cells of the body and be used for energy.There are two types of diabetes.Type 1: The body is unable to produce any insulin. This is the less common form.Type 2: The body can still make some insulin but not enough, or the insulin produced does not work properly. This is the most common type of diabetes.Although there is no cure for diabetes it can usually be controlled by medication and an appropriate diet.A hypoglycaemic reaction can be caused by blood sugar levels falling too low. This results in sweating, palpitations, shakiness, hunger or nausea, visual difficulties and listlessness. Hypoglycaemia can be easily treated by ingesting sugar or glucose.Hyperglycaemia is the opposite of hypoglycaemia and is caused by lack of insulin. Without intervention it can lead to a diabetic coma.If left untreated, diabetes can lead to other very serious conditions such asheart diseasevisual impairmentkidney diseaseneurological problemslower limb amputation.?Implications for learning and teachingAdults with diabetes normally have the condition under control and it is unlikely that the ability to study will be impeded. In a tutorial a student might need to eat something sweet to maintain the appropriate blood sugar levels.If a student with type 1 diabetes develops a related condition such as visual impairment* or heart disease* there will be considerable implications for learning.External linksDiabetes UKilepsyThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with the student support team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationEpilepsy is defined as a tendency to have recurrent seizures. Excess electricity in the brain leads to temporary disruption of the messages sent between the cells. The two main types of epilepsy generalised and partial, are described below.Generalised epilepsy involves the whole brain, and in a seizure the individual suddenly becomes unconscious and falls. They may have no memory of the incident. Generalised seizures can be broken down into five sub-types.Tonic–clonic seizure?- All the muscles contract, causing the person to fall (the tonic stage), followed by a jerking motion as the muscles tighten and relax (the clonic stage). The person may call out or bite their tongue in the tonic stage. After a while the individual will go limp and return to consciousness. Recovery times differ between individuals.Tonic seizure?- All the muscles contract and, unless supported, the person will fall. This often happens in sleep and lasts around 20 seconds.Atonic seizure?- All the muscles relax causing the individual to fall. These seizures are brief and the recovery quick. However, there is a strong chance of injury from the fall.Myocolonic seizure?- Can affect the whole body, but often occurs in the arms or head. There will be a sudden jerk when the person is unconscious. The seizure is so brief the individual may appear to be aware. The jerking can be strong enough to cause a fall.Absence seizure?-The individual appears to be daydreaming or ’switched off‘ but will not wake up. They will be unconscious and unaware, so they may miss information which can disrupt learning.Partial epilepsy involves one part of the brain. Each individual’s experience varies depending on the part the seizure affects.Simple?-The individual remains conscious and the seizure may cause twitching in a limb, an unusual taste or strange sensation in a part of the body. These sometimes develop into other types of seizure and are known as a ’warning‘ or ’aura’.Complex?- Causes unconsciousness and leaves the person with little or no memory of the seizure. It may cause a change in awareness and automatic movement, although the individual may respond when spoken to.Implications for learning and teachingMost people with epilepsy successfully manage their condition through medication. However the student’s condition may affect their self-esteem so encouragement and reassurance will be beneficial. Medication can mean students have problems with concentration and memory so it will be useful to discuss teaching strategies you can adopt to support them in tutorials.It is advisable for tutors to have electronic or hard copies of each tutorial so that any time missed due to seizures or absences will not lead to the student falling behind in their study. It may also be helpful to arrange notetakers or recording equipment to be available in the tutorial as an added record for each session.External linksEpilepsy ActionYoung EpilepsyHeart and circulatory disease (cardiovascular disease)The following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationCardiovascular disease?(CVD) is also known as heart and circulatory disease. It includes coronary heart disease, angina, heart attack and stroke.Coronary heart disease?causes arteries to narrow and makes it difficult for blood to be transported to the heart.Angina?is the response to a lack of blood entering the heart. It is usually felt as a pain in the chest but can radiate to the arms, shoulder or jaw areas. Mild or severe angina rarely lasts longer than 10 minutes.Heart attack?happens when the blood supply is completely cut off and can be fatal. This causes similar pain to angina, but lasts longer.Stroke?is caused by a blockage of an artery carrying blood to the brain.?Implications for learning and teachingStudents with CVD may experienceunusual breathlessnesspoor level of stamina and periods of tirednessadditional vulnerability to stress.?These may impact onthe distances that can be walked and the pace of walkingthe length of study session that can be tolerated.?Some students may have to take time out for hospital treatment, be unable to attend sessions and fall behind with study.It can be helpful if tutors supply notes that outline the main learning points of each session so the student can catch up on missed work. Students may cope better if they are encouraged students to plan an even workload. Tutors should refer the student to their student support team for further assistance if necessary.External linksBritish Heart FoundationHuman immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS)The following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationAIDS stands for acquired immune deficiency syndrome.Acquired - transmitted through an infectionImmune deficiency - a weakness in the body’s system that fights diseaseSyndrome - a group of health problems that make up a diseaseAIDS is caused by a virus called HIV: human immunodeficiency virus, which is passed from one person to another through blood-to-blood and sexual contact (routine social contact poses no risk of infection). Being HIV positive does not mean that a person has AIDS, although many people do develop AIDS as a result of their HIV infection.About half the people with HIV develop AIDS within ten years of becoming infected. The length of time varies between individuals, depending on factors such as health-related behaviours. AIDS develops where the immune system has been weakened by HIV infection to a point where it has difficulty fighting off certain infections. These opportunistic infections (OI) take advantage of a weakened immune system to cause illness. Most commonly these includePCP (pneumocystis carinii), a lung infectionKS (Kaposi’s sarcoma), a skin cancerCMV (cytomegalovirus), an infection that usually affects the eyes.There is as yet no cure for AIDS but there are drugs that can slow down the HIV virus and prevent or treat some of the opportunistic infections. Some people with AIDS can maintain periods of relatively good health.Symptoms of HIV infection, which are unpleasant but not life threatening, includefevernight sweatssore muscles and jointsneurological disordersweight lossswollen glands.These symptoms tend to indicate that the virus has caused some degree of damage to the immune system.In addition to specific OIs AIDS can produce serious weight loss, brain tumours which cause more significant neurological problems, and fungal skin disorders. Some OIs are very resistant to treatment. Where these are present the affected person will face the challenge of life-threatening illness.Taking antiviral medications can affect a person’s daily routine and the side effects, for example acute nausea and diarrhoea, can be very difficult to live with.Implications for learning and teachingStudents who notify the University of their HIV status will expect the information to be treated in confidence. There may be a level of anxiety concerning whether the tutor will respond positively, and early reassurance that this is the case should be given. For students with AIDs, in particular, the nature of any special requirements may be difficult to predict and tutors should be alert to changing needs.Symptoms such as profound fatigue, short-term memory loss and other neurological problems will impact on study and learning. Periods of hospitalisation, unpleasant side effects of drugs, and general ill health may well place increasing restrictions on the student’s programme of study. Copies of tutor notes and teaching content summaries will be very helpful in this case. Where ill health prevents attendance at sessions or day schools, special sessions using alternative methods of communication such as telephone or email should be arranged.External linksTerrence Higgins TrustMyalgic encephalopathy (ME), chronic fatigue syndrome (CFS) and post-viral fatigue syndrome (PVFS)The following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationME, CFS, PVFS are names given to a debilitating illness whose cause is still uncertain. It is estimated that there are 250,000 people in Britain affected by this condition. Some people do eventually return to full well-being, but in most cases variable health continues, with relapses often triggered by infections, temperature extremes or stressful events.The main symptoms of ME includeoverwhelming fatigue, both physical and psychologicalpainful muscles and jointsproblems with short-term memory and concentrationclumsiness and disturbed balancedisturbed sleep patternsintolerance to alcohol and certain foodsflu-like symptoms (e.g. sore throat, swollen glands, joint pains)irritable bowel syndromedepression?Implications for learning and teachingAttendance at sessions or day schools may not be possible; even if able to attend, the student may need to negotiate time out in order to rest. Those who have short-term memory and concentration difficulties may find additional tutor support through special sessions helpful, in order to focus on study skills strategies.For students with dexterity difficulties, comb-bound course materials may be beneficial. Where writing by hand is a problem, copies of any tutor notes or overheads used will reduce the need for note taking; the student might also ask to tape-record the session, employ a note taker or use appropriate access technology.The majority of people with ME/CFS/PVFS have a fluctuating pattern of health with some good periods and some bad periods. This may mean that they will struggle to manage the full workload, and advice on study priorities should be offered.Anxiety and depression may cause a student’s work to be inconsistent. Reassurance and encouragement are valuable, especially as the illness is likely to cause a degree of isolation and undermine self-confidence.External linksThe ME AssociationMultiple sclerosis (MS)The following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationMultiple sclerosis (MS) is a chronic disease of the central nervous system, involving random attacks on a fatty material (myelin) in the brain and spinal cord. The body is able to make repairs, thereby leading to some remission of symptoms, but eventually patchy areas of scarring develop on nerve fibres where healthy myelin once was. This irreparable damage can lead to progressive paralysis. The majority of people with MS are diagnosed between the ages of 20 and 40; there is no known cure for the disease, but many of the symptoms can be managed through a range of medications.Implications for learningThe symptoms of MS are highly variable, depending on the areas of the central nervous system that have been affected. Not only do the symptoms vary from one person to another, but also from day to day in a given individual. Common physical symptoms includefatiguenumbness and/or tingling sensationspain (chronic or acute)visual disturbance (blurred or double vision – usually temporary)speech and swallowing disordersmuscle weaknessdizziness and vertigotremorchanges in bladder and bowel functiondepression?Where brain tissue is damaged or lost, cognitive changes occur which particularly affectshort-term memoryreasoning abilityspeed of information processinglanguage and verbal fluency.?Implications for teachingThe various cognitive changes inevitably impact on the learning process. Memory loss can occur from the earliest stages of MS, and particularly affects the speed at which a recent event can be recalled. Abstract reasoning and problem-solving abilities may be impaired; these include the capacity to analyse a situation, identify the key points, plan a course of action and carry it out.If speech disorders (dysarthrias) and language difficulties are present, it may be difficult to understand what a student is saying. For example, disruption of the normal speech pattern creates abnormally long pauses between words or individual syllables; weakness of the muscles of the tongue, lips, cheeks and mouth may cause slurring of words. In this case telephone conversation may be difficult, and communication by email or textphone should be considered.The student may ask to record a tutorial session, or employ someone to take notes. Copies of any tutor notes or overheads used would be helpful in this situation.Some students with MS have a physical disability, in which case access arrangements such as reserved parking nearby, few steps or wheelchair access may be required at the study centre, residential school and examination centre.In severe cases of MS an individual may be unable to leave the home, in which case special sessions by telephone, textphone or email should be offered.External linksThe Multiple Sclerosis SocietyObsessive compulsive disorderThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationObsessive compulsive disorder (OCD) is a serious anxiety-related condition. It can affect people of any age and is potentially disabling. It causes people to feel trapped in a pattern of repetitive irrational thoughts and behaviours. These are distressing and extremely difficult to overcome.It has been described as having three components.Thoughts that cause anxiety (obsessions)Anxiety experienced,Actions to (temporarily) reduce the anxiety (compulsions)?Common obsessions includecontamination and germspotential harm that could happen to self or othersthe ordering or arrangement of objectsworries about throwing things away.?Compulsions can commonly involve compulsive checking, for example that appliances are turned off or doors properly locked, cleaning, counting or dressing rituals. These can bring some temporary relief from anxiety. Very often the person with OCD is aware that their fears are unfounded but it is difficult for them to stop.Recent research suggests that approximately one in fifty people is affected. OCD afflicts men and women in roughly equal numbers. Counselling, psychotherapy, cognitive behavioural therapy and medication can lessen the effects of the condition, and complete recovery is possible.Implications for learningObsessive–compulsive behaviour patterns can, for example, slow down reading or writing tasks if a student feels they have to repeatedly go back to the beginning and start again. The following comment from a student who was obsessed with counting, and convinced that certain numbers were either ‘good’ or ‘bad’, provides an example.When I set my alarm at night, I had to set it to a number that wouldn’t add up to a ‘bad’ number. It took me longer to read a text book because I’d have to count the lines in a paragraph. If I was writing an essay, it couldn’t have a certain number of words on a line if it added up to a bad number. Getting dressed in the morning was difficult because I had a routine, and if I deviated from the routine I’d have to get dressed again.Some students with OCD who apply for Disabled Students’ Allowances (DSA) are able to fund someone to help them organise and focus on their study more effectively.A student with OCD may seem anxious and distracted. They may perform physical rituals during sessions. This could affect other students who may not understand the nature of the condition. It is therefore important that the tutor’s behaviour towards the student shows acceptance and understanding. It is essential for a tutor to make contact with a student with OCD prior to the first tutorial meeting to explore any particular anxieties or concerns they may have.Implications for teachingMaking contact with the student will enable you to discuss any reasonable adjustments that might be needed, for example to help withfatigue, stress or side effects of medicationsuitable accommodation and consistent routinepreparing for interactions with other students in case of obvious distracting OCD behavioursproviding individual tuition in using appropriate strategies for study skillstime for the student to familiarise themselves with equipmentvisual aids that might be useful if students find handling material difficult.External linksMental Health Foundation?OCD – UKOCD ActionThe Anxiety Panic Internet Resource (tAPir)Mental Help NetHealing National Institute of Mental HealthParkinson’s diseaseThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationParkinson’s disease (PD) is a chronic neurological condition affecting a small area of cells in the mid brain known as the substantia nigra. Gradual degeneration of these cells causes a reduction in the vital chemical dopamine, leading to one or more of the classic signs of PD.Generalised slowness of movementStiffness of limbsBalance problemsTremor of the resting limbs on one side of the body?PD is generally regarded as a disease that affects older adults, although about 15% of those diagnosed are under 50. The cause is as yet unknown, and there is no cure, although many symptoms can be effectively treated. PD is neither fatal nor contagious.The nature and severity of symptoms vary from person to person. PD is not normally a painful condition, and the intellect is not affected, although there may be deterioration of mental processes in the later stages. In addition to the common effects noted above, some people are affected bysmall, cramped handwriting (micrographia)decreased facial expression (hypomimia)lowered voice volume (dysarthria)anxietydepressionless frequent blinking and swallowinga sense of walking 'as if through quicksand”episodes of ‘freezing’ on initiating a simple movement.Implications for learning and teachingDue to the progressive nature of PD it is important to maintain regular contact with the student in order to identify changing needs. Many students are able to attend tutorials, but those with associated physical disabilities may require special facilities such as nearby parking. If gait and balance problems cause concern about falling, the student may choose to attend with the support of a personal assistant (often a family member or friend).Dexterity difficulties are likely to affect handwriting, in which case copies of any tutor notes or overheads used should be provided. The student may ask to tape record the tutorial, or bring a note taker.Speech difficulties can make telephone conversations awkward, so communication via e-mail or textphone should be considered.External linksParkinson’s Disease SocietyPhysical disabilities and dexterity difficultiesThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationThe effects of physical disability cover a wide spectrum, from people who walk with slight difficulty to those who use a wheelchair. The disability may be congenital or acquired, and caused by conditions affecting bones (e.g. brittle bones), joints (e.g. rheumatic disorders, muscles (e.g. muscular dystrophy), nerves and tendons (e.g. multiple sclerosis), spinal cord (e.g. spinal cord injury) or brain (e.g. stroke, cerebral palsy). Medical conditions such as myalgic encephalopathy can also cause mobility difficulties. While many conditions are stable, others – such as multiple sclerosis – are degenerative or may be variable over time.Many students with impaired mobility also have associated manual dexterity problems. Disorders of the upper limb (e.g. repetitive strain injury, RSI) become chronic conditions if not treated at an early stage.Possible effectsPhysical disability can cause chronic pain and fatigue. Pain may be controlled by medication, which may have unpleasant side effects such as blurred vision and reduced ability to concentrate. There may be a particular susceptibility to changes in temperature, particularly where these occur suddenly. Where the disability results from brain damage, specific learning difficulties may be present, such as cognitive, perceptual or memory problems.Implications for learning and teachingThe physical environment presents the most significant barrier for people with mobility difficulties. For those with impaired manual dexterity, the everyday mechanics of studying are also affected.Students should use Facility Request Form 1 (available from the student support team) to indicate their requirements for accessing the Study Centre, but are also encouraged to check that arrangements are in place before attending sessions or day schools. Such arrangements might include convenient car parking, wheelchair access to the entrance, lift and toilet, or allocation of a ground-floor room close to the main entrance. Any difficulties encountered at the site should be reported to the security staff, but if these are not satisfactorily resolved at the time it is important to inform the student support team.It is unlikely that ergonomically designed furniture can be provided at the study centre, and standard tables and chairs may exacerbate postural problems. If discomfort occurs, the student may need to shift position from time to time, perhaps by getting up and moving around. A student may opt not to attend sessions, in which case special session support should be offered where possible. Students should also be encouraged to use online resources, including participation in email-based discussion sites.If the student has difficulty manipulating standard print materials it is possible to provide comb-bound books and/or audio transcriptions for many courses. Students with manual dexterity or stamina problems may prefer not to hand write notes in sessions or day schools. Some students pay a note taker to write the notes for them, or use a digital recorder. Provision of handouts summarising the main points to be covered in a tutorial will greatly help with note taking.External linksScopeCerebral PalsyThe Multiple Sclerosis SocietyRheumatic disordersThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationThere are around 200 different types of rheumatic disease, affecting over 8 million people of all ages. Four main groups of the disease can be identified.Inflammatory arthritis, in which the joint lining becomes inflamed, causing damage to the surface of the joint and underlying bone. Examples include rheumatoid arthritis (RA), gout and systemic lupus erythematosus (SLE).Osteoarthritis, a common condition where there is thinning of the cartilage and extra bone forms at the edges of the joint. This can be caused by abnormal stress on the joints, injury or joint disease, although some cases develop for no obvious reason. Any joint can be affected, but the hips, knees and hands are most likely.Soft tissue rheumatism, where tissues around joints (e.g. ligaments and tendons) become irritated and cause pain. Overuse or minor injury can result in localised pain which lasts for a relatively short time, such as in tennis elbow. Also, more generalised pain can develop in the muscles or joints without arthritis, as in fibromyalgia.Back pain, arising from discs, ligaments, muscles, bones or joints. It can be difficult to determine the precise cause of the pain. Certain types of inflammatory arthritis, such as ankylosing spondylitis, can affect the spine, and osteoarthritis can also affect the back, where it is referred to as spondylosis. Osteoarthritis of the spine tends to manifest as back pain initially.Most rheumatic diseases are caused by several factors acting together. Some forms of arthritis tend to run in families, or may be triggered by an environmental factor or mild infection. Cold, damp weather can affect symptoms but it does not cause rheumatism or arthritis.Many forms of rheumatism improve within a relatively short period of time; others, such as gout, can be effectively controlled through medication. Several of the major types of arthritis, however – including rheumatoid arthritis – are chronic conditions. They tend to ‘flare-up’, giving much worse symptoms, followed by periods of remission where symptoms are less severe.Chronic arthritis affects people in very different ways, with considerable variation in severity. Symptoms can include any of the following.Stiffness, swelling and pain in or around jointsFatigueWeight lossMild fevers or night sweatsSkin rashesAnxietyDepression?Mobility is usually impeded to some extent, ranging from slight difficulty in walking long distances to physical disability requiring the use of a wheelchair. Depending on which joints are affected, there may also be difficulty with manual skills (handling a book or holding a pen, for example). Stress, while not a cause of arthritis, can certainly make it feel worse.A wide range of treatment is available to manage symptoms, and in many cases the individual is able to live a full life with relatively little pain or disability. In cases where joint damage is severe enough to make life difficult, surgery may be necessary. Various joints are routinely replaced in people with advanced arthritis, and there are other reconstructive operations which can help to relieve the pain.Implications for learning and teachingSpecial session support should be offered at a time when the student feels well enough to undertake this. If by telephone, the session should be presented in short blocks (not more than 20 minutes) as far as possible. Where manual dexterity is affected, comb-bound course materials may be helpful; in some cases students prefer to study from audio-cassette. Written work can be produced on a computer rather than handwritten, perhaps with the aid of voice-recognition software.Students with mobility difficulties will need arrangements made to be able to access study centre facilities, such as reserved nearby parking, or a route with few steps.External linksArthritis CareSchizophreniaThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements. All information regarding a student’s disability must be treated as confidential and used sensitively.General informationThere's considerable disagreement about the diagnosis of schizophrenia, with some people seeing it as an extreme form of distress [1: MIND 2010]. It manifests itself in a variety of ways, but usually involves a dramatic disturbance in thoughts and feelings, and results in behaviour that may seem odd to other people. It affects one in 100 people at some time in their life. About 20% of people affected only experience one episode of serious thought disturbance (psychosis) and then recover completely. About 60% recover partly but continue to experience intermittent bouts of psychosis. The remaining 20% remain symptomatic, needing long-term social and medical care. People with schizophrenia are no more likely to be violent than anyone else, but are at ten times greater risk of suicide.A combination of medication and talking therapies can help control the condition.In addition to the symptoms of the illness, a person with schizophrenia may display the side effects of prescribed medication, which can be fairly severe. Common side effects aremuscle stiffness, which can make body movements difficult and stilted, possibly inducing a characteristic shuffling walkuncontrollable muscle tremors and shaking limbs (e.g. ‘sewing machine leg’)drowsinessdifficulty remembering things and making decisionsslowness of thoughtstilted speech.?Implications for learning and teachingA student with schizophrenia may find that fluctuations in mood and the impact of thought disturbances make it difficult to follow their course of study. However, this does not preclude them from completing a course of study or, indeed, a degree.Students with schizophrenia may not have any special requirements; however the following general guidelines should be followed.Don’t make prior assumptions about the student.If the student’s behaviour or words seem strange or out of context, respond calmly and with tolerance.Try to communicate clearly, simply and calmly.Do not attempt to humour someone whose behaviour indicates that they are experiencing delusional thoughts.Be patient and consistent in what you do and say.Offer additional reassurance and encouragement if the student becomes despondent.Remember that the effects of medication may affect concentration levels.Don’t be afraid to clarify things that are being said.Respond with tolerance and open mindedness so that other students feel confident to follow your example.Sometimes a student with a diagnosis of schizophrenia may be accompanied by a friend or a family member for support in tutorials. Make this person welcome and include them in initial introductions to the group.Set contracts and goals in order to make good progress, while agreeing reasonable amounts of available time and resources. Students may require some flexibility with assignment deadlines.Avoid becoming involved in issues that do not relate to the student’s studies.Encouragement and constructive feedback are helpful tools.Contact the disability adviser at your regional or national centre to discuss any worries or concerns, or if you feel alarmed by things that the student does or says.External linksMINDRethinkMental Health FoundationMental Health Welfare for ScotlandMental Health WalesSanelineSamaritans?Speech and language difficultiesThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with the student support team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationSpeech and language difficulties range from the mild to the severe and long term. The causes are not always known, but in some cases arise from other medical conditions such as cerebral palsy, multiple sclerosis, head injury or stroke. Early experience of hearing loss can also restrict the development of accurate speech and language skills.People with speech difficulties may be unable to articulate sounds at all, or have speech which is hesitant, stumbling or jerky (a stammer or stutter). They may have difficulty in translating thoughts into written or spoken words (dysphasia), or are able to grasp concrete ideas but find more abstract concepts difficult or impossible to understand.Speech which lacks fluency can make both the speaker and the listener feel anxious; people with speech difficulties may lack confidence and so avoid situations where they will be required to speak. For this reason speech difficulties are not always easy to detect, but possible indicative behaviour might includesigns of physical tension or nervousnessblinking hard or grimacingavoiding eye contactavoiding talkingcoughing, gulping or swallowingbecoming flustered, blushing.?Speech and language fluency can vary from month to month, or even hour to hour. It is therefore important to be responsive to the changing needs of individual students.Most people find that their difficulties become worse in stressful situations, such as when under time pressure.For information about deaf students who communicate through sign language, refer to Deaf and hard of hearing. For information about students who have difficulty with written communication, refer to Specific learning difficulties (including dyslexia).Implications for learning and teachingAny speech or language difficulty inevitably impacts on the learning process. Comparison of written and oral performance may reveal marked discrepancies in attainment levels, and alert tutors to potential difficulties if these are not already apparent.Oral participation is likely to be challenging, and reassurance may be needed to encourage the student to take part. Allow the student time to gain confidence before joining in, and bear in mind that activities based on discussion or verbal input may need to be modified to allow people with communication difficulties to demonstrate their understanding. If the student has impaired speech, try to maintain natural eye contact and concentrate on the content of what is being said; ask them to repeat if you have not understood. Avoid interrupting the student, finishing words or sentences, hurrying them along or asking them to slow down.Where there are language difficulties, new ideas and concepts should be introduced explicitly and preferably through a multi-sensory learning environment, such as diagrams, videos, practical and experiential activities. Ask questions in a clear, straightforward way, avoiding unnecessarily abstract or contrived language. Special session support may be helpful, especially where the student’s difficulties may cause them to misinterpret the requirements of an assignment.Establish with the student their preferred means of contact (e.g. email, letter, telephone). If telephone contact is likely but the student has severe speech difficulties, a minicom or textphone should be considered. Contact the student support team for advice.External linksBritish Stammering AssociationHeadwayThe Association for Rehabilitation of Communication and Oral SkillsSpecific learning difficulties (including dyslexia)The following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationSpecific learning difficulty (SpLD) is a term used for a cluster of difficulties of neurological origin which affect how the brain processes language. These difficulties are regularly associated together under various names, includingDyslexia?means ’difficulty with words‘ and is a difference in the part of the brain which processes language, and affects the skills required for learning reading, writing, spelling and numeracy.Dyspraxia?means ’difficulty with doing‘ and is an impairment of the organisation of movement, affecting the planning of what to do and how to do it.Dyscalculia?means ’difficulty performing mathematical calculations’.Attention deficit disorder (ADD)?affects the ability to concentrate and maintain attention to tasks.Attention deficit hyperactive disorder (ADHD)?is where inattention is combined with significantly heightened activity level and impulsiveness.SpLD is a developmental, rather than an acquired, condition and has a tendency to run in families. The following notes refer mainly to dyslexia, because that is the typical diagnosis for people who experience SpLD. However, the general principles broadly apply to the other conditions outlined above, which nearly always occur in conjunction with dyslexia.The dyslexic brain processes certain information in a different way than other brains; why, or exactly how this occurs is not yet known. Reading, spelling and written language can be affected, together with motor function and organisational skills, although it is particularly the written word that creates a barrier for people with dyslexia. Approximately 10% of the general population is thought to have some form of dyslexia, 4% of which is severely affected. Dyslexia is classified as a disability under the Disability Discrimination Act 1995.Implications for learningThe most common effects of SpLD include problems withreading (slow, and a tendency to misread)concentration (variable, but generally not sustained)spelling and grammar (inconsistent and unorthodox)motor skills (poor physical coordination and handwriting)working within time limitsthinking and working in sequencesorganising and planning.?People with dyslexia often excel in certain areas. Many are innovative thinkers, intuitive problem solvers, and demonstrate a highly creative approach. Students with dyslexia are often able to reason, argue, conceptualise, understand and absorb information, but may have great difficulty communicating their ideas in written form. Dyslexia therefore presents a combination of both strengths and difficulties, which vary in degree and from person to person. This has nothing to do with an individual’s general intelligence, as dyslexia occurs in people of all abilities.Students who have formally told the university they have dyslexia receive the booklet ‘Studying with dyslexia’. Registered students can also download a copy from StudentHome, where they can also find details on the availability of accessible course materials.Implications for teachingAs reading, writing and basic numeracy skills are essential to most conventional forms of learning, students with SpLD are very disadvantaged if their needs are not taken into account.Students with dyslexia are able to learn effectively, but may take a different approach to learning. A diagnostic report provided by an appropriately qualified professional will draw attention to areas of both strength and difficulty, which will guide the student to develop appropriate strategies.Most students prefer to use a computer for written work, often with software packages such as screen readers and voice recognition. There may also be a requirement for additional support from a qualified dyslexia teacher; typically this will not focus on course or subject content, but address general issues such as alternative study skills, organising workload and managing stress.Students with SpLD appreciate positive attitudes and cooperation from tutors and other staff, especially as they may have encountered lack of understanding in the past. The following suggestions offer some general guidelines for good practice, most of which will benefit the learner group as a whole.Provide materials in advance to allow additional time for reading and processing informationProvide an overview of the session so that the structure is clearAvoid using unnecessarily complicated languageIntroduce new ideas and concepts explicitlyPresent information in more than one way, for example as verbal description and diagrammatic representationAllow students to tape record lectures or sessions.? See? activities such as written group work or reading aloudEncourage the use of ICTWrite clearly on the board and on students’ workProvide clear handouts summarising the main points covered in a session.?A set of guidelines on how to mark the work of students with dyslexia is available at?. It is essential that you read these and refer to them when marking.Accessible course materialsAccessible materials can include, for exampleaudio versions of printed materialdigital versions in Adobe PDF.Students can check the availability of these materials for their course at? by contacting their Student Support Team.External linksBrritish Dyslexia AssociationProfessional Association of Teachers of Students with Specific Learning Difficulties??TinnitusThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationTinnitus is the sensation of noises such as ringing, whistling or buzzing heard by an individual and not connected to any external source. Tinnitus is not a disease or illness, but is generated within the auditory pathways. The condition affects many people with normal hearing as well as those with other hearing difficulties. It is not age related.Severe forms of tinnitus can be distressing and distracting. A tinnitus masker, a noise generator that feeds noise into the ear, may help with the symptoms for some people. The condition does vary, and individuals may find thatpitch or loudness alter through the daythe sensation disappears for short periodsit is worse after waking up in the morningstress can exacerbate it.?The causes of tinnitus are not fully understood, but there may be an association with loud noise, such as loud music, industrial processes, explosions or gunfire, or with illness or infection causing damage. Individuals may suffer from sleep deprivation, headaches and depression due to the condition.Implications for learning and teachingStudents with acute tinnitus may struggle to hear everything, and the provision of visual outlines and notes of the main points covered in a session will allow students to fill in any gaps.Concentrating for long periods may be difficult and may mean that some flexibility with deadlines will be required.External linksRoyal National Institute for the DeafThe British Tinnitus AssociationTourettes syndrome (TS)The following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationTourettes syndrome (TS) is an inherited neurological disorder characterised by tics – involuntary, rapid, sudden movements and sounds that occur repeatedly. The term ’involuntary‘, used to describe TS tics, is sometimes confusing, as it is known that some people with TS do have some control over their symptoms. What is not recognised is that the control, which can be exerted from seconds to hours at a time, may merely postpone more severe outbursts of symptoms. People with TS often seek a secluded spot to release their symptoms after delaying them at school or at work. Typically, tics increase as a result of tension or stress, and decrease with relaxation or concentration of an absorbing task.TS tics are categorised as simple or complex.Simple?motor tics include eye blinking, head jerking, shoulder shrugging and facial grimacing. Examples include throat clearing, yelping and other noises, sniffing and tongue plex?motor tics include jumping, touching other people or things, smelling, twirling about, and, sometimes, self-injurious actions such as hitting or biting. Examples include uttering words or phrases out of context, coprolalia (vocalising socially unacceptable words) and echolalia (repeating a sound, word, or phrase).The range of tics or tic-like symptoms in TS is very broad. The complexity of some symptoms is often perplexing to others, who may find it hard to believe that the actions or vocal utterances are involuntary.Linked behavioursMany individuals with TS have additional conditions.Obsessive compulsive disorder, where the person feels that something must be done repeatedly. Examples include touching an object with one hand after touching it with the other hand to ’even things up‘, or repeatedly flicking the light switch on and off.Attention deficit hyperactivity disorder (ADHD)?occurs in many people with TS, and may include difficulty with concentration, failing to finish what is started, not listening, being easily distracted, often acting before thinking, shifting constantly from one activity to another, needing a great deal of supervision and general fidgeting. Hyperactivity (e.g. fidgeting) and attention deficit (e.g. concentration problems) can be present independently of one another.Learning disabilities, such as difficulties with reading, writing or arithmetic, and perceptual problems.Difficulties with impulse control, which may result, in rare instances, in overly aggressive behaviours or socially inappropriate acts. Also, defiant and angry behaviours can occur.Sleep disorders?are fairly common among people with TS. These include frequent awakening, or walking or talking while asleep.?Implications for learningDuring sessions, the use of tape recorders, typewriters, or computers to aid reading and writing, and prior agreement with the tutor to leave the classroom when tics become overwhelming are often helpful.Implications for teachingThere are a number of issues that tutors may wish to consider.Ignore the tics – in the sense that you don't comment on them publicly at all, as that can make them worse. Your lack of response will demonstrate to other students that they should adopt the same approach.If tics are directly interfering with a student's ability to receive information, find alternative ways to present the material. If reading becomes too difficult due to eye or neck tics, use books on tape or have someone read to the student or record the reading for them. Be sensitive, however, to how the student may feel about having someone read to them. For other kinds of learning activities, using multi-sensory, hands-on approaches is often effective. Importantly, some students can still learn during very rough periods if you pitch to their strengths. There is usually (but not always) something that the student can do to be academically engaged, so be creative.If a student has vocal tics, consult with them privately about how they feel about class discussions, presentations etc. Students with loud or frequent vocal tics may prefer to excuse themselves from the session for a while.Where a student cannot physically write without frustration or limitation due to tics, encourage alternative means of production such as keyboarding, tape recording, or use of voice dictation software.Consult with the student as to where they'd feel most comfortable. Seating near the door for an unobtrusive exit works best for some.Encourage the student to let you know what support he or she prefers.?External linksTourette Syndrome (UK) AssociationVisual impairmentThe following notes are intended as a general guide for OU staff.Individual students manage their particular situation in their preferred way. Usually a student discusses his or her options with their Student Support Team, and will have approved a disability and additional requirements profile. Tutors have access to this report via their student list, and should make sure to read it before the course starts. Tutors should also contact the student to discuss any additional requirements.General informationVisual impairment varies considerably in type and effect from one individual to another. These guidance notes inevitably include some generalisations owing to their relatively limited scope.A person might describe themselves, or be described, as blind, partially sighted, or visually impaired. In practice this terminology reveals relatively little about levels of visual functioning: 29% of registered blind people, for example, are able to read standard print.Visual impairment is present from birth in only a small minority of people; the majority lose sight as the result of accident or disease. The incidence of visual impairment increases markedly with age, affecting at least one person in ten over the age of 60.In older adults there is also an increased likelihood of further conditions. Of registered blind people, 35% are deaf or hard of hearing*, and 58% have a physical disability*. (RNIB and Department of Health statistics)Establishing the type of functional loss (e.g. loss of visual field) is usually more helpful than knowing the name of the medical condition. The table below briefly describes some examples of functional loss, with some possible causes and effects.The effects of visual impairment are often permanent. Temporary sight loss can result from some medication.A person’s visual functioning can be affected by factors such as amount of light, contrast between objects and their background, and the closeness of the person to the object concerned.Examples of functional sight loss, with some possible causes and effectsType of lossExampleCauseEffectAcuity (sharpness of view)Objects look fuzzy and washed outCataracts, nystagmus, myopiaLoss of detail, sensitivity to glare, loss of depth perceptionPeripheral fieldSimilar to looking down a tube or narrow tunnelGlaucoma,retinitis pigmentosaDifficulty in moving around, vision worse in poor lightCentral fieldObjects looked at directly are hazy or missing, may appear distortedMacular disease, some forms of retinitis pigmentosaDifficulty with close work, e.g. reading, and in recognising facesPatchy or interruptedHazy or blind spots distributed across the visual field distort the viewDiabetic retinopathy or other retinal damageDifficulty with close work and in moving around, quantity and quality of vision often variesTotal, or light perception onlyNo image at all can be discriminatedCongenital, accident, progressive disease?No useful sight, so alternative communication methods are neededImplications for learningBecause sight is the principle means of communicating and learning, visual impairment has significant implications for study.Studying is likely to take at least a third longerActive listening and concentrating when audio is speeded up are skills that have to be learntPersonalising study texts (highlighting and adding margin notes to text) is not an option for many visually impaired studentsSome popular methods of note taking, such as mind maps, are not possible to many VI studentsAudio figure descriptions, though valuable, are not as rich as the print or electronic originalsThere is a considerable learning burden to mastering assistive technologyScreen reading technologies (programs that speak the contents of the screen) are unable to read mathematical symbols or formulae or to convey the meaning of charts or diagrams intelligibly.Some visually impaired people are able to study using print, audio or braille. For others sighted assistance may be necessary for some study activities including assessment completion.Implications for teachingYou should contact a visually impaired student (often by phone) before the first tutorial or TMA, and agree an accessible method of feedback on the student’s work.The student should be encouraged to attend tutorials and you should arrange to meet the student before the first tutorial and help them find the correct roomA student’s guide dog should be allowed to tutorials, although it may have to wait in another room, for example if another student has an allergy to dogs.Handouts for tutorials could either be provided to the student in a large font size or provided in advance by email.If a student wants to record all or part of a session guidance can be found here? with the student where they would prefer to sit – often in the centre of the group, with their back to the window to avoid glare is bestAsk the student group give their name when they contribute to discussions, so the VI student knows who is speaking.Consider the impact of reduced or lack of nonverbal communication to interaction within the group.When using a white board, remember to read out whatever you write.Consider how a VI student can gain access to the visual elements of a DVD, experiment, or practical exerciseThe OU booklet?Studying with Little or No Sight?also contains useful information for tutorsExternal linksRNIBSmoking and sight lossThe Partially Sighted Society ................
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