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PART ONE
Learning Problems of Disabled People
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1 Communication, Learning and Disabled People
The Basic Issues
For many disabled people, communication problems are at the heart of their disablement and central to their personal struggle to learn to overcome their disabilities. This is true whether they are young or old, whether they are male or female, whether they are disabled from birth or became disabled later in life. They are often left isolated, powerless and dependent. They are deprived of important ways of expressing their individuality.
For humans generally, being able to communicate means being able to send, transform and receive information. Sending, transforming and receiving information depend on a wide range of human abilities. âDisablementâ frequently implies loss or lack of some of these functional abilities, and the degree of disablement is often related to how many remain. âHandicapâ is sometimes used as a synonym for âdisabilityâ in the literature, but elsewhere and in this book it is used to refer to the disadvantage actually caused by the disability.
Of disabled people, those who are speech-impaired, blind, deaf or who have certain motor disabilities also have particular difficulties in sending information. Those whose speech is impaired cannot articulate the words and sounds they wish to. This is distressing whether it is congenital, due perhaps to cerebral palsy, or when it occurs later in life through a stroke or multiple sclerosis. Blind people are hampered in sending written information. Deaf people may have difficulties in enunciating words, especially if they are congenitally deaf. Those who cannot move their upper limbs properly may struggle to write, type or even to use a simple word board. Blind and deaf people also have immense difficulties in receiving information, of course, because they cannot see or cannot hear. Unfortunately, blind people may misunderstand despite their often acute hearing, and deaf ones despite their lip-reading.
Difficulties in sending and receiving may also hinder transforming of information, that is, the process by which information is changed into different symbols, codes, languages and modes (see Chapter 7). This transforming process underlies communication between humans, and between humans and their machines.
Education of disabled children and adults depends on communication. Without communication, others cannot pass on their knowledge and skills to disabled people through the two-way processes of teaching and learning, in classrooms, workshops or at home.
Types of Communication Disability
Who are the people with communication disabilities and how many are there in a country like the United Kingdom? Nobody can answer these questions precisely because different categories of disability overlap and the statistics differ according to the categories used. One classification (see the Royal Society of Health Journal, February 1975) uses nine categories to cover the full range of disability (in this document termed handicap), with a total of 41 components or sub-categories. Of the main categories, one is actually labelled âcommunication handicapâ and its four subcategories are impaired hearing, talking, reading and writing. Visual handicap is shown separately, and incorporates subcategories of total loss of sight, impaired (uncorrectable) visual acuity, impaired visual field and perceptual defect. A third main category, locomotor handicap, includes one sub-category, impaired manual dexterity, that has vast implications for communication. Other main categories such as visceral handicap (for example, disorders of excretion), invisible handicap (for example, metabolic disorders) and senescence handicap (for example, reduced recuperative powers) are somewhat remote from problems of communication. This book does not deal with them, nor with intellectual handicap (ranging from congenital mental retardation to impaired memory), emotional handicap (for example, psychoses and drug disorders) and aversive handicap (tics, skin disorders, etc.), although these last three may indeed have some indirect impact on communication.
Some American authors (for example, Vanderheiden and Krause, 1983) try to distinguish between those who are non-vocal (speech not fully functional) and those who are speech-impaired (speech functional but impaired), and similarly between the blind and visually-impaued and between the deaf and hearing-impaired. Clearly, as in the case of physical disability, the degree and nature of impairment is what matters rather than precise labelling.
Perhaps not surprisingly, the exact numbers of disabled people are difficult to determine and there may well be some double counting. For example, from a 1968-9 survey, Harris and others (1971) estimated that there were about three million handicapped people aged 16 and over living in private households in the United Kingdom and suffering from some physical, mental or sensory impairment, but their categories included only those who considered that their impairment actually handicapped them in their work, in getting about or in taking care of themselves. Counting numbers of people with particular disabilities is made more difficult by lack of agreement among authorities on what constitutes âofficialâ disability. For instance, if there are about 100,000 registered blind people in England and Wales, this means that each of these has failed a particular sight test. There may be other blind people, unregistered, who have never taken the test, or if the test were slightly different, the number registered would be higher or lower. Distinguishing blind from partially sighted people may be important in certain contexts, but the problems in doing so are so well known as to inspire little confidence in the statistics. Few people are completely blind, and those who cannot perceive forms can usually sense light. People with the same measured visual acuity may be able to do quite different things. Low (1983) quotes a 1981 figure of only about 3000 blind or partially-sighted children attending schools in England and Wales. The numbers of people of all ages with disabilities of the kinds discussed here, however, probably amount to roughly one million or about 2 per cent of the United Kingdom population, with a similar percentage in other Western countries, including the United States. In other words, in the United Kingdom up to a million disabled children and adults may be able to use information technology to improve their education, should they so wish.
In the United States, recent estimates suggest there are nearly two million speech-impaired people (Gibbons, 1982), of whom about 60,000 are non-vocal cerebral palsied children (Meyers, 1982). Again, two million people are blind or visually-impaired (Jampolsky and others, 1982); about 120,000 can make virtually no use of visual information. About four million handicapped children are at school: many of these do not have communication disabilities (US Department of Education, 1982).
Examples of Communication Disabilites
The harsh realities of being disabled are disguised in statistics but not in personal case histories, of which there are many in this book. George became progressively deaf after an illness at about 14. He managed to complete his schooling at a local grammar school, then, in the 1920s, using a hearing aid with a large battery which he carried around in a special case, with great difficulty he trained as an accountant. Despite increasing deafness, he held down a Civil Service job until retirement, by which time he had been profoundly deaf for a decade. At work or at home, he could never use the telephone; everyone had to communicate with him either in writing or by depending on his lip-reading. His speech deteriorated with age, although it never became completely unintelligible. For his colleagues, explaining new procedures to him was particularly trying. He died after a long decline during which he became increasingly withdrawn and socially isolated.
A few years ago, Tony was a young officer in the Army. By accident, he was blown up and blinded at 24 by a land-mine while on manoeuvres. He came out of hospital and started studying braille, which he found far from easy. He persisted, however, and two years later registered for an Open University degree, having to depend on braille or tape-recorded versions of the texts and on his girlfriend reading aloud to him. He attended the residential summer schools, where he needed much assistance, particularly with laboratory and field work. He took his examinations through dictating to somebody who wrote down what he said.
Rachel received serious head injuries in a car accident when she was ten, write Hall and Turner (1983). She is now spastic, a quadriplegic with very badly impaired mobility and no speech. Her left hand is reasonably effective, but not the right. The family expected that her speech might be restored and apparently did not encourage her to learn to communicate through symbols and signs. At any rate, her interest in doing so was low. Before the accident, however, she had acquired basic literacy skills, and after it was very frustrated by having to resort to very crude communication techniques, such as âair writingâ and gestures. Chapter 9 describes how Rachel overcame these communication problems to a remarkable extent with the help of new information technology.
In each of these cases, and in hundreds of thousands of others, communication was difficult or nigh impossible between the disabled person and those around him or her. Learning depends on good communication, therefore disabled people with communication problems are at a double disadvantage, when learning first to overcome their disability by substituting other abilities and then to learn what other people learn, whether in the formal education system or informally.
To compensate for congenital communication disabilities, children need help most urgently before and during primary school, but both they, and adults who are disabled through illness, accident or old age, need some help for the rest of their lives. Can technology provide it?
The Challenge to New Information Technology
People who have never been disabled look to new information technology to improve communication and to solve all kinds of communication problems. They are not being disappointed, as a spate of devices and systems comes out of laboratories and onto the market, backed by powerful political and economic forces.
The challenge to new information technology from people who are disabled is similar: can it improve communication and solve communication problems for them? Can the same devices and systems, or perhaps others developed specially for disabled people, meet their needs? The answer is beginning to emerge, and it has particular implications for the education of disabled children and adults.
Consider, for example, the case of Michael Rogers (reported by Mahon, 1983). When he was 23, Michael was self-employed and a sportsman. He contracted a viral infection which left him paralysed from the shoulders down, a tetraplegie. He is able to use a variety of mouth-sticks, but in recent years has been experiencing excessive wear of his neck joints due to this activity. With the sticks he operates a microcomputer with a printer. To cope with the need to press two keys simultaneously for some operations on the computer, he has three extra switches to hold down the shift, control and repeat keys when he wants to. He has complete control of the computer and even changes discs (see Chapter 9) with his mouth-sticks. He uses a tape dictating machine and an electric typewriter, which he operates with mouth-sticks. With his word processing program, he has written one book about paraplegia and is completing another, as well as using the program in his domestic life to communicate with those around him. He suffers less physical strain because some of the effort is taken out of his typing and, like many able-bodied people who start word processing, he finds his writing has improved because of the ease of re-formatting and correcting text.
A different example is quoted by Duncan (1983). This man, whom we shall call Mr F, is middle aged. He had a stroke several years ago, which paralysed his right side and arm and severely impaired his speech. He could use a typewriter before his stroke, but now can only type with his left hand. Mr F now has a small typewriter-like device which he carries in a satchel on a strap over his shoulder. Its keyboard is like a typewriterâs but with extra keys, about 50 in all. The device incorporates software (programs) that allow Mr F to use a kind of shorthand. By typing in various two-letter codes, devised by himself, he can made the device speak names of family, friends, items of food and drink (âGTâ for âGin and tonic, please!â), everyday activities (âDTâ for âShall I take the dog out or will you?â), in fact, anything he wishes to code in this way. Mr F is so keen to express himself that at first he used to hit two keys simultaneously, the spoken result being gibberish. This problem was solved by fitting a keyguard. He is happy taking his device with him to the corner shop and will show it off. He does not mind its peculiar computerised voice as long as people understand it (after repetition if necessary). He wants to communicate and the device helps him to do so. Mr F has retrained himself to use his device in everyday life.
These two examples show that using new information technology to improve communication for disabled people is already possible. In neither is education the prime purpose of the particular innovation, yet clearly in each case it can be immensely useful in enabling disabled users to gain access to education.
Summary
In this first chapter, we looked briefly at the basic issues concerning communication, learning and disabled people. We reviewed types of communication disabilities and their extent in the population, illustrated by several case histories. From disabled people, the essential challenge to information technology is, âHelp us with our communication problemsâ. This challenge is already being answered in significant ways, as a few examples show, with important implications for the education of disabled children and adults.
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2 Learning Problems of Physically-Disabled People
Causes of Physical Disability
Physical disability can arise from early disorders, possibly congenital, of the nervous, skeletal and muscular systems, such as cerebral palsy or spina bifida. Since students with this kind of disorder are likely to have been at a disadvantage since birth, their problems are often less tractable than those who become physically-disabled later in life.
Many people become physically-disabled by damage to the nervous, skeletal and muscular systems due to accidents, for example, involving brain and spinal injury. Others contract diseases, for example, tuberculosis of the spine, motor neurone disease, multiple sclerosis, myasthenia gravis, brittle bone disease. Still others, not all old, have disorders such as Parkinsonism, muscular atrophy, progressive muscular dystrophy and cerebral vascular accidents (strokes).
Physical disability is no respecter of age or person. The type and degree of handicap experienced varies from individual to individual.
Types and Degrees of Physical Disability
The basic definition of physical disability is inability to move normally or to exercise proper control over movement. Physically-disabled individuals are those with decreased range and strength of movement, or who have unwanted and uncontrolled movements. For instance, a child with cerebral palsy (paralysis and associated disorders of motor function arising from damage to the brain during birth or soon afterwards) may be unable to hold her hand still enough to write clearly. An adult with muscular dystrophy (disorders of muscle function and structure that lead to increasing weakness and degeneration of the muscles) may become quickly exhausted by writing, which demands great effort. A student with Friedreichâs ataxia, a hereditary progressive disease of the nervous system that causes increasing inco-ordination of movement, may find it impossible even to press the keys of a calculator.
The boundary between physical and mental handicap is blurred. Many mentally-handicapped people are also physically-disabled and because they have great problems in conceptualising are...
