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Chapter 5
Chapter 5
Handicap
John Frederiksen, Mike Martin, Leonor Moniz Pereira, Ramxa2n Puig de la
Bellacasa and Stephen von Tetzchner
"Although there is clearly a biological difference between the disabled and the
able-bodied, this is not the decisive difference between the two groups. Handicap
is a social construct. There is a biological sub-stratum, but what it means to be
handicapped to others and to oneself is overwhelmingly social and decisively
political" (Roth, 1983, p. 56). Many different types of impairments and disabilities
may have an impact on the use of telecommunications. Knowledge about
impairments and disabilities is important to understand possible consequences for
the use of telecommunications. It is also a prerequisite for designing and producing
standard telecommunications equipment and services that can be used by as many
people as possible, and for developing specialised equipment designed to alleviate
the negative consequences of a disability. The present chapter reviews some
common impairments and disabilities. (Chapter 21 reviews some specific
consequences of impairments and disabilities for telecommunication use in relation
to standardisation activities).
In this brief review of impairment and disability, differences in degree are dealt
with only in a very general manner. The emphasis is on typical features rather than
variations. However, when assessing the needs of a single individual, variation that
may influence the handicapping effects of the condition must be taken into
account.
Blindness implies a total or near total loss of the ability to perceive form. Partial
sight implies an ability to utilize some aspects of visual perception, but with a great
dependency on information from other modalities, in particular touch and hearing.
Reduced vision may handicap a person in situations which put great demands on
the use of vision, but in most situations the person will not be handicapped by the
visual impairment; they will, for example, be able to read large type print with
glasses.
The incidence of all kind of visual impairment increases considerably with age.
Less than 10 percent of blind people are under 20 years of age while nearly 50
percent are 65 years or older (Bauman, 1969). In addition, people older than 40
need higher light intensity and contrast than 20-year-olds, and the difference
increases dramatically between age 40 and 60.
Problems with orientation and mobility are one of the typical consequences of
failing sight. In the case of elderly people, difficulties in orientation and mobility
may be intensified by other cognitive impairments.
The term deaf is used to describe people with profound hearing losses while hard
of hearing is used for those with mild to severe hearing losses. Hearing loss is
expressed in decibel (Db) relative to an audiometric cero which is a standardized
normal threshold of hearing. Deafness is usually defined as an average hearing loss
of more than 92 Db in the speech area. A person with a hearing loss of 70-90 Db is
severely hard of hearing. A person with a hearing loss of 50-60 Db is considered
moderately hard of hearing (Davis, 1970). Measured losses of less than 20 Db is
considered normal acuity.
The onset of the hearing impairment is important for language development and
for identification with the deaf community. A person who was born profoundly
deaf or has become deaf at a very early age, i.e. prelingual deafness, is dependent
mainly on visual communication for speech and language development, and often
uses sign language. A person who becomes deaf later in life usually has a good
mastery of both spoken and written language before the onset of deafness. Some
deaf people may fall between these two groups. For example, they may become
deaf at an early age, but after they have learned to speak, say at 3-4 years of age,
and therefore may not have a full mastery of spoken or written language.
Written text is closely related to spoken language, and the function of writing is to
mirror speech (Saussure, 1916). Thus, although mastery of spoken language may
not be a prerequisite for learning to read, it greatly facilitates the acquisition of
reading and writing. Thus, due to the limited knowledge of spoken language, the
written language skills of many prelingually deaf people may often be limited as
well (cf., Conrad, 1979).
Post-lingually deafened people usually have intelligible speech, but because they
cannot hear their own voice, their control of volume may be erratic, and they may
therefore speak too softly or too loudly. While they typically have no special
problems in the use of written language for, if their hearing impairment was
acquired in childhood, vocabulary and other aspects of both spoken and written
language use may be adversary influenced, due to more limited experience with
spoken language.
People of any age may have a mild to severe hearing loss, but the majority will be
elderly. For people who are hard of hearing, speech and hearing remain the main
mode of communication, often with the help of a hearing aid. In the case of a
severe hearing impairment, however, the person may be dependent on lip reading
in addition to using a hearing aid, and for some types of hearing impairment, a
hearing aid is of limited help. Furthermore, although many hard-of-hearing people
hear speech with the help of amplification, their ability to understand speech may
be hindered due to the effect of hearing loss. The ability to hear is not necessarily
equal with the ability to understand what is said.
People with language disorders and a more general intellectual handicap may have
some understanding of language but a limited vocabulary and reduced
comprehension of sentence structure. The understanding of language may be
strongly related to context, which means that comprehension is very dependent on
non-linguistic cues, such as the presence of persons or objects, or limited to a small
number of well known situations. Most forms of telecommunication will be
hindered because of the limitation in non-linguistic contextual cues.
A person in a wheelchair with a normal arm function will usually be able to reach
0,4-1,2 m. Thus, for installations to be within reach, they should be placed at not
more than 0,4 m from the nearest place a wheelchair user can access, for example,
not more than 0.4 meters from the side of a table. People who use walking aids,
such as crutches and sticks, are mobile over short distances, but will have
difficulties moving longer distances. Therefore, it is essential that they do not have
to travel long distances and that suitable resting places are provided. Snow and ice
are particularly troublesome for people with difficulties in walking. Even rainy
weather may cause considerable problems, as many kinds of surface, such as
stripes in pedestrian crossings, woodfloors and paving stones, become very
slippery when they are wet. In a telephone booth, it may, for example, cause
problems to hold the receiver and dial while holding the balance.
A person who lacks one arm or who has lost the ability to use one arm in a
functional way, will typically be handicapped in manipulating equipment that
demands the simultaneous use of both hands. This includes a large range of
equipment, and especially the simultaneous pressing of two or three keys on
computer or terminal keyboards.
For people who cannot move their fingers independently, all fine motor skills will
be affected. They may not be able to use keyboards or keypads, ticket automats,
etc. Turning of pages, and inserting paper into printing devices, may also be
difficult.
People with severely reduced strength may be unable to use the keyboard of a
typewriter or computer, and the keypad of a telephone. They may not be able to
press down the handle to open a door, or to lift a book or a telephone receiver.
People with moderate loss of strength may be able to lift and move only very small
objects, and to hold them for only a limited time. They may not be able to push
open heavy doors, or to open drawers.
Reduced ability to coordinate the movements of the arms and hands will influence
all activities that demand manipulation of objects or equipment. Impaired
coordination may also increase the probability of hitting and breaking things, and
to make errors when operating equipment. For example, a person with cerebral
palsy or Parkinson's disease may be unable to drive a car, pour a glass of water,
write a message, or dial a telephone number.
It should be noted, however, that also people who are significantly taller than the
average of the population may have some problems in using equipment that is
mounted at a low level, or where the ceiling, for example of a telephone booth, is
too low.
Some people have multiple impairments; for example, combined visual and
hearing impairment, or hearing impairment and problems in controlling the
movement of their arms and hands. People with intellectual impairment typically
have several impairments. Within the scope of the present chapter, it has not been
possible to discuss such multiple impairments. When assessing the needs of people
with multiple impairments, it may be difficult to distinguish the effect that the
different impairments have on the use of telecommunication equipment, and the
impact of multiple impairments may be greater than the added sum of the
individual impairments. For example, most people with reading disorders have no
problems with the use of ordinary telephones, although their inability to use the
telephone directory may prove an obstacle for them. However, if a person with
severe reading disorders acquires a profound hearing loss, text transmission via the
telephone network is impossible, and the person is excluded from a form of
telecommunications ordinarily used by people with hearing impairment.
The impact of each impairment may also vary according to the situation. For
example, for a person with moderate hearing impairment and cerebral palsy,
manipulating the equipment may be the most difficult task at home where the
telephone has augmented amplification. In a public telephone, the low sound
intensity may be a relatively greater problem than handling the equipment.