information on functional limitations
TRANSCRIPT
Information on functional limitations
Wageningen University, Wageningen UR
December 2009
© 2009 Wageningen, Wageningen University, Wageningen UR
All rights reserved. Nothing in this publication may be reproduced, stored in a retrieval system, or published in any
form or by any means, whether electronic, mechanical, photocopying, recording, or other ways, without the prior
written permission of Wageningen University, Wageningen UR.
Wageningen University, Wageningen UR
Address : Student Counseling Service
: P.O. Box 414, 6700 AKWageningen
Tel. : 0317 - 483618
E-mail : [email protected]
Internet : http://www.wageningenuniversity.nl/UK/
Table of contents
page
Foreword 1
ADHD/ADD Attention Deficit Hyperactivity Disorder 3
Asthma and allergies 5
Auditory limitations 7
Autism Spectrum Disorders 11
Chronic diseases 13
Dyslexia 15
Energy problems 19
Motor limitations (including RSI) 21
Psychological problems 23
Visual limitations 27
Information about services provided to students with a functional limitation 29
1
Foreword
As a teacher or student facilitator, you may be faced with a student who has problems.
Perhaps this involves a functional limitation, causing difficulties in class, which could lead
to the student failing to complete the course.
But how do you, as a teacher or facilitator, identify these limitations and their
consequences? And – even more important – how do you deal with them?
A functional limitation is chronic in most cases and interferes with the student's ability to function normally. It may
therefore be difficult for the student to participate in education. Note that a functional limitation isn't always visible.
Examples of functional limitations include not only dyslexia, depression, RSI, and muscle diseases, but also ADHD and
autism spectrum disorder.
More students with functional limitations are now continuing on from secondary education to higher education. As a
result, higher educational institutions are more often faced with students who qualify for admission to higher
education, but whose study could be delayed or even terminated without the necessary adaptations and
understanding. Some limitations make it almost impossible to take certain studies or practice certain professions.
When viewed from a realistic perspective, however, it is still possible to create an appropriate learning pathway for
most students.
With this guide we aim to provide information about various functional limitations that could affect students . This
guide also contains tips on educational facilities and adaptations that you can make to the lessons and the general
educational situation as a teacher or facilitator. The tips help ensure that such students can participate appropriately in
education. We also hope to create more understanding of the sometimes awkward situations in which students with a
functional limitation find themselves.
This guide does not pretend to be complete. Therefore, where possible, we have provide references to other
sources of information.
The descriptions of the limitations have been largely derived from the information folder for study advisors at TU
Delft, produced with the help of the IMPULS 2004 funding. Information was also obtained from Achtergronden van en
tips voor de omgang met leerlingen met een specifieke hulpvraag by Pyt Nauta and Marinus Giesing (www.nauta-
giesing.nl. In addition, we used information from a supplement in the NRC newspaper from 18 November 2006:
Thema Gezondheidszorg, kinderen van 6 tot 16 jaar. Finally, much of the information in this guide was acquired
from experiences with such students at the Student Affairs departments of the University of Amsterdam and
Amsterdam University of Applied Sciences and at the Student Counselling Service of Wageningen University.
This guide was developed as part of the Education Culture and Science (OCW) project ‘Studeren met een functie-
beperking’, which ran from 2006 to 2009.
Student Counselling Service of Wageningen University
To table of contents
2
3
ADHD/ADD
Attention Deficit Hyperactivity Disorder
ADHD is characterised by difficulty with concentration, impulsiveness and
hyperactivity. In ADD there is no hyperactivity.
Characteristics
Student has difficulty with planning, sitting still, focussing and being patient.
Consequences
Social and/or psychological problems, such as underachievement, depression, neurosis and personality disorder.
Problems in an educational setting
Mostly occur when:
- Studying subject matter
- Taking classes (attendance, processing information, taking notes)
- Participating in project groups, seminars etc.
- Working on individual projects and doing internships
- Taking exams
- Planning and keeping records
Possible measures and facilities
A student with ADHD will benefit from the following measures:
- Low-stimuli environments
o individual study space/computer space
o avoid commotion and distractions in the classroom
- Separate examination room
o record lectures
o partial exams
o extra lighting
Possible educational measures
- Use rooms with low stimuli environment
- Additional guidance, for example with planning (weekly schedule, for instance together with a study partner)
- Modified study plan, interim deadlines or partial exams
Tips for teachers
- Provide lesson material in advance (digitally via Blackboard or the intranet)
- Provide clearly structured lessons
- Offer clear feedback
4
Tips for students
- Take medication at set times
- Use alarm clock
- Study actively (underlining, summarising, reading aloud)
- Clearly state expectations and options
- Use digital agenda
- Use memory aids, such as memo notes
- Use tablet PC for making digital notes in a document
- Have regular partner for labs and project groups
- Take study and career tests (contact student psychologists)
Facts worth knowing
- Twice as many boys as girls suffer from ADHD
- ADHD is often associated with dyslexia
- It appears to have exactly the same hereditary predisposition as chronic fatigue
- Epidemiological studies have shown that 1 in 3 children never entirely recover from ADHD, but that most do
"outgrow it". In particular, the hyperactivity can decrease.
Sources and more information
- www.handicap-studie.nl (part of the site available in English)
- www.adhd.nl (only in Dutch)
- www.hersenstorm.nl (adults with ADHD; only in Dutch)
To table of contents
5
Asthma and allergies
Both diseases usually involve increased irritability of the airways. Allergy may also
cause skin rashes or itching.
Symptoms of asthma
Asthma is caused by chronic inflammation and can lead to increased irritability of the airways. During an asthma
attack, people have difficulty breathing: they become short of breath, breathe with a 'squeaking' noise or have to
cough. These symptoms occur when the airways become severely irritated by various substances. Asthma patients
are often allergic to more than one substance. Asthma is a chronic disease.
Symptoms of allergies
Common problems that accompany allergies are respiratory symptoms, colds, itchy or watery eyes, sneezing,
coughing and shortness of breath, itching and/or eczema. Eczema may cause embarrassment and social difficulties.
Food allergies may also cause stomach aches, diarrhoea and migraines.
Consequences
The effects vary according to the type of allergy, but the substances that trigger an allergic reaction should be
avoided. A no-smoking environment, dust-free rooms and sufficient humidity provide relief to students with asthma or
allergies to moulds and dust mites. Most people with allergies and/or asthma suffer from fatigue. The 'invisible'
nature of allergies can cause problems in an educational setting.
Problems in an educational setting
Students will mainly have problems with the following:
- Attendance, fatigue and loss of concentration
- Environmental factors such as smoke, dust and humidity
Possible measures and facilities
- Air conditioning or ventilation that can be controlled for each room
- Windows that can be controlled in each room
- Temperature that can be controlled in each room
- Blinds that can be controlled in each room
- Linoleum or tile flooring instead of carpeting
- Blinds instead of curtains
- Whiteboards instead of blackboards to avoid chalk dust
- Individual study spaces where the environment can be controlled
6
Education measures and tips for students and teachers
- Use classrooms with good climate control
- Ensure a good balance between rest and activity
- Avoid stress
- Allow breaks during exams to apply ointments or take medication
Sources and more information
- www.handicap-studie.nl (part of the site available in English)
- www.astma-copd.nl (only in Dutch)
- www.astmafonds.nl (information about asthma and COPD; parts of the Research page have been translated in
English)
- www.astmaforum.nl (discussion forum on asthma, COPD and eczema; only in Dutch)
To table of contents
7
Auditory limitations
Auditory disorders affect the hearing. Besides full and partial deafness, Ménière's
disease and oversensitivity to sound are also defined as auditory disorders.
More students with a hearing impairment are gradually being admitted to higher
education. Some have mastered sign language or lip reading, but most people use
devices to enhance their hearing.
Characteristics
These disorders are expressed in various ways:
- Sounds that are too soft or too loud may be heard poorly or not at all
- High or low pitched sounds may be heard poorly or not at all
- Loud noises can be painful
- A noisy environment can distort hearing
- Speech problems can occur in some cases of early deafness
- Communication is noticeably affected and there are problems with understanding
This limitation is often invisible. A student's behaviour sometimes provides clues that not everything has been heard.
Consequences
For students who become deaf later in life, it is often difficult for them to learn new ways of communicating. Students
who have been deaf from birth may have a smaller vocabulary and have more difficulty speaking. There may also be a
general knowledge gap. Hearing impairment hinders communication, both in term of content and level of
interpretation. This can lead to frustration and uncertainty for the student and the tendency to become more and more
withdrawn.
Joining in with the usual methods of communication with other students takes more effort and this therefore causes
the student to be more affected by fatigue. Partly because the limitation is often invisible, misunderstandings can
occur, which may cause the student to feel left out.
Problems in an educational setting
Depending on the specific disorder and the extent of hearing impairment, students with hearing problems may
depend more on non-verbal communication and tools. E-mail is a valuable communication tool for them.
During their study, students with this disorder have particular difficulty with:
- Listening to lectures
- Taking part in project groups
- Finding an internship and completing an internship
- Performing practical activities
8
Possible measures and facilities
- Induction loop system (ask Facility Services for details)
- Individual sender/receiver equipment
- Recording equipment combined with speech recognition software
Educational measures
Hearing impaired students will benefit from the following facilities:
- Scheduling educational activities in rooms with a permanent or temporary induction loop
- Good room lighting and seating to allow lip-reading
- Written support for lectures and other activities that corresponds well with the oral explanation (PowerPoint,
sheets or whiteboard)
- Well structured and accessible study material
- A curriculum that has been planned well in advance
Interim examinations
- Announcements that are made without a PA system (for example during a written exam) will not be heard or
understood
- During an oral exam, a sign language interpreter can be used
- If you notice that a student does not understanding you exactly, write down names, numbers and dates
Tips for teachers
- Move deaf and hearing impaired students to the front of the classroom or lecture hall
- Make sure your face is adequately illuminated
- Speak as much as you can facing the room; stop speaking when you turn around to write on a board
- Speak slowly and articulate clearly, but try not to exaggerate
- Repeat the questions and statements made by other students
- Use the transmitter of the solo equipment if a student requests this
- Try eliminating ambient sound, such as air conditioning, as much as possible and ask the other students to limit
unnecessary noise
- Ensure that important information is also shown in writing (e.g. on the board), such as names, formulas and
deadlines
- Ensure highly disciplined behaviour in project groups and try involving the hearing impaired or deaf students in
the discussion by calling them by their names
- Deaf and hearing impaired students will not understand comments that are irrelevant to the discussion, wordplay
jokes (especially when mumbled) and information that varies in intonation or that is inconsistent with body
language
Personal contacts
(teachers, student counsellors, study advisors, study guidance counsellors)
- When making an appointment, ask how much time the student expects to need, as discussions could take longer
due to the student's limitations
- If a student is deaf, you can ask him or her to bring a sign language interpreter
- Ensure that your face is sufficiently illuminated, sit directly across from the student and have the student sit with
his or her back to the window
- Keep your face visible as you speak, speak slowly (without exaggeration) and look at the student. Speak only at
short distances
- If you can't understand a word or a name, ask the student to write it down
- A hearing aid may be strongly affected by ambient noise. For a conversation, find a room with low ambient noise
(even the sound of a computer or an open window can be annoying)
9
Tips for students
- Make sure that everyone who needs to know is told that you are hearing impaired; tell them yourself or use the
services of the study advisor and/or student dean. Make sure that teachers are informed in advance about how
they can take your limitation into account
- Ask another student if you can copy notes, or if this is difficult, consult the study advisor or dean about
possibilities to arrange lecture notes through them
- At lectures where audio-visual material is used for subtitling, request a summary or an explanation beforehand
- If necessary, ask if it is possible to do your oral exams in writing
- Find out how severely your limitation can be an obstacle in your career
Sources and references
- www.handicap-studie.nl (part of the site available in English)
- www.nvvs.nl (Dutch association for the hearing impaired; only in Dutch)
- www.shjong.nl (Organisation run by and for hearing impaired youth; only in Dutch)
- www.hoorzaken.nl (information on hearing; only in Dutch)
- www.doof.nl (news for the deaf and hearing impaired; only in Dutch)
- www.gezondheidsnet.nl (only in Dutch)
To table of contents
10
11
Autism Spectrum Disorders
There are various forms of autism, including Asperger and PDD-NOS. The most
important problems involve the processing of information, the ability to empathise
in social interaction, language skills, oversensitivity to stimuli and a lack of
confidence.
Characteristics
People with autism keep to fixed patterns and are susceptible to stress when faced with different and new
situations. They are slower at processing information (spoken or otherwise) because they have difficulty
distinguishing between main and subsidiary aspects and making connections and abstractions. People with autism
often show little mutuality in their social interactions. Sometimes they may have a strong interest in one subject
(obsessive) and overestimate their own capabilities (especially with Asperger).
Consequences
These students need structure and clarity. Not perceiving subtle signals (verbal and non-verbal) causes difficulty with
social interaction. Stress and fatigue are the result of an irregular situation and too many stimuli or too much
information at the same time. Fear of failure can result from the combination of reduced self-confidence, lack of
confirmation and perfectionism.
Problems in the educational setting
Students have problems especially with:
- studying subject matter
- identifying structure and coherence (main point, subsidiary details)
- going to class (attendance, processing information, keeping notes)
- taking part in project groups (communication, collaboration and presentation)
- doing individual projects
- undergoing internship supervision and completing an internship
- taking exams
Possible educational provisions
- Provide an overview of the lesson material in advance
- Use rooms with a low stimuli environment
o individual study space/separate examination room
o avoid distractions and commotion in the classroom, exam room and computer room
- Extra lighting, reading device, computer adjustments (use of contrast), audio book, typoscope (piece of dark
cardboard with a slit in it, so you read just one line at a time), voice recorder
- Avoid unexpected events (always use the same classroom if possible)
12
- Provide a curriculum that has been planned well in advance
- Offer guidance with planning (possibly a study partner)
- Make sure the summaries are complete
- Schedule rest breaks
- Provide flexible attendance rules
- Assign students to small groups
Tips for teachers
- Provide notes/summaries digitally or on paper
- Provide sheets or lesson materials in advance (enlarged if necessary)
- Write down and repeat new words
- Provide clearly structured lessons
- Provide opportunity to ask questions after class by e-mail/phone
- Give clear feedback
- Assign students to small groups, possibly with a permanent group partner
Tips for students
- Use alarm clock
- Use active learning (underlining, summarising, reading aloud)
- Clearly indicate your expectations and possibilities
- Use a digital agenda
- Find a permanent partner for labs and project groups
- Take a part-time or duo internship
Sources/more information
- www.handicap-studie.nl (part of the site available in English)
- www.landelijknetwerkautisme.nl (education and autism in the Netherlands; website also in English available)
- www.users.dircon.co.uk/~cns/ (about university students with Autism; in English)
- www.autisme.nl (from the Dutch Association for Autism; only in Dutch)
To table of contents
13
Chronic diseases
Chronic diseases are diseases that have a long duration and generally a slow
progression. The resulting functional limitations depend on the nature and severity of
the disease. Examples of chronic diseases are: Multiple Sclerosis (MS), Rheumatism,
Fibromyalgia, COPD, Cystic Fibrosis, Bowel Diseases (e.g. Crohn's Disease) and
Diabetes.
Characteristics
Many of these diseases can cause chronic pain and/or fatigue.
Consequences
Pain, fatigue and medication can often cause concentration problems.
Problems in the educational setting
Absence from lectures, etc. may result in reduced performance. Regular hospital visits and tests may also cause
absences. If students have an energy deficit, this will affect the workload they can handle, depending on the severity
of the disease. Some diseases result in decreased mobility, which could lead to students being overtaxed or having
problems moving about the building or operating equipment.
If the disease first becomes apparent during the study, acceptance may be difficult and require patience. Worsening
symptoms can cause the study to be interrupted or terminated.
Possible measures and facilities
- Provide room for resting
- Give permission to submit assignments later
- Modify attendance rules
- Record lectures (video or voice recording)
- Give partial exams, or provide a break during the exam
- Provide comfortable furniture for lectures or exams
Educational measures
- Determine the best possible schedule (in consultation with the study advisor)
- Look for an internship close to home (to limit travel time)
- Provide extra time for exams
- Use a customised programme (in consultation with the student counsellor/dean)
- Provide a study partner (for taking notes or voice recording)
14
Tips for teachers
- Send lecture sheets etc. to the student in advance: attendance is not always possible
- Provide opportunity to ask questions via e-mail
- A permanent lab partner is useful
Tips for students
- Make sure that teachers (and other students, if desired) understand your problems in advance by telling them
yourself or doing this through a student advisor or student dean. Make sure that the teachers are informed in
advance
- Make timely arrangements, for example about alternative exams
Sources and references
- www.handicap-studie.nl (part of the site available in English)
- www.rivm.nl/en/healthanddisease/chronicdiseases/
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15
Dyslexia
Dyslexia is the most common functional limitation among students. Also known as
word blindness, dyslexia causes serious and stubborn problems with reading and
spelling. Even with extra help, dyslexics have trouble learning to read and spell
skilfully. They also have difficulty learning to read and spell in foreign languages.
Dyslexia has nothing to do with intelligence. It occurs with normal or even high levels of
intelligence. Students with dyslexia fall behind in their school performance. This
happens despite effort and determination, with serious consequences in the
personal, family and social settings.
Characteristics
The causes of dyslexia are not entirely clear. Scientists generally agree on the following factors: the speed of
phonological processing and the accessibility of language knowledge. Dyslexics have difficulty quickly processing
letters (visual code) into sounds (auditory code). The cause of these problems lies primarily in the auditory code.
Dyslexics tend to have less ability to process this information.
Consequences
The reading and spelling problems that result from dyslexia have turned out to be treatable in practice. This means
that by far the majority of dyslexics can achieve an acceptable level of literacy, which enables them to take a full-
fledged role in society. To accomplish this, it is essential that the disability is detected as early as possible. Moreover,
the treatment method must be adapted to the individual situation as much as possible. During this process, besides
the individual problem description, other matters play a role such as: what motivates students, what are their strengths,
what level of literacy do they require, do they like to work with computers? How can computers help them to learn to
read and spell?
People with dyslexia are often creative visual or logical thinkers. When they are properly supervised at school and
suitable learning strategies are developed for them, they will have less difficulty taking a position in society that
corresponds with their talents. Underperformance or failure to finish school are therefore not as common as they
once were.
Problems in the educational setting
Problems can occur with the following aspects:
- Going to class (requires a combination of listening and writing)
- Taking notes
- Studying lesson material, books, articles
- Working on individual projects
- Taking written exams
- Studying in another language, for example English
16
Possible facilities and provisions
- Provide PC with spell checker or speech recognition software for students with writing problems
- Offer speech synthesis software to help when studying or taking exams
- Provide a study partner who helps to correct papers, etc
Educational measures
- Provide digital lesson material (for speech synthesis) and digital textbooks
- Allow extra exam time, and if necessary use a bigger typeface (enlarge from A4 to A3).
- Possibly use speech synthesis software for exams
- Possibly provide separate room for exams
- Possibly give an oral exam
Tips for teachers regarding exams
- Use a clear text layout (good contrast, font and line spacing, headings)
- Do not count spelling errors made during exams in non-language courses
Tips for teachers regarding lectures, project groups
- Provide handouts in advance or a table of contents of the lesson material
- Use images and drawings with words and texts
- Bring as much structure as possible into the learning material
- Use clear text layout (contrast, font and line spacing, headings)
Tips for teachers regarding clear presentations
- Use only one theme per slide and restrict your text to 5 or 7 lines of text per slide
- Place keywords or key ideas preferably in the middle of the slide
- Make sure pictures, diagrams and such are sufficiently large and clear
Tips for students
- Take a course on studying with dyslexia (study skills, planning and writing strategies, using various aids). Go to:
http://www.studerenmetdyslexie.nl, or take a course on learning how to study (memory, fast reading and mind
mapping): www.purplemonkey (course is given in English).
- Use the expertise of other students who are further along in the same study
- Use a spell checker, also for keywords in search engines
- Get a study partner who will check your work and discuss it with you.
- At the student deans office borrow a laptop that has speech recognition and text-to-speech software, so you can
see if this will support your study
Sources and references
- www.handicap-studie.nl (part of the site available in English)
- www.iwal.nl (institutes for dyslexia; the page Research is also available in English)
(http://www.iwal.nl/site/research/research-en.html)
- www.dyslexie.nl (dyslexia foundation; only in Dutch)
17
Facilities
- http://www.surfdiensten.nl (lowest cost, they have an agreement with institutions; only in Dutch)
- http://www.lexima.nl (information about Kurzweil and Sprint text-to-speech software; only in Dutch)
- http://www.kanteffspeech.nl/school-spraakherkenning.asp (information about Dragon software; only in Dutch)
Dyscalculia
Dyscalculia, or math disability, is often accompanied by a number of other limitations such as poor spatial
understanding, inability to tell time, poor memory, spelling problems and lack of insight. There are indications that it
is an inherited disability with a neurological background. For more information, go to:
http://www.dyscalculie.org/english/eng_index.htm.
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18
19
Energy problems
CFS (chronic fatigue syndrome), sometimes called ME, is one of the most well-
known diseases where fatigue and energy problems play a role. However, there
are many other diseases, both physical and psychological, that have fatigue as a
side effect. Examples include Coeliac disease (gluten allergy), Crohn's disease
(chronic inflammation of the bowels), COPD (chronic respiratory inflammation),
diabetes, epilepsy, rheumatism and depression.
Characteristics
Often, nothing can be seen on the outside. The pattern is capacious: sometimes things go well and the student can do a lot,
sometimes things go very poorly and the student can do little. This often leads to a lack of understanding. Energy problems
occur with most diseases and disorders. The severity of the problem will differ according to the individual and the disease, but
pain and limitations always require more energy to be expended; the same applies to making adaptations and arrangements.
Therefore take account of energy problems, even if this is not the primary reason that the student is contacting you.
Consequences
Energy problems are expressed not only in terms of the amount of sleep someone needs, but they also cause symptoms such
as tired muscles, concentration and/or memory problems and reduced immunity. Students with energy problems often have
fewer reserves than others and may need longer recovery periods after mental and/or physical exertion.
Problems in the educational setting
Depending on the severity of the disease, the following limitations can occur:
- Difficulty with taking classes, or when this is possible, a longer recovery period is required
- Concentration problems or memory difficulties
- Study delay caused by not being able to finish the work on time
For each student and each disease, the energy problem can differ. it is especially important for the student to indicate what
kinds of activities cause the biggest problems.
Possible educational provisions
- Space for resting
- Help with part-time planning
- Help with establishing optimal schedule (scheduling classes for later in the day, sufficient time between
mandatory classes and labs/practicals)
- Flexibility regarding unavoidable absence
- No classes during the first hour. With energy problems, you generally need more sleep
- Compensate absence by providing notes, recording lectures, offering possibilities to catch up
- Provide a permanent contact person for schedule changes
- Limit changes in classroom location/avoid long distances
- Offer possibility to continue on to the next study period, despite insufficient points
- Provide separate examination room
- Split exams into parts
20
Tips for teachers
There are many tips for supervising students with energy problems, but the most important tip is to take the energy problem
seriously. A frequently heard remark is that 'everyone is busy', but people with energy problems have fewer reserves; they will
have problems during the subsequent days if they 'have to work a little harder today'. This requires a change in thinking. The
important thing is not the quantity of work produced by the students, but demonstrating the quality of the work and making sure
they achieve the required competencies at the end of the study.
Tips for lectures, project groups, etc.
- Allow questions to be asked by e-mail/telephone
- Ensure that lecture sheets, summaries, lesson material etc are available in advance on the Internet, or mail them
directly to the students; they cannot always attend classes
- Have lectures recorded via WUR-TV
- Modify regulations for courses with mandatory attendance
- Provide alternative assignments instead of project group assignments, or explain the limitation to the group (if
desired)
- Ensure that submission dates, presentations, project group consultations are sufficiently spread out; allow later
submission or split assignments into smaller parts. Another possibility is to provide a different kind of
assignment, for example a presentation instead of a paper (or perhaps the other way around)
Tips for exams
- Allow a break during the exam, or give the exam in parts
- Provide a take-home exam
- Provide an oral instead of written exam
- Offer multiple choice questions instead of open questions
- Have exam questions on a computer/laptop
Tips for students
For students, the following tips can be useful:
- Ensure that everyone who needs to know understands what kind of problems you have by telling them yourself,
or ask the official facilitator to do this. Ensure that the teachers are informed in advance about how they can take
your limitation into account
- Make timely agreements about aspects such as schedule changes and exams
Sources/more information
- www.handicap-studie.nl (part of the site available in English)
- www.me-platform.vuurwerk.nl (forum about ME/CFS; only in Dutch)
- www.me-cvsvereniging.nl (except the part of the documentary page is in English; direct link:
http://www.me-cvs.nl/index.php?pageid=6879)
- http://www.cfs-news.org/ (information about Chronic Fatigue Syndrome / Myalgic encephalomyelitis; in English)
To table of contents
21
Motor limitations (including RSI)
There are many causes for a motor limitation: muscle disease, an accident or
overuse (such as RSI). Motor limitations involve problems with the mobility of the
limbs, including sitting, moving or fine motor control. In most cases, there is a
reduced stamina.
Characteristics
Some motor limitations are visible, but some are not, such as RSI or rheumatism. The limitations can vary in terms of
intensity, cause and type, including muscle diseases, spasticity and diseases such as MS, which lead to reduced
mobility.
Consequences
For students with a motor limitation, the frequent use of the computer often causes problems. This can lead to
students having to request educational adaptations. It can also make it difficult or even impossible for students to
enter buildings and/or classrooms. For example, monumental buildings do not have ramps for wheelchairs or
revolving doors. These limitations often require students to make many additional arrangements; all the energy
expended in this process may affect their studies.
Problems in the educational setting
It can be difficult to provide accessibility, not only to rooms but also to apparatus. It is important that the students
indicate promptly what they need in order to participate properly in education. This can involve a modified table or
chair, using a laptop (modified or otherwise) during an exam or the need for a break during an exam.
Possible measures and facilities
- Modified furniture
- Space for resting
- Accessible buildings, or moving a class/project group to a room that is accessible
- Using a computer, possibly modified, during lectures and exams
- Ergonomic mouse and keyboard or speech recognition software
- Toilet for disabled people
Educational measures
- Plan breaks
- Limit changes in classroom location or avoid long distances
- Split exams into parts
22
Tips for teachers
- Allow questions to be asked by e-mail
- Ensure that lecture sheets, lesson materials etc. are available in advance on the Internet, or mail them directly to
the students; they cannot always attend classes
- Modify attendance rules
- Provide a permanent lab partner
- Plan a break during the exam
- Offer a take-home exam
- If possible, offer an oral exam instead of a written one
Tips for students
- Make sure that teachers (and other students, if desired) are informed beforehand about your limitations by telling
them yourself or doing this through a student advisor or student dean
- Make timely arrangements, for example about alternative exams and facilities
- On request, the student dean will loan out a laptop with speech recognition and text-to-speech software, or an
ergonomic mouse and keyboard, to determine if this supports you in dealing with your limitation
- Install the Workpace program (via the link below) or Workrave (Linux)
- In case of RSI, consider activities such as yoga, fitness training or mensendieck therapy
Sources and references
- www.handicap-studie.nl (part of the site available in English)
- www.intranet.wur.nl/nl/people/welzijn-en-gezondheid/gezondheidpreventie/Pages/rsipreventie.aspx (with tips for
RSI prevention; also in English available)
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Psychological problems
There are many types of psychological problems, which vary in terms of their
characteristics, consequences and severity. Moreover, physical diseases and
limitations (such as MS or dyslexia) can also result in psychological symptoms.
Characteristics and consequences of the most common psychological problems among students
Depression
A sombre, depressed mood is often a normal reaction to disappointment or loss. In this case, the mood swing is
temporary and requires no focused antidepressant treatment for most people.
The diagnosis of depression is based on the following assessment. During at least two weeks, one or more of the
following symptoms occur, where one of the first two symptoms is obligatory.
- sombre mood
- loss of interest or enjoyment
- indecisiveness or concentration problems
- feelings of worthlessness or guilt
- thoughts of death or suicide
- agitation or inhibition
- fatigue or loss of energy
- insomnia or excessive sleep
- change in appetite or weight
A mild depression is a depression with three or four of the above symptoms. A severe depression is a depression
with five or more of the above symptoms. The severity of the depression is determined in part by the duration and
intensity of the symptoms and the consequences for daily life and social functioning. Besides the distinction in
severity, two other forms of depression are distinguished: the bipolar disorder and psychotic depression. A bipolar
disorder is characterised by manic episodes followed by episodes of severe depression. A psychotic depression is a
severe depression that is accompanied with hallucinations and delusions.
Fear of failure
Fear of failure is where someone feels anxious about failing to perform at the expected level. If students experience
a certain tension (exam stress) during their studies, this is not a problem in itself; in fact it can lead to better
performance. It becomes problematic if this tension becomes an obstacle to delivering the required performance.
Anxiety about an assignment or task (presentation, paper) can completely dominate thinking and also cause physical
reactions such as heart palpitations, sweating, stomach problems, bowel problems, headaches, insomnia or
hyperventilation. The invisibility of the disorder can lead to a lack of understanding.
A distinction is sometimes made between active and passive fear of failure. People who suffer from the active form
are never satisfied with their preparation and are often considered to be perfectionists. People with the passive form
are immobilised; they have enormous difficulty executing a specific task.
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Students with fear of failure often have a negative self-image. If they do succeed, this is attributed to external
factors, while poor results confirm their negative self-image.
Anxiety disturbances
The difference between normal anxiety and anxiety disturbance is not always easy to determine. With anxiety
disturbance, the anxiety is extreme and often unrealistic, which is so troublesome that daily life becomes seriously
restrained. There are various types of anxiety disturbance and varying forms of expression, such as panic disorder,
phobias and generalised anxiety disorder. The invisibility and lack of familiarity with these disturbances can create a
lack of understanding.
A panic attack can cause students to terminate their studies. Absenteeism and limited stamina can also result. The
students become uncertain and susceptible to stress, which can lead to social limitations and isolation.
Borderline
This is a personality disorder which is accompanied with symptoms such as anxiety, depression and confusion. Its
basic characteristics are impulsiveness and emotional instability. Many characteristics can lead to a totally different
picture in combination with others. For example, with some patients a single aspect can become highly apparent (with
men, alcohol abuse; with women, eating disorders), while other borderline patients suffer from all characteristics in a
mild form.
Addiction issues, not only drug and alcohol abuse but also eating disorders, are sometimes difficult to see and are
very stubborn. These students often ask for help at a late stage or perhaps not at all. Such students have high
expectations of themselves and others, which quickly results in disappointment. They have a negative self-image and
difficulty with relationships, but also with being alone.
General information
Besides the above symptoms, most people with psychological problems also suffer from fatigue and an inability to
concentrate, which may or may not be due to the medication used in their treatment. This is not always apparent and
can lead to additional problems in the educational setting.
Problems in the educational setting
Impairments can occur with:
- interim examinations
- studying subject matter
- taking classes, regarding both processing information and attendance
- completing individual assignments
- participating in project groups, making presentations and collaborating
- practicals, internships, fieldwork
Possible measures and facilities
- Spaces for resting
- Possible separate room for exams
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Educational measures
- Flexible attendance rules
- Oral exams given by a teacher whom the student trusts
- Customised programme (in consultation with the student dean and/or study advisor)
- In the most extreme case, terminating the study
Tips for teachers
- Provide clear feedback
- Offer possibilities for later submission dates
- Acquire advice from experts (such as the Student Counselling Service)
- Provide assistance during internships
- If possible, have students give presentations together or in front of a small audience
Tips for students
- Talk with a student dean about what your obstacles and solutions are
- Despite fatigue due to psychological problems, try to continue studying anyway, possibly with additional help
- Use active learning (underlining, summarising, reading aloud)
- Work at home
- Record lectures
- Make realistic plan
- Keep a ‘concentration diary’ and work at times when your concentration is at a peak
- Provide a clear explanation to the project group (possibly following consultation with a student dean, study
advisor or teacher)
Make agreements about expectations, possibilities and limitations for an internship or thesis (including internship
contract and/or thesis's contract)
Sources and references
- www.handicap-studie.nl (part of the site available in English)
- www.mentalhelp.net (information on psychological problems; in English)
- http://www.sleepnet.com (all about sleep(problems; in English)
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Visual limitations
Visual limitations are visual disorders where vision is limited or entirely absent.
Examples include glaucoma, retinitis pigmentosa, blindness and tunnel vision.
Characteristics
Blurry vision, limited field of vision, limited depth of field, limited colour perception and limited adaptation to light or
dark conditions.
Consequences
Problems with communication (nonverbal communication is not perceived), safety, navigation, reading, writing,
handling and using certain objects.
Problems in the educational setting
Problems can occur especially with written activities during the study, such as exams or papers, but also when using
computers, taking classes and participating in practicals or project groups. By means of good preparation and
knowledge of the student's limitations, many of these problems can be prevented. It takes additional effort to study
with a limitation, but the activities of daily living also require more effort; as a result, many visually impaired students
are also troubled by energy problems.
Possible measures and facilities
- Computer modifications, such as a Braille line and Braille printer, speech synthesis or enlargement software
(screen magnifier)
- Individual study space with modified computer and other facilities such as additional light
- Digital agenda
- Voice recorder for taking notes
Educational measures
- Additional supervision
- Study partners to take notes or read the study material out loud
- Additional breaks
- Expert advice
- Permanent contact person for schedule changes, possible help with navigating to classrooms
- Agreements about labs or practicals, including additional supervision and agreements that actions which do not
have to be performed can be described orally (possible exemption for specific components or a replacement
assignment, permanent lab partner)
- Send information from the study programme via e-mail
- Alternative assignments or subjects (for example as an alternative for labs or practicals)
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Tips for teachers
- Be aware that body language is not perceived or is perceived poorly
- Use clear language, ask clear questions, provide clear information and advice
- Use an appropriate voice tone. This will prevent misinterpretation
- Supply material digitally: e-mail information/names/addresses so that students are capable of reading them with
enlargement software
- Supply reading list promptly (convert into Braille/spoken book/digital form)
- Explain the illustrations and hyperlinks
- Summarise lectures, videos and other visual presentations
- Provide additional time for reading
- Offer possibilities for making oral explanations and submitting recorded papers
- Allow students to give a presentation instead of writing a paper
- Split assignments into smaller parts
- Diagnostic tests (make a trial test to determine how questions should be asked, to try out your adaptations and
to split up the material on the exam)
Taking exams
Among other things, provide extra time, use a large typeface, offer individual exam space, speech recognition and
speech synthesis
Tips for students
- Ensure that everyone who needs to know understands that you have a visual limitation by telling them yourself,
or ask the official facilitator to do so. Ensure that the teachers are informed in advance about how they can take
your limitation into account
- Ask another student if you can copy their notes (enlarged)
- Make clear agreements about information provision (e.g. via e-mail), for instance ask the teacher to e-mail the
notes
- For lectures, presentations and other activities where visual or video material is used, request a summary or
explanation beforehand
- Use a voice recorder for taking notes
- If necessary, ask if you can take written exams orally
- Find out how severely your limitation can be an obstacle in your career. For example, find an internship location
where the possibilities and limitations are obvious
- Survey the accessibility of the faculty and a possible internship location, take measures where possible
- Provide an internship report or portfolio presentation as part of the evaluation; as a result you will be less
dependent on the personal opinion of your internship supervisor and you will be given an extra opportunity to
demonstrate your capabilities
Sources and references
- www.handicap-studie.nl (part of the site available in English)
- www.dedicon.nl (provides audio books on CD and accessible text files via internet; parts of the website available
in English)
- www.nvbs-jongeren.nl (interest group for visually impaired and blind young people and students; only in Dutch)
- www.visio.org/Home (Visio provides information, advice and various forms of revalidation, supervision, education
and housing for people with a visual impairment; only in Dutch)
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Information about services provided to students with
a functional limitation
Useful addresses at Wageningen University
- Student physician
Duivendaal 4, 6701 BH Wageningen
tel. 0317 484022
e-mail: [email protected]
- Student psychologists
Duivendaal 4, 6701 BH Wageningen
tel. 0317 482027 / 486830 / 482133
e-mail: [email protected]; [email protected]; [email protected];
- Student deans
Forum, Droevendaalsesteeg 2, 6708 PB Wageningen
tel. 0317 483618
e-mail: [email protected]
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