![](media/image1.png){width="1.2034722222222223in"
height="1.0in"}National Aeronautics and

# Space Administration

**People With and Without Disabilities:**

## **Interacting & Communicating**

![](media/image2.jpeg){width="4.25in" height="3.178472222222222in"}

Photo courtesy of National Multiple Sclerosis Society

Equal Opportunity Programs Office

Goddard Space Flight Center

# Revised July 2005

For the latest version of this booklet, please go to our Web site at:

**http://eeo.gsfc.nasa.gov/disability/publications.html**

People With and Without Disabilities: Interacting & Communicating

This publication was prepared for all Goddard employees, especially
those who have supervisors, managers, employees, or co-workers with
disabilities. It is intended to provide general information and
suggested behaviors that will increase the efficacy of interaction and
communication.

This publication will be updated regularly. For the latest version of
this document, including additional features, please go to the
Publications Web page of the Program for People with Disabilities, Equal
Opportunity Programs Office, Goddard Space Flight Center, National
Aeronautics and Space Administration.

You can find this booklet at:
http://eeo.gsfc.nasa.gov/disability/publications.html

This publication is available in an alternate format upon request.

For further information, please contact the author:

Michael J. Hartman\
Program Manager for People with Disabilities\
E-Mail: <Michael.J.Hartman@nasa.gov>

Telephone: (301) 286-5715, voice and TTY

**Equal Opportunity Programs Office\
Code 120\
Goddard Space Flight Center\
Greenbelt, MD 20771**

**(301) 286-7348, voice and TTY**

**http://eeo.gsfc.nasa.gov**

![](media/image3.jpeg){width="4.322222222222222in"
height="3.2333333333333334in"}

Photo courtesy of National Multiple Sclerosis Society.

**People With and Without Disabilities: Interacting & Communicating**

![](media/image4.png){width="1.09375in" height="0.9152777777777777in"}

People With and Without Disabilities: Interacting & Communicating

[INTRODUCTION](http://eeo.gsfc.nasa.gov/disability/#intro)
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1

[ALL PEOPLE WITH DISABILITIES](http://eeo.gsfc.nasa.gov/disability/#all)
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3

[LANGUAGE CONSIDERATIONS](http://eeo.gsfc.nasa.gov/disability/#language)
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4

[ACQUIRED BRAIN INJURIES](http://eeo.gsfc.nasa.gov/disability/#acquired)
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7\
People with an Acquired Brain Injury

[AMPUTATION](http://eeo.gsfc.nasa.gov/disability/#amputation)
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9\
People Who Have Had an Amputation

[ATTENTION DEFICIT
DISORDER](http://eeo.gsfc.nasa.gov/disability/#attention)
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10\
People Who Have an Attention Deficit Disorder\
People Who Have an Attention Deficit Hyperactivity Disorder

[AUDITORY](http://eeo.gsfc.nasa.gov/disability/#auditory)
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12\
People Who Are Deaf Or Hard of Hearing

[COGNITIVE](http://eeo.gsfc.nasa.gov/disability/#cognitive)
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18\
People with Autism\
People Who Have an Intellectual Disability

[EPILEPSY](http://eeo.gsfc.nasa.gov/disability/#epilepsy)
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21\
People with Epilepsy or Other Seizure Disorder

[HIV and AIDS](http://eeo.gsfc.nasa.gov/disability/#HIV)
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22\
People Who Have an HIV Infection or AIDS

[LEARNING DISABILITIES](http://eeo.gsfc.nasa.gov/disability/#learning)
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23\
People with a Learning Disability

[MOBILITY](http://eeo.gsfc.nasa.gov/disability/#mobility)
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26\
People Who Have a Mobility Disability\
People Who Had Polio or Have Post-Polio Syndrome\
People Who Have Had a Spinal Cord Injury\
People Who Use a Wheelchair

[MUSCULAR/NEUROLOGICAL](http://eeo.gsfc.nasa.gov/disability/#muscular)
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29\
People with Cerebral Palsy\
People Who Have Multiple Sclerosis\
People Who Have Muscular Dystrophy\
People Who Have Had a Stroke

[PSYCHIATRIC](http://eeo.gsfc.nasa.gov/disability/#psychiatric)
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31\
People with, or Have History of, a Psychiatric Disability

[SPEECH](http://eeo.gsfc.nasa.gov/disability/#speech)
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34\
People Who Have a Speech Disability

[TOURETTE](http://eeo.gsfc.nasa.gov/disability/#tourette)
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35\
People with Tourette Syndrome

[VISION](http://eeo.gsfc.nasa.gov/disability/#vision)
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36\
People Who Are Blind Or Have Low Vision

[AFTERWORD](http://eeo.gsfc.nasa.gov/disability/#after)
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40

INTRODUCTION

NASA\'s Goddard Space Flight Center is dedicated to the principle of
inclusion for people with disabilities. We have made great strides in
making our physical environment convenient for all people. In recent
years, Goddard has been proactive in recruiting people with disabilities
as interns, and as participants in our cooperative education program, in
addition to other student \"pipelines.\" As always, we continue to
recruit and hire individuals with disabilities into our permanent work
force.

We recognize, however, that we need to do more than merely provide an
accessible campus and invite people in. While there are legislative
requirements and standards to guarantee physical access and to remove
programmatic barriers, we have an additional goal. We strive to diminish
attitudinal and communication barriers that are less obvious than
physical barriers, but just as critical to ensure success for employees
with disabilities.

This publication is written to suggest ways to promote effective
communication between people with and without disabilities. In general,
there is nothing extraordinary about such communication; however, using
the suggested behaviors could bridge some of the perceived and real
distinctions between co-workers. This booklet is not intended to address
reasonable accommodation, unless an accommodation would promote more
effective communication and interaction.

People with disabilities are just people who may happen to have
difficulty with basic life activities, such as walking, moving, talking,
learning, breathing, seeing, or hearing. It is important to understand,
though, that not all conditions, illnesses, or diseases rise to the
level of a disability as defined by law. Nonetheless, the suggested
behaviors found in this document should facilitate communications with
all individuals, with and without disabilities.

Some of the biggest barriers faced, and the hardest to remove, are
stereotypical thinking about, and erroneous images of, people with
disabilities, often resulting in feelings of pity, fear, paternalism, or
disdain. People with disabilities are often wrongly perceived as
helpless, confined, sick, needy, of limited intelligence or capacity, or
as victims.

There is no particular personality type for people with disabilities in
general, nor for individuals with the same disability. Furthermore, each
person has his or her unique strengths and weaknesses, likes and
dislikes. Therefore, it is important to remember that the suggestions in
this booklet are designed to facilitate the interactions, but they will
not automatically improve the quality of relationships, among co-workers
with and without disabilities. Once the communication barriers are
diminished, it is up to the individuals involved to create their own
mutually acceptable relationship. It is important to note also that what
is

appropriate for one person might not be appropriate for another person,
even if

the two people have the same disability. So, when in doubt, ask your
colleague what he or she prefers.

There are some people who, because of fear or discomfort, will avoid
interacting with people with disabilities. Other people simply do not
know what appropriate behavior is when around a person with a
disability. Learning that people with disabilities are fundamentally no
different from people without disabilities helps reduce fear and
avoidance. People with disabilities, like all other large groups of
people, represent a full range of personalities. Put simply, some are
nice, some are not; some are easy to work with as colleagues, some are
not; some you would like as friends, some you would not.

This booklet is arranged into broad disability groups. It does not
attempt to discuss every disability or condition, only those where
specific behaviors might be preferred when interacting and
communicating.

Within each segment, there are two sections. \"General Information\"
provides an introduction and basic overview of the disability.
\"Suggested Behaviors\" provides a variety of options that will be
appropriate in most situations.

Finally, it is important to recognize that there are many people with
hidden disabilities or conditions that may not be immediately apparent.
These include, but are not limited to, alcohol or other addictions,
allergies, asthma, arthritis, cancer, chronic fatigue, chronic pain,
diabetes, environmental illness, fibromyalgia, lung disease, kidney
failure, hemophilia, hypertension, fragrance sensitivity, as well as the
early stages of Multiple Sclerosis, Muscular Dystrophy, Amyotrophic
Lateral Sclerosis, Parkinson\'s Disease, heart disease, and other
conditions or disabilities.

People are very often affected by these hidden disabilities and
conditions in ways that are less obvious, but no less severe than
visible disabilities. Though there are usually no special communication
needs, it should be noted that they are, nonetheless, bona fide
disabilities. As such, they may require reasonable accommodations but
are not included in this booklet, which will focus only on interaction
and communication.

**FOR ALL PEOPLE WITH DISABILITIES**

GENERAL INFORMATION

A person with a disability does not necessarily need help. Most people
with disabilities try to be as independent as possible and will ask for
assistance only if they need it. However, if you see a situation in
where you think you might be of some assistance, ask, but do not insist
that the person accept your aid.

If your offer for assistance is accepted or requested, ask how you can
best be of help, and then try to do it with minimum attention drawn to
the person with a disability, yourself, or your activities. Don\'t be
embarrassed to admit that you don\'t know what to do or how to help.
Simply ask the person for guidance, and he or she will instruct you.

SUGGESTED BEHAVIORS

When talking with a person with a disability, speak and ask questions
directly to the person rather than to a companion, interpreter, or aide
who might be accompanying that person.

Use first names only when socially appropriate, and when you extend the
same familiarity to all others.

Ask questions when you are unsure of what to do.

Maintain eye contact without staring.

Use a natural tone of voice and body gestures.

If a person has a service dog or other assist animal, do not pet or
otherwise distract the animal when it is working i.e., when the harness,
jacket, special leash, or other designation is worn or displayed. If the
person offers to let you interact with the assist animal, ask for
direction in how to do so.

**LANGUAGE CONSIDERATIONS**

The way we describe people with disabilities, like other stigmatized
minorities, has changed so the words we now use are more accurate and
appropriate. Words and phrases we have used in the past have been
factually incorrect or hurtful and should be avoided. A sampling of
these words and phrases include: cripple, crippled, invalid, retard,
sick, victim, afflicted, suffering from, deaf mute, mute, deaf and dumb,
wheelchair-bound, or confined to a wheelchair.

The language we use, and the images that we create and promote through
language, reflect the attitudes we have towards any particular group of
people. Our language is picked up and emulated by others around us. The
preferred words and phrases show respect for the dignity of people with
disabilities.

We sometimes make the mistake of speaking as if all people with a
certain disability, or all people with disabilities, share the same
characteristics, have the same needs, or think and act the same. We also
use adjectives as if they were nouns; we speak of \"the deaf\" or \"the
blind.\" Group designations such as \"the blind,\" \"the deaf,\" or
\"the disabled\" are inappropriate because they do not reflect the
individuality of people with disabilities.

When writing or speaking about people with disabilities, it is important
to put the person first. Often, the focus is wrongly placed on the
disability instead of on the person by naming the disability first. We
refer to \"blind people\" or \"a deaf accountant.\" Some people describe
this concept as \"people-first\" language where the individual is
recognized as a person first, and then further defined in terms of his
or her characteristic, disability, or functional limitation. Although
this is sometimes verbally cumbersome or awkward or lengthy to write,
you will not be wrong in speaking and writing thus. However, as with all
other things, check with the person with whom you are interacting to see
if he or she has a preference.

Some examples of \"people first\" language:

A person with\... a physical disability, muscular dystrophy\
A person who uses\...a wheelchair, an interpreter, an assistive device\
A person who is\...Deaf, blind, autistic\
A person who has\... multiple sclerosis, cerebral palsy

Likewise, services and programs do not have disabilities, but they are
provided for people who do. So we should not write or speak about
\"disabled services\" and \"handicapped parking.\" A better way to
convey these ideas would be \"services for people who are disabled\" and
\"parking spaces designated for people with disabilities.\"

Do not feel guilty or embarrassed you can do something that he or she
cannot. You can talk about things that a person may not be literally
able to do. You can say to a person who is blind, \"You have got to see
that play,\" a person who is Deaf, \"Did you hear about John?\" or a
person who uses a wheelchair or has a mobility disability, \"Why don\'t
we run over to the market.\"

Our attitudes towards people with disabilities are revealed when talking
about people who are not disabled. When we say \"able-bodied\" or
\"normal,\" we must be aware of the implication and subtle message we
are sending that says we feel people with disabilities are not \"able\"
or \"healthy\" or are \"abnormal.\" A more appropriate way to say this
would be \"people without disabilities\" or \"people who are not
disabled.\" This also applies to programs or services provided for
people who are not necessarily disabled that are described as, for
example, \"regular\" with the implication that services provided to
people with disabilities are \"irregular.\" Instead, you might say,
\"typical\" programs.

Not all people with disabilities agree on which language or terminology
is preferred. Like any other large, diverse, yet identifiable group of
people, individuals will vary as to how they refer to themselves and how
they prefer others to refer to them. The suggestions given above will
apply to most people and be correct in most situations. Some examples of
other terminology that some people with disabilities have chosen to
identify themselves as are \"physically or mentally challenged\" and
\"handicappers,\" while others still talk about themselves as
\"handicapped.\" It is important to remember that when talking to a
person, ask what he or she prefers.

Here are some examples that exemplify these language principles:

USE: person with an intellectual, cognitive, or developmental
disability\
NOT: retard, mentally defective

USE: person who is Deaf or hard of hearing, chooses to not speak, or
uses

synthesized speech\
NOT: the deaf, deaf and dumb, suffers a hearing loss, dumb, mute

USE: person who uses a wheelchair\
NOT: confined or restricted to a wheelchair, wheelchair-bound

USE: person who has muscular dystrophy\
NOT: stricken, afflicted, suffers from, or victimized by muscular
dystrophy

USE: person with a physical disability or a person who has functional
limitations\
NOT: crippled, lame, deformed, the walking wounded

USE: person with a psychiatric disability\
NOT: crazy, nuts, \"gone Postal\"

USE: person who is successful or productive\
NOT: has overcome his/her disability, is courageous (when it implies the
person

has courage because of having a disability), in spite of a disability

USE: person who is seeking accommodations or working accommodation
issues\
NOT: person who is having employment problems

**ACQUIRED BRAIN INJURY**

**People with an Acquired Brain Injury**

GENERAL INFORMATION

Acquired brain injury (ABI) can be caused by direct injury, external
physical forces applied to the head, hemorrhage, swelling or may occur
suddenly in the course of normal development. Other conditions that can
result in a brain injury include heart attacks, aneurysms, chemical and
drug reactions, breathing difficulties, infections, a car or other
accident, and lack of oxygen to the brain. The injury may affect several
areas of the brain and may be either closed or open head in nature.

In many cases, an ABI will result in an increased need for support in
one or more of the following areas: physical capacities (i.e., the way
we move and manipulate things); cognitive capacities (i.e., the way we
think and process information); and behavioral and emotional capacities
(i.e., the way we act, tolerate, and feel).

People who acquire brain injuries typically experience a variety of
symptoms. These symptoms can vary in intensity over time, and could
interact in unpredictable ways.

Physical Symptoms may include persistent headaches, fatigue, seizures,
lack of motor coordination, weakness or involuntary muscle activity,
double vision, partial loss of vision or hearing, delayed or difficult
speech, sleeping disorders, and communication disabilities.

Cognitive Symptoms may include short and long-term memory loss,
confusion, limited attention span, delayed response time, inability to
make decisions, gaps in knowledge and skill, and difficulty managing two
or more tasks simultaneously.

Behavioral/Emotional Symptoms may include inappropriate behavior,
\"disinhibition\" (lack of inhibitions or appropriate boundaries), mood
swings, depression, irritability, impulsivity, and denial of the
disability. It should be noted that many individuals who have had an ABI
experience some form of agitation during recovery.

With reasonable accommodations, though, all of these symptoms can, for
the most part, be mitigated.

SUGGESTED BEHAVIORS

If the person\'s memory is affected, provide written information and
instructions.

Break tasks into smaller sequential steps that are clear, consistent,
and concise to increase understanding and remembering.

Verbally explain and demonstrate how to do a task.

Provide frequent feedback and recognize successes especially as new
skills or gains are acquired.

Redirect a conversation that has gotten off track by using appropriate
cues and reinforcers. For example, repeat important information about
the purpose, duration, and guidelines of a meeting, or other type of
gathering; summarize previous progress and review where previous
meetings left off.

Follow-up spoken communications with a written communication (such as an
e-mail or memo) to assist a person who may have memory support needs.

When asked to repeat a statement, use the same words and then paraphrase
it for greater comprehension.

Provide only as much information or feedback as the person is capable of
receiving and processing at any one time.

**AMPUTATION**

**People Who Have Had an Amputation**

GENERAL INFORMATION

Amputation is the removal of all or part of a limb. An amputation may
occur as the result of an accident or as a surgical intervention for a
medical condition. Most amputations are for people who have wounds that
do not heal properly due to vascular disease, atherosclerosis, and blood
clots. Amputation may also be carried out to prevent the spread of
cancer in the lower end of a limb.

\"Phantom pain\" is a sensation felt by a person who has had a limb
amputated. The sensation has been described as one of a compressing,
contracting, or a bent feeling in the absent body part. Some individuals
may also feel an aching or burning pain, where the extremity was. The
sensation is caused by stimulation along a nerve pathway, where the
sensory ending has been severed in the amputated body part. The pain
usually lasts between 2 to 3 months after the amputation, although some
individuals experience phantom pain for years.

Some persons who have had an amputation replace the missing limb with a
prosthetic device. Prosthetic devices vary greatly in appearance and
function. Some are made to look like biological limbs, while others do
not. Some prosthetic hands have a grasping device that looks much like a
hook to manipulate objects. Prosthetic hands, arms, legs, and feet
function much the same as natural limbs with similar flexibility,
strength, range of motion, and function.

SUGGESTED BEHAVIORS

Think of the prosthetic limb or device as you would a biological hand,
arm, or leg.

When introduced to a person with a metal grasping device or an
artificial hand, it is appropriate to offer to shake the device or
artificial hand.

Some people who have nonfunctioning or missing right hands prefer to
shake hands with their left hand. Take your cue from the individual.

If the person does not have arms, it is appropriate to gently grasp his
or her shoulder in a collegial manner or device in lieu of shaking
hands.

**ATTENTION DEFICIT DISORDER**

**People Who Have an Attention Deficit Disorder or an Attention Deficit
Hyperactivity Disorder**

GENERAL INFORMATION

Attention Deficit Disorder (ADD) is defined as a persistent pattern of
inattention that is more frequent and severe than behavior seen in
individuals of a similar age. Add hyperactivity and impulsiveness to
this condition, and you get an individual with Attention Deficit
Hyperactivity Disorder (ADHD). This section will focus primarily on
individuals with ADHD because that is the more severe of the two
conditions. There are many more factors involved with ADHD than ADD. So,
while this section will focus mainly on ADHD, the information does, for
the most part, apply to an individual with ADD as well. Both conditions
generally have an onset prior to the age of seven, but symptoms may be
diagnosed at an earlier age, or not until the individual is an adult.

The exact cause of ADD and ADHD is not known at this time, but
researchers have found that they are neurologically based. The
conditions lie in a person\'s neurotransmitters \-- the chemicals that
regulate brain behavior.

ADHD and ADD are not learning disabilities. ADHD is a behavioral
condition that is characterized by impulsiveness and an inability to pay
attention for more than a set period of time. This attention span varies
with each individual. The condition might cause some individuals to make
mistakes on the job, but these mistakes are usually a result of their
ADHD, not a reflection on their ability to learn. This differs from
learning disabilities, which refer to specific developmental disorders
associated with learning and the ability to process or interpret
information.

While adults with ADHD might find it challenging to focus their
attention for extended periods of time, meet deadlines, follow up on
assignments, or to organize their offices, desks and materials, most are
able to effectively find coping mechanisms that help them to adapt to
their disability, and they can and do thrive professionally. Thus, there
should be no ADHD-related barriers to increased responsibilities and
career development. As such, there is no need to restrict the nature or
the amount of work that is assigned to a person with ADHD.

If a person with ADHD is taking medication, there might be side effects.
For example, the medication could exacerbate the symptoms of other
conditions such as Tourette Syndrome.

One effective, coping mechanism is to maintain a structured, consistent,
predictable daily schedule. It may also be helpful if the employee is
able to limit the number and kinds of distractions in his or her work
area.

SUGGESTED BEHAVIORS

Communicate in direct, clear terms. Be patient, specific, and
consistent. Apply structure whenever possible in communication and work
tasks.

Ask clarifying questions throughout the conversation to ensure that the
person is grasping the information provided. Repetition may be
necessary.

For new employees, clearly state expectations, policies, and procedures,
as well as both defined and \"hidden\" rules in the organization.

Allow for several short breaks during a long meeting or workshop rather
than one long break. People with ADHD have the most difficulty in
situations that require prolonged periods of attention.

If tasks are regularly performed, it is helpful to work with the
employee to develop a book of procedures to assist you in communicating
instructions for these tasks.

**AUDITORY**

**People Who Are Deaf or Hard Of Hearing**

General Information

The term \"deaf\" refers to a profound loss of hearing. Persons are
considered deaf if they are unable to hear or understand speech and must
rely on vision for communication. The term \"hard of hearing\" refers to
a hearing loss from mild (i.e., difficulty with or inability to hear
soft sounds) to severe (i.e., difficulty with or inability to hear loud
sounds). The severity of a person\'s hearing loss may be different at
various frequencies. Also, the ability to hear a voice might be
different from the ability to discriminate between sounds and to
understand speech. Some people cannot hear voices but can hear
environmental sounds.

Deafness is unlike other disabilities in that the same term is used to
refer to two distinct groups of people. Those who consider themselves
\"deaf\" (written with a lower-case \"d\") have a profound hearing loss
but identify primarily with the hearing culture. Those who consider
themselves \"Deaf\" (written with an upper-case \"D\") consider
themselves to be a member of the Deaf Community, which generally
perceives hearing loss to be a cultural and communication distinction
rather than disability. These communities no longer commonly use the
term \"hearing impaired.\"

People who refer to themselves as \"Deaf\" often have Deaf parents and
have attended state schools for children who are Deaf. For this
population, American Sign Language (ASL) is the primary language. ASL is
a linguistically recognized language with its own vocabulary,
grammatical rules, and syntax that allows users to express themselves
fully. It employs a subtle combination of hand, face, and body movements
to convey messages. ASL is a completely separate language from English
and follows neither the word order nor grammar rules of English. It is
important to remember that, for people who use ASL as their primary
language, English is a second language. Just as in the general
population, the ease and competence with which someone learns a \"second
language\" varies widely.

ASL is not a universal sign language. People who are Deaf from other
countries use their own unique culturally determined Sign Language such
as French Sign Language or Spanish Sign Language.

Some people who embrace their Deaf culture take pride in their deafness
and do not necessarily seek to be integrated into the hearing world.
They celebrate their Deaf experience through drama, poetry,
storytelling, dance and other uniquely Deaf art forms that are passed
down from one generation to the next.

People who refer to themselves as \"deaf\" often relate more easily with
the hearing culture. Often these people have hearing parents and have
attended public schools in mainstreamed classes. People who are deaf
typically do not use ASL as their primary communication method. Instead,
they use an English-based sign system to communicate with each other and
with hearing people who know that communication method.

Persons who lose their hearing later in life, sometimes referred to as
\"late deafened,\" may have different communication preferences and rely
on residual hearing, lipreading, captioning, or perhaps an English-based
sign system.

The ability and facility to communicate orally often depends on when the
individual became deaf. People who lost their hearing after the
development of their speaking skills may have little difficulty
speaking. In contrast people who were born without hearing, or who lost
it at a very early age, may experience difficulty in learning to speak,
though this is not always the case. Because speech develops as one
listens to others and imitates the sounds heard, vocal communication can
be more complicated for people who have never heard speech than for
those whose hearing loss developed later in life. Many persons who have
a hearing loss learn to use their voices in speech class and prefer to
communicate vocally. Others choose to communicate in variety of other
ways, including sign language, speechreading (also known as lipreading),
cued speech, and writing.

People with a hearing loss communicate with people who are hearing in a
variety of ways. Some do so with assistive technology, such as Assistive
Listening Devices, Cochlear Implants, or reliance on various kinds of
hearing aids.

Assistive Listening Devices include large and small area amplification
of spoken speech. Very simply stated, Cochlear Implants are surgically
embedded devices that change the acoustic signal of sound into an
electrical stimulus. Through both external and internal devices the
auditory nerve is stimulated and that information is transmitted to the
brain.

Assistive technology that presents a text rendition of spoken language
includes CART (Computer Assisted Real Time Captioning) and another
method called \"C-Print Captioning.\" Both of these methods utilize a
hearing person who listens to the speaker, inputs the spoken word into
an electronic word processor, and produces written English onto a screen
or other kind of display.

Individuals with a hearing loss sometimes use a telephone relay service.
The relay service operator communicates with the person with a hearing
loss through a TTY (a telecommunications device for people with a
hearing loss or have speech disabilities) and with the person who is
hearing through the telephone. The operator, who is not an interpreter,
voices the TTY message and types the spoken message between the
participants in the conversation.

A relatively new technology allows for Video Relay services where a
qualified interpreter, in a remote location, communicates with the
person with a hearing loss via the Internet with a web camera and the
person who is hearing through the telephone and provides interpreting
services between the two individuals.

Many people with a hearing loss prefer to use a qualified professional
interpreter to facilitate communication. The need for an interpreter
depends on the situation and the people involved. The term interpreter
here is meant as a general term for both interpreters and
transliterators.

A qualified interpreter facilitates and culturally mediates
communication between people who do not share a common language or means
of exchanging messages. Interpreters bridge this communication gap by
rendering the message of one person to another in the most appropriate
language for the participating consumers. This communication need is
shared by all of the persons involved. Interpreters transmit messages
using one or more of the following modes of communication: spoken
English, ASL, an English based sign system, cued speech, or the oral
method (utilizing lip movements, but no voice and no signs). The mode is
fundamentally dependent on the preference of the individual with a
hearing loss.

Professional certified interpreters all follow a Code of Ethics
developed by their certifying organization. While there are some
differences among various codes, which are reviewed and revised from
time to time, virtually all of the codes share some basic concepts.
These concepts most likely will include, but are not limited to,
confidentiality, faithful rendering of the message, non-intervention,
discretion when accepting assignments, competency, integrity,
compensation, appropriate behavior, responsiveness to consumers, and
professional development.

The two national certifying bodies for professional interpreters, the
Registry of Interpreters for the Deaf (RID) and the National Association
of the Deaf (NAD), have recently formed the National Council on
Interpreting (NCI) to develop a National Interpreter Certification (NIC)
test. This new test replaces certain RID and NAD certification testing.
Certification will be awarded by the NIC.

If the person with a hearing loss chooses to use an interpreter, here
are some guidelines that will facilitate the process.

COMMUNICATING THROUGH AN INTERPRETER:

When using an interpreter, communicate directly with the person with a
hearing loss, rather than speaking as if he or she were not there. Avoid
phrases such as, \"tell him\...\" Ask questions directly of the person
with a hearing loss, e.g., \"How do you feel about that?\" not, \"How
does she feel about that?\" Talk to, not about, the person with a
hearing loss. Talk through, not to, the interpreter.

Maintain eye contact with the person with a hearing loss, even as he or
she is looking at the interpreter.

At times, the person with a hearing loss may prefer to have the
interpreter voice the message that is communicated in sign. If this is
the case, remember to respond to the person with the hearing loss, not
the interpreter. Sometimes the gender of the person with a hearing loss
is different from the interpreter. Do not be confused by this,
especially on the telephone.

Be aware that the interpreter is there only to facilitate communication,
not to participate in the conversation or activity.

The person with a hearing loss should be consulted about where to place
the interpreter. This will usually be in a well-lit area near the
speaker. The person with a hearing loss should have a clear view of the
interpreter and any visual aids the speaker may use. Avoid bright lights
or colors directly behind the interpreter.

Adequate lighting of the interpreter is necessary at all times,
especially when the room is darkened.

Speak at a customary rate of speed, in a natural tone, and using usual
speech patterns.

As the interpreter will be a few words behind the speaker, allow
additional time for questions before continuing during a conversation,
meeting, or workshop.

Be mindful that the person with a hearing loss cannot watch the
interpreter and look at visuals simultaneously. Therefore, allow time
for people to look in each direction.

The person watching the interpreter usually cannot take notes
simultaneously so it is helpful to provide written instructions,
directions, or notes when possible. In a meeting, a volunteer note-taker
(perhaps a co-worker or clerical assistant) will be extremely helpful.

When planning a meeting or event, find out the preferred communication
mode of the person with a hearing loss, if possible, in order to obtain
the most appropriate interpreting services. In some specialized
situations, a person with a hearing loss may prefer CART or C-Print
captioning instead of a sign language interpreter.

Provide as much information about the meeting to participants, CART or
C-Print Captioning providers, and sign language interpreters prior to
the meeting time including acronyms, specialized vocabulary, correct
spelling of names, agendas, and speakers\' notes or prepared remarks.

SUGGESTED BEHAVIORS

To get the attention of a person with a hearing loss, vocalize a
greeting, and if necessary, discreetly wave your hand or gently tap the
person\'s shoulder. If you are entering his or her office and the
person\'s back is to you, you could flicker the room lights. Wildly
gesticulating, hitting the person, or throwing objects at the person is
not appropriate.

When speaking to an individual with a hearing loss, use meaningful
facial expressions and gestures to emphasize your intent and attitude.
This helps to visually display your tone of voice. Try to find a quiet
place away from computers, telephones, and other sources of noise that
has adequate lighting.

Pen and paper are handy communication devices in some situations.

Although you want to avoid gross or exaggerated arm waving, pantomime is
sometimes helpful.

Be aware that if you point to an object or area during a conversation
with a person with a hearing loss, that person will most likely turn to
look at where you are pointing. Wait to resume speaking until the person
faces you again.

When talking to an individual with a hearing loss, position yourself so
that any bright sunlight or other light is in front of you rather than
in back of you. Keep your face out of shadows. Illuminate your face as
much as possible.

Remove from your mouth objects such as pens, pencils, gum, or food. Keep
your hands or any other objects from covering your mouth.

If a person is speaking for himself or herself and you do not understand
that person\'s speech, it is appropriate for you to ask him or her to
repeat, or even write down what was said.

If the person has difficulty understanding something you\'ve said, try
repeating the phrase. If your message is still not understood, try to
rephrase your thought rather than repeating the same words. Do not raise
your voice or yell because the essential barrier is not the person
hearing you, it is the person understanding you. If needed, jot the
phrase down on paper.

Not all individuals with a hearing loss can lipread, but many do and
some do it quite well. Even good lipreaders, though, sometimes miss
words. It is important to check with the person to make sure you are
communicating effectively. When a person is lipreading you, enunciate
clearly, but do not overenunciate your

words, as you will distort your lip movements and make understanding
more

difficult. Use your voice when talking to the person so that your lip
movements will be more natural and the person can use his or her
residual hearing for better understanding.

Face the person when conversing so he or she can augment communication
by lipreading.

Try to learn some elementary or \"survival\" sign language and
fingerspelling from colleagues, coworkers, or managers who have a
hearing loss. Secondary resources could include interpreters or other
people skilled in sign language.

If you telephone a person who is hard of hearing, let the phone ring
longer than usual. Speak clearly and be prepared to repeat who you are,
and the reason for the call.

When talking with a person with a hearing loss, explain any interruption
(such as a phone ringing or knock at the door) before attending to it.

Provide written notices of events that are usually announced orally.
Arrange to have messages that are delivered by a public address system
relayed in writing.

At meetings, strive to enforce the process of only one person speaking
at a time. Some meeting facilitators use a small object such as a ball
or gavel to indicate whose turn it is to speak. This allows the person
with a hearing loss to easily identify who is speaking.

Provide paper and pencils at all tables to facilitate communication.

E-mail is a better way to communicate than voice mail. Make use of
\"Instant Messaging\" (IM) technology.

In meetings or on conference calls, each individual should identify
himself or herself by name to facilitate understanding, flow of ideas,
and exchange of information.

Be aware that when using an interpreter, there may be a need to be more
precise. For example, in English, there is a big difference between \"I
would\" and \"I will\". Yet, the sign that the interpreter would most
likely use is the same for both. Thus, it could be confusing unless the
interpreter adds the concept of \"if\" to the first phrase, such as,
\"If I were you, I would\...\" compared with \"I will\...\" The
interpreter may not make the distinction that in the first instance, the
speaker is suggesting that the listener do something, and in the second,
the speaker is taking the action. This is especially critical in
supervisor and employee conversations.

**COGNITIVE**

**People Who Have a Cognitive Disability**

GENERAL INFORMATION

\"Cognition\" refers to the ability to comprehend what you see and hear,
and to infer information from social cues and body language. People with
impaired cognitive functions may have trouble learning new things,
generalizing from one situation to another, and expressing themselves
through spoken or written language. Cognitive disabilities are sometimes
referred to as \"developmental disabilities\" because they are
manifested before the person reaches adulthood and they affect cognitive
development. As children, people with these kinds of disabilities might
have been classified in school with one of the following conditions:
learning disability, mental retardation (now called intellectual
disability), autism, multiple disabilities, having a head injury, or
Down syndrome.

When working with someone whose cognitive functioning is different from
yours, it is important to distinguish between learning and working style
preferences and disabilities.

**People with Autism** have a complex neurological disability that
affects the functioning of the brain, which typically appears during the
first three years of life. Autism ranges from mild to severe. Typically,
people with autism have some difficulties in verbal and non-verbal
communication, processing information, social interactions, and leisure
or play activities. They may exhibit repeated body movements (such as
hand flapping or rocking), unusual responses to people or attachments to
objects, and resistance to changes in routines. However, autism does not
affect intelligence. Therefore, many people with autism function very
well in the workplace and can perform the duties of virtually any job.

**People with Intellectual Disabilities (formerly mental retardation)**
may have average or superior abilities in some areas, while at the same
time, are slower to learn or retain skills in other respects.
Intellectual disability should not be confused with psychiatric
disability, learning disability, or behavioral and emotional disability.

While it is true that some people with an intellectual disability are
not able to think, reason, or remember as well as others, the effects of
the disability can be lessened. Skills and abilities are increased
through rehabilitation, education, and experience on the job.

Most people with an intellectual disability want to be independent and
responsible for their own support. For them, success on the job often
depends upon the willingness of coworkers to devote reasonable time and
interest to helping these individuals adjust initially and meet new
challenges as they arise.

To achieve workplace success, some people with an intellectual
disability may utilize a \"job coach\" to facilitate and support their
mastery over assigned tasks. This \"supported employment\" model helps
the employee navigate the workplace.

SUGGESTED BEHAVIORS

**Cognitive Disabilities \-- in general**

Be prepared to repeat what you say -- orally, in writing, or using
multiple formats \-- to communicate with the person.

Offer assistance in understanding written instructions and in completing
forms or documents.

Provide extra time for decision-making.

Be patient, flexible, and supportive. Take time to listen to, and
understand the individual and make sure the individual understands you.

Adjust the length of conversations to maximize the individual\'s ability
to remain attentive and decrease stress level.

Give instructions and have discussions in a quiet, informal,
distraction-free environment.

Describe job tasks clearly, concisely, and simply. Break down large
tasks into clearly defined small, sequential steps, keeping verbal
descriptions short and direct. Use concrete terms and avoid abstract
ideas

Establish tasks that include a set routine and consistent work.

**People Who Have Autism**

Remember that the person may have difficulty making eye contact and
interpreting nonverbal cues, such as facial expression, gestures, and
tone of voice in social settings

Be aware the person may be sensitive to touch, sounds, light, or color.

Be aware the person may tend to focus or fixate on particular objects or
topics of discussion.

Be aware the person may quietly talk to himself or herself frequently
throughout the day.

As the degree of impact of the disability varies tremendously with each
individual, it helps to ask the person for advice and guidance in
setting up his or her work environment. Things to consider would be the
amount of noise, light, and other distractions in the person\'s work
area.

Be aware the person may be socially awkward or shy.

As the person may have difficulty interpreting nonverbal cues, direct,
specific, and clear communication is important.

**People Who Have an Intellectual Disability**

Simplify and minimize wording in written and oral communications, but be
sure to retain the original meaning.

Periodically, ask the person if he or she understands you. Have him or
her paraphrase the meaning of your words and ideas to confirm this.
Likewise, repeat information back to the individual to show that you
understood what was said.

Routine and consistent job duties are usually the easiest to master. Add
new responsibilities only after previous duties have been learned.
Provide lists or checklists of job duties to help the person work
independently.

Ask the person how he or she learns best and can stay on track.

Demonstrate what needs to be done, and then let the person practice with
guidance and corrections from you.

**EPILEPSY**

**People with Epilepsy or Other Seizure Disorder**

GENERAL INFORMATION

A seizure occurs when there is a sudden electrical discharge in the
brain. Each individual is uniquely affected. A seizure can result in a
relatively slight reaction, such as a short lapse in attention, to a
more severe reaction, such as a loss of consciousness. Some seizure
disorders can be controlled with medication; however, side effects of
the medication may make the person lethargic or slow their reaction time
to situations. When controlled by medication, seizure episodes in the
workplace are rare. If a person discloses that he or she has such a
disorder, ask what to do in case of a seizure. Be mindful, though, that
some individuals may not disclose that they have epilepsy due to their
experiences with other people and societal stigma.

SUGGESTED BEHAVIORS

If a person is having a seizure, stay calm.

If the seizure lasts beyond a few minutes, or if the person seems to
pass from one seizure to another or does not regain consciousness after
the seizure episode ends, call for emergency assistance.

When the seizure begins, help ease the person to the floor. Helping the
person lie on one side often helps keep the airway open.

Do not try to stop the seizure. Do not try to \"revive\" the person
during the seizure.

Let the seizure run its course.

Do not move the person unless the environment in which the seizure
occurring is clearly dangerous.

Remove hard, sharp, or hot objects from the vicinity of the person to
avoid injuries, but do not interfere with the person\'s movements.

Loosen the person\'s tight clothing and remove his or her glasses.

Do not put your hand or any hard implement in the person\'s mouth to
hold down the tongue. Contrary to popular belief, the tongue cannot be
swallowed.

Make sure that breathing is unobstructed but do not be concerned if
breathing is slightly irregular.

**HIV and AIDS**

**People Who Have an HIV Infection or AIDS**

GENERAL INFORMATION

Medical and public health authorities have established that HIV
infection cannot be transmitted through casual, social contact as exists
in the vast majority of workplaces. Nor is HIV infection transmissible
through food or food handling. As a result, HIV transmission in the
workplace will rarely constitute a direct threat.

Workplace education emphasizing the fact that HIV and AIDS are not
transmitted by casual contact affords an employee a supportive
atmosphere in which to work. It will also serve to reassure co-workers
that they are not at risk and help preserve workforce productivity.

It is important to maintain confidentiality about any individual, but
our society has shown this to be particularly critical when considering
a person with HIV or AIDS.

SUGGESTED BEHAVIORS

The Centers for Disease Control and Prevention has stated that you
cannot contract HIV through casual contact. Your interaction should
reflect this understanding.

Be mindful that close co-workers, friends, and family members might feel
the stigma that is sometimes attached to persons with HIV or AIDS.

Do not pity, overreact, or be paternalistic to a person with AIDS or
HIV.

Because HIV and AIDS may be contracted in various ways, do not presume
to know the lifestyle of a person with AIDS or HIV.

**LEARNING DISABILITIES**

**People with a Learning Disability**

GENERAL INFORMATION

The term \"learning disability\" is used to describe a variety of
neurological disorders in acquiring, storing, retrieving, or expressing
information. In other words, learning disabilities involve speaking,
writing, or understanding in persons who have average or above average
intelligence. Manifestations include difficulty in oral expression,
listening comprehension, thinking, interpreting information, reading
skills, reading comprehension, written expression, spelling, reasoning,
organization skills, problem solving, or doing mathematical
calculations. A learning disability can also affect the social aspects
of a person\'s life such as team participation and interpersonal
relationships.

Although its impact can be lessened somewhat as a person develops and
learns adaptive techniques, a learning disability is a life-long
condition. A person is very likely to have a combination of two or more
learning disabilities in varying degrees rather than only one type.
Also, the instance of learning disabilities with Attention Deficit
Disorder or Attention Deficit Hyperactivity Disorder being present at
the same time is quite common.

It is not always apparent that a person has a learning disability. A
possible indication that a person has a learning disability is when he
or she performs in a way that seems inconsistent with his or her
intelligence or personality. For example, employees with unrecognized
learning disabilities may be perceived as clumsy, inefficient,
accident-prone, unmotivated, careless, slow, distracted, or inattentive.
In addition, they may seem to lack social skills or emotional maturity.

People with learning disabilities must discover their own personal
coping mechanisms to accommodate their specific learning disability.
Just as learning disabilities are unique, so too, are coping mechanisms.
Alternative work strategies can help people with learning disabilities
adapt. Once they learn new skills in an appropriate manner, they
generally perform to their maximum capability.

Some common types of specific learning disabilities that have been
identified are academic, perceptual, and motor. These types often
overlap in the way they are manifested.

The academic learning disabilities and the difficulties they present
include Dyslexia, reading; Dysgraphia, writing; Dysphasia, speaking; and
Dyscalculia, math.

The employee who has severe dyslexia, for example, often reads printed
matter by using computers and calculators with artificial speech. They
may ask another individual to read to them or they use audiotapes to
gather information. They usually prefer verbal rather than written
instructions.

Coping mechanisms for other learning disabilities follow similar
patterns of identifying the disability, and finding ways to work around
the barriers imposed by the disability.

People who have a perceptual learning disability have difficulty
receiving information through their senses. This includes auditory,
tactile and visual perception.

People with motor learning disabilities experience difficulty when their
muscles react differently than expected to brain signals, resulting in a
lack of coordination.

Other learning disabilities involve attention deficit, balance, crossing
the midline (going from the one side of the body to the other side of
the body), directionality, lack of inhibition, short-term memory, and
social skills.

SUGGESTED BEHAVIORS

Explain the organization\'s unique culture or \"politics\" and the
relationship between organizations and individuals, including the
\"hidden\" rules by which organizations or individuals operate. Openly
discuss the rules of \"turf\" and \"territory\" that other employees
might instinctively perceive and understand.

Recognize that some people with learning disabilities, especially when
not diagnosed, experience feelings of frustration, anger, inadequacy,
and low self-esteem. Once diagnosed, it is important to recognize these
feelings as being a result of the learning disability and to address
them openly and honestly.

Be firm about any limits that are set.

If inappropriate behavior is observed or reported, tell the person
exactly what behavior is inappropriate and what changes need to be made.

Reduce distractions and unnecessary visual and auditory stimulation.

Be thorough, direct, and specific in communication. Ask questions to
insure understanding. Allow adequate time for a response.

When giving instructions or directions, break large tasks into small and
clearly defined sequential steps.

Demonstrate how to do a task in addition to explaining it verbally.

Give frequent and constructive feedback.

Allow adequate time to learn certain skills.

Whenever possible, notify the person of changes well in advance.

Decide together the preferred way to communicate. This may be in
writing, verbally, or even by telephone.

For the employee who has difficulty with visual perception, it is
important to have neat and well-organized surroundings.

For people who read slowly, give advance notice of reading materials,
allow extra time, and prioritize the work. Audiotape written
communications. Provide graphic presentations such as diagrams and flow
charts when appropriate.

For people with auditory perception difficulties, catch their eye before
beginning a conversation. Talk in a quiet place. Ask them to repeat what
you said. If they take notes, allow them to finish writing before you
continue talking.

**MOBILITY**

**People Who Have a Mobility Disability**

GENERAL INFORMATION

Mobility disabilities include a broad range of disabilities that affect
a person\'s independent movement. Mobility disabilities may result from
cerebral palsy, spinal cord injury, stroke, Parkinson\'s Disease,
arthritis, muscular dystrophy, multiple sclerosis, amputation, polio, or
other conditions resulting in paralysis, muscle weakness, nerve damage,
stiffness of the joints, strength and endurance, short stature,
conditions like Osteogenesis Imperfecta (\"brittle bones\"), or lack of
balance or coordination.

Some people with mobility disabilities use manual or power wheelchairs,
while others use a variety of mobility aides, such as crutches, canes,
walkers, or scooters. Not every person who uses a wheelchair or other
mobility device is unable to walk; many use these devices to conserve
their energy, or to cover long distances. Prosthetic devices, such as
artificial arms or legs, and body braces might also be used. Some people
with mobility disabilities use service animals to assist them with
carrying or retrieving items and opening doors in order to achieve
greater independence.

The conditions that cause mobility disabilities each have distinct
characteristics. Some mobility disabilities are acquired at birth, while
others are caused by accidents, illnesses, or the natural process of
aging. People with mobility disabilities have highly diverse levels of
physical ability and range of motion.

A major cause of mobility disability is spinal cord injury and disease.
Causes include motor vehicle accidents, falls, and sports injuries, such
as diving accidents. Other causes of damage to the spinal cord include
conditions such as polio and spina bifida. Chronic pain often
accompanies a spinal cord injury.

Spinal cord injuries can be either complete, meaning that there is no
sensation or voluntary movement below the injury, or incomplete, meaning
that there is some functioning below the injury. In addition to a lack
of muscle control and/or sensation, people with a spinal cord injury may
experience loss of involuntary functions such as unassisted breathing or
body temperature control.

Spinal cord injuries result in varying levels of movement and sensation.
For example, it is possible for someone with a spinal cord injury to
have no muscle control of his or her lower extremities, but to have
sensation to touch.

People with a mobility disability who use a wheelchair do so for a
variety of reasons. Each person may have different needs and physical
abilities. Some people with a mobility disability, including paraplegia
(commonly, paralysis of the lower body), who use a wheelchair will need
to stretch and relieve pressure from time to time by slightly lifting
themselves off the chair with their arms. This is done to stimulate
circulation.

Do not be surprised if the person transfers from a wheelchair to an
ergonomically superior stationary chair or gets out of the wheelchair to
move about. Many people who use wheelchairs can walk with or without the
aid of canes, braces, or crutches, but their speed, range, and
convenience of movement is enhanced by the use of wheelchairs and
scooters. People who use wheelchairs participate in many different
physical activities such as swimming, skiing, driving and other
activities both in and out of their wheelchair.

Mobility is also an issue for individuals with short stature. There are
literally hundreds of medical or genetic conditions that cause short
stature, that is, a person who is approximately 4 feet 10 inches or
shorter. The most common is Achondroplasia. A person with this condition
has arms and legs that are short when compared to the trunk length. This
shortness is particularly noticeable in the upper arms and thighs. Other
persons with short stature have proportional arms and legs when compared
with the trunk of the body. Mobility issues include walking and climbing
steps with a shorter stride, while communication issues involve
face-to-face interactions.

Schedule meetings at convenient accessible locations and be mindful of
the length and directness of the route to get there, using the shortest
and most accessible route when providing instructions on how to get
there. Make sure there are accessible bathrooms near meeting locations.
Floor or ground surfaces should be free of obstacles that would inhibit
the movements of people. Provide convenient places to sit at meetings or
other group activities.

SUGGESTED BEHAVIORS

If a person uses crutches, a walker, a cane, or some other assistive
equipment, offer assistance with coats, bags, or other belongings.

If you call a person with a mobility disability, allow the phone to ring
longer than usual to allow extra time for her or him to reach the
telephone.

The use of touch with a person using a wheelchair (e.g., a pat on the
shoulder or arm to show support) adheres to the same rules as when
touching a person not using a wheelchair. In short, use common sense and
be respectful.

When walking with a person who walks slower than you, walk alongside and
not in front of the person.

Offer to shake hands even if the person appears to have little hand
strength or movement.

If a person falls or is off balance, simply offer assistance. A natural
tendency is to overreact, but you need not be overprotective of a person
with a mobility disability.

Do not hold on to a person\'s wheelchair. It is a part of the person\'s
body space and holding on is both inappropriate and dangerous.

Talk directly to the person using the wheelchair, not to a companion or
other third party.

It is appropriate to offer to assist with a particular task such as
opening a door, loading a wheelchair into a car, or pushing it up a
steep hill, but do not be offended if your help is not accepted. Never
assume the person needs your assistance and start grabbing or pushing
his or her wheelchair.

If the person uses a cane or crutches, the person will want to keep them
within reach. If, however, they are in the way or pose a tripping
danger, it\'s fine to ask the person to move them under the chair or
desk.

As the person may have decreased physical stamina and endurance, finding
a place to sit and talk is preferable to standing during the entire
interaction.

When conversing, place yourself at eye level with the person. Some ways
to

accomplish this without drawing attention to yourself are kneeling,
sitting on a chair, or standing a little farther away to reduce the
steep angle of the sightline. This is effective when interacting with
all people who are sitting as well as persons with short stature.

If the person\'s speech is difficult to understand, do not hesitate to
ask him or her to repeat what was said. Never pretend you understand
when you do not.

If a person chooses to communicate using assistive technology, such as
an augmentative communication device, be patient with the speed of the
device. Though not generally done, some individuals may not mind having
his or her sentences finished by you in order to ease communication.
Absolutely confirm this, though, before doing it.

Some people with paraplegia, quadriplegia, or other disabilities may
have difficulty in holding a pen or in writing. Although you should not
assume so, the individual may want or need your assistance in this task
and ask for it. If this is the case, ask how you can best assist him or
her. For example say, \"If you would like assistance, I am available to
help you fill out the form.\"

Do not physically lift or manipulate a person with a mobility disability
in any manner against his or her will.

**MUSCULAR/NEUROLOGICAL**

**People Who Have a Muscular/Neurological Condition**

GENERAL INFORMATION

Muscular or neurological disabilities can affect motor ability and/or
speech. A person with such a disability may exhibit some involuntary or
halting movement or limitation of movement in one or more than one
appendage, as well as some lisping, indistinct speech, lack of saliva
control, or flatness of tone due to lack of fine motor control of the
tongue and lips. The severity and functional effects of the disability
vary from person to person.

**Cerebral Palsy** is a condition caused by damage to the brain, usually
occurring before, during, or shortly after birth. Cerebral palsy is
characterized by an inability to fully control motor functions. This may
include stiff or difficult movements; involuntary and uncontrolled
movements; involuntary spasms; impairments in sight, hearing or speech;
a disturbed sense of balance and depth perception; difficulty in
maintaining balance; unsteady or irregular gait, or mobility
impairments. Because of these traits, some people with cerebral palsy
might appear to be under the influence of alcohol or drugs when they are
not. Cerebral palsy does not affect intelligence, though it may co-exist
with an intellectual disability.

Some people who have significant cerebral palsy or other muscular or
neurological disabilities may communicate with the aid of assistive
technology, such as typing, or using a communication board or other
electronic device.

**Multiple Sclerosis** (MS) is a condition of the brain and spinal cord
(Central Nervous System) in which the covering of the nerves is
destroyed. This condition impedes the communication between the brain
and spinal cord, thus creating a multitude of different symptoms.

Although each case of MS is unique, typical symptoms include difficulty
with balance and coordination, fatigue, tremors and spasms, pain,
weakness, numbness, tingling, and weakness or other reactions to hot or
cold weather conditions or room temperature. Vision, hearing, and/or
speech might also be affected. In some cases, the symptoms become
gradually more severe, while in others there may be a pattern of
exacerbation followed by complete or partial remission.

**Muscular Dystrophy** (MD) is the common name for several progressive
hereditary conditions, including Amyotrophic Lateral Sclerosis (ALS),
which cause muscles to weaken and degenerate. MD is caused by altered
genes, which prevent the body from manufacturing essential substances in
adequate amounts to maintain and fuel the muscles.

Since MD encompasses many conditions, the symptoms will vary with the
type. However, some symptoms are prevalent in many of the conditions.
These symptoms include, but are not limited to, generalized weakness,
muscle atrophy, or paralysis affecting limb and trunk muscles, as well
as a person\'s face, feet, hands, or neck. Sometimes respiratory muscles
are also affected.

**Stroke** is a brain injury caused by a sudden interruption of blood
flow to the brain. When an area of the brain is damaged by stroke,
functions controlled by that area no longer work as they previously did.
There are four areas of brain function that can be affected by stroke:
motor control, sensation, communication/cognition, and personality.
People who survive a stroke often have weakness on one side of the body.
They also might experience a variety of disabling effects such as
partial or full paralysis of the body, memory loss, or speech
difficulties.

Many of the conditions caused by stroke can be significantly improved
with rehabilitation. Through physical, occupational, recreational,
speech, and other therapies, people who have had a stroke can enhance
their functional abilities and live and work independently.

SUGGESTED BEHAVIORS

If the person\'s speech is difficult to understand, ask him or her to
repeat what was said. Never pretend to understand when you do not.

If a person chooses to communicate using assistive technology, such as
an augmentative communication device, be patient with the speed of the
technology. Though not generally done, some individuals may not mind
having his or her sentences finished by you in order to ease
communication. Absolutely confirm this, though, before doing it.

Some people with muscular or neurological disabilities may have
difficulty holding a pen or writing. If this is the case, do not assume
anything, but rather ask how you can be of assistance. For example say,
\"If you would like assistance, I am available to help you fill out the
form.\" Do not say, \"Oh, you cannot do that, I will do it for you.\"

When introduced to a person with a disability, it is appropriate to
offer to shake hands. People with limited hand use can usually shake
hands. Shaking hands with the left hand is an acceptable greeting.

**PSYCHIATRIC**

**People with, or History of, a Psychiatric Disability**

GENERAL INFORMATION

Psychiatric disabilities cover a wide range of behavioral, emotional, or
psychological conditions. These include anxiety disorders, major
depression, bi-polar disorders, (formerly called manic-depressive
illness), schizophrenia, as well as, personality, disassociative and
post-traumatic stress disorders.

Not all causes of psychiatric disabilities are known, but it is
generally believed that these disorders are due to a combination of
biochemical, psychological, and environmental factors. They can
interfere with a person\'s ability to think, feel, and interact with or
relate to other people and the environment. Many of these conditions can
be treated successfully with medication and treatment.

Psychiatric disabilities are often not apparent. Supervisors will
probably not know whether an employee has a psychiatric disability
unless he or she chooses to disclose it. Supervisors should be aware,
though, that a noticeable change in a person\'s work habits, level of
accomplishment, quality of work, or interpersonal relationships with
colleagues and managers, might be an indication of a psychiatric
disability. Supervisors and managers are encouraged to seek guidance and
assistance from the Employee Assistance Program (EAP) and the Equal
Opportunity Programs Office (EOPO) if they notice these changes.

The symptoms of psychiatric disabilities manifest themselves differently
depending on the type of disorder and the unique traits and support
systems of the individual. For example, some workers with psychiatric
disabilities find it difficult to concentrate while workers who take
medications to control their psychiatric symptoms may experience side
effects such as hand tremors, excessive thirst, or blurred vision. Some
individuals report difficulty in focusing on multiple tasks
simultaneously, particularly amid noise and distractions. Other
employees find it difficult or impossible just to get out of bed and
come to work.

While it is not unusual for many people to feel anxious during times of
stress, people with anxiety disorders experience feelings of excessive
anxiety and overwhelming fears that interfere with their usual daily
activities. Anxiety disorders include generalized anxiety disorder,
panic disorder, post-traumatic stress disorder, obsessive-compulsive
disorder, as well as social and other phobias.

Depression is probably the most commonly diagnosed psychiatric
disability. Clinical depression is characterized by a loss of energy,
sleep disturbances, changes in appetite, and feelings of hopelessness
that are experienced

continually for more than two weeks. Depressive illnesses include major
depression, dysthymic disorder, atypical depression, and manic
depression/bi-polar disorder.

Schizophrenia is among the more severe forms of psychiatric disability.
It generally refers to a psychotic disorder characterized by a loss of
contact with the environment and a disintegration of personality. Even
though this condition cannot be cured, it can be controlled with
medication and psychotherapy.

Psychiatric disability does not affect a person\'s intelligence.
However, sometimes during adjustment periods to medications, people with
psychiatric disabilities may appear lethargic. Some people with
psychiatric disabilities may experience difficulties with their
attention span or discussing topics that produce anxiety. Some
individuals may have difficulty processing or expressing emotions or
might overreact to emotionally charged topics. All of these behaviors
can result in miscommunication.

Although some psychiatric disabilities include symptoms of aggressive
behavior, people with these disabilities are generally no more violent
than anyone else. If violent behaviors are part of a person\'s specific
condition, they can usually be controlled with medication and
psychotherapy.

Applicants and employees are often deterred from discussing their
psychiatric disabilities with employers because of the stigma often
associated with these disorders. Disclosure is a personal decision on
the part of the worker that involves many factors including trust,
comfort with others in the workplace, job security, and the perceived
open-mindedness and support of the immediate supervisor.

Sometimes it is difficult to share an office if you have a psychiatric
disability because of the communication and interpersonal dynamics of
having an office mate. Therefore, if possible, it might be better for an
employee with a psychiatric disability to have his or her own office.

SUGGESTED BEHAVIORS

Be sensitive to requests for a flexible work schedule to allow the
person to attend medical appointments and therapy sessions and to deal
with medication issues, insomnia, fatigue, or other conditions that
often accompany psychiatric disabilities.

Through your own behavior and demeanor, show that you trust the
individual\'s ability to control his or her behavior.

Integrate the person fully into office activities.

If the person makes an occasional odd statement, try to just agree or
let the comment pass. Simply help redirect the person to the topic or
task.

Minimize stress for the employee as much as possible.

Approach each employee with an open mind about his or her strengths and
abilities.

Convey important information objectively and avoid using sarcasm and
giving mixed messages. Talk to the individual in a calm and relaxed
manner. Make sure that any instructions are defined carefully and
clearly. Repeat or summarize information and write it down for the
person\'s reference when needed. Explain things even though they may
seem obvious to you.

Clearly express expectations for performance. Maintain continuous
communication with the individual, providing timely feedback on a
regular basis. Do not assume the employee knows when he or she is doing
either well or poorly.

Be firm, fair, flexible, and consistent, especially in administering
policies and work assignments.

**SPEECH**

**People Who Have a Speech Disability Including People Who Stutter**

GENERAL INFORMATION

Speech disabilities vary greatly, and may be related to another
condition such as cerebral palsy, brain injury, stroke, or hearing loss.
Stuttering is one type of a speech disability. Sometimes, involuntary
body and facial movement associated with the effort to speak accompany
speech disabilities.

Individuals with a speech disability sometimes use a telephone relay
service. The relay service operator communicates with the person with a
speech disability through a TTY (a telecommunications device for people
with a hearing loss or have speech disabilities) and with the other
person through the telephone. The operator, who is not an interpreter,
voices the TTY message and the other person can respond by voice.

SUGGESTED BEHAVIORS

Wait for the person to finish his or her thought rather than
interrupting or finishing it for the person, unless that person
expressly gives you permission to do so.

Do not pretend to understand when you do not. This will hinder
communication, not enhance it. Ask the person to rephrase the thought or
spell out a particular word to facilitate your understanding.

Repeat back what you do understand so the other person may fill in or
correct your understanding where needed.

If you are having difficulty understanding what the person is saying,
let the person know. \"I didn\'t understand that last part. Could you
please repeat it?\" \"I\'m not sure if I understood correctly. Did you
say\...?\"

Do not make unsolicited suggestions, such as \"relax\" or \"take your
time\"

Allow the communication to take as much time as necessary. Hurrying
through the interaction can make the situation worse.

If you continue to have difficulty, offer pen and paper if the person is
physically able to write, but first ask the individual if this is
acceptable.

Concentrate on the words the person is saying, not how they are being
said.

If no solution to the communication barrier can be worked out between
you and the individual, ask if there is someone who could facilitate the
conversation.

**TOURETTE**

**People with Tourette Syndrome**

GENERAL INFORMATION

Tourette Syndrome is a neurological disorder with two basic features:
involuntary motor tics and involuntary vocal tics. The symptoms come and
go, vary in intensity, and change over time. Many individuals with
Tourette Syndrome have Attention Deficit Disorder (i.e., difficulty with
attention and impulse control) and Obsessive-Compulsive Disorder (i.e.,
controlling urges) and/or some form of learning disability.

Motor tics caused by Tourette Syndrome include eye blinking, shoulder
shrugging, facial grimaces, and arm waving. Vocal tics include
production of noises such as throat clearing, humming, tongue clicking,
and barking sounds, as well as vocalization of socially unacceptable
words such as cursing and insulting comments. Remember the person cannot
control the tics and behaviors.

The symptoms of Tourette Syndrome are often exacerbated by both positive
and negative stress, anxiety or worry. Therefore, the symptoms could be
manifested differently or more repeatedly each day depending on the
circumstances of that particular day. To reduce the symptoms, the
individual is advised to rest or temporarily leave the stressful
situation. Some medications for Attention Deficit Hyperactive Disorder
or other conditions might also increase the frequency and intensity of
these symptoms.

SUGGESTED BEHAVIORS

If someone is exhibiting the symptoms of Tourette Syndrome, it is best
to ignore the symptoms.

If the symptom is bothersome or intrusive and cannot be ignored, bring
it to the attention of the person in a non-judgmental and
non-threatening way.

If the symptom is a physical one, move out of the way.

Do not react with anger, annoyance, or disdain if the person displays
motor or vocal tics.

Be patient and respectful.

Several short breaks are often more effective than one long break.

It may help to allow the person to briefly go to a private place where
the person is comfortable to relax and release tics. Short time-outs are
very helpful.

**VISION**

**People Who Are Blind or Have Low Vision**

GENERAL INFORMATION

People who have congenital blindness have been without sight since early
childhood or birth. People who have adventitious blindness lost their
sight later in life often as a result of disease, aging, or a sudden
injury. It is important to differentiate between these two conditions
because of the diversity in education, employment, and attitudes among
people with these two different types of blindness.

An individual who has congenital blindness most likely formed his or her
identity as a person who is blind. People with congenital blindness
probably received special education services throughout school and
learned to use Braille and assistive devices at a young age.

Someone with adventitious blindness most likely formed his or her
identity as a person who is sighted. When people lose their sight later
in life, they often experience a period of tremendous shock. They need
to learn the skills to help them adapt to a life without vision. Very
often, these individuals do not know Braille.

The terms \"blindness\" and \"low vision\" mean either a complete or
partial loss of vision. What a person is able to see depends upon the
age of onset, degree of visual memory, and degree of usable vision
regarding light, shape, color, and other factors. For some persons, only
the edges or a part of the visual field might be obscured. Others might
have no central vision although side or peripheral vision still exists.

Vision disabilities also include tunnel vision and color blindness.
Tunnel vision has been described as seeing the world through a small
tube. It is often accompanied by night blindness. This means that the
person with tunnel vision may function very well in good light but not
when the light gets below a certain level. The most common causes of
tunnel vision are glaucoma and retinitis pigmentosa (RP). Color
blindness describes a number of difficulties in identifying various
colors and shades. The severity of the condition ranges from only a
slight difficulty distinguishing among different shades of the same
color to the rare inability to distinguish any colors.

\"Low vision\" generally refers to a severe vision disability, not
necessarily limited to distance vision. Low vision applies to all
individuals with sight who are unable to read the newspaper at a normal
viewing distance, even with the aid of eyeglasses or contact lenses.
This includes individuals who are legally blind.

There is a large range of behaviors that are common for some people who
are blind. For example, a person who is blind may or may not look
directly at you. An individual might rock back and forth or move his or
her head around. In a room with a public address system, the person who
is blind might face the nearest electronic speaker rather than the
podium because that is from where he or she hears the voice of the
person who is speaking.

Some people who are blind use an assist animal or cane to get around
independently while others do not use these mobility aids.

SUGGESTED BEHAVIORS

Announce your presence by name because your voice may not be
recognizable. When you leave a person\'s presence, say so.

Speak directly to the person in a normal speed and tone of voice.
Shouting or speaking overly slow is not helpful.

When conversing with a group of people, identify the person to whom you
are speaking. If a person who is blind or has low vision does not
respond to you, it may be because he or she thinks you are talking to
someone else.

In meetings, ask each person to identify himself or herself by name
before they speak. Continue this until people\'s voices become familiar
and recognizable.

Offer assistance in filling out forms, and be prepared to read aloud any
information that is written, if requested. Many people with a vision
disability can fill out forms and sign their names if the designated
spaces are indicated to them.

When giving directions, use a relevant reference. \"Two steps to your
left\" is a better way to describe a location than a vague expression
such as, \"over there.\" Some individuals like to refer to positions in
terms of clock hands: \"The chair is at your 2 o\'clock.\"

Use directional words with the other person\'s orientation. For example,
when you are facing someone, the door that is on your \"left\" is the
same door that is on that person\'s \"right.\"

If a person asks you for assistance in going from one location to
another, put out your arm and tell him or her that your arm is there. He
or she will then take your arm and you can proceed. Do not just grab the
person\'s arm.

Walk at a comfortable pace when guiding a person who is blind. There is
no need to walk slowly. Let the person know if you are approaching a
step or other obstacle, and how you plan to navigate it.

When guiding a person into a new or strange surrounding, describe
special features or physical characteristics of the area. When going
into a room, orient the person to the surroundings: describe where
furniture is, where the door is, and where the person is in relation to
these objects.

When speaking to a person with low vision, position yourself so that the
sun or any other bright lights are in front of, not behind, you. Your
face will be illuminated and, at the same time, glare or blinding light
in the eyes of the other person will be eliminated.

Petting or touching a dog guide or other service animal (usually
indicated by a harness) while it is \"on duty\" is not appropriate. When
the animal is not on duty, it is up to the animal\'s human to decide if
play is permitted.

If you are offering a seat, physically indicate the back or arm of the
chair or give a verbal cue as to the seat\'s location, e.g., \"The chair
is one step to your right\" or \"The chair is two steps behind you.\"
Then the person will be able to sit down by him or herself. Neither
force the person into the chair, nor move the chair without telling the
person.

Be aware that the person may need to use a tape recorder or Braille
device to note information.

When a person who has low vision is meeting many people, introduce each
person individually. This helps the person to better associate names and
voices for subsequent encounters.

Be precise and thorough when you describe people, places, or things. Use
descriptive language. If the person has visual memories, references to
colors, patterns, designs and shapes are perfectly acceptable. If not,
try to attach other descriptive words and ideas to colors. For example,
red is often associated with hot, blue with cool, green with calm,
yellow with cheery.

Use alternative formats for written materials, such as Braille, large
print, computer disk, and audio. Also, increase the frequency of oral
announcements, provide audiotapes or Braille transcripts of frequently
requested information, and read aloud brochures or important
information.

Many people who are blind or have low vision are quite comfortable
reading documents and messages from a computer utilizing a screen
reader, magnification software, or other assistive technology, so
electronic mail with or without text attachments is an excellent way to
communicate on a regular basis.

When interviewing or meeting with people with vision disabilities, ask
whether they would prefer a well-lit area. Avoid sharp contrasts of
light and dark areas.

Ask the employee whether he or she learns best from oral instruction or
a combination of hands-on, written, and aural learning.

At a meeting, read and describe all information that is included in a
visual presentation so that everyone understands it.

When preparing visual presentations, keep font sizes large and use
contrasting colors to ensure ease in reading. You might also provide the
materials in alternate formats.

**AFTERWORD**

This document is meant to provide a quick guide to facilitate
communication and ease interactions between people with and without
disabilities. It is an expansion and revision of a publication that was
originally published in 1994 by the Equal Opportunity Programs Office at
NASA\'s Goddard Space Flight Center. It had its roots in materials I
originally developed for the inauguration of President Jimmy Carter in
1977 and expanded for the Office of the Assistant Secretary for
Personnel Administration at the U.S. Department of Health and Human
Services.

It is the hope and desire of the Equal Opportunity Programs Office that
this information will be especially useful to new managers and
supervisors. We cannot stress enough the importance of training and
education in this area. This booklet is designed to augment training,
not to replace it.

Most of the material was developed from over 30 years of professional
experience in the field of disability. Some was taken from reading and
discussions with colleagues and other professionals. This current
revision could not have been done without the support and review of
several individuals, primarily in the fields of communication,
disability, and diversity. This was truly a collaborative effort.

This booklet has been and will continue to be revised and updated as the
author becomes more enlightened. The latest version can be found at:
http://eeo.gsfc.nasa.gov/disability/publications.html

As such, if you have any comments, concerns, or suggestions on how to
improve this document, please contact me at Michael.J.Hartman@nasa.gov,
or call me at (301) 286-5715, voice and TTY.

This document is available in an alternate format upon request.

Michael J. Hartman, March 2004