Week 11 Discussion

Limitations of Hearing and Deafness

People with hearing impairments have difficulty comprehending usable speech with or without amplification. Deafness is defined as a hearing impair- ment that limits the ability to understand normal conversation. The level of functional limitation depends on the degree of impairment in auditory discrimination of speech frequencies and the age of onset (Harvey, 2002). Functional limitations associated with hearing problems are rated in severity by the degree of decibel loss associated with the impairment. These prob- lems exist on a continuum of severity and range from conditions involving a slight hearing loss to a profound hearing loss or deafness (Moores, 2001). For example, a moderate hearing impairment involves a loss of between 26 and 40 decibels. With a moderate loss, the person can hear conversation at a distance of 3 to 5 feet, but understanding speech is difficult and the full-time use of a hearing aid is necessary. A severe hearing impairment involves a loss of 71 to 90 decibels, and the person can hear only very loud speech from about 1 foot from the ear. Hearing aids may be of limited use for a person with a severe loss, and lip reading and sign language may also be necessary. Workplace accommodations include the use of interpreters, amplified tele- phones, flashing lights and alarms, communication aids, and telecommuni- cation devices for people who are deaf. Environmental restrictions related to hearing impairments may include avoiding loud noise work settings or exposure to hazards such as moving machinery.

Limitations in Lifting, Reaching, and Carrying

These types of limitations may be related to a variety of disabling condi- tions that result in decreased range of motion and strength in the upper extremities and back, including spinal cord injuries, musculoskeletal inju- ries, multiple sclerosis, arthritis, neurological diseases, and other permanent injuries. Limitations may involve the magnitude, frequency, and duration of a person’s ability to lift, carry, push and pull, and reach. In severe cases, paralysis of one or both of the upper extremities requires substantial modi- fication to work tasks that require handling, reaching, lifting, and carry- ing. Ergonomic evaluation of the workstation may be needed to identify job accommodations for limitations involving the upper extremities (Olsheski & Breslin, 1996). The use of worksite physical and occupational therapy may also be useful in transitioning individuals who have these types of functional limitations back to work (Breslin & Olsheski, 1996).

Difficulty in Using the Lower Extremities

Functional limitations associated with impairments of the lower extremities include slowness of gait and impairment of the ability to walk, stand, kneel, and climb stairs or ladders. These limitations may be related to spinal cord injuries, degenerative joint disease, arthritis, stroke, peripheral neuropathy, congenital deformities, amputation, cardiovascular or pulmonary diseases, and other neurological impairments. Functional limitations include impaired ability to ambulate, stoop, bend, lift, balance, kneel, climb, carry, and stand (Andrews, 2000). Workplace accommodations may involve the use of wheel- chairs or other motorized vehicles for mobility and minimization of job tasks that require prolonged periods of standing, use of foot controls, and bending (Brodwin et al., 2003).

Limitations Related to Fainting, Dizziness, and Seizures

These limitations involve conditions in which the person experiences periods of unconsciousness from fainting or seizures and a loss of bal- ance because of dizziness. People with these types of limitations may have epilepsy, cerebral palsy, brain injury, vertigo, migraine headaches, hyper- tension, and other various neurological or cardiac impairments (Brodwin et al., 2003). These types of impairments may restrict the individual from being exposed to certain environmental risk factors, for example, unpro- tected heights, hazardous machinery, and extreme temperatures. For indi- viduals with epileptic seizures, the severity and frequency of the seizure, the effectiveness of antiseizure medication, and the time needed to recover after having a seizure will influence the degree of environmental restric- tion and need for accommodation. Individuals who have problems with dizziness may need such accommodations as supportive grab bars and avoiding exposure to unprotected heights, slippery surfaces, and hazard- ous machinery (Mueller, 1990).

Functional Capacity

Evaluation To make appropriate educational and vocational decisions, people with dis- abilities must have an accurate understanding of their functional assets and limitations. This information is essential in all phases of the career plan- ning process, including the development of vocational goals, selection of appropriate training or educational programs, and identification of the need for potential accommodations. Functional capacity evaluations may be con- ducted by physical and occupational therapists who also have expertise in job analysis methods (Chen, 2007). This information quantifies the person’s functional capacities by measuring standing tolerance, sitting tolerance, lift- ing capacity, ability to assume various postures, pushing and pulling capacity, fine and gross manipulation abilities, reaching, range of motion, strength, endurance, and ability to tolerate exposure to various work environment conditions (Lynch & Lynch, 1998; Wind, Gouttebarge, Kaijer, Sluiter, & Frings-Dresen, 2009). Chen (2007) noted that by comparing information about the person’s functional capacities with job analysis data, the degree of compatibility between the worker’s capacities and the requirements of the job can be determined. Reasonable accommodations may be used to remove or reduce specific areas of incompatibility between the worker’s capacities and the job requirements.

Job Analysis Information

Job analysis is the gathering, evaluating, and recording of accurate, objec- tive, and complete job data (Materials Development Center, 1992). Job analysis describes in a systematic manner what the worker does; how the work is done; results of the work; worker characteristics; and the context of the work in terms of environmental and organizational factors (U.S. Department of Labor, 1982). Job analysis data include the essential job tasks performed by the worker and the tools, equipment, or work aids that are used on the job. In addition, job analysis data describe the general educational development, training, aptitudes, interests, and skills that are required to perform a job. Job analysis data are used to classify the physical demands of the occupation and assign it to a strength category; specify the frequency and duration of various physical traits such as handling, reach- ing, bending, climbing, and so forth; and describe various factors in the work environment such as exposure to hazardous machinery, dust, fumes, or temperature extremes. Occupations may be classified in various strength categories on the basis of the amount of standing, sitting, walking, lifting and carrying, and pushing and pulling. These factors are used to define the five physical demand categories defined in the Dictionary of Occupational Titles (U.S. Department of Labor, 1991): sedentary work, light work, medium work, heavy work, and very heavy work. Sedentary work requires the worker to lift up to 10 pounds occasionally and to work primarily in a seated posi- tion. Light work requires the worker to lift items weighing up to 20 pounds occasionally and items weighing 10 pounds or less on a frequent basis. Medium work requires the worker to lift up to 50 pounds occasionally and up to 25 pounds frequently. Heavy work requires the worker to lift up to 100 pounds occasionally and up to 50 pounds frequently. Very heavy work requires the worker to occasionally lift 100 pounds or more and to lift up to 50 pounds or more on a frequent basis. Most of the occupations that exceed the sedentary classification typically require standing or walking for approximately 6 of 8 hours.

Having a physical disability affects not only the individual’s physical capacities for meeting the physical demands or strength factors required to perform a specific occupation but also the type of work environment in which the individual is able to function. Job analysis data are useful for evaluating environmental factors that workers may be exposed to in the course of performing job duties. These factors may hinder successful job performance and pose a threat to safety. For example, a person who experi- ences epileptic seizures may not be able to tolerate extremely hot tempera- tures in the workplace if the seizures are precipitated by exposure to high heat. Similarly, individuals with pulmonary impairments may be restricted to work environments that are free of dust and fumes. Environmental condi- tions are defined as specific physical working conditions to which the worker is exposed while performing assigned work tasks (Materials Development Center, 1992). Environmental conditions include exposure to weather; extreme cold; extreme heat; wet conditions, humid conditions, or both; noise; vibration; atmospheric conditions; moving mechanical parts; electric shock; high, exposed places; radiant energy; explosives; toxic or caustic chemicals; and dust, fumes, gases, and odors. Noise intensity is rated on the Occupational Safety and Health Administration decibel continuum ranging from quieter exposures (10 decibels) to very loud exposures (115 decibels and higher).

Although the most accurate job analysis data are obtained from perform- ing an onsite analysis of the job, several generic sources of job analysis infor- mation are also useful in career planning. A number of U.S. Department of Labor publications contain valuable job analysis information, including the Dictionary of Occupational Titles (U.S. Department of Labor, 1991), the Revised Guide to Job Analysis (U.S. Department of Labor, 1991), and the Internet tool known as the Occupational Information Network, or O*NET (Peterson et al., 1997). The O*NET is designed to replace the Dictionary of Occupational Titles, which was last updated in 1991. The Dictionary of Occupational Titles contained descriptions of more than 12,000 discrete occupational titles. However, O*NET groups a number of similar occu- pations into 1,172 occupational units. The O*NET database is relational in nature and is more useful in evaluating transferable work skills. The O*NET model merges information from the Dictionary of Occupational Titles and other U.S. Department of Labor publications such as the New Guide for Occupational Exploration (Farr, Shatkin, & Ludden, 2006) and the Occupational Outlook Handbook (U.S. Department of Labor, 2010–2011; the pdf can be downloaded at http://www.bls.gov/oco). Information con- tained in the O*NET model includes experience requirements (training, experience, licensing); worker requirements (basic skills, cross-functional skills, general knowledge, education); worker characteristics (abilities, interests, work styles); occupational characteristics (labor market informa- tion, occupational outlook, wages); occupational requirements (generalized work activities, organizational context, work conditions); and occupation- specific requirements (occupational knowledge, occupational skills, tasks, duties, machines, tools and equipment). The O*NET offers easy access to job analysis data and vocational information that is useful in career plan- ning, assessing transferable skills, and identifying reasonable accommoda- tions (Olsheski & Schelat, 2003).

Vocational and career planning for individuals with physical disabili- ties requires an accurate assessment of their functional capacities and an integration of this information with job analysis information (i.e., the physical demands, job requirements, and work conditions). By synthesiz- ing these two important sets of data, appropriate vocational choices and career paths may be selected that enhance the likelihood of a successful work adjustment. In addition, this information is critical in identify- ing reasonable accommodations that may be implemented to minimize or eliminate any discrepancies between the worker’s abilities and the requirement of the job.