Disability < the the Ability Support Center | The Sudent Support, Nagoya University

1. Definition of disability

Defining disability is harder than we usually think. Laws and other regulations in Japan oridinary says "this is what considered as disability" based on medically designated impariments. However, the concept of "disability" itself is not clearly defined.
In 1980, WHO adopted the concept of the disability. It says disability is conditions having impariment, suffering from disability, and socially handicapped. Such definition was rooted on medial perspectives of disability. Many services, including in Nagoya University, ground on the model in order to think about disabilities and to provide thier services. And so is the explanations of each disability in this page.
However, this definition was revised in 2000. According to the new one, disability occurs independently from but interactively associated between each domain such as body functions and structures, individual activity, and social participation. Then "health" is placed opposite to "disability". This new definition emphasizes that disability is not nessessarily based on medical condition, but also social barrier makes an individual disabled. It implies, therefore, that one can be disabled or health owing to function of their society.
For instance, those who have week eyesight can fullfil their capacity and participate to their society with glass or contact lens. Whether or not a person becomes disabled or health depends how a society can creat environment equivalent to "glass" or "contact lens".
This new perspective of disability appeals that the disabiilty is to be generated not at condition of a person, rather in relationshop between an individual and their society, acknowledging presence of impariment in medical senses. Nagoya University Ability Support Center is exploring next form of support based on such conception.

2. Physical disability

Physical disability in a medical sense includes visual impairment, hearing impairment, orthopedic and motor impairments, and disability caused by medical conditions.

2-1. Visual impairment

Visual Impairments and Disorders refer to decreased or lost ability to see because of functional impairments in visual system (eye, optic nerve, or brain). Blindness is the situation in which complete or nearly complete vision loss. Low vision is the decreased ability to see not fixable by corrective means such as glasses, contact lenses.

Low vision includes vision field loss (e.g., Bitemporal Hemianopsia, Binasual Hemianopsia, Right Homonymous Hemianopsia, Left Homonymous Hemianopsia), Central Scotoma, Photophobia, Nyctalopia, Nystagmus. That is, the type of visual impairments and disorders are more than we imagined.
The way of communication of people with visual impairments and disorders are not only Braille, but also speech information. There are persons with visual impairments and disorders who do not use Braille. It means that methods of support are various. Therefore, the support should be based on their own need.

2-2. Hearing impairment

Hearing Impairments and Disorders refer to some kind of hearing loss caused by malfunctions in structures or functions that transmit sound waves (i.e., the outer ear, the middle ear, the inner ear, the vestibular nerve, the cochlear nerve). Hearing Impairments and Disorders can be mild, moderate, severe or profound measured by decibels (dB) scale, which is the unit of expressing sound level. The larger the number of dB is, the more difficult it is to hear. 'Deaf' people refer to people with profound hearing loss, who are unable to hear the sound with 100dB or above. People with 'hard of hearing' refers to people with mild, moderate or severe hearing loss. The hearing loss may be by congenital or acquired. In addition, some people experience of sudden deafness/hearing loss, or psychogenic hearing loss which is not caused by malfunctions.

The ear structure mainly consists of the outer ear, the middle ear, the inner ear, the vestibular nerve and the cochlear nerve. There are three types of hearing loss; conductive hearing loss, sensorineural hearing loss, and mixed hearing loss. Conductive hearing loss occurs when there are mechanical problems in the outer ear and/or the middle ear. People with conductive hearing loss have something wrong with the bones or ear drum which transmit sound waves, so they can hear loud sounds. Therefore, hearing aids, which make sounds louder, is helpful to their daily lives. Sensorineural hearing loss occurs when there are sensory problems in the inner ear, the vestibular nerve and/or the cochlear nerve. People with sensorineural hearing loss are unable to hear clearly even when sound level is loud enough. The difficulties can be reduced by the hearing aids, which amplify sound or are tuned to correct impaired hearing. Age-related hearing loss is caused by the problems in the inner ear, the vestibular nerve and/or the cochlear nerve. That is, most of presbycusis is sensorineural hearing loss. Mixed hearing loss is a combination of both conductive hearing loss and sensorineural hearing loss.
Described above, the situation of hearing loss is various. In addition, social environment affects the difficulty. For example, it is difficult to hear in lecture in a lecture hall, or in seminar because many people talk. It is important to understand each situation and to consider better ways of academic support.

2-3. Orthopedic and Motor Impairments

Disabilities by Orthopedic and Motor Impairments means the condition that you have impairments of limbs and/or trunk that have substantial and long-term negative effect on your ability to do normal daily activities regardless of the cause.

We sometimes regard all people with orthopedic and motor impairments as wheelchair users. There are people who have difficulties in their legs. In addition, some people have difficulties in arms, some people loss their total or partial part of the bodies, some people have difficulties in keeping their postures, etc. The degree is also various. Some people have substantial difficulties, others do not experience many difficulties. Some people use crutches, others do not use anything.
Some difficulties are not seen from the appearance. For example, some people cannot use their arms or control their arms. Some people have difficulties in thermoregulation. For supporting people with orthopedic and motor impairments, it is important to consider these difficulties.

2-4. Disability caused by medical conditions

Disabilities caused by medical conditions include internal disease that means functional problems in visceral organs or immune system, chronic illness (i.e., Diabetes Mellitus), Disabilities of physical or social functions caused by intractable diseases. These disabilities may decrease physical functions and ability to see or hear, cause symptoms of having depression, etc. Some people need to use wheelchairs. In other words, medical conditions consequently cause physical disabilities (visual impairments and disorders, hearing　impairments and disorders and orthopedic and motor impairments) or psychiatric disorders. By acute disease. These disabilities are shown temporarily. However, because medical treatment is essential, it is case by case whether the case is a target of academic support. Medical treatments cause to decrease social functions. For example, if a person needs artificial hemodialysis for long hours because of low kidney function, they have a disability in social functions.

3. Intellectual disability

Intellectual disability is a condition of reterdation of general cognitive function appearing in early childhood, which has low abilities of remembering and learning, those of communication, and clumsiness for hand and low ability in mobilization such as running and jumping. One says genetic factors cause the condition, but it is not clear yet. Because reterdation goes across whole areas of functioning, adaptation is likely to be detrimented, which brings about secondary problems of tendency to lose one's temper, or be depressed. Developmental disability also shows general or limited intellectual problems, frequently comorbid with intellectual disability. Though there is reterdation, development can occur, and it requires promotion of their ability at thier pace together with environmental setup and adaptation of others, for instance providing explains easly understood and/or structualizing situations.

4. Mental disorder

The definition of mental disorder differs in lows and diagnostic standard (e.g., DSM-5, ICD-10). Among those, Schizophrenia, depression, anxiety disorder, and psychogenic physical symptoms are representative in our services.

4-1. Schizophrenia

Schizophrenia is a mental disorder with hallucination, delusion, loss or reduction of volition, disorganization symptoms, etc, which seems to have genetic cause thought not clear. There are two major types of symptoms, that is, positive and negative symptoms, and they does not recognize halluciation is not real, or they is ill (lack of insight of desease). It is possible to have a daily life with continuously receiving therapy, but also lower cognitive function or difficulty in emotion regulation may last, and halluciation can remain.

Positive symptoms includes hallucination and delusion. Most frequent hallucination is auditory one, hearing voice which seems to be not present. visual hallucination of seeing things unexisting, olfactory hallucination of smelling things unexisting, cenestopathie of unexisting bodily sense are other hallucinations. Delusions are persecutory delusion (being persecuted by someone), paranoid delusion (being stolen of something or being suffered by someone), delusion of persuit (being pursued by someone), delusion of observation (being monitored by someone), idea of reference (being talked about, having romantic relationship with a celebrity, and so on), etc.. Other positive symptoms involves self disturbance consisting of thought disorder such as disorganization of or incoherence of thinking, thought broadcasting such as delusion of spreading thoughts, thought insertion such as delusion of being inserted thoughts and affections by others, and withdrawal of thought such as delusion of being taken over. For these symptoms have often distressful contents to them, they are suffered by the symptoms.
Negative sympsoms includes low or reduciton volition, flattened emotion, diminished thinking, and futhert schizophrenic autism that is withdrowal from outer world. These can cause problems of not relating to others, indifference to social custom, disinterest to grooming and cleaness, and withdrowal from surroundings being pereoccupied with internal world. Diagnosis is not done only based on negative symptoms, but it can be caused by positive symptoms and fuctions as defense from positive symptoms, so it needs careful observation.

4-2. Depression

Depression is a mental illness which is usually expressed in low mood. Depressive state also show low keyness, but depression is diagnosed when depressive state lasts more than two weekis. Its symptoms consists of psychic and physical; the former includes affectional disturbances, behavioral impairs, and thought disroders. Varous stress is said to cause depression, and as a physical mechanism, neuro transmitters. such as serotonin, noradorenaline, and dopamine, is considered to be causes. For general acitivity level is to become low, it leads to disabilities across everyday life, such as unable to get up in the morning, impossible to go to school or work, and/or incapable of housework.

Psychic symptoms includes affectional disturbance of low moode, reduction of volition, loss of interest, not feeling joy, hightened anxiety, and irritability, behavioral impairment of inability to do things, distress to move body, and avoidance to meet others, and thought disorders of difficulty in thinking, lack of attention, and incomprehensibleness when reeding or watching TV. Physical symptoms are loss of appetite, sleep disorders such as being unable to sleep, awakening in midnight, and impossibleness of getting up in the morning, and being easily tired and feeling listless, in some cases physical pain is accompanied. These symptoms can be generated from physical deseases, so it is required to examine physical condition not just judge by symptoms.
What we need to pay special attention with regard to depression is suicide. Hopelessness and helplessness (being pesimistic about future and being unable to imagine bright side of years to come) or feeling of guilt (seeing thierself responsible to failures in life or social incidents) can make one feel distressed to be alive and force them to choose death. The risk of it is observed to highten in recovery phase, which requires continuous therapeutic involvement. The goal may be not to return to former health condition, rather to take recovery process of prevening from being swallowed by wave of depsression.

4-3. Anxiety disorder

Althoug anxiety disorder consists of intense anxiety. anxiety itself is a feeling everyone can have. However if they feel chronic excessive anxiety inappropriate to the situation, it would be diagnozed as anxiety disiorder. While genetic factors can be thought operate, anxiety would sustain under psychological burdern accompanied with physical conditions such as being tired and having sleep problems. One may call it anxiety disorder when such intense anxiety makes social life difficult.

Medical diagnoses of anxiety disorder have several subcategories; generalized anxiety disorder (persistent concern and anxiety), panic attacks (unpredictable attacks of strong anxiety), and phobia (fear of a certain things among which are agora, closed space such as inside of train, specific animal or object) , social anxiety (anxiety to perform in front of others), and taijin kyofusho (gross fear of interpersonal relationship ,concerning how one is seen by others). Hightened anxiety goes along with symptoms such as headach, heart pulsating, feeling dizzy, pulse becoming fast, sweating, hard to breath, and hand and foot getting cold, and in case of panic attack fear to die is experienced.
They will show problems that they avoids to meet others, is afraid of going out, is difficult to concentrate, and have depressive state, because of solitude in which their inappropriate anxiety is not comprehensible for others, fear of unpredictable occurance of anxiety, hopelesness of uncertainity of recovery, etc.. Psychotherapy as well as medication can be helpful, so support to broaden the range of their activity with therapeutic care is needed.

4-4. Psychogenic physical issues

Psychogenic physical issues often observed in the Office for the Students with Disabilites are psychogenic pollakiuria (feeling urge to go to toilet in short interval without any physical dysfunction), somatic symptom disorder previously called as somatoform disorder (pain, unable to see, hear, and move arms and legs without any physical dysfunction as well). Though it is said psychogenic, causal factors are not clear, so that harmonize their mind through counseling and psychotherapy would be an important support, which requires environmental adjustment.

5. Developmental disorder

Recently it is said that the number of persons with developmental disorders has been increased. Although the cause of these disorders is not mentioned here, the number of students with developmental disorders in higher education in Japan is also increasing. Not a few students have difficulties with processing information (e.g., difficulties in registering for classes, understanding the notices, scheduling, memorizing the procedure for experiments) and social communication (e.g., difficulties in expressing the feeling, cooperating with others and understanding others’ intention or feeling). “Developmental Disorders” is categorized in “Neurodevelopmental Disorders” according to the DSM-5, the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013). “Developmental Disorders” includes Intellectual Disabilities, Communication Disorders, Autism Spectrum Disorder (ASD), Attention-Deficit/ Hyperactivity Disorder (ADHD), Specific Learning Disorder (SLD), Motor Disorders and other Neurodevelopmental disorders.
Students with Communication Disability, ASD, ADHD and SLD seems to be more apparent in higher educational institutions. The more diversification students at higher educational institutes have, the more students with various types of disabilities can be admitted in the near future. Here are characteristics of developmental disorders that are more apparent in higher education institutes.

Communication Disorders

Persons with communication Disorders have difficulties with the social use of verbal and nonverbal communications. Some students with communication disorders find it hard to greet others or to share information with others. They also have problems in conversations in appropriate manners: they are not able to talk differently to classmates than teachers, take turns in conversation, and understand what is not explicitly stated and ambiguous meaning of language (e.g. metaphors).

Autism Spectrum Disorder (ASD)

Students with ASD have difficulties in social communications and social interactions across multiple contexts. They have similar difficulties in communicating with others mentioned in Communication Disorders. They also have difficulties in reading between lines, responding during the social interactions, have no concern with associates and have few friends. Stereotyped or repetitive behavior, so-called “persistency” may appear in their behavior. Although Autisms, Asperger Disorders and High-Functioning Autisms had been classified in Pervasive Developmental Disorders, they are now included in “Autism Spectrum Disorder” in the DSM-5.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/ Hyperactivity Disorder is characterized by Inattention and Hyperactivity or Impulsivity. Some students with ADHD have difficulties in arranging schedule or in handling tasks efficiently in learning. ADHD is categorized into three types: Inattentive type, Hyperactivity or Impulsivity type, and Combination type. a. Inattentive type: This type of students often leave or lost things necessary for tasks or activities, cannot keep promises, have poor time management, difficulties in keeping belongings in order. b. Hyperactive-impulsive type: Those students are likely to talk one-sidedly about their own matters, likely to be restless, often unable to listen to others, often make inappropriate remarks without forethought.

Specific Learning Disorder (SLD)

Specific Learning Disorders is a development disorder with some problems in learning and/or academic skills, not better accounted for by intellectual disabilities. Some students with specific learning disorders have difficulties reading; Some have difficulties spelling; the other have difficulties mastering calculation. Some students have multiple difficulties. A impairment in reading is called “Dyslexia”. Students with Dyslexia have difficulties with word recognition, conversion of written languages into sound, and reading comprehension.

　The term "developmental disability" can be used to describe a wide range of symptoms and difficulties, and often the symptoms and difficulties manifest themselves in different ways, even with the same diagnosis. For this reason, it is necessary to understand the characteristics of each individual person, in addition to the name of the diagnosis, and to address specific problems in a timely manner.