Disabilities at Post-Secondary Institutions: Access Through Accommodation
Acquired Brain Injuries
Acquired Brain Injuries
Effects from an acquired brain injury can be both physical and/or psychological including subtle cognitive and behavioral disturbances, which can impact academic performance. A student with an acquired brain injury may experience difficulties with memory, retaining information or retrieving information. Communication skills may be affected in either the expressive or receptive modes. some motor impairment may also be evident. With accommodations, often similar to those made for students with learning disabilities, a student with an acquired brain injury can succeed at a post-secondary institution such as Napa Valley College.
A learning disability (LD) is defined as a generic term that refers to the heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities. These disorders occur in persons of average to very superior intelligence and are presumed to be due to central nervous system dysfunction. Even though LD may exist concomitantly with other disabling conditions (e.g., sensory impairments) or environmental influences (e.g., cultural/language difficulties), it is not the direct result of these conditions or influences.
In order to be identified as having LD, a student must exhibit:
- average to above average intelligence;
- severe processing deficit(s);
- severe aptitude-achievement discrepancy(ies);
- measure achievement in an instructional or employment setting.
As increasing numbers of students with LD are pursing higher educations as an option (Astin, Green, Korn, Sohalit, and Berg, 1988; U.S. Department of Education, 2005), consideration must be given to a number of issues relating to the implementation of Section 504 of the Rehabilitation Act of 1973 in the post secondary setting. Section 504, as it applies to post secondary institutions, stipulates that "a recipient shall operate each program or activity so the program or activity, when viewed in its entirety is readily accessible to handicapped persons" (Section 104.22[a].) This provision applies to the physical facilities on campus, as well as aspects of a student's life, including admissions, recruitment to academic programs, and academic adjustments (Bruncheroff, Shaw and McGuire August 1992).
At the post secondary level, once documentation of the LD is obtained (including a complete psycho-educational assessment), it is the responsibility of the learning-disabled service provider to respond to the student's request for services. The provision of services is required only if the student informs DSPS of a disabling condition and requests services. Academic adjustments may include adaptations in the manner in which a course is conducted, use of auxiliary equipment, and modifications in academic requirements. Specific examples include administering an exam with additional time in a private room or permitting a student to tape record lectures. Typically, auxiliary aids for students with LD include access to textbooks in alternate formats, readers, computers, and lecture notes.
It is the goal and philosophy of DSPS to provide and monitor supportive services (i.e., learning strategies, study skills, self-advocacy, planning for independence, utilizing other campus resources) to ultimately work towards academic independence using the DSPS program for consultation and support on an "as needed basis".
Learning Services Program
At NVC’s Learning Services Program (LSP), LD Specialists and the student, through the interpretation of the student's diagnostic assessment and history, determine the appropriate accommodations in the academic setting. It is important for the student to make a timely request for services. Because it is essential to recognize the individual nature of a LD for any student that requests services, LSP faculty, in collaboration with the student and non-DSPS faculty, will often work to develop a means of effectively meeting the individual student's needs.
Some students are unable to communicate effectively through printing or cursive writing (dysgraphia) and this condition may manifest itself in written work that appears careless or sloppy. For such students, oral examinations and reports are more valid evaluations of what has been learned. Some of these students may be unable to use the typewriter for written communication, thus another solution is for the student to dictate answers to a scribe.
Other students may have difficulty processing auditory information, such as information provided during a class lecture. Many of the accommodations that assist a student who is deaf will also assist these students, including but not limited to: role-playing and captioned audiovisual materials. Still other students will have difficulty with sequential memory tasks involving letters (spelling), numbers (mathematics), and following step-by-step instructions. For these students, it will help to break up assigned tasks into smaller parts. Also, tutoring in math and spelling is usually helpful. In general, these students may learn better when multiple sensory modalities (visual, auditory, tactile, and kinesthetic) are used in the teaching/learning process.
Because the expectation is that a college student will absorb information, communicate information, and be evaluated through the printed page, the student with a LD may need assistance and support from instructors in finding innovative ways of receiving and transmitting information and in being evaluated. Because a LD is a “hidden” disability, it is understandable that the instructor may have doubts about the validity of these alternative approaches. However, the fact remains that the student’s capacity for learning is intact and it is only the means by which information is processed by the student with LD that is different.
Often, assistive technology hardware and software is targeted for visually impaired students with visual impairments, but are also quite useful for students with LD, particularly those with written language difficulties. For many, composing at a computer rather than with a pencil and paper much more effectively facilitates the creative process. Furthermore, a voice navigational system (voice-to-text) can also enhance their proofing and editing skills.
Deaf and Hearing Impaired Students
The major challenge facing the student who is deaf or hearing impaired is communication. Speech reading (lip reading) is a partial solution, but at best, a person who is deaf can read only 30 to 40 percent of spoken English by watching the speaker’s lips.
Another form of communication used by many, but not all persons who are deaf or hearing-impaired, is American Sign Language (ASL), a form of “manual” communication. In sign language, thoughts are expressed through a combination of hand and arm movements, positions, and gestures. The intensity and repetition of the movements and the facial expressions accompanying the movements are also important elements of ASL. Finger spelling is usually used in sign language and consists of various finger and hand positions for each of the letters of the alphabet. This alphabet is called the American Manual Alphabet.
Students who are deaf will also communicate in writing when speech reading, sign language, or finger spelling cannot be used effectively, writing notes when necessary to communicate with a another person. Many students who are deaf or hearing impaired can and do speak. Most have normal organs of speech and many learn to use them in speech classes. Some people who are deaf cannot automatically control the tone and volume of their speech so the speech may be initially difficult to understand. Understanding of the person’s communication improves as one becomes more familiar with the speech patterns of the person who is deaf.
Telecommunication Devices For The Deaf (TDDs) allow the person to use the telephone. These devices provide visual communication, rather than amplifying or modifying auditory transmission. These devices are located throughout NVC and in the DSPS Office (Room 1339).
Students vary to some degree in their communication skills. Factors such as personality, intelligence, the degree of deafness, residual hearing, age of onset, and family environment all affect the kind of communication the student uses. As a result of these and other variables, a student may use a number of the communication modes discussed above.
The main form of communication within the deaf community is sign language. In view of this, many persons who are deaf have not mastered the grammatical subtleties of their “second language” - English. However, this does not mean overlook errors in written (or spoken) work. Furthermore, instructors should understand this difficulty with English is not related to intelligence, but is similar to that experienced by students whose native language is other than English (ESL).
In the classroom, most students who are deaf will use a sign language interpreter. The presence of an interpreter in the classroom enables the student who is deaf to understand what is being said. There are two types of interpreters - oral and manual, and the two methods are often used in combination. The oral interpreter “mouths” what is being said while the manual interpreter uses sign language. There is a time lag, which will vary in length depending on the situation, between the spoken word and the interpretation or translation, thus a deaf or hard-of-hearing student’s contribution to the lecture or discussion may be slightly delayed.
Interpretation will be easier in lecture classes and more difficult in seminar or discussion classes. Because class formats are so varied, it is recommended that the professor, interpreter, and student schedule a conference early in the course to discuss any special arrangements that may be needed.
The interpreter and student who is deaf will usually choose to sit in the front of the classroom. The interpreter is aware that sign language may be a distraction to the class and the professor. The interpreter is also aware that the initial curiosity of the class wanes and the professor often adapts easily to the interpreter’s presence. Interpreters who are certified by the Registry of the Interpreters for the Deaf (RID) subscribe to a strict code of ethics that requires confidentiality of private communications and honesty in interpretation or translation.
At NVC, students who are deaf usually have assigned note-takers because it is difficult to follow an interpreter or speech read the instructor and take notes at the same time. Most students who are deaf will be able to take examinations and be evaluated in the same way as other students. If the test is written, it has been found that some students who are deaf do better if an interpreter reads and translates the question to the student in sign language (because of English subtleties). However, many other students prefer to read tests themselves and if the method of evaluation is oral, the interpreter can serve as the reverse interpreter for the student.
Sound Amplification Systems (FM Listening Systems) can assist students who are hearing impaired, but not deaf. These systems consist of a transmitter, worn by the transmitting individual, and a receiver, worn by the receiver. The transmitter sends the voice to the receiver’s systems via fm signals, thereby improving the receiver’s ability to hear.
Assumptions should not automatically be made about the ability of the student who is deaf to participate in certain types of classes. For example, students taking a music class may be able to learn a great deal about music styles, techniques, and rhythms by observing a visual display of the music on an oscilloscope or similar apparatus, or by feeling the vibrations of music.
Some students will have enough residual hearing so that amplification through earphones or hearing aids will allow greater class participation. It is always best to discuss with the student the requirements of a class and to determine if there are ways that the materials can be modified so that the student can participate in what may become an exciting learning experience for all parties involved.
In conclusion, the following hints compiled from personal experience and from publications of the National Technical Institute for the Deaf, the RID, and Gallaudet University, will facilitate the participation of deaf and hard-of hearing students inside and outside of the classroom.
- Look at the person when you speak.
- Don’t smoke, chew gum, or otherwise block the area around your mouth with your hands or other objects.
- Speak naturally and clearly. Don’t exaggerate lip movements or volume.
- Try to avoid standing in front of windows or other sources of light. The glare from behind you makes it difficult to read lips and other facial expressions because it causes a shadow to fall on your mouth and face.
- Using facial expressions, gestures, and other “body language” is helpful in conveying your message.
- If you are talking through the assistance of an interpreter, direct your conversation to the individual. This is more courteous and allows the deaf person the option of viewing both you and the interpreter and to more fully follow the flow of conversation.
- When other people speak who may be out of the deaf or hard-of-hearing person’s range of vision, repeat the question or comment and indicate who is speaking (by motioning) so the affected student can follow the discussion.
- The use of visual media may be helpful to students since slides and videotaped materials supplement and reinforce what is being said. Alteration in lighting may interfere with the student’s capacity to read manual or oral communication. These materials may be difficult to interpret because of sound quality and speed of delivery, therefore interpreter “lag” may be greater. If a written script is available, provide the interpreter and student with a copy in advance.
- Captioned visual aids such as Captioned Films for the Deaf are extremely helpful. If appropriate, foreign language films with English subtitles are also useful.
- When new materials will be covered, especially those which include the use of technical terminology, if possible, supply a list of these words or terms in advance to the student and interpreter. Unfamiliar words are difficult to speech read or interpret.
- Avoid speaking with your back to the person such as when writing on the whiteboard.
- When particularly important information is being covered, be sure to convey it very clearly. Notices of class cancellations, assignments, etc. can be put in writing or on a chalkboard to ensure understanding.
- Establish a system for getting messages to the student when necessary. Class cancellations can be particularly costly when an interpreter is not informed in advance of such changes.
Speech Impaired Students
Speech impairments may be congenital or the result of illness or injury. They may be found alone or in combination with other disabilities, particularly with deafness. In any case, college students' with speech impairment (unless it has been recently acquired) will probably have received some speech therapy. Impairments range from problems with articulation or voice strength to being totally non-vocal. They include stuttering (repetition, blocks, and/or prolongations occasionally accompanied by distorted movements and facial expressions), chronic hoarseness (dysphonia), difficulty in evoking an appropriate word or term (nominal asphasia), and esophageal speech, perhaps resulting from removal of the larynx.
Some students with speech impairments will be hesitant about participating in activities that require speaking. Even if the student has adjusted well to having a speech impairment, new situations may aggravate old anxieties. It is important that self-expression be encouraged, but pressure to speak is not apt to be helpful. It is important to allow time for the student to express himself or herself so that confidence can be gained. Speaking in front of a group can be an agonizing experience for anyone and the student with speech impairment is no exception. It is important for the instructor to accept and respond to all appropriate attempts at communication by this student. When speaking to a person with a speech impairment, continue talking naturally, resisting the temptation to complete words or phrases for this person.
For persons who cannot speak and who are otherwise physically disabled so that they cannot sign, write, or type, various communication aids are available. These aids may range from sophisticated electronic “speaking” machines activated by punching a keyboard with a Head Pointer or Mouth Wand, to a spelling board that consists of a layout of the alphabet, a few common words and phrases to which the speech impaired person points and an assistant may vocalize for the person. Some devices provide a “ticker tape” print-out or display the message on a calculator-like screen across which characters move. With some less portable devices, the message is displayed on a TV screen.
Depending on the severity of the impairment, various adaptive methods may be required for the student with a speech impairment. Many of the methods for accommodations evaluation suggested for other disabilities will also be appropriate for this student. Some will require no adaptive methods at all, but most will need patience, encouragement, and an opportunity to develop self-confidence in an academic setting. The instructor can set the tone that encourages appropriate self-expression in the classroom.
Students with Visual Impairments
Students who are Blind
The major challenge facing students who are blind is the overwhelming mass of printed material with which they are confronted in the classroom: textbooks, class outlines, class schedules, bibliographies, campus newspapers, posters, tests, etc. The increasing use of films, videotapes, overhead projectors, and close circuit television adds to the volume of visual material to which they must have access. By the time these students reach college (unless newly blind), they have probably developed various methods for dealing with the volume of visual materials. Most students who are blind use a combination of methods including assistive technology and computers, readers, Brailled books, books on tape, and LCD or MP3 or other technology.
The rapid and ever-evolving world of computer technology has provided an array of assistive technologies which can accommodate students who are blind, enabling them to more independently and effectively pursue their academic goals. Voice navigational systems (JAWS) and screen magnifiers (Zoomtext) are just two examples. Through computer modems, a student can now use computer stations equipped to facilitate their disabilities, to access course projects, library reference materials, and correspond with instructors via electronic mail.
Students may also use raised line drawings of diagrams, charts, and illustrations; relief maps; three-dimensional models of physical organs shapes and microscopic organisms, etc. Modem technology has made available other aides for persons who are blind, including: talking calculators, paperless (refreshable) Braille machines, Braille computer terminals, and reading machines.
Most students who use Braille prefer to take their own notes in class using a Slate and Stylus or a Brailler. Some students have a note taker and their notes are later read onto tape or the computer for future use. Some students’ audio-record lectures and later transcribe notes from them into Braille.
When there is a student in the classroom who is blind, the usage of “this and that” phrases are basically meaningless to that student. For example, “the sum of this plus that equals this” or “the lungs are located here and the diaphragm here” can be confusing. In the first example, an instructor may be writing on the whiteboard and can just as easily say “The sum of 4 plus 7 equals 11.” The student in this case is getting the same information as a sighted student. In the second example, the instructor may be pointing to a model or to the body itself. In this instance, the professor can “personalize” the locations of the lungs and diaphragm by asking the class members to locate them by touching on their own bodies. Examples of this type will not always be possible, however if the faculty member is sensitized not to use strictly visual examples, the student who is blind, and probably the rest of the class, will benefit.
Another area in which the student who is blind will need an accommodation is in testing. Most students will prefer to take examinations with a familiar reader or scribe. Arrangements can be made with the Testing and Tutoring Center (Bldg. 1700, Room 1764) and the DSPS Counselor to select and provide an appropriate reader. This is often beneficial to the student because it does not add anxiety to the testing process, which is already an anxiety-producing situation. Another method that may be used is to administer the test orally or by audiotape to the student who in turn either records the answers orally onto another tape recorder or Brailles the answers. It is also possible to have the tests Brailled or taped in advance.
Some instructors may prefer to administer tests themselves or have an instructional assistant do it. Although this approach is certainly within the prerogative of the instructor, it can be an uncomfortable situation for the student. If the instructor is not concerned about “test security” or prefers not to rely on the “honor system” a take-home test can be given to the student. However, it is better to avoid giving the student “different” tests because it creates segregations, makes it difficult to compare test results, and may create negative attitudes. In any case, the instructor and the student should agree early in the course on how the student’s progress will be evaluated.
Some instructors are concerned about having their lectures tape-recorded, whether the student is blind or sighted. When an instructor is planning to publish his or her lectures, the fear may be that the recordings will somehow interfere with these plans. If this is the case, the faculty member may ask the student to sign an agreement not to release the recording or otherwise hinder the instructor’s ability to obtain a copyright. This agreement is available from the DSPS Coordinator.
Instructors can be very helpful by choosing class texts early as it takes a long time to have a text audio-recorded or Brailled. If texts are selected early, making this information readily available through a departmental office or the campus bookstore, the student has time to make the necessary arrangements for alternate formatting of the text.
Some students who are blind use dog guides. There is no need to worry that the dog guide will disturb the class as they are very highly trained and disciplined. Most of the time, the dog will lie quietly, next to the student, under or beside the table or desk. The greatest disruption a professor can expect may be an occasional yawn or stretch. (Sometimes a rescue siren can cause a low moan.) It is good to remember that as tempting as it may be to pet a dog guide, the dog, while in a harness, is responsible for guiding its owner who cannot see and it should not be distracted from that duty.
Courses, which are extremely “visual” by their very nature, can be accommodated for the blind student. However, it should not be assumed automatically that this will be necessary. Conversations between the student and the professor can lead to new and even exciting instructional techniques that can be beneficial to the entire class. For example, it is often thought that a student who is blind or visually impaired cannot take a course in art appreciation and that if this is a requirement for graduation, it should be accommodated. However, the student should have the opportunity to become familiar with the world’s great art as any other “educated” person. A classmate or reader who is particularly talented at verbally describing visual images can assist the student as a visual “interpreter” or “translator.”
For example, there is no reason for the student not to know what the “Mona Lisa” (or other great works of art) looks like. It can be described and there are poems written about the “Mona Lisa” that may be used as teaching aids to give more insight and understanding to the work. Miniature models of great works of sculptures can be made available for display and touching in the classroom and many modern museums have tactile galleries. The point is that certain disabilities (in this case blindness) do not automatically preclude participation in certain activities or classes.
Students, professors, and advisors must be careful not to lower expectations solely on the basis of disability. If classes involve field trips to out-of-class locations, discuss traveling needs with the student. In most instances, all that will be required is for a member of the class to act as a Sighted Guide. In localities where public transportation is adequate, many persons who are blind travel quite independently
Students with Low or Partial Vision:
Between 70 and 80 percent of all legally blind persons in the United States have measurable vision and often the partially sighted student meets the challenge of disability in much the same way as the blind student. This includes the use of readers, audio-taped texts, raised line drawings, computers with screen magnifiers, etc. In addition, the partially sighted students may be able to use large print books, a Closed Circuit TV (CCTV) Magnifier, or other magnifying devices. The student may also produce papers in large print and some partially sighted students will be able to take notes in class by printing very large with a felt tip pen or marker. Others will tape record lectures for later use.
Any potential difficulties can be alleviated if the student and professor discuss the student’s needs early in the term. Sitting in the front of the room, having large print on the whiteboard, or the use of enlarged print on an overhead projector may assist a partially sighted student. However, the capacity to read printed materials depends greatly on classroom conditions, such as the degree of contrast, brightness, and color. It is preferable to have the student and instructor discuss what methods, techniques, or devices may be used to maximum advantage.
Physical access is one of the major concerns of the student who uses a wheelchair. The student must learn routes to and from classes and across campus that do not present barriers. They may encounter delay mechanisms such as a vehicle or bicycle blocking a curb cut or ramp, a sign in the middle of what would otherwise be a wide enough walkway, or inclines in the pathways that cause them to move too fast.
Classes held in theaters may present difficulties unless there is a large enough flat floor space in the front or rear of the classroom for a wheelchair to park. There must also be an entrance to and from that theater or classroom level. Classrooms with tables (provided there is an under-table clearance of at least 27.5”)are more accessible to students in wheelchairs than rooms with standard classroom desks. It is better if the tables and chairs are movable rather than stationary.
It is difficult to make generalizations about the classroom needs of students who use wheelchairs because some students may be able to stand for short periods of time while others will not be able to stand at all.
There are some general considerations, listed below, that will apply to most, if not all, students who use wheelchairs.
If a classroom or faculty office is inaccessible, it will be necessary to find an accessible location or alternate class section that is held in an accessible location. DSPS can assist in this effort.
If breaks between classes are short (10 minutes or less), the student who uses a wheelchair may frequently be a few minutes late. Usually, the student must wait for an elevator, take a circuitous (but accessible) route, wait for assistance in opening doors (unless electric doors are available), and maneuver along crowded paths and corridors. If a student who uses a wheelchair is frequently late, it is, of course, appropriate to discuss the situation with the student and seek solutions, but most students will be aware of time restrictions and will schedule their classes accordingly. Early classes and attendants’ schedules can also pose particular difficulties.
If a class involves fieldwork or field trips, ask the student to participate in the selection of sites and modes of transportation. If the college provides transportation for field trips, we are required to provide accessible transportation for students who use wheelchairs. DSPS has a wheelchair accessible van which can be made available if scheduled through the Facilities Department (707-253-3340).
Classes in physical education and recreation can almost always be modified so that the student in a wheelchair can participate. Classmates are usually more than willing to assist, if necessary. Most students who use wheelchairs do not get enough physical exercise in daily activity, so it’s particularly important that they be encouraged, as well as provided, the opportunity to participate. Information on DSPS adaptive physical education (APE) courses is available from the Physical Education Department.
Classes taught in laboratory settings (science, wood and metal workshops, language labs, art studios, etc.) will usually require some modification of the workstation. Considerations include under-counter knee clearance, working countertop height, and horizontal working reach and aisle widths. Working directly with the student may be the best way to provide modifications to the workstation. However, if a station is modified in accordance with established accessibility standards, the station will be usable by most students in wheelchairs.
For those students who may not be able to participate in a laboratory class without the assistance of an aide, the student should be allowed to benefit from the actual lab work to the fullest extent. For example, the student can give all instructions to an aide -from what chemical to add to what type of test tube to use to where to dispose of used chemicals – allowing the student to learn everything except the physical manipulation of the chemicals.
Students are not “confined” to wheelchairs, as they may often transfer to and from automobiles and furniture. Some who use wheelchairs can walk with the aid of canes, braces, crutches, or walkers, thus the chair may be a means to conserve energy or move about more quickly.
Most students who use wheelchairs will ask for assistance if they need it. Don't assume automatically that assistance is required. Offer assistance if you wish, but do not insist, and accept a “No, thank you” graciously.
When talking to a student in a wheelchair, if the conversation continues for more than a few minutes, sit down, kneel, or squat if convenient.
A wheelchair is part of the person’s body space. Don’t automatically hang on or lean on the chair - it’s similar to hanging or leaning on the person. It’s fine it you are friends but inappropriate otherwise.
Because a student sitting in a wheelchair is about as tall as most children, and because a pat on the head is often used to express affection toward children, many people are inclined to reach out and pat the person in a wheelchair on the head. Such a gesture is very demeaning and patronizing.
There are many other disabilities that largely affect mobility, such as cardiac conditions, arthritis, chronic back pain, chronic fatigue syndrome, active sickle cell anemia, diabetes, and respiratory disorders.
Students of Short Stature may have in-classroom access problems unique to their stature.
The student with epilepsy will have little problem in the classroom and in most cases, seizures will be controlled by medication. Some students with epilepsy will have learned to manage seizure activity through adequate rest, proper diet, and regular medication. Most will be able to participate in sports and lead active, normal lives. There are some whose seizure activity simply cannot be controlled. Students with seizure disorders are advised to submit emergency medical information to the NVC’s Health Services by making an appointment with the Nurse Practitioner (707-259-8005). Seizures in class often result in the contacting of emergency medical services to ensure the well-being of the student.
Students who have had an ostomy (urostomy, colostomy, ileostomy) may be advised not to participate in violent contact sports or wrestling. However, most permissible restrictions on participation will be the result of causes other than the ostomy itself. Swimming is permissible for many of these students and most have found that a matter-of-fact attitude toward their appliance encourages other students to behave in the same way.
Spinal Bifida (open spine) may cause a range of disabilities varying from no noticeable effects to hydrocephalus and paralysis. The student with spinal bifida may have short stature and may use a wheelchair, braces or crutches. Classroom modifications that may be required will depend on the student’s functional limitations and most adaptations that are required have been discussed in earlier sections.
Multiple Sclerosis (MS), the number one cause of chronic disability among young adults, may affect the student in a multitude of ways. Because MS most often occurs between the ages of 20 and 40, the college student with MS is apt to be in the process of adjusting to the new disability. Depending on the degree to which the MS has progressed, the student’s mobility, speech, vision, and emotional state may be affected. One of the most difficult aspects of MS is that the symptoms have a tendency to come and go, but they continue to progress. Periods of remission may last from a few days to months in the early stages and during an exacerbation, the student may appear as if intoxicated - slurred speech, staggering, unfocused eyes. Understanding that fluctuations may occur in the student’s behavior, make it easier to understand variations in classroom performance. The physical adaptations, if any, will vary from student to student, depending on functional limitation and the most common accommodations have been discussed in previous sections.
Other conditions that may result in marked fluctuations of behavior and performance are Muscular Dystrophy and certain kidney problems, some of which may necessitate dialysis. As a final note, some of the conditions described in this section require medication for control of symptoms. If an instructor has valid educational questions about the potential effect of various medications on the student’s performance, the student, if willing, can best provide some information. The instructor should not hesitate to discuss such issues tactfully with the student. NVC’s student health Nurse practitioner or the DSPS Administrator or DSPS Counselor may be able to provide relevant information.