Kirk's Masters Thesis Chapter 1: Introduction and Why It's Important
Today there are “over 43 million Americans who have disabilities” (Access Press, 2006 p.12). A good percentage of people with disabilities continue to enter the criminal justice system as criminals, victims, and witnesses. People with disabilities are capable of being fatally dangerous to criminal justice professionals as criminals i.e. gang members with spinal cord injuries, disabled veterans engaging in domestic disputes etc. Some people with disabilities can be more vulnerable to being crime victims due to their extra physical or mental challenges. Furthermore, people with disabilities can be helpful and credible crime witnesses. However, people with disabilities often necessitate extra things from criminal justice professionals such as extra time, patience, transportation and communication accommodations etc. Thus, it is essential for criminal justice professionals to be comfortable with and to know how to effectively interact with people who have disabilities. Therefore, I decided to discuss the following items in this capstone document:
General descriptions of common disabilitiesA literature review of the issues that criminal justice professionals encounter when interacting with people who have disabilitiesSurvey results regarding how various criminal justice professionals feel when interacting with people who have disabilitiesStep by step instructions to guide criminal justice professionals on how to effectively and appropriately interact with people who have disabilities along with training scenarios that I have designed and/or used for future and current criminal justice professionalsAlso a list of many resources enabling criminal justice professionals to research and/or get assistance on various issues in their workFurthermore, the remainder of this chapter will be an overview of main disabilities and how they can affect people.
Cerebral palsy:
"Cerebral palsy refers to a group of disorders that affect a person's ability to move and to maintain balance and posture" National Center on Birth Defects and Developmental Disabilities [NCBDDD], 2004, para.1). It is due to a non-progressive brain abnormality, which means that it does not get worse over time, though the exact symptoms can change over a person's lifetime. People with cerebral palsy have damage to the part of the brain that controls muscle tone. Muscle tone is the amount of resistance to movement in a muscle. It is what lets you keep your body in a certain posture or position. For example, it lets you sit up straight and keep your head up. "Changes in muscle tone let you move. For example, to bring your hand to your face, the tone in your biceps muscle at the front of your arm must increase while the tone in the triceps muscle at the back of your arm must decrease" (NCBDDD, 2004, para.3). The tone in different muscle groups must be balanced for you to move smoothly.
According to the National Center on Birth Defects and Developmental Disabilities, there are four main types of cerebral palsy: spastic, athetoid, ataxic, and mixed.
· Spastic: People with spastic cerebral palsy have increased muscle tone. Their muscles are stiff. Their movements can be awkward. Seventy to eighty percent of people with cerebral palsy have spasticity. Spastic cerebral palsy is usually described further by what parts of the body are affected. In spastic diplegia, the main effect is found in both legs. In spastic hemiplegia, one side of the person's body is affected. Spastic quadriplegia affects a person's whole body (face, trunk, legs, and arms).
· Athetoid or dyskinetic: People with athetoid cerebral palsy have slow, writhing movements that they cannot control. The movements usually affect a person's hands, arms, feet, and legs. Sometimes the face and tongue are affected and the person has a hard time talking. Muscle tone can change from day to day and can vary even during a single day. Ten to twenty percent of people with cerebral palsy have the athetoid form of the condition.
· Ataxic: People with ataxic cerebral palsy have problems with balance and depth perception. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something. People with ataxic cerebral palsy can have increased or decreased muscle tone. Five to ten percent of people with cerebral palsy have ataxia.
· Mixed: Some people have more than one type of cerebral palsy. The most common pattern is spasticity plus athetoid movements. (NCBDDD, 2004, para.4).
The symptoms of cerebral palsy vary from person to person. Symptoms can also change over time. A person with severe cerebral palsy might not be able to walk and might need lifelong care. A person with mild cerebral palsy, on the other hand, might walk a little awkwardly, but might not need any special help. "People with cerebral palsy can have other disabilities as well. Examples of these conditions include seizure disorders, vision impairment, hearing loss, and mental retardation" (NCBDDD, 2004, para.6). However, cerebral palsy itself is not a disease and it’s not contagious, and normally people don’t die from it.
Spinal cord injuries usually begin with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. “Most spinal cord injuries do not completely sever the spinal cord" (National Institute of Neurological Disorders and Stroke [NINDS], 2006, para.1). Instead, injuries are more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. "An injury to the spinal cord can damage a few, many, or almost all of these axons" (NINDS, 2006, para.1). Some injuries will allow almost complete recovery where others will result in complete paralysis.
Spinal cord injuries:
Spinal cord injuries are classified as either complete or incomplete. "An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost" (NINDS, 2006, para.3). People with incomplete injuries retain some motor or sensory function below the injury. "A complete injury is indicated by a total lack of sensory and motor function below the level of injury" (NINDS, 2006, para.3). People who survive spinal cord injuries will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Also "respiratory complications are often an indication of the severity of the specific spinal cord injury, and about one-third of those with injury to the neck area will need help with breathing and require respiratory support" (NINDS, 2006, para.2). Furthermore, successful recovery depends upon how well these chronic conditions are handled day to day.
Multiple sclerosis:
"Multiple sclerosis (MS) is an unpredictable disease of the central nervous system, but it's not contagious" (NINDS, 2006, para.1). MS can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted. MS is often characterized as an autoimmune disease in that the body launches a defensive attack against its own tissues through its immune system, and more specifically, "MS causes the nerve-insulating myelin to be under assault" (NINDS, 2006, para.1). Such assaults may be linked to an unknown environmental trigger, perhaps a virus.
"Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye" (NINDS, 2006, para.2). Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Most people with MS also exhibit transitory abnormal sensory feelings such as numbness, prickling, or pins and needles, sensations, and some people may also experience pain. Speech / writing impediments, hearing loss, tremors, dizziness, and depression are all probable effects of MS. Also "approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked" (NINDS, 2006, para.2). Furthermore, "avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue" (NINDS, 2006, para.4).
Muscular dystrophy:
"Muscular dystrophies (MD) are a group of more than 30 genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles that control movement" (NINDS, 2006, para.1). Some forms of MD are seen in infancy or childhood where others may not appear until middle age or later. The disorders differ in terms of the distribution and extent of muscle weakness (some forms of MD also affect cardiac muscle), age of onset, rate of progression, and pattern of inheritance. "Duchenne MD is the most common form of MD and primarily affects boys" (NINDS, 2006, para.1). It is caused by the absence of dystrophin, a protein involved in maintaining the integrity of muscle. "Onset is between three and five years and the disorder progresses rapidly, and most boys are unable to walk by age 12" (NINDS, 2006, para.1). "Girls in these families have a 50 percent chance of inheriting and passing the defective gene to their children" (NINDS, 2006, para.1). Boys with Becker MD (very similar to but less severe than Duchenne MD) have faulty or not enough dystrophin. “Facioscapulohumeral MD usually begins in the teenage years” (NINDS, 2006, para.1). It causes progressive weakness in muscles of the face, arms, legs, and around the shoulders and chest. It progresses slowly and can vary in symptoms from mild to disabling. “Myotonic MD is the disorder's most common adult form and is typified by prolonged muscle spasms, cataracts, cardiac abnormalities, and endocrine disturbance” (NINDS, 2006, para.1). Individuals with myotonic MD have long, thin faces, drooping eyelids, and a swan-like neck. In summary, the severity of MD varies according to the specific type and somewhat unpredictable progression of the disorder. Some cases may be mild and progress very slowly over a normal lifespan, while others produce severe muscle weakness, functional disability, and loss of the ability to walk. Some children with MD die in infancy while others live into adulthood with only moderate disability. Furthermore, "there isn't any specific treatment to stop or reverse any form of MD" (NINDS, 2006, para.2). However, some individuals may benefit from drug therapy, occupational therapy, and assistive technology. Also "some patients may need assisted ventilation to treat respiratory muscle weakness and a pacemaker for cardiac abnormalities" (NINDS, 2006, para.2).
Mental retardation:
“Mental retardation is a term used when a person has certain limitations in mental functioning and in skills such as communicating, taking care of him or herself, and social skills” (National Dissemination Center for Children with Disabilities [NICHCY], 2004, para.3). These limitations will cause a child to learn and develop more slowly than a typical child. “Children with mental retardation may take longer to learn to speak, walk, and take care of their personal needs such as dressing or eating” (NICHCY, 2004, para.3). They are likely to have trouble learning in school. They will learn, but it will take them longer. However, there may be some things they cannot learn.
According to the National Dissemination Center for Children with Disabilities, there are many signs of mental retardation. For example, children with mental retardation may: sit up, crawl, or walk later than other children; learn to talk later, or have trouble speaking, find it hard to remember things, not understand how to pay for things, have trouble understanding social rules, have trouble seeing the consequences of their actions, have trouble solving problems, and/or have trouble thinking logically. (NICHCY, 2004, para.9).
In summary, mental retardation is not a disease, and it is not contagious. Mental retardation is also not a type of mental illness, like depression. Furthermore, there isn't any cure for mental retardation. However, “most children with mental retardation can learn to do many things” (NICHCY, 2004, para.4).
Based on my own personal experience as a person who has had cerebral palsy since birth, the above disabilities are some of the more common types that criminal justice professionals may see. However, there are many more disabilities in America. Thus, chapter five will list websites where criminal justice professionals can easily find more detailed information about the above disabilities and others. I highly recommend that criminal justice professionals browse the websites, because they offer a lot of detailed information on many disabilities such as the causes, treatments, specific prognoses, preventative tips, and much more.
General descriptions of common disabilitiesA literature review of the issues that criminal justice professionals encounter when interacting with people who have disabilitiesSurvey results regarding how various criminal justice professionals feel when interacting with people who have disabilitiesStep by step instructions to guide criminal justice professionals on how to effectively and appropriately interact with people who have disabilities along with training scenarios that I have designed and/or used for future and current criminal justice professionalsAlso a list of many resources enabling criminal justice professionals to research and/or get assistance on various issues in their workFurthermore, the remainder of this chapter will be an overview of main disabilities and how they can affect people.
Cerebral palsy:
"Cerebral palsy refers to a group of disorders that affect a person's ability to move and to maintain balance and posture" National Center on Birth Defects and Developmental Disabilities [NCBDDD], 2004, para.1). It is due to a non-progressive brain abnormality, which means that it does not get worse over time, though the exact symptoms can change over a person's lifetime. People with cerebral palsy have damage to the part of the brain that controls muscle tone. Muscle tone is the amount of resistance to movement in a muscle. It is what lets you keep your body in a certain posture or position. For example, it lets you sit up straight and keep your head up. "Changes in muscle tone let you move. For example, to bring your hand to your face, the tone in your biceps muscle at the front of your arm must increase while the tone in the triceps muscle at the back of your arm must decrease" (NCBDDD, 2004, para.3). The tone in different muscle groups must be balanced for you to move smoothly.
According to the National Center on Birth Defects and Developmental Disabilities, there are four main types of cerebral palsy: spastic, athetoid, ataxic, and mixed.
· Spastic: People with spastic cerebral palsy have increased muscle tone. Their muscles are stiff. Their movements can be awkward. Seventy to eighty percent of people with cerebral palsy have spasticity. Spastic cerebral palsy is usually described further by what parts of the body are affected. In spastic diplegia, the main effect is found in both legs. In spastic hemiplegia, one side of the person's body is affected. Spastic quadriplegia affects a person's whole body (face, trunk, legs, and arms).
· Athetoid or dyskinetic: People with athetoid cerebral palsy have slow, writhing movements that they cannot control. The movements usually affect a person's hands, arms, feet, and legs. Sometimes the face and tongue are affected and the person has a hard time talking. Muscle tone can change from day to day and can vary even during a single day. Ten to twenty percent of people with cerebral palsy have the athetoid form of the condition.
· Ataxic: People with ataxic cerebral palsy have problems with balance and depth perception. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something. People with ataxic cerebral palsy can have increased or decreased muscle tone. Five to ten percent of people with cerebral palsy have ataxia.
· Mixed: Some people have more than one type of cerebral palsy. The most common pattern is spasticity plus athetoid movements. (NCBDDD, 2004, para.4).
The symptoms of cerebral palsy vary from person to person. Symptoms can also change over time. A person with severe cerebral palsy might not be able to walk and might need lifelong care. A person with mild cerebral palsy, on the other hand, might walk a little awkwardly, but might not need any special help. "People with cerebral palsy can have other disabilities as well. Examples of these conditions include seizure disorders, vision impairment, hearing loss, and mental retardation" (NCBDDD, 2004, para.6). However, cerebral palsy itself is not a disease and it’s not contagious, and normally people don’t die from it.
Spinal cord injuries usually begin with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. “Most spinal cord injuries do not completely sever the spinal cord" (National Institute of Neurological Disorders and Stroke [NINDS], 2006, para.1). Instead, injuries are more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. "An injury to the spinal cord can damage a few, many, or almost all of these axons" (NINDS, 2006, para.1). Some injuries will allow almost complete recovery where others will result in complete paralysis.
Spinal cord injuries:
Spinal cord injuries are classified as either complete or incomplete. "An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost" (NINDS, 2006, para.3). People with incomplete injuries retain some motor or sensory function below the injury. "A complete injury is indicated by a total lack of sensory and motor function below the level of injury" (NINDS, 2006, para.3). People who survive spinal cord injuries will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Also "respiratory complications are often an indication of the severity of the specific spinal cord injury, and about one-third of those with injury to the neck area will need help with breathing and require respiratory support" (NINDS, 2006, para.2). Furthermore, successful recovery depends upon how well these chronic conditions are handled day to day.
Multiple sclerosis:
"Multiple sclerosis (MS) is an unpredictable disease of the central nervous system, but it's not contagious" (NINDS, 2006, para.1). MS can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted. MS is often characterized as an autoimmune disease in that the body launches a defensive attack against its own tissues through its immune system, and more specifically, "MS causes the nerve-insulating myelin to be under assault" (NINDS, 2006, para.1). Such assaults may be linked to an unknown environmental trigger, perhaps a virus.
"Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye" (NINDS, 2006, para.2). Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Most people with MS also exhibit transitory abnormal sensory feelings such as numbness, prickling, or pins and needles, sensations, and some people may also experience pain. Speech / writing impediments, hearing loss, tremors, dizziness, and depression are all probable effects of MS. Also "approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked" (NINDS, 2006, para.2). Furthermore, "avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue" (NINDS, 2006, para.4).
Muscular dystrophy:
"Muscular dystrophies (MD) are a group of more than 30 genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles that control movement" (NINDS, 2006, para.1). Some forms of MD are seen in infancy or childhood where others may not appear until middle age or later. The disorders differ in terms of the distribution and extent of muscle weakness (some forms of MD also affect cardiac muscle), age of onset, rate of progression, and pattern of inheritance. "Duchenne MD is the most common form of MD and primarily affects boys" (NINDS, 2006, para.1). It is caused by the absence of dystrophin, a protein involved in maintaining the integrity of muscle. "Onset is between three and five years and the disorder progresses rapidly, and most boys are unable to walk by age 12" (NINDS, 2006, para.1). "Girls in these families have a 50 percent chance of inheriting and passing the defective gene to their children" (NINDS, 2006, para.1). Boys with Becker MD (very similar to but less severe than Duchenne MD) have faulty or not enough dystrophin. “Facioscapulohumeral MD usually begins in the teenage years” (NINDS, 2006, para.1). It causes progressive weakness in muscles of the face, arms, legs, and around the shoulders and chest. It progresses slowly and can vary in symptoms from mild to disabling. “Myotonic MD is the disorder's most common adult form and is typified by prolonged muscle spasms, cataracts, cardiac abnormalities, and endocrine disturbance” (NINDS, 2006, para.1). Individuals with myotonic MD have long, thin faces, drooping eyelids, and a swan-like neck. In summary, the severity of MD varies according to the specific type and somewhat unpredictable progression of the disorder. Some cases may be mild and progress very slowly over a normal lifespan, while others produce severe muscle weakness, functional disability, and loss of the ability to walk. Some children with MD die in infancy while others live into adulthood with only moderate disability. Furthermore, "there isn't any specific treatment to stop or reverse any form of MD" (NINDS, 2006, para.2). However, some individuals may benefit from drug therapy, occupational therapy, and assistive technology. Also "some patients may need assisted ventilation to treat respiratory muscle weakness and a pacemaker for cardiac abnormalities" (NINDS, 2006, para.2).
Mental retardation:
“Mental retardation is a term used when a person has certain limitations in mental functioning and in skills such as communicating, taking care of him or herself, and social skills” (National Dissemination Center for Children with Disabilities [NICHCY], 2004, para.3). These limitations will cause a child to learn and develop more slowly than a typical child. “Children with mental retardation may take longer to learn to speak, walk, and take care of their personal needs such as dressing or eating” (NICHCY, 2004, para.3). They are likely to have trouble learning in school. They will learn, but it will take them longer. However, there may be some things they cannot learn.
According to the National Dissemination Center for Children with Disabilities, there are many signs of mental retardation. For example, children with mental retardation may: sit up, crawl, or walk later than other children; learn to talk later, or have trouble speaking, find it hard to remember things, not understand how to pay for things, have trouble understanding social rules, have trouble seeing the consequences of their actions, have trouble solving problems, and/or have trouble thinking logically. (NICHCY, 2004, para.9).
In summary, mental retardation is not a disease, and it is not contagious. Mental retardation is also not a type of mental illness, like depression. Furthermore, there isn't any cure for mental retardation. However, “most children with mental retardation can learn to do many things” (NICHCY, 2004, para.4).
Based on my own personal experience as a person who has had cerebral palsy since birth, the above disabilities are some of the more common types that criminal justice professionals may see. However, there are many more disabilities in America. Thus, chapter five will list websites where criminal justice professionals can easily find more detailed information about the above disabilities and others. I highly recommend that criminal justice professionals browse the websites, because they offer a lot of detailed information on many disabilities such as the causes, treatments, specific prognoses, preventative tips, and much more.