Chronic Illness

What is Chronic Illness?

Students who have a chronic illness may experience a disability as a result of their condition. Unlike many other disabilities, however, the limitations that impact their academic success may come and go over time. This means that they may begin the semester feeling relatively well, then experience a flare-up, relapse, or other change in health status.

In the postsecondary education context, it is up to each individual student with a disability to decide whether to register with DRS and whether to disclose the presence of a disability to professors.  In the case of a student living with a chronic illness, the disclosure decision may hinge upon how the student is feeling during the semester in question. The tendency of symptoms – and therefore functional limitations – to wax and wane leads some students to avoid disclosure early in the semester, in the hope that their health will remain stable. Therefore, faculty should be prepared for disclosure at any point in the semester.  This makes universal design measures especially appealing; because they are built into the course structure from the beginning, they are in place should a chronic illness interfere.

In a brief 2010 International Women’s Day address, Carolina Pineda identifies four reasons why chronic illnesses make it difficult for students to succeed in post-secondary education:

  1. Invisibility: Chronic illness is one type of disability that instructors won’t know about unless the student reveals it. But invisibility entails a further consequence: those who have never lived with chronic illness may be inclined to think that the student is exaggerating or even making up the problems caused by the illness or treatment.
  2. Unpredictability: Many chronic conditions ebb and flow in an unpredictable way, creating the potential for major disruptions of learning and course work. 
  3. Social stigma: Because some degree of social stigma is still carried by chronic illnesses (especially those, like chronic fatigue syndrome, that are not universally recognized), students often hesitate to disclose an illness unless absolutely necessary. Their reluctance to discuss their condition may extend beyond the classroom to their peers, increasing their sense of isolation as a consequence.
  4. Tighter limits: The effects of chronic illness often prevent students from holding a job while in school; this increases the financial burden of college. Even so, they may have less productive time available on a typical day than their professors expect.

A common theme in the reflections of adults with chronic illness is the frustration they feel when someone who does not have to cope with that illness expresses skepticism about their limitations or expects them to simply think positively and get past it. It is crucial for faculty to be sensitive to their own assumptions when responding to a student who has disclosed that s/he has difficulties related to a chronic illness. The Resources section below provides links to several sources of personal accounts of life with chronic illness. Faculty who have no experience with the wide variety of chronic illnesses can explore these to get a sense of how chronic illness can reshape one’s life and horizons.

Challenges and Strategies

The table below lists several challenges a student may confront related to his/her illness, and suggests strategies – aside from accommodations determined by DRS – that faculty might deploy to mitigate their academic impact.  Beside each strategy are the letters “UDL” ; this indicates consistency with Universal Design for Learning.  The instructor implements the given measure for the whole class, so that not only the student with a disability benefits from it.  This also assures that a student with a disability is not unnecessarily singled out or identified as needing special provisions.

Potential Challenges Strategies
Medication or the underlying condition may adversely affect the student’s level of energy and concentration.  S/he may tune out for periods of time, or may be unable to simultaneously listen and take notes. 

Avoid lecturing for the full class session.  Break the time into segments of 10-15 minutes, punctuated by activities that require students to think about, organize, practice, or use what they are learning. UDL

Take a break during classes longer than 50 minutes. UDL

Before class, post a skeletal outline, graphic organizer, or other structure for students to fill in or expand on when taking notes.  This should highlight in some way the critical information. UDL

Post a copy of your lecture notes (and/or PowerPoint or other presentation tool) on Blackboard so that any student, including one with ADHD, may review them and fill in gaps in her/his notes. UDL

Incorporate a system in which several students each day – on a voluntary or required basis – post their notes for that class on Blackboard (a wiki or discussion board works well for this). UDL

Capture your class sessions or record your voice on a digital recorder and post it on Blackboard as a podcast. UDL

Allow the student to record lectures and other important informational segments. UDL
The student may be absent frequently or for extended periods.

Post on Blackboard all assignments – in-class as well as homework.  Post announcements about any changes to the original schedule.  UDL

Create an archive on Blackboard with materials related to each class session: e.g., your notes/outline; notes taken by student volunteers; PowerPoint slides or other media; audio or video recordings of the session. UDL
Absences may prevent the student from engaging in discussions, asking questions, or otherwise contributing to the learning of the whole group.

Offer ways for students to participate and interact online: e.g., by blogging; contributing to a wiki; engaging in asynchronous discussions via discussion board; or conducting small group work remotely. UDL

If your student has a computer at home with sound capabilities (and a microphone, ideally), arrange to set up a Wimba classroom through Blackboard, so that the student may be “present” remotely – able to see you and hear what you say, see documents or slides that you open on-screen, and ask or type in questions.  For help with the Wimba tools, contact the Instructional Support Center on your campus. UDL
Sometimes, a flare-up of a chronic illness will make it difficult to move or to hold and manipulate objects.

Provide all your course materials in digital form, so that students can use assistive software that reads aloud or that responds to voice commands instead of requiring a mouse. UDL

If possible identify an appropriate textbook that is available in recorded or digital form so that students don’t need to hold it or turn pages. UDL

 

Resources

Buchanan, Ricky. “An open letter to those without invisible disability or chronic illness.”

DO-IT Faculty Room, Knowledge Base articles on health-related disabilities.  The list includes several case studies as well as more general articles.

DO-IT Faculty Room, information for faculty about Health Impairments.  Includes links to two case studies, FAQs, and Resources.

Royster, Lynn.  “Going back to school when you have a chronic illness.” Transcript of radio program.