Blindness
Blindness generally refers to a loss of vision. While it often describes total sightlessness, it can also include partial blindness, where vision is extremely limited (low vision).
Causes of Blindness
There are several causes of blindness, including (but not limited to):
Diabetes
Macular Degeneration
Glaucoma
Accidents or traumatic injuries to the eye
Stroke
Retinitis Pigmentosa
Legal Definition of Blindness
In the United States, blindness has a legal definition used solely to determine eligibility for various programs, such as schooling, disability benefits, vocational services, assistive device programs, and tax exemptions. This legal definition is not meant to describe functional vision, so it does not indicate what a person can or cannot see.
According to U.S. law, a person is considered legally blind if the visual acuity in their better-seeing eye is 20/200 or worse with corrective lenses, or if their field of vision in that eye is 20 degrees or less.
Experiences Using the Web
“When I tell people that my job is to help make the web more accessible to people with disabilities, it’s always interesting to witness their reactions. Often their first impulse is to say something like, “Wow, that’s cool.” Then, almost as immediately, they often ask, “What kind of disabilities are you talking about?” I tell them that the main categories are visual disabilities, including blindness, low vision, and color blindness, auditory disabilities, motor disabilities, cognitive disabilities, and seizure disorders. Sometimes before I get a chance to finish my list of disability types, though, people will stop me and ask, “Wait, how does a blind person use the web?” That usually marks the beginning of an interesting discussion that allows people to think in new ways that they never thought of before.” - Paul Bohman, PhD, Director of Training at Deque
So, how does a blind person use the web? The answer is that they use a software program called a screen reader.
Screen Readers
Screen readers convert the text on a web page into spoken words, allowing blind users to listen to the content. In the video below, Rakesh Babu, an Assistant Professor in the School of Information Studies at the University of Wisconsin-Milwaukee, explains what it’s like to use a screen reader and highlights some of the challenges that arise when websites aren’t designed with accessibility in mind.
Note: Experienced screen reader users often turn up the speed on their screen readers, so if you have a hard time understanding the screen reader as he uses it, that’s why. The default speed is slower and more conversational, which is easier to follow.
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Video source can be found here: Helping the blind navigate the online world opens in a new window
Video Transcript
Skip transcript (134 words)
(screen reader speaking)
- [Rakesh] As I was growing up and I began to lose my sight, the whole world was shut, because I couldn’t see anything.
(screen reader speaking)
I just heard it say “Google.” That means I am on my home page. Screen readers are these software that are designed to translate text into speech.
(screen reader speaking)
So, and that’s the primary way or other technology that helps blind people interact with the web and the computers. And this seems like there’s a calendar here, (laughs) but that’s just my guesswork. With a little bit of understanding and compassion, designers can build technologies that are more blind-friendly. People like me who can’t see can, in fact, contribute, participate effectively in every aspect of life, you know, just as other people do.
(screen reader speaking)
Challenges & Solutions for People Who Are Blind
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who are blind experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Blindness: Examples of Challenges and Solutions Domain Challenges Solutions
Information and Communication Technology (ICT) Cannot see digital or electronic interfaces (computers, automated teller machines (ATMs), mobile devices, airport kiosks, televisions, printers, copiers, phones, GPS devices, etc.)
Screen readers convert digital text to speech so users can hear content and interface elements, but they only work if the interface is designed to be accessible. They usually don’t announce text styles like font, color, size, bold, or italic.
Self-voicing applications can also speak content without a screen reader, but they’re mainly used for broadcasting information since they don’t interact with interfaces the way screen readers do.
Refreshable braille devices use screen readers to convert text to braille. These devices are costly, and only a small number of blind people read braille.
ICT Cannot use screen readers on digital content and interfaces not designed with accessibility in mind
Interface designers and content authors can modify code to make it compatible with assistive technologies for blind users.
Architecture & Built Environment Cannot see when walking
Canes allow blind people to sense their surroundings while walking.
Service animals (e.g., "Seeing Eye" dogs), trained to assist blind people, help with navigation.
GPS-based walking instructions, delivered via audio—either automated or through a remote human navigator.
Raised tiles on the ground signal platform edges, sidewalks, or stairways.
Remove low-hanging architectural obstacles that a blind person might bump into.
Keep hallways and sidewalks clear of obstructions.
Architecture & Built Environment Cannot read signs or text in the built environment.
Map and geolocation apps on mobile devices can announce the names and descriptions of buildings and other location-related information.
Braille labels and descriptions on entrances, rooms, bathrooms, historical markers, and other points of interest allow blind people to explore their surroundings, provided the person knows braille and the labels are easy to locate.
Tactile models of building exteriors or interior floorplans help blind people form a mental map of their surroundings.
AI tools (like Microsoft’s Seeing AI app) and human-assisted tools (like Be My Eyes) can describe text, people, currency, color, and objects for blind users.
Consumer & Industrial Products Cannot see or feel controls on flat interfaces of consumer devices, including microwaves, ovens, and dishwashers
Alternative interfaces with knobs or other tactile controls
Audio interfaces
Can control devices remotely through mobile applications
Consumer & Industrial Products Cannot read the text on the containers or packaging for consumer items such as medication, toothpaste, shampoo, sunscreen, personal care products, foods, drinks, candy, etc.
Embossed braille or braille stickers on packaging and product containers help consumers identify items in stores and after purchase
Consumer & Industrial Products Cannot read money to determine its value
Mobile applications can photograph money and read its value to blind users.
Paper bills and coins could vary in size, shape, or texture so blind people can identify value by touch.
Non-cash payment systems allow blind people to make transactions using computers, mobile devices, or on-site payment hardware with screen readers or self-voicing output.
Consumer & Industrial Products Cannot read books, magazines, posters, mail, or other printed materials
Optical character recognition (OCR) software converts scanned text images into digital text readable by screen readers, with accuracy depending on the original document, font choices, line spacing, and the quality of the software.
Information can be provided online or in other digital formats so blind users can access it with their own assistive technologies.
ICT In websites and other technologies: images, controls, and other meaningful elements that do not have text alternatives.
Provide text alternatives for non-text information.
ICT Videos without text or audio alternatives, or an audio description track.
Provide audio alternatives for video content.
ICT Websites, web browsers, and authoring tools that are not fully keyboard accessible.
Ensure that all website functionality can be performed with a keyboard and does not rely solely on the mouse.
Low Vision
Overview
People with low vision can see, but their vision remains significantly impaired even with strong corrective lenses. Many may be unable to drive or read most printed text without enlarging it. Low vision is not a single condition; it is a broad category that includes a variety of vision impairments with differing degrees of severity. People with low vision often cannot read small fonts or clearly discern details without magnification. There is considerable diversity in the types of low vision a person can experience. Here are a few common types and characteristics:
Blur
Blur with Low Contrast
Cataracts
Diabetic Retinopathy
Glaucoma
Hemianopia
Macular Degeneration
Retinal Detachment
Simulation of blurred vision where larger headings are visible, but smaller paragraph text is hard to decipher
For people with low vision, faces and objects appear blurry, making it hard to distinguish specific features. On websites, foreground elements may be difficult to separate from backgrounds. For example, in this image, large text like headings may be readable, while smaller text can be hard to see.
Low Vision Experiences on the Web
Screen Magnification
Reading small text is extremely difficult for users with low vision. Many rely on screen magnification software, such as ZoomText, which enlarges a small portion of the screen at a time at high resolution.
Specialized screen magnification tools include features designed to optimize the visual experience for people with low vision. While many options exist, the video below highlights the main features of ZoomText, a widely used tool.
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Video source can be found here: Introduction to ZoomText and Screen Magnifiers opens in a new window
Video Transcript
Skip transcript (1319 words)
One of the most important technologies for people with low vision is a screen magnifier. Screen magnifiers enlarge parts of the screen, just like a magnifying glass would so that the text and the images on the screen are easier to see.
I’m going to demonstrate some of the features on ZoomText, which is one brand of screen magnifier, so that we can see how they work. When you first start up ZoomText, the default zoom is set to two times normal view, and you can see on the interface it says 2x for the power. ZoomText can go all the way up to 36 times normal size, which is quite large.
I’ll step you through some of these enlargements, just so you can see how big it can get. So here we are at the largest setting, and you can see that the text is still easy to read. ZoomText takes over the font smoothing and enhances it quite a bit over the normal operating system font smoothing technology. Now, 36 times is really too big for what I want to do, so I’m going to decrease the zoom and go back down to two times, 2x.
Now, the screen enlargement is only part of what ZoomText can offer. It also offers enhancements of the colors, the pointer for the mouse, and the cursor for the keyboard, as well as the focus when you’re navigating around menu systems, around web pages. So, let’s take a look at the colors first. We’re on the normal color scheme at the moment. I’m going to change that to Invert Brightness, which changes everything to the opposite color, so this is like a photo negative back in the days of film, and what was, you know, black is now white, and the other colors are their opposites as well. Some people find this easier to read.
Another scheme that we can choose is yellow on black. Now this one is mainly for people who experience difficulty, in fact even can experience pain, when they see bright lights, so looking at a white computer screen with black text is really hard for them; it hurts their eyes, so they change it to a lot of black with yellow text. Now, this particular website, it has a dark background to begin with, so that’s what gets converted into the yellow. For the parts that were bright before, those are the ones that are now dark.
Another option that we have is to convert just to black and white. And we can set it to be a black text on a white background, basically just removing the color but leaving things as they are, and then we can reverse this so that what was black is now white, what was white is now black, and we get variations in the gradations of grey that were the opposite of what they were before.
Let’s turn it back to normal and take a look at some of the options for the pointer. Now, this is referring to the mouse pointer, which is usually in the shape of an arrow, sometimes in the shape of a hand when it’s over links. One of the options is to use yellow with a full cross, which converts the pointer to a yellow color with a black outline and then puts a red cross at the point of the pointer, at the very tip of it, and that makes it really easy to see where the mouse pointer is as you’re moving across the screen. You could turn off the full cross and just leave the large yellow cursor. Some people find that easier to use.
Another option is to put a red circle around the cursor, and you could leave it, in this case, a color red. You can also customize these options, but the default color for this particular setting is to leave it red. And a variation on this idea is to use a circle only when moving. So, if I leave the mouse alone, it doesn’t have a circle, but if I start moving it, it puts a circle around it. And then, as soon as I stop, the circle goes away. And if you have a really hard time seeing the pointer because it’s just too small, you could turn it to the giant green option, which just makes it huge, and as you move across the screen it’s very visible. I’m going to put it back to normal.
The cursor is what you see when you put the focus inside of a form element or when it’s in a word processor and you’re typing, or an email, or something like that. And the default option, if you just look at the regular cursor, it’s just this really small blinking line, and it’s really hard for people with low vision to see. We can make it more visible by choosing some of these options. So, one of them is to put a green circle around the focus. So right now, I’m not in a text area; I’m not in a form input or anything like that, so it looks normal. If I click inside the search field, it puts the green circle where the focus is, which makes it immediately obvious. And if I start typing something, the green circle will follow the keystrokes.
I’m going to go ahead and turn that one off and demonstrate the last category that I’m going to talk about here, which is the focus. The focus can be hard to see on a webpage. If I start tabbing through the web page, it will put an outline or a dotted line around the links, which is great, as long as it shows up. As we tab through things, you notice that it sometimes doesn’t show up. Right now, for example, I’m on the login button for Facebook, but there’s no outline around it because the designers who put together this site took away the outline for that particular link. If I tab to the next link which is the sign in link, the outline comes back, so we have some inconsistencies here.
And some of these are really difficult to see, so, for example, on the Send me to Mars! and Hotels link, this can be a bit difficult for someone with low vision to see, so let’s go down to ZoomText and make it more visible. I’m going to choose the first option, which is to put a red rectangle around the focus. So, going back to the web page, now I have a really easily visible red outline around the link, and if I tab around to the other options, the red outline follows the focus. And you can change these colors as well, but that’s the first option there.
ZoomText has other options; you can use it to zoom in just on a portion of the screen, or you could leave it as is right now, which is enlarging the whole thing. And you notice also when you move around, the mouse tracks the zoom along with it so that you don’t lose your place. You can use a reader as well, a screen reader, and there are several options available for the screen reader. You can change the rate of speech, you can let it follow your typing, and some other options there. And it acts basically like JAWS, or like NVDA, or VoiceOver, some of the other screen readers that are out there reading the text to you.
So, for someone who has low vision, this is really the best way for them to gain access to their computer and to websites. It allows them to access things that they really couldn’t access before, in a way that makes it possible for them to be independent, which is an important aspect of web accessibility overall.
End of transcript.
Though large magnification can help overcome the main challenges of low vision, there are still some issues a user can encounter. For instance, if an image is particularly large, a user may need to scroll around the screen to see the whole thing. If a JavaScript alert pops up to the side of the current visual focus, the alert may actually appear out of the visible area for the user with low vision, so the user may not see the alert at all. It is best to place popups, alerts, error messages, and other similar messages near the visual focus, to make sure users don’t miss them.
Screen Readers
Screen readers are often associated with blind users, but people with low vision can benefit from them as well. Hearing text read aloud can make visual content easier to understand, especially for those with severe low vision. ZoomText includes basic screen reader functionality. While screen readers bundled with screen magnifiers are not as full-featured as standalone screen readers, they are sufficient for most tasks.
Color Customization
For people with low contrast or low color vision, colors may be hard to see or distinguish. Text with little contrast from the background in color or luminance (brightness) can be difficult to read. Bright lights or bright screen areas may also cause discomfort, and all-white backgrounds can be especially challenging. To reduce these effects, users often adjust color settings in the operating system or web browser.
Colors can be used in web design, but color alone should not convey important information, since users may customize colors to meet their needs. Important information should always be available in text.
Review the simulations below to see how people with low vision use screen magnification and color customization.
Enlarged Text
Enlarged Yellow Text
Enlarged White Text
Enlarged Green Text
Enlarged Text
Low vision users may use screen magnification to read small text and view detailed graphics. The image here simulates text enlargement, with high-contrast operating system settings overriding the browser’s display.
Challenges & Solutions for People with Low Vision
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who have low vision experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Low Vision: Examples of Challenges and Solutions Domain Challenges Solutions
General Small text can be hard to read.
Screen magnifiers can enlarge items on the screen to make them easier to read.
Utilities that enhance contrast, change colors, or adjust other aspects of visual appearance can improve legibility.
Screen readers can supplement magnifiers by reading interfaces and content aloud through synthesized speech, but only if the digital information is designed to be accessible.
Self-voicing interfaces and applications, such as ATMs, kiosks, and transportation systems, can communicate without a screen reader, but are mainly for broadcasting information since they do not interact with content like screen readers.
Large-print versions of small text can make printed materials easier to read.
Digital versions of printed materials, including websites and mobile applications, allow users to access content using their own assistive technologies.
General Low contrast text can be hard to read.
Software or hardware can enhance the contrast of digital text.
Interface designers and content creators can select color combinations with sufficient contrast for easy readability.
ICT Text, images, and page layouts that cannot be resized or lose information when resized.
Ensure graphical interfaces support magnification.
ICT Websites, web browsers, and authoring tools that do not enable users to set up custom color combinations.
Allow custom color combinations so users can select what is easiest for them to see.
Color-Blindness
Color-blindness (or color vision deficiency) does not mean a person cannot see any color at all (except in very rare cases). It refers to the inability to distinguish between certain colors, especially those of similar brightness or luminosity, even when the colors appear quite different to people without color-blindness.
Types of Color-Blindness
There are several kinds of color-blindness, with varying degrees within each type, making it difficult to specify which color combinations are most challenging. The most common form is red-green color-blindness, with Deuteranopia and Protanopia as frequent subtypes. Some people have Tritanopia, or blue-yellow color-blindness. Very rarely, individuals inherit an insensitivity to all colors; those with Achromatopsia see the world in grayscale.
Although it is difficult to fully capture how people experience color-blindness, the tabs below simulate how colors appear to someone with red-green color-blindness or grayscale vision.
For reference, in the original images: the first circle shows the number six (green numeral on a red background); the second, eight (green on orange); the third, forty-five (orange on green); and the fourth, fifty-six (red on green).
Red and Green Colors
Red/Green Color Blindness
All Colors
Four circles with numbers inside of them
The most common form of color-blindness is red-green color-blindness, which makes it difficult to distinguish reds, oranges, and greens. Above are examples of color combinations that can be easily confused. Can you identify the numbers in each circle?
Red and Black Colorblindness
People with red-green color-blindness may perceive the images as shown here, making the numbers very difficult to distinguish.
Red and Black Colors
Red and Black Simulation
Red text saying, “Return of the Red Baron” on a black background
Red and black can be difficult for some people to distinguish. Here is how these colors may appear to someone without color-blindness.
Do Not Use Color Alone to Communicate Information
Since colors may look similar to those who are colorblind, it is critical that color is not used as the only way to communicate or distinguish information.
The example below demonstrates how a person who is colorblind may miss information that is only conveyed through color.
Original Table
Colorblind Perspective
JavaScript Courses Course Title Level*
Angular.js
Node.js
JQuery
Introduction to JavaScript
*Red = advanced, Yellow = intermediate, Green = beginner
This table uses color alone to indicate class difficulty. Some individuals with red-green color-blindness may have trouble distinguishing the colors.
Assistive Technologies for People with Color-Blindness
There aren’t many assistive technologies for people with color-blindness, so it’s largely a condition that people must adapt to. Some companies have developed glasses designed to help compensate for certain types of color-blindness. However, their effectiveness varies widely depending on the type and severity of color vision deficiency.
Another example of helpful technology is macOS’s “Differentiate without color” feature, which conveys status or information using shapes in addition to (or instead of) color.
Challenges & Solutions for People Who Are Colorblind
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who are colorblind experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Color-Blindness: Examples of Challenges and Solutions Domain Challenges Solutions
General Certain color combinations (red and green in particular) can be difficult to distinguish
Materials can be designed so that information is not conveyed solely through color.
ICT Websites, web browsers, and authoring tools that do not enable users to set up custom color combinations.
Allow users to select custom color combinations that are easiest for them to see.
Deafblindness
Deafblindness is a sensory disability involving both deafness and blindness. Most people who are Deafblind are not completely deaf or blind and retain some hearing and vision.
Tactile Signing
closeup of two people communicating via tactile signing
Deafblind individuals often use tactile signing to communicate, a method in which they place their hands on the signer’s hands to feel the shapes and movements of sign language. This allows them to perceive messages through touch rather than sight or hearing. Tactile signing can include standard sign language adapted for touch, as well as specialized tactile alphabets, enabling full conversation and interaction despite combined vision and hearing loss.
Braille Displays
closeup of hands on a braille display
For people who are both deaf and blind, a refreshable braille display can be used in combination with a screen reader. Instead of reading text aloud, the screen reader outputs it to the braille display, allowing the user to read by touch.
Refreshable braille displays have a line of holes with small pins that rise and fall to form braille characters. The screen reader sends a line of text to the display; users read that line, then press a button to move to the next, with the pins reconfiguring to reflect the new text.
Braille displays can be connected to regular computers and often supplement the main keyboard. Users typically switch between the keyboard for typing and the braille display for reading.
Challenges & Solutions for People Who Are Deafblind
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who are deafblind experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Deafblindness: Examples of Challenges and Solutions Domain Challenges Solutions
Information and Communication Technology (ICT) Digital text cannot be seen
A screen reader can convert text to braille on a refreshable braille display or produce hard copy braille using a braille embosser.
ICT Audio (including the audio portion of videos) cannot be heard
A text transcript of audio can also be converted to refreshable braille or embossed in braille.
ICT Cannot see or hear visual or auditory alerts and feedback.
Provide haptic alerts and feedback.
General Speakers cannot be seen or heard
Provide tactile sign language interpretation, where signs are communicated through touch between people’s hands.
Auditory Disabilities
Auditory disabilities involve varying degrees of hearing loss, including deafness. Individuals with these disabilities may have difficulty understanding speech and distinguishing foreground sounds from background noise. Depending on the condition, some may use hearing aids or rely on lip reading to communicate. For those with total hearing loss, augmentative and alternative communication (AAC) methods, such as sign language or communication boards, are used.
Another condition in this category is Central Auditory Processing Disorder (APD), which affects how the brain processes sounds or speech. People with APD have no measurable hearing loss but may struggle to interpret, organize, or analyze what they hear. APD can be mistaken for ADHD, learning disabilities, or emotional delays. Its causes are not fully known but may include illness (e.g., meningitis), nervous system disorders, premature birth, low birth weight, head injury, or genetics.
Causes of Auditory Disabilities
There are various causes of hearing loss and deafness. They may include genetics, premature birth, infections/illnesses, ear trauma, exposure to loud noises, and aging.
Deafness versus Deaf Culture
The terms “deaf” (lowercase) and “Deaf” (uppercase) have distinct meanings. Lowercase deaf refers to the physical condition of hearing loss (partial or total) from a medical perspective. Uppercase Deaf refers to Deaf Culture or the Deaf Community, which encompasses the beliefs, values, norms, and shared experiences of people who identify as culturally Deaf. The capitalization of the term “Deaf” is used to reference a member of the Deaf Community.
This distinction reflects differences in perspective. People who can hear often view deafness through the medical model of disability, emphasizing loss or impairment. In contrast, members of the Deaf Community view deafness as a cultural identity, not a deficit. They use sign language to communicate and belong to an established cultural group. This perspective aligns with the Social Identity or Cultural Affiliation Model, which emphasizes identity, community, and lived experience rather than viewing deafness as a limitation.
Experiences Using the Web
Much of the web remains accessible to people with auditory disabilities through visual or text-based content. However, as video-based content, including social media posts, vlogs, TV clips, and movies, has become more common, accessibility depends on captions and transcripts. Many platforms, such as Instagram, support captions, which creators can add to make content accessible even when viewed without sound.
Web Accessibility for Deafness
The main accessibility concern for deafness is audio, whether in audio-only formats or combined with video. For pre-recorded audio, a transcript including narration, dialogue, and key sounds (applause, crashes, music, etc.) is the best solution.
For video, audio is synchronized with visuals, so captions are required. A transcript alone is insufficient because viewers need synchronized text to know exactly when each line occurs in the video.
Provide Synchronized Video Captions Plus a Transcript
Below is an example of a video with synchronized captions. If they are not automatically turned on for you, select the play button, then select the CC button (“CC” stands for “closed captions”) on the bottom left side of the video.
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Video source can be found here: Blind Skier’s Edge opens in a new window
Transcripts are important because they let users navigate content at their own pace. They are also essential for people who are both deaf and blind, as neither video nor audio is directly accessible. Only digital text can be accessed, since it can be converted to braille by a screen reader.
Video Transcript
Skip transcript (300 words)
(whizzing)
[Jeff, skiing guide] Turn a left, turn a right. Turn a left, turn a right. Turn a left, turn a right.
[Erik Weihenmayer, blind skier] I think in a blind person’s daily life, they don’t get speed, and that’s what I think the most exciting part of skiing is when you’re blind, is that you’re really moving fast. When you’re blind, you’re reacting to what you’re feeling under your feet, so you’re literally reacting instantaneously. It’s very exciting or terrifying, depending on how you look at life.
(guitar music, Jeff and Erik skiing down the hill)
[Jeff] Turn a left, turn a right. Turn a left, turn a right.
[Erik] In only eight, simple words, Jeff tells me everything I need to know on the slope. With each syllable, there’s no guesswork. I know exactly where to be.
(guitar music)
[Jeff] Go towards me here. Back to the right, to check your speed, and here we go. We’re gonna start to ski to the left. Turn a left.
[Erik] To become a good blind skier, it takes an investment. You have to have a good guide who you really trust, and you have to build that relationship.
(guitar and vocal music)
[Jeff] I have to make sure that somebody up the hill is not running out of control, isn’t gonna take, you know, Erik out or myself out. I cannot mess up. (calling out while skiing) Turn and stop.
[Erik] You can still, in bumps, get, just get completely hammered every now and then, you know? So, it’s just part of the, I guess, fun. (laughs) (Erik hits a snow bank and falls) Whoa! I really did hit something there.
[Jeff] Turn a right. Turn a left. (guitar music)
Challenges & Solutions for People Who Are Deaf or Hard-of-Hearing
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who are deaf or hard-of-hearing experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Auditory Disabilities: Examples of Challenges and Solutions Domain Challenges Solutions
Information and Communication Technology (ICT) Audio in videos cannot be heard
Synchronized captions for videos
Sign language interpretation
ICT Audio content in general cannot be heard
Transcript
Sign language interpretation
CART (Communication Access Realtime Translation) — a service that provides real-time captions for people who are deaf or hard of hearing
STTR (Speech to Text Reporter) — a person who provides real-time transcription of what is said, which is then relayed to a laptop, projector, or tablet screen
General Speeches and talks cannot be heard
Sign language interpretation
Live captions on a monitor during the speech
Assistive listening systems and devices in meeting rooms and auditoriums
Architecture and the Built Environment Doorbells, alarms, and other sounds may not be heard
Alternative visual alerts, such as lights that flash, pulse, dim, turn on, or turn off
Haptic alerts/feedback
Mobility, Flexibility, and Body Structure Disabilities
Mobility disabilities affect a person’s ability to move independently and purposefully. People with missing limbs, multiple sclerosis, cerebral palsy, stroke, paralysis, or arthritis may experience limitations in moving their body or specific body parts. These disabilities may be present at birth, develop with age, or result from disease, and they can be temporary, permanent, or episodic.
Mobility disabilities may affect ambulation, or the ability to walk without an assistive device, as well as dexterity and fine motor control. For example, hand tremors can make it difficult to use a mouse or other tools requiring precise movement. Other challenges may include difficulty with handwriting, tying shoelaces, or picking up small objects.
Body size or shape disabilities relate to a person’s stature, proportions, or body shape. Examples include dwarfism, rheumatoid arthritis, acromegaly, and obesity. These conditions may be associated with muscle weakness, muscle fatigue, hearing loss, vision loss, or diabetes.
Although disabilities affecting mobility, flexibility, and motor control vary widely, they share a common accessibility principle: all web content must be operable regardless of how a person accesses a computer. Content must work with a mouse, keyboard, or disability-specific assistive technologies and be compatible with a wide range of input devices. For example, someone missing one or both hands may use other body parts, such as their feet, and rely on tools like a foot mouse to operate a computer.
Real People with Motor Disabilities
Do you recognize the man in the photo below?
Stephen and Jane Hawking on their wedding day
The man in the photo above is the same man as in the photo below.
Stephen Hawking in a wheelchair next to a space exhibit
Physicist Stephen Hawking
The man pictured is Stephen Hawking, the renowned physicist. The contrast between the two photographs is striking. In the earlier image, he is standing and smiling, with no visible indicators of physical disability. In the later image, he is seated in a wheelchair, reflecting the significant mobility loss he experienced over time. His muscles had atrophied, his facial movement was limited, and he was no longer able to speak without assistance.
Stephen Hawking had a degenerative neuromuscular disease called ALS (amyotrophic lateral sclerosis), also known as Lou Gehrig’s disease. ALS progressively reduced his ability to control voluntary muscles and, in later stages, can also affect involuntary muscle control, including breathing and other life-sustaining functions. Despite this progression, he produced numerous influential scholarly and popular works on science and the universe, made possible through the use of assistive technologies.
He used a computer system to communicate, write, and interact with the world. A sensor attached to his glasses detected small movements in his cheek. As options appeared on the screen, he selected letters and words using this input method, and the computer generated synthesized speech to vocalize his text.
Stephen Hawking with the sensor hooked up to his glasses
Stephen Hawking’s computer, showing a section of text highlighted, with other menu items for typing above his text
This process was slow and time-intensive, often taking several minutes to produce a single sentence. In a 2008 TED Talk, Hawking discussed humanity’s relationship with the universe and the possibility of extraterrestrial life. During the talk, viewers can see him using motion-detecting hardware and word-prediction software. Although the video does not explicitly address web accessibility, observing how he interacted with his computer provides insight into how similar assistive technologies enable access to websites and digital content.
One of the memorable quotes from his talk (at about 7:45):
"All my life I have sought to understand the universe and find answers [...] I have been very lucky that my disability has not been a serious handicap. Indeed, it has probably given me more time than most people to pursue the quest for knowledge."
The video of the full talk opens in a new window is available on the TED web site.
Something to Think About:
What if Stephen Hawking had been born several decades earlier? He likely would not have had access to the assistive technologies that enabled him to communicate independently. Writing full lectures, scholarly articles, and books would have been far more difficult, if not impossible, without those tools.
Assistive technologies made it possible for him to express his ideas, share his work, and participate fully in academic and public life. His achievements highlight how access to modern technologies can remove communication barriers and allow people with disabilities to contribute their knowledge and expertise. This illustrates the critical role assistive technology plays in enabling independence, participation, and inclusion.
Actor Christopher Reeve
Christopher Reeve rose to fame as Superman and appeared in many other movies and shows.
Christopher Reeve as Superman
In 1995, a fall from his horse during a competition caused a cervical spinal injury, leaving him paralyzed from the neck down. He lost the use of his legs, hands, and torso, but with rehabilitation, he could operate an electric wheelchair using a puff-and-sip system, which he controlled by blowing or sucking through a straw.
Christopher Reeve in his motorized wheelchairChristopher Reeve with a puff and sip control on his wheelchair
He became a passionate advocate for spinal cord injury research. Using voice recognition software and other assistive technologies, he wrote books, including his memoir “Still Me,” and the reflective “Nothing Is Impossible.”
book cover of ‘Still me’ book cover for ‘Nothing Is Impossible’
Typewriter Artist Paul Smith
Paul Smith (1921–2007) was born with cerebral palsy, a condition that made his movements spastic and difficult to control. While using a mouse would have been challenging, he was able to work with a keyboard, creating detailed artwork using only a typewriter.
A typewriter drawing of the Mona Lisa is shown on the left. A typewriter drawing of a tropical beach with flamingos, sailboats, and a coconut tree is shown on the right
Watch this brief video about his artwork:
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Video source can be found here: Typewriter Artist opens in a new window
Video Transcript
Skip transcript (742 words)
[One finger of a hand pushes down one key at a time on a typewriter keyboard.]
[Narrator:] Keystroke by keystroke, he types his latest masterpiece in an Oregon nursing home.
[An outdoor sign in front of the building says Rose Haven.]
But Paul Smith is not an author; he’s an artist.
[Paul:] I’m going to work on the tail.
[A picture of a dog is visible on a paper in the typewriter in front of Paul.]
[Narrator:] He was born with severe cerebral palsy, yet Paul Smith has created hundreds of works of art using a typewriter.
[An image is shown of mountains, then an image of George Washington crossing the Delaware River.]
[Woman:] You give me a typewriter, I can’t even type twelve words a minute looking at my hands, okay. There is no way that I could come up with a picture like that.
[Three works of art are shown: a cityscape, a squirrel, a gondola and gondolier on the water with a city in the background.]
[Man:] Every time I flip through the work, I am just amazed because it’s as good as art as you can find.
[Paul moves the lever on the typewriter and uses the roller to adjust the position of the paper.]
[Narrator:] Paul’s movements are severely limited; his determination, endless. His disorder makes using a brush or pen impossible, but as a young man, he discovered the keys to expressing himself at the top of a typewriter keyboard. Using just 10 of the symbol keys, he taught himself to paint. Look closely and you can see how Paul typed pound signs to create the facial detail on his Mona Lisa.
[Closeups of Paul’s Mona Lisa are shown.]
[A closeup of an image of a desk with a typewriter on top is shown, then the full room.]
[Narrator:] Here, the @ symbol doubles for desk drawer knobs in this scene of his childhood bedroom; note the typewriter prominently displayed.
[A portrait of a man’s face, then a colored scene in the countryside at a river are shown.]
[Narrator:] Paul has created incredibly detailed pictures by artistically aligning those 10 keys against a black or colored ribbon.
[Paul:] It’s something to do.
[Man:] His joy in life is finding ways to be creative. I think he sees it — that’s part of why he’s on earth, why we’re on earth.
[Man:] Well, I think the dog now has a tail.
[Paul’s in-progress picture of a dog is shown next to the photograph that inspired it.]
[Narrator:] When someone says, I could never do that, Paul answers,
[Paul:] What can you do?
[An image of a water wheel is shown, then an image of a house.]
[Narrator:] Places Paul’s lived or visited are the inspiration for much of his art, some of which lines the hallway of Rose Haven Nursing Center.
[Man:] There’s a lot of memories on this wall. Let’s see, that’s the ship you went to Bermuda on.
[Paul:] My whole family went.
[Paul plays chess with another man. Paul indicates his moves by pointing to the pieces and the squares on the board.]
[Narrator:] His family now is the staff and residents of Rose Haven, where he has lived since 1967.
[Woman:] Hey, Paul. How are you doing today?
[Paul:] All right.
[Woman:] Are you still working on that dog?
[Woman:] Hi, sweetie. How you doing?
[Man:] He’s such a terrific person; he’s a — such a humble man, a real gentle soul.
[Man, speaking on Paul’s behalf:] She’s really nice.
[Woman:] Oh, thanks, Paul. It’s easy to be nice.
[Woman:] All right, Paul. I’ll catch up with you later.
[Narrator:] Paul Smith would much rather brag about his friends at Rose Haven than about himself or his art.
[Paul:] He’s a good guy. He’s a real good guy!
[Narrator:] And those who know him say the same thing about Paul. The artist is even more inspiring than his art.
[Woman:] It’s wonderful to watch him work, and it’s wonderful to enjoy his art, but not as good as it is enjoying him.
[Narrator:] Deeply religious, Paul says his artistic ability is a gift from God.
[Paul’s picture of the Last Supper is shown.]
[Narrator:] His faith and something else keeps him going.
[Paul:] My finger.
[Man:] Your finger. [laughing]
[Narrator:] And with that finger, for as long as he is able, this extraordinary man will continue creating his extraordinary art, one keystroke at a time.
End of transcript.
Artist Zohreh Etezad
Iranian artist Zohreh Etezad was born without arms and uses her feet to paint and weave. She has exhibited her work in several countries, demonstrating a level of dexterity with her feet that rivals most people’s hands. She paints with a brush, weaves yarn, and completes all the tasks involved in creating her art entirely with her feet.
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The original video source can be found here: Iranian Artist Paints With Her Feet opens in a new window.
Video Transcript
Skip transcript (120 words)
[Narrator]: For 49-year old artist Zohreh Saltaneh,
it’s not just her paintings
that are drawing a lot of attention,
but also her toes.
Born with a birth defect
that can stunt the growth of
an unborn baby’s arms and hands,
she paints by holding the brush
between her toes.
The Tehran-born painter
uses her feet and toes
for just about everything,
including daily chores
like cleaning the house, cooking,
and helping her elderly mother.
But despite her disability,
her artwork has gained her
a number of different awards,
and her paintings have been shown
in about 60 exhibitions
around the world.
And in case you’re wondering,
her creativity isn’t limited to painting.
She also weaves Persian carpets.
Gary Hamilton for CBSnews.com
End of transcript.
Assistive Technologies Used by People with Motor Disabilities
Assistive technologies for people with motor disabilities are tailored to individual needs. Some examples include:
Vertical Keyboard with Mouth Stick
A person using a mouth stick to type on a vertical keyboard
One-Handed Keyboard
A one-handed keyboard
Expanded Keyboard with Raised Sections Between Keys
Speech Recognition
Many devices, including smartphones and tablets, now include built-in speech recognition. This technology converts spoken words into text and can be used to type, fill out forms, or navigate web pages using keyboard-style commands or mouse emulation. For more advanced features and greater accuracy, users can turn to specialized software like Dragon opens in a new window.
Challenges and Solutions for People Who Have Mobility, Flexibility, and Body Structure Disabilities
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who have motor disabilities experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Motor Disabilities: Challenges and Solutions Domain Challenges Solutions
Information and Communication Technology (ICT) May have difficulty using a mouse or be unable to use one.
Alternative keyboards, mouth sticks, single-switch devices, speech recognition software, and eye-tracking technologies allow users to operate a computer without a mouse.
Developers and designers can make digital content accessible using keyboard-based input.
ICT May require additional time to interact with digital content and interfaces due to slower movements.
Interface designers and developers can notify users of session timeouts and provide options to adjust, extend, or disable the time limit.
Architecture & Built Environment Wheelchair users cannot use steps.
Building entrances should include accessible ramps alongside steps, with accessible parking available.
For interior steps, provide accessible ramps and elevators.
Accessible routes inside and outside the building should be clearly labeled and easy to identify.
Architecture & Built Environment Wheelchair users may have difficulty navigating tight spaces.
Doors, hallways, rooms, and restrooms should be wide enough for all users, including wheelchair users.
All corridors and routes should be unobstructed.
Architecture & Built Environment May have difficulty using hands or arms to open doors.
Provide automatic doors or doors than can be opened with a large button.
Equip doors with lever-type handles or doorknobs for easier operation.
Architecture & Built Environment May encounter seating that is too small or at the wrong height.
Provide seating that accommodates a range of body sizes.
Consumer & Industrial Products May be unable to turn pages of books, magazines, pamphlets, or other printed materials.
Provide printed materials in digital formats so users can access them with their assistive technologies. Touchscreen interfaces can also improve accessibility.
ICT May have difficulty using digital interfaces with small or closely spaced touch targets.
Ensure that touch targets are big enough to hit easily and spaced adequately apart.
General May have trouble with tasks requiring fine motor skills, accuracy, or strength.
Provide alternatives to such tasks when possible (for example, an automatic door instead of a manual one).
Cognitive and Intellectual Disabilities
Cognitive Disabilities
Cognitive disabilities can result from congenital or developmental conditions present from birth or early childhood, as well as from traumatic injury, infections, chemical imbalances, or other conditions acquired later in life.
These disabilities can affect one or more mental functions to varying degrees. Subcategories include:
Intellectual Disabilities: Significant limitations in intellectual functioning (reasoning, learning, problem-solving) and adaptive behavior, typically with an IQ below 70–75.
Learning Disabilities: Difficulties with reading (e.g., dyslexia) or math (e.g., dyscalculia).
Memory or Processing Disorders: Challenges with memory, attention, or information processing that affect learning and daily activities.
And many others
There is no single way to describe cognitive disabilities. Individuals may experience challenges in only one area, and severity can vary widely. These categories are useful for understanding trends within the broader spectrum of cognitive differences.
Non-Verbal Learning Disability
NLD is a learning disability in which individuals typically have normal intelligence and strong verbal skills but may face challenges with social interactions, interpreting sensory information, and adapting to changes. People with NLD often have excellent memory and attention to detail but may find tasks that require visual-spatial reasoning, abstract thinking, or physical coordination more difficult. These challenges can sometimes contribute to anxiety, depression, or low self-esteem.
Intellectual Disabilities
People with intellectual disabilities have significant limitations in reasoning, learning, problem-solving, and adaptive functioning. Terminology may vary by country, but “intellectual disability” is the preferred modern term.
According to the Diagnostic and Statistical Manual of Mental Disorders 5th Revision (DSM-V), the three criteria for diagnosis are:
Deficits in intellectual functioning (e.g., reasoning, problem-solving, learning).
Deficits in adaptive functioning that limit independence in social, communication, or practical skills.
Onset during the developmental period (early childhood).
a child with down syndrome smiling
Neurodevelopmental Disabilities
ADHD
Attention Deficit Hyperactivity Disorder, or ADHD, is a neurodevelopmental disorder characterized by difficulty focusing, sustaining attention, and regulating behavior. Individuals may also display hyperactivity. ADHD typically begins in childhood and can continue into adulthood. Genetics and environmental factors are believed to play a role in its development.
Symptoms are divided into two domains:
Inattention:
Diminished attention to detail
Trouble sustaining attention
Easily distracted
Difficulty starting, organizing, and completing tasks
Forgetfulness or frequently losing items
Hyperactivity/Impulsivity:
Restlessness or fidgeting
Difficulty remaining seated
Excessive talking
Trouble waiting their turn
A person may exhibit primarily inattention, primarily hyperactivity/impulsivity, or a combined presentation.
Autism Spectrum Disorders (ASD)
ASD is a neurodevelopmental disorder that affects brain development, leading to differences in social communication, interaction, and behavior. People with ASD may have difficulty understanding social cues, forming relationships, or navigating typical social expectations. They may also engage in repetitive movements, follow routines, or focus intensely on specific interests. Sensory differences, such as sensitivity to sounds, lights, or textures, are also common.
Asperger Syndrome and related diagnoses are now considered part of the ASD spectrum.
Symptoms appear in early development and can vary widely in severity and support needs. Many people with ASD also have unique strengths, such as detailed focus, strong memory, or creative problem-solving.
Core diagnostic criteria:
Persistent difficulties with social communication and interaction across multiple contexts (e.g., home, school, work).
Restricted, repetitive patterns of behavior, interests, or activities, including routines, movements, or sensory differences.
Symptoms must be present from early development and cause significant impact in daily functioning.
Web Accessibility Considerations
Limited Comprehension
Some people may have difficulty understanding complex information. This can include challenges with abstract language, metaphors, idioms, or unfamiliar terminology. Others may have strong abilities in specific areas, such as memory or factual recall, while experiencing difficulties in areas like social understanding or emotional awareness.
Sensitivity to Cognitive Overload
Some people may become overwhelmed when presented with too much information at once or when an interface feels complex or unpredictable. Too many choices, competing stimuli, or unclear steps can lead to frustration or make it difficult to continue a task.
Difficulty with Problem Solving
When tasks require multi-step reasoning or unclear actions, some users may struggle to determine what is expected. For example, confusing CAPTCHAs or poorly explained error messages can be difficult to interpret, making it hard to recover from mistakes or complete the task.
screenshot of a confusing captcha
Short-Term Memory Challenges
Some users may have difficulty retaining information from one step to the next. Lengthy or complex processes, such as account registration, online purchases, or configuration workflows, can cause users to lose track of their progress or forget required information.
Attention Deficit
Some users experience attention limitations that make it harder to maintain focus on a task. Distractions such as advertisements, animations, or unrelated content may interrupt their concentration and make it difficult to complete tasks efficiently.
Challenges & Solutions for People with Cognitive Disabilities
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who have cognitive disabilities experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Cognitive, Intellectual, and Neurodevelopmental Disabilities: Challenges and Solutions Domain Challenges Solutions
Information and Communication Technology (ICT) May find complex digital designs and tasks overwhelming
Create simple, predictable, organized designs and simplify user interface components.
ICT May have difficulty solving technical problems or correcting errors when instructions or feedback are unclear
Notify users of errors and provide clear, actionable instructions for resolving them.
General May have difficulty processing information, particularly text that uses complex language.
Supplement text with images or other visuals to support understanding.
Use clear, straightforward language when presenting written information.
Note:
Cognitive, intellectual, and neurodevelopmental disabilities vary widely in presentation and severity. Not all individuals experience the same challenges. The considerations on this page reflect functional barriers that may affect some people within this broad group.
Math Disabilities
confused boy standing in front of a chalk board with math problems
Math and Computational disabilities affect a person’s ability to learn and communicate math. Two examples are:
Dyscalculia: the inability to understand arithmetic and how to calculate
Dysgraphia: the inability to draw or copy figures and graphs
Some signs that may indicate dyscalculia are:
Not understanding that 10 (the number) and ten (the word) are the same thing
Trouble with counting money or making change
Remembering math facts like times tables
Understanding the logic behind math
Some people experience math anxiety, an emotional or psychological fear that arises when faced with math problems. Although not classified as a disability, it can interfere with their ability to perform math tasks.
Challenges & Solutions for People with Math Disabilities
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who have math disabilities experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Math and Information and Communication Technology (ICT): Challenges and Solutions Domain Challenges Solutions
ICT
Difficulty distinguishing right from left in graphic images
Can use data tables or text descriptions as alternatives to graphical representations when provided
May receive additional time to complete tasks
ICT
Difficulty copying graphs, figures, or diagrams
Can use speech-to-text to verbalize instructions when questions follow accessibility guidelines and are compatible with text-to-speech technology
May receive additional time to complete tasks
ICT
Difficulty performing calculations
Can use an accessibility accommodation link to a reference sheet with common equations when provided.
Can use a reference sheet with common equations or an onscreen calculator when provided as accommodations
May receive additional time to complete tasks
Difficulty Reading
Many people with cognitive disabilities may experience difficulty reading. Some read below the typical level for their age, and some may be unable to read at all. Providing visual or audio aids can help supplement text. For example, people with dyslexia may have strong conceptual or reasoning skills but still find it difficult to spell or read text.
a teenager sitting cross legged in the library, reading a book
Dyslexia Simulation
Some people with dyslexia describe letters as moving, switching, or swapping places while reading. Below is an animated image of a paragraph of text, with the letters of each word shifting. This simulates how the paragraph might appear to someone with dyslexia.
Dyslexia simulation of a paragraph where letters appear to be swapping in and out of place
Challenges & Solutions with Dyslexia and Reading Disabilities
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who have dyslexia or other reading disabilities experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Dyslexia and Reading Disabilities: Challenges and Solutions Domain Challenges Solutions
Information and Communication Technology (ICT)
Often perceive words as floating or not aligned
Can use a special font designed for dyslexia, which weights letters and distinguishes similar characters
May receive additional time to complete tasks
ICT
Often perceive letters differently, for example confusing p, b, d, and q
Can adjust font, contrast, or underline text to help keep words aligned
May receive additional time to complete tasks
ICT
Often require extra time to read and process content.
Can extend timeouts and return to the same location on the page
Can use a screen reader to hear content or to highlight words and phrases for tracking
Can use enhanced focus indicators, visual supports, or programs that pair words with pictures
May receive additional time to complete tasks
ICT
May have difficulty understanding content as presented
Can apply a custom style sheet to adjust layout, fonts, or colors for easier comprehension
ICT
May have difficulty solving problems presented through security features such as CAPTCHA
Can provide alternative types of challenges
ICT
May have difficulty processing content visually
Can use a screen reader to access content audibly and reinforce visual information
May receive additional time to complete tasks
ICT
May have difficulty spelling words correctly
Can use a spelling and grammar checker
Speech and Language Disabilities
A person who has difficulty articulating words may have a speech disability. It is characterized by challenges in producing or organizing speech sounds and syllables correctly or fluently, and in some cases, a total loss of voice. Causes may include genetic factors, learning or auditory disabilities, autism spectrum disorder, traumatic brain injury, stroke, cancer affecting the mouth or larynx, or structural issues such as cleft lip and palate.
a speech therapist showing a little girl how to shape her mouth to produce sounds
Types of Speech Disabilities
Speech disabilities include a wide range of specific disorders. Some of the more common types are:
Stuttering affects the fluency of speech. Words or parts of words may be repeated involuntarily, sounds may be prolonged, or speech may be blocked completely.
Cluttering, sometimes categorized as a language disability, involves rapid or irregular speech that may lack proper rhythm, syntax, or grammar. Speech may start clear but become rushed, and slurring can occur.
Apraxia is a motor speech disability in which a person has difficulty using the muscles needed to produce speech sounds. Multiple attempts may be required to form words correctly.
Aphasia results from brain injury, most commonly stroke, and affects all aspects of language, including speech production, comprehension, reading, and writing.
Dysarthria is a motor speech disability caused by brain damage. It affects the muscles used for speech, leading to slurred, slow, mumbled, hoarse, or breathy speech.
Speech sound disorders involve difficulty producing specific speech sounds, particularly consonants. They are generally classified as articulation disorders or phonemic disorders.
Articulation disorders involve trouble physically producing sounds. This can lead to sounds being omitted, added, substituted, or distorted.
Phonemic disorders involve difficulty distinguishing or using speech sounds in language. Only a limited set of sounds may be used, which can affect word meaning. For example, "call" and "tall" might both be pronounced as "tall," even if the intended word was "call."
Neurogenic mutism results from brain injury, while psychogenic mutism stems from psychological factors. The three types of psychogenic mutism are:
Elective mutism – the person chooses not to speak
Selective mutism – the person wants to speak but is sometimes unable due to anxiety
Total mutism – the person does not speak at all
Communication Options
Assistive Technologies
People with speech disabilities may use any of the following: touch screens, alternative keyboards, single switch devices, eye-tracking technologies, speech-generating software, word prediction software, symbol boards and languages, symbol software, translation software, and other tools.
Augmentative and Alternative Communication (AAC)
Augmentative and Alternative Communication (AAC) includes all forms of communication other than oral speech that people with speech disabilities can use to express themselves. People with severe speech disabilities may use AAC to supplement or replace speech. AAC can be classified into two types: unaided AAC and aided AAC.
Unaided AAC
Unaided AAC does not use external tools and relies on nonverbal communication such as body language, facial expressions, gestures, and sign language.
Aided AAC
Aided AAC uses both the person’s body and an external tool, which can be electronic or non-electronic. Tools include communication books or boards, pen and paper, and electronic devices that generate speech. Non-electronic tools are called low-tech aids, while electronic devices are high-tech aids, often allowing users to store and retrieve messages.
The video below shows how high-tech AAC has impacted the life of Rachel Monk.
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Video source can be found here: Rachel Monk: What it’s like to use AAC opens in a new window
Video Transcript
Skip transcript (217 words)
[Music plays]
[Narrator’s Voice speaking as Rachel, Music plays in the background]: My name is Rachel Monk. I really enjoy going to the art club where I can socialize with my friends. It is great to be able to spend time with everyone while doing something I enjoy so much. I was excluded from doing my exams at school but that didn’t stop me. I went to college and studied fine arts and I got an “A” level. I can hear and see and understand everything you say to me. It can be very hard with strangers as a lot of people do not give me enough time to speak. They do not realize how long it
[Transition to Rachel’s computer-generated voice] takes for me to select the icons I need to respond to them. I am a bright person and intelligent, and I want my thoughts and feelings to be heard and not wasted. Everyone has the right to communicate. I may sound different in my head to how I sound to others, but it is all my voice. Now hear me…
[Music continues to play]
[Visual advertisement displays] Now Hear Me: It’s my right to speak. Find out more about what you can do to help people who use augmentative and alternative communication. www.nowhearme.co.uk opens in a new window #myrighttospeak
Challenges & Solutions for People with Speech Disabilities
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who have speech disabilities experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Speech Disabilities: Challenges and Solutions Domain Challenges Solutions
Information and Communication Technology (ICT) May be unable to use voice-based technology, such as virtual meetings
Provide text-based alternatives, including chat, email, and forms
ICT May have additional disabilities, including hearing loss, fine motor difficulties, challenges with information processing, or visual impairments
Ensure digital content works with multiple assistive technologies, such as screen readers
Provide captions and transcripts for video and audio materials
Verify that content is keyboard accessible
Present information in multiple formats to support comprehension and processing
Architecture & Built Environment May use a wheelchair or have limited use of hands or arms
Apply the same accessibility solutions used for motor disabilities
General Difficulty producing speech sounds
Can use low-tech AAC, such as communication boards or gestures, to supplement speech
Can use high-tech AAC, such as computer-generated voices, to replace speech
Allow enough time for communication and ask for clarification when needed
General Complex communication systems may be ineffective
Offer simplified methods with multiple options
General Insufficient time for communication, accessing information, or responding
Allow adequate time and avoid rushing
Seizure Disorders
Seizures are abnormal electrical impulses in the brain that can affect information processing or, in some cases, voluntary muscle control. Some seizures cause convulsions that put a person at risk of injury. A tendency to have recurrent seizures is called epilepsy, which affects about 50 million people worldwide (according to the World Health Organization (WHO)). Causes include brain injury, dehydration, sleep deprivation, infections, fevers, drug overdoses or withdrawal, and flashing lights, the last of which is particularly relevant for web accessibility.
Photo-Epileptic Seizures
Flashing or strobe effects in videos, graphics, or animations can trigger seizures in some viewers. These seizures, known as photo-epileptic seizures, are caused by exposure to flashing lights. A well-known example occurred in 1997, when a Pokémon cartoon scene with intense flashing lights sent 685 children to the hospital as a result of seizures.
a still image taken from a Pokémon cartoon with flashing lights
More recently, the movie Breaking Dawn featured an intense scene with flashing lights that caused people to experience seizures in the movie theater.
movie poster for Breaking Dawn
Not everyone with a seizure disorder is sensitive to flashing lights. Seizures can be triggered by various other factors, many beyond the control of web designers. However, avoiding flashing lights in digital content helps reduce the risk of triggering seizures in viewers who are sensitive to them.
Challenges & Solutions for People Who Experience Seizures
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who experience seizures experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Seizure Disorders: Challenges and Solutions Domain Challenges Solutions
Information and Communication Technology (ICT) / General Sensitivity to flashing lights, blinking, and flickering stimuli
Avoid creating animations, videos, or other graphics with flashing or strobe-like effects whenever possible.
If flashing content must be used, it should not flash more than 3 times per second.
Provide media controls that allow users to stop or turn off video animations.
Provide warnings when content contains flashing.
Use tools to scan videos for potential seizure-causing risks (e.g., Photosensitive Epilepsy Analysis Tool (PEAT)).
Helpful tools include flicker-free monitors, monitor glare guards, and non-glare glasses.
Psychological / Psychiatric Disabilities
Psychological, or psychiatric, disabilities encompass a wide range of mental health conditions. A condition is typically first diagnosed as a mental illness. When it substantially limits one or more major life activities, it may be recognized as a disability. Examples include depression, anxiety disorders, eating disorders, and schizophrenia.
a young woman talking with a mental health therapist
Psychological disabilities may be influenced by trauma, brain chemistry, genetic factors, and social or environmental factors. Individuals may experience symptoms over many years, and symptoms can vary or be unpredictable. The type of condition, severity, symptoms, and duration differ from person to person. Treatment may include counseling, psychotherapy, medication, and self-help strategies.
The types of psychological disabilities discussed in this section include anxiety disorders, mood disorders, schizophrenia, and other related conditions.
In This Section:
Anxiety Disorders
Mood Disorders
Schizophrenia
Other Disorders
Challenges and Solutions for People Who Have Psychological/Psychiatric Disabilities
Anxiety Disorders
Anxiety disorders are the most common group of mental health conditions. People with anxiety disorders experience persistent fear or excessive worry about specific situations or objects. They may avoid triggers that provoke intense anxiety. These reactions can feel uncontrollable and may significantly interfere with daily life.
a woman at her desk, with her hand pressed to her head, looking stressed
Common types of anxiety disorders include:
Panic Disorder: Characterized by recurrent panic attacks - sudden episodes of intense fear that may include rapid heart rate, chest pain, dizziness, and difficulty breathing (hyperventilation). Symptoms can resemble those of a heart attack.
Phobias: Intense, excessive fear of specific objects or situations. For example, claustrophobia (fear of enclosed spaces), arachnophobia (fear of spiders), and social phobia/social anxiety involving social situations. People may experience panic symptoms such as rapid heart rate, shortness of breath, or an urge to escape.
Post-Traumatic Stress Disorder (PTSD): May develop after exposure to a traumatic event such as violence, war, natural disasters, or other life-threatening experiences. Symptoms may include nightmares, flashbacks, intrusive memories, and feelings of anxiety, anger, sadness, or guilt. Symptoms may appear soon after the event or months to years later.
Obsessive-Compulsive Disorder (OCD): Involves persistent, distressing thoughts (obsessions) and repetitive behaviors (compulsions) performed to reduce anxiety. For example, a person with contamination fears may repeatedly wash their hands.
Generalized Anxiety Disorder (GAD): Characterized by excessive, ongoing anxiety and worry lasting months or longer, beyond typical everyday stress.
Social Anxiety Disorder: Involves intense fear of being judged, evaluated, or negatively perceived by others. It may significantly interfere with work, school, or social activities.
Mood Disorders
Mood disorders, also known as affective disorders or depressive disorders, involve significant disturbances in mood. These conditions may include prolonged periods of sadness, elevated mood, or fluctuations between emotional extremes.
a woman sitting on the floor with her head propped in her hands, seeming depressed
Common types of mood disorders include:
Depression (Major Depressive Disorder): A mental health condition characterized by persistent sadness, loss of interest in previously enjoyed activities, feelings of worthlessness or hopelessness, and possible thoughts of suicide. Depression is associated with genetic, biological, environmental, and psychological factors.
Bipolar Disorder: A mood disorder involving cycles of elevated mood (mania or hypomania) and depression. Manic episodes may include increased energy, reduced need for sleep, and elevated or irritable mood, while depressive episodes involve persistent sadness and low energy.
Seasonal Affective Disorder (SAD): A form of depression that typically occurs during the fall and winter months, often associated with reduced daylight exposure. Symptoms generally improve during the spring and summer.
Schizophrenia
Schizophrenia is a complex mental health disorder. While its exact cause is unknown, research suggests that genetic and biological factors contribute to its development.
Symptoms are commonly grouped into positive and negative categories:
Positive symptoms involve the presence of experiences not typically observed in others, such as hallucinations (seeing or hearing things that are not present) and delusions (strongly held false beliefs).
Negative symptoms involve a reduction or absence of typical functioning, such as decreased motivation, limited emotional expression (flat affect), and social withdrawal.
People with schizophrenia may also experience difficulty with attention, memory, communication, and movement.
In the following video, mental health professionals Dr. Paris Williams, Professor Elyn Saks, and Debra Lampshire share their personal experiences with schizophrenia and discuss how they work to challenge common myths about the disorder.
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This video is a trailer for a film titled Surviving Schizophrenia.
Video Transcript
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[Video Title: Surviving Schizophrenia]
[DR. PARIS WILLIAMS:] There needs to be that idea that there’s some light at the end of this tunnel.
[PROFESSOR ELYN SAKS:] There are people out there who have Schizophrenia and are doing well.
[DEBRA LAMPSHIRE:] The reality is that the majority of people get on, and get on with their lives and it’s just a small portion of their lives.
Yeah, I work at Auckland University. I’m called a Professional Teaching Fellow and I would cover all areas of mental health. When I came into mental health it wasn’t by choice, it was because I was committed.
[LAMPSHIRE SPEAKING TO CLASS:] I first started hearing voices when I was about five or six years old. After a while, I’m hearing the voices of demons. I believed I was possessed and I used to cut myself to try and get the demons out.
[SAKS:] Everybody becomes psychotic in his or her own way. For me I have delusions, sometimes bizarre delusions, like that I’ve killed hundreds of thousands of people with my thoughts, or a nuclear explosion’s going off in my head. I think Schizophrenia is still probably the most stigmatized, and I don’t think we do well enough trying to incentivize people to really try to do well. I think too many people say, you know, lower your expectations.
[WILLIAMS:] Kind of in a nut shell, I basically had a pretty painful childhood, and I have what I would call essentially kind of a break down, really confusing, kind of wild, kind of beliefs, what you would kind of call paranoia, delusions of grandeur. Bit by bit I worked through it. I mean, there’s a lot of different ways to think of recovery, but I think the most important thing is to recognize that there is definitely hope and strong possibility of moving into a better and better life, and life that really is enjoyable.
[LAMPSHIRE in INTERVIEW:] It’s just normal people dealing with normal human emotions, probably just experience them in a very extreme way.
[SAKS:] There is a lot of stigma and a lot of misinformation. I think people believe that people with Schizophrenia can’t live independently, and can’t work, or are unlikely to get married, and are going to basically sit in a day room watching a blaring TV at best. At worst, they’re going to go out and shoot up a movie theatre and kill lots of people. So, there’s a lot of negative stereotypes, and that’s hard for those of us who suffer with those illnesses to think, you know, this person is scared of me, how horrible.
[LAMPSHIRE:] I never speak to my diagnosis at all. In my private or my professional life, I would never name it. For me, to categorize somebody in that way is far too limiting. And even in mental health itself, the diagnosis is highly contentious. What is this thing that we’re calling people being psychotic etcetera, etcetera, and the social, and personal, and professional consequences of doing that to people? I would think that if I was to declare my diagnosis to people that it would be almost impossible to cultivate relationships.
[WILLIAMS:] When we talk about these mental disorders, I think the idea of hope is really important. Here is someone in a dark place, in a painful place. And there needs to be that idea that there’s some light at the end of this tunnel.
[LAMPSHIRE:] First, I had to believe that things could be different, and when I started to experience a difference, that’s when I started to believe. And then I started to realize that I could have the life that I wanted, and I just had to work at it. So, life for me now is, I’ve got all the things that I never thought I would achieve and all the things that I was told that I would never have. I managed to get married and have three children. I just do ordinary things.
[WILLIAMS:] We don’t have much control over inner experiences like feelings, sensations, thoughts. We actually have a lot less control than most of us realize. But what we do have fairly good control over, including someone in psychosis, is what we’re doing with our body and where I put my attention. And it is hard at first, especially if you’re experiencing extreme states, yet almost anyone can actually learn how to do this.
[LAMPSHIRE:] What I have the opportunity to see is people work through their issues and go out and have the life that they choose for themselves, you know, get married, have children, have jobs, go and get the groceries. You know, people have been written off in lots of ways by the system, but also by our community, as well. And they are just getting on with their lives. There is nothing as satisfying to see people doing that.
[VIDEO CREATED BY ATTITUDELIVE]
End of transcript.
Additional Resources
Web Page: National Institute of Mental Health (NIMH) - Schizophrenia opens in a new window
Online Articles: Schizophrenia Education Guide opens in a new window by John M. Grohol, Psy.D.
Other Disorders
Personality Disorders
Personality disorders involve long-standing patterns in how someone thinks, feels, and relates to others that deviate from cultural expectations. These patterns typically begin in adolescence or early adulthood and can affect relationships, work, and daily life. The behaviors may feel normal or justified to the person experiencing them, which can make change difficult. Many people benefit from treatment.
Two common personality disorders are antisocial personality disorder and borderline personality disorder.
Antisocial Personality Disorder involves a consistent pattern of ignoring or violating the rights of others. This can show up as chronic dishonesty, impulsive or reckless behavior, and repeated disregard for rules or laws. A diagnosis isn’t based on one or two bad decisions; it reflects a long-term pattern that causes harm or serious problems.
Borderline Personality Disorder is marked by intense emotions and instability in behaviors, relationships, self-image, and mood. Someone may struggle with fear of abandonment, sudden shifts in how they see themselves or others, feelings of emptiness, or anger that feels hard to manage. Relationships can feel intense and unpredictable. Some people may experience self-harm or suicidal thoughts. Effective treatments exist, and many people improve significantly with support.
Eating Disorders
Eating disorders are mental health disorders marked by an intense preoccupation with food, eating, body weight, or body shape. They involve patterns of thoughts, emotions, and behaviors that disrupt normal eating habits and can affect overall health. The exact causes are not fully understood, but research indicates that a combination of biological, genetic, psychological, and social factors contributes to their development. The three most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Anorexia nervosa involves severe restriction of food, an intense fear of gaining weight, and a distorted view of one’s body. A person may eat very little, exercise excessively, or follow rigid food rules. Anorexia can lead to significant medical complications, including effects on the heart, bones, and other vital systems.
Bulimia nervosa involves cycles of binge eating followed by behaviors meant to "undo" the eating, such as vomiting, misusing laxatives, fasting, or excessive exercise. These cycles are often driven by shame and a sense of being out of control.
Binge-eating disorder involves repeated episodes of eating large amounts of food in a short time while feeling out of control. Unlike bulimia, it does not involve regular purging or other compensatory behaviors. Episodes are often followed by guilt, distress, or depression.
Challenges and Solutions for People Who Have Psychological/Psychiatric Disabilities
Learning Goals
The CPACC exam will ask you questions that show you know how to:
Identify accessibility challenges that people who experience psychological or psychiatric disabilities experience.
Match the challenges with appropriate:
Assistive technologies (products or items that people can use)
Adaptive strategies (methods to work around or avoid the challenges)
Psychological and Psychiatric Disorders: Challenges and Solutions Domain Challenges Solutions
General Difficulty managing emotions or stress
Apps with mood, stress, and anxiety management functions
Skills-based therapy
Grounding and emotion regulation techniques
Structured routines and sleep support
Medication when appropriate
General Impulsivity or disrupted behaviors
Structured coping plans and safety planning
Distress tolerance skills
Harm-reduction approaches
Specialized treatment programs when needed
Information and Communication Technology (ICT) / General Cognitive and executive function difficulties
Task breakdown and clear step-by-step instructions
Planners, reminder apps, or visual schedules
Reduced-distraction environments
Cognitive remediation or skills training
General Relationship and social strain
Interpersonal or group therapy
Social skills training
Clear communication strategies and boundaries
Peer or family support programs
Multiple/Complex Disabilities
People with multiple or complex disabilities have two or more disabilities that occur together. These may include combinations of physical, sensory, communication, intellectual, developmental, or learning disabilities.
The term “multiple disabilities” does not specify which disabilities are present, how many, or their level of impact. The key consideration is not simply the number of diagnoses, but how they interact and affect daily life. Support and accommodations should reflect the combined impact of those disabilities, not just each one in isolation.
Depending on the individual, the following may be impacted:
Difficulty processing or organizing information
Challenges with speech or communication
Limited mobility or fine motor coordination
Hearing or auditory processing differences
Vision differences
Difficulty applying skills across different settings
Accessibility for Multiple Disabilities
A smiling woman with Down syndrome, sitting in a wheelchair and communicating with a care provider
Accessibility for people with multiple disabilities depends on each individual’s specific needs. Communication can be supported with augmentative and alternative methods, such as sign language, tangible symbols, or computer-generated speech. Assistive technologies can help overcome functional challenges and enhance participation. Because needs vary widely, providing a range of communication aids, assistive tools, and following accessibility standards is essential for making both physical and digital environments more usable.