Aspiration Precautions

Children and adults with developmental disabilities often face challenges with eating, drinking and swallowing disorders than the general population. It is estimated that adults with intellectual disabilities require support from caregivers during mealtime. It is common among people who have a diagnosis of cerebral palsy, intellectual disability, physical  disability and muscular dystrophy.

Dysphasia is a medical term used to describe any person having difficulty swallowing foods and liquids taking  more energy and time to move food from the mouth to the stomach. Signs of dysphasia may include:

  • Drooling
  • Food or liquid remaining in the oral cavity after swallowing
  • Complaints of pain when swallowing
  • Coughing during or right after eating or drinking
  • Extra time needed to chew or swallow
  • Reflux of food

Dysphasia can lead to aspiration. Aspiration is defined when food, fluid, or other foreign material gets into the trachea or lungs instead of going down the esophagus and into the stomach. when this occurs, the person is able to cough to get the food or fluid out of their lungs, in some cases especially with children and adults with disabilities may not be able to cough. This is known as Silent Aspiration.

A complication of aspiration is Pneumonia which is defined as inhaling food, saliva, and liquids into the lungs

According to the Office of People with Developmental Disabilities Health and safety Alert, factors that place people at risk for aspiration include:

  • Being fed by others
  • Weak or absent coughing, and/or gag reflexes, commonly seen in people with cerebral palsy.
  • food stuffing and rapid eating/drinking
  • Poor chewing or swallowing pills
  • GERD- the return of partially digested food or stomach contents to the esophagus
  • Providing liquids or food consistencies the person is not able to tolerate such as eating whole foods.
  • Seizures that may occur during eating and/or drinking.

How to recognize signs and symptoms of Aspiration:

  • Choking or coughing while eating or just after eating
  • Drooling while eating or just after eating
  • Eyes start to water
  • Shortness of breath
  • Fever 30 minutes after eating
Intervene immediate if there are signs of aspiration:
  • Stop feeding immediately
  • Keep the person in an upright position
  • Call 911 if the person has difficulty or stops breathing and no pulse
  • Start rescue breathing

Minimize aspiration from occurring by serving the appropriate food texture and liquid consistency. If you are not sure of the right consistency, check with your health care provider. The following are pictures of food consistencies.

Courtesy of OPWDD

Courtesy of OPWDD

Whole. Food is served as it is normally prepared; no changes are needed in
preparation or consistency

Courtesy of OPWDD

1 ” Pieces cut to size. Food is served as prepared and cut into 1-inch pieces
(about the width of a fork).

Courtesy of OPWDD

1/4 Pieces Cut to Size. Food is cut with a knife or a pizza cutter or placed in a food
processor and cut into ¼ -inch pieces (about the width of a #2 pencil)

Courtesy of OPWDD

Ground. Food must be prepared using a food processor or comparable equipment
until MOIST, COHESIVE AND NO LARGER THAN A GRAIN OF RICE, or relish
like pieces, similar to pickle relish. Ground food must always be moist. Ground meat
is moistened with a liquid either before or after being prepared in the food processor
and is ALWAYS served with a moistener such as broth, low fat sauce, gravy or
appropriate condiment. Hard, dry ground particles are easy to inhale and must be
avoided.

 

Courtesy of OPWDD

Pureed. Food must be prepared using a food processor or comparable equipment.
All foods are moistened and processed until smooth, achieving an applesauce-like or
pudding consistency. A spoon should NOT stand up in the food, but the consistency
should not be runny. Each food item is to be pureed separately, unless foods are
prepared in a mixture such as a soup, stew, casserole, or salad.

Aspiration Precautions

  • Make sure the person eats slowly and takes small bites of food
  •  Ensure the person takes small sips of liquids
  • Focus on the person’s swallowing
  • Make sure the person remains upright for a minimum of thirty minutes after eating

Intellectual Disabilities And Epilepsy

According to the Epilepsy Foundation, epilepsy is the fourth most common neurological disorder and affects people of all ages. In fact, 1 in 26 people have seizures and while people who are diagnosed with epilepsy may have no other problems, this is not the case for children and adults with an intellectual and developmental disability where the rates are much higher.

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It is estimated that 30% of children with epilepsy also have another type of disability. Some studies show that children with an intellectual disability and cerebral palsy, had a 35% chance of developing epilepsy, children with an intellectual disability alone had an 8% chance and children with a brain injury occurring after birth stood a 75% chance of developing epilepsy. Statistically, the risky of a child with a developmental disability experiencing an unprovoked seizure by age 5 is 4 times likely than the general population. It is estimated 1.8% of U.S. adults have epilepsy compared to 22% among people with intellectual disabilities.

People with intellectual disabilities tend to also have worse prognosis with adults having a higher rate of death including Sudden Unexplained Death In Epilepsy (SUDEP).

Epilepsy

Epilepsy is a chronic disorder with recurrent unprovoked seizures. According tot he National Institute of Neurological Disorders and Stroke (NINDS), epilepsys are a spectrum of brain disorders ranging from severe, life-threatening to ones that are more benign. The International League Against Epilepsy created a new definition of epilepsy. A person is considered to have epilepsy if they meet any of the following conditions:

  1. At least two provoked (or reflex) seizures occurring greater than 24 hours apart.
  2. One Unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years.
  3. Diagnosis of an epilepsy syndrome

A seizure is defined as an event and epilepsy is the disease involving recurrent unprovoked seizures.

Intellectual Disability

According to DSM-5, an intellectual disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual social, and practical domains including deficits in intellectual functions such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning and learning from experiences.  The severity levels range from mild to profound.

Although there is a high relationship between epilepsy and an intellectual disability, little research has been conducted on safe prescribing practices of an antiepileptic drugs for people with intellectual disabilities. What is known about epilepsy and an intellectual disability is that more severe disabilities are typically caused by damage to the brain

Why is it important to discuss?

Given the large number of people with an intellectual disability and epilepsy, treatment may be more complicated due to multiple impairments including people with a diagnosis of autism, intellectual disability and epilepsy. More research needs to occur which will help to reduce morbidity rates and help to develop accurate guidelines.

10 Easy Steps of Audit and Survey Readiness

Annual audits and surveys can be very intimidating. A group of state surveyors showing up at the residence or day program to review services given to individuals with developmental disabilities.

What is the purpose of the audit?

In each state, Immediate Care Facilities (ICF), Immediate Residential Alternatives (IRAs), Waiver services or privately operated programs are funded through Medicaid Assistance Annually State agencies. Annual surveys serve the purpose of recertifying facilities and to make any further recommendations. Overall, the goal is to ensure the quality of for the individuals receiving services.

What are surveyors looking for?

In recent years, the focus is more on ensuring facilities that provide services and supports to individuals with intellectual and developmental disabilities are providing opportunities for individual choices including person-centered planning, community inclusion and choice-making. Typically, State auditors will review the Individualized service Plan (ISP) document to determine it the ISP is both current and accurate.

Audit Preparation

State Auditors generally spend some time talking to staff. They may ask you questions relating to the person’s plan. The questions are often generated after they have read the individual’s ISP plan. The questions that are asked are more than likely things that you do well everyday. here are 10 easy steps as you prepare for the auditing process:

  1. Knowledge of Individuals. know each person’s plan including person-centered planning plan, medical needs, preferences and habilitation plan.
  2. Cleanliness. Make sure the environment is neat and orderly.
  3. Privacy. Remember to give the person privacy when needed.
  4. Choice. Offer choices throughout activities whenever possible. The auditors may ask you how do you teach choice-making.
  5. Tone. Always speak in a positive and appropriate tone of voice.
  6. Small groups. Work in small groups whenever possible. Incorporate variety  of choice during activities.
  7. Community activities. Ensure individuals are able to make choices in activities in the community and community inclusion opportunities are available.
  8. Universal Precaution Guidelines. Know the precautions and follow them. Remember to change gloves when moving from one individual to the next.
  9. Active Programming. The auditors may ask questions related to what they have read in the individuals ISP or CFA (Comprehensive Functional Assessment).
  10. Safeguards. make sure you are able to describe the individual’s supervision needs.

Remember: Demonstrate your self-confidence, because you are good at what you do!

What is Lowe Syndrome?

Lowe Syndrome also known as Oculocerebrorenal Syndrome is a rare genetic disorder that affects the eyes, brain and kidneys. It has a prevalence of 1 in 500,000 and mainly affects males.

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Signs and Symptoms
  • Congenital cataracts
  • eye abnormalities and eye disease
  • glaucoma
  • kidney abnormalities (Renal Fanconi Syndrome)
  • dehydration
  • abnormal acidic blood
  • progressive kidney problems
  • feeding problems
  • bone abnormalities
  • scoliosis
  • weak or low muscle tone (hypotonia)
  • joint problems
  • developmental delays including motor skills
  • short stature
  • intellectual disability
  • seizure
  • behavioral issues

Children and adults diagnosed with children and adults may also show the following signs and symptoms due to an intellectual disability:

  • decrease learning ability
  • delays in crawling
  • delays in sitting up
  • difficulty solving problems
  • lack of curiosity
  • language and speech delays
  • poor memory
  • behavior problems
Teaching Strategies

The following strategies will help when teaching a child or an adult diagnosed with Lowe Syndrome:

  • Use short and simple sentences to ensure understanding
  • Repeat directions
  • Teach specific skills when possible
  • Use strategies such as chunking, backwards shaping, forward shaping and role modeling.
  • Use concrete information
  • Provide immediate feedback

Image thanks to Robert Thomson on Flickr.com (creative commons)

Resources

National Organization for Rare Disorders

Genetics Home Reference

Dove Med

Wikipedia

How To Organize Clothing In A Residential Setting

Organizing clothes in a regular household can be challenging. Imagine striving to clean, organize and store clothes when it is 12 people living under one roof! This can often lead to clothing getting mixed up causing further confusion.

There are a number of steps you can take that will help to alleviate this often challenging task:

  1. Create an inventory list for each person. This list should include a tri-annual schedule when clothing are sorted. Choose a time in the spring, fall and winter when to sort out clothing. An inventory list should also list the types of clothing and the number of items for each. Below is an example of an inventory.  You will find a free template here: clothing_inventory
  2. Spend a day with each person and go through the closet taking everything out. Sort the clothing and throw out anything that is torn or broken. People may have a favorite item they might like to wear. Look to see if it can get either fixed or replaced
  3. Once clothing is organized, choose a day with the person and determine a laundry day. While it can be easier to try to do wash clothing for several people at a time, you risk the chance of mixing up clothing.
  4. Always make sure if possible, the person participates as much as they can in this household task. It encourages independence and individuality at the same time.

I like to hear tips you use for clothing organizing for multiple people.

 

 

20 Task Box Resources To Use In Your Classroom or Home

Task boxes (also known as work boxes) are structured work systems created by Division TEACCH t the University of North Carolina Chapel Hill. This system allows the student to work independently on a task for a specific time in a supportive environment.  Task boxes are now used for students with a variety of disabilities including students required pervasive levels of support.

 

There are 3 types of task boxes: stacking- Helps with eye-hand coordination and fine motor skills; sorting- may break activities by size, color, texture, shape and flavor and fine motor- strengthens the smaller movement in the wrists, hands and fingers.

The following sites include information on how to set up a task box system in your classroom or in your home.

How I Set Up My Task Box System ( Delightfully Dedicated)

How to Set Up An Independent Workbox (Breezy Special Ed)

How to Start a Task Box System (Autism Adventures)

Task Box Set Up- (Autism Adventures)

Websites that will give you ideas on creating task boxes, and the material needed.

Autism Classroom Workbox System (Teaching Special Thinkers)

Fine Motor Morning Work Bins (Differentiated Kindergarten)

Assembly Work Task (Autism Classroom News and Resources)

Free Math Printable Task Box for Special Education ( My Creative Inclusion)

Higher Level Academics in Task Boxes (Mrs. P’s Specialties)

How I Use Workboxes in My Classroom (Creating and Teaching)

Pre-Vocational Work Boxes (SPED Adventures)

Quick and Easy Task Box Ideas (Little Miss Kim’s Class)

Task Boxes: A Hands On Approach to Life Skills (Therablog)

Task Boxes for Autistic Children (Love to Know)

Structured Work Boxes (University of Mary Washington)

Ways to Up the Ante in Your Work Task System (The Autism Vault)

Winter Task Boxes (You Aut-aKnow)

Work Boxes in Autism Classrooms (Noodle Nook)

Work Box Task Ideas (The Autism Helper)

Work Task (Breezy Special Ed)

 

4 Tips On Task Initiation For Children and Adults

Task Initiation is often a challenge for children and adults with an executive functioning disorder. For a child, it may be lack of initiative in doing homework while for an adult, it may include forgetting or putting off paying bills. Children and adults with task initiation issues generally have a diagnosis of autism, ADHD, Intellectual disability or a learning disorder.

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Signs of a task initiation impaired executive functioning skill would be someone having difficulty in getting started on a task and keeping the effort needed in order to complete the task. A child or an adult require external cues in order to complete the task. Also, it will require understanding what is expected and understanding the task. Here are a few strategies:

  1. Limit Distractions. In the classroom any type of added sensory input can defer the student from getting started in their school work.
  2. Create a List. Visual support will help to increase getting the work done for a school-age child, you may want to create a to-do list which the steps are broken down into smaller steps. When a person with an executive function is given a task, it may be overwhelming, making it more difficult to get started.
  3. Use Cues. A clock or a timer will help the child or adult stay on time and understanding the amount of time it will take to complete a task
  4. Break task down. Create where the work is done in chunks so that the work will not be as overwhelming for the student.

Speech-language Pathology and Adult Services

speech-word-cloud
Guest Blogger, Anne Marie Pineiro, M.A. CCC-SLP, 

Speech-language Pathologists serve individuals, families, and groups from diverse

linguistic and cultural backgrounds. Services are provided based on applying the

best available research evidence, using expert clinical judgments, and considering

clients’ individual preferences and values. Speech-language pathologists address

typical and atypical communication and swallowing in the following areas:

pragmatics (language use, social aspects of communication)

-literacy (reading, writing, spelling)

– prelinguistic communication (e.g., joint attention, intentionality, communicative signaling)

paralinguistic communication

  • cognition- attention,  memory,  sequencing,  problem solving,  executive functioning
  • feeding and swallowing- 4 phases of swallowing

-oral, pharyngeal, laryngeal, esophageal

orofacial myology (including tongue thrust)

-oral-motor functions

Source:   http://www.asha.org/uploadedFiles/SP2007-00283.pdf

In providing services to those Adults diagnosed with a variety of Developmental Disabilities, the SLP’s role may become much more defined, focusing on what is most functional to an individual in the areas of speech, receptive and expressive language (verbal or non-verbal communication) and feeding/ swallowing.  Very often we are attempting to assess and/or maintain an individual’s current level of functioning in the above areas and to train all those involved in the care of that individual in the strategies and implementation of them to achieve that goal.  In our Agency, for example, we break the assessment down into the following areas in order to develop functional and measurable outcomes:

Speech

  1. Does the individual use speech functionally to communicate wants/needs in a variety of settings?
  2. If so, is their speech understood by all, some, few communicative partners?  Are there any strategies a person might use to increase his/her intelligibility- modifying volume, rate, resonance, increasing fluency, etc.?  Does the person use Augmentative Communication to supplement speech when he/she cannot be understood e.g. low/high tech communication device, writing, American Sign Language, Picture Language Board, etc.

Language

  1. Receptive language (Language comprehension) including attention to objects, using objects functionally, identification of objects and/or pictures, comprehending one, two or three-step oral directives, vocabulary, comprehension of attributes and spatial relationships, or auditory comprehension on the word, sentence and paragraph levels.  Is comprehension on the literal or inferential levels?
  2. Expressive language- (Language expression)- for those who are verbal, the MLU (mean length of utterance) is assessed.  For non-verbal individuals, language expression can be in the form of pointing to one or two picture symbols consecutively on a picture language communication board or AAC device, writing or typing single words, phrases, sentences or paragraphs on paper, computer or AAC device.

-AAC device assessments for nonverbal individuals take into account the individual’s cognitive skills, physical abilities in order to access the device (direct selection with hand or finger, eye gaze, head pointer, switch/scanning, etc.), receptive and expressive language skills, communicative intent and pragmatic language abilities, and literacy.  All those involved in the individual’s care play an extremely important role in whether or not someone may receive an AAC device since they will be the ones to set up/take down the device and provide basic maintenance for the device, including programming, charging, etc.

Feeding and Swallowing:

Many people wonder why an SLP would be the one to review an individual’s mealtime plan or protocol.  ASHA guidelines state it best: “The speech-language pathologist is a primary professional involved in assessment and management of individuals with swallowing and feeding disorders. These areas include:

  • Performing clinical swallowing and feeding evaluation;
  • Performing instrumental assessment of swallowing function with medical professionals as appropriate;
  • Identifying normal and abnormal swallowing anatomy and physiology;
  • Identifying signs of possible or potential disorders in upper aerodigestive tract swallowing and making referrals to appropriate medical personnel;
  • Making decisions about management of swallowing and feeding disorders;
  • Developing treatment plans;
  • Providing treatment for swallowing and feeding disorders, documenting progress, and determining appropriate dismissal criteria;
  • Providing teaching and counseling to individuals and their families;
  • Educating other professionals on the needs of individuals with swallowing and feeding disorders and the speech-language pathologists’ role in the diagnosis and management of swallowing and feeding disorders;
  • Serving as an integral part of a team as appropriate;
  • Advocating for services for individuals with swallowing and feeding disorders;
  • Advancing the knowledge base through research activities.

In addition, Speech-language pathologists have extensive knowledge of anatomy, physiology, and functional aspects of the upper aerodigestive tract for swallowing and speech across the age spectrum including infants, children, and adults (including geriatrics). The upper aerodigestive tract includes oral, pharyngeal, and cervical esophageal anatomic regions. Speech-language pathologists also have extensive knowledge of the underlying medical and behavioral etiologies of swallowing and feeding disorders. In addition, they have expertise in all aspects of communication disorders that include cognition, language, and behavioral interactions, many of which may affect the diagnosis and management of swallowing and feeding disorders.”

Source: http://www.asha.org/policy/TR2001-00150/#sec1.3

The dysphagia and feeding disorders that are seen in adults with developmental disability include poorly developed and absent feeding and oral preparation skills and competencies, physiological and anatomical impairments that degrade oral-pharyngeal and esophageal bolus motility, and disruptive or maladaptive mealtime behaviors. Nutrition, hydration, saliva management, ingestion of medications, and management of the oral hygiene bolus may be involved. Upper airway obstruction (choking), aspiration, malnutrition, and dehydration may result from the disorder (Rogers et al., 1994, Sheppard et al., 1988).  Source: http://www.asha.org/policy/TR2001-00150/#sec1.3

Therefore, in our Agency that serves Adults with Developmental Disabilities, the SLP works as one member of the Team, including the Occupational Therapist, Physical Therapist, Nurse, Residential Team and Family Members to create a mealtime protocol or plan which simply states the best way to maximize nutrition while at the same time attempting to decrease incidents of choking (partial or complete blockage of the airway) or aspiration (food or liquid making its way into the lungs which can lead to aspiration pneumonia).  These plans are developed so that all involved in the individual’s care may be informed of the best feeding practices for that individual which include: adaptive mealtime equipment (any cup spoon, plate, straw, etc. used for an individual to improve ability to eat independently and to improve oral-motor control), positioning in chair or wheelchair, degrees of assistance needed for self-feeding, food and liquid consistencies, food allergies and intolerances, the presence of any mealtime behaviors, including rapid pace of eating which may increase risk of choking or aspiration, and any specific instructions the caregiver would find useful in feeding the individual or maximizing the individual’s ability to feed themselves.

I hope you find this information helpful in identifying the SLP’s role in providing services to adults with Developmental Disabilities.

This information is in no way intended to serve as a complete guide in this area, but is meant to simply assist in identifying ways the SLP works as part of the Interdisciplinary Team in serving adults with developmental disabilities in a day habilitation setting

Epilepsy- General Information

Epilepsy is a chronic disorder of the central nervous system. It is often characterized by seizures and is the fourth most common neurological disorder and affects people of all ages.

epilepsy ribbon

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A person is considered to have epilepsy if they meet any of the following conditions:

  1. At least two unprovoked seizures occurring greater than 24 hours apart.
  2. One unprovoked seizure and after two unprovoked seizures occurring over the next 10 years.
  3. Diagnosis of an epilepsy syndrome.
Seizures

A seizure is caused by a burst of abnormal activity in the brain. With a seizure, a person has change in awareness, behavior, body movement or sensation. A seizure can last from a few seconds to a few minutes. Seizures can take on many different forms and affect people in different ways.

Auras

Auras are often describes as a warning before the occurrence of a seizure. Not everyone experiences an aura. Some have described it as a change in feeling, sensation, thought or behaviors. this may include:

  • An overpowering smell.
  • Nausea or indigestion.
  • A rising/sinking feeling in the stomach.
  • a sleepy/dreamy feeling.
Types of Seizures

Generalized Tonic Clonic Seizures. Involves the entire brain. May also be referred to as a grand mal seizure. This occurs when abnormal electrical activity affects all or most of the brain. often the body will stiffen and then the person will lose consciousness and then the body will shake due to uncontrollable muscle contractions.

Absence Seizure– A brief loss of consciousness or awareness. It generally last only seconds and mainly occurs in children. Signs may include a blank stare, lip smacking and repeated blinking, chewing or hand movement.

Focal Seizures– The burst of electrical activity is contain in one part of the brain. In a simple focal seizure, you may have muscular jerks or strange sensations in one arm or leg. The person does not lose consciousness or awareness.

Causes
  • brain trauma
  • genetics
  • stroke
  • tumors
  • brain infections
  • head injury.
Risk Factors
  • Babies who are born small for their age
  • Babies who have seizures in the first month of life
  • Cerebral Palsy
  • Autism Spectrum Disorders
  • Conditions with intellectual and developmental disabilities
  • Family history of epilepsy (febrile)
Triggering Factors
  • Stress or anxiety
  • Lack of sleep or tiredness
  • Skipping meals
  • Alcohol intake
  • Flickering lights
  • Fever
  • Caffeine
Diagnosis
Treatment

 

The following websites offer additional information on epilepsy including causes, symptoms, treatment, and diagnosis:

Centers for Disease Control and Prevention

Epilepsy Foundation

Mayo Clinic

Medical News Today

Medlineplus

National Institute of Neurological Disorders and Stroke 

WebMD

Wikipedia

None of the information provided is meant to treat or diagnose any conditions. Not is it a substitute for medical, or psychological diagnosis and treatment.

October is National Disability Employment Month

 

Image result for national disability employment awareness month 2016

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National Disability Employment Awareness is recognized each October to highlight the workforce contributions of people with disabilities.

So much as been accomplished over the years, but still, we have a long way to go. In almost all states, the number of people working with disabilities is half of those without disabilities. This year, I wanted to reflect on how much has been achieved over the years.

A History of Disability Employment Awareness

1920- The Smith-Fess Act: Signed into law by President Woodrow Wilson, establishes the Vocational Rehabilitation program for Americans with Disabilities.

1935- Social Security Act of 1935- establishes an income system for those unable to work by providing benefits.

1936- Randolph-Sheppard Act: Signed by President Franklin D. Roosevelt in 1936, the Randolph-Sheppard Act mandates a priority to people who are blind to operate vending facilities on federal property.

1938- Wagner-O’Day Act:The Wagner-O’Day Act is passed, requiring all federal agencies to purchase specified products made by people who are blind. In 1971, the Javits-Wagner O’Day Act expands the program to include services as well as supplies and incorporate people with other significant disabilities. In 2006, the program is renamed AbilityOne.

1945- Declaration of National Employ the Physically Handicapped Week:The return of service members with disabilities from World War II sparks public interest in the contributions of people with disabilities in the workplace. On August 11, 1945, President Harry S. Truman approves a Congressional resolution declaring the first week in October “National Employ the Physically Handicapped Week.’ In 1962, the word “physically” is removed to acknowledge the employment needs and contributions of individuals with all types of disabilities.

1954- Vocational Rehabilitation Gains Momentum:Congress passes the Vocational Rehabilitation Amendments of 1954, increasing the scope of the VR system. Targeting people who could proceed or return to work with assistance, VR helps thousands of people obtain employment. Mary Switzer, Director of the Office of Vocational Rehabilitation at the time, uses this authority to fund more than 100 university-based rehabilitation programs. The Act also initiates funding for research, eventually leading to the National Institute on Disability and Rehabilitation Research.

1956- Creation of Social Security Disability Insurance: Congress passes the Social Security Amendments of 1956, which create a Social Security Disability Insurance (SSDI) program for workers with disabilities aged 50 to 64. Additional amendments two years later extend SSDI benefits to the dependents of workers with disabilities.

1973- The Rehabilitation Act:The Rehabilitation Act of 1973 marks a major step forward in legislation impacting the employment of people with disabilities, extending and revising state Vocational Rehabilitation services and prohibiting discrimination on the basis of disability by federally funded and assisted programs, federal employers and federal contractors.

1977- Section 504 of Rehabilitation Act: After major demonstrations in 10 U.S. cities on April 5, including a 150-person sit-in in San Francisco led by Judith Heumann and Kitty Cone lasting 28 days, U.S. Secretary of Health, Education and Welfare Joseph Califano signs regulations implementing Section 504 of the Rehabilitation Act. These regulations extend civil rights to people with disabilities, covering any program or activity, including employment services, receiving federal financial assistance

1986- Employment Opportunities for Disabled Americans Act of 1986:The Employment Opportunities for Disabled Americans Act enhances work incentives for people with disabilities under the Supplemental Security Income (SSI) program by making permanent section 1619 of the Social Security Act, which provides for special SSI payments and Medicaid coverage while eligible individuals make attempts to work.

1990- Americans with Disabilities Act: President George H. W. Bush signs the Americans with Disabilities Act (ADA) into law. Modeled on the Civil Rights Act and Section 504 of the Rehabilitation Act, the ADA stems from collective efforts by advocates in the preceding decades and is the most comprehensive disability rights legislation in history. Its employment provisions prohibit discrimination in job application procedures, hiring, advancement and termination and provide for equal access to workers’ compensation; job training; and other terms, conditions and privileges of employment.
1992- Rehabilitation Act Amendments: Amendments to the Rehabilitation Act emphasize employment as the primary goal of vocational rehabilitation (VR). Specifically, they mandate presumptive employability, meaning applicants should be presumed to be employable unless proven otherwise, and state that eligible individuals must be provided choice and increased control in determining VR goals and objectives, determining services, service providers and methods of service provision.