Customers with disabilities or medical conditions 008-18052200

Neck and back pain are the most common forms of musculoskeletal conditions. Some causes of neck and back pain are:

• muscle and ligament strain
• direct trauma
• fractures and whiplash
• disc damage (ruptured or a prolapsed disc)
• arthritis and osteoporosis
• nerve or nerve root damage (sciatica)
• congenital deformity or disease
• spondylosis and disease

A person with a neck or back condition may have some or all of the following reduced abilities or limitations such as:

• reduced tolerance to sitting and standing
• reduced capacity to work or drive
• reduced ability to walk, inability to run, climb, squat or bend
• inability to lift or carry moderate to heavy objects
• reduced range of movement, sensation or strength in the neck, back, arms or legs
• mobility restrictions on public and private transport
• social isolation with a reduced capacity to be with other people due to restrictions, pain or medication
• some confusion and/or difficulty remembering things due to the effects of medication
• loss of self-esteem or low mood due to chronic pain, inability to participate in the workforce and/or participate in family and social functions
• grief at loss and/or reduced financial independence

Most causes of spinal cord injury (SCI) are traumatic, e.g, motor vehicle accidents, falls, water sports and crash injuries. Non-traumatic causes are less common and include infections and tumours.

The types of SCI are:

• Complete injury – this is the loss of all movement and sensation below the level of the SCI
• Incomplete injury – there may be some sensation or muscle movement below the level of injury
• Quadriplegia – injury is at the level of the cervical (neck) cord segments. Quadriplegia means paralysis or weakness in all four limbs and trunk
• Paraplegia – the level of injury is below the cervical (neck) cord segments. Paraplegia means paralysis or weakness in the legs and sometimes the trunk (depending on the level of injury)
• Paraplegia or quadriplegia can be complete or incomplete. Not all people in wheelchairs have an SCI and not all people with an SCI use wheelchairs

A person may experience impairments in their mental health when their thoughts, behaviour and feelings cause acute stress to themselves or others and interfere with their social or occupational functioning. They may or may not have a formal diagnosis of a psychological/psychiatric condition.

When assisting customers with this condition, consider the various impacts of the condition on their ability to comply, including their capacity to attend appointments. Customers may attend appointments with a support person of their choice, e.g. a relative, friend or an advocate from a disability, mental health or community organisation.

Customers with psychiatric and psychological conditions may experience episodes of being unwell in between periods of good health and functioning, while others may be continually unwell. Co-occurring mental disorders are common, and a person may present with 2 or more psychiatric/ psychological conditions.

Types of psychiatric and psychological conditions include:

• Mood disorders – such as depression and bipolar disorders
• Anxiety disorders – such as generalised anxiety disorder and/or phobias
• Obsessive-compulsive and related disorders - such as obsessive-compulsive disorder (OCD) and hoarding disorder
• Trauma- and stressor-related disorders - such as posttraumatic stress disorder (PTSD), and adjustment disorders
• Psychotic disorders – such as schizophrenia
• Personality disorders – such as borderline personality disorder and antisocial personality disorder

Depression

Depression is a common mental health condition which can sometimes be associated with other medical conditions. The symptoms include changes in emotion/mood, impaired cognitive functioning, reduced motivation and changes in physical functioning such as weight loss/gain, reduced energy levels and sleep disturbance. Some people can feel suicidal.

Anxiety Disorders

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioural disturbances. Anxiety disorders may be associated with panic attacks. A panic attack characterised by sudden onset of intense fear accompanied by symptoms such as rapid heartbeat, shortness of breath, sweating, dizziness, trembling and feelings of unreality. The intensity of the attack can vary.

A phobia is an excessive or unreasonable fear of certain objects or situations. For example, agoraphobia is a fear of being somewhere from which it would be difficult to escape or here help might not be readily available.

Obsessive compulsive disorder

An obsessive compulsive disorder involves repeated, intrusive thoughts or compulsive behaviours which are usually known to be irrational. Obsessions may focus on a fear of harming others, acquiring or spreading contamination, doubt about having performed a task. Compulsions can involve rituals of cleaning, repeating, checking, hoarding or avoiding.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder is a severe reaction to a traumatic event often involving actual or threatened death or serious injury to themselves or others. Post-traumatic stress disorder occurs where a person experiences persistent and intrusive recollections or dreams about the event. They often try to avoid situations which are associated with the trauma.

Bipolar Affective disorder

Bipolar Affective disorder is a mood disorder characterised by a person experiencing both episodes of depression and extreme elation or mania.

During a manic phase, a person is often highly excited, over-active, over-confident, over-talkative and may lose touch with reality. In the depressed phase, a person can become sad, pessimistic about the future, withdrawn, underactive or have guilt feelings.

In either mood, people may experience hallucinations/delusions, sleep disturbance, frequent tearfulness, loss of concentration, a short attention span, confused thinking and mood swings from a general hyperactive state to a flattened mood.

Borderline Personality Disorder

Borderline personality disorder is a mental health condition that can affect a person’s thoughts, emotions and behaviours, making it difficult to function in many areas of life.

A person with borderline personality disorder may have difficulties with interpersonal relationships and self-image. They may experience significant mood changes or find it difficult to manage their emotions and/or behaviour.

Schizophrenia

Schizophrenia is characterised by social withdrawal, reduced emotional expressiveness and perceptual distortions. A misconception about schizophrenia is that the person has a split personality. The cause of schizophrenia is unknown and it has many varied symptoms, such as:

• Delusions
• Hallucinations – auditory and visual
• Disordered thinking and attention
• Bizarre behaviour
• Emotional withdrawal
• Loss of motivation

An acute schizophrenic episode is characterised by such things as:

• Alterations in the senses e.g., hearing voices
• Changes in emotional responsiveness
• Changes in behaviour such as neglect of personal health care, hygiene and presentation
• Having an altered sense of self and others e.g. may have unrealistic ideas about their own importance or unreasonable fears that others are trying to influence or harm them in some way
• Having impaired concentration and cognitive functioning resulting in an inability to response appropriately

Neurodevelopmental disorders are a group of conditions that begin during the developmental period and are characterised by developmental deficits or differences in brain processes that result in impairments of personal, social, academic, or occupational functioning. These disorders may impact day-to-day functioning by impairing physical, learning, language or behaviour areas. The disorder usually lasts throughout the person’s lifetime. Neurodevelopmental disorders frequently co-occur with one another.

Common neurodevelopmental disorders include:

• Intellectual Developmental Disorder (Intellectual Disability)
• Autism Spectrum Disorder (ASD)
• Attention-Deficit/Hyperactivity Disorder (ADHD)

Intellectual developmental disorder (intellectual disability)

Intellectual Developmental Disorder includes deficits in:

• intellectual functions such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience; and
• adaptive functioning such as activities of daily life, communication, social participation, and independent living.

A person with an intellectual impairment may have reduced learning capacity, comprehension, memory and communication ability, and may have difficulty in understanding a string of instructions, abstract concepts and information

To determine if a person has an intellectual developmental disorder, a formal assessment of cognitive functioning is required. This involves a standardised assessment where the results of the tests can be compared to a population average and an Intelligence Quotient (IQ) is determined.

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is a lifelong developmental condition that impairs the ability to communicate and interact. The range and severity of symptoms can vary widely between individuals.

Common symptoms include:

• difficulty with communication
• difficulty with social interactions
• obsessive interests
• repetitive behaviours
• sensory sensitivities – for example individuals may get easily upset by certain sounds or textures

Attention deficit/hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) is a pattern of behaviour that begins in childhood, and in most cases continues throughout the person’s life. Key features of ADHD are inability to concentrate and easily distracted, as well as hyperactivity and impulsiveness.

Intellectual developmental disorder (intellectual disability) has onset during the developmental period, generally take to mean before age 18. Causes may be before (prenatal), during (perinatal), or after (post-natal) birth, or may occur during childhood or adolescence in some cases.

Prenatal Causes - This is where the cause is considered to have occurred prior to birth but the actual cause may not be known. Below are some causes of intellectual impairments at the prenatal stage:

• Chromosomal disorders – Examples of these are Down Syndrome (trisomy 21) occurs by a person having an extra chromosome, and Klinefelter’s Syndrome (XXY Syndrome), where a male has an extra ‘X’ chromosome
• Inborn errors of Metabolism – This is where the body cannot absorb and/or process chemical substances naturally present in the food and necessary for the health of the body and brain. e.g., if the thyroid gland is absent or is only partially functioning at birth
• Developmental Disorders of Brain Formation – These abnormalities that occur in the development of a person’s brain prior to birth, e.g. incomplete closure of the neural tube which results in anencephaly and the condition where the size of the person’s head is significantly affected (hydrocephaly or microcephaly)
• Environmental Influences – This can include maternal malnutrition, the effects of drugs or alcohol, and some maternal diseases.

Perinatal causes – Below are some perinatal causes of intellectual impairment:

• Intrauterine Disorders – These are conditions within the uterus such as toxaemia, complications of labour or multiple births
• Neonatal Disorders – These conditions arise from trauma or damage to the newborn brought about by things such as abnormal bleeding, respiratory problems and infections.

Postnatal causes – Intellectual impairments can also occur after birth, e.g in early childhood due to diseases and/or environmental factors. Below are some postnatal causes of intellectual impairment:

• Infections – These include encephalitis, and meningitis
• Demyelinating Disorders
• Degenerative Disorders – These affect intellectual and often physical functions over a period of time
• Seizure Disorders
• Toxic-Metabolic Disorders
• Accidents resulting in oxygen deprivation e.g., near drowning
• Head injuries
• Malnutrition – This is the inadequate dietary intake of essential nutrition
• Environmental Deprivation – This includes disabilities due to psycho-social disadvantage such as poverty, child abuse, neglect and social deprivation

Human Immunodeficiency Virus (HIV) is a virus which harms the immune system by destroying the white blood cells that fight infection. Acquired Immune Deficiency Syndrome (AIDS) occurs when the immune system has been permanently damaged by HIV and is no longer effective at protecting the body.

HIV and AIDS are not the same. HIV is the virus that leads to AIDS. Not everyone who has HIV will develop AIDS.

In the early 1980’s, when the HIV/AIDS epidemic began, patients rarely lived longer than a few years. But today, there are many effective medicines to fight the infection, and people with HIV have longer, healthier lives.

These medicines help people with HIV, but they are not perfect. They do not cure HIV/AIDS. People with HIV infection still have the virus in their bodies.

• Relate to the person with HIV/AIDS as you would any other person. Don’t show reluctance to handle the person’s papers
• Recognise that the person may be dealing with a lot of personal and social and endeavour to make interactions with Centrelink as positive and painless as possible
• Provide information about appointing a nominee or authorised person, if appropriate
• Be sensitive to any privacy concerns. Respecting the privacy and confidentiality of the information they are handling. The HIV status must not be disclosed to employers, employment service providers or anyone else
• Sensitive medical conditions such as HIV/AIDS should not be recorded on a DOC

Neurological conditions affect the brain, spinal cord, and the nerves that connect them. There are more than 600 diseases of the nervous system.

Brain tumours and brain cancer

A brain tumour is a lump of abnormal cells growing in the brain. The brain controls all the parts of your body and its functions and produces your thoughts. Depending on where it is, a tumour in your brain can affect these functions.

People with brain tumours and brain cancer may experience:

• headaches — these are often the first symptom of a brain tumour
• seizures
• problems with balance and coordination
• weakness on one side or part of the body
• nausea and vomiting
• confusion
• disturbance
• vision loss
• impaired sense of smell or taste
• drowsiness and fatigue
• dizziness or loss of consciousness
• changes to their personality and how they behave, e.g. irritability
• changes to how they think
• endocrine dysfunction (hormone/gland changes)

Cerebral palsy

Cerebral palsy is the result of a brain injury. The injury can happen before, during or after birth. Cerebral palsy can affect movement, coordination, muscle tone and posture.

People with cerebral palsy may experience:

• being stiff or floppy
• having exaggerated reflexes
• muscle weakness
• lack of muscle coordination
• uncontrolled body movements
• problems with balance and coordination
• problems with swallowing, sucking or eating
• using one side of the body to reach for things
• delays in learning how to speak

People with cerebral palsy may also have other conditions such as:

• intellectual disability,
• epilepsy
• delayed growth
• spinal deformities,
• Tourette syndrome and
• trouble with seeing, hearing and speaking.

Dementia

Dementia is a condition that affects a person’s thinking, behaviour and ability to do everyday tasks. Dementia is not one specific disease, but a collection of symptoms of a long-term brain disorder such as Alzheimer’s disease or vascular dementia.

People with dementia may experience:

• loss of memory — at first for recent events, and later for events further back in their lives
• speech and language difficulties
• changes in personality
• poor judgement and lack of insight
• difficulties completing everyday tasks, or care for themselves
• loss of interest in things and activities they used to enjoy
• loss of sense of time and place
• irregular sleep hours

Epilepsy

Epilepsy is a long-term brain condition where a person has repeated seizures. These are episodes of disrupted electrical activity in the brain and can vary greatly depending on the part of the brain involved. Epilepsy is not one single condition. There are a range of different conditions that can cause seizures. Seizures usually last 1 to 3 minutes.

Seizures can cause symptoms such as:

• a loss of consciousness,
• unusual jerking movements (convulsions) as well as
• other unusual feelings, sensations and behaviours

Motor neurone disease (MND)

MND is a progressive disease that often starts slowly and gets worse over time. Symptoms usually start on one side of the body before spreading.

Usually, the first things people may experience are:

• weakness in their hands and grip
• slurred speech
• weakness in their legs, and a tendency to trip
• weakness of their shoulder, making lifting difficult
• cramps and muscles twitching

Multiple sclerosis (MS)

MS is a chronic illness that affects your central nervous system. Symptoms of MS depend on which part of your central nervous system is affected and how much damage has occurred. Symptoms vary widely from person to person and can also come and go. MS is unpredictable.

MS can cause problems with the body, such as:

• muscle cramps and stiffness
• weakness
• tremor (shaking)
• loss of coordination and balance
• trouble with talking and swallowing

Other common symptoms people experience may include:

• vision problems
• tiredness
• vertigo
• unusual sensations — such as pins and needles, nerve pain and sensitivity to heat
• bladder and bowel problems — such as incontinence, diarrhoea and constipation
• changes in memory, concentration or thinking
• depression and anxiety

Tourette syndrome / Tourette’s disorder

Tourette syndrome is a neurological disorder which causes a person to make involuntary and uncontrollable vocal sounds and/or movements. These are called tics.

At certain times, for example, when someone is under stress, the tics can become more severe, happen more often, or last longer. Or the type of tic may change.

One set of symptoms is known as motor tics. People with Tourette syndrome may experience:

• Jerking of the head
• Stretching of the neck
• Stamping of the feet

Some people may bite themselves or hurt themselves in other ways or find it necessary to repeatedly touch other people and things.

Another set of symptoms is known as vocal tics. People who experience vocal tics might:

• clear their throat
• cough
• sniff
• click their tongue
• grunt
• yelp
• bark or shout
• swear or repeat certain sounds or phrases

It is important staff understand these are visible symptoms of Tourette syndrome and are involuntary and uncontrollable.

An Acquired Brain Impairment (ABI) is an injury to the brain that has occurred sometimes after birth. Other terms that can be used for brain impairments include acquired cerebral insult.

The brain has two cerebral hemispheres – left and right. These are divided into lobes. Each lobe controls different functions.

• The Frontal lobe is located at the front of the brain and controls:
• planning and problem solving
• decision making and judgement
• learning from mistakes and adapting to new situations
• emotions, impulses
• expressive language and voluntary movement
• The Occipital lobe is located at the back of the brain. It receives visual information and interprets colours, shapes and distances.
• The Parietal lobe is towards the back of the brain and has the following functions:
• monitors body sensation and position
• controls reading, time recognition and recognition of faces, and
• judges what objects are
• The Temporal lobe is towards the side of the brain and controls:
• memory and learning
• emotions
• hearing and language, including the rhythm and pitch of speech

An ABI is not the same as an intellectual disability. People with an ABI usually retain their intellectual abilities but have cognitive problems such as difficulty controlling, coordinating and or communicating their thoughts, emotions or actions. Customers with an ABI can experience a significant recovery with appropriate treatment and rehabilitation.

• Traumatic Brain Injury Accidents such as a motor vehicle or sporting accident, gunshot wound, fall, assault or violent shaking
• Stroke or Cerebral Vascular Accident (CVA) – A stroke can cause brain damage when a blood vessel within the brain is ruptured or blocked, interrupting its blood supply. A stroke can occur in many places in the brain, however, it usually affects specific areas of the brain and other areas function normally
• Tumours – The effects of the tumour will depend on its size, type and its location within the brain. There are three main types of brain tumours:
• Malignant (primary) tumours – begin in the brain and progressively invade the surrounding area
• Malignant (secondary) tumours – spread from the cells of malignant tumours in other parts of the body
• Benign tumours – are usually slow growing and may cause symptoms due to pressure on the brain
• Infections – The brain has a protective barrier called the blood brain banner. This can be broken by bacteria or viruses, which can result in meningitis or encephalitis
• Poisoning – This is a physical damage to the brain as a result of substance misuse due to alcohol or drug related brain damage and can affect thinking, emotions, behaviour and movement
• Lack of oxygen – This can occur in the case of a drowning or heart attack, where the heart ceases to beat and the oxygen supply is affected. A lack of blood supply can cause brain damage. The longer the brain goes without a blood supply, the more severe the injury will be
• Epilepsy – Damage to the brain may cause scarring and this may affect the brain’s electrical activity, which can cause a fit or seizure

Recovery from an ABI will vary from person to person and the outcome is very difficult to predict. Recovery is usually rapid at first, with improvements occurring rapidly as swelling and bruising subsides. The most significant improvements usually occur within the first three to six months. After this, the recovery process slows.

There are generally three stages of recovery from an ABI:

• Acute stage – the period of intense treatment where the main priority is the survival and medical treatment of the person
• Rehabilitation stage – this involves intensive therapy aimed at the natural process of recovery which aims to reduce the long term effects of the disability. It focuses on regaining previous skills and overcoming ongoing problems. This stage may take between six to twelve months
• Community re-entry stage – this focuses on issues of everyday living and returning to previous activities such as work, study and leisure. This will help the person and their family to adapt to any long term effects of the injury. This stage of recovery may go for a long period of time

Post traumatic amnesia (PTA) is a state of acute confusion characterised by difficulty with perception, thinking, remembering, and concentration. PTA is the time between the injury and the recovery of continuous memory. The length of time of PTA may predict the severity and outcome of the brain injury. A general assessment is, a :

• PTA of less than 1 hour, is usually related to mild brain damage
• PTA of 1 to 24 hours, usually indicates moderate brain damage
• PTA greater than 24 hours, is commonly associated with severe brain damage

Each person affected by an ABI will have different types and degrees of impairment which may include:

• reduced overall ability to cope, resulting in distress and irritability
• difficulty with speed and co-ordination of actions and reactions
• concentration difficulties including being easily distracted, difficulty coping with more than one thing at a time, getting bored quickly, not being able to complete things they start and wandering off the topic of conversation
• taking longer to complete tasks or be unable to keep track of lengthy conversations and instructions
• finding it hard to remember new information and frequently losing things, forgetting appointments and what people say
• difficulty solving problems
• difficulty working out the steps involved in a task, organising thoughts or not considering the end result of their actions
• taking statements literally, having simplistic understanding of emotions and being resistant to change
• having difficulty finding the right words when explaining things, being unable to determine what information is important and being easily overloaded, and being unable to understand non-verbal cues or subtlety
• having slurred speech or difficulty understanding spoken messages
• personality changes, inappropriate or impulsive behaviour
• headaches and seizures

Blindness is the loss of normal or correct vision. A person may be classified as legally blind but may have some residual or remaining vision (low vision). The type and extend of the visual impairment will determine the amount of residual vision. A person may need assistance, such as the prescription of appropriate low vision optical resources, i.e, magnifiers and telescopes, and training in their use.

• Cataracts – This is a clouding of the lenses within the eyes, which is normally clear and transparent
• Diabetic retinopathy – This eye condition is directly related to diabetes mellitus and involves the retina and can include haemorrhage, swelling, detachment and growth of new blood vessels which leads to the progressive blurring of vision
• Glaucoma – This involves a rise in the level of pressure within the eye which leads to damage of the optic. This in turn can result in the loss of peripheral (side) vision and, unless detected early, can lead to blindness
• Cone dystrophy – This results in the damage or breakdown of cone cells in the macula (this is the small central spot on the retina responsible for detailed vision). This condition does not result in total blindness, as peripheral vision remains intact
• Retinitis pigmentosa – This is an inherited degenerative condition which affect the retina. It particularly affects the rods which are the receptors in the retina responsible for night vision and detecting movement in the peripheral vision
• Hemianopia – This is caused by a Cerebral Vascular Accident (CVA) which is more commonly known as a stroke. The condition can vary in severity and may be temporary or permanent

• When entering the presence of someone who is blind or has low vision, say who you are and let them know when entering or leaving their presence.
• When providing instructions or directions, do not give visual hand signals in the place of words
• When speaking, ensure you face the person and speak in a clear, normal voice and state clearly who you are
• You may need to describe seating to the person, such as whether the chair has arms and a back
• Do not leave the person sitting or standing on their own without explaining what is happening
• Verbalise thoughts and feeling that would usually be sent through non-verbal mannerisms and cues
• Ask the person if they require assistance or further explanation of a task. Do not assume what the person’s requirements are and remember to offer assistance at the end of the interview, as they may need assistance to leave the office
• Offer assistance in completing any forms. Many people who are visually impaired can sign their name, however they may need assistance in locating the appropriate place on the form to sign
• Explanations may have to be repeated to facilitate understanding of tasks. What type of assistance, if any, does the person require? Do not assume they need help and do not assist them without telling them what is about to happen
• It is vital for the sighted guide to talk to the vision impaired person about the surrounding environment and what movements are intended to get from point A to B. This assists in giving the person an appreciation of the situation and environment around them
• It is also highly recommended, when guiding the person, that you initially offer the back of your hand, thus indicating the location and position of your body. Most people who have low vision or are blind are taught to grip the arm above the elbow. This enables the person to walk at your side but just slightly behind you. In some instances the person may be more comfortable holding your shoulder instead; if you are uncomfortable with where the person is gripping you, let them know so they are able to select a more appropriate/comfortable location
• The person will walk half a step behind you. Ask if unsure of the speed
• When approaching an obstacle such as a narrow doorway or blockage, inform the person of what the difficulty is and provide specific details of how you will get around this

These are varying degrees of and different types of hearing loss and it can be complete or partial. The severity and the age of the person at the onset of hearing loss, can affect the person’s ability to hear and speak.

People who are not hearing impaired often use the term ‘deaf’. It is more appropriate to use the term deaf for people who are born deaf or became deaf prior to language acquisition and whose preferred method of communication is sign language.

People affected with speech disability are more likely to have mental illness, learning difficulties, behavioural disorders or may be socially isolated.

• Tinnitus- This is where the person hears a sound, a ringing, or a noise when no external noise is present. The noise can be intermittent or constant, mild or severe and may vary from a low roar to a high-pitched sound
• Noise induced hearing loss (Sensorineural hearing loss) This usually develops over a period of years, although it can occur more rapidly following exposure to a loud noise. A noise which is regular and of a continuing frequency or pitch level can result in this kind of hearing loss
• Meniere’s disease – A progressive disease of the inner ear in which the first symptom is usually vertigo (dizziness). Over time tinnitus and hearing loss can develop.
• Presbycusis – a progressive, high frequency hearing loss that is associated with increasing age. It can be complicated not only by a decrease of the nerve cells in the inner ear available for transmission of auditory signals, but also the additional loss of hearing receptors in the brain in which results in poorer speech discrimination than might be expected from the degree of hearing loss
• Outer/middle ear infections – This may be cause by the build-up of wax in the outer ear cancel, which can lead to a reduction in hearing acuity. Medical treatment to remove the wax is usually all that is required. Middle ear infections can lead to permanent damage if not treated. These are common in young children. Chronic ear infection may result in ‘glue ear’, which affects the ability of the tiny bones of the middle ear to transmit sound to the inner ear.

The age of onset of hearing loss has significant implications for a person. A hearing loss is described as either:

• Prelingual (no exposure to oral language). Prelingual deafness or hearing loss may be present before birth or before language is developed, or
• Acquired (some exposure to oral language) hearing loss, depending on the age of the person at onset

Hearing loss can also be acquired post lingually (after language has developed), however, the important difference between prelingual deafness and an acquired hearing loss is that the person has had exposure to the spoken language and, therefore, has had an opportunity to develop an appreciation of the sound and structure of language.

A person may also have a:

• Hearing aid – a device that is used to improve hearing that a person wears in or behind the ear. The type of hearing aid a person has will be dependent on their lifestyle and situation, or
• Cochlear implant – an implanted electronic hearing device. It works by electronically stimulating the nerves inside the inner ear. This is different to a hearing aid.

• Lip reading and speech reading – Lip reading is a skill of understanding speech by interpreting the shape of the lips and the visual movements of the muscles involved in speech production. Speech reading is the ability to understand the intent of a speaker by watching the movements of the face and body by using information and language used by the situation
• Manual communication – Refers to communication which is achieved by the use of the hands rather than verbal communication
• Finger spelling – This should not be confused with sign language. In finger spelling, signs represent letters of the alphabet. The person writes in the air using their finger, spelling words out letter by letter. In Australia finger spelling is used more extensively by older members of the community
• Mime – This is a way using gestures and bodily movement, without speech or sound, to act out something
• Gesture – This is movement of the body and especially the hands and arms which express an idea, emotion or attitude
• Signs – This is the most commonly series of movements used by people who are deaf
• Sign language – The native sign language of Australia is Auslan. In order to increase the person’s exposure to English, various methods have been devised for sign language. Some people will use just the 26 hand configurations to represent the letters of the alphabet while others use a combination of signs and finger spelling
• Writing - This is a common form of communication that can be used either via a device or pen and paper
• Internet – If the person has access to the internet, they may prefer to conduct their business via this option
• Assistive Technology – There is a range of assistive technologies available to assist customers with hearing loss to hear the telephone, television or doorbell
• Hearing Augmentation Devices - (also known as Hearing Loop, and Audio Loop technology), some form of these devices are available in all Services Australia service centres for customers or staff that have compatible hearing aids to assist with face to face communication. Some sites have a permanent hearing loop system and other have portable sound shuttles. See supplied office instruction for appropriate set up and use
• Teletypewriter communication (TTY) – These messages are sent via phone lines. The person who is deaf or has a hearing loss types their message via a keyboard and these messages are then decoded by a TTY at the other end of the phone line and displayed as a written message. When communicating with someone via the TTY make sure that the language is simple and a message is short. See the Resources page
• National Relay Service (NRS) – If a person wants to contact someone who does not have a TTY, they can do so by using the NRS. This is an Australian wide phone and internet service to allow access to the telecommunications system for people who are deaf, or have a hearing and speech impairment
• Hearing Services Program - provides information about the Australian Government Hearing Services Program (Department of Health and Aged Care)
• Interpreter - see Interpreter Services for customers who are deaf or hard of hearing

Many medical conditions or disabilities can affect children. They can be categorised into physical or learning disabilities and illnesses, which may include Cerebral Palsy, Down Syndrome and cancer.

Some common medical conditions that a child may have include:

• Cerebral Palsy
• Autism
• Attention Deficit Hyperactivity Disorder (ADHD)
• Asthma
• Acute illnesses such as cancer, leukaemia
• Psychiatric illnesses
• Genetic and/or chromosomal disorders including Down Syndrome
• Hearing or visual impairment
• Haemophilia
• Fetal Alcohol Spectrum Disorder (FASD)

Many medical conditions or disabilities can be more common with customers who are aged. They can be categorised into physical disabilities, cognitive impairments and illnesses.

Common medical conditions that aged customers may have include:

• arthritis, rheumatism and osteoporosis, with associated pain
• digestive and urinary disorders
• visual and hearing impairments
• deaf, have hearing loss or, have a speech disability
• dementia and Alzheimer’s disease
• Parkinson’s disease
• Heart disease
• Diabetes (Type II)
• Respiratory disorders
• Urinary disorders
• Aged related skin changed such as skin thinning and a thinning of the fat layer under the skin

Common ailments that aged customers may report to a Service Officer include:

• joint pain
• reduced physical tolerance
• restricted mobility and dexterity
• Anxiety, fear and insecurity
• visual, hearing and speech impairment
• skin ulcerations, abrasions and temperature sensitivity
• shortness of breath
• short term memory loss
• confusion and disorientation
• incontinence
• involuntary shakiness or freezing of the legs (hesitation to move when beginning to walk or a sudden inability to move the feet) associated with Parkinson’s disease

It is important to be sensitive when dealing with aged customers or their carers when they are providing information about their medical conditions. When speaking to a customer:

• Be patient, respectful and courteous
• Seek permission before calling the customer by their first name
• Listen fully to what the person is saying before speaking
• Do not interrupt, explain information clearly and respectfully
• Read and offer to complete forms for the customer
• Reduce the customer’s waiting time as much as possible
• Ensure that comfortable, yet functional, seating is available
• Provide private interview facilities if requested