Risks in the arts for disabled people- expert paper

[Tzipporah Ben Avraham]

Index Number: 31043

TEACHING ART SAFELY TO THE DISABLED

By Michael McCann, Ph.D., C.I.H.

Overview-
Today, programs in the arts are reaching out more and more
to people with a variety of disabilities. As a result of Public
Law 94-142, the Education for All Handicapped Children Act of
1975, disabled children are to receive the least restrictive
education possible. One result of this law has been the
mainstreaming of disabled children into regular art classes. In
hospitals and other health care settings, patients with chronic
illnesses and disabilities are involved in the arts through
programs in art therapy, recreational therapy, and occupational
therapy. However, exposure to art materials or processes, or
placement in situations that exceed an individual's physical
limitations, may sometimes place a disabled individual at high
risk for further illness or injury. Some examples of such high
risk situations are:

* people with hearing impairments in noisy environments such as woodshops
* people with epilepsy exposed to organic solvents such as
turpentine, lacquer thinners, and paint thinners
* retarded individuals with difficulty in reading and following
directions, and in understanding warning labels
* emotionally disturbed individuals who have a tendency to
"sniff" hazardous solvents
* orthopedically or neurologically impaired individuals
experiencing difficulty in operating hazardous machinery
* someone with hepatitis exposed to organic solvents
* asthmatics exposed to dusts, molds, spray mists, etc.
* people taking medications exposed to solvents

This data sheet is intended for school districts,
administrators of arts programs in hospitals, community art
centers and other art settings, and of course art teachers. It
will discuss the various types of disabilities and the situations
in which disabled individuals might find themselves at especially
high risk for further injury or illness. The problems of
disabled students in elementary and secondary schools will be
emphasized and recommendations will be made for the safe
placement of these disabled individuals in art and special
education classrooms. Much of the information in this data
sheet is also applicable to disabled adults in art classes and
art therapy, and to artists who have become ill or temporarily
injured, or are disabled, and are continuing to create artwork.

The information found in this data sheet is intended to help
prevent injuries or illnesses in disabled individuals. In
addition it could help prevent lawsuits from disabled students
who have been injured in art class.

Because little research has been done on this topic, which
is of growing concern to many people, this data sheet lists only
some of the potential special risks that disabled individuals
might face in the arts.

Types of Hazards in the Arts

In order to understand the extra risks faced by disabled
students and artists, it is necessary to first discuss what types
of hazards are normally found in the arts, and then see how
particular disabilities might put an ill or disabled person at a
significantly higher risk than a healthy individual. The
following is a brief overview of the various types of hazards
found in the arts.

Chemical Hazards

Organic solvents (e.g. lacquer thinners, paint thinners,
turpentine), lead, cadmium, asbestos, silica and a large number
of other chemicals found in art and craft materials, can cause
immediate (acute) or long-term (chronic) illnesses in anyone
overexposed to these materials. Depending on the chemical, such
effects can occur through skin contact and absorption, inhalation
or ingestion. The type of illness will depend on the chemical,
but skin, lungs, nervous system, liver, kidneys and the
reproductive system are some common target organs of chemical
attack. See the bibliography for further reading.

Physical Hazards

There are a number of physical agents used in the arts that
can cause injury or illness. These include noise, infrared and
ultraviolet radiation, vibration, and heat stress.

Prolonged exposure to steady noise or even short exposure to
very intense noise can cause noise-induced hearing loss. For
example, studies have shown that woodshop teachers can develop
noise-induced hearing loss after several years of exposure to
noisy wood-working machinery.

Direct exposure to infrared radiation can cause cataracts
and cases of infrared-induced cataracts have been found in
glassblowers, potters and enamelists. Ultraviolet radiation
exposure, for example from arc welding, can cause damage to the
cornea, conjunctivitis, and skin cancer. Other problems caused
by physical agents include circulation problems from pneumatic
and other vibrating tools, heat-induced diseases (e.g.heat
stroke) from excess heat, and eye strain from improper lighting.

Safety Hazards

Safety hazards can include accidents from working with
tools and powered machinery, electric shock from electrical
equipment, burns from hot surfaces and equipment, falls and
sprains. A less familiar category of safety hazards is injuries
to the musculoskeletal and neuromuscular systems due to
repetitive motions. Examples include carpal tunnel syndrome and
tendonitis in potters.

Biological Hazards

Microorganisms such as viruses, bacteria, fungus, molds, and
mildew can cause a wide variety of infections and allergies.
Examples of such problems in the arts include mold-contaminated
clay or diluted acrylic paints, bacterial contaminated stage
make-up, and anthrax-infected imported wool or hair. If
sufficient amounts of these biological agents are inhaled,
ingested, or absorbed through cuts in the skin, then infections
or allergies can result.

High Risk Situations for the Disabled

Mentally Retarded

Mentally retarded individuals in general have difficulty
functioning socially, and in dealing with abstract ideas. They
learn concepts in short units, have short attention spans, are
easily distracted, often have difficulty with motor control and
coordination, and require careful organization of teaching
concepts. Educable mentally retarded children and adults tend to
have these problems to a lesser degree and could be mainstreamed
into regular classrooms.

Mentally retarded individuals would be at high risk for
injury from powered machinery and sharp tools because of their
short attention spans, poor motor control and coordination, and
difficulty in learning about these hazards and proper
precautions. They would also be at high risk from exposure to
toxic chemicals due to difficulty in understanding the nature of
chemical hazards and in carrying out precautions on a consistent
basis. In particular inadvertent hand-to-mouth contact is common
and could result in the ingestion of art materials. Chemicals
such as lead, mercury, and manganese which affect the brain might
be particularly harmful.

A higher number of institutionalized mentally retarded
individuals are known to be Hepatitis B carriers. Certain common
art materials in wet form such as wet clay and tempera paints
could conceivably help transmit the hepatitis virus ( and
possibly other infective agents) from infected children to other
children through contamination of the art materials with saliva
or other body fluids.

Recommendations

1. Use only non-toxic children's art materials with mentally
retarded students. (See later discussion of non-toxic under
PLANNING SAFE ARTS PROGRAMS FOR THE DISABLED
2.Do not allow these students to use tools or machinery which
could cause cuts, burns or more serious injury unless individual
evaluations indicate that the disabled students can understand
the hazard and they are closely supervised.
3. Any mentally retarded students with hepatitis or other
contagious diseases should have their planned activities
evaluated to ensure that they could not transmit the disease to
other students through contact with wet art materials.
4. If a disabled student is on medication, make sure that the
medications will not affect any physical activities being
planned. (See later section on Medications

Neurologically Impaired

Neurological impairments can involve either the central
nervous system (brain and spinal cord) or the peripheral nervous
system (nerves of hands, arms, feet, legs).

Central nervous system impairments in children can include
cerebral palsy, head trauma, hydrocephalus, spina bifida, brain
tumors, and epilepsy (seizure disorders). Central nervous system
impairment in adults can also include stroke, multiple sclerosis,
Parkinson's Disease, and Alzheimer's disease. Spasticity, loss
of motor control and balance, fatigue, weakness and paralysis are
common symptoms of central nervous system impairment.

Diseases causing peripheral nervous system impairments in
children include Guillian-Barre Syndrome, diabetes, birth defects
and trauma. For adults, alcoholism, diabetes, kidney disease,
polio, and chemical neuropathies from lead and hexane are
examples of additional diseases affecting the peripheral nervous
system. Common symptoms of peripheral nervous system damage
include weakness, paralysis, pain, numbness, loss of reflexes,
and loss of fine control.

Neurological impairments can cause the following problems:
1) motor, affecting muscular activity such as decreased
muscular power and endurance, and/or spasticity); 2) sensory,
affecting temperature, pressure and pinprick sensations; 3)
coordination, including hand-eye problems and a disturbed
position sense; 4) balance; and 5) behavioral, including
hyperactivity, judgement, alertness, emotional swings, and short
attention span.

Individuals with motor, coordination or balance problems
may be at higher risk operating hazardous machinery, using hand
or power tools, welding, etc. People with sensory impairments
involving the sense of touch can be at very high risk for severe
injury since they often are not aware of heat, sharp edges and
points, or dangerous pressure. Visual and hearing impairments
are discussed separately in later sections. Individuals with
severe, neurologically-caused behavior problems could be a threat
to themselves or others in some situations involving hazardous
machinery or toxic art materials. In addition, some epileptics
can be sensitive to the flicker rate on computer video display
terminals.
A
AChemicals that can affect the nervous system - including
organic solvents, lead, manganese, and mercury - may be
especially hazardous to individuals who already have neurological
impairment. Further damage to an already damaged nervous system
could be very serious.

Recommendations
1. Avoid exposure to organic solvents and other neurotoxins
either by not using these chemicals or by using them only with
adequate local exhaust ventilation such as a laboratory hood.
2. Make sure that students with severe motor problems do not work
with machinery or tools which could result in a physical
accident. Older students or adults might be able to participateT
h) T in many such activities if some of the more hazardous operations
are conducted by a volunteer (student or other) under the
direction of the disabled individual.
3. Students with deficits in sense of touch should have their
activities closely monitored to ensure they are not in situations
where they could get severe burns from hot equipment, or cuts
from sharp tools or irregular surfaces. In some cases of severe
sensory impairments, restriction of activities might be
necessary.
4. Students with muscular weakness or decreased endurance should
be supervised to ensure that their physical limitations are not
exceeded in situations where injury might result (e.g. lift,ing or
manipulating heavy objects, repetitive movements).
5. Schedule activities so as not to overtire people whose
disability involves rapid onset of fatigue.
6. See recommendations under C CEmotionally DisturbedD D for students
with severe behavioral problems.
7. Students on medications should have the medications evaluated
to ensure that the medications will not put them at high risk
during art activities (e.g. operating machinery or using art
materials). See recommendations under C CMedicationsD D.

C CLearning DisabledD D
A
ALearning disabled individuals exhibit difficulties of
perceptual origin in one or more areas of listening, reading,
speaking, writing, thinking, spelling and arithmetic. The cause
of these perceptual problems is not primarily due to sensory
disorders, motor handicaps, mental retardation, emotional
disturbance or environmental disadvantage. The learning disabled
may have visual and/or audio perceptual problems which interfere
with internal brain communication. The brain has difficulty in
correctly perceiving, assimilating and coordinating external
information, and in translating this information into action. As
a result they are often poorly coordinated. Their symptoms can
be similar to perceptual difficulties found in neurologically
impaired individuals.
A
AThe major problem that could occur with learning disabled
students might be difficulty in correctly understanding verbal or
written directions. Such difficulties could result in safety
problems.

Recommendations
1. Learning disabled students should be closely supervised if
there is question about their understanding instructions.
Sometimes alterna,tive methods of communication, such as writing
or illustrations if the problem is verbal comprehension, can be
of use. Repeating instructions in different ways can also help.

C COrthopedically ImpairedD D
A
AOrthopedic impairments are physical disabilit,ies involving
interference with mobility. People with orthopaedic impairments
often require assistive devices such as braces, splints,T
h) T crutches, walkers, and wheelchairs. In children orthopedic
impairments can be due to trauma (usually involving temporary
disability), Duchennes muscular dystrophy, birth defects (e.g.
drug-induced limb malformations), juvenile rheumatoid arthritis,
cerebral palsy and spina bifida. A + - AIn adults, arthritis and
amputations are also of concern. In addition many people with
neurological impairments, such as multiple sclerosis, cerebral
palsy and other progressive diseases, also may be effectively
orthopedically impaired.
A
AThe major problems that could occur are due to poor motor
control, lack of coordination, and balance difficulties. The
major risks faced by orthopedically impaired students or
individuals include difficulty in operating machinery or using
tools safely, falls due to balance problems, or spills when
working with art materials. Accessibility problems, such as
difficulty in reaching machinery or stored art materials might
also create a hazardous situation for students with mobility
impair,ments. Medications might affect the perceptions of an
orthopedically impaired child or adult.

Recommendations
1. All rooms, machinery, tools, and art materials should be
readily accessible to disabled students, including those in
wheel,chairs. This might require specially built chairs or work
surfaces to put work areas within reach. In many instances this
might eliminate direct use of fixed machinery which is not easily
accessible. The use of student volunteers or other aides to
carry out some of these operations could allow the disabled
student to participate in such activities.
2. Hazardous machinery or tools should be evaluated to determine
whether a disabled student with motor problems can safely operate
or use the machine or tool. Proper machine guards and close
supervision might eliminate this hazard. There are also a wide
variety of specially adapted equipment and ways of modifying
equipment for the use of orthopedically impaired students.
3. Students with muscle weakness might need assistance and close
supervision with lifting or other forms of physical exertion.
4. Chances of spills of art materials can be minimized by not
using glass containers, having materials easily accessible, using
self-closing containers, adaptive devices, etc.
5. Students or artists that use their feet or mouths for
manipulating materials should take particular care to ensure that
they are minimizing the possibility of accidental ingestion or
skin contact with hazardous materials.

C CHearing ImpairedD D
A
AHearing impairment can cover a wide range of hearing loss.
Contrary to common belief, most hearing-impaired people are not
completely deaf and can hear with or without the help of hearing
aids, although often with difficulty. A 1 p 2 AMost people with hearing
loss use lip reading to augment their residual hearing; few
hearing-im,paired people rely on sign language. As a result,T
h) T anything that interferes with that residual hearing, or destroys
it, could be disastrous to a hearing-impaired person.
A
AAs discussed previously, excessive noise can cause hearing
loss. People with an already existing hearing impairment could
be at very high risk for further hearing loss if they are exposed
to noisy situations, even at noise levels which would not affect
most people. A 8 AThe elderly could also be at higher risk from
noisy situations since we all experience a steady loss of hearing
with age.
A
AOne myth has been that it is acceptable to expose "deaf"
people to noise because their hearing cannot be further damaged.
However, since most hearing impaired people are not totally deaf
and still have some residual hearing which can be crucial to
their understand,ing speech, exposure to high noise levels could
be disastrous. In addition, many experts believe that it is not
acceptable to expose hearing impaired people to excessive noise
even if further damage to the nerve cells will not further affect
their ability to hear. In the future, new methods of restoring
hearing may be developed which will require the nerve cells to be
undamaged so that noise vibrations may be converted into nerve
impulses.
A
AThe ability to hear audible warning signals is another area
where hearing impaired individu,als are at higher risk. In many
situations, for example in woodshops, art foundries, and on
theater stages, the ability to hear warnings is crucial to
safety.

Recommendations
1. All hearing-impaired students or artists should be examined by
an otologist to determine whether they would be at high risk for
further hearing loss from noise. If so, they still may be able
to work in noisy environments if, at the otologist's
recommendation, they wear appropriate hearing protectors (ear
plugs, ear muffs, helmets). Note that, contrary to common
opinion, turning down the volume of a hearing aid or turning it
off may not protect hearing. Aids with vented ear pieces or ear
molds which do not fit tightly can transmit substantial amounts
of noise.
2. Use of visual warning signals or close supervision can alert
hearing-impaired students who cannot hear auditory warning
signals. This could also be important for a hearing-impaired
student wearing hearing protectors.
3. It is important that warnings about the hazards of art
techniques and suitable precau,tions be clearly communicated to
hearing-impaired students. Clearly displayed signs and written
materials can be one way of ensuring this.

C CVisually ImpairedD D
A
ALike hearing impairment, visual impairment can cover a wide
range of disability. Someone is legally blind if his or her
visual acuity with correction is 20/200 or poorer in the better
eye and requires use of Braille. However most visually impaired
people do not use Braille and have varying degrees of vision.
A
ASince any further damage to the eyes could be disastrous,T
h) T visually-impaired people would be at higher risk from chemical
splashes in the eyes, flying particles, and from direct exposure
to infrared and ultraviolet radiation. Further, if the visual
impairment requires them to work closely with materials, they
might be at greater risk of inhaling gases, solvent vapors and
other airborne materials. Some chemicals, for example methyl
alcohol, can cause eye damage through skin absorption or
inhalation.
A
ASome of the types of visual problems that could result in
safety problems in the arts include limited range of eye motion,
reduction in peripheral vision, difficulty in focusing for long
periods, and dizziness. These could result in not noticing
hazardous situations, leading to possible accidents.
A
A

Recommendations
1. Students with visual impairments that may interfere with their
noticing hazardous situations should be warned about the
situations and closely supervised. Teaming with another student
can also be helpful. In some instances it might be decided that
participation in a particular activity might be too hazardous for
a visually impaired person.
2. Visually impaired students should always wear appropriate
protective goggles in any situation where there is the risk of
chemical splash, flying particles or radiation. (This should
also apply to other students). Goggles can be made with
prescription lenses.
3. Proper local exhaust ventilation, gloves or restriction of
materials would be crucial to a student who needs to work at
close eye range with his materials in order to see adequately.

C CEmotionally DisturbedD D
A
AEmotionally disturbed individuals are those whose behavior
pattern results in an inability to interact with other people in
an effective way and whose emotional response to a situation is
inappropriate in degree and quality. Emotion,ally disturbed
students includes those with a wide variety of mental illnesses,
and those whose behavior can be antisocial and involve rejection
of rules and regulations. Although students with serious mental
illness would not be expected to be in a standard art class, they
are in special education classes.
A
AIn an art class, emotionally disturbed students can be a
potential danger to themselves and others. The possibility of
violent behavior with certain emotionally disturbed students
would be a serious problem around dangerous machinery, tools, and
hazardous chemicals. In addition self-destructive behavior would
be a problem.
A
AOne major area of concern is the potential for inhalant
abuse or "glue sniffing" as it is commonly called. It has been
well documented that, in order to get "high", emotionally
disturbed adolescents in particular will deliberately inhale
solvents found in paint thinner, gasoline, spray paints, and
solvent-con,taining glues. This can result in addiction. Several
cases of fatalities have been documented from the inhaling ofT
h) T Liquid Paper correction fluid, which contains the solvent
1,1,1-tri,chloroethane. Nerve and brain damage have occurred from
inhaling the solvents toluene (toluol) and hexane found in many
adhesives and rubber cements.
A
ASince many emotionally-disturbed students are on various
types of medications, there is also concern about possible
interactions between the medications and chemicals being used in
art. See the section on C CMedicationsD D.

Recommendations
1. An individual psychological evaluation of emotionally
disturbed students should be made before placing them in classes
where hazardous machinery or tools are being used, or where
hazardous chemicals or processes are involved.
2. Careful supervision of emotionally disturbed individuals is
essential in all cases where there is a potential for harm to
themselves or to others.
3. Emotionally disturbed individuals taking tranquilizers and
similar medications should not be exposed to organic solvents.

C CMultiply HandicappedD D
A
AMany individuals have disabilities in one or more of the
areas discussed. In these cases, restrictions applying to each
type of disability would apply since they could have multiple
susceptibilities. For example, cerebral palsy can involve motor
and sensory deficits, balance problems, visual impairments, and
emotional difficulties, all of which can involve special risks in
the art classroom.

C COther Health ImpairmentsD D
A
AIn addition to the various types of disabilit,ies already
discussed, a variety of other temporary or permanent health
problems can occur which could put students with these health
problems at high risk in a variety of art classroooms. In
general, if a body organ is damaged through illness or injury,
then further damage to that organ could be very serious since it
has already lost a major portion of its function. This was
discussed earlier in terms of noise exposure for hearing impaired
persons. In other instances, exposure to chemicals affecting a
particular organ could interfere with proper healing of that
organ.
A
AThe following section will discuss some examples.

C C1. Allergies:D D People with significant allergies are more
susceptible to developing additional allergies to many chemicals
used in art. Many people with asthma in particular tend to be
very sensitive to molds, dusts, spray mists, and other airborne
contaminants. Many asthmatics are very sensitive to sulfur
dioxide given off from pottery kilns from firing of clay, and
from fixing baths in photography.
A
ARecommendations include careful wet mopping to reduce dust
levels, and sometimes avoidance of the situation causing the
asthmatic reaction. Dust masks can help in some situations,T
h) T although the extra strain on the respiratory system from wearing
a respirator can sometimes precipitate an asthma attack.

C C2. Heart and Circulation Problems:D D In children, heart problems
are most frequently caused by congenital defects, heart
transplants, infec,tions, and rheumatic heart disease. In adults,
arteriosclerosis, congestive heart disease, and diabetes (which
can affect the circulatory system) are the major concerns.
A
ASmokers and people with heart problems should avoid exposure
to chemicals such as methylene chloride (found in many paint
strippers and aerosol spray products) which can affect the
heart. In addition very high concentrations of some solvents
such as freons, toluene and some chlorinated hydrocarbons can
cause heart arrhythmias. People with heart problems should also
avoid high heat situations such as foundries, gas-fired kiln
rooms, and glassblowing since the cardiovascular system is very
susceptible to heat stress. High activity levels can also
involve extra risk for people with heart problems, as can some
heart medica,tions.
A
APeople with anemia should be especially careful to avoid
exposure to substances such as lead and the cellosolves (glycol
ethers) since they can cause anemia and aggravate an already
existing anemic condition.

C C3. Respiratory System Problems:D D In children common causes of
respiratory problems include severe scoliosis and cystic
fibrosis. In adults, acute or chronic bronchitis and emphysema
are common types of respiratory problems. The lungs in general
are very susceptible to irritating chemicals, and having an
existing respiratory problem can make a person even more
susceptible to chemical irritants. People with colds, for
example, often find it difficult to get rid of the cold if they
are being exposed at the same time to chemicals which are
continually irritating the throat and lungs.

C C4. Liver and Kidney Problems:D D The liver and kidneys are
sensitive to many chemicals, especially organic solvents and
heavy metals. If these organs are damaged, for example the
kidneys by diabetes or the liver by alcohol, then they are even
more susceptible to further damage. For example, people with
viral hepatitis are usually told by their physicians to avoid
drinking alcoholic beverages until their liver heals because the
alcohol could cause more damage to the already injured liver.
They should also generally avoid exposure to organic solvents
since many solvents are more toxic than ethyl alcohol to the
liver, even by inhalation.
A
ALike the heart, the kidneys are very sensitive to heat.
Therefore people with kidney problems should avoid heat stress in
order to prevent further damage.

C C4. Immune System Problems:D D Diseases affecting the immune system
can be classified either as immunodeficiency, caused by the AIDS
virus, many anti-cancer drugs, or anti-rejection drugs used in
organ transplants; or as autoimmune diseases, where the immuneT
h)
T system attacks the body's own tissues and organs, for example
rheumatic diseases, myasthenia gravis, and lupus. People with
immunodeficiency are very susceptible to infections and
potentially to chemicals such as glycol ethers which affect the
bone marrow.

C C5. The Elderly:D D The elderly can be considered a high risk group
in general because they tend to have increased incidences of
lowered resistance to infections, visual impairments, hearing
impairments, chronic illnesses, susceptibility to heat, etc.
Earlier sections should be consulted where applicable. In
addition the elderly are often taking a variety of medications
which may contribute to increased susceptibility to chemical or
physical hazards.
A
AIn general, individual evaluations of any health problems an
elderly individual might have is necessary to determine possible
restrictions and other precautions needed for them to participate
safely in art programs.

C C6. Pregnancy:D D Although not a disease, pregnancy can involve high
risks from exposures to chemicals and other hazards. Birth
defects and miscarriages can result from exposure to many
chemicals, especially during the first trimest,er. Unfortunately
there has not been adequate research on the reproductive effects
of most chemicals.
A
AIn general pregnant women should avoid exposure to toxic
chemicals during pregnancy not because we know they are hazardous
but because we do not have evidence that they are safe or at what
levels they are safe. If proper ventilation and other
precautions are not adequate, then complete avoidance is
recommended. For further information and recommendations see
CSA's booklet C CReproductive Hazards in the Arts and Crafts.D D

C C7. Chemical Hypersensitivity:D D In recent years, chemical
hypersensitivi,ty has begun to be recognized as a disability. A
person with chemical hypersensitivity appears very sensitive to
even small amounts of most solvents, paints, perfumes and other
chemicals associated with art and everyday life. At present, we
do not know the causes of this illness.

C CMedicationsD D
A
AMany temporarily ill and disabled individuals are taking
both prescribed and over-the-counter medications, including
tranquilizers, anti-con,vulsant drugs, pain-killers, muscle
relaxants, antibiotics, antihistamines, and decongestants. Many
of these medications, especially those affecting the central
nervous system, may put a disabled child or adult at high risk
for exacerbation of an existing condition or cause other health
effects. This can result from physical side effects of the
medications, or from adverse interactions of the medications with
chemicals or physical agents used in art.
A
AThe following are some specific examples of problems with
medications and art materials and processes. This list is not
complete and anyone taking medication should consult his or herT
h) T physician about possible interactions of medications with
chemicals or effects on machinery operation.
1.A AAny medication affecting the central nervous system can have
side effects such as drowsiness, loss of coordination, and
increased reaction time which could interfere with safe use of
machinery and tools, and cause injuries in physical exertions.
In addition pain medications may mask important warning signals
like pain and fatigue. Table 1 lists types of medications which
are known to affect the central nervous system.
2. Medications acting on the central nervous system can interact
with chemicals that also affect the central nervous system to
create more severe side effects. A classic example of such an
effect is the interaction of ethyl alcohol and barbiturates,
which can be potential,ly fatal. This is not unique to
barbiturates and there is a large body of medical literature
discussing the interaction of ethyl alcohol with medications.
A
AEthyl alcohol, however, is a mild central nervous system
depressant compared to most organic solvents, many of which are
found in art materials. These solvents can cause central nervous
system depression by inhalation and sometimes skin absorption, as
well as ingestion. The medications in Table 1 which affect the
central nervous system are known to interact with alcohol and
would be expected to cause adverse reactions in conjunction with
most organic solvents.
P PP P

C CTable 1 Medications Affecting the Central Nervous System D D

A
AGeneric names are used rather than brand names because of
the large number of different brand names for a particular
medication. In instances where several members of a class of
medications cause central nervous system effects, the generic
class name is used instead of listing individual medications.
This list is not complete and anyone taking medication should
check with his or her physician concerning possible interactions
with art materials.

Antianxiety drugs - See Sedatives
Anticonvulsants
A
A- hydantoins
A
A- succinimides
A
A- carbamazepine
Antidepressants
A
A- tricyclic
A
A- monamine oxidase inhibitors
Antihistamines
Antineoplastic agents
A
A- procarbazine
Antipsychotics
A
A- phenothiazines
A
A- thioxanthinesT
h) T A
A- butyrophenones
Antiarrhythmics (heart)
A
A- quinidine
A
A- lidocaine
Cough suppressants
A
A- codeine
A
A- diphenylhydramine
A
A- dextromethorphan
Hypnotics - See Sedatives
Muscle relaxants, skeletal
A
A- benzodiazepines
A
A- baclofen
A
A- dantrolene
A
A- orphenadrine
A
A- carisoprodol
A
A- chlorzoxazone
A
A- cyclobenzaprine
A
A- methocarbamol
Narcotics
A
A- codeine
A
A- meperidine
A
A- methadone
A
A- morphine
A
A- propoxyphene
Pain medications - see Narcotics
Sedatives
A
A- barbiturates
A
A- benzodiazepines
A
A- chloral derivatives
A
A- clomethiazole
A
A- ethchlorvynol
A
A- ethyl alcohol
A
A- meprobromate
- methaqualone
Tranquilizers - See Sedatives, Antipsychotics
P P
P P3. Some medications interact adversely with ethyl alcohol in
ways not related to central nervous system depression. These
medications include many drugs for hypertension, as well as
anticoagulants, beta-blockers, and antibiotics. These
medications might also interact with other alcohols such as
isopropyl and methyl alcohols. Table 2 lists some examples.

C CTable 2. Medications that interact with ethyl alcoholD D
P Pcephalosporins
chloramphenicol
disulfuram
erythromycin
griseofulvin
guanethidine
hypoglycemic agents, oral
insulin
methotrexateT
h)
T metronidazole
nitrates, organic
P P
P P4. Very high concentrations of several solvents including
1,1,1-trichloroethane, freons, toluene, and xylene can sensitize
the heart to epinephrine which is found in the body. This can
lead to heart arrhthymias and fatalities. If a person was taking
medications containing catecholamines (e.g. epinephrine,
norepinephrine, dopamine) or amphetamine derivatives (e.g.
amphetamine, ephedrine and phenylephrine), then these effects on
the heart might occur at much lower solvent concentratio,ns.
These solvents can be found in permanent markers, solvent-based
correction fluids, aerosol spray products and many other art
materials.
5. Some medications can interact with the ultraviolet component
of sunlight to cause photosensitization of the skin or eyes.
This interaction can also be caused by the ultraviolet radiation
in art processes such as arc welding and photoprintmaking. This
photosensitization can be either a toxic reaction (phototoxic) or
an allergic reaction (photoallergic). Reactions can include
rashes, swelling, redness, blistering, and hyperpigmentation of
the skin, and keratoconju,nctivitis or corneal and lens opacities
in the eyes. Table 3 lists medications which can cause these
photosensitization effects.

C CTable 3 Medications Causing PhotosensitivityD D
P Pcarbamezapine
coumarin derivatives
diphenhydramine
furocoumarins (psoralens)
glyceryl PABA (sunscreen component)
hydantoins
nalidixic acid
phenothiazines
salicylanilides, halogenated
sulphonamides (sulfas)
tetracyclines
P P
P PP P6. Other types of problems related to medications and ar
materials include interactions between monamine oxidase
inhibitors and amines (e.g. some epoxy resins); and between
lithium salts used in treatment of manic-depression and
lithium-containing pottery or enamel glazes.

Recommendations
1. Students should not be allowed to use potentially dangerous
machinery or tools if they are taking medications that affect the
central nervous system, causing symptoms such as drowsiness, loss
of coordination, dizziness, and slowed reaction times.
2. Students taking pain medications should be monitored to ensure
that the medication is not masking warning signals.
3. Any student taking medication that is known to interact withT
h) T the central nervous system should not be exposed to organic
solvents, unless the solvent is used in a local exhaust hood. For
example, oil painting, and use of permanent markers or rubber
cement in the open would be particularly hazardous.
4. Students taking medications which might interact with alcohol
or other chemicals or cause photosensitization should have their
art program evaluated to ensure that they will not be at excess
risk for injury or illness.
4. Students taking any medication should be closely monitored by
medical personnel to see if the chemicals found in art materials
might be causing an adverse interaction with the medication.

C CPlanning Safe Arts Programs for the DisabledD D
A
AIt is essential that administrative procedures be developed
for the safe placement in arts programs of disabled students,
hospital patients, the elderly or other high risk groups.
Failure to do so could result in a disabled student becoming ill
or injured, as well as incurring possible lawsuits.
A
AThere are several steps involved in developing such
administrative procedures. These stages are 1) organizing an
institutional review panel, 2) evaluating the disabled student,
3) evaluating the arts program, 4) evaluating the art classroom
and instituting recommendations, 5) teacher training and 6)
emergency procedures.

C CInstitutional Review PanelD D
A
ABefore any disabled student or other high risk individual is
placed in an arts class, he or she should be individually
evaluated by an institutional review panel to determine whether a
disability might restrict involvement in the proposed arts
class. This institutional review panel should include a
physician, preferably one with experience in rehabilitation
medicine, a special education expert, a physical/occupational
therapist, and institution officials. Additional assistance can
be obtained from industrial hygienists, physicians with
expertise in occupational medicine, and toxicologists. The
purpose of this review panel is to evaluate the medical problem
of the disabled student and develop a plan on how to safely
place the student in a particular arts class. This is similar to
the Individual Evaluation Plan already used by many school
districts in placing disabled students in standard classrooms.

C CEvaluation of the Disabled StudentD D
A
AThe first step is to determine what types of restrictions
might apply to the disabled student or other individual. The
medical history should be obtained through interviews with the
parents, physicians, therapists, previous teachers, and when
possible the student. In particular information should be
obtained about any unusual reactions to chemicals, about
medications the student is taking, or other situations that
might have a bearing on the safe placement of the student. A
clinical evaluation would also be advisable. Prospective
teachers should also participate in these deliberations sinceT
h) T they will have to implement recommendations.

C CEvaluation of the Arts Program
A
AD DAfter evaluation of the student's health status, the next
step is to determine what particular hazards might face a
disabled student in the proposed arts program.
1. For students under the age of 12, only non-toxic art materials
should be used because of the higher risk facing young children,
and because children under the age of 12 can not be expected to
carry out precautions necessary for working with toxic
chemicals. Unfortunately the term "non-toxic" only applies to
immediate hazards and cannot be relied upon for evaluating
long-term risks. As of 1987, six states have passed laws banning
toxic art supplies from elementary schools, and the California
Department of Health Services has published a list of non-toxic
children's art materials. This list is available from the Center
for Safety in the Arts. (See also the CSA data sheet
"Children's Art Supplies Can be Toxic".) These non-toxic
children's art materials can be used with mentally retarded
children and adults, as well as for other high risk individuals.
2. Disabled individuals over the age of 12 could work with
hazardous chemicals and art techniques if the evaluation panel
agrees that the risk is not severe and suitable precautions are
taken. In order to evaluate the risk, it is necessary to
determine the composition of the art materials that will be
used. Reading the label is usually not sufficient since most
labels do not list long-term or chronic hazards. Art materials
with the HL (Health Label) seal of the Arts and Crafts Materials
Institute do list the chronic hazards along with target organs of
the chemicals. Another important source of information on the
contents of art materials are Material Safety Data Sheets
(MSDSs). See the CSA publication on Material Safety Data Sheets
for further information on how to read and interpret MSDSs. The
ingredients listed on an MSDS should be investigated for
hazardous ingredients.
3. For disabled students at high risk for injury from powered
machinery, hand tools, etc., due to motor, sensory or other
impairments, the art program has to be evaluated to determine
where such hazards could exist.

C CEvaluation of the Art ClassroomD D
A
AOnce the potential high risk situations have been evaluated,
the next step is to see if the classroom can be made safe for the
disabled student. This can involve substitution of safer
materials or art forms, modification of the classroom environment
and tools, or in some cases not allowing the student to
participate in the art activity.
1. If the student is sensitive to organic solvents, the
classroom should be examined to see if there is suitable
ventilation to protect the disabled student. A window exhaust
fan providing dilution ventilation is usually not adequate in
such a situation even though the exhaust fan might be sufficient
for other students; in this case, local exhaust ventilationT
h) T (e.g. lab hood or slot exhaust hood) which captures the toxic
contaminants at their source would be required. Other
precautions including use of protective clothing, gloves, and
respirators might also be needed. If there is not adequate
ventilation then the proposed art activity might be changed or
the disabled student should not participate in that activity.
2. Where the safe use of machinery or hand tools is in question,
possible solutions include ensuring adequate machine guards,
modifying tools or equipment to suit the disabled individual,
having someone assist him or her in carrying out the more
dangerous steps, or finding alternative techniques for the
student to use.
3. Other modifications that might be necessary to make an art
classroom safe for orthopedically impaired students include
removing obstacles to free movement, avoiding overcrowding,
providing comfortable work heights (e.g. ensuring sinks and work
tables are at a usable height), and having accessible storage.
Many of the modifications might have to be improvised depending
upon a particular disabled student's needs.
4. Adequate supervisory assistance is essential for safe
placement of students in arts classes. Disabled students take
more of a teacher's time than do other students. Therefore it is
essential that the teacher be provided with additional trained
help to ensure that both the disabled student and other students
receive adequate attention.
5. The art classroom should have adequate emergency facilities
that are accessible to disabled students. This includes
accessible eyewash fountains, visual warning signals for hearing
impaired, adequate first aid equipment, and emergency telephones.

C CTeacher TrainingD D
A
AOne of the most important parts of placing a disabled
student in a particular classroom is ensuring that the teacher,
aide or volunteer is trained to deal with the particular
situation. Although special education teachers do receive
specific training in teaching disabled children, most art
teachers do not. This is a growing problem as more and more
disabled students are mainstreamed into regular classrooms.
There is a definite need for developing training workshops for
teachers who will be teaching disabled students. This training
can help ensure that the disabled students receive adequate care,
and that the school and teacher are protected from liability.
This type of training would also apply to teachers who are
teaching in non-school situations such as hospitals, community
arts centers, and homes for the elderly.

C CEmergency ProceduresD D
A
AAlthough emergency medical situations can arise with any
student, the problem is compounded with disabled students who can
have medical problems that require quick action. Examples
include an asthma attack, an epileptic seizure, violent behavior
on part of an emotionally disturbed student, falls, and
medication problems. It is crucial that procedures be developed
to inform teachers of the likelihood of any such situations withT
h) T disabled students and what to do about them.
A
AAlthough all schools have emergency procedures such as fire
escape routes and fire drills, most schools do not have plans for
the emergency egress of the disabled. Although this is most
apparent with people in wheelchairs or with other mobility
impairments, it would also be a problem with mentally retarded
students who might not be able to understand the emergency and
what to do, and with visually or hearing impaired students who
might not hear emergency signals or be able to follow an escape
route.
A
AEmergency plans should be developed that take the particular
problems of disabled students into account. This would mean
updating of such a plan regularly, depending upon what disabled
students are in the art classroooms. In some instances, the
emergency procedures can be fairly simple. A responsible student
(and backup) could be assigned to assist a blind or mentally
retarded student. Of course the teacher has to oversee to ensure
that those assisting students comprehend the importance of their
task. Visual warning signals can be used to alert hearing
impaired students.
A
AFor students with serious mobility impairments who are not
on ground floors - for example students in wheelchairs - the
problem is more complicated. Procedures that have been developed
for evacuation include having the disabled students wait for
assistance in special holding areas that have a high degree of
fire resistance, providing trained people to come and remove the
disabled student (abandoning the wheelchair if necessary), and
using specially adapted elevators. Your local fire department
might be of assistance in developing such emergency procedures
for your institution. The problem of the emergency evacuation of
the disabled is one that is of growing concern, and needs to have
a lot more attention addressed to it.

Bibliography

Gilman, Alfred Goodman, Louis Goodman, Theodore Rall, and Ferid
Murad (Eds.) Goodman and Gilman's The Pharmacological Basis of
Therapeutics 7th edition, MacMillan Publishing Company, New York
(1985).

Greenberg, Pearl. Visual Arts and Older People Charles C. Thomas,
Springfield, IL (1987).

Griffith, H. Winter Complete Guide to Prescription &
Non-Prescription Drugs HP Books, Tucson, AZ (1983).

Klaassen, Curtis, Mary Amdur and John Doull. Casarett and Doull's
Toxicology: The Basic Science of Poisons 3rd edition, MacMillan
Publishing Company, New York (1986).

McCann, Michael. Artist Beware: Hazards and Precautions in
Working with Art and Craft Materials Watson-Guptill, New York
(1979).

Rodriquez, Susan. The Special Artist's Handbook. Prentice-Hall,
Englewood Cliffs, NJ (1984).

Shectman, Angel E. (Ed.) Insights: Art in Special
Education Revised edition, Art Educators of New Jersey,
Millburn, NJ (1981).

Silverman, Harold. "Potential Effects of Medication at Work I, II
and III", Occupational Health and Safety p.48 (February 1981);
p. 33 (April 1981); p. 26 (June 1981).

For Further Information

Written and telephone inquiries about high risks in art for
the disabled will be answered by the Art Hazards Information
Center of the Center for Safety in the Arts (formerly Center for
Occupational Hazards). For permission to reprint this data
sheet, for a copy of our publications list, or for a sample copy
of our newsletter Art Hazards News, please write: Center for
Safety in the Arts, 5 Beekman Street, Suite 1030, New York, NY
10038. Telephone 212/227-6220.

This data sheet has been published with public funds from
the New York City Department of Cultural Affairs and with
assistance from Resources for Artists with Disabilities. We are
also partially supported with public funds from the National
Endowment for the Arts, and the New York State Council on the
Arts.

c copyright Center for Safety in the Arts, 1987.