Article

This is take two of an arti­cle I wrote a few weeks back (when I had a brain!). It’s a com­pan­ion piece to the one for col­lege stu­dents with FMS—an intro­duc­tion to FMS for educators.

I’d appre­ci­ate feed­back from any­one who has the time to read it. I don’t expect most of you will be inter­est­ed, though, as it’s pret­ty focused on one topic.

This is a very rare friends-locked post since I will be sub­mit­ting the arti­cle for pub­li­ca­tion. Please do not share the arti­cle with any­one else.

Fibromyal­gia: An Intro­duc­tion for Edu­ca­tors

If you’ve been giv­en this arti­cle, you prob­a­bly have a stu­dent in your class who suf­fers from fibromyal­gia. As this com­plex syn­drome is often mis­un­der­stood, this arti­cle will attempt to give you the infor­ma­tion you need and guide you to oth­er resources if you’re inter­est­ed in them.

Fibromyal­gia Syn­drome (FMS) is a debil­i­tat­ing neu­ro­log­i­cal dis­or­der char­ac­ter­ized by chron­ic wide­spread pain and fatigue. It affects approx­i­mate­ly 2% of the pop­u­la­tion and is more com­mon in women than in men. Cen­tral ner­vous sys­tem sen­si­ti­za­tion affects the entire body, lead­ing to many sec­ondary symp­toms. Those symp­toms will vary from one per­son to the next, but often include migraines, irri­ta­ble bowel/bladder syn­drome, nau­sea, mus­cle spasms/cramps, numbness/tingling, and impaired coordination.

The sever­i­ty of symp­toms will vary from day to day, or even by the time of day. Stress and qual­i­ty of sleep have a sig­nif­i­cant effect on the FMS patient.

FMS in the Class­room

In an aca­d­e­m­ic set­ting, the main issues that arise with FMS are flares, cog­ni­tive deficits, envi­ron­men­tal sen­si­tiv­i­ty, and an impaired immune system.

Flares are episodes dur­ing which the FMS patient expe­ri­ences increased symp­toms. Those symp­toms are usu­al­ly far more intense than nor­mal, and the patient may become bedrid­den. A stres­sor of some sort, such as an ill­ness or injury, trig­gers most flares. Oth­er fac­tors, like sea­son­al or hor­mon­al changes, may also pro­voke flares.

FMS patients expe­ri­ence vari­able cog­ni­tive deficits that include mem­o­ry loss, con­fu­sion, and slow pro­cess­ing. Dur­ing a flare, espe­cial­ly, most patients expe­ri­ence a phe­nom­e­non called “brain fog.” The stu­dent may have dif­fi­cul­ty con­cen­trat­ing or pay­ing atten­tion, be eas­i­ly con­fused, lose things, and require more time to com­plete assign­ments or tests. Hav­ing a qui­et envi­ron­ment away from the class­room in which to take tests may help matters.

Your stu­dent is espe­cial­ly sen­si­tive to just about every­thing in her envi­ron­ment-changes in the weath­er, tem­per­a­ture vari­a­tions, drafts, light­ing, odors, etc. It is impor­tant that your class­room envi­ron­ment be as sta­ble as pos­si­ble, and that aggra­vat­ing fac­tors such as flick­er­ing lights be reme­died. Insti­tut­ing a fra­grance-free, smoke-free build­ing pol­i­cy is wise. Be aware of loose cords and oth­er haz­ards that may cause falls, as the FMS patient may be unsteady on his feet. Don’t open win­dows in the class­room unless you’ve asked the stu­dent about poten­tial aller­gen problems.

Final­ly, most FMS patients have impaired immune sys­tems. Remind your stu­dents that if they have any kind of virus or oth­er con­ta­gions, they should not attend class. If they must attend, ask that they sit away from the oth­er stu­dents as much as possible.

Accom­mo­da­tions

The accom­mo­da­tions a par­tic­u­lar stu­dent needs will vary depend­ing on the sever­i­ty of her symp­toms and the spe­cif­ic sec­ondary symp­toms she expe­ri­ences. Sug­gest­ed accom­mo­da­tions that will help most stu­dents with FMS are list­ed here.

* Advance plan­ning. Give the stu­dent infor­ma­tion about assign­ments and dead­lines as ear­ly as pos­si­ble. Because she may expe­ri­ence a flare at any time, being able to work ahead of the sched­ule when­ev­er pos­si­ble can help her avoid falling behind the class. Be open to work­ing out a con­tin­gency plan in case the stu­dent does expe­ri­ence a major flare dur­ing the semester.
* Mem­o­ry aids. Pro­vide infor­ma­tion in writ­ing. Hand out copies of any over­heads or oth­er doc­u­ments used dur­ing class. Pub­lish­ing class mate­r­i­al on a web­site or sim­i­lar resource may help oth­er stu­dents as well as the FMS sufferer.
* Reduce dis­trac­tions and stress. Keep the door closed while class is in ses­sion. Ask that oth­er stu­dents refrain from mak­ing extra­ne­ous nois­es, such as drum­ming their fin­gers on their desks. Avoid out­bursts or oth­er loud noises.
* Breaks. The stu­dent may need to get up, move around, and stretch from time to time. She may need more fre­quent bath­room breaks than oth­er students.
* Seat­ing. The stu­dent may need to put her feet up or oth­er­wise adjust seat­ing in order to tol­er­ate it. Un-cush­ioned seat­ing may be intol­er­a­ble. Be flex­i­ble and understanding.
* Group projects. The stu­dent with FMS may have prob­lems in peer groups due to the need for accom­mo­da­tions and the unre­li­a­bil­i­ty of her health. Meet­ings and activ­i­ties out­side the class­room may present par­tic­u­lar dif­fi­cul­ties. If request­ed, allow the stu­dent to work inde­pen­dent­ly when­ev­er possible.
* Sta­mi­na. The stu­dent will have reduced sta­mi­na, and should not be expect­ed to par­tic­i­pate in activ­i­ties that last more than a cou­ple of hours. Col­lege lab cours­es, in par­tic­u­lar, may present endurance prob­lems. Work out a flex­i­ble sched­ule that respects the stu­den­t’s phys­i­cal lim­its while cov­er­ing the course mate­r­i­al. Per­mit the stu­dent to sit rather than stand.
* Coor­di­na­tion. Because the stu­dent may have impaired coor­di­na­tion, phys­i­cal activ­i­ties may present par­tic­u­lar prob­lems. Car­ry­ing out lab exper­i­ments, for instance, can be dicey when one’s hands shake or unex­pect­ed­ly refuse to grip objects. Have anoth­er stu­dent or an assis­tant work with the FMS suf­fer­er when necessary.
* Writ­ing alter­na­tives. Essay tests and oth­er sit­u­a­tions requir­ing any sig­nif­i­cant amount of writ­ing may be dif­fi­cult. If request­ed, allow the stu­dent to type mate­r­i­al rather than writ­ing it out. The stu­dent may need to use a recorder dur­ing lec­tures and should be offered the ser­vices of a note-taker. 

Vari­ables

Because fibromyal­gia is an invis­i­ble dis­abil­i­ty, it can be dif­fi­cult to remem­ber that the stu­dent is, in fact, impaired. The vari­able nature of FMS requires that its suf­fer­ers mon­i­tor them­selves care­ful­ly. The stu­dent may need a cane one day, but not the next. 

Lis­ten to the stu­dent. She knows her body and abil­i­ties bet­ter than any­one else. Respect her opin­ions, ask ques­tions when nec­es­sary, and be pre­pared to deal with ques­tions from oth­er stu­dents in a sen­si­tive fash­ion when necessary.

Each patien­t’s orig­i­nal abil­i­ties are unique, so her degree of impair­ment may not be imme­di­ate­ly evi­dent. A stu­dent who is high­ly intel­li­gent and ded­i­cat­ed, for instance, may not seem to have any cog­ni­tive deficits. If, how­ev­er, she states that she needs accom­mo­da­tions, they should be granted. 

Resources

The fol­low­ing sources will pro­vide more spe­cif­ic infor­ma­tion should you need it.
* The Fibromyal­gia Net­work, http://www.fmnetnews.com/, PO Box 31750, Tuc­son, AZ 85751, 800–853-2929
* The Nation­al Fibromyal­gia Asso­ci­a­tion, http://fmaware.org/, 2200 N. Glas­sell St., Suite A, Orange, Ca 92865, 714–921-0150
* The Job Accom­mo­da­tion Net­work, “Acco­mo­dat­ing Peo­ple With Fibromyal­gia,” http://www.jan.wvu.edu/media/Fibro.html

Copy­right © 2005, Cyn­thia L. Armis­tead, All Rights Reserved.