Chapter 17

1. Chapter 17 Children with Orthopedic and Neurological Impairments

2. Defining Orthopedic and Neurological Impairments • IDEA 2004 • Orthopedic impairment means a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by a congenital anomaly, impairments caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

3. Defining Orthopedic and Neurological Impairments • IDEA 2004 • Traumatic brain injury means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech.

4. Prevalence of Orthopedic and Neurological Impairments • 1976-1977 • 8.3 percent of public school children had a disability (IDEA) • 0.2 percent had an orthopedic impairment • 2005-2006 • 13.8 percent of public school children had a disability (IDEA) • 0.1 percent had an orthopedic impairment

5. Causes of Orthopedic and Neurological Impairments • Lack of oxygen to the brain during prenatal development or delivery • Disease and prolonged high fever • Poisoning • Chronic health problems • Automobile accidents

6. Bones, Muscles, and Nerves: The Vocabulary • Tendons: Attach muscles to bones • Ligaments: Attach bones to bones (joints) • Flexion: Bending a joint or joints • Extension: Straightening or stretching a joint • Muscle tone: Ability of muscles to respond to stretch • Hypertonic or spastic is muscle tone that is too high (tight) • Hypotonic is muscle tone that is too low (floppy) • Muscle strength: Force that a muscle exerts • Contracture: Shortening of muscle fibers, usually irreversible

7. Bones, Muscles, and Nerves: More Vocabulary • Spasticity: Inability of muscles to relax • Athetosis: Random, writhing, involuntary movements, especially of the hands • Ataxia: Irregular, uncoordinated muscular movement, especially walking • Range of motion: Amount of movement present around a joint • Midline: Imaginary line divides the body in half vertically • Abduction: Movement away from the midline • Adduction: Movement toward the midline

8. Early Identification of Orthopedic and Neurological Impairments • Missed motor milestones • Patterns of gross and fine motor development • Levels of muscle tone

9. Assessment of Orthopedic and Neurological Impairments • Assessed by severity, type, and parts of body involved • Mild impairments can walk (may use crutches, walker, or other prosthetic devices), use their arms, and communicate enough to make wants and needs known. • Moderate impairments require special help with locomotion, self-help and communication • Severe impairments use a wheelchair. Self-help and communication skills are challenging

10. Types of Orthopedic and Neurological Impairments • Absent Limbs • Cerebral Palsy • Spastic cerebral palsy is the most common • Hemiplegia (one side of body) • Diplegia, the whole body is involved, legs more than arms • Quadriplegiainvolves all four limbs. Head control may be poor, usually impairment of speech and eye coordination • Correctable Orthopedic Impairments • Developmental Coordination Disorder • Affects 6 to 10 % of children 5 to 11 years • Praxis: Ideation, motor planning, execution

11. Types of Orthopedic and Neurological Impairments • Muscular Dystrophies • Neural Tube Defects • Spina bifida • Meningocele • Meningomyelocele or myelomeningocele • Encephalocele • Anencephaly • Spinal Cord Injuries • Traumatic Brain Injury • Impact forces: Head strikes or is struck by a moving object • Inertial forces: Brain undergoes violent motion inside the skull

12. Mobility Aids • Splinting, Bracing, and Positioning • Short-Distance Mobility Aids • Walkers, scooters, crutches, and canes • Long-Distance Mobility Aids • Strollers and wheelchairs • Transferring

13. Guidelines • Give children tasks they can accomplish • Use assistive technology routinely • Ensure children touch as well as see things • Demonstrate how things are used • Hang pictures of individuals using mobility devices • Work on developing language skills • Help children establish a sexual identity • Prioritize tasks • Keep in contact

14. Guidelines: Accessibility • Use tables with adjustable legs • Move sand and activity tables away from walls • Provide many different types of chairs • Add ramps • Use nonslip floor coverings • Evaluate toileting facilities

15. Guidelines: Accessibility • Shorten and widen handles • Use deep-sided bowls and be sure the food you serve is not too hot • Provide ways for children to carry things • Use large and small versions of manipulative toys • Remove equipment that overturns easily • Use padded lapboards • Use a book or music stand with a page holder

16. Adapting Curriculum • Social awareness • Use a full-length mirror to develop body awareness and self-concept • Provide self-help aids such as buttoners and reachers • Ask open-ended questions about feelings • Get children out into the community • Have appropriate community visitors

17. Adapting Curriculum • Language and literacy • Use puppets to encourage expressive language • If children cannot speak, support them in using their communication device • Read stories and show pictures of children who have orthopedic impairments • Use flannelboard stories • Follow field trips by language-experience stories • Teach prewriting skills that require finger and wrist movement and rotation • Help children warm up their small muscles before writing • Encourage children to use the computer to write

18. Adapting Curriculum • Discovery • Teach the relationship between speed and distance • Discuss shapes that roll and those that don’t • Teach casual relationships • Help children learn to use simple machines • Use objects that vary in shape, size, and texture • Use computers and any necessary adaptations • Wellness • Teach children where to put mobility aids • Practice safety drills • Supervise children carefully • Use magnetic toys, pop beads, and pegboards • Make playdough in different textures and consistencies

19. Adapting Curriculum • Creative arts • Choose activities that require two hands • Tape drawing paper to the table and adapt drawing materials • Paint on large paper and large objects • Use mittens with Velcro to help children hold materials and instruments • Allow for individual differences and creativity • Play hospital and doctor’s office • Routines and transitions • Use transitions to teach and assess concepts • Tell children what you are planning to do before you do it

20. Reflections • How would you deal with a child in your classroom who always seemed to bump into things and was clumsy? Do you see this as a potential disability? • Do you feel comfortable with your knowledge about what you would do if a child fell and was unconscious? If not, what could you do to feel more comfortable?