Review of DETA Criteria for Physical Impairment

1. Review of DETA Criteria for Physical Impairment

2. Key Issues The working party identified there was a need to: • align DETA definition and criteria with national and international standards • clarify the relationship between diagnosed medical conditions and impairment • describe the nature and extent of a physical impairment • clarify how the impairment is linked with activity limitations/ participation restrictions in the school context • evaluate the effectiveness of the current verification form for this category • identify when a review of verification is required

3. Definition of Physical Impairment International Definitions Variety of definitions including physical/motor/motion/orthopaedic and disability/handicap/impairment. Students with disabilities or impairments viewed in medical terms as organic disorders attributable to organic pathologies(e.g. in relation to sensory, motor or neurological defects). The educational need is considered to arise primarily from problems attributable to these disabilities. Organisation for Economic Cooperation and Development (OECD) 2005

4. Definition of Physical Impairment Nationally Variety of definitions including physical, disability, disorder, and impairment – some include separate category of ABI. Definitions also related to funding. Physical/diverse disability – “the presence of an impairment, which may have diverse effects within and among individuals, including effects on physical activities such as mobility. Included in this broad category is the subcategory Acquired brain injurywhich is used to describe multiple disabilities arising from damage to the brain acquired after birth. Note: Due to its low prevalence among children, acquired brain injury has not been reported separately in this bulletin. Australian Institute of Health and Welfare 2005 Disabilities Updates: Children with disabilities

5. DETA Criteria for Physical Impairment pre 2005 • Significant physical impairment and • Student requires regular specialised supportfor access and participation in schooling. Source: Senate Employment, Workplace Relations and Education References Committee report, Education of students with disabilities (2002), Appendix 5, pp.157-166 and ACT Student Disability Criteria (ACT Government), July 2003.

6. Criteria (until 12 November 2007) A Physical Impairment is a dysfunction of neurological and musculoskeletal systems which affects the ability to move or coordinate and control movement when performing tasks. (A Physical Impairment may also affect the ability to use or feel certain parts of the body. Different) The body systems (may be)involved: • musculoskeletal – involving the joints, limbs and associated muscles • neurological – involving the central or peripheral nervous systems (brain, spinal cord or nerves). There are a wide range of conditions that may result in a Physical Impairment including cerebral palsy, spina bifida, muscular dystrophy, arthritis, osteogenesis imperfecta, congenital malformations of the limbs, some acquired brain injury, some orthopaedic conditions. A Physical Impairment may result from neurological damage, congenital malformation, genetic disorders, orthopaedic impairment , accidents resulting in brain injury, loss of limbs, severe burns. There is a broad continuum of Physical Impairment and resulting implications for students. Some students may experience a mild impact on their access to, participation in, and outcomes from schooling, while others will experience a more significant impact. A Physical Impairment may be: • present from birth (congenital) or acquired later (for example through an accident or illness) • progressive or non-progressive (this refers to whether or not the condition increases in extent or severity over time). The diagnosis of the body structure and function that is affected must be provided by medical specialist. Education Queensland recognises a diagnosis of a condition that affects these body systems and which may result in a Physical Impairment provided by a paediatrician, neurologist, orthopaedic surgeon, + rheumatologist and/or geneticist

7. Criteria (until 12 November 2007) Students functioning not to be accounted for existing diagnosis of IntelIectual Impairment, Autism Spectrum Disorder or Learning Difficulties • High incidence of combination of physical impairment with other impairments according to Australian Institute of Health and Welfare 2004 analysis of Australian Bureau of Statistics data(49% comorbidity in 2006 verifications) • No substantiated evidence provided in 2006 to exclude students with II, ASD or LD Recommendation - Noexclusion of students with these impairments butmust have a musculoskeletal and/or neurological diagnosis and be able to demonstrate difficulties with movement

8. The Impairment – dysfunction in body structure and function Under the ICF - “Impairments are the problems in body function or structure • Body structure- anatomical parts of the body • Structures of the nervous system e.g. spinal cord and related structures Chapter 1 • Structures related to movement e.g. structure of head and neck region Chapter 7 • Body function- the physiological functions of body systems • Neuromusculoskeletal and movement-related functions Chapter 7

9. New Criteria (from November 12 2007) Criterion 1 Diagnosis of a Musculoskeletal and/or Neurological Condition (body structure) which affects the ability to move or coordinate movement (body function) • Musculoskeletalconditions - involving joints and muscles • e.g. Congenital or acquired physical malformations, joint conditions, skin conditions where impact on joints and muscles, Neurofibromatosis where impact on joints and muscles • Neurological conditions - involving brain, spinal cord or nerves • e.g. Cerebral Palsy, Muscular Dystrophy, Spinal Atrophy, Spina Bifida, spinal tumours, Genetic Degenerative Diseases/Syndromes, Acquired neurological conditions including acquired brain injuries

10. Some musculoskeletaland/orneurologicalconditions may not affect the ability to move or coordinate movement e.g. • Epilepsy • Acquired Brain Injury • Hydrocephalus • Mild Cerebral Palsies • Evidence needed to determine the nature and extent of the impairment in body function - Ability to move or coordinate movement

11. Additional information required in 2005 Section 3 information provided by the school • Student’s difficulty with activities in their education program • Impact on access, participation and educational outcomes + adjustments • Disability specific needs to be identified From 2006 all students verified are eligible for a profile to be submitted so information on adjustments is not required for verification

12. Physical Impairment - Activity Limitation/ Participation Restriction in the school context

13. “The range and extent of activity limitation and participation restriction will vary with the extent of impairment as well as with environmental factors. Environmental adjustments and support needs are related to areas of activity limitation and participation restriction” Australian Institute of Health and Welfare 2005 Disabilities Updates: Children with disabilities

14. New Criteria (from November 12 2007) Criterion 2 Information to be provided by the school on Activity Limitations and Participation restrictions i.e. extent of the impairment (limitation in function) and the effect of the physical condition on the student’s functional performance (at the level of the individual) within the school setting (consideration of context of learning and environment) • How to record this information for a physical impairment?

15. Activity Limitations Activity is described as the nature and extent of functioning at the level of the person. Activities may be limited in nature, duration and quality. (Physical Disability Council of Australia) Activity is the execution of a task or action by an individual.Also described as “capacity”. ICF, 2001 • Activity Limitations are the difficulties an individual may have in executing activities

16. Educational Impact 2006 verification data collected 70% of students verified demonstrated difficulties with Mobility e.g mobility around classroom - transfers, hoists, assistance, equip mobility around school - walking, stairs, wheelchair 90% with Gross Motor difficulties gross motor skills (age related) - GM programs, modified HPE 82% with Fine Motor difficulties hand/arm function - writing FM programs, AT, assistance 60% Self care difficulties dressing, eating, toileting 50% Leisure often incorporated with Mobility and Gross Motor - swimming, sport, playground 35% Communication - assistive technology 30% Social - assistance with peers

17. ICF’s nine domains of life • Learning and applying knowledge • General Tasks • Communication • Mobility • Self Care • Domestic Life • Interpersonal interactions and relationships • Major Life areas • Community, social and civic life All 9 domains affected by a physical impairment however 3 domains provide disability specific information required – Mobility, Communication, Self Care

18. Activity Limitations and Participation Restrictions • Mobility, Self Care and Communication domains provide disability specific information for Physical Impairment • Mobility(ICF) includes gross motor and fine motor but some conditions affect only one of these – separated Mobility to Gross mobility and Fine mobility This information should be as recent as possible to accurately reflect student’s current functioning.

19. Gross Mobility Ability to Maintain positions – sitting, standing Change positions Move indoors Move outdoors Move (other) – run/hop/jump, use playground equipment, be involved in play/sports activities Fine Mobility Ability to Access and transport materials Manipulate environment fittings and furniture Manipulate materials Produce written work Other Mobility

20. Self Care Ability to Manage mealtime Manage toileting Manage hygiene Manage clothing Other Communication Ability to Use physical structures to speak Use physical movement to gesture Use augmentative and alternative communication Other

21. Verification Form

22. Review of form - Key considerations • How to provide information simply and easily – open boxes difficult to complete • Difficulty with access to specialists (medical and educational) • Need to scaffold best practice and consistency • Need to encourage communication between schools and the AVT: PI • Need to link impairment to activity limitation and participation restriction to assist schools to determine appropriate educational adjustments

23. PI Verification Form – Part B Criteria 1 Diagnosis by Medical Specialist • Dysfunction ofmusculoskeletal and/or neurologicalsystemswhich affects the ability to move or coordinate movement diagnosed by - Paediatrician (79% in 2006), Neurologist (7%), Orthopaedic Specialist (7%), Geneticist (6%), Rheumatologist (3%) • Diagnosis by letter or signature on form with condition named. This diagnosis needs to be as current as possible.

24. PI Verification Form – Part B Criterion 2 Activity Limitations Student’s ability to move within the school setting Qualifiers 0 = inability to move 1 = partial ability to move 2 = ability to move Can include comments – how child performs movement ie with equipment, assistance, physical or verbal cues etc

25. PI Verification Form – Part B Criterion 2 Participation restrictions Student’s access to Foundation or Key Learning areas Qualifiers N/A = not applicable an option 1 = 1 Learning area affected 2 = 2 or more learning areas affected 3 = All learning areas affected Can specify area if only 1 or 2 learning areas affected e.g. HPE, Home Economics

26. Students Needs Optional tick boxes of assistance, equipment and programs • Links the verification information to student’s IEP goals, school program and profile Diagnosis + difficulty with movement (Activity Limitations) + curriculum access/participation • leads to decisions around how to best support students needs

27. Verification Reviews and Removal from Category

28. Verification Reviews • No mandatory review for most diagnoses - a review of the diagnosis not necessary as many conditions do not change • Reviews required for: • Perthes • Recent Acquired Brain Injury • Review and date of review determined by the verifier Removals from category

29. Contact Details • Suzy.Chainey@deta.qld.gov.au • For PI Verification questions • Ph: 3240 9382 • For general Verification questions • Ph: 3240 9348 (Jeannie Grace) • Fax: 3240 9300EAP Verification Team 141 Merton Rd WOOLOONGABBA Q 4102