ORTHOPEDIC IMPAIRMENTS

1. ORTHOPEDIC IMPAIRMENTS TLSE 457-Section 1 Summer 2004 By Andy J. Arison & Kristen Barco-Kida

2. What is an orthopedic impairment? • Our textbook defines orthopedic impairments as diseases or disorders that are related to the bones, joints, and/or muscles. • An orthopedic impairment is covered under IDEA if it adversely affects educational performance.

3. A few of the orthopedic impairments that we will discuss today include: • Cerebral Palsy; • Muscular Dystrophy; • Spinal Cord Injuries; and • Spina Bifida.

4. What is cerebral palsy? • Cerebral palsy is a physical impairment that affects movement. • The four types of cerebral palsy are: 1) spastic; 2) athetoid or dyskinetic; 3) ataxic; and 4) any combination of the those above.

5. Presumed causes of cerebral palsy • Before birth: • Failure of a part of the brain to develop, blocked blood vessel, complications during labor, extreme prematurity, multiple births, STDs, poor nutrition, effects of anesthetics or analgesics • Early childhood: • Head injury, near drowning, poison ingestion, illness/infection, genetics

6. Prevalence/Incidence Rates • It affects 1 in every 400 births. • It is estimated that 500,000 people in the United States currently have cerebral palsy. • It is the most common orthopedic impairment among students in public schools.

7. How can cerebral palsy be diagnosed? • Test an infant’s motor skills. • Examine the mother’s and infant’s medical histories. • Test the infant’s reflexes and early development of hand preference. • Look for signs of slow development, abnormal muscle tone, and unusual posture.

8. What are some characteristics of students with cerebral palsy? • Difficulty with fine motor tasks, maintaining balance, and chewing and swallowing • Involuntary movements • Abnormal reflexes • Weak or tight muscles • Poor coordination • Speech difficulties

9. What is muscular dystrophy & what causes it? • Muscular dystrophy is a disease that weakens the muscles. • There are 43 types of muscular dystrophy, most of which are caused by alterations in specific genes. • The most common type is Duchenne muscular dystrophy, and it only affects boys. • It is a genetic disease passed from mother to son or it can arise in a young boy due to a spontaneous genetic mutation.

10. Prevalence/Incidence Rates • In the United States, it is estimated that between 50-250,000 people are affected each year. • That number is on the rise due to technological advancements and earlier testing.

11. How can muscular dystrophy be diagnosed? • Muscular dystrophy can be diagnosed through an EMG (electromyogram), blood test, and/or a muscle biopsy. • If a blood test is performed and it reveals high levels of creatine kinase, this indicates that the muscles are damaged.

12. What are some characteristics of students with muscular dystrophy? • Between two and six years of age: • Frequent falling; • Difficulty getting up from sitting or lying position; • Waddling gait; and • Fattening of the leg muscles. • Later on in life: • Wheelchair by age 12; and • By the late teens or early 20s, respiratory and cardiovascular problems develop and ultimately result in death.

13. What is spinal cord injury? • Spinal cord injuries occur when a traumatic event results in damage to cells within the spinal cord or severs the nerves that relay signals up and down the spinal cord. It causes paralysis, loss of sensation, and loss of reflex function. • Spinal cord injuries occur suddenly and without warning. • The four types of spinal cord injuries are: 1) compression; 2) contusion; 3) lacerations; and 4) central cord syndrome. • Terms for the types of paralysis: 1) paraplegia; and 2) quadraplegia.

14. What causes spinal cord injury? • Traumatic injury: • Car accidents; • Falls; • Diving accidents; • Shotgun wounds; • Horse, motorcycle, sporting event-related; and • Various other types. • Alcohol plays a significant role in many of these.

15. Prevalence/Incidence Rates • In the United States, there are approximately 10,000 new spinal cord injuries each year. • There are over 250,000 people currently affected. • Spinal cord injuries can happen to anyone at any time of life. • The typical case is a man age 19-26.

16. How is spinal cord injury diagnosed? • Diagnosis occurs after a traumatic injury by a medical professional.

17. What are some characteristics of students with spinal cord injury? • Varying degrees of paralysis

18. What is spina bifida? • Spina bifida is a birth defect where an abnormal opening in the spinal column results in some degree of paralysis. • Spina bifida literally translates to “cleft” or split spine. • There are 3 types of spina bifida: • [1]-Spina bifida occulta; and • Spina bifida cystica ([2]-meningocele; & [3]-myelomeningocele)

19. What causes spina bifida? • There are environmental as well as genetic factors: • Lack of folate/folic acid in the mother during pregnancy; and • Heredity.

20. Prevalence/Incidence Rates • Approximately 4 in every 1,000 births are affected. • There are many thousands of people currently affected.

21. How is spina bifida diagnosed? • Ultrasound • Amniocentesis, checking for increased levels of alpha-fetoprotein. • After birth, it is physically apparent if a baby has spina bifida. • There may be a buildup of fluid around the brain (hydrocephalus)

22. What are some characteristics of students with spina bifida? • Muscle weakness • Paralysis • Incontinence • Poor short term memory • Easily distracted • Poor attention, organization, sequencing, time, generalization, motivation, left-right discrimination, and coordination.

23. Altered pencils and pens Altered keyboards (BAT) Powerpads Eye-controlled input systems (cyberlink) Touch screens Track ball Foot mice Standing table Easels Adjustable seats and desks Portable reading racks Speech-controlled input systems (dragon-dictate and write-away) Icon-driven communication (dynavox) What are some assistive technologies that can be used for students with orthopedic impairments? *A website that includes several examples is located here

24. Some instructional ideas & resources for teachers: • Please see handout

25. References Bigge, J.L., & O’Donnell, P.A. (1976). Teaching individuals with physical and multiple disabilities. Columbus: Charles E. Merrill Publishing Company. Calhoun, M.L., & Hawisher, M. (1979). Teaching and learning strategies for physically handicapped students. Baltimore: University Park Press. Friend, M. & Bursuck, W.D. (2002). Including students with special needs: A practical guide for classroom teachers. Boston: Allyn and Bacon. The Irish Association for Spina Bifida and Hydrocephalus (2004). What is spina bifida? Retrieved May 24, 2004 from http://www.iasbah.ie. Muscular Dystrophy Family Foundation (2002). Muscular dystrophy family foundation. Retrieved May 24, 2004 from http://www.mdusa.org. National Information Center for Children and Youth with Disabilities (2004). National dissemination center for children with disabilities. Retrieved May 25, 2004 from http://www.nichcy.org. National Institute of Neurological Disorders and Stroke (2001). Spinal cord injury information page. Retrieved May 24, 2004 from http://www.ninds.nih.gov. Ohlone College (2004). Students with physical disabilities. Retrieved May 25, 2004 from http://www.ohlone.cc.ca.us/org. Texas Pediatric Surgical Associates (n.d.). Spina bifida neurological issues. Retrieved May 24, 2004 from http://www.pedisurg.com. United Cerebral Palsy (2001). Cerebral palsy facts and figures. Retrieved May 24, 2004 from http://www.upc.org. West Virginia University (1999). Strategies for teaching students with motor/orthopedic impairments. Retrieved May 25, 2004 from http://www.as.wvu.edu.