Understanding Students with physical Disabilities and Other Health Impairments

1. Understanding Students with physical Disabilities and Other Health Impairments Chapter 12 Mary Ellen Kearns

2. Physical Disability • Physical Disability refers to students with mobility limitations • IDEA definition is a severe orthopedic impairment which adversely affects a child’s educational performance. Includes congenital anomaly, impairments caused by disease and other causes (such as fractures) • Focus here will be on Cerebral Palsy (CP) and Spina Bifida (SB)

3. Cerebral Palsy • CP is a term used for a group of non-progressive disorders of movement and posture • Can occur before, during, or after birth • Child’s brain cannot control his/ her muscles • Occurs in the brain’s development- usually by age 6 • Prevalence is 2 per 1,000 individuals • Not a specific diagnosis but a description of a broad group of neurological and physical problems • Symptoms and severity are variable

4. CP Terminology Monoplegia: one limb Paraplegia: legs only Hemiplegia: one half of body Triplegia: three limbs (usually two legs and one arm) Quadriplegia: all four limbs Diplegia: more affected in the legs than in the arms Double Hemiplegia: arms more involved than the legs

5. Spina bifida • Spina bifida is a part of a group of birth defects called neural tube defects. Neural tube is the embryonic structure which eventually forms the brain and spinal cord • In SB part of the neural tube does not develop properly • Can occur anywhere on spine- if higher up worse damage • 1 out of 1,000 individuals • Non-progressive • Treatment done through surgery- usually in vitro

6. Spina bifida • 3 Forms of SB • Occulta • Meningocele • Myelomeningocele

7. Spina Bifida • Causes are uncertain, combination of genetics and environment • Exposure to medications • Hyperthermia • Folic acid deficiency

8. Other Health Impairments • IDEA Definition: Having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment that is • Due to to chronic or acute health problems such as asthma, ADHD, diabetes, epilepsy, heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever and sickle cell • Adversely affects a child’s educational performance • If child doesn’t qualify under IDEA, they may qualify under 504 • ½ million age 6-21 were classified OHI • More than 200 conditions • We will address epilepsy and asthma

9. Epilepsy • Epilepsy is a seizure disorder • Seizures are temporary neurological abnormalities that are a result of electrical discharge in the brain • At least two unprovoked seizures, on separate days and 24hours apart • By age 20- 1% of population will develop epilepsy • Lower intelligence • Absence seizures have difficulty paying attention • Medication side effects can affect attention/ alertness • 20-30% have emotional and behavioral considerations • Causes: 40% genetic • Environmental- birth trauma, poisoning, stress

10. 2 Types of Seizures Partial • Can cause loss of consciousness; low level of injury • Often fall to ground • Sudden involuntary contractions of groups of muscles • Simple: twitching movements and sensation of deja-vu • Complex: altered level of consciousness General • Level of injury higher with tonic clonicie. Hit head, drowning • Tonic clonic: uncontrolled jerking, loss of consciousness, disorientation, loss of continence • Tonic: stiffening • Atonic: loss of muscles and fall to the ground • Absence: brief interruptions of consciousness

11. Asthma • Chronic lung condition characterized by airway obstruction, inflammation and increased sensitivity. It is the most common chronic disease among children in the U.S. • Seek emergency care for: • Symptoms that worsen after administration of medication • Student develops SOB when speaking, walking or playing • Chest/ neck appears sucked in • Lips, fingernails turn blue • Second wave occurs after first episode subsides and/or shows obvious signs of feelings uncomfortable

12. Evaluating for PD’s and OHI’S • Initial testing is done by a physician and the testing done depends on the medical condition • Physical therapists and occupational therapists test their functional competence • School Function Assessment Tests • Participation • Task supports • Activity Performance

13. Designing Appropriate Services • Students that do not qualify for an IEP will need a 504 that covers their health services and other accommodations. Healthcare plans should include: • Medications/ treatment/ procedures and who will perform them • Emergency response plans and phone numbers • Description of health goals and school adaptations • Description of OT, PT, RT to be received at school • Written consents/ prescriptions/ instructions from physicians and parents Partnership among parents/ guardians and the professionals caring for student is key to success

14. Comprehensive Health Plan • Comprehensive Health Plan includes: • AAC devices for communication limitations • Switches for computers, mobility equipment, tape recorders etc. • Electronic or digital text formats which can deliver core content in many ways • Physical education needs to be adapted according to the person’s disability and should include sports

15. Effective Instructional Strategies • Early Childhood • Token Economy System • Elementary and Middle School students • Healthy Self Awareness • Secondary and Transition Students • Obtaining Driver’s License

16. Inclusion • The Committee on School Health emphasizes that homebound instruction should be for acute or catastrophic health problems. Period of time should be addressed in their IEP.

17. Assessing Progress • Because of fine and gross motor limitations hand writing alternatives, such as computer technology, are frequently used to augment curriculum based measurement • Other Accommodations may include: extended time, a scribe or computer administrator, physical access to testing site • Progress in physical education can be measured by • Cardiovascular • Height/ weight • Muscle strength/ endurance • Joint flexibility • Posture • Mobility