Los Angeles Unified School District Division of Special Education

2. Orthopedic Impairment A student has a severe orthopedic impairment which adversely affects the student�s educational performance. Such orthopedic impairments include impairments caused by congenital anomaly, impairments caused by disease, and impairments from other causes. Section 3030(e), Title 5, CCR

3. Definition A severe orthopedic impairment is persistent and significantly restricts an individual�s normal physical development, movement, and activities of daily living. Accompanying sensory, intellectual, behavioral, learning, and medical problems often occur that may impact the student�s ability to access his/her educational program. Students may need support to pursue the District�s Core Curriculum (with or without adaptations) or the Alternate Curriculum. �Code of Federal Regulations, Title 34, � 300.(7)(c)(8) The term orthopedic impairment includes those impairments caused by congenital anomalies (e.g. spina bifida, absence of limb), diseases (e.g. poliomyelitis, bone tuberculosis), genetic diseases (e.g. muscular dystrophy) and other conditions (e.g. cerebral palsy, amputations, spinal cord injuries, fractures or burns that cause contractures). These conditions may improve, remain stable, or deteriorate. Changes in characteristics or progression of disease may occur at varying rates.The term orthopedic impairment includes those impairments caused by congenital anomalies (e.g. spina bifida, absence of limb), diseases (e.g. poliomyelitis, bone tuberculosis), genetic diseases (e.g. muscular dystrophy) and other conditions (e.g. cerebral palsy, amputations, spinal cord injuries, fractures or burns that cause contractures). These conditions may improve, remain stable, or deteriorate. Changes in characteristics or progression of disease may occur at varying rates.

4. Eligibility Criteria Orthopedic Impairment: must be documented adversely affects educational performance requires special education to meet the student�s needs

5. Who is Rebecca Moore? She is a very social and engaging, 12-year-old girl in a gifted and talented education program. She uses a power wheel chair for mobility, and requires special devices to help her breathe and to receive nutrients. She has a very limited range of arm motion and significantly reduced finger strength. She has a condition called spinal muscular atrophy, which is degenerative.

6. Who is Jose Gonzales? He is a 7-year old boy, with a great sense of humor, in a second grade general education classroom. He uses a manual wheelchair for mobility, and is able to maneuver and transfer in and out independently. He has significant cognitive challenges, and is not expected to meet grade level standards. He has a condition called spina bifida.

7. Who is Jonathan Yee? He is a 16-year old student just returning to his comprehensive high school. He has a large circle of friends, most of which he has known since elementary school. He has difficulty recalling information, retaining facts, and expressing himself verbally. Although he had been a student athlete, he now has gross coordination issues. He has significant traumatic brain injury following an automobile accident.

8. Levels of Intervention Student Study Team (SST) 504 Plan Referral for Special Education Assessment *Assessment plan must consider the unique needs of student Before a special education referral is initiated, most pupils with suspected special needs including severe orthopedic impairments should be referred to the Student Study Team (SST). Exceptions are pupils who transfer from another special education program, or pupils whose parents have referred them for an assessment to determine the need for special education. A function of the regular educational program, the SST primarily develops interventions and modifications that can be applied to the regular program and monitors their effects. All students with orthopedic impairments will not necessarily require the support of special education services. Beginning with the SST committee interventions can be discussed and implemented without the necessity of special education eligibility. The SST committee can recommend the development and implementation of a 504 Plan to support the student in the general education classroom. A 504 Plan can clarify all necessary accommodations for that student. For students with more significant needs a referral for a special education assessment would be recommended. An important member of the IEP assessment team for this student would be the school nurse and/or doctor, in order to discuss the health and medical implications for that student�s educational program. Even though a student with a physical impairment has an obvious disability, the student�s assessment team must remember to consider and assess in all areas of suspected disability � this may include additional areas of need, such as, processing deficits, cognitive delays, or sensory impairments. All members of the student�s assessment should be familiar with the general needs of students with severe physical disabilities and be able to access specific experts who can determine the most effective methods and materials to be used for assessment. Many children with severe orthopedic impairments have accompanying impairments that further complicate the assessment process. When preparing the assessment plan, the assessors most consider whether a child has sensory impairments, limited physical movements, severe speech impairments, and a need for speech aid(s) or augmentative mode of communication and whether the child�s primary language is other than English. For example, if the child has an accompanying visual problem, the person knowledgeable about the visual impairments may need to assist in selecting the appropriate assessments. If the child has limited physical motion, the occupational therapist or physical therapist, or both may be contacted to determine the extend of the child�s capability of physical response. An excellent addition to either of these teams would be the assistive technology specialist who could assist with the assessment and make recommendations for any assistive devices.Before a special education referral is initiated, most pupils with suspected special needs including severe orthopedic impairments should be referred to the Student Study Team (SST). Exceptions are pupils who transfer from another special education program, or pupils whose parents have referred them for an assessment to determine the need for special education. A function of the regular educational program, the SST primarily develops interventions and modifications that can be applied to the regular program and monitors their effects. All students with orthopedic impairments will not necessarily require the support of special education services. Beginning with the SST committee interventions can be discussed and implemented without the necessity of special education eligibility. The SST committee can recommend the development and implementation of a 504 Plan to support the student in the general education classroom. A 504 Plan can clarify all necessary accommodations for that student. For students with more significant needs a referral for a special education assessment would be recommended. An important member of the IEP assessment team for this student would be the school nurse and/or doctor, in order to discuss the health and medical implications for that student�s educational program. Even though a student with a physical impairment has an obvious disability, the student�s assessment team must remember to consider and assess in all areas of suspected disability � this may include additional areas of need, such as, processing deficits, cognitive delays, or sensory impairments. All members of the student�s assessment should be familiar with the general needs of students with severe physical disabilities and be able to access specific experts who can determine the most effective methods and materials to be used for assessment. Many children with severe orthopedic impairments have accompanying impairments that further complicate the assessment process. When preparing the assessment plan, the assessors most consider whether a child has sensory impairments, limited physical movements, severe speech impairments, and a need for speech aid(s) or augmentative mode of communication and whether the child�s primary language is other than English. For example, if the child has an accompanying visual problem, the person knowledgeable about the visual impairments may need to assist in selecting the appropriate assessments. If the child has limited physical motion, the occupational therapist or physical therapist, or both may be contacted to determine the extend of the child�s capability of physical response. An excellent addition to either of these teams would be the assistive technology specialist who could assist with the assessment and make recommendations for any assistive devices.

9. What level of intervention does the student require? Rebecca Moore? Jose Gonzales? Jonathan Yee? (Chart your groups decisions)

10. Educational Needs Considerations Decreased physical stamina Prolonged absences Longer response times Accompanying sensory impairment Some pupils have limited physical abilities, decreased physical stamina, prolonged absences, longer response times, and accompanying sensory impairments. Some pupils have limited physical abilities, decreased physical stamina, prolonged absences, longer response times, and accompanying sensory impairments.

11. Educational Needs Access to Standards-based Instruction Exposure to core curriculum and rigorous instruction Implementation of differentiated instructional strategies Adaptations to facilitate accessibility Accommodations Modifications Use of Alternate Curriculum and/or Life Skills Many of these students will access the core curriculum with the implementation of appropriate instructional accommodations and/or adaptation to facilitate accessibility. Other pupils with severe orthopedic impairments accompanied by other disabilities, such as, multiply disabled (MD) students, including developmental delays, may benefit from additional instruction emphasizing basic academic skills, daily living skills, and/or community-based vocational training. All students require exposure to the core curriculum and rigorous instruction.Many of these students will access the core curriculum with the implementation of appropriate instructional accommodations and/or adaptation to facilitate accessibility. Other pupils with severe orthopedic impairments accompanied by other disabilities, such as, multiply disabled (MD) students, including developmental delays, may benefit from additional instruction emphasizing basic academic skills, daily living skills, and/or community-based vocational training. All students require exposure to the core curriculum and rigorous instruction.

12. What educational supports does the student require to access standards-based instruction? Rebecca Moore? Jose Gonzales? Jonathan Yee? (Chart your group�s decisions)

13. Educational Needs  Specialized Materials and Equipment Low Tech Dycem Slant Boards Book stands Page fluffers Pencil grips Specialized writing paper (e.g. larger lines, raised lines) Audiotapes of printed materials Instruction must be differentiated to meet the needs and learning styles of all students. For example, audio tapes may replace printed materials as a source of information. Pupils with significant speech impairments will need alternative methods to respond and communicate information. Multiple systems can be implemented ranging from low teach devices, such as, picture exchange cards or a simplified alphabet keyboard to high tech voice output communication systems. Special homework paper may need to be prepared for the pupil whose writing exceeds the dimensions of standard size paper. To be able to write, a pupil may need to have the paper secured to the desk. Instead of using the usual workbook pages, another pupil may be able to do widely spaced problems or to select from widely spaced answers. Specialized technological equipment and adaptive materials should be used only when regular classroom materials require an excessive amount of practice or study time or limit the pupil�s exposure to information. If a pupil becomes physically fatigued or weak or lacks coordination, available materials and equipment may be adapted; or specialized equipment may be designed to make the most effective use of the pupil�s voluntary physical movements. Pupils with severe physical limitations may be unable to turn a page of a book, hold a pencil, see the chalkboard, or maintain a grasp on objects. Simple adaptations and constructions allow pupils to use learning tools otherwise inaccessible to them. Assistive devices can be designed that the pupil can operate with any voluntary repetitive movement or movements; for example, eye blinks or nose twitch. With regular or modified access to computer-assisted technology, the pupil will be able to read and go on to the next page, draw or write without holding a pencil, work on academic subjects, and learn to communicate thoughts and desires. Instruction must be differentiated to meet the needs and learning styles of all students. For example, audio tapes may replace printed materials as a source of information. Pupils with significant speech impairments will need alternative methods to respond and communicate information. Multiple systems can be implemented ranging from low teach devices, such as, picture exchange cards or a simplified alphabet keyboard to high tech voice output communication systems. Special homework paper may need to be prepared for the pupil whose writing exceeds the dimensions of standard size paper. To be able to write, a pupil may need to have the paper secured to the desk. Instead of using the usual workbook pages, another pupil may be able to do widely spaced problems or to select from widely spaced answers. Specialized technological equipment and adaptive materials should be used only when regular classroom materials require an excessive amount of practice or study time or limit the pupil�s exposure to information. If a pupil becomes physically fatigued or weak or lacks coordination, available materials and equipment may be adapted; or specialized equipment may be designed to make the most effective use of the pupil�s voluntary physical movements. Pupils with severe physical limitations may be unable to turn a page of a book, hold a pencil, see the chalkboard, or maintain a grasp on objects. Simple adaptations and constructions allow pupils to use learning tools otherwise inaccessible to them. Assistive devices can be designed that the pupil can operate with any voluntary repetitive movement or movements; for example, eye blinks or nose twitch. With regular or modified access to computer-assisted technology, the pupil will be able to read and go on to the next page, draw or write without holding a pencil, work on academic subjects, and learn to communicate thoughts and desires.

15. Educational Needs  Specialized Materials and Equipment High Tech Computer Specialized keyboards (e.g IntelliKeys) Software programs (e.g. word predict, print to voice, math applications)

17. Educational Needs  Augmentative/Alternative Communication Low Tech Picture Exchange Communication System (PECS) Single switch voice output device Picture schedules Conversation Books

19. Educational Needs  Augmentative/Alternative Communication High Tech Multi-level voice output communication device Computers Print to voice computer software

21. What assistive devices may be required by the student? Rebecca Moore? Jose Gonzales? Jonathan Yee? (Chart your group�s decisions)

22. Unique NeedsSocial Emotional The psychological needs of the physically disabled are identical to those of their typical peers. Physiological or survival needs Safety needs Belongingness and love needs Esteem needs Self-actualization Maslow(1954)

23. Unique NeedsSocial Emotional Encourage maximum independence! Ecological Assessment Natural Supports Self-Advocacy Encourage maximum independence and encouraging him/her to use his/her capabilities provided a strong foundation upon which to build a healthy personality. Encourage maximum independence and encouraging him/her to use his/her capabilities provided a strong foundation upon which to build a healthy personality.

24. Unique NeedsMobility and Access Assist the student in developing motor skills to their maximum utilizing a variety of aids: Wheelchairs Braces Walkers Canes Efforts should be made to assist the student in developing his/her motor skills to the fullest extent possible. Students may use a variety of mobility aids, such as braces, wheelchairs, walkers and canes. The kind of mobility aid is prescribed by the physician on the basis of observation and on the recommendation of the parents and student when appropriate. The physical therapist, occupational therapist, and various educational staff may also make recommendations.Efforts should be made to assist the student in developing his/her motor skills to the fullest extent possible. Students may use a variety of mobility aids, such as braces, wheelchairs, walkers and canes. The kind of mobility aid is prescribed by the physician on the basis of observation and on the recommendation of the parents and student when appropriate. The physical therapist, occupational therapist, and various educational staff may also make recommendations.

25. Unique NeedsTransition and Career Planning

26. What other unique factors need to be addressed in order to support the student? Rebecca Moore? Jose Gonzales? Jonathan Yee? (Chart your group�s decisions)

27. School Site Preparation/Training Prior to enrollment: Discuss specific student needs with classroom teacher Share factors relating to disability of incoming student with new classmates; such as, means of: Communication Mobility Support Enrollment of a student with significant challenges at their home school should be done with preparation given to the classroom teacher and students. Preparation may involve providing an opportunity to talk about the new student and discuss the ways in which that individual may communicate or move. It will provide an opportunity for students to have some of their curiosity appeased before the arrival of the student. Ongoing and further questions will arise, which can be dealt with naturally within the classroom setting. Enrollment of a student with significant challenges at their home school should be done with preparation given to the classroom teacher and students. Preparation may involve providing an opportunity to talk about the new student and discuss the ways in which that individual may communicate or move. It will provide an opportunity for students to have some of their curiosity appeased before the arrival of the student. Ongoing and further questions will arise, which can be dealt with naturally within the classroom setting.

28. Share your vision for� Rebecca Moore? Jose Gonzales? Jonathan Yee? (Chart your group�s decisions)