Children With Physical Disabilities and other Health Impairments

1. Children With Physical Disabilities and other Health Impairments • By: Kelsey Allen & Chelsea Hollinger

2. Definition and Classifications • “Children with physical disabilities and other health impairments are those whose physical limitations or health problemsinterfere with school attendance or learning to such an extent that they require special services, training, equipment, materials, or facilities” (p.399)

3. Classifications & Characteristics • Congenital anomalies: defects the child is born with • Acquired disabilities through accident or disease (after birth) • Can be mild and transitory • ORprofound and progressive (incapacitation and ultimately an early death) • Acute illness: A serious illness or condition that a person can overcome with medical treatment • Chronic condition: An incurable condition that is ongoing and will never resolve itself, even with the best treatment • Example: Cerebral Palsy • Episodic: A condition that occurs repeatedly but with medication and treatment, an individual can function normally (does not have to become more serious or severe over time) • Example: Asthma and seizure disorders (epilepsy) • Progressive: condition that gets worse over a period of time • Example: Muscular Dystrophy

4. Neuromotor Impairments • Neuromotor Impairment- injury to brain or spinal cord that affects the ability to move one’s body. • If a child’s nervous system is damaged, most commonly they will experience muscular weakness or paralysis. • Causes and injuries include: • Traumatic Brain Injury: brain damage with an identifiable external cause after birth • Hypoxia: Reduced oxygen to the brain • Stroke • Infection • Metabolic Disorder • Toxic Chemicals or drugs

5. Cerebral Palsy • ”Cerebral palsy is a disorder of movement and posture. It is caused by a brain injury that occurred before birth, during birth, or during the first few years after birth. The injury hinders ability of the brain to control muscles of the body properly” (p.400) • It can be considered part of a syndrome that includes motor dysfunction, psychological dysfunction, seizures, and emotional or behavioral disorders due to brain damage. • Paralysis, weakness, lack of coordination, and other motor dysfunctions are caused because of damage before a child’s brain matures. • There is no cure for cerebral palsy. However, with help from new technologies (medical and rehabilitation technologies), there is hope for overcoming this neurological disorder. • Example: long-term physical therapy in combination with a surgical procedure where selected nerve roots are cut below the spinal cord that help with spasticity of legs - this can create progress with walking.

6. Causes & Types of Cerebral Palsy • Anything that can damage the brain before birth which includes: • maternal infections, chronic diseases, physical trauma, maternal exposure to toxic substances (drugs/alcohol), x-rays, pre-mature birth, hypoxia, high fever, infections, poisoning, hemorrhaging etc. • Types: • Quadriplegia: All 4 limbs involved • Paraplegia: Only legs involved • Spasticity: Stiffness of muscles and inaccurate voluntary movement • Choreoathetoid: Abrupt, involuntary movements and difficulty maintaining balance • Atonic:Floppiness, and an overall lack of muscle tone

7. Cerebral Palsy’s Associated Disabilities and Educational Implications • Cerebral Palsy affects an individual’s sensory abilities, cognitive functions, and emotional responsiveness and motor performance. • Hearing impairments • Visual impairments • Perceptual disorders • Speech and language problems • Emotional/ behavioral disorders/ intellectual disability or a combination of these • Some children have normal to above-average mental capacity or are considered “gifted” • Lower than the average IQ –standardized tests could play a role • Children with cerebral palsy require special equipment, procedures, and individualized considerations • Teaching a child who has cerebral palsy demands knowledge and background in special education and experience working with a variety of disabling conditions.

8. Meet Eric... • http://youtu.be/iItgeWUeQ_4

9. Discussion Time! • Turn and talk to your table neighbors about the challenges, frustrations, and limitations you would personally face if you had this disorder. • For example: operating a vehicle

10. Seizure Disorder (Epilepsy) • Seizure: when an abnormal discharge of electrical energy occurs in certain brain cell. The irregular discharge spreads to surrounding cells which may cause lack of consciousness, involuntary movements, and/or abnormal sensory phenomena • 1 in 10 children have seizures at one time (high fever or serious illness) but this is NOT epilepsy. • Epilepsy: chronic neurological condition that is recurrent and caused by damage to the brain • Most known common causes include: hypoxia, low blood sugar, infections, and physical trauma • Epilepsy may be progressive (damaging the brain/disrupting its functioning in such a way that having a seizure increases the probability of having another)

11. Best Way To Classify Seizures • Duration:can range from a few seconds to several minutes • Frequency: can occur as frequently as every few minutes to once a year • Onset: set off by identifiable stimuli, unrelated to the environment, totally unexpected, or be triggered by internal sensations. • Movements: can cause major convulsive movements or only minor motor symptoms • Example: Flopping body or eye blinks • Causes: high fever, poisoning, trauma, and unknown causes • Associated Disabilities: can be associated with other disabilities that could be a related medical problem • Control: can be controlled or partially controlled by drugs

12. Seizure Disorder Information • Half of people with epilepsy have average or higher intelligence (same for general population) • Among children with seizure disorders (without intellectual disabilities), learning disabilities tends to be higher • Helpful Tips: • educate the population about epilepsy and that it can be handled • be prepared to manage someone who has seizures • keep record • know how to help and seek medical assistance • These children may have behavioral disorders from brain function or as a side effect from medications • These children are associated with having problems with executive function, adaptive behavior, low IQ, psychological difficulties, and low family income

13. Spina Bifida • Spina Bifida- A congenital midline defect that results from failure of the bony spinal column to close completely and occurs anywhere down the spine from the head to the lower back. • Often results in paralysis of the legs, anal region, and bladder sphincters because nerve impulses cannot travel past the defected area • Similar defects include: cleft lip and a cleft palate that occur during the early fetal development stage where the two halves of the embryo grow together at the midline. The incomplete fusing results in congenital midline defects just like spina bifida. • Surgery can be performed in early infancy to close the spinal opening, but this does not fix nerve damage • Spina Bifida one of the most common birth defects

14. Spinal Cord Injuries • “Most spinal cord injuries resulting from accidents after birth are also a major cause of paralysis” (p.404) • An individual must adjust to their acquired disability in contrast to developing normally by: • Using wheelchairs, braces, or learning to walk independently again (extremely varying because those with paralysis have varying extents). • Spinal cord injuries can also result in: • Lack of sensation in skin can lead to burns, abrasions, and sores • Lack of bowel and bladder control requiring catheterization

15. Orthopedic & Musculoskeletal Disorders • Two of the most common musculoskeletal conditions affecting youth: muscular dystrophy and juvenile rheumatoid arthritis • Muscular dystrophy:a hereditary disease that is characterized by progressive weakness cause by degeneration of muscle fibers • No cure, advances in pharmacology • Juvenile rheumatoid arthritis: potentially debilitating disease in which the muscles and joints are affected • Cause and cure are unknown • Very painful and often accompanied by fever, respiratory problems, heart problems, eye infections • Scoliosis: Spinal curvature • Missing or malformed limbs intelligence is unaffected unless additional disabilities are present • Placing the student in a special education setting is beneficial for: improving mobility, ensuring proper posture and positioning, providing education during home confinement time, and for making the educational experience as normal as possible.

16. OTHER conditions that affect a child’s HEALTH or PHYSICAL ABILITIES • A wide array of diseases affect a child’s health and/or physical abilities including: physiological disorders, congenital malformations, and injuries that can affect student health and physical abilities which creates a need for special education. Also, obesity, diabetes, asthma. • Asthma- increasingly common lung disease characterized by episodic inflammation or obstruction of the air ways making it hard to breathe—restricting activities • Accidents- many children are hurt in accidents each year resulting in traumatic brain injury, spinal cord injuries, and short term hindrances such as broken bones • AIDS-often acquire neurological symptoms, including: intellectual disabilities, cerebral palsy, seizures, and emotional or behavioral disorders • Fetal alcohol syndrome-disabilities acquired during pregnancy because of drinking of mothers…results in distinct physical and developmental abnormalities, many need early intervention and help throughout

17. Psychological and Behavioral Characteristics • Academic achievement: • Erratic school attendance due to hospitalization and doctor’s visits • Widely varied of severity of conditions • Some require special teaching methods because of intellectual or sensory impairments, and some do well in general education • May be deprived of “regular” education experience because they are not able to manipulate educational materials and respond to tasks the way most students do

18. Personality Characteristics • Varied in personality type just as much as non-disabled children • Public reactions:if the public is fearful or rejecting the child may spend time trying to hide their disability, if it is pitiful and helpless the child will be dependent, if they see them as limited but otherwise normal the youth will become less dependent and productive members of society • Children and families reaction: largely a reflection of how those respond to them, realistic self-perceptions and set realistic goals to the extent that those are honest with them

19. Where are children with physical disabilities educated?

20. Answer • - 53.3 % of those with orthopedic, other health impairments, and traumatic brain injury spend less than 21% of the day outside the general education class room. • - 21.3% spend 21-60% of the day outside the general education classroom. • - 18.6% spend more than 60% outside the general education classroom. • - 4% are served in a separate school. • - .3% are served in separate facility. • - 1.4% are in homebound or hospital placement

21. Prosthetics, Orthotics, and Adaptive Devices • Prosthesis: artificial replacement for missing body part • Example: artificial body part like an arm • Orthosis: a device that enhances the partial function of a part of a person’s body • Example: Wheelchair or a brace • Adaptive Devices: used for daily living that helps make adaptions for ordinary devices used throughout the home, office, school, etc. • Example: a device to aid in bathing • Technology has been an essential tool in making all types of assistive devices much stronger, safer, and efficient (metallurgy and plastics)

22. Two Important Points... • 1. “Residual function is often important even when a prosthesis, orthosis, or adaptive device is not used” (p.411) • The child needs to learn use the device independently • 2. “Spectacular technological developments often have very limited meaning for the immediate needs of the majority of individuals with physical disabilities” (p.411) • The cost of new technological devices in aiding those with a physical disability is very expensive and offered to a small group of individuals

23. Educational Considerations • “We forget, though, that many people with physical disabilities can learn to do many or all of the things that most non-disabled people do, although sometimes they must perform these tasks in different ways” (p.412)

24. Educational Considerations • “Adapted physical education is now a special educational feature of all school programs that make appropriate adaptions for students with disabilities” (p.412) • It is SO important to educate the non-disabled community about physical disabilities. • “Design adaptions in buildings, furniture, household appliances, and clothing can make it possible for someone with a physical disability to function as efficiently as a person without disabilities in a home, school, or community” (p.412) • It’s critical to understand the environmental and psychological factors that affects classroom performance and behavior.

25. Individualized Planning • Individualized education plans or IEPs are specific with minute details about the child’s disability. • Instructional goals and objectives • Many children under the age of three who need special education and/or related services have a physical disability. • Children under three years old who have a physical disability are required, by federal law, to have am individualized family service plan (IFSP) to accommodate their needs.

26. Educational Placement • Many different educational setting options available - it mainly depend on the severity of the child’s disability and what type of daily care they require. • Example:child’s classroom located in a hospital, a homebound instructor for those students who can not leave their house will receive educational instruction until they are able to return to the general education setting. • Most children today are integrated into public schools because of the: • advanced treatment, new development in bioengineering, greater mobility and functional movement, decrease in architectural barriers and transportation problems, and public education for all children.

27. Educational Goals and Curricula • The individual’s limitations vary greatly. THEREFORE, curriculum can be tailored specifically for a student with a physical disability of other health impairment. • Goals and curriculum must base their assessments off of intellectual, physical, sensory, and emotional characteristics of the student • A severe and chronic disability that limits mobility has two implications: • The child may be deprived of experiences that a non-disabled child has • The child may not be able to manipulate materials and respond to educational tasks the way the other general education students do • Students who need mechanical devices to perform tasks • Severe or profound: student’s participate in everyday community environment goals and functional lessons for daily life.

28. Links with Other Disabilities • Most children with physical disabilities need services from a physical therapist and an occupational therapist • Professionals can help give the teacher suggestions about how to help the child physically, emotionally, and academically. • The teacher should always be aware of the child’s handling and positioning to minimize risk and maximize independent movement to enhance learning • Teacher should be familiar with prosthetics and orthotics • Specialist can help instruct the teacher with the operation and function of said devices • Cooperation with a psychologist and social workers to prevent lapses in the child’s treatments • Speech language therapist • Example: Cerebral Palsy

29. Early Intervention • Biggest Concerns: • Early identification and intervention • Development of communication • Handling: how the child is picked up, carried, held, and assisted • Positioning: providing support for the child’s body and arranging instructional or play materials in certain ways. • teacher must know how to teach gross motor responses and how abnormal reflexes can interfere with learning basic motor skills

30. Transitions • Transitions are generally a difficult time for those individuals who are affected with a physically disability of health impairment • Two areas of concern for transition that stand out clearly for adolescents and young adults with disabilities are: • Careers • Sociosexuality • This individuals begin wanting to experiment with jobs, make social relations, and address their sexuality and serious ways • These individuals often have a hard time dealing with developmental issues and if they will be accepted in society • They ask themselves questions like: • “Can I become independent?” • “Can I hold a well paying job?” • “Will anyone find me physically attractive?” • “What I make close friends and long lasting relationships?”

31. Choosing a Career • “One of the greatest problems in dealing with adolescents who have physical disabilities is helping them to attain a realistic employment outlook” (p.420) • Characteristics, other than their physical disability, that are important to assess: intelligence, emotions, highly motivated, work habits, etc • Supported Employment: a person with a severe disability works in a regular work setting. They become a regular employee, perform valued function, and receives a fair wage. • Ex: Greeter at a store. They may need training in how to properly greet a person. • Technology is creating more jobs for those who are disabled

32. Sociosexuality • “People who were not typical physically, especially if they had limited mobility, were thought of as having no sex appeal for anyone and as having little or no ability or right to function sexually” (p.422) • This attitude towards sexuality for those who are disabled has changed • People with disabilities have rights to take family life education, sex education, full range of human relationships and sexual expression • It is not realistic to expect people with physical disabilities to keep all of their relationships “platonic” • When teaching students who have physical disabilities and health impairments, it is the teacher’s duty to provide alternative means of sexual stimulation and about accepting sexual practices and relationships that are different from the norm

33. Resources • Local: • http://www.schoolsoup.com/scholarship-directory/disability/physically-disabled/ • This website is scholarly based. It contains a vast number of scholarships for students with physical disabilities. • http://www.ncpad.org/NewsletterIndex • This website is composed of newsletters and various websites that contain general information for the public. The community could benefit from gaining knowledge from the National Center on Health, Physical Activity, and Disability. • Parents: • https://www.learningally.org/parents-students/parent-resources-overview/?gclid=COLPyN217roCFSJo7AodeUcAUw • This is a website for parents with articles and videos about disabilities. The website also offers tutor and specialist links for parents to help their children in educational need. • http://www.cyh.com/healthtopics/healthtopicdetails.aspx?p=114&np=306&id=1874 • This website is an informational website with definitions of different physical disabilities and also different pathologists. Parents could benefit from reading this site to gain knowledge on their child’s disability and also possible specialist help. • http://www.fiestaeducativa.org/home.html • http://www.education.com/games/info/ • This website has games and resources for children. The website has games on all grade level so students can have resources that fit their needs best.

34. Resources • Teachers: • www.mtsu.edu/ada/docs/physical.doc • This article is an article for teachers of students with physical disabilities. It has in class, transition ideas, and other classroom management ideas. • http://teacher.scholastic.com/professional/childdev/working_with_children.htm • The scholastic website has teacher ideas for working with physically disabled children. It has ideas for encouragement, focus on abilities, and specific skills and challenges. • Students: • http://www.education.com/games/info/ • This website has games and resources for children. The website has games on all grade level so students can have resources that fit their needs best. • http://www.blazesports.org/ • Students can go to this website to find out more information about joining sports teams that offer programs for disabled children.