Orthopedic Impairments, Health Impairments, & ADHD: Putting the Puzzle Pieces Together SPE 500 Presented by April Coleman SPE 500 Presented by April Coleman

Agenda Introductions Opening Activity Overview & Definitions Physical & Other Health Impairments Types, Causes, & Accommodations Instructional Strategies Inside a Real Classroom Break Activity – Wiki/Webquest (Computer Lab) Debriefing Introductions Opening Activity Overview & Definitions Physical & Other Health Impairments Types, Causes, & Accommodations Instructional Strategies Inside a Real Classroom Break Activity – Wiki/Webquest (Computer Lab) Debriefing

How is special education like a puzzle?

Pieces of the Special Education Puzzle Identification Collaboration Assessment Instruction

Think about it… What is your main goal as a professional in the field of special education? How does this goal relate specifically to students with orthopedic and other health impairments? What is your main goal as a professional in the field of special education? How does this goal relate specifically to students with orthopedic and other health impairments?

OVERVIEW & DEFINITIONS Orthopedic Impairments, Other Health Impairments, & ADHD Orthopedic Impairments, Other Health Impairments, & ADHD

Orthopedic Impairments A severe orthopedic impairment adversely affects a child’s educational performance, including impairments Caused by a congenital abnormality (i.e. clubfoot, absence of limb), Caused by disease (i.e. polio, bone tuberculosis), From other causes (i.e. cerebral palsy, amputation, fracture, burn, etc.) (IDEA, 2004). 2 Types: Orthopedic, Neuromotor A severe orthopedic impairment adversely affects a child’s educational performance, including impairments Caused by a congenital abnormality (i.e. clubfoot, absence of limb), Caused by disease (i.e. polio, bone tuberculosis), From other causes (i.e. cerebral palsy, amputation, fracture, burn, etc.) (IDEA, 2004). 2 Types: Orthopedic, Neuromotor

Other Health Impairments 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 chronic or acute health problems such as asthma, ADD/ADHD, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and Adversely affects academic performance (IDEA, 2004). 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 chronic or acute health problems such as asthma, ADD/ADHD, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and Adversely affects academic performance (IDEA, 2004).

OI & OHI: The Big Picture Common criteria in both definitions: that adversely affects a child’s educational performance Conditions may be congenital or acquired. Not all students with physical or health conditions need/receive special education. Chronic vs. acute conditions Common criteria in both definitions: that adversely affects a child’s educational performance Conditions may be congenital or acquired. Not all students with physical or health conditions need/receive special education. Chronic vs. acute conditions

Why is ADD/ADHD included? Children with attention-deficit/hyperactivity disorder are served under the OHI category of IDEA with the reasoning that their condition results in a heightened alertness that adversely affects their educational performance.

Prevalence Chronic medical conditions affect up to 20% (about 12 million) school-age children in the U.S. (Sexson & Dingle, 2001). In , of children between 6-21: 62,618 received services under OI category. 557,121 received services under OHI category. (U.S. Department of Education, 2007) Chronic medical conditions affect up to 20% (about 12 million) school-age children in the U.S. (Sexson & Dingle, 2001). In , of children between 6-21: 62,618 received services under OI category. 557,121 received services under OHI category. (U.S. Department of Education, 2007)

Initial Reactions… What words and feelings immediately come to mind… When seeing a child in a wheelchair? When seeing a non-verbal child communicate in other ways? When seeing a school-age child exhibit impulsive behavior? As a special educator, how should you view these children? What words and feelings immediately come to mind… When seeing a child in a wheelchair? When seeing a non-verbal child communicate in other ways? When seeing a school-age child exhibit impulsive behavior? As a special educator, how should you view these children?

COMMON PHYSICAL & OTHER HEALTH IMPAIRMENTS Types, Causes, & Accommodations

Cerebral Palsy Most prevalent physical disability in school- age children. Permanent condition, not progressive Results from a brain lesion or abnormal brain growth (before, during, or after birth). Varies in type and degree of impairment 23% - 44% also have cognitive impairments. Some also have vision and/or hearing impairments. Most prevalent physical disability in school- age children. Permanent condition, not progressive Results from a brain lesion or abnormal brain growth (before, during, or after birth). Varies in type and degree of impairment 23% - 44% also have cognitive impairments. Some also have vision and/or hearing impairments.

Cerebral Palsy A disorder of involuntary movement and posture May affect one or multiple limbs Symptoms: Disturbances of voluntary motor function May include paralysis, weakness, lack of coordination, involuntary convulsions Little or no control over arms, legs, or speech Effects muscle tone A disorder of involuntary movement and posture May affect one or multiple limbs Symptoms: Disturbances of voluntary motor function May include paralysis, weakness, lack of coordination, involuntary convulsions Little or no control over arms, legs, or speech Effects muscle tone

Effects on muscle tone and quality: Hypertonia – tense, contracted muscles; results in jerky movements Hypotonia – weak, floppy muscles; may need external supports Athetosis – causes large, irregular, twisting movements, including drooling Ataxia – causes poor sense of balance and hand use Effects on muscle tone and quality: Hypertonia – tense, contracted muscles; results in jerky movements Hypotonia – weak, floppy muscles; may need external supports Athetosis – causes large, irregular, twisting movements, including drooling Ataxia – causes poor sense of balance and hand use Cerebral Palsy

CP Accommodations Collaboration of physicians, teachers, physical/occupational therapists, and communication specialists. Muscle stretching and strengthening exercises Careful positioning Use of assistive devices in walking Use of a wheelchair Collaboration of physicians, teachers, physical/occupational therapists, and communication specialists. Muscle stretching and strengthening exercises Careful positioning Use of assistive devices in walking Use of a wheelchair

Communication devices Stabilization tools Grasping aids Creation of boundaries Modification of toys and equipment MOVE Curriculum – Activity-based program (p. 411) Communication devices Stabilization tools Grasping aids Creation of boundaries Modification of toys and equipment MOVE Curriculum – Activity-based program (p. 411) CP Accommodations

Most common neural tube defect, in which the vertebrae do not enclose the spinal cord, causing a portion of the spinal cord and nerves controlling lower body muscles to fail to develop normally. Myelomeningocele – most common and serious form High risk of paralysis and infection 80-90% also develop hydrocephalus, accumulation of spinal fluid in tissues surrounding the brain Most common neural tube defect, in which the vertebrae do not enclose the spinal cord, causing a portion of the spinal cord and nerves controlling lower body muscles to fail to develop normally. Myelomeningocele – most common and serious form High risk of paralysis and infection 80-90% also develop hydrocephalus, accumulation of spinal fluid in tissues surrounding the brain Spina Bifida

Typical symptoms: Some degree of paralysis in lower limbs Lack full bladder control Good upper-body usage Accommodations Use of wheelchair, braces, crutches, or walkers Catheterization Assistance in dressing and toileting Typical symptoms: Some degree of paralysis in lower limbs Lack full bladder control Good upper-body usage Accommodations Use of wheelchair, braces, crutches, or walkers Catheterization Assistance in dressing and toileting Spina Bifida

Refers to a group of about 40 inherited diseases marked by progressive atrophy of the body’s muscles. Duchenne MD – most common and severe type. Progressive reduction of muscle tone causes difficulty in walking and other movements. Refers to a group of about 40 inherited diseases marked by progressive atrophy of the body’s muscles. Duchenne MD – most common and severe type. Progressive reduction of muscle tone causes difficulty in walking and other movements. Muscular Dystophy

Goals of treatment: Maintaining function of unaffected muscles for as long as possible. Facilitating movement. Providing emotional support to child and family. No known cure currently exists. Encourage children to be as active as possible. Avoid lifting or pulling children by their limbs. Goals of treatment: Maintaining function of unaffected muscles for as long as possible. Facilitating movement. Providing emotional support to child and family. No known cure currently exists. Encourage children to be as active as possible. Avoid lifting or pulling children by their limbs. MD Accommodations

Condition resulting in chronic repetition of seizures. A disorder, not a disease 30% of cases caused by other conditions (i.e. cerebral palsy, brain infection, high fever). Psychological, physical, or sensory factors may trigger seizures (i.e. fatigue, anger, hormonal changes, light); may experience aura beforehand. Condition resulting in chronic repetition of seizures. A disorder, not a disease 30% of cases caused by other conditions (i.e. cerebral palsy, brain infection, high fever). Psychological, physical, or sensory factors may trigger seizures (i.e. fatigue, anger, hormonal changes, light); may experience aura beforehand. Epilepsy

Types of seizures: Generalized tonic-clonic seizure (grand mal) – most serious type; loss of consciousness, muscles become stiff and body shakes violently, usually diminishing in 2-3 minutes Absence seizure (petit mal) – far less severe but may occur more frequently; brief loss of consciousness occurs for a few seconds, causing person to stare blankly Types of seizures: Generalized tonic-clonic seizure (grand mal) – most serious type; loss of consciousness, muscles become stiff and body shakes violently, usually diminishing in 2-3 minutes Absence seizure (petit mal) – far less severe but may occur more frequently; brief loss of consciousness occurs for a few seconds, causing person to stare blankly Epilepsy

Use of medication During a seizure: Keep everyone around calm. Ease child gently to floor. Put something soft under his head. Turn him gently to his side. Do not attempt to restrain movements or do anything to his mouth. Allow the child to rest until full consciousness returns. Use of medication During a seizure: Keep everyone around calm. Ease child gently to floor. Put something soft under his head. Turn him gently to his side. Do not attempt to restrain movements or do anything to his mouth. Allow the child to rest until full consciousness returns. Epilepsy Accommodations

Other Health Impairments Spinal Cord Injuries Diabetes Asthma Cystic Fibrosis HIV/AIDS May require special education and other related services, such as health care services or counseling. Spinal Cord Injuries Diabetes Asthma Cystic Fibrosis HIV/AIDS May require special education and other related services, such as health care services or counseling.

ADD & ADHD To be diagnosed with attention- deficit/hyperactivity disorder, a child must display 6 or more symptoms listed in the DSM-IV of inattention or hyperactivity-impulsivity for a period of at least 6 months. List on p. 421 Many children with ADHD who meet eligibility requirements are served under other disability categories (LD, emotional disturbance). Prevalence: 3-5% of all school-age children To be diagnosed with attention- deficit/hyperactivity disorder, a child must display 6 or more symptoms listed in the DSM-IV of inattention or hyperactivity-impulsivity for a period of at least 6 months. List on p. 421 Many children with ADHD who meet eligibility requirements are served under other disability categories (LD, emotional disturbance). Prevalence: 3-5% of all school-age children

Remember… Kids with disabilities are kids first.

INSTRUCTIONAL STRATEGIES Research-Based Educational Approaches

Inside a Real Classroom Meet Hope Bailey, special educator and parent of a child with spina bifida. Hope teaches a Multiple Disabilities Class at Sprayberry Education Center, in Tuscaloosa County School System. Meet Hope Bailey, special educator and parent of a child with spina bifida. Hope teaches a Multiple Disabilities Class at Sprayberry Education Center, in Tuscaloosa County School System.

Guiding Principles Use ongoing assessment to guide instruction. Individualize instruction to the greatest extent possible (IEP). Promote student independence. Collaborate with a team of experts to develop and implement a comprehensive educational, physical, and medical plan. Use ongoing assessment to guide instruction. Individualize instruction to the greatest extent possible (IEP). Promote student independence. Collaborate with a team of experts to develop and implement a comprehensive educational, physical, and medical plan.

Collaboration Special educators Para-professional aides Physical therapists Occupational therapists Speech-language pathologists Adapted physical educators Recreation therapists School nurses Counselors & Psychologists Special educators Para-professional aides Physical therapists Occupational therapists Speech-language pathologists Adapted physical educators Recreation therapists School nurses Counselors & Psychologists

Environmental Modifications Include adaptations to provide increased access to a task or activity, changing the way in which instruction is delivered, and changing the manner in which the task is done. Examples: Location of items in classroom Soft-tip pens for writing Modifying response requirements Include adaptations to provide increased access to a task or activity, changing the way in which instruction is delivered, and changing the manner in which the task is done. Examples: Location of items in classroom Soft-tip pens for writing Modifying response requirements

Assistive Technology Any piece of equipment used to increase, maintain, or improve a child’s functional capabilities. IDEA defines as both devices and services needed to help a child obtain and use devices. Include both low-tech and high-tech devices Examples: Power wheelchairs Communicative aides Online list of tools Any piece of equipment used to increase, maintain, or improve a child’s functional capabilities. IDEA defines as both devices and services needed to help a child obtain and use devices. Include both low-tech and high-tech devices Examples: Power wheelchairs Communicative aides Online list of tools

Healthcare Strategies Individualized Health Care Plan (IHCP) Describes health-related needs and procedures Included as part of a student’s IEP Chart on p. 440 – Example of IHCP objectives Establish routines and procedures to ensure proper positioning, seating, lifting, and moving. Benefits & Guidelines on pp. 437 & 441 Sample Routine – p. 442 Individualized Health Care Plan (IHCP) Describes health-related needs and procedures Included as part of a student’s IEP Chart on p. 440 – Example of IHCP objectives Establish routines and procedures to ensure proper positioning, seating, lifting, and moving. Benefits & Guidelines on pp. 437 & 441 Sample Routine – p. 442

Behavioral Interventions Positive reinforcement for on-task behavior Modification of instructional activities Systematically teaching self-control Research indicates success in students with ADHD when self-monitoring is directly linked with clear instructions and consistent reinforcement (Biscard & Neef, 2002). Positive reinforcement for on-task behavior Modification of instructional activities Systematically teaching self-control Research indicates success in students with ADHD when self-monitoring is directly linked with clear instructions and consistent reinforcement (Biscard & Neef, 2002).

Self-Monitoring Steps 1. Specify target behavior and performance goals. 2. Select materials that simplify the process. 3. Provide supplementary cues to self-monitor. 4. Provide explicit instruction. 5. Reinforce accurate self-monitoring. 6. Reward improvements in the target behavior. 7. Encourage self-evaluation. 8. Evaluate the program. (pp ) 1. Specify target behavior and performance goals. 2. Select materials that simplify the process. 3. Provide supplementary cues to self-monitor. 4. Provide explicit instruction. 5. Reinforce accurate self-monitoring. 6. Reward improvements in the target behavior. 7. Encourage self-evaluation. 8. Evaluate the program. (pp )

Fostering Independence & Self-Esteem How parents, teachers, classmates, and others react to a child with a disability is as important as the disability itself. Strategies: Encouragement of a positive, realistic self-view Opportunities to experience success and failure Reasonable expectations for performance and behavior Embracing unique interests and abilities Fostering independence – box on pp How parents, teachers, classmates, and others react to a child with a disability is as important as the disability itself. Strategies: Encouragement of a positive, realistic self-view Opportunities to experience success and failure Reasonable expectations for performance and behavior Embracing unique interests and abilities Fostering independence – box on pp

Placement Alternatives About 50% of students with physical impairments and chronic health conditions are served in general education classrooms. The amount of support and accommodations varies greatly according to condition, needs, and level of functioning. Placement decisions should be made on a case-by- case basis, with the student’s needs and best interest in mind. About 50% of students with physical impairments and chronic health conditions are served in general education classrooms. The amount of support and accommodations varies greatly according to condition, needs, and level of functioning. Placement decisions should be made on a case-by- case basis, with the student’s needs and best interest in mind.

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