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

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)

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

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

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

Spina bifida 3 Forms of SB Occulta Meningocele Myelomeningocele

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

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

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

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

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

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

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

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

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

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.

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