1. OO Orthopedic Impairment Ronda L. Harrison University of St. Thomas School of Education and Human Services Evidence-Based Practices for Students with Mild Disabilities

2. Definition of Orthopedic Impairments (OI) An orthopedic impairment is defined by IDEA as a “severe orthopedic impairment that adversely affects a child’s educational performance.” Orthopedic impairment includes impairments cause by a congenital anomaly (birth defects), impairments cause by disease (e.g. poliomyelitis, bone tuberculosis), and impairments from other causes (e.g. cerebral palsy, amputations, and fractures or burns that cause contractures) U.S. Department of Education. (2004) Building the Legacy. Retrieved February 21, 2016 from http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,c,8,http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,c,8

3. Overview of OI Orthopedic impairments are conditions that affect movement. Gross motor control or mobility (ex: walking) Fine motor control (ex: writing) May be mild, moderate, or severe Genetic abnormalities, injury, birth trauma, stroke, and diabetes can also be causes of OI. Typically students with OI have the same cognitive abilities as their peers without disabilities and can be mainstreamed.

4. Identifying Orthopedic Impairments Evaluating children with orthopedic impairments can be complicated because there are so many different types of disabilities and causes of impairment. Most orthopedic impairments are identified before a child enters school, but sometimes they are missed or do not appear until a later age. A teacher may notice signs of poor coordination, frequent accidents, or complaints of acute or chronic pain. Teresa Odle, (2009). Orthopedic Impairment Retrieved February 21, 2016 from http://www.education.com/reference/article/orthopedic-impairments/http://www.education.com/reference/article/orthopedic-impairments/

5. Assessing Orthopedic Impairments Assessment must include a thorough medical evaluation of the child’s orthopedic impairment by a licensed physician. Other data generally includes documentation of observations and assessments of how the orthopedic impairment affects the child’s ability to learn in the educational environment, as well as observations concerning mobility and activities of daily living. Teresa Odle, (2009). Orthopedic Impairment Retrieved February 21, 2016 from http://www.education.com/reference/article/orthopedic-impairments/http://www.education.com/reference/article/orthopedic-impairments/

6. Assessing Orthopedic Impairments cont. It is important to assess the student’s social and physical adaptive behaviors through various checklists, inventories, rating scales, and interviews with those who know the child best. The severity of functional limitations must be such that they adversely impact the child’s educational performance. If the physical condition is not going to last more than 60 days, it’s usually not considered an orthopedic impairment. Teresa Odle, (2009). Orthopedic Impairment Retrieved February 21, 2016 from http://www.education.com/reference/article/orthopedic-impairments/http://www.education.com/reference/article/orthopedic-impairments/

7. Common Types of Orthopedic Impairments Congenital anomaly: club foot, absence of some member Impairments due to the effects of disease: poliomyelitis, bone tuberculosis Impairments from other causes: cerebral palsy, amputations, fractures or burns that cause contractures. Contracture – permanent shortening of muscle, tendon, or scar tissue producing deformity or distortion. More than 50 diseases and disorders are associated with orthopedic impairments..

8. Three Main areas of Orthopedic Impairments Orthopedic impairment can be divided into three main areas: 1. neurological/neuromotor impairments 2. degenerative diseases 3. musculoskeletal disorders Friend, M. (2014). Special Education Contemporary Perspectives for School Professionals, Students with Severe and Multiple Disabilities (pp.454-485.Upper Saddle River, New Jersey: Pearson.

9. Neuromotor Impairments A neuromotor impairment is an abnormality of, or damage to, the brain, spinal cord, or nervous system that sends impulses to the muscles of the body. Acquired at or before birth Often result in complex motor problems that can affect several body systems Motor problems can include limited limb movement, loss of urinary control, and loss of proper alignment of the spine. The two most common types of neuromotor impairments are cerebral palsy and spina bifida.

10. Neuromotor Impairment: Cerebral Palsy Cerebral palsy refers to several nonprogressive disorders of voluntary movement or posture that are caused by malfunction of or damage to the developing brain that occurs before or during birth or within the first few years of life. Individuals with cerebral palsy have abnormal, involuntary, and/or uncoordinated motor movements. The four most common types of cerebral palsy include: Spastic (very tight muscles occurring in one or more muscle groups that result in stiff, uncoordinated movements) Athetoid (movements are contorted, abnormal, and purposeless) Ataxic (poor balance and equilibrium in addition to uncoordinated voluntary movement) Mixed (any combination of the types)

11. Neuromotor Impairment: Cerebral Palsy cont. Cerebral palsy is also classified by which limbs (arms and legs) are affected. Major classifications include hemiplegia (left or right side), diplegia (legs affected more than arms); paraplegia (only legs), and quadriplegia (all four limbs).

12. Neuromotor Impairment: Spina Bifida Spina bifida is a developmental defect of the spinal column. Spina bifida is characterized by an abnormal opening in the spinal column and frequently involves some paralysis of various portions of the body. It may or may not affect intellectual functioning. Spina bifida is usually classified as either spina bifida occulta or spina bifida cystica. Spina bifida occulta is a mild condition while spina bifida cystica is more serious.

13. Degenerative Diseases Degenerative diseases are composed of various diseases that affect motor development. The most common degenerative disease found in the school population is muscular dystrophy. Muscular dystrophy is a group of inherited diseases characterized by progressive muscle weakness from degeneration of muscle fibers. The Muscular Dystrophy Association, (2016). Congenital Muscular Dystrophy. Retrieved February 21, 2016 from http://aasep.org/professional- resources/exceptionalstudents/orthopedicimpairment/index.html#c2738http://aasep.org/professional- resources/exceptionalstudents/orthopedicimpairment/index.html#c2738

14. Musculoskeletal Disorders Musculoskeletal disorders are composed of various conditions that can result in various levels of physical limitations. Two examples of musculoskeletal disorders include juvenile rheumatoid arthritis and limb deficiency.

15. Educational Challenges Orthopedic impairments involve physical disabilities which could affect the academic progress. Non-accessible transportation Trouble maneuvering around the classroom Difficulty navigating eth hallways Earning mandated Physical education credit Communicating effectively

16. Prevalence of OI Orthopedic impairments are the most common of physical disabilities. The U.S. Department of Education reported for the 1995-1996 school year there were 63,157 students identified with orthopedic impairment. The U.S. Department of Education reported in 2004 that a little over 1% of all students receiving special education services were based upon classification of orthopedic impairment. (approximately 72,000) By 2010-2011 the number dropped to 55,704. Numbers should be interpreted with caution, as the students may be included as having ID, TBI, or Multiple Disabilities

17. Orthopedic Impairment Childhood Implications SocialStudents may become aggressive as a means of expressing their frustrations. They may need social skills training to learn how to communicate and integrate with their non-disabled peers. Early intervention in a school setting is optimal to teach social skills and to begin inclusive academic practices. Being able to participate in childhood play and exploration is critical. AcademicThe abilities range from extraordinary giftedness and special talents to significant intellectual disability. Most may receive early education beginning at age 3. Interventionists, physical therapists, occupational therapists, speech and language pathologists and others may provide services as needed. Special seating arrangements may be needed when they go to school. Assistive technology needs must be assessed. MedicalDepending on the type of orthopedic impairment the medical needs can range from extensive medical intervention, to regular physical therapy, to simply needing assistive device for mobility. In home services to teach parents to provide additional therapy for their child’s physical impairments can aid in maximizing the child’s motor skills. Braces, prosthetics, walkers, wheelchairs, exercise equipment may be prescribed. These students can suffer injuries as a result of their orthopedic impairment. EmotionalThey may be bullied, teased or grow weary having to explain their condition. They may not understand why they are different or are unable to do certain activities like their peers. Some students are unable to move, use, feel, or control certain body parts and this can be frustrating.

18. Orthopedic Impairment Adolescent/Teenage Implications SocialStudents may need to learn how to join in athletic games, discussions with classmates, and how to develop new friendships/relationships as they transition through elementary and middle school. They may grow weary having to explain their condition. Loss of urinary control can be a huge social stigma for these students. AcademicThey may need to learn to advocate for themselves, to work with teachers, counselors, and other professionals to positively benefit from class activities. They may miss school due to multiple surgeries and fall behind academically. Inclusive practices to the extent possible, depending on the needs of the child are ideal and should begin early to ensure student success. Navigating the school hallways, gym class, cafeteria can be especially challenging for these students. MedicalDepending on the severity of the disability, the student may need to seek medical treatment often, miss school, endure surgeries, deal with chronic or terminal illnesses. Others may need to learn to use and adjust medical equipment. The student may experience fatigue and depression from the extreme effort involved in day-to-day tasks as they attempt to become independent of their parents. EmotionalStudents may need to learn to interact without becoming aggressive or reactionary to how other respond to them or their disability. They may need counseling to cope with feeling of being less valuable than others. Limited motor, self-help, and self-care skills can be difficult to accept as the pre-teen/teenager develops.

19. Orthopedic Impairment Adult Implications SocialTransportation, living arrangements, and ability to maintain employment affect the social life of people with orthopedic impairments. Access to social service agencies is critical, which is why transition services should begin in secondary school. AcademicThe student and their family must consider if post-secondary education is the best option for the student. The student’s stamina, needs for surgeries, susceptibility of illnesses and other issues should be factored into the decision regarding whether or not to pursue post-secondary education or some type of vocational training. Assistive technology can aid in the independence of the adult if they decide to pursue higher education. Also, the ability of the school to respond to emergencies should be a consideration. MedicalSurgeries, hospital procedures, frequent illnesses and related conditions can heavily impact the life of a person with orthopedic disability. For those with significant physical limitations and the inability to drive, personal assistance may be needed in the home. Insurance and social security disability may influence the amount and quality of medical and personal care services received by the adult with orthopedic disability. Hospitalization, medication, and durable medical equipment are possible needs. EmotionalIndependent living skills need to be assessed as the student becomes an adult. It can be very depressing and frustrating to be dependent on care-givers as a young adult, especially if the person is cognitively equal to his peers without disabilities. To the extent possible and desired by the adult with OI, they should be afforded the opportunity to live the life and participate in the activities of their adult peers without disabilities..

20. References U.S. Department of Education. (2004) Building the Legacy. Retrieved February 21, 2016 from http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,c,8, http://idea.ed.gov/explore/view/p/,root,regs,300,A,300%252E8,c,8 Teresa Odle, (2009). Orthopedic Impairment Retrieved February 21, 2016 from http://www.education.com/reference/article/orthopedic-impairments/ http://www.education.com/reference/article/orthopedic-impairments/ Friend, M. (2014). Special Education Contemporary Perspectives for School Professionals, Students with Severe and Multiple Disabilities (pp.454-485.Upper Saddle River, New Jersey: Pearson. The Muscular Dystrophy Association, (2016). Congenital Muscular Dystrophy. Retrieved February 21, 2016 from http://aasep.org/professional-resources/exceptionalstudents/orthopedicimpairment/index.html#c2738 http://aasep.org/professional-resources/exceptionalstudents/orthopedicimpairment/index.html#c2738 American Academy of Special Education Professionals, (2016). Orthopedic Impairments. Retrieved February 21, 2016, from http://aasep.org/professional-resources/exceptionalstudents/orthopedicimpairment/index.html#c2738 http://aasep.org/professional-resources/exceptionalstudents/orthopedicimpairment/index.html#c2738 Special Education Guide, (2016). Orthopedic Impairments. Retrieved February 21, 2016, from http://www.specialeducationguide.com/disability-profiles/orthopedic-impairments/ http://www.specialeducationguide.com/disability-profiles/orthopedic-impairments/