1. Special Education 547 Unit One - Part 2 Physical/Health Disabilities: Definitions and Impact on Education Kevin Anderson Minnesota State University Moorhead 2006

2. Physical and Health Disabilities General Information –Review of definitions –Associated medical conditions –Medical and therapeutic interventions Onset of disability –Congenital –Acquired Nature of disability –Acute –Chronic Impact and strategies

3. Review of disabilities Neuromotor impairments Degenerative diseases Orthopedic and musculoskeletal disorders Health disabilities

4. Neuromotor Impairments Originate in the CNS Affect nerves and muscles Types –CP –Neural Tube defects –TBI

5. Cerebral Palsy Definitions –Disorder of movement and posture –Non-progressive brain abnormality –Developmental disability –Affects physical development Movement Muscle tone Position in space

6. Time of Assault Prenatal –Brain malformation –Genetic syndrome –Infection –Anoxia Perinatal –Asphyxia –Infection Postnatal –Infection –TBI –Poison –Anoxia

7. Classifications Location –Diplegia –Hemiplegia –Quadriplegia Neuroanatomy –Area of the brain involved –Neurological or neurophysiological dysfunction

8. Classifications Movement –Spastic –Dyskinesia –Ataxia –Mixed Function –Mild –Moderate –Severe

9. Associated Conditions Sensory impairments Communication impairments Orthopedic deformities Nutrition needs Cognitive dysfunction Learning disabilities Seizures

10. Treatment Therapeutic –Physical therapy –Occupational therapy Orthotics Medication Surgical

11. Developmental Impact Physical Management –Spasticity –Athetosis –Ataxia –Mixed Body mechanics Communication Social/emotional

12. Educational Impact Inclusion Differences Learning issues Self-determination Adult outcomes

13. Neural Tube Defects (NTD’s) Malformations of the brain, spinal cord, and/or vertebrae Commonly referred to collectively as spina bifida Failure of spinal column to close properly Contributing factors –Nutrition –Medication –Temperature Folic acid supplements Genetic links - ethnic prevalence Gender ratio

14. Types of NTD’s Malformation of skull and portion of brain pushes out - encephalocele Absence of brain development beyond the brain stem - anencephaly Most common - spina bifida –Few vertebrae are bifid and no protrusion - spina bifida occulta –Covering or meninges protrude through open defect in spine - meningocele –Protrusion of spinal cord and meninges through vertebral defect - myelomeningocele

15. Associate Medical Conditions with Myelomengingocele Location of vertebral defect is directly associated with the level of paralysis and loss of sensation Lower level may impact only spinal nerves and higher level may impact spinal cord Loss of sensation Loss of bowel or bladder control –Lack of urge may lead to overfilling or reflux –Infections and overstretched bladder results

16. Levels of Paralysis Cervical. The neck area contains 8 vertebrae (C1 through C8). Loss of function in the chest, arms, and legs. Thoracic. The chest area contains 12 vertebrae (T1 through T12). The first thoracic vertebra, T1, is the vertebra where the top rib attaches to the spine. Affects the chest and the legs. Lumbar. The lumbar area (between the chest area and the pelvis) contains 5 vertebrae (L1 through L5). Affects the hips and legs. Sacral. The sacral area (from the pelvis to the end of the spine) contains 5 vertebrae (S1 through S5). Affects the hips and legs, as well as bowel and bladder function.

17. Associate Medical Conditions with Myelomengingocele Blocked cerebral spinal fluid (CSF) drainage - hydrocephalus –Head enlargement –Brain abnormalities –Seizures Joint deformities and spinal curvature Spinal cord “caught” on vertebrae or restricted by scar tissue - tethered cord –Cord is stretched –Causes spinal curvature or nerve damage

18. Interventions Surgical interventions –Closure shortly after birth to prevent infection and protect nerves from injury –Placement of shunt to allow CNF drainage and prevent brain damage –Release of tethered cord Orthopedic treatment –Prevention of deformities of spine, hip, and legs through supported standing and prone –Surgery, braces, and splints –Impact on ambulation Therapeutic interventions –Physical therapy –Occupational therapy –Clean intermittent catheterization (CIC) and program for regular bowel movements

19. Developmental Impact Early intervention –Sensory-motor skills –Social development School age programs –Motor development –Functional skills self-care mobility

20. Developmental Impact Physical and cognitive development –Motor impairment Increased dependency Limited manipulation of materials and play Contraindicated activities due to shunt –Cognitive impairment Restricted opportunities Damage to brain tissues Psychosocial development –Motivation and frustration level –Lack of mastery of skills –Stigmatization due to odor associated with incontinence –Self-esteem and body image issues

21. Educational Impact Unique needs –Frequent absences –Self-care training needs –Therapy activities Academic challenges –Learning disabilities –Emotional disorders –Motor planning issues Language issues – “cocktail party language” –False impression of ability may lead to unrealistic expectations

22. Educational Impact Personal autonomy –Signs of shunt malfunction (see Fig. 2-2, p. 36) Headache, lethargy, nausea or vomiting Subtle changes in performance, handwriting, or social behavior –Management and strategies for care of personal needs Skin Fractures Bladder and bowel Independence Career and adult outcomes

23. Traumatic Brain Injury (TBI) Head injury –No fracture - closed –Penetration of skull - open Brain injury –Traumatic or non-traumatic events –Acquired condition Concussion - mild TBI –There may be no apparent damage –Second impact syndrome (swelling and bleeding) may result if not resolved Contusion –Sudden movement of brain towards inside of skull - coup/contracoup

24. Associated Medical Conditions with TBI Cognitive impairment –Memory and attention –Organization and perception –Problem-solving and reasoning –Seizure activity Sensation loss –Damage to eyes –Cortical visual impairment (CVI) and nystagmus or diplopia –Damage to ears Motor impairment –Spasticity –Ataxia –Tremors Other impairments –Feeding –Communication –Behavior

25. Interventions Medical response –Support vital functions - ABC (Airway, breathing, circulation) –Appropriate head and neck positioning –Medication management –Reduction of environmental stimulation Neurological assessment Neurosurgery may be indicated –Reduce intracranial pressure –Remove foreign objects

26. Therapeutic Interventions Acute care –Coma stimulation –Stabilization –Passive mobility Rehabilitation –Compensatory skills –Prevention of complications –Promote residual skills

27. Coma Recovery Definition –Loss of consciousness –Unresponsiveness Measurement –Glascow Coma Scale (GCS) (table 2-1, p. 40) Baseline of responsiveness 3 measures - Eye movement, motor response, and verbal response –Emerging from coma - “lightening” –Rancho Los Amigos Cognitive Scales (table 2-2, p. 41) Initial stages of recovery Reference for rate of recovery and functional ability

28. Developmental Impact Physical and cognitive development –Factors Injury-related Treatment-related Patient-related –Physical changes Sensory problems Balance issues Seizure activity –Cognitive changes Attention Perception Memory and learning

29. Strategies for Physical and Cognitive Problems Attending and limited response rate is not deliberate Stimulation needs to be controlled Reduce complexity Modify instruction Repetition Localized versus diffuse damage

30. Developmental Impact Psychosocial development –Behavioral changes –Emotional lability –Response to specific “antecedents” may be predictable –Poor self-esteem or image –Depression

31. Educational Impact School reentry (Fig. 2-3, p. 47) –Transition needs –Gradual introduction to academics –Gradual introduction to teachers and peers Career and adult outcomes

32. Degenerative Diseases Features –Progressive loss of motor movement –Increasingly restricted physical ability –Psychosocial factors - control, fatigue, discomfort, and mortality Muscular Dystrophy is one of the many types of degenerative diseases –Progressive weakness and death of muscle fibers –Most common is Duchenne Muscular Dystrophy (DMD) - absence or alteration of protein called dystrophin

33. Duchenne Muscular Dystrophy Symptoms observed between 2-6 years Weakness usually begins in lower legs and pelvic girdle muscles Muscle tissue replaced with fat and fibrous tissue Uses arms to support posture Sway back leads to scoliosis Gradual loss of mobility leads ultimately to respiratory dysfunction Death at young adulthood usually due to respiratory or heart failure

34. Associate Medical Conditions with DMD Loss of respiratory function secondary to abdominal and thoracic muscle weakness Difficulty coughing up secretions may lead to pneumonia Cardiac muscle weakness Deterioration of ambulatory skills Development of contractures

35. Interventions Goal is to maintain function and slow progression of symptoms Surgery may be indicated –Release contractures to prolong ambulation –Stabilize vertebrae to improve respiratory function and aid sitting Orthopedic treatment –Mobility equipment –Handling issues –Powered mobility Therapy needs –Mobility –Self-care

36. Developmental Impact Physical development –Initially normal development –Slow, progressive loss of function –Implications for physical changes Understanding of mobility and progression Periodic monitoring of skills Match status with appropriate level of assistance Allow maximal level of independence while monitoring endurance Monitor weight and dietary changes

37. Developmental Impact Cognitive development –May impact verbal performance –Low performance expectations –Frequent absences Psychosocial development –Implications of terminal illness –Increasing dependency –Social isolation –Changing body image –Depression

38. Educational Impact Maintain level of activity and educational rigor Use adaptation strategies –Low-tech –High-tech Personal autonomy –Maintain level of participation –Introduce adaptations carefully –Maintain expectations Career and adult outcomes

39. Orthopedic and Musculoskeletal Conditions Any condition related to muscular or skeletal system Limb deficiency is one disorder in this category –Absence or partial loss of a limb –Congenital or acquired –Terminal or intercalary

40. Associate Medical Conditions with Musculoskeletal Conditions May be related to a condition which is characterized by multiple anomalies Thalidomide treatment in the 50’s and 60’s is now available for cancer and AIDS related nausea

41. Interventions Surgery –Surgical amputations –Corrective procedures to improve function –Preparing limb for prosthetic device Orthopedic treatment –Prosthetics –Extend length, reach, and motion of limb Therapy –Prosthetic training –Adjusting to loss limb –Monitor health and fit of prosthesis’

42. Developmental Impact Psychosocial development –Age is important factor –Family attitudes and expectations –Loss of ability versus development of compensatory skills –Dealing with reactions of others

43. Educational Impact Adaptations Compensatory skills Personal autonomy –Allow different ways of completing tasks –Care for own prosthesis –Allow student to struggle to achieve independence Career and adult outcomes

44. Health Disabilities Conditions that limit strength, vitality, and alertness Chronic or acute Increasing numbers in public schools

45. Major Health Impairments Heart disorders Blood disorders Asthma Cystic fibrosis Juvenile diabetes Chronic renal failure Childhood cancer

46. Infectious Diseases Hepatitis Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Disease (AIDS) Other infectious diseases

47. Guidelines for Educators CEC –Knowledge of condition and effect on development –Psychological and emotional characteristics –Lesson adaptation to accommodate effects –Understand medical perspective –Practice and teach universal precautions and confidentiality practices –Access professional organizations

48. Visibility Factor Developmental impact Lack of visual reminder Not perceived as ill Engage in activities which are not appropriate May not be disclosed or identified Chronic nature lead to lifetime management issues

49. Asthma Most common pulmonary disease Mild to life-threatening symptoms Reactive to uncontrolled variables, such as the environment Classifications –Extrinsic, intrinsic, or mixed –Aspirin/exercise/occupation induced

50. Description Result of body’s immune response Antigens (foreign substances) enter lungs and antibodies are produced to suppress antigens Asthmatic - specific antibodies that react adversely to antigens –Swelling –Mucus secretion –Muscle tightening –Leads to airway restriction and difficulty breathing

51. Associated Medical Conditions Trapped air Over-inflated lungs Difficulty exhaling Barrel-shaped chest

52. Treatment Prevention –Cause –Environmental control measures Removing triggers Reduce allergens –Immunotherapy –Medication

53. Treatment Intervention –Bronchodilators Inhaler Nebulizer –Symptoms Shortness of breath Unresponsive Cyanosis Other options to reduce mucus –Moist air –Pulmonary percussion –Postural drainage –Coughing techniques –Breathing exercises

54. Developmental Impact Not related to cognitive development, unless associated with syndrome or injury Early development stages may be limited due to limited mobility and exploration Adaptations may be necessary to promote access to materials Temperature awareness due to difficulty regulating body temperature

55. Developmental Impact Physical or cognitive development Psychosocial development –Historical perspective –May be induced by heightened emotional state –Attacks may impact others reactions –Overprotection –Absenteeism

56. Educational Impact Fatigue or alertness Attendance related to fears or avoidance Educational responsibility –Environmental control –Intervention techniques Remove irritant Encourage student to sit and use appropriate medication and clear liquids Contact appropriate personnel Keep record

57. Educational Impact Emergencies –Develop and follow a plan of response –Maintain support and reassurance –Remove other students –Clear space –De-brief Self-determination –Medication use –Privacy –Side effects or impact of medication Future outcomes –Environmental impact –Stamina and motivation

58. Cystic Fibrosis Hereditary and progressive disease Affects lungs and other major organs No gender difference CF gene on 7th chromosome Exocrine system disease –Sticky mucus in respiratory system –Decreased lung efficiency –Lungs may collapse or over-inflate Digestive system –Impacts release of pancreatic juices –Affects digestion and overall nourishment Progressive and terminal disease

59. Associated Medical Conditions Systemic condition - affects many organs of body Mucus traps secretions “Cysts” and scar tissue develop Leads to pneumonia and other respiratory complications Bowel obstruction Unbalance caloric intake and nutrient absorption Salt and fluid loss through sweat May develop diabetes Late onset of puberty

60. Treatment Gene therapy Antibiotics Expectorants Chest percussion Postural drainage Transplants Vitamin and mineral supplements Digestive enzymes Healthy and low-fat diet

61. Developmental Impact Growth Sexual development Physical abnormalities Attendance may impact learning Psychosocial development –Medical needs –Family burden –Personal self-image, hopelessness

62. Educational Impact Medical treatments at school Medical appointments Attendance Self-determination –Managing treatments –Responsibility for class work Future outcomes –Physical endurance issues –Terminal nature of disease

63. Cancer Growth and spread of abnormal cells Tumors or neoplasms Benign vs. malignant Metastasizing cells Terminal disease Usually involves connective or supporting tissue in children

64. Associated Medical Conditions Depends on site of cancer Illness associated with site Metastasizing cancer may affect systems

65. Treatments Early identification important Surgical intervention Chemotherapy –Drugs to prevent cell division –Unpleasant side effects –Drugs may be used to counteract side effects Radiation –Attacks atomic structure of cancer cells –Used in conjunction with chemotherapy Bone marrow transplants for leukemia

66. Developmental Impact Altered physical development Deterioration of body functions Pain impacts overall functioning Psychosocial development –Fears –Self-consciousness –Terminal possibility

67. Educational Impact Consistency in programming Medical appointments and treatments Flexibility Self-determination –Awareness of impact –Learning to cope Adult outcomes –Maintain goals –Instill hope