1. Teaching Students with Lower-Incidence Disabilities
Chapter 11
Dr. Julie Esparza Brown
SPED 518: Survey of the Exceptional Learner

2. Focus Questions
How are visual impairments defined? How can you provide accommodations for students with visual impairments in your classroom?
How are hearing impairments defined? How can you provide accommodations for students with hearing impairments in your classroom?
How are physical disabilities, health impairments, and traumatic brain injury defined? What are some areas to consider when developing an education plan for these students?

3. Definition and Types of Visual Impairments
Legal definitions:
Legal blindness – defined as a visual acuity of 20/200 with best correction in the best eye or a visual field loss in a visual field of 20 degrees or less. The legally blind person can see at 20 feet what the average person can see at 200 feet. Only 2% of people with vision impairments are totally blind.
Low Vision – limited or diminished vision that cannot be corrected with standard lenses
Partial Sight – the field of vision is impaired because of an illness, a degenerative syndrome, or trauma. Individuals who have a visual acuity in the range of 20/70 to 20/200.
Visual acuity – the ability to see detail clearly
Visual field – how well a person can see using peripheral or side vision

4. Definition and Types of Visual Impairments
Educational definition:
Emphasizes academic tasks, particularly reading more and visual acuity less.
Visual impairment including blindness – means an impairment in vision that even with correction, adversely affects a child’s educational performance (IDEA [c][13].

5. Causes of Visual Impairments
Structural impairments
Damage to one or more parts of the visual system
Refractive errors
Inability of the eye to focus the light rays onto the retina correctly
Cortical visual impairments
Problem with the neurological pathways

6. Characteristics of Students with Visual Impairments
Possible delays in development include:
Concept development
Communication
Motor skills and mobility
Self-help
Social skills

7. Prevalence of Visual Impairments
Visual impairments are a low-incidence disability
During school year 25,855 school-age students (ages 6-21) with vision impairments were served under IDEIA
1,310 deaf-blind students also received services
25% of visual impaired students are visual readers
7% of visual impaired students auditory readers
The remaining visual impaired students are prereaders or nonreaders.

8. Identification and Assessment of Students with Visual Impairments
Red-rimmed, swollen, or encrusted eyes
Excessive blinking
Itchy eyes
Eyes that are tearing
Eye(s) turn inward, outward, upward, or downward
Extreme sensitivity to light
tilting or turning head to see objects
Squinting
Cover one eye to view objects
Thrust head forward to view object
Headache, fatigue, dizziness after doing close work
Tripping, bumping into objects, or appearing disoriented
Recurring sties
Common physical characteristics that indicate visual impairments include:

9. Identification and Assessment of Students with Visual Impairments
Assessments used by visual impairments teacher include:
Functional vision assessment
Learning media assessment
Compensatory skills

10. Instructional Guidelines and Accommodations for Students with VI
Some of the accommodations include:
General accommodations
Use of Braille and Braille devices
Orientation and mobility skills
Optical, nonoptical, and instructional aids
Testing accommodations

11. Examples of Nonoptical Aids
Nonoptical aids include:
Lamp
Reading stand
Bold-line paper
Hats and visors
Color acetate
Cranmer abacus
Raised-line paper
Writing guides
Measurement tools

12. Some Considerations
Some students use canes or guide dogs for mobility purposes. If the guide dog has a harness, it is working and should not be petted.
When speaking to a student with a vision impairment, speak in a normal voice.
Identify yourself when entering a room.
When giving directions (e.g., right, left) convert directions to the student’s perspective. Offer your arm and let students take it.

13. Instructional Considerations
Most students in primary years can access their school materials with minimal aides. As they process, however, the prints in texts become smaller and some form of magnification may become necessary.
Enlarged print is a less desirable option than standard print with the use of a low vision device. As students progress through the grades, the large amount of reading materials makes the use of enlarged print inefficient.
Enlarged print can result in inefficient reading because the reading rate is slower and this impacts comprehension.

14. Braille
Braille is a good option for many children, even those with good functional vision.
A good Braille reader may be preferable to a poor print reader.
Braille texts can now be stored electronically and there are now portable embossers.

15. Assistive Technology
Assistive technology is an integral part of a students with a vision impairment’s world.
They can range from low tech, non-optical devices like a reading stand, to a high tech piece of equipment like the Braille Note.
Structured instruction must be provided on the use of assistive technology.

16. Orientation and Mobility
Orientation is knowing where one is in relation to the environment and where one wants to go.
Acquiring orientation skills allows an individual to be an independent traveler. They may need to learn to read maps and directions and public transportation guides.
Mobility is the ability to move to one’s target location in the safest and most efficient way.
Students may need to use the white cane, protective techniques and the use of guide dogs.

17. Daily/Independent Living Skills
A child with a vision impairment may need to learn self-help skills such as eating, brushing teeth and choosing clothes.
Students may require direction instruction in skills that are at their developmental level.

18. Social Skills
Much of what children know about social behavior is learned through imitation and modeling.
Children with vision impairments are unable to learn these skills through incidental learning.
They must be taught through structured experiences.
Remember that merely placing students into regular classes does not automatically result in social inclusion.

19. Testing Accommodations
Modifications may include:
Assigning alternative items
Orally reading sections of the test
Using large-print or braille answer sheets
Providing real objects for items shown in pictures
Coloring pictures to make them easier to see

20. What’s It Like to Have a Vision Impairment?

21. Definitions and Types of Hearing Loss
Hearing loss can result from several factors:
Heredity
Illness or disease
Excessive prolonged exposure to loud noises
Prelingually deaf – children who lose hearing prior to learning language
U.S. federal government definition of hearing loss

22. Definitions and Types of Hearing Loss
Type of Hearing Loss
Definition
Unilateral
Bilateral
Conductive
Sensorineural
Mixed
Loss of hearing in one ear
Loss of hearing in both ears
Outer and middle ears do not transfer enough acoustic energy to inner ear fluids
When there is damage to the cochlea or auditory nerve
Loss is both sensorineural and conductive

23. Characteristics of Students with Hearing Loss
Degrees of Hearing Loss
16 – 25 dB = minimal loss
25 – 40 dB = mild hearing loss
40 – 65 dB = moderate hearing loss
65 – 90 dB =severe hearing loss
Greater than 90 dB = profound hearing loss
Normal hearing falls within the range 0-15 dB.

24. Characteristics of Students with Hearing Loss
Hard of hearing – person with a mild to moderate loss
Deaf – person with severe or profound loss
Residual hearing – amount of hearing remaining after a hearing loss
American Sign Language (ASL) – primary mode of communication for deaf students
Finger spelling – system for representing the English alphabet manually

25. Prevalence of Hearing Loss
In a survey of 37,352 hard of hearing students:
42.4% received instruction in the general education setting, and
12.1% received instruction in a resource setting.
The remainder received services in self-contained, special schools or were home-schooled
In the school year 71,332 students with hearing impairments received special education services.

26. Identification and Assessment of Students with Hearing Loss
Mild to moderate loss detected during kindergarten screening or by teacher
Moderate, severe, and profound losses detected prior to school
Identification and intervention are key to development of language and learning
Infants should be screened for hearing loss before hospital discharge

27. Identification and Assessment of Students with Hearing Loss
Warning signs to look for in classroom:
Day-dreaming
Lethargy
Articulation errors
Inappro-priate response to questions
Mouth breathing
Inatten-tion
Failure to follow simple verbal commands
Limited speech or vocabulary
Difficulty decoding phoneti-cally
Persistent colds
Behavior problems and frustration
Verbal expressions of misunder-standing (“Huh?”)
Difficulty with verbal tasks
Unusual voice quality
Watching other students for instructional cues

28. Make classroom accommodations Use of assistive technologies
Instructional Guidelines and Accommodations for Students with Hearing Loss
Use of amplification
Hearing aids
Implants
Make classroom accommodations
Use of assistive technologies
Personal FM system
Sound field FM system
Use of interpreters and note takers

29. If possible, provide transcripts of audio information.
Instructional Guidelines and Accommodations for Students with Hearing Loss
Use a circular seating arrangement. This offers deaf or hard of hearing students the best advantage for seeing all class participants.
When desks are arranged in rows, keep front seats open for students who are deaf or hard of hearing and their interpreters.
Repeat the comments and questions of other students, acknowledge who has made the comment so the deaf or hard of hearing student can focus on the speaker.
When appropriate, ask for a hearing volunteer to team up with a deaf or hard of hearing student for in-class assignments.
Assist the student with finding an effective notetaker or lab assistant from the class
If possible, provide transcripts of audio information.

30. Instructional Guidelines and Accommodations for Students with Hearing Loss
Face the class while speaking; if an interpreter is present, make sure the student can see both you and the interpreter
If there is an interruption in the class, get the deaf or hard of hearing student's attention before resuming teaching.
Use visuals frequently. Because visual information is a deaf student's primary means of receiving information, films, overheads, diagrams, and other visual aids are useful instructional tools.
Be flexible: allow a deaf student to work with audiovisual material independently and for a longer period of time.
Don't assume. When in doubt about how to assist the student, ask him or her.
Allow the student the same anonymity as other students (i.e., avoid pointing out the student or the alternative arrangements to the rest of the class).

31. Have a plan ready in case of emergencies, such as fire.
Instructional Guidelines and Accommodations for Students with Hearing Loss
When using films, videos, or other forms of visual media make sure that captioning is used so the student can read what is being said in the film or video.
When student is working in a group, have classmates sit in a horseshoe shape so that the student can see everyone.
Allow extra time for students to process questions and allow them to participate in answering questions aloud.
Have a plan ready in case of emergencies, such as fire.

33. Definitions and Types of Physical Disabilities, Health Impairments, and Traumatic Brain Injury
IDEIA Categories
Orthopedic impairment or physical disabilities
Other health impairment
Traumatic brain injury
Neuromotor Impairment
Muscular dystrophy, polio, multiple sclerosis
Neurological Impairment
Seizure disorders, cerebral palsy, spina bifida
Other Health Impairments
Medically fragile
Technologically dependent
Traumatic Brain Injury

34. Types of disabilities include:
Characteristics of Students with Physical Disabilities, Health Impairments, and TBI
Types of disabilities include:
Asthma
Cerebral Palsy
Spinal Bifida
Epilepsy
Muscular Dystrophy
HIV and AIDS
Traumatic Brain Injury

35. Prevalence of Physical Disabilities, Health Impairments, and TBI
Prevalence figures on the rise
Chronic health conditions vary from .22% to 44% of children in the U.S.
During school year 60,100 students had orthopedic impairments and 625,187 with health impairments.
23,805 students with TBI received special education services.

36. Identification and Assessment
Students are assessed in the following areas:
Activities of daily living
Attention, concentration, initiation, or sustained effort
Adaptations for learning
Communication
Mobility
Physical abilities and limitations
Psychosocial development
Transition skills

37. Instructional Guidelines and Accommodations
Transdisciplinary teaming
Use assistive technology
Make environmental modifications
Provide instruction for motor skills
Promote literacy development
Educate classmates
Deal with chronic illness and death

38. Great Website for TBI

39. Closing Thought
“Great teachers empathize with kids, respect them, and believe that each one has something special that can be built upon.” Ann Lieberman