1. Chapter 11 Physical Disabilities, Health Impairments, and ADHD Maria Alfonso Prof. Sylvia G. Doane-Ward EEX2000/ 353671 2005-3

2. Physical Disabilities And Health Impairments Children with physical disabilities and health conditions who require special education are served under two IDEA disability categories. Orthopedic Impairments ( including Neuromotor Impairment ) Other Health Impairments

3. Definitions –An orthopedic impairment involves the skeletal system- bones, joints, limbs, and associated muscles. –A neuromotor impairment involves the central nervous system, affecting the ability to move, feel or control certain parts of the body. –Children served under other health impairments have limited strength, vitality, or alertness due to chronic or acute health problems. e.g., Heart condition, tuberculosis, hemophilia, epilepsy, conditions that adversely affects a child’s educational performance.

4. Prevalence It is estimated that chronic medical conditions affect up to 8.6% of school age children. Students with physical disabilities may be served under other categories, because their health impairments accompany other disabilities.

5. Types and Causes Cerebral Palsy –CP is a permanent condition resulting from a lesion to the brain or an abnormality of brain growth. Types of CP –Spastic: tense, contracted muscles –Athetoid: large, irregular, uncontrolled twisting motion. –Ataxia: poor sense of balance, body position, and lack of coordination of the voluntary muscles. –Rigidity and Tremor: least common; extreme stiffness in affected limbs; tremors are uncontrollable movements

6. The Mobility Opportunities Via Education (MOVE) curriculum is a program to teach students with cerebral palsy how to walk and also teaches other functional mobility skills.

7. Spina Bifida –Spina bifida is a condition in which the vertebrae does not enclose the spinal cord. Types of Spina Bifida –Spina bifida occulta (mildest form): only a few vertebrae are malformed. –Meningocele: the covering of the spinal cord protrudes through an opening in the vertebrae, but the cord and nerve roots are enclosed. –Myelomeningocele (most common, most serious): a protrusion on the back of a child consisting of a sac of nerve tissue bulging through a cleft in the spine. –Hydrocephalus: an enlarged head caused by cerebral spinal fluid accumulating in the cranial cavity; often causes brain damage and severe retardation can sometimes be treated successfully with a shunt.

8. Muscular Dystrophy –Muscular dystrophy refers to a group of inherited diseases marked by progressive wasting away of the body’s muscles. –At this time there is no known cure, and in most cases, this disease is fatal in adolescence or young adulthood. –Death is often caused by heart failure or respiratory failure due to atrophied chest muscles. –Treatment focuses on maintaining function of unaffected muscles for as long as possible.

9. Spinal Cord Injuries –Spinal cord injuries are caused by a penetrating injury ( e.g. a gunshot wound), stretching of the vertebral column ( e.g. whiplash during an auto accident), fracture of the vertebrae, or compression of the spinal cord ( e.g. a diving accident). –The high the injury on the spine and the more the injury cuts through the spinal cord, the greater the paralysis. –Rehabilitation programs for children with spinal cord injuries usually involve physical therapy, use of adaptive devices for mobility, and psychological support to help them adjust to sudden disability.

10. Epilepsy –Epilepsy is when seizures occur chronically and repeatedly, however the condition is also called seizure disorder. A seizure is a disturbance of movement, sensation, behavior, and/or consciousness caused by abnormal electrical discharges in the brain. Types of Epilepsy –Generalized tonic-clonic seizure (most severe): violent convulsions, loses consciousness, and becomes rigid. –Absence seizure: occurs frequently, loses consciousness for less than half a minute. –Complex partial: a brief period of inappropriate or purposeless activity in which lasts from 2-5 minutes, after which the child has amnesia about the entire episode.

11. Diabetes (chronic disorder of metabolism) –Children with Type I diabetes (formerly called juvenile diabetes or early-onset diabetes) have insufficient insulin, a hormone normally produced by the pancreas and necessary for the metabolism of glucose, a form of sugar produced when food is digested. –Hypoglycemia (low blood sugar) symptoms: faintness, dizziness, blurred vision, drowsiness, and nausea. Concentrated sugar ends the insulin reaction in a few minutes. (e.g. sugar cubes, glass of fruit juice, or a candy bar) –Hyperglycemia (high blood sugar) symptoms: fatigue, thirst, dry/hot skin, deep/labored breathing, excessive urination, and fruity-smelling breath. A doctor or nurse should be called immediately when a student shows symptoms of hyperglycemia.

12. Asthma –Asthma is a chronic lung disease characterized by wheezing, coughing and difficulty breathing. –An asthmatic attack is usually triggered by allergens (e.g. pollen, certain foods, pets), irritants (e.g. cigarette smoke, smog), exercise, or emotional stress, which results in narrowing of the airflow in and out of the lungs making it hard to breathe. –Asthmatic attacks can occur from very mild to extremely severe requiring emergency treatment. –Asthma is the most common lung disease in children and it’s the leading cause of absenteeism in school.

13. Cystic Fibrosis –Cystic fibrosis is a genetic disorder in which the exocrine glands excrete thick mucus that can block the lungs and parts of the digestive system. –It is a hereditary disease found predominantly in Caucasians. –Malnutrition and poor growth are common characteristics of children with cystic fibrosis.

14. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) Students with AIDS are not able to fight off infections because of a breakdown of the immune system. AIDS is caused by HIV, which is found in bodily fluids of an infected person. Children with HIV/AIDS legally cannot be excluded from attending school unless they are deemed a direct health risk to others. Parents are not required to inform the school that their child has HIV ( or any other medical or health condition), and a particular student or staff member may have HIV without knowing it. Students receiving special education services may be more prone to contracting HIV because of a lack of knowledge about the disease.

15. Attention-Deficit/Hyperactivity Disorder (ADHD) ADHD is a persistent pattern of inattention and/or hyperactivity/impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. ADHD is not a category recognized by IDEA, but is estimated that students with ADHD also have learning disabilities and/or emotional and behavioral disorders and receive special education under those categories. It is estimated that 3-5% of all school-age children have ADHD. In most cases, the cause is unknown. Growing evidence that genetic factors may place individuals at a greater than normal risk of an ADHD diagnosis. Neuroimaging technology shows that some individuals with ADHD have structural or biochemical differences in their brains. Ritalin is the most frequently prescribed medication for children with ADHD. Behaviorally based interventions for students with ADHD includes reinforcing on-task behavior, modifying assignments and instructional activities to promote success, and teaching self- control strategies.

16. Educational Approaches Teaming and Related Services –Physical therapists: plan and oversee a child’s program for making correct and useful movements. –Occupational therapists: help a child learn (or relearn) diverse motor behaviors especially those that will be useful in self- help, employment, recreation, communication, and aspects of daily living. –Other specialists include: Speech-language pathologists (SLPs), Adapted physical educators, Recreation therapists, School nurses. Environmental Modifications –Environmental modifications are frequently necessary to enable a student with physical and health impairments to participate more fully and independently in school. –Includes adaptations to provide increased access to a task or an activity changing the way in which instruction is delivered and changing the manner in which the task is done.

17. Educational Placement Alternatives About 40% of students with physical disabilities are served in special classes in the public schools. Some children with the most severe physical and health impairments are served in homebound or hospital education programs. Home or hospital settings are usually regarded as the most restrictive placements because little or no interaction with nondisabled students is possible. Successful reentry of a child who has missed extended periods of school because of illness or the contraction of a disease requires preparation of the child, the parents, classmates, and school personnel.

18. References Heward, William L. (2006). “Physical Disabilities, Health Impairments, and ADHD.” Exceptional Children: An Introduction to Special Education, 11, 423-460