Chapter Fourteen

Individuals With Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities

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Brief History of the Field

• Brief History of the Field– Early history: Babies were often left to die if they were physically

“defective”– Middle Ages: Religious influences resulted in more humane care– 1890: First U.S. institution for children with physical disabilities

(Industrial School for Crippled and Deformed Children), Boston originally planned for treatment and training, it deteriorated into a custodial care facility that segregated individuals with disabilities from society.

– Emergence of public education: Beattie v. State Board of Education (1919) stated that students with physical disabilities could be excluded from school because they produced a “depressing and nauseating effect” on other students!

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Prevalence of Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities

School-age children receiving special education by disability during the 2011-2012 school year:

‒ Orthopedic impairments (54,410 children)‒ Traumatic brain injury (24,886 children)‒ Other health impairments (734,348 children) ‒ Multiple disabilities (125,150 children)‒ Deaf-blindness (1,378 children)

The first four categories represent approximately 16% of students receiving a special education with a range of .42% (TBI) to 12.68% (OHI).

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• Federal Definitions Pertaining to Physical or Health Disabilities and Deaf-Blindness– Deaf-blindness means concomitant hearing and visual

impairment, the combination of which causes such severe communication and other developmental and educational needs that students cannot be accommodated in special education programs solely for children with deafness or children with blindness.

– Multiple disabilities means concomitant impairments (such as mental retardation–blindness, mental retardation–orthopedic impairment, etc.), the combination of which causes such severe educational needs that students cannot be accommodated in special education programs solely for one of the impairments. The term does not include deaf-blindness.

– Orthopedic impairment means a severe orthopedic impairment that adversely affects a child’s educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

– Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the education environment that • Is due to chronic or acute health problems such as asthma, attention

deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and

• Adversely affects a child’s educational performance.

• Traumatic brain injury means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma

Etiology of Physical Disabilities, Health Disabilities, and Related Low-Incidence

DisabilitiesChromosomal and genetic causes

– Muscular dystrophy, sickle cell anemia, hemophilia, cystic fibrosis

– CHARGE Association (syndrome) and Usher syndrome are the two examples of genetic causes of deaf-blindness

Teratogenic causes– TORCH – toxoplasmosis, other, rubella, cytomegalovirus, and

herpes.Prematurity and pregnancy complications

– Neurological conditions, cerebral palsy, vision or hearing loss, intellectual disability

Acquired causes– Traumatic brain injury (TBI), child abuse, environmental toxins10

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Categories of Students with Orthopedic Impairments

• Neuromotor impairments– Cerebral palsy (CP)• Four most common forms: spastic, athetoid, ataxic,

and mixed• Classified according to which limbs are affected

– Spina biffida• Degenerative diseases– Duchenne Muscular Dystrophy (MD)

• Orthopedic and Musculoskeletal disorders– Juvenile idiopathic arthritis (JRA) – Limb deficiency 12

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Characteristics of Studentswith Multiple Disabilities

Multiple Disabilities is an umbrella term that refers to individuals with concomitant impairments whose needs cannot be met in a special education program designed solely for one impairment.

Examples:• Intellectual disabilities and spina bifida• Cerebral palsy and seizures• Muscular dystrophy and behavior disorders• Deafness and AIDS• Learning disabilities and asthma

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Characteristics of Students with Traumatic Brain Injury (TBI)

• Traumatic brain injury:– Temporary or permanent injury to the brain– Often mild, varies by area of brain injury– May impair cognition and social/behavioral

functioning• Added as a separate disability category under IDEA in

1990• Often requires rehabilitative services

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Characteristics of Students with Other Health Impairments (OHI)

Major Health Impairments• Seizure Disorders– Absence seizures (formerly petit-mal)• Loss of consciousness, appears trancelike

– Complex partial seizure• Impaired consciousness, involuntary movements

– Tonic-clonic seizures (formerly grand-mal)• Convulsive seizure, loss of consciousness

• Asthma

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Characteristics of Students with Other Health Impairments (OHI)

Infectious Diseases • Acquired immune deficiency syndrome (AIDS)– Human immunodeficiency virus (HIV) destroys

immune system

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Characteristics of Students with Deaf-Blindness

• Students with deaf-blindness represent an extremely heterogeneous population.

• Students with deaf-blindness may exhibit cognitive deficits, physical impairments, and complex health needs

• Additional considerations‒ Speech and language development‒ Social and behavior skills

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Assessment of Physical Disabilities, Health Disabilities, and Related Low-Incidence

Disabilities• Medical evaluation– Physician confirms diagnosis of physical or health

condition• Educational evaluations– Team determines if the disability negatively

impacts educational performance• Students with deaf-blindness– Developmental, rather than standardized,

assessments are used in conjunction with informal observations

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Impact on School Performance

School performance of individuals with physical or health disabilities is impacted by the type of

disability and its functional effects, in addition to psychosocial and environmental factors.

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Insert Table 14.4 from page 514

Educational Considerations for Students with Physical or Health Difficulties

Physical/health monitoring Modifications and adaptations of

instruction, assessment, communication, physical environment, class participation, and use of assistive technology

Specialized instructional strategies Specialized expanded curriculum areas

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Educational Considerations for Students Who are Deaf-Blind

• Communication• Orientation and mobility• Collaborative efforts

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Services for Young Children with Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities

Early intervention services address:• Collaborative services• Motor development• Communication development• Use of augmentative communication• Building of experiences

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Transition into AdulthoodTransition planning typically addresses:• Career planning• Post-secondary education• Employment opportunities• Daily living skills• Independent living• Use of technology

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Adults with Physical Disabilities, Health Disabilities, and Related

Low-Incidence Disabilities• Community acceptance and supports• Preventative medical care• Medical and technological support • Terminal illnesses

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Family Issues

• Coping with stress• Daily living activities• Medical interventions• Terminal illness

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Issues of Diversity

Physical, health, and related low-incidence disabilities occur in individuals from all backgrounds, cultures, and economic levels.• Lack of cultural bias in diagnosis• Cultural differences in coping with illness and

disability

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Technology and Individuals with Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities

• Computer access• Assistive technology• Augmentative communication• Positioning and seating devices• Mobility devices• Environmental control and assistive technology

for daily living• Assistive technology for play and recreation

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– Computer assistive technology: Input, output, and processing aids allow computer adaptations

– Augmentative communication: Forms of language that are used to supplement oral language

– Positioning and seating devices: Provide proper positioning and seating for optimal learning

– Mobility devices: Assistance in moving from one location to another

– Environmental control and assistive technology for daily living. Devices that control electronic appliances, modified daily items (toothbrush, hairbrush, utensils, dressing aids, etc.)

– Assistive technology for play and recreation devices used to access toys, adapted sports teams

Trends, Issues, and Controversies

• Assessing capabilities and needs• Specialized technology, adaptations, instructional

strategies• Appropriate curriculum

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