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Highlights
Announcement…Major Works from Special Education Department
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A team approach involving specialists from more than one discipline, such as team made up of a physical therapists, a speech and language pathologist, a child development specialist, and occupational therapist, or other specialists as needed is a must for special education.
1. Educational Needs of Pakistan in the Twenty
First Century 2-4
3. An Investigation of Growth Profile of Pakistan
Children 5-13
4. Community Living 14-16
5. Hearing Conservation for Hearing Impaired
Worker 17-22
6. A Historical Review of Technology Research in
Special Education 23-28
7. Medical Conditions and Disorders 29-32
8. Dictionary of Terms Used in Special
Education 33-36
9. Inclusion Advisory Council 37
10. Rehabilitation Process 38-45
Table of Contents Page Nos.
Speech Therapy
Special Education
Physiotherapy
Occupational Therapy
Orthopedic Disorder
Artificial Limbs
MA-Ayesha Institute of Education and Allied Health SciencesAn affiliated institute of University of Karachi
SNPA-22, Block 7/8, Near Commercial Area K.M.C.H.S., Karachi-75350-PAKISTAN.Phone: 454-1281, 454-2685, 4546874, 4387686, Fax: 455-0699
E-mail: [email protected]
Inside…
Educational Needs of
Pakistan in the Twenty First
Century Dr. Ismail Saad
Dean Faculty of Education &Learning Science
Iqra University, Karachi________________________________________________________________________
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couple of years are left before we enter the twenty first century. Metaphorically, we are at the eve of a
new century. Objectively speaking, the time left is almost as much or even less than has been used for regular economic plans of the country. The need is to grab this opportunity and make use of it as best and as productively as possible. It is clear that the country is confronted with a formidable challenge. It is formidable not only because of its magnitude but even more so because of the urgency to attend to the challenges of time. We are racing against time. The matters have already been delayed and a further delay can only be suicidal. The onset of the twenty first century may only add to the poignancy of an already worsened situation if we show any unprepared ness. A most striking feature of the new times to come is, perhaps, the expected increase in the velocity and speed of human scientific and technological endeavors. This process will cause a chain effect and is bound to accelerate the pace of progress in all walks of human life. The increase in the momentum will exert greater pressure and place heavier demands on the developing nations, specially, on those countries which have had a disappointing record of achievement in the second half of the twentieth century. Pakistan cannot count it self out in the list of these countries.
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Entry into the twenty first century would need adequate preparation based on fore thought
and planning. We should have learnt from past experience that problem which requires long sustained effort for their solution can neither afford excessive ambition nor can they subsist on periodical outbursts of energy. We shall have to be realistic, with firm feet on the ground, aiming only at targets which are achievable in the period assigned to them. In the field of education we have lost considerable time in setting targets which were unrealizable from day one and have wasted energy a resources in pursuing elusive goals. Most of our educational efforts have been based not on a realistic appraisal of our needs, resources and
limitations but on political day-dreaming. We shall have to embark upon the educational work with a new sense of realism and will have to measure every as we go along. In planning and organizing resources for education our model need not be the developed countries that have outdistanced us with such a wider gap that there is little relevance left in their experience to suit our immediate situation. Instead, Pakistan should focus attention on the experience of those developing countries which started the independence as a new nation. Their example can provide us with a better comparative perspective to realize where we have faltered and what can now be done to redeem pat mistakes.
In the field of education Pakistan is confronted both with a challenge of quantity and quality. We hold a disappointing record in the expansion of educational opportunity in the country and our performance in maintaining a reasonable standard of education is equally dismal. The two dimensions need to be looked at separately, since in planning and preparing for the new century we shall have to pursue a two pronged policy, delicately balancing each against the. Let us first survey the challenge of quantity.
Pakistan is a democratic country with a firm faith in Islamic values of social justice and equality. With these convictions the gap between belief and action appears even more glaring. Despite a number of expensive experiments. Pakistan is still to be counted among those four or five countries in the world which have the lowest literacy rate. Our literacy figures though variously quoted, indicate that at least seventy percent of the population suffers from illiteracy, which virtually means that they are not capable of signing their names on a piece of paper. Thirty percent is the literacy percentage with which we started our journey as a new nation in 1947. This indicates that in the expansion of literacy the pace of progress has been stationery throughout and we have not moved a bit from the original position. No doubt the increase in population and the rate of population growth have significantly contributed
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to off setting the progress in literacy but, how so ever it may be, when the achievement is compared with other developing countries we can hardly hide out embarrassment.
The low rate of literacy is further aggravated by the imbalances in the spread of literacy throughout the country. The literacy rate is highly uneven among the provinces with Baluchistan as the region with lowest rate of literacy. Similarly, there is disequilibrium between the literacy rate of cities and villages. The bulk of the population lives in rural areas and these areas indicate an alarmingly poor level of literacy. The most conspicuous literacy imbalance may be seen between the two sexes. Female literacy is phenomenally low as compared to men, with merely 2% the lowest in Baluchistan. In the race between Population growth and increase in literacy, the latter must always lag behind. In the past twelve years the literacy rate according to official claims has been increasing over 3% every year. The net result is that the country has nearly 80 million people who do not know how to read and write.
Not unrelated to literacy is the issue of primary schooling for all children. As we new democracy Pakistan cannot deny the right of any child born and reaching the school-going age to have access to free and compulsory primary education. But the factual position is that only half the primary age population has an opportunity to attend schools. Here again there is a gender discrepancy and even less than one third of the girls attend primary schools. Compared to 8% increase in enrolment since 1981 for boys, the increase for female is only 5%. The sad part is that even the 50% intake of children in class I suffers a serious set back in the form of drop-outs and by class V, the last grade of the primary school, one half of the children discontinue their schooling. The situation requires greater awareness and inducement among parents for the education of their children, more environmental attractions in schools and a stable structural arrangement of non-formal education to bring back the drop-outs to the fold of education, specially, to a vocationally meaningful programme of
education. In post primary stages of formal education the number of students continue to dwindle, though the dropout rate tends to slow down in successive stages, those who manage to reach the post-secondary level, number only 5% of the population in the relevant age group. The yearly increase in student enrolments is, to say the least, very modest but it is remarkable that even this increase has resulted in serious overcrowding of educational institutions and a very great strain on educational facilities available in these places. Let us turn our attention to quality considerations in education.
The dimension of quality is even more important, for a low standard of education virtually means that we are not getting proper return on our investment in education. In the first place, the country is hard pressed in resource generation for education and if our educational effort fails to reach the desired objectives the investment of money, time and energy shall only be calculated as a total waste. It is difficult to measure standard of education because the objectives a nation tries to reach through education are not always tangible. For instance, the wish to see education as an integrating force, helpful in the promotion of national integrity, is not a thing that can be precisely measured. Same is the case with the aspiration that education should nurture and reinforce patriotic sentiments among people, or give our young men an emotional attachment to moral values and create a sense of discipline in them. Again, to see education as a means to bring cultivation to the life of the young and give them poise and balance in their personality desires which do nor permit to statistical calculation. We can only arrive at a rough estimate if the success or failure of the process of education in catering top these needs. It is apparent that our system of education has failed to measure up the national expectations on these intangible but important quality indicators of a system of education. An important area with relevance to standard of education which is more amenable to quality measurement and can inform us of the utility of education in calculable term is the relationship of education with the job market. The strongest motivation
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for a person to receive education is the capability education can develop in our individual to sustain himself economically. To be able to get respectable job is, perhaps, the greatest fascination which lures, initially, the parents an eventually the student to education. This should explain why the non-availability of a job at the end is the most frustrating experience with which our graduates suffer and is responsible for the bitterness experienced in youth about the system of education and the country. Education in Pakistan is a matter of habit and chance and reflects very little planning and forethought. Never a serious attempt has been made at manpower planning or human resource development. As a result there is no
correlation between the job available in the market and the numbers of graduates aspiring for the job. There is also a blind rush in the direction of higher education for there is no diversification of talent in different vocational fields at low educational levels. Even in professional and technical fields the preparation and training leaves much to be desired and the employers can hardly do without training the incumbents on the job.
Seminars and Workshops
INT. J. BIOL, BIOTECH., 1 (4): 709-717, 2004 Names & Contacts TopicMr. Shahzad QamarC/o Yasmeen Muhammad Head Training & Support Research Based Education System
Ordinary Teaching Methods for Special
Children
Yasmeen Muhammad Montessori Teacher
Montessori Teaching Method Used for Special Education
Mr. Shahid Ahmed Memoon Chairman, Pakistan Disabled Foundation
Braille Introduction
Dr. Akif Rehman Look & Listen Center,
Anatomy & Physiology of the Eye
Dr. Kausar Waqar Institute of Educational Development (Aga Khan)
Inclusive Education
Nooruddin Disabled Activist Muscular Dystrophy
Prof. Dr. Syed Arif KamalDepartment of Mathematics Body Measurement
Mrs. Zareena Fazal Administrator, Al Imran Rehabilitation Center
Cerebral Palsy
Shabbir NawazNISE
Meeting for Inclusive Education
Mr. Aamir Rehman Eye & Hearing Care Center Ibn-e-Sina Hospital Complex,
1. Audio logy & Audiometry
2. Hearing Aids
Mr. Javed Jaffery Braille Workshop
Zafar Iqbal Mental Retardation
Qazi Fazli Azeem Hyperlexia: A Positive
Look towards Asperser’s Syndrome
5
AN INVESTIGATION
OF THE GROWTH PROFILES OF
PAKISTAN CHILDREN
by: S.A . KAMAL, S. FIRDOUS1 and ALAM2
Department of Mathematics, University of Karachi, Karachi 75270, Pakistan; e-mail: [email protected] Department of Mathematics, Govt. S.M. Science College, Karachi, Pakistan2 Max-Planck-Institute fur Informatik, Saarbrucken, Germany
Abstracthe NGDS (National Growth and Developmental Standards for the Pakistani Children) Pilot Projects was
initiated in 1998 to establish Pakistan-based anthropometrical data library and growth charts, to formulate mathematical models, which predict growth parameters, to write software, which generate detailed growth profiles and to develop inexpensive anthropometry instruments from local resources, which could be employed in obtaining anthropometric measurements of Pakistani rural and slum area children. Standing and sitting heights, shoulder widths, weights and mid –upper-arm circumferences as measured on
Tover 200 healthy children. Mathematical procedure / software was developed, which takes as input heights and weights of biological parents, and those of child at 2 successive occasions, 6 months apart. The output is a detailed growth profile indicating stunting and wasting (if present), overweight / underweight conditions, height velocity, rate of weight gain / loss and biomass index (comparison of all three with references). Failure to grow may be the first indication of a major underlying problem. The authors recommend growth monitoring and
analysis of all 4-10 year old children using the software.
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Keywords: Anthropometry, Pakistani Children, height, weight, growth velocity, stunting, nutritional assessment
IntroductionAnthropometry (measurement of the
man) is one of the oldest sciences. To be able to use growth data fruitfully, there is a need to study and to constantly update growth charts (Karlberg et al., 1999). They are used in the fields of health care planning, education, industry and government (Hensinger, 1998). The techniques and the instrumentation must also be under constant scrutiny (Kamal, 1982; 1986; Kamal and El-Sayyad, 1980). Literature is available on growth studies in North America (Rosner et al. 1998), Europe (Edlund et al., 1999; Moilanen and Rantakallio, 1989; Power et al., 1997), Asia (Abolfootuh et al., 1993; Ayatollahi, 1993) and Australia (Magarey et al., 1999).
There has not been a serious effort to develop growth standards for Pakistani children. American and European growth standards are inadequate for Asian Children. Approximation methods need to be devised to use them locally (Abolfotouh et al., 1993). Inadequate furniture in schools, offices and public transport is an indication of lack of national standards. A study was started in 1998 to collect data on children, representing a representing a national sample, in a better-than-average health (Kamal et al., 2002b). This study was designed after taking into account complexities of the system and the operations (Kamal et al., 2002a). the study sample consists of 4-11 year old healthy boys and girls, studying in pre-primary and primary sections, i.e., students in classes of ECE (Early Childhood Education) / Montessori as well as classes 1-5, having no complications before birth and during the weaning period. The sample, drawn from institutions run by the Armed Forces of Pakistan, represented all provinces and localities. In general, the children were healthier as compared to average population. Theses children represented all socio-economic groups. Informed consent was obtained from parents employing opt-in-policy. Consent-form slips requested data regarding
education and occupation of both parents as well as size of the nuclear family. This sample appeared to be ideal for establishing National Growth and Developmental Standards (NGDS) for the Pakistani Children. The growth profile was analyzed keeping in view the ICP model of growth (Karlberg 1987; 1996). The Early Childhood Integrated Developmental Examination, which covers the age range 3 to 8 years, was administered to selected children (Kamal 2002).
Materials and Methods Project Protocols
Barefoot standing height, mass (weight), mid-upper-arm circumstance and shoulder width were measured with the children undressed t short underpants, all clothing above the waist removed (older girls, barefoot, in school uniforms,sweaters, coats and hair bands removed). Clothing worn by the child as well as behavior exhibited during the measurement was recorded. Mathematical codes, i.e., Dress Code and Behavior Code were devised for this purpose. Children were measured during the morning hours on the school premises (children are generally 1-1.5 cm taller in the morning as compared to bedtime). An engineering tape mounted on the wall was utilized. Standing height was recorded to the nearest millimeter with the child’s back touching the tape, feet together, heels touching the wall, in anatomical position. Child was asked to breath in and hold breath. A set square was used to read off heights. A similar procedure was adopted for recording sitting height. Mid-upper –arm circumference (MUAC) was taken on both arms and compared. Shoulder widths were measured by asking the child to stand touching a wall and by placing set square on the free arm to record width. Mass (weight) was recorded, with the child instructed to breath in, hold breath, and look at a pen held at the eye level (Kamak and Firdous, 2002a, b).
Children were screened for factors, which may contribute to growth retardation. These include screening for anemia, cardiac disease and spinal curvatures, specially,
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scoliosis. The tests used to detect spinal curvatures were: visual inspection of back in the anatomical and the mild-stretching positions, Adam’s forward bending test and moiré fringe topography (Kamal, 1998). A certain routine was devised and followed for the check up (Kamal et al., 2002c).
Mathematical ModelIt was assumed that the growth curves
(height and weight graphs) were linear if the measurements were performed 6-months apart. This was a good approximation for most of the regions, except where there was a rapid change of growth rate, for example, from infancy to childhood phase, and childhood to puberty phase. During these phase transitions, the growth curve (height) was continuous, but not smooth according to ICP model (Karlberg, 1987). Therefore, height velocity was not defined during phase transitions. Other than these transitions regions, height at some age grid (8.0, 8.5 year, etc.,) was computed using linear interpolation. From the mid-parental height boys’ and girl’s excepted heights were computed using the following relations:
(1). B = F+Mathematical+13 2
(2) G= F+Mathematical-13 2
The variables, B,G, F and M represent boys’ expected height, girl’s expected height, biological father’s measured height and biological mother’s measured height, respectively. All heights were measured in centimeter.
These computed heights were extrapolated backwards to compute desired height at the reference age grid. This was compared with the interpolated-actual height at the same age to determine whether the child was stunted (short height for age) or tall far age. Similar calculations were done for weight to determine if the child was overweight, normal or underwrite for age. Biomass index was computed by taking the ratio of mass (in
kilogram) to square of height (in meter) and compared with the reference value to determine obesity profile. In addition, optimum mass for given height was determined and compared with the actual mass to find out whether the child was fat, normal or wasted (low mass for height). The model has provisions to compute height velocities and rates of gain/loss of weight, in order to predict height and weight during the next 6 months.
Software DevelopmentSoftware was developed using Microsoft
Visual Studio, Version 6.0 (Kamal et al., 2002 b). it has the following basic modules:
a) The child’s database, i.e., the software is able to query the record necessary for computations of growth profile. The module is a complete database by it self and necessary data modeling is done with requirement analysis.
b) A mathematical library for the software. All mathematical models, simple and complex, were coded in visual basic after being properly specified as programmable algorithms and the software computations would use this library, accordingly.
c) Output, on terms of graphical and numerical representations. Reports are generated and the necessary material is printable. This requires mathematical and graphics-based routines along with proper handling of plots.
d) A tutorial as an interactive guide for the users, which acts as reference.
The algorithm first identifies child’s identity and retrieves record from it’s achieves consisting of parent’s height and child’s previous measurements. If this is the first examination, the Programme creates a new record. Results can only be generated when data for at least 2 examinations are entered. Subroutines were written, which performed linear interpolations. Once the child’s data are available the program reads reference heights and masses from the reference database to determine rates. There is another subroutine,
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which compares the reference values with the actual values and interprets the difference.
ResultsHere are measurements obtained during
four check ups:
Vital Statistics (all dates given in the format; Year-Month-Day)Name: A. S.Date of Birth: 1994-07-27Sex: FemaleParents’ Heights Mother (measured): 150.8 cm on 2000-10-25Father (reported): 5 feet 6 inches
HistoryHospitalization: Between her second and
her hard check-up A.S. was hospitalized. Mother reported weight loss.
Physical ExaminationNutritional: A.S. showed signs of
anemia during her first three check ups. Mother was asked t have Blood Hemoglobin done. Her condition considerably improved during the fourth check up.
Cardiac: A.S. had normal heart sounds (standing and squatting)
Trunk Deformities A.S. Showed signs of trunk deformity during all her checkups. Mother was asked to have AP X ray (standing) of the entire spine (external auditory) meat us to hip joint), for the detection of scoliosis, done.
Anthropometry
First checkup Height: 96.0 cm (child relaxed and cooperative)
On 1999 -03-01 Weight: 136.5 kg (in short underpants)
Second Checkup Height: 107.2 cm (child relaxed and cooperative)
On 2000-10-25 Weight: 17.0 kg (in short school uniform)
Third Checkup Height: 109.0 cm (child relaxed and cooperative)
On 2001-03-19 Weight: 19.0 kg (in short school uniform)
Fourth Check up Height: 115.9 cm (child relaxed and cooperative)
On 2002-04-06 Weight: 21.0 kg (in street clothes)
Growth ProfilePredicted adult height: 152.72 cm (5 feet 0.13 inch)Predicted adult mass (weight) 46.67 kg (102.91 lb)Expected to follow the CDC- 5.489Growth-curves percentile:
Between The First and the Second CheckupHeight-for-age profile: 1.57 cm (0.62 inch) SHORT for age [STUNTED] Height-velocity-for-age profile:Height velocity 0.23 cm/yr (0.09 inch/yr) More thanThe reference value [growing FAST]Height prediction at the age 108.9 cm (3 feet 6.9 inches)6 years 6 months:
Mass-for-age (weight-for age) 0.07 kg LESS mass for age Profile:
(UNDERWEIGHT for age by 0.16 lb)Rate-of –mass-gain/loss-for-age 0.08 kg/yr(0.17 lb/yr) lesser than the reference value [rateLOW] (Weight-gain/loss-for-age) profile:Mass (weight) prediction at the 17.54 kg
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(38.67 lb)age 6 years 6 months:Obesity profile: Bio-mass index (BMI) 0.31kg/m2 MORE than the reference value [OBESE]Mass-for-height (weight-for- 0.35 kg EXCESSmass for height (OVERWEIGHT for height by 0.76 lb)Height) profile [FAT]
Between The Second and the Third CheckupHeight-for-age profile: 1.35 cm (0.53 inch)SHORT for age [STUNTED]Height-velocity-for-age profile: Height velocity1.53 cm/yr (0.60 inch/yr) LESSER than the reference value [growing SLOW]Height prediction at the age 110.6 cm (3 feet 7.5 inches)7 years:
Mass-for-age (weight-for age) 0.93 kg EXCESS mass for age Profile:
(OVERWEIGHT for age by 2.04 lb)Rate-of –mass-gain/loss-for-age3.27 kg/yr (7.20 lb/yr) MORE than the referencevalue (Weight-gain/loss-for-age) profile: [rate HIGH]Mass (weight) prediction at the 20.80 kg (45.85 lb)age 7 years:Obesity profile: Bio-mass index (BMI) 1.61kg/m2 MORE than the reference value [OBESE]Mass-for-height (weight-for- 1.89 kg EXCESS ]mass for height (OVERWEIGHT for height by4.17 lb)Height) profile [FAT]
Between the Third and the Fourth Checkup
Height-for-age profile: 1.06 cm (0.41 inch)SHORT for age [STUNTED]Height-velocity-for-age profile:Height velocity 1.03 cm/yr (0.40 inch/yr)MORE than the reference value[growing FAST]Height prediction at the age 117.9 cm (3 feet 10.4 inches) 8 years:Mass-for-age (weight-for age) 1.53 kg EXCESS mass for age Profile: (OVERWEIGHT for age by 3.38 lb)Rate-of –mass-gain/loss-for-age 3.27 kg/yr
(7.20 lb/yr) MORE than the reference value (Weight-gain/loss-for-age) profile:[rate HIGH]Mass (weight) prediction at the 21.58 kg (47.5 lb)age 7 years:Obesity profile: Bio-mass index (BMI) 1.57kg/m2 MORE than the reference value [OBESE]Mass-for-height (weight-for- 2.07 kg EXCESSmass for height (OVERWEIGHT for height by4.56 lb)Height) profile [FAT]
Table: 1 Actual Growth Parameters (Interpolated at the reference ages)
Age 6 Year 6 Years 6 Months 7years 6 Months
Hgt (cm) 105.5 108.3 114.6Hgt [feet –inches] 3 ft 5.5 in 3 ft 6.6 in 3ft 9.1 inPercentile-for-Hgt 3.5 <3 3.2Mass [kg] 17.54 20.80 21.58Weight [lb} 38.67 45.85 47.5Percentile-for-wgt 4.9 10.2 22.6
Table 2: Growth Profile(Growth Parameter) B/w 1st and B/w 2nd and
B/w3rd =Reference Value-Actual Value2nd checkup 3rd Checkup 4th CheckupHgt-for-age [cm] -1.57 -1.35 -1.06Hgt-for-age-[inch] -0.62 -0.53 -.41Status STUNTED STUNTED STUNTEDHeight-Velocity-for-age [cm/year]+0.23 -1.53 +1.03 Hgt-Velocity-for-Age [inch/year] +0.09 -0.60 +0.40Status GROWING FAST GROWING SLOW GROWING FASTMass-for-age [kg] -0.07 +0.93 +1.53 Weight-for-age [lb] -0.16 +2.04 +3.38Status NDERWEIGHT OVERWEIGHT OVERWEIGHT Rate-of-mass-gain-for-age [kg/year] -0.08 +3.27 +0.13Rate-of-weight-gain-for-age[lb/year] -0.17 +7.20 +0.29Status RATES LOW RATES HIGH RATES HIGHBio-Mass Index[kg/M2]+0.31 +1.61 +1.57StatusOBESE OBESE OBESEMass-for-Height [kg] +0.35 +1.89 +2.07Weight-for-Height [lb] +0.76 +4.17 +4.56Status FAT FAT FAT
Table: 3 Growth Predictions
Age 6 yr. 6 mth 7 yrs 8 yrs
Hgt [cm] 108.9 110.6117.9
Hgt [feet-inches] 3 ft 6.9 in 3 ft 7.5 in 3 ft 10.4 inPercentile-for-Hgh 3.8 <3 4.4
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Mass [kg] 17.54 20.8021.58
Wgt [lb] 38.67 45.85 47.5Percentile-for-Wgt 6.4 28.8 19.4
Fig. 1. Height ProfileSummary of FindingsThe gap between reference height and actual height is DECREASING. However, A.S. is overweight both for age and for height.
ImplicationsThe overweight condition may lead to cardiac problems. It may, also, cause early puberty, and eventually, stunting.
RecommendationsA.S. must be, closely, watched for signs of trunk deformities on a regular basis, using visual and moiré examinations. She must indulge in fat-burning activities to control her weight.
Fig. 2. Mass Profile
Fig. 2 Mass Profile
Fig. 3 Height Profile
Fig. 4 Mass Profile
120
110 105
100
6 6.5 7 7.5
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eigh
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)
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Age (Year)
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ass (
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cm)
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Fig. 5. Height prediction
Discussion This pilot study was able to identify
variables of interest and their interactions, elaborate response and involvement of the community, and the difficulties of data-collection in a conservative society. Further, it provided opportunities for community awareness, education and participation as well as initial step to develop formal human-rights protocols of this part of world.
The software developed for growth analysis takes as input growth data of a child at 2 successive occasion’s 6-months apart, along with heights and weights of biological father and biological mother. The software generates as output a detailed growth profile of the child. The results are generated in a format easily understandable by parents and older children, avoiding technical jargon. In addition to the descriptive format, the information is made available in tabular form (for quick review by the attending pediatrician), in graphical form (for studying trend by the anthropometrist and the nutritionist) and in bar-chart form (for visual display, which may be helpful to parents with little or no education). The software shall be made accessible on the internet for real-time processing of data. This information may prove valuable for pediatricians, nutritionist and
physical-education instructors, who may, together, plan diet-cum-cum exercise programs, supplemented by medicines, if required, to achieve optimum height and weight. There is a dire need to accurately monitor growth of a child. “failure to Thrive” is the first indicator of an underlying physical or emotional problem, which must be taken seriously requiring a head-to-toe examination as well as a psychiatric evaluation of the child.
Failure to intervene in childhood cases of stunting and wasting may result in “short-height and underweight adolescents” eventually, producing “underweight mothers”. These underweight mothers will, in turn, deliver “ low-birth-weight (LBW) babies”, resulting in “growth failure in childhood”, and the cycle continues (Hunt 2002).
The software is being tested in field studies conducted as part of the NGDS Pilot Project. Selected families are being studies in detail. Height and weight of parents is also recorded during the initial visit. The software is designed based on growth charts released by CDC (Centre for Disease Control, Atlanta, USA).
Further studies of growth should include somatotype as factor to determine optimum mass (weight) for a given height. Stereophotogrammetic techniques, such as, moiré fringe topography and rasterstereography (Kamal, 1998) may be helpful in documenting somatotypes.
Acknowledgements
We express our gratitude to prof. (Dr.) Zulfiqar Ahmad Bhutta, the Aga Khan University Medical College (Karachi), for discussions at the planning stage, Prof. (Dr.) Bo S Lindblad, Karolinksa Institute (Sweden), for motivating and introducing to key researchers in the field, Dr. Johan Karlberg, Queen Mary Hospital, University of Hong Kong (Hong Kong), for providing a copy of his thesis. We would like to thank all children, their parents and principles for the participating schools
25
20
15
10
5
0 6 .5 7 8
M
ass (
Kg)
Age (Year)
Fig. 6. Mass Prediction
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(Army Public School, ‘O’ Levels, Karachi, Fazaia Degree college, PAF Base ’Faisal’, Karachi, Bahria College, NORE I, Karachi) for their kind support. Last but not the least, we are indebted to Ex-Chancellor, University of Karachi, Lt. Gen. (Retd). Moinuddin Haider, HI (Mathematical), for asking administrators of the participating institutions to extend cooperation for this study. This work was supported, in part, by Dean’s Research Grant, University of Karachi, which is sincerely acknowledged.
References
Abolfotouh, M.A., H. A.H. Abu Zeid, I. A. Badawi and A.A. Mahfouz (1993). A method for adjusting the international growth curves for local use in the assessment of nutritional status of Saudi pre-school children. J. Egypt. Pub. Health, 68: 688-702Ayatollahi, S.M.T. (1993). Weight-for-height of South Iranian school children and the NCHS reference data. Int. J. Obesity, 17: 471-474Edlund, B., Parent-O. Sjoden and M.Gebre-Medhin (1999). Anthropometry, body composition and body image in dieting and non-dieting 8-16 year-old Swedish girls Acta Pediatrica, 88: 537-44Hensinger, R.N. (1998). The challenge of growth: the fourth dimension of pediatric care. J. Ped. Orthop., 18: 141-144Hunt, J. (2002). Strategies for ending childhood malnutrition. The 16th International Biennial Conference of Pakistan Pediatric Association, Karachi (Pakistan), 2002, p 24Kamal, S. A., (1982). Improvements in instruments for anthropometric measurements. Bull. Am. Phy. Soc., 27: 502Kamal, S.A., (1986). The relationship of anthropometric measurements taken on clothing to those taken on the body. Kar. U.J. Sc., 14: 35-39Kamal, S.A., (1998). 3-D optical imaging and image processing (biomedical applications). Proceedings of International Workshop on Recent Advances in Computer Vision, (J.R., Laghari, A.A. Naqvi, A.Q. Rajput, N. A. Sangi
and M.A.. Shah, eds.). SZABIST, Karachi, Pakistan. Pp 86-95Kamal, S.A., (2002). The Early Childhood Integrated Development Examination (ECIDE) for 3-8 years old children. The Aga Khan University National Health Sciences Research Symposium: Early Childhood Care and Development, Karachi (Pakistan), September 2002, p.32Kamal, S.A., and M.M. El-Sayyad (1980). An experimental verification of relation connecting the anthropometric measurements taken on the clothing to those taken on the body. Proceedings of the Biomechanics Symposium, Indiana University, Bloomington, Indiana (USA), p.346Kamal, S.A., S.J. Alam and S. Firdous (2002b). The NGDS Pilot Project: A software to analyze growth of a child (a telemedicine perspective). National Telemedicine Conference Pakistan 2002, Technology Resource Mobilization Unit (TreMU), Ministry of Science and Technology, Government of Pakistan, Islamabad (Pakistan), June 2002, p.2Kamal, S.A., S.J. Alam and S.Firdous (2002c). A precedence graph for the physical examination of children. National Telemedicine Conference Pakistan 2002, Technology Resource Mobilization Unit (TreMU), Ministry of Science and Technology, Government of Pakistan, Islamabad (Pakistan), June 2002, p.2Kamal, S.A. and S. Firdous (2002a). The NGDS Pilot Project: Anthropometry of the Pakistani Children. The 16th International Biennial Conference of Pakistan Pediatric Association, Karachi (Pakistan), February 200, p.127Kamal, S.A. and S. Firdous (2002a). The NGDS Pilot Project: Modeling Growth of the Pakistani Children. The 16th International Biennial Conference of Pakistan Pediatric Association, Karachi (Pakistan), February 200, p.80Kamak, S.A., S. Firdous and S..J., Alam (2002a). The NGDS Pilot Project: Dealing with a complex system. The Aga Khan University PGME Conference 2002: Complexity Science and Health Care, Karachi (Pakistan), May 2002, p.5
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Kamal, S.A., S. Firdous and S.J., Alam(2002b). The NGDS Pilot Project: Aiming at the future of Pakistan. The Aga Khan University National Health Sciences Research Symposium: Early Childhood Care and Development, Karachi (Pakistan), September 2002, p.26Karlberg, J. (1987). Modeling of human growth. PhD Dissertation, University of Gotebotg, Goteborg, SwedenKarlberg, J. (1996). Computer simulation of final height after growth-promoting therapy. Acta Pediatrica Suppl.,
417:61-3Karlberg, J., Y.B. Cheung and Z.C. Luo (1999). An update on the update of growth charts. Acta Pediatrica, 88: 797-802Magarey, A.M., T.J.C.Boulton, B.E. Chatterton, C. Schulz, B.E.C. Nordin and R.A. Cockington (1999). Bone growth from 11 to 17 years: relationship to growth, gender and changes with pubertal status including timing of menarche. Acta Pediatrica, 88: 139-146Moilanen, I. and P. Rantakallio (1989). The growth, the development and the education of Finish twins: a longitudinal follow-up study in a birth cohort from pregnancy to nineteen years of age. Growth Dev. Aging, 53: 145-150Power, C., J.K. Lake and T.J. Cole (1997). Body-mass index and height from childhood to adulthood in the 1958 British birth cohort. Am. J. Clin. Nutrition, 66: 1094-1101Rosner, B., R. Prineas, J. Loggie and S.R. Daniels (1998). Percentiles for body-mass index in US children 5 to 17 years of age. J. Pediatrics, 132: 211-222
(Accepted for Publication: 15 September 2004)
News
Seminars held during
the Semester
Clinical Works
Visits, and Practical
Ph. D. Awarded to
Ms. Kaneez Fatima
Ms. Anjum Kazimi
Mr. Mir Afzal Khan
Ms. Khadija
Faculty Movements &
Training Imparted
Two Week Course of
Allama Iqbal Open
University
One Week Course on Sign
Language for Teachers 1
of Special Schools
Short Term Training in
Early Intervention for out
going Students.
News Avenues in Research
Students of Masters Degree are being encouraged to find out issues related to Special Education by Web searching through international seminar Teachers are supervising the prose of topic selection and proposal writing to carry out research projects in the forth coming semester. 14
Community Livingby: Nighat Iftikhar
What is community living?
ommunity living refers to the programs, services and other supports that enable children and adults with mental retardation
and related disabilities to live much the same way that people without disabilities live. For children, this usually means living with their family in their own home and in their own communities. For adults, it usually means having opportunities and supports to live apartment, or perhaps in a small group home. Community living may also include a variety of other supports and services. For example, a family that is caring for a child with mental retardation may need occasional respite services so that they can take a break from care giving or attend to other needs. Or, an adult living in a small group home may require help finding a job a through an employment program.
C
What types of community services are available?
Community services can take a number of different forms. Community programs in which adults with mental retardation live are usually called supported living or small group home programs.
Supported living: Usually individuals living in homes or apartments of their own. The person may live alone or choose to live with a roommate versus being placed with others. Supported living often involves partnerships between individuals with disabilities, their families and professionals in making decisions about where and how the person wishes to live. Focus is one giving utmost attention to the desires of the person with a disability in how he or she would like to live, and to support the individual in having
control over choices of lifestyle. People in supported living may need little or no
services from professionals, or they may need 24-hour personal care. The kind and amount of supports are tailored to the individual’s needs.
Small group homes: Small groups homes are living environment where six of fewer individuals live, usually with 24-hour staff support. In 1996, Prouty & Lakin found that an average of 3.8 people with mental retardation and retarded development disabilities lived in each residential setting in the U.S. The average number was 22.5 people in 1977, and so has continued to drop over the past 19 years.
Community services also include other non-residential types of services that support adults in their own homes, supplement services to individuals who live in the community and support families in keeping their child with a disability at home. These include, but are not limited to:
o Crises intervention services: on-call support to assist in dealing with situations;
o Respite care: temporary relief for full-time, at-home care providers;
o Other family support services: states offer a variety of services, from cash subsidies to families so they can purchase their own services, to transportation that enables families so they can purchase their own services, to transportation that enables families to get to services;
o Services coordination (case management): professionals that serve as coordinators or “breakers” between services, assisting
15
families and individuals with accessing and benefiting from various programs; and,
o Employment programs: services, which help adults with mental retardation, find jobs.
How much care / support do people with mental retardation need?
Mental retardation affects each individual differently. While some may need 24-hour care, others are able to live independently or with minimal supports. That is why it is so important for individuals and families to be able to choose flexible programs and services that best meet their needs.
What are the economic benefits of community living alternatives?
Community support can save taxpayers a substantial amount of money. In 1996, the average annual cost for a person in a community setting served under the Home and Community Based Services program (flexible Medicaid funding) was $ 24, 783. The annual average cost per resident in large, state-run institutions in 1996 averaged $92,345. (Prouty & Lankin, 1997).
Won’t increased funding for community programs and supports mean bigger government and higher spending?
Not at all, in fact, just the opposite is true. Community living programs represent an alternative to institutionalization, not an added expense. Further, community alternatives generally save money by providing more cost-effective care. And since the whole point of community supports is allowing people with mental retardation to live more independently, either with their families or in small homes, it actually requires fewer state resources.
What about those state that have closed their institutions? How has it affected services for people with mental retardation?
Of the four New England states that have closed their institutions, Maine, New Hampshire and
Vermont have reduced the size of their waiting list; Rhode Island has no waiting list. In Connecticut and Massachusetts, states that maintain institutions, the waiting list ha increased in numbers.
What are some of the trends that affect the availability and use of community services?
There are several trends that affect the availability and use of community services. Many of these trends inter-relate in how they impact individuals with mental retardation and their families.
Perhaps the most significant trend is the increasing waiting list for community services. Hayden (1992) found an estimated 186,000 people in the U.S. waiting for residential, employment and other services. As states either cap or cutback the number and kinds of services, more and more individuals end on long waiting lists for necessary services. Many individuals with mental retardation do not receive the full array of services they need to increase their independence, and there are many who still reside with their families and receive no services whatsoever.
The number of adults with mental retardation still residing with their parents, especially aging parent, is another area of concern. Many parents provide some or all care for an adult son or daughter with mental retardation, but these families increasingly recognize the need to plan for the time when the parents can no longer provide care. As these families begin to explore community residential and other services, they are finding waiting lists for services, sometimes up to several years long. Compounding this problem is the fact that some of these families do not even have access to support system for providing information and assistance. A recent study in New York found that many of these families are neither in the aging service system of the mental retardation / developmental disabilities services system.
De institutionalization of people with mental retardation has been as extremely positive trend. However, this trend has also increased the need for
16
community services to serve individuals with mental retardation and their families. Many states are not allowing funds to “follow” individuals from institutions to the community. Thus, costly institutions continue to exist while states struggle with funding quality community services.
Dramatic changes in how the service-delivery system for people with mental retardation operates are having a major impact. States are experimenting with service delivery measures—often referred to as “managed care”—in an effort to reduce costs for health and long-term car. While managed care and other systemic changes have the potential to reduce costs and improve the quality and quantity of services, the speed and degree at which states are changing systems may create service gaps or result in less than optimal services for some or all people with mental retardation.
Resources:
The Arc’s supported Living Resources List contains information on books, fact sheets, videos and organization on supported living and other aspects of community living. For a free copy, send your request and a self-addresses stamped envelops to: The Arc of the United States, 500 East Border ST., Suite 300, Arlington, Texas 76010. Information on community living and other topics on mental retardation can also be located on The Arc’s World Wide Website at: http:// The arc.org/welcome.html
References:
Hayden, M.F., (1992). Adults with mental retardation and other developmental disabilities waiting for community-based services in the U.S. (Policy Research Brief, Vol. 04, No.03). Minneapolis, MN: University of MN. Institute on Community Integration.
Prouty, R.W., & Lakin, K.C., (Eds.) (1997). Residential Services for Persons with Developmental Disabilities: Status and Trends through 1996. Minneapolis: University of Minnesota, Research and
Training Center on Community Living. Institute on Community Integration.
Website:www.google.com.pk
http://www.thearc.org/faqs.comliv.htmalNote: Many if the above questions and answers have been adapted from The Arc of Illinois “Campaign for Community living Fact Sheet”.
Assistive Technology Partners
Farming with a Hearing Impairment Working conditions exposing farmers and ranchers to
high levels of noise from tractors, augers, combines, grain dryers, power tools, chain sews, lawn mowers and snowmobiles make them prime targets for noise-induced hearing loss. Agricultural procedures are also susceptible to other ways of acquiring hearing impairments: traumatic injury, disease, or conditions present at birth.
Prevention of Noise-Induced Hearing LossThe first step in preventing a noise-induced hearing
loss is to identify sources of noise. They may have been taken for granted previously, so investigate thoroughly. Once sources are identified, reduced exposure to high levels of noise in one of the following ways.
Reduce the level of noise at the source: The best method to prevent noise-induced hearing loss is to remove the source or reduce its volume to a safe level. If it is not feasible to remove the source of noise, it is important to identify steps that may be taken to reduce its volume.
Accommodating a Hearing Loss
There is an abundance of technology that attempts to aid communication by person with hearing loss. The following are a few of the many personal aids available. Neck loops are worn around the neck for use with a hearing aid T-coil. The neck loop has a plug that can connect to the output jack of a personal receiver, a television set, a radio, or other audio instruments. Some alarm clocks flash a strobe light or vibrate your pillow or bed to signal, “Time to wake up!” phone call signalers alert you of an incoming call flashing a lamp on and off. Close captioning decoders print a TV program or videotape’s dialogue and sound effects on the TV screen, similar to subtitles (not all programs or videotapes have closed captions). Smoke and fire detectors are available
17
Home ServicesAT Info
TrainingHome
Research
that flash a strobe light when activated. Portable computers can serve as a communication aid by typing messages on the screen.
U.S. Department of Labor Occupational Safety and Health Administration Directorate of Science, Technology and Medicine Office of Science and Technology Assessment
Hearing Conservation for
the Hearing-Impaired Worker
Safety and Health Information Bulletin
his safety and Health Information Bulletin is not a standard or regulation, and it creates no new legal obligations. This bulletin is
advisory in nature, informational in content, and is intended to assist employers in providing a safe and healthful workplace. Pursuant to the Occupational Safety and Health Act, employers must comply with hazard-specific safety and health standards promulgated by OSHA-approved state plan. In addition, pursuant to Section 5 (a) (1), the general Duty Clause of the Act, employers must provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. Employers can be cited for violating the General Duty Clause if there is not, in itself, a violation of the General Duty Clause. Citations can be based on standards, regulations, and the General Duty Clause.
T Introduction:
Hearing-impaired workers face many challenges in the workplace, including communication, identifying and using suitable hearing protection and the use of hearing aids at work. Industrial hearing conservation programs may not fully address the specific needs of hearing-impaired workers for hearing protection and communication. This Safety and Health Information Bulletin (SHIB) focuses on how hearing conservation programs can address the needs of hearing-impaired workers who are exposed to high levels of noise in their workplace. For additional information on workplace accommodations for hearing-impaired workers for emergency preparedness / response and workplace safety in
18
general, please refer to “Innovative Workplace Safety Accommodations for Hearing-Impaired Workers”, SHIB 07-22-2005.
Purpose
The purpose of this SHIB is to raise awareness about issues associated with protecting hearing-impaired workers in noisy environments and to provide employers, workers and professional organizations guidance on accommodating hearing-impaired individuals in the workplace when exposed to high levels of noise. Specifically, this SHIB: 2005.
1. Informs employers that specialized hearing protectors are available that may benefit occupationally exposed hearing-impaired workers in variety of noisy workplace;
2. Encourages employers to work as a team with hearing-impaired workers and the professional in change of the hearing conservation program to determine the appropriate hearing protection for the hearing-impaired employee, and to determine on a case-by –case basis whether the worker’s hearing aid can be appropriately worn in a noisy workplace under a earmuff;
3. Informs employers and hearing-impaired workers that individualized audiometric testing protocols may be necessary to obtain valid audiograms.
4. Raises awareness about the need to protect the residual hearing of workers with hearing loss.
Hearing Conservation Issues Relating to Hearing-Impaired Workers
Use of Hearing Protection
OSHA’s occupational exposure standard includes requirements for hearing protection as part of the employ’s hearing conservation program (29 CFR 1910.95(i)). It requires employers to make hearing protectors available o all employees exposed to an 8-hour time –weighted average (TWA) sound level of 85 decibels (DBA) or greater. It also requires that hearing protectors be worm by
employees exposed to an 8-hour TWA of 85 dBA if they have experienced a standard threshold shift (STS). Hearing protectors are also required to be used prior to receiving a baseline audiogram, and as required by 29 CFR 1910.95(b) (1). Employees must be given the opportunity to select their hearing protectors from a variety of suitable hearing protectors provided by the employer. The employer must also evaluate the protector’s attenuation for the specific noise environments in which the protector will be used.
The use of hearing protection in the workplace is of special concern to workers who already have hearing loss. Hearing impaired workers can difficulty hearing co-workers, verbal instructions, the sound of machinery, of they make lack the ability to identify the direction of a sound source. Hearing-impaired workers may experience difficulty in using hearing protectors because conventional hearing protectors may reduce the speech volume label below the person’s threshold of audibility, especially for the important middle to higher frequency consonant sounds [3].
Manufacturers are continually designing and upgrading specialized hearing protectors for industrial, military, law enforcement, and fire and rescue team use. These may also benefit occupationally exposed hearing-impaired worker because they provide better clarity for speech recognition and communication, while still providing adequate protection in noisy environments by keeping the sound that reaches the ear at a safe level [1]. As manufacturers respond to the need, a number of affordable hearing protection options are emerging that aloe hearing-impaired workers to function safely and effectively in noisy environments without the risk of further hearing loss [2].
Although workers with hearing impairment have lost part of their ability, OSHA 29 CFR 1910.95 © provides for protection of their residual hearing ability. Even employees who have been diagnosed with severe or profound deafness may have some residual hearing that needs to be protected from additional loss. Therefore, OSHA has taken the position that the requirements for using hearing protection in accordance with 29 CFR 1910.95(i)(2) apply to deaf employees. The agency has stated that “there is no exception (for hearing protection) for
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employees who have diminished capacity to hear or for employees who have been diagnosed as deaf”. OSHA Letter of Interpretation, Tekia A, Staley, August 3, 2004.
Specialized Hearing Protectors
Specialized hearing protectors include passive (no electronics or amplification), active (a power supply and electronics), or communication headsets.
Passive Hearing Protectors
Flat or uniform-attenuating hearing protectors use mechanical means to fitter the sound and provide nearly equal attenuation across the audible frequency range. In general, the signal sounds more natural, clearer and less distorted than the sound from conventional hearing protectors, which often provide greater attenuation in the higher frequencies. When properly fitted, passive-hearing protectors can provide adequate protection and users can hear more and clearly and thus feel less isolated on the job. Workers with high frequency hearing losses may find the beneficial [3,4].
Active Hearing Protectors
“Level dependent” (also known as sound restoration) hearing protectors not only block sound but use electronic circuitry to transmit low-level sounds through the hearing protector. They amplify incoming sounds up to a specified sound level depending on the model and type of hearing protector. Above the specified level, the electronic input is automatically reduced so that the protector no longer provides amplification, which could lead to overexposure. An advantage of these protectors is that during quiet time and intermittent noise there is no need to remove the hearing protector to hear well [3,4].
Earmuffs with communication features are also available. These devices are designed with wireless (FM of infrared) or wired technology for-one or two-way communication systems. The devices provide specialized electronic circuits to limit the incoming sounds so that the earphones
themselves do not create sound levels that are hazardous to the wearer [3,4].
In extremely high noise level, dual hearing protection (such as an earplug under an earmuff) equipped with electronic / communication features may permit clearer communication without sacrificing attenuation. [3].
For more information on available hearing protectors, the National Institute for Occupational Safety and Health (NIOSH) has an online compendium of hearing protection devices. Additionally, the U.S Department of Labor’s Office of Disability Employment Policy Technical Assistance Program’s Job Accommodation Network (JAN) has a Searchable Online Accommodation Resources (SOAR) feature that lists hearing protector manufacturers that have provided information to that network. Neither OSHA nor JAN recommends or endorses any company’s products. However, JAN has valuable information on the availability of specific hearing protectors for use with the hearing-impaired population.
Many workers have strong preferences for a particular type of hearing protector because of comfort, fit, and communication demands. Experience has shown that the effectiveness of hearing protection is diminished if it is remove for even a short period of time [3,11]. Therefore, comfort, communication, and hearing protectors that allow for necessary job-related hearing is key to their preventive effect and the actual protection received [3]. The right hearing protector is one that is consistently worn. The graph below depicts the relationship between effective hearing protection attenuation and the amount of time hearing protection is worn.
20
Eff
ectiv
e Att
enua
tion
(dB
)
0
5 1
0 1
5 2
0 2
5 3
0 3
5
-NRR=30-NRR=20-NRR=10
For problems accessibility in using figures and illustrations in this document, please contact the Directorate of Sciences, Technology and Medicine at (202 693-2300)
Selecting and Fitting Hearing Protection Devices
29 CFR 1910.95 (i) (3) states that “employees shall be given the opportunity to select their hearing protectors from a variety of suitable hearing protectors provided by the employer”. The Phrases “suitable hearing protectors” has been interpreted to mean protectors that are comfortable to wear and that offer sufficient attenuation to prevent hearing loss. OSHA Letter of Interpretation, Danny D. Anderson, September 30, 1983.
In general, “employers are advised to give workers a choice between at least one type of earplug ad one type of muff; … the number of different hearing protectors required to constitute an adequate variety is simply the number needed to supply each employee that requires a hearing protector a suitable one”. OSHA Letter of Interpretation, G.A, Brown, October 17, 1983.
To motivate workers to consistently wear hearing protectors in noisy situations, employers should engage workers in determining their individual hearing protector needs. An employer should also consider referring a worker with a hearing impairment for a one-on-one consultation with a qualified hearing conservation professional to determine the most suitable hearing protector for the particular working environment. Important considerations for selecting the appropriate hearing protector include the worker’s hearing and noise exposure levels, job assignment, job-related hearing requirements, communication requirements and environmental considerations. The chosen hearing protector must provide the needed amount of attenuation specific to each worker’s noise exposure
situation. Over attenuation (blocking too much sound) can produce undesirable and unnecessary interference with speech and warning signals [5].
More information in the selection of hearing protectors and OSHA’s requirements for a hearing conservation program can be found on the OSHA website. The website will direct you to standards, letter of interpretation, technical guidance documents and information pamphlets. NIOSH also has a wide variety of information on noise and hearing loss and has a dedicated website for Noise and Hearing Loss Prevention.
Hearing Aid usage in Industry
Some hearing-impaired workers who wear hearing aids want to be able to continue to wear hearing aids in their workplaces even when exposed to high levels of noise. They feel that with the hearing aid they can communicate better with co-workers, are able to better localize sound, and can hear warning or equipment sounds. Hearing aids, however, in addition to amplifying useful sounds also amplify unwanted background noise [4]. As demonstrated in both laboratory and site measurements, noise amplified by hearing aids may exceed the OSHA 8-hour permissible limit of 90 dBA [6,7].
Consequently, hearing aids should not be worn in areas with hazardous noise [2,6,7]. However, on a case-by-case basis, hearing aids can be worn underneath an earmuff [7,12]. The hearing conservation professional, overseeing the hearing conservation program should be consulted to evaluate and manage these situations on a case-by-case basis to ensure no further change in hearing occurs.
Workers have suggested that they want to wear their hearing aids at work in the turned-off position in lieu of using hearing protection since they are accustomed to their own ear molds, and the hearing aids is already in their ear. Hearing aids are not hearing protectors. Hearing aids turned off do not provide enough blockage of sound to act as hearing protection, but may reduce the sound enough to prevent the worker from hearing warning signals or other essential sounds [2]. OSHA has stated that
21
8 7 6 5 4 3 2 1 0Hours HPD Removed During Exposure
employees with a “diminished capacity to hear cannot satisfy the requirement to wear hearing protection simply by turning off their hearing aids when working in a high noise area. Hearing aids are not hearing protectors”. OSHA Letter of Interpretation, Take A, Staley, August 3, 2004.
Individual evaluation by a qualified occupational hearing conservation professional and following-up with the employees at the worksite will ascertain the suitability of the hearing aid and / or hearing protector for that particular employee’s noise environment.
Audiometric Testing Requirements
For the purpose of determining whether an employee has a standard threshold shift (STS), the hearing impaired employee must remove his /her hearing aid and be tested with the appropriate headphones and procedures specified in the hearing conservation standard, 29 DFR 1910.95 (h) (1)- (h) (5); audiometric test requirements. Considerations for testing hearing-impaired employees may include switching from an automatic testing technique (with a microprocessor audiometer) to a manual technique to obtain valid thresholds. This may be necessary due to the degree of hearing loss of other confounding factors such as ringing in the ears. Also, “employees with hearing aids should keep the aids on during the audiometric test instructions”, hearing aids should, of course, be removed after the instructions have been given” [5]. Some hearing-impaired workers may need to be referred for further evaluation and testing if a valid audiogram can not be obtained on-site [5].
The correct approach to address these challenges will depend on facts specific to each individual situation, and should be resolved by collaborative teamwork involving the employer, the hearing-impaired employee and the hearing conservation professional [6,7].
Conclusion
The recommendations provided in this bulletin offer guidance on addressing the specific
needs of hearing-impaired workers to protect their hearing in high noise environments.
The risk of miscommunication, injury, and other challenges presented to the hearing-impaired employee in the workplace can be minimized through the implementation of certain practical steps. These include but are not limited to:
Awareness that hearing-impaired workers may have special needs to protect their hearing,
Providing information, Soliciting input, Providing choices, Team collaboration to ascertain individual
workplace needs, and Referral for further evaluation, as
appropriate,
References
1. Hearing Health, “Further for Workers?”. Lee Hager, Fall 2003.
2. Worker’s Compensation Board of British Columbia, Work Safe, “Working with Hearing Loss—hearing Impairment, Noise, and Job Safety / Performance”, May 29, 2003.
3. The Noise Manual, Fifth Edition, Chapter 10, Hearing Protection Devices, Elliott Berger, May 2000, AIHA, Fairfax, Va.
4. Encyclopedia of Acoustics, “Hearing Protection Devices”, ISBN 0-471-80465-7, 1977 John Willey & Sons, Inc., and the 2004 TeleWeb Virtual Seminar Series, New Developments in Hearing Protection, with an update on Ratings and Specialized Types of HPDs, July 27, 2004, Elliott Berger.
5. Council for Accreditation in Occupational Hearing Conservation (CAOHC) Manual, Chapters 7, The Audiometric Testing Program, Chapter 8, Understanding the Audiogram and Follow-Up Procedures, and Chapter 10, Hearing Protectors.
22
6. Journal of Speech and Hearing Research, Noise Exposure Associated with Hearing Aid Use in Industry”. Thomas Dolan and James Maurer. Volume 39, 251-260, April 1996.
7. Occupational Health and Safety, “Hearing Aids in Occupational Settings: Safety and Mangaement Issues”.
8. Earlog # 18, “Can Hearing Aids Provide Hearing Protection?” Elliott Berger, E-A-R, Indianapolis, Ind.
9. Responses to NHCA / OSHA Alliance Questionnaire on Application of Accommodations to hearing conservation practices.
10. U.S. Department of Labor / OSHA
11. For information ion the effect of hearing protector removal during exposure, visit Kevin Michael and Associates. The web address is http: //www.michealassociates.com
12. National Hearing Conservation Association, comments provided.
Other Useful Resources
The office of Disability Employment Policy offers the following technical assistance programs: office of Disability Employment Technical Assistance Programs: Training and Technical Assistance to Providers (T-TAP), The National Center on Work force and Disability for Adults (NCWD-Adults), the National Collaborative on Workforce and Disability fro Youth (NCWD / Youth).
Job Accommodation Network’s Searchable Online Accommodation Resources, (SOAR) Resources for Hearing Protectors. The National Hearing Conservation Association (NHCA). The American Academy of Audio logy (AAA) American Speech-Language-Hearing Association (ASHA).
National Institute for Occupational Safety and Health (NIOSH). National Institute on Deafness and other Communication Disorders (NIDCD) wise EARS Campaign. For educational information on hearing conservation, visit E-A-R Hearing Conservation.The Better Hearing InstituteFor information on innovations in technology and hearing conservation, you may visit Hearing Products Report. The Web
ICDRIThe International Center for Disability Resources on the Internet
Missouri Technology Center for Special Education
Resource Name: Missouri Technology Center for Special Education. Associated Organization: University of Missouri at KC. Country of Origin: USA. Address: City:
www.icdri.org/education/moat.htm
Missouri Technology Center for Special Education
Resource Summary Page
Resource Name: Missouri Technology Center for Special Education
Associated Organization: University of Missouri at KCCountry of Origin: USA
E-mail: [email protected]
Site Summary: The Missouri Technology Center for Special Education provides information, training and technical assistance to Missouri’s educators interested in effectively integrating computer technology into their curriculum. New advances in computer technology can improve the educational opportunities for students with special computer needs. Housed in the school of education at the University of Missouri-Kansas City, the center is funded by the Missouri Department of Elementary and Secondary Education, Division of Special Education.
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Disability Association(s): All Disabilities
Internet Location: http://techctr.edu.umkc.edu/welcomepageInternet Resource Type: Web site
Resource Type: Government Site, Assistive Technology, and Education Site.
Methods and Technology
The Center Today
Today the center is using HTML and standard search and presentation methods to present the resources we are collecting. The resources are being collected and stored in such a way that they will be usable with future presentation and retrieval methods. The center is currently concentrating on gathering resources related to disabilities. This is being done on a worldwide basis. The center expects to have the largest collection of disability resources anywhere in the world. You may register you site through our registration page. Enter your information and the center’s staff will put your organization in our database. If your organization does not have a presence on the Internet the center can create a page for you. Please go to the create page and enter the information about your organization. The center’s staff will put your organization in our database and create a web page for you on our site.
A Historical Review of
Technology Research in
Special EducationJohn Woodward
University of Puget Sound
Herbert ReithUniversity of Texas at Austin
Review of Educational ResearchWinter 1997, Vol. 67, No. 4, pp.503-536.
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n this article we receive the research literature since 1980 on uses of technology in special education. Unlike past reviews, which have
typically focused on academically related issues and the effectiveness of computer assisted instruction, this review also summarizes the extensive observational and naturalistic studies, as well as research efforts in technology-based assessment. This diversity of research in special education stems from the multiple roles of the special education teacher, who, in addition to bearing instructional responsibilities, often determines eligibility for services, tracks progress toward IEP goals, and facilitates a student’s day-to-day participation in general education settings.
I
Research on the use of technology for students with disabilities has expanded considerably over the last two decades. Resulting in an agenda that encompasses a diverse range of innovative instructional and assessment programs. In addition to experimental research, important observational and naturalistic studies have been conducted during this period of time, the general findings of which are a sober reminder of how difficult it is to translate innovation of any kind into practice. Finally, studies of assistive devices, through fewer in number, have uniquely contributed to what now broadly constitutes special education technology research.
This range and depth of research did not exist in the 1970s or the early 1980s. The limited number of studies in special education technology from those years tended to reflect a general interest in the impact of microcomputers on all students in public schools. At the time, technologists in both general and specific education largely focused on the effectiveness and the efficiency of computer-assisted instruction (CAI). Software programs for general and special education students were commercially developed and were predominantly limited to drill-and-practice programs, tutorials, simulations (Budoff, Thormann, & Gras, 1984). And like the reports and journal articles in mainstream journals, writing on technology in the special education literature were generally enthusiastic about
Motivation:
Although students with learning disabilities are generally acknowledgement to have significant deficits in basic skills, special educators (Deci & Chandler, 1986:Okolo, 1992) also note that motivation is a key factor that influences their performance. Ensuring that students will benefit from the discrete instructional design variables mentioned above and attain high level of proficiency in a CAI environment, then, is contingent on their active engagement. This issue becomes even more important in computer lab settings, where it is difficult for a teacher to successfully monitor individual students (Reith, Bahr, Okolo, Polsgrove, Eckert, 1988). Thus, there have been a series of studies exploring the motivational effects of arcade-like games on the acquisition of math facts and vocabulary words.
Christensen and Gerber (1990) compared a popular math CAI drill-and-practice arcade program with an experimenter-developed, non-arcade program containing addition math facts and, like its commercial counterpart, simple corrective feedback. While all students show considerable gains over the course of the study, those students who used the non-arcade program showed the greatest gains. Researchers also found that students in the experimental group practiced significantly more problems than the arcade group.
These results are consistent with other studies (Axelrod, Mcgregor, Sherman, & Hamlet, 1987; Chiang, 1986) which have indicated that arcade games create extraneous distractions and that potential increase in learning come at the expense of entertaining learning environments. Bahr and Rieth (1989), in a study of multiplication drill-and-practice arcade games, also found that games had little effect, in part because they were not incorporated into regular classroom instruction.
Only Malouf’s (1988) study of vocabulary acquisition indicated that students who played a “space invaders” program, where they matched prefixes with root words. Show higher levels of motivation for the arcade condition. However, motivation was measured on tasks that immediately
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followed the intervention, and the researchers acknowledge that the extended effects of the program were not documented. Furthermore, they reported equivalent increase in academic performance for all students in the study.
These studies suggest that arcade games compete for time and attention in the context of drill and practice. Under carefully supervised conditions, arcade games seem to detract from the high amounts of practice required of students with disabilities if they are to master target skills. Researchers also contend that relatively poor performance on game software may be a function of selective attention deficits (Semmel & Lieber, 1986). Consequently, students with learning disabilities are less capable than their non-disabledPeers of focusing on the drill features of the program.
Summary:
Over a decade of research the bases in the mid 1980s reflects a conditions in which students in the experimental and comparison conditions used modified versions of the same CAI program. Special Education technology researchers (e.g., Carmine, 1989) noted that in instances when the medium did vary, it was the specific instructional design principles rather than the medium (i.e., not the CAI or the textbook) that contributed to significant differences in outcomes. These studies clearly attempted to address Clark’s (1983) observations on media as a confounding variable in instructional technology research.
Feedback:
Non-technology-based research in special education has long pointed to various of feedback as a critical instructional design variable for students with disabilities. Correlational (Englert, 1984) and observational (Reith & Frick, 1983) research during the 1980s suggested that this was an effective practice for enhancing student understanding, at least for basic skills. Feedback in these contexts has connoted either redundant information (e.g., visual prompts, verbal cuing) or immediate corrective feedback (e.g., “correct/incorrect”, right / try
again”). Further research synthesis (e.g.,Bangret-Drowns, Kulik, Kulik, Morgan, 1991: Lysakowski & Walberg, 1982) supported the use of even more detailed forms of feedback. For example, instead of merely telling students the correct answer, these researchers argued that strategic feedback –briefly reviewing the steps r strategies for answering a question or completing an algorithm-was an even more effective way of reducing errors and helping students master skills.
Feedback as redundant information. Torgensen and his colleagues (Torgesen, Waters, Cohen, & Torgesen, 1988) conducted a series of studies on the effects of speech synthesis as a form of feedback. They were particularly interested in the different informational attributes of microcomputers (i.e., graphics, sound, and text) and their effects on the beginning decoding process in reading.
Torgensen et al., (1988) found that students were taught decoding with three different computer presentations- visual only (pictorial representation, synthesis pronunciation of the word, and the word itself)-showed comparable improvements in levels of speed and accuracy, at least when contrasted with a no-treatment condition. Moreover, the number of sessions required to achieve word mastery was similar. Other reading studies (e.g., Jones, Torgensen, & Sexton, 1987; Wise & & Olson, 1994) generally support the view that synthesized speech can help students learn how to segment words.
The effectiveness of speech synthesis is less clear when students are allowed to employ it selectivity. In Farmer, Klein, and Bryson’s (1992) study, Students with learning disabilities could highlight words they did not know, and a speech synthesis device would pronounce the words for them. When measures of comprehension and recognition indicated no significant differences, the authors suggested that poor readers may tend to skip over words they do not know in text and thus be less likely to
Organization of the Review:
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This review of research on the applications of technology in special education presents a historical as well as thematic synthesis of the extant literature. The special nature of special education technology research is that it is directly tied to a series of traditional questions in the field (e.g., how to accurately and reliably determine eligibility for special education services, how to adapt instruction or provide assistive devices to best meet individual needs, how to systematically track progress toward IEP goals over time). Thus, there have been distinct but related themes in research efforts over the last 15 years.
The first section of this article describes research efforts over the last 15 years that have examined the academic impact of technology-based instruction on students with disabilities. Rather than a meta-analysis of CAI or a summary of CAI and its effectiveness by content area, the research will be presented at it evolved historically, that is, from abroad comparisons between CAI and traditional instruction to a more focused look at the effects of instructional variables (e.g., feedback, schedules of practice, explicit strategies) embedded in the software. This section will also review research into more comprehensive instructional interventions through videodiscs and multimedia. Much of the research discussed in this section is guided by the effort to adapt software to the unique instructional needs of students with mild disabilities.
The second section offers a summary of the research conducted since the mid 1980s in the area of computer-based assessment. Sophisticated programs, often developed by the same researchers who conducted the cited studies, are used to determine a students’ eligibility for special education services and to monitor a students’ day-to-day progress toward annual IEP goals. Other innovative assessment programs model student understanding in arithmetic or social competence in the classroom. Technology provides researchers a medium for systematically and reliably analyzing student behavior.
Finally, the third section of this review examines the limited observational and naturalistic research that has been done regarding the use of
technology for students with disabilities. Students conducted over the last 15 years attest to a range of logistical as well as pedagogical constraints. These findings serves as an important counterpoint to the central assumptions that special education researchers tend to make regarding the optimal use of computers in special education settings. Many in this field uncritically believe that research and / or technology developed by professionals should transfer directly to everyday settings. The studies discussed in this section of the review underscore the need for a closer look at issues of professional development if special education technology research is to be come a part of common practice.Literature Search Procedures:
The studies included in this review were located after and extensive search of electronic and print resources. A computerized search was conducted of the diverse if not overly complex roles required of public school special educators. The day-to-day activities of these individuals was (and remains) more than instructional. Special education teachers, particularly resource room teachers, were charged with diagnostic responsibilities (i.e. determine eligibility for special education services), as well as documenting student progress toward the goals enumerated in individualized educational programs, IEPs. Researchers also began exploring how unique applications of technology could be applied to the needs of “low-incident” populations such as students with hearing and visual impairments, mental retardation, and physical disabilities.
A central force in accelerating the research and development of technology in special education from the early 1980s on ward was the U.S. Department of Education’s Office of Special Education Programs. Extensive funding in the form of open or “field-initiated” competitions for research on students with disabilities as well as numerous directed competitions funded by the Technology, Media, and Materials Program-enabled researchers to investigate an array of issues (Hauser & Malouf, 1994), from projected applications of technology available (at the time) only to the military and business to the use of technology for administrative purposes. Since 1986, this program
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has sponsored over $35 million of research and development designed to advance the quality, availability, and effective use of technology (Okolo, Cavalier, Ferretti, & Macarther, 1995). To be sure, this level of support for software development and research has dramatically advanced technology research in special education.Past Literature Reviews on Special Education Technology:
Previous reviews of the research have used either meta-analytic techniques or broad, thematic approaches to the literature on the use of technology for students with disabilities. More importantly, they have focused almost exclusively on the academic effectiveness of educational technologies. Schmist, Weinstein, Niemic, and Walberg (1986), while citing a number of problems with the extent CAI research (e.g., anecdotal or poorly written results, use of single subject as well as group designs), nonetheless conducted a meta-analysis of a subtest of the literature. Their Meta analysis, which generally supported CAI as a means of increasing academic performance for students with disabilities, was based onglobal comparisons of CAI and traditional forms of instruction. McDermid (1989) presented a similar analysis of the literature, while also highlighting the substandard nature of many research reports of the time.
Ellis and Saborine (1986) offered another method of research synthesis that has continued until today. They organized their synthesis of the technology literature thematically specifically, they delineated a series of “promise” that reflected hypotheses or expectations for CAI which were either explicit in individual studies or widely held beliefs about the potential benefits of the use technology in special education. More recently, Shiah, Mastropieri, and Scruggs (1995) used content areas as a framework for reviewing CAI studies. That is they examined. What is striking about the most prominent strands of this research has been the interplay between software development and research. Frequently, the same researchers have prototyped, evaluated, refined, and researched their assessment systems, only to modify the programs further by adding new features. Another distinctive feature of this development and
research is the use of commercial expert systems to aid in the decision-making process.
Classroom Observational Systems
Greenwood and his colleagues (Carta & Greenwood, 1985; Greenwood, Carta, & Atwater, 1991; Greenwood, Carta, Kamps, Terry, & Delquadri, 1994) have used technology to address the problem of peripheral observations and consultations for students at risk for (or currently enrolled in) special education. Through several iterations and field tests, these researchers have developed a highly sophisticated computer program that can be used to document student behavior, teacher behavior, and the instructional features of the classroom environment or ecology. Trained observers make low- inference observations (e.g., the student is reading aloud, the teachers is at the front of the room teaching, the subject is social studies) and use a laptop computer to enter their data. After the observation, professionals (e.g., special educators, teachers, school psychologists) can examine a range of behaviors in isolation or in context of other behaviors using any one of the program’s many data display features. Greenweeod et al., ‘s (1991) program also graphically portrays changes in behavior over time, perhaps as a function of an intervention. A nationwide survey formed the basis for the behavioral categories, and the researchers have progressively refined the interface in order to reduce taxonomic complexity (Greenwood et al., 1994).
Computer Based Diagnosis:
Professionals have found decisions regarding eligibility for special education services as well as compliance with district, state, and federal guidelines problematic both because of the complexities and shifts in laws and because of the considerable variations in training for individuals involved in this process; Hofmeiter and others (Geldern, Ferra, Parry, & Rude, 1991; Hofmeister, 1986; Hofmeister & Ferrara, 1986; Parry & Hofmeister, 1986) have developed a series of expert system programs that attempt to standardize procedures for determining whether or not a student is eligible for special education services.
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Early programs focused on simple eligibility issues (e.g., Was the student sufficiently below grade level in a subject matter?, Did the student have an IQ in the normal range?). Validity studies, the kind that have characterized basic expert system development and research (Hayes-Roth, Waterman, & Lenat, 1983; Wenger, 1987), contrasted human experts with computer programs. More recent programs such as SMH.PAL (Hofmeister et al., 1994) carefully aid the user in identifying important target behaviors and assist in program interventions based on the needs of the student and the teachers’ level of sophistication (i.e., the likelihood that the teacher will be able to implement the intervention program SMH.PAL are often used for motivational purposes and not as a systematic means of increasing academic abilities (MacArthur & Malouf, 1991).
The struggle to adjust technology to the perceived needs of the teacher is also apparent in the work of the Fuchses and their colleagues (Deno, 1990; L. Fuchs et al., 1994; L. Fuchs et al., 1989). Early CBM systems were designed merely to remove the drudgery of recording and summarizing data. The main intent was to provide teachers with information that would in turn facilitate careful pedagogical decisions- how best to adjust a student’s program of instruction. The most recent versions of CBM, however, automate this kind of decision making through highly scripted intervention that are generated by an expert system. This move toward more directive interventions that are generated by an expert system. This move toward more directive interventions is based on the view that teachers, on their own, generally do not use a wide variety of instructional strategies and need specific recommendations (L. Fuchs, Fuchs, Bishop, & Simmons, 1992).
Yet as D. Fuchs and Fuchs (1996) recently noted, the objective and expert nature of outside consultations clashes with the view that teachers are the best judges of who qualifies for special education or what kind of instruction needs to be done next. This observation pertains to expert systems for classroom observation (e.g., Greenwood et al., 1994) as well as those designed to improve decisions as to who qualifies for special education
services (Hofmesiter et al., 1994). Comparable problems arise with constructive approaches reviewed in this article, as these researchers attempt to move special educators from a traditional focus on specific skills to more integrated and student-directed approaches.
For special education technologists, all of this suggests that productive future research could be conducted in the areas of school culture and professional development. Yet the argument that teachers resist technology because of fundamental and conflicting visions of technology is complex in special education. Unlike the general educator whom Cuban (1993) had in mind, the special educator helps assure that students are eligible fore services and monitors progress toward IEP goals. Effectively implementing and managing technology presents significant challenges for a single teacher who often designs and provides services for a wide range of students with disabilities. These demands, which are understandably beyond the scope of Cuban’s analysis, may actually lead to significant uses of technology because of the need to make one or more dimensions of the practitioner’s job more efficient, if not more sensitive to the highly individualized nature of special education services.
References
Alcantra, P. (1996). Video-based anchored instruction versus in –vivo instruction on independent job performance of students with disabilities. Unpublished doctoral dissertation, Vanderbilt University, Nashville, TN>
Anderson, J. (1983). The architecture of cognition, Cambridge, MA: Harvard University Press.
Axelord, S., McGregor., Sherman, J., Hamlet, C., (1987). Effects of video games.
Recent ActivitiesThe center has begun to implement the use of style for easier maintenance to improve the accessibility of the site. Watch for more improvements in the future.
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The Center in the FutureThe goal of the center is to use XML and related technologies to store, retrieve and present all of the resources we collect. The center will be developing methods that allow the user to choose the type of presentation that they prefer or need depending on their preferences and circumstances.Many of the methods that the center will use are not confined to people with disabilities, but are usable by many people in different circumstances. For example, surfing the web via sound is something many people may have a need to do. If you are driving a car and need information or you eyes are otherwise occupied you will find you have a need to listen to a web page, not view it. If you are using a device with a small screen auditory surfing may be the best choice for you. The
methods developed and used here have many uses some of which have nor even been imagined. Follow some of the links below to learn more about the basic technology that will be used by the center.
Web Technology ResourcesThe W3C Extensible Markup Language Page at http://www..w3.org/XML/ is the best place to start it gives numerous resources to help understand what XML is and what it can do.
XML.COM is a publication devoted to XML and what is going on in the industry. It can be found at http://www.xml.com/pub. They alos provides a Resource Guide. This can be found at http://www.xml.com/xml/pub/listercat. It will provide useful links to vendors and information about using XML.
The SGMl /XML Web Page Extensible Markup Language (XML) By: Robin Cover.
This is both and explanation of the XML language and a collection of resources by one of the most knowledgeable people in the field. It is to be found at http://www.oasis-open.org/cover/xml/html there is also an XML Support Page that lists many companies that support XML. It is found at: http://www.oasis-open.org/cover/xmlsupport.html
Other Technology Resources
Below are resources of new technology that is interesting and innovative and can assist people with various types of disabilities.
ICDRI Activities and ProjectsIn addition to the activity of collecting and presenting disability resources on the internet, the center provides other services, some of them are listed below: The center is available to make presentations and to participate in other activities related to disabilities. For further details, please contact the center at [email protected]
Current ActivitiesCommunity Technology Centers Accessibility Resource Page
The Center is collecting resources to help community technology Centers to increase access to their facilities for people with disabilities.Ongoing Collection of Legal and Policy Best Practices.
Medical Conditions and
DisordersEdited by: Dr. Shagufta Shahzadi
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Physical Disability, Impairment or Delay ny of a variety of conditions that may be due to muscular, skeletal or neuro-muscular disorders, paralysis or loss of one
or more limbs which impose physical limitations of the individual including an impaired ability to walk, stand or use one’s hands.
ACerebral Palsy – a no progressive paralysis that is caused by development defects in the brain or trauma at birth that results in loss of muscular control, spasms, weakness and speech problems. There are a number of forms of cerebral palsy including ataxia, athetosis, rigidity, spasticity, and tremor.
Muscular dystrophy – A familiar disease that is characterized by progressive atrophy and wasting of the muscles.
Spina bifida – A congenital defect in the walls of the spinal cord caused by lack of union between the laminae of the vertebrae. As a result of this deficiency, the membrance of the cord are pushed through the opening forming the spina bifida tumor.
Mental Disability or DelayAny mental defect or characteristic resulting from a congenital abnormality, traumatic injury, or disease that impairs normal intellectual functioning and prevents a person from participating normally in the activities appropriate for his particular age group Down syndrome (Trisomy 21) – A variety of congenital development disorder that is marked by sloping forehead, presence of epicanthal folds, gray or very light yellow spots at the periphery pf the iris, short broad, hands with a single palmer crease, a flat nose or absent bridge, low set ears and
generally short physique.
Fragile X Syndrome - A condition of an X-linked mutation association with a fragile site near the tip
of the long arm of the X chromosome. Most males and 30% of females with this mutation are mentally deficient. The after puberty.
Tuberous sclerosis – A syndrome that is manifested by convulsive seizures, progressive mental disorder, benign sebaceous tumors on the face, and the tumors of the kidneys and brain with projections into the cerebral ventricles.
Medical condition
Baby or young child who routinely needs special medical attention.
Nasogastric (NG) tube - A nasogastric tube is a rubber or plastic tube that passes through the nose, down the throat and esophagus (food pipe) and into the stomach. NG tubes may be used for feedings, fluids or medicines when a child cannot take these by mouth.
Multiple oral medications – When a child takes multiple prescription medicines on a regular basis.
Ventilator dependent – Any person who is dependent on a device used to provide assisted respiration and positive pressure breathing.
Developmental Delay A term used when a baby or young child has
not achieved new abilities within normal time range and has a pattern of behavior that is not appropriate
for his age.
Birth Injuries - Physical or neurological injuries to the neonate that are caused by difficulties in the birth process.
Fetal alcohol syndrome – Birth defects in infants arising from the mother’s chronic alcoholism during the gestation period. The syndrome has a specific pattern of malformation involving a parental onset of growth deficiency, developmental delay, cranio-facial anomalies and limb defects.
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Shaken infant (baby) syndrome – A condition that can occur when a baby is shaken so violently that his or her brain, spine or spinal cord is injured. Long term complications include mentally handicapped, paralysis, vision loss and possibly death.
Significant vision or hearing impairment
Visually impaired – Eye optic nerve malfunctions which prevent affected individuals from seeing normally.
Hearing impairments – A defect in one or more parts of the ear its associated nerve pathways that lead from the ear to the brain which prevents the individual from adequately hearing, receiving or attending to faint speech, ordinary conversational speech, loud speech or other sounds.
Blindness – A condition in which affected individuals have central visual acuity of 20 /200 or less in the better eye with maximum correction, or a peripheral field of vision that is so contracted that its widest diameter subtends an angle no greater than twenty degrees. These individuals are termed legally blind. Educationally blind individuals are people whose visual impairments such that they principally read Braille.
Cockayne’s Syndrome – An heredity syndrome transmitted as an autosomal recessive trait, consisting of dwarfism with retinal atrophy and deafness, associated with progeria, prognathism, mental retardation and photo sensitivity.
Deafness – A hearing loss that is so severe at birth and in the per lingual period (before that child is two to three years of age) that the normal spontaneous development of language is precluded.
Serious Behavioral Disorders
Behavior which seriously interferes with the normal life of a person or the lives of those with whom he lives or works; may be caused by environmental, emotional or psychiatric factors.
Prader –Willi syndrome – A rare, incurable and sometimes fatal disesase of childhood that is characterized by short stature; lack of muscle tone, size and strength; underdeveloped or small genitals; an insatiable appetite which leads to obesity if untreated; and cognitive delays in most cases.
Tourette’s syndrome – A neurological movement disorder which begins when the individual is age two to sixteen and characterized by rapidly repetitive muscular movements called “tics” including rapid eye blinking, shoulder shrugging, head jerking, facial twitches or other torso / limb movements; and involuntary vocalizations including repeated sniffing, throat clearing, coughing, grunting, braking or shrieking.
Speech and Language Delay or Impairment
Any of a number condition that interface with the individual’s ability to produce audible utterances to such a degree that the resultant sounds do not serve satisfactory as the basic tool for oral expression. Speech disabilities fall into several categories; articulation problems in which speech sounds are omitted, replaced by substitute sounds or distorted; voice problems in which pitch, loudness quality of voice are affected; and stuttering.
Articulation Disorders – same as above.
Echolalia - An automatic repetition of sounds, words and phrases, including responding to questions by repeating the ending of the question rather than processing and answering it.
Cleft lip / Cleft plate – A congenital fissure in the upper lip and / or the roof of the mouth which forms a communicating passageway between the mouth and nasal cavities. This condition may lead to articulation and voice problems.
Seizure Disorders Seizures are characterized by uncontrolled
movements of the muscles of the body or change in alertness or behavior. They are caused by certain abnormalities in the brain. In the normal brain,
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there is organized electrical activity which is always present. A seizure happens when bursts of unorganized electrical impulses interface with the normal brain electrical activity. A bursts is the sudden appearance of electrical impulses. The different types of seizures are caused by different kinds of electrical bursts or by electrical bursts in different parts of the brain.
Tonic –clonic (also known as Grand mal)
Seizures are the most common type of seizure. First the child goes through the tonic phase with loss of consciousness, stiffening of the body, drooling, heavy breathing, and at times loss of bladder and bowel control. This followed by the clonic phase during which the muscles change from rigid to relaxed. The seizure is often followed by a post-ictal state which is period of sleepiness or confusion.
Absence (Petit mal) – These seqizures often involve very brief periods of starting as if the child is daydreaming. Often the child will have no change in muscle one. For example, if standing the child does not fall. There will be a momentary loss of consciousness and child will not know what happened during the brief time of the seizure.
Infantile (Infantile myoclinic) – Occur during the first two years of life and usually before one years age. During infantile seizures, children may demonstrate different signs of seizure activity, such as brief nooding of the head or flexing the head and arms many times during the day.
Partial – simple (focal) – seizure may involve any part of the body. The term simple means that generally there is no loss of consciousness.Complex (psychomotor) - Seizures are similar to the simple partial seizures in that only a part of the body is involved. The term complex means that there is the additional component of mental confusion, behavioral symptoms and loss of consciousness. These seizures are often followed by a period of confusion.
ADHD / ADD(Attention deficit disorder with hyperactivity) / (attention deficit disorder without hyperactivity)
A disorder in which developmentally inappropriate in attention and impassively are exhibited. There are two subtypes: Attention deficit disorder with hyperactivity and attention deficit disorder without hyperactivity. Some characteristics are: not staying on task, difficulty organizing and completing work, inability to stay with activities of periods of time appropriate for child’s age, failure to follow through on parental requests. Symptoms may vary with situation and time, i.e., home, schools, groups, and one-on-one interactions.
Autism
A lifelong developmental disability which affects communication and behavior and which usually appears before age three. It is characterized by lack of meaningful speech or inappropriate speech; withdrawn, anti-social and / or affectionless behavior; a fascination with objects rather than with people; prolonged odd body movements; a hypersensitivity to stimuli; stereo-typic and compulsive behavior; and a failure to initiate or relate to people.
Cystic Fibrosis
An inherited disease that affects the pancreas, respiratory system and sweat glands, which usually begins in infancy and is characterized by chronic respiratory infection, pancreatic insufficiency and heat intolerance. Prognosis is not good as there is no cure, but antibiotics and new treatments have prolonged the life of many patients.
Diabetes
A disorder in which the pancreas produces too little insulin with the result that the body is unable to adequately metabolize sugar. Principle symptoms are elevated blood sugar, sugar in the urine, excessive urine production and increased food intake. Complications of diabetes if left untreated include low resistance to infections leading to a susceptibility to gangrene, cardiovascular and kidney disorders, disturbances in the electrolyte
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balance and eye disorders, some of which may lead to blindness.
Severe allergies
A condition in which the individual has an acquired hypersensitivity to substances that normally do not cause a reaction. Manifestations most commonly involve the respiratory tract or skin and include eczema, hives, nasal discharge and inflammation of the nasal mucous membrane.
Severe Asthma
A disorder of the bronchial system that is characterized by labored breathing accompanied by wheezing that is caused by a spasm of the bronchial tubes or by swelling of their mucous membrane. Recurrence and severity of attacks is influenced by secondary factors: mental or physical fatigue, exposure to fumes, endocrine changes at various periods in life and emotional situations.
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NASA Presentation
The center provided materials support for our advisory board member Michael Burks who made an hour long presentation to NASA regarding the Digital Divide and people with disabilities.
Announcements of B.S.
Four Year Program
On the initiative of the honorable Vice Chancellor, University of Karachi, the Department has developedProcessed and got approval for the Four Year BS Program and has started the course from January, 2007.
Welcome Farewell Party
New coming students, existing students and out going students arranged a party, which was a unique one. The party has fun, drama, art, and Music. All the students enjoyed the event.
Dictionary of Terms Used in
Special Educationote: the following definitions have been compiled from a variety of sources. The content of this dictionary does not
necessarily represent definitions endorsed by the U.S Department of Education
NAdaptive development
Development of the child in comparison to other children the same age. This might include the child’s ability to dress, eat without the assistance of others, toilet training, how he plays with other children’s, how he play alone, understanding dangers in crossing the street, how he behaves if mother leaves the room etc.
Advocate Someone who takes action to help someone
else (as in “Educational advocate”); also to take action on someone’s behalf.
Amendment Changes, revision, or addition to made to a
low.
AppealA written request for a change in a decision;
also, to make such a request.
Appropriate
Able to meet a need; suitable or fitting; in special education, it usually means the most normal situation possible.
Assessment A collecting and bringing together of
information about a child’s needs, which may
include social, psychological, and educational evaluations used to determine services; a process using observation, testing, and test analysis to determine and individual’s strengths ad weaknesses in order to plan his or her education services.
Assessment team A team of people from different
backgrounds who observe and test a child to determine his or her strengths and weaknesses
At risk A team used with children who have, or
could have,problem with their development that may affect later learning.
Child Find A service directed by each state’s
Department of Education or lead agency for identifying and diagnosing unserved children with disabilities; while child find looks for all unserved children, it makes a special effort to identify children from birth to six years old.
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Cognitive A term that describes the process people use
for remembering, reasoning, understanding, and using adjustment; in special education terms, a cognitive disability refers to difficulty in learning.
Comprehensive service system Refers to a list of 14 years each participating
state is to provide under the Early Intervention Program for Infants and Toddlers (Part H). These 1q4 points range from definition of developmentally delayed, to guidelines for identification, assessment, and provision of early intervention services for the child and family.
CounselingAdvice or help given by someone qualified
to give such advice or help (often psychological counseling).
Developmental Having to do with the steps or stages in
growth and development before the age of 18 years
Developmental history The developmental progress of a child
(age’s birth to 18 years) in such skills as sitting, walking, talking or learning
Developmental testsStandardized tests that measure a child’s
development as it compares to the development of all other children at that range
Disability The result of any physical or mental
condition that affects or prevents one’s ability to develop, achieve, and/or function in an educational setting at a normal rate
Due process (Procedures)Action that protects a person’s rights in
special education, this applies to action taken to
protect the educational rights of students with disabilities.
Early interventionist Someone who specializes in early childhood
development, usually having a Master’s degree or Ph.D. in an area related to the development of infants, toddlers, and preschoolers
Early intervention policies See policy / policie
Early intervention service or programsPrograms or services designed to identify and treat a developmental problem as early as possible; before age 2-3 (services for 3-5 year olds are referred to as preschool services).
Eligible Able to quality
Evaluation (as applied to children from
birth through two years of age)The procedures used to determine if a child is eligible for early intervention services; (as applied to preschool and school-aged children) the procedures used t5o determine whether a child has a disability and the nature and extent of the special education and related services the child needs.
Free appropriate public education [often
referred to as FAPE]One of the key requirements of the IDEA, which requires that an education program be provided for all school-aged children (regardless of disability) without cost to families; the exact requirements of “appropriate” are not defined, but other references with the law imply the most “normal” setting available.
HandicapSee disability
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Identification The process of locating and identifying children needing special services.
Lead agency The agency (office) within a state or territory in charge of overseeing and coordinating the service system for children ages birth through 2
Least Restrictive Environment An educational setting or program that provides a student with disabilities with the chance to work and learn to the best of his or her ability; it also provides the student as much contact as possible with children without disabilities, while meeting all of the child’s learning needs and physical requirements.
Multidisciplinary
A team approach involving specialists from more than one discipline, such as a team made up of a physical therapist, a speech and language pathologist, a child development specialist, occupational therapists, or other specialists as needed.
Occupational Therapy
A therapy or treatment provided by an occupational therapist that helps individual developmental or physical skills that will aid in daily living; it focuses on sensory integration, on coordination of movement, and on fine motor and self help skills, such as dressing, eating with a fork and spoon etc.,
Parent training and information programs
Programs that provide information to parents of children with special needs about acquiring services, working with schools and educators to ensure the most effective educational placement for their child, understanding the methods of testing
and evaluating a child with special needs, and making informed decisions about their child’s special needs.
Physical therapy
Treatment of (physical) disabilities given by a trained physical therapist (under doctor’s orders) that includes the use of message, exercise, etc., to help the person improve the use of bones muscles, joints, and nerves.
PlacementThe classroom, program, service, and / or therapy that is selected for a student with special needs
Policy / policies Rules and regulations; as related to early
intervention and special education programs, the rules that a state or local school system has for providing services for and educating its students with special needs.
Private agency A non-public agency which may be
receiving public funds to provide services for some children
Private therapist Any professional (therapist, tutor,
psychologist, etc.,) not connected with the public school system or with a public agency.
Program(s)In special education, a service, placement,
and / or therapy designed to help a child with special needs.
Psychologist A specialist in the field of psychology,
usually having a Master’s degree or Ph. D. in Psychology
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Public Agency An Agency, office or organization that us
supported by public funds and serve the community at large
Public Law (P.L.) 94-142A law passed in 1975 requiring that public
schools provide a “free appropriate public education” to school-aged children ages 3-21 (exact ages depend on your state’s mandate, regardless of
disabling condition; also called the Education for All Handicapped Children Act of 1975 or the Education of the Handicapped Act (EHA), with recent amendments now called the individuals with Disabilities Education Act (IDEA).
Public Law (P.L.) 102-119Passed in 1991, this is an amendment to the
individuals with Disabilities Education Act (IDEA), which requires states and territories to provide a “free appropriate public education” to all children ages 3-5; and provides funds for states and territories to plan and implement a comprehensive service system for infants and toddlers (ages birth through 2 years) with disabilities.
Related services Transportation and development, corrective,
and other support services that a child with disabilities requires in order to benefit from education, example of related services include speech / language pathology and audio logy, psychological services, physical occupational therapy, recreation, counseling services, interpreters for those hearing impairments, medical services for diagnostic and evaluation purpose, and assistive technology devices and services.
Service coordinator Someone who acts as a coordinator of an
infant’s or toddler’s services, working in partnership with the family and provides of special programs; service coordinators may be employed by the early intervention agency.
Services / service delivery The services (therapies, instructions,
treatment) given to a child with special needs.
Social or emotional (development)The psychological development of a person
in relation to his or her social environment
Special education See special education programs and services
Special education coordinator The person in charge of special education
programs at the school. District. Or state level.
Special education programs / servicesPrograms, services, or specially designed
instruction (offered at no cost to families) for children over 3 years old with special needs who are found eligible for such services; these include special learning methods or materials in the regular classroom and special classes and programs if the learning or physical problems indicate this type or program.
Special needs-(as in “special needs” child)A term to describe a child who has
disabilities or who is at risk of developing disabilities and who, therefore, requires special services or treatment in order to progress.
Speech /language pathologyA planned program to improve and / or
correct communication problemsResources Consulted
Burchinal, Margaret B., and Richard M. Clifford, Ellen S. Peisner-Feinberg, Noreen Yazejian. Children of the cost, Quality and Outcomes go to School. Chapel Hill: University of North Carolina.
Kendig, Paula, A pro Guide to the Alphabet of Acronyms. Pensacola, Florida: Parent Resources Organization, 2000
Long, Lou Ann. Florida Directory of Early Childhood Services / Central Directory
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Manual. Tallahassee, Florida: Florida Children’s Forum, 1997.
Inclusive Child Care Booklet . Tallahassee, Florida: Florida Children’s Forum, 1997.
Mason, Tony, Ph. D., and Lou Long. Good News for Center and Family Child Care
Providers: Mainstreaming and Inclusion Become A Reality. Tallahassee, Florida: Florida Children’s Forum, 1994
(Contributing authors unknown). Inclusive Child Care: Open Hearts- Open Doors. Salem, Oregon, 1999.
Inclusion Advisory Council
collected by: Mr. Nadeem Akhter
Holly Cromer National Association of Child Development 7670 Winward Way West Jacksonville, FL 32256
Pat CrononFlorida Association of Child Care Management 6225 Hazeltine National Drive Orlando, FL 32822
Susan Gold Ed. Maliman Center for Child Development University of Miami 1601 NW12th Avenue –Room 4012Miami, FL 33136
Mark GrossFamily Central, Inc.840 SW 81st Avenue North Lauderdale, FL 33068
Kathryne McGhee Rehabilitation Services Provider PARC 3100 75th Street North St. Petersburg, FL 33708
Pam KautzQuality Improvement Center for Disabilities 6698 68th Avenue North – Suite D Pinellas Park, FL 33781
Paula Kending Parent Resource Organization (PRO)2921 Inverness Place Pensacole, FL 32503
Lou Ann Long Florida Children’s Forum 2807 Remington Green Circle
Tallahassee, FL 32308Lynn Marie Pricew
Department of Health /Children’s Medical Services 4025 Espalande Way Tallahassee, FL 32311
Cheryl Liles Florida Inclusion Network6264 Bradford ville Road Tallahassee, FL 32308
Rachel SpanjerDepartment of Education FDLRS / Child Find 310 Bolunt Street – Suite 206Tallahsssee, FL 32301
Jim Stevens Department of Children and Families / WAGES408-E Bldg. 3
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1317 Winewood Blvd.Tallahassee, FL 32399-0700
Eileen Templeton Family Network on Disabilities of Florida 2735 Whitney Road Clearwater, Florida 33760
Deborah Russo / Regina PleasDepartment of Children and Families / Child Care 1317 Winewood Blvd, Bldg 7 – Room 231
Tallahassee, FL 32399-0700
Kim Latta Florida Developmental Disabilities Coucil 124 Marriot Drive –Suite 203 Tallahassee, FL 32301
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Rehabilitation Process
by: Mr. Shabbir Qadri
Introductionhe Education and Rehabilitation process go through a structured form. It involves a multi faceted approach involving
various components. It is a daily process through which children gain more skills through therapeutic activities such as.
T Special Education Physiotherapy Yoga Speech Therapy Creative Activities
Play Music Dance Therapy Arts Craft Drawing / PaintingComputer
Hydro therapy Field Trip Picnic Toy Library Care-Givers Meeting
Parents as VolunteerSynergy
Family Tour Parents Day Pre-vocational Medical Management adopting the multi
disciplinary team approach Success story
The concept behind adopting these above mention activities not only provide the child scope for learning but also helps in the
development of the persons mind, body and spirit.
Special Education
It is teaching through innovative teaching materials / equipments, tailor made frame like flash cards, toys, puzzles etc. This is known as IEP (Individual Education Programme). Each individual is given training according to his / her ability & needs). Through the improving their skills, the trainee is enabled to lead and independent, living like (They learn to dress by themselves, engage in leisure
Physiotherapy
It is a physical exercise, provided for the children with physical deformities like cerebral palsy. It helps in management of the deformity. (At inter line physiotherapist unit, works during afternoon session). Physiotherapy is given to the children in need of it by way of exercise, by the therapist. In this we have all the necessary physiotherapy equipments like parallel bar, cycle etc. Through physiotherapy exercises our children have shown improvement in their “Gross and Fine Motor Skills” which important skill is required for the development of their functional abilities.
Yoga
It is a form of exercises coupled with meditation that is used for the management of behavior problems, hyperactive, obesity, etc., in children; it has an overall improvement effect. At Interline Yoga Therapy is provided for all
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children by a well trained yoga instructor (during the afternoon session).
There is an improvement in academic skills, hyperactive behavior is managed and the children are able to sit in a place allotted to them, which they were unable to do earlier.
Through yoga therapy children have shown improvement in attention and concentration. It has also resulted in the improvement of the trainee’s physical health.
Speech Therapy
It is therapy given for the improvement of speaking skills. This training is imparted by an experienced speech therapist who gives speech therapy to the children in need of it by way of constant blowing and tongue twisting exercises. Each trainee is given training according to their need and ability.
By speech therapy, children have gained and developed their language skills and good social communication.
The result of this therapy has enabled the children in winning many prizes in vocal music competition that were held in recent times.
Creative Activities
It is a multiple activity, which improves the children, gross, motor, social, recreational personal, and academic, attention, and concentration skills. These activities are providing through…
Play
It is an activity provided through recreation. At interline rehabilitation center, we have multi facility play garden. All children enjoy this facility during the post non sessions. Special Education supervises and engages the children in the activities of play and games according to their individual needs and interest. This has resulted in the development of social skills like helping others, co-operating with group etc., among the children. They have won
gold medal Special Olympics other local level competitions.
Music
A therapy that involves the use of musical instruments in the process of treatment and training. It improves motor skills, attention and concentration as playing the instrument requires the rapid movement of arms and figures and good listening etc. Singing practice is also provided for vocal cord improvement. At interline well-versed professional provides music therapy. Children are given music training according to other need and ability. The result is that it has led to the development of concentration motor skills and attention that ultimately brings good performance in functional academic of the children as an end result.
Dance Therapy
A therapeutic activity involving physical movement. It improves motor movement, social and concentration skills. This activity is provided at interline with a group of selective children. Dance therapy eventually helps the child to develop their social and concentration skills especially in the area of group dance. This activity is also used as a re-enforcement (token economy) as children tend to enjoy this activity.
Arts Craft Drawing / Painting
An activity involving the holding a pen / pencil and scribbling / coloring etc.Drawing & painting, art and craft training is provided to the children at interline according to individual needs & ability. It improves the child’s creativity, color concept, concentration and motor development.
The Use of Computer
With the help of computers, concepts are taught by way of interactive games and story etc.
Hydro Therapy
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A therapeutic activity, where the children are placed in a pool of water, it helps the child to develop motor skills as a result of their movement in the pool.
Inter line has a water pool for hydrotherapy and a physiotherapist supervises and facilitates the training according to the individual needs of the children.
The result is the improvement in the motor activity. Phobic behavior is also reduced in the case of some children.
Apart from all these activities an exposure to the outside world is very essential for the emotional and social development of the children. For this purpose activity such as field trips and visits and picnics are organized for the children.
Field Trip
Children at interline are taken for field trip to public places like markets, post office, bus station, departmental store, church, mosque etc., this enable the children in the process of learning as to how others behave and interact in general.
Through field trips, the children gain social skills where it enables them to behave accordingly in public places. They gain sense of independency and also learn skills like shopping skills, or day-today affairs like going to the markets to pick up groceries with the list given by their parents.
Picnic
An enjoyable activity that provides emotional strengthening to the children and build the sense of social interaction.
Once in a term the children are taken for a picnic to various picnic spots. They are also taken for movies. Through picnic and visits to movie theatres, the children are able to learn to behave appropriately in public places. It eventually helps them in the management of keeping a decorum during their family festivals, religious ceremonies etc.
Sky-“The Petty Shop”
This small shop started in the year 2001 on the 15th August. The petty shop functions during lunch break time.
Pre-vocational trainees are places as shopkeeper, sweets, stationary and snacks are sold here. The children influence their peers to buy sweets from “sky” to teach the concept of money management special educator’s guide the children and teach them. This concept is an eye opener for parents. This in a case has resulted in a parent starting a petty shop just to teach money concepts to his child. The end result is that the trainees have shown immense development in money concepts & shopping skills.
Toy Library
Toys always have a special place in the lives of every child. The access to toys is the rights of a child and this concept when out into proactive has shown its positive influence.
A library without books but just toys in indeed a unique library. The novel concept of “The Toy Library” was introduced to interline on November 14th 2003 with a view to develop motivation. Social skills to for children through the use of toys and play. Playing with toys brings about greatest joy when the children select, touch and play with the toys of their choice. This activity apart from giving pleasure to the children ultimately develops their motor co-ordination and social interaction.
In the educational and rehabilitative process, the most vital strength namely the family is actively involved by a number of programmes and activities especially formulated for the family is incorporated at various stages. This is done by way of meetings and programmes.
Care-Givers Meeting
An interline every 2nd Saturday s of every month a meeting in order to educate the caregivers, a meeting is concede.
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The special educators discuss every child’s & and also educate parents on the various aspects of mental retardation and management. They also aim to sensitizing the various matters associated with it. The caregivers meetings stand to improve the support between the parent, special educators and the child.
The parents gain knowledge on the subject of mental retardation and mental health and it helps them in not only in effective managing their children but also in helping and guiding people who are unaware of such facilities.
Parents as Volunteer
Yet another programme that involve the enthusiastic volunteers in the process of rehabilitation parents who is willing to share the responsibilities by way of contributing their time and imparting various skills to the children supports this programme.
Every week a parent is there to help in the school activities along with the special educator. They also teach the child (A parent now teaches vocal music as an example).
This has developed the attitude of acceptance and sharing of responsibility.
Synergy
A concept with a difference. This programme involves the participation of the siblings of the mentally disabled. They meet every month and share their experience of heaving and living with a disable.
During the meeting they not only share their experience, they meet the special educators to get to know their siblings ability and problems. The special educator many a times is able to educate the sibling as to the problems of the disabled child and the management aspects from the point of view of the siblings.
This has led to the acceptance sharing and involvement of the family members in the management of the disabled family member.
Not to mutation the amount of happiness the child gets when he / she feels the love and warmth of the family members.
Family Tour
Are also organized once a year as a tool to bring about understanding and social interaction for both the family and the disabled children.
Parents Day
Annual day in the name of parent’s day is celebrated once a year. The importance of this day is ever child is given in opportunity to bring out his / her talent. It gives a sense of joy and confidence for the child. Each and every child is encouraged to participate in the programme.
Pre-vocational
Skills like tailoring, candle making, telephone mat making are given for the children as pre vocational activity. Aspects like kitchen activities (washing vessels, cleaning etc) are also provided as part of the training.
Parent volunteers also take the responsibility to each pre-vocational skill. It helps the trainees’ social and occupational development it helps him/ her to be independent in their future.
Medical management adopting the Multidisciplinary Team Approach
Medical professionals provide medical management. Appropriate drugs and counseling is given on need basis. The medical check up is conducted once a month to assess the physical and general conditions of the child, free medicines are provided to the needy. A multidisciplinary team is involved in the treatment and rehabilitation process.
These teams of professional’s diagnosis study the case and adopt suitable methods of treatment and rehabilitation.
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Team Members Medical Professionals Psychologist Psychiatrist Social Workers Special Educators Occupation Therapist
The team discusses each individual case to
formulate the most appropriate means of treatment. This team also plans the curriculum for the trainee based on the result of their discussion.
Success Stories (A) (B) (C)
Madiha a Nineteen Year-old girl was taken into inter line as a child diagnosed as Down syndrome. She was given systematic treatment coupled with education focusing on pre-vocational skills training. Having a special liking for children she learned her skills very quickly, which gave her the room for her for her future at inter line itself. Now she is full of life enjoying her work as “Care Taker” for the children of pre primary, engaging them in dance, song and play activities. Her parents are now a content couple who are more than happy to see their child not only happy but independent too.
Definition of Mental Retardation
Mental retardation is not something you have, like blue eyes, or a bad heart, nor is its something you are, like short, thin. It is not a medical disorder, nor a mental disorder.
Mental retardation is a particular state of functioning that begins in childhood and is characterized by limitation in both intelligence and adaptive skills.
Mental retardation reflects the “fit” between the capabilities of individuals and the structure and expectations of their environment.
The AAMR Definition of Mental Retardation Mental Retardation is a disability characterized by significant
Limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18.
Five Assumptions Essential to the Application of the Definition
1. Limitations in present functioning must be considered within the context of community environments typical of the individuals’ age peers and culture.
2. Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor and behavioral factors.
3. Within an individual, limitations often coexist with strengths.
4. An important purpose of describing limitation is to develop a profile of needed supports.
5. With appropriate personalized support over a sustained period, the life functioning of the person with mental retardation generally will improve.
What is the Official AAMR Definition of Mental Retardation?
Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive be3havior expressed in conceptual, social, and practical adaptive skills. This disability originates before the age of 18. A complete and accurate understanding of mental retardation involves realizing that mental retardation refers to a particular state of functioning that begins in childhood, has many dimensions, and is affected positively by individualizes supports. As a model of functioning, it includes the contexts and environment within which the person functions and interacts and requires a multidimensional and ecological approach that reflects the interaction of the individual with the environment, and the outcomes of that interaction with regards to independence, relationships, societal contributions, participation in school and community, and the personal well being.
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What Factors must be considered when Determine if a Person has Mental Retardation and Developing an Individualized Support Plan?
When using the AAMR definition, classification and systems of supports professionals and other team members must:
1. Evaluate laminations is present functioning with the context of the individuals’ age peers and culture.
2. Take into account the individual’s cultural and linguistic differences as well as communication, sensory, motor, and behavioral factors;
3. Recognize that within an individual limitations often coexist with strengths;
4. Describe limitations so that an individualized plan of needed supports can be developed and
5. Provide appropriate personalized support to improve the functioning of a person with mental retardation.
What is Disability?
A disability refers to personal limitations that represent a substantial disadvantage when attempting to function in society. A disability should be considered within the context of the environment, personal factors, and the need for individualized supports.
What is Intelligence?
Intelligence refers to a general mental capability. It involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly, and learn from experience. Although not perfect, intelligence is represented by intelligent quotient (IQ) scores obtain from standardized tests given by a trained professional. In regard to the intellectual criterion for the diagnose of mental retardation, mental retardation is generally thought to be present if an individual has an IQ test score of approximately 70 or below. An obtained IQ score must always be considered in light of its standard error of measurement, appropriateness, and consistency with administration guidelines. Since the standard error of measurement for most IQ tests is
approximately 5, the ceiling may fo up to 75. This represents a score approximately 2 standard deviations below the mean, considering standard error of measurement. It is important to remember, however, that an IQ score is only one aspect in determining if a person has mental retardation. Significant limitations in adaptive behavior skills and evidence that the disability was present before age 18 are tow additional elements that are critical in determining if a person has mental retardation.
What is Adaptive Behavior?
Adaptive behavior is the collection of conceptual, social, and practical skills that people have learned sop they can function in their everyday lives. Significant limitations in adaptive behavior impact a person’s daily life and affect the ability to respond to a particular situation or to the environment.
Limitations in adaptive behavior can be determined by using standardized tests that are formed on the general population including people with disabilities and people without disabilities. On these standardized measures, significant limitations in adaptive behavior are operationally defined as performance that is at least 2 standard deviations below the mean of either (a) one of the following three types of adaptive behavior: conceptual, social, or practical, or (b) an overall score on a standardized measure of conceptual, social, and practical skills.
What are Some Specific Examples of Adaptive Behavior Skills?
Conceptual Skills
Receptive and expressive language Reading and writing Money concepts Self-directions
Social SkillsInterpersonalResponsibilitySelf-esteem
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Gelidity (Likelihood of being tricked or manipulated)NaivetéFollow rules Obeys lawsAvoid victimization
Practical SkillsPersonal activities of daily living such as
eating, dressing, mobility, and toileting. Instrumental activities of daily such as preparing meals. Taking medication, using the telephone, managing money, using transportation and doing housekeeping activities.Occupational skills Maintaining a safe environment
What are Supports? The concept of supports originated about 15 years ago and it has revolutionized the way habilitation and education services are provided to persons with mental retardation. Rather than mold individuals into pre existing diagnostic categories and force them into existing models of service, the supports approach evaluates the specific needs of the individual and then suggests strategies, services and supports that will optimize individual functioning. The supports approach also recognizes that individual needs and circumstances will change overtime
Supports were an innovative aspect of the 1992 AAMR manual and they remain critical in the 2002 system. In 2002, they have been dramatically expanded and improved reflect significant progress over the last decade.
Supports are defined as the resources and individual strategies necessary to promote the development, education, interests, and personal well-being of a person with mental retardation. Supports can be provided by a parent, friend, teacher, psychologist, doctor or by an appropriate person or agency.
Why is Supports Important?
Providing individualized supports can improve personal functioning, promotes self-determination and societal inclusion, and improve personal well-being of a person with mental retardation, focusing on supports as the way to improve education, employment, recreation, and living environments is an important part of person-centered approaches to providing supports to people with mental retardation.
How are Some Determine What Supports are Needed?
AAMR recommends that an individuals’ need for supports be analyzed in at least nine key areas such as human development, teaching, and education, home living, community living, employment, health and safety, behavior, social, and protection and advocacy.
What are Some Specific Examples of Supports Areas and Support Activities?
Human Development Activities - Providing physical development
opportunities that include eye-hand coordination, cine motor skills, and gross motor skills activities
- Providing cognitive development opportunities such as using words and images to represent the world and reasoning logically about concrete events
- Providing social and emotional developmental activities to foster trust, autonomy, and initiative
Teaching and Education Activities
- Interacting with trainers and teachers and fellow trainees and students
- Participating in making decisions on training and educational activities
- Learning and using problem-solving strategies
- Using technology for learning - Learning and using functional academics
(reading signs, counting change, etc.)- Learning and using self-determination skills
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Home Skills Activities - Using the restroom / toilet- Laundering and taking care of clothes - Preparing and eating food - Housekeeping and cleaning - Dressing - Bathing and taking care of personal hygiene
and grooming needs- Operating home appliances and technology - Participating in leisure activities within the
home
Community Living Activities - Using transportation - Participating in recreation and leisure
activities - Going to visit friends and family- Shopping and purchasing goods- Interacting with community members - Suing public buildings and settings
Employment Activities - Learning and using specific job skills- Interacting with co-workers- Interacting with supervisors - Completing work-related tasks with speed
and quality - Changing job assignments- Accessing and obtaining crises intervention
and assistance
Health and Safety Activities- Accessing and obtaining therapy services- Avoiding health and safety hazards - Communication with health care providers - Accessing emergency services - Maintaining a nutritious diet- Maintaining physical health - Maintaining mental health / emotional well
being
Behavioral Activities - Learning specific skills or behaviors - Learning and making appropriate decisions - Accessing and obtaining mental health
treatments - Accessing and obtaining substance abuse
treatments
- Incorporating personal preferences into daily activities
- Maintaining socially appropriate behavior in public
- Controlling anger and aggression
Social Activities- Socializing within the family - Participating in recreation and leisure
activities - Making appropriate sexual decisions - Socializing outside the family- Making and keeping friends - Communicating with others about personal
needs- Engaging in loving and intimate
relationships - Offering assistance and assisting others
Has AAMR Always had the Same Definition of Mental Retardation?
No. AAMR has updated the definition of mental retardation ten times since 1908. Changes in the definition have occurred when there is new information, or there are changes in clinical practice or breakthroughs in scientific research. The 10th edition of mental retardation: definition, classification and systems of supports contains a comprehensive update to the landmark 1992 system and provides important new information, tools and strategies for the field and for anyone concerned about people with mental retardation.
What are the Causes of Mental Retardation?
The causes of mental retardation can be divided into biomedical, social, behavioral, and educational risk factors that interact during the life of an individual and / or across generations from parent to child. Biomedical factors are related to biologic processes, such as genetic disorders or nutrition. Social factors are related to social and family interaction, such as child stimulation and adult responsiveness. Behavioral factors are to harmful behaviors, such as maternal substance abuse, and educational factors are related to the availability of family and educational supports that promote
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mental development and increases in adaptive skills. Also, factors present during one generation can influence the outcomes of the next generation. By understanding inter-generational causes, appropriate supports can be used to prevent and reverse the effect of risk factors.
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An
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