Orthopedic Impairments,Health Impairments, & ADHD:Putting the Puzzle Pieces Together
SPE 500Presented by April Coleman
AgendaIntroductionsOpening ActivityOverview & DefinitionsPhysical & Other Health ImpairmentsTypes, Causes, & AccommodationsInstructional StrategiesInside a Real ClassroomBreakActivity Wiki/Webquest (Computer Lab)Debriefing
How is special education like a puzzle?
Pieces of the Special Education Puzzle IdentificationCollaborationAssessmentInstruction
Think about itWhat is your main goal as a professional in the field of special education?
How does this goal relate specifically to students with orthopedic and other health impairments?
OVERVIEW & DEFINITIONSOrthopedic Impairments, Other Health Impairments, & ADHD
Orthopedic ImpairmentsA severe orthopedic impairment adversely affects a childs educational performance, including impairmentsCaused by a congenital abnormality (i.e. clubfoot, absence of limb),Caused by disease (i.e. polio, bone tuberculosis),From other causes (i.e. cerebral palsy, amputation, fracture, burn, etc.) (IDEA, 2004).
2 Types: Orthopedic, Neuromotor
Other Health ImpairmentsHaving limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that
Is due to chronic or acute health problems such as asthma, ADD/ADHD, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and
Adversely affects academic performance (IDEA, 2004).
OI & OHI: The Big PictureCommon criteria in both definitions: that adversely affects a childs educational performance
Conditions may be congenital or acquired.
Not all students with physical or health conditions need/receive special education.Chronic vs. acute conditions
Why is ADD/ADHD included?Children with attention-deficit/hyperactivity disorder are served under the OHI category of IDEA with the reasoning that their condition results in a heightened alertness that adversely affects their educational performance.
PrevalenceChronic medical conditions affect up to 20% (about 12 million) school-age children in the U.S. (Sexson & Dingle, 2001).
In 2005-06, of children between 6-21:62,618 received services under OI category.557,121 received services under OHI category.(U.S. Department of Education, 2007)
Initial ReactionsWhat words and feelings immediately come to mindWhen seeing a child in a wheelchair?When seeing a non-verbal child communicate in other ways?When seeing a school-age child exhibit impulsive behavior?
As a special educator, how should you view these children?
COMMON PHYSICAL & OTHER HEALTH IMPAIRMENTSTypes, Causes, & Accommodations
Cerebral PalsyMost prevalent physical disability in school-age children.Permanent condition , not progressiveResults from a brain lesion or abnormal brain growth (before, during, or after birth).Varies in type and degree of impairment23% - 44% also have cognitive impairments.Some also have vision and/or hearing impairments.
Cerebral PalsyA disorder of involuntary movement and postureMay affect one or multiple limbsSymptoms:Disturbances of voluntary motor function May include paralysis, weakness, lack of coordination, involuntary convulsionsLittle or no control over arms, legs, or speechEffects muscle tone
Effects on muscle tone and quality:Hypertonia tense, contracted muscles; results in jerky movementsHypotonia weak, floppy muscles; may need external supportsAthetosis causes large, irregular, twisting movements, including droolingAtaxia causes poor sense of balance and hand useCerebral Palsy
CP AccommodationsCollaboration of physicians, teachers, physical/occupational therapists, and communication specialists.Muscle stretching and strengthening exercisesCareful positioningUse of assistive devices in walkingUse of a wheelchair
Communication devicesStabilization toolsGrasping aidsCreation of boundariesModification of toys and equipmentMOVE Curriculum Activity-based program (p. 411)CP Accommodations
Most common neural tube defect, in which the vertebrae do not enclose the spinal cord, causing a portion of the spinal cord and nerves controlling lower body muscles to fail to develop normally.Myelomeningocele most common and serious formHigh risk of paralysis and infection80-90% also develop hydrocephalus, accumulation of spinal fluid in tissues surrounding the brain Spina Bifida
Typical symptoms:Some degree of paralysis in lower limbsLack full bladder controlGood upper-body usage
AccommodationsUse of wheelchair, braces, crutches, or walkersCatheterizationAssistance in dressing and toileting
Refers to a group of about 40 inherited diseases marked by progressive atrophy of the bodys muscles.Duchenne MD most common and severe type.Progressive reduction of muscle tone causes difficulty in walking and other movements.Muscular Dystophy
Goals of treatment:Maintaining function of unaffected muscles for as long as possible.Facilitating movement.Providing emotional support to child and family.No known cure currently exists.Encourage children to be as active as possible.Avoid lifting or pulling children by their limbs. MD Accommodations
Condition resulting in chronic repetition of seizures.
A disorder, not a disease
30% of cases caused by other conditions (i.e. cerebral palsy, brain infection, high fever).
Psychological, physical, or sensory factors may trigger seizures (i.e. fatigue, anger, hormonal changes, light); may experience aura beforehand.
Types of seizures:Generalized tonic-clonic seizure (grand mal) most serious type; loss of consciousness, muscles become stiff and body shakes violently, usually diminishing in 2-3 minutes
Absence seizure (petit mal) far less severe but may occur more frequently; brief loss of consciousness occurs for a few seconds, causing person to stare blankly
Use of medication
During a seizure:Keep everyone around calm.Ease child gently to floor.Put something soft under his head.Turn him gently to his side.Do not attempt to restrain movements or do anything to his mouth.Allow the child to rest until full consciousness returns.
Other Health ImpairmentsSpinal Cord Injuries DiabetesAsthmaCystic FibrosisHIV/AIDS
May require special education and other related services, such as health care services or counseling.
ADD & ADHDTo be diagnosed with attention-deficit/hyperactivity disorder, a child must display 6 or more symptoms listed in the DSM-IV of inattention or hyperactivity-impulsivity for a period of at least 6 months.List on p. 421
Many children with ADHD who meet eligibility requirements are served under other disability categories (LD, emotional disturbance).
Prevalence: 3-5% of all school-age children
RememberKids with disabilities are kids first.
INSTRUCTIONAL STRATEGIESResearch-Based Educational Approaches
Inside a Real ClassroomMeet Hope Bailey, special educator and parent of a child with spina bifida.
Hope teaches a Multiple Disabilities Class at Sprayberry Education Center, in Tuscaloosa County School System.
Guiding PrinciplesUse ongoing assessment to guide instruction.
Individualize instruction to the greatest extent possible (IEP).
Promote student independence.
Collaborate with a team of experts to develop and implement a comprehensive educational, physical, and medical plan.
CollaborationSpecial educatorsPara-professional aidesPhysical therapistsOccupational therapistsSpeech-language pathologistsAdapted physical educatorsRecreation therapistsSchool nursesCounselors & Psychologists
Environmental ModificationsInclude adaptations to provide increased access to a task or activity, changing the way in which instruction is delivered, and changing the manner in which the task is done.
Examples:Location of items in classroomSoft-tip pens for writingModifying response requirements
Assistive TechnologyAny piece of equipment used to increase, maintain, or improve a childs functional capabilities.IDEA defines as both devices and services needed to help a child obtain and use devices.
Include both low-tech and high-tech devices
Examples:Power wheelchairsCommunicative aidesOnline list of tools
Healthcare StrategiesIndividualized Health Care Plan (IHCP)Describes health-related needs and proceduresIncluded as part of a students IEPChart on p. 440 Example of IHCP objectives
Establish routines and procedures to ensure proper positioning, seating, lifting, and moving.Benefits & Guidelines on pp. 437 & 441Sample Routine p. 442
Behavioral InterventionsPositive reinforcement for on-task behavior
Modification of instructional activities
Systematically teaching self-controlResearch indicates success in students with ADHD when self-monitoring is directly linked with clear instructions and consistent reinforcement (Biscard & Neef, 2002).
Self-Monitoring StepsSpecify target behavior and performance goals.Select materials that simplify the process.Provide supplementary cues to self-monitor.Provide explicit instruction.Reinforce accurate self-monitoring.Reward improvements in the target behavior.Encourage self-evaluation.Evaluate the program.