Children with Physical Disabilities, Health Impairments, and Multiple Disabilities

1. Chapter 12 Children with Physical Disabilities, Health Impairments, and Multiple Disabilities

2. The first major legislative response to individuals with physical disabilities was passed in 1917 to help meet the vocational needs of World War I veterans with disabilities (Best, Heller, & Bigge, 2005). • President Franklin Delano Roosevelt is credited with advancing the cause of individuals with disabilities through his New Deal; the 1935 Social Security Act provided funds for vocational rehabilitation, retirement support, and insurance benefits (Best, Heller, & Bigge, 2005).

3. The civil rights movement served as a model for the disabilities rights movement, and the 1968 Architectural Barriers Act laid the groundwork for later accessibility legislation. • Two key areas where substantial progress supporting full participation for individuals with physical disabilities has been made are medical advances and expanded technologies. Advances in medical interventions have led to life-saving interventions for children with physical disabilities and health impairments

4. A physical disability is a condition that interferes with the child’s ability to use his or her body. Many but not all physical disabilities are orthopedic impairments. The term orthopedic impairment generally refers to conditions of the muscular or skeletal system and sometimes physically disabling conditions of the nervous system. • Traumatic brain injury is an acquired injury caused by an external physical force, resulting in total or partial functional disability and/or psychosocial impairment that requires special educational services.

5. Definitions • Physical impairment • Orthopedic impairment • Traumatic brain injury • Multiple disabilities • Deafblindness • Other health impairments

6. Usher syndrome, often referred to as retinitis pigmentosa, is the most common condition that involves both vision and hearing, and the condition worsens over time. Usher syndrome is inherited, which means that it is passed from parents to their children through genes. Approximately 3 to 6 percent of all children who are deaf and another 3 to 6 percent of children who are hard-of-hearing have Usher syndrome • http://www.youtube.com/watch?v=aCm9C7lnfs8 • Early intervention appears to be critical for children who are deafblind and their families. Generally students with multiple disabilities have sensory deficits, motor disabilities, health or neurological disorders, or genetic inheritances that interfere with the normal progression of development.

7. A condition that requires ongoing medical attention is a health impairment. To be considered a disability, the impairment must substantially limit the child’s participation in routine school or home activities.

8. Physical Impairments • Children with Physical Disabilities : • Neuromotor impairments. These are disabilities resulting from damage to the central nervous system that impairs the brain’s control of muscle movement and the muscle receptors’ sensory feedback about speed, direction of movement, and body position. • Cerebral palsy. A number of disabilities are caused by damage to the motor control centers of the brain. The damage affects muscle tone, which in turn interferes with voluntary movement and full control of the muscles, and delays gross and fine motor development. CP includes four major classifications: spastic, dyskinetic, ataxic, and mixed.

9. spastic cerebral palsy, muscle tone is abnormally high (hypertonia) and increases during activity. Muscles and joints are tight or stiff, and movements are limited in the affected areas of the body. • dyskinetic cerebral palsy, tonal abnormalities involve the whole body. The individual’s muscle tone is changing constantly, often rigid while he or she is awake and decreased when asleep (Best et al., 2005). • Ataxic cerebral palsy is a condition in which voluntary movement involving balance is abnormal. Individuals with ataxic CP have difficulty controlling their hands and arms, and their gait is unsteady. • A child with mixed cerebral palsy has a combination of spastic, dyskinetic, and ataxic CP. The affected area can be (1) hemiplegic—just one side of the body (either left arm and left leg, or right arm and right leg); (2) diplegic—the whole body is involved, but the legs are more severely involved than the arms; and (3) quadriplegic—involvement is equally distributed throughout the body.

10. Neural tube defects. This includes spina bifida (the separation of a portion of the backbone) and myelomeningocele (the protrusion from the spinal cord of a sac of fluids containing portions of the spinal cord). • Seizure disorders/epilepsy. This disorder occurs when the brain cells are not working properly. It can be present in one hemisphere of the brain (partial seizure) or in both (generalized seizure). • An estimated 2 million children and adolescents have seizure disorders in the United States (Porter, 2008). Most seizure disorders respond well to medical treatment (either medication or surgery).

11. Traumatic brain injury. An acquired injury caused by an external physical force, resulting in total or partial functional disability and/or psychosocial impairment that requires special educational services. TBI accidents involve the head and may result in cognitive, social, and language deficits. Loss of a limb, broken bones, or paralysis may also result from accidents.

12. Physical Impairments • Degenerative diseases. These affect the muscles and their supporting framework, the skeleton. • Muscular Dystrophy. This is an inherited condition in which the muscles weaken and deteriorate. The most common form, Duchenne muscular dystrophy, occurs primarily but not exclusively in boys (Leet, Dormans, & Tosi, 2002). http://www.youtube.com/watch?v=f3WX4fBVqkE

13. Orthopedic and musculoskeletal disorders • Juvenile arthritis. Inflammation of the joints accompanied by fever and pain in the joints during acute periods. This begins at or before age 16 and causes swelling, stiffness, effusion, pain, and tenderness in the joints (Leet, Dorman, & Tosi, 2002; Porter, 2008). • http://www.youtube.com/watch?v=EzhEzWGCdkg&feature=related • b. Spinal curvatures. Scoliosis is a form of spinal curvature in which the spine forms a “c” or an “s” when it is viewed from behind. • c. Other types of orthopedic and musculoskeletal disorders include limb deficiencies, hip conditions, and other musculoskeletal conditions.

14. Children with Health Impairments • These impairments require ongoing medical attention. Table 12.5 provides classroom modifications and teacher requirements. • Diabetes is a disorder in which the blood sugar of the individual is abnormally high because the body does not produce enough insulin (Type 1 diabetes) or because the body is insensitive to the insulin that is produced (Type 2 diabetes) • Type 1 diabetes can develop at any time (including in infancy) but usually begins between ages 6 and 13. Type 2 diabetes used to be considered a disease of adolescents or adults, but it is becoming more common in children who are overweight or obese, and 10 to 50 percent of the newly diagnosed childhood cases of diabetes are Type 2 (Porter, 2008).

15. Cardiopulmonary conditions. These are health problems that affect the heart, blood, and lungs. • Asthma. This condition affects breathing; it involves swollen lungs, difficulty breathing, negative reactions to environmental conditions, and acute constriction of the bronchial tubes. • Cystic fibrosis. This is a lethal genetic disease affecting the respiratory and digestive systems • http://www.youtube.com/watch?v=ht3FxIg6k-M&feature=relmfu

16. AIDS (acquired immune deficiency syndrome). This is a breakdown of the body’s immune system caused by the human immunodeficiency virus (HIV). All educational professionals should be instructed in and use universal precautions. • 4. Cooley’s anemia and sickle cell anemia. These are genetic blood cell diseases. Children with Cooley’s anemia are listless, have poor appetites, and contract frequent infections. In sickle cell anemia, the oxygen-carrying cells are crescent-shaped and can be trapped in body organs, resulting in a shortage of oxygen and vulnerability to infection

17. Substance abuse. Abuse of legal or illegal substances by pregnant women can affect the fetus. • Alcohol. Fetal alcohol syndrome produces growth deficiencies, facial malformations, and central nervous system damage (mental retardation and challenging behaviors). • Cocaine. Cocaine use causes lower birth weight, shorter body length, and smaller head circumference. • Heroin. Heroin causes low birth weight and premature delivery. • Marijuana. Marijuana causes smaller babies who may be highly irritable.

18. 6. Other health-related conditions. These include chronic and sometimes life-threatening diseases such as cancer (leukemia, malignant tumors), diabetes, and hemophilia

19. Physical Impairments • Orthopedic and musculoskeletal disorders • Juvenile arthritis • Spinal curvatures • Limb deficiencies • Hip conditions • Other musculoskeletal conditions

20. Health Impairments • Asthma • ADD/ADHD • Cystic fibrosis • HIV/AIDS • Heart defects • Cancer • Diabetes • Substance Abuse • Hemophilia • Lead poisoning • Leukemia • TORCH infections • Rheumatic Fever • Sickle cell anemia • Meningitis/encephalitis • Hepatitis B

21. Table 12.3: Prevalence Source: U.S. Department of Education (2005). Twenty-sixth annual report to Congress: Implementation of the Individuals with Disabilities Act. Washington, DC: Office of Special Education Programs.

22. With the use of medication and the provision of an accessible setting and/or medical support teams, most students with physical or health impairments are able to function well in regular classes.

23. Early intervention—identification at birth or infancy or as soon as the disability occurs—is critical. Early intervention can minimize the severity of the disability or prevent the development of additional disabling or medical conditions. • In addition, the use of correct physical management procedures, adaptations, and devices can increase the acquisition of motor and self-care skills.

24. The inclusion movement has suggested that even children with multiple and severe disabilities should be included in the general education classroom (Giangreco, 1993), but many in the field disagree (Kaufman & Hallahan, 1994). Regardless of one’s position, five axioms should be considered when providing services for the severely disabled: (1) the child has the right to services that improve the quality of life and that maximize developmental potential, (2) early childhood services are an effective way of improving the quality of life and maximizing developmental potential, (3) intervention services that begin earlier in the child’s life will be more effective,

25. (4) early childhood services that involve families are more effective than those that do not (Westlake & Kaiser, 1991), and (5) including children with disabilities in regular classrooms increases their social skills and interpersonal relationships (Helmstetter, Peck, & Giangreco, 1994).

26. Most children with multiple and severe disabilities are identified at birth through early assessment (Apgar, Brazelton Neonatal Behavioral Assessment Scale). Sometimes the disability is easy to recognize (some types of spina bifida, Down syndrome). The first evaluation therefore will be made by a physician or a team of specialists. An educational assessment will follow; however, it is challenging to get a valid representation of the educational strengths and weaknesses of the student with physical disabilities. • Norm-referenced tests or standardized tests are difficult to use with this population because the norm group usually does not include children with these types of disabilities.

27. Therefore, it is usually quite difficult to draw conclusions about the strengths and weaknesses of the child with disabilities.. • Assessment accommodations should be made in four areas to assess more accurately the student’s strengths. The four areas are presentation (use of readers, translators, etc.), response (assistive technology, communication boards, etc.), setting (wheelchair accessibility), and timing (extended time and more breaks). There is currently a movement for the development of universally designed assessments (Salvia, Ysseldyke, & Bolt, 2007). Universal design is a concept that emerged in the attempt to create architectural designs that give everyone access. Universal design features should be incorporated into all assessments so it will be easier to test children with disabilities.

28. ADAPTATIONS • http://www.youtube.com/watch?v=ErG50hdtlnE • http://www.youtube.com/watch?v=WHBPGqhAwPY&feature=related

29. Early Intervention • Early identification is critical • Minimize the severity of the disability • Prevent secondary conditions or behaviors • Increase motor and self-care skills • Provide foundation for learning