Anne Arundel County Public Schools- Division of Special Education

1. Anne Arundel County Public Schools- Division of Special Education Para Educator Training Series Working with Students with Physical Disabilities

2. Pre AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos Name: School: Date: • 1. The role of the TSA/TA when working with student’s with physical disabilities you should • a.Leave eating and bathroom routine to the teacher • b.Talk to the family about other student’s problems • c.Assist with academics, movement and ADLs • d.Always be with the student during all class periods • 2. Students with physical disabilities often use adaptive equipment for • a.Mobility • b.Eating • c.Standing • d.All of the above

3. Pre AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos • 3. Students who use wheelchairs • a.Always have an IEP • b.Always have cognitive impairments • c.Should rely on others to push them in the hallways • d.Should be expected to become as independent as they can • 4. When transferring a student from a wheelchair to another piece of equipment the first thing to do is • a,Remove the seatbelt • b.Remove the footrests • c,Lock all brakes • d,Tickle the student

4. Pre AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos 5. MOVE is a curriculum used in special centers only T/F 6. When working with students with physical disabilities the TA should a. Always be available b. Set up opportunities for practicing independent skills c. Have minimal expectations of the student d. Allow the student to have extra socializing time

5. Pre AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos 7. When working with students with physical disabilities a. Check with the PT when there is conflicting information b. Check with the PT when the student reports new medical information c. Check with the PT when equipment seems to be "not right" d. All of the above 8. The TA/TSA should make adjustments to adapted equipment whenever they feel it is necessary T/F

6. Pre AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos 9. . The goal of using adapted equipment is to promote the student's a. Access to education b. Health c. Independence d. All of the above 10. TA/TSA input is valuable to the team T/F

7. Contacts • Amy Hicks PT, M.Ed : ahicks@aacps.org • Judith Davidson PT Manager: jmdavidson@aacps.org

8. Role of TSA/TA • Instructional tasks • Behavioral support tasks • Supervision tasks • Personal care tasks

9. Students with motor impairments and TA/TSA • Students with motor impairments may need assistance to move about the environment • Be placed in specialized equipment • Need assistance with toileting • Need assistance with supplies, communication devices and modifications to educational tasks • Need assistance with eating

10. Common Medical Diagnoses • CP- Cerebral Palsy • SP- Spina Bifida • Down Syndrome • Arthrogryposis • OsteogenesisImperfecta (OI) • Rett Syndrome • TBI- Traumatic brain injury • SCI- Spinal Cord Injury • Muscular Dystrophy

11. Spastic quadriplegia • Entire body is affected • Difficulty with head and truck control • May or may not be able to ambulate • Has many or all of the following deficits • feeding, speech, visual, hearing, • cognition, seizures

12. Spastic Diplegia • Mainly lower limb involvement • although, trunk almost always affected to some degree • Usually can ambulate with abnormal gait patterns (scissoring, toe walking, etc)

13. Spastic Hemiplegia • Only one side of the body is affected • the trunk is almost always involved to some degree by compensating for lack of control in other areas of the body

14. Spina Bifida/Myelodysplasia • failure of the tube around the spinal cord to fully form • many different classifications ranging from mild to severe • range of symptoms depending on location of the affected area of the spinal cord,

15. Basketball Team Students with Spina Bifida

16. Arthrogryposis in action

17. Sources of Information • http://nichcy.org • http://www.spinabifidaassociation.org • http://www.ucp.org • http://www.ninds.nih.gov

18. Objectives • Know types of adaptive equipment and their use • Understand safe use of equipment • Understand basic transfer and lifting principles • Introduction to MOVE

19. Adaptive Equipment Seating Systems Standing Devices Mobility Devices activities of daily living Orthotics/braces

20. Equipment Overview • Adaptive equipment can be used for a variety of reasons and to promote various outcomes • Most equipment has multiple adjustments and components to accommodate growth and size • Equipment must be maintained to be effective and safe – cleaned, tighten components, batteries charged

21. Safety When Using • Care must be taken when transferring and positioning a student into a piece of equipment • Providers must be aware of safe lifting techniques • Providers must be aware of how to handle abnormal movement of student such as increased tone, contractures, weakness • Physical therapist can assist with instruction and training for safe movement of students

22. Examples of Adaptive Seating

23. Standing Devices Dynamic stander Prone stander Supine stander

24. Easy Stand

25. Walking • One of life’s most important skills for bone and muscle health, learning, exploring and daily function • Some students require the use of walkers and/or gait trainers to develop this skill. • Benefits caretakers as well as student- walking is a critical life skill

26. Mobility Devices

27. Wheelchairs

28. Wheelchair Safety • Safety First • Ask student to help • Lock brakes • Move footrests • Remove chest harness • Unlatch seat belt last

29. Activities of Daily Living- ADL • Various assistive devices for use in the bathroom are available • Assistive devices for bathroom use can range from a railing to a fully supported toilet system. • For more involved student a changing table may be the only device that is appropriate. • Depending on the size of the student- a mechanical lift may be necessary to transfer the student onto the changing table. • If student is too heavy get assistance

30. Blue Wave Toileting Systems

31. Lifting devices

32. Ankle Foot Orthotics -AFOs

33. MOVE curriculum M- Movement O- Opportunities V- Via E- Education • Curriculum followed for some students with physical disabilities which may guide • goals for a student

34. Purpose of the MOVE program • Use education as a means of systematically acquiring motor skills • Combines therapy and education to establish activity based functional programs • Helps students practice their motor skills while performing everyday tasks • Reduce time and energy for daily care • Provide sequence of motor skill development for function • Provide way to measure improvement

35. Objectives • Identify functional skills that foster optimal independence. • Identify opportunities to integrate independence throughout the school day. • Assist students with the development of self-advocacy and responsibility skills. • Assist school teams with fostering student independence in preparation for the student’s transition to adult life.

36. What is needed for Optimal Independence? • Self determination (Functional skills) • Problem solving skills • Community support

37. Levels of support • Range from full support to natural supports • Goal is to have students demonstrate what they are capable of and when possible move to less support

38. Functional Skills that Promote Independence SELF CARE • Encourage student to indicate need for self care, teach skills for self care such as wiping mouth after ever bite, MOBILITY • Encourage use of mobility devices COMMUNICATION • Encourage communication with gestures, signs, words or communication device. Encourage student to ask/indicate need or want rather than anticipating what the student needs/wants. This takes patience and practice BEHAVIOR CONTROL • Encourage age appropriate behavior; limit inappropriate behavior. Monitor BIPs

39. Opportunities for Integrating skills throughout the day • Your role as a TA/TSA is to create opportunities within the school environment to promote self determination resulting in independence • We strive for kids to master the skills to move themselves, communicate, manipulate, explore and learn • Challenge yourself to recognize/create learning environments where skills can be fostered for adulthood

40. Sample: Mobility Independence • View the wheelchair as the student’s legs, • without it they would not be able to move

41. Mobility and Navigation • Encourage movement in the school building that is typical for the age of the student • Allow opportunities to practice movement and navigation • Think long term- can they find their way?

42. Barriers to Independence • Number of adults interacting with student • Uncertainty of how to help foster independence • Overcoming feelings of pity, anxiety, need to prevent failure • Learned helplessness - student relies on adults for everything, even paying attention in class

43. With a Little help…. • If you can imagine it , You can achieve it • If you can dream it , You can become it • William Arthur Ward

44. Summary • When working with student’s with physical disabilities in the county schools, the goal is to promote safe, healthy, access to their educational curriculum. The physical therapist involved with the student will answer any questions you have and train you on how to use any equipment involved. Our goal is to promote and develop independent skills and self advocacy skills with the student as they advance through their educational years.

45. POST AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos Name: School: Date: • 1. The role of the TSA/TA when working with student’s with physical disabilities you should • a.Leave eating and bathroom routine to the teacher • b.Talk to the family about other student’s problems • c.Assist with academics, movement and ADLs • d.Always be with the student during all class periods • 2. Students with physical disabilities often use adaptive equipment for • a.Mobility • b.Eating • c.Standing • d.All of the above

46. Post AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos • 3. Students who use wheelchairs • a.Always have an IEP • b.Always have cognitive impairments • c.Should rely on others to push them in the hallways • d.Should be expected to become as independent as they can • 4. When transferring a student from a wheelchair to another piece of equipment the first thing to do is • a,Remove the seatbelt • b.Remove the footrests • c,Lock all brakes

47. POST AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos 5. MOVE is a curriculum used in special centers only T/F 6. When working with students with physical disabilities the TA should a. Always be available b. Set up opportunities for practicing independent skills c. Have minimal expectations of the student d. Allow the student to have extra socializing time

48. POST AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos 7. When working with students with physical disabilities a. Check with the PT when there is conflicting information b. Check with the PT when the student reports new medical information c. Check with the PT when equipment seems to be "not right" d. All of the above 8. The TA/TSA should make adjustments to adapted equipment whenever they feel it is necessary T/F

49. POST AssessmentPlease submit to your administrator AACPS-Division of Special Education – Para Educator Training Videos 9. . The goal of using adapted equipment is to promote the student's a. Access to education b. Health c. Independence d. All of the above 10. TA/TSA input is valuable to the team T/F