Orthopedic Impairments,

Health Impairments, & ADHD:

Putting the Puzzle Pieces Together
SPE 500
Presented by April
Coleman

Agenda

Introductions
Opening Activity
Overview & Definitions
Physical & Other Health Impairments

Instructional Strategies

Types, Causes, & Accommodations

Inside a Real Classroom

Break
Activity Wiki/Webquest (Computer
Lab)
Debriefing

How is special
education like
a puzzle?

Pieces of the Special Education

Puzzle
Collaboration
Identification

Assessment

Instruction

Think about it

What 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 &
DEFINITIONS
Orthopedic Impairments,
Other Health Impairments, & ADHD

Orthopedic Impairments

A severe orthopedic impairment

adversely affects a childs educational
performance, including impairments

Caused 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 Impairments

Having 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 Picture

Common 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 attentiondeficit/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.

Prevalence

Chronic 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 Reactions

What words and feelings

immediately come to mind

When 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 IMPAIRMENTS
Types, Causes, & Accommodations

Cerebral Palsy

Most prevalent physical disability in schoolage children.

Permanent condition , not progressive
Results from a brain lesion or abnormal
brain growth (before, during, or after birth).
Varies in type and degree of impairment
23% - 44% also have cognitive impairments.
Some also have vision and/or hearing
impairments.

Cerebral Palsy

A disorder of involuntary movement

and posture
May affect one or multiple limbs
Symptoms:

Disturbances of voluntary motor function

May include paralysis, weakness, lack of
coordination, involuntary convulsions
Little or no control over arms, legs, or
speech
Effects muscle tone

Cerebral Palsy

Effects on muscle tone and quality:

Hypertonia tense, contracted

muscles; results in jerky movements
Hypotonia weak, floppy muscles;
may need external supports
Athetosis causes large, irregular,
twisting movements, including
drooling
Ataxia causes poor sense of balance
and hand use

CP Accommodations

Collaboration of physicians,
teachers, physical/occupational
therapists, and communication
specialists.
Muscle stretching and
strengthening exercises
Careful positioning
Use of assistive devices in walking
Use of a wheelchair

CP Accommodations

Communication devices
Stabilization tools
Grasping aids
Creation of boundaries
Modification of toys and equipment
MOVE Curriculum Activity-based
program (p. 411)

Spina Bifida

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 form

High risk of paralysis and infection

80-90% also develop hydrocephalus,
accumulation of spinal fluid in tissues
surrounding the brain

Spina Bifida

Typical symptoms:

Some degree of paralysis in lower limbs

Lack full bladder control
Good upper-body usage

Accommodations

Use of wheelchair, braces, crutches, or

walkers
Catheterization
Assistance in dressing and toileting

Muscular Dystophy

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.

MD Accommodations

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.

Epilepsy

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.

Epilepsy

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

Epilepsy Accommodations

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 Impairments

Spinal Cord Injuries

Diabetes
Asthma
Cystic Fibrosis
HIV/AIDS

May require special education and

other related services, such as
health care services or counseling.

ADD & ADHD

To be diagnosed with attentiondeficit/hyperactivity disorder, a child must

display 6 or more symptoms listed in the
DSM-IV of inattention or hyperactivityimpulsivity 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

Remember
Kids with
disabilities
are kids first.

INSTRUCTIONAL
STRATEGIES
Research-Based Educational Approaches

Inside a Real Classroom

Meet 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 Principles

Use 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.

Collaboration

Special educators
Para-professional aides
Physical therapists
Occupational therapists
Speech-language
pathologists
Adapted physical educators
Recreation therapists
School nurses
Counselors & Psychologists

Environmental
Modifications

Include 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 classroom

Soft-tip pens for writing
Modifying response requirements

Assistive Technology

Any 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 wheelchairs
Communicative aides
Online list of tools

Healthcare Strategies

Individualized Health Care Plan (IHCP)

Describes health-related needs and procedures

Included as part of a students IEP
Chart on p. 440 Example of IHCP objectives

Establish routines and procedures to

ensure proper positioning, seating, lifting,
and moving.

Benefits & Guidelines on pp. 437 & 441

Sample Routine p. 442

Behavioral Interventions

Positive reinforcement for on-task

behavior

Modification of instructional activities

Systematically teaching self-control

Research indicates success in students with

ADHD when self-monitoring is directly
linked with clear instructions and consistent
reinforcement (Biscard & Neef, 2002).

Self-Monitoring Steps
1.
2.
3.
4.
5.
6.
7.
8.

Specify 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.
(pp. 428429)

Fostering Independence
& Self-Esteem

How parents, teachers, classmates, and

others react to a child with a disability is as
important as the disability itself.

Strategies:

Encouragement of a positive, realistic self-view

Opportunities to experience success and failure
Reasonable expectations for performance and
behavior
Embracing unique interests and abilities
Fostering independence box on pp. 445-446

Placement Alternatives

About 50% of students with physical

impairments and chronic health conditions
are served in general education classrooms.

The amount of support and

accommodations varies greatly according to
condition, needs, and level of functioning.

Placement decisions should be made on a

case-by-case basis, with the students
needs and best interest in mind.

321
On your note card, please list:

3 key ideas

2 things I enjoyed or benefitted

from

1 question or request