ASPERGERS SYNDROME

FACT SHEET Specific type of pervasive developmental disorder characterized by problems in development of social skills and behavior. CHARACTERISTICS Cognitive: Normal intelligence Use words by age 2 Speech patterns may be different, speak rapidly ADD Obsessive Compulsive Disorder High IQs Speech inaccuracies Affective: Difficulty interacting with peers Tend to be loners Display eccentric behaviors depression Frustration Low self esteem

Psychomotor: Coordination difficulties Normal fine and gross motor development Clumsy ETIOLOGY AND PROGNOSIS Individuals with Aspergers Syndrome are high functioning and have very adaptive behaviors. There is limited if any social interaction amongst peers. By age 2 individuals with Aspergers have an inability to use single words or to speak in full sentences or phrases by age 3. With early intervention individuals with Aspergers, although diagnosed as having autism at a young age, respond well to specific teaching strategies. ASSESSMENT SUGGESTIONS TGMD2 Brockport Physical Fitness Peabody EFFECTIVE TEACHING STRATEGIES Limit amount of stimulus in the gymnasium Activities that encourage interaction Positive reinforcement Avoid large amount of down time Provide direct instruction Tactile directions

RESOURCES Direct parental contact School Psychologist Teacher interaction Cross-disciplinary teaching REFERENCES American Academy of child and Adolescent psychiatry NO. 69 September, 1999 Block, Martin E., 1995, A teachers guide to including students with disabilities in regular physical education. pgs. 27, 144-145

AUTISM
FACT SHEET Autism is a brain disorder that impairs a persons ability to communicate, form relationships, socially interact, and respond appropriately within a given environment. CHARACTERISTICS May avoid eye contact May seam deaf May lack awareness of the existence feelings of others Can be physically aggressive or have outbursts when familiar environment is hanged Can remain fixated on single activity or object May engage in strange actions such as hand flapping, rocking, or flicking objects May lick toys/objects May not show sensitivity to pain (burns, bruises) May engage in self-mutilation, such as eye gouging CAUSE Research continues to determine the causes of autism. These studies are looking at various parts of the brain and how they function compared to a typical child. Scientists have come up with some hypothesis, which include the following: Brain cells may migrate to the wrong place in the brain that could affect communication skills. (Parietal area of brain controls communication.) Scientists have found impairments of the amygdala in autistic children. The area known as the amygdala helps regulate social and emotional behavior. Research has found that individuals with autism may have high levels of the neurotransmitter serontonin. Since neurotransmitters are responsible for the passage of nerve impulses to the brain, these chemical differences could distort sensations in individuals with autism. Impaired social interaction Impaired verbal/non-verbal communication Seeks sensory input (ex. Weighted vest) Shows repetitive interests and activities, preoccupied with certain objects Absence of imaginative activity May withdraw from people Abnormal response to external stimuli such as sound and lights May lack appropriate play May be tactile defensive May be sensitive to touch

Research will continue as to the cause of autism that could someday lead to permanent treatment and prevention procedures. ETIOLOGY Autism is a brain disorder that impairs a persons ability to communicate, form relationships, socially interact, and respond appropriately within a given environment. Autistic symptoms must be present before the age of 3. The disability can affect the individuals level of functioning in a variety of ways. Some autistic individuals may have severe cases in which they have mental retardation and serious language delays. Others may be high functioning individuals that can speak and are very intelligent.

The symptoms of autistic individuals can vary; however, most people with autism share problems associated with social, communication, motor, and sensory issues. Autism occurs in 5-15 per 10,000 children. Boys are four times more likely to get autistic symptoms (National Dissemination Center for Children with Disabilities, 2003). PROGNOSIS Autism is a very challenging disability to solve because of many unknown factors. Since there is no cure for autism, proper procedures such as therapy must be taken to help these individuals handle their problems. With proper therapy sessions, autistic individuals can improve their modes of communication and socialization to live very productive independent lifestyles in society. Autistic children with IQ scores of 70 and above normally can live and work more productive independent lifestyles within society (Gale Encyclopedia of Psychology, 2001). Autism symptoms vary from mild to severe. The prognosis for these individuals depends on the severity of their disability and the level of therapy they receive. Most autistic individuals will have some sort of impairment of their senses throughout life. These could include: smell, taste, vision, hearing, and sensory issues. Autistic individuals are often labeled incorrectly as loners because of their inability to socially interact. Approximately 33% of children with autism will eventually develop epilepsy. The highest risk is with children that have severe cognitive impairments and motor deficits (Turkinson, 1999). Autistic individuals can live very active lifestyles. They are very capable of performing most physical activities. This will depend on the severity of the disability. Also, an active lifestyle is more likely to help these individuals with weight control, muscular endurance, muscular strength, cardiovascular endurance, self-esteem, and self-confidence.

IMPLICATIONS FOR PHYSICAL EDUCATION In the community, may need 1:1 supervision for child Use a PECS book (Picture Exchange Communication System) to allow non-verbal student choices of physical activities. Provide an initial screening process to determine students physical strengths and weaknesses. This will help in writing IEP objectives and goals. Establish routines and smooth transitions throughout the lesson Modify equipment so that the student can be successful, yet challenged. Provide balls that will provide sensory output during activities. (ie: Knobby balls) Videotapes can be useful for autistic children who can follow visual cues. ASSESSMENT SUGGESTIONS STANDARDIZED ASSESSMENTS BROCKPORT PHYSICAL FITNESS TEST: This is a criterion-referenced test that measures physical fitness levels for students between 10-17 years old. . It includes tests for body composition, muscular strength, muscular endurance, speed, power, flexibility, coordination, and cardiovascular endurance. This test could be used for an individual with autism if there were a concern with their fitness levels. BRUININKS-OSERETSKY TEST OF MOTOR PROFICIENCY: This is a norm-referenced test that measures an individuals speed, agility, fine motor, hand-eye coordination, and strength for disabled students between 4.5-14.5 years old. TGMD-2: This test provides criteria for different locomotor and object control skills for ages 3-10. I CAN: This criterion and content test is for disabled children who are ambulatory. The test measures motor and play skills and recreation skills.

MOTOR ACTIVITIES TRAINING PROGRAM: SPECIAL OLYMPICS SPORTS SKILL PROGRAM: This contentreferenced test is for severe handicaps of any age. The test measures striking, kicking, aquatics, and mobility. OHIO STATE UNIVERSITY SCALE OF INTRA GROSS MOTOR ASSESSMENT: This content and criterion referenced test measure basic locomotor skills, balance, object-control, gymnastics, health related fitness and sport skills for disabled individuals between 2.5-14 years old. PHYSICAL BEST: This criterion and norm based test could be used for severe cases of autistic individuals. This test measures aerobic capacity, body composition, flexibility, upper and lower body strength and endurance for children between 5-17 years old. FITNESSGRAM: This criterion-referenced test (level of mastery) tests an individuals overall wellness. This includes: body composition, cardiovascular endurance, muscular strength and endurance, and flexibility.

AUTHENTIC ASSESSMENTS RUBRICS: A rubric is a authentic assessment tool which can be used for assessing students with disabilities. In the rubric, there are various sets to each progression which have a scoring criteria and level of achievement. These progressions can be used to assess any locomotor and object-control skills. This type of assessment will tell exactly where the individual lies in terms of skill/health development. Types of rubrics: 1. Holistic rubric: Addresses a skill without task analyzing. This rubric is usually used for older population who are at the mastery level for that particular skill. 2. Analytic rubric: Breaks down a skill to meet the needs of someone working on mastering a skill. Usually addresses younger population. 3. Individual rubric: This rubric is used to meet the individual need of a child. This can be used to address someone with a disability whose needs must be met in a small class setting. This is an excellent procedure to use to meet a childs IEP goals/objectives.

OTHER ASSESSMENT IDEAS MOTOR DEVELOPMENT CHECKLIST: This is a progressive checklist for locomotor and object-control skills. Each skill is broken down from simplest to most difficult. As the student performs the assigned task, teacher will observe physical movement and check off the components of the skill that were accomplished. RECOMMENDED ACTIVITIES Any activity that requires vigorous activity and will improve their overall fitness levels. (flexibility, cardiovascular endurance, strength, muscular endurance) Walking/Hiking Bike riding (Type of bike will depend on ability/balance levels) Swimming: An excellent low impact activity that can benefit student in a variety of health-related ways

Activities that require the use of their senses. Autistic children like deep pressure that helps them relax. Weighted backpacks/vest can help provide this deep pressure. Find out the students physical activity interests.

CONTRAINDICATED ACTIVITIES Having class in a loud and/or bright environment; providing too much stimuli within the environment. (ie: Over stimulating with too much noise/equipment (Block et al, 2003). Activities that require a lot of contact. Spending too much time on a single activity and not providing enough choices (Block et al., 2003). EFFECTIVE TEACHING STRATEGIES Pre-school-Secondary Use teaching stations Change activities regularly Eliminate different distractions Keep directions short and age-appropriate. (Limit prompts) Use sensory stimulation to increase attention span Use smooth transitions Instruct in an environment were noise, smells, lights will not interfere with learning. Teach in less stimulating environment. Provide students with ear plugs/cotton balls in noisier environment. Keep motivational music at low level. Establish predictable routines within lessons Create high structured environment which is organized and predictable Warm-up, Activity, Closure Stations

Use visual aids during activities Use vigorous aerobic exercises to keep student on task Use a consistent behavior modification program Provide lots of practice time/repetitions. Show enthusiasm when teaching.

Preschool-Elementary Use sticker chart as a reward system Teach students basic locomotor and object control skills.

Middle School - Secondary Provide reward system that allows students the opportunity to participate in enjoyable activity. Teach students lead-up activities for team, individual, and cooperative activities. Have child perform task and draw parts of a picture (face) every time task is completed

Use a peer tutor to assist child in learning. Teach students lifelong activities that can be used for the rest of their lives. Allow choices when setting up the curriculum so they can choose an activity that is of interest to them.

Positive Behavior Management Strategies Set realistic goals and expectations Increase amount of activity time, while decreasing instructional and transition periods Check for basic understanding to make sure students know expectations Provide a structured environment with appropriate routines Challenge the students to keep them motivated Provide a reward system for good attitudes and behavior Provide non-verbal feedback and encouragement with high 5s and cheering Be consistent and fair with your rules and consequences Use proximity control if a problem is arising Get to know the students and show interest toward them outside of the physical education environment. Create a positive and enthusiastic environment for everyone Provide vigorous activities to help students remain on task.

RESOURCES Teachers and Parents: Web sites: P.E. Central Project Inspire PE Links4U California Physical Education Resources www.nichcy.org www.educationworld.com www.ncpad.org www.nimh.gov http://members.aol.com www.asd.k12.ak.us http://ncperd.usf.edu www.americanfitness.net (Physical Best) www.educationworld.com Journals: Palaestra Teaching Elementary Physical Education JOPERD Strategies Adapted Physical Activity Quarterly Books: Principles and Methods of Adapted Physical Education and Recreation Including Students with Disabilities in General Physical Education Inclusive Games Organizations: AAHPERD - www.aahperd.org Sport: Special Olympics - www.specialolypics.org Empire State Games for the Physically Challenged - www.empirestategames.org/physical Disabled Sport USA - www.dsusa.org

REFERENCES Anchorage School District. (2003). Common Disabilities: Autism. Retrieved February, 16, 2004 from http://www.asd.k12.ak.us/Depts/ape/common/autism.html Allrefer.com . (2004). Prognosis of Autism. Retrieved February 18, 2004 from http://health.allrefer.com/health/autism-prognosis.html Autism. (2001). Gale Enclopedia of Psychology, Ludd. Gale Group. Auxter, D., Pyfer, J., & Huettig, C. (2001). Determining Educational Needs Through Assessment. In V. Malinee (Ed.), Principles and Methods of Adapted Physical Education and Recreation, 9th edition (pp.32-68). New York, N.Y: McGraw-Hill Higher Education. Block, M.E., Lieberman, L.J., & Conner-Kuntz, F. (1998). Authentic assessment in adapted physical education. JOPERD, 69, 48-55. Huettig, C. (1999). Use of physical activity to improve behavior of children with autism. Retrieved February 16, 2004 from http://www.palaestra.com/autism.html National Dissemination Center for Children with Disabilities. (2003). Autism and Pervasive Developmental Disorder. Retrieved February 11, 2004 from http://www.nichcy.org/pubs/factshe/fs1txt.htm OConner, J., French, R., & Henderson, H. (1999). Use of physical activity to improve behavior of children with autism. Retrieved February 16, 2004 from http://www.palaestra.com/autism.html PE Central. (2000). Common disabilities defined/described. Retrieved February 9, 2004 from http://www.pecentral.org/adapted/adapteddisabilities.html Project Inspire. (2004). Autistic disorder fact sheet. Retrieved May 22, 2003 from http://twu.edu/~f_huettig/Fact_Sheets/autism.htm Prognosis for people with Autistic Disorder. Retrieved February 18, 2004 from http://www.webspawner.com/users/austisticprognosis Turkington, C.A. (1999). Autism. Gale Encyclopedia of Medicine. Gale Research.

DEPRESSION AND EMOTIONAL DISTURBANCE

FACT SHEET Depression A feeling of low self-esteem that adversely affects the students behavior, education, and social relationships Emotional Disturbance An inability to learn, build relationships, and maintain happiness over a period of time that negatively affects academic performance CHARACTERISTICS Depressed mood most of the day, nearly every day Markedly diminished interest or pleasure in almost all activities most of the day, nearly every day Significant weight loss/gain Feelings of helplessness and hopelessness. Feeling useless. Self-hatred, constant questioning of thoughts and actions, an overwhelming need for reassurance. Being vulnerable and "over-sensitive". Feeling guilty. Self harm. CAUSE Major life changes Traumatic event Death in the family End of a relationship Failure to meet expectations ETIOLOGY AND PROGNOSIS Biological Factors Genetic Factors Psycho-social Factors Imbalance in neurotransmitters Varies depending on cause and treatment used. Must be evaluated according to recovery from incident and reoccurrence 74% recovery for children after 1 year 92% recovery for children after 2 years 70% of children have reoccurrence within 5 years Family problems divorce, separation, abuse Loss of employment their employment or parental employment Financial problems Difficulty with getting off to sleep or feeling tired more then usual Agitation and restlessness. Finding it impossible to concentrate for any length of time, forgetfulness. A sense of unreality. Physical aches and pains, sometimes with the fear that you are seriously ill. Suicidal tendencies Loss of appetite Decline in participation of everyday activities A loss of energy and motivation, that makes even the simplest tasks or decisions seem difficult.

IMPLICATIONS FOR PHYSICAL EDUCATION Student might have a developmental delay Lack of confidence could lead to inactivity Student might not be social and have poor teamwork habits The student could be overweight or have an eating problem resulting in low energy levels Not able to focus on activity due to short attention span Does not feel like doing activity, loss of interest ASSESSMENT SUGGESTIONS Use authentic assessment Dont have students perform skills test in front of other students Grade on effort and knowledge along with skill. Do assessment more then once in case the student is having a badday RECOMMENDED ACTIVITIES Do skills that will bring success Have enjoyable activities for that individual Let them be the leader or the person that is IT Exercise continuous activities such as running, walking, biking, swimming Stress Management techniques CONTRAINDICATED ACTIVITIES De-emphasize competition Do not pit the students against each other Test in separate areas or during game play (authentic), not in front of all of the students EFFECTIVE TEACHING STRATEGIES Structure the class for success Do not set a student up for failure Establish class rules that are stated positively Do not be negative Have a set routine - not different class outline each time Organize and plan class for active participation by all; little waiting time Show same attention to all students Dont play favorites Base grades on different aspects of the class Not just skill level Use teamwork skills to help with socializing and taking eyes off of individual students POSITIVE BEHAVIOR MANAGEMENT Reward appropriate behavior Enforce fair and humane consequences for inappropriate behavior Provide students with a safe space to be alone so that they can develop skills to control their behavior

RESOURCES Teacher: Familiarize themselves with the National SED (Serious Emotional Disturbances) The Relationship of Self-Esteem and Depression In Adolescence: http://www.help4teachers.com/depression.htm Lessons for Living: http://www.lessons4living.com Stress Management: http://stress.about.com/ Mastering Stress: http://www.psywww.com/mtsite/smpage.html Teacher Notes: http://ecdc.tamucc.edu/HELP/depression/teachernotes.html Parent: The Depression Resource Center: http://www.healingwell.com/depression/ Have a Hearts Depression Resource: http://www.have-a-heart.com/ National Mental Health Association: http://www.nmha.org/ What to do when a friend is depressed: http://www.hoptechno.com/book34.htm Depression Chat: http://www.depressionchat.com/ Parents Guide: http://ecdc.tamucc.edu/HELP/depression/parentguide.html Sport: Exercise Against Depression: http://www.physsportsmed.com/issues/1998/10Oct/artal.htm REFERENCES http://www.montana.edu/wwwebm/Depression.htm http://www.hp.ufl.edu/~jjohnson/1 http://www.bipolarhome.org/understanding.html http://www7.twu.edu/~f_huettig/fact_sheets/Emotdis.htm http://ecdc.tamucc.edu/HELP/default.html

DOWN SYNDROME
FACT SHEET Down syndrome, also called Trisomy 21 is the most common cause of mental retardation and malformation in a newborn. CHARACTERISTICS Psychomotor Possible difficulty in walking Severe motor delays will put individual at a disadvantage Balance deficits limit motor skills Poor muscle tone Hyperflexibility Heart conditions could affect activity and fitness levels through out lifetime. Cognitive Delayed mental or social skills Affective Stubbornness and refusal to talk when not fully understanding what is expected of them or when trying to gain control over their lives Will talk to one-self in an uncomfortable or confusing situation CAUSE Down Syndrome, also called Trisomy 21, is caused by an error in cell division called non-disjunction. An accident in cell development results in 47 instead of the usual 46. The extra chromosome, number 21, is present in all or most of Down Syndrome individuals cells. This extra 21st chromosome has an impact on psychomotor, cognitive and language development. Two other types of chromosomal abnormalities, mosaicism and translocation, are implicated but to a much lesser extent. ETIOLOGY AND PROGNOSIS Down Syndrome is the most common cause of mental retardation and malformation in a newborn. It occurs because of the presence of an extra chromosome, number 21, which has an effect on the psychomotor, cognitive and language development. Some physical characteristics Down Syndrome individuals display are being short in stature, having short fingers, toes, limbs and neck. They also display distinct facial features including small skull, slanting, almond shaped eyes, flat-bridged nose and small oral cavity which can make tongue look large and protruding. Individuals with Down Syndrome have a tendency to be overweight. Future conditions for individuals with Down Syndrome include; an inability to ever reach normal growth development, possibility of poor hearing, heart conditions that will affect activity and fitness levels through life, and a faster aging process with a tendency to develop diseases of aging like Alzheimers at an early age. Also, individuals with Down Syndrome are affected by certain eye disorders including Strabismus (crossed eyes), which affects tracking skills and binocular vision through out life. IMPLICATIONS FOR PHYSICAL EDUCATION Some important things that may affect a students performance in P.E. include: visual problems mild to moderate hearing loss possible cardiovascular irregularities

In addition, some individuals with Down Syndrome have Atlantoaxial Instability(AAI), a condition where there is increased mobility between the first and second cervical vertebrae, allowing the vertebrae to slip out of alignment easily, causing damage to the spinal cord. Because there are no symptoms of AAI, it is important for individuals with Down Syndrome to have X-rays taken. Copies of these X-rays should be given to the school before any participation in physical activities. (www7.twu.edu/~f_huettig/Fact_Sheets/down.htm) ASSESSMENT SUGGESTIONS BASIC MOTOR ABILITY TESTS REVISED (BMAT-R): This test is used in children ages 4-12 to evaluate motor responses such as; eye-hand coordination, finger dexterity, hand speed, flexibility, leg power, agility, static balance, arm strength and eye-foot coordination (Test can be obtained by writing to the following address: Motor Thearpy, 2nd Ed., C,V. Mosby Co., St. Louis, MO 63141). BROCKPORT PHYSICAL FITNESS TEST: For use in students ages 10-17. Test measures 3 components of health related physical fitness; aerobic functioning, body composition and musculoskeletal function. (www.humankinetics.com) PEABODY DEVELOPMENTAL MOTOR SCALES: Tests motor abilities, early movement milestones and fundamental movement skills in children ages birth- 6 years 11 months. Test helps to determine if a child is delayed in skill development, determine if there is a need for intervention and plan the program and assess improvements.( Test kit can be obtained by writing to the following address: DML Teaching Resources, One DML Park, Allen, TX 75002). RECOMMENDED ACTIVITIES Yoga poses which help to stretch, tone and strengthen the whole body. Yoga benefits central nervous system and helps develop balance, body awareness, concentration and memory (www.specialyoga.com) CONTRAINDICATED ACTIVITIES Students and athletes with Down Syndrome should be restricted from participation in gymnastics, diving, the butterfly stroke in swimming, the high jump, heading in soccer, and any exercise which places pressure on the muscles of the neck. EFFECTIVE TEACHING STRATEGIES Preschool Teach individual in a highly structured environment. Allow for touching and feeling to learn Use lighter weight equipment. Use smaller teaching space Use visual and auditory aid

Elementary Allow student to make choices with some activities to help their decision-making skills Keep the same routine for class structure Keep directions specific and brief Use visual and auditory aids Demonstrate skills Use lighter weight equipment. Breakdown the task into simple, small steps Use of peer partners Use positive behavior management strategies

Secondary Allow student to make choices with some activities to help their decision-making skills Keep the same routine for class structure Use visual and auditory aids Breakdown the task into simple, small steps RESOURCES Teacher: www.nas.com/downsyn www.ds-health.com www.faculty.fairfield.edu/fleitas/contents.html Parent www.downs-syndrome.org.uk/ www.downsyn.com www.nas.com/downsyn www.ds-health.com www.nads.org/ www.ndss.org www.downscity.com Sport www.specialyoga.com www.specialolympics.org www.irsc.org REFERENCES Burton, A.W. & Miller, D.E. (1998). Movement Skill Assessment. United States:Human Kinetics www.asd.k12.ak.us/Depts/ape/ www.downs-syndrome.org.uk www.pecentral.adapted/adaptedassessmentchart.html www7.twu.edu/~f_huettig/Fact_Sheets/down.htm Demonstrate skills Use of peer partners Use positive behavior management strategies

EPILEPSY
FACT SHEET According to the Epilepsy Foundation of America, epilepsy is a physical condition that occurs when there is a sudden, brief change in how the brain works. When brain cells are not working properly, a persons consciousness, movement, or actions may be altered for a short time. These physical changes are called epileptic seizures. Epilepsy affects people in all nations and of all races, and there are about two million Americans that have epilepsy. Some people can experience a seizure and have epilepsy. A single seizure does not mean that the person has epilepsy.

CHARACTERISTICS Epilepsy is a group of symptoms caused from abnormal electrical activity in the brain which results in seizures of varying magnitude. These symptoms listed are not necessarily indicators of epilepsy, it wise to consult a doctor if you or a person experiences one or more of them: Blackouts or periods of confused memory Episodes of staring or unexplained periods of unresponsiveness Involuntary movement of arms and legs fainting spells with incontinence or followed by excessive fatigue Odd sounds, distorted perceptions, episodic feelings of fear that cannot be explained

Seizures can be generalized where all brain cells are involved. Partial are when those brain cells not working properly are limited to one part of the brain. There are many different types of seizures. Not all of them involve convulsions. When naming seizures, it is important to use terms which describe what is happening during the seizure and to avoid terms such as mild or major which do not describe the event. A person can experience more than one type of seizure. The frequency, length and pattern of seizures tends to be fairly constant for each person, although it may change in the longer term. CAUSE For some people seizures are triggered by certain stimuli, which may differ from one individual to another. Identifying these triggers can help to avoid situations where seizures might occur. Such triggers may include: lack of sleep or fatigue, stress, alcohol, flickering lights (photosensitive), hyperventilation, growth spurts, high alkalinity of the blood, low blood sugar, constipation, excessive noise, improperly used medications, intense concentration, menstruation, hyperthermia, or hyperhydration.

ETIOLOGY AND PROGNOSIS When naming seizures, it is important to use terms which describe what is happening during the seizure and to avoid terms such as mild or major which do not describe the event. A person can experience more than one type of seizure. The frequency, length and pattern of seizures tend to be fairly constant for each person, although it may change in the longer term. Partial / Focal: The seizures begin or involve one part of the brain. A persons experience during their seizure will depend on which part of the brain that is being affected. Simple Partial / Jacksonian Focal seizures: consciousness is not impaired. The seizure may be confined to either rhythmical twitching of one limb or part of a limb, or to unusual tastes or sensations such as pins and needles in a specific area. Partial seizures sometimes develop into other sorts of seizures and so they may be referred to as a warning or aura.

Complex partial seizures: differ from simple in that consciousness is affected and so the person may have limited or no memory of the seizure. The seizures may be characterized by a change in awareness as well as automatic movements such as fiddling with clothes or object, mumbling or making chewing movements, or wandering around in a confused fashion. Person may respond if spoken to. Most often they involve the temporal lobes of the brain. They may also affect the frontal, parietal and occipital lobes.

For some people these partial seizures may spread to involve the whole brain. This is called a secondarily generalized seizure and the person will loose consciousness. Some are not even aware of the partial seizure onset. Generalized seizures: In these the whole brain is involved and consciousness is lost. They often occur with a warning (aura) and the person will have no memory of it. Tonic-clonic convulsive seizure : Seizures that always produce a loss of consciousness. This type of seizure often starts with an aura(warning signal), such as ringing in the ears, tingling sensation or a distinct smell. The actual seizure starts with the tonic phase(continuous, stiff or rigid) may cause a fall, followed by the clonic phase, (the person may lose bladder or bowel control) the muscles then relax and tighten rhythmically causing the person to convulse. At the beginning the person may bite their tongue or cry out then breathing may become labored. Afterwards the person may be very tired or want to sleep, confused, and/or have a headache. o Tonic: There is a general stiffening of the muscles without the convulsions, the person may fall to the ground risking injury, the recovery is quick o Atonic: Involve a sudden loss of muscle tone, causing the person to fall risking injury. The recovery is quick. o Myoclonic: Involves brief and abrupt jerking of one or more limbs, usually happens within a short time and wake up on their own, or this also can happen with other generalized seizures o Absence : Occur most commonly in children. The person experiences a brief interruption of consciousness and becomes unresponsive, where they appear to stare into space and have a lapse of attention. The eyelids may flutter rapidly, usually only last for a couple of seconds. This type of seizure may go unnoticed. It may seem like the person is daydreaming.

Some seizures do not fit into any of these categories or may include different elements from the different seizures, and these are called unclassifiable. Some may only have them during the night which are called nocturnal, describing only the time not the form. Epilepsy is not curable, but it can be controlled by medications. Here are some of the commonly used medications; Valium, Dilantin, Depakene, Diazepam, Tegretol, Luminal, and Phenobarbital. Seizure medications have a number of adverse side effects. Among these are reduced coordination and concentration, poor reaction time, drowsiness, blurred vision and irritability. IMPLICATIONS FOR PHYSICAL EDUCATION Students with epileptic disorders are eligible for special education and related services under the IDEA. Epilepsy is classified as other impaired and an IEP would be developed to specify appropriate services. Some students may have additional conditions such as learning disabilities along with the seizures. Seizures may interfere with the childs ability to learn, and s/he may be missing parts of what the teacher is saying. Depending on the type of seizure or how often they occur, some children may need additional assistance to help them keep up with classmates. Assistance can include adaptations in instruction, first aid on seizure management and counseling, all of which should be written in the IEP. It is important that teachers and school staff are informed about the childs condition, possible effects of medication, and what to do in case a seizure occurs at school. What to if a seizure occurs During: Remain calm, (you cant stop the seizure), help the person down to the floor, check the time (to monitor length of it), place something soft under the head. You only move the person if they are in

danger, move all obstacles away from the person, keep people from crowding around, do not restrain the person, do not place anything in their mouth, loosen any restricting clothing, observe the person throughout seizure. Call for medical help if seizure lasts for more than 5 minutes, if one seizure follows another, if it is the first one known, if the person has injured themselves, or has difficulty breathing. After: Roll the person onto their side (recovery position), wipe excess saliva away, check airway if breathing labored, allow the person to rest, minimize any embarrassment, stay with the person until fully recovered, and do not give any food or beverage until fully recovered

*Convulsive seizures can be frightening to observe, but remember the person is not in pain and will not have any memory of it. Any of these functions can be temporarily disturbed during the course of a seizure; personality, mood, memory, sensations, movement, or consciousness. ASSESSMENT SUGGESTIONS School personnel should monitor the effectiveness of the medication as well as any side effects. If a childs physical or intellectual skills seem to change, it is important to tell the doctor. Written observations of school staff will be helpful in the discussions with the childs doctor. When a student displays or has their first known seizure in class, the teacher must contact the school nurse, and write down all information that pertains to the situation before, during, and after. EFFECTIVE TEACHING STRATEGIES Before actually setting up a strategy, check the districts medical history sheet and contact the students physician, past teachers, and parents. Most parents and school staff find that a friendly conversation at the beginning of the school year is the best way to handle the situation. Activities can improve both mental and physical health and should be encouraged for people with epilepsy. Most individuals with epilepsy can safely exercise in a gymnasium, pursue sports and use equipment even though seizures arent completely under control, but a buddy system may be needed. All activities should be monitored and individually adjusted to each persons exercise tolerance and medical history. Through the use of the buddy system and consistent use of safety equipment,(helmet, knee and elbow pads) the student can participate in most activities. These are some suggested activities which require a physicians permission or should be modified: water sports activities that place the student a few feet above ground archery activities that have repeated blows to the head.

Children and youth with epilepsy must also deal with the psychological and social aspects of the condition. These include misperceptions and fear of seizures, uncertain occurrence, loss of self control during the episode, and medications. To help children feel more confident about themselves and accept their epilepsy, there should be education programs for staff and students, including information on seizure recognition and first aid.

RESOURCES There are many materials available for families and teachers so that they can understand how to work most effectively as a team. Epilepsy Foundation: http://www.efa.org/ SITES ON EPILEPSY Charge-The experience of Epilepsy: http://www.charge.org.uk Aims to promote social understanding and acceptance of this disease by demystifying the processes in the human brain which lead to seizure. Includes a bulletin board. Epiweb: http://www.epiweb.org Information for parents with children who suffer from epilepsy. Includes resources, news, links, education, treatment and a notice board. To Aid Someone Having A Seizure: http://www.assumption.edu/HTML/Admin/HealthServices/SEI.HTML What you should do if someone has a seizure. SITES IN RESOURCES Childhood Epilepsy: http://www.suite101.com/welcome.cfm/childhood_epilepsy Informative site featuring information for parents of children with epilepsy. offers articles, helpful websites, and discussions. Epilepsy Facts & Latest News HealthNewsflash: http://www.healthnewsflash.com/conditions/seizures_and_epilepsy.htm This resource has a medical fact book concerning information on diagnosis and treatment of epilepsy with the latest medical news for patients and their families. Epilepsy Resources on the Web: http://people.zeelandnet.nl/fhof/angelman/epilepsy.htm The facts, links, parent support, personal stories.

FETAL ALCOHOL SYNDROME (FAS)

FACT SHEET

A pattern of mental and physical defects which develop in some unborn babies when the mother drinks too much alcohol during pregnancy.
CHARACTERISTICS Distinct pattern of facial abnormalities, growth deficiency and evidence of central nervous system dysfunction. Most individuals affected by alcohol exposure before birth do not have the characteristic facial abnormalities and growth retardation identified with FAS, yet they have brain and other impairments that are just as significant. Mental retardation, individuals with FAS, ARND and ARBD may have other neurological deficits such as poor motor skills and hand-eye coordination. May have a complex pattern of behavioral and learning problems, including difficulties with memory, attention and judgment. Have trouble generalizing behaviors and information Act impulsively Exhibit reduced attention span or is distractible Display fearlessness and are unresponsive to verbal cautions Demonstrate poor social judgment. Cannot handle money age-appropriately Difficulty structuring work time Show impaired rates of learning Experience poor memory Have trouble internalizing modeled behaviors May have differences in sensory awareness (Hypo or Hyper). Language Production higher than comprehension. Show poor problem solving strategies. CAUSE FAS is a lifelong yet completely preventable set of physical, mental and neurobehavioral birth defects caused by alcohol consumption during pregnancy. FAS is the leading known cause of mental retardation and birth defects. ETIOLOGY AND PROGNOSIS Fetal Alcohol Syndrome (FAS) is a set of birth defects caused by maternal consumption of alcohol during pregnancy. At birth, children with FAS can be recognized by growth deficiency and a characteristic set of minor facial traits that tend to become more normal as the child matures. Less evident at birthbut far more devastating to FAS children and their familiesare the lifelong effects of alcohol-induced damage to the developing brain. FAS is considered the most common nonhereditary cause of mental retardation. In addition to deficits in general intellectual functioning, individuals with FAS often demonstrate difficulties with learning, memory, attention, and problem solving as well as problems with mental health and social interactions. Thus these individuals and their families face persistent hardships in virtually every aspect of life. Birth defects related to alcohol use are permanent. Surgery can repair some of the physical problems, and schools and day care centers offer programs to improve mental and physical development.

However, children born with FAS remain below average in physical and mental development throughout their lives.
(http://www.nofas.org/main/what_is_FAS.htm)

IMPLICATIONS FOR PHYSICAL EDUCATION Leisure, recreation, fitness, and sport activities. Teachers will need to modify instruction. ASSESSMENT SUGGESTIONS Brockport Physical Fitness Test DEVPRO Motor Skills Assessment Assessment for APE Achievement Based Curriculum (ABC) EFFECTIVE TEACHING STRATEGIES Provide short and clear instructions. Provide frequent feedback to the individual. Repeat directions. Have the individual demonstrate the task for clear understanding. Keep the learning environment consistent with little change. Eliminate distractions (visual and auditory). Demonstrate tasks for visual understanding. Use peers as partners for the individual Slow down the speed of the activity especially if it is concerning a noncompetitive activity, i.e. (stretching, exercises, etc).

EFFECTIVE BEHAVIOR MANAGEMENT STRATEGIES Set limits and follow them consistently. Change rewards often to keep interest in reward getting high. Review and repeat consequences of behaviors. Ask them to tell you consequences. Do not debate or argue over rules already established. "Just do it." Notice and comment when your child is doing well or behaving appropriately. Avoid threats. Redirect behavior. Intervene before behavior escalates. Avoid situations where child will be overstimulated. Have child repeat back their understanding of directions. Protect them from being exploited. They are naive. Have pre-established consequences for misbehavior

RESOURCES Teachers: http://www.thearc.org/misc/fasresources.doc

Parents: http://www.taconic.net/seminars/fas02.htm http://www.nofas.org/main/what_is_FAS.htm

Sport: www.come-over.to/FAS/ REFERENCES Troccoli, K.B. (1992). Fetal Alcohol Syndrome: the impact on childrens ability to learn. National Education Consortium. http://www.nofas.org/main/what_is_FAS.htm http://www.nofas.org/main/what_is_FAS.htm

HEARING IMPAIRMENT
FACT SHEET An impairment in hearing, weather permanent or fluctuating, that adversely affects a childs educational performance, from IDEA, PL 101-476 (Winnick, 1995). CHARACTERISTICS The following are the different severity of hearing impairment types: deaf, hard of hearing, and hearing impairment (conductive, sensory-neural, and mixed). The following is going to exclusively focus on hearing impairment as an overall disability (Winnick, 1995). An individual with a hearing impairment may experience: Muffled quality of speech and other sounds. Difficulty understanding words, asking others to speak more slowly and with a clear/louder voice. Need for longer time to process information, lack of attention, shies away from oral participation, uses a monotone voice, has difficulty following directions, responds to noises instead of words, and withdrawals from conversations. A clear delay in social/emotional interactions. Social/emotional individuals typically have a developmental delay and teachers will see that in how they learn, speak, and interact with others. May act out and imitate others to get attention or acting out due to their inability to fully understand what is being asked of them. May show a constant use of hand signal to communicate, and cocking their head to try to hear better or due to discomfort. CAUSE Wear and tear of noise contributes to the damage of the cochlea. Heredity and chronic exposure to loud noises over time. A tiny hole in the eardrum or the buildup of earwax. Traumatic brain injury Unknown reasons Ear infections or fluid in the ear Fall Diseases that can lead to an individual hearing loss: rubella, otosclerosis, meningitis Meneires disease scarlet fever Meningitis Measles pertussis ototoxicity. At birth due to: improper development of the inside of the ear birth injury

ETIOLOGY AND PROGNOSIS Hearing loss can occur prenatal, postnatal; prenatal which is damage to the cochlea at different times during or after the birth. Most individuals hearing loss is from damaging the cochlea. Three major types of hearing loss are conductive, sensory-neural, and mixed. Conductive loss happens when there is a problem with the outer or middle ear.

Sensory-neural loss happens when the cochlea is damaged, destroyed, or the connection to the brain is not working. Mixed is a combination f conductive and sensory-neural loss.

The prognosis of an individuals hearing loss depend on the amount of nerve damage, which determines the severity. Some ways to help restore some hearing is by: hearing aids, cochlear implants, or removing wax blockage. IMPLICATIONS FOR PHYSICAL EDUCATION Individuals with hearing impairments can do just about everything with the same motor ability as nondisabled individuals. However, a hearing impaired individual may experience static and dynamic balance challenge, physical fitness, some delays in gross and fine motor skills, and some difficulty with applied force and coordination. Making small adaptations for individuals with hearing impairments will make them to be able to be just as successful as anyone else in their class: Make the environment more conducive to them by: less excess noise, if you use music have it at a reasonable level for all students, use an auditory device, have clear instructions better, and keep a routine for the student. Educate all the students in his/her class about his/her disability. Have disability awareness to increase acceptance, social skills, and tolerance of individuals that maybe a little different for the entire school. Simulating the students disability can help everyone feel more comfortable and aware of what it is like to be hearing impaired. ASSESSMENT SUGGESTIONS Assess to see if the student has a hearing impairment by using standardized tests and from those tests develop the students IEP (Individual Education Plan). Some good standardized tests include: ASSESSMENT FOR ADAPTED PHYSICAL EDUCATION (A-APE): assessment of motor development accurately and makes the IEP process more efficient (http://a-ape.com/) BROCKPORT PHYSICAL FITNESS TEST: for ages 10-17; addresses fitness concerns of individuals with disabilities. The test describes 27 tests to assess an individual with disability. The manual makes recommendations on which tests to use when assessing individuals with specific disabilities (http://www.humankinetics.com) BRUININKS-OSERETSKY TEST OF MOTOR PROFICIENCY: for ages 4 - 14 ; subtests to measure such areas as: speed, agility, balance, coordination, strength, and fine motor dexterity TEST OF GROSS MOTOR DEVELOPMENT (TGMD II): for ages 3-10; tests 12 gross motor patterns such as running, galloping, and jumping. The manipulative patterns include such items as bouncing, catching, and kicking (http://www.proedinc.com) SPECIAL OLYMPICS SPORTS SKILLS PROGRAM: written and illustrated so that teachers and coaches at every level of experience can improve their skills. There are several sports skill books, which contains an assessment instrument for the novice and experienced athlete, along with teaching/coaching ideas on basic skills and appropriate drills (http://www.specialolympics.org/)

Make your own informal types of assessments like: rubrics, checklists, authentic assessment, product tasks, portfolios, and through video taping.

RECOMMENDED ACTIVITIES Bowling: simplify/reduce the number of steps use two hands instead of one remain in stationary position use a bowling ramp use a partner give continuous signed cues Basketball: use various size balls (bright colors) allow traveling allow two-hand dribble use larger/lower goal slow the pace down Golf: use a club with a larger head use shorter/lighter club use larger balls use tee for all shots shorten distance to hole Soccer: use walking instead of running use a deflated ball, nerf ball, bright colored ball reduce playing area play six-a-side soccer use bigger goal Softball: use a bright softball use larger or smaller bats use a batting tee reduce the base distances provide a peer to assist Tennis: use a soft bright ball use lighter racquets use larger head racquets hit ball off tee allow a drop serveuse a peer for assistance Volleyball: use larger, lighter, softer, bright colored balls allow players to catch ball instead of volleying allow student to self toss and set ball lower the net reduce the playing court stand closer to net on serve allow ball to bounce first hold ball and have student hit it

CONTRAINDICATED ACTIVITIES Swimming, due to the damage already from their disability. Too much water pressure could damage their hearing even more. EFFECTIVE TEACHING STRATEGIES Need to have a safe environment that they can enjoy do the activity in. Keep it free of obstacles, and with no loud noises. Assistance may be needed for some activities to get the most out of the student. Learn basic sign language, and keep a positive attitude. Use other teachers as a valuable resource. Make sure hearing impaired students can see your lips when you talk. Use visual demonstrations when you teach. Learning basic sign language, so you can communicate better with the student and fellow classmates can. Using an Alphanumeric Pager - is basically like any other pager that you call and text a message to, except there are more options and a clearer display. When you teach standing in one place and giving visual attention-getters will help get him/her on task. Have the student feel safe and comfortable in their environment and with others around them.

POSITIVE BEHAVIOR MANAGEMENT Determine the cause of your students behavior before the situation increases into a bigger problem. Be aware of everything that is going around in your class, and what kind of personalities each one of your studentss have. Mange time effectively. Set a comfortable pace to learn at. Keep the students motivated before they get of track and into trouble.

RESOURCES Teacher: http://www.as.wvu.edu/~scidis/hearing.html http://www.chelt.ac.uk/gdn/disabil/deaf/deaf.pdf http://education.qld.gov.au/curriculum/learning/students/disabilities/practice/strategies/histrategie s.html http://www.pecentral.com http://www.teachersfirst.com/sped/prof/deaf/strategies.html Parent: http://www.deafness.about.com http://www.kidshealth,org http://www.marky.com http://www.mayoclinic.com/

Sport: http://www.ciss.org/ http://www.nsad.org/ http://www.madd.org/ http://www.narha.org/ http://www.nwadd.org/ http://www.specialolympics.org/Special+Olympics+Public+Website/default.htm http://www.usdsaa.org/ http://www.usadsf.org/ REFERENCES Winnick, P.J. (1995). Adapted Physical Education and Sport. Champaign, IL: Human Kinetics. http://www.mayoclinic.com/ (hearing loss). http://www.pecentral.com http://www.deafness.about.com http://www.twu.edu/~_huettig/ http://www.kidshealth,org http://www.marky.com

JUVENILE DIABETES
FACT SHEET Juvenile Diabetes, also called Type 1 diabetes, or insulin-dependent diabetes, is a disorder of the bodys immune system the bodys system for protecting itself for viruses, bacteria or any foreign substances. CHARACTERISTICS The warning signs of juvenile diabetes include extreme thirst, frequent urination, drowsiness or lethargy, sugar in the urine, sudden vision changes, increased appetite, sudden weight loss, fruity or sweet odor on the breath, heavy or labored breathing, stupor, or unconsciousness. CAUSE Scientists do not know exactly what causes Juvenile Diabetes. They believe it may stem from autoimmune, genetic, and/or environmental factors. The appearance of Juvenile Diabetes is suspected to follow exposure to an environmental trigger such as an unidentified virus. The exposure to a virus stimulates an immune attach against the beta celss of the pancreas (that produce insulin) in some genetically predisposed people. ETIOLOGY AND PROGNOSIS People with Juvenile Diabetes must take insulin in order to stay alive. This means undergoing multiple injections daily, or having insulin delivered through and insulin pump, and testing blood sugar by pricking their fingers for blood six or more times daily. People with diabetes must also carefully balance food intake and exercise to regulate their blood sugar levels. Maintaining appropriate diet and exercise levels helps to avoid hypoglycemic (low blood sugar) and hyperglycemic (high blood sugar) reactions, which can be life threatening. While insulin allows a person with Juvenile Diabetes to stay alive, it does not cure the disease. The potential complications associated with Juvenile Diabetes include: Retinopathy Diabetic retinopathy is the most common and serious eye-related complication of diabetes. It is a progressive disease that destroys small blood vessels in the retina, eventually causing vision problems. In its most advanced form it can cause blindness. Nearly all people with Juvenile Diabetes show some symptoms of diabetic retinopathy. After living with diabetes for 20 years, nearly 25% develop the advanced form. Nephropathy Diabetic kidney disease is one of the most common and most devastating complications of diabetes. It is a slow deterioration of the kidneys and kidney function. In severe cases, it can eventually result in kidney failure, also known as end stage renal disease. About 30% of people living with Juvenile Diabetes develop nephropathy. Cardiovascular Disease Cardiovascular disease, a range of blood vessel system diseases that include both stroke and heart attack, is the major cause of death in people with diabetes. The two most common types of cardiovascular disease are coronary heart disease, caused by fatty deposits in the arteries that feed the heart, and hypertension, or high blood pressure. Neuropathy Neuropathy, or nerve damage, affects more than 60% of people with juvenile diabetes. The impact of nerve damage can range from slight inconvenience to major disability and even death. Diabetic neuropathy leads to loss of feeling and sometimes pain and weakness in the feet, legs, hands, and arms. It is the most common cause of amputations not caused by accident in the Unites States. In one type of neuropathy, known as automatic neuropathy, high glucose levels injure the autonomic nervous system, which controls bodily functions such as breathing, circulation, urination, sexual function, temperature regulation, and digestion. Autonomic neuropathy may result in various types of digestive problems, diarrhea, erectile dysfunction, a rapid heartbeat, and low blood pressure. IMPLICATIONS FOR PHYSICAL EDUCATION Lack of insulin production by the pancreas makes Juvenile Diabetes particularly difficult to control. Students will need to maintain a carefully regulated diet, planned physical activity, blood glucose testing several times

a day, and multiple daily insulin injections in order to maintain participation in physical education. Participation in physical activities and sport should be encouraged. However, be aware that hypoglycemia can occur during and after physical activity. Be prepared to recognize the signs and symptoms of diabetic emergency and how to treat in an emergency situation. Treat students with diabetes the same as other students, except to meet medical needs. Make sure substitute P.E. instructor is aware of student needs without violating the students right to privacy Create a Quick Reference Emergency Plan (QREP) in case the student goes into diabetic shock. The QREP should be created by the student, his/her parent(s), the school nurse, and the physical education teacher. The plan should include: Names and numbers of important contact personnel Causes, signs and symptoms of hypoglycemia Locations (gym, playing fields, off-campus facilities) for all units of instruction for quick response of emergency medical personnel Actions needed, or instructions for response to hypoglycemia o Include instructions for emergency glucagon kit if applicable

Carry personal supplies and keep readily available: Blood glucose monitoring equipment Emergency Glucagon Kit if prescribed Sugar in the form of juice, candy, or glucose tablets A Practical Program for Juvenile Obesity Often times, children with diabetes also struggle with obesity. The following guidelines pertain to exercise recommendations for individuals who are obese:
Activity must involve large muscle groups to induce large energy expenditure. Examples include walking, cycling, swimming, dancing, cross-country skiing, skating, basketball, and soccer. By performing such activities for 30 to 45 minutes, 10- to 11-year-old obese children burned 200 to 250 kcal (40). This amount will vary according to the body weight of the child and the intensity of exercise. It is the total energy expenditure, rather than the intensity of the activity, that matters. For example, walking 1 mile will have an almost identical effect to that of running 1 mile. At the start of a program, the intensity and duration of the activities should be low and gradually increase as the program progresses. Activity must be fun, and the child should enjoy it. A play-like, recreational atmosphere is particularly important for children in the first decade of life. Compared with structured prescriptions, "lifestyle" activities yield more compliance during the intervention and a greater adherence once the structured element of the program has concluded (49). Obese children and, particularly, adolescents feel less inhibited when they exercise in the company of other obese patients, rather than exercising with nonobese people.

http://www.physsportsmed.com/issues/2000/11_00/bar_or.htm

ASSESSMENT SUGGESTIONS Treat students with diabetes the same as other students, except to meet medical needs. RECOMMENDED ACTIVITIES Treat students with diabetes the same as other students, except to meet medical needs.
Water-based activities are often more suitable for obese patients than are land-based activities. The advantages of aquatic activities are threefold: 1) Because of their high fat content, obese individuals are more buoyant than their leaner peers 2) Subcutaneous fat is an excellent thermal insulator, which gives obese people an advantage in cool water 3) During water-based activities, most of the body is submerged. This provides a psychological advantage over land-based activities in which the body shape of the obese child is exposed.

CONTRAINDICATED ACTIVITIES Treat students with diabetes the same as other students, except to meet medical needs. Note that vigorous or unplanned exercise can trigger a diabetic emergency. EFFECTIVE TEACHING STRATEGIES Treat students with diabetes the same as other students, except to meet medical needs. RESOURCES Teachers: Websites: http://www.ncpad.org/ http://www.ncpad.org/abstracts/default.htm Abstract of Carnethon MR, Gidding SS, Nehgme R, Sidney S, Jacobs DR, Liu K.2003. Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. Journal of the American Medical Association. 290 (23): 3092-3100. Abstract of Epstein LH, Roemmich JN. Reducing sedentary behavior: Role in modifying physical activity. Exercise and Sport Sciences Review. 2001; 29 (3): 103-108. Abstract of Vincent SD, Pangrazi RP, Raustorp A, Tomson LM and Cuddihy TF Activity Levels and Body Mass Index of Children in the United States, Sweden and Australia . Medicine and Science in Sports and Exercise. 2003; 35(8): 1367-1373. http://www.palaestra.com/

Parents: Websites: http://www.ncpad.org/discus_script/discus.cgi http://www.disabilitycentral.com/activteen/magazine/entertainment_recreation/ent_rec.htm http://www.nscd.org/ TheNational Sports Center for the Disabled provides therapeutic recreation programs that are designed for individuals with disabilities who require adaptive equipment and/or special instruction. Instructors have taught individuals with a variety of disabilities, including amputation, congenital disabilities, visual and hearing impairments, developmental disabilities, and physical disabilities http://www.jdf.org/ http://www.palaestra.com/ http://www.childrenwithdiabetes.com/d_0b_200.htm http://www.childrenwithdiabetes.com/index_cwd.htm http://www.diabetes.org/home.jsp REFERENCES http://www.physsportsmed.com/issues/2000/11_00/bar_or.htm http://www.diabetes.org/home.jsp http://www.jdf.org/ http://www.jdrf.org/index.cfm?fuseaction=home.viewPage&page_id=C7E16B03-5E34-4D9FA5F8C6732367F03D http://www.jdf.org/index.cfm?fuseaction=home.viewPage&page_id=0FC9970A-635A-43C28D37B6894CF78C72

SAMPLE

QUICK REFERENCE EMERGENCY PLAN

For a student with Diabetes Hypoglycemia (Low Blood Sugar)
Students Name:

Grade/Teacher: Emergency Contact Information:

Date of Plan:

Mother/Guardian:

Father/Guardian:

Home Phone

Work Phone

Cell Home Phone

Work Phone

Cell

School Nurse/Trained Diabetes Personnel

Contact Numbers

Never send a child with suspected low blood sugar anywhere alone. Causes of Hypoglycemia Too much insulin Missed food Delayed food Too much or too intense exercise Unscheduled exercise Onset Sudden

SYMPTOMS
Mild Hunger Shakiness Weakness Paleness Anxiety Irritability Dizziness Sweating Drowsiness Personality change Inability to concentrate Moderate Headache Behavior change Poor coordination Blurry vision Weakness Slurred speech Confusion Severe Loss of consciousness Seizure Inability to swallow

Actions Needed Notify School Nurse or Trained Diabetes Personnel. If possible, check blood sugar, per Diabetes Medical Management Plan. When in doubt, treat for hypoglycemia

Mild Student may/may not be able to treat self Provide quick sugar source Wait 10 to 15 minutes Recheck blood glucose Repeat food if symptoms persist or if blood sugar is . less than Follow with a snack of carbohydrate and protein

Moderate Someone assists Give student quick sugar source Wait 10 to 15 minutes Recheck blood glucose Repeat food if symptoms persist or if blood sugar is . less than Follow with a snack of carbohydrate and protein

Severe Dont attempt to give anything by mouth Position on side if possible Contact school nurse Administer glucagon, as prescribed Call 911 Contact parent(s)/guardian(s) Stay with student

MULTIPLE DISABILITIES
FACT SHEET Concomitant impairments (such as mental retardation-blindness, mental retardation-orthopedic impairments, etc.), the combination of which causes such severe educational needs that they cannot be accommodated in a special program solely for one of the impairments. The term does not include deaf-blindness (IDEA, 1997). CHARACTERISTICS Individuals may have one or more of the following: Movement difficulties Sensory losses Behavior problems Limited speech or communication Difficulty in basic physical mobility Tendency to forget skills through disuse CAUSE There is no identifiable cause in 40% of cases of multiple disabilities. Most individuals with multiple disabilities with known causes are due to prenatal biomedical factors. Other possible causes may be linked to genetic metabolic disorders, dysfunction in production of enzymes leading to a buildup in toxic substances in the brain, or brain malformations. PROGNOSIS The prognosis of multiple disabilities is dependent on specific disabilities associated with each individual. IMPLICATIONS FOR PHYSICAL EDUCATION An individual with multiple disabilities may be challenged with: Motor delays Abnormal muscle tone Muscle atrophy, contractures ASSESSMENT SUGGESTIONS Traditional or standardized assessments are often not practical. Authentic assessments have to be developed to suit the needs of the student Keep in mind these assessments should be functional to skills the student will need in life. For many individuals, posture and range of motion are more appropriate criteria to assess compared to strength and skills. Problem balancing Behavioral problems Trouble generalizing skills from one situation to another A need for support in major life activities (domestic, leisure, community integration, and vocational) Presence of primitive reflexes Possibly nonambulatory

CONTRAINDICATED ACTIVITIES Activities that involving fast moving objects student may have difficulty tracking and moving out of the way Holding a child with head and neck out of mid-line W sitting position Dynamic stretching EFFECTIVE TEACHING STRATEGIES Maintain a small teacher to student ratio Learn from caregivers what the child likes and dislikes Use positive reinforcement Establish rapport Talk to child as if they were any other child Mirror their movements to see if they notice assessing Obtain behavior management information use consistently Use all forms of communication sign, language, visual and tactile Slow instructions avoid excess words Learn what primitive reflexes are still present Focus instruction on lifetime physical activity Teach in the pool monitor temperature of pool (most cases the warmer the water the better) learn of any allergies of chlorine Find out as much information about the child as possible allergies and feeding procedures Use sensory integration instruction when appropriate Preschool age children should be included

RESOURCES Teachers: Websites: www.slc.sevier.org/sevmltol.htm www.nichey.org.disabinf.asp Books: Adapted Physical Activity, Recreation and Sport Sherrill Parent: Websites: www.parentsoup.com/offline/special/articles/ www.childrensdisabilities.info/ parenting/bklivingskin.html www.teach-at-home.com/FastFacts/ disabilities/FactSheet.asp?A=10 Sport: Websites: http://www.lowvision.org/sports_and_recreation.htm http://recreation-and-leisure-for-students-with-severe-disabilities.thecycles.com/ www.skillsndrills.com REFERENCES Sherril, C. (1998). Adapted physical activity, recreation and sport: crossdisciplinary and lifespan (5th ed.). Boston: McGraw Hill. Curtis, S.R. (1982). The joy of movement in early childhood. New York: Teachers College. National Dissemination Center for Children With Disabilities 2003. Severe/Multiple disabilities. Retrieved March 2, 2004, from http://www.nichcy.org/pubs/factshe/fs10.pdf.

MUSCULAR DYSTROPHY
FACT SHEET Genetic muscle disorders that may also involve atrophy of the heart and respiratory muscles.

CHARACTERISTICS Muscular Dystrophy involves a group of genetic muscle disorders that may also involve atrophy of the heart and respiratory muscles. Muscular Dystrophy may also be referred to as: MD, Inherited myopathy or Pseudohypertrophic muscular dystrophy. Depending upon the type, symptoms may range from muscle weakness with low disability, to functional loss of ambulation and with certain types, death. The different types below differ from each other by: inheritance-from a dominant or recessive gene, the age symptoms appear The development or onset of specific symptoms. Most often the genetic abnormality comes from one or both parents and causes missing or malformed muscle membranes, leading to muscle weakness and deterioration. CAUSE Duchenne muscular dystrophy: caused by a defective gene (x-recessive) meaning it almost never affects females, since females have two x chromosomes. Becker muscular dystrophy: Myotonic dystrophy: Myotonia congenital: due to excess chloride in a muscle cell Limb-girdle muscular dystrophy: Fascioscapulohumeral muscular dystrophy: ETIOLOGY AND PROGNOSIS Duchenne muscular dystrophy: Occurs in approximately 2 out of 10, 000 individuals and can be detected through genetics during pregnancy, with about 95% accuracy Symptoms usually appear in males, ages 1 to 6 years with initial muscle weakness in the legs and lower body. Children may require braces for walking by age 10 and experience wheelchair confinement by age 12. Muscle weakness and skeletal deformities can cause breathing disorders. Some intellectual impairment, although not progressive, may occur Students may have difficulty with basic locomotor skills such as running, jumping or hopping and may frequently fall. Progressive muscle weakness, difficulty walking, fatigue, scoliosis and calf muscle enlargement is obvious. Death, due to respiratory conditions, may occur by early twenties. Becker muscular dystrophy:. Occurs in 3-6 out of 100,000 male births with females rarely demonstrating symptoms Onset of symptoms typically occur during adolescence, but may occur anywhere from age 5 to age 25. Pelvic muscle deterioration may lead to inability to walk and loss of strength in back and shoulders. Unlike Duchenne, individuals may have a normal life span. similar to Duchenne muscular dystrophy however with much slower progression

Myotonic dystrophy: the most common adult form of dystrophy, although 50% diagnosis occurs under the age of twenty. facial/hand muscle weakness (inability to release grip) myotonia (slow relaxation after muscle contraction). Myotonia congenital: May also be known as Thomsens disease Present from birth characterized by slow relaxation from muscle contractions, usually legs. Due to excess chloride in a muscle cell, (Chloride ions are required for a muscle to relax.) potassium triggers the sodium chain in muscle cells. (Sodium ions trigger muscle contraction.) When the cells have too much sodium and not enough chloride, the electrical discharges cause a stiffness called myotonia. Children may not show symptoms until age 2 or 3 and initially may have trouble with swallowing or gagging due to oropharyngeal muscles inability to relax after contraction. Limb-girdle muscular dystrophy: Shows onset of symptoms between ages of 5 and 30, with initial pelvic, shoulder or back weakness. Progression eventually involves both the lower and upper locations. Varies greatly by individual however many people are disabled by middle age. Fascioscapulohumeral muscular dystrophy: Affects approximately 5 out of 100,000 people Unlike other dystrophies (Duchenne & Becker) occurs equally in both men and women and. Often appears in adolescents, however may appear between the ages of 10 and 26. Unlike other dystrophies, affects the upper rather than lower extremities initially. Symptoms include: facial muscle weakness, eyelid drooping, inability to whistle and difficulty pronouncing words. Shoulder weakness may involve difficulty in working with raised arms and pronounced shoulder blades.

Treatments may involve: Steroids: Prednisone for patients with Duchenne at the age of 5 or 6 to delay muscle degeneration (Side effects associated with steroid intervention may include weight gain and loss of bone density). This treatment doesnt work in some individuals. Spinal fusion: Spinal fusion involves placing metal rods down the spine and fusing the vertebrae together. Generally considered when a 25 degree curvature exists to prevent pain, ensure seating posture and improve breathing. Respiratory care: (Respiratory assistance is necessary because children are often unable to cough out phlegm, (weak respiratory muscles) making them prone to infections. Health care and vaccinations are important. Assistive technology: Assistive technology such as manual and powered wheelchairs, joysticks, switches and voice activated devices can foster independence in a child. For students who cannot fully use a computer because of physical limitations in their hands or arms, explore avenues for obtaining adaptive access software, altered keyboards (including Unicorn keyboards), special switches (latching devices, keylocks), and Power Pads, eye-controlled input systems, or touch-screens in conjunction with a light talker, trackballs, footmice, and other special equipment. Similar assistive technology devices may foster meaningful participation in physical education.

The condition severity is dependent upon the type of disorder and progression. Students with Duchenne may have difficulty walking in elementary and be in a wheelchair by middle school. Braces and/or wheelchairs are forms of assistive technology and depending upon curriculum and safety may be accommodated in a General Physical Education setting.

IMPLICATIONS FOR PHYSICAL EDUCATION General consideration factors include: Communication and collaboration with physical therapists, special education teachers, parents and others involved with the child, to gain insight concerning disability, behavior, safety, medications and other information. Safety considerations for all students: wheelchairs or braces must not provide an unsafe environment. Allowing the involvement of older students, enabling them to participate in their own specific individual modification planning. Adapting different teaching styles to meet learner needs and designing an individualized learning environment with multiple success levels, thus benefiting all students. Using different ball/bat choices, target selections, playing area modifications and ramps for wheelchairs. An ecological approach:(Block, 2000) based upon student and parent interests, specific targeted skill development, available supports and lifetime community recreational activities could be valuable to a student with Becker muscular dystrophy. ASSESSMENT SUGGESTIONS Assessment should be individual, appropriate and consider disability limitations. For example, a student in a wheelchair should not be assessed using the same throwing criteria as another. The student in the wheelchair is unlikely to step with opposition, demonstrate side orientation or show upper body rotation. The goal of assessment, regardless of tool, should be to determine a baseline, provide intervention (instruction) and improve skill level. The need for ongoing, individualized assessment of targeted skills is critical. Individualized assessment, similar to individualized instruction, benefits all participants.

RECOMMENDED ACTIVITIES Aquatics, with the natural buoyancy, may foster movement and range of motion objectives. EFFECTIVE TEACHING STRATEGIES Specific Aquatic Teaching Strategies: Students with Duchenne are generally good floaters. As the disease progresses, swimmers may lose the strength necessary to hold their head out of the water while in a prone position. Activities in the supine position may promote relaxing and optimize respiratory function. Recoveries to supine, elementary backstroke and sculling may be useful skills. Swimmers with MD are often heavy and difficult to lift into and out of the pool. Avoid lifting that puts pressure on the shoulders, where muscle tone may be lacking. An important objective is to slow the MD atrophy by maintaining muscle tone throughout activity ... while avoiding undue fatigue.

Know your student and do not hesitate to seek his/her input. Help him/her keep a positive outlook. Students may have lowered motivation, lack of interest, or a low frustration tolerance when unable to do skills once had ability to do (as disease progresses).

RESOURCES Teacher: Websites: http://www.parentprojectmd.org/resources/index.html: This website offers information for parents and teachers. The section titled education, offers resources ranging from lesson plans for students with MDA to legal disability definitions under legislation. Books: Block, M. E. (2000). A teachers guide to including students with disabilities in general physical education. (2nd ed ). Baltimore: Paul H. Brookes

Parent Resources: Websites: http://www.parentprojectmd.org/research/index.html: This website: Parent Project Muscular Dystrophy is broken down into: causes, symptoms, current news, research, who gets MD and progression. Children with Duchenne, parents and grandparents are featured through questions as well as personal submissions concerning Muscular Dystrophy. http://www.nlm.nih.gov/medlineplus/musculardystrophy.html: This National Institute of Health website utilizes information from the National Library of Medicine pertaining to: NIH clinical trials, coping strategies, diagnosis/symptoms, research, types of MD, treatments, genetics, organizations and impact upon children/teens.

Sports Resources: Wheelchair Sports, USA 10 Lake Circle Suite G19 Colorado Springs, CO 80906 Office Phone: (719) 574-1150 Email: wsusa@aol.com Internet: http://www.wsusa.org Special Olympics International 1325 G Street, N.W., Ste. 500 Washington, DC 20005 Phone: 202-628-3630 Fax: 202-824-0200 E-mail: specialolympics@msn.com Internet: www.specialolympics.org Program locations: http://www.specialolympics.org/program_locations/index.html REFERENCES Block, M. E. (2000). A teachers guide to including students with disabilities in general physical education. (2nd ed.). Baltimore: Paul H. Brookes http://health.yahoo.com/health/encyclopedia/001190/_0.htmlMuscular Dystrophy Retrieved March 28, 2004 http://health.yahoo.com/health/encyclopedia/000705/0.html Retrieved March 28, 2004 http://health.yahoo.com/health/encyclopedia/001190/_0.html Retrieved March 28, 2004 http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=134&article_set=21775 Retrieved March 28, 2004

http://www.as.wvu.edu/~scidis/motor.html Retrieved April 14, 2004 http://www.brookespublishing.com/cgi-bin/dictionary.pl Retrieved March 28, 2004 http://www.mdausa.org/ Retrieved April 13, 2004 http://www.noah-health.org/english/illness/neuro/musdys.html Retrieved March 28, 2004 http://www.uvm.edu/~rgobin/imanual/28SPEC~1.HTM) Retrieved April 14, 2004

SEIZURE DISORDER
FACT SHEET There are two kinds of seizure disorders, an isolated, non-recurrent attack, such as may occur during a febrile illness or after head trauma, and epilepsy--a recurrent, paroxysmal disorder of cerebral function characterized by sudden, brief attacks of altered consciousness, motor activity, sensory phenomena, or inappropriate behavior caused by excessive discharge of cerebral neurons. This fact sheet will focus more on the isolated, non-recurrent attacks and those seizures that are drug-induced. CHARACTERISTICS Aura - warning signs of a seizure Postictal state - symptoms that follow a seizure deep sleep headache confusion muscle soreness Simple partial seizure - motor, sensory, or psychomotor phenomena without a loss of consciousness Jacksonian seizure - a seizure that starts in one part of the body and spreads. Ex - starts in hand and moves up arm Complex partial seizure - a seizure in which the individual will lose contact with surroundings for 1-2 minutes. The individual might: Stare Perform automatic purposeless movement Utter unintelligible sounds Resist aid Mental confusion continues for 1-2 minutes after the seizure Generalized seizure - this type of seizure causes a loss of consciousness and motor function. It is genetic or metabolic in cause Infantile spasms - a seizure characterized by sudden flexion of arms, forward flexion of trunk, and flexion of legs. They last only a few seconds and repeat many times a day. They only occur in children within the first three years. Absence seizure - (petit mal) - brief primarily generalized attacks manifested by a 20-30 second loss of consciousness, eyelid fluttering, may or may not have the presence of axial muscle tone loss. The individual will not fall over or convulse and will resume activity as soon as seizure is over. They will have no knowledge of the seizure once it is over. These types of seizures often happen when an individual is sitting quietly, they rarely occur during activity. Generalized tonic-clonic seizure - begins with outcry, continues loss of control and a fall, tonicclonic contractions of muscles, possible loss of bowels. Lasts 1-2 minutes, usually begins with simples or complex partial seizure. Atonic Seizure - brief, primarily generalized seizure in children complete loss of muscle tone and consciousness fall or pitch to the ground chance of serious head trauma Myoclonic seizure - brief, lightening like jerks of the limbs or trunk, may be repetitive leading to tonic-clonic seizure. No loss of consciousness

Febrile seizure - associated with fever without evidence of intracranial infection. They occur in children ages 5 and younger. CAUSE

The following may be triggers for a seizure: Convulsant drug Growth spurts Hypoxia High alkalinity of blood Hypoglycemia Low blood sugar Lack of sleep Constipation Stress Excessive noise Alcohol Improperly used medication Flickering lights Intense concentration Hyperventilation Menstruation Hypothermia Hyper hydration

ETIOLOGY AND PROGNOSIS Our brain is an enormously huge and complex network of electrical circuits. Seizures are the result of abnormal activity in one area of this circuit which causes abnormal currents to spread to the rest of the brain. The result is a seizure with physical and/or behavioral manifestations. Seizures are associated with many medical conditions: Most convulsions in infants and toddlers are caused by fever; rarely cause lasting damage Gastrointestinal disease Poisoning Head injury Brain disease such as a tumor Breath-holding during a tantrum (rare)

In order for a medical provider to diagnose cause of the seizure the following needs to be recorded: Eyewitness account of a typical seizure Frequency of seizures and the longest and shortest intervals between them History of prior head trauma, infection, or toxic episodes must be evaluated Family history of seizures or neurological disorders IMPLICATIONS FOR PHYSICAL EDUCATION A PE teacher can best help a student with seizure disorder by trying to prevent a seizure from occurring by choosing appropriate activities for the class to participate in. They should also be prepared by knowing what to do if a student does have a seizure in class.

A PE teacher should: Encourage a normal life for a student with seizure disorder Recommend exercise Encourage student to be social

If a seizure occurs the PE teacher should: Remain calm Remove sharp objects from the area Loosen clothing around neck to help person breathe Place a pillow or soft object (mat) under the head Roll the patient onto his/her side to keep air passage clear Do not attempt to force open the person's mouth or insert any objects inside the person's mouth ASSESSMENT SUGGESTIONS What to assess in PE if a child has seizure disorder: Motor skills; if the skills seem to change a doctor should be notified CONTRAINDICATED ACTIVITIES Students with seizure disorder should refrain from: Doing activities that require them to be off the ground: balance beam jumping from elevated mats cargo net adventure activities that require elevation rope climbing ex-rock climbing They should also be monitored closely when participating in any water activity: swimming water aerobics water polo diving synchronized swimming scuba diving or snorkeling EFFECTIVE TEACHING STRATEGIES Teachers who have students with seizure disorder in their class should be aware of the disorder and know the implications and etiology for that specific child. They should know the situations or external factors that affect the student and teach and to avoid those situations. Teachers could use a buddy system with students with seizure disorder. This would assure that the student always had someone with them to alert a teacher if a seizure were to occur. The other student should be educated about seizures so they do not become frightened if a student has a seizure in class. Do not try to hold the person down or restrict movement Do not attempt CPR, unless the person does not start breathing again after the seizure is over Remain with the person until the seizure has ended Reassure the person as consciousness return

RESOURCES Websites: http://www.familyvillage.wisc.edu/lib_epil.htm This is a comprehensive website giving a huge amount of information. It gives parents associations to contact to find out more about seizure disorder and what they can do for their children. It gives parents a place to go online to talk with others and get support. There are links to other websites that teach about seizure disorder and finally there are links to other organizations and websites that deal with seizure disorder. http://xpedio02.childrenshc.org/stellent/groups/public/@xcp/@web/@bibliography/@parents/d ocuments/policyreferenceprocedure/web020893.asp & http://www.amazon.com/exec/obidos/tg/detail/-/0596500033/103-4185789-3707031?v=glance These two websites talk about books parents can purchase to learn more about seizure disorder and what they can do for their children. http://health.indiamart.com/kidshealth/illness/seizures.html This is a very easy to read, informational website about seizures and seizure disorder. REFERENCES http://www.merck.com/mrkshared/mmanual/section14/chapter172/172a.jsp http://groups.msn.com/ParentsofVaccineDamagedChildren/yourwebpage2.msnw http://health.indiamart.com/kidshealth/illness/seizures.html

SERIOUS EMOTIONAL DISTURBANCE

FACT SHEET

CHARACTERISTICS Exhibits one or more of the characteristics over a long period of time: inability to learn which cannot be explained by intellectual, sensory, or health factors inability to build or maintain satisfactory interpersonal relationships with peers and teachers inappropriate types of behavior or feelings under normal circumstances general pervasive mood of unhappiness or depression tendency to develop physical symptoms or fears associated with personal or school problems

(Federal Register, Sept. 1992, p. 44802)

Students may also show signs of these over a long period of time, when a person or student is emotionally disturbed:

Defiant Impertinent Uncooperative Irritable Attention seeking Negative Hypersensitive Hyperactivity (short attention span, impulsiveness)

Aggression/self-injurious behavior (acting out, fighting) Withdrawal (failure to initiate interaction with others) Retreat from exchanges of social interaction Excessive fear or anxiety Immaturity (inappropriate crying, temper tantrums, poor coping skills) Learning difficulties (academically performing below grade level)

Academy of Education, kidsource.com, 2004 Sherrill, 1998, p.552

CAUSE The cause of serious emotional disturbance has not been determined exactly some factors that may contribute to it are: heredity, brain disorder, diet, stress, and family functioning abuse when younger, late or no pre-natal care

nichy.org, Fact Sheet, 2004

ETIOLOGY AND PROGNOSIS Students described as Seriously Emotionally Disturbed (SED) make up 10.5% of all students with disabilities. In 1991-92 there were 400,670 ages 6-21 qualified as Seriously Emotionally Disturbed (Wagner, Mary, 1995). However, 16% did not show these characteristics until secondary levels of education. Males make up the greatest number of students with SED at 76.4% (Wagner, 1995). Families with earnings of less than $12,000 a year make up the greatest percent at 38.2% (Wagner 1995).

Percentages show that students with SED in grades 9-12 receive more attention than other students with disabilities (Wagner, Table 7, 1995). Approximately 60% of these students are receive planning for when they continue with life out of High School. (Wagner, Table 7, 1995)
www.futureofchildren.org/usr_doc/vol5no2ART7.pdf, Mary Wagner

ASSESSMENT SUGGESTIONS One model for use in assessing includes Don Hellisons Social Development or Social Responsibility Model (1978, 1984). The social development levels assessed include: Level 0: Irresponsibility disruptive behaviors, abuse, and refusal to participate and cooperate Level 1: Self Control accepting responsibility for ones action, no longer disruptive, not prepared or fully participating Level 2: Involvement effort to follow instructions and cooperate with others, behavior inconsistent, needs frequent prompts and rewards Level 3: Self-Responsibility works independently, sets personal goals, stay on task with minimal or no assistance Level 4: Control self-initiative in helping others, emphasize and sustain caring relationships Level 5: Going Beyond social maturity to accept leadership responsibilities
Sherrill, 1998, p. 558

Other Assessments: Westchester IQ Series Walker and McConnell Scale of Social Competence and School Adjustment Woodcock-Johnson Psycho-Educational Battery RECOMMENDED ACTIVITIES Exercise can help decrease anger, depression and disruptive behaviors. Exercise should be: perceived as pleasant aerobic or as close as the individual can handle noncompetitive non threatening moderate intensity used two or three times or as individual sees fit

Ideally, structure the environment that provides the student with the greatest opportunity for success. CONTRAINDICATED ACTIVITIES Students with SED can participate in activities that all other students in general PE may participate in. A student with SED will be least constructive in an activity that does not personally interest him/her.

EFFECTIVE TEACHING STRATEGIES Guidelines for class with students with SED: Display appropriate authority Explain class goals on 1st day and routine to be followed Discuss goals often with each student, develop a contract what student must do to achieve goal, relate goals to the group goals Keep simple class rules, set as few as possible to obtain order Clearly explain consequences of not following the rules, or regulations and the rewards for following them as well Allow students to be involved in the consequence process, post in the room or allow them to take part in making them. Demonstrate consistency in enforcing rules and providing feedback.

Applied Behavior Principles (ABA) Target behaviors that need to change and define components of these behaviors Observe, chart and analyze behaviors to change Select and apply specific strategies to achieve behavior changes (i.e. start and stop signals, routines for transitions, techniques for forming groups, strategies for coping with disruptive behaviors) Periodically evaluate progress toward changing an individuals behaviors and revise their behavior change plan

Banduras (1977) Self Efficacy Theory: Allow individuals to feel safe by task analyzing and structuring activities to assure personal mastery Promote vicarious feelings of mastery by watching and listening to models who look successful and appear to be having fun Use personal persuasion by significant others Provide counseling or psychotherapy that teaches cognitive control of anxiety and fear

Sherrill, 1998, p. 559-560

RESOURCES People who should be used in this process are the students immediate family, including distant family if they are around the student a lot. Also special education teachers should be contacted to find out the best management techniques. Heads of each department as well, Special Education and Adapted Physical Education will aid in the management process. REFERENCES Sherrill, Claudine; Adapted Physical Activity, Recreation and Sport; 1998, McGraw Hill, ch. 22 pecentral.com kidsource.com nichy.org www.futureofchildren.org/usr_doc/vol5o2ART7.pdf, Mary Wagner

SPINA BIFIDA
FACT SHEET

A cleft spine, which is an incomplete closure in the spinal column. According to Individuals with Disabilities Education Act (IDEA) 1991; all children and youth with disabilities are entitled to receive instruction in Physical Education.

CHARACTERISTICS Spina Bifida Occulta This is the mildest form. There is an opening in one or more of the vertebrae (bones) of the spinal column without apparent damage to the spinal cord. Approximately 40% of Americans may have it, but because they experience little to no symptoms, very few of them ever know that they have it (http://www.nichcy.org/pubs/factshe/fs12txt.htm). Meningocele A moderately severe form of spina bifida in which the meninges protrude, causing a bulge under the skin. The spinal cord remains intact. This form can be repaired with little or no damage to the nerve pathways. Myelomeningocele Most Severe Form and also the most common complex congenital (present at birth) abnormality. A portion of the spinal cord itself protrudes through the back. In some cases, sacs are covered with skin; in others, tissue and nerves are exposed. Spina Bifida Manifesta The combination of Meningocele and Myelomeningocele. This occurs in approximately one out of every thousand births.

(http://www.kimber.cjscreations.com/ksbpics.htm)

Common Characteristics: Muscle Weakness (in the feet, ankles and/or legs) Paralysis below the area of the spine where the incomplete closure (or cleft) occurs. Loss of sensation below the cleft Loss of bowel and bladder control Hydrocephalus (fluid build up that causes accumulation of fluid in the brain. This can be controlled by shunting. Shunting relieves the fluid build up in the brain lessening the chances of brain damage, seizures, or blindness.) Growth Deficiency Difficulty with learning

Difficulty with paying attention Difficulty with expressing or understanding language Difficulty grasping reading and math Difficulty in locomotor and mobility movements Difficulty with fitness levels (Obesity is common) Motor Difficulties in the arms and hands with perhaps some slowness in performing certain tasks. Possible Seizures Latex Allergies

CAUSE Present at Birth (congenital) Inefficient amounts of Folic Acid in the mothers diet while pregnant. ETIOLOGY This birth defect results from the failure of the vertebrae to close completely around the part of the spinal cord that it is supposed to protect. This occurs during the first three months of pregnancy. Spina bifida is a congenital malformation however the causes are still unknown. Taking folic acid before conception and during the first few weeks of pregnancy may help reduce the risk of spina bifida. PROGNOSIS Spina bifida doesnt deteriorate Hydrocephalus can be controlled by a surgical procedure called shunting The child should learn to manage their bowel and bladder functions. Those with a history of hydrocephalus experience learning problems Early intervention can help considerably

IMPLICATIONS FOR PHYSICAL EDUCATION Be aware of weather conditions extreme conditions (Cold or Heat) can have an adverse affect on the individual and their learning. Maintain Steady and ambient conditions (http://www.nichcy.org/pubs/factshe/fs12txt.htm). Be aware of Latex Materials. It is common for a child with Spina Bifida to be allergic to latex. Be aware of latex equipment like: Balloons, Rubber Bands, Elastic in clothing, Beach toys, Koosh Balls, Diapers, Art supplies, gloves, elastic bandages, adhesive tape, Band-Aids. RECOMMENDED ACTIVITIES Mobility Skills (Using crutches, braces, or wheelchairs) Emotional and Social Development Encourage children within the limits of safety and health, to be independent and to participate in activities with their non-disabled peers. Bladder Management Program Modify equipment and curriculum for inclusion purposes Early Intervention can help considerably Work on Physical Fitness Develop good cardiorespiratory fitness early in life. Cooperative Activities Increase self-esteem, self-consciousness and self-image Increase Peer Awareness ASSESSMENT SUGGESTIONS DENVER DEVELOPMENTAL SCREENING TEST II http://www.denverii.com/ http://www.fpnotebook.com/PED59.htm

http://www.uvm.edu/~cdci/pedilinks/pediatric/tools/ddstII.htm

HAWAII EARLY LEARNING PROFILE (HELP) http://www.vort.com/profb3.htm PEDIATRIC EVALUATION OF DISABILITY INVENTORY (PEDI) http://www.med.unc.edu/wrkunits/syllabus/distedu/childas/publish/refsupp/pedi.pdf http://www.nemc.org/rehab/pedi_inf.htm OBSERVE Social interactive signals between the child and caregiver (learn about the childs communication styles, behavior management procedures, and the childs responses to the environment) Observe the child in a pre-established free play environment. Observe the physical, motor, and interactive abilities. Look for visual pursuits, muscle, tone, gross motor patterns, functional mobility, and fine motor/hand function. With formal assessments look for: reflexes, development of equilibrium and balance reactions, and development of gross motor and fine motor patterns.

EFFECTIVE TEACHING STRATEGIES Modify equipment, and the environment. larger racket, Velcro band to help student hold racket, larger ball, larger target, smaller field, less distractions, softer balls, slower down the activity, modify the rules (ex: two bounces in tennis). Use developmentally appropriate equipment Set up Exercise Routines Use large bright and to the point visual aids Having repetition in activities and verbal instructions/demonstrations Setting up routines Modeling organization POSITIVE BEHAVIOR MANAGEMENT STRATEGIES Teaching organization (have the students think to themselves how they can stay organized and what they can do to be more organized) Teaching the concept of time and performing activities in steps, providing exercises that work on sequence Developing games for the students where they work on solving problems To increase the lack of attention give short assignments or chores that can be done successfully. This will increase the childs concentration.

Keeps activities developmentally appropriate Use routines Use peer tutoring

Limit transition time Use reward systems (token economy, stickers)

RESOURCES Teachers: Websites Http://www.sbaa.org www.sbaa.org/html/sbaa_facts.html www.waisman.wisc.edu/~rowley/sb-kids/index.htmlx www.nichcy.org/pubs/factshe/fs12txt.htm

Parents: Websites www.waisman.wisc.edu/~rowley/sb-kids www.familyvillage.wisc.edu/lib_spin.htm kidshealth.org/kid/health_problems/bone/spina_bifida.html kidshealth.org/parent/system/ill/spina_bifida.html

Sports: Websites www.sbawp.org/fitw/Free%20in%20the%20Water%20How%20Does%20Swimming%20Help.doc www.lumc.edu/rmch/peds/ortho.htm

SPINAL CORD INJURY (SCI)

FACT SHEET A spinal cord injury disrupts the communication between the brain and other parts of the body and messages no longer flow past the damaged area of the spinal cord.

CHARACTERISTICS An individual with a spinal cord injury may experience a loss of function, such as mobility or feeling. CAUSE The primary causes of SCI from trauma are: Motor vehicle accident 44% Acts of violence 24% Falls 22% Sports injuries 8%

Spinal cord damage can also occur from diseases such as polio, spina bifida, Friedreichs Ataxia. The extent of the communication breakdown is dependent on the severity and location of the injury. The spinal cord does not have to be severed in order for a loss of functioning to occur. For most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis, or pinched nerves. ETIOLOGY AND PROGNOSIS The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete. A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common. The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses. Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand. C-6 injuries generally yield wrist control, but no hand function. Individuals with C-7 and T-1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers. Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control. Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.

Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder,. Sexual functioning is frequently with SCI may have their fertility affected, while women's fertility is generally not affected. Very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury, and chronic pain.
Project Inspire, The National Spinal Cord Injury Association, Spinal Cord Injury Resource Center

POSSIBLE COMPLICATIONS ASSOCIATED WITH SPINAL CORD INJURY Skin Breakdown: Skin breakdowns (also termed pressure sores) are a major complication associated with spinal cord injury. They occur as a result of excessive pressure, primarily over the bones of the buttock (particularly the ischial tuberosities and the trochanters at the hip). Osteoporosis and Fractures: The majority of people with SCI develop osteoporosis. In people without SCI, the bones are kept strong through regular muscle activity or by bearing weight. When muscle activity is decreased or eliminated and the legs no longer bear the body's weight, they begin to lose calcium and phosphorus and become weak and brittle. Pneumonia, Atelectasis, Aspiration: Patients with spinal cord injuries above the T4 level of injury are at risk to develop restriction in respiratory function, termed restrictive lung disease. This occurs five to 10 years following spinal cord injury and can be progressive in nature. Heterotopic Ossification: Heterotopic ossification is a condition not well understood that occurs in acute spinal cord injury and consists of the laying down of bone outside the normal skeleton, usually occurring at large joints such as the hips or knees. The primary problem with heterotopic ossification, or HO, is the risk for joint stiffening and fusion. Spasticity: Spasticity is an exaggeration of the normal reflexes that occur when the body is stimulated in certain ways. After spinal cord injury, when nerves below the injury become disconnected from those above, these responses become exaggerated. Autonomic Dysreflexia: Autonomic dysreflexia (AD) is a condition that can occur in anyone who has a spinal cord injury at or above the T6 level. It is related to disconnections between the body below the injury and the control mechanisms for blood pressure and heart function. It causes the blood pressure to rise to potentially dangerous levels. Deep vein thrombosis: (DVT) or pulmonary embolism is a potentially severe complication of spinal cord injury. As mentioned above, there are changes in the normal neurologic control of the blood vessels that can result in stasis or "sludging". Cardiovascular Disease: Cardiovascular disease is a major long-term risk of spinal cord injury. SCI individuals live in general rather sedentary lives and are at higher risk for cardiovascular disease than the able-bodied population. Neuropathic/Spinal Cord Pain: Neuropathic (nerve-generated) pain is a significant problem in some spinal cord-injured patients. Varying types of pain are described in spinal cord injury. Damage to the spine and soft tissues surrounding the spine can cause aching at the left of the injury. Nerve root pain is described as sharp or may be described as having an electric shock-type quality. Respiratory Dysfunction: Respiratory complications and infection predominate as post-SCI complications. When the injury involves the upper thorax, the normal breathing pattern is permanently altered. When the intercostal and abdominal muscles are paralyzed, the entire load is taken by the diaphragm. This results in poor coughing and a high risk of pneumonia.

Spinal Cord Injury Resource Center

FUNCTIONAL GOALS FOR SPECIFIC LEVELS OF COMPLETE INJURY

Level C1-C3 Muscles Tested Abilities C3-limited movement of head and neck Functional Goals Breathing: Depends on a ventilator for breathing. Communication: Talking is sometimes difficult, very limited or impossible. If ability to talk is limited, communication can be accomplished independently with a mouth stick and assistive technologies like a computer for speech or typing. Daily tasks: Assistive technology allows for independence in tasks such as turning pages, using a telephone and operating lights and appliances. Mobility: Can operate electric wheelchair by using a head control, mouth stick, or chin control, or a power tilt wheelchair for independent pressure relief. Breathing: May initially require a ventilator for breathing, usually adjust to breathing full-time without assistance. Communication: Normal. Daily tasks: With specialized equipment, may have limited independence in feeding and operating an adjustable bed with an adapted controller. Daily tasks: Independence with eating, drinking, face shaving/washing, brushing teeth, & hair care after aid in setting up specialized equipment. Health care: Can manage their own health care by doing self-assist coughs and pressure reliefs by leaning forward Mobility: May have strength to push a manual wheelchair for short distances over smooth surfaces. A power wheelchair with hand controls is used for daily activities. Driving may be possible after evaluation by a qualified professional to determine special equipment needs. Daily tasks: With help of some specialized equipment, can perform with greater ease in daily tasks of feeding, bathing, grooming, personal hygiene and dressing. May independently perform light housekeeping duties. Health care: Can independently do pressure relief, skin checks, turn in bed Mobility: Can independently do transfers but often require a sliding board. Can use a manual wheelchair for daily activities but may use power wheelchair for greater independence.

C3-C4

C5

Elbow flexors (biceps brachii)

C6

Wrist extensors (extensor carpi ulnaris, extensor carpi radialis longus and radialis brevis)

Usually has head and neck control. Individuals at C4 level may shrug their shoulders. Typically has head and neck control, can shrug shoulder and has shoulder control. Can bend his/her elbows and turn palms face up. Has movement in head, neck shoulders, arms and wrists. Can shrug shoulders, bend elbows, turn palms up and down and extend wrists.

C7

Elbow extensors (triceps brachii)

Similar movement as an individual with C6, may straighten elbows. Added strength & precision of fingers resulting in limited hand function. Has normal motor function in head, neck, shoulders, arms, hands/fingers, greater use of rib/chest muscle Added motor function from increased abdominal control. Has additional return of motor movement in the hips and knees. Various degrees of return of voluntary bladder, bowel and sexual functions.

Daily tasks: Able to perform household duties. Need fewer adaptive aids in independent living. Health care: Able to do wheelchair pushups for pressure reliefs. Mobility: Daily use of manual wheelchair. Can transfer with greater ease. Daily tasks: Can live independently without assistive devices in feeding, bathing, grooming, oral and facial hygiene, dressing, bladder management and bowel management.

C8

T1

T2-T6

Finger flexors (Flexor digitorum profundus) Finger abductors (Abductor digiti minimi)

Mobility: Has increased ability to do some unsupported seated activities. A few individuals capable of limited walking with orthodic aids. This requires extremely high energy and puts stress on the upper body, offering no functional advantage. Can lead to damage of upper joints.

T7-L1

Daily tasks: Able to perform unsupported seated activities. Health care: Has improved cough effectiveness.

L2-L5

Mobility: Walking can be a viable function, with the help of specialized leg and ankle braces. Lower levels walk with greater ease with the help of assistive devices.

S1-S5

Ankle plantar flexors (Gastrocne mius)

Mobility: Increased ability to walk with fewer or no supportive devices.

Spinal Cord Injury Information Network

IMPLICATIONS FOR PHYSICAL EDUCATION Exercise is good for everyone, regardless of functional capabilities. Fitness and recreation not only provide health benefits, they promote the inclusion of people, enhancing social connections, motivation, and self-esteem. Many individuals with SCI can participate in almost all physical activities with some modifications. However, the adapted equipment is essential for participation to ensure safety and success. Adaptation and equipment should be based on the individuals functional abilities and personal preferences. Support staff (physical education teacher, PT, physician) should discuss adaptations and modifications with the individual. Based on the nature of the injury, there are many functional levels of what people with SCI can do. It is important to empower the individual, and stress the importance of physical activity. Many opportunities are available for individuals with SCI to participate in the community. When prescribing an exercise program and participation in physical activity for individuals with SCI, there are some important considerations to make. Important Safety Considerations Get physician consent. Regularly monitor blood pressure, heart rate, RPE, and symptoms. Stop exercising if you feel pain or discomfort Dont exercise if you are ill (i.e., cold, flu, bladder infection, pressure ulcer, unusual spasticity). Check medications and their effect on exercise tolerance. Extended periods of inactivity may cause osteoporosis. Important Considerations When Exercising Incontinence (flaccid or neurogenic bowel/bladder): Individuals with lesions above the sacral level experience a loss of control with their bowel or bladder. Spasticity: characterized by high muscle tone and hyperactive stretch reflexes, it typically occurs in the muscles below the site of injury and is exacerbated by exposure to cold air, urinary tract infections and physical exercise. Stretch spastic muscle groups and avoid exercises that cause excessive spasticity. Autonomic Dysreflexia: A sudden rise in blood pressure resulting from an exaggerated autonomic nervous system response to noxious stimuli below the level of injury, usually due to bladder/bowel overdistension or blocked catheter. Symptoms include profuse sweating, sudden elevation in blood pressure, flushing, shivering, headache, and nausea. KEY: Seek medical attention immediately when it occurs. Orthostatic hypotension: A drop in blood pressure (greater than 20 mmHg for systolic blood pressure and greater than 10 mmHg for diastolic blood pressure). It occurs in upright postures, especially moving from supine to upright sitting/standing/head-up tilt. Symptoms include nausea, dizziness and lightheadedness. KEY: Monitor blood pressure throughout exercise, avoid quick movements, perform othostatic training (if available), maintain proper hydration, and use compression stockings and an abdominal binder. If orthostatic hypotension occurs, lie in a supine position with your feet elevated. Thermoregulation: Irregular body temperatures are often experienced by individuals with SCI. KEY: Wear appropriate clothing, drink plenty of fluids and take precautions in certain environments; in warm environments, a fan and water spray will aid in cooling, and in cold environments, wear extra layers. Pressure sores (decubitis ulcers): Damage to the skin or underlying tissue caused by prolonged sitting, using old wheelchair cushions, sitting on hard surfaces, shear forces or as a result of a fall. Check skin regularly and perform wheelchair push-ups. Transfers: Be sure to follow appropriate guidelines. Balance: Use physical assistance devices to hold body in position during upright exercise.

Importance of Exercise Prevents secondary conditions such as cardiovascular disease, diabetes, pressure sores, carpal tunnel syndrome, chronic obstructive pulmonary disease, hypertension, urinary tract infections, and respiratory disease. Prevents deconditioning and obesity Provides psychological and/or recreational benefits

RECOMMENDED ACTIVITIES Aerobic exercise to maintain cardiovascular health The American College of Sports Medicine (ACSM) recommends performing 20 to 60 minutes of continuous aerobic exercise or multiple sessions of short duration (approximately 10 minutes) for three to five sessions per week. For individuals just starting an exercise program, a circuit-training program is effective. Aerobic exercise can be monitored using an individuals maximal heart rate (MHR) or rating of perceived exertion (RPE). MHR for individuals with SCI is significantly lower than for individuals without SCI while RPE should be moderate to somewhat strong. Strength training to maintain the ability to perform activities of daily living and mobility, as well as to prevent injury through muscular balance Training sessions should be held three days per week. Refrain from training the same muscle groups on consecutive days. Upper-body pushing and pressing exercises (bench press, overhead press) will help transfers and wheeling, while pulling/rowing exercises will help prevent shoulder overuse injuries and improve sitting posture. Perform wheelchair push-ups every 10 to 30 minutes and hold for 30 to 60 seconds. When doing wheelchair push-ups, be sure to bend the elbows slightly. Use straps or a partner for stabilization and balance. Vary exercises to reduce over-use injuries and emphasize muscle groups that are still functional. Types of strength training that benefit individuals with SCI are free weights, weight machines (Nautilus, for example), medicine ball, wall pulley, and theraband. Flexibility training to improve range of motion and reduce spasticity Flexibility training is important to prevent contractures (permanently shortened muscles). Paralyzed muscles should be passively stretched by an exercise specialist; specifically, the hamstrings, adductors, hip flexors, plantar flexors, and lumbar extensors. Types of flexibility training are passive resistance, theraband and standing in a standing frame (if not medically contraindicated).

Quadriplegia MHR typically does not exceed 100 to 125 bpm, and training intensity should be between 50% and 70% maximal heart rate. Therefore, average target heart rate (THR) falls between 65/91bpm. Arm ergometry is a preferred type of exercise training for individuals with quadriplegia. Be sure the wheelchair is locked, the hands are secured to the equipment (straps can be used for stability and balance) and the ergometer is in a fixed position. Paraplegia The MHR of individuals with a lesion T1 to T6 is suppressed; however, for lesions below T6, the MHR is closer to the age-predicted maximum. Training intensity should not go above 70%. Types of cardiovascular training that benefit individuals with paraplegia are wheelchair ergometry, upper-body calisthenics, rowing machine, sports: (basketball, track, swimming, quad rugby), and functional electrical stimulation-leg cycle ergometer (FES-LCE).
Project Inspire Christopher and Dana Reeve Paralysis Resource Center The National Center on Physical Activity and Disability

RESOURCES & REFERENCES

Christopher Reeve Paralysis Foundation/ Paralysis Resource Center 500 Morris Avenue Springfield, NJ 07081 info@crpf.org; research@crpf.org http://www.christopherreeve.org Tel: 973-379-2690 800-225-0292 Fax: 973-912-9433 National Rehabilitation Information Center (NARIC) 4200 Forbes Boulevard Suite 202 Lanham, MD 20706-4829 naricinfo@heitechservices.com http://www.naric.com Tel: 301-562-2400 800-346-2742 Fax: 301-562-2401

National Spinal Cord Injury Association 6701 Democracy Blvd.

#300-9 Bethesda, MD 20817 NSCIA2@aol.com http://www.spinalcord.org Tel: 301-214-4006 800-962-9629 Fax: 301-881-9817 Paralyzed Veterans of America (PVA) 801 18th Street, NW Washington, DC 20006-3517 info@pva.org http://www.pva.org Tel: 202-USA-1300 (872-1300) 800-4248200 Fax: 202-785-4452

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorde rs/sci.htm The National Center on Physical Activity and Disability http://www.ncpad.org/Factshthtml/sciexguide.htm Spinal Cord Injury Information Network http://www.spinalcord.uab.edu/show.asp?durki=1967 9 Spinal Cord Injury Resource Center http://www.spinalinjury.net/index.html Project Inspire http://www7.twu.edu/~f_huettig/fact_sheets/spinalcor d.htm

VISUAL IMPAIRMENT AND BLINDNESS

FACT SHEET

An impairment in vision that, even with correction, adversely affects a childs educational performance. The term includes both partial sight and blindness. This impairment refers to abnormality of the eyes, the optic nerve or the visual center for the brain resulting in decreased visual acuity.

CHARACTERISTICS Behavioral: Appears clumsy, especially in a new situation Holds head in an awkward position to look at something or holds a book or other objects in a peculiar position to look at them Tunes Out when information is on the chalkboard or in a book which the student cannot read Constantly asks a neighbor to tell him/her what is going on Shows signs of fatigue or inattentiveness Exhibits poor self concept and ego development

Communicative Abilities: Less effective use of gesture and bodily action Uses less lip movement in the articulation of sounds

Physical: Behavior: Rubs eyes excessively Shuts or covers one eye, tilts head or thrusts head forward Has difficulty in reading or in other work requiring close use of the eyes Blinks more than usual or is irritable when doing close work Holds books close to eyes I unable to see distant things clearly Squints eyelids together or frowns Appearance: Crossed eyes Inflamed or watery eyes Recurring styes Complaints: Eyes itch, burn or feel scratchy Cannot see well Dizziness, headaches, or nausea following close eye work Blurred or double vision Possible General Characteristics: Physical Fitness is below those of sighted peers Balance development is impaired Fundamental motor patterns and skills are delayed Physical growth and maturation may be imparired Wide variation in residual vision

CAUSE Every year 50,000 Americans become blind. Blindness occurs most often with advancing age, with half of all blind people generally considered to be over sixty-five. A significant number of blind people, however, are children or young adults. (National Federation of the Blind, 1995) The following causes are most likely to occur in younger populations: Malnutrition Infectious Diseases Parasitic Infestations Other: Infants of mothers who have had rubella (German measles) in early pregnancy. Infants of mothers with gonorrhea (countered with administration of erythromycin ointment or silver nitrate solution at birth to newborns eyes) Diabetic Retinopathy: The increased lifespan of diabetics has increased the incidence of this disorder. Changes in the tiny blood vessels of the diabetics retina can cause blindness. Abnormal blood vessels are formed, some may burst and the retina may even break loose for the back of the eye. Laser treatments to seal blood vessels or reattach the retina may help if undertaken early. Some diabetics, incidentally, do not experience vision loss. Retinitis Pigmentosa: Frequently beginning as what is called night blindness, this condition brings degeneration of the retina and the choroid (a related vascular area), usually involving an abnormal development of excess pigment. It is hereditary, with a variety of patterns of inheritance and development. The most common pattern of development is as follows: At approximately age ten or twelve, the youngster begins to experience some difficulty in seeing at night and in poorly lighted areas. His visual field also begins to narrow, frequently resulting in what is commonly termed tunnel vision although he may not realize this at first. The Visual loss is progressive, so that the individual is usually legally blind by young adulthood and slowly loses more and more vision thereafter. Many adults with retinitis pigmentosa have a very tiny field of vision in which they see well under a good light but which is so small as to be of little use. Total blindness often results. There is no known treatment. ETIOLOGY AND PROGNOSIS

IMPLICATIONS FOR PHYSICAL EDUCATION

ASSESSMENT SUGGESTIONS

RECOMMENDED ACTIVITIES

CONTRAINDICATED ACTIVITIES

EFFECTIVE TEACHING STRATEGIES Use other sensory modalities for providing information (hearing, tactile, etc.) Use games for social development Use a beeper, constant sound source, etc. Place students where they can easily hear instruction Use contrasts / bright colors between figure and background, on target objects Increase or decrease the grade to indicate play boundaries Begin new game in slower motion

RESOURCES American Council of the Blind 1155 15th Street NW, Suite 720, Washington, DC 20005 800/424-8666 American Foundation for the Blind 15 West 16th Street, New York, NY 10011 212/620-2000 National Federation of the Blind 1800 Johnson Street, Baltimore, MD 21230 410/659-9314 Rehabilitation Research and Training Center on Blindness and Low Vision P.O. Drawer 6189, Mississippi State, MS 39762 601/325-2001