Special Education 547

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Special Education 547

• Unit One - Part 2
• Physical/Health Disabilities Definitions and
  Impact on Education
• Kevin Anderson
• Minnesota State University Moorhead
• 2006

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Physical and Health Disabilities

• General Information
• Review of definitions
• Associated medical conditions
• Medical and therapeutic interventions
• Onset of disability
• Congenital
• Acquired
• Nature of disability
• Acute
• Chronic
• Impact and strategies

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Review of disabilities

• Neuromotor impairments
• Degenerative diseases
• Orthopedic and musculoskeletal disorders
• Health disabilities

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Neuromotor Impairments

• Originate in the CNS
• Affect nerves and muscles
• Types
• CP
• Neural Tube defects
• TBI

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Cerebral Palsy

• Definitions
• Disorder of movement and posture
• Non-progressive brain abnormality
• Developmental disability
• Affects physical development
• Movement
• Muscle tone
• Position in space

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Time of Assault

• Prenatal
• Brain malformation
• Genetic syndrome
• Infection
• Anoxia
• Perinatal
• Asphyxia
• Infection
• Postnatal
• Infection
• TBI
• Poison
• Anoxia

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Classifications

• Location
• Diplegia
• Hemiplegia
• Quadriplegia
• Neuroanatomy
• Area of the brain involved
• Neurological or neurophysiological dysfunction

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Classifications

• Movement
• Spastic
• Dyskinesia
• Ataxia
• Mixed
• Function
• Mild
• Moderate
• Severe

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Associated Conditions

• Sensory impairments
• Communication impairments
• Orthopedic deformities
• Nutrition needs
• Cognitive dysfunction
• Learning disabilities
• Seizures

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Treatment

• Therapeutic
• Physical therapy
• Occupational therapy
• Orthotics
• Medication
• Surgical

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Developmental Impact

• Physical
• Management
• Spasticity
• Athetosis
• Ataxia
• Mixed
• Body mechanics
• Communication
• Social/emotional

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Educational Impact

• Inclusion
• Differences
• Learning issues
• Self-determination
• Adult outcomes

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Neural Tube Defects (NTDs)

• Malformations of the brain, spinal cord, and/or
  vertebrae
• Commonly referred to collectively as spina bifida
• Failure of spinal column to close properly
• Contributing factors
• Nutrition
• Medication
• Temperature
• Folic acid supplements
• Genetic links - ethnic prevalence
• Gender ratio

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Types of NTDs

• Malformation of skull and portion of brain pushes
  out - encephalocele
• Absence of brain development beyond the brain
  stem - anencephaly
• Most common - spina bifida
• Few vertebrae are bifid and no protrusion - spina
  bifida occulta
• Covering or meninges protrude through open defect
  in spine - meningocele
• Protrusion of spinal cord and meninges through
  vertebral defect - myelomeningocele

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Associate Medical Conditions with
Myelomengingocele

• Location of vertebral defect is directly
  associated with the level of paralysis and loss
  of sensation
• Lower level may impact only spinal nerves and
  higher level may impact spinal cord
• Loss of sensation
• Loss of bowel or bladder control
• Lack of urge may lead to overfilling or reflux
• Infections and overstretched bladder results

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Levels of Paralysis

• Cervical. The neck area contains 8 vertebrae (C1
  through C8). Loss of function in the chest, arms,
  and legs.
• Thoracic. The chest area contains 12 vertebrae
  (T1 through T12). The first thoracic vertebra,
  T1, is the vertebra where the top rib attaches to
  the spine. Affects the chest and the legs.
• Lumbar. The lumbar area (between the chest area
  and the pelvis) contains 5 vertebrae (L1 through
  L5). Affects the hips and legs.
• Sacral. The sacral area (from the pelvis to the
  end of the spine) contains 5 vertebrae (S1
  through S5). Affects the hips and legs, as well
  as bowel and bladder function.

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Associate Medical Conditions with
Myelomengingocele

• Blocked cerebral spinal fluid (CSF) drainage -
  hydrocephalus
• Head enlargement
• Brain abnormalities
• Seizures
• Joint deformities and spinal curvature
• Spinal cord caught on vertebrae or restricted
  by scar tissue - tethered cord
• Cord is stretched
• Causes spinal curvature or nerve damage

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Interventions

• Surgical interventions
• Closure shortly after birth to prevent infection
  and protect nerves from injury
• Placement of shunt to allow CNF drainage and
  prevent brain damage
• Release of tethered cord
• Orthopedic treatment
• Prevention of deformities of spine, hip, and legs
  through supported standing and prone
• Surgery, braces, and splints
• Impact on ambulation
• Therapeutic interventions
• Physical therapy
• Occupational therapy
• Clean intermittent catheterization (CIC) and
  program for regular bowel movements

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Developmental Impact

• Early intervention
• Sensory-motor skills
• Social development
• School age programs
• Motor development
• Functional skills
• self-care
• mobility

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Developmental Impact

• Physical and cognitive development
• Motor impairment
• Increased dependency
• Limited manipulation of materials and play
• Contraindicated activities due to shunt
• Cognitive impairment
• Restricted opportunities
• Damage to brain tissues
• Psychosocial development
• Motivation and frustration level
• Lack of mastery of skills
• Stigmatization due to odor associated with
  incontinence
• Self-esteem and body image issues

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Educational Impact

• Unique needs
• Frequent absences
• Self-care training needs
• Therapy activities
• Academic challenges
• Learning disabilities
• Emotional disorders
• Motor planning issues
• Language issues
• cocktail party language
• False impression of ability may lead to
  unrealistic expectations

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Educational Impact

• Personal autonomy
• Signs of shunt malfunction (see Fig. 2-2, p. 36)
• Headache, lethargy, nausea or vomiting
• Subtle changes in performance, handwriting, or
  social behavior
• Management and strategies for care of personal
  needs
• Skin
• Fractures
• Bladder and bowel
• Independence
• Career and adult outcomes

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Traumatic Brain Injury (TBI)

• Head injury
• No fracture - closed
• Penetration of skull - open
• Brain injury
• Traumatic or non-traumatic events
• Acquired condition
• Concussion - mild TBI
• There may be no apparent damage
• Second impact syndrome (swelling and bleeding)
  may result if not resolved
• Contusion
• Sudden movement of brain towards inside of skull
  - coup/contracoup

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Associated Medical Conditions with TBI

• Cognitive impairment
• Memory and attention
• Organization and perception
• Problem-solving and reasoning
• Seizure activity
• Sensation loss
• Damage to eyes
• Cortical visual impairment (CVI) and nystagmus or
  diplopia
• Damage to ears
• Motor impairment
• Spasticity
• Ataxia
• Tremors
• Other impairments
• Feeding
• Communication
• Behavior

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Interventions

• Medical response
• Support vital functions - ABC (Airway, breathing,
  circulation)
• Appropriate head and neck positioning
• Medication management
• Reduction of environmental stimulation
• Neurological assessment
• Neurosurgery may be indicated
• Reduce intracranial pressure
• Remove foreign objects

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Therapeutic Interventions

• Acute care
• Coma stimulation
• Stabilization
• Passive mobility
• Rehabilitation
• Compensatory skills
• Prevention of complications
• Promote residual skills

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Coma Recovery

• Definition
• Loss of consciousness
• Unresponsiveness
• Measurement
• Glascow Coma Scale (GCS) (table 2-1, p. 40)
• Baseline of responsiveness
• 3 measures - Eye movement, motor response, and
  verbal response
• Emerging from coma - lightening
• Rancho Los Amigos Cognitive Scales (table 2-2, p.
  41)
• Initial stages of recovery
• Reference for rate of recovery and functional
  ability

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Developmental Impact

• Physical and cognitive development
• Factors
• Injury-related
• Treatment-related
• Patient-related
• Physical changes
• Sensory problems
• Balance issues
• Seizure activity
• Cognitive changes
• Attention
• Perception
• Memory and learning

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Strategies for Physical and Cognitive Problems

• Attending and limited response rate is not
  deliberate
• Stimulation needs to be controlled
• Reduce complexity
• Modify instruction
• Repetition
• Localized versus diffuse damage

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Developmental Impact

• Psychosocial development
• Behavioral changes
• Emotional lability
• Response to specific antecedents may be
  predictable
• Poor self-esteem or image
• Depression

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Educational Impact

• School reentry (Fig. 2-3, p. 47)
• Transition needs
• Gradual introduction to academics
• Gradual introduction to teachers and peers
• Career and adult outcomes

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Degenerative Diseases

• Features
• Progressive loss of motor movement
• Increasingly restricted physical ability
• Psychosocial factors - control, fatigue,
  discomfort, and mortality
• Muscular Dystrophy is one of the many types of
  degenerative diseases
• Progressive weakness and death of muscle fibers
• Most common is Duchenne Muscular Dystrophy (DMD)
  - absence or alteration of protein called
  dystrophin

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Duchenne Muscular Dystrophy

• Symptoms observed between 2-6 years
• Weakness usually begins in lower legs and pelvic
  girdle muscles
• Muscle tissue replaced with fat and fibrous
  tissue
• Uses arms to support posture
• Sway back leads to scoliosis
• Gradual loss of mobility leads ultimately to
  respiratory dysfunction
• Death at young adulthood usually due to
  respiratory or heart failure

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Associate Medical Conditions with DMD

• Loss of respiratory function secondary to
  abdominal and thoracic muscle weakness
• Difficulty coughing up secretions may lead to
  pneumonia
• Cardiac muscle weakness
• Deterioration of ambulatory skills
• Development of contractures

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Interventions

• Goal is to maintain function and slow progression
  of symptoms
• Surgery may be indicated
• Release contractures to prolong ambulation
• Stabilize vertebrae to improve respiratory
  function and aid sitting
• Orthopedic treatment
• Mobility equipment
• Handling issues
• Powered mobility
• Therapy needs
• Mobility
• Self-care

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Developmental Impact

• Physical development
• Initially normal development
• Slow, progressive loss of function
• Implications for physical changes
• Understanding of mobility and progression
• Periodic monitoring of skills
• Match status with appropriate level of assistance
• Allow maximal level of independence while
  monitoring endurance
• Monitor weight and dietary changes

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Developmental Impact

• Cognitive development
• May impact verbal performance
• Low performance expectations
• Frequent absences
• Psychosocial development
• Implications of terminal illness
• Increasing dependency
• Social isolation
• Changing body image
• Depression

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Educational Impact

• Maintain level of activity and educational rigor
• Use adaptation strategies
• Low-tech
• High-tech
• Personal autonomy
• Maintain level of participation
• Introduce adaptations carefully
• Maintain expectations
• Career and adult outcomes

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Orthopedic and Musculoskeletal Conditions

• Any condition related to muscular or skeletal
  system
• Limb deficiency is one disorder in this category
• Absence or partial loss of a limb
• Congenital or acquired
• Terminal or intercalary

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Associate Medical Conditions with Musculoskeletal
Conditions

• May be related to a condition which is
  characterized by multiple anomalies
• Thalidomide treatment in the 50s and 60s is now
  available for cancer and AIDS related nausea

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Interventions

• Surgery
• Surgical amputations
• Corrective procedures to improve function
• Preparing limb for prosthetic device
• Orthopedic treatment
• Prosthetics
• Extend length, reach, and motion of limb
• Therapy
• Prosthetic training
• Adjusting to loss limb
• Monitor health and fit of prosthesis

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Developmental Impact

• Psychosocial development
• Age is important factor
• Family attitudes and expectations
• Loss of ability versus development of
  compensatory skills
• Dealing with reactions of others

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Educational Impact

• Adaptations
• Compensatory skills
• Personal autonomy
• Allow different ways of completing tasks
• Care for own prosthesis
• Allow student to struggle to achieve independence
• Career and adult outcomes

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Health Disabilities

• Conditions that limit strength, vitality, and
  alertness
• Chronic or acute
• Increasing numbers in public schools

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Major Health Impairments

• Heart disorders
• Blood disorders
• Asthma
• Cystic fibrosis
• Juvenile diabetes
• Chronic renal failure
• Childhood cancer

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Infectious Diseases

• Hepatitis
• Human Immunodeficiency Virus (HIV) and Acquired
  Immunodeficiency Disease (AIDS)
• Other infectious diseases

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Guidelines for Educators

• CEC
• Knowledge of condition and effect on development
• Psychological and emotional characteristics
• Lesson adaptation to accommodate effects
• Understand medical perspective
• Practice and teach universal precautions and
  confidentiality practices
• Access professional organizations

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Visibility Factor

• Developmental impact
• Lack of visual reminder
• Not perceived as ill
• Engage in activities which are not appropriate
• May not be disclosed or identified
• Chronic nature lead to lifetime management issues

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Asthma

• Most common pulmonary disease
• Mild to life-threatening symptoms
• Reactive to uncontrolled variables, such as the
  environment
• Classifications
• Extrinsic, intrinsic, or mixed
• Aspirin/exercise/occupation induced

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Description

• Result of bodys immune response
• Antigens (foreign substances) enter lungs and
  antibodies are produced to suppress antigens
• Asthmatic - specific antibodies that react
  adversely to antigens
• Swelling
• Mucus secretion
• Muscle tightening
• Leads to airway restriction and difficulty
  breathing

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Associated Medical Conditions

• Trapped air
• Over-inflated lungs
• Difficulty exhaling
• Barrel-shaped chest

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Treatment

• Prevention
• Cause
• Environmental control measures
• Removing triggers
• Reduce allergens
• Immunotherapy
• Medication

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Treatment

• Intervention
• Bronchodilators
• Inhaler
• Nebulizer
• Symptoms
• Shortness of breath
• Unresponsive
• Cyanosis
• Other options to reduce mucus
• Moist air
• Pulmonary percussion
• Postural drainage
• Coughing techniques
• Breathing exercises

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Developmental Impact

• Not related to cognitive development, unless
  associated with syndrome or injury
• Early development stages may be limited due to
  limited mobility and exploration
• Adaptations may be necessary to promote access to
  materials
• Temperature awareness due to difficulty
  regulating body temperature

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Developmental Impact

• Physical or cognitive development
• Psychosocial development
• Historical perspective
• May be induced by heightened emotional state
• Attacks may impact others reactions
• Overprotection
• Absenteeism

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Educational Impact

• Fatigue or alertness
• Attendance related to fears or avoidance
• Educational responsibility
• Environmental control
• Intervention techniques
• Remove irritant
• Encourage student to sit and use appropriate
  medication and clear liquids
• Contact appropriate personnel
• Keep record

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Educational Impact

• Emergencies
• Develop and follow a plan of response
• Maintain support and reassurance
• Remove other students
• Clear space
• De-brief
• Self-determination
• Medication use
• Privacy
• Side effects or impact of medication
• Future outcomes
• Environmental impact
• Stamina and motivation

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Cystic Fibrosis

• Hereditary and progressive disease
• Affects lungs and other major organs
• No gender difference
• CF gene on 7th chromosome
• Exocrine system disease
• Sticky mucus in respiratory system
• Decreased lung efficiency
• Lungs may collapse or over-inflate
• Digestive system
• Impacts release of pancreatic juices
• Affects digestion and overall nourishment
• Progressive and terminal disease

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Associated Medical Conditions

• Systemic condition - affects many organs of body
• Mucus traps secretions
• Cysts and scar tissue develop
• Leads to pneumonia and other respiratory
  complications
• Bowel obstruction
• Unbalance caloric intake and nutrient absorption
• Salt and fluid loss through sweat
• May develop diabetes
• Late onset of puberty

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Treatment

• Gene therapy
• Antibiotics
• Expectorants
• Chest percussion
• Postural drainage
• Transplants
• Vitamin and mineral supplements
• Digestive enzymes
• Healthy and low-fat diet

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Developmental Impact

• Growth
• Sexual development
• Physical abnormalities
• Attendance may impact learning
• Psychosocial development
• Medical needs
• Family burden
• Personal self-image, hopelessness

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Educational Impact

• Medical treatments at school
• Medical appointments
• Attendance
• Self-determination
• Managing treatments
• Responsibility for class work
• Future outcomes
• Physical endurance issues
• Terminal nature of disease

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Cancer

• Growth and spread of abnormal cells
• Tumors or neoplasms
• Benign vs. malignant
• Metastasizing cells
• Terminal disease
• Usually involves connective or supporting tissue
  in children

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Associated Medical Conditions

• Depends on site of cancer
• Illness associated with site
• Metastasizing cancer may affect systems

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Treatments

• Early identification important
• Surgical intervention
• Chemotherapy
• Drugs to prevent cell division
• Unpleasant side effects
• Drugs may be used to counteract side effects
• Radiation
• Attacks atomic structure of cancer cells
• Used in conjunction with chemotherapy
• Bone marrow transplants for leukemia

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Developmental Impact

• Altered physical development
• Deterioration of body functions
• Pain impacts overall functioning
• Psychosocial development
• Fears
• Self-consciousness
• Terminal possibility

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Educational Impact

• Consistency in programming
• Medical appointments and treatments
• Flexibility
• Self-determination
• Awareness of impact
• Learning to cope
• Adult outcomes
• Maintain goals
• Instill hope