Orthopedic Impairments, Health Impairments,

1
Orthopedic Impairments,Health Impairments,
ADHDPutting the Puzzle Pieces Together

• SPE 500
• Presented by April Coleman

2
Agenda

• Introductions
• Opening Activity
• Overview Definitions
• Physical Other Health Impairments
• Types, Causes, Accommodations
• Instructional Strategies
• Inside a Real Classroom
• Break
• Activity Wiki/Webquest (Computer Lab)
• Debriefing

3

• How is special education like a puzzle?

4
Pieces of the Special Education Puzzle
Collaboration
Identification
Assessment
Instruction
5
Think about it

• What is your main goal as a professional in the
  field of special education?
• How does this goal relate specifically to
  students with orthopedic and other health
  impairments?

6
Overview Definitions

• Orthopedic Impairments,
• Other Health Impairments, ADHD

7
Orthopedic Impairments

• A severe orthopedic impairment adversely affects
  a childs educational performance, including
  impairments
• Caused by a congenital abnormality (i.e.
  clubfoot, absence of limb),
• Caused by disease (i.e. polio, bone
  tuberculosis),
• From other causes (i.e. cerebral palsy,
  amputation, fracture, burn, etc.) (IDEA, 2004).
• 2 Types Orthopedic, Neuromotor

8
Other Health Impairments

• Having limited strength, vitality, or alertness,
  including a heightened alertness to environmental
  stimuli, that results in limited alertness with
  respect to the educational environment, that
• Is due to chronic or acute health problems such
  as asthma, ADD/ADHD, diabetes, epilepsy, a heart
  condition, hemophilia, lead poisoning, leukemia,
  nephritis, rheumatic fever, sickle cell anemia,
  and Tourette syndrome and
• Adversely affects academic performance (IDEA,
  2004).

9
OI OHI The Big Picture

• Common criteria in both definitions
• that adversely affects a childs educational
  performance
• Conditions may be congenital or acquired.
• Not all students with physical or health
  conditions need/receive special education.
• Chronic vs. acute conditions

10
Why is ADD/ADHD included?

• Children with attention-deficit/hyperactivity
  disorder are served under the OHI category of
  IDEA with the reasoning that their condition
  results in a heightened alertness that adversely
  affects their educational performance.

11
Prevalence

• Chronic medical conditions affect up to 20
  (about 12 million) school-age children in the
  U.S. (Sexson Dingle, 2001).
• In 2005-06, of children between 6-21
• 62,618 received services under OI category.
• 557,121 received services under OHI category.
• (U.S. Department of Education, 2007)

12
Initial Reactions

• What words and feelings immediately come to mind
• When seeing a child in a wheelchair?
• When seeing a non-verbal child communicate in
  other ways?
• When seeing a school-age child exhibit impulsive
  behavior?
• As a special educator, how should you view these
  children?

13
Common Physical Other Health Impairments

• Types, Causes, Accommodations

14
Cerebral Palsy

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

15
Cerebral Palsy

• A disorder of involuntary movement and posture
• May affect one or multiple limbs
• Symptoms
• Disturbances of voluntary motor function
• May include paralysis, weakness, lack of
  coordination, involuntary convulsions
• Little or no control over arms, legs, or speech
• Effects muscle tone

16
Cerebral Palsy

• Effects on muscle tone and quality
• Hypertonia tense, contracted muscles results
  in jerky movements
• Hypotonia weak, floppy muscles may need
  external supports
• Athetosis causes large, irregular, twisting
  movements, including drooling
• Ataxia causes poor sense of balance and hand use

17
CP Accommodations

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

18
CP Accommodations

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

19
Spina Bifida

• Most common neural tube defect, in which the
  vertebrae do not enclose the spinal cord, causing
  a portion of the spinal cord and nerves
  controlling lower body muscles to fail to develop
  normally.
• Myelomeningocele most common and serious form
• High risk of paralysis and infection
• 80-90 also develop hydrocephalus, accumulation
  of spinal fluid in tissues surrounding the brain

20
Spina Bifida

• Typical symptoms
• Some degree of paralysis in lower limbs
• Lack full bladder control
• Good upper-body usage
• Accommodations
• Use of wheelchair, braces, crutches, or walkers
• Catheterization
• Assistance in dressing and toileting

21
Muscular Dystophy

• Refers to a group of about 40 inherited diseases
  marked by progressive atrophy of the bodys
  muscles.
• Duchenne MD most common and severe type.
• Progressive reduction of muscle tone causes
  difficulty in walking and other movements.

22
MD Accommodations

• Goals of treatment
• Maintaining function of unaffected muscles for as
  long as possible.
• Facilitating movement.
• Providing emotional support to child and family.
• No known cure currently exists.
• Encourage children to be as active as possible.
• Avoid lifting or pulling children by their limbs.

23
Epilepsy

• Condition resulting in chronic repetition of
  seizures.
• A disorder, not a disease
• 30 of cases caused by other conditions (i.e.
  cerebral palsy, brain infection, high fever).
• Psychological, physical, or sensory factors may
  trigger seizures (i.e. fatigue, anger, hormonal
  changes, light) may experience aura beforehand.

24
Epilepsy

• Types of seizures
• Generalized tonic-clonic seizure (grand mal)
  most serious type loss of consciousness, muscles
  become stiff and body shakes violently, usually
  diminishing in 2-3 minutes
• Absence seizure (petit mal) far less severe but
  may occur more frequently brief loss of
  consciousness occurs for a few seconds, causing
  person to stare blankly

25
Epilepsy Accommodations

• Use of medication
• During a seizure
• Keep everyone around calm.
• Ease child gently to floor.
• Put something soft under his head.
• Turn him gently to his side.
• Do not attempt to restrain movements or do
  anything to his mouth.
• Allow the child to rest until full consciousness
  returns.

26
Other Health Impairments

• Spinal Cord Injuries
• Diabetes
• Asthma
• Cystic Fibrosis
• HIV/AIDS
• May require special education and other related
  services, such as health care services or
  counseling.

27
ADD ADHD

• To be diagnosed with attention-deficit/hyperactivi
  ty disorder, a child must display 6 or more
  symptoms listed in the DSM-IV of inattention or
  hyperactivity-impulsivity for a period of at
  least 6 months.
• List on p. 421
• Many children with ADHD who meet eligibility
  requirements are served under other disability
  categories (LD, emotional disturbance).
• Prevalence 3-5 of all school-age children

28
RememberKids with disabilities are kids first.
29
Instructional strategies

• Research-Based Educational Approaches

30
Inside a Real Classroom

• Meet Hope Bailey, special educator and parent of
  a child with spina bifida.
• Hope teaches a Multiple Disabilities Class at
  Sprayberry Education Center, in Tuscaloosa County
  School System.

31
Guiding Principles

• Use ongoing assessment to guide instruction.
• Individualize instruction to the greatest extent
  possible (IEP).
• Promote student independence.
• Collaborate with a team of experts to develop and
  implement a comprehensive educational, physical,
  and medical plan.

32
Collaboration

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

33
Environmental Modifications

• Include adaptations to provide increased access
  to a task or activity, changing the way in which
  instruction is delivered, and changing the manner
  in which the task is done.
• Examples
• Location of items in classroom
• Soft-tip pens for writing
• Modifying response requirements

34
Assistive Technology

• Any piece of equipment used to increase,
  maintain, or improve a childs functional
  capabilities.
• IDEA defines as both devices and services needed
  to help a child obtain and use devices.
• Include both low-tech and high-tech devices
• Examples
• Power wheelchairs
• Communicative aides
• Online list of tools

35
Healthcare Strategies

• Individualized Health Care Plan (IHCP)
• Describes health-related needs and procedures
• Included as part of a students IEP
• Chart on p. 440 Example of IHCP objectives
• Establish routines and procedures to ensure
  proper positioning, seating, lifting, and moving.
• Benefits Guidelines on pp. 437 441
• Sample Routine p. 442

36
Behavioral Interventions

• Positive reinforcement for on-task behavior
• Modification of instructional activities
• Systematically teaching self-control
• Research indicates success in students with ADHD
  when self-monitoring is directly linked with
  clear instructions and consistent reinforcement
  (Biscard Neef, 2002).

37
Self-Monitoring Steps

1. Specify target behavior and performance goals.
2. Select materials that simplify the process.
3. Provide supplementary cues to self-monitor.
4. Provide explicit instruction.
5. Reinforce accurate self-monitoring.
6. Reward improvements in the target behavior.
7. Encourage self-evaluation.
8. Evaluate the program. (pp. 428-429)

38
Fostering Independence Self-Esteem

• How parents, teachers, classmates, and others
  react to a child with a disability is as
  important as the disability itself.
• Strategies
• Encouragement of a positive, realistic self-view
• Opportunities to experience success and failure
• Reasonable expectations for performance and
  behavior
• Embracing unique interests and abilities
• Fostering independence box on pp. 445-446

39
Placement Alternatives

• About 50 of students with physical impairments
  and chronic health conditions are served in
  general education classrooms.
• The amount of support and accommodations varies
  greatly according to condition, needs, and level
  of functioning.
• Placement decisions should be made on a
  case-by-case basis, with the students needs and
  best interest in mind.

40
321

• On your note card, please list
• 3 key ideas
• 2 things I enjoyed or benefitted from
• 1 question or request