Chapter 9: Physical Impairments and Special Health Care Needs

Opportunities for a Better Future

• Incorrect stereotypes about physical impairments are common
• Physical perfection is often wrongly associated with goodness

Thinking about Dilemmas to Solve

• How can the educational system best respond to their needs
• Why some states use separate special education schools for students with physical disabilities while others do not
• The impact of fully including all medically fragile students in general education classrooms on all of those directly and indirectly involved
• The implications of including ADHD as a condition under the health impairments category
• How teachers should be prepared to work with children with these special needs

Physical Impairments and Special Health Care Needs Defined

• Physical impairments
  • IDEA uses the term orthopedic impairments
  • Children have problems with structure or functioning of their bodies
  • Includes impairments caused by:
    • Congenital anomaly
    • Disease
    • Other causes such as cerebral palsy and amputations
• Special health care needs
  • IDEA uses the term other health impairments
  • IDEA describes these students as having:
    • Limited strength
    • Chronic or acute health problems
    • Affected educational performance
  • Can be divided into two categories
    • Neuromotor
    • Muscular/skeletal

Physical Impairments

• Neuromotor impairments
  • Brain and spinal cord damage
  • Includes:
  • Seizure disorders
    • Cerebral palsy
    • Spinal cord disorders
    • Polio
    • Muscular dystrophy
    • Multiple sclerosis
• Muscular/Skeletal conditions include:
  • Juvenile arthritis
  • Limb deficiencies
  • Skeletal disorders

Assisting a Child who is Having a Seizure

• Create a safe place free from hazards
• Loosen clothing
• Protect the head
• Turn person sideways
• Call ambulance for seizures longer than five minutes
• Keep individual calm when they return to consciousness

Special Health Care Needs

• Chronic Illnesses
  • Asthma
  • Sickle cell anemia
  • Tuberculosis
  • Childhood cancer
  • Cystic fibrosis
  • Congenital heart defects
  • Blood disorders
  • Diabetes
• Infectious Diseases
  • HIV and AIDS
  • STORCH infections
  • Hepatitis B

Attention Deficit Hyperactivity Disorder

• ADHD is estimated to affect 10-20% of the school-age population in U.S.
• Students with ADHD can be served at school through:
  • Section 504 of the Rehabilitation Act
  • "Other health impairments" category
  • EBD or LD category
• Interventions include medical, behavioral techniques, direct and systematic instruction, and providing a highly structured environment

History of the Field

• Treatment dates to prehistoric times, but was often based in superstition and unsafe practices
• Architectural barriers, though improving, are still problems
• Brief timeline:
  • 1861: William Little describes cerebral palsy
  • 1900: First public classes for "crippled" children
  • 1973: Section 504 of the Rehabilitation Act is passed
  • 1977: Section 504 is implemented
  • 1990: The Americans with Disabilities Act is signed into law
  • 1997: IDEA calls out ADHD in other health impairment category

Prevalence

• In 1998-99, orthopedic impairments comprised 66,574 students ages 6-17
• Health impairments comprise 245,098
• Both conditions combined only involve 0.65% of all schoolchildren
• Sickle cell anemia affects 8% of all African Americans
• Asthma is on the rise (8-12% of all children)
• In 1998, 382 cases of pediatric AIDS occurred in the U.S.

Causes and Prevention

• Causes
  • Allergies and infections
  • Heredity
  • Accidents and injuries
  • Multiple factors
  • "unknown"
• Prevention
  • Good prenatal care
  • Universal immunization
  • Avoiding injuries
  • Medical treatment or management
• Teachers can help by:
• Referring sick children to school nurse and parents
• Keeping play areas and objects disinfected
• Having students wash their hands frequently
• Using disposable gloves when cleaning up an accident
• Keeping classrooms free of pollutants

Characteristics

• Fatigue
• Inconsistent abilities to pay attention
• Weakened muscles and physical conditions
• Absences from school
• Loss of physical coordination

Accommodations and Modifications

• Accommodations
  • Arrange times for naps or rest
  • Monitor medical equipment
  • Work with parents
• Modifying the environment includes:
  • Modifying the physical environment
  • Altering student response demands
  • Adapting materials and equipment
  • Modifying instruction
  • Arranging for extra assistance

Early Childhood Education

• Focus on the development of motor responses
• Body awareness, motor planning and mobility skills set the stage for independence
• Communication skills must be encouraged
• Multi-disciplinary team members ensure development of an effective program
• Students need to be positioned properly and often

Elementary Through High School

• School children may require special features and instructional accommodations such as:
  • Adjusted schedules and extra time
  • Accessible physical and learning environments
  • Planning for health care in the classroom
  • Creative solutions to lessen impact of absences
  • Goals that foster independence
  • Assistive technology

Collaboration for Inclusion

• Accessibility is important at school, home, and in the community
  • Remove physical barriers
  • Eliminate social barriers
  • Participate in extra curricular activities
  • Inclusion in sports and leisure time activities
• Coordination and collaboration with multidisciplinary team members is crucial
• More students with physical disabilities (46%) and those with special health care needs (44%) are receiving their education primarily in the general education class
• Teachers are being called on to resume more medical management responsibilities due to:
  • Shortage of nurses
  • Courts expansion of duties
  • Local education budget cuts

Transition through Adulthood

• Students attaining a high school diploma
  • Physical disabilities - 63%
  • Special health care needs - 67%
• Independent living is the goal for many people
• Transition programs in school can be helpful
• Barriers to full participation include:
  • Coping with inaccessible environments
  • Dealing with bias, rejection, and discrimination
  • Difficulties living independently
  • Difficulties finding jobs
  • Social rejection by people without disabilities

Families

• A child's chronic illness can affect families in ways such as:
  • Fatigue
  • Low vitality
  • Restricted social lives
  • Preoccupation with decisions related to the child's illness
• Some families find that seeking out others with similar problems is helpful

Technology

• Assistive technology
  • Help with independent living
  • IDEA and courts have clarified its role as a related service
  • IDEA does not cover medical services provided by physicians
  • Includes high-tech devices such as computers and wheelchairs
  • Includes low-tech devices such as communication booklets
  • Individualizing and creativity are important
• Cutting edge technology includes:
  • Rehabilitation engineering including bionics and robotics
  • Gait training laboratories
  • Voice activated systems

Challenge Question

• What are the barriers to the full participation of these individuals in society, and how can they be minimized?
  • Barriers include:
  • Inaccessible environments
  • Bias, rejection, and discrimination
  • Difficulties living independently
  • Difficulties finding jobs
  • Social rejection by people without disabilities
  • Students require:
  • Accessible physical and learning environments
  • Acceptance and understanding
  • Goals that foster independence
  • Accommodations for learning, physical, and health needs
  • Special teaching, scheduling, counseling, therapies, equipment, and technology