Special Education 447

Curriculum Considerations and Personal Care

Management for Students with Physical and Health

Impairments

Curriculum Considerations

• Assessment• Identification of priority needs• Impact on core curriculum• Designing program• Instruction techniques

Assessment

• Discrepancy analysis– Task analysis– Observation of performance– Record of performance error’s– Determining instructional approach

• Direct instruction• Use of adaptations• Alternative methods

Instruction

• Prompting systems• Learning strategies• Demonstration model• Response prompts

Personal Care Management

• Issues regarding feeding and respiration

• Issues regarding personal cares• Impact on educational program• Personal and social development

and awareness• Progress towards independence

Feeding and Respiration• Terms

– Feeding– Swallowing– Aspiration

• Considerations– Feeding skills– Feeding utensils– Positioning– Swallowing– Respiratory and gastrointestinal factors– Nutritional requirements– Oral and pharyngeal activity

Impacting Conditions

• Prematurity• Upper airway

obstruction/anomalies• Congenital defects• Traumatic injury• Neurological conditions

Impact on Learning

• Nutritional intake• Development and maintenance of

teeth and gums• Sensory stimulation• Communication and

personal/social skills• Security and attachment

Typical Development• Oral-motor skills related to feeding

– Rooting response– Automatic phasic bite-release pattern– Gag response– Bottle drinking

• Sucking• suckling

– Spoon feeding– Cup drinking– Solid foods

• Bite• Munch• Rotary jaw movements

Typical Development

• Respiratory development– “Belly breathing” through most of first year– Develops coordination with movement, feeding and

swallowing, and communication– Increased abdominal control, stability of shoulder

girdle, expansion of rib cage - leading to abdominal thoracic breathing

• Respiratory coordination with oral/pharyngeal activity in feeding and swallowing– Postural control– Physical growth– Skeletal changes in alignment– Sensory experiences– Respiratory function

Essential Components• Feeding

– Upper airway protection– Gag response– Lower respiratory system function– Oral-motor skills

• Sound production– Coordination with movement and respiration– Emotional state– Lips, tongue, teeth– Imitation– Basic needs– Interaction

Dysfunction in Feeding

• Impact of tone• Atypical movement patterns for

example…– Upper body hyper-extension leading to jaw

thrust and retraction– Asymmetry leading to retraction and

deviation to side– Tongue retraction leading to tongue thrust

• Decreased sensory experiences

Dysfunction in Respiration

• Impact of tone• Compensatory patterns for example…

– Low tone leading to thoracic retraction– High tone leading to elevation and internal

rotation of shoulder girdle

• Decreased respiratory function – Impacts feeding and swallowing,

compromising safety– Interferes with phonation

Evaluation Process

• Conducted by specialists who are knowledgeable in typical and atypical development

• Oral-motor structures• Feeding and swallowing skills• Respiratory coordination• Body systems

• Monitored by educational team– Oral sensory needs– Nutritional needs– Medication impact– Positioning and handling issues

Considerations for Consultant

• Postural control and movement• Sensory stimulation• Respiratory function• Positioning• Methods of liquid intake• Use of utensils for solid food intake• Biting and chewing• Drooling• Sound/speech production• Communication

Considerations for Intervention

• Establish goals and objectives for student performance

• Determine adaptations and strategies for intervention

• Ensure proper training• Introduce interventions outside of actual

“mealtime” or informal feeding opportunities

• Oral hygiene

Considerations for Intervention

• Use of positioning and handling• Selection of utensils• Selection of food and liquids

– Consistency– Texture– Taste– Nutrition

• Preparatory activities– Facial and oral tactile sensitivity– Facial and oral preparation– Incorporating into normal routines

Considerations for Intervention

• Direct intervention techniques– Oral control– Cup drinking– Spoon feeding– Solid foods

• Respiratory coordination– Preparatory activities of oral-motor structures– Neurodevelopmental treatment of trunk and

extremities

Personal Cares• Self-care skills

– Hygiene– Eating and toileting– Dressing– Use of adaptations

• Home management skills– Kitchen skills– Housekeeping– Use of technology

• Community-based skills– Transportation– Access to facilities– Barriers

• Recreation and leisure opportunities

Hygiene

• Personal and family values• Impact of disability• Areas of care

– Hand washing– Face and body washing– Hair care– Oral hygiene– Personal hygiene

Eating and Toileting

• Typical development• Impact of disability• Independent skills• Training methods• Alternative methods

– Tube feedings– Catheterization– Colostomy care– Independent care versus adult assistance

Dressing

• Typical development• Impact of disability• Motivation and preferences• Use of adaptations

Recreation and Leisure Opportunities

• Impact of Section 504 and ADA• Physical access versus program or

service access• Role of DAPE teachers• Terms

– Recreation– Leisure

Physical Education

• “Physically educated”– Skills necessary to participate in physical

activity– Level of physical fitness– Appreciation of physical activity– Physical activity for enjoyment and health

• “Physical education”– Physical and motor fitness– Fundamental motor skills– Special PE, APE, movement education, and

motor development

DAPE

• Modeled after regular PE program with necessary adaptations for success

• Challenging• Consideration of life-long needs• Integration with non-disabled peers• Individualized selection of activities

Collaboration

• Assessment of motor abilities• Prioritizing needs• Anticipation of future environments• Consideration of extracurricular

activities• Developing plan, including goals

and objectives, placement, activities, and adaptations

Leisure and Recreation Education

• Personal preferences• Non-competitive nature• Not only fitness-related• Domain-based

– Creative– Science and technology– Nature– Sports