Special Education 547

Unit One - Part 2

Physical/Health Disabilities: Definitions and Impact on

EducationKevin Anderson

Minnesota State University Moorhead2006

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

Review of disabilities

• Neuromotor impairments• Degenerative diseases• Orthopedic and musculoskeletal

disorders• Health disabilities

Neuromotor Impairments

• Originate in the CNS• Affect nerves and muscles• Types

– CP– Neural Tube defects– TBI

Cerebral Palsy

• Definitions– Disorder of movement and posture– Non-progressive brain abnormality– Developmental disability– Affects physical development

• Movement• Muscle tone• Position in space

Time of Assault

• Prenatal– Brain malformation– Genetic syndrome– Infection– Anoxia

• Perinatal– Asphyxia– Infection

• Postnatal– Infection– TBI– Poison– Anoxia

Classifications

• Location– Diplegia– Hemiplegia– Quadriplegia

• Neuroanatomy– Area of the brain involved– Neurological or neurophysiological

dysfunction

Classifications

• Movement– Spastic– Dyskinesia– Ataxia– Mixed

• Function– Mild– Moderate– Severe

Associated Conditions

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

Treatment

• Therapeutic– Physical therapy– Occupational therapy

• Orthotics• Medication• Surgical

Developmental Impact

• Physical• Management

– Spasticity– Athetosis– Ataxia– Mixed

• Body mechanics• Communication• Social/emotional

Educational Impact

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

Neural Tube Defects (NTD’s)

• 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

Types of NTD’s

• 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

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

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.

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

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

Developmental Impact

• Early intervention– Sensory-motor skills– Social development

• School age programs– Motor development– Functional skills

• self-care• mobility

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

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

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

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

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

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

Therapeutic Interventions

• Acute care– Coma stimulation– Stabilization– Passive mobility

• Rehabilitation– Compensatory skills– Prevention of complications– Promote residual skills

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

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

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

Developmental Impact

• Psychosocial development– Behavioral changes– Emotional lability– Response to specific “antecedents”

may be predictable– Poor self-esteem or image– Depression

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

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

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

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

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

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

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

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

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

Associate Medical Conditions with Musculoskeletal

Conditions• May be related to a condition

which is characterized by multiple anomalies

• Thalidomide treatment in the 50’s and 60’s is now available for cancer and AIDS related nausea

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’

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

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

Health Disabilities

• Conditions that limit strength, vitality, and alertness

• Chronic or acute• Increasing numbers in public

schools

Major Health Impairments

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

Infectious Diseases

• Hepatitis • Human Immunodeficiency Virus

(HIV) and Acquired Immunodeficiency Disease (AIDS)

• Other infectious diseases

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

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

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

Description

• Result of body’s 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

Associated Medical Conditions

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

Treatment

• Prevention– Cause– Environmental control measures

• Removing triggers• Reduce allergens

– Immunotherapy– Medication

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

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

Developmental Impact

• Physical or cognitive development• Psychosocial development

– Historical perspective– May be induced by heightened

emotional state– Attacks may impact others reactions– Overprotection– Absenteeism

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

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

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

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

Treatment

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

Developmental Impact

• Growth• Sexual development• Physical abnormalities• Attendance may impact learning• Psychosocial development

– Medical needs– Family burden– Personal self-image, hopelessness

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

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

Associated Medical Conditions

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

systems

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

Developmental Impact

• Altered physical development• Deterioration of body functions• Pain impacts overall functioning• Psychosocial development

– Fears– Self-consciousness– Terminal possibility

Educational Impact

• Consistency in programming• Medical appointments and treatments• Flexibility• Self-determination

– Awareness of impact– Learning to cope

• Adult outcomes– Maintain goals– Instill hope