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
