This category covers a diverse group of students.
Some students have minimal limitations.
Many students with physical limitations and special
health care needs have multiple disabilities.
In addition, there is overlap in health issues - like
seizure disorders - and aligned physical limitations.
signs or characteristics of physical and health impairments (Smith,1998)
|limited vitality and energy
||poor motor coordination
|| frequent falls
|need for physical accommodations
||lack of concentration
Defining Physical Disabilities
|IDEA refers to physical disabilities as orthopedic impairment,
and in C.F.R. Sec 300.7 states: "Orthopedic impairment means
a severe orthopedic impairment that adversely affects a child's
educational performance. The term includes impairments caused by
congenital anomaly (e.g. clubfoot, absence of some member, etc.),
impairments cause by disease (e.g., poliomyelitis, bone tuberculosis,
etc.), and impairments from other causes (e.g., cerebral palsy,
amputations and fractures or burns that cause contractures).
This material will be most focused on students with orthopedic issues.
Click here to visit material about Traumatic Brain
Injury. Click here to find material about seizures.
Health issues such as anemia, cancer,
HIV, illnesses and CPR are also discussed in a separate location.
Attention Deficit Disorder
This is covered in a separate section
Click here to view the
Cerebral Palsy is a medical condition that affects control
of the muscles. It is caused by an injury to the brain before, during,
or shortly after birth. In many cases, no one knows for sure what caused
the brain injury or what may have been done to prevent the injury. Cerebral
means head and palsy refers to anything wrong with control of the muscles
or joints in the body. When someone has cerebral palsy, an injury to
their brain (that's the cerebral part) keeps some of the muscles in
the body from working in the normal way (that's the palsy part). Children
who have cerebral palsy, or CP, may not be able to walk, talk, eat or
play in the same ways as most other kids.
CP is the result of damage to the area of the brain that
controls muscle tone. Depending on where the brain injury occurs and
how serious the damage, muscle tone may be too tight, too loose, or
some of each. Muscle tone is what lets us keep our bodies in a certain
position, like sitting with our heads up to look at the teacher in class.
Changes in muscle tone help us move, keep our bodies in a sitting position,
help us hold our head, up and even hold it still. Each time we move
our muscles must shorten, or increase the tone in one set of muscles
while they lengthen, or decrease the tone in another set of complimentary
muscles. To move smoothly without jerks, the tone in muscles must change
in a way that is just right. Children with CP are not able to change
muscle tone in a smooth and even way, so movements may be jerky or wobbly.
Spastic Cerebral Palsy When muscle tone is too
high or too tight, stiff and jerky movements are the results of movements.
It can be difficult to change positions or let go of something. Spastic
CP is the most common form,with about 50 per cent of youngsters included
in this form.
Ataxic Cerebral Palsy Low muscle tone and poor
coordination of movements is described as ataxic CP. Those who have
ataxic CP have a tremor when they are trying to do something. That also
makes it hard to have good balance and contributes to unsteady movements.
Because of the shaky movements and coordination problems, students with
ataxic CP usually have problems with projects that require small muscle
Athetoid Cerebral Palsy This is cerebral palsy
with mixed muscle tone. Children with athetoid CP have trouble holding
themselves in an upright, steady position and their bodies make random,
involuntary movements. Because of mixed muscle tone and trouble keeping
a position, they may not be able to hold onto things. About 25 per cent
of all cases of CP fit the definition of athetoid.
Mixed Cerebral Palsy When muscle tone is too low
in some muscles and too high in other muscles, the type of cerebral
palsy is called mixed. About 25 per cent of all people with CP have
Besides different kinds of muscle tone, CP may be occur
in different parts of the bodies. This is also due to what part of their
brain was hurt and how big the injury was.
Quadriplegia CP in all four limbs--both arms and
both legs. Usually youth with quadriplegia have trouble moving all the
parts of their bodies, their face and trunk as well as their arms and
legs, and may need a wheelchair to get around. Because of the problems
controlling the muscles in their face and upper body, they also have
trouble talking and eating.
Hemiplegia CP that affects one side of the body,
so the right arm and leg or the left arm and leg are affected. The other
side of the child's body works just fine. Many youth with hemiplegia
can walk and run, perhaps a little awkwardly or with a limp.
Diplegia CP just in legs or much more severe in
legs than arms. Youth with diplegia have difficulty walking and running.
Because the upper body is not typically affected arms and hands are
usually fine. Students rarely have arms affected rather than legs.
Spina Bifida means cleft spine, which is an incomplete
closure in the spinal column. In general, the three types of Spina
bifida (from mild to severe) are:
1. Spina Bifida Occulta: There is an opening in
one or more of the vertebrae (bones) of the spinal column without
apparent damage to the spinal cord.
2. Meningocele: The meninges, or protective covering
around the spinal cord, has pushed out through the opening in
the vertebrae in a sac called the "meningocele." However, the
spinal cord remains intact. This form can be repaired with little
or no damage to the nerve pathways.
3. Myelomeningocele: This is the most severe form
of spina bifida, in which a portion of the spinal cord itself
protrudes through the back. In some cases, sacs are covered with
skin; in others, tissue and nerves are exposed. Generally, people
use the terms "spina bifida" and "myelomeningocele" interchangeably.
- from NICHCY
Educational Implication -
Quoted from NICHCY
Educational Implications: Although spina bifida is relatively
common, until recently most children born with amyelomeningocele
died shortly after birth. Now that surgery to drain spinal fluid
and protect children against hydrocephalus can be performed in
the first 48 hours of life, children with myelomeningocele are
much more likely to live. Quite often, however, they must have
a series of operations throughout their childhood.
School programs should be flexible to accommodate these special
needs. Many children need training to learn to manage their bowel
and bladder functions. Some require catheterization, or the insertion
of a tube to permit passage of urine. The courts have held that
clean, intermittent catheterization is necessary to help the child
benefit from and have access to special education and related
services. Many children learn to catheterize themselves at a very
early age. A successful bladder management program can be incorporated
into the regular school day.
In some cases, children with spina bifida who also have a history
of hydrocephalus experience learning problems. They may have difficulty
with paying attention, expressing or understanding language, and
grasping reading and math. Early intervention with children who
experience learning problems can help considerably to prepare
them for school. Mainstreaming, or successful integration of a
child with spina bifida into a school attended by non disabled
young people, sometimes requires changes in school equipment or
the curriculum. Although student placement should be in the least
restrictive environment the day-to-day school pattern also should
be as "normal" as possible.
In adapting the school setting for the child with spina bifida,
architectural factors should be considered. Section 504 of the
Rehabilitation Act of 1973 requires that programs receiving federal
funds make their facilities accessible. This can occur through
structural changes (for example, adding elevators or ramps) or
through schedule or location changes (for example, offering a
course on the ground floor). Children with myelomeningocele need
to learn mobility skills, and often require the aid of crutches,
braces, or wheelchairs. It is important that all members of the
school team and the parents understand the child's physical capabilities
and limitations. Physical disabilities like spina bifida can have
profound effects on a child's emotional and social development.
To promote personal growth, families and teachers should encourage
children, within the limits of safety and health, to be independent
and to participate in activities with their non disabled classmates.
Muscular dystrophy is the name given to
a group of diseases that are, for the most part, genetically
determined and cause gradual wasting of muscle with accompanying
weakness and deformity. This group of muscle diseases has three
features in common: they are hereditary they are progressive
each causes a characteristic, selective pattern of weakness
The most well known of the muscular dystrophies is Duchenne
muscular dystrophy (DMD), followed by Becker muscular dystrophy
The two cause similar patterns of weakness and
disability and are inherited in the same way. Weakness and disability
are more severe in DMD than in BMD. Becker dystrophy is like
a less severe form of Duchenne dystrophy. They are due to defects
of the same gene, the normal function of which is to enable
muscle fibers to make a particular chemical substance, a protein
called dystrophin. Muscle fibers in people affected with DMD
are extremely deficient in dystrophin, in BMD the deficiency
is less severe. - University of Kentucky
major types defined and described
Muscular Dystrophy - Australian
site gives great definitions for numerous classifications
MUSCULAR DYSTROPHIES: Duchenne Muscular Dystrophy
(DMD - Also known as Pseudohypertrophic) Becker Muscular
Dystrophy (BMD) Emery-Dreifuss Muscular Dystrophy
(EDMD) Limb-Girdle Muscular Dystrophy (LGMD) Facioscapulohumeral
Muscular Dystrophy (FSH - Also known as Landouzy-Dejerine)
Myotonic Dystrophy (DM - Also known as Steinert's Disease)
Oculopharyngeal Muscular Dystrophy (OPMD) Distal Muscular
Dystrophy (DD) Congenital Muscular Dystrophy (CMD)
MOTOR NEURON DISEASES: Amyotrophic Lateral
Sclerosis (ALS-Also known as Lou Gehrig's Disease) Infantile
Progressive Spinal Muscular Atrophy (Also known as Werdnig-Hoffman)
Intermediate Spinal Muscular Atrophy (Also known as SMA
Type 2) Juvenile Spinal Muscular Atrophy (SMA - Also
known as SMA Type 3, Kugelberg-Welander) Spinal Bulbar Muscular
Atrophy (SBMA - Also known as Kennedy's Disease)
INFLAMMATORY MYOPATHIES: Dermatomyositis, Polymyositis
DISEASES OF THE NEUROMUSCULAR JUNCTION: Myasthenia
Gravis, Lambert-Eaton Syndrome
MYOPATHIES DUE TO ENDOCRINE ABNORMALITIES: Hyperthyroid
Myopathy, Hypothyroid Myopathy
DISEASES OF PERIPHERAL NERVE: Charcot-Marie-Tooth
Disease or Peroneal Muscular Atrophy Friedreich's Ataxia, Dejerine-Sottas
Disease or Progressive Hypertrophic Interstitial Neuropathy
OTHER MYOPATHIES: Myotonia Congenita - Thomsen's
and Becker's Disease, Paramyotonia Congenita, Central Core Disease,
Nemaline Myopathy, Myotubular Myopathy, Periodic Paralysis
METABOLIC DISEASES OF MUSCLE: Phosphorylase Deficiency
-McArdle's Disease, Acid Maltase Deficiency - Pompe's Disease,
Phosphofructokinase Deficiency - Tarui's Disease,Debrancher
Enzyme Deficiency - Cori's or Forbes' Disease, Mitochondrial
Myopathy, Carnitine Deficiency, Carnitine Palmityl Transferase
Deficiency, Phosphoglycerate Kinase Deficiency, Phosphoglycerate
Mutase Deficiency, or Lactate Dehydrogenase Deficiency, Myoadenylate
guide to MD
ideas from parents
Several examples of high and lo tech devices are provided. Now come
up with examples of your own for 25 points. Add benefits for another
25 points. Find and explore web sites for 25 additional points.
Tips and Strategies
Human Body system
- a wonderful, colorful site
Oxygen and CP therapy
how it works - motoric functions
Brain and sensory
section diagrams and explanations
Clothing for easy
dressing and changing
Devices to assist in mobility
Physical Therapy, often called 'PT,' helps children learn
better ways to move and balance. It may include assistance in
learning to walk, use wheelchairs, stand alone, or go up and down
stairs. Physical therapy may include support in learning or increasing
ability in running, kicking and throwing a ball, or learning to
ride a bike.
Speech and Language Therapy helps children with gaining
or enhancing communication skills. That may mean talking, using
sign language, or using a communication aid. A communication aid
might be a book or poster with pictures that shows items the person
might want, or an alphabet board that the child can use to spell
out messages. Computers can be used as communication aids that
talk for the person Children who are able to talk may work with
a speech therapist on making their speech clearer (articulation)
or on building their language skills by learning new words, learning
to speak in sentences, or improving listening skills.
Occupational Therapy, often called 'OT' usually helps
children use their arms, hands, and upper body in better ways,
facilitating easier ways of writing, drawing, cutting with scissors,
self help and personal grooming tasks, or controlling a wheelchair.
They assist in finding the right special equipment to make some
everyday jobs easier. They may help adjust equipment so it is
tailored to the child, especially crucial during growth spurts.
Recreational Therapy helps children have fun and develop
hobbies and lifelong pastimes. It includes working with children
on sports skills and leisure activities. In recreational therapy
students may work on swimming, sports, bowling or horseback riding.
Mobility, access, safety.
These are basic needs - and viable ways we can support students.
. . . .
First things first.
I am me first, and my health and mobility are secondary.
I want to be appreciated and respected for myself and what I can do,
not what I cannot do..
I have needs, and my ability to express those needs is critical to being
happy or feeling unfulfilled.
If I am feeling unfulfilled, I may behave in ways that express how unfulfilled,
thwarted and unhappy I am.
If I go for a long time feeling thwarted, and cannot gain acceptance
and ways to honor who I am and what I can do, I may express my needs
in ways that oppress others, I may not be able to fully develop and
reach my potential, and I will not have the opportunity to share my
strengths and gifts with others.
These statements are statements
of human nature -- this is the way healthy people feel.
It is normal for human
beings to respond with strong emphasis when not getting needs met.
|Student uses a wheelchair to get around
Student - Acceptance, safety, mobility enhanced rather than curtailed
Teacher - to teach and have peace - Safety for all children
Class - Understanding, community building opportunities
|Student needs a communication board to
Fill in the chart, giving ideas for how the school community
can work together to enhance mobility for the first youngster, and to
encourage interchange in the second. [25 points]. For even more practice
in recognizing and facilitating educational opportunities for youth
while also building the school community, fill in the next three cell
rows, using the ideas you gain from experience, from materials in the
text and in your web searches. Identify a physical challenge that may
hamper learning and then go through the process of defining needs, then
finding a solution that allows everyone to get needs met [25 points
have been allotted for this activity].
1. Read a book written by a family member, telling about
their personal insights and challenges. Make a list of the ways a
teacher might support the parent experiences. Make a second list of
things parents might tell an educator about a child. [50 points].
2. Locate a parent who will allow you to visit the child
at the school or in the home and spend a minimum of 4 hours observing
the youngster. As part of the observation experience, identify at
least three student strengths. Look for the youngster's interests
and determine some of the ways contact points that could be used to
engage the student. [25 points per hour for observing; 50 points for
the adaptation summary].
3. Watch My Left Foot, the movie for 50 points
and send a review of the characterization of cerebral palsy for another
25 points. Another movie is Born on the Fourth of July. You
may watch and report on this movie, too.
4. Learn about assistive technology. Try to find an
opportunity to spend an hour in a technology lab. There are usually
a number of them in large communities and at universities. Many programs
that provide services will also have a technician who you can interview.
Write a short essay describing some of the high tech and low tech
devices available to assist students, summarizing by stating your
personal feelings about the techniques and their usefulness. [25 points]
5. Identify three commonly held fallacies about youngsters
with Cerebral Palsy and then provide three fact based beliefs about
people with CP. [15 points]
6. Review the wide range of diagnostic forms of Muscular
Dystrophy. Focus on the one that is most interesting to you and find
a family page on the web that talks about the child or youngster and
provides insights about the life and experiences for the family. [25
7. Remember to feel free to develop your own personal
response to the material. Allot yourself approximately 25 points per
hour for your work.
8. There are numerous very different kinds of physical
disabilities and clusters of symptoms that are included in the broad
diagnosis of orthopedic impairment. Choose one and find at least 10
articles or discussions about the characteristics and the orthopedic
condition. Feel free to use materials on the web, as well as printed
materials. Then write a paper of 500-100 words, discussing the challenges
these young people have and provide a set of methods or materials
that might address strengths and diminish barriers to education. [100
9. Interview a teacher who works with youngsters with
physical disabilities. If possible, spend time in the classroom observing.
[25 points for the interview, and 25 points/hour for observation.
10. Observe in a classroom with youngsters who are mulitiply
handicapped. Write a cameo of the student who seemed most valiant. [50
|Born on the Fourth of July
|The Bone Collector
||My Left Foot
|I sent a letter to my love
||An affair to remember
|What ever happend to Baby Jane?
|Other side of the mountain
||An affair to remember
|Cerebral Palsy - What every mother should know
You should now:
Go back to Characteristics
E-mail J'Anne Ellsworth at Janne.Ellsworth@nau.edu
Course developed by J'Anne
Copyright © 1999
Northern Arizona University
ALL RIGHTS RESERVED