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ESE504 : The Class : Advanced CD : Physical disability

Physical Disabilities


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.

Critical considerations: signs or characteristics of physical and health impairments (Smith,1998)
limited vitality and energy poor motor coordination frequent falls
need for physical accommodations poor attendance inarticulate speech
  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.

Personal notes



Cerebral Palsy

Spina Bifida

Muscular Dystrophy

Overview and multiple links at

Assistive devices for those with low vision


Attention Deficit Disorder

This is covered in a separate section

Click here to view the file

Cerebral Palsy

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 coordination.

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 mixed CP.

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.

Cerebral Palsy
Personal notes

Personal page about Cerebral Palsy

Cerebral Palsy

Medical Information - UCLA

CP Network - chat and support group


Spina Bifida


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.

Spina Bifida
Personal notes

John's personal page and chat links

Pediatric Neurosurgery, including parent information about screening

Spina Bifida Association of America

Links, including personal pages

Australian Spina Bifida Association

Muscular Dystrophy US


Muscular Dystrophy


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 (BMD).

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

Nine major types defined and described

Muscular Dystrophy - Australian site gives great definitions for numerous classifications

Neuromuscular Diseases

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 Deaminase Deficiency

Educational Implications

Teacher's guide to MD

Educational ideas from parents

Assistive Technology

Information on Assistive Technology

Low Tech Devices





High Tech Devices



Web Sites

Equipment to help with mobility and communicating

Links to devices and assists

Communication devise links

Augmentive speech devises

Adaptive Technology Index

Educational site

Assistive technology - Monash University

Personal Notes







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

Education and Intervention

The Visible Human

Human Body system - a wonderful, colorful site

Hyperbaric Oxygen and CP therapy

Brain and how it works - motoric functions

Brain and sensory functions

Brain cross section diagrams and explanations

Clothing for easy dressing and changing

Independent Living helps

Whole brain site

Health links

Counseling about disabilities

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.

Basic Needs

Mobility, access, safety. These are basic needs - and viable ways we can support students.

SO . . . .

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 action


Creative solution
Student uses a wheelchair to get around the school

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 share ideas

Student -

Teacher -

Class -


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].

Activity List

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 points].

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 points each]

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 points].

Movie List

Born on the Fourth of July Chariot races Mask Notting Hill
The Bone Collector My Left Foot Right Moves Above suspicion
I sent a letter to my love An affair to remember Piccoli Orrori Coming home
What ever happend to Baby Jane? Clockwork Orange The Men Man hunt
Other side of the mountain An affair to remember Valerie 23 Silver bullet
Cerebral Palsy - What every mother should know Good luck! Gattaca Wiseguy

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E-mail J'Anne Ellsworth at

Course developed by J'Anne Ellsworth


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