12-1 Turnbull et al. Exceptional Lives, 7e © 2013 Pearson Education, Inc. All rights reserved....

12-1Turnbull et al.Exceptional Lives, 7e © 2013 Pearson Education, Inc. All rights reserved.

Chapter 12Chapter 12Understanding Students with Physical Disabilities and Other

Health Impairments


Defining Physical Defining Physical DisabilitiesDisabilities

• IDEA uses the term orthopedic impairments, but educators typically use the term physical disabilities.

• Typically refers to a large group of students who experience conditions that are very different from each other but usually include mobility issues

• The term may also be used to include students with:

• Severe and multiple disabilities

• Traumatic brain injury

• Focus on two types of physical disabilities:

• Cerebral palsy

• Spina bifida


Characteristics of Characteristics of Cerebral PalsyCerebral Palsy

• A disorder of muscle control due to damage in the brain• Multiple types

• Spastic• Dyskinetic• Athetoid• Ataxic• Mixed

• Topographical Classification System• Monoplegia• Paraplegia• Hemiplegia• Triplegia• Quadriplegia• Diplegia• Double hemiplegia


Characteristics of Characteristics of Cerebral PalsyCerebral Palsy

• Causes• Prenatal

• Perinatal

• Postnatal

• Other associated conditions• Possible intellectual disability

• Speech/language problems

• Vision impairments

• Seizures


Characteristics of Spina Characteristics of Spina BifidaBifida

• Malformation of the spinal cord prior to birth• Three common forms

• Spina bifida occulta• Meningocele• Myelomeningocele

• Causes• Occurs in early pregnancy due to environmental and genetic factors

o Maternal exposure to certain acne medicationso Excessive use of saunas (hyperthermia)o Prenatal diabetes

• Mothers using regular supplements containing folic acid reduce their risk


Characteristics of Spina Characteristics of Spina BifidaBifida

• Other associated conditions:

• Approximately 75% of persons with Spina Bifida have average intelligence, however, may struggle

with attention, memory, and executive functioning

• Depending on location of defect, may cause o incontinence or other urinary and bowel problems

• Children and youth may also experience challenges in social development


Defining Other Health Defining Other Health ImpairmentsImpairments

• IDEA defines as chronic health problems those that have an adverse impact on educational performance.

• Distinguished from severe and multiple disabilities, physical disabilities, and traumatic brain injuries

• May be:

• Chronic: develops slowly and has long-lasting symptoms

• Acute: develops quickly with intense symptoms that last a relatively short period of time


Prevalence of Other Prevalence of Other Health ImpairmentsHealth Impairments

• In 2008, 11% of students receiving services under IDEA (ages 6-21), were classified as OHI

• This includes AD/HD

• Of all students, 10–30% will experience a childhood chronic illness lasting three months or longer

• More than 200 specific health impairments exist


Characteristics of Characteristics of EpilepsyEpilepsy

• Characterized by seizures (abnormal electrical discharges in the brain)

• Generalized seizures

o Tonic-clonic

o Absence

• Partial seizures

o Simple partial

o Complex partial


Characteristics of Characteristics of EpilepsyEpilepsy

• Conditions associated with epilepsy

• Approximately 75% of individuals with epilepsy have normal intelligence

• They are at risk for being diagnosed with learning disabilities

• Research also indicates a higher prevalence of emotional disorders

• Causes

• Approximately 40% of individuals with epilepsy have a genetic contribution

• Environmental factors include: Prenatal brain infections, birth trauma, poisoning, stress, fatigue, and sleep deprivation

• In three-fourths of individuals with epilepsy, the cause is unknown


Characteristics of Characteristics of AsthmaAsthma

• Lung condition characterized by airway obstruction, inflammation, and hyperirritability of the bronchial tubes

• Most prevalent chronic illness of children

• Symptoms can vary widely• Mild intermittent

• Mild persistent

• Moderate persistent

• Severe persistent


Characteristics of Characteristics of AsthmaAsthma

• Conditions associated with asthma• Fatigue from waking during the night because of

breathing difficulties• Absences from school due to symptoms• Fatigue and school absenteeism are associated with

lower academic performance

• Causes• Asthma symptoms are triggered by food, exercise, cold

air, respiratory infections, and environmental allergens, including cigarette smoke, dust, mold, gases, and chemicals

• Sometimes asthma is an inherited condition


Partnering for Special Partnering for Special Education and Related Education and Related

ServicesServices• Health condition must adversely impact educational

performance for an IEP

• Otherwise, develop a 504 plan

• Components of the health care plan (Box 12.3)


Determining Determining Supplementary Aids Supplementary Aids

and Servicesand Services•Adaptive Switches

•Pressure

•Timed

•Pneumatic or puffing switches

•Movements

•Sound

•Electronic Wheelchairs

•Transporting the chair

•Adjusting the size

•Maintenance• Recharging the batteries

•Selecting the navigation tools

•Assuring safety• Brake system


Planning for Other Planning for Other Educational NeedsEducational Needs

• Adaptive PE

• Allows for student with disabilities to participate in a typical sport or physical activity

• Modified equipment

• Beeping ball for student with visual impairment


Effective Instructional Strategies:Effective Instructional Strategies:

Early Childhood StudentsEarly Childhood Students• Token economies

• Not age- or disability-specific

• Relates to errorless learning and using prompts for modifying the “three-term contingency” sequence (discriminative stimulus, response, and reinforcing stimulus)

o Another way to modify the three-term contingency is by changing aspects of the reinforcing stimulus (e.g., altering the schedule on which a reinforcer is delivered)

• Token economies use reinforcers



Elementary and Middle School StudentsElementary and Middle School Students• Self-awareness

• Middle school is difficult for most children, and a disability or illness only adds to the stress

• The term self-awareness refers to one’s understanding of oneself as a unique individual and is often used in conjunction with the notions of self-understanding and self-knowledge

o This includes the process referred to as disability awareness, which involves the capacity of an individual to appraise his or her own abilities as a function of a specific disabling condition



Secondary and Transition StudentsSecondary and Transition Students

• Driver’s Ed• A driver’s license is the key to freedom and independence

• Having a driver’s license impacts a student’s social activity

• Schools need modified vehicles for students with disabilities


Including Students with Physical Including Students with Physical

Disabilities and Other Health ImpairmentsDisabilities and Other Health Impairments

• Physical Disabilities (Figure 12.6)• 7% in a separate setting• 25% in a regular class 0-39% of their time• 17% in a regular class 40-79% of their time• 52% in a regular class 80-100% of their time

• Other Health Impairments (Figure 12.7)• 4% in a separate setting• 11% in a regular class 0-39% of their time• 24% in a regular class 40-79% of their time• 60% in a regular class 80-100% of their time

• NOTE: Percentages have been rounded and collapsed into categories


Making Making Accommodations for Accommodations for

AssessmentAssessment• Computer-Based Assessment

• Frequent Breaks

• Scribe

• Physical access to testing environment

• Security concerns, test materials, and environmental controls

12-1 Turnbull et al. Exceptional Lives, 7e © 2013 Pearson Education, Inc. All rights reserved....

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