orthopedic impairments, health impairments, & adhd: putting the puzzle pieces together

Orthopedic Impairments,Health Impairments, & ADHD:

Putting the Puzzle Pieces Together

Orthopedic Impairments,Health Impairments, & ADHD:

Putting the Puzzle Pieces Together

SPE 500Presented by April Coleman

SPE 500Presented by April Coleman

AgendaAgenda

• Introductions• Opening Activity• Overview & Definitions• Physical & Other Health Impairments

• Types, Causes, & Accommodations• Instructional Strategies

• Inside a Real Classroom• Break• Activity – Wiki/Webquest (Computer Lab)• Debriefing

• Introductions• Opening Activity• Overview & Definitions• Physical & Other Health Impairments

• Types, Causes, & Accommodations• Instructional Strategies

• Inside a Real Classroom• Break• Activity – Wiki/Webquest (Computer Lab)• Debriefing

How is special education like a

puzzle?

How is special education like a

puzzle?

Pieces of the Special Education Puzzle Pieces of the Special Education Puzzle

Identification

Collaboration

Assessment Instruction

Think about it…Think about it…

• What is your main goal as a professional in the field of special education?

• How does this goal relate specifically to students with orthopedic and other health impairments?

• What is your main goal as a professional in the field of special education?

• How does this goal relate specifically to students with orthopedic and other health impairments?

OVERVIEW & DEFINITIONSOVERVIEW & DEFINITIONSOrthopedic Impairments, Other Health Impairments, & ADHDOrthopedic Impairments, Other Health Impairments, & ADHD

Orthopedic ImpairmentsOrthopedic Impairments

• A severe orthopedic impairment adversely affects a child’s educational performance, including impairments• Caused by a congenital abnormality (i.e. clubfoot,

absence of limb),• Caused by disease (i.e. polio, bone tuberculosis),• From other causes (i.e. cerebral palsy, amputation,

fracture, burn, etc.) (IDEA, 2004).

• 2 Types: Orthopedic, Neuromotor

• A severe orthopedic impairment adversely affects a child’s educational performance, including impairments• Caused by a congenital abnormality (i.e. clubfoot,

absence of limb),• Caused by disease (i.e. polio, bone tuberculosis),• From other causes (i.e. cerebral palsy, amputation,

fracture, burn, etc.) (IDEA, 2004).

• 2 Types: Orthopedic, Neuromotor

Other Health ImpairmentsOther Health Impairments

• Having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that

• Is due to chronic or acute health problems such as asthma, ADD/ADHD, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and

• Adversely affects academic performance (IDEA, 2004).

• Having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that

• Is due to chronic or acute health problems such as asthma, ADD/ADHD, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and

• Adversely affects academic performance (IDEA, 2004).

OI & OHI: The Big PictureOI & OHI: The Big Picture

• Common criteria in both definitions: • that adversely affects a child’s educational

performance

• Conditions may be congenital or acquired.

• Not all students with physical or health conditions need/receive special education.• Chronic vs. acute conditions

• Common criteria in both definitions: • that adversely affects a child’s educational

performance

• Conditions may be congenital or acquired.

• Not all students with physical or health conditions need/receive special education.• Chronic vs. acute conditions

Why is ADD/ADHD included?Why is ADD/ADHD included?

Children with attention-deficit/hyperactivity disorder are served under the OHI category of IDEA with the reasoning that their condition results in a heightened alertness that adversely affects their educational performance.

Children with attention-deficit/hyperactivity disorder are served under the OHI category of IDEA with the reasoning that their condition results in a heightened alertness that adversely affects their educational performance.

PrevalencePrevalence

• Chronic medical conditions affect up to 20% (about 12 million) school-age children in the U.S. (Sexson & Dingle, 2001).

• In 2005-06, of children between 6-21:• 62,618 received services under OI category.• 557,121 received services under OHI category.

(U.S. Department of Education, 2007)

• Chronic medical conditions affect up to 20% (about 12 million) school-age children in the U.S. (Sexson & Dingle, 2001).

• In 2005-06, of children between 6-21:• 62,618 received services under OI category.• 557,121 received services under OHI category.

(U.S. Department of Education, 2007)

Initial Reactions…Initial Reactions…

• What words and feelings immediately come to mind…• When seeing a child in a wheelchair?• When seeing a non-verbal child communicate

in other ways?• When seeing a school-age child exhibit

impulsive behavior?

• As a special educator, how should you view these children?

• What words and feelings immediately come to mind…• When seeing a child in a wheelchair?• When seeing a non-verbal child communicate

in other ways?• When seeing a school-age child exhibit

impulsive behavior?

• As a special educator, how should you view these children?

COMMON PHYSICAL & OTHER HEALTH IMPAIRMENTSCOMMON PHYSICAL & OTHER HEALTH IMPAIRMENTSTypes, Causes, & AccommodationsTypes, Causes, & Accommodations

Cerebral PalsyCerebral Palsy

• Most prevalent physical disability in school-age children.

• Permanent condition , not progressive• Results from a brain lesion or abnormal brain

growth (before, during, or after birth).• Varies in type and degree of impairment• 23% - 44% also have cognitive impairments.• Some also have vision and/or hearing

impairments.

• Most prevalent physical disability in school-age children.

• Permanent condition , not progressive• Results from a brain lesion or abnormal brain

growth (before, during, or after birth).• Varies in type and degree of impairment• 23% - 44% also have cognitive impairments.• Some also have vision and/or hearing

impairments.

Cerebral PalsyCerebral Palsy

• A disorder of involuntary movement and posture

• May affect one or multiple limbs• Symptoms:

• Disturbances of voluntary motor function • May include paralysis, weakness, lack of

coordination, involuntary convulsions• Little or no control over arms, legs, or speech• Effects muscle tone

• A disorder of involuntary movement and posture

• May affect one or multiple limbs• Symptoms:

• Disturbances of voluntary motor function • May include paralysis, weakness, lack of

coordination, involuntary convulsions• Little or no control over arms, legs, or speech• Effects muscle tone

• Effects on muscle tone and quality:• Hypertonia – tense, contracted muscles;

results in jerky movements• Hypotonia – weak, floppy muscles; may need

external supports• Athetosis – causes large, irregular, twisting

movements, including drooling• Ataxia – causes poor sense of balance and

hand use

• Effects on muscle tone and quality:• Hypertonia – tense, contracted muscles;

results in jerky movements• Hypotonia – weak, floppy muscles; may need

external supports• Athetosis – causes large, irregular, twisting

movements, including drooling• Ataxia – causes poor sense of balance and

hand use

Cerebral PalsyCerebral Palsy

CP AccommodationsCP Accommodations

• Collaboration of physicians, teachers, physical/occupational therapists, and communication specialists.

• Muscle stretching and strengthening exercises

• Careful positioning• Use of assistive devices in walking• Use of a wheelchair

• Collaboration of physicians, teachers, physical/occupational therapists, and communication specialists.

• Muscle stretching and strengthening exercises

• Careful positioning• Use of assistive devices in walking• Use of a wheelchair

• Communication devices• Stabilization tools• Grasping aids• Creation of boundaries• Modification of toys and equipment• MOVE Curriculum – Activity-based program

(p. 411)

• Communication devices• Stabilization tools• Grasping aids• Creation of boundaries• Modification of toys and equipment• MOVE Curriculum – Activity-based program

(p. 411)

CP AccommodationsCP Accommodations

• Most common neural tube defect, in which the vertebrae do not enclose the spinal cord, causing a portion of the spinal cord and nerves controlling lower body muscles to fail to develop normally.

• Myelomeningocele – most common and serious form• High risk of paralysis and infection• 80-90% also develop hydrocephalus, accumulation

of spinal fluid in tissues surrounding the brain

• Most common neural tube defect, in which the vertebrae do not enclose the spinal cord, causing a portion of the spinal cord and nerves controlling lower body muscles to fail to develop normally.

• Myelomeningocele – most common and serious form• High risk of paralysis and infection• 80-90% also develop hydrocephalus, accumulation

of spinal fluid in tissues surrounding the brain

Spina BifidaSpina Bifida

• Typical symptoms:• Some degree of paralysis in lower limbs• Lack full bladder control• Good upper-body usage

• Accommodations• Use of wheelchair, braces, crutches, or walkers• Catheterization• Assistance in dressing and toileting

• Typical symptoms:• Some degree of paralysis in lower limbs• Lack full bladder control• Good upper-body usage

• Accommodations• Use of wheelchair, braces, crutches, or walkers• Catheterization• Assistance in dressing and toileting

Spina BifidaSpina Bifida

• Refers to a group of about 40 inherited diseases marked by progressive atrophy of the body’s muscles.

• Duchenne MD – most common and severe type.

• Progressive reduction of muscle tone causes difficulty in walking and other movements.

• Refers to a group of about 40 inherited diseases marked by progressive atrophy of the body’s muscles.

• Duchenne MD – most common and severe type.

• Progressive reduction of muscle tone causes difficulty in walking and other movements.

Muscular DystophyMuscular Dystophy

• Goals of treatment:• Maintaining function of unaffected muscles for as

long as possible.• Facilitating movement.• Providing emotional support to child and family.

• No known cure currently exists.• Encourage children to be as active as possible.• Avoid lifting or pulling children by their limbs.

• Goals of treatment:• Maintaining function of unaffected muscles for as

long as possible.• Facilitating movement.• Providing emotional support to child and family.

• No known cure currently exists.• Encourage children to be as active as possible.• Avoid lifting or pulling children by their limbs.

MD AccommodationsMD Accommodations

• Condition resulting in chronic repetition of seizures.

• A disorder, not a disease

• 30% of cases caused by other conditions (i.e. cerebral palsy, brain infection, high fever).

• Psychological, physical, or sensory factors may trigger seizures (i.e. fatigue, anger, hormonal changes, light); may experience aura beforehand.

• Condition resulting in chronic repetition of seizures.

• A disorder, not a disease

• 30% of cases caused by other conditions (i.e. cerebral palsy, brain infection, high fever).

• Psychological, physical, or sensory factors may trigger seizures (i.e. fatigue, anger, hormonal changes, light); may experience aura beforehand.

EpilepsyEpilepsy

• Types of seizures:• Generalized tonic-clonic seizure (grand mal) –

most serious type; loss of consciousness, muscles become stiff and body shakes violently, usually diminishing in 2-3 minutes

• Absence seizure (petit mal) – far less severe but may occur more frequently; brief loss of consciousness occurs for a few seconds, causing person to stare blankly

• Types of seizures:• Generalized tonic-clonic seizure (grand mal) –

most serious type; loss of consciousness, muscles become stiff and body shakes violently, usually diminishing in 2-3 minutes

• Absence seizure (petit mal) – far less severe but may occur more frequently; brief loss of consciousness occurs for a few seconds, causing person to stare blankly

EpilepsyEpilepsy

• Use of medication

• During a seizure:• Keep everyone around calm.• Ease child gently to floor.• Put something soft under his head.• Turn him gently to his side.• Do not attempt to restrain movements or do

anything to his mouth.• Allow the child to rest until full consciousness

returns.

• Use of medication

• During a seizure:• Keep everyone around calm.• Ease child gently to floor.• Put something soft under his head.• Turn him gently to his side.• Do not attempt to restrain movements or do

anything to his mouth.• Allow the child to rest until full consciousness

returns.

Epilepsy AccommodationsEpilepsy Accommodations

Other Health ImpairmentsOther Health Impairments

• Spinal Cord Injuries • Diabetes• Asthma• Cystic Fibrosis• HIV/AIDS

• May require special education and other related services, such as health care services or counseling.

• Spinal Cord Injuries • Diabetes• Asthma• Cystic Fibrosis• HIV/AIDS

• May require special education and other related services, such as health care services or counseling.

ADD & ADHDADD & ADHD

• To be diagnosed with attention-deficit/hyperactivity disorder, a child must display 6 or more symptoms listed in the DSM-IV of inattention or hyperactivity-impulsivity for a period of at least 6 months.• List on p. 421

• Many children with ADHD who meet eligibility requirements are served under other disability categories (LD, emotional disturbance).

• Prevalence: 3-5% of all school-age children

• To be diagnosed with attention-deficit/hyperactivity disorder, a child must display 6 or more symptoms listed in the DSM-IV of inattention or hyperactivity-impulsivity for a period of at least 6 months.• List on p. 421

• Many children with ADHD who meet eligibility requirements are served under other disability categories (LD, emotional disturbance).

• Prevalence: 3-5% of all school-age children

Remember…Kids with disabilities

are kids first.

Remember…Kids with disabilities

are kids first.

INSTRUCTIONAL STRATEGIESINSTRUCTIONAL STRATEGIESResearch-Based Educational Approaches Research-Based Educational Approaches

Inside a Real ClassroomInside a Real Classroom

• Meet Hope Bailey, special educator and parent of a child with spina bifida.

• Hope teaches a Multiple Disabilities Class at Sprayberry Education Center, in Tuscaloosa County School System.

• Meet Hope Bailey, special educator and parent of a child with spina bifida.

• Hope teaches a Multiple Disabilities Class at Sprayberry Education Center, in Tuscaloosa County School System.

Guiding PrinciplesGuiding Principles

• Use ongoing assessment to guide instruction.

• Individualize instruction to the greatest extent possible (IEP).

• Promote student independence.

• Collaborate with a team of experts to develop and implement a comprehensive educational, physical, and medical plan.

• Use ongoing assessment to guide instruction.

• Individualize instruction to the greatest extent possible (IEP).

• Promote student independence.

• Collaborate with a team of experts to develop and implement a comprehensive educational, physical, and medical plan.

CollaborationCollaboration

• Special educators• Para-professional aides• Physical therapists• Occupational therapists• Speech-language pathologists• Adapted physical educators• Recreation therapists• School nurses• Counselors & Psychologists

• Special educators• Para-professional aides• Physical therapists• Occupational therapists• Speech-language pathologists• Adapted physical educators• Recreation therapists• School nurses• Counselors & Psychologists

Environmental Modifications

Environmental Modifications

• Include adaptations to provide increased access to a task or activity, changing the way in which instruction is delivered, and changing the manner in which the task is done.

• Examples:• Location of items in classroom• Soft-tip pens for writing• Modifying response requirements

• Include adaptations to provide increased access to a task or activity, changing the way in which instruction is delivered, and changing the manner in which the task is done.

• Examples:• Location of items in classroom• Soft-tip pens for writing• Modifying response requirements

Assistive TechnologyAssistive Technology

• Any piece of equipment used to increase, maintain, or improve a child’s functional capabilities.• IDEA defines as both devices and services needed to

help a child obtain and use devices.

• Include both low-tech and high-tech devices

• Examples:• Power wheelchairs• Communicative aides• Online list of tools

• Any piece of equipment used to increase, maintain, or improve a child’s functional capabilities.• IDEA defines as both devices and services needed to

help a child obtain and use devices.

• Include both low-tech and high-tech devices

• Examples:• Power wheelchairs• Communicative aides• Online list of tools

Healthcare StrategiesHealthcare Strategies

• Individualized Health Care Plan (IHCP)• Describes health-related needs and procedures• Included as part of a student’s IEP• Chart on p. 440 – Example of IHCP objectives

• Establish routines and procedures to ensure proper positioning, seating, lifting, and moving.• Benefits & Guidelines on pp. 437 & 441• Sample Routine – p. 442

• Individualized Health Care Plan (IHCP)• Describes health-related needs and procedures• Included as part of a student’s IEP• Chart on p. 440 – Example of IHCP objectives

• Establish routines and procedures to ensure proper positioning, seating, lifting, and moving.• Benefits & Guidelines on pp. 437 & 441• Sample Routine – p. 442

Behavioral InterventionsBehavioral Interventions

• Positive reinforcement for on-task behavior

• Modification of instructional activities

• Systematically teaching self-control• Research indicates success in students with ADHD

when self-monitoring is directly linked with clear instructions and consistent reinforcement (Biscard & Neef, 2002).

• Positive reinforcement for on-task behavior

• Modification of instructional activities

• Systematically teaching self-control• Research indicates success in students with ADHD

when self-monitoring is directly linked with clear instructions and consistent reinforcement (Biscard & Neef, 2002).

Self-Monitoring StepsSelf-Monitoring Steps

1. Specify target behavior and performance goals.

2. Select materials that simplify the process.3. Provide supplementary cues to self-monitor.4. Provide explicit instruction.5. Reinforce accurate self-monitoring.6. Reward improvements in the target behavior.7. Encourage self-evaluation.8. Evaluate the program. (pp. 428-429)

1. Specify target behavior and performance goals.

2. Select materials that simplify the process.3. Provide supplementary cues to self-monitor.4. Provide explicit instruction.5. Reinforce accurate self-monitoring.6. Reward improvements in the target behavior.7. Encourage self-evaluation.8. Evaluate the program. (pp. 428-429)

Fostering Independence & Self-Esteem

Fostering Independence & Self-Esteem

• How parents, teachers, classmates, and others react to a child with a disability is as important as the disability itself.

• Strategies:• Encouragement of a positive, realistic self-view• Opportunities to experience success and failure• Reasonable expectations for performance and behavior• Embracing unique interests and abilities• Fostering independence – box on pp. 445-446

• How parents, teachers, classmates, and others react to a child with a disability is as important as the disability itself.

• Strategies:• Encouragement of a positive, realistic self-view• Opportunities to experience success and failure• Reasonable expectations for performance and behavior• Embracing unique interests and abilities• Fostering independence – box on pp. 445-446

Placement AlternativesPlacement Alternatives

• About 50% of students with physical impairments and chronic health conditions are served in general education classrooms.

• The amount of support and accommodations varies greatly according to condition, needs, and level of functioning.

• Placement decisions should be made on a case-by-case basis, with the student’s needs and best interest in mind.

• About 50% of students with physical impairments and chronic health conditions are served in general education classrooms.

• The amount of support and accommodations varies greatly according to condition, needs, and level of functioning.

• Placement decisions should be made on a case-by-case basis, with the student’s needs and best interest in mind.

3…2…1…3…2…1…

On your note card, please list:

• 3 key ideas

• 2 things I enjoyed or benefitted from

• 1 question or request

On your note card, please list:

• 3 key ideas

• 2 things I enjoyed or benefitted from

• 1 question or request