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    Inclusion ofpupil with

    quadriplegia

    PORTUGAL

    2013Case Study elaborated by CRTIC Chaves

    Maria Adalgisa Babo

    Joaquim Virglio Perfeito Ribeiro

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    Introduction

    This case study was elaborated in the scope of the european project SENnet and it

    takes place in the SchoolsCluster GomesMonteiro, Boticas,inPortugal.

    Its purpose is to research the impactof inclusive technologyused by a pupil with

    permanent disability, in a mainstream school. The pupils condition affects her

    activity and participation, who is unable to carry out daily life routines. The

    assistive technology helps her to minimize certain limitations, allowing access to

    the curriculum.

    The pupils functioning profile is described as well as the physical environment

    that surrounds her, according to the International Classification of Functioning,

    Disability and Health from the World Health Organization, which was adopted by SEN

    legislation in Portugal, and its components of activity, participation and environment are

    relevant for children and youth attending school.

    The evaluation process for assigning assistive technology is reported, held at the

    ICT Resource Centre for Special Education (CRTICChaves).

    The analysis of this pupils case is contextualized in the regular classroom with the

    involvement of the staff and parents in order topromote herinclusion andautonomy.

    Who conducted the case study?

    The ICT Resource Center for Special Education (CRTIC-Chaves) is located in the

    region of Trs-os-Montes. This region has a unique landscape and rich cultural

    heritage.

    The main economic resources are based in agriculture, cattle ranching and

    commerce in urban centers.

    The Centre is situated in a geographical location with good accessibility. It is

    opened to the entire educational community that is supposed to cover and, among

    other duties, aims to respond appropriately to the specific needs of the pupils in a

    personalized way, with the support of qualified staff and special equipment and

    adapted materials. The target population consists of all pupils with permanent

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    limitations regarding activity and participation in one or more life areas, due to

    functional and structural body alterations, resulting in permanent difficulties in

    communicating and learning and limitations in mobility, autonomy, interpersonal

    and social participation, from Early Childhood through Secondary Education.

    The team that conducted the study consists of two teachers working at the CRTIC

    Chaves - Maria Adalgisa Ferreira da Silva Babo and Joaquim Virglio Perfeito

    Ribeiro, both specialized in the field of mental / motor disability, with a career of

    over 25 years in special education.

    The teachers have technical skills that allows them to handle and advise the use of

    assistive technology and assess pupils needs in different contexts.

    Institution where the case study was conducted

    Schools Cluster Gomes Monteiro Primary School of Boticas.

    Date (beginning and end of case study)

    From 12th January to 23rdMay

    Period of observation (beginning and end)

    From 1st April to 23rd May 2013

    Pupils age

    Cristiana is 8 years old

    Context

    The Primary School (Schools Cluster Gomes Monteiro) is situated in the village of Boticas.

    The municipality of Boticas is located in the North of Portugal, in the province of Trs-os-

    Montes, Vila Real district, Alto Tras-os-Montes. It is also part of the Municipalities

    Association of Alto Tamega (AMAT).

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    It extends as far as 322.41 km2 and has about 5,750 inhabitants (census 2011).

    This school serves the whole municipality and is installed in a recent building, 12 years in

    operation.

    The total number of students is about 420, distributed by school years, from grade 1 up to

    9 years of compulsory schoolingi.

    About 16% of the population of the municipality has not completed compulsory education,

    46% have primary schooling, 11% have the 2nd cycle of basic education and 10% have the

    3rd cycle. About 10% have secondary education, attended in the town of Chaves at a

    distance of 25 kilometers from the village of Boticas.

    OBJECTIVES (general and specific objectives)

    The main purpose is to assess the impact of using assistive technology for reading and

    writing by a pupil with tetraparesis, neuromuscular problems of unknown etiology.

    The objectives are:

    To observe the interaction of the student with assistive devices; To verify the best use of devices supporting the teaching / learning process;

    To check the need for more effective devices

    Bibliography and references

    ABC.MED.BR, 2013. Tetraplegia: o que ? Quais as causas e os sintomas? Como o

    tratamento? Disponvel em: .

    Ainscow, M. (1997). Educao para todos: torn-la uma realidade. In Caminhos para as

    escolas inclusivas, pp. 11-31. Lisboa: Instituto de Inovao Educacional.

    Barthorpe, T. (1989). Curriculum accesses for all. Ed. Mike Hinson-Longman

    Batshaw, Mark L.; PERRET, Yvonne M.; Criana com Deficincia Uma Orientao

    Mdica; 1 Edio, 1990, Livraria Santos Editora

    Bautista, Rafael, et al; Necessidades Educativas Especiais; 1 Edio, 1997, DINALIVRO.

    Crespo, Alexandra et al; Educao Especial - Manual de Apoio Prtica, 2008, Ministrio

    da educao DGIDC

    http://www.abc.med.br/p/348064/tetraplegia-o-que-e-quais-as-causas-e-os-sintomas-como-e-o-tratamento.htm%3ehttp://www.abc.med.br/p/348064/tetraplegia-o-que-e-quais-as-causas-e-os-sintomas-como-e-o-tratamento.htm%3ehttp://www.abc.med.br/p/348064/tetraplegia-o-que-e-quais-as-causas-e-os-sintomas-como-e-o-tratamento.htm%3ehttp://www.abc.med.br/p/348064/tetraplegia-o-que-e-quais-as-causas-e-os-sintomas-como-e-o-tratamento.htm%3e
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    Pereira, Filomena; Educao Inclusiva da Retrica Prtica Resultados do plano de Ao

    2005 -2009, 2009, DGIDC e DSEEASE

    Stainback, S.; Stainback, W.; Jackson, J.H. (1999). Hacia las aulas inclusivas. In Susan

    William (Coord.), Aulas Inclusivas. Madrid: Narcea Editores

    Decreto-Lei n 3/2008, de 7 de janeiro

    Classificao Internacional da Funcionalidade, Incapacidade e de Sade- CIF-CJ

    http://moodle.dgidc.min-edu.pt/

    http://www.dgidc.min-edu.pt/educacaoespecial/index.php?s=directorio&pid=58

    Methodology and tools

    The methodology followed the case study approach , a descriptive study focused on a

    pupil. It used different tools to analyze the case:

    - Document analysis

    - Comments

    - Meetings

    - Interviews with SEN teacher, class teacher, mother

    - Video recording in school

    Pupils Functioning Profile

    According to medical report, Cristiana has a neuromuscular disease of unknown etiology.

    She was subjected to tracheotomy since neonatal period, requiring mechanical ventilation.

    The mobility is severely affected, she moves in a wheelchair, with pad positioning and

    stabilization.

    She presents serious difficulty in the respiratory system, specifically the breathing

    function (b440.3)ii

    With regard to the neuromuscular skeletal functions, the child has the mobility impaired,

    presenting a severe dysfunction of mobility of the joints and bones (b710.3), control of

    voluntary movement (b760.3), involuntary movement functions (b765.3) and sensations

    related to muscles and movement (b 780.3) - also presents severe disability in functions

    related to muscle power (b730.3), muscle tone (b735.3), muscle endurance (b740.3),

    motor reflexes (b750.3) gait pattern dysfunction (b770.4).

    http://moodle.dgidc.min-edu.pt/http://www.dgidc.min-edu.pt/educacaoespecial/index.php?s=directorio&pid=58http://www.dgidc.min-edu.pt/educacaoespecial/index.php?s=directorio&pid=58http://moodle.dgidc.min-edu.pt/
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    She has serious difficulty in changing the basic positions of the body (d410.3) and

    maintaining body position (d415.3). She reveals difficulty in performing tasks such as

    lifting and carrying objects (d430.2), and difficulty in moving objects with lower limbs

    (d435.4) has severe difficulty in performing fine motor activities with the hands (d 440.3)

    and is not capable of using the foot (d446.4), floor (d450.4) and move (d455.3).

    This condition affects seriously her activity and participation, limiting it to general tasks

    and requirements. She presents a moderate deficit in carrying out multiple tasks (d220.2),

    to carry out the daily routine (d230.2), and a slight deficit in performing simple tasks

    (d210.1).

    Regarding self-care, the pupil has a hard time taking care of her body parts (d520.3) to

    wash or dry up (d510.3).

    She has difficulties to perform tasks and coordinate gestures to dress up (d540.3), eating

    (d550.2), drinking (d560.1) and cannot take care of her own safety (d571.3).

    The pupil requires continued support by an adult to perform the tasks, since all areas of

    her behavior are compromised. She performs learning activities using a computer, yet

    reveals tiredness in their realization, particularly in literacy and numeracy. She expresses

    difficulty in concentrating, paying and maintaining attention to problems, distracting

    herself for no apparent reason (d160.2).

    She reveals slight difficulty in solving simple problems (d175.1) due to impaired judgment

    and concentration. Unrelated data provided in order to find possible solutions to the

    resolution. She has difficulties in formulating and sorting ideas, concepts and images. Due

    to her muscle problem, she has great difficulties in manipulating objects for learning

    (d131.2). She is not able to write independently with the help of computer (d145.1).

    Reveals uncertainty in knowledge and always needs guidance from the teacher.

    Her mother shows great concern and attention in monitoring her school and social life.

    Schoolfellows also act as facilitators (e325.2). She is well accepted by peers, they includeher in games and are always available to help.

    Educational Measures

    Based on this assessment CRTIC Chaves has recommended the following educational

    measures in the framework of Decree-Law No. 3/2008 of 7 January, to be implemented:

    a)Article 17 - Personalized Pedagogical Support

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    Strategies reinforcement to develop together with the student in her group / class,in the organization of space and activities:

    o the same classroom for all subjects (except PE/Gym);o organization of the space of the classroom, adequate positioning of the

    pupil, close to the whiteboard;

    o use of adapted desk to prevent incorrect postures;o use of whiteboard in the classroom.

    Skills reinforcement to develop a SEN specific program shared with the family:o program to develop skills in the use of assistive technology, encouraging its

    use and daily application in different contexts.

    b) Article 18 - Individual Curricular Adaptations

    Exemption of activity proved difficult to implement due to pupils disabilityc) Article 20 - Adaptations in the assessment process

    Change of type of test:o delivery of assessment tools in digital format made available in the pupils

    computer

    Assessment tools:o oral participation, worksheets, summative tests, formative records, team

    work and other evaluation tools specific to different subjects.

    Assessment terms:o promotion of oral assessment;o Office software use to record and evaluate in digital format;o extending testing time and exams, 30 minutes extra and in a separate

    room.

    d) Article 22 - Assistive Technologies

    o Use of assistive technology in different contexts in daily life: personal computer laptop; kids keyboard; kidtrack; adapted desk.

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    Teaching Methodology

    The SEN teacher supports class teacher reinforcing writing and reading skills in the use of

    special software, namely Aventuras II as well as Office software (Word).

    Aventuras II allows every pupil to use its own workbook. Contents produced by the pupil

    are added as evidence of what the pupil learns. The pupil writes sentences, expressions or

    words, adds images, photos or drawings, illustrates words with drawings associating

    them, divides sentences. Pupils can record their own voice associating text and image.

    This software helps to improve language skills, since it includes portuguese texts for

    reading practice and many proverbs. It includes ready-made thematic workbooks, but the

    teacher also produces some thematic contents so that the pupils may explore and learn.

    The software has 5 educational games; (i) spider game which connects words to images;

    (ii) ant game which produces words with two syllables; (iii) bee game which produces

    words with 3 syllables; (iv) monkey game which stimulates to write names corresponding

    to images, with audio feature; (v) cat game to order elements of a sentence or phrase.

    Teachers promote the use of assistive technology recommended by CRTIC, stimulating its

    daily use in different contexts, either at school or at home.

    Tests are adapted to digital format suitable to Cristianas needs, so that equalopportunities with peers are guaranteed.

    The SEN teacher gives support 3 days a week in the classroom to Cristiana.

    Pedagogical situation

    The muscle tone does not allow Cristiana to hold objects effectively and therefore

    the use of the hand is seriously compromised, since it cannot hold a pencil, pen,

    spoon, etc.. This condition affects school attendance since all handling,

    conventional means of performing tasks is damaged (writing on paper, painting on

    paper, book reading, editing / paper, etc.).

    With regard to our assessment, held for the first time in 2010, we have tried

    various peripherals for accessibility, since the conventional mouse at home in

    family PC could not be manipulated by the child. She uses KidTrac, Joystick,

    Helpijoy in free computer games. Yet none of these peripherals have the desired

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    effect, as they require, apart from handling and coordination, some hand muscle

    strength. Weve experimented finally, IntelliKeys and this type of keyboard is the

    most appropriate for the pupil, as it is flat and the student may exert pressure on

    the keys using the entire surface of her hand. This device was used by the pupil to

    introduce her to the computer.

    Later on, in 2012, the characteristics of functionality of Cristiana led us to consider

    that her performance in reading and writing might improve, if she used the

    following devices, experimented during reassessment:

    "Kids Keyboard" (Lifetech product): considering its bright colours andlarger size keys (than the conventional ones), for better distinction of

    letters, numbers and symbols, which enables better learning, reading and

    writing and is easy to use. The keys are sturdy and responsive to the fingers

    of the child. It also has a USB connection and software plug-in);

    "KidTRAC" mouse: trackball with shape and dimension that allowsadequate hand support. Very easy to use, connects to computer through a

    USB port and starts running automatically).

    The pupil uses these products with "Office" software. However, we have advised the useof "Adventures II" software as well, also tested, since it can be used systematically and in

    an organized way, used as individual workbook, a virtual environment for easy self-

    correction.

    The next step for a future reevaluation will take place when the pupil will have acquired

    the reading and writing skills. Then, well test the use of virtual keyboards with auto scan

    and selection with a pressure switch.

    Collaborators in the study

    Pupil - Cristiana Borges Afonso

    Parent - Anabela Borges Afonso

    Class teacher - Rosria Moura Martins

    SEN teacher - Maria Jlia Natividade

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    Links (complementary to study)

    Video of Cristiana in the classroom environment

    https://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.

    m2p

    https://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.

    wmv

    https://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.

    mov

    http://youtu.be/Z4da8KMka60

    Powerpoint (PT version) -http://www.slideshare.net/slideshow/embed_code/24837683

    Powerpoint (EN version) -http://www.slideshare.net/idabrandao/case-study-se-

    nnetchaves2013en

    iAt present, compulsory schooling is 12 years in Portugal, from 5 years old (pre-school) to 18 years old,

    stated by law in 2009 (Lei n. 85/2009, de 27 de agosto)iiThe International Classification of Functioning (ICF Children and Youth) is adopted by SEN law in

    Portugal, since 2008 (D.L. n 3/2008, 7 de janeiro)

    https://www.dropbox.com/s/4usdp75iimaag0y/CRTIC%20Chaves_Cristiana_Portugal_2013.m2phttps://www.dropbox.com/s/4usdp75iimaag0y/CRTIC%20Chaves_Cristiana_Portugal_2013.m2phttps://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.wmvhttps://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.wmvhttps://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.movhttps://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.movhttps://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.movhttp://youtu.be/Z4da8KMka60http://youtu.be/Z4da8KMka60http://www.slideshare.net/slideshow/embed_code/24837683http://www.slideshare.net/slideshow/embed_code/24837683http://www.slideshare.net/slideshow/embed_code/24837683http://www.slideshare.net/idabrandao/case-study-se-nnetchaves2013enhttp://www.slideshare.net/idabrandao/case-study-se-nnetchaves2013enhttp://www.slideshare.net/idabrandao/case-study-se-nnetchaves2013enhttp://www.slideshare.net/idabrandao/case-study-se-nnetchaves2013enhttp://www.slideshare.net/idabrandao/case-study-se-nnetchaves2013enhttp://www.slideshare.net/idabrandao/case-study-se-nnetchaves2013enhttp://www.slideshare.net/slideshow/embed_code/24837683http://youtu.be/Z4da8KMka60https://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.movhttps://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.movhttps://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.wmvhttps://dl.dropboxusercontent.com/u/28022157/CRTIC%20Chaves_Cristiana_Portugal_2013.wmvhttps://www.dropbox.com/s/4usdp75iimaag0y/CRTIC%20Chaves_Cristiana_Portugal_2013.m2phttps://www.dropbox.com/s/4usdp75iimaag0y/CRTIC%20Chaves_Cristiana_Portugal_2013.m2p