Orthopedic Impairments, Health Impairments, & ADHD: Putting the Puzzle Pieces Together

1. Orthopedic Impairments,Health Impairments, & ADHD:Putting the Puzzle Pieces Together SPE 500 Presented by April Coleman

2. Agenda • 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

3. How is special education like a puzzle?

4. Pieces of the Special Education Puzzle Collaboration Identification Assessment Instruction

5. 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?

6. Orthopedic Impairments, Other Health Impairments, & ADHD Overview & Definitions

7. Orthopedic 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

8. Other 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).

9. OI & 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

10. 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.

11. Prevalence • 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)

12. 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?

13. Types, Causes, & Accommodations Common Physical & Other Health Impairments

14. Cerebral 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.

15. Cerebral 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

16. Cerebral Palsy • 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

17. CP 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

18. CP Accommodations • Communication devices • Stabilization tools • Grasping aids • Creation of boundaries • Modification of toys and equipment • MOVE Curriculum – Activity-based program (p. 411)

19. Spina Bifida • 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

20. Spina 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

21. Muscular Dystophy • 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.

22. MD Accommodations • 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.

23. Epilepsy • 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.

24. Epilepsy • 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

25. Epilepsy Accommodations • 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.

26. Other 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.

27. ADD & 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

28. Remember…Kids with disabilities are kids first.

29. Research-Based Educational Approaches Instructional strategies

30. Inside 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.

31. Guiding 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.

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

33. 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

34. Assistive 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

35. Healthcare 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

36. Behavioral 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).

37. Self-Monitoring Steps • Specify target behavior and performance goals. • Select materials that simplify the process. • Provide supplementary cues to self-monitor. • Provide explicit instruction. • Reinforce accurate self-monitoring. • Reward improvements in the target behavior. • Encourage self-evaluation. • Evaluate the program. (pp. 428-429)

38. 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

39. Placement 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.

40. 3…2…1… On your note card, please list: • 3 key ideas • 2 things I enjoyed or benefitted from • 1 question or request