Physical Disability , Types and Causes

"Why does that person sit in a chair?" "Why is that person putting his cane forward all the time?" "Why does that person only have one hand (or foot)? When your child starts asking this kind of questions, they're usually ready to hear the answer. Hopefully this article will help you provide these answers.

Also Known As: Orthopedic impairments are sometimes called physical disabilities or other health impairments.

A physical impairment is defined as a dysfunction of the musculoskeletal and/or neurological body systems, which affects the functional ability of a student to move or coordinate movement.

People with physical disabilities, also known as disabled people or physically disabled people, have a physical impairment which has a substantial and long term effect on their ability to carry our day-to-day activities. Someone with a moderate physical disability would have mobility problems, e.g. unable to manage stairs, and need aids or assistance to walk. Someone with a severe physical disability would be unable to walk and dependent on a carer for mobility.

Depending on their individual needs, disabled people may require an accessible home, with or without aids and adaptations. Occupational therapists will assess an individual person's needs for these, and refer the person on to the appropriate agency to have adaptations carried out. Care & Repair Services help disabled owner occupiers and private tenants to have adaptations carried out.

Some disabled people require extra support to live in the community. This may be a visiting service that provides regular assistance with daily living tasks, and can be a combined housing support and care service. Some organisations provide specialist accessible housing without support, and there also is supported housing - mainly self contained accessible accommodation with visiting support.

Q. What is a physical disability?

A. A physical disability is any physiological disorder or condition, anatomical loss or cosmetic disfigurement affecting one or more of the following body systems: neurological, musculoskeletal, respiratory (including speech organs), special sense organs, cardiovascular, reproductive, digestive, genito-urinary, hemic and lymphatic, skin and endocrine. Physical disability can arise from early disorders of the nervous, skeletal and muscular systems, such as cerebral palsy and spina bifida. Others, who become physically disabled later in life, may have experienced brain or spinal injury usually as a result of an accident or warfare.

Q. What are the characteristics of a physical disability?

A. Disability, like humanity, is expressed uniquely in every human being. People with physical disabilities are unable to move normally or to exercise proper control over movement. These people can find gross and/or fine movements difficult. Some may have unwanted or uncontrolled movements and others may experience a decreased range and strength of movement. There is a wide range of conditions that may limit mobility and/or hand functions. For some children, a physical disability may be unnoticeable, for others the effects may be profound, causing involuntary movements, paralysis, problems with speech and balance and/or learning difficulties. Physical access can be a major concern for individuals who are physically disabled. Those who use wheelchairs, braces, crutches, rolators, canes, prostheses or those who fatigue easily may have difficulty moving around.

Q. What can be done to help someone with a physical disability?

A. Management of all forms of physical disability should involve a team approach consisting of the child's parents, paediatrician, educational psychologist, physiotherapist, occupational therapist, speech and language therapist, teacher and sometimes dietician/nutritionist. It is important for parents to keep informed of each step of the team's evaluation and to be involved in the ongoing development of their child's Individual Education Plan. As a physical disability can affect the child and family in so many ways, help may be needed in many areas including educational, medical, emotional, physical and practical.

What is life-long physical disability?

Physical disability pertains to total or partial loss of a person’s bodily functions (eg walking, gross motor skills, bladder control etc) and total or partial loss of a part of the body (eg a person with an amputation).

What are some examples of life-long physical disabilities?

Examples of physical disability include

• amputation;
• arthritis;
• cerebral palsy;
• upper limbs;
• multiple-sclerosis;
• muscular dystrophy;
• acquired spinal injury (paraplegia or quadriplegia);
• post-polio syndrome;
• spina bifida.

There are many different kinds of disability and a wide variety of situations which people experience.

Does this mean you have the disability from birth or childhood?

• The disability may exist from birth or be acquired later in life.
• A person may have one disability or a number of disabilities.
• A person may be treated as having a disability when in fact he or she does not.
• A person's disability may be apparent, such as loss of a limb; or hidden, such as epilepsy or post-polio syndrome.
• Disability may be more or less severe in its impact.
• People with the same disability are as likely as anyone else to have different abilities.

How is this different from a broken arm or leg?

A broken arm or leg usually heals up with a functional return to activity similar or the same as the ability before the fracture (break). The Physical Disability  priorities focus on those people who have a physical disability which exists for the rest of their lives.

What is difference between physical disability and orthopedic impairments?

Orthopedic impairments are the most common of physical disabilities. A physical disability is any condition that interferes with a student's ability to use his or her body. The term physical disabilities may be used interchangeably when referring to orthopedic impairments. In 2004 the U.S. Department of Education reported that 74,000 students between age 6 and 21 received special education services under the orthopedic impairments disability category.

ORTHOPEDIC IMPAIRMENT DEFINITION

According to the Individuals with Disabilities Education Improvement Act of 2004 (IDEA), orthopedic impairment is as follows: “a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments due to the effects of congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments due to the effects of disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures)” (Pierangelo & Giuliani, 2007, p. 268).

Skeletal system impairments that involve the joints, bones, limbs, and associated muscles represent the mus-culoskeletal disorders. Orthopedic impairments often are divided into three main categories to help characterize the potential problems and learning needs of the students involved. These categories are neuromotor impairments, musculoskeletal disorders, and degenerative diseases. Although neuromotor impairments involve the central nervous system (brain, spinal cord, or nerves that send impulses to muscles), they also affect a child's ability to move, use, feel, or control certain parts of the body. Clinically, they are separate and distinct types of disabilities with entirely different causes from musculoskeletal disorders, but they result in similar limitations in movement. Some examples of neuromotor impairments are spina bifida, cerebral palsy, and spinal cord injuries. Musculoskeletal disorders include defects or diseases of the bones and muscles, such as limb deficiency or club-foot. Degenerative diseases are those that affect motor movement such as muscular dystrophy.

Orthopedic impairments involve a wide range of causes and a diverse group of students. Some children have impairments caused by congenital anomalies, whereas others have experienced injuries or conditions that have resulted in orthopedic impairments. Congenital causes include cerebral palsy, osteogenesis imperfecta, joint deformity, and muscular dystrophy. Motor vehicle accidents, sports injuries, premature birth, and other injuries and conditions may cause orthopedic impairments. Burns and broken bones can result in damage both to bones and muscles. Some children have their impairments from birth, while others acquire a physical disability, so age of onset varies widely. There does not appear to be any trend toward greater incidence of orthopedic impairment in boys or girls or based on cultural or racial factors.

Some children with skeletal deformities have surgery. Others have to use various types of braces, prosthetic, and orthotic devices before, after, or in place of surgery. Others may use adapted wheelchairs. Many children identified with severe and multiple disabilities have an orthopedic impairment that must be considered when assessing and establishing services.

ASSESSING ORTHOPEDIC IMPAIRMENTS

Evaluating children with orthopedic impairments can be complicated because there are so many different types of disabilities and causes of impairment. Most orthopedic impairments are identified before a child enters school, but sometimes they are missed or do not appear until a later age. A teacher may notice signs of poor coordination, frequent accidents, or complaints of acute or chronic pain.

The assessment must include a thorough medical evaluation of the child's orthopedic impairment by a licensed physician. Other data generally include documentation of observations and assessments of how the orthopedic impairment affects the child's ability to learn in the educational environment, as well as observations concerning mobility and activities of daily living. It is important to assess a student's social and physical adaptive behaviors through various checklists, inventories, rating scales, and interviews with those who know the child best. The severity of functional limitations must be such that they adversely impact the child's education performance.

A social history supplements the medical history, as does basic screening information on hearing, vision, speech and language skills, and development in areas such as cognition and social/emotional, or self-help behaviors. A team approach is taken for assessment and recommendations. The team that assesses a child with an orthopedic impairment must involve a parent and at least one of the child's general education classroom teacher(s). It should also include a licensed special education teacher, school counselor and/or psychologist, a licensed physician, and other profession personnel as appropriate. For example, a licensed physical therapist or occupational therapist should assess specific motor dysfunction in gross and fine motor development, neuromuscular development, daily living activities, sensory integration, and the need for adaptive equipment. The assessment also considers the permanent nature of the child's impairment. Usually the condition will not be considered an orthopedic impairment if it is not going to last at least 60 days.

More than one test always should be used to evaluate a child's needs for services. In all, the assessment must take into consideration the entire education from all angles, not just physical access to buildings, computers, libraries, or equipment that facilitates learning. For instance, a child may need to receive occupational therapy or other treatments, requiring time away from the general education classroom. Educators will need to develop adaptive strategies and adopt a hands-off approach at times to help students develop some independence. Then, too, social and peer issues also must be considered. The final evaluation should describe how the orthopedic impairment adversely affects a student's areas of development.

CHARACTERISTICS OF CHILDREN WITH ORTHOPEDIC IMPAIRMENTS

Children with orthopedic impairments have a wide range of characteristics that are specific to the underlying diagnosis. Therefore, it is difficult, perhaps even impossible, to generalize about the students in this category. For example, a child with a spinal cord injury could have immobility limited to one side of his or her body, just the arms or legs, or total paralysis. A child with cerebral palsy may have movement but need a wheelchair because he or she has slow, uncontrolled movements that make it difficult to walk.

It also is difficult to know prior to a thorough assessment, including input from medical professionals, what types of associated symptoms to expect. However, many students with orthopedic impairments have problems with motor skills, such as those involved in using standard writing tools, turning pages or books, or exploring and participating in typical classroom activities. Some students have associated speech impairments or multiple disabilities that may affect particular academic areas.

Some students with physical disabilities may lack common experiences and knowledge or common places, items, and activities as compared with general education students. This is due to a lack of mobility and, if their condition has existed since birth, the lack of typical childhood play and exploration. These students' social interactions often are limited because of limited motor, self-help, and self-care skills. Sometimes, standard instructional materials includes mention of objects and experiences or assumes comprehension that is beyond the experience and background of the child with an orthopedic impairment. Children with orthopedic impairments may have pain and discomfort, may sleep poorly and therefore be fatigued in class, and may be on medications. They also may miss school more frequently than other students because of their medical conditions.

Poor self-concept and poor self-advocacy skills may affect an individual student's performance or behavior. Some students with orthopedic impairments feel helpless or depressed as a result of their physical disability.

Some diseases, such as muscular dystrophy, are progressive, which means a child's need for services is likely to increase and certainly to change throughout the continuum of education. Other orthopedic impairments, particularly those caused by injury or temporary impairments from surgery, may lessen over time. Advances in medical care have allowed for better diagnosis and treatment of some disorders and diseases that cause orthopedic impairments. It is important to realize that some children with orthopedic impairments also face issues related to having both chronic and terminal illness.

EXAMPLES OF ORTHOPEDIC DISORDERS

More than 50 diseases and disorders are associated with orthopedic impairments. Along with subgroup types for these disorders. Spina bifida, scoliosis, cerebral palsy, and muscular dystrophy are some of the more well-known conditions that cause orthopedic impairments in children. Spina bifida is a cleft spine, or incomplete closure of the spinal column. It is the most common permanently disabling birth defect. Spina bifida occulta is the mildest and most common form; next in severity is meningocele. With this type, the spinal cord develops normally, but the meninges, or protective covering, push through the opening in the vertebrae. Meningocele can be repaired surgically. Myelomeningocele is the most severe form of spina bifida. The bones of the spinal cord do not completely form and the spinal canal is incomplete, resulting in the spinal cord and meninges protruding out of the child's back. Spina bifida may be associated with hydrocephalus.

Scoliosis is a side-to-side curvature of the spine, measured by x-ray examination as greater than 10 degrees. It makes the shoulders, hips, or both appear uneven and can cause pain in the back. Most cases of scoliosis have no known cause, and although scoliosis can occur in children with other orthopedic impairments, it normally occurs in otherwise healthy children.

Cerebral palsy (CP) includes a number of chronic disorders that impair movement control. They appear early in life and generally do not worsen as children age. Cerebral palsy affects about 500,000 people in the United States; about 8,000 infants and 1,500 preschool-age children are diagnosed with it each year. Cerebral palsy is caused by injury to parts of the brain that control the ability to use muscles. The injury can occur before birth, during delivery, or soon after birth. Early signs normally appear by the time a child is 18 months of age. The three main types of CP are spastic, where muscle tone is too high or too tight; athetoid or dyskinetic CP, which can affect the whole body with slow, uncontrolled movements and low muscle tone; and mixed CP, a combination of the symptoms from both athetoid and spastic CP. A child with mixed CP has some muscles that are too tight and others that are too loose so that some movements are involuntary and mobility is limited in other areas by stiffness.

Muscular dystrophy (MD) is a group of genetic diseases characterized by progressive muscle weakness. The muscles most affected by MD vary, as do the types of the disease. Some are ultimately fatal, such as Duch-enne muscular dystrophy, which also is the most severe form and the most common form affecting children. Although Duchenne MD results from a defective gene, it often occurs in families with no known history of the disease. Muscle weakness, rapid progression, and difficulty with motor skills are some of the characteristics of Duchenne MD. It primarily affects boys and symptoms usually begin in early childhood. There are several forms of muscular dystrophy, each with unique characteristics. For example, Emery-Dreiffus MD typically causes symptoms in late childhood and early adolescence.

EDUCATIONAL PRACTICES

Several laws ensure an inclusive education for students with physical disabilities. The Individuals with Disabilities Education Improvement Act (IDEA) was introduced in 1975 and passed in 1990. It was reauthorized in 1997 and 2004 and includes provisions for children with orthopedic impairments as defined above. Students with orthopedic impairments also may be eligible for accommodations for general classroom inclusion under Section 504 of the Vocational Rehabilitation Act, passed in 1973. In addition, the Americans with Disabilities Act (ADA), which was passed in 1990, includes provisions concerning discrimination against individuals with disabilities and requirements that school facilities are accessible to all.

Placement is a key consideration for students with orthopedic impairments. The goal is inclusion in general education classes, but some students may need services from resource rooms, special classes, schools, or residential facilities, as well as hospital or homebound programs. In 2004, the U.S. Department of Education reported that about 46% of school-age children receiving special education services under the orthopedic impairments category were educated in general education classrooms. Setting up the appropriate placement, services, and environment begins with asking the student what he or she needs and evolves through the assessment and individualized education plan (IEP) process.

Students with orthopedic impairments may present unique challenges in adapting instructional environments that call for creative solutions. Some students may be paralyzed and require assistance moving from place to place. A student may require assistance with basic self-care such as toileting. These and other needs call on teachers to perform duties that historically have not been part of their role in school. Becoming familiar with orthotics, prostheses, adaptive devices, and the specific characteristics of a student's impairment can improve the experience for student and teacher.

To assist with academic tasks, a teacher might secure papers to a student's work area with tape, clipboards, or magnets; place rubber strips or pads on work tools such as rulers and calculators to help keep them from slipping during use; and provide writing instruments that require less pressure to produce a mark, such as felt-tip pens or soft lead pencils. Communication technology can assist the student and teacher in the classroom as well.

Specialists such as physical therapists and orthopedic therapists will be involved in the educational assessment and often will have ongoing involvement in the care of students with orthopedic impairment. States may have specific qualification requirements for teachers who participate in special education programs for children with orthopedic impairments, including basic study of disabilities, anatomy, physiology, and therapeutic movement.

ASSESSMENT AND INSTRUCTIONAL ISSUES

The varying degrees and types of physical disabilities can present special challenges to those local schools and educators who instruct students with orthopedic impairments. Providing the least restrictive environment and promoting eventual independence for students with physical disabilities requires addressing each case specifically, working in a team approach with the student, parents, and education and health professionals to provide a plan that best meets the student's needs. It is important that the teacher can carry over techniques from these professionals into the classroom.

Alliance of state laws with IDEA is an important consideration. The team must consider all applicable laws and regulations in planning for the education of a child with a physical disability. This work includes testing of students under state and federal guidelines such as the No Child Left Behind (NCLB) Act, which was signed into law in 2002 by President George W. Bush. The act revised the Elementary and Secondary Education Act, which is the primary federal law in pre-collegiate education. NCLB requires annual testing of all students in reading and math proficiency.

The NCLB Act initially allowed up to 1% of special education students to take alternate tests; in 2005 the number was raised to 3%. Students may take alternative tests if they meet certain legal criteria. Several options are available, including having different achievement criteria or taking the regular assessment with approved accommodations or modifications.

Common Traits

As IDEA’s definition demonstrates, orthopedic impairments can stem from various causes. While most of the causes listed are fairly self-explanatory, “burns that cause contractures” warrants further explanation. The National Institutes of Health’s Medline Plus Medical dictionary defines “contracture” as “a permanent shortening (as of muscle, tendon, or scar tissue) producing deformity or distortion.”

Educational Challenges

Considering the diversity in conditions that are embodied by the orthopedic impairments category, educational challenges will differ case by case, and the strategies used in each case should focus on a student’s unique needs. Possible academic barriers include:

• Non-accessible transportation
• Trouble maneuvering around the classroom
• Difficulty navigating school hallways
• Earning mandated physical education credit
• Communicating effectively

Tips for Teachers and Parents

Parents, know your child’s rights! For instance, IDEA requires schools to provide accessible transportation to and from school, as well as within and in between school buildings. Teachers, you will want to keep in mind mobility devices (such as wheelchairs, walkers, crutches and canes) when arranging classroom furniture and assigning seats. For example, placing a student who uses a walker close to your room’s entrance is usually more practical than placing him or her in the middle of the classroom.

Types of orthopaedic impairment

Orthopaedic impairments can dramatically affect quality of life, and even shorten the life span if left untreated. With impaired mobility, affected people may not be able to sit, walk or handle things on their own. Where orthopaedic impairment is already established, physiotherapy, orthopaedic surgery, and providing impaired persons with mobility aids (e.g. braces, walking splints, orthopaedic shoes, and wheelchairs) can greatly improve quality of life.

Polio paralysis

This is a condition that causes paralysis of muscles without loss of sensation. Contractures deform joints and interfere with the patient's ability to walk. The initial disease, polio (short for poliomyelitis), is a viral disease that can damage the nerves in the spinal cord, causing paralysis of the arms, legs, or trunk. Polio mainly affects children under the age of three.

• Polio is caused by a virus that enters the body through the mouth
• The polio virus lives in the throat and intestinal tract of infected persons
• It is usually contracted from hands or eating utensils contaminated with the stool of an infected person
• Initial polio attacks are preventable by immunisation

With polio, there are also ways to promote mobility:

• Surgery: Operations, used to release contractures, transfer tendons, and stabilise joints, can enable the patients to stand upright and walk
• Equipment: Braces, walking splints, orthopaedic shoes, and wheelchairs can support paralysed muscles and deformed joints

Tuberculosis of the spine

This is an infection of the spinal column. The disease progressively destroys the backbone and causes severe physical impairment and may lead to death if left untreated. Tuberculosis can be recognised by a sharp bend in the middle section of the backbone that goes along with shortening and thickening of the chest.

• The disease is caused by the tubercle bacillus. Pulmonary tuberculosis, an infection of the lungs, is the most common presentation.
• Tuberculosis of the spine occurs when a tubercular infection of the lungs spreads to the spinal bones. This frequently happens in children.
• Risk factors include overcrowded and poor living conditions, malnutrition, and HIV infection.
• The infection can be cured with anti-tuberculous medicine but extensive surgery is often necessary to stabilise the spine, correct deformity and allow recovery of the spinal cord.

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close panel:Cerebral palsy

Cerebral palsy describes a group of chronic conditions affecting body movement, muscle coordination, and often mental capability. The conditions are characterised by stiff muscles and a loss of control and coordination of movements. This often makes walking impossible or even causes difficulties in sitting.

• Cerebral palsy is caused by faulty development or damage to motor areas in the brain.
• Risk factors include premature birth, prolonged labour or deprivation of oxygen during birth, and early infection with malaria.
• Cerebral palsy is incurable but treatment and specially designed equipment can promote mobility while ongoing physiotherapy helps exercise the involved muscle.
• Helpful appliances include cerebral palsy chairs, walking aids, foot splints, orthopaedic shoes, wheelchairs.
• Surgery is occasionally necessary to correct joint contractures.

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close panel:Hydrocephalus

Hydrocephalus translates as "water on the brain" and describes a condition characterised by excess cerebrospinal fluid in the brain. This leads to pressure build-up under the skull, causing the head to swell and possibly brain damage.

• The condition occurs when the normal flow of the cerebrospinal fluid that bathes the brain and the spinal cord is blocked and the continuously produced liquid has no way to leave the skull.
• In most cases, hydrocephalus is not hereditary.

Shunts, or bypass tubes, are the primary method to treat hydrocephalus: With this lifelong treatment, the cerebrospinal fluid is shunted to another area of the body and generally allows patients to lead active lives.

Another method is a newer neurosurgical procedure that decompresses the brain without a permanent shunt.

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close panel:Clubfoot

Clubfoot, also known as ‘congenital talipes equinovarus’ (CTEV), is a condition in which the child is born with the foot turned inwards and pointing down; either one or both feet may be affected. If left untreated, the condition causes the person to walk painfully on the top of the foot. The majority of clubfoot cases are congenital (present at birth) hereditary and result from abnormal development of the muscles, ligaments, tendons and bones while the baby is forming in the uterus. The exact causes of clubfoot are not known. Scientific studies have found that familial inheritance, genetics and environment are all likely to be factors which interact to cause clubfoot but how this happens is not well understood.

Around the world, 150,000 – 200,000 babies with clubfoot are born each year.  Approximately 80% of these will be in low and middle income countries. The incidence of clubfoot varies around the world but is on average 1 in 800 live births.

What can be done for clubfoot?

• Manipulation and casting (the Ponseti technique): Slowly stretching the tightened soft tissues and muscles and holding the foot in the improved position with a plaster cast which is changed every week. This will take about 6 weeks. After this correction the baby needs to wear foot splints at night (and at the beginning also during the day).
• Surgery: If the foot is too rigid and cannot be corrected with just plaster casts, then additional surgery will be necessary. Casts are applied after surgery and remain on for 4-6 weeks. Often foot splints and orthopaedic shoes need to be used which are important to maintain the correction. This has to be continued over a period of months and sometimes for years.

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close panel:Cleft lip and palate

Cleft lip and palate is a common congenital deformity. It occurs when the separate areas of the face that develop individually and then join together, do not join properly.

• A cleft lip is an opening between the upper lip and the nose and looks like a split in the lip.
• A cleft palate occurs when the roof of the mouth has not joined completely.
• The conditions may occur separately or be combined.

It is especially important to detect and treat cleft lip and palate early, as neglect of the condition may lead to malnutrition or even death due to the difficulty of feeding children with a cleft lip and palate. Reconstructive surgery can have a beneficial effect, enabling normal feeding.

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close panel:Angular Bone Deformity

Angular bone deformities are bent bones, most often occurring just above or just below the knee. The condition causes severe knock knees (genu valgus) or bow legs (genu varus) that develop and worsen with growth. The deformities make walking difficult and may damage the joints, resulting in arthritis.

It is vital to raise awareness of this physical disability in developing countries because angular bone deformity incidence is more common where malnutrition is also present, yet simple and effective surgery can be used to re-align the bones.

What Causes Angular Bone Deformity?

• The condition occurs when the bone softens and then deforms with stress of weight bearing.
• Malnutrition and a lack of Calcium and Vitamin D restrict healthy bone development and may cause angular bone deformities.
• Other causes include: growth-plate abnormalities, badly mended fractures, metabolic conditions, and infections.

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close panel:Burn contractures

Burn contractures describe a permanent shortening of burn scar tissue that pulls joints out of position and results in physical impairment.

Burn contractures may occur after thermal injury. Not every burn results in burn contractures but when burn wounds are left untreated or exposed to dirt, the chances of the condition occurring increases. Surgery and subsequent skin transplants are used to release the contracture. The treatment should be followed by physiotherapy to stretch the joints.

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 aboutTraumatic 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.

Subject	Personal notes
TBI+ Seizures Cerebral Palsy Spina Bifida Muscular Dystrophy Overview and multiple links at About.com 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

Definition

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

Definitions 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

Impact on Learning

The specific impact on learning of an individual is contingent upon the disease, its severity, and individual factors. Two individuals with identical diagnoses may be quite different in terms of their capabilities.

Many students with orthopedic impairments have no cognitive, learning, perceptual, language, or sensory issues. However, individuals with neuromotor impairments have a higher incidence of additional impairments, especially when there has been brain involvement. For most students with orthopedic impairments, the impact on learning is focused on accommodations necessary for students to have access to academic instruction.

Teaching Strategies

As with most students with disabilities, the classroom accommodations for students with orthopedic impairments will vary dependent on the individual needs of the student. Since many students with orthopedic impairments have no cognitive impairments, the general educator and special educator should collaborate to include the student in the general curriculum as much as possible.

In order for the student to access the general curriculum, the student may require these accommodations:

• Special seating arrangements to develop useful posture and movements
• Instruction focused on development of gross and fine motor skills
• Securing suitable augmentative communication and other assistive devices
• Awareness of medical condition and its affect on the student (such as getting tired quickly)

Because of the multi-faceted nature of orthopedic impairments, other specialists may be involved in developing and implementing an appropriate educational program for the student. These specialists can include:

• Physical Therapists who work on gross motor skills (focusing on the legs, back, neck and torso)
• Occupational Therapists who work on fine motor skills (focusing on the arms and hands as well as daily living activities such as dressing and bathing)
• Speech-Language Pathologists who work with the student on problems with speech and language
• Adapted Physical Education Teachers, who are specially trained PE teachers who work along with the OT and PT to develop an exercise program to help students with disabilities
• Other Therapists (Massage Therapists, Music Therapists, etc.)

Assistive Technology

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used. As with any student with a disability, the assistive technology would need to address a need of the student to be able to access the educational curriculum. For students with orthopedic impairments, these fall into three categories:

Devices to Access Information: These assistive technology devices focus on aiding the student to access the educational material. These devices include:

• speech recognition software
• screen reading software
• augmentative and alternative communication devices (such as communication boards)
• academic software packages for students with disabilities

Devices for Positioning and Mobility: These assistive technology devices focus on helping the student participate in educational activities. These devices include:

• canes
• walkers
• crutches
• wheelchairs
• specialized exercise equipment
• specialized chairs, desks, and tables for proper posture development