Physical Disabilities, TBI, and Health Disorders


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  • Heavy on related services“Physical disabilities” is a term generally used to refer to impairments that interfere with a person’s mobility, coordination, communication, learning, or personal adjustment. This chapter discusses a representative sample of disabling physical conditions, including cerebral palsy, seizure disorders (epilepsy), spina bifida, spinal cord injuries, and muscular dystrophy. Health disabilities are conditions resulting in “limited strength, vitality, or alertness,” which are “due to chronic or acute health problems.” Such health disabilities significantly alter not only the life of the person, but also the lives of that person’s family and friends.Individuals often require a diverse array of highly specialized services to realize their maximum potential.
  • The Individuals with Disabilities Act (IDEA) uses the term orthopedically impaired to describe students with physical disabilities and the term other health impaired to describe students with health disabilities. Health disorders cause individuals to have limited strength, vitality, or alertness due to chronic or acute health problems that adversely affect educational performance.In recent years new subgroups have emerged within the health disabilities field and include the medically fragile or technology dependent. Physical and health disabilities impact how individuals with various conditions or diseases view themselves and how others see them. The impact of these disabilities is felt on a number of social, educational, and psychological fronts. Individuals with physical and health disorders often require a diverse array of highly specialized services to realize their maximum potential.
  • Definitions and concepts1) Cerebral palsy represents a group of chronic conditions that affect muscle coordination and body movement. It is caused by damage to one or more parts of the brain, usually occurring during fetal development, during the birth process, or during infancy.2) Cerebral palsy is not curable but carefully targeted interventions and therapies can help an individual’s functioning.3) There are three basic types of cerebral palsy: spastic, athetoid, and ataxic.4) Individuals with cerebral palsy are considered to be multidisabled, since they often experience several disabilities including hearing deficits, speech and language problems, intellectual deficits, visual disabilities, and general perceptual problems.ii. Prevalence and causation1) The prevalence of cerebral palsy is about 1.5 to 2.45 per 1,000 live births.2) Cerebral palsy may be caused by any condition that adversely affects the brain, such as chronic diseases, insufficient oxygen to the brain, premature birth, maternal infections, birth trauma, blood incompatibility, fetal infection, and post-birth infections.iii. Interventions – Rather than treat cerebral palsy (CP), professionals and parents work at managing the condition.
  • Neuromuscular disorderCerebral = brain and palsy = muscle weaknessThere are three basic types: SpasticAthetoidAtaxic Page 375 for table
  • Go to wikispace pageFor the girl with mixed CP, have students follow along with the text below the clip so they can read what she is saying. Prompt them following with some questions about how much they would have understood if they hadn’t had the script? How long would they have let her talk if she were right in front of them, before stopping her/finishing her sentence/assuming she wasn’t actually saying words?
  • Refer to handout with the discussion questions
  • Definition and concepts-- Spina bifida is the most commonly occurring permanently disabling birth defect and is characterized by an abnormal opening in the spinal column which frequently causes some form of paralysis. It may or may not affect intellectual functioning. The two types of spina bifida are spina bifida occulta and spina bifida cystica. Spina bifida occulta is a very mild condition in which a small slit is present in one or more of the vertebral structures. It has little if any impact on a developing infant and may go unnoticed. The two subdivisions of spina bifida cystica are spina bifida meningocele and spina bifidamyelomeningocele. Individuals with spina bifida occulta exhibit the normal range of intelligence. Most individuals with myelomeningocele also have normal IQs. For children whose learning is normal or above average, no special education programming is necessary. 2. Prevalence and causation-- In the United States, spina bifida affects about 7 out of ever 10,000 newborns. The specific causes of spina bifida are unknown, but it is suspected that it is hereditary or the result of teratogens in the mother’s body during early pregnancy. Folic acid deficiencies have been implicated in the causes of spina bifida.
  • Health plan for catheter changing or toileting needsMyelomeningecele requires surgery, shunt is placedTeachers must learn about signs of shunt failure (irritability, fatigue, losing balance, flu-like symptoms)Failure can progress rapidly
  • Genetic protein abnormalityNo cure“care over cure”Inheritance - X-linked recessive. DMD primarily affects boys, who inherit the disease through their mothers. Women can be carriers of DMD but usually exhibit no symptoms. Carriers have 50% chance of passing the gene.1/3 occurs with no family history
  • Differs from CP b/c there is generally NO sensation or muscular control in affected areas
  • Video on wikispace : Murderball
  • Primary damage: direct outcome of initial impactSecondary damage: may occur with passage of time
  • Anoxia: no oxygenHypoxic: not enough oxygen
  • 5 million kids and adults living with lasting consequences of a TBI in the US.Babies/kids: - falls from short distances (playground, furniture, etc) - SBS or other physical abuseShaken Baby SyndromeShaken Baby Syndrome is a violent criminal act that causes traumatic brain injury. Shaken Baby Syndrome occurs when the perpetrator aggressively shakes a baby or young child. The forceful whiplash-like motion causes the brain to be injured. Blood vessels between the brain and skull rupture and bleed. The accumulation of blood causes the brain tissue to compress while the injury causes the brain to swell. This damages the brain cells. Shaken Baby Syndrome can cause seizures, lifelong disability, coma, and death. Irritability, changes in eating patterns, tiredness, difficulty breathing, dilated pupils, seizures, and vomiting are signs of Shaken Baby Syndrome. A baby experiencing such symptoms needs immediate emergency medical attention. - near drownings and chokings as wellAges 15-24: - sports, car accidents involving alcohol, risky behavior in generalThe leading causes of TBI are:Falls (28%);Motor vehicle-traffic crashes (20%);Struck by/against (19%); andAssaults (11%).1Blasts are a leading cause of TBI for active duty military personnel in war zones.2
  • Page 399 for detailed listSimilar to intellectual disabilitiesNeuro: sensory deficits, motor coordination, paralysis, weakness, seizure disorder, speech problems (APHASIA, expressive)Cognitive: paying attention, problem solving, abstract thinking and reasoning, concentration, inflexibility, slowed processingBehavioral: aggressive, low frustration tolerance, uninhibited, impulsiveSocial: difficulty restricting inappropriate behaviors, insensitivity to others, failure to initiate social interactionsEmotional: , flat affect (showing no emotion), depression, irritable, easily upsetImportant to remember: sparks of the “old self” may exist, too. May have splinter skills in some areas and are seemingly unaffected. Not every person with a TBI will share these characteristicsAll of these issues impact educational performance and usually cause frustration on the part of the student with the TBI.
  • Short-term IEPs written to reflect current needs, and adjust as needed. Not just annually. Often have vast improvement within first year of injury. Must continue to raise expectations to maximize recovery
  • One person come up and blindly select health disorder type for their group from jar/envelope.
  • They should all take notes using this as a model
  • Physical Disabilities, TBI, and Health Disorders

    2. 2. PhysicalTraumaHealth
    3. 3. Affected areas:• Mobility• Coordination• Communication• Learning
    4. 4. “Orthopedic Impairment”• Cerebral palsy• Spina bifida• Spinal cord injury• Muscular dystrophy• others
    5. 5.  Group of chronic conditions that affect the brain’s ability to coordinate muscles and body movement Damage to one or more parts of the brain  Fetal development  Birth process  Infancy Symptoms often appear at birth through first year Currently about 765,000 people in US Treatment MANAGEMENT
    6. 6. Page 375 • Rigid and jerkySpastic • “scissor” gait • InvoluntaryAthetoid movement • Average intelligence • Poor balance Ataxic • Fine motor • Tremors
    7. 7.  A sickness Intellectual disability A reason for segregated instruction
    8. 8.  Abnormal opening in spinal column frequently causes some form of paralysis  May/may not affect intellectual functioning Spina bifida occulta - mild condition in which a small slit is present in one or more of the vertebral structures  Little impact on a developing infant
    9. 9.  Subdivisions of spina bifida cystica:  Spina bifida meningocele - a tumor-like sac on the back of infant which can be open or closed  Contains spinal fluid but no nerve tissue  Spina bifida myelomeningocele - sac does contain nerve tissue  Paralysis or partial paralysis  Lack of bowel & bladder control
    10. 10.  Group of inherited & progressive conditions & characterized by loss of ability to use arms & to walk effectively due to fatty tissues that gradually replaces muscle tissue Degree of seriousness influenced by heredity, age of onset, physical location, nature of onset & rate of progression  Duchenne-type muscular dystrophy (DMD) is most severe form of muscular degeneration
    11. 11. ACCESSIBILITYphysical instructional communication
    12. 12.  Discuss obstacles to AUTHENTIC inclusion in school for kids with physical disabilities.  Role of adults in the child’s day  Communication differences  “Output” in class
    13. 13.  Spinal cord is traumatized or severed  Site & nature of the insult – severed, bruised?  Different from CP – no sensation Paraplegia Quadriplegia Hemiplegia
    14. 14. Take-AwaysRemember theeffects of labelingImportance ofPerson-first languageand philosophyInclusion requiresaccessibility for thestudentFlexibility of adults
    15. 15. TBI/ABI
    16. 16.  Blow to the head or against stationary object  Car accidents: head hits windshield  Bike accidents: head hits ground Rapid acceleration & deceleration of brain  Tearing of nerve fibers  Bruising of brain tissue against skull  Brain stem injuries  Swelling of the brain Video: what happens to the brain during a TBI
    17. 17. 1. Primary damage• Direct outcome of the initial impact to the brain2. Secondary damage• Develops over time as the brain responds to the initial trauma
    18. 18.  IDEA definition:  An acquired injury to the brain  Caused by an external force  Total or partial functional disability, psychosocial impairment, or both  Adversely affects educational performance IDEA RECOGNIZES TBI AS ITS OWN DIAGNOSIS AND CODE FOR SPECIAL EDUCATION.
    19. 19.  Adversely affects:  Information processing  Social behavior (and control of emotions)  Memory  Reasoning & thinking  Speech & language skills  Sensory & motor abilities
    20. 20. Acquired Brain Injury (ABI)  Traumatic brain injuries  Falls, car accidents, assaults, shaken baby syndrome, combat- related trauma  Alcohol-related accidents  Non-traumatic brain injuries (no forceful impact to the head)  Strokes, vascular accidents, infectious diseases, anoxic or hypoxic injuries (choking and near drowning), illegal drug use, poisoning
    21. 21. 40% of head injuries Ages 0-5 (falls, SBS, or other abuse) Ages 15-24 (risky behavior, car accidents)Military personnel (blasts are leading cause) Ages 75+ (falls)
    22. 22. Neurological Cognitive Behavioral• Expressive aphasia, • Problem-solving, • Aggression, motor skills, abstract thinking, impulsive, easily coordination slowed processing frustrated Social Emotional • Can be • Flat affect, easily uninhibited, may upset, irritable seem insensitive “Flickers” of the individual’s personality at times. Uneven skill maintenance in these areas, depending on area of brain affected.
    23. 23. Acute Rehabilitation Community Reintegration•Life-saving •Months, in hospital •Maintaining•Minimize •Relearning progress swelling and physical, communication, •Attaining services complications behavioral skills •Re-entrance into•Parents in crisis •Families prep for school homecoming and new life Most experience the most improvement within 1st year following the TBI. Over one-third experience life-long effects.
    24. 24.  Not the “old” student you knew before the trauma Preparing the school community Preparing the student IEP  Short-term  Reflect CURRENT needs  Educational, communication, physical, social, adaptive skills  Adjust often in response to progress within first year  Raise expectations to maximize recovery
    25. 25. Impact on Special Education
    26. 26. What are health disorders?What do they have to do with special education?
    27. 27.  By last name:  AIDS/HIV  A-C  Asthma  D-H  Seizure Disorder  J-L  Diabetes  N-R  S  Cystic Fibrosis  T-Z  Sickle Cell Anemia
    28. 28.  With your group, research your assigned disorder. Chapter 14 Start on p.384 Identify the following and capture on board:  Definition and summary of concepts about the disorder  Summary of prevalence/causation  Summary of Interventions Appoint a speaker to share your information.
    29. 29. Disorder Definition/Concept Prevalence/Caus InterventionsName s e
    30. 30.  “limited strength, vitality, and alertness” Adversely affect educational performance
    31. 31. Judith Scott speaks!