Physical Disabilties and TBI


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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
  • Degree of cerebral palsy varies from child and can include fine motor task difficulties, speech impairment, loss of balance, uncontrollable hand movements, drooling, mental impairment or seizures.
  • 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
  • Differs from CP b/c there is generally NO sensation or muscular control in affected areas
  • 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
  • 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
  • Physical Disabilties and TBI

    1. 1. PHYSICAL DISABILITIES<br />AND <br />TRAUMATIC BRAIN INJURY<br />Chapter Fourteen<br />
    3. 3. Physical Disabilities<br />
    4. 4. Physical Disabilities and IDEA<br />
    5. 5. Group of chronic conditions that affect muscle coordination and body movement<br />Damage to one or more parts of the brain<br />Fetal development<br />Birth process <br />Infancy<br />Symptoms often appear at birth through first year<br />1.5 to 4.0 in 1,000 live births<br />No cure – treatment focuses on managing symptoms and related conditions<br />CEREBRAL PALSY <br />
    6. 6. CEREBRAL PALSY <br />
    7. 7. Individuals with cerebral palsy are considered to be multi-disabled<br />Motor development<br />Delayed<br />Fine motor difficulties<br />Gross motor dififculty (gait)<br />Speech & language impairment<br />Intellectual deficits<br />Visual and hearing disabilities & general perceptual problems <br />Seizures <br />CEREBRAL PALSY<br />
    8. 8. Abnormal opening in spinal column frequently causes some form of paralysis<br />May/may not affect intellectual functioning <br />Spina bifida occulta - mild condition in which a small slit is present in one or more of the vertebral structures <br />Little impact on a developing infant<br />SPINA BIFIDA <br />
    9. 9. SPINA BIFIDA <br />Subdivisions of spina bifida cystica:<br />Spina bifida meningocele- a tumor‑like sac on the back of infant which can be open or closed <br />Contains spinal fluid but no nerve tissue<br />Spina bifida myelomeningocele- sac does contain nerve tissue <br />Paralysis or partial paralysis<br />Lack of bowel & bladder control<br />
    10. 10. Spinal cord is traumatized or severed<br />Site & nature of the insult<br />Other serious damage to other parts of body<br />Paraplegia<br />Quadriplegia<br />Hemiplegia <br />SPINAL CORD INJURY <br />
    11. 11. 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 <br />Degree of seriousness influenced by heredity, age of onset, physical location, nature of onset & rate of progression<br />Duchenne-type muscular dystrophy (DMD) is most severe form of muscular degeneration<br />MUSCULAR DYSTROPHY <br />
    12. 12. Traumatic & Acquired Brain Injury<br />TBI/ABI<br />
    13. 13. Blow to the head or against stationary object<br />Car accidents: head hits windshield<br />Bike accidents: head hits ground<br />Rapid acceleration & deceleration of brain<br />Tearing of nerve fibers<br />Bruising of brain tissue against skull<br />Brain stem injuries<br />Swelling of the brain<br />DEFINITION OF TBI:<br />
    14. 14. TWO Types of Brain Damage<br />
    15. 15. IDEA definition:<br />An acquired injury to the brain<br />Caused by an external force<br />Total or partial functional disability, psychosocial impairment, or both<br />Adversely affects educational performance<br />IDEA recognizes TBI as its own diagnosis and code for special education.<br />TRAUMATIC & ACQUIRED BRAIN INJURY and IDEA<br />
    16. 16. Adversely affects:<br />Information processing<br />Social behavior (and control of emotions)<br />Memory<br />Reasoning & thinking<br />Speech & language skills<br />Sensory & motor abilities <br />TRAUMATIC & ACQUIRED BRAIN INJURY<br />
    17. 17. Acquired Brain Injury (ABI)<br />Traumatic brain injuries<br />Falls, car accidents, assaults, shaken baby syndrome, combat-related trauma<br />Alcohol-related accidents<br />Non-traumatic brain injuries (no forceful impact to the head)<br />Strokes, vascular accidents, infectious diseases, anoxic or hypoxic injuries (choking and near drowning), illegal drug use, poisoning<br />TRAUMATIC & ACQUIRED BRAIN INJURY<br />
    18. 18. At-Risk Groups<br />40% of <br />head injuries<br />Ages 0-5 (falls, SBS, or other abuse)<br />Ages 15-24 (risky behavior, car accidents)<br />Military personnel (blasts are leading cause)<br />Ages 75+ (falls)<br />
    19. 19. CHARACTERISTICS<br />“Flickers” of the individual’s personality at times.<br />Uneven skill maintenance in these areas, depending on area of brain affected.<br />
    20. 20. TREATMENT STAGES<br />Most experience the most improvement within 1st year following the TBI.<br />Over one-third experience life-long effects.<br />
    21. 21. Not the “old” student you knew before the trauma<br />Preparing the school community <br />Preparing the student<br />IEP<br />Short-term<br />Reflect CURRENT needs<br />Educational, communication, physical, social, adaptive skills<br />Adjust often in response to progress within first year<br />Raise expectations to maximize recovery<br />RETURNING TO SCHOOL<br />