The document discusses educational adaptations for children with physical disabilities, emphasizing Vygotsky's principles of remediation that focus on creating new functional systems to support learning. It outlines the various types of cerebral palsy, their causes, symptoms, and potential therapeutic approaches, stressing the importance of early intervention and comprehensive treatment. Additionally, it touches on cystic fibrosis, indicating its impact on lung function and digestion, and detailing the range of symptoms that may present in affected children.

1. Educational Adaptation for Children with Physical Disabilities-I
(3609)
Q.1 Describe the general principles of remediation of learning problems of the handicapped children.
With this, according to Vygotsky, “in the whole multitude of stimuli one group clearly stands out for me, which is the group of social
stimuli coming from people. It stands out because I myself can reconstruct these stimuli, because they very soon become reversible for
me and thus determine my behavior in a way different from all others. They make me comparable to another and identical to myself.
The source of social behavior and consciousness lies in speech in its full meaning”.
The Vygotsky’s principle of “doubling experience” is primordial to understand the specific nature of human behaviour and
consciousness, both normal and abnormal.
According to Vygotsky, the natural processes such as physical maturation and sensory mechanisms interact with culturally determined
processes to produce the psychological functions of adults and the variety of ways the functions are carried out, through “A bifurcation
in the course of a child’s behavioral development into natural-psychological and cultural-psychological development” (Vygotsky &
Luria, 1930, p. 20).
These new formations have a cultural origin, a dynamic psychological structure, and a dynamic brain (body) organization as well. So a
word is considered to be an external material sign, a psychological tool for organization of human behavior.
With this, “The mentality should be considered not as special processes above and outside the cerebral processes or between them, but
it is their subjective expression, a particular aspect and a special feature of the higher cerebral functions” (Vygotsky, 1930/1982, p. 137).
So, the cultural-historical approach in neuropsychology stipulates that the origins of human conscience and mental activity should be
searched for neither inside the brain, nor in the mechanisms of nervous processes but in the human social life. In other words, if we want
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2. to trace how it functions (or why it dysfunctions) in the behavior of an individual, we must consider how it is used to function in social
behavior.
Assuming these theoretical foundations I will pass to the problems of remediation for learning disabled children. L.S Vygotsky proved
that the education entails development, then remediating education determines development.
The remediating education differs from the general one in its aims. The aim of general education is to acquire knowledge, the remediation
is aimed to form new functional organs or a new functional system that make it possible to perform a mental process. For learning of a
special need child a remediation must endorse the general school education and create a base for future education. New basic functional
systems formed during remediation make independent learning of the child possible in the future.
These basic systems include voluntary regulation and control of own behavior, space orientation, phonemic and kinesthetic verbal
analysis and syntheses, motor ability, volume and stability of verbal and visual memory, logic reasoning and communicative skills.
Some of these systems should be already formed by the moment of entering primary school, the others, like space orientation, are in the
process of formation.
The main task of remediation is to create the means of compensation together with a child and to overcome underdevelopment of
some mental functions, with the ‘strong’ components of mentality compensating the weak ones.
 pupils unsuccessful at school because of underdevelopment (retardation) in some mental functions (sometimes, talented in some others);
 children with low neurodynamic capacities in mental functioning;
 children with poor executive functioning;
 children with problems of behavior and social communication;
 pupils achieving success at school bringing harm to their general health.
This list can be continued.
Some common features or psychological consequences of academic failure unify these children, such as:
 negative attitude to education;
 fear of failures;
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3.  low self-appraisal and self-credit.
Therefore remediation process is oriented to the following tasks:
 cognitive development and increasing success at school;
 correction of negative traits of personality and emotional reactions;
 improving of behavior at school and at home;
 development of communicative skills;
 psychological assistance to parents.
A multitude of remediation tasks determines necessity of a complex approach to their solution. This approach is based on Vygotsky’s
and Luria’s principles of neuropsychological rehabilitation and remediation:
 Neuropsychological qualification of child’s problems is systemic neuropsychological assessment revealing both deficits and strengths in
child’s development, his zone of proximal development, that, according to Vygotsky, are possibilities and conditions to improve the results
with a help of an examiner. It is only possible with the use of Luria’s principle of dialogue assessment, including components of education
with form a base for individual program of remediation (Leontiev, Luria, & Smirnov, 1968). Together with this, Luria’s assessment in
contrast to psychometric methods measures not an achieved level of education (retrospective aspect), but a potential to education
(prospective aspect). Luria’s tests are oriented not at the result of the assessment (pass or fail), but at its process and possibilities to make
it more efficient.
 The principle of complex remediation means a combination at of cognitive, motor, respiratory and emotional methods each session so
that together they form the same mental function.
 For instance (Fig. 2), to develop space orientation in the motor part of the remediation session a child has to roll over from one
part of the room to another oriented by two toys which must always be placed at the level of his waist. In the cognitive part of
remediation, in the game called “fly” the task is to follow the flight of a fly in accordance with teacher’s instructions – two rows
up, one to the right and so on, – and they “catch” the fly if it gets out the cage. The respiratory method called “blow-ball” when
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4. a child blows an inflated ball into gates, not only increases the general activation, but also trains orientation in the space of the
table, mutual interaction and adequate emotional reactions to success and failure.
 The principle of systemic remediation means that the program for each child does not focus on surmounting of an isolated defect alone
but tries to balance the whole mentality and personality of the child. It doesn’t leave aside the need of choice of the main orientation and
specific techniques at each step of remediation for every one child, based upon the data of his neuropsychological assessment and his
personal needs. This principle provides the efficiency of neuropsychological remediation for learning disabled children.
 Play remediation favors emotional involvement and motivation of the child in the remediation process. Games, competitions, small gifts
etc. significantly increase the efficiency of remediation. It provides that the child becomes a subject, not an object of remediation. To
realize it, the proposed tasks should be interesting and accessible for the child, being appropriate to his age and life experience, the failures
should not follow one another, but the successes should not be achieved without efforts. The most important is not to teach something
but to stimulate a desire to learn this thing.
 If a child is a subject of own remediation, it forms “the affective basis of education”, that is, according to Vygotsky, “the alfa
and omega, the beginning and the end, the prologue and the epilogue of each mental development” (Vygotsky, 1984, p. 297). A
child chronically unsuccessful at school must experience a feeling of success to increase own self-estimation and self-credit.
 It results in an individualized remediation of every child. Every problematic child has his own problems and concerns.
 The weak components of mental functions are developed through support from the strong ones. It means that at the beginning of
remediation the teacher performs himself the functions of the weak components, and then gradually moves them to the child following
the rules of interiorization, described by L.S. Vygotsky: from common activity to an independent one, from an action mediated with
external means to an internal one, from step by step analytic action to a global automatized one (Akhutina & Pylaeva, 2008).
 The cultural-historical approach in neuropsychological remediation of educating disabled children consists of further development of the
theory of mediation. L.S. Vygotsky proved that mediation is a natural way of cognitive development as well as of the psychological
compensation of cognitive and physical deterioration in children. This last principle results in a search for mediation methods in
remediation instead of direct training of underdeveloped functions.
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5.  Hand writing and its underdevelopment in dysgraphia can be a good example. Dwelling upon Vygotsky’s viewpoint, orthography
is a tool of written communication where a finite number of signs. They are continually recombined into symbols by following
artificial rules of formulation. It is a set of abstract tools for written communication. So, to overcome dysgraphia – one of the
most common problems of learning disability, a psychologist must form an instrumental behavior.
Q.2 Give an account on the functional limitation and their possible solutions for a child suffering from cerebral palsy.
Cerebral palsy (CP) is a neurological condition caused by brain damage, and it is the most common motor and movement disability of
childhood. If your child has been diagnosed with cerebral palsy, you need to know what to expect. Get the answers to all of your
questions so that you can make informed decisions about diagnosis, treatment, therapies, and legal action.
As an umbrella term, cerebral palsy refers to a group of symptoms and disabilities.[1] They are all related, but each child will have a
unique and individual experience of cerebral palsy.
Some of the potential issues a child with cerebral palsy may face include:
 Movement and walking disabilities
 Speech difficulties
 Learning disabilities
 Cognitive impairments
 Hearing or vision loss
 Epilepsy
 Emotional and behavioral challenges
 Spinal deformities
 Joint problems[2]
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6. Brain damage is the cause of CP, but many different things can trigger damage.[4] For this reason, the exact cause of cerebral
palsy can’t always be determined. Possibilities include:
 Poor brain development in the womb
 Maternal infections or medical conditions
 Disruption of blood flow to the developing brain
 Genetic conditions
 Ingestion of toxins or drugs during pregnancy
 Damage to the head or skull during delivery
 Complications related to premature delivery
Yes, it is possible that negligent medical mistakes caused brain damage during pregnancy or childbirth and lead to cerebral palsy.
In some cases, errors are not negligent and could not have been prevented; however, negligent mistakes that may be considered
malpractice include:
 Anything that deprives a baby of oxygen during birth
 Excessively forceful use of forceps or a vacuum extractor
 Failure to order a Cesarean section or perform one in time to prevent brain damage
 Failure to monitor fetal development during pregnancy or distress during labor
 Inadequate treatment of maternal health conditions during pregnancy
Types of Cerebral Palsy
There are four types of cerebral palsy:
1. Spastic Cerebral Palsy
Spastic cerebral palsy accounts for 75 percent of all cases. It causes increased muscle tone, known as spasticity, and other
symptoms:
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7.  Delayed developmental milestones for moving
 Abnormal movements
 Movement inhibition
 Stiff and spastic muscles
 Difficulties controlling muscle movement
 Problems moving from one position to another
Spastic quadriplegia impacts a child’s upper and lower limbs and body, severely restricting mobility.
Spastic diplegia only affects the lower half of the body. Many of these children can still walk with some impairments and may need
assistive devices such as walkers.
Spastic hemiplegia affects one side of the body only, usually the arm more than the leg. Most children with hemiplegia can walk.
2. Dyskinetic Cerebral Palsy
Dyskinetic cerebral palsy is the second most common type of CP. Symptoms include:
 Dystonia, repetitive and twisting motions
 Athetosis, writhing movements
 Chorea, unpredictable movements
 Poor posture
 Painful movements
 Difficulty swallowing or talking
3. Ataxic Cerebral Palsy
Ataxic cerebral palsy is the least common. It causes poor balance, limited coordination, tremors, and shaky movements that are
difficult to control.
4. Mixed Cerebral Palsy
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8. Mixed cerebral palsy causes symptoms characteristic of two or three of the other types. Spastic-dyskinetic cerebral palsy is the most
common type of mixed CP.
Some of the signs of cerebral palsy in an infant or toddler are:
 Delays in movements and motor skills, such as holding head up, rolling over, sitting, crawling, and walking
 Body parts that are too stiff or floppy
 Favoring one side of the body
 Scooting on the bottom instead of crawling
 Inability to stand, even with support
Always consult your child’s pediatrician if you notice unusual symptoms, even if you aren’t sure they are caused by cerebral palsy. Early
intervention is critical when helping children with cerebral palsy.
There is no single or simple test for cerebral palsy. It takes time and multiple tests and observations to get an accurate diagnosis and
to rule out other conditions.
Your pediatrician can either make a diagnosis or recommend a specialist if you suspect your child has any issues with motor
development, muscle tone, or coordination and balance.
Doctors look for spastic movements, abnormal muscle movements, delayed development, and poor coordination when diagnosing
cerebral palsy.
There is no foolproof way to prevent CP, but there are steps you can take to lower the risk:
 Before pregnancy, eat well and have any pre-existing medical problems under control.
 While pregnant, continue with these healthy habits and take recommended prenatal vitamins.
 See your obstetrician for regular checkups throughout pregnancy.
 Get screened for potential complications.
Unfortunately, there is no easy way to predict when an infant will suffer brain damage due to negligence. The best you can do is choose
your doctors carefully and advocate for your own healthcare and that of your child.
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9. There is no cure for cerebral palsy, but it will also not get worse with time. This is not a progressive disease, and early therapies and
treatments can reduce symptoms and disabilities while also improving mobility.
A variety of treatment options can improve symptoms and quality of life for babies and children. Many interventions can be started
immediately after receiving a diagnosis.
Medications
Various medications help control spastic movements, seizures, relieve pain, and manage other symptoms and related conditions:
 Baclofen or other muscle relaxants
 Diazepam
 Anticonvulsants
 Anticholinergics
 Antacids
 Stool softeners/laxatives
 Sleep aids
Surgery
Surgery is a critical part of treatment for many children with CP. Surgical procedures may improve mobility or manage
pain. Standard procedures include tendon or muscle release, the repair of hip dislocations, and scoliosis surgery.
Therapies
Several different types of therapies are used for children and babies with cerebral palsy. They can improve physical, mental, social, and
learning deficits. If started early, therapies for cerebral palsy can reduce impairment and lessen the risk of developing other associated
conditions.
Common types of therapy used to help children with cerebral palsy are:
 Physical
 Occupational
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10.  Feeding
 Aqua
 Horse and animal
 Music
 Play
 Behavioral
 Speech/Language
 Bowel program
Many children diagnosed with cerebral palsy have the same life expectancy as any other. This wasn’t always true, but earlier diagnosis
and better therapies have improved many health conditions for these children.
While CP does not usually shorten life expectancy, it does require early intervention and good medical care for the best outcomes.
This is especially true for those with severe disabilities.
Some of the conditions associated with cerebral palsy can be life-threatening if not treated. These include breathing and swallowing
difficulties (which can cause pneumonia or malnutrition), seizures, chronic nutritional deficiencies, or life-threatening pressure
infections.
Q.3 Mention the physical aberrance of the children suffering from Cystic Fibrosis.
Cystic fibrosis (CF) is an inherited disease in which the body makes very thick, sticky mucus. The mucus causes problems in
the lungs, pancreas, and other organs.
People with cystic fibrosis (SIS-tik fye-BROH-sis) get lung infections often. Over time, they have more trouble breathing. They also
have digestive problems that make it hard to gain weight.
CF can cause symptoms soon after a baby is born. The first sign a baby might have cystic fibrosis is an intestinal blockage called
meconium ileus. Other kids don't have symptoms until later on. Cystic fibrosis can be mild or severe, depending on the person.
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11. Symptoms of cystic fibrosis include:
 lung infections or pneumonia
 wheezing
 coughing with thick mucus
 bulky, greasy bowel movements
 constipation or diarrhea
 trouble gaining weight or poor height growth
 very salty sweat
Some kids also might have nasal polyps (small growths of tissue inside the nose), frequent sinus infections, and tiredness.
Newborn screening tests catch most cases of CF. If the screening test is positive, or if a child has cystic fibrosis symptoms, doctors do
a painless sweat test. They collect sweat from an area of skin (usually the forearm) to see how much chloride (a chemical in salt) is in
it. People with CF have higher levels of chloride.
Most children with CF are diagnosed by the time they're 2 years old. But someone with a mild form may not be diagnosed until they are
a teen.
Kids with CF will have it all their lives. Doctors use different medicines depending on a child's needs. But all people with CF need to:
 Loosen and clear mucus. There are different ways to do this. The doctor might recommend a child:
o get regular exercise
o use an inhaler or nebulizer
o do breathing exercises and cough on purpose
o wear a therapy vest that shakes the chest
o have chest physical therapy (when a parent or trained person bangs gently on the chest or back)
 Prevent or fight lung infections. Washing hands well and often, avoiding people who are sick, and staying at least 6 feet away from others with
CF can help prevent infections. Taking preventive antibiotics also can help.
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12.  Take enzymes. Most kids with CF need enzymes to help them digest food and get nutrients from it.
 Eat a high-calorie diet and take vitamin supplements, when needed.
Cystic fibrosis is caused by a change (mutation) in the gene that makes cystic fibrosis transmembrane regulator (CFTR) protein. To have
CF, a baby must get two copies of the CF gene, one from each parent.
In CF, the body makes abnormal CFTR protein or none at all. Without normal CFTR protein, the cells lining the pathways (tubes) inside
some organs make thick, sticky mucus rather than the normal thin, watery kind.
Thick mucus can trap bacteria in the lungs, leading to infection, inflammation, and breathing problems. Mucus also can block the path
where digestive enzymes flow between the pancreas and the intestines. This makes it hard for a child to digest food and get the vitamins
and nutrients they need from it.
Thick mucus can also affect the liver, the sweat glands, and the reproductive organs.
To help your child:
 Follow the treatment plan. Help your child stay as healthy as possible. Give medicines as directed, serve high-calorie meals and snacks, and
follow instructions for clearing chest mucus.
 Offer encouragement. Help your child find pastimes to enjoy, like art, music, reading, or learning to cook. It's important for kids with CF to
get exercise, so also look for ways your child can stay physically active. Maybe you can do some of them together.
 Turn to the care team. Your child's care team can offer practical tips on living with CF, and information about clinical trials, support groups,
and new therapies.
 Learn all you can about CF. Experts are always working on new treatments to help people with CF have a better quality of life and live
longer. Online, turn to resources like the Cystic Fibrosis Foundation website.
 Teach self-care as your child gets older. Start early to help your child understand and manage CF. Encourage an older child or teen to handle
some parts of their health care, like disinfecting equipment or asking questions at doctor visits. Ask the care team about ways you can help
your child get ready for things like going to college or getting a job. Learning about cystic fibrosis and its care helps kids and teens become
confident adults managing a chronic health condition.
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13. Q. 4 Write a comprehensive note on the education implication of the students with congenital heart diseases.
Most children with simple heart defects do not require any special care when they attend school. Those with more complicated heart
defects, however, may show signs that occasionally require attention. These signs include:
 Cyanosis: This is a blueness of the lips and nail beds that may increase with exercise but should not bother the student. It is caused by
reduced oxygen in the blood flow to the body.
 Increased fatigue: Children may tire more easily or may be short of breath after exercise.
 Increased susceptibility to chest infections: Students may be more likely to get common respiratory infections such as bronchitis and
pneumonia. In some types of heart disease, too much blood reaches the lungs, making them more susceptible to infection.
 Small size: Students with heart defects may be shorter or lighter than their classmates. Many children with congenital heart defects have
difficulty gaining weight.
If a CHD or its treatment has had a negative impact on cognitive development, this will become apparent at school age when children
have to meet specific cognitive and social benchmarks. This is more likely in a child with a complex heart condition. For example, a
child with a severe form of congenital heart disease, and has undergone a procedure such as a Fontan operation is likely to require extra
care or special attention at school. Children with transposition of the great arteries show lower overall scores on arithmetic, learning,
and general knowledge tests. In general, children with cyanotic defects and hypoplastic left heart syndrome appear to have lower abilities
in math, reading, and spelling. One study showed that about one in three children with a complex CHD requires extra help in school,
and another found that about 15% were assigned to a special education classroom. A child with CHD might be more likely to be
inattentive or hyperactive in the classroom. For these reasons, and other secondary consequences of a CHD such as missing multiple
classes for doctor’s visits or surgery, or having overprotective parents, about 1 in 10 children with severe CHD will need to repeat a
grade.
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14. What your child’s teacher needs to know
It is important that teachers know the nature of a student’s heart condition and the implications it has for school activities. For example,
if there are only five minutes between classes but a child with a heart condition needs ten minutes to travel from one class to another,
arrangements should be made to give the child the extra time to get to class and not be penalized for taking a few extra minutes. Parents,
cardiology clinic nurses, and physicians can provide you with information about the student’s health, permitted activity level,
medications, and future treatment.
Your child’s permitted activity level
Permitted activity levels are determined by your child’s health care team. In general, activity restrictions are graded in the following
manner:
 Full: The child is allowed to exercise at will and participate fully in all sports.
 No competitive sports: The child is allowed to exercise but is not allowed to participate in races, organized games, or team sports.
 Restricted: Please obtain specific guidelines from your child’s doctor.
If you have any questions about any activity restrictions, please contact your child’s doctor, or speak to the staff at your child’s cardiac
clinic.
Your child’s medications at school
Medication is usually taken at home. In cases where children need to take some medication while at school, it is helpful to make
arrangements with school board officials. The teacher should be kept informed of the medications your child is taking and of their
specific purpose.
Keeping your child’s teacher informed
Continuing contact with your child’s teachers will keep them informed about plans, if any, for your child’s future hospitalization. This
information can help the teacher identify and respond to your child’s needs and concerns. The prospect of hospitalization or surgery
may create anxiety, which sometimes results in changes in behaviour and performance at school.
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15. What to do if your child is going for surgery
To help your child prepare for surgery, you may want to discuss the date of surgery, the reason for it, the proposed length of
hospitalization, and the time needed to recover before they can return to school. You can also share this information with your child’s
teacher and determine whether it is all right for the teacher to discuss the surgery with your child or their classmates.
In order to maintain a degree of normalcy in the child’s life, many hospitals have a teacher on staff to help your child keep up with their
schoolwork. If your child is going to be in hospital longer than two weeks, continuation of schoolwork can at times be arranged.
A child in hospital can benefit from contact with their classmates. Speak to your child’s teacher about ways your child’s classmates can
get involved. It can take the form of get-well cards or audio cassettes sent to the hospital, or visits once the patient has returned home.
Returning to school after surgery: notes for teachers
Generally, children recover at home for about two weeks following heart surgery. A gradual return to school and other normal activities
is usually the recommendation. For example, a student may initially attend classes for half days for the first few days back at school.
Possible behavioural changes
You may see an improvement in the energy or activity level of a child after surgery. It is important for you to discuss with parents, or,
together with the parents, speak to the medical or nursing staff at the child's cardiac clinic regarding any changes in the limitations placed
on the student’s activities.
You may encounter some behaviour changes when the child returns to school. These changes may occur in response to hospitalization
and surgery and are usually temporary. Some children will require more of your time and attention than before surgery. Others
experience nightmares and disrupted sleep patterns, and tire more quickly than usual. All these things may affect their school behaviour.
Possible physical and mental effects due to surgery
Depending on the type and difficulty of the surgery, some students may experience vision problems, neurological impairments, or gross
and fine motor delays. This may be more common following open-heart surgery. These deficits can affect a child’s everyday functioning
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16. and social and emotional well-being. Prompt identification of deficits in any of these areas can lead to early interventions and improved
outcomes.
Support from teachers and the school board
Students with a congenital heart condition need your support to develop their full academic potential, since physical limitations may
exclude them from certain types of employment. Your help is essential. If a student has any special needs arising from a cardiac problem,
they should be referred for review by the appropriate school or board committee. Please discuss your student’s needs with the parents
or, together with the parents, speak to the medical or nursing staff at the child's cardiac clinic.
What can be done if your child is having problems learning
Experience has shown that the best way to teach children is using direct, one-on-one instruction. If your child is currently not getting
extra resources at school, find out what they are entitled to have and try to find ways to make sure they get help when needed.
Early intervention is important. In some cases, meeting with a neuropsychologist can be helpful. The doctor can do some testing and
determine where problems may lie and provide you with information. In general, children in Kindergarten and Grade 1 need to develop
their basic reading, writing, and math skills as much as they can – even beyond what their classmates are doing. Extra tutoring or other
supports are important even at this stage, before you see any changes.
In the classroom setting, discuss the following suggestions with teachers:
 Seat your child near the front of the classroom to help focus and avoid distraction.
 Provide less written work.
 Use visual tools to teach such as charts and illustrations.
 Use tape-recorded textbooks.
 Allow extra time for tests and assignments.
 Provide extra help with problem areas.
 Develop a modified learning regime.
 Provide special education.
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17.  Ask the teacher to “check in” with your child each day to see how they are doing.
In some instances, special education may be required. Older children who are having difficulty in school may do well in a special
vocational program at the high school level.
At home, children can benefit from an environment rich in language and numbers. As much as possible, reading lots of stories, doing
number rhymes and counting together, and working on math and reading exercise books will help. School-aged siblings may be able to
help as well. Teachers or a school liaison person may be able to recommend good resources to use at home.
Finally, you can help your child find a skill, interest or hobby at which they can excel. For example, your child’s creativity in art, dance
or a musical instrument may be the same or even greater than other children. Focus on your child’s successes.
Children may find it difficult to learn a second or third language. This may be an issue for families who speak more than one language,
or who do not speak English at home. Your child’s treatment team may have suggestions to deal with this issue.
Some of the learning problems that children can experience are:
 handwriting problems
 spelling problems
 reading problems
 math problems
 Attention and concentrationproblems such as when a child may be inattentive, hyperactive, or both. They may not be able to concentrate
for extended periods of time.
 Slowness in completing tasks compared to other children.
 Memory difficulties. For example, a child may study a topic, but not remember it the next day.
 Difficulty planning and organizing, such as when a child has difficulty finishing assignments, expressing ideas in writing or verbally, or
finding the way to school.
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18. The emotional impact of learning problems
Although the majority of children with CHD seem to function at a normal level, there are some children who are at a greater risk of
developing emotional problems. If your child develops learning problems as a result of their heart condition or its treatment, they may
become frustrated or angry with themselves. Tasks that they once did routinely may become more difficult. They may see their
classmates moving ahead at a faster pace than he can. When that anger is unexpressed, anxiety or depression may result. Children’s
difficulties in school may not be clearly evident in the classroom since many children who have CHD internalize their emotions and
keep any anxiety or fears to themselves.
It can be helpful to talk to your child about these problems, to understand how they feel and to figure out how you can help deal with
any issues. Some other ideas that may help your child are:
 Focus on your child’s skills and talents. This can help enhance creativity. Consider providing opportunities for them to show off their skills.
 Advocate for your child in school. Creating a supportive environment in school with their teacher and classmates will make it easier for
your child. Their learning will be assisted when extra supports are available.
 Emphasize your child’s personality. Rather than focusing on grades, praise your child’s behaviour and efforts when appropriate.
Q.5 How could you manage a child with hemophilia with reference to the complication of disease and education?
Hemophilia is an inherited bleeding disorder. Children with hemophilia can’t stop bleeding because they don’t have enough clotting
factor in their blood. Clotting factors are needed for blood to clot. Blood clots to prevent excessive bleeding.
There are many blood clotting factors involved in the forming of clots to stop bleeding. Two common factors that affect blood clotting
are factor VIII and factor IX.
How severe your child’s hemophilia is depends on the level of blood clotting factors in his or her blood.
The 3 main forms of hemophilia include:
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19.  Hemophilia A. This is caused by a lack of the blood clotting factor VIII. About 9 out of 10 people with hemophilia have type
A disease. This is also referred to as classic hemophilia or factor VIII deficiency.
 Hemophilia B. This is caused by a deficiency of factor IX. This is also called Christmas disease or factor IX deficiency.
 Hemophilia C. Some doctors use this term to refer to a lack of clotting factor XI.
Hemophilia types A and B are inherited diseases. They are passed on from parents to children through a gene on the X chromosome.
Females have two X chromosomes, while males have one X and one Y chromosome.
 A female carrier has the hemophilia gene on one of her X chromosomes. When a hemophilia carrier female is pregnant, there is
a 50/50 chance that the hemophilia gene will be passed on to the baby.
o If the gene is passed on to a son, he will have the disease.
o If the gene is passed on to a daughter, she will be a carrier.
 If the father has hemophilia but the mother does not carry the hemophilia gene, then none of the sons will have hemophilia
disease, but all of the daughters will be carriers.
In about one-third of the children with hemophilia, there is no family history of the disorder. In these cases, it’s believed that the disorder
could be related to a new gene flaw.
Carriers of the hemophilia gene often have normal levels of clotting factors but may:
 Bruise easily
 Bleed more with surgeries and dental work
 Have frequent nosebleeds
 Have heavy menstrual bleeding
Hemophilia C usually doesn’t cause problems, but people may have increased bleeding after surgery.
What are the symptoms of hemophilia?
The most common symptom of this disorder is heavy, uncontrollable bleeding.
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20. The severity of hemophilia depends on the amount of clotting factors in the blood. Those affected with hemophilia that have
levels greater than 5% (100% being average for unaffected children) most often have bleeding only with major surgeries or tooth
extractions. These children may not even be diagnosed until bleeding complications from a surgery occur.
Severe hemophilia is when the factor VIII or IX is less than 1%. Bleeding can occur in these children, even with the minimal activities
of daily life. Bleeding may also occur from no known injury. Bleeding most often occurs in the joints and in the head.
Your child's symptoms may also include:
 Bruising. Bruises can occur from even small accidents. This can result in a large build up of blood under the skin causing
swelling (hematoma). For this reason, most children are diagnosed around 12 to 18 months of age. This is when the child is more
active.
 Bleeds easily. A tendency to bleed from the nose, mouth, and gums with minor injury. Bleeding while brushing teeth or having
dental work often suggests hemophilia.
 Bleeding into a joint. Hemarthrosis (bleeding into a joint) can cause pain, immobility, and deformity if not treated. This is the
most common site of complications due to hemophilia bleeding. These joint bleeds can lead to chronic, painful, arthritis,
deformity, and crippling with repeated occurrences.
 Bleeding into the muscles. Bleeding into the muscles can cause swelling, pain, and redness. Swelling from excessive blood in
these areas can increase pressure on tissues and nerves in the area. This can cause permanent damage and deformity.
 Bleeding in the brain from injury or spontaneously. Bleeding from injury, or spontaneously in the brain, is the most
common cause of death in children with hemophilia and the most serious bleeding complication. Bleeding in or around the brain
can occur from even a small bump on the head or a fall. Small bleeds in the brain can result in blindness, intellectual disability,
a variety of neurological deficits. It can lead to death if not spotted and treated right away.
 Other sources of bleeding. Blood found in the urine or stool may also signal hemophilia.
The symptoms of hemophilia may look like other problems. Always check with your child's doctor for a diagnosis.
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21. How is hemophilia in children diagnosed?
he diagnosis of hemophilia is based on your family history, your child's medical history, and a physical exam. Blood tests include:
 Complete blood count (CBC). A complete blood count checks the red and white blood cells, blood clotting cells (platelets),
and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red
blood cells.
 Clotting factors. To check the levels of each clotting factor.
 Bleeding times. To test the speed that blood clots.
 Genetic or DNA testing. To check for abnormal genes.
How is hemophilia treated?
Your child's healthcare provider will refer you to a hematologist, an expert in blood disorders. Your child’s health care provider will
figure out the best treatment based on:
 How old your child is
 His or her overall health and medical history
 How sick he or she is
 How well your child can handle specific medications, procedures, or therapies
 How long the condition is expected to last
 Your opinion or preference
Treatment depends on the type and severity of the hemophilia. Treatment for hemophilia is aimed at preventing bleeding complications
(mainly head and joint bleeds). Treatment may include:
 Bleeding in the joint may need surgery or immobilization. Your child may need rehab of the affected joint. This may include
physical therapy and exercise to strengthen the muscles around the area.
 Blood transfusions may be needed if major blood loss has occurred. This is when your child gets donated blood.
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22.  Self-infused factor VIII or IX can allow a child with hemophilia to lead a near normal lifestyle.
What are the complications of hemophilia?
Complications of hemophilia include:
 Bleeding in the joints or muscles
 Inflammation of the joint lining
 Long-term joint problems
 Very serious tumor-like enlargements, of the muscle and bone
 Development of antibodies against clotting factors
 Infections from transfusions (HIV and hepatitis B and C are no longer transmitted in donated blood)
ASSIGNMENT No. 2
Q.1 Design and implement the environment based on the Least Restricted Environment for the Physically Handicapped Children as a
Headmaster/headmistress in Pakistan.
When 4-year-old Kayla started at a Montessori pre-school and childcare program, the school district recommended that she leave
Montessori daily and take a bus to another preschool for special services. At the other preschool, the district would provide time with
an early childhood special education (ECSE) teacher, as well as physical and occupational services.
“But once we tried the system, I started to wonder why I was pulling her out of a setting where she was functioning well,” said Kayla’s
mother, Madeleine. “I wanted her to meet her IEP goals, but I didn’t want her to leave the Montessori school.”
Kayla’s Individualized Education Program (IEP) emphasized learning social skills and gross and fine motor skills. Specific activities
included Kayla participating in a game of “Duck, Duck, Grey Duck” with her peers, going down the slide during playground time,
initiating play with her classroom friends, and playing dress-up with her peers.
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23. By being pulled out of the Montessori preschool program, Kayla was losing time needed to become acquainted with her peers, play
confidently with them, and feel comfortable approaching them.
“How would she learn social skills, like playing ‘Duck, Duck, Grey Duck,’ without her peers?” Madeleine said. “I realized that pulling
her out of the Montessori school didn’t allow her to function in her least restrictive environment (LRE).”
Least restrictive environment (LRE) is a requirement under the Individuals with Disabilities Education Act (IDEA), which states that:
“...to the maximum extent appropriate, children with disabilities, including children in public and private institutions or other care
facilities, [be] educated with children without disabilities, and that special classes, separate schooling, or other removal of children
with disabilities from regular educational environments occur only when the nature or severity of the disability is such that education
in regular classes with the use of supplementary aids and services cannot be achieved.”
With that in mind, Madeleine questioned if Kayla would succeed in school while going back and forth between both programs. She
asked the school district if they could provide the services at the Montessori school. Now, Kayla receives physical and occupational
therapy for a half-hour every week with the peers she sees on a regular basis. Minnesota has had a long history of including children
with disabilities in regular education and preschool environments, and there has been state support for inclusive services, said Norena
Hale, state director of special education at the Minnesota Department of Education.
“But still, the model of services for 3-year-olds has been to try to serve them in a classroom instead of serving them where they are
learning naturally,” she said. “Children have a right to a free, appropriate education in a setting that is as ‘normal’ as possible. You
only remove children from that setting, even part-time, when support or adapted services would be more effective to provide in
another way, and the IEP team, which includes parents, makes those decisions.”
For children ages 3-5, a childcare center could be considered the least restrictive environment, if that is where the child usually goes
every day. For other children, the least restrictive environment might be the local Head Start program, a half-day preschool, or at
home.
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24. For Jolie Cummins, the least restrictive environment for her son, Charlie, is not the typical kindergarten program in his school district,
but a slightly modified program with five other children with disabilities.
Charlie, who has Down syndrome and is nonverbal, attends a program where he experiences a typical classroom with 25 children as
well as a self-contained classroom for six children with disabilities. With his aide, Charlie experiences circle time with the 25- student
classroom, but then he goes to his smaller classroom to draw when the other students are working on writing the alphabet.
“This program gives the students a safe place to be,” said Jolie. “Charlie and the other children with disabilities start their day in the
self-contained classroom where they hang up their coats, choose their lunch for the day, and receive some individual attention. If
Charlie was always in the typical classroom, he could get lost in the shuffle.”
So far, Charlie’s program is a perfect fit. He goes on field trips regularly—bowling and swimming with the small class, for example—
which would be very difficult in a typical kindergarten classroom, his mother said. He enjoys school, and he has been invited to a
birthday party by one of the children in the typical classroom.
“My goal is for Charlie to be as independent as possible,” Jolie said. “I believe this program will help him reach those goals.”
(i) Each public agency shall ensure—
(ii)That to the maximum extent appropriate, children with disabilities, including children in public or private institutions or other
care facilities, are educated with children who are nondisabled; and
(1) That special classes, separate schooling or other removal of children with disabilities from the regular educational environment
occurs only if the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and
services cannot be achieved satisfactorily.
§300.115 Continuum of Alternative Placements
(a)Each public agency must ensure that a continuum of alternative placements is available to meet the needs of children with
disabilities for special education and related services.
(b) The continuum required in paragraph (a) of this section must—
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25. (1)Include the alternative placements listed in the definition of special education under §300.38 (instruction in regular classes, special
classes, special schools, home instruction, and instruction in hospitals and institutions); and
(2)Make provision for supplementary services (such as resource room or itinerant instruction) to be provided in conjunction with
regular class placement.
Common Translation
The “public agency” is the school. The school is responsible for making sure that children with disabilities are educated alongside
children without disabilities as much as appropriate. “Appropriate” means that the education fits the child’s special needs and allows
the child to make educational progress.
The regular education classroom is the first placement choice the IEP team must consider.
When an IEP team considers where a child will be educated, they must ask, What can we provide so this child can stay in the regular
education classroom or activity? They must consider what “supplementary aids and services”—what extra supports—will allow the
child to be placed in a regular classroom environment. Examples might include assistive equipment, special behavior strategies, use
of a resource room, or changes in the curriculum or assignments.
If the IEP team decides a child cannot be educated in the regular classroom even with supplementary aids and services, then they
must consider other options: special classes, special schools, home instruction, or instruction in hospitals or other institutions.
The school is required to make the appropriate option available, based on the child’s individual needs and the services required to
meet those needs.
IDEA Regulation
§300.116 Placements
In determining the educational placement of a child with a disability, including a preschool child with a disability, each public agency
shall ensure that—
(a) The placement decision—
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26. (1)Is made by a group of persons, including the parents, and other persons knowledgeable about the child, the meaning of the
evaluation data, and the placement options; and
(2) Is made in conformity with the LRE provisions of this subpart, including §§300.114-300.118;
(a) The child’s placement—
(1) Is determined at least annually;
(2) Is based on the child’s IEP; and
(3) Is as close as possible to the child’s home;
(c)Unless the IEP of a child with a disability requires some other arrangement, the child is educated in the school that he or she would
attend if nondisabled;
(d) In selecting the LRE, consideration is given to any potential harmful effect on the child or on the quality of services that he or she
needs; and
(e)A child with a disability is not removed from education in age-appropriate regular classrooms solely because of needed
modifications in the general curriculum.
§300.117 Nonacademic settings
In providing or arranging for the provision of nonacademic and extracurricular services and activities, including meals, recess periods,
and the services and activities set forth in §300.107, each public agency must ensure that each child with a disability participates with
nondisabled children in those extracurricular services and activities to the maximum extent appropriate to the needs of that child. The
public agency must ensure that each child with a disability has the supplementary aids and services determined by the child’s IEP
Team to be appropriate and necessary for the child to participate in nonacademic settings.
§300. 320(a) Participation with Nondisabled Children
(5) An explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular class and in
the activities described in paragraph (a)(4) of this section.
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27. Common Translation
Parents, as members of the IEP team, help decide what educational placement and services are appropriate for their child. The team
must discuss educational placement at least once a year when a new IEP is written. Placement decisions must be based on the child’s
individual needs for specific educational services.
The IEP team must consider whether the proposed placement will have any possible harmful effects on the child or on the quality of
the services the child receives.
Further, children with disabilities should be educated in their home schools whenever possible, and they must not be removed from
the regular classroom simply because they need a modified curriculum.
Children with disabilities must have an equal opportunity to participate in all activities sponsored by the school: counseling services,
athletics, transportation, special interest groups and clubs, music, and other services and activities.
Anytime a child with disabilities has education or other school activities that include only other children with disabilities, the school
must provide an explanation in the IEP.
Q.2 Describe the reaching practices in a regular classroom with Physically Handicapped Children.
When teaching a student with any disability, it is important to remember that many of the principles for inclusive design could
be considered beneficial to any student. The idea of “Universal Design” is a method of designing course materials, content, and
instruction to benefit all learners. Instead of adapting or retrofitting a course to a specific audience, Universal Design emphasizes
environments that are accessible to everyone regardless of ability. By focusing on these design principles when crafting a syllabus, you
may find that most of your course easily accommodates all students. Many of Universal Design’s methods emphasize a deliberate
type of teaching that clearly lays out the course’s goals for the semester and for the particular class period. For instance, a syllabus with
clear course objectives, assignment details, and deadlines helps students plan their schedules accordingly. Additionally, providing an
outline of the day’s topic at the beginning of a class period and summarizing key points at the end can help students understand the
logic of your organization and give them more time to record the information.
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28. Similarly, some instructional material may be difficult for students with certain disabilities. For instance, when showing a video in class
you need to consider your audience. Students with visual disabilities may have difficulty seeing non-verbalized actions; while those
with disorders like photosensitive epilepsy may experience seizures with flashing lights or images; and those students with hearing loss
may not be able to hear the accompanying audio. Using closed-captioning, providing electronic transcripts, describing on-screen action,
allowing students to check the video out on their own, and outlining the role the video plays in the day’s lesson helps reduce the access
barrier for students with disabilities and allows them the ability to be an active member of the class. Additionally, it allows other students
the opportunity to engage with the material in multiple ways as needed.
Q.3 Write a detailed note on the Hospital Educational Program designed for the Physically Handicapped Children.
The Individuals with Disabilities Act requires that students with disabilities receive physical education services, specially designed if
necessary. If your child has a disability and an IEP, the school must provide physical education as part of your child's special education
program.
Many students with disabilities can safely and successfully participate in general physical education, with or without accommodations
and supports. However, some children benefit from specially designed or adapted physical education. Content in adapted physical
education should mirror the general physical education curriculum to the greatest extent possible.
Because physical education is a required component of special education, your child's general and/or adapted physical education teacher
should be included as a member of the IEP team if the student is receiving specially designed physical education.
At a minimum, if your child is receiving specially designed or adapted physical education, the IEP should include a summary of present
level of performance in physical education content, the frequency and duration (minutes and days per week or stipulated time period)
of physical education services, measurable goals and objectives about content, and the placement where these services are provided.
Like all other special education and related services, physical education instruction should be detailed in the IEP.
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29. Note: These required physical education services are different and separate from related services such as physical and occupational
therapy. Best practice is a “motor team” approach or service delivery model where adapted and general physical education teachers and
related service personnel work collaboratively to meet the unique needs of students with disabilities.
Physical Education Content and Requirements in IDEA
34 C.F.R.300.39(b)(2) IDEA defines "physical education" as the development of:
 Physical and motor skills
 Fundamental motor skills and patterns
 Skills in aquatics, dance, and individual and group games and sports (including intramural and lifetime sports)
 Includes special physical education, adapted physical education, movement education, and motor development
20 U.S.C. 1401(29) Special Education. The term 'special education' means specially designed instruction, at no cost to parents, to meet
the unique needs of a child with a disability, including -
(A) instruction conducted in the classroom, in the home, in hospitals and institutions, and in other settings; and
(B) instruction in physical education.
34 CFR 300.108 Physical Education. The State must ensure that public agencies in the State comply with the following:
(a) General. Physical education services, specially designed if necessary, must be made available to every child with a disability
receiving FAPE, unless the public agency enrolls children without disabilities and does not provide physical education to children
without disabilities in the same grades. [See Commentary to IDEA below for more information on this often confused "grade level"
misconception.]
(b)Regular physical education. Each child with a disability must be afforded the opportunity to participate in the regular physical
education program available to nondisabled children unless -
(1) The child is enrolled full time in a separate facility; or
(2) The child needs specially designed physical education, as prescribed in the child's IEP.
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30. (c)Special physical education. If specially designed physical education is prescribed in a child's IEP, the public agency responsible for
the education of that child must provide the services directly or make arrangements for those services to be provided through other
public or private programs.
(d) Education in separate facilities. The public agency responsible for the education of a child with a disability who is enrolled in a
separate facility must ensure that the child receives appropriate physical education services in compliance with this section.
Wrightslaw: Special Education Law, 2d Edition, p. 55, p. 202, and p. 206.
Interpretation of the PE Requirement by the U.S. Department of Education
Commentary to IDEA (page 46583) discusses when PE is required for students with disabilities beyond the grade level requirement of
nondisabled peers.
Note: This is a very important clarification that is often not known or understood by school district personnel since it appears in the
discussion section of the IDEA regulations in the Federal Register. You should bring this clarification to the attention of school officials
if PE is being characterized as a grade level requirement based on what nondisabled peers receive.
1. Physical education must be made available equally to children with disabilities and children without disabilities.
2.If physical education is specially designed to meet the unique needs of a child with a disability and is set out in that child’s IEP, those
services must be provided whether or not they are provided to other children in the agency.
From H. Rpt. No. 94–332, p. 9, (1975):
Special education as set forth in the Committee bill includes instruction in physical education, which is provided as a matter of course
to all non-handicapped children enrolled in public elementary and secondary schools. The Committee is concerned that although these
services are available to and required of all children in our school systems, they are often viewed as a luxury for handicapped children.
US Department of Education - Office of Special Education Programs: Policy Letters, Guidance, and Clarification
The following letters from the US Department of Education clarify some common misconceptions about PE services for students with
disabilities.
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31. The two letters below cover the age range of required PE services for students with disabilities (3-21 years). The preschool and high
school transition ages are often overlooked. These periods are important times for motor development, health-related fitness, sport skills,
aquatics, community-based physical activity, and many other content areas common in general and adapted physical education
programs.
Applicability of Physical Education for Children (Age 18-21) with Disabilities in Transition Program, OSEP Policy Letter to Luke
Kelly, October 23, 2013
Applicability of Physical Education for Preschool Children with Disabilities, OSEP Policy Letter to Garth Tymeson, July 31, 2013
The next letter clarifies that other subjects or services cannot be substituted for or replace required PE.
Denying Mandatory Physical Education Instruction for Children with Disabilities, OSEP Policy Letter to James Irby, February 12, 2010
The following Guidance Document provides information about extracurricular athletics or sports for students with disabilities. Section
300.107 of IDEA includes information on Nonacademic Services, including extracurricular athletics or sports. These services are a
required part of special education.
The state must ensure the following: (a) Each public agency must take steps, including the provision of supplementary aids and services
determined appropriate and necessary by the child’s IEP Team, to provide nonacademic and extracurricular services and activities in
the same manner necessary to afford children with disabilities an equal opportunity for participation in those services and activities, (b)
Nonacademic and extracurricular services and activities may include counseling services, athletics, transportation, health services,
Schools’ Obligation to Provide Equal Opportunity to Students with Disabilities to Participate in Extracurricular Athletics, OCR
Guidance Document, January 25, 2013.
Adapted Physical Education
Adapted or specially designed physical education (APE) is about meeting the unique needs of individual students with disabilities. In
APE, the instructor provides planning and assessment, consultation for general physical education teachers, specially designed
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32. instruction, and adapts or modifies the curriculum, task, equipment, and/or environment so a child can participate in all aspects of
physical education.
APE and general physical education teachers work together to design meaningful and beneficial instruction for all students.
APE Certification for Teachers
It is common for teachers to specialize or have advanced preparation in adapted physical education. National and state level
adapted physical education teacher certifications or licenses exist.
Adapted Physical Education National Standards (APENS). The mission of APENS is to promote the 15 Adapted Physical Education
Standards and national certification exam. The goal of APENS is to ensure that all students who qualify for specially designed physical
education services receive them from a "qualified" teacher. Teachers who pass the APENS exam receive CAPE recognition (Certified
Adapted Physical Educator).
Some individual states also have add-on teaching licenses or certifications in adapted physical education. The following states have
separate teaching licenses in adapted physical education: CA, LA, ME, MI, MN, NE, OH, OR, RI, SD, WI, and WY.
Talk with your school district. Ask about teacher qualifications. Encourage your district to hire staff who are qualified to teach adapted
or specially designed PE.
See the directory below for samples of many adapted physical education teacher preparation programs.
NCPEID National Directory of APE Teacher Preparation Programs
Preparing Qualified and Effective Adapted Physical Educators to Improve Outcomes for Students with Disabilities. Personnel
development in adapted physical education can lead to meaningful student success and positive education outcomes. This Webinar from
the National Center to Improve Recruitment and Retention of Qualified Personnel for Children with Disabilities highlights the roles &
responsibilities and preparation of adapted physical education (APE) teachers.
Q.4 Illustrate the essential variables to consider in student placement of Physically
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33. There was a time when people thought of special education as a place. But that really isn’t the case any longer. Special education instead
refers to services that are used to meet the learning needs of students with disabilities. You can find out more about special education
terms and services on our Special Education 101 page.
Special Education Placement Options
Once your child’s Admission, Review, and Dismissal (ARD) committee (which you are a part of) has developed your
child’s Individualized Education Program (IEP), the next step is to decide on an educational placement.
Placement refers to the amount of time in each school day that a student spends in the resource or in a general education classroom. The
school district is required to have a range of placements where your child can be taught, including in the general education classroom.
In deciding your child’s placement, the ARD committee must make sure your child spends as much of their school day (as is appropriate)
with children who do not have disabilities. This includes academic, nonacademic, and after school activities. This part of IDEA is called
Least Restrictive Environment or LRE. And, in this case, the word "appropriate" follows the definition of Free Appropriate Public
Education (FAPE).
The LRE for children with disabilities depends on each child’s unique needs. It’s important to know that the school district cannot use
a “one size fits all” approach to educating children who have disabilities.
The Educational Setting
There are some common placements in which students might get specific services. Teams of trained teachers and aides are in all types
of placements.
A student could be placed in a single setting all day or spend parts of the day in different settings. For example, a student in a mainstream
education classroom all day might receive special education services in the same general education classroom as part of regularly
scheduled instruction time. Or, a student might go to different educational settings for part – or all – of the day to receive special
education services.
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34. There shouldn’t be any surprises, because educational placement is part of an Individualized Education Program (IEP) created by your
child’s ARD committee. You are a part of this committee and have the right to agree with (or disagree with) your child’s placement. To
learn more about what to do when you disagree with your child's placement, see our When You’re Having Trouble Getting the Right
Services for Your Child page.
Here are some educational settings your child could have:
 Mainstream (many people refer to this as General Education): Many students receive special education and related services in a general
education classroom where peers without disabilities also spend their days. This is called inclusion. Some services that a student might
receive in a mainstream setting include: direct instruction, a helping teacher, team teaching, co-teaching, an interpreter, education aides,
modifications or accommodations in lessons or instruction, or more teachers per student.
 Resource: This is a class for students who receive special educationservices and need intensive help to keep up with grade-level work. The
class may have 1 or 2 students, or may have many students. However, students receive instruction or support based on their unique needs.
The number of minutes your child spends in a resource class must be written into the IEP.
 Self-Contained Programs: This is a general term for placements for which the student needs to receive services outside of the general
education classroom for half of the school day or more. Placement in a self-contained classroom has to be based on a student’s unique
needs, not on the disability alone.
Programs That Often Have Specialized Settings
Each school district is going to offer its own set of special education programs and services, and the names of these programs will be
different. However, here are 4 examples of programs often delivered in specialized settings that we thought you should know about:
 Preschool Program for Children with Disabilities (PPCD): This is a set of special education services for children age 3 to 5. PPCD services
can take place in different settings, including a child development center, Head Start, a private preschool,or right on an elementary school
campus. Any PPCD placement can include related services like occupational, physical, or speech therapy. See our PPCD page to learn more.
 Life Skills: This helps students with many different types of disabilities but generally those who need support with academic, social, or
behavioral issues as well as daily living skills. Students who receive services in this program may stay until they turn 22 years old.
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35.  Social Behavior Skills (SBS): This goes by different names in different districts. It is also called Applied Behavior Skills or just Behavior Skills.
In this program, trained teachers help students learn decision-making and social skills (to promote self-responsibility) with other peers
around. SBS is a separate classroom that children can stay in full-time or part-time, depending on their IEP.
 Transition or 18+: A small number of students may stay enrolled in special education services until they turn 21 or 22 years old (depending
on which calendar month they turn 22), even after they have graduated with a certificate of completion. Students are able to get into
these programs if it is approved by their ARD committee and written into their IEP before they graduate. Most of these programs are
designed to help the student build more independence and get ready to go out into the workforce. Students might stay in the classroom
for some of the day and go to job training for the rest of the day. You can find out more on our Transitioning Out of Public Education page.
Q.5 Mention the cautions in testing process of the Physically Handicapped Children in a school environment.
More than a billion people—approximately 15 percent of the world’s population—have some type of disability (World Health
Organization [WHO], 2011) including sensory disabilities (such as blindness and deafness), intellectual disabilities, developmental
disabilities, physical disabilities, and psychosocial disabilities. Although some individuals may acquire a disability as adults, many are
born with a disability or acquire a disability in childhood. The United Nations Children’s Fund (UNICEF) estimates that 150 million
children under the age of 18 have a disability. Such children often require special education services in school (UNICEF, 2005).
The United Nations Convention on the Rights of Persons with Disabilities (CRPD), adopted in 2006, mandates that children with
disabilities have access to inclusive education. Inclusive education means that children do not attend segregated schools based on
disability, but are instead educated in their local schools alongside their peers, with appropriate supports. As a result, many of the 177
countries (as of April 2018) that ratified the CRPD are developing new systems and supports to promote and ensure inclusive education
opportunities for all children with disabilities (United Nations, 2006). Developing an inclusive education system, however, is often
arduous and complicated for many countries.
Complicating this educational reform process are the challenges of identifying students with disabilities. Some disabilities may be
apparent (e.g., mobility impairment), but others—such as learning disabilities—cannot be determined based on appearances alone.
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36. A learning disability is a neurological disorder that affects a student’s ability to read, write, spell, reason, and organize information
taught in conventional ways (Learning Disabilities Online, 2017). When given the appropriate classroom supports, (more...)
Identifying a student with a learning disability requires
 a multistep process
 the use of tools and resources that are translated and adapted to the local cultural context, and
 the participation of a multidisciplinary team of experts.
Many countries recognize the need to support students with learning disabilities and are looking for ways to provide that support.
Unfortunately, in doing so, many have moved straight to trying to identify learning disabilities without having the needed systems, tools,
and practices in place to do it effectively. This type of identification goes against international best practices. An incomplete or
ineffective screening and evaluation process can lead to large rates of misdiagnosis, and students may not receive the services and
supports they need to be academically successful.
RTI takes seriously the imperative to address the needs of vulnerable children and to give all children the best possible education. In all
of its projects, RTI promotes equitable, quality inclusive education, helping governments to put policies and mechanisms in place to
meet that long-term goal. This guide is one in a series of guides intended to support school systems, schools, and teachers as they meet
the learning needs of their students, including students with disabilities.
High-incidence disabilities, like learning disabilities, speech challenges, behavioral challenges, and mild intellectual disabilities,
generally affect 80 percent of all students receiving special education services in United States schools (Friend & (more...)
This guide is a complementary resource to existing resources and tools for inclusive education that RTI developed: School and
Classroom Disabilities Inclusion Guide for Low- and Middle-Income Countries and Disabilities Inclusive Education Systems and
Policies Guide in Low- and Middle-Income Countries. Before they review this guide on learning disabilities, readers who are just
learning about inclusive education practices will find it beneficial to review these two other foundational guides first.
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37. The School and Classroom Guide provides information on differentiating instruction that benefits all students, regardless of whether
they have been identified as having a disability. The School and Classroom Guide is a useful resource for teachers as they begin to
provide services to students with learning disabilities without having the systems in place to effectively conduct screenings and
evaluations. The School and Classroom Guide also introduces basic concepts of Response to Intervention (see page 10), one screening
method to identify and address learning challenges.
The Disabilities Inclusive Education Systems and Policies Guide in Low- and Middle-Income Countries offers additional information
to government representatives and policymakers on systematic interventions and programs that support students with learning
disabilities in the classroom.
The concept of learning disabilities is thought to have originated in the United States in the 1960s. Learning disability is recognized as
one of the 13 categories of disability within the Individuals with Disabilities Education Act (IDEA), the comprehensive education law
for individuals with disabilities in the United States. Although the definition of learning disability has slight variations, the IDEA defines
it as a “disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written,
that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations” (US
Department of Education, Office of Special Education Programs [OSEP], 2004). However, many countries have yet to officially
recognize learning disabilities. For example, many African countries have no formal local definitions of learning disabilities or high-
incidence disability, and students with learning disabilities are typically not recognized in the classroom (Abosi, 2007). Likewise, the
Indian government does not formally recognize learning disabilities within its policies or programs (Ahmad, 2015).
Another challenge is that different terminology can be used in different countries to refer to the same conditions. The United States
uses learning disabilities, Australia and Zimbabwe use learning disabilities or learning difficulties, while Belgium uses the
term instrumental disabilities. In some countries, the terminology used for children with disabilities can be highly disparaging and
discriminatory. For example, some communities in northern Ghana use terms such as Zu’kpinglana and Zuuku (deadhead and empty-
head, respectively) to describe children who exhibit challenges in learning. This lack of a common definition or understanding of learning
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38. disabilities presents challenges in identifying and providing services to students. Throughout this report and all of its work, RTI uses the
term learning disability.
Forms of learning disabilities. Common forms of learning disabilities include those shown in Table 1, as defined by the Learning
Disabilities Association of America.
Learning disabilities can vary significantly in severity and how they affect an individual’s ability to learn. Teachers may not recognize
that multiple types of learning disabilities can occur and may use a one-size-fits-all approach when determining supports for students.
From the opposite side of this spectrum, students may have documentation that indicates that they have a learning disability without
identifying the specific disability or the area of learning that is impacted. This practice can prevent a student from receiving specialized
supports.
Prevalence estimates. Estimates for learning disabilities vary depending on the method of data collection, resulting in significantly
different prevalence rates even within the same country. For example, a study in Belgaum, India, found that 15 percent of primary school
students between the ages of 8 and 11 had some form of learning disability (Mogasale et al., 2012). Another study in Kerala, India,
which identified students through local teachers in a different city, estimated that only 2 percent of students had a learning disability
(Gafoor, 2015). In the United States, 5 percent of all students in school have been identified as having a specific learning disability, and
another 15 percent or more of students are believed to have unidentified learning and attention difficulties (Cortiella & Horowitz, 2014).
Identification challenges. Identifying learning disabilities can be challenging for several reasons. Although some students have obvious
low-incidence disabilities such as mobility or sensory disabilities, students with learning disabilities are physically and often
behaviorally difficult to distinguish from students without disabilities, particularly outside of school settings (Friend & Bursuck, 2012).
Furthermore, not all learning challenges are caused by a learning disability. Students without disabilities may also have academic,
emotional, and behavioral difficulties that can result in learning challenges, even without an underlying disability (National Association
of Special Education Teachers, n.d.). Other disabilities (such as low vision or hearing difficulties), linguistic or cultural differences, and
environmental factors (e.g., poor nutrition or lack of prior formal education) may also cause learning difficulties (Aro & Ahonen,
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39. 2011; Fernald et al., 2009; National Joint Committee on Learning Disabilities [NJCLD], 2010). Such factors must be ruled out as causes
of learning difficulties during the screening or evaluation process; neglecting to do so may lead to misdiagnosis.
Dispelling Myths Related to Learning Disabilities
Learning disabilities occur in every culture, race, ethnicity, and socioeconomic status. Common misperceptions about learning
disabilities, however, can impact the way in which students are identified and the services they receive. This section helps to dispel
some of the more frequently held myths about learning disabilities.
Myth #1: Persons with learning disabilities are lazy, do not want to learn, and cannot be successful. Academic challenges caused
by a learning disability do not indicate laziness or an inability to learn. With proper accommodations and supports, students with learning
disabilities can succeed in school. Supporting these students in school can help lead to further success, as adults with learning disabilities
successfully pursue higher education and work in virtually all career fields.
Myth #2: Persons with learning disabilities are less intelligent. Having a learning disability does not affect a student’s intelligence.
In fact, some students with learning disabilities are gifted.4 Although students with learning disabilities may “appear to be functioning
adequately in the classroom, their performance may be far below what they are capable of, given their intellectual ability” (NJCLD,
2011, p. 2). Having a learning disability does not mean that a student does not have the capacity to learn, but rather benefits from learning
materials and concepts using alternative methods.
Myth #3: Learning disabilities can only be identified once a student is fully literate. Many countries do not provide early
identification services for learning disabilities, often because of the misperception that identifying a student with a disability is related
to literacy skills. For instance, learning disability evaluation in the Indian city of Bangalore generally takes place during the seventh
grade, after a student has experienced years of academic underachievement (Thomas & Whitten, 2012). Although many students are
identified as having learning disabilities because they have trouble learning to read, other students with learning disabilities do not
display challenges in reading and writing. Therefore, identifying a potential vulnerability or screening for learning disabilities can and
should begin before a student learns to read: as early as age 3, children can exhibit signs and indicators of learning disabilities (Lange
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40. & Thompson, 2006). Table 2 shows examples of signs of learning disabilities at different ages. Identifying a learning challenge as early
as possible is ideal, because early educational interventions are much more likely to yield long-term gains than those implemented at
higher grades or in adulthood. Early identification has been tied to positive life outcomes such as higher academic performance, increased
likelihood of graduating from secondary school, and decreased likelihood of committing crimes (Heckman & Masterov, 2005).
Myth #4: People with learning disabilities outgrow them by adulthood. A learning disability is a lifelong condition (National
Institutes of Health, 2017). Although many adults adopt coping mechanisms and strategies to reduce the impact of their learning
disabilities, some continue to struggle with learning difficulties throughout adulthood. Learning disabilities are not usually curable,
though many adults select careers that reinforce their strengths rather than positions that may be more challenging due to their learning
disability.
Myth #5. Learning disabilities are caused by a curse or by sin. In many cultures worldwide, disability is seen as a curse, the result
of a sin, or a punishment for doing something wrong (Wa Munyi, 2012). For this reason, many children with disabilities are hidden, and
many families are hesitant to have their child assessed for any form of related disability. In reality, researchers and scientists have
documented multiple causes of learning disabilities including structural brain differences, genetics, and environmental causes. In
research about structural brain differences, individuals with learning disabilities in reading were found to have neural wiring impairments
in the right hemisphere of their brain (Ashkenazi, Black, Abrams, Hoeft, & Menon, 2013). In terms of genetics, studies of twins have
documented that two-thirds of reading deficits could be attributed to genetic factors (Astrom, Wadsworth, Olson, Willcutt, & DeFries,
2012). Learning disabilities are not caused by challenges seeing or hearing, emotional disturbance, cultural factors, lack of proficiency
in the local language, environment or economic factors, or inadequate instruction (Cortiella & Horowitz, 2014).
Myth #6. Learning disabilities will impact all people the same way. Learning disabilities can vary significantly from person to person,
even within the same type of learning disability (NJCLD, 2010). For example, one person with dyslexia may struggle significantly with
reading while another individual may only have problems reading in certain situations, like reading aloud. Students with other types of
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41. disabilities (such as autism, students who are blind or deaf, or students with emotional disturbances) may also have a learning disability
(NJCLD, 2010). It is important to address all disabilities that a student may have.
Go to:
Screening and Evaluating Learning Disabilities
Identifying a student with a learning disability is a complex and multifaceted process. Unfortunately, many schools and ministries of
education have tried to simplify the process, to the detriment of students. When done appropriately, screening and evaluation processes
can help identify students who may need additional educational supports to reach their full academic potential. Conversely, when the
screening and evaluation of learning disabilities are conducted in a rushed, haphazard manner, or without using international best
practices, harmful outcomes can result, such as incorrectly identifying students without disabilities as having learning disabilities, or
improperly identifying students who may have learning disabilities. This section of the guide introduces typical signs of learning
disabilities, the screening process to identify students with learning needs, and then the steps needed to effectively evaluate a student for
a specific disability. This guide focuses on screening and evaluating children in the classroom (typically primary and secondary schools)
versus early identification process or other non-classroom-related identification processes.
Many experts use different terminology to explain the evaluation process used to determine a specific learning disability. This process
can also be referred to as an assessment, and some use these two terms interchangeably. Evaluation and assessment can (more...)
Typical Signs of a Learning Disability
The identification process usually begins when either a family member or a teacher becomes concerned that a student is not making
adequate progress in school. Common characteristics of learning disabilities include the following, as described by the Learning
Disabilities Association of America (2017):
 Short attention span
 Poor memory
 Difficulty following directions
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42.  Inability to discriminate between/among letters, numerals, or sounds
 Poor reading, writing, and/or math ability
 Eye-hand coordination problems, poor coordination
 Difficulty with sequencing
 Disorganization and other sensory difficulties
These characteristics are found in all individuals, regardless of disability, at some time in their development. A person with a learning
disability, however, may have more than one of these characteristics (Learning Disabilities Association of America, 2017).
Characteristics of a learning disability may also change depending on a student’s age and development. Table 2 shows the different
characteristics that students with learning disabilities typically exhibit by age. These characteristics may vary slightly based on cultural
context. A student’s native language must be considered, because many students may have difficulties learning and communicating in
their non-native language. Such challenges are not related to a learning disability and should not be considered evidence of one. For
instance, a 1989 study found that Berber-speaking students in Morocco had lower Arabic reading scores than their Arabic-speaking
counterparts in their first year of school. However, both groups obtained similar reading scores after 5 years of public education
conducted in Arabic (Wagner, Spratt, & Ezzaki,1989). Therefore, it is critical to consider the role of language and culture in evaluating
a student’s learning difficulties.
ASSIGNMENT No. 1
Q.1 Describe the general principles of remediation of learning problems of the handicapped children.
Vygotsky, "among the vast plethora of stimuli one group definitely stands out for me, which is the group of social stimuli originating from people."
[Citation needed] It sticks out to me because I can reassemble these stimuli myself; very quickly, they become reversible for me, and as a
result, they govern my behavior in a way that is distinct from how other people's behaviors are shaped. They enable me to be compared to
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43. another person while simultaneously being identical to myself. The origin of social activity and consciousness can be traced back to speech
in its most comprehensive sense.
To understand the specific nature of human behavior and consciousness, it is essential to have a fundamental understanding of Vygotsky's
"doubling experience" principle. This applies to both normal and abnormal human behavior and consciousness.
According to Vygotsky, "A bifurcation in the course of a child's behavioral development into natural-psychological and cultural-psychological
development" refers to the way in which natural processes, such as physical maturation and sensory mechanisms, interact with culturally
determined processes to produce the psychological functions of adults and the variety of ways in which the functions are carried out. This
occurs as a result of "A bifurcation in the course of a child's behavioral development into cultural-psychological and natural- (Vygotsky &
Luria, 1930, p. 20).
These new formations have their roots in culture, as well as a dynamic psychological structure and an equally fluid organization in the brain and
the rest of the body. Therefore, one may say that a word is an exterior material indicator as well as a psychological instrument for the
structuring of human action.
In light of this, "The mentality should be considered not as special processes above and outside the cerebral processes or between them," as
Vygotsky wrote in 1930/1982 (page 137), "but rather as their subjective expression, a particular aspect, and a special feature of the higher
cerebral functions."
Therefore, the cultural-historical approach to neuropsychology stipulates that the origins of human consciousness and mental activity should not
be searched for within the brain, nor in the mechanisms of nervous process, but rather in the human social life. This is because the cultural-
historical approach believes that human social life is where consciousness and mental activity first emerged. In other words, if we want to
track how it functions (or why it dysfunctions) in the behavior of an individual, we need to analyze how it is employed to function in social
conduct. Only then will we be able to determine how it functions in the behavior of an individual.
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44. Assuming these theoretical foundations, I will now move on to discussing the challenges of providing remediation for children with learning
disabilities. Since L.S. Vygotsky demonstrated that education is necessary for development, it follows that correcting education is what
determines development.
The goals of a remediating education are distinct from those of a general education. The goal of general education is to teach students information,
while the objective of remediation is to help students develop new functional organs or a new functional system that will enable them to
carry out mental operations. Remediation must support the kid's participation in the general school education and establish a foundation
for the child's further education in order for the child to be successful in their learning. The development of new fundamental functioning
systems by the kid during remediation paves the way for the child's future capacity for autonomous learning.
The ability to voluntarily regulate and control one's own behavior, orientation in space, phonemic and kinesthetic verbal analysis and synthesis,
motor ability, volume and stability of verbal and visual memory, logical reasoning, and communicative skills are all included in these
fundamental systems. Some of these systems, such as space orientation, should already be created by the time a child enters primary school,
while others, such as language, are still in the process of forming.
The primary objective of remediation is to assist the kid in developing the tools of compensation in order to overcome the underdevelopment of
certain mental functions. This is accomplished by having "strong" components of mentality compensate for those that are deficient.
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45. • students who are unsuccessful in school due to underdevelopment (retardation) in certain mental processes (although sometimes being skilled
in other mental functions);
• children with low neurodynamic capacities in mental functioning;
• youngsterswho have difficulties with their executive functioning
• children who have issues with their behavior and their ability to communicate socially;
Why students' overall wellbeing could be negatively impacted if they were to achieve academic achievement.
This list might go on indefinitely.
These children have some psychological characteristics that are common as a result of their poor academic performance, such as:
• unfavorable attitude to education;
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46. • the dread of making mistakes;
• having a negative self-perception and self-credit.
As a result, the process of remediation is geared toward the following activities:
• cognitive advancement and rising levels of academic accomplishment in school;
• the remediation of unfavorable characteristics of one's personality and emotional reactions;
• an increase in responsible behavior both in school and at home;
• the enhancement of one's ability to communicate;
• providing parents with counseling and therapy services
Because there are so many different remedial jobs, it is necessary to take a complicated strategy to solving them. The following ideas of
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47. neuropsychological rehabilitation and remediation underpin this method, which was developed by Vygotsky and Luria:
• Neuropsychological evaluation and classification of the child's issues is a systemic neuropsychological assessment that reveals both deficits and
strengths in a child's development, his zone of proximal development. According to Vygotsky, these deficits and strengths in a child's
development are possibilities and conditions that can improve the results with the help of an examiner. Only by employing Luria's theory of
conversation assessment, which incorporates educational components that serve as a foundation for each person's unique program of
remediation, is it even possible (Leontiev, Luria, & Smirnov, 1968). In addition to this, in contrast to psychometric approaches, Luria's
evaluation assesses not an accomplished level of education (a retrospective component), but rather an individual's capacity to become
educated (prospective aspect). The focus of Luria's examinations is not on the outcome of the test (whether the candidate passes or fails), but
rather on the procedure itself and the ways in which it might be made more effective.
• The combination of cognitive, motor, respiratory, and emotional procedures in each session is what is meant by the idea of complex remediation.
These methods, when combined, should provide the same result in terms of mental function
The idea behind systemic remediation is that rather than concentrating on overcoming a single, isolated problem, the treatment plan for each
child should instead work on restoring harmony to the individual's overall mindset and personality. It does not ignore the necessity of
choosing the primary orientation and specific procedures at each level of remediation for each individual child, based on the results of his
neuropsychological exam and his individual requirements, as this does not bypass this requirement. Children that struggle academically can
benefit from neuropsychological remediation in an effective manner thanks to this approach.
• Play therapy promotes the child's emotional participation and motivation in the treatment process, which is a significant advantage. The
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48. effectiveness of the rehabilitation is considerably improved by activities such as games and competitions, as well as by giving out modest
presents. It ensures that the child is transformed into a subject rather than an object of the repair process. In order to make this goal a
reality, the activities that are suggested should be engaging and within the child's reach, in addition to being suitable for his age and the
amount of life experience he has had. The child shouldn't have a string of consecutive failures, but he also shouldn't succeed without putting
in any effort. The most important thing is not to actually teach something but rather to arouse a desire in someone else to learn it.
• If a child is the subject of his or her own remediation, this constitutes "the affective basis of education," which, according to Vygotsky, is "the
alpha and omega, the beginning and the end, the prologue and the epilogue of each mental development" (Vygotsky, 1984, p. 297). A child who
has a history of being unsuccessful in school has to have positive school experiences in order to improve their own self-credit and evaluation
of themselves.
• As a result, tailored remediation plans can be developed for each child. Every troubled child has his or her unique set of challenges and issues to
deal with.
• The less robust aspects of mental functioning are strengthened as a result of the support provided by the more robust aspects. It means that at
the beginning of remediation, the teacher performs himself the functions of the weak components, and then gradually moves them to the child
following the rules of interiorization, which were described by L.S. Vygotsky: from a common activity to an independent one, from an action
mediated with external means to an internal action, and from step-by-step analytic action to a global automatized action (Akhutina & Pylaeva,
2008).
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49. • The cultural-historical approach to neuropsychological rehabilitation in the education of children with disabilities consists of further developing
the theory of mediation as a foundational tenet of the methodology. L.S. Vygotsky provided conclusive evidence that mediation is a natural
means of cognitive development in children, as well as a psychological compensation for deterioration in children's cognitive and physical
abilities. As a consequence of this last premise, an alternative to the direct instruction of undeveloped functions is the search for techniques of
mediation in the repair process.
• One such example is handwriting and how it might be underdeveloped in those who have dysgraphia. Orthography, from the perspective of
Vygotsky, is a method of written communication that utilizes a fixed amount of signals. They are constantly being recombined into symbols by
according to a set of arbitrary rules that govern the formulation process. It is a collection of conceptual tools for use in the process of written
communication. Therefore, in order to overcome dysgraphia, which is one of the most prevalent issues associated with learning disability, a
psychologist needs to develop an instrumental habit.
Q.2 Give an account on the functional limitation and their possible solutions for a child suffering from cerebral palsy.
Cerebral palsy (CP) is a neurological illness that is caused by injury to the brain. It is the motor and mobility handicap that affects
children more frequently than any other. If your child has been diagnosed with cerebral palsy, it is important for you to be aware of what
to anticipate in terms of their condition. Find out the answers to all of your questions so that you may make educated decisions regarding
the diagnosis, treatment, therapy, and legal action you should take.
Cerebral palsy is a catch-all diagnosis that can refer to a number of different disorders and symptoms.
[1] Although they are all connected, each child affected by cerebral palsy will have a distinct and personalized experience with the
condition.
There is a possibility that a child with cerebral palsy will experience the following problems:
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50. • Movement and walking disabilities
• Difficulties with one's speech
• Learning disabilities
• Cognitive deficits
• Impairment of either vision or hearing
• Epilepsy
• Difficulties relating to emotions and behaviors
• Spinal malformations
• Joint problems[2]
Damage to the brain is what leads to CP, although there are many other factors that can cause brain damage.
[4] Because of this, it is not always possible to pinpoint the precise reason why certain people are born with cerebral palsy. The following
are some possibilities:
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51. • Problems with brain development during pregnancy
• Infections or other medical issues affecting the mother
• Interference with the normal flow of blood to the growing brain
• Disorders caused by genes
• The consumption of poisons or drugs while a woman is pregnant
• Trauma to the head or skull while the baby is being delivered
• Complications associated with having the baby too early
Cerebral palsy could have been caused by negligent medical mistakes during pregnancy or childbirth, which is a possibility. These
mistakes could have caused harm to the brain.
In certain instances, errors are not the result of negligence and could not have been avoided; nonetheless, the following are examples of
errors that are the result of negligence and could be deemed malpractice:
• Anything that prevents a baby from receiving adequate oxygen during labor and delivery
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52. • The use of forceps or a vacuum extractor with an excessive amount of pressure
• Failing to request or carry out a cesarean section in a timely manner to protect the baby's brain from injury.
• Failure to monitor the progression of the fetus during pregnancy or distress experienced during birth and delivery
•The inadequacy of care provided for a variety of maternal health issues during pregnancy
Different varieties of cerebral palsy
There are four distinct forms of cerebral palsy, which are as follows:
1. Spastic Cerebral Palsy
The majority of people diagnosed with cerebral palsy have spastic forms of the condition. It results in increased muscular tone, often
known as spasticity, as well as other symptoms, including:
• Delays in reaching certain developmental milestones like walking and moving
• Abnormal motions
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53. • Disinhibition of Movement
• Muscles that are rigid and spastic
• Difficulties controlling muscular movement
• Difficulties in transitioning from one employment to the next
Because it affects a child's upper and lower limbs as well as their body, spastic quadriplegia significantly limits the child's mobility.
The lower half of the body is the only part of the body that is affected by spastic diplegia. Many of these youngsters are still able to
walk, but they may require assistive devices like walkers in order to do it safely and independently.
Spastic hemiplegia is a condition that only affects one side of the body, most frequently the arm rather than the leg. The vast majority
of children who have hemiplegia are able to walk.
2. Cerebral Palsy with Dyskinetic Movements
The second most frequent type of cerebral palsy is known as dyskinetic cerebral palsy. Among the symptoms are:
• Dystonia, involuntary twisting and turning movements
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54. • Athetosis, also known as twisting movements
• Unpredictable and chorea-causing movements
• Poor posture
• Painful motions
• Difficulty in choking down food or in communicating
3. Ataxic Cerebral Palsy
The least frequent form of cerebral palsy is known as ataxic cerebral palsy. It results in unstable motions that are difficult to maintain
control over, as well as impaired balance, limited coordination, and tremors.
4. Mixed Cerebral Palsy
Mixed cerebral palsy is characterized by symptoms that are typical of two or three of the other kinds of the condition. The most frequent
kind of mixed cerebral palsy is known as spastic-dyskinetic cerebral palsy.
The following are some of the symptoms that an infant or toddler might have cerebral palsy:
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55. • Delays in motions and motor skills, such as holding the head up, rolling over, sitting down, crawling, and walking
• Components of the body that are either excessively rigid or too pliable
• Leaning to one side of the body more than the other
• Moving along the ground by scooting on the bottom rather than crawling
• Incapacity to stand, despite the presence of support
Always make an appointment with your child's pediatrician if you become aware of any strange symptoms, even if you are unsure
whether or not they are the result of cerebral palsy. When trying to treat children who have cerebral palsy, early intervention is absolutely
essential.
There is not a single or straightforward test that can diagnose cerebral palsy. To arrive at an accurate diagnosis and to ensure that no
other conditions are present, it is necessary to conduct a number of different tests and to keep careful notes.
If you are concerned that your kid may have problems with motor development, muscle tone, coordination, or balance, you should
discuss your concerns with your child's pediatrician, who can either make a diagnosis or recommend a specialist.
When making a diagnosis of cerebral palsy, medical professionals look for symptoms such as spastic movements, irregular muscle
movements, delayed development, and poor coordination.
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56. There is no failsafe method for preventing CP, but there are things you can do to minimize your risk, including the following:
• Before becoming pregnant, ensure that your diet is healthy and that any pre-existing medical conditions are under control.
• Maintain these healthy routines and be sure you take your prenatal vitamins as directed throughout your pregnancy.
• Make sure to schedule visits with your doctor on a consistent basis throughout your pregnancy.
• Have yourself checked out for any possible issues.
Regrettably, there is no foolproof method for determining in advance whether or not a newborn may develop brain damage as a result
of negligent treatment. The best thing you can do is to be selective in the medical professionals you see and to be an advocate for both
your own health and the health of your child.
Although there is currently no treatment that may reverse the effects of cerebral palsy, the condition will not get any worse over time.
This is not a condition that worsens over time, and if caught and treated in their early stages, patients may experience fewer symptoms
and fewer limitations in their movement.
Babies and toddlers have access to a wide range of treatment choices, all of which have the potential to improve their symptoms and
overall quality of life. After acquiring a diagnosis, one might initiate many different interventions almost immediately.
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57. Medications
Several drugs can assist treat spastic movements, seizures, and pain, as well as a variety of other symptoms and linked conditions,
including the following:
• Baclofen or other medications that relax the muscles
• Diazepam
• Anticonvulsants
• Anticholinergics
• Antacids
• Laxatives and products that soften the stool
•Sleep aids
Surgery
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58. Surgery is an essential component of the treatment plan for the majority of children diagnosed with CP. Mobility can be improved or
discomfort can be managed with surgical techniques. The release of a tendon or muscle, the surgical correction of hip dislocations, and
the surgical correction of scoliosis are all standard procedures.
Therapies
Children and infants diagnosed with cerebral palsy typically participate in a wide variety of therapeutic interventions. They have the
ability to improve a variety of learning as well as physical, mental, and social deficiencies. Treatments for cerebral palsy, if begun at an
early age, have the potential to minimize the severity of the condition as well as the chance of developing other conditions that are
connected with it.
The following are examples of common types of therapy that are used to help children who have cerebral palsy:
• Physical
• Occupational
• Feeding
• Aqua
• The horse and the other animal
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59. • Music
• Play
• Behavioral
• Speech/Language
• Bowel program
The life expectancy of many children who have been diagnosed with cerebral palsy is comparable to that of other children. This
wasn't always the case, but because to improved diagnostics and treatment options, many of these children's health situations have
significantly improved.
Although CP does not often reduce a person's life expectancy, it does necessitate prompt medical attention and early management in
order to get the best possible results. This is particularly relevant for individuals who have severe disabilities.
If they are not addressed, certain disorders that are associated with cerebral palsy can pose a threat to the patient's life. Problems with
breathing and swallowing (which can lead to pneumonia or malnutrition), seizures, chronic nutritional deficits, or life-threatening
pressure infections are examples of these complications.
Q.3 Mention the physical aberrance of the children suffering from Cystic Fibrosis.
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60. Cystic fibrosis (CF) is an inherited disease in which the body makes very thick, sticky mucus. The mucus causes problems in
the lungs, pancreas, and other organs.
People with cystic fibrosis (SIS-tik fye-BROH-sis) get lung infections often. Over time, they have more trouble breathing. They also
have digestive problems that make it hard to gain weight.
CF can cause symptoms soon after a baby is born. The first sign a baby might have cystic fibrosis is an intestinal blockage called
meconium ileus. Other kids don't have symptoms until later on. Cystic fibrosis can be mild or severe, depending on the person.
Symptoms of cystic fibrosis include:
 lung infections or pneumonia
 wheezing
 coughing with thick mucus
 bulky, greasy bowel movements
 constipation or diarrhea
 trouble gaining weight or poor height growth
 very salty sweat
Some kids also might have nasal polyps (small growths of tissue inside the nose), frequent sinus infections, and tiredness.
Newborn screening tests catch most cases of CF. If the screening test is positive, or if a child has cystic fibrosis symptoms, doctors do
a painless sweat test. They collect sweat from an area of skin (usually the forearm) to see how much chloride (a chemical in salt) is in
it. People with CF have higher levels of chloride.
Most children with CF are diagnosed by the time they're 2 years old. But someone with a mild form may not be diagnosed until they are
a teen.
Kids with CF will have it all their lives. Doctors use different medicines depending on a child's needs. But all people with CF need to:
 Loosen and clear mucus. There are different ways to do this. The doctor might recommend a child:
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61. o get regular exercise
o use an inhaler or nebulizer
o do breathing exercises and cough on purpose
o wear a therapy vest that shakes the chest
o have chest physical therapy (when a parent or trained person bangs gently on the chest or back)
 Prevent or fight lung infections. Washing hands well and often, avoiding people who are sick, and staying at least 6 feet away from others with
CF can help prevent infections. Taking preventive antibiotics also can help.
 Take enzymes. Most kids with CF need enzymes to help them digest food and get nutrients from it.
 Eat a high-calorie diet and take vitamin supplements, when needed.
Cystic fibrosis is caused by a change (mutation) in the gene that makes cystic fibrosis transmembrane regulator (CFTR) protein. To have
CF, a baby must get two copies of the CF gene, one from each parent.
In CF, the body makes abnormal CFTR protein or none at all. Without normal CFTR protein, the cells lining the pathways (tubes) inside
some organs make thick, sticky mucus rather than the normal thin, watery kind.
Thick mucus can trap bacteria in the lungs, leading to infection, inflammation, and breathing problems. Mucus also can block the path
where digestive enzymes flow between the pancreas and the intestines. This makes it hard for a child to digest food and get the vitamins
and nutrients they need from it.
Thick mucus can also affect the liver, the sweat glands, and the reproductive organs.
To help your child:
 Follow the treatment plan. Help your child stay as healthy as possible. Give medicines as directed, serve high-calorie meals and snacks, and
follow instructions for clearing chest mucus.
 Offer encouragement. Help your child find pastimes to enjoy, like art, music, reading, or learning to cook. It's important for kids with CF to
get exercise, so also look for ways your child can stay physically active. Maybe you can do some of them together.
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62.  Turn to the care team. Your child's care team can offer practical tips on living with CF, and information about clinical trials, support groups,
and new therapies.
 Learn all you can about CF. Experts are always working on new treatments to help people with CF have a better quality of life and live
longer. Online, turn to resources like the Cystic Fibrosis Foundation website.
 Teach self-care as your child gets older. Start early to help your child understand and manage CF. Encourage an older child or teen to handle
some parts of their health care, like disinfecting equipment or asking questions at doctor visits. Ask the care team about ways you can help
your child get ready for things like going to college or getting a job. Learning about cystic fibrosis and its care helps kids and teens become
confident adults managing a chronic health condition.
Q. 4 Write a comprehensive note on the education implication of the students with congenital heart diseases.
Most children with simple heart defects do not require any special care when they attend school. Those with more complicated heart
defects, however, may show signs that occasionally require attention. These signs include:
 Cyanosis: This is a blueness of the lips and nail beds that may increase with exercise but should not bother the student. It is caused by
reduced oxygen in the blood flow to the body.
 Increased fatigue: Children may tire more easily or may be short of breath after exercise.
 Increased susceptibility to chest infections: Students may be more likely to get common respiratory infections such as bronchitis and
pneumonia. In some types of heart disease, too much blood reaches the lungs, making them more susceptible to infection.
 Small size: Students with heart defects may be shorter or lighter than their classmates. Many children with congenital heart defects have
difficulty gaining weight.
If a CHD or its treatment has had a negative impact on cognitive development, this will become apparent at school age when children
have to meet specific cognitive and social benchmarks. This is more likely in a child with a complex heart condition. For example, a
child with a severe form of congenital heart disease, and has undergone a procedure such as a Fontan operation is likely to require extra
care or special attention at school. Children with transposition of the great arteries show lower overall scores on arithmetic, learning,
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63. and general knowledge tests. In general, children with cyanotic defects and hypoplastic left heart syndrome appear to have lower abilities
in math, reading, and spelling. One study showed that about one in three children with a complex CHD requires extra help in school,
and another found that about 15% were assigned to a special education classroom. A child with CHD might be more likely to be
inattentive or hyperactive in the classroom. For these reasons, and other secondary consequences of a CHD such as missing multiple
classes for doctor’s visits or surgery, or having overprotective parents, about 1 in 10 children with severe CHD will need to repeat a
grade.
What your child’s teacher needs to know
It is important that teachers know the nature of a student’s heart condition and the implications it has for school activities. For example,
if there are only five minutes between classes but a child with a heart condition needs ten minutes to travel from one class to another,
arrangements should be made to give the child the extra time to get to class and not be penalized for taking a few extra minutes. Parents,
cardiology clinic nurses, and physicians can provide you with information about the student’s health, permitted activity level,
medications, and future treatment.
Your child’s permitted activity level
Permitted activity levels are determined by your child’s health care team. In general, activity restrictions are graded in the following
manner:
 Full: The child is allowed to exercise at will and participate fully in all sports.
 No competitive sports: The child is allowed to exercise but is not allowed to participate in races, organized games, or team sports.
 Restricted: Please obtain specific guidelines from your child’s doctor.
If you have any questions about any activity restrictions, please contact your child’s doctor, or speak to the staff at your child’s cardiac
clinic.
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64. Your child’s medications at school
Medication is usually taken at home. In cases where children need to take some medication while at school, it is helpful to make
arrangements with school board officials. The teacher should be kept informed of the medications your child is taking and of their
specific purpose.
Keeping your child’s teacher informed
Continuing contact with your child’s teachers will keep them informed about plans, if any, for your child’s future hospitalization. This
information can help the teacher identify and respond to your child’s needs and concerns. The prospect of hospitalization or surgery
may create anxiety, which sometimes results in changes in behaviour and performance at school.
What to do if your child is going for surgery
To help your child prepare for surgery, you may want to discuss the date of surgery, the reason for it, the proposed length of
hospitalization, and the time needed to recover before they can return to school. You can also share this information with your child’s
teacher and determine whether it is all right for the teacher to discuss the surgery with your child or their classmates.
In order to maintain a degree of normalcy in the child’s life, many hospitals have a teacher on staff to help your child keep up with their
schoolwork. If your child is going to be in hospital longer than two weeks, continuation of schoolwork can at times be arranged.
A child in hospital can benefit from contact with their classmates. Speak to your child’s teacher about ways your child’s classmates can
get involved. It can take the form of get-well cards or audio cassettes sent to the hospital, or visits once the patient has returned home.
Returning to school after surgery: notes for teachers
Generally, children recover at home for about two weeks following heart surgery. A gradual return to school and other normal activities
is usually the recommendation. For example, a student may initially attend classes for half days for the first few days back at school.
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65. Possible behavioural changes
You may see an improvement in the energy or activity level of a child after surgery. It is important for you to discuss with parents, or,
together with the parents, speak to the medical or nursing staff at the child's cardiac clinic regarding any changes in the limitations placed
on the student’s activities.
You may encounter some behaviour changes when the child returns to school. These changes may occur in response to hospitalization
and surgery and are usually temporary. Some children will require more of your time and attention than before surgery. Others
experience nightmares and disrupted sleep patterns, and tire more quickly than usual. All these things may affect their school behaviour.
Possible physical and mental effects due to surgery
Depending on the type and difficulty of the surgery, some students may experience vision problems, neurological impairments, or gross
and fine motor delays. This may be more common following open-heart surgery. These deficits can affect a child’s everyday functioning
and social and emotional well-being. Prompt identification of deficits in any of these areas can lead to early interventions and improved
outcomes.
Support from teachers and the school board
Students with a congenital heart condition need your support to develop their full academic potential, since physical limitations may
exclude them from certain types of employment. Your help is essential. If a student has any special needs arising from a cardiac problem,
they should be referred for review by the appropriate school or board committee. Please discuss your student’s needs with the parents
or, together with the parents, speak to the medical or nursing staff at the child's cardiac clinic.
What can be done if your child is having problems learning
Experience has shown that the best way to teach children is using direct, one-on-one instruction. If your child is currently not getting
extra resources at school, find out what they are entitled to have and try to find ways to make sure they get help when needed.
Early intervention is important. In some cases, meeting with a neuropsychologist can be helpful. The doctor can do some testing and
determine where problems may lie and provide you with information. In general, children in Kindergarten and Grade 1 need to develop
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66. their basic reading, writing, and math skills as much as they can – even beyond what their classmates are doing. Extra tutoring or other
supports are important even at this stage, before you see any changes.
In the classroom setting, discuss the following suggestions with teachers:
 Seat your child near the front of the classroom to help focus and avoid distraction.
 Provide less written work.
 Use visual tools to teach such as charts and illustrations.
 Use tape-recorded textbooks.
 Allow extra time for tests and assignments.
 Provide extra help with problem areas.
 Develop a modified learning regime.
 Provide special education.
 Ask the teacher to “check in” with your child each day to see how they are doing.
In some instances, special education may be required. Older children who are having difficulty in school may do well in a special
vocational program at the high school level.
At home, children can benefit from an environment rich in language and numbers. As much as possible, reading lots of stories, doing
number rhymes and counting together, and working on math and reading exercise books will help. School-aged siblings may be able to
help as well. Teachers or a school liaison person may be able to recommend good resources to use at home.
Finally, you can help your child find a skill, interest or hobby at which they can excel. For example, your child’s creativity in art, dance
or a musical instrument may be the same or even greater than other children. Focus on your child’s successes.
Children may find it difficult to learn a second or third language. This may be an issue for families who speak more than one language,
or who do not speak English at home. Your child’s treatment team may have suggestions to deal with this issue.
Some of the learning problems that children can experience are:
 handwriting problems
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67.  spelling problems
 reading problems
 math problems
 Attention and concentrationproblems such as when a child may be inattentive, hyperactive, or both. They may not be able to concentrate
for extended periods of time.
 Slowness in completing tasks compared to other children.
 Memory difficulties. For example, a child may study a topic, but not remember it the next day.
 Difficulty planning and organizing, such as when a child has difficulty finishing assignments, expressing ideas in writing or verbally, or
finding the way to school.
The emotional impact of learning problems
Although the majority of children with CHD seem to function at a normal level, there are some children who are at a greater risk of
developing emotional problems. If your child develops learning problems as a result of their heart condition or its treatment, they may
become frustrated or angry with themselves. Tasks that they once did routinely may become more difficult. They may see their
classmates moving ahead at a faster pace than he can. When that anger is unexpressed, anxiety or depression may result. Children’s
difficulties in school may not be clearly evident in the classroom since many children who have CHD internalize their emotions and
keep any anxiety or fears to themselves.
It can be helpful to talk to your child about these problems, to understand how they feel and to figure out how you can help deal with
any issues. Some other ideas that may help your child are:
 Focus on your child’s skills and talents. This can help enhance creativity. Consider providing opportunities for them to show off their skills.
 Advocate for your child in school. Creating a supportive environment in school with their teacher and classmates will make it easier for
your child. Their learning will be assisted when extra supports are available.
 Emphasize your child’s personality. Rather than focusing on grades, praise your child’s behaviour and efforts when appropriate.
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68. Q.5 How could you manage a child with hemophilia with reference to the complication of disease and education?
Hemophilia is an inherited bleeding disorder. Children with hemophilia can’t stop bleeding because they don’t have enough clotting
factor in their blood. Clotting factors are needed for blood to clot. Blood clots to prevent excessive bleeding.
There are many blood clotting factors involved in the forming of clots to stop bleeding. Two common factors that affect blood clotting
are factor VIII and factor IX.
How severe your child’s hemophilia is depends on the level of blood clotting factors in his or her blood.
The 3 main forms of hemophilia include:
 Hemophilia A. This is caused by a lack of the blood clotting factor VIII. About 9 out of 10 people with hemophilia have type
A disease. This is also referred to as classic hemophilia or factor VIII deficiency.
 Hemophilia B. This is caused by a deficiency of factor IX. This is also called Christmas disease or factor IX deficiency.
 Hemophilia C. Some doctors use this term to refer to a lack of clotting factor XI.
Hemophilia types A and B are inherited diseases. They are passed on from parents to children through a gene on the X chromosome.
Females have two X chromosomes, while males have one X and one Y chromosome.
 A female carrier has the hemophilia gene on one of her X chromosomes. When a hemophilia carrier female is pregnant, there is
a 50/50 chance that the hemophilia gene will be passed on to the baby.
o If the gene is passed on to a son, he will have the disease.
o If the gene is passed on to a daughter, she will be a carrier.
 If the father has hemophilia but the mother does not carry the hemophilia gene, then none of the sons will have hemophilia
disease, but all of the daughters will be carriers.
In about one-third of the children with hemophilia, there is no family history of the disorder. In these cases, it’s believed that the disorder
could be related to a new gene flaw.
Carriers of the hemophilia gene often have normal levels of clotting factors but may:
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69.  Bruise easily
 Bleed more with surgeries and dental work
 Have frequent nosebleeds
 Have heavy menstrual bleeding
Hemophilia C usually doesn’t cause problems, but people may have increased bleeding after surgery.
What are the symptoms of hemophilia?
The most common symptom of this disorder is heavy, uncontrollable bleeding.
The severity of hemophilia depends on the amount of clotting factors in the blood. Those affected with hemophilia that have
levels greater than 5% (100% being average for unaffected children) most often have bleeding only with major surgeries or tooth
extractions. These children may not even be diagnosed until bleeding complications from a surgery occur.
Severe hemophilia is when the factor VIII or IX is less than 1%. Bleeding can occur in these children, even with the minimal activities
of daily life. Bleeding may also occur from no known injury. Bleeding most often occurs in the joints and in the head.
Your child's symptoms may also include:
 Bruising. Bruises can occur from even small accidents. This can result in a large build up of blood under the skin causing
swelling (hematoma). For this reason, most children are diagnosed around 12 to 18 months of age. This is when the child is more
active.
 Bleeds easily. A tendency to bleed from the nose, mouth, and gums with minor injury. Bleeding while brushing teeth or having
dental work often suggests hemophilia.
 Bleeding into a joint. Hemarthrosis (bleeding into a joint) can cause pain, immobility, and deformity if not treated. This is the
most common site of complications due to hemophilia bleeding. These joint bleeds can lead to chronic, painful, arthritis,
deformity, and crippling with repeated occurrences.
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70.  Bleeding into the muscles. Bleeding into the muscles can cause swelling, pain, and redness. Swelling from excessive blood in
these areas can increase pressure on tissues and nerves in the area. This can cause permanent damage and deformity.
 Bleeding in the brain from injury or spontaneously. Bleeding from injury, or spontaneously in the brain, is the most
common cause of death in children with hemophilia and the most serious bleeding complication. Bleeding in or around the brain
can occur from even a small bump on the head or a fall. Small bleeds in the brain can result in blindness, intellectual disability,
a variety of neurological deficits. It can lead to death if not spotted and treated right away.
 Other sources of bleeding. Blood found in the urine or stool may also signal hemophilia.
The symptoms of hemophilia may look like other problems. Always check with your child's doctor for a diagnosis.
How is hemophilia in children diagnosed?
he diagnosis of hemophilia is based on your family history, your child's medical history, and a physical exam. Blood tests include:
 Complete blood count (CBC). A complete blood count checks the red and white blood cells, blood clotting cells (platelets),
and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red
blood cells.
 Clotting factors. To check the levels of each clotting factor.
 Bleeding times. To test the speed that blood clots.
 Genetic or DNA testing. To check for abnormal genes.
How is hemophilia treated?
Your child's healthcare provider will refer you to a hematologist, an expert in blood disorders. Your child’s health care provider will
figure out the best treatment based on:
 How old your child is
 His or her overall health and medical history
 How sick he or she is
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71.  How well your child can handle specific medications, procedures, or therapies
 How long the condition is expected to last
 Your opinion or preference
Treatment depends on the type and severity of the hemophilia. Treatment for hemophilia is aimed at preventing bleeding complications
(mainly head and joint bleeds). Treatment may include:
 Bleeding in the joint may need surgery or immobilization. Your child may need rehab of the affected joint. This may include
physical therapy and exercise to strengthen the muscles around the area.
 Blood transfusions may be needed if major blood loss has occurred. This is when your child gets donated blood.
 Self-infused factor VIII or IX can allow a child with hemophilia to lead a near normal lifestyle.
What are the complications of hemophilia?
Complications of hemophilia include:
 Bleeding in the joints or muscles
 Inflammation of the joint lining
 Long-term joint problems
 Very serious tumor-like enlargements, of the muscle and bone
 Development of antibodies against clotting factors
 Infections from transfusions (HIV and hepatitis B and C are no longer transmitted in donated blood)
ASSIGNMENT No. 2
Q.1 Design and implement the environment based on the Least Restricted Environment for the Physically Handicapped Children as a
Headmaster/headmistress in Pakistan.
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72. The Individuals with Disabilities Education Act (IDEA) stipulates that "...to the maximum extent appropriate, children with disabilities,
including children in public and private institutions or other care facilities, [be] educated with children without disabilities, and that
special classes, separate schooling, or other removal of children with disabilities from regular educational environments occur only
when necessary." The Least Restrictive Environment (LRE) mandate stipulates that "...children with disabilities, including children in
public and private institutions or other care facilities, [be] educated
In light of this information, Madeline questioned whether or not Kayla would be successful in school while simultaneously participating
in both of these programs. She inquired about the possibility of the services being offered at the Montessori school by contacting the
local school system. Currently, Kayla participates in both physical and occupational therapy for a half an hour once a week with the
other students who she interacts with frequently. According to Norena Hale, the state director of special education for the Minnesota
Department of Education, the state of Minnesota has a long history of supporting inclusive services and including children with
disabilities in regular education and preschool settings. In addition, the state has provided financial support for inclusive services.
"But nonetheless, the paradigm of services for 3-year-olds has been to attempt to serve them in a classroom instead of serving them
where they are learning naturally," she added. "This is in contrast to the model of services for older children, which serves them where
they are learning naturally." "Children have the right to get an education that is both free and suitable for them in an environment that
is as close to "normal" as is feasible. You only remove children from that environment, even on a part-time basis, when support or
tailored services would be more effective to give in another manner, and the IEP committee, which includes the parents, takes those
decisions.
If a child spends the majority of his or her waking hours at a childcare center, then that setting may qualify as the environment with
the fewest restrictions for children aged three to five. The local Head Start program, a preschool that only meets for half days, or even
the child's own home could be the least restrictive environment for certain youngsters.
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73. The kindergarten program that is typically offered in Charlie Cummins's school district is not considered by Jolie Cummins to be the
least restrictive environment for her son Charlie because she has found that a slightly modified program with five other children who
have disabilities is.
Charlie, who has Down syndrome and is nonverbal, participates in a program that allows him to experience both a traditional classroom
with 25 children and a self-contained school for six children with impairments. Charlie also has the opportunity to observe other
children with Down syndrome. Charlie participates in circle time with the other 25 students in the school with the assistance of his
assistant. However, when the other students are working on writing the alphabet, Charlie heads back to his more intimate classroom to
draw.
Jolie remarked that the program offers the students a secure environment in which to participate. "Charlie and the other children with
impairments begin their day in the self-contained classroom where they can hang up their coats, choose what they want to eat for lunch,
and receive some individualized attention. If Charlie were to spend all of his time in the conventional classroom, it would be easy for
him to get lost in the crowd.
To this point, Charlie's program seems to be an excellent choice. According to his mother, he is able to participate in activities such as
bowling and swimming with his class on a regular basis, which is something that would be quite challenging in a conventional
kindergarten setting. He is in the regular classroom, and one of the kids there has extended an invitation to him to attend a birthday
celebration that they are throwing for another student.
Jolie has stated that she wants her son Charlie to have as much autonomy as is humanly possible. "I feel that participating in this
program will assist him in achieving those objectives."
I Each public agency is responsible for ensuring that— (ii) To the greatest extent feasible, children with disabilities, including children
residing in public or private institutions or other care facilities, are educated alongside children who do not have disabilities; and (2)
That children with disabilities are only segregated into special classes, sent to separate schools, or otherwise removed from the regular
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74. educational environment if the nature or severity of the disability is such that education in regular classes would not be appropriate for
the child.
Continuum of Alternative Placements (section 300.115 of the code)
(a)Every public agency is responsible for ensuring that a continuum of different alternative placements is available to satisfy the needs
of children with disabilities for special education and other associated services.
(b) The continuum that is required in paragraph (a) of this section must— (1) Include the alternative placements listed in the definition
of special education under 300.38 (instruction in regular classes, special classes, special schools, home instruction, and instruction in
hospitals and institutions); and (2) Make provision for supplementary services (such as resource room or itinerant instruction) to be
provided in conjunction with regular class placement. These provisions must be met in order for the continuum to be considered
compliant with the requirements of this section
Translation Used Commonly
The school functions as the "public agency." It is the responsibility of the school to ensure that children with disabilities receive an
education that is as similar to that received by children who do not have disabilities as possible. When we talk about education being
"appropriate," we imply that it caters to the child's unique requirements and enables the youngster to make academic advancements.
The first option for placement that must be considered by the IEP team is the student's regular education classroom.
When deciding where a kid will receive their education, the IEP team is required to ask themselves, "What can we provide so that this
child can stay in the regular education classroom or activity?" They have to think about what "supplementary aids and services" the
child will need, often known as additional supports, in order for them to be able to be placed in a regular classroom setting. Examples
of these accommodations include the provision of assistive technology, individualized behavior management plans, access to a resource
room, and alterations to the instructional material or the tasks assigned.
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75. If the IEP team determines that a child cannot be educated in a regular classroom even with additional aids and services, then they
must consider other options, such as special classes, special schools, home instruction, or instruction in hospitals or other institutions.
Home instruction is the most common alternative.
The child's particular needs and the assistance required to address those needs will determine which option the school is expected to
make accessible to the student. The school must comply with this requirement.
IDEA Regulation
§300.116 Placements
Each public agency is responsible for ensuring that the following criteria are met when determining the educational placement of a
child with a disability, including a preschool child with a disability: (a) The placement decision— (1) Is made by a group of persons,
including the parents, and other persons knowledgeable about the child, the meaning of the evaluation data, and the placement options;
and (2) Is made in conformity with the LRE provisions of this subpart, including 300.114-300.118; (b)
§300.117 places outside of the classroom
Each public agency is required to ensure that, when providing or arranging for the provision of nonacademic and extracurricular
services and activities, such as meals, recess periods, and the services and activities set forth in 300.107, that each child with a disability
participates with nondisabled children in those extracurricular services and activities to the maximum extent appropriate to the
needs of that child. This includes meals, recess periods, and the services and activities set forth in 300.107. Each child with a
disability must be provided by the public agency with the supplementary aids and services that have been deemed by the child's
Individualized Education Program (IEP) Team to be suitable and necessary in order for the child to participate in nonacademic
settings.
§300. 320
(a) Participation with Nondisabled Children (5) An explanation of the extent, if any, to which the child will not participate with
nondisabled children in the regular class and in the activities described in paragraph (a)(4) of this section. This requirement applies
only if the child has a disability that prevents them from participating with children who do not have a disability.
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76. Translation Used Commonly
As members of the IEP team, parents are involved in the decision-making process regarding their child's educational placement and
the services that should be provided to them. At the very least once a year, the IEP team needs to have a conversation about the
educational placement of the student. The individual requirements of the child for the particular educational services being
sought should serve as the foundation for placement decisions.
The IEP team has a responsibility to examine whether the child would suffer any potential negative impacts as a result of the proposed
placement, as well as how the proposed placement will affect the quality of the services the child receives.
Further, it is unacceptable to remove children with disabilities from their regular classrooms simply because they require a different
educational plan. These children should be educated in their local schools whenever it is feasible to do so, and they should not be
singled out for special treatment.
The school is obligated to provide children with disabilities with an equal opportunity to participate in all of the services and activities
that are offered, including counseling services, athletics, transportation, special interest groups and clubs, music, and any other services
and activities that are offered.
In the Individualized Education Program (IEP), the school is required to offer an explanation for any instance in which a child with a
disability participates in education or other school activities that include only other children with disabilities.
Q.2 Describe the reaching practices in a regular classroom with Physically Handicapped Children.
It is essential to keep in mind, if one is instructing a student who possesses any kind of impairment, that the majority of the tenets of
inclusive design could be construed as being advantageous to any learner. The term "Universal Design" refers to an approach that
prioritizes the success of all students when developing instructional resources, content, and activities. Universal Design places an
emphasis on creating surroundings that are accessible to everyone, regardless of aptitude, rather than tailoring a course to a specific
audience through adaptation or retrofitting. When you create a course outline with an emphasis on these design principles, you may
discover that the majority of your curriculum is able to comfortably accommodate all of your students. The majority of the approaches
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77. used in Universal Design place an emphasis on a technique of instruction known as "deliberate teaching," which explicitly outlines the
objectives of the course both for the duration of the semester and for the specific time period covered by the class. Students are better
able to organize their schedules when they have access to a syllabus that outlines the objectives of the course, the specifics of the
assignments, and the due dates. Students will have an easier time understanding the logic behind your organization and will have more
time to record the information if you begin each class period by providing an overview of the topic that will be covered that day and
then summarize the most important points at the end of the period.
In a similar vein, there is the possibility that some educational content will be challenging for pupils who have particular disabilities.
When presenting a video in front of the class, for instance, you need to keep your audience in mind. Students who have problems with
their vision may have trouble seeing non-verbal actions; students who have disorders such as photosensitive epilepsy may experience
seizures when exposed to flashing lights or images; and students who have hearing loss may not be able to hear the audio that goes along
with the flashing images or lights. The use of closed captioning, the provision of electronic transcripts, the description of on-screen
action, allowing students to check out the video on their own, and outlining the role that the video plays in the day's lesson all help to
reduce the access barrier for students with disabilities, thereby allowing them to participate actively in the classroom discussion.
Additionally, it gives the possibility for other students to connect with the content in numerous ways, depending on what is required of
them.
Q.3 Write a detailed note on the Hospital Educational Program designed for the Physically Handicapped Children.
Students who have disabilities are required by the Individuals with Disabilities Act to receive special services in the form of physical
education if those services are deemed necessary. The school is required to include physical education as part of your child's special
education program if your child has a disability and an individualized education program (IEP).
It is possible for a significant number of students who have disabilities to participate in general physical education in a manner that is
both safe and successful, with or without accommodations and supports. However, some children would benefit more from a physical
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78. education program that was tailored to their specific needs. The general curriculum for physical education should serve as the basis for
the content of adapted physical education classes as much as is practically possible.
Your child's general and/or adapted physical education teacher should be included as a member of the IEP team if the student is receiving
specially designed physical education. This is because physical education is a required component of special education, and your child's
teacher should be aware of this requirement.
If your child is receiving specially designed or adapted physical education, the Individualized Education Program (IEP) should at the
very least include a summary of the present level of performance in physical education content, the frequency and duration (minutes
and days per week or stipulated time period) of physical education services, measurable goals and objectives about content, and the
placement where these services are provided. If your child is not receiving specially designed or adapted physical education, the IEP
should not include any of these components. Instruction in physical education ought to be detailed in the IEP, just like any and all other
forms of special education and associated services.
Please take note that the services described here for required physical education are distinct from and distinct from the services described
here for related services such as physical and occupational therapy. A "motor team" approach or service delivery model is considered
to be the gold standard for meeting the specific requirements of students who have disabilities. This model calls for general and adapted
physical education teachers, as well as related service personnel, to work together.
Physical Education Content and Requirements in IDEA
 Physical and motor skills
 Fundamental motor skills and patterns
 Skills in aquatics, dance, and individual and group games and sports (including intramural and lifetime sports)
 Includes special physical education, adapted physical education, movement education, and motor development
The term 'special education' means specially designed instruction, at no cost to parents, to meet the unique needs of a child with a
disability, including -
(A) instruction conducted in the classroom, in the home, in hospitals and institutions, and in other settings; and
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79. (B) instruction in physical education.
The State must ensure that public agencies in the State comply with the following:
(a)General. Physical education services, specially designed if necessary, must be made available to every child with a disability
receiving FAPE, unless the public agency enrolls children without disabilities and does not provide physical education to children
without disabilities in the same grades. [See Commentary to IDEA below for more information on this often confused "grade level"
misconception.]
(b)Regular physical education. Each child with a disability must be afforded the opportunity to participate in the regular physical
education program available to nondisabled children unless -
(1) The child is enrolled full time in a separate facility; or
(2) The child needs specially designed physical education, as prescribed in the child's IEP.
(c)Special physical education. If specially designed physical education is prescribed in a child's IEP, the public agency responsible for
the education of that child must provide the services directly or make arrangements for those services to be provided through other
public or private programs.
(d)Education in separate facilities. The public agency responsible for the education of a child with a disability who is enrolled in a
separate facility must ensure that the child receives appropriate physical education services in compliance with this section.
Interpretation of the PE Requirement by the U.S. Department of Education
Commentary to IDEA (page 46583) discusses when PE is required for students with disabilities beyond the grade level requirement of
nondisabled peers.
Note: This is a very important clarification that is often not known or understood by school district personnel since it appears in the
discussion section of the IDEA regulations in the Federal Register. You should bring this clarification to the attention of school officials
if PE is being characterized as a grade level requirement based on what nondisabled peers receive.
1. Physical education must be made available equally to children with disabilities and children without disabilities.
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80. 2. If physical education is specially designed to meet the unique needs of a child with a disability and is set out in that child’s IEP, those
services must be provided whether or not they are provided to other children in the agency.
Special education as set forth in the Committee bill includes instruction in physical education, which is provided as a matter of course
to all non-handicapped children enrolled in public elementary and secondary schools. The Committee is concerned that although these
services are available to and required of all children in our school systems, they are often viewed as a luxury for handicapped children.
US Department of Education - Office of Special Education Programs: Policy Letters, Guidance, and Clarification
The following letters from the US Department of Education clarify some common misconceptions about PE services for students with
disabilities.
The two letters below cover the age range of required PE services for students with disabilities (3-21 years). The preschool and high
school transition ages are often overlooked. These periods are important times for motor development, health-related fitness, sport skills,
aquatics, community-based physical activity, and many other content areas common in general and adapted physical education
programs.
The next letter clarifies that other subjects or services cannot be substituted for or replace required PE.
Denying Mandatory Physical Education Instruction for Children with Disabilities, OSEP Policy Letter to James Irby, February 12, 2010
The following Guidance Document provides information about extracurricular athletics or sports for students with disabilities. Section
300.107 of IDEA includes information on Nonacademic Services, including extracurricular athletics or sports. These services are a
required part of special education.
The state must ensure the following: (a) Each public agency must take steps, including the provision of supplementary aids and services
determined appropriate and necessary by the child’s IEP Team, to provide nonacademic and extracurricular services and activities in
the same manner necessary to afford children with disabilities an equal opportunity for participation in those services and activities, (b)
Nonacademic and extracurricular services and activities may include counseling services, athletics, transportation, health services,
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81. Schools’ Obligation to Provide Equal Opportunity to Students with Disabilities to Participate in Extracurricular Athletics, OCR
Guidance Document, January 25, 2013.
Adapted Physical Education
Adapted or specially designed physical education (APE) is about meeting the unique needs of individual students with disabilities. In
APE, the instructor provides planning and assessment, consultation for general physical education teachers, specially designed
instruction, and adapts or modifies the curriculum, task, equipment, and/or environment so a child can participate in all aspects of
physical education.
APE and general physical education teachers work together to design meaningful and beneficial instruction for all students.
APE Certification for Teachers
It is common for teachers to specialize or have advanced preparation in adapted physical education. National and state level
adapted physical education teacher certifications or licenses exist.
Adapted Physical Education National Standards (APENS). The mission of APENS is to promote the 15 Adapted Physical Education
Standards and national certification exam. The goal of APENS is to ensure that all students who qualify for specially designed physical
education services receive them from a "qualified" teacher. Teachers who pass the APENS exam receive CAPE recognition (Certified
Adapted Physical Educator).
Some individual states also have add-on teaching licenses or certifications in adapted physical education. The following states have
separate teaching licenses in adapted physical education: CA, LA, ME, MI, MN, NE, OH, OR, RI, SD, WI, and WY.
Talk with your school district. Ask about teacher qualifications. Encourage your district to hire staff who are qualified to teach adapted
or specially designed PE.
See the directory below for samples of many adapted physical education teacher preparation programs.
NCPEID National Directory of APE Teacher Preparation Programs
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82. Preparing Qualified and Effective Adapted Physical Educators to Improve Outcomes for Students with Disabilities. Personnel
development in adapted physical education can lead to meaningful student success and positive education outcomes. This Webinar from
the National Center to Improve Recruitment and Retention of Qualified Personnel for Children with Disabilities highlights the roles &
responsibilities and preparation of adapted physical education (APE) teachers.
Q.4 Illustrate the essential variables to consider in student placement of Physically
There was a time when people thought of special education as a place. But that really isn’t the case any longer. Special education instead
refers to services that are used to meet the learning needs of students with disabilities. You can find out more about special education
terms and services on our Special Education 101 page.
Special Education Placement Options
Once your child’s Admission, Review, and Dismissal (ARD) committee (which you are a part of) has developed your
child’s Individualized Education Program (IEP), the next step is to decide on an educational placement.
Placement refers to the amount of time in each school day that a student spends in the resource or in a general education classroom. The
school district is required to have a range of placements where your child can be taught, including in the general education classroom.
In deciding your child’s placement, the ARD committee must make sure your child spends as much of their school day (as is appropriate)
with children who do not have disabilities. This includes academic, nonacademic, and after school activities. This part of IDEA is called
Least Restrictive Environment or LRE. And, in this case, the word "appropriate" follows the definition of Free Appropriate Public
Education (FAPE).
The LRE for children with disabilities depends on each child’s unique needs. It’s important to know that the school district cannot use
a “one size fits all” approach to educating children who have disabilities.
The Educational Setting
There are some common placements in which students might get specific services. Teams of trained teachers and aides are in all types
of placements.
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83. A student could be placed in a single setting all day or spend parts of the day in different settings. For example, a student in a mainstream
education classroom all day might receive special education services in the same general education classroom as part of regularly
scheduled instruction time. Or, a student might go to different educational settings for part – or all – of the day to receive special
education services.
There shouldn’t be any surprises, because educational placement is part of an Individualized Education Program (IEP) created by your
child’s ARD committee. You are a part of this committee and have the right to agree with (or disagree with) your child’s placement. To
learn more about what to do when you disagree with your child's placement, see our When You’re Having Trouble Getting the Right
Services for Your Child page.
Here are some educational settings your child could have:
 Mainstream (many people refer to this as General Education): Many students receive special education and related services in a general
education classroom where peers without disabilities also spend their days. This is called inclusion. Some services that a student might
receive in a mainstream setting include: direct instruction, a helping teacher, team teaching, co-teaching, an interpreter, education aides,
modifications or accommodations in lessons or instruction, or more teachers per student.
 Resource: This is a class for students who receive special education services and need intensive help to keep up with grade-level work. The
class may have 1 or 2 students, or may have many students. However, students receive instruction or support based on their unique needs.
The number of minutes your child spends in a resource class must be written into the IEP.
 Self-Contained Programs: This is a general term for placements for which the student needs to receive services outside of the general
education classroom for half of the school day or more. Placement in a self-contained classroom has to be based on a student’s unique
needs, not on the disability alone.
Programs That Often Have Specialized Settings
Each school district is going to offer its own set of special education programs and services, and the names of these programs will be
different. However, here are 4 examples of programs often delivered in specialized settings that we thought you should know about:
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84.  Preschool Program for Children with Disabilities (PPCD): This is a set of special education services for children age 3 to 5. PPCD services
can take place in different settings, including a child development center, Head Start, a private preschool, or right on an elementary school
campus. Any PPCD placement can include related services like occupational, physical, or speech therapy. See our PPCD page to learn more.
 Life Skills: This helps students with many different types of disabilities but generally those who need support with academic, social, or
behavioral issues as well as daily living skills. Students who receive services in this program may stay until they turn 22 years old.
 Social Behavior Skills (SBS): This goes by different names in different districts. It is also called Applied Behavior Skills or just Behavior Skills.
In this program, trained teachers help students learn decision-making and social skills (to promote self-responsibility) with other peers
around. SBS is a separate classroom that children can stay in full-time or part-time, depending on their IEP.
 Transition or 18+: A small number of students may stay enrolled in special education services until they turn 21 or 22 years old (depending
on which calendar month they turn 22), even after they have graduated with a certificate of completion. Students are able to get into
these programs if it is approved by their ARD committee and written into their IEP before they graduate. Most of these programs are
designed to help the student build more independence and get ready to go out into the workforce. Students might stay in the classroom
for some of the day and go to job training for the rest of the day. You can find out more on our Transitioning Out of Public Education page.
Q.5 Mention the cautions in testing process of the Physically Handicapped Children in a school environment.
More than a billion people—approximately 15 percent of the world’s population—have some type of disability (World Health
Organization [WHO], 2011) including sensory disabilities (such as blindness and deafness), intellectual disabilities, developmental
disabilities, physical disabilities, and psychosocial disabilities. Although some individuals may acquire a disability as adults, many are
born with a disability or acquire a disability in childhood. The United Nations Children’s Fund (UNICEF) estimates that 150 million
children under the age of 18 have a disability. Such children often require special education services in school (UNICEF, 2005).
The United Nations Convention on the Rights of Persons with Disabilities (CRPD), adopted in 2006, mandates that children with
disabilities have access to inclusive education. Inclusive education means that children do not attend segregated schools based on
disability, but are instead educated in their local schools alongside their peers, with appropriate supports. As a result, many of the 177
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85. countries (as of April 2018) that ratified the CRPD are developing new systems and supports to promote and ensure inclusive education
opportunities for all children with disabilities (United Nations, 2006). Developing an inclusive education system, however, is often
arduous and complicated for many countries.
Complicating this educational reform process are the challenges of identifying students with disabilities. Some disabilities may be
apparent (e.g., mobility impairment), but others—such as learning disabilities—cannot be determined based on appearances alone.
A learning disability is a neurological disorder that affects a student’s ability to read, write, spell, reason, and organize information
taught in conventional ways (Learning Disabilities Online, 2017). When given the appropriate classroom supports, (more...)
Identifying a student with a learning disability requires
 a multistep process
 the use of tools and resources that are translated and adapted to the local cultural context, and
 the participation of a multidisciplinary team of experts.
Many countries recognize the need to support students with learning disabilities and are looking for ways to provide that support.
Unfortunately, in doing so, many have moved straight to trying to identify learning disabilities without having the needed systems, tools,
and practices in place to do it effectively. This type of identification goes against international best practices. An incomplete or
ineffective screening and evaluation process can lead to large rates of misdiagnosis, and students may not receive the services and
supports they need to be academically successful.
RTI takes seriously the imperative to address the needs of vulnerable children and to give all children the best possible education. In all
of its projects, RTI promotes equitable, quality inclusive education, helping governments to put policies and mechanisms in place to
meet that long-term goal. This guide is one in a series of guides intended to support school systems, schools, and teachers as they meet
the learning needs of their students, including students with disabilities.
High-incidence disabilities, like learning disabilities, speech challenges, behavioral challenges, and mild intellectual disabilities,
generally affect 80 percent of all students receiving special education services in United States schools (Friend & (more...)
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86. This guide is a complementary resource to existing resources and tools for inclusive education that RTI developed: School and
Classroom Disabilities Inclusion Guide for Low- and Middle-Income Countries and Disabilities Inclusive Education Systems and
Policies Guide in Low- and Middle-Income Countries. Before they review this guide on learning disabilities, readers who are just
learning about inclusive education practices will find it beneficial to review these two other foundational guides first.
The School and Classroom Guide provides information on differentiating instruction that benefits all students, regardless of whether
they have been identified as having a disability. The School and Classroom Guide is a useful resource for teachers as they begin to
provide services to students with learning disabilities without having the systems in place to effectively conduct screenings and
evaluations. The School and Classroom Guide also introduces basic concepts of Response to Intervention (see page 10), one screening
method to identify and address learning challenges.
The Disabilities Inclusive Education Systems and Policies Guide in Low- and Middle-Income Countries offers additional information
to government representatives and policymakers on systematic interventions and programs that support students with learning
disabilities in the classroom.
The concept of learning disabilities is thought to have originated in the United States in the 1960s. Learning disability is recognized as
one of the 13 categories of disability within the Individuals with Disabilities Education Act (IDEA), the comprehensive education law
for individuals with disabilities in the United States. Although the definition of learning disability has slight variations, the IDEA defines
it as a “disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written,
that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations” (US
Department of Education, Office of Special Education Programs [OSEP], 2004). However, many countries have yet to officially
recognize learning disabilities. For example, many African countries have no formal local definitions of learning disabilities or high-
incidence disability, and students with learning disabilities are typically not recognized in the classroom (Abosi, 2007). Likewise, the
Indian government does not formally recognize learning disabilities within its policies or programs (Ahmad, 2015).
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87. Another challenge is that different terminology can be used in different countries to refer to the same conditions. The United States
uses learning disabilities, Australia and Zimbabwe use learning disabilities or learning difficulties, while Belgium uses the
term instrumental disabilities. In some countries, the terminology used for children with disabilities can be highly disparaging and
discriminatory. For example, some communities in northern Ghana use terms such as Zu’kpinglana and Zuuku (deadhead and empty-
head, respectively) to describe children who exhibit challenges in learning. This lack of a common definition or understanding of learning
disabilities presents challenges in identifying and providing services to students. Throughout this report and all of its work, RTI uses the
term learning disability.
Forms of learning disabilities. Common forms of learning disabilities include those shown in Table 1, as defined by the Learning
Disabilities Association of America.
Learning disabilities can vary significantly in severity and how they affect an individual’s ability to learn. Teachers may not recognize
that multiple types of learning disabilities can occur and may use a one-size-fits-all approach when determining supports for students.
From the opposite side of this spectrum, students may have documentation that indicates that they have a learning disability without
identifying the specific disability or the area of learning that is impacted. This practice can prevent a student from receiving specialized
supports.
Prevalence estimates. Estimates for learning disabilities vary depending on the method of data collection, resulting in significantly
different prevalence rates even within the same country. For example, a study in Belgaum, India, found that 15 percent of primary school
students between the ages of 8 and 11 had some form of learning disability (Mogasale et al., 2012). Another study in Kerala, India,
which identified students through local teachers in a different city, estimated that only 2 percent of students had a learning disability
(Gafoor, 2015). In the United States, 5 percent of all students in school have been identified as having a specific learning disability, and
another 15 percent or more of students are believed to have unidentified learning and attention difficulties (Cortiella & Horowitz, 2014).
Identification challenges. Identifying learning disabilities can be challenging for several reasons. Although some students have obvious
low-incidence disabilities such as mobility or sensory disabilities, students with learning disabilities are physically and often
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88. behaviorally difficult to distinguish from students without disabilities, particularly outside of school settings (Friend & Bursuck, 2012).
Furthermore, not all learning challenges are caused by a learning disability. Students without disabilities may also have academic,
emotional, and behavioral difficulties that can result in learning challenges, even without an underlying disability (National Association
of Special Education Teachers, n.d.). Other disabilities (such as low vision or hearing difficulties), linguistic or cultural differences, and
environmental factors (e.g., poor nutrition or lack of prior formal education) may also cause learning difficulties (Aro & Ahonen,
2011; Fernald et al., 2009; National Joint Committee on Learning Disabilities [NJCLD], 2010). Such factors must be ruled out as causes
of learning difficulties during the screening or evaluation process; neglecting to do so may lead to misdiagnosis.
Dispelling Myths Related to Learning Disabilities
Learning disabilities occur in every culture, race, ethnicity, and socioeconomic status. Common misperceptions about learning
disabilities, however, can impact the way in which students are identified and the services they receive. This section helps to dispel
some of the more frequently held myths about learning disabilities.
Myth #1: Persons with learning disabilities are lazy, do not want to learn, and cannot be successful. Academic challenges caused
by a learning disability do not indicate laziness or an inability to learn. With proper accommodations and supports, students with learning
disabilities can succeed in school. Supporting these students in school can help lead to further success, as adults with learning disabilities
successfully pursue higher education and work in virtually all career fields.
Myth #2: Persons with learning disabilities are less intelligent. Having a learning disability does not affect a student’s intelligence.
In fact, some students with learning disabilities are gifted.4 Although students with learning disabilities may “appear to be functioning
adequately in the classroom, their performance may be far below what they are capable of, given their intellectual ability” (NJCLD,
2011, p. 2). Having a learning disability does not mean that a student does not have the capacity to learn, but rather benefits from learning
materials and concepts using alternative methods.
Myth #3: Learning disabilities can only be identified once a student is fully literate. Many countries do not provide early
identification services for learning disabilities, often because of the misperception that identifying a student with a disability is related
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89. to literacy skills. For instance, learning disability evaluation in the Indian city of Bangalore generally takes place during the seventh
grade, after a student has experienced years of academic underachievement (Thomas & Whitten, 2012). Although many students are
identified as having learning disabilities because they have trouble learning to read, other students with learning disabilities do not
display challenges in reading and writing. Therefore, identifying a potential vulnerability or screening for learning disabilities can and
should begin before a student learns to read: as early as age 3, children can exhibit signs and indicators of learning disabilities (Lange
& Thompson, 2006). Table 2 shows examples of signs of learning disabilities at different ages. Identifying a learning challenge as early
as possible is ideal, because early educational interventions are much more likely to yield long-term gains than those implemented at
higher grades or in adulthood. Early identification has been tied to positive life outcomes such as higher academic performance, increased
likelihood of graduating from secondary school, and decreased likelihood of committing crimes (Heckman & Masterov, 2005).
Myth #4: People with learning disabilities outgrow them by adulthood. A learning disability is a lifelong condition (National
Institutes of Health, 2017). Although many adults adopt coping mechanisms and strategies to reduce the impact of their learning
disabilities, some continue to struggle with learning difficulties throughout adulthood. Learning disabilities are not usually curable,
though many adults select careers that reinforce their strengths rather than positions that may be more challenging due to their learning
disability.
Myth #5. Learning disabilities are caused by a curse or by sin. In many cultures worldwide, disability is seen as a curse, the result
of a sin, or a punishment for doing something wrong (Wa Munyi, 2012). For this reason, many children with disabilities are hidden, and
many families are hesitant to have their child assessed for any form of related disability. In reality, researchers and scientists have
documented multiple causes of learning disabilities including structural brain differences, genetics, and environmental causes. In
research about structural brain differences, individuals with learning disabilities in reading were found to have neural wiring impairments
in the right hemisphere of their brain (Ashkenazi, Black, Abrams, Hoeft, & Menon, 2013). In terms of genetics, studies of twins have
documented that two-thirds of reading deficits could be attributed to genetic factors (Astrom, Wadsworth, Olson, Willcutt, & DeFries,
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90. 2012). Learning disabilities are not caused by challenges seeing or hearing, emotional disturbance, cultural factors, lack of proficiency
in the local language, environment or economic factors, or inadequate instruction (Cortiella & Horowitz, 2014).
Myth #6. Learning disabilities will impact all people the same way. Learning disabilities can vary significantly from person to person,
even within the same type of learning disability (NJCLD, 2010). For example, one person with dyslexia may struggle significantly with
reading while another individual may only have problems reading in certain situations, like reading aloud. Students with other types of
disabilities (such as autism, students who are blind or deaf, or students with emotional disturbances) may also have a learning disability
(NJCLD, 2010). It is important to address all disabilities that a student may have.
Go to:
Screening and Evaluating Learning Disabilities
Identifying a student with a learning disability is a complex and multifaceted process. Unfortunately, many schools and ministries of
education have tried to simplify the process, to the detriment of students. When done appropriately, screening and evaluation processes
can help identify students who may need additional educational supports to reach their full academic potential. Conversely, when the
screening and evaluation of learning disabilities are conducted in a rushed, haphazard manner, or without using international best
practices, harmful outcomes can result, such as incorrectly identifying students without disabilities as having learning disabilities, or
improperly identifying students who may have learning disabilities. This section of the guide introduces typical signs of learning
disabilities, the screening process to identify students with learning needs, and then the steps needed to effectively evaluate a student for
a specific disability. This guide focuses on screening and evaluating children in the classroom (typically primary and secondary schools)
versus early identification process or other non-classroom-related identification processes.
Many experts use different terminology to explain the evaluation process used to determine a specific learning disability. This process
can also be referred to as an assessment, and some use these two terms interchangeably. Evaluation and assessment can (more...)
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91. Typical Signs of a Learning Disability
The identification process usually begins when either a family member or a teacher becomes concerned that a student is not making
adequate progress in school. Common characteristics of learning disabilities include the following, as described by the Learning
Disabilities Association of America (2017):
 Short attention span
 Poor memory
 Difficulty following directions
 Inability to discriminate between/among letters, numerals, or sounds
 Poor reading, writing, and/or math ability
 Eye-hand coordination problems, poor coordination
 Difficulty with sequencing
 Disorganization and other sensory difficulties
These characteristics are found in all individuals, regardless of disability, at some time in their development. A person with a learning
disability, however, may have more than one of these characteristics (Learning Disabilities Association of America, 2017).
Characteristics of a learning disability may also change depending on a student’s age and development. Table 2 shows the different
characteristics that students with learning disabilities typically exhibit by age. These characteristics may vary slightly based on cultural
context. A student’s native language must be considered, because many students may have difficulties learning and communicating in
their non-native language. Such challenges are not related to a learning disability and should not be considered evidence of one. For
instance, a 1989 study found that Berber-speaking students in Morocco had lower Arabic reading scores than their Arabic-speaking
counterparts in their first year of school. However, both groups obtained similar reading scores after 5 years of public education
conducted in Arabic (Wagner, Spratt, & Ezzaki,1989). Therefore, it is critical to consider the role of language and culture in evaluating
a student’s learning difficulties.
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92. ASSIGNMENT No. 1
Q.1 Describe the remedial methods of teaching for the Physically Handicapped Children. How remedial teaching does is different from
the casual mood of teaching?
The guiding principle of mainstreaming public services for people with disabilities was adopted by the Government in 2000. The
inclusion of young children with disabilities in pre-school settings is an integral part of the mainstreaming agenda.
Recent data from an Annual Beneficiary Questionnaire published by POBAL is based on respondents from early years services funded
under the National Childcare Investment Programme (NCIP) 2006-2010 capital funding, the Community Childcare Subvention (CCS)
scheme and all services participating in the Early Childhood Care Education (ECCE) and Childcare Education & Training Supports
(CETS) programmes. 3,401 questionnaires were completed representing an overall response rate of 78.1%.
Services were asked to provide details of the number of children with special needs (as diagnosed by the HSE) currently attending their
services. In response to this question, 47% (1,587) of all services were found to have at least one child with a disability in attendance.
A total of 4,679 children with disabilities of varying types were accessing services. The attendance is higher within the community
sector, where 58% of all services report having at least one child with a disability attending, as compared with 41% of all private
providers. The largest single category is that of “autism spectrum” disabilities; respondents reported a total of 1,302 children with this
type of disability attending their service.
Within the school sector, special needs assistants (SNAs) are allocated by the Department of Education and Skills to special and
mainstream schools to support pupils with disabilities who also have significant care needs. The current provision does not extend to
children in Early Start Programme. The Department of Education and Skills also supports pre-school provision for children with
disabilities in a number of areas, namely, autism pre-school classes, home tuition grants and visiting teacher services.
Outside of the school sector, support services for pre-school children are provided by the HSE. The Office of Disability and Mental
Health in the Department of Health has overall responsibility for these services. The HSE provides grant aid support for children with
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93. disabilities in pre-school through two different arrangements; service level arrangements (SLAs) where the total grant to the agency (for
all services) is in excess of €250k and grant aid agreements where the total grant to agencies is less than €250k.
The HSE funds pre-school provision for children with disabilities through the provision of:
 Day Special Pre Schools which are pre-schools run by statutory or voluntary agencies specifically for children with disabilities
and through;
 Pre-school supports which refers to supports given to children with disabilities who are attending mainstream pre-school services.
The HSE also supports pre-school aged children (0-5 years) through the provision of multi-disciplinary early intervention services,
which includes speech and language therapy, psychology, occupational therapy, physiotherapy, early intervention specialists, and
elements of nursing and social work. A proportion of the costs in the Multi-Disciplinary Early Intervention Services category also relates
to supporting children in pre-schools. However, it is not possible to apportion these costs with any accuracy as the organisation of HSE
multi-disciplinary services focuses on all young children in a catchment area and does not distinguish between children attending pre-
schools and younger children (up to the age of three) and older children who do not attend pre-schools.
The provision of two year's free pre-school to all children has the potential to promote equality of opportunity at the most important
developmental stage of children’s lives. Special flexibility is allowed for children with special needs regarding the scheme’s age criterion
and such children are allowed spread the provision over more than one year. Furthermore, all services participating in the scheme are
required to make reasonable accommodation for children with special needs.
The Child Care (Pre-School Services) Regulations 2006 set out recommended adult/child ratios and maximum group sizes that should
apply in full- and part-time day care, sessional and child minding services. Settings with children with special needs are not required to
apply lower ratios.
Central to Síolta is the principle that pedagogy in early childhood must be supported within a flexible and dynamic framework that
addresses the learning potential of the whole child and should be expressed by curricula or programmes of activities which take a holistic
approach to the development and learning of the child and reflect the inseparable nature of care and education.
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94. Síolta, the National Quality Framework for Early Childhood Education, was developed by the Centre for Early Childhood Development
and Education on behalf of the DES. It was published in 2006, following a three-year developmental process. Since December 2008,
the Early Years Education Policy Unit in the DES has been responsible for the implementation of Síolta with three distinct but
interrelated elements: Principles, Standards and Components of Quality. The 12 Principles provide the overall vision of the Framework,
while the 16 Standards and 75 Components allow for the practical application of this vision across all aspects of ECCE practice. The
Components of Quality are further explained by a set of ‘Signposts for Reflection’ and ‘Think-abouts’ which are intended to support
practitioners in early education settings to become aware of and critical of their practice. These core elements of Síolta are set out in
detail in the Síolta user manual.
A visiting teacher service is in place to provide specialist teaching, information and guidance for learners who are visually impaired,
deaf/hard of hearing in pre-school, primary and post-primary sectors. The service supports families and children of pre-school age.
Special Classes
Targeted early intervention is in place for children with autistic spectrum disorders (ASDs) either through early intervention classes or
a home-tuition scheme. In November 2007, throughout the country there were 277 classes for children with ASD, up from 90 such
classes in 2000. 145 of these classes were attached to mainstream primary schools where children with ASDs may enrol from age
three. 75 new classes were set up in 2007 alone. The NCSE continues to work with schools and parents in seeking to ensure that services
are available locally for children.
Since 2011, the NCSE has increased the number of special classes by over 130% from 548 in 2011 to 1,456 across the country in October
2018, of which 1,192 are Autism Spectrum Disorder (ASD) special classes. This network includes 129 ASD early intervention classes,
742 primary ASD classes and 321 post-primary ASD classes in mainstream schools.
In 2017-18 there were 948 special classes in mainstream schools with 5,572 pupils. There were 37 special schools and 235 special
classes attached to mainstream schools in Dublin. Of these, 17 were ASD early intervention classes, 138 were primary ASD classes and
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95. 40 were post primary ASD classes. The number of ASD special classes in Co. Dublin has increased from 66 in 2011/2012 to 195 in
2017/2018. (Details of all special classes available on www.ncse.ie in county order).
Each of these classes has a maximum of six children, with a specially trained teacher and a minimum two Special Needs Assistants
(SNAs). More than 17,000 people work in schools on a daily basis with children who have special educational needs. This includes
some 8,450 resource and learning support teachers helping children in primary and post primary schools.
In November 2018 there were 9,309 SNA Posts at primary level, 3,047 at post-primary level, 2,521 in special schools, making for a
total of 14,877 allocated across the system, helping children during the school day, compared with just 300 less than twenty years ago.
The Government also funds early intervention classes for younger children with autism and the DES is working hard to expand the
network of early intervention places. The Government believes that as each child with autism is unique, they should have access to a
range of different approaches to meet their individual needs. Having services available in the local school where children can go with
their siblings is important for the development of children with special educational needs and for the integration of children of all abilities
in our schools to the benefit of all.
Providing an appropriate education for children with autism, through the primary and post primary school network, whether through
placement in mainstream classes, in special classes or in special schools is a priority. The preferred multi-skills approach in providing
education of children with autism is where teachers may draw down from a range of autism specific interventions including Treatment
and Education of Autistic and Related Communication Handicapped Children (TEACCH), ABA (Applied Behavioural Analysis) and,
Picture Exchange Communication System (PECS).
Home Tuition
The home tuition scheme provides a compensatory educational service for children:
 With a significant medical condition likely to cause major continuing disruption to school attendance;
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96.  With special educational needs awaiting an educational placement, as an interim measure, including those with an autism
spectrum disorder (ASD), aged three upwards who cannot access a place in an ASD setting including an early intervention class.
Home tuition funding is provided to children with ASD aged over 3 years of age where a school placement is not available;
 Children aged two-and-a-half to three who have been assessed as having ASD based on the DSM IV or ICD 10 criteria.
As home tuition takes place outside of school supervision it is necessary to ensure that the tuition provider is a fully qualified teacher
who is registered with the Teaching Council of Ireland. If it is not possible to recruit a tuition provider who is a qualified and registered
teacher then alternative qualifications may be acceptable as appropriate. The State aims over time to support a single early intervention
setting structure for all children, including children with special educational needs.
Primary Schools
Funding for special education provision in 2018 will amount to some €1.75 billion, up 43% since 2011 and equivalent to 18.7% of the
gross overall current allocation for education and training.
Children from age four may attend primary mainstream schools for eight years. In 2017-18, there were 3,246 aided primary schools and
563,459 pupils attending these schools – this includes mainstream and special schools. The pupil-teacher ratio for that academic year
was 15.3. There are also 38 private primary schools.
Learners with special educational needs may be included in mainstream classes and receive additional teaching support and/or support
from a special needs assistant (SNA). Additional teaching is provided through a withdrawal or in-class model of support. The class
teacher is expected to maintain responsibility for the learner’s education programme and to liaise with the support teacher regarding the
individualised learning and teaching programme that is in place for the learner. Special needs assistants are allocated to assist teachers
in meeting the care needs of learners and are assigned duties of a non-teaching nature. The average class size in mainstream primary
schools is approximately twenty-four pupils, however classes can range from less than twenty-four up to twenty-nine pupils.
In September 2017, a new assessment was introduced to determine how special education teachers are allocated to mainstream schools.
Under the new system, each school gets a single allocation of special education teachers. The number of special education teachers
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97. allocated to a school is determined by the size of the school and its educational profile. A school’s educational profile is broadly based
on the number of students with complex special educational needs, the results of standardised tests and the social context of the school
taking account of disadvantage and gender.
It is designed to give a fairer allocation of special education teachers to each school. It recognises that all schools need an allocation for
special needs support, but provides a graduated allocation which takes into account the actual level of need in each school. Schools are
now provided with the necessary resources in advance so that children with special educational needs can be enrolled into schools and
access the additional teaching supports they need (Circular 0013/2017).
There is also a range of special class provision in mainstream primary schools that provides for learners with a diversity of special
educational needs. Depending on the particular special educational needs of the learners, class size can range from six to nine pupils in
the special classes. SNAs are also allocated to special classes to support students with significant care needs. There were 948 special
classes in mainstream schools with approximately 5,572 pupils in the 2017-18 school year.
The Minister for education signed a Commencement Order on the October 04 2018 to bring a number of sections of the Education
(Admission to Schools) Act, 2018 into operation. The Minister has a power, after a process of consultation with the NCSE, the board of
management and the patron of the school, to compel a school to make additional provision for the education of children with special
educational needs. This power came into effect on Monday 3rd December 2018.
Post-Primary Schools
Mainstream post-primary schools cater for learners aged from age twelve to eighteen years. In 2016-17, there were 711 aided post-
primary schools catering for over 352,000 learners in total. This includes 52 fee-paying secondary schools with 25,282 pupils, which
are also aided by the DES. Of the total, approximately 63,000 learners had special educational needs.
Classes at post-primary level are organised around particular subject areas or programmes that learners are engaging with. Learners with
special educational needs may be included in mainstream classes and receive additional teaching support from a support teacher and/or
additional care support from a SNA. Additional teaching is provided through a withdrawal or in-class model of support. The subject
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98. teacher is expected to maintain responsibility for the learner’s progress in a particular subject area, in and to liaise with the support
teacher regarding the learner’s individualised learning and teaching programme learner. Special needs assistants are allocated to assist
teachers in meeting the care needs of learners, and are assigned duties of a non-teaching nature.
There is also a range of special class provision in mainstream post-primary schools that provides for learners with a diversity of special
educational needs. Depending on the particular special educational needs of the learners, class size can range from six to eleven pupils
in the special classes. Special needs assistants are also allocated to special classes in post-primary schools, to support students with
special educational need who have significant care needs. There were approximately 150 special classes attached to post-primary schools
in the 2017/2018 school year.
Q.2 According to the American Academy of Cerebral Palsy, mention the classification along with its description of cerebral palsy.
Epilepsy is a brain condition that causes a child to have seizures. It is one of the most common disorders of the nervous system. It affects
children and adults of all races and ethnic backgrounds.
The brain consists of nerve cells that communicate with each other through electrical activity. A seizure occurs when one or more parts
of the brain has a burst of abnormal electrical signals that interrupt normal brain signals. Anything that interrupts the normal connections
between nerve cells in the brain can cause a seizure. This includes a high fever, high or low blood sugar, alcohol or drug withdrawal, or
a brain concussion. But when a child has 2 or more seizures with no known cause, this is diagnosed as epilepsy.
There are different types of seizures. The type of seizure depends on which part and how much of the brain is affected and what happens
during the seizure. The 2 main categories of epileptic seizures are focal (partial) seizure and generalized seizure.
Focal (partial) seizures
Focal seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. Before a focal
seizure, your child may have an aura, or signs that a seizure is about to occur. This is more common with a complex focal seizure. The
most common aura involves feelings, such as deja vu, impending doom, fear, or euphoria. Or your child may have visual changes,
hearing abnormalities, or changes in sense of smell. The 2 types of focal seizures are:
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99.  Simple focal seizure. The symptoms depend on which area of the brain is affected. If the abnormal electrical brain function is
in the part of the brain involved with vision (occipital lobe), your child’s sight may be altered. More often, muscles are affected.
The seizure activity is limited to an isolated muscle group. For example, it may only include the fingers, or larger muscles in the
arms and legs. Your child may also have sweating, nausea, or become pale. Your child won’t lose consciousness in this type of
seizure.
 Complex focal seizure. This type of seizure often occurs in the area of the brain that controls emotion and memory function
(temporal lobe). Your child will likely lose consciousness. This may not mean he or she will pass out. Your child may just stop
being aware of what's going on around him or her. Your child may look awake, but have a variety of unusual behaviors. These
may range from gagging, lip smacking, running, screaming, crying, or laughing. Your child may be tired or sleepy after the
seizure. This is called the postictal period.
Generalized seizure
A generalized seizure occurs in both sides of the brain. Your child will lose consciousness and be tired after the seizure (postictal state).
Types of generalized seizures include:
 Absence seizure . This is also called petit mal seizure. This seizure causes a brief changed state of consciousness and staring.
Your child will likely maintain posture. His or her mouth or face may twitch or eyes may blink rapidly. The seizure usually lasts
no longer than 30 seconds. When the seizure is over, your child may not recall what just occurred. He or she may go on with
activities as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken
for a learning or behavioral problem. Absence seizures almost always start between ages 4 to 12.
 Atonic seizure. This is also called a drop attack. With an atonic seizure, your child has a sudden loss of muscle tone and may
fall from a standing position or suddenly drop his or her head. During the seizure, your child will be limp and unresponsive.
 Generalized tonic-clonic seizure (GTC). This is also called grand mal seizure. The classic form of this kind of seizure has 5
distinct phases. Your child’s body, arms, and legs will flex (contract), extend (straighten out), and tremor (shake). This is
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100. followed by contraction and relaxation of the muscles (clonic period) and the postictal period. During the postictal period, your
child may be sleepy. He or she may have problems with vision or speech, and may have a bad headache, fatigue, or body aches.
Not all of these phases occur in everyone with this type of seizure.
 Myoclonic seizure. This type of seizure causes quick movements or sudden jerking of a group of muscles. These seizures tend
to occur in clusters. This means that they may occur several times a day, or for several days in a row.
Your child’s symptoms depend on the type of seizure. General symptoms or warning signs of a seizure can include:
 Staring
 Jerking movements of the arms and legs
 Stiffening of the body
 Loss of consciousness
 Breathing problems or stopping breathing
 Loss of bowel or bladder control
 Falling suddenly for no apparent reason, especially when associated with loss of consciousness
 Not responding to noise or words for brief periods
 Appearing confused or in a haze
 Nodding head rhythmically, when associated with loss of awareness or consciousness
 Periods of rapid eye blinking and staring
During the seizure, your child’s lips may become tinted blue and his or her breathing may not be normal. After the seizure, your child
may be sleepy or confused.
The goal of treatment is to control, stop, or reduce how often seizures occur. Treatment is most often done with medicine. Many types
of medicines used to treat seizures and epilepsy. Your child’s healthcare provider will need to identify the type of seizure your child is
having. Medicines are selected based on the type of seizure, age of the child, side effects, cost, and ease of use. Medicines used at home
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101. are usually taken by mouth as capsules, tablets, sprinkles, or syrup. Some medicines can be given into the rectum or in the nose. If your
child is in the hospital with seizures, medicine may be given by injection or intravenously by vein (IV).
It is important to give your child medicine on time and as prescribed. The dose may need to be adjusted for the best seizure control. All
medicines can have side effects. Talk with your child’s healthcare provider about possible side effects. If your child has side effects,
talk to the healthcare provider. Do not stop giving medicine to your child. This can cause more or worse seizures.
While your child is taking medicine, he or she may need tests to see how well the medicine is working. You may have:
 Blood tests. Your child may need blood tests often to check the level of medicine in his or her body. Based on this level, the
healthcare provider may change the dose of medicine. Your child may also have blood tests to check the effects of the medicine
on his or her other organs.
 Urine tests. Your child’s urine may be tested to see how his or her body is reacting to the medicine.
 Electroencephalogram (EEG). An EEG is a procedure that records the brain's electrical activity. This is done by attaching
electrodes to the scalp. This test is done to see how medicine is helping the electrical problems in your child’s brain.
Your child may not need medicine for life. Some children are taken off medicine if they have had no seizures for 1 to 2 years. This will
be determined by your child's healthcare provider.
Q.3 How could you help the parents in the modification of home structure for the children of Cystic Fibrosis?
The management of cystic fibrosis (CF) at school has several facets. Educators must consider the physical, psychosocial, cognitive and
educational issues of this diagnosis in order to ensure that the young person with CF is successful at school.
The physical aspects of CF must be addressed at school. Often, these students qualify for special education support as students who are
Other Health Impaired (OHI) under the Individuals with Disabilities Education Act (IDEA). A comprehensive evaluation should be
conducted to see if the student would qualify as a student who is OHI. The following accommodations and adaptations might be
warranted for a child with CF.
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102.  Due to the possibility of fatigue, a child with cystic fibrosis might need to rest during the school day. This should be done in the
nurse's office or another location away from the other students. It is important to avoid increasing peers' feelings that the child
with CF is somehow different or getting special attention.
 Coughing is a common part of CF, and the child should have water and tissues readily available. Coughing is encouraged and
necessary to clear the mucus out of the lungs. If the coughing is disruptive to the classroom, the child should be excused for a
drink of water.
 Restroom privileges should be flexible provided when needed.
 Due to the productive cough and urgent bathroom needs, the child should feel free to leave the classroom when necessary, to
avoid unnecessary embarrassment over disease symptoms.
 Pancreatic enzymes, which aid in digestion, are needed before every meal and snack. Just to be clear, these enzymes are not
dangerous and are not addictive.
 Exercise can provide great benefit to the child with CF by helping to clear mucus and increasing the strength of the respiratory
muscles. The child with CF should be encouraged to participate in all physical activities at school. At times, child might encounter
limitations in strength or endurance. Nevertheless, the child needs to be encouraged to participate as much as possible, but should
be allowed to set individual limits on total physical exertion. When questions arise, please contact the child's parents or healthcare
provider.
 Extra fluid consumption should be encouraged before, during and after physical activity. During aerobic activity, a child with
CF should drink between six and twelve ounces of fluid every 20 to 30 minutes. Because of the added carbohydrates and salt,
sports drinks provide an excellent choice for kids with cystic fibrosis.
Psychosocial concerns for the student with cystic fibrosis can be significant. Due to frequent absences, frequent infections and limitations
on physical activity, young people with cystic fibrosis often struggle with issues of "fitting in". They may feel left out by their peers,
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103. and struggle with keeping up socially as they flow in and out of school. In order to encourage healthy psychological, emotional and
social adjustment, the school should consider:
 With the consent of the child and parents, educate peers about cystic fibrosis. The hospital school teacher is a good resource for
offering a presentation, suggesting materials or assisting with the education of educators, peers or other interested community
members.
 Encourage peers to stay in contact with their friend during absences. Cards, letters and phone calls can serve to bridge the gap
when students must be away from school and activities.
 Seize this wonderful opportunity to teach peers about supporting a friend, showing compassion and other essential life lessons.
 Identify strong peers to mentor the student upon returning to school. Many students say that having someone fill you in on what
you missed while away can make all the difference in smoothing the re-entry to school.
 Help the student find areas of expertise and ways to excel in the school environment. Mentoring support could be included in
the IEP to help the young person maintain or develop self-confidence.
 Include social work or counseling services as an integral part of the IEP. Having someone at school to talk to or act as an advocate
for the youngster can be a significant asset. The student might need the opportunity to discuss fears about the future, worries
about keeping up with schoolwork, socialization issues, or concerns about other family members.
Finally, cognitive status and academic progress must be monitored on an ongoing basis for the student. Children with cystic fibrosis do
not have any cognitive or learning difficulties as a result of the diagnosis or treatment. However, they likely will miss a lot of school,
and therefore will need assistance and flexibility in completing assignments and work upon their return. As much as possible, the student
should be encouraged to attend school. Homebound education is an option, but it should be used as a last resort — ONLY if the child
cannot possibly come to school.
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104. Medical appointments, home administration of IV antibiotics and other treatment requirements can result in excessive absences for the
student with cystic fibrosis. This might cause the child to feel concerned about keeping up academically. To ensure that the student
continues to progress, educators should:
 Evaluate for potential classification of the student as other health impaired.
 Create an IEP that allows for the possibility of ongoing change and fluctuation in ability and physical stamina.
 Provide a great deal of flexibility when the child has been absent. Give plenty of time to complete missed work.
 Provide tutorial assistance if the student has been absent for a prolonged period or is having difficulty learning specific material.
 Provide careful monitoring to determine whether the student shows a decline in performance.
Q.4 Give your opinion on the modification of the classroom syllabus for the children of Spina Bifida.
It is a congenital problem, present before birth, and it is caused by the incomplete closing of the embryonic neural tube. It is a neural
tube defect.
There are four main types of spina bifida: myelomeningocele, spina bifida occulta, closed neural tube defects, and meningocele.
Myelomeningocele is the most serious type, and symptoms can be severe. In spina bifida occulta, symptoms may be barely noticeable.
Surgery and other treatment options can improve the quality of life for a person with severe symptoms. This article will look at the
symptoms, causes, and treatment for the most serious type, myelomeningocele.
 Spina bifida is a congenital condition in which the spinal column is exposed.
 Myelomeningocele is the most serious type and it is present around 60 births in every in 100,000.
 Exposure means the spinal column is more at risk of infection.
 Excess cerebrospinal fluid can build up and result in hydrocephalus, and this increases the chances of learning difficulties.
 A low intake of folic acid before and during pregnancy has been linked to spina bifida.
 Treatment options include surgery, physical therapy, and assistive devices.
 During the first month after conception, the embryo develops a primitive tissue structure known as the neural tube.
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105.  This structure gradually develops into bones, nerves, and tissue. These eventually form the nervous system, the spinal column,
and the spine, a ridge of bone that protects and surrounds the nerves.
 In spina bifida, the neural tube and spinal column do not develop properly. The spine does not close fully, and the spinal column
remains exposed along several vertebrae.
 A sac forms on the fetus' back as the membranes and spinal cord push out. The sac may be covered with meninges, or membranes.
 Out of 4 million babies born in the United States (U.S.) each year, spina bifida affects between 1,500 and 2,000 of them.
 Types
 There are four main types of spina bifida:
 Occulta: This is the mildest form. Most patients have no neurological signs or symptoms. There may be a small birthmark,
dimple or tuft of hair on the skin where the spinal defect is. The person may never know they have spina bifida unless a test for
another condition reveals it by chance.
 Closed neural tube defects: In this version, there can be a variety of potential defects in the spinal cord's fat, bone, or meninges.
In many cases, there are no symptoms; however, in some, there is partial paralysis and bowel and urinary incontinence.
 Meningocele: The spinal cord develops normally, but the meninges, or protective membranes around the spinal cord, push
through the opening in the vertebrae. The membranes are surgically removed, usually with little or no damage to nerve pathways.
Symptoms
An infant who is born with spina bifida may have or develop:
 weakness or paralysis in the legs
 urinary incontinence
 bowel incontinence
 a lack of sensation in the skin
 a build up of cerebrospinal fluid (CSF), leading to hydrocephalus, and possibly brain damage
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106. The nervous system will also be more prone to infections, some of which can be life-threatening.
CSF is a watery fluid that flows through the cavities inside the brain and also around the surface of the brain and the spinal cord. If there
is too much CSF, this can lead to hydrocephalus, pressure on the brain, and ultimately brain damage.
If the opening in the vertebrae occurs at the top of the spine, there is a higher chance of complete paralysis in the legs and other problems
with movement elsewhere in the body. If the openings are in the middle or the base of the spine, symptoms tend to be less severe.
Symptoms of myelomeningocele
Myelomeningocele is the most severe form of spina bifida. If hydrocephalus is present, it increases the chance of learning problems.
A range of symptoms can occur.
Cognitive symptoms: Awareness, thinking, learning, judging and knowing are known as cognition. Problems in the neural tube can
have a negative impact on brain development. If the brain's cortex, and especially the frontal part, does not develop properly, cognitive
problems can arise.
Type 2 Arnold-Chiari malformation: This is an abnormal brain development involving a part of the brain known as the cerebellum.
This may cause hydrocephalus. It can affect language processing and physical coordination.
Learning difficulties: People with spina bifida have normal intelligence. However, learning difficulties can occur, leading to problems
with attention, solving problems, reading, understanding spoken language, making plans, and grasping abstract concepts.
Coordination: There may also be problems with visual and physical coordination. Doing up buttons or shoelaces can be difficult.
Paralysis: Most patients have some degree of paralysis in their legs. In cases of partial paralysis, leg braces or a walking stick may be
necessary. A person with total paralysis will need a wheelchair. If the lower limbs are not exercised, they can become weak, leading to
dislocated joints and misshapen bones.
Bowel and urinary incontinence: These are common.
Meningitis: There is a higher risk of meningitis among people with spina bifida. This can be life-threatening.
Other problems: In time, the individual may experience skin problems, gastrointestinal problems, latex allergies, and depression.
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107. Q.5 Write a comprehensive note on the enhancement of community support service for the Physically Handicapped Children.
Perhaps the most critical role in successful inclusive schools is the role of the principal. The school principal’s active participation is the
single most important predictor of success in implementing change, improving services, or setting a new course. The school principal
is central to facilitating systemic change and leading faculty to adopt new attitudes and new practices.
State your support, clearly and explicitly, for an inclusive philosophy and practice across all classrooms in your school in a faculty
meeting or other gathering that involves all staff members.
The reason? A faculty needs and wants a clear vision of the direction their leader is promoting and his or her rationale for doing so. A
formal opportunity to state your expectations will significantly increase goal clarity and progress toward implementation. Informal
conversations are not as effective as a formal presentation with clear expectations from the principal leader.
Resource: inclusion basics online tutorial
Assign special education staff to grade level or department teams, instead of disability or program-specific teams.
The reason? This action quickly demonstrates a philosophy of shared ownership versus separate responsibility and reiterates that ‘every
student is a general education student’. This one change has a surprisingly rapid and positive impact on your inclusive efforts. The entire
faculty recognizes that segregation of the teaching staff is a silent message that contradicts a verbal commitment to an inclusive school.
Resource: categorical vs non-categorical staffing
Provide planning time for teaching team of general and special educators.
The reason? The lack of common planning time is the most often cited reason that faculties become frustrated with inclusive efforts.
School leaders know that common planning time is an important prerequisite for successful inclusion. Collaborative teachers must have
time to plan instructional delivery and ways to increase success for diverse learners in the classroom. Without protected planning time,
the full advantage of having two teachers in the same classroom will never be realized.
Resource: effective use of planning time online tutorial
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108. Ensure that students receiving special education services are participating in on-grade level general curricula and that all special
education teachers receive relevant professional development regarding curriculum with their general education peers.
The reason? Actually, the law requires access to the general curriculum for students with disabilities. “congress finds…almost 30 years
of research and experience has demonstrated that the education of children with disabilities can be made more effective by having high
expectations for such children and ensuring their access to the general education curriculum in the regular classroom, to the maximum
extent possible, in order to meet developmental goals and, to the maximum extent possible, the challenging expectations that have been
established for all children; and be prepared to lead productive and independent adult lives, to the maximum extent possible” (idea
2004). Why is access to the general curriculum important? Historically, children with special needs only had limited if any access to the
general curriculum. Students with disabilities were taught an alternative curriculum. Thus, these individuals were not able to progress
to their full potential. Now there is one core curriculum for every student.
Resource: frequently asked questions about access to the general curriculum
Communicate that the use of appropriate instructional accommodations for any student who requires them is an expected instructional
delivery activity in every classroom. Communicate that any student with an individual education program (iep) must receive all
specified accommodation and/or curricular modification and modified grading procedures as specified in the iep.
It is important to identify appropriate accommodations with students as part of their regular classroom activities and then to use the
accommodations as needed throughout a student’s daily instruction. Accommodations: provide students with disabilities with equal
access to course instruction, materials, and evaluation, “level the playing field” and minimize the impact of the student’s disability on
their academic performance. When indicated on the student’s iep the accommodations must be provided. The student should be involved
in selecting the best accommodations for their learning style and needs and teachers should receive staff development on selecting and
providing these accommodations. They typically have a significant and positive impact on student success. Leaders must make this
expectation clear and must periodically monitor to be certain that accommodations are provided appropriately.
Resource: instructional accommodations article
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109. Convene meetings with general and special education teachers to complete the step-by-step planning forms for each student with an iep
to begin the staffing process for the next school year. Be sure to ask each set of teachers to consider the possibility of more time in the
general education classroom for each student. Recommended: january-february
The reason? For decades, special education staffing allocations were based on formulas and ratios without consideration of the actual
personal support needs of each individual student. As a result, students were either undersupported, over-supported or did not receive
support at the appropriate times. The sbs approach to staffing for inclusive schools relies on information regarding individual student
needs to build a schedule. Two outcomes can generally be expected from this process: 1) student achievement increases because
instructional and behavioral support needs are the basis for staffing — not numbers and 2) the need for staff in inclusive schools is
generally less than expected because many schools are actually over- supporting students or are not using current resources wisely.
Resource: scheduling online tutorial
Use the information from forms 1 and 2 (step 7) to create the schedule of instructional and personal supports for the next school
year. This step should be completed in advance of the creation of the master schedule. Notify the teaching staff of their assigned students
for the upcoming year. Recommended: march-april
The reason? Just as leaders consider ‘singleton courses’ as a starting point for building the master schedule, the same logic is true with
supports needed for students with ieps. By simply placing the staffing for students with ieps ‘on the board’ first, assistance is targeted
for student success, additional staff may not be needed, resources are used more wisely, and it is much easier to schedule collaborative
planning time for those teachers who will work and teach together in inclusive classrooms.
Resource: student centered scheduling
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110. Take steps to include students and parents in creating an authentic inclusive school. Pay particular attention to social inclusion by
creating specific opportunities for all students to develop friendships and a sense of belonging through shared activities. Use students,
faculty, parents, and community to plan these activities.
The reason? While physical inclusion (serving students in their neighborhood schools and in the general education classroom whenever
appropriate) and academic inclusion (including students with ieps in the general education curriculum with high expectations and grade-
level standards) are critical aspects of a leader’s role, social inclusion is often neglected. It is assumed that social inclusion or authentic
student-to-student friendships and interactions will ‘automatically’ occur in inclusive schools, the reality is that adults must purposively
plan for these relationships to grow. Parents and community members should be partners with the school in planning for and carrying
out these opportunities.
Provide data snapshots of increases in time students spend in the general education classrooms and in achievement, attendance, and
graduation to your faculty twice each year. Celebrate your successes and plan for continuous improvement.
The reason? As the saying goes, “what gets measured, gets done!” In addition, leaders know that the many demands on teachers can
seem overwhelming and we often neglect the many opportunities to reward and celebrate accomplishments. Successful leaders
recognize that celebrations cement greater commitment and contribute to teacher retention! Not only do we plan for implementation of
inclusive practices — we have to plan for sustaining them over time!
ASSIGNMENT No. 2
Q.1 How could you deliver the instruction in the Least Restricted Environment as special education teachers?
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111. The Individuals with Disabilities Education Act (IDEA) stipulates that school children be educated in the Least Restrictive Environment.
This means that, to the extent possible, they will be educated with their non-disabled peers, and school systems will provide additional
supports and modifications to make this happen. This is the case for students with severe and multiple disabilities as well as those with
mild ones. However, this is not a mandate for mainstreaming or inclusion. “To the extent possible” is key. Placement decisions are made
on an individual basis by the child’s Individualized Education Plan (IEP) team. The court has found that a Free and Appropriate Public
Education (FAPE) is the overarching goal of IDEA. There are times when FAPE isn’t compatible with full inclusion.
It is possible to educate children who have very different levels of academic functioning in the same classroom; sometimes special needs
students study a parallel curriculum. It is also possible to modify the environment in various ways (for example, to increase predictability
or to increase or decrease sensory load). There are still many reasons full inclusion may not be the most appropriate option. The
Children’s Hospital of Philadelphia Center for Autism Research has noted that sometimes so much support would be required in the
general classroom to focus a child away from distractions and back on his or her curriculum that the child could actually function more
independently in a special education room. This might be determined preferable to having an aide providing constant one-on-one support
in the general classroom. (One difference between a special education classroom and a general classroom is class size). There are cases,
too, where inclusion is determined to be too disruptive.
IEPs are fluid. At points along the way, a child may need a somewhat restrictive environment. This doesn’t mean that he or she will
remain there for the duration of schooling.
Placements are made along a continuum. On the one end, there is full inclusion in the general classroom with educational decisions
made “behind the scenes” that make this possible. The curriculum may be modified. The student may have various tools and
technologies. A special education teacher may work in partnership supporting the general education teacher.
At the other extreme, the child may receive his or her education in an entirely separate setting from non-disabled peers; this may be a
school or another type of institution.
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112. Many children spend part of their day in the general education classroom and part of the day receiving specialized services in another
part of the school. Educators and the general public may use the terms “inclusion” and “self-contained” to describe the primary
placement, but these suggest a dichotomy that doesn’t necessarily exist.
The child’s homeroom may be a special education classroom or a general education classroom. Some children receive all or most
academic instruction in a self-contained special education classroom but interact with non-disabled peers on the playground, in the
cafeteria, and during special activities. It is very common for students in self-contained special education classrooms to take “specials”
(for example, art and music) with their general education peers. They may come into the general education classroom at other times, for
example, when the class is doing silent reading or participating in individualized reading instruction. The amount and type of inclusion
is determined by the child’s IEP. The team will take into account the child’s academic strengths and weaknesses as well as his or her
social and emotional functioning.
Sometimes disabled students are accompanied by instructional assistants during all or some of the time that they spend in the general
education classroom. The instructional assistant may have responsibility for one or more special education children in the room.
Sometimes aides sit with individual children and provide intensive support. Sometimes they move around the classroom and provide
support to other children, as appropriate.
Many children have a general education classroom as their primary placement but spend a portion of the day in a resource room receiving
individualized academic instruction. In some cases, they will leave the room only for instruction in one area (for example, mathematics).
Students whose primary placement is the general education classroom may also leave the room for related services such as speech
therapy, physical therapy, and or occupational therapy. This may be termed “pull-out”. Sometimes an alternative “push in” model
is utilized, whereby specialists come into the classroom to deliver services. Obviously, this is not always feasible. An occupational
or physical therapist may utilize a lot of equipment!
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113. School systems are expected to place students in their neighborhood schools when appropriate. Some, though, will need to attend a
school that is slightly further in order to get the type of education that they need. Transportation is covered under IDEA as a related
service.
While the degree of disability will have some bearing on what is appropriate, educational placements are not made categorically. The
school system may have classrooms designed specifically for students with autism. However, this doesn’t mean that there won’t be
students with autism who are functioning in less restrictive environments.
Q.2 Elaborate the duties of Grade IV public servant the regular school along with Physically Handicapped Children its
population.
The IDEA legislation has affected the work of teachers by creating three new expectations. The first expectation is to provide alternative
methods of assessment for students with disabilities; the second is to arrange a learning environment that is as normal or as “least
restrictive” as possible; and the third is to participate in creating individual educational plans for students with disabilities.
Alternative assessments
In the context of students with disabilities, assessment refers to gathering information about a student in order both to identify the
strengths of the student, and to decide what special educational support, if any, the student needs. In principle, of course, these are tasks
that teachers have for all students: assessment is a major reason why we give tests and assignments, for example, and why we listen
carefully to the quality of students’ comments during class discussions. For students with disabilities, however, such traditional or
conventional strategies of assessment often seriously underestimate the students’ competence (Koretz & Barton, 2003/2004; Pullin,
2005). Depending on the disability, a student may have trouble with (a) holding a pencil, (b) hearing a question clearly, (c) focusing on
a picture, (d) marking an answer in time even when he or she knows the answer, (e) concentrating on a task in the presence of other
people, or (f) answering a question at the pace needed by the rest of the class. Traditionally, teachers have assumed that all students
either have these skills or can learn them with just modest amounts of coaching, encouragement, and will power. For many other students,
for example, it may be enough to say something like: “Remember to listen to the question carefully!” For students with disabilities,
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114. however, a comment like this may not work and may even be insensitive. A student with visual impairment does not need be reminded
to “look closely at what I am writing on the board”; doing so will not cause the student to see the chalkboard more clearly—though the
reminder might increase the student’s anxiety and self-consciousness.
There are a number of strategies for modifying assessments in ways that attempt to be fair and that at the same time recognize how busy
teachers usually are. One is to consider supplementing conventional assignments or tests with portfolios, which are collections of a
student’s work that demonstrate a student’s development over time, and which usually include some sort of reflective or evaluative
comments from the student, the teacher, or both (Carothers & Taylor, 2003; Wesson & King, 1996). Another is to devise a system for
observing the student regularly, even if briefly, and informally recording notes about the observations for later consideration and
assessment. A third strategy is to recruit help from teacher assistants, who are sometimes present to help a student with a disability; an
assistant can often conduct a brief test or activity with the student, and later report on and discuss the results with you.
If you reflect on these strategies, you may realize that they may sometimes create issues about fairness. If a student with a disability
demonstrates competence one way but other students demonstrate it another, should they be given similar credit? On the other hand, is
it fair for one student to get a lower mark because the student lacks an ability—such as normal hearing—that teachers cannot, in principle,
ever teach?
Least restrictive environment
The IDEA legislation calls for placing students with disabilities in the least restrictive environment (or LRE), defined as the
combination of settings that involve the student with regular classrooms and school programs as much as possible. The precise
combination is determined by the circumstances of a particular school and of the student. A kindergarten child with a mild cognitive
disability, for example, may spend the majority of time in a regular kindergarten class, working alongside and playing with non-disabled
classmates and relying on a teacher assistant for help where needed. An individual with a similar disability in high school, however,
might be assigned primarily to classes specially intended for slow learners, but nonetheless participate in some school-wide activities
alongside non-disabled students. The difference in LREs might reflect teachers’ perceptions of how difficult it is to modify the
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115. curriculum in each case; rightly or wrongly, teachers are apt to regard adaptation as more challenging at “higher” grade levels. By the
same token, a student with a disability that is strictly physical might spend virtually all his or her time in regular classes throughout the
student’s school career; in this case, adjustment of the curriculum would not be an issue.
For you, the policy favoring the least restrictive environment means that if you continue teaching long enough, you will very likely
encounter a student with a disability in one or more of your classes, or at least have one in a school-related activity for which you are
responsible. It also means that the special educational needs of these students will most often be the “mildest.” Statistically, the most
frequent forms of special needs are learning disabilities, which are impairments in specific aspects of learning, and especially of reading.
Learning disabilities account for about half of all special educational needs—as much as all other types put together. Somewhat less
common are speech and language disorders, cognitive disabilities, and attention deficit hyperactivity disorders (or ADHD). Because of
their frequency and of the likelihood that you will meet students for whom these labels have been considered, I describe them more fully
later in this chapter, along with other disability conditions that you will encounter much less frequently.
Individual educational plan
The third way that IDEA legislation and current educational approaches affect teachers is by requiring teachers and other professional
staff to develop an annual individual educational plan (or IEP) for each student with a disability. The plan is created by a team of
individuals who know the student’s strengths and needs; at a minimum it includes one or more classroom teachers, a “resource” or
special education teacher, and the student’s parents or guardians. Sometimes, too, the team includes a school administrator (like a vice-
principal) or other professionals from outside the school (like a psychologist or physician), depending on the nature of the child’s
disability. An IEP can take many forms, but it always describes a student’s current social and academic strengths as well as the student’s
social or academic needs. It also specifies educational goals or objectives for the coming year, lists special services to be provided, and
describes how progress toward the goals will be assessed at the end of the year. Exhibit 3 shows a simple, imaginary IEP. (But keep in
mind that the actual visual formats of IEP plans vary widely among states, provinces, and school jurisdictions.) This particular plan is
for a student named Sean, a boy having difficulties with reading. IEPs, like the one in the figure, originally served mainly students in
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116. the younger grades, but more recently they have been extended and modified to serve transition planning for adolescents with
disabilities who are approaching the end of their public schooling (West, et al., 1999). For these students, the goals of the plan often
include activities (like finding employment) to extend beyond schooling.
If you have a student with an IEP, you can expect two consequences for teaching. The first is that you should expect to make definite,
clear plans for the student, and to put the plans in writing. This consequence does not, of course, prevent you from taking advantage of
unexpected or spontaneous classroom events as well in order to enrich the curriculum. But it does mean that an educational program for
a student with a disability cannot consist only of the unexpected or spontaneous. The second consequence is that you should not expect
to construct an educational plan alone, as is commonly done when planning regular classroom programs. When it comes to students
with disabilities, expect instead to plan as part of a team. Working with others ensures that everyone who is concerned about the student
has a voice. It also makes it possible to improve the quality of IEPs by pooling ideas from many sources—even if, as you might suspect,
it also challenges professionals to communicate clearly and cooperate respectfully with team members in order to serve a student as well
as possible.
Q.3 Being a teacher in special education school, design a Home Based Educational Program for the Physically Handicapped
Children.
The beginning of school is such a busy time for everyone, and it is especially busy for teachers of students with visual impairments.
The following is a summary of some of the things I try to do to cut down on the annual hassle surrounding the start of school.
1. Obtain class schedules for students and school bell schedules. If you have high school students on your case load, try to sit down
with the scheduling office in the summer, usually around the first part of August, (this depends totally on their schedule) and
develop a schedule for your student. This can be particularly beneficial if you can pick the student’s teachers. Ask questions of
the scheduling officer or a teacher who has been on the campus for a long time about different teachers. You need to try to find
teachers who USE the state adopted textbook and not their notes or another textbook. You also need teachers who do not solely
use the overhead or write on the blackboard for presentation of materials. These practices can leave a VI student with little or
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117. no hope of academic succeeding. Middle schools usually have their schedules ready before school starts, so usually I can pick
them up before school starts. The elementary campus can tell you who the teacher will be, but usually you can’t get their
schedules until you have a chance to sit down and talk with the classroom teacher. You need a student’s schedule regardless of
whether you see the student on a direct basis or consult. You need the bell schedules too because the student’s class schedule
will be meaningless if you don’t know when classes begin and end.
2. Prepare a folder, preferably one that is brightly colored, to hand out to regular teachers. Include, a letter of introduction about
yourself, schedule, and contact information. Provide a handout about either a low vision student or Braille student, and a copy
of your progress report. Some type of written communication is important for documentation of service since there are times
when you have little contact with a student, like one you see 1 or 2 hours a semester. When you meet the new regular teacher
you can go over all of these forms and tell them that each 6 weeks you will be sending this form for them to complete and return
to you. This will prevent you from showing up at an annual ARD only to find out the VI student is failing a class. I usually send
this to all the teachers I work with because I want to know what is happening in the classroom and this prevents the teacher from
telling you that everything is “fine” when it is not. If a teacher has to indicate if a student is passing their class, then you have
documentation to show the progress being made.
3. Braille and enlarge copies of school calendars for your students. This is a great organizational tool. If they have something where
they can write dates for special projects or tests, then they are more organized. Laminate the large print copies, fold them in half,
and 3-whole punch them so they fit in notebooks.
4. Plan lessons by writing down what you intend to teach. If you don’t, you will find that time just slips by. When I have a lesson
plan written down, I am talking about what the lesson will cover from the moment I meet the student. Since I usually have to
take the student to another room for our lesson, I am introducing material, giving background info., or reviewing previously
learned material as we move. I also take the students IEP and rewrite it in a check-list format, laminate it and carry it in the
student’s folder or in my lesson plan book. This helps me stay focused on my job of TEACHER. I am an “intensive teacher”
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118. because I realize that my student has twice as much to learn as his/her peers and I have half the teaching time (or less) to
accomplish the lesson. So I teach, check for comprehension, re-teach, check again, and so on. When I walk away, I want to
KNOW that I did the best I could do. This will not happen if I don’t have a lesson plan and follow it.
5. Tape record a lesson from time to time. This will make you realize how to help yourself become a better teacher. You can pick
up on your student’s learning style and your teaching style. If you don’t like what you hear, then you can figure out what to do.
This is something special to share with your appraiser. They will be impressed that you are strong and caring enough to
implement a technique to improve your teaching style.
6. At some point, you will have a student who has a poor home life in your opinion. Try not to judge the parents too harshly. You
don’t know where they have been or what they have been through. If you are asked for help, then give it, but you must accept
the situation. You can encourage parents to change some things, but for the most part, your main effect will be on that child.
Make school the best it can be for your student.
7. Invite your “boss” to see your student’s when they are being recognized or participating in special programs. Rarely, does my
director have time to visit with me or my students, but she knows what honors they receive and what activities they participate
in. Your director or supervisor will come to trust you to keep him/her informed. It is also important that you tell your boss about
other district and campus administrators who are really helpful to you or your students. Being positive has tremendous rewards.
8. I often run into people who think that special education means “stupid.” It is part of your job to teach them to see special
education and special education teachers in another light. There have been times in my past when I saw an itinerant teacher slack
off, sneak off, or abuse the freedom of her position. Try to live above the law. Be a model so you don’t have to answer
embarrassing questions about your where-abouts.
9. If possible, deliver textbooks and special materials before classes start. This might mean you will “donate” a day of work since
there are rarely days to deliver materials built into the calendar. Getting these materials to teachers before classes start will make
the beginning of school so much easier on your students and on you. If you box and label materials when you pick them up at
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119. the end of the school year, it makes it easier in the fall. Also, maintain a written list, SOMEWHERE, of all the materials you
loan out to a classroom or student. A page in your lesson plan book is a good place for this because you always have that with
you. Be sure to label your lesson plan book in big contrasting letters so if it gets lost, the one who finds it will know how to
contact you. A great lesson plan book is made by Elan, edition @ 101, forty weeks. It is 81/2 by 11, has the days across the top,
and the periods of the day can be scheduled any way you like. There is an extra blank field on the right to keep personal notes
or memos.
10. Enjoy in-services because learning new information will help you maintain a perspective. It is critical to stay fresh and aware.
Even during the most boring sessions (and we have all been in some) try to learn at least one thing. In-service programs designed
for the regular classroom teacher may seem boring to you, but these sessions give you important information about what other
teachers and students are learning, how they are grading, the curriculum for the grade/subject, etc. (This article from the
newspaper says a lot about maintaining perspective.)
11. Make it a point to meet and know the parking lot attendants, janitors, security guards, and secretaries. You will always have tons
of stuff to tote, need a space to work, and a place to store materials during the year and summers. These people will be your best
friends. They will have suggestions for you and are usually willing to help you.
12. Schedule a time to meet with the classroom teachers of your students who receive direct services. Try to make this a weekly,
scheduled event because there is so much you need to know and so much that the regular teacher needs to hear from you. When
you meet, find out about your student’s social and academic skills. Ask what special events are coming up so you can adjust or
modify schedules or materials. This meeting helps to promote teamwork. Ask what you can do to help the teacher. There have
been times in my past when I would take a slow reader, at the teacher’s request, to read with my Braille student. This was a great
way for my student to learn about others in the class and it helped the sighted student learn about the special student, as well as
having a chance to read in a non-threating situation. I know there are some teachers that you would rather never meet because
they are not meeting the needs of your student and you honestly can’t stand them. Go anyway, and praise them for something
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120. they have done right. If you are seen in a positive light, it is possible you can evoke some changes. You student needs and
deserves that.
13. Don’t judge the regular teacher. Try to fit into their schedule and adjust to their standards if at all possible. You are a guest in
their room. Remember there is something to be learned from everyone!
14. Don’t be afraid to ask for help or to ask questions. It will save you time and keep you from making work harder on yourself.
Remember, it is not how hard we work; it is how smart we work. This job is challenging so look for ways to make it easier on
you.
15. There is a form called VI Registration Worksheet. Fill it out and keep it in your lesson plan book in a plastic sleeve. This gives
you all the information needed to know to complete the VI registration in January. It is also a great way to keep pertinent
information handy to answer questions about what books and tests to order, dates for re-evals., etc.
16. There is an example of a blank weekly schedule. When completed, give copies to your director, the teachers you work with, and
your co-workers. It is a good idea to write your phone numbers on this sheet.
17. The page containing the Braille code and Nemeth info. is one to laminate and keep in your lesson plan book. You never know
when you may need a braille refresher!
18. Teaching social skills is so important for your student. Spend extra time developing a list of goals for each student. Your student
will never be successful in life without good people skills.
Q.4 Write a note on the Placement System designed for the disabled students with special reference of Physically Handicapped
Children.
Special education teachers work with students who have learning, mental, emotional, or physical disabilities. They adapt general
education lessons and teach various subjects to students with mild to moderate disabilities. They also teach basic skills to students
with severe disabilities.
Special education teachers typically do the following:
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121.  Assess students’ skills and determine their educational needs
 Adapt general lessons to meet students’ needs
 Develop Individualized Education Programs (IEPs) for each student
 Plan activities that are specific to each student’s abilities
 Teach and mentor students as a class, in small groups, and one-on-one
 Implement IEPs, assess students’ performance, and track their progress
 Update IEPs throughout the school year to reflect students’ progress and goals
 Discuss students’ progress with parents, other teachers, counselors, and administrators
 Supervise and mentor teacher assistants who work with students with disabilities
 Prepare and help students transition from grade to grade and from school to life outside of school
Special education teachers work with students from preschool to high school. They instruct students who have mental, emotiona l,
physical, or learning disabilities. For example, some help students develop study skills, such as highlighting text and using flashcards.
Others work with students who have physical disabilities and may use a wheelchair or other adaptive devices. Still others wor k with
students who have sensory disabilities, such as visual or hearing impairments. They also may work with those who have autism
spectrum disorders or emotional disorders, such as anxiety and depression.
Special education teachers work with general education teachers, specialists, administrators, and parents to develop IEPs. S tudents’
IEPs outline their goals, including academic or behavioral milestones, and services they are to receive, such as speech thera py.
Educators and parents also meet to discuss updates and changes to IEPs.
Special education teachers must be comfortable using and learning new technology. Most use computers to keep records of their
students’ performance, prepare lesson plans, and update IEPs. Some teachers also use assistive technology aids, such as Brail le writers
and computer software, that help them communicate with their students.
Special education teachers’ duties vary by their work setting, students’ disabilities, and specialties.
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122. Some special education teachers work in classrooms or resource centers that include only students with disabilities. In these settings,
teachers plan, adapt, and present lessons to meet each student’s needs. They teach students individually or in small groups.
In inclusive classrooms, special education teachers instruct students with disabilities who are in general education classrooms. They
work with general education teachers to adapt lessons so that students with disabilities can more easily understand them.
Some special education teachers work with students who have moderate to severe disabilities. These teachers help students, who may
be eligible for services until age 21, develop basic life skills. Some teach the skills necessary for students with moderate disabilities
to live independently, find a job, and manage money and their time. For more information about other workers who help individuals
with disabilities develop skills necessary to live independently, see the profiles on occupational therapists and occupational therapy
assistants and aides.
The median annual wage for special education teachers was $61,030 in May 2019. The median wage is the wage at which half the
workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $40,730, and the
highest 10 percent earned more than $98,530.
Median annual wages for special education teachers in May 2019 were as follows:
Special education teachers, secondary school $61,710
Special education teachers, middle school 61,440
Special education teachers, kindergarten and elementary school 60,460
Special education teachers, preschool 60,000
In May 2019, the median annual wages for special education teachers in the top industries in which they worked were as follows:
Elementary and secondary schools; local $61,620
Elementary and secondary schools; private 53,560
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123. Special education teachers typically work during school hours. In addition to providing instruction during this time, they grade papers,
update students’ records, and prepare lessons. They may meet with parents, students, and other teachers or specialists before and after
classes.
Many work the traditional 10-month school year and have a 2-month break during the summer. They also have a short midwinter
break. Some teachers work in summer programs.
Teachers in districts with a year-round schedule typically work 9 weeks in a row and then are on break for 3 weeks.
Q.5 Give an account on Choosing a Test Battery designed for the Physically Handicapped Children?
Physical disability may have an impact on some or all activities to a greater or lesser extent. Students with physical disabilities may
have problems related to movement, posture (e.g., sitting, standing), grasping or manipulating objects, communication, eating,
perception, reflex movements, and/or automatic motricity (e.g., sphincter, intestinal muscles).
The initial barrier experienced by many students with physical disabilities is physically accessing the learning environment itself. For
many students with physical disabilities the inaccessibility of buildings and surrounding areas is a problem.4
Students with physical disabilities and neurological conditions may also have perceptual difficulties that can take various forms. Some
students have difficulty actually receiving information by hearing or sight, while others can see or hear, but cannot process the
information they receive. This can cause difficulties with reading and writing, such as locating the correct place on the page, or moving
from left to right when reading and writing.
Students with a neurological condition, and who may also have a physical disability, may have speech and language difficulties, along
with students who are deaf, or who have partial hearing, may have difficulty communicating through speech. People with communication
difficulties are often thought to be far less able than they really are. It is important to avoid making quick judgments about these students
to ensure that automatic assumptions are not being made concerning a student’s intelligence and ability if their speech is very slow,
slurred, or if they are non-verbal. The potential of these students often goes unrecognized. Berry and Domene (2015) observed that
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124. students with physical disabilities report that support from postsecondary faculty and staff along with environmental and material
supports to be important for achieving success in their postsecondary studies.
Common Characteristics of a Student with Physical
Disabilities
Commonly Suggested Accommodations/Classroom Adaptations
Has unique needs in terms of physical space or has
difficulty using chairs/tables in the classroom/lab.
Create a physically accessible environment that is not mobility-limited.
Student needs specialized transportation.
Be flexible with the schedule. Students may arrive late or have to leave
before the class is over due to adapted transportation services.
Is often physically unable to hold a pen and write for
extended periods of time or may experience
challenges with input, output, and information
processing when working on assignments, tests,
and/or exams.
Replace written exams or assignments with an oral exam or presentation.
Use of note takers.
Use of assistive technology (e.g., computer, assistive software, mini
recorder, etc.). 5
Use of a scribe or speech-to-text software to record answers on tests/exams.
Provide a room other than the classroom for exams if required.
Student has difficulty finishing assignments and/or
tests in allotted time.
Extra time for tests/exams and perhaps some components of coursework.
Experiences fatigue and limited mobility when
speaking to a person for a long period of time.
When speaking to a person who uses a wheelchair for a long period of time,
avoid the need for them to strain in order to look up at you by sitting beside
or leaning toward them during the conversation, in order for them to avoid
experiencing fatigue and/or pain.
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125. Common Characteristics of a Student with Physical
Disabilities
Commonly Suggested Accommodations/Classroom Adaptations
Requires extra time to obtain formats compatible with
assistive technology.
Provide digital copies of texts. (It is very important to provide students with
a complete list of reference documents as early as possible or prior to the
start of the semester).
Feels excluded during group exercises or has
difficulty moving around the classroom.
Make sure that the person is always included with others when forming
groups.
Expends a great deal of energy to complete daily
tasks.
To reduce fatigue of students with physical disability, it may be helpful to
limit the number of exams on a given day or week. Extra time should be
planned for oral reports on occasion if the person has diction problems.
Perhaps suggest a reduced course load.
Experiences challenges with daily living activities
and mobility.
Ensure all off-site activities are accessible or provide alternative assignment
options.
Individuals with a motor disability sometimes use a service animal, which
is usually trained to respond to unique commands. (It is preferable to ask
permission before you pet the service animal).
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