Physical barriers

EDCC 323
Welcome / Welkom
O amohetswe / O amohelehile
Wamukelekile

EDCC 323
Study Unit 4.1:
Physcal barriers in education
Chapter 10 pg 195
Leereenheid 4.1:
Fisiese hindernisse in onderwys
Hoofstuk 10 bl 195

Aanbevole leesmateriaal vir hierdie gedeelte:
Recommended reading material for this section:
• Bornman, J. & Rose, J. (2017). Believe that all can
achieve. Increasing classroom participation in learners
with special support needs. Van Schaik. Pretoria. ISBN
978- 0-627-02796-3. (Chapters 7 & 10)
• Additional sources as indicated in study unit 4.
Studiemateriaal / Study material

Uitkomste / Outcomes
U sal in staat wees om:
• oor jou begrip van fisiese hindernisse in
die onderwys uit te wei;
• ŉ oorsig van verskillende fisiese
hindernisse in die onderwys te gee;
• vaardighede ter ondersteuning van
leerders met verskillende tipes fisiese
hindernisse in die onderwys te
demonstreer;
• jou begrip van die kompleksiteit van
gedragshindernisse in die onderwys te
demonstreer;
• te beskryf hoe verskillende
gedragshindernisse in die onderwys
bestuur kan word; en
• strategieë te bespreek om leerders met
gedragshindernisse in die onderwys
positief te benader.
You should be able to:
• elaborate on your understanding of
physical barriers in education;
• give an overview of different physical
barriers in education;
• demonstrate skills to support learners
with different types of physical barriers
in education;
• demonstrate your understanding of the
complexity of behavioural barriers in
education;
• describe how different behavioural
barriers in education can be managed;
and
• discuss strategies to approach learners
with behavioural barriers in education
positively.
4

Inleiding / Introduction
Bornmann & Rose p 195 - 216
• Fisiese gestremdhede kan voorkom in
verskillende grade van erns, van skaars sigbaar
tot diepliggend.
• Dit kan aangebore wees (ontstaan voor
geboorte) of verwerf word deur siekte of ŉ
ongeluk.
• Dit kan ook die gevolg wees van ŉ oorerflike
sindroom of skade veroorsaak aan die fetus voor
geboorte deur siekte of medikasie deur die
moeder geneem.
• Algemene eienskappe van leerders wat fisies
gestremd is, is dat hulle probleme ervaar op die
gebied van mobiliteit en fisiese lewenskrag.
• Hulle kan ook probleme ervaar met hul selfbeeld
as gevolg van die negatiewe reaksies wat hul
voorkoms by ander mense wek weens die
bewustheid van hul gestremdhede.
• Hulle kan ook intens geraak word deurdat hulle
‘anders is’ as ander.
• Affektiewe en sosiale probleme kan ook ervaar
word as gevolg van hul onvermoë om hul
liggame te beheer soos hulle sou wou.
• Physical disabilities may occur in various degrees of
severity from barely perceptible to profound.
• It may be congenital (originating prior to birth) or
acquired through illness or an accident.
• It may also be the result of a hereditary syndrome,
or damage caused to the foetus before birth
through disease or medication taken by the mother.
• General characteristics of learners who are
physically disabled are that they experience
difficulties in the area of mobility and physical
vitality.
• They may also experience difficulties with regard to
their self-concept as a result of the negative
reactions that their appearances evoke from other
people owing to the conspicuousness of their
disabilities.
• They may also be intensely affected by their ‘being
different’ from others.
• Affective and social problems may also be
experienced as a result of their inability to control
their bodies as they would like to.

4.1
Serebrale
verlamming
Cerebral
palsy
Spina
Bifida
Muskulêre
distrofie
Muscular
dystrophy
Onder-
steuning
Support

Serebrale verlamming / Cerebral Palsy
(Bornman & Rose:p197)
As a person with cerebral
palsy who walks with
crutches, people have the
assumption that I've had
to overcome a lot of
obstacles in my life
because of it, and to some
degree, I have. However,
the most difficult obstacle
to overcome is other
people's perception of
who a person with a
disability is.
Greg Walloch

01 02
03
Motoriese stelsel
/ Motor system
Waarneembare tekens van die motoriese stelsel wat
geaffekteer word /Perceptible signs of the motor system
being affected owing to the lesion or to inadequate
development

Definisie Serebrale Verlamming /
Definition Cerebral Palsy p. 197
• Die gestremdheid omvat een
of meer van die volgende
kenmerke : verlamming,
swakheid, gebrek aan
koordinasie, en funksionele
afwyking van die motoriese
stelsel.
• Dit is permanent
• Dikwels geassosieerde
belemmerings- verstandelik,
konvulsief, sensories,
perseptueel en affektief.
• The disability has one or
more of the following
characteristics: paralysis,
poor coordination and
dysfunctional motoric
system.
• It is permanent
• Can cause the following:
convulsions, impedes
sensory-, perceptual and
cognitive ability and
affective.

– Genetiese abnormaliteite
veroorsaak wan-ontwikkeling
gedurende die vroeë
embrioniese stadium van
ontwikkeling
– Infeksies wat die
ontwikkelende senuweestelsel
van die fetus beskadig.
– Swangerskap-verwante
abnormaliteite mag tot vroeë
geboorte en verwante
komplikasies lei.
– Ongunstige toestande
gedurende geboorte ontneem
die onvolwasse areas van die
brein van suurstof en bloed
– Traumatiese breinbesering
– Amper-verdrinking
– Virale infeksies soos enkefalitis
(encephalitis), meningitis
– Genetic malformation in
early sages of embryonic
development
– Infections damaging
developing nervous
system of fetus
– Pregnancy-related
abnormalities – may lead
to pre-term delivery and
related complications
– Adverse conditions
during labour – deprive
immature areas of brain
form oxygen and blood
– Traumatic brain injury
– Near drowning
– Viral infections –
encephalitis, meningitis
Oorsake / Causes p 197

Serebrale verlamming: 2 klassifikasie
Cerebral Palsy: 2 classifactions
Topografies
Topographical
Monoplegia
Hemiplegia
Triplegia
Quadri-
plegia
Diplegia
Paraplegia
Fisiologies
Physiological
Spasticity
Diskynesia
Hypotonia
Ataxia
Mixed
types
Topografiese
klassifikasie:
Klassifikasie volgens
die liggaamsdele wat
geaffekteer word.
Topographical
classification:
according to the body
parts affected.
Fisiologiese klassifikasie:
Klassifikasie volgense die
motoriese funksie van
die liggaam.
Physiological
classification:
Classification according
to the motoric function of
the body.

Topografiese / Topographical
Mono-
plegia
Triplegia
Qudri-
plegia
Diplegia
Para-
plegia
Hemi-
plegia

13
Topografiese klassifiseringstelsel
Topographical classification system
(Bornman & Rose p 198)
 Monoplegie - een ledemaat is
geaffekteer
 Hemiplegie – linker of regterkant
van die liggaam is geaffekteer
 Triplegie – drie ledemate –
gewoonlik beide bene en een arm
 Kwadruplegie – al vier ledemate
 Diplegie – al vier ledemate veral
baie ernstig in laer ledemate
 Paraplegie - albei onderste
ledemate (bene)maar nie boonste
ledemate nie
 Monoplegia - one limb is
affected
 Hemiplegia – left or right hand
side of body
 Triplegia – three limbs –
usually both legs and one arm
 Quadriplegia – all four limbs
 Diplegia – all four limbs –
worst involvement in lower
limbs
 Paraplegia - both lower limbs

Fisiologiese
Klassifikasie
/
Physiological
classification
Spastisiteit/ Spasticity
Diskenesie / Dyskinesia:
- Atetose / Athetosis
- Senutrekkings/ Choreiform movements
- Distonie/ Distonia
- Choreo-atetose /Choreo-athetosis
Hipotonie/ Hypotonia
Ataksie/ Ataxia
Gemengde tipes/ Mixed types

Fisiologiese klassifikasie
Physiological classification
1. Spastisiteit
 Toestand van disharmonieuse spieraktiwiteit
veroorsaak deur skade aan die motoriesegedeeltes
van die brein – stywe ledemate
 Hiper-tonus– gevolglik van die oordrewe strek-
refleks
 Toenemende weerstand tot passiewe beweging –
hoofsaaklik beweging in een rigting
 Toenemende spiertonus in spastiese spiere, asook
swakheid in teenoorstaande spiere
2. Diskinese
 Atetoses – oordadige onwillekeurige bewegings in ‘n
vasgestelde patroon. Word beskryf as ongereelde
onritmiese gewriemel en ineenkrimping
 Stadige beweging
 Gebruik van ledemate ernstig ingekort
 Gesigspiere verwronge
 Onwillekeure gesig, tong en nekbewegings -
belemmerde spraak, kou en sluk – voeding word
baie bemoeilik
 Postuurprobleme– bemoeilik sit en loop
 Gedurende slaap beleef persoon algehele
ontspanning 15
1. Spasticity
 Condition of disharmonic muscle activity caused by
damage to the motor areas of the brain – stiffness
 Hyper tonus – resulting from the exaggeration of
normal stretch reflex
 Increased resistance to passive movement – mainly
moment in one direction
 Increased muscle tone in spastic muscles,
accompanied by weakness in muscles that act in
opposition to them
2. Dyskinesia
 Athetosis – excessive involuntary movements
following n fixed pattern and described as irregular,
arrhythmic wriggling and writhing
 Movement slow
 Use of limbs seriously impaired
 Muscles of face distorted
 Involuntary movements of face, tongue and throat -
impede speech, chewing and swallowing – feeding
difficult
 Postural problems – hamper sitting and walking
 During sleep – complete relaxation

• Spastisiteit/ Spasticity
https://www.youtube.com/watch?v=J3cGY58x5JM (0:47)
• Diskinese/ Dyskinesia
https://www.youtube.com/watch?v=48evbuUMtpI

17
3. Choreiform bewegings
• Skielike rukkerige bewegings
• https://www.youtube.com/watch?v=HOal
YWvVLU8
4. Dystonia – stadige bewegings met
uitstrekking van onderlyf en ledemate
5. Choreo-athetosis- stadige, doelgerigte
beweging gemeng met rukkerige bewegings
6. Hypotonia – verminderde spiertonus en
kenmerkende weerstand teen passiewe
beweging
• Gewrigte verminder weerstand wanneer
dit gestrek word
7. Ataxia (soos dronk persoon) – swak
koördinasie, balans, liggaamshouding en
kinestetiese terugvoer prosesse
• Onvermoë om balans te behou, tesame
met afwesigheid van groot en/of
fynmotoriese koördinasie of lompheid
8. Gemengde tipes
3. Choreiform movements
 Sudden jerking movements
 https://www.youtube.com/watch?v=HOalYWv
VLU8
4. Dystonia – slow movements with extension of
trunk and limbs
5. Choreo-athetosis- slow and purposeful
movements mixed with jerky movements
https://www.youtube.com/watch?v=XCzdUiSo8Y8
6. Hypotonia – decrease in muscle tone and
characterized by decreased resistance to passive
movement
 Joints offer decreased resistance when flexed
7. Ataxia – poor coordination, disturbances of
balance, body posture and kinaesthetic feedback
processes
 Inability to maintain balance, associated with
lack of gross and/or fine motor coordination
or clumsiness
 https://www.youtube.com/watch?v=-
s77voH8nRI
8. Mixed types

18
• Choreiform bewegings/Choreiform movements
https://www.youtube.com/watch?v=3Qwufr-vH_U
• Distonie / Dystonia
https://www.youtube.com/watch?v=wVVrN4tnxVU
• Choreo-atetose/ Choreo-athetosis
• Hipotonie / Hypotonia
• Ataksie / Ataxia
https://www.youtube.com/watch?v=bKyYTzdHv2I
https://www.youtube.com/watch?v=-s77voH8nRI

Kognitief/
Cognitive
Kommunikasie/
Communication
Visueel / Visual
Gehoor/ Hearing
Sosiaal/ Social
Vaardighede betrokke / Skills involved p.199

• Belemmerde motoriese funksie
het ernstige implikasies vir
onderwys: skryf, spraak en visie.
• Geaffekteerde gesigspiere wat
vertrek word het ‘n impak op
sosialisering
• Indien spiere wat postuur beheer
geaffekteer word: Belemmer
effektiewe uitvoering van
daaglikse aktiwiteite soos
selfversorging, eet, was, bad en
aantrek.
• Self-konsep kan geaffekteer
word. Kan verwerp voel.
• Impede motor function has severe
implications for education:
writing, speech and vision.
• Affected facial muscles causing
constant grimacing has
implication on socialisation.
• When muscles controlling posture
are affected: effective
performance of daily activities
such as self-care, eating, washing,
bathing and dressing are
impeded.
• Self-concept can be affected.
They can feel rejected.
Uitdagings van SV / Challenges of CP
(B & R p 200)

• Associate impairments: 40% of learners with
CP develop seizures; susceptible to
respiratory infections; feeding problems may
result in poor nutrition.
• Learned helplessness: Lack of motivation or
passivity.
• Pain:
• Challenging behaviour: frustration due to
limited functional abilities. Family and
societal attitudes – overprotection, rejection,
limited or unrealistic expectations, isolation,
belief in witchcraft or evil spirits.

22
Klaskamerondersteuning
L p 330
• Pas kurrikulum aan rakende volume
werk
• Maak gebruik van alternatiewe
metodes – tikmasjien, rekenaar
• Mondstuk
• Spesiale hulpmiddels – handklamp
(hand brace) kop-wyser –
onderwyser moet bekend wees met
moontlike hulpmiddels
• Samewerking met terapeute
• Ontspan spiere – leer hul hoe om hul
spiere te masseer
• Maak beweging in en om klaskamer
maklik
• Funksionele werkstasie
• Help leerders op speelgrond
• Help leerders om praktiese
oplossings te vind
Klaskamer ondersteuning
Classroom support
• Adjust curriculum regarding
volume of work
• Alternative methods –
typewriter, computer
• Mouthpiece
• Special aids – hand braces or
head pointers- teachers should
be familiar
• Cooperate with therapists
• Relax muscles – teach them
how to massage it
• Make movement in classroom
easy
• Workstation – functional
• Learners help on playground
• Help learner to think practically

Ondersteuning in die klaskamer
Classroom support – Assistive devices

• Hulp met geskrewe werk –
hulle skryf stadig en onnet –
buddy stelsel – deel notas met
hom
• Kopieer notas
• Dra skooltas, pak boeke uit,
maak oop op regte plek –
omblaai van bladsy is moeilik
en tydrowend
• Aanvaar die persoon
onvoorwaardelik
• Hanteer hom menswaardig
24
• Assist with written work –
work slow and untidy –
buddy system – share
notes
• Copy notes
• Carry bag, help with books,
open book, turn the page,
etc.
• Accept him as a human
being

Verdere Ondersteuning in die klaskamer /
Further Classroom support
• Vorm samewerkende
verhouding met
arbeidsterapeute of
fisioterapeute.
• Jy kan bv. In die klas
bystand verleen om die
kind met postuur te
help.
• Maak seker die kind kan
maklik rondbeweeg in
die klas
• Cooperate with
occupational therapists
or physiotherapists.
• You can maybe assist
them with things like
the learner's posture in
class.
• Make sure learner can
move around in class
and reach his/her desk
easily.

Ondersteuning / Support
• Beplan die leerder se
werkstasie sodat dit
funksioneel is.
• “Buddy”-sisteem – leer
ander om kind by te staan
met uithaal van boeke,
kosblik ens.
• Leer kinders om op die
speelgrond te help.
• Help leerders om prakties
te dink.
• Plan the learner's
workstation so that is
functional. The learner
should have a special
table equipped for his/her
needs.
• Buddy system – learners
to assist with packing
books, turning pages
• Teach children to help on
the playground.
• Help the learner to think
practically.

Pippie Kruger
The accident – which occurred
when a firestarter gel exploded at
the family braai – left Pippie with
severe burns all over her body
and caused her to suffer brain
damage.
She had five strokes in her short
life, which caused all her muscles
to contract.
She underwent 62 surgeries.
She is 12 years now.
SLP_IE @North-West University 27

Topografiese / Topographical
Mono-
plegia
Triplegia
Qudri-
plegia
Diplegia
Hemi-
plegia
5 6 7 8 9

Wat is Spina Bifida?
What is Spina Bifida? P 201
• Ook genoem spinale spleet
• Genetiese abnormaliteit van die
ruggraat
• Dit is ‘n neurologiese
abnormaliteit wat ander sisteme
van die liggaam permanent kan
beskadig
• Een of meer van die werwels van
die werwelkolom is nie volledig
gevorm nie
• Gewoonlik die agterste deel wat
ontbreek
• Spina bifida beteken “werwel in
twee dele”
• Also called spinal fissure
• Genetic abnormality of the
spinal cord
• Is a neurological abnormality
which may permanently affect
other systems of the body.
• One or more of the vertebrae
of the vertebral column is not
completely formed.
• Usually the posterior (back)
part which is lacking.
• Spina bifida means “vertebra
in two parts”.

Gesonde Ruggraat / Healthy Spinal Cord
Meninges (breinvliese)
Cerebrospinal fluid/
Serebrospinale vloeistof
Spinal cord / ruggraat
Vertebra / Werwel

Spina Bifida
• By die opening van die rug mag die
membraan uitstoot en ‘n sak gevul
met serebrospinale vloeistof vorm
(en soms dele van die ruggraat)
• Die sak is gewoonlik nie bedek met
vel nie
• Die opening kan op enige plek op die
werwelkolom voorkom (van die kop
tot die koksis) – gewoonlik laer af
• Gevolge van Spina Bifida hang af van
die plek in die ruggraat waar die
opening voorkom
• At the opening the membrane may
bulge to form a sac containing
cerebrospinal fluid (and sometimes
part of the spinal cord.)
• The sac is usually not covered with
skin.
• The opening may appear at any place
on the spinal column (from head to
coccyx)- usually at the lower parts.
• The consequences of spina bifida
depend on the place in the spinal
column at which the opening
appears.

Spina Bifida
3 vorme / forms
(B & R p 202)
Spina bifida
occulta
Spina bifida
occulta
Spina bifida
meningocele
Spina bifida
meningocele
("mi-nin-gi-seal")
Spina bifida
myelomeningocele
Spina bifida
myelomeningocele
("my-lo-mi-nin-gi-seal")

Spina Bifida
Meningoseel/Meningocele
• Minder algemene vorm
• Die sak/sist wat op die ruggraat vorm bevat slegs serebrospinale vloeistof en membrane wat die rugmurg bedek
(m.a.w. geen senuwees of deel van die rugmurg nie).
• Less common form
• The sac/sist which forms consists only of cerebrospinal fluid and the membranes which cover the spinal cord (It does
not contain part of the spinal cord)

Spina Bifida
Miëloseel/Myelomeningocele
• Meer algemeen en meer
ernstig van aard.
• Die sak/sist bevat weefsel ,
serebrospinale vloeistof,
senuwees en ‘n deel van die
rugmurg. Dele van die
rugmurg en die membrane
wat die sak omring kan
gebreek of geperforeer
wees.
• Die rugstring is m.a.w.
kwesbaar vir beserings en
infeksies.
• More often and is of a
serious nature.
• The sac/sist also contains
part of the spinal cord but
the membrane
surrounding the sac may
be complete or it may be
broken or perorated.
• The spinal cord is
vulnerable to injury,
desiccation and infection.

Spina Bifida
Miëloseel/Myelomeningocele

Spina Bifida
Occulta
• Kom voor in 5-25% van die populasie.
• Affekteer 2 keer soveel meisies as
seuns.
• Geen knop/swelling kom voor by die
opening in die rugstring nie.
• Sterk membrane ontwikkel gewoonlik
in hierdie area.
• Die opening is slegs identifiseerbaar
deur ‘n duiking (dimple) of ‘n klossie
hare in die area op die rug.
• Gewoonlik simptoomvry.
• Soms ‘n mate van inkontenensie en
sommige persone ontwikkel
rugprobleme jare later.
• Appears in 5-25% of the
population.
• Affects twice as many girls as
boys.
• No bulge occurs at the opening
in the spinal column.
• Strong membranes usually
develop in this area.
• The opening is only revealed
by a dimple or a tuft of hair in
the area on the back.
• Usually, symptom free.
• Sometimes there is a measure
of urinary incontinence, and
some persons develop back
problems years later.

Toets jou kennis
Test your knowledge
1 2 3 4
Meningocele: No
nerves from the
spinal cord are
displaced
Normal spine:
Mieloseel/
Myelomeningocele:
Spinal cord and
nerves are disrupted
and abnormal
Spina bifida
occulta: Fatty mass
and hair may or
may not be present

1 2 3 4
Meningocele: No
nerves from the
spinal cord are
displaced
Mieloseel
/Myelomeningocele:
Spinal cord and nerves
are disrupted and
abnormal
Normal spine:
Spina bifida occulta:
Fatty mass and hair
may or may not be
present

Beperkte mobiliteit / Limited mobility
Sensoriese verlies / Sensory loss
Inkontinensie / Incontinence
Hidrosefalie / Hydrocephalus
Intellektuele gebrek / Intellecutal impairment
Epileptiese aanvalle / Epileptic seizures
Visuele gebreke / Visual impairments
S
i
m
p
t
o
m
e
/
S
y
m
p
t
o
m
s

• Beperkte
beweeglikheid van
onderste ledemate
• Hang af van waar die
defek / lestsel in die
rugstring is.
• Fisio- en arbeidsterapie.
• Sensoriese verlies
• Veral in voete, boude,
tussen die bene, om die
anus en geslagsdele.
• Agterkant van diebene
• Druksere
• Brandwonde
• Apnee /
• Limited mobility of
lower limbs
• Depends on where the
defect/ lesion is in the
spinal cord
• Physio and occupational
therapy
• Sensory loss
• Especially in feet,
buttocks, between legs
around anus and genitalia
• Back of legs
• Pressure sores
• Suffer from burns

• Inkontensie
• Van uriene en stoelgang
• Blaasinfeksies
• Hardlywigheid
• Hidrokefalie (water op die
brein)
• Oorgrote meerderheid van
kinders
• Klein pompie – reguleer-
versamel vog.
• Moet vervang word wanneer
verstop.
• Braking, geïrreteerdheid en
hoofpyne – foutiewe pomp.
• Incontinence
• Of urine and stools
• Urinary infections
• Constipation
• Hydrocephalus (water on
brain)
• Majority of children
• Small pump – shunt –
collects fluid
• Must be replaced when
blocks
• Vomiting, irritability, and
headaches – faulty pump

• Intellektuele onvermoë
• 10% - wat nie hydrocephalus het
nie.
• Met hydrocephalus - 25% -
infeksies weens regulering
• Meerderheid het normale
intelligensie
• Geringe gestremdheid in
perseptuele vaardighede, aandag,
geheue en
organiseringsvermoëns –
leerprobleme.
• Epileptiese aanvalle
• 15%
• Beheer met medikasie
• Foutiewe regulering van "shunt"
kan oorsaak wees
• Visuele gestremdheid
• Strabismus – skeel oë
• Intellectual impairments
• 10% - who doesn’t have
hydrocephalus
• With hydrocephalus – 25% -
infections of shunts
• Majority have normal
intelligence
• Significant impairments in
perceptual skills, attention,
memory and organisational
abilities – learning problems
• Epileptic seizures
• 15%
• Controlled with medication
• Faulty shunt could be cause
• Visual impairments
• Strabismus - squinty eyes

Groepwerk &
bespreking
Group work &
discusison
Groepwerk: Uitdagings
Group work: Challenges (B & R p 202)
Reflekteer op die volgende uitdagings en bespreek in u groep of n leerder met Spina Bifida in 'n
algemene klaskamer geakkommodeer kan word:
Reflect on the following challenges and discuss in your group if a learner with Spina Bifida can be
accommodated in a general classroom:

Onderwys / Education
• Kan in ‘n gewone klas wees
• Spesiale aandag aan sosiale
ontwikkeling
• Oorgewig, met misvormde bene
en lyf, totaal afhanklik en kan
soms ruik.
• Beperkte beweeglikheid
• Voorkoms
• Leerprobleme
• Gewoonlik moet hierdie kinders ‘n
paar operasies ondergaan
• Skoolprogram buigbaar wees om
hulle te akkommodeer.
• Baie kinders met myelomeningocele
moet geleer word om hulle derm en
blaas funksies te beheer.
• Sommige moet kateters of die insit
van ‘n buis om uriene te dreineer.
• Can be in general classrooms
• Special attention to social
development
• Obese, with deformed legs and trunk,
totally dependant and perhaps smelly
• Limited mobility
• Appearance
• Learning problems
• Quite often, however, they must have
a series of operations throughout their
childhood.
• School programs should be flexible to
accommodate these special needs.
• Many children with myelomeningocele
need training to learn to manage their
bowel and bladder functions.
• Some require catheterization, or the
insertion of a tube to permit passage
of urine

• Mag aandagafleibaar wees
• Sukkel soms om taal te verstaan en
hulself uit te druk
• Hindernisse t.o.v van lees en
wiskunde
• Vroeë intervensie kan leerders help
om hul voor te berei vir die skool-
opset
• Moet mobiliteitsvaardighede aanleer
– gebruik krukke, rolstoele of bande
• Belangrik dat skool en ouers kind se
fisiese vermoëns en beperkinge
verstaan
• Het ŉ geweldige uitwerking op kind
se sosiale en emosionele
ontwikkeling
• Moedig kind aan om binne
veiligheids- en gesondheidsperke
onafhanklik te wees en deel te neem
aan aktiwiteite saam met hul
klasmaats
• They may have difficulty paying attention,
• expressing or understanding language, and
• grasping reading and math.
• Early intervention with children who
experience learning problems can help
considerably to prepare them for school
• Children with myelomeningocele need to
learn mobility skills, and often require the aid
of crutches, braces, or wheelchairs.
• It is important that all members of the school
team and the parents understand the child's
physical capabilities and limitations.
• Physical disabilities like spina bifida can
have profound effects on a child's emotional
and social development.
• To promote personal growth, families and
teachers should encourage children, within
the limits of safety and health, to be
independent and to participate in activities
with their non-disabled classmates

Denkkaart... / Thinking Map...
In pare: Klassifiseer die uitdagings
wat ’n kind met Spina bifida ervaar
deur gebruik te maak van ’n
geskikte denkkaart.
In pairs:
Classify the challenges a child
with Spina bifida may experience
by utilising a suitable thinking
map

Muskulêre distrofie
Muscular dystrophy p 203

Aanbevole leesmateriaal vir hierdie afdeling:
Recommended reading material for this section:
Bornmann & Rose, 2017:203
Studiegids / Study guide
https://www.mda.org/disease/duchenne-muscular-dystrophy/causes-inheritance
https://patient.info/health/duchenne-muscular-dystrophy-leaflet
https://musculardystrophynews.com/muscular-dystrophy-diagnosis/
https://www.nichd.nih.gov/health/topics/musculardys/conditioninfo/types
Studiemateriaal / Study material

Definisie
Definition
P 203
Affekteer spiere
Affects muscles
Genetiese toestand
Genetic condition
Progressiewe siekte – spiere
word swakker en swakker
oor maande en jare
Progressive disease –
muscles get weaker and
weaker over months and
years
Ma is draer van
geen, maar het nie
MD nie.
Mother carries the
gene, but does not
have the disorder
Kom meestal voor onder
seuns. 1 uit 3 500
pasgebore seuntjies is
geaffekteer
Occurs mostly in boys. 1 out
of 3 500 new-born boys are
affected
Affekteer groot- en fyn
motoriese funksie, hart
& longe
Affects gross- and fine
motor function, heart &
lungs
Geleë in X chromosoom
Located on X chromosome

Onderskei krities tussen die twee tipes MD
en som dit op
Critically distinguish between the two
types of MD and summarise it
Tipes MD
Types MD
Duchenne
MD
Becker MD

Tipes MD / Types MD
Becker MD
• Individue met genetiese
mutasies van Becker MD
maak distrofien wat
gedeeltelik funksioneel is,
wat hul spiere dan beskerm
van degenerasie so erg of
so vinnig soos met DMD.
• Individuals with Becker MD
genetic mutations make
dystrophin that is partially
functional, which protects
their muscles from
degenerating as badly or as
quickly as in DMD.
Duchenne MD
• DMD kom voor omdat
gemuteerde geen nie
daarin slaag om enige
funksionele distrofien te
produseer nie.DMD occurs
because the mutated gene
fails to produce virtually
any functional dystrophin.

DUCHENNE (DMD)
What It Is Common Symptoms How It Develops
The most common and severe
form of MD among children,
DMD accounts for more than
50% of all cases. DMD is
caused by a deficiency of
dystrophin, a protein that
helps strengthen muscle fibers
and protect them from injury.
Weakness begins in the upper
legs and pelvis. People with
DMD may also:
•Fall down a lot
•Have trouble rising from a
lying or sitting position
•Waddle when walking
•Have difficulty running and
jumping
•Have calf muscles that
appear large because of fat
accumulation
DMD appears typically in boys
between ages 3 and 5 and
progresses rapidly. Most
people with DMD are unable
to walk by age 12 and may
later need a respirator to
breathe. They usually die in
their late teens or early 20s
from heart trouble,
respiratory complications, or
infection.
BECKER
What It Is Common Symptoms How It Develops
Also caused by a deficiency of
dystrophin, and with
symptoms similar to those of
DMD, Becker can progress
slowly or quickly.
•Patients with Becker MD
may: Walk on their tiptoes
•Fall down a lot
•Have difficulty rising from the
floor
•Have cramping in their
muscles
Becker MD appears primarily
in males between ages 11 and
25. Some people may never
need to use a wheelchair,
while others lose the ability to
walk during their teens, mid-
30s, or later.

Ondersoek die uitdagings wat 'n kind met MD het deur gebruik te maak van 'n
borrelkaart
Investigate the challenges a learner with MD faces by using a bubble map p 204

Ondersteun leerders met 'n fisiese gestremdheid – Som op
Support learners with a physical barrier - Summarise
P204

Spesiale aandag / Special attention
Selfbeeld/ Self image
Affektiewe reaksies
/affective reactions
Gewigsprobleme/
Weight problems

Ondersteuning / Support
• Vorming van ‘n positiewe, maar realistiese
selfkonsep is van groot belang
• Moet gehelp word om realistiese beeld te
vorm van sy eie liggaam – vorm begrip vir
liggaam se moontlikhede en beperkings
• Vorm ‘n realistiese beeld van homself as
‘n persoon met waarde en moontlikhede
• Aktiewe steuning ten opsigte van
sosialisering – skep geleenthede
• / Rolspel kan bruikbaar wees (Bv. begrip
en deernis ook aan ander.)
• Gee aan ander kinders in die klas leiding
om met hierdie persoon saam te werk en
te aanvaar.
• Onderwyser se eie houding is baie
belangrik
• Maak gebruik van eksterne motivering –
ideaal is dat dit oorgaan tot intrinsieke
gemotiveerdheid
• Forming a positive but realistic self-image is
important.
• Must be helped to form a realistic image of
his own body – also understand the
possibilities and limitations.
• Form a realistic image of himself as a person
with worth and potential
• Active support regarding socializing.
• Role play can be useful (E.g. Understand ant
to show compassion for others).
• / Give guidance to other students in class on
how to work with these children and to
accept them.
• Teachers own attitude and example may
contribute greatly.
• Make use of external motivation – would be
ideal if it develops into intrinsic motivation.
Psigososiale probleme / Psycholsocial problems

• Sover moontlik toelaat dat kind
onafhanklik werk en beweeg
• Waar moontlik moet kinder so
lank moontlik staan of beweeg
sodat bloedsomloop verbeter
• (Ook belangrik vir nierfunksie).
• Spasie vir rolstoele in die klas. (Vir
bewegin en sodat rolstoel onder
die bank inpas.)
• Raam rondom tafel sodat boeke
ens. nie kan afval nie.
• Wasgeriewe – sodat kind hande
kan was na rolstoel hantering.
• Soms gehelp word om te sit of op
te staan.
• Allow the learner to work and
move independently
• If possible – make learner stand
for longer periods to improve
blood circulation (Also important
for kidney function)
• Make space for wheelchairs in
class. (To move around easily and
to fit in under desks).
• Frame around desk to prevent
books from falling.
• Washing facilities should be made
available after they used their
hands to move a wheelchair.
• Sometimes helped to sit or to
stand up.
Mobiliteit / Mobility

• Kinders benodig spesiale leiding of
hulp om so droog moontlik te bly.
• Kinders moet dalk meer gereeld
badkamer toe gestuur word
• Spesiale aandag moet gegee word aan
die manier waarop die kind sy/haar
blaas ledig (Aanbeveel deur die
uroloog). /
• Daar moet gelet word na die
perineum om te verseker dat die vel
nie rooi en geïrriteerd raak nie.
• Leer kinders van nie-verbale
kommunikasie sodat hy/sy weet
wanneer sy liggaamsreuke aanstoot
gee
• Skerp urinereuk kan indikasie van
infeksie wees.
• Besonderse aandag aan leerders se
higiëne sodat sosialisering bevorder
kan word.
• Lei ook ander kinders in die klas om
hierdie leerder te ondersteun.
• Children need special guidance and
care to stay as dry as possible.
• Need to send them to the bathroom
more often.
• Special attention must be given to the
way the child empties their bladder
(Recommended by an urologist).
• Give attention to the perineum to
make sure skin is not red or irritated.
• Teach children about non-verbal
communication so that they can know
when their body odours are offensive.
• Urine with sharp smell can be
indication of infection.
• Special attention can be given to
learner's hygiene in order to improve
socialising.
• Educate other children in class on how
to support other learners.
Inkontenensie / Incontinence.

• Besonderse oplettendheid is
nodig om druksere te
voorkom.
• Let ook op die passing van
skoene en ortopediese
hulpmiddels.
• Kinders moet aangemoedig
word om elke halfuur op te
lig.
• Dele wat rooi is kan gevryf
word om sirkulasie te
bevorder.
• Kontak ouers indien jy oor
iets bekommerd is.
• Particular attention should
be padi to prevention of
pressure sores.
• Take note of shoes and aids
which have become too
small.
• Children should be
encouraged to rise every
half hour.
• Pressure points that are red
may be rubbed to improve
circulation.
• Contact the parents if you
are worried about
something.
Verlies aan sensasie en druksere. / Loss of sensation and pressure sores.

• Onderrighulpmiddels – sodat
hulle sover moontlik kan
deelneem.
• Skriftelike werk kan verminder
word om ontwerp word om
aan hul behoeftes te voldoen.
• Arbeidsterapeute kan
waardevolle hulp verleen.
• Wanneer hulle gou vermoeid
raak kan die program aangepas
word – die kind kan bv.
rusperiodes kry.
• Werk kan minder gemaak word
– maak seker hy/sy verstaan.
Kwaliteit is belangriker as
kwantiteit.
• Na afwesighede moet daar
moeite gedoen word om werk
in te haal.
• Special educational media
should be provided so that they
can participate as far as
possible.
• Written work can be reduced.
• Occupational therapists can be
valuable.
• When children tire easily the
program can be adapted. (Rest
periods).
• Work can be reduced – make
sure the child understands.
Quality is more important than
quantity.
• After a child was absent extra
effort must be made to catch
up.

Ander probleme:
• A.g.v. postuur soms moeilik om bv.
skryfwerk te behartig.
• Raak gou vermoeid.
• Soms baie afwesig.
Other problems:
• As a result of poor posture – sometimes
difficult to write;
• tire easily ;
• can often be absent.

Volgende week aanlyn
Next week online
Unit 4.2
Gedragshindernisse
Behavioural barriers

Please assess me
on eFundi.
I need YOUR
input to improve
MY practice.
Dankie !
Thank you !
Ke a leboga!
E
D
C
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323

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Volgende week / Next week
ONLINE CLASS
DUE TO TEST SERIES
Unit 4.2
Ke a leboga!
Thank you!
Dankie!

Physical barriers

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