Transcript Unit One - Part 2 Physical/Health Disabilities: Definitions and Impact

Special Education 547
Unit One - Part 2
Physical/Health Disabilities:
Definitions and Impact on
Education
Kevin Anderson
Minnesota State University Moorhead
2006
Physical and Health
Disabilities
• General Information
– Review of definitions
– Associated medical conditions
– Medical and therapeutic interventions
• Onset of disability
– Congenital
– Acquired
• Nature of disability
– Acute
– Chronic
• Impact and strategies
Review of disabilities
• Neuromotor impairments
• Degenerative diseases
• Orthopedic and musculoskeletal
disorders
• Health disabilities
Neuromotor Impairments
• Originate in the CNS
• Affect nerves and muscles
• Types
– CP
– Neural Tube defects
– TBI
Cerebral Palsy
• Definitions
– Disorder of movement and posture
– Non-progressive brain abnormality
– Developmental disability
– Affects physical development
• Movement
• Muscle tone
• Position in space
Time of Assault
•
•
•
Prenatal
– Brain malformation
– Genetic syndrome
– Infection
– Anoxia
Perinatal
– Asphyxia
– Infection
Postnatal
– Infection
– TBI
– Poison
– Anoxia
Classifications
• Location
– Diplegia
– Hemiplegia
– Quadriplegia
• Neuroanatomy
– Area of the brain involved
– Neurological or neurophysiological
dysfunction
Classifications
• Movement
–
–
–
–
Spastic
Dyskinesia
Ataxia
Mixed
• Function
– Mild
– Moderate
– Severe
Associated Conditions
•
•
•
•
•
•
•
Sensory impairments
Communication impairments
Orthopedic deformities
Nutrition needs
Cognitive dysfunction
Learning disabilities
Seizures
Treatment
• Therapeutic
– Physical therapy
– Occupational therapy
• Orthotics
• Medication
• Surgical
Developmental Impact
• Physical
• Management
–
–
–
–
Spasticity
Athetosis
Ataxia
Mixed
• Body mechanics
• Communication
• Social/emotional
Educational Impact
•
•
•
•
•
Inclusion
Differences
Learning issues
Self-determination
Adult outcomes
Neural Tube Defects (NTD’s)
•
•
•
•
Malformations of the brain, spinal cord, and/or vertebrae
Commonly referred to collectively as spina bifida
Failure of spinal column to close properly
Contributing factors
– Nutrition
– Medication
– Temperature
• Folic acid supplements
• Genetic links - ethnic prevalence
• Gender ratio
Types of NTD’s
• Malformation of skull and portion of brain
pushes out - encephalocele
• Absence of brain development beyond the
brain stem - anencephaly
• Most common - spina bifida
– Few vertebrae are bifid and no protrusion - spina
bifida occulta
– Covering or meninges protrude through open
defect in spine - meningocele
– Protrusion of spinal cord and meninges through
vertebral defect - myelomeningocele
Associate Medical Conditions
with Myelomengingocele
• Location of vertebral defect is directly associated with
the level of paralysis and loss of sensation
• Lower level may impact only spinal nerves and higher
level may impact spinal cord
• Loss of sensation
• Loss of bowel or bladder control
– Lack of urge may lead to overfilling or reflux
– Infections and overstretched bladder results
Levels of Paralysis
•
•
•
•
Cervical. The neck area contains 8 vertebrae (C1 through C8).
Loss of function in the chest, arms, and legs.
Thoracic. The chest area contains 12 vertebrae (T1 through T12).
The first thoracic vertebra, T1, is the vertebra where the top rib
attaches to the spine. Affects the chest and the legs.
Lumbar. The lumbar area (between the chest area and the pelvis)
contains 5 vertebrae (L1 through L5). Affects the hips and legs.
Sacral. The sacral area (from the pelvis to the end of the spine)
contains 5 vertebrae (S1 through S5). Affects the hips and legs, as
well as bowel and bladder function.
Associate Medical Conditions
with Myelomengingocele
• Blocked cerebral spinal fluid (CSF) drainage hydrocephalus
– Head enlargement
– Brain abnormalities
– Seizures
• Joint deformities and spinal curvature
• Spinal cord “caught” on vertebrae or restricted by
scar tissue - tethered cord
– Cord is stretched
– Causes spinal curvature or nerve damage
Interventions
•
•
•
Surgical interventions
– Closure shortly after birth to prevent infection and protect nerves
from injury
– Placement of shunt to allow CNF drainage and prevent brain
damage
– Release of tethered cord
Orthopedic treatment
– Prevention of deformities of spine, hip, and legs through supported
standing and prone
– Surgery, braces, and splints
– Impact on ambulation
Therapeutic interventions
– Physical therapy
– Occupational therapy
– Clean intermittent catheterization (CIC) and program for regular
bowel movements
Developmental Impact
• Early intervention
– Sensory-motor skills
– Social development
• School age programs
– Motor development
– Functional skills
• self-care
• mobility
Developmental Impact
•
•
Physical and cognitive development
– Motor impairment
• Increased dependency
• Limited manipulation of materials and play
• Contraindicated activities due to shunt
– Cognitive impairment
• Restricted opportunities
• Damage to brain tissues
Psychosocial development
– Motivation and frustration level
– Lack of mastery of skills
– Stigmatization due to odor associated with incontinence
– Self-esteem and body image issues
Educational Impact
• Unique needs
– Frequent absences
– Self-care training needs
– Therapy activities
• Academic challenges
– Learning disabilities
– Emotional disorders
– Motor planning issues
• Language issues
–
“cocktail party language”
– False impression of ability may lead to unrealistic
expectations
Educational Impact
• Personal autonomy
– Signs of shunt malfunction (see Fig. 2-2, p. 36)
• Headache, lethargy, nausea or vomiting
• Subtle changes in performance, handwriting, or social behavior
– Management and strategies for care of personal needs
•
•
•
•
Skin
Fractures
Bladder and bowel
Independence
• Career and adult outcomes
Traumatic Brain Injury (TBI)
• Head injury
– No fracture - closed
– Penetration of skull - open
• Brain injury
– Traumatic or non-traumatic events
– Acquired condition
• Concussion - mild TBI
– There may be no apparent damage
– Second impact syndrome (swelling and bleeding) may result
if not resolved
• Contusion
– Sudden movement of brain towards inside of skull coup/contracoup
Associated Medical
Conditions with TBI
•
•
•
•
Cognitive impairment
– Memory and attention
– Organization and perception
– Problem-solving and reasoning
– Seizure activity
Sensation loss
– Damage to eyes
– Cortical visual impairment (CVI) and nystagmus or diplopia
– Damage to ears
Motor impairment
– Spasticity
– Ataxia
– Tremors
Other impairments
– Feeding
– Communication
– Behavior
Interventions
• Medical response
–
–
–
–
Support vital functions - ABC (Airway, breathing, circulation)
Appropriate head and neck positioning
Medication management
Reduction of environmental stimulation
• Neurological assessment
• Neurosurgery may be indicated
– Reduce intracranial pressure
– Remove foreign objects
Therapeutic Interventions
• Acute care
– Coma stimulation
– Stabilization
– Passive mobility
• Rehabilitation
– Compensatory skills
– Prevention of complications
– Promote residual skills
Coma Recovery
• Definition
– Loss of consciousness
– Unresponsiveness
• Measurement
– Glascow Coma Scale (GCS) (table 2-1, p. 40)
• Baseline of responsiveness
• 3 measures - Eye movement, motor response, and verbal
response
– Emerging from coma - “lightening”
– Rancho Los Amigos Cognitive Scales (table 2-2, p. 41)
• Initial stages of recovery
• Reference for rate of recovery and functional ability
Developmental Impact
• Physical and cognitive development
– Factors
• Injury-related
• Treatment-related
• Patient-related
– Physical changes
• Sensory problems
• Balance issues
• Seizure activity
– Cognitive changes
• Attention
• Perception
• Memory and learning
Strategies for Physical and
Cognitive Problems
• Attending and limited response rate is
not deliberate
• Stimulation needs to be controlled
• Reduce complexity
• Modify instruction
• Repetition
• Localized versus diffuse damage
Developmental Impact
• Psychosocial development
– Behavioral changes
– Emotional lability
– Response to specific “antecedents” may be
predictable
– Poor self-esteem or image
– Depression
Educational Impact
• School reentry (Fig. 2-3, p. 47)
– Transition needs
– Gradual introduction to academics
– Gradual introduction to teachers and peers
• Career and adult outcomes
Degenerative Diseases
• Features
– Progressive loss of motor movement
– Increasingly restricted physical ability
– Psychosocial factors - control, fatigue, discomfort, and
mortality
• Muscular Dystrophy is one of the many types of
degenerative diseases
– Progressive weakness and death of muscle fibers
– Most common is Duchenne Muscular Dystrophy (DMD) absence or alteration of protein called dystrophin
Duchenne Muscular
Dystrophy
• Symptoms observed between 2-6 years
• Weakness usually begins in lower legs and pelvic girdle
muscles
• Muscle tissue replaced with fat and fibrous tissue
• Uses arms to support posture
• Sway back leads to scoliosis
• Gradual loss of mobility leads ultimately to respiratory
dysfunction
• Death at young adulthood usually due to respiratory or
heart failure
Associate Medical Conditions
with DMD
• Loss of respiratory function secondary to
abdominal and thoracic muscle weakness
• Difficulty coughing up secretions may lead to
pneumonia
• Cardiac muscle weakness
• Deterioration of ambulatory skills
• Development of contractures
Interventions
• Goal is to maintain function and slow progression of
symptoms
• Surgery may be indicated
– Release contractures to prolong ambulation
– Stabilize vertebrae to improve respiratory function and aid
sitting
• Orthopedic treatment
– Mobility equipment
– Handling issues
– Powered mobility
• Therapy needs
– Mobility
– Self-care
Developmental Impact
• Physical development
– Initially normal development
– Slow, progressive loss of function
– Implications for physical changes
•
•
•
•
Understanding of mobility and progression
Periodic monitoring of skills
Match status with appropriate level of assistance
Allow maximal level of independence while monitoring
endurance
• Monitor weight and dietary changes
Developmental Impact
• Cognitive development
– May impact verbal performance
– Low performance expectations
– Frequent absences
• Psychosocial development
–
–
–
–
–
Implications of terminal illness
Increasing dependency
Social isolation
Changing body image
Depression
Educational Impact
• Maintain level of activity and educational rigor
• Use adaptation strategies
– Low-tech
– High-tech
• Personal autonomy
– Maintain level of participation
– Introduce adaptations carefully
– Maintain expectations
• Career and adult outcomes
Orthopedic and
Musculoskeletal Conditions
• Any condition related to muscular or
skeletal system
• Limb deficiency is one disorder in this
category
– Absence or partial loss of a limb
– Congenital or acquired
– Terminal or intercalary
Associate Medical Conditions
with Musculoskeletal
Conditions
• May be related to a condition which is
characterized by multiple anomalies
• Thalidomide treatment in the 50’s and
60’s is now available for cancer and
AIDS related nausea
Interventions
• Surgery
– Surgical amputations
– Corrective procedures to improve function
– Preparing limb for prosthetic device
• Orthopedic treatment
– Prosthetics
– Extend length, reach, and motion of limb
• Therapy
– Prosthetic training
– Adjusting to loss limb
– Monitor health and fit of prosthesis’
Developmental Impact
• Psychosocial development
– Age is important factor
– Family attitudes and expectations
– Loss of ability versus development of
compensatory skills
– Dealing with reactions of others
Educational Impact
• Adaptations
• Compensatory skills
• Personal autonomy
– Allow different ways of completing tasks
– Care for own prosthesis
– Allow student to struggle to achieve independence
• Career and adult outcomes
Health Disabilities
• Conditions that limit strength,
vitality, and alertness
• Chronic or acute
• Increasing numbers in public
schools
Major Health Impairments
•
•
•
•
•
•
•
Heart disorders
Blood disorders
Asthma
Cystic fibrosis
Juvenile diabetes
Chronic renal failure
Childhood cancer
Infectious Diseases
• Hepatitis
• Human Immunodeficiency Virus (HIV)
and Acquired Immunodeficiency
Disease (AIDS)
• Other infectious diseases
Guidelines for Educators
• CEC
–
–
–
–
–
Knowledge of condition and effect on development
Psychological and emotional characteristics
Lesson adaptation to accommodate effects
Understand medical perspective
Practice and teach universal precautions and confidentiality
practices
– Access professional organizations
Visibility Factor
•
•
•
•
•
•
Developmental impact
Lack of visual reminder
Not perceived as ill
Engage in activities which are not appropriate
May not be disclosed or identified
Chronic nature lead to lifetime management issues
Asthma
• Most common pulmonary disease
• Mild to life-threatening symptoms
• Reactive to uncontrolled variables, such
as the environment
• Classifications
– Extrinsic, intrinsic, or mixed
– Aspirin/exercise/occupation induced
Description
• Result of body’s immune response
• Antigens (foreign substances) enter lungs and
antibodies are produced to suppress antigens
• Asthmatic - specific antibodies that react adversely to
antigens
–
–
–
–
Swelling
Mucus secretion
Muscle tightening
Leads to airway restriction and difficulty breathing
Associated Medical
Conditions
•
•
•
•
Trapped air
Over-inflated lungs
Difficulty exhaling
Barrel-shaped chest
Treatment
• Prevention
– Cause
– Environmental control measures
• Removing triggers
• Reduce allergens
– Immunotherapy
– Medication
Treatment
•
•
Intervention
– Bronchodilators
• Inhaler
• Nebulizer
– Symptoms
• Shortness of breath
• Unresponsive
• Cyanosis
Other options to reduce mucus
– Moist air
– Pulmonary percussion
– Postural drainage
– Coughing techniques
– Breathing exercises
Developmental Impact
• Not related to cognitive development, unless
associated with syndrome or injury
• Early development stages may be limited due
to limited mobility and exploration
• Adaptations may be necessary to promote
access to materials
• Temperature awareness due to difficulty
regulating body temperature
Developmental Impact
• Physical or cognitive development
• Psychosocial development
– Historical perspective
– May be induced by heightened emotional
state
– Attacks may impact others reactions
– Overprotection
– Absenteeism
Educational Impact
• Fatigue or alertness
• Attendance related to fears or avoidance
• Educational responsibility
– Environmental control
– Intervention techniques
• Remove irritant
• Encourage student to sit and use appropriate medication
and clear liquids
• Contact appropriate personnel
• Keep record
Educational Impact
• Emergencies
– Develop and follow a plan of response
– Maintain support and reassurance
– Remove other students
– Clear space
– De-brief
• Self-determination
– Medication use
– Privacy
– Side effects or impact of medication
• Future outcomes
– Environmental impact
– Stamina and motivation
Cystic Fibrosis
•
•
•
•
•
Hereditary and progressive disease
Affects lungs and other major organs
No gender difference
CF gene on 7th chromosome
Exocrine system disease
– Sticky mucus in respiratory system
– Decreased lung efficiency
– Lungs may collapse or over-inflate
• Digestive system
– Impacts release of pancreatic juices
– Affects digestion and overall nourishment
• Progressive and terminal disease
Associated Medical
Conditions
•
•
•
•
•
•
•
•
•
Systemic condition - affects many organs of body
Mucus traps secretions
“Cysts” and scar tissue develop
Leads to pneumonia and other respiratory
complications
Bowel obstruction
Unbalance caloric intake and nutrient absorption
Salt and fluid loss through sweat
May develop diabetes
Late onset of puberty
Treatment
•
•
•
•
•
•
•
•
•
Gene therapy
Antibiotics
Expectorants
Chest percussion
Postural drainage
Transplants
Vitamin and mineral supplements
Digestive enzymes
Healthy and low-fat diet
Developmental Impact
•
•
•
•
•
Growth
Sexual development
Physical abnormalities
Attendance may impact learning
Psychosocial development
– Medical needs
– Family burden
– Personal self-image, hopelessness
Educational Impact
•
•
•
•
Medical treatments at school
Medical appointments
Attendance
Self-determination
– Managing treatments
– Responsibility for class work
• Future outcomes
– Physical endurance issues
– Terminal nature of disease
Cancer
•
•
•
•
•
•
Growth and spread of abnormal cells
Tumors or neoplasms
Benign vs. malignant
Metastasizing cells
Terminal disease
Usually involves connective or supporting tissue in
children
Associated Medical
Conditions
• Depends on site of cancer
• Illness associated with site
• Metastasizing cancer may affect
systems
Treatments
• Early identification important
• Surgical intervention
• Chemotherapy
– Drugs to prevent cell division
– Unpleasant side effects
– Drugs may be used to counteract side effects
• Radiation
– Attacks atomic structure of cancer cells
– Used in conjunction with chemotherapy
• Bone marrow transplants for leukemia
Developmental Impact
•
•
•
•
Altered physical development
Deterioration of body functions
Pain impacts overall functioning
Psychosocial development
– Fears
– Self-consciousness
– Terminal possibility
Educational Impact
•
•
•
•
Consistency in programming
Medical appointments and treatments
Flexibility
Self-determination
– Awareness of impact
– Learning to cope
• Adult outcomes
– Maintain goals
– Instill hope