Physical

Disabilities, Health
Impairments, and
ADHD
Presented by: Group 3
Dela Torre
Fuenzalida
Funcion
Hill
Disability is part of being human and is integral to the human experience. It results
from the interaction between health conditions such as dementia, blindness or
spinal cord injury, and a range of environmental and personal factors. An estimated
1.3 billion people – or 16% of the global population – experience a significant
disability today. This number is growing because of an increase in
noncommunicable diseases and people living longer. Persons with disabilities are a
diverse group, and factors such as sex, age, gender identity, sexual orientation,
religion, race, ethnicity and their economic situation affect their experiences in life
and their health needs. Persons with disabilities die earlier, have poorer health, and
experience more limitations in everyday functioning than others.
An estimated 1.3 billion people experience significant disability. This represents
16% of the world’s population, or 1 in 6 of us.
Some persons with disabilities die up to 20 years earlier than those without
disabilities.
Persons with disabilities have twice the risk of developing conditions such as
depression, asthma, diabetes, stroke, obesity or poor oral health.
Persons with disabilities face many health inequities.
Persons with disabilities find inaccessible and unaffordable transportation 15
times more difficult than for those without disabilities.
Health inequities arise from unfair conditions faced by persons with disabilities,
including stigma, discrimination, poverty, exclusion from education and
employment, and barriers faced in the health system itself.
Definitions of Physical Disabilities and Health
Impairments

Children with physical disabilities and health conditions who require special
education
are served under two of the disability categories of the Individuals with Disabilities
Education Act (IDEA) disability categories: orthopedic impairments and other health
impairments. According to IDEA, a severe orthopedic impairment adversely affects a
child’s educational perform ance. The term includes impairments caused by a
congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments
caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from
other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause
contractures). (
Definitions of Physical Disabilities and Health
Impairments
Although IDEA uses the term orthopedic impairment, children with physical disabilities may have
orthopedic impairments or neuromotor impairments. An orthopedic impairment involves the skeletal
system—bones, joints, limbs, and associated muscles. A neuromotor impairment involves the central
nervous system, affecting the ability to move, use, feel, or control certain parts of the body. Although
orthopedic and neuromotor impairments are two distinct and separate types of disabilities, they may
cause similar limitations in movement.
Health impairments include diseases and special health conditions that affect a child’s educational
activities and performance such as cancer, diabetes, and cystic fibrosis. According to IDEA Other
health impairment means having limited strength, vitality, or alertness, including a heightened
alertness to environmental stimuli, that results in limited alertness with respect to the educational
environment, that— (i) Is due to chronic or acute health problems such as asthma, attention deficit
disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia,
lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and
(ii) Adversely affects academic performance.
PREVALENCE
Studies of the number of children with physical disabilities and health impairments have
produced hugely diverse findings. One review of prevalence studies found estimates of chronic
health conditions in childhood ranging from as low as 0.22% to as high as 44%, depending on the
researchers’ concepts and definitions (van der Lee, Mokkink, Grootenhuis, Heymans, & Offringa,
2007). In the middle of that range is Sexson and Dingle’s (2001) estimate that chronic medical
conditions affect up to 20% (approximately 12 million) of school-age children in the United States.
Two factors make the actual number of children with physical disabilities and health conditions
much higher than the number of children receiving special education services under these two
IDEA categories. First, numerous children have chronic health conditions or physical impairments
that do not adversely affect their educational performance sufficiently to warrant special
education (Hill, 1999). Second, because physical and health impairments often occur in
combination with other disabilities, children may be counted under other categories, such as
multiple disabilities, speech impairment, or intellectual disabilities. For example, for the purpose
of special education eligibility, a diagnosis of intellectual disabilities often takes precedence over
a diagnosis of physical impairment.
TYPES AND CAUSES

Literally hundreds of physical impairments and health conditions can adversely

affect
children’s educational performance. Here we address only those that are
encountered
most frequently in school-age children.
Cerebral Palsy
—A disorder of voluntary movement and posture—is the
most prevalent
physical disability in school-age children. Cerebral palsy
is a permanent condition resulting from a lesion to the
brain or an abnormality of brain growth. Many diseases
can affect the developing brain and lead to cerebral palsy
(Batshaw et al., 2007). Children with cerebral palsy
experience disturbances of voluntary motor functions
that may include paralysis, extreme weakness, lack of
coordination, involuntary convulsions, and other motor
disorders. They may have little or no control over their
arms, legs, or speech, depending on the type and degree
of impairment. More severe forms of cerebral palsy are
often diagnosed in the first few months of life.
Spina Bifida
Congenital malformations of the brain, spinal cord, or
vertebrae are known as neural tube defects. The most
common neural tube defect is spina bifida, a condition in
which the vertebrae do not enclose the spinal cord. As a
result, a portion of the spinal cord and the nerves that
control muscles and feeling in the lower part of the body
fail to develop normally.
In myelomeningocele—the most common and most
serious form of spina bifida— the spinal lining, spinal
cord, and nerve roots all protrude. The protruding spinal
cord and nerves are usually tucked back into the spinal
column shortly after birth. This condition carries a high
risk of paralysis and infection. In general, the higher the
location of the lesion on the spine, the greater the
effect on the body and its functioning.
Muscular Dystrophy
Muscular dystrophy refers to a group of about 40
inherited diseases marked by progressive atrophy
(wasting away) of the body’s muscles. Duchenne
muscular dystrophy (DMD) is the most common and most
severe type. DMD affects only boys (1 in 3,500 male
births), but about one-third of cases are the result of
genetic mutation in families with no history of the
disease (Best, 2010b). Muscle weakness is usually evident
between the ages of 2 and 6, when the child begins to
experience difficulty in running or climbing stairs. The
child may walk with an unusual gait, showing a
protruding stomach and hollow back. The calf muscles of
a child with muscular dystrophy may appear unusually
large because the degenerated muscle has been replaced
by fatty tissue.
Spinal Cord Injuries
Spinal cord injuries are usually the result of a lesion to
the spinal cord caused by a penetrating injury (e.g., a
gunshot wound), stretching of the vertebral column
(e.g., whiplash during an auto accident), fracture of the
vertebrae, or compression of the spinal cord (e.g., a
diving accident). Motor vehicle accidents (41.3%), falls
(27.3%), acts of violence (15%), and sports (7.9%) are
the most common causes of spinal cord injuries
(National Spinal Cord Injury Statistical Center, 2010). In
general, paralysis and loss of sensation occur below the
level of the injury. The higher the injury on the spine
and the more the injury (lesion) cuts through the entire
cord, the greater the paralysis.
Epilepsy
Whether we are awake or asleep, electrical activity
continually occurs in the brain. A seizure is a
disturbance of movement, sensation, behavior, and/or
consciousness caused by abnormal electrical
discharges in the brain. “Some have likened the event,
known as a seizure, to an engine misfiring or to a power
surge in a computer” (Hill, 1999, p. 231 ). Anyone can
have a seizure. It is common for a seizure to occur when
someone has a high fever, drinks excessive alcohol, or
experiences a blow to the head. Epilepsy is not a
disease, and it constitutes a disorder only while a
seizure is actually in progress. It is estimated that 3% of
the population is prone to seizures and about 3 million
Americans have epilepsy (Goldman, 2006; NICHCY,
2010b).
Epilepsy
Diabetes
Diabetes is a chronic disorder of metabolism that
affects an estimated 25.8 million
children and adults in the U.S., or 8.3% of the
population (American Diabetes Association, 2011).
Without proper medical management, the diabetic
child’s system cannot
obtain and retain adequate energy from food. Not only
does the child lack energy but
also many important parts of the body (particularly the
eyes and the kidneys) can be
affected by untreated diabetes. Early symptoms of
diabetes include thirst, headaches,
weight loss (despite a good appetite), frequent
urination, and cuts that are slow to heal.
Asthma
Asthma is a chronic lung disease characterized by
episodic bouts of wheezing, coughing, and
difficulty breathing. An asthmatic attack is usually
triggered by allergens (e.g., pollen, certain foods,
pets); irritants (e.g., cigarette smoke, smog);
exercise; or emotional stress. The result is a
narrowing of the airways in the lungs, which
increases resistance to the airflow in and out of the
lungs and makes it harder for the individual to
breathe. The severity of asthma varies greatly,
from mild coughing to extreme difficulty in
breathing that requires emergency treatment.
Many asthmatic children experience normal lung
functioning between episodes
Cystic Fibrosis
Cystic fibrosis is a genetic disease of children and
adolescents in which the body’s exocrine glands
excrete thick mucus that block the lungs and parts of
the digestive system.
Cystic fibrosis occurs predominantly in Caucasians, but
it can affect all races. Children
with cystic fibrosis often have difficulty breathing and
are susceptible to pulmonary
disease (lung infections). Malnutrition and poor growth
are common characteristics of
children with cystic fibrosis because of pancreatic
insufficiency that causes inadequate
digestion and malabsorption of nutrients, especially
fats. Affected children often have
large and frequent bowel movements because food is
only partially digested. Getting
children with cystic fibrosis to consume enough
calories is critical to their health and
development.
HIV and AIDS
HIV is the human immunodeficiency virus (HIV) that
can lead to acquired immune
deficiency syndrome (AIDS). A person with AIDS
cannot resist and fight off infections.
because of a breakdown in the immune system.
Opportunistic infections such as
tuberculosis, pneumonia, and cancerous skin
lesions attack the person’s body, grow
in severity, and ultimately result in death. Although
no known cure or vaccine exists for AIDS, advances
in antiretroviral drug treatment have dramatically
reduced mortality rates. HIV, which is found in the
bodily fluids of an infected person (blood, semen,
vaginal secretions, and breast milk), is transmitted
from one person to another through sexual contact
and blood-to-blood contact (e.g., intravenous drug
use with shared needles, transfusions of unscreened
contaminated blood).
Attention- Deficit/Hyperactivity Disorder

Everyone has difficulty attending at times (attention deficit), and we all sometimes
engage in high rates of purposeless or inappropriate movement (hyperactivity). A
child
who consistently exhibits this combination of behavioral traits may be diagnosed
with
attention-deficit/hyperactivity disorder (ADHD). Children with ADHD present a
difficult
challenge to their families, teachers, and classmates. Their inability to stay on task,
impulsive behavior, and fidgeting impair their ability to learn and increase the
likelihood of unsatisfactory interactions with others
Definition and Diagnosis
“The essential feature of attention-deficit/hyperactivity disorder is a persistent pattern
of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is
typically observed in individuals at a comparable level of development” (American
Psychiatric Association, 2000a, p. 85 ).
Inattention —not attending to details, difficulty sustaining attention to tasks or
activities, does not seem to listen, not following through on instructions (e.g., starts a
task but soon gets sidetracked), difficulty organizing tasks and activities (e.g., work is
messy and disorganized), dislikes tasks that require sustained mental effort, frequently
loses things, easily distracted, often forgetful.
Hyperactivity and impulsivity —fidgeting, restlessness, runs about or climbs on
furniture, often excessively loud or noisy, often “on the go” as if “driven by a motor,”
talks excessively, blurts out answers, difficulty waiting to take his or her turn, interrupts
others, acts without thinking (e.g., starts a task without reading or listening to the
instructions), impatient, rushes through activities or tasks, has difficulty resisting
temptations. (adapted from American Psychiatric Association, 2011c)
Prevalence
The most frequently cited estimate of the prevalence of ADHD is 3% to 7% of
school age children (American Psychiatric Association, 2004). As of 2007,
approximately 5.4 million children ages 4 to 17, or 9.5%, had at some point been
diagnosed with ADHD, and boys are about three times more likely to be diagnosed
with ADHD than are girls, with the ratio being higher at younger ages (CDC, 2011d).
The typical classroom will have one or two children either diagnosed with ADHD or
presenting the problems typically associated with ADHD. Child count data
reported by the states reveal a large increase in the numbers of students served
under IDEA’s other health impairments category, because the federal government
stipulated that students with ADHD were eligible for special education under that
disability category. Some states reported increases of 20% in the number of
children served under the other health impairments category between the 1997–
98 and 1998–99 school years (U.S. Department of Education, 2000).
Academic Achievement and Comorbidity with other
Disabilities
Most children with ADHD struggle in the classroom. They score lower than
their age mates on IQ and achievement tests, more than half require remedial
tutoring for basic skills, and about 30% repeat one or more grades (Barkley,
2005). A national study of more than 1,400 students found that 58% of those
students receiving special education services under the disability category of
emotional disturbance had ADHD and that 20% of those students receiving
special education in the intellectual disability and learning disability
categories had ADHD (Schnoes, Reid, Wagner, & Marder, 2006). Many children
with Asperger syndrome and Tourette syndrome are identified as having
ADHD (Kube, Peterson, & Palmer, 2002; Prestia, 2003).
Eligibility for Special Education
Researchers estimate that between 40% and 50% of students with ADHD qualify
for special education services, the majority being served under the disability
categories of emotional disturbance and learning disabilities (Reid & Maag, 1998;
Zentall, 2006). Students with ADHD can be served under the other health
impairment category if the outcome of the disorder is a “heightened alertness to
environmental stimuli that results in limited alertness with respect to the
educational environment that adversely affects academic performance” (20 USC
§1401 [2004], 20 CFR §300.8[c][9]). Many children with ADHD who are not served
under IDEA are receiving services under Section 504 of the Rehabilitation Act. As
discussed in Chapter 1 , Section 504 is a civil rights law that provides certain
protections for people with disabilities. Under Section 504, schools may be
required to develop and implement accommodation plans to help students with
ADHD succeed in the general education classroom. Accommodation plans often
include such adaptations and adjustments as extended time on tests, preferred
seating, additional teacher monitoring, reduced or modified class or homework
assignments and worksheets, and monitoring the effects of medication on the
child’s behavior in school.
Causes
The causes of ADHD are not well understood. Similar patterns of behavior leading to
the diagnoses of ADHD in two different children likely, if not certainly, will be caused
by completely different factors or sets of factors (Gresham, 2002; Maag & Reid, 1994).
Although many consider ADHD to be a neurologically based disorder, no clear and
consistent causal evidence links brain damage or dysfunction to the behavioral
symptoms of ADHD (National Institute of Health Consensus Statement, 1998).
However,
significant evidence indicates that genetic factors may place individuals at a greater
than normal risk of an ADHD diagnosis (Willcutt, Pennington, & Defries, 2000).
Genetics may provide certain risk or resilience factors, and environmental influences
(i.e.,
life experiences) then determine whether an individual receives a diagnosis of ADHD
(Goldstein & Goldstein, 1998).
Treatment

Drug therapy and behaviorally based interventions are the two most widely
used treatment approaches for children with ADHD.
Medication

Prescription stimulant medication is the most common intervention for

children with ADHD. Methylphenidate, sold under the trade name Ritalin, is
the most frequently prescribed medication for ADHD. Other stimulants such
as dextroamphetamine (Dexedrine), dextroamphetamine sulfate (Adderall),
methamphetamine hydrochloride (Desoxyn), and pemoline (Cylert) are also
widely prescribed.
BEHAVIORAL INTERVENTION

The principles and methods of applied behavior analysis provide teachers

and parents with practical strategies for teaching and living with children
with ADHD (Pelham & Fabiano, 2008). These methods include positive
reinforcement for on-task behavior, modifying assignments and
instructional activities to promote success, and systematically gradually
teaching self-control.
Characteristics of Children with Physical
and Health Impairments
The characteristics of children with physical disabilities and health
impairments are so varied that attempting to describe them is nearly
impossible. Knowing the underlying cause of a student’s physical
impairment or health condition provides limited guidance in planning
needed special education and related services.
Coping emotionally with a physical disability or a chronic health impairment
presents a major problem for some children (Antle, 2004; Kanner & Schafer,
2006). Maintaining peer relationships and a sense of belonging to the group can
be difficult for a child who must frequently leave the instructional activity or the
classroom to participate in therapeutic or health care routines. Anxiety about
fitting in at school may be created by prolonged absences from school (Olsen &
Sutton, 1998). Students with physical disabilities and health impairments
frequently identify concerns about physical appearance as reasons for emotional
difficulties and feelings of depression (Sexson & Dingle, 2001).
Variables Affecting the Impact of Physical Disabilities
and Health Impairments on Educational Performance

Many factors must be taken into consideration in assessing the effects of a

physical disability or health impairment on a child’s development and
behavior. A physical impairment or medical condition can limit a child’s
ability to engage in age-appropriate activities, mobility, cognitive
functioning, social and emotional development, sensory functioning, and
communication across a continuum ranging from normal functioning (no
impact) to extremely impaired. A minor or transient physical or health
impairment, such as those most children experience while growing up, is not
likely to have lasting effects; but a severe, chronic impairment can greatly
limit a child’s range of experiences. In addition to the severity with which
the condition affects different areas of functioning, two particularly
important factors are age of onset and visibility
Variables Affecting the Impact of Physical Disabilities
and Health Impairments on Educational Performance

AGE OF ONSET- Some conditions are congenital (present at birth); other

conditions are acquired during the child’s development as a result of illness,
accident, or unknown cause. As with all disabilities, it is important for the
teacher to be aware of the child’s age at the time he acquired the physical or
health impairment.
Visibility-Physical impairments and health conditions range from highly
visible and conspicuous to not visible. How children think about themselves
and the degree to which others accept them often are affected by the visibility
of a condition. The visibility of some physical disabilities may cause other
children and adults to underestimate the child’s abilities and limit
opportunities for participation. By contrast, many health conditions such as
asthma or epilepsy are not visible, and others may not perceive that the child
needs or deserves accommodations. This misperception is supported by the
fact that the child functions normally most of the time (Best, 2010a).
Educational
Approaches In addition to
progressing in the general education
curriculum to the maximum extent possible,
Special education of children with physical many students with physical disabilities or
disabilities and health impairments health impairments also need intensive
in the United States has a history of more instruction in a “parallel curriculum” on ways
than 100 years. While of “coping with their disabilities”
some students with physical and health (Bowe, 2000, p. 75 ). Similar in function to the
impairments can fully access and benefit “expanded core curriculum” for students with
from education with minimal visual impairments, the parallel curriculum for
students with physical
accommodations or environmental
and health impairments includes using
modifications, the
adaptive methods and assistive technologies
intensive health and learning needs of other for mobility, communication, and daily-living
students require a complex and coordinated tasks; increasing independence by
array of specialized instruction, therapy, and self-administering special health care routines;
related services. and learning self-determination and
self-advocacy skills.
Teaming and Related Services
The transdisciplinary team approach has
special relevance for students with physical
disabilities and health impairments. No other
group of exceptional children comes into
contact, both in and out of school, with as
many different teachers, physicians, therapists,
and other specialists. Because the medical,
educational, therapeutic, vocational, and social
needs of these students are often complex,
educational and health care personnel must
openly communicate and cooperate with one
another. Two particularly important members
of the team for many children with physical
disabilities and health impairments are the
physical therapist and the occupational
therapist. Each is a licensed health professional
who must complete a specialized training
program and meet rigorous standards
Physical therapists (PTs) are involved in the
development and maintenance of motor skills,
movement, and posture. They may prescribe
specific exercises to help a child increase
control of muscles and use specialized
equipment, such as braces, effectively.
Occupational therapists (OTs) are concerned
with a child’s participation in activities,
especially those that will be useful in self-help,
employment, recreation, communication, and
aspects of daily living (e.g., dressing, eating,
personal hygiene). They may help a child learn
(or relearn) diverse motor behaviors such as
drinking from a modified cup, buttoning
clothes, tying shoes, pouring liquids, cooking,
and typing on a computer keyboard.
Teaming and Related Services
Other specialists who frequently provide related
services to children with physical disabilities and
health impairments include the following:
Speech-language pathologists (SLPs), who
provide speech therapy, language
interventions, oral motor coordination (e.g.,
chewing and swallowing), and augmentative
and alternative communication (AAC) services.
Adapted physical educators, who provide
physical education activities designed to meet
the individual needs of students with
disabilities
Health aides, who carry out medical
procedures and health-care services in the
classroom
Counselors and medical social workers, who
help students and families adjust to disabilities.
Recreation therapists, who provide
instruction in leisure activities and
therapeutic recreation.
School nurses, who provide certain health
care services to students, monitor
students’ health, and inform IEP teams
about the effects of medical conditions on
students’ educational programs.
Prosthetists, who make and fit artificial
limbs
Orthotists, who design and fit braces and
other assistive devices.
Orientation and mobility specialists, who
teach students to navigate their
environment as effectively and
independently as possible.
Biomedical engineers, who develop or
adapt technology to meet a student’s
specialized needs
 Self-monitoring that helps Students
do more than just be on Task
Self-monitoring is a relatively
simple procedure in which
a person observes his behavior
systematically and records the
occurrence or nonoccurrence of a
specific
behavior.
Self-monitoring not only often
changes the behavior observed
and recorded but also typically
changes the behavior in the
desired direction.
1. Specify the target behavior and
performance
goals.
2. Select or create materials that make
self-monitoring easy.
3.Provide supplementary cues to self-
monitor.
4. Provide explicit instruction.
5. Reinforce accurate self-monitoring
6.Reward improvements in the target
behavior
7. Encourage self-evaluation
8. Evaluate the program.
Environmental Modifications

Environmental modifications are frequently necessary to enable a student

with physical and health impairments to participate more fully and
independently in school. Environmental modifications include
adaptations to provide increased access to a task or an activity, changing
the way in which instruction is delivered, and changing the manner in
which the task is done (Best, Heller, & Bigge, 2010; Heller, Dangel, &
Sweatman, 1995).
 Assistive Technology
Although the term technology often conjures up images of
sophisticated computers and other hardware, technology
includes any systematic method based on scientific
principles for accomplishing a practical task or purpose.
IDEA defines assistive technology as both assistive
technology devices and the services needed to help a child
obtain and effectively use the devices. Assistive technology
device means any item, piece of equipment, or product
system, whether acquired commercially off the shelf,
modified, or customized, that is used to increase, maintain,
or improve the functional capabilities of a child with a
disability. The term does not include a medical device that
is surgically implanted or the replacement of such device.
 Animal Assistance
Animals can help children and adults with physical
disabilities in many ways. Nearly everyone is
familiar with guide dogs, which can help people who
are blind travel independently. Some agencies now
train hearing dogs to assist people who are deaf by
alerting them to sounds. Another recent and
promising approach to the use of animals by people
with disabilities is the helper or service dog.
Depending on a person’s needs, dogs can be trained
to carry books and other objects (in saddlebags),
pick up telephone receivers, turn light switches on
or off, and open doors.
Special Health Care Routines
Many students with physical disabilities have health care needs that require
specialized procedures such as taking prescribed medication or self-
administering insulin shots, CIC (described earlier in this chapter),
tracheotomy care, ventilator/respirator care, and managing special nutrition
and dietary needs. These special health-related needs are prescribed in
individualized health care plan (IHCP), which is included as part of the
student’s IEP. In addition to general information describing the history,
diagnosis, and assessment data relevant to the condition, the IHCP “includes
precise information about how to handle routine healthcare procedures,
physical management techniques, and medical emergencies that may arise
while the child is at school” (Getch et al., 2007, p. 48 ). Teachers and school
personnel must be trained to safely administer the health care procedures
they are expected to perform (Heller, Fredrick, Best, Dykes, & Cohen, 2000)
Special Health Care Routines
IMPORTANCE OF POSITIONING, SEATING, AND MOVEMENT Proper positioning,
seating, and regular movement are critically important for children with
physical disabilities. Proper positioning and movement encourage the
development of muscles and bones and help maintain healthy skin (Heller,
Forney, Alberto, Schwartzman, & Goeckel, 2000).
• Good positioning results in alignment and proximal support of the body.
• Stability positively affects use of the upper body.
• Stability promotes feelings of physical security and safety.
• Good positioning distributes pressure evenly and provides comfort for
seating tolerance and long-term use.
• Good positioning can reduce deformity.
• Positions must be changed frequently.
Special Health Care Routines
Proper seating helps combat poor circulation, muscle tightness, and pressure
sores and contributes to proper digestion, respiration, and physical
development. Be attentive to the following (Heller, Forney et al., 2000):
• Face should be forward, in midline position.
• Shoulders should be in midline position, not hunched over.
• Trunk should be in midline position; maintain normal curvature of spine.
• Seatbelt, pommel or leg separator, and/or shoulder and chest straps may be
necessary for shoulder/upper trunk support and upright positions.
• Pelvic position: hips as far back in the chair as possible and weight
distributed evenly on both sides of the buttocks.
• Foot support: both feet level and supported on the floor or wheelchair
pedals.
Independence and Self-Esteem
All children, whether or not they face the challenges presented by a
physical disability or a chronic health condition, need to develop respect
for themselves and feel that they have a rightful place in their families,
schools, and communities. Effective teachers accept and treat children
with physical impairments and special health care needs as worthwhile
and whole individuals rather than as disability cases. They encourage the
children to develop a positive, realistic view of themselves and their
physical conditions. They enable the children to experience success,
accomplishment, and, at times, failure.
Educational Placement Alternatives

For no group of exceptional children is the continuum of educational

services and placement options more relevant than for students with
physical impairments and special health needs. Some children with the
most severe physical and health impairments are served in homebound or
hospital education programs. If a child’s medical condition necessitates
hospitalization or treatment at home for a lengthy period (generally 30
days or more), the local school district is obligated to develop an IEP and
provide appropriate educational services to the child through a qualified
teacher. Some children need home- or hospital based instruction because
their life support equipment cannot be made portable.
 PROMOTING THE INDEPENDENCE OF STUDENTS
WITH PHYSICAL DISABILITIES AND SPECIAL
HEALTH CARE NEEDS

• A student’s independence can be sabotaged by

Encourage Independent Movement
Sometimes efforts to assist and be nice
to a student with physical
and health challenges can contribute to
learned helplessness,
which becomes increasingly difficult to
overcome as the child
grows older. Teachers should help
children with physical and health
challenges learn to be as motorically
independent and self-sufficient
as possible. Doing things for themselves
develops and maintains
children’s muscular function and
enhances their self-esteem.
inefficient room arrangement.
• If one of your students uses a wheelchair, obtain
one (ask the school nurse or the PT), get in it, and
navigate the classroom layout yourself. Looking at
wheelchair access from this level is
very sobering.
• Troubleshoot each activity in the classroom and
around the school building and grounds that
students should do themselves if they can: opening
doors, turning pages in a book, feeding the class
pet, holding up a test tube in science lab, going
through the lunch line in the cafeteria, and so forth.
 PROMOTING THE INDEPENDENCE OF STUDENTS
WITH PHYSICAL DISABILITIES AND SPECIAL
HEALTH CARE NEEDS

Teach Students to Ask For and
Decline Help As important as it is
to build their independence,
students with physical and special
health needs must also learn to
recognize and accept their limits.
• Teach students that it is okay to politely
request assistance with tasks or situations that
they cannot do independently. Manners should
always be stressed! The pendulum can swing
very quickly from a student who does not self-
advocate to an imperious leader barking orders
at one and all.
• A student who has politely requested and
received assistance from others will likely
experience an increase in unsolicited offers of
help. Teach the student that it is also okay to
say, “No, thanks, I don’t need help now.” .
 PROMOTING THE INDEPENDENCE OF STUDENTS
WITH PHYSICAL DISABILITIES AND SPECIAL
HEALTH CARE NEEDS
Don’t be Afraid of the Equipment
The special equipment used by
some students with physical
disabilities and their special
health needs—braces,
wheelchairs, ventilators, and voice
boxes—can be intimidating to
other students and to adults.
• If one of your students uses special equipment, get
to know it. Ask the PT, the OT, the school nurse, or
other health professionals on the student’s IEP team
to demonstrate and explain the equipment before
the first week of school begins. The student should
participate in this demonstration and discussion as
much as possible. Ask what to look for to ensure that
the equipment is in good working order and who to
contact if you notice any problems.
• Ask the student with physical disabilities or special
health care needs to do a show-and-tell of his
equipment for the class. This not only helps
classmates become comfortable with the equipment
but also helps build friendships and quickly puts the
equipment in the background where it should be so
that children can see their classmate as just another
kid.
Related Services in the Classroom
We will likely see a continuation of the trend to serve children with
physical and health impairments in general education classrooms as
much as possible. Therapists and other related service and support
personnel will come into the classroom to assist the teacher, the child,
and classmates. Including students with physical impairments and
special health care needs in general education classrooms, however,
has raised several controversial issues. Many questions center on the
extent of responsibility properly assumed by teachers and schools for a
child’s physical health care needs. Some educators and school
administrators believe that services such as catheterization,
tracheotomy care, and tube feeding are more medical than educational
and should not be the school’s responsibility
Inclusive Attitudes

Inclusive Attitudes After health care objectives, acceptance is the

most basic need of children with physical disabilities and health
impairments. How parents, teachers, classmates, and others react
to a child with physical disabilities is at least as important as the
disability itself. Many children with physical disabilities suffer from
excessive pity, sympathy, and overprotection; others are cruelly
rejected, stared at, teased, and excluded from participating in
activities with nondisabled children (Pivik, McComas, & LaFlamme,
2002)
Promoting the Success of Students with Physical
Disabilities and Special Health Care Needs in the
Regular Classroom

HOLD HIGH EXPECTATIONS FOR ALL STUDENTS Some teachers

feel sorry for students with significant physical disabilities or health
conditions and, as result, tend to hover and baby them.
• Expect and support maximum independence
• Allow the freedom to fail.
• Provide supports and other forms of scaffolding to help, and then
gradually withdraw those supports as much as possible
•Expect and require appropriate social behavior.
•Correct errors as you would those of any other student.
Promoting the Success of Students with Physical
Disabilities and Special Health Care Needs in the
Regular Classroom

TRUST YOURSELF, BUT SEEK HELP, TOO As a beginning teacher,

you will sometimes feel overwhelmed, unsettled by your lack of
effectiveness, and unsure of what to do next.
• Don’t ever get too comfortable with your teaching.
• Go back to fundamentals of sound instructional lesson design and
delivery.
• Seek assistance from colleagues and other professionals