Chapter 12

Children with Physical

Disabilities, Health
Impairments, and
Multiple Disabilities
• The first major legislative response to individuals
with physical disabilities was passed in 1917 to
help meet the vocational needs of World War I
veterans with disabilities (Best, Heller, & Bigge,
2005).
• President Franklin Delano Roosevelt is credited
with advancing the cause of individuals with
disabilities through his New Deal; the 1935
Social Security Act provided funds for vocational
rehabilitation, retirement support, and insurance
benefits (Best, Heller, & Bigge, 2005).

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• The civil rights movement served as a model for
the disabilities rights movement, and the 1968
Architectural Barriers Act laid the groundwork for
later accessibility legislation.
• Two key areas where substantial progress
supporting full participation for individuals
with physical disabilities has been made are
medical advances and expanded
technologies. Advances in medical
interventions have led to life-saving interventions
for children with physical disabilities and health
impairments

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• A physical disability is a condition that interferes
with the child’s ability to use his or her body.
Many but not all physical disabilities are
orthopedic impairments. The term orthopedic
impairment generally refers to conditions of the
muscular or skeletal system and sometimes
physically disabling conditions of the nervous
system.
• Traumatic brain injury is an acquired injury
caused by an external physical force, resulting in
total or partial functional disability and/or
psychosocial impairment that requires special
educational services.

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 Definitions
• Physical impairment
• Orthopedic impairment
• Traumatic brain injury
• Multiple disabilities
• Deafblindness
• Other health impairments

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• Usher syndrome, often referred to as retinitis pigmentosa,
is the most common condition that involves both vision
and hearing, and the condition worsens over time. Usher
syndrome is inherited, which means that it is passed from
parents to their children through genes. Approximately 3 to
6 percent of all children who are deaf and another 3 to 6
percent of children who are hard-of-hearing have Usher
syndrome
• http://www.youtube.com/watch?v=aCm9C7lnfs8
• Early intervention appears to be critical for children who
are deafblind and their families. Generally students with
multiple disabilities have sensory deficits, motor
disabilities, health or neurological disorders, or
genetic inheritances that interfere with the normal
progression of development.

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• A condition that requires ongoing medical
attention is a health impairment. To be
considered a disability, the impairment must
substantially limit the child’s participation in
routine school or home activities.

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 Physical Impairments
• Children with Physical Disabilities :
• Neuromotor impairments. These are disabilities
resulting from damage to the central nervous system that
impairs the brain’s control of muscle movement and the
muscle receptors’ sensory feedback about speed,
direction of movement, and body position.
• Cerebral palsy. A number of disabilities are caused by
damage to the motor control centers of the brain. The
damage affects muscle tone, which in turn interferes with
voluntary movement and full control of the muscles, and
delays gross and fine motor development. CP includes
four major classifications: spastic, dyskinetic, ataxic, and
mixed.

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• spastic cerebral palsy, muscle tone is abnormally high
(hypertonia) and increases during activity. Muscles and joints are
tight or stiff, and movements are limited in the affected areas of
the body.
• dyskinetic cerebral palsy, tonal abnormalities involve the whole
body. The individual’s muscle tone is changing constantly, often
rigid while he or she is awake and decreased when asleep (Best et
al., 2005).
• Ataxic cerebral palsy is a condition in which voluntary movement
involving balance is abnormal. Individuals with ataxic CP have
difficulty controlling their hands and arms, and their gait is
unsteady.
• A child with mixed cerebral palsy has a combination of spastic,
dyskinetic, and ataxic CP. The affected area can be (1)
hemiplegic—just one side of the body (either left arm and left leg,
or right arm and right leg); (2) diplegic—the whole body is
involved, but the legs are more severely involved than the arms;
and (3) quadriplegic—involvement is equally distributed
throughout the body.

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• Neural tube defects. This includes spina bifida (the
separation of a portion of the backbone) and
myelomeningocele (the protrusion from the spinal cord
of a sac of fluids containing portions of the spinal cord).
• Seizure disorders/epilepsy. This disorder occurs when
the brain cells are not working properly. It can be present
in one hemisphere of the brain (partial seizure) or in both
(generalized seizure).
• An estimated 2 million children and adolescents have
seizure disorders in the United States (Porter, 2008).
Most seizure disorders respond well to medical
treatment (either medication or surgery).

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• Traumatic brain injury. An acquired injury
caused by an external physical force, resulting in
total or partial functional disability and/or
psychosocial impairment that requires special
educational services. TBI accidents involve the
head and may result in cognitive, social, and
language deficits. Loss of a limb, broken bones,
or paralysis may also result from accidents.

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 Physical Impairments
• Degenerative diseases. These affect the
muscles and their supporting framework, the
skeleton.
• Muscular Dystrophy. This is an inherited
condition in which the muscles weaken and
deteriorate. The most common form, Duchenne
muscular dystrophy, occurs primarily but not
exclusively in boys (Leet, Dormans, & Tosi,
2002).
http://www.youtube.com/watch?v=f3WX4fBVqkE

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 Orthopedic and musculoskeletal
disorders
• Juvenile arthritis. Inflammation of the joints
accompanied by fever and pain in the joints during acute
periods. This begins at or before age 16 and causes
swelling, stiffness, effusion, pain, and tenderness in the
joints (Leet, Dorman, & Tosi, 2002; Porter, 2008).
• http://www.youtube.com/watch?v=EzhEzWGCdkg&featu
re=related
• b. Spinal curvatures. Scoliosis is a form of spinal
curvature in which the spine forms a “c” or an “s” when it
is viewed from behind.
• c. Other types of orthopedic and musculoskeletal
disorders include limb deficiencies, hip conditions,
and other musculoskeletal conditions.

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 Children with Health Impairments
• These impairments require ongoing medical attention.
Table 12.5 provides classroom modifications and
teacher requirements.
• Diabetes is a disorder in which the blood sugar of the
individual is abnormally high because the body does not
produce enough insulin (Type 1 diabetes) or because
the body is insensitive to the insulin that is produced
(Type 2 diabetes)
• Type 1 diabetes can develop at any time (including in
infancy) but usually begins between ages 6 and 13.
Type 2 diabetes used to be considered a disease of
adolescents or adults, but it is becoming more common
in children who are overweight or obese, and 10 to 50
percent of the newly diagnosed childhood cases of
diabetes are Type 2 (Porter, 2008).

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• Cardiopulmonary conditions. These are
health problems that affect the heart, blood, and
lungs.
• Asthma. This condition affects breathing; it
involves swollen lungs, difficulty breathing,
negative reactions to environmental conditions,
and acute constriction of the bronchial tubes.
• Cystic fibrosis. This is a lethal genetic disease
affecting the respiratory and digestive systems
• http://www.youtube.com/watch?v=ht3FxIg6k-
M&feature=relmfu

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• AIDS (acquired immune deficiency
syndrome). This is a breakdown of the body’s
immune system caused by the human
immunodeficiency virus (HIV). All educational
professionals should be instructed in and use
universal precautions.
• 4. Cooley’s anemia and sickle cell anemia.
These are genetic blood cell diseases. Children
with Cooley’s anemia are listless, have poor
appetites, and contract frequent infections. In
sickle cell anemia, the oxygen-carrying cells are
crescent-shaped and can be trapped in body
organs, resulting in a shortage of oxygen and
vulnerability to infection

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• Substance abuse. Abuse of legal or illegal
substances by pregnant women can affect the
fetus.
• Alcohol. Fetal alcohol syndrome produces
growth deficiencies, facial malformations, and
central nervous system damage (mental
retardation and challenging behaviors).
• Cocaine. Cocaine use causes lower birth
weight, shorter body length, and smaller head
circumference.
• Heroin. Heroin causes low birth weight and
premature delivery.
• Marijuana. Marijuana causes smaller babies who
may be highly irritable.

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• 6. Other health-related conditions. These
include chronic and sometimes life-
threatening diseases such as cancer
(leukemia, malignant tumors), diabetes, and
hemophilia

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 Physical Impairments
• Orthopedic and musculoskeletal disorders
– Juvenile arthritis
– Spinal curvatures
– Limb deficiencies
– Hip conditions
– Other musculoskeletal conditions

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 Health Impairments
• Asthma • Hemophilia
• ADD/ADHD • Lead poisoning
• Cystic fibrosis • Leukemia
• HIV/AIDS • TORCH infections
• Heart defects • Rheumatic Fever
• Cancer • Sickle cell anemia
• Diabetes • Meningitis/encephalitis
• Substance Abuse • Hepatitis B

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 Table 12.3: Prevalence

Source: U.S. Department of Education (2005). Twenty-sixth annual report to Congress: Implementation of
the Individuals with Disabilities Act. Washington, DC: Office of Special Education Programs.

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• With the use of medication and the provision of
an accessible setting and/or medical support
teams, most students with physical or health
impairments are able to function well in regular
classes.

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• Early intervention—identification at birth or
infancy or as soon as the disability occurs—is
critical. Early intervention can minimize the
severity of the disability or prevent the
development of additional disabling or medical
conditions.
• In addition, the use of correct physical
management procedures, adaptations, and
devices can increase the acquisition of motor
and self-care skills.

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• The inclusion movement has suggested that
even children with multiple and severe
disabilities should be included in the general
education classroom (Giangreco, 1993), but
many in the field disagree (Kaufman & Hallahan,
1994). Regardless of one’s position, five axioms
should be considered when providing services
for the severely disabled: (1) the child has the
right to services that improve the quality of life
and that maximize developmental potential, (2)
early childhood services are an effective way of
improving the quality of life and maximizing
developmental potential, (3) intervention
services that begin earlier in the child’s life will
be more effective,

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• (4) early childhood services that involve families
are more effective than those that do not
(Westlake & Kaiser, 1991), and (5) including
children with disabilities in regular classrooms
increases their social skills and interpersonal
relationships (Helmstetter, Peck, & Giangreco,
1994).

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• Most children with multiple and severe
disabilities are identified at birth through early
assessment (Apgar, Brazelton Neonatal
Behavioral Assessment Scale). Sometimes the
disability is easy to recognize (some types of
spina bifida, Down syndrome). The first
evaluation therefore will be made by a physician
or a team of specialists. An educational
assessment will follow; however, it is challenging
to get a valid representation of the educational
strengths and weaknesses of the student with
physical disabilities.
• Norm-referenced tests or standardized tests are
difficult to use with this population because the
norm group usually does not include children
with these types of disabilities.
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• Therefore, it is usually quite difficult to draw conclusions
about the strengths and weaknesses of the child with
disabilities..
• Assessment accommodations should be made in four
areas to assess more accurately the student’s strengths.
The four areas are presentation (use of readers,
translators, etc.), response (assistive technology,
communication boards, etc.), setting (wheelchair
accessibility), and timing (extended time and more
breaks). There is currently a movement for the
development of universally designed assessments
(Salvia, Ysseldyke, & Bolt, 2007). Universal design is a
concept that emerged in the attempt to create
architectural designs that give everyone access.
Universal design features should be incorporated into all
assessments so it will be easier to test children with
disabilities.

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 ADAPTATIONS
• http://www.youtube.com/watch?v=ErG50hdtlnE
• http://www.youtube.com/watch?v=WHBPGqhAw
PY&feature=related

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 Early Intervention
• Early identification is critical
• Minimize the severity of the disability
• Prevent secondary conditions or behaviors
• Increase motor and self-care skills
• Provide foundation for learning

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