ERIC Identifier: ED314915
Publication Date: 1989-00-00
Author: Venn, John
Source: ERIC Clearinghouse on
Handicapped and Gifted Children Reston VA.
Students with Physical Disabilities and Health Impairments.
Revised. ERIC Digest #459.
Used in the special education context, physical disability or orthopedic
impairment includes severe disabilities that adversely affect educational
performance. There is a diverse range of disabilities in this category including
such conditions as cerebral palsy, spina bifida, amputations or limb absences,
and muscular dystrophy. According to Connor, Scandary, and Tulloch (1988),
"[the] physiological and functional problems [of this population] are complex
and diverse, and their handicaps may be temporary, intermittent, chronic,
progressive, or terminal" (p. 7).
The term special health impairment refers to a variety of health problems
that dictate the need for special medical or educational services. Health
impairments include convulsive disorders, cystic fibrosis, heart disease, sickle
cell disease, hemophilia, asthma, rheumatic fever, cancer, AIDS, or any other
chronic or acute health problem that limits strength, vitality, or alertness and
adversely affects the student's educational development.
Approximately 1.3% (58,328) of all students receiving special education
services are orthopedically impaired, while 1.2% (52,658) are counted as other
health impaired (Tenth Annual Report to Congress, 1988).
WHAT ARE SOME OF THE CHARACTERISTICS OF THESE
Some students have no restrictions on what they can do and
learn, while others are extremely limited in their activities and require
intensive medical and educational help. A physical problem can hamper a
student's mobility, coordination, stamina, communication, or learning abilities
to such an extent that educational objectives are difficult to accomplish and
special education intervention is required.
For example, children with cerebral palsy typically have deficits in gross
and fine motor development as well as speech and communication problems. Some
children have extremely debilitating physical conditions that result in low
intellectual functioning, serious limitations in activities, and multiple
primary handicaps. Others function in the average or gifted range intellectually
and participate full time in regular classes.
WHAT SPECIAL CONSIDERATIONS ARE NECESSARY IN ASSESSING STUDENTS WITH PHYSICAL DISABILITIES
OR HEALTH IMPAIRMENTS?
Examiners must have a broad base of skills in
order to measure adequately the functional and cognitive abilities of students
who are physically disabled or health impaired. In addition to the areas
traditionally evaluated in the assessment of children with mild handicaps,
measures should be included in the areas of gross motor, fine motor, and daily
living skills; perception; recreation and leisure skills; augmentative
communication; and sensory input. Competent diagnosticians recognize their
personal limitations and seek help from therapists, educators, physicians,
nurses, social workers, and others to gather appropriate data.
Since the assessment of a student who has physical or health impairments is
often time consuming and taxing to both the examiner and the child, the team of
professionals should meet before data are gathered to consider: (a) the nature
of the data base desired; (b) the potential use of the data; (c) specific
measurement techniques or modifications of traditional measures; (d) who should
present the items; (e) the method of data collection; (f) appropriate response
modes and/or equipment; (g) position(s) for testing; (h) stamina and fatigue
factors; (i) the order in which professionals will conduct the testing; (j)
implications of medications for test performance and for the best time of day to
test; (k) how data will be shared when evaluations are completed; and (l) the
nature of nontraditional measures that should be incorporated in the assessment
(e.g., evaluation of the child's milieu) (Reynolds & Clark, 1983).
Developing a comprehensive preassessment plan ensures that the information
necessary for establishing programs and setting priorities for intervention will
be available when needed.
WHAT ARE THE KEY EDUCATIONAL CONSIDERATIONS?
One of the
main considerations is the use of the team approach in developing and carrying
out a child's educational program. The team generally includes the parents,
teachers, medical professionals, and health-related professionals such as a
physical therapist. Parents are critical members of the team and should be
involved in all educational decisions. Sirvis (1988) noted that the team should
design a program that meets the needs of the student in five basic goal areas: "(a) physical independence, including mastery of daily living skills; (b)
self-awareness and social maturation; (c) communication; (d) academic growth;
and (e) life skills training" (p. 400). Interdisciplinary services such as
occupational and physical therapy and speech and language therapy are of prime
importance for youngsters who have physical disabilities.
Another important educational consideration is placement. Educational
services are provided in a variety of settings including regular classrooms,
resource rooms, special classes, and other, more restrictive settings including
hospital and homebound programs. Approximately 8% of students with orthopedic
impairments and 18% of students with health impairments are served in home and
hospital environments (Tenth Annual Report to Congress, 1988). Since educational
services may include extensive medical and health-related support, arrangements
often need to be made to provide these services in diverse educational settings.
The need for support services is often a vital consideration in fitting a
program to an individual student. Most common among the related services are
transportation, physical therapy, occupational therapy, diagnostic services,
school health services, counseling, and school social work services (Tenth
Annual Report to Congress, 1988).
It is often necessary to modify and adapt the school environment to make it
accessible, safe, and less restrictive. Accessibility guidelines are readily
available, and when these guidelines are followed the environment becomes easier
for the child to manage independently.
It is important that modifications be no more restrictive than absolutely
necessary so that the student's school experiences can be as normal as possible.
Many authorities stress the importance of avoiding overprotection of students
with physical or health impairments. It is also important to permit students
with disabilities to take risks just as their able-bodied cohorts do.
Recent advances in technology have helped to make life more nearly normal for
students with physical disabilities. For example, students with cerebral palsy
can use computer terminals to aid in communication. Through technology, even a
person with the most severe handicaps can have greater control over
communication and daily living skills.
Modifying the environment may mean providing special adaptive equipment such
as specially designed desks, positioning devices, wedges, or standing tables.
Adaptations also may include establishing procedures for dealing with medical
emergencies when students have serious medical problems.
WHAT ARE SOME OF THE SPECIAL PROBLEMS IN WORKING WITH PRESCHOOL CHILDREN WITH PHYSICAL DISABILITIES?
One area requiring
special attention is the handling and positioning of young children. Handling
refers to how a child is picked up, carried, held, and assisted. Positioning
refers to providing support for the child's body and arranging instructional or
play materials in special ways. Proper handling helps make the child more
comfortable and more receptive to instruction. Proper positioning allows the
child to perform and manipulate materials most efficiently (Fraser & Hensinger, 1983).
Communication skills are often difficult for children who have physical
disabilities; therefore, preschool programs need to pay special attention to
Connor, F., Scandary, J., & Tulloch, D.
(1988). Education of physically handicapped and health impaired individuals: A
commitment to future. DPH Journal, 10, 5-24.
Fraser, B. A., & Hensinger, R. N. (1983). Managing physical handicaps. A
practical guide for parents, care providers, and educators. Baltimore: Paul H.
Reynolds, C. R., & Clark, J. H. (1983). Assessment and programming for
young children with low incidence handicaps. New York: Plenum.
Sirvis, B. (1988). Physical disabilities. In E. Meyen & T. Skrtic (Eds.),
Exceptional children and youth: An introduction (3rd ed.). Denver: Love
Tenth Annual Report to Congress on the Implementation of the Education of the
Handicapped Act. (1988). Washington, DC: U. S. Department of Health and Human
Services. Office of Special Education and Rehabilitative Services.
(1) Accent on Information
P.O. Box 700
Gillum Road and High Drive
Bloomington, IN 61701
(2) American National Standards Institute
New York, NY 10018
(3) American Coalition of Citizens with Disabilities
1346 Connecticut Avenue, N.W.
Washington, DC 20036
(4) Division on Physically Handicapped
c/o The Council for Exceptional Children
1920 Association Drive
Reston, VA 22091
(5) National Center for a Barrier-Free Environment
1140 Connecticut Avenue, N.W.
Washington, DC 20036
202/466-6896 or 800/424-2809
(6) National Library Service for the Blind
and Physically Handicapped
Library of Congress
1291 Taylor Street, N.W.
Washington, DC 20547