Return to Newsletter | Revised 2-20-02

Bureau for Students with Physical & Health Impairments On-Line Newsletter

Students with orthopedic impairments are often in general education classes, learning course content along with their general education peers with support from teachers certified in orthopedic impairments. For general education teachers who have never had a student with an orthopedic impairment, there may be much confusion over the unique educational needs of students with orthopedic impairments and the role played by the teacher certified in Orthopedic Impairments. Sometimes this is addressed through casual explanation, but other times the teacher may be asked to train a group of school personnel. To address this situation, a suggested inservice on orthopedic impairments is provided. 

DEFINING ORTHOPEDIC IMPAIRMENTS

The term "orthopedic impairments" includes a wide range of students who require special education due to the impact of the orthopedic impairment on their school performance. The Georgia Department of Education defines Orthopedic Impairment as follows:

Orthopedic Impairment refers to students whose severe orthopedic impairments affect their educational performance to the degree that the student requires special education. This term may include:

(1) Impairment caused by congenital anomalies, e.g., deformity or absence of some member.

(2) Impairment caused by disease, e.g., poliomyelitis or bone tuberculosis.

(3) Impairment from other causes, e.g., cerebral palsy, amputations, and fractures or burns that cause contractions. [refer to 34CFR 300.7 (8)]

Secondary disabilities may be present, including, but not limited to, visual impairment, hearing impairment, communication impairment and/or intellectual disability.

Another way of examining students comprising the orthopedic impairments category is by dividing these disabilities into: a) neuromotor impairments (e.g., cerebral palsy, spina bifida, spinal cord injuries); b) degenerative diseases (e.g., muscular dystrophy); and c) orthopedic & musculoskeletal disorders (e.g., limb deficiency & arthrogyposis). Students with neuromotor impairments often have additional disabilities (e.g., visual impairments, communication disorders) that often result in adaptations to accommodate for the physical disability, as well as further modifications to accommodate for secondary disabilities. Students with degenerative diseases often require ongoing assessment to meet changing modifications that are needed as physical status declines. Also, students with degenerative diseases may have emotional issues of having a terminal illness that may need to be addressed. Students with orthopedic & musculoskeletal disorders often have only a singular disability, but may require adaptations and assistive technology to gain access to the general education curriculum. A brief description is given of a sampling of different types of orthopedic impairments following this article.

GENERAL IMPACT OF ORTHOPEDIC IMPAIRMENTS    

Orthopedic impairments can severely impact student's functioning in school. These can be divided into 6 categories and can result in many difficulties. Some sample problems are given in each category as follows: 

1. Poor Motor Skills: Lack of arm/hand usage can result in such problems as the inability to use a standard writing tool, turn pages of a book, explore items, or participate in dissection in biology class. Mobility issues may restrict participation in activities and movement from one location to another.

2. Restricted Language: Students who have severe speech impairments with their orthopedic impairment can be affected academically by being unable to fully communicate their questions and ideas, ask for clarification of the teacher's lecture, or fully participate in the learning activity.

3. Lack of experiences: Students with physical impairments may lack knowledge of common places due to problems in mobility and lack of experience of common items (e.g. ants) due to motoric restriction. This may be apparent in a lack of comprehension of literature readings and material in other content areas.

4. Individual Factors: Students may have several individual factors occurring as a part of their orthopedic impairments that affect education performance. Some of these include: pain & discomfort, fatigue and endurance problems, effects of medications, and absenteeism.

5. Psychological Factors: If the student has any cognitive or learning issues, this will affect performance. Also, some students may have motivational issues such as leaned helplessness or depression which will also impact on performance. A poor self-concept or poor self-advocacy skills can also affect performance.

6. Ineffective Learning Environment: Some school personnel have very low expectations for students with orthopedic impairments. When this is the case, the student is being set up for failure.

EDUCATIONAL TEAMS & OI TEACHERS

Students with orthopedic impairments often have a team of individuals working together to meet their needs. The composition of the team can vary greatly. A typical team may be composed of the OI teacher, general education teacher, occupational therapist (OT), physical therapist (OT), speech language pathologist (SLP), parents, student, and others.

The teacher certified in orthopedic impairments is trained to meet the needs of students with orthopedic impairments in the school setting. Teachers certified in orthopedic impairments have specialized knowledge & skills in such areas as:

 1. Implications of the orthopedic impairment and how to meet the specific implications of the student's particular disorder in the school setting.

2. Specialized instructional strategies (e.g., teaching phonics to nonverbal students).

3. Specialized expanded curriculum areas (e.g., teaching student to use a piece of assistive technology, teaching a student to tube-feed independently).

4. Modifications and adaptations (e.g., modifying a test).

5. Assistive technology.

The OI teacher will work with the general education teacher and the educational team to devise and implement modifications necessary for the student to succeed.

CLASSROOM MODIFICATIONS

 A wide range of modifications may be needed to help the student who has an orthopedic impairment succeed in the general education classroom. General areas include:

1. Implications of the type of orthopedic impairment

2. Physical/health monitoring

3. Environmental Arrangement

4. Augmentative & Alternative Communication (AAC)

5. Instructional & Curricular modifications

6. Assistive technology for content areas

7. Class participation

8. Assignments/Tests

9. Other modifications for motoric problems

10. Sensory & perceptual modifications

The Classroom Modification Checklist (on this website under Products) may be distributed during the inservice which addresses each of these areas. Examples of modifications, AAC devices, or assistive technology may be shown to demonstrate how material may be modified or accessed. Using a case study may be helpful, as well as stressing the support the general education teacher will be receiving from the OI teacher and the educational team.

In closing, the presenter will want to stress the positive impact of having a student with an orthopedic impairment in the classroom. Not only will he student benefit from the general education teachers instruction, but can succeed with appropriate modifications. It is also positive academically for students without disabilities. Some students may benefit from modification used by the OI student. Overall, it is a wonderful learning experience for teachers and students alike.

 

HANDOUT: EXAMPLE ORTHOPEDIC IMPAIRMENTS

Cerebral Palsy refers to a variety of nonprogressive disorders of voluntary movement or posture that is caused by malfunctioning of or damage to the brain occurring before birth, during birth, or within the first few years of life. Students with cerebral palsy typically have abnormal and uncoordinated motor movements, ranging from very mild (e.g., walks with a little difficulty) to very severe (e.g., unable to walk, talk, eat without assistance, or pick up an item). Even through cerebral palsy does not progress, the symptoms may get worse. For example, movement may become more inhabited over time. Often other disorders are present such as seizures and visual impairments.

Spina bifida (myleomeningocele type) is a birth defect in which the neural tube (that forms the brain and spinal cord) does not completely close during the first 28 days of gestation, resulting in damage to part of the spinal cord. Characteristics depend upon the level of the incomplete closure and associated conditions (e.g. hydrocephalus). Children will often require a walker, crutches, or a wheelchair. Learning problems may be present such as visual-perceptual deficits and organizational problems. Some students have language abnormalities that give false impression of their intelligence (e.g., cocktail party language).

Spinal Cord Injury refers to damage to the spinal cord that can be caused by a wide range of disorders and traumatic events. Typically there is impaired or no sensation and movement below the level of injury. Depending on the location and severity of the injury, the child may have symptoms ranging from weakness of a limb (e.g., leg) to paralysis of all parts of the body below the neck.

 Muscular Dystrophy can broadly be defined as a group of inherited diseases characterized by progressive muscle weakness, due to the primary degeneration of muscle fibers. The most common form is Duchenne Muscular Dystrophy in which there is a rapid downward progression of muscle weakness, first seen in the legs, and then moving upward. weakness is often detected by three years of age. Around 10 to 12 years of age the child typically needs a manual wheelchair and when he can no longer push with his arms, an electric wheelchair is needed. Eventually it will be difficult to even hold the head up and the child typically dies in late teens to early twenties.

Limb Deficiencies refer to any number of skeletal problems in which one or more of the limbs (arms & legs) are missing or malformed.

Arthrogryposis is a term used to refer to multiple congenital contractures (a shortening of a muscle so that motion is limited). When infants are born with arthrogryposis, they have multiple contractures in which many joints are fixed in extension (straight) or flexion (bent). After multiple surgeries and treatments, some children may gain the ability to walk, but continue to have limited hand and arm usage.

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