Chapter 14 -Physical Disabilities, Other Health Impairments and ADHD

Definitions of Physical Disabilities and Health Impairments

According to IDEA, a severe orthopedic impairment adversely affects a child's educational performance. The term includes impairments caused by a congenital anomaly (clubfoot, absence of some members, etc.), impairments caused by disease (poliomyelitis, bone tubercolosis), and impairments from other causes (cerebral palsy, amputation, and fractures or burns that cause contractures).

Orthopedic Impairment

Involves the skeletal system-bones, joints, limbs, and associated muscles

Neuromotor Impairment

Involves the central nervouse system, affecting their ability to move, use, feel, or control certain parts of the body.

Definition for Other Health Impairment

According to IDEA, Other Health Impairment means having limited strength, vitality, or alertness, including heightened alertness with respect to the educational environment that is a) due to chronic or acute health probelms such as ASTHMA, ADD or ADHD, DIABETES, EPILEPSY, A HEART CONDITION, HEMOPHILIA, LEAD POISONING, LEUKEMIA, NEPHRITIS, RHEUMATIC FEVER, SICKLE CELL ANEMIA, and TOURETTE SYNDROME

b) Adversely affects academic performance

Chronic Conditions

Long-lasting and most oftern permanent (e.g. CEREBRAL PALSY)

Acute Condition

May produce severe and debilitating symptoms, but is limited in duration (e.g. PNEUMONIA)

Prevalence of Physical Disabilities and Health Impairments

Ranges from .22% to 44%

Types and Causes of Physical Disabilities and Health Impairments

Cerebral Palsy

SpinalBifida

Muscular Dystrophy

Spinal Cord Injuries

Epilepsy

Diabetes

Asthma

Cystic Fibrosis

HIV and AIDS

Cerebral Palsy

1. A disorder of voluntary movement and posture

2. The most prevalent physical disability in school-age children.

Prevalence of cerebral palsy

1. 3.3 per 1,000 live births

2. boys > girls (4:1)

3. 70% of brain damage happens before birth. 30% occurs during the birth process.

Causes of Cerebral Palsy

Attributed to the occurence of injuries, accidents, or illnesses that are:

prenatal (before borth)

perinatal (at or near the time of birth)

postnatal (soon after birth)

and that result in decreased oxygen to low-birth-weight newborns.

Classifications of Cerebral Palsy

Monoplegia - only one limb (upper or lower) is affected

Hemiplegia - two limbs on same side of the body are involved

Triplegia - three limbs are affected

Quadraplegia - all four limbs (both arms and legs) are involved; movement of the trunk and face may also be impaired

Paraplegia - only LEGS are impaired

Diplegia - Impairment primarily involbes the legs, with less severe involvement of the arms

Double Hemiplegia - impairment primarily involves the arms, with less severe involvement of the legs.

Hypertonia

Spastic Cerebral Palsy that involves tense, contracted muscles.

Hypotonia

Weak , floppy muscles, particularly in the neck and trunk. Most infants with cerebral palsy have this.

Athetosis

20% of all cases of cerebral palsy. Characterized by large, irregular, twisting movements that cannot be controlled. The muscles may be tesne and rigid or loose and flaccid. Often accompanied by difficulty with oral language.

Ataxia

10 % of all cases of cerebral palsy. Characterized by a poor sense of balance and body poistion and lack of coordination of the voluntary muscles.

Spina Bifida/Myelodysplasia

Condition in which the vertebrae do not enclose the spinal cord causing a portion of the spinal cord, nerves and feelings in the lower part of the body not to develop normally.

Types of Spina Bifida

1. Spina Bifida Occulta - the mildest form of spina bifida. Only a few vertebrae are malformed, usually in the lower spine.

2. Spina Bifida Cystica - more severe and may lead to significant impairments in mobility and sensation.

• Meningocele

• Myelomeningocele

Meningocele (Spina Bifida Cystica)

A type of spina bifida in which the covering of the spinal cord protrudes through an opening sac formed by the protective membranes surrounding the spinal cord but the cord itself and the nerve roots are enclosed.

Myelomeningocele (Spina Bifida Cystica)

a type of spina bifida where a protrusion on the back on a child consist of a sac of nerve tissue bulging through a cleft in the spine

Prevalence of Spina Bifida

1. 1 in 1,500 births, more common in Hispanic women.

2. Folic acid (0.4 mg daily) significantly reduces risk of neural tube defects.

3. Rates have decreased due to prenatal screening, folic acid use, and elective termination.

4. Causes include genetic factors, folic acid deficiency, anti seizure medications, and other environmental risks.

Hydrocephalus

An enlarged head caused by the accumulation of cerbrospinal fluid in the cranial cavity; often causes brain damage and severe retardation.

Shunt

A one-way valve that diverts the cerebrospinal fluid away from the bain and into the bloodstream

Spina Bifida Interventions

1. detected prenatally through alpha-fetoprotein blood tests and ultrasound.

2. Surgical intervention at birth aims to close the spinal opening and reduce infection risks.

3. Children may need bladder and bowel management training starting as early as age 4.

4. Physical therapy and mobility aids (e.g., braces, wheelchairs) support independence and development.

5. In school, students benefit from accessible environments, inclusion, and monitoring for shunt issues.

Spinal Cord Injury

An injury derived from the bruising, traumatizing, or severing of the spinal cord.

• Common effects include loss of mobility, feeling, and voluntary bowel/bladder control.

Prevalence of Spinal Cord Injury

1. 450,000 people in the U.S. live with spinal cord injuries.

2. Leading causes: motor vehicle accidents (42%), falls (27.1%), violence (15.3%), and sports (7.4%).

3. Nearly 25% of SCIs are alcohol-related.

4. Average age of injury is 38 years.

5. About 5% of SCIs occur in children, mostly due to car accidents and falls.

Spinal Cord Injury Interventions

1. Early treatment focuses on managing shock, immobilizing the spine, and reducing swelling.

2. Methylprednisolone

3. Rehab includes training in muscle use, adaptive equipment, and pain management.

4. Psychological support and education help individuals adjust and regain independence.

5. Teachers must monitor for pressure sores and emotional issues like depression.

Muscular Dystrophy

Group of genetic diseases that gradually weakens muscle tissue; usually becomes evident by the age 2-6.

• loss of walking ability by the early teens and often results in death by early adulthood due to respiratory or cardiac failure.

• Fatty tissue gradually replaces healthy muscle, contributing to loss of function.

Prevalence of Muscular Dystrophy

1. occurs in about 1 in every 4,700 male births.

2. inherited through carrier mothers, with a 50% chance of affecting male offspring.

3. a mutation in the gene that produces dystrophin, a crucial muscle protein.

• Without dystrophin, muscle cells deteriorate and die over time.

Duchenne Muscular Dystrophy

The most common form of Muscular Dystrophy.

Interventions for Muscular Dystrophy

No cure exists for muscular dystrophy; treatments aim to maintain mobility and slow progression.

Common symptoms include fatigue, pain, difficulty swallowing, respiratory issues, and seizures.

• palliative care only

Epilepsy

Seizurs that occur chronically and repeatedly (two or more)

Seizure

sudden burst of excessive electrical activity in the brain disrupting normal function (involuntary movements, sensations, emotions, behavior changes, or loss of consciousness.). may last less than one minute or up to 20 minutes.

Types of Seizures

1. Generalized Tonic-Clonic Seizure (formerly called grand mal) is the most conspicuous and serious type of seizure. The effected child usually has little or no warning.

• Tonic phase: body stiffens, loss of consciousness, person falls down, trunk and head become rigid.

• Clonic phase: repeated muscle contractions and relaxations (violent shaking).

3. Complex Partial Seizure (Psychomotor) individual goes through a brief period of inappropriate or purposeless activity (e.g. smaking lips, walking around aimlessly, shouting). May appear conscious, but are not actually aware of the behavior.

4. Simple Partial Seizure - Sudden jerking with no loss of consciousness. These may occur weekly, monthly, or only once or twice a year.

Absence seizures (petit mal)

• brief, sudden lapses in consciousness.

• The brain temporarily stops functioning normally, altering consciousness subtly.

Prevalence of Seizure

• More common in children than adults.

• Half of seizure disorder cases in children begin before 10 years old.

• Children may have up to 100 absence seizures daily.

• Epilepsy affects about 50 million people worldwide, with 5 million new cases annually.

• Higher in low- and middle-income countries (up to 139 per 100,000) due to infections, injuries, and limited healthcare.

Aura

Warning sensation a short time before a seizures (e.g. feelings, sights, sounds, tastes, and even smells).

Treatments for Seizure

Antiseizure meds, surgery(if resectable), ketogenic diet (dietary therapy), neurostimulation.

Surgical treatment for seizures

Goal: Remove the damaged brain area causing seizures. (55-90% success rate)

• Resective surgery: Removes seizure focus (e.g., lobectomy, lesionectomy).

• Laser interstitial thermal therapy: Minimally invasive destruction of seizure-causing tissue.

• Corpus callosotomy: Cuts neural connections between brain hemispheres to prevent seizure spread.

• Hemispherectomy/hemispherotomy: Removes/disconnects half of the brain’s cortex (common in children).

Vagus Nerve Stimulator (VNS)

Implanted under chest skin, sends electrical pulses to the brain via the vagus nerve.

• Effect: Reduces seizure frequency by 20–40%

Brain Infusion Therapies

infusion into affected brain areas (specific mechanism not detailed in sources; general principle aligns with targeted therapies)

Educator Role

• Know seizure first-aid (protect head, time seizure).

• Report seizure type, duration, aftereffects.

• Prepare for attention/memory challenges after seizures.

Diabetes

Chronic disoder of metabolism where the body does not produce enough or properly use insulin.

2 types of diabetes

• Type 1 diabetes (IDDM): insulin-dependent, often starts in youth, caused by autoimmune destruction of insulin-producing cells.

• Type 2 diabetes (NIDDM): non-insulin-dependent, usually adult-onset, caused by insulin resistance and eventual insulin deficiency

Symptoms of Diabetes

Thirst, urination, hunger, fatigue, slow healing of wounds, blurred vision.

Intervention for Diabetes

• Insulin therapy, glucose checks, insulin pumps.

• Diet, exercise, emergency response for hypo/hyperglycemia.

Hypoglycemia

Low Blood Sugar

Hyperglycemia

High Blood Sugar

Asthma

Chronic lung disease swelling and inflammation of the air passages characterized by episodic bouts of wheezing, coughing, and difficulty breathing.

Prevalence of asthma

• 1 in 10 children in the U.S. has asthma.

• About 9.3% of children and 8% of adults have asthma.

• male > female

• adults: female

• blacks and IPs

• most common and costly disease

Interventions for Asthma

• Eliminate or reduce exposure to asthma triggers

• Increase anti-inflammatory medication

• bronchodilators

• Anti-IgE therapy

• Teachers and caregivers should understand asthma and its effects to support children effectively.

Asthma management plan

• Daily disease management.

• Rescue plan for severe attacks, including warning signs, rescue medicines, steps during an attack, and when to call a doctor.

• includes history

Medications for Asthma

• Inhaled corticosteroids

• Long-acting bronchodilators

• Leukotriene modifiers

• Mast cell stabilizers

• Biologic medicines for hard-to-control asthma, given by injection.

• Asthma medications are generally safe; some long-term medicines may slightly slow children's growth but are essential for health.

• Children with asthma should receive annual flu shots, which are safe even for those with egg allergies.

• Proper use of inhalers with spacers or nebulizers helps deliver asthma medication effectively.

Cystic Fibrosis

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. Found mostly among Caucasians.

Human Immunodeficiency Virus (HIV)

a virus that attacks certain white blood cells (T CELLS) within the body. causes AIDS

Acquired Immune Deficiency Syndrome (AIDS)

A set of fatal symptoms and infections in which the body's immune system breaks down. No cure.

 1st stage (exposure stage) - AIDS

• transmission of the HIV occurs

• Young people may be infected with HIV but may not yet exhibit the life-threatening conditions associated with AIDS.

2nd stage (production of antibodies) - AIDS

• appear about 2 to 12 weeks after the initial transmission of the virus

• 30% of individuals experience flu-like symptoms for a few days to several weeks

3rd stage - AIDS

• immune system declines

• virus begins to destroy cells of the immune system

• asymptomatic phase may continue for 3 to 10 years.

• half of all individuals with HIV develop AIDS within 10 years.

• Most children with HIV infection are diagnosed before the illness manifests itself

• For children, the onset of AIDS ranges from one to three years.

• AIDS manifests itself within two years of the initial infection.

4th stage - AIDS

• begin to manifest symptoms of a damaged immune system (weight loss, fatigue, skin rashes, diarrhea, and night sweats)

• In more severe cases, opportunistic diseases appear in individuals with AIDS.

5th stage - AIDS

• recurrent and chronic diseases begin to take their toll on individuals

• immune system fails and death occurs.

AIDS-EXPOSED CHILDREN

the average age is 4.1 years

33% of children remain aids-free until 13 years of age

Prevalence of HIV

• The Centers for Disease Control and Prevention - 1,201,000 persons aged 13 years and older are living with HIV infection

• the annual number of people living with HIV has increased

• nearly 2,300 adolescents aged 13 to 19 are infected annually, or about six per day (Centers for Disease Control and Prevention, 2015a)

How can mothers reduce HIV virus transmission to their offsping?

by taking zidovudine during pregnancy

Opportunistic Infection

Germs that are only capable of causing infection with changes in the immune system

Children with aids

• develop more serious neurological problems associated with mental retardation

• cerebral palsy

• seizure disorders

Antiretroviral Therapy (ART) and Early Diagnosis

Treatment for children with HIV. Early ART limits the size of the viral reservoir, reduces HIV genetic variability, and improves the immune response. Started within 6–12 hours after birth and continued for at least 2–6 weeks.

Highly Active Antiretroviral Therapy (HAART)

a combination of several antiretroviral drugs that significantly improves health and prognosis in some infants.

• Zidovudine (ZDV)

• Lamivudine (3TC)

• Either Nevirapine (NVP) or Raltegravir (RAL)

3 drug regimen for high-risk infants exposed to HIV

• nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)

• integrase strand transfer inhibitor (INSTI) or one protease inhibitor

• non-nucleoside reverse transcriptase inhibitor (NNRTI) is used with 2 NRTIs.

Most common ART for infants

Goals of HIV Treatment in Children

• Suppress HIV replication (keep viral load low)

• Maintain or restore normal CD4+ counts (immune health)

• Minimize drug toxicity

• Address both medical and social needs for long-term well-being.

Prevention and Risk Reduction of HIV

1 Sex Education

2 Condom use and safe practices

3 Voluntary Counseling and Testing (VCT)

4 Pre-Exposure Prophylaxis (PrEP)

Universal Precautions

A set of standard safety techniques that interrupt the chain of inection spreadby potential biohazards such as blood and body fluids

Attention deficit/hyperactivity disorder (ADHD)

A diagnostic category of the American Psychiatric Association for conditions in which a child exhibits developmentally inappropriate inattention, impulsivity, and hyperactivity.

Prevalence of ADHD

3% to 7% of school-aged children

Boys are three times more likely to be diagnosed than girls

Causes of ADHD

Not fully understood. Thought to be caused by genetics

Variables Affecting the Impactof Physial Disabilities and Health Impairments on Educational Performance

1. Age of Onset

2. Visibility

Physical Therapists (PTs)

Professionals trained to help people with disabilities develop and maintainmuscular and orthopedic capability and make correct and useful movements (e.g. massage and prescriptive exercises).

Occupational Therapists (OTs)

Professionals who programs and/or delivers instructional activities and materials to help children and adults with disabilities learn to participate in useful activities (e.g. dressing, eating, personal hygiene)

Other Specialists

Adapted Physical Educators - provide physical education activities desgined to meet the individual needs of students with disabilities.

Recreation Therapists - provide instruction in leisure activities and therapeutic recreation

Prosthetists - Make and fit artificial limbs

Orthotists - Design and fit braces and other assistive devices

Health aides - Carry out medical proceduresand health-care services in the classroom

Counselors and medical social workers - help students and families adjust to disabilities

Assistive Technology

According to IDEA, this is 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.

Individualized Health Care Plan (IHCP)

The individualized education program (IEP) component for students whith special health care needs; specificies health care procedures and services administered by the school personnel and plan for emergencies.