A student with a physical disability have any one of the following. You text book provides excellent descriptions and illustrations.
- Cerebral palsy
- Spastic
- Dyskinetic
- Anthetoid
- Ataxic
- Spina bifida
- Occulta
- Meningocele
- Myelomeningocele
- Muscular dystrophy
- Arthritis
- Congenital anomalies
- Osteogenesis imperfecta
- Arthrogryposis
Below are some physical characteristics associated with physical disabilities. They may be present in any combination.
- Paralysis
- Altered muscle tone
- Sensory disturbance
- Unsteady gait
- Non-ambulation (often requiring alternate means of mobility)
- Inability (or loss) of ability to use one or more limbs
- Poor gross or fine motor skills (be sure that you know the difference between each)
- Loss of or poor oral-motor control
The following list of challenges and strategies is meant to assist adult educators in providing educational opportunities for individuals with physical disabilities. The problems listed are learning challenges found in many individuals with disabilities, and the suggested teaching strategies can be used regardless of the disability.
Starting, Changing, and Maintaining Activities
It might take students with physical disabilities longer to begin assignments or make the switch to other assignments or activities. In addition, depending on the disability, a student might become easily fatigued. Changing from one task or subject to another can alleviate the feeling of fatigue. These steps might help:
- Begin the session by reviewing what was completed in the prior session and what is expected today.
- Use checklists. List steps to the task and check them off when completed; emphasize where they are in relation to the final step.
- Give one task at a time.
- Explain several examples to help the student get started.
- Praise the student once he/she has begun a task. Assure the student that he/she is capable of completing the activity.
- End each session with a successful experience. Remind the student of prior success.
- Consider having a volunteer tutor cue the student to begin activities and redirect the student as necessary.
Processing and Retaining Information
Some students with physical disabilities have difficulty taking notes or writing math problems. They must rely on their listening skills. To improve them:
- Provide a scribe or tape recorder for important information.
- Provide relevant notes following a lesson.
- Encourage the student to repeat new information as many times as necessary for mastery (Links to an external site.). Over-learn the information.
- Begin each session with a review of the previous lesson and end each session with a review of material covered that day. Encourage the student to tell you what he/she remembers in his/her own words.
- Base new learning on prior knowledge or learning.
- Use material that is significant and relevant to the adult student.
- Use verbal rehearsal. After the visual or auditory information is presented, have the student practice and repeat it as they listen to themselves.
- Limit the amount of new information presented each day. The student should try to attend school during the time each day in which he/she learns best. Have the student take notes or record information on tape.
- Underline or highlight key words in a passage for emphasis.
- Use computer-assisted instruction.
- Use mnemonic devices such as visualization, chunking and acronyms.
- Use a multi-sensory presentation.
- Teach compensatory strategies, such as the use of journals and assignment calendars.
- Provide frequent breaks to prevent information overload.
- Allow extra processing time.
Language Comprehension and Expression
Students with severe physical disabilities may take longer to complete tasks. As a result, some students may not have had time to reach their learning potential in their K-12 years. A student that is non-verbal might not have learned phonics. Likewise, these students would not have had time to practice new learning, read books and develop their vocabulary skills. To help:
- Limit the amount of information presented—perhaps only one or two sentences at a time.
- State information in concrete terms. Use pictures or visual symbols if necessary.
- Teach the student to ask for clarification. It’s okay to have questions!
- Present verbal information at a relatively slow pace with appropriate pauses for processing time, and with repetition if necessary.
- Limit the amount of background noise when listening and understanding is critical.
- Give the students opportunities to increase their vocabulary skills through vocabulary workbooks and software programs.
- Encourage the student to ask the teacher to say something in a different way if it’s not clear the first time.
Visual Perception and Motor Skills
Visual perception problems are common with some disabilities such as cerebral palsy or MS. Even though students don’t need glasses, they might benefit from large print because it provides more space between the lines. Also, some students with physical disabilities have difficulty copying from the chalkboard, and write too slowly or illegibly to take readable notes. Often their writing slants across the paper. Moving quickly from a test booklet or text to an answer sheet can be challenging. To help:
- Provide longer viewing times or repeat viewings when using visual instructional materials.
- Limit lines of text on a page or screen.
- Use line markers.
- Provide large print materials. Space between the lines is important. Use a copy machine or computer to enlarge the print.
- Use books on tape and, if possible, furnish large print materials for following along with the audio.
- Place a colored acetate sheet, of the student’s choice, over a worksheet or computer screen to increase the readability of the print.
- Provide visual clues for the beginnings and ends of lines. Place a colored dot in the left and right margins of the paper or draw a line with a colored marker down the left and right margins. Instruct the student to read to the colored line.
- Use a multi-sensory presentation of materials—visual and audible.
- Choose materials and software that provide an uncluttered format.
- Use paper with black or raised lines.
- Write with a large pen or marker.
- Use pencil pillows or grips.
- Allow extra time to complete written tests and assignments.
- Alter the length of written assignments when possible.
- Let the student underline answers on worksheets rather than copying them onto a blank space.
- Let the student answer questions in one or two words rather than a complete sentence.
- Teach the student to use a note taker effectively.
- Schedule instruction during the student’s optimum performance time.
- Pay attention to and make accommodations for the student’s physical comfort.
- Place a sheet of lined paper on a clipboard which has rubber shelf lining glued to the back to prevent slipping.
- Teach the student to use word processing to record answers.
- Tape record answers.
- Provide assistive technology such as a trackball mouse and an alternative keyboard for word processing and computer-assisted instruction.
- Ensure that tables and monitors are at an appropriate height for the student.
Sequential Processing
Some students have great difficulty planning an essay or determining the steps necessary to complete an assignment. After hearing a story, they would have difficulty repeating the events in the correct sequence. To help:
- Limit the number of steps in a task.
- Present one step of a lesson at a time.
- Provide checklists.
- Have the student repeat, in his own words, the instructions he/she has heard.
- Provide sample items describing how to proceed through parts of a worksheet.
- Teach the student to refer back to the directions.
- Teach sequence in reading and writing. Practice putting a story in order. Plan writing activities based on a sequence.
- Provide part of a sequence and have the student finish the sequence.
Problem Solving/Reasoning
The student might struggle with higher level thinking skills, such as making an inference, finding the main idea, determining a cause and effect relationship or drawing a conclusion. The student might be very concrete in his/her thinking. To help:
- Teach the structure or format of a task.
- Maintain a familiar format in materials or software.
- Have completed sample worksheets serve as models.
- Develop a problem solving guide to help the student through the stages of problem solving (e.g., identify the problem; acquire relevant information for solving the problem; generate several possible solutions; list pros and cons for each solution; identify the best solution; create a plan of action; evaluate the effectiveness of the plan).
- Raise questions about alternatives and consequences.
- Carefully introduce roadblocks and complications to enhance “detouring” skills and to encourage flexibility.
- Provide ongoing, non-judgmental feedback.
- Provide concrete dialogue and information.
- Be certain expectations are clear and understood.
- Ask the student to explain his/her understanding of what he/she has just heard or understands.
- Rephrase oral communication if student does not understand.
- Ask the student to tell what they are thinking before responding to the student.
- Introduce reading materials by objective. That is, the students should listen or read for the main idea. Then they should listen or read to draw a conclusion etc.
Organization and Planning Skills
Some students with physical disabilities will have difficulty not only finding the topic for a paper, but also planning and organizing the writing of the paper. They may have a tendency to think only in broad terms.
Similarly, determining how to organize daily assignments can be overwhelming. Even the student’s desk might become cluttered. The student may become frustrated and gives up completely before accomplishing much of anything.
- Attempt to limit impulsive responses by encouraging the student to take “thinking time” before he/she answers.
- Have the student organize information by using categories (e.g., who, what, when, where).
- Focus on one type of information at a time. Teach reading by objective (main idea, details, inference, cause and effect, context).
- Decrease rambling by directing the student to express a thought “in one sentence.”
- Limit the number of steps in a task.
- Structure thinking processes graphically (e.g., with time lines, outlines, flow charts, graphs).
- Use computer-assisted instruction.
- Encourage the use of a planning calendar.
- Practice estimating the time it takes to complete a task. If there are multiple steps in the task, how long will each step take?
- Encourage the student to develop a list of steps needed to complete a task.
- Develop checklists.
- Determine realistic goals.
Achievement of Academic Potential
In order to help your student achieve all he or she can, use the following tips:
- Assure the student that your program is student-centered. Students will have the opportunity to work on their identified goals.
- Assist the students in improving their independence. Empower them to make decisions.
- Include math and reading materials that relate to the CASAS/TABE Assessments.
- Use materials that will help students increase their vocabulary skills.
- Provide activities on employment skills.
- Provide group activities.
- Give the gift of time and repetition to students with severe physical disabilities. They need it.
- Teach students who cannot use their hands to read cursive writing.
- Teach phonics to individuals that are non-verbal.
- Teach basic foundational skills in reading, writing and math.
- Use manipulatives in teaching math.
- Use materials that are relevant.
- Emphasize the student’s strengths. Point out progress that has been made. Use a learning log to compare past and present work.
- Chart progress graphically
- Praise specific learning achievements or behaviors. Be consistent.
- Expect your student to make progress.
Instructional Strategies for Students with Physical Disabilities
- Use mnemonics such as SLANT (Sit up, lean forward, ask questions, nod your head, track the teacher).
- Consider environmental issues: seating placement in classroom, workspace free from distractions, proximity seating, student remove all non-related materials from space.
- Use textured mats under worksheets and manipulatives to stabilize work area.
- Provide a paper stabilizer (clipboard, non-slip writing surface).
- Use colored highlighters to direct attention to key information.
- Use digital timer to help pace student while working.
- Use a line or a place-marker.
- Provide adapted paper (bold line, raised line, enlarged spacing).
- Use colored sticky notes to draw attention or clarify important information.
- Use large pencils and/or pencil grips/weighted pencils.
- Use adaptive equipment for posture: booster seats, arm rests, etc.
- Use computers with touch screen capabilities.
- Demonstrate all concepts with manipulatives.
- Provide copies of work that is presented on the board or textbook to cut down on. “copying” for students.
- Vary group size for instruction.
- Provide large-print handouts of text.
- Provide a bookstand for books and assignment pages.
- Provide specifically lined/oriented paper.
- Make available computer speech-enhanced text and lessons.
- Use drawings and real-life examples such as lunch counts and class lists.
Part 2 – Traumatic Brain Injuries – Introduction and Characteristics
You can choose to either:
- Read Parts 1 and 2 of the brief handbook attached to this section (There are some excellent case stories here.)
- Read the excerpt below.
The Brain as a Human Command Center
The brain is a remarkable, mysterious organ and is responsible for all of a person’s thoughts and actions. It is both sensitive and robust. Brain wiring (networks of neurons) is somewhat redundant, meaning there is often more than one pathway for a message to travel from one part of the brain to another. If one path becomes disabled, there may be another to carry on. New pathways may form with experience.
On the other hand, inside the skull are bony ridges that can tear at neurons when the brain is shaken. The hard, inflexible skull can inflict bruising on soft brain tissue. This is why it doesn’t take an impact or penetrating wound to significantly injure the brain. Any sudden and severe jolting of the brain inside the skull can cause injury.
All brain activities are conducted via a complex electro-chemical cascade designed to nourish brain cell function and maintain balance. This process can be altered by a number of means — including the introduction of foreign chemicals, loss of oxygen-carrying blood to brain cells, changes instigated by a disease process, and the neurochemical response of brain cells and networks to brain injury.
Sources of Brain Injury
By definition, a brain injury is acquired when a healthy brain is subject to an injurious force. It is not an inherited disorder or a product of genetic mutation.
Traumatic Brain Injuries (TBI)
The major source of documented TBI is motor vehicle accidents in teens and young adults or falls in young children and older adults.
When a student reports a history of multiple head injuries resulting in loss of consciousness or confusion, it is likely but not certain they have acquired permanent effects of brain injury. The likelihood increases if combined with a history of substance use/abuse.
Students who have sustained a traumatic brain injury (TBI) return to the school setting with a range of cognitive, psychosocial, and physical deficits that can significantly affect their academic functioning. Successful educational reintegration for students with TBI requires careful assessment of each child’s unique needs and abilities and the selection of classroom interventions designed to meet those needs (Bowen, 2013).
Most children who have sustained a traumatic brain injury (TBI), even a severe brain injury, will eventually return to a school or classroom setting following discharge from acute hospitalization. Some will return after only a brief hospitalization and others after a lengthy hospitalization and rehabilitation program. Because the recovery process can take several months or even years, many of these children continue to have rehabilitation needs and cognitive impairments and will return to school while still in the recovery stages. It often becomes the responsibility of the educational system to facilitate ongoing recovery and to provide needed services to help these children progress in their academic and social functioning (Bowen, 2013).
Non-Traumatic Brain Injuries
In some patient samples, more individuals have suffered a brain injury due to non-traumatic causes than TBI. Those brain injuries that are not traumatically induced occur when the normal, electro-chemical action of brain cells is blocked or altered by other means — such as over-exposure to toxic substances, tumors, disease progression, temporary loss of oxygen, and an imbalance of fluids or hormones in the brain. A common source in older adults is stroke. In children it is often oxygen loss at birth or exposure to lead paint and other toxins.
Often the first sign of a progressive disease such as multiple sclerosis, AIDS, and cardiovascular disorder is a decline in cognitive functioning. Unexpected learning difficulties or changes in personality or thinking in a younger person may also lead one to suspect environmental causes (e.g., toxins, carbon monoxide exposure) or substance abuse (alcohol, illicit drugs, side effects of prescription drugs). A series of generalized seizures can cause brain injury along with reduced oxygen absorption due to lung disease and poor blood circulation.
Common Difficulties Following Brain Injury
Attention and Memory
A person’s interaction with the environment involves attention and memory. Information is received via any of the senses and given meaning by the brain, which draws on memory to interpret it. Effective responses to the environment, including any information targeted for learning requires:
- Attention – paying attention to environmental stimuli
- Concentration – focusing on giving meaning to what the senses are taking in
- Information processing – interpreting a stimulus by drawing on past experience with it or something similar
- Memory – drawing from a reservoir of prior experiences for help in interpreting a new stimulus
Individuals post brain injury may find that some kinds of stimuli are more difficult to process (i.e., pay attention to, remember) than others. A teacher will recognize these difficulties as differences by learning modality.
Processing Speed
Even when no impairments are noted in attention, concentration and memory, it typically takes more time after a brain injury for someone to absorb, interpret, and respond to information from the environment. In situations that require the person to respond quickly or reasonably fast, he or she can become overwhelmed with the rate at which information is coming to them. Group conversations may be difficult to follow for this reason. Reactions vary but often include anger, feeling discouraged, or shutting down. Staying engaged often depends on keeping the rate of stimulus presentation in sync with the person’s slower processing speed.
Sensory Acuity
Distinct areas of the brain are associated with each sense — sight, sound, touch, smell, taste and proprioception (balance, sense of oneself in space). Several of these are particularly vulnerable to trauma-induced injury, and effects may involve distortion, loss, or increased sensitivity to associated stimuli.
Executive Functioning
This class of brain activities is diverse, but all of its features have in common two requirements: goal-oriented deliberation and a self-observing eye. Normal executive functions direct a person’s actions in response to what he or she experiences or wants to experience. They include:
- Reasoning ability and insight
- Judgment and ability to anticipate consequences
- Problem solving
- Planning and organizing
- Initiation
- Monitoring and evaluating effects of ones behavior
- Adaptability
When executive functions are impaired as a result of brain injury one or both of the following kinds of effects may be observed (if both, then alternately):
- Poor initiation – The person appears unmotivated. Even though they sincerely want to achieve a particular goal, they are unable to begin the action necessary to achieve it. Repeated reminders do no good. This person may also appear unaware and unconcerned about failure to act. Actions that are taken may be perseverative (repeated over and over)with little apparent need to move on.
- Disinhibition – Here judgment and problem solving are impaired and consequences are not anticipated. Action is impulsive. The person may regret the consequences later but appears to forget when an opportunity to repeat the mistake shows up again. This set of symptoms can coexist with thinking rigidity and impatience, making it hard to teach problem solving and self management.
Emotional, Behavioral, and Social Effects
Effects on emotion often stem from frustration and loss of self esteem following a brain injury, when the person sees they can no longer do or be what they were accustomed to prior to the injury. Depression is common along with irritability. Frustration and anger may be quicker and more intense than normal when the person finds it harder to do something that was once easy. Impulsive behaviors are common, and physical acting out is a risk.
Other Effects
- Fatigue
- Emotional, Behavior, Social effects
- Interpersonal relationships may be affected
- Physical disabilities may manifest
- Speech and language difficulties (including written expression)
Instructional Strategies
Because of the varied and complex manifestations of traumatic brain injury, students with brain injuries often benefit from instructional strategies similar to those listed for other disabilities. The following strategies are suggested to enhance accessibility of course instruction, materials, and activities. They are general strategies designed to support individualized reasonable accommodations.
- Keep instructions brief and as uncomplicated as possible.
- Assist the student with finding an effective notetaker or lab assistant from the class, if the student is eligible for these services.
- Allow the student to record lectures.
- Clearly define course requirements, the dates of exams, and when assignments are due; provide advance notice of any changes.
- Provide handouts and visual aids.
- Use more than one way to demonstrate or explain information.
- Break information into small steps when teaching many new tasks in one lesson (state objectives, review previous lesson, summarize periodically).
- Allow time for clarification of directions and essential information.
- Provide study guides or review sheets for exams.
- Provide alternative ways for the students to do tasks, such as dictations or oral presentations.
- As the semester progresses, verbal reminders in class of impending deadlines (e.g. “Remember, the problem sets are due Friday”) are very helpful to students with traumatic brain injuries.
- Whenever possible, start each lesson with a summary of material to be covered or provide a written outline. Broad margins and triple spacing on handouts enables students to take notes directly onto the outline, an aid to organization. Provide a review of the major points at the conclusion of each lecture.
- Avoid making assignments only in oral form, since students with traumatic brain injuries may miss them. In addition to oral announcements, always write assignments on the board or pass them out in written form.
- For large projects or long papers, students with traumatic brain injuries benefit from assistance with breaking the task down into its component parts and setting deadlines for each part.
- When in doubt about how to assist the student, ask him or her.
- Allow the student the same anonymity as other students (i.e. avoid pointing out the student or the alternative arrangements to the rest of the class).
Part 3 – Other Health Impairment – Introduction & Characteristics
Other Health Impairments is one of the IDEA (2004) disability categories.
IDEA states that:
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 a child’s educational performance. [§300.8(c)(9)]
The primary issue in other health impairments, whatever the condition, the resulting symptoms could adversely impact the student’s educational performance. If a child has diabetes, but it is controlled through medication and does not impact learning, special education services are not appropriate for that child.
What’s immediately clear from this definition is that there are quite a few disabilities and disorders that fall under the umbrella of “other health impairment.” And those disabilities are very different from one another. This makes it somewhat difficult to summarize “other health impairment” in this brief unit.
Here is a list of links from the National Dissemination Center for Children with Disabilities (NICHCY) that will take you to additional specific information on these disabilities under the category of Other Health Impairment. Click on each for additional information. Scroll mid-page and click Fact Sheets on Specific Disabilities
- ADD and AH/HD (Links to an external site.)
- Diabetes (Links to an external site.)
- Epilepsy (Links to an external site.)
- Heart conditions (Links to an external site.)
- Hemophilia (Links to an external site.)
- Lead poisoning (Links to an external site.)
- Leukemia (Links to an external site.)
- Nephritis (Links to an external site.)
- Rheumatic fever (Links to an external site.)
- Sickle cell anemia (Links to an external site.)
- Tourette syndrome (Links to an external site.)
There are additional health impairments can also fall under the umbrella of IDEA’s disability category besides the ones specifically mentioned in the law. The U.S. Department of Education mentions specific other disorders or conditions that may, in combination with other factors, qualify a child for services under IDEA–for example:
- fetal alcohol syndrome (FAS),
- bipolar disorders,
- dysphagia, and
- other organic neurological disorders.
The reason these weren’t specifically mentioned in IDEA’s regulations? According to the Department:
…because these conditions are commonly understood to be health impairments…The list of acute or chronic health conditions in the definition of other health impairment is not exhaustive, but rather provides examples of problems that children have that could make them eligible for special education and related services under the category of other health impairment. (71 Fed. Reg. at 46550)
