17 Orthopedic Impairments

Paula Lombardi

Orthopedic Impairments

 …means a severe orthopedic impairment that adversely affects a child’s educational performance. The term includes impairments caused by a congenital anomaly, impairments caused by disease (e.g., poliomyelitis, bone tuberculosis), and impairments from other causes (e.g.,cerebral palsy, amputations, and fractures or burns that cause contractures).

Center for Parent Information and Resources, (2017), Categories of Disability under IDEA. Newark, NJ, Author, Retrieved 3.28.19 from https://www.parentcenterhub.org/categories/   public domain

Cerebral palsy and spina bifida are two common orthopedic impairments that will be presented, according to the Center for Parent Information and Resources fact sheets.


The following text is an excerpt from: Center for Parent Information and Resources, (2017), Cerebral Palsy, Newark, NJ, Author, Retrieved 4.1.19 from https://www.parentcenterhub.org/cp/  public domain

Cerebral Palsy

Jennifer’s Story

Jen was born 11 weeks early and weighed only 2½ pounds. The doctors were surprised to see what a strong, wiggly girl she was. But when Jen was just a few days old, she stopped breathing and was put on a ventilator. After 24 hours she was able to breathe on her own again. The doctors did a lot of tests to find out what had happened, but they couldn’t find anything wrong. The rest of Jen’s time in the hospital was quiet, and after two months she was able to go home. Everyone thought she would be just fine.

At home, Jen’s mom noticed that Jen was really sloppy when she drank from her bottle. As the months went by, Jen’s mom noticed other things she didn’t remember seeing with Jen’s older brother. At six months, Jen didn’t hold her head up straight. She cried a lot and would go stiff with rage. When Jen went back for her six-month checkup, the doctor was concerned by what he saw and what Jen’s mom told him. He suggested that Jen’s mom take the little girl to a doctor who could look closely at Jen’s development.

Jen’s mom took her to a developmental specialist who finally put a name to all the little things that hadn’t seemed right with Jen–cerebral palsy.

What is CP?

Cerebral palsy—also known as CP—is a condition caused by injury to the parts of the brain that control our ability to use our muscles and bodies. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. Often the injury happens before birth, sometimes during delivery, or, like Jen, soon after being born.

CP can be mild, moderate, or severe. Mild CP may mean a child is clumsy. Moderate CP may mean the child walks with a limp. He or she may need a special leg brace or a cane. More severe CP can affect all parts of a child’s physical abilities. A child with moderate or severe CP may have to use a wheelchair and other special equipment.

Sometimes children with CP can also have learning problems, problems with hearing or seeing (called sensory problems), or intellectual disabilities. Usually, the greater the injury to the brain, the more severe the CP. However, CP doesn’t get worse over time, and most children with CP have a normal life span.

What About Treatment?

With early and ongoing treatment the effects of CP can be reduced. Many children learn how to get their bodies to work for them in other ways. For example, one infant whose CP keeps him from crawling may be able to get around by rolling from place to place. Typically, children with CP may need different kinds of therapy, including:

Physical therapy (PT), which helps the child develop stronger muscles such as those in the legs and trunk. Through PT, the child works on skills such as walking, sitting, and keeping his or her balance.

Occupational therapy (OT), which helps the child develop fine motor skills such as dressing, feeding, writing, and other daily living tasks.

Speech-language pathology (S/L), which helps the child develop his or her communication skills. The child may work in particular on speaking, which may be difficult due to problems with muscle tone of the tongue and throat.

All of these are available as related services in both early intervention programs (for very young children) and special education (for school-aged children).

Children with CP may also find a variety of special equipment helpful. For example, braces (also called ankle-foot orthoses, or “AFOs”) may be used to hold the foot in place when the child stands or walks. Custom splints can provide support to help a child use his or her hands. A variety of therapy equipment and adapted toys are available to help children play and have fun while they are working their bodies. Activities such as swimming or horseback riding can help strengthen weaker muscles and relax the tighter ones.

New medical treatments are being developed all the time. Sometimes surgery, Botox injections, or other medications can help lessen the effects of CP, but there is no cure for the condition. It’s also important to understand that cerebral palsy is not contagious, not inherited, and not progressive.  The symptoms will differ from person to person and change as children and their nervous systems mature. (Healthcommunities.com, 2007)

What About School?

A child with CP can face many challenges in school and is likely to need individualized help. Fortunately, states are responsible for meeting the educational needs of children with disabilities.

As we’ve said, for children up to the 3rd birthday, services are provided through an early intervention system. Staff work with the child’s family to develop what is known as an Individualized Family Services Plan, or IFSP. The IFSP will describe the child’s unique needs as well as the services the child will receive to address those needs. The IFSP will also emphasize the unique needs of the family, so that parents and other family members will know how to help their young child with CP. Early intervention services may be provided on a sliding-fee basis, meaning that the costs to the family will depend upon their income.

For school-aged children, including preschoolers, special education and related services will be provided through the school system. School staff will work with the child’s parents to develop an Individualized Education Program, or IEP. The IEP is similar to an IFSP in that it describes the child’s unique needs and the services that have been designed to meet those needs. Special education and related services, which can include PT, OT, and speech-language pathology, are provided at no cost to parents. In addition to therapy services and special equipment, children with CP may need what is known as assistive technology. Examples of assistive technology include:

  • Communication devices, which can range from the simple to the sophisticated. Communication boards, for example, have pictures, symbols, letters, or words attached. The child communicates by pointing to or gazing at the pictures or symbols. Augmentative communication devices are more sophisticated and include voice synthesizers that enable the child to “talk” with others.
  • Computer technology, which can range from electronic toys with special switches to sophisticated computer programs operated by simple switch pads or keyboard adaptations.

The ability of the brain to find new ways of working after an injury is remarkable. Even so, it can be difficult for parents to imagine what their child’s future will be like. Good therapy and handling can help, but the most important “treatment” the child can receive is love and encouragement, with lots of typical childhood experiences, family, and friends. With the right mix of support, equipment, extra time, and accommodations, all children with CP can be successful learners and full participants in life.

Tips for Teachers

Learn more about CP. The resources and organizations listed organizations listed at the end of this publication  have a lot of information about CP to offer.

This may seem obvious, but sometimes the “look” of CP can give the mistaken impression that a child who has CP cannot learn as much as others. Focus on the individual child and learn firsthand what needs and capabilities he or she has.

Tap into the strategies that teachers of students with learning disabilities use for their students. Become knowledgeable about different learning styles. Then you can use the approach best suited for a particular child, based upon that child’s learning abilities as well as physical abilities.

Be inventive. Ask yourself (and others), “How can I adapt this lesson for this child to maximize active, hands-on learning?”

Learn to love assistive technology. Find experts within and outside your school to help you. Assistive technology can mean the difference between independence for your student or not.

Always remember, parents are experts, too. Talk candidly with your student’s parents. They can tell you a great deal about their daughter or son’s special needs and abilities.

Effective teamwork for the child with CP needs to bring together professionals with diverse backgrounds and expertise. The team must combine the knowledge of its members to plan, implement, and coordinate the child’s services.

(Center for Parent Information and Resources, CP, 2017)


The following text is an excerpt from: Center for Parent Information and Resources, (2015), Spina Bifida, Newark, NJ, Author, retrieved 4.1.19, from https://www.parentcenterhub.org/spinabifida/#ref1  public domain

Spina Bifida

Juan José’s Story

This story comes to you from the Real Stories collection of the Spina Bifida Association.

I remember when the doctors told me my child had hydrocephalus and myelomeningocele and that he would not be able to do anything that another child would do. I was devastated to say the least!

Through the years, my son has proved them wrong time and time again by overcoming obstacles that having Spina Bifida can give. He spoke his first sentence at nine months old, he crawled on time, he used a wheelchair for the first time at 12 months old. My son is now an honor student in “regular” education classes and very active in wheelchair sports. He has many friends and excels in everything that he does.

About Spina Bifida

Spina bifida is one of the most common birth defects in the United States, affecting some 1,500 babies each year. 2 Spina bifida happens during the first month or so of pregnancy and means that the baby’s spine did not close completely. Damage to the nerves and the spinal cord may result.

Characteristics and Health Considerations

The effects of spina bifida vary from person to person, depending on the type involved. Children born with spina bifida occulta typically have few symptoms or adverse effects from the condition. As we mentioned, many may never even know that they have it. Those with meningocele, also a mild form, may be only minimally affected as well.

The effects of myelomeningocele, the most serious form of spina bifida, may include:

  • muscle weakness or paralysis below the area of the spine where the incomplete closure (or cleft) occurs,
  • loss of sensation below the cleft, and
  • loss of bowel and bladder control.

Educational Implications

Quite often, children with myelomeningocele will need to have a series of operations throughout their childhood and school years. School programs should be flexible to accommodate these special needs.

Many children with myelomeningocele need training to learn to manage their bowel and bladder functions. Some require catheterization, or the insertion of a tube to permit passage of urine.

The courts have held that clean, intermittent catheterization is necessary to help the child benefit from and have access to special education and related services. A successful bladder management program can be incorporated into the regular school day. Many children learn to catheterize themselves at a very early age.

In some cases, children with spina bifida who also have a history of hydrocephalus experience learning problems. They may have difficulty with paying attention, expressing or understanding language, and grasping reading and math. Early intervention with children who experience learning problems can help considerably to prepare them for school.

Successful integration of a child with spina bifida into school sometimes requires changes in school equipment or the curriculum. In adapting the school setting for the child with spina bifida, architectural factors should be considered. Section 504 of the Rehabilitation Act of 1973 requires that programs receiving federal funds make their facilities accessible. This can occur through structural changes (for example, adding elevators or ramps) or through schedule or location changes (for example, offering a course on the ground floor).

Children with myelomeningocele need to learn mobility skills, and often require the aid of crutches, braces, or wheelchairs. It is important that all members of the school team and the parents understand the child’s physical capabilities and limitations.

As Juan José’s story at the beginning of this fact sheet illustrates, families and teachers can play a key role in promoting the personal growth and independence of children with spina bifida. The foundations of that independence are laid a step at a time.
(Center for Parent Information and Resources, 2015)


Go to the Disability Summary Overview for OI for specific instructions on developing your OI summary.

The primary reading for OI in addition to this chapter is:


 

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