Kimberly Barnett #2

SPED 5360
Chapter 11
Other Health Impaired (OHI) & Orthopedically Impaired (OI)
1. IDEA definition:
The IDEA classifies physical disability and health problem into two disability categories;
orthopedic impairments and other health impairments.
Orthopedic Impairment (OI): according to IDEA, an orthopedic impairment negatively
impacts a childs academic performance. Orthopedic impairments are defined as impairments
that are a result of a child being born with the condition, the condition is a result of a disease, or
the condition is caused by something else that is not a result of disease or abnormality from birth.
Other Health Impairment (OHI): according to IDEA, OHI causes decreased focus and
attentiveness to the environment. As a result, a child with an OHI is not fully alert while in an
educational setting which results in a decrease in academic performance. Decrease in alertness is
a result of long lasting or sudden onset health problems. Health problems that are part of the
IDEA definition include conditions such as diabetes, asthma, epilepsy, blood cancers, heart
conditions, anemia, etc.
Attention Deficit Hyperactivity Disorder (ADHD): this condition is classified under the
OHI category, although ADHD can fall into other disability categories as well. ADHD can fall
under EBD or learning disabilities. The reasoning behind placing ADHD under the OHI category
is that a child with ADHD is highly alert which causes a decrease in academic performance.
Note: OI and OHI must negatively impact a childs academic performance according to the
IDEA guidelines.
2. Characteristics of Each Disability
Children with physical and health impairments share one common characteristic and that is
poor academic performance. Children with physical disabilities and health problems often times
are on many medications that cause them to be tired and sleepy during class time. They are often
times taken out of classes in order to receive some medical treatment, or miss school days
because of doctor appointments and therapies (e.g., physical therapy).
Although poor academic performance is a shared characteristic for every child with OHI or
OI, certain characteristics are dependent on which condition the child has. The ones that are most
commonly found in school age children include, cerebral palsy, spina bifida, muscular dystrophy,
spinal cord injury, epilepsy, diabetes, asthma, cystic fibrosis, HIV and AIDS
Characteristics:
Orthopedic Impairments:
Cerebral Palsy: this is the most commonly seen condition in the schools. Cerebral Palsy
(CP) is disorder that affects voluntary movement and posture. A child with CP will display
muscle weakness, poor coordination, involuntary convulsions, and sometimes paralysis. Children
may have limited to no control of their arms, legs, or speech. Often times a child with CP may

have sensory problems, which result in vision and/or hearing loss. CP is classified based on what
area of the body is being affected, CP can affect just one limb or up to all four limbs based on the
severity. Cerebral palsy is defined by the effect it has on the childs muscle tone and range of
motion.
Types of CP include:
Spastic cerebral palsy: a child with this type of CP will have muscles that are tense and
contracted. The child will struggle to move, and any movements made will look jerky, spastic,
and not coordinated. Children with this condition tend to use a wheel chair, but sometimes they
can walk. If a child can walk, they often times are seen standing with their knees pointed inward,
and do not have a smooth gait when they walk, their walking is said to be a scissor gait.
Athetoid cerebral palsy: a child with this form of CP will display movements that appear
irregular, and the child will be seen making twisting movements. Children have limited control
of their facial muscles which result in their inability to control their tongue, throat, and lips. The
child may drool as a result of limited control of their lips and tongue. Sometimes, the childs
muscles will be tense, but other times the childs muscles will be loose and moveable. Other
problems that occur with this form of CP include problems with speaking (expressing language),
mobility, and struggle with basic daily living skills (e.g., bathing, feeding themselves, brushing
their teeth etc.).
Ataxic cerebral palsy: a child with this form of CP struggles with their balance and use of
their hands. The child will struggle to remain balanced when walking, and will constantly
readjust themselves to compensate for gravity. When the child tries to get an object, they will be
observed making exaggerated movements and will often times not overshoot and miss the
targeted object.
Rigidity type of cerebral palsy: a child with rigidity type of CP, will have severe stiffness of
arms and legs that are affected, and a child can become unable to move for long periods of time.
Tremor type of cerebral palsy: a child with tremor type of CP will display movements that
appear rhythmic, especially when the child is trying to control the movements and actions.
Mixed cerebral palsy: if a child processes two or more of the types listed above, they are said
to have mixed CP, which is most commonly seen with severe cases of CP.
Spina Bifida: there are many forms of spina bifida, two forms do not cause any problems for
the child and the child is able to function normally. The forms that does cause concern is
myelomeningocele.
Myelomeningocele spina bifida: a child with this form of spina bifida may have an enlarged
head due to accumulation of cerebral spinal fluid, this is also called hydrocephalus. Most
childrens legs will have some degree of paralysis, which makes walking hard. A child may also
have trouble holding in their urine.
Muscular Dystrophy (MD): is a disease where the muscles of the body slowly waste away
(atrophy). Children with MD will be observed struggling to stand after being on the floor, they
might fall down a lot, later in the progression, the child will be unable to walk.
Duchenne muscular dystrophy: a child with this type of MD will have pervasive muscle
weakness, trouble walking, their stomach may be distended, their back may be hollowed, and
they can have larger calf muscles.
Spinal Cord Injuries: characteristics of spinal cord injuries are dependent on which part of

the spinal column was damaged. Some form of paralysis is characteristic of all spinal cord
injuries. Children with spinal cord injuries will have trouble controlling their bladder and bowel
movements. Respiratory problems are common for children who have quadriplegia.
Other Health Impairments:
Epilepsy: is a condition marked by recurrent seizure activity which occurs over a long period
of time. Some children can feel when a seizure is about to happen, also called an aura. There are
two types of epilepsy; generalized tonic-clonic seizure and absence (petit mal) seizures.
Generalized tonic-clonic seizure (grand mal): is the most noticeable and severe type of
seizure. A childs body will freeze up, they pass out, and fall to the floor shaking. During the
seizure the child might urinate or defecate, and may drool from the mouth. The seizure usually
only lasts 2-3 minutes. After the seizure the child might be groggy, or falls asleep.
Absence (petit mal) seizure: is the less severe type of seizure, but occurs more frequently.
When a child is having this type of seizure, they do not shake violently, but might lose
consciousness. The child might be seen staring, or batting their eyes, which can look like the
child is daydreaming or not paying attention.
Complex partial seizure (psychomotor): is a seizure where the child may display lip
smacking, get up out of their seat and walk around for no apparent reason, or can yell and
scream. The child is unconscious in the fact that they are not aware of what they are doing during
the seizure, but can be verbally redirected while they are having the seizure.
Simple partial seizure: is a type of seizure where the child does not lose consciousness but
does display jerky movements.
Diabetes: is a disorder that affects the metabolism. Children with diabetes either have Type 1
or Type 2 diabetes. Teachers need to know the symptoms that indicate the child needs insulin or
needs food to raise sugar levels. A child who is showing sign of hypoglycemia (low blood sugar)
may complain of dizziness and blurred vision, other symptoms like drowsiness and nausea may
also be present. If a child is suffering from hyperglycemia (high blood sugar) the child may
display symptoms that need immediate medical attention. Symptoms include fatigue, labored
breathing, increased thirst and urination, as well as a fruity odor coming from their mouth.
Teachers need to contact the school nurse if a child presents with these symptoms.
Asthma: is a common respiratory disorder in children. Symptoms include wheezing, trouble
breathing, and coughing. Asthma is treated with medications such as inhalers. Children with
asthma may carry a respiratory inhaler with them to use when they have an asthma attack.
Cystic Fibrosis: is a serious, life threatening disease in which the body produces too much
mucus in the lungs which makes it hard to breathe. Children with this disorder do not grow
normally and have symptoms of malnutrition. Children also have a hard time digesting their food
which results in frequent and large bowel movements. Teachers may need to intervene to help a
child clear their lungs through patting their back while the child coughs.
HIV/AIDS: is a disease that affects the childs immune system. Teachers need to be aware of
how to prevent accidental exposure. Careful preventive precautions should be implemented (e.g.,
precautions when treating an open wound). Children with HIV and/or AID do not present with

noticeable symptoms so most of the time school staff are not aware the child has the disease.
ADHD: is a disorder that two specific behavioral traits, hyperactivity and inattention. The
DSM goes into detail about specific behaviors of both traits.
Inattention: is when a child struggles to remain attentive to tasks they are doing, they might
appear as if they are not listening or following directions, have trouble with organization, appear
distracted, forget things easily, and does not like tasks that require them to remain focused and
attentive for a long period of time.
Hyperactivity: is when a child has a hard time staying still. Children with ADHD are often
observed engaging in behaviors such as running around, being loud, fidgets, rushing through
assignments, being disruptive in the classroom, and can be impulsive.
3. Prevalence of ADHD:
ADHD is very common in school aged children. The percentage of school aged children who
have ADHD are estimated to be between 3-5%, or about 5.4 million children. Boys are more
likely to receive the diagnosis of ADHD than girls. In any given classroom, it is estimated that 1
or 2 children in that classroom will have a diagnosis of ADHD.
4. Educational Approaches:
Students with OI and/or OHI may need specialized instruction, as well as information about
how to cope with their disability. Educational approaches for a child with OI or OHI include a
transdisciplinary team, environmental modifications, assistive technology, animal assistance,
health care routines, and promoting independence.
Teaming and Related Services:
Transdisciplinary team approach: this is when every professional who is working with a
child with OI or OHI communicates and shares information about the child. A child with an OI
or OHI will have professionals that are outside the school (e.g., physical therapists) as well as
professionals inside the school. When all members of the childs treatment team are commutating
with each other and sharing information about the child with each other, the child receives the
best quality care. Professionals that a child may have include, but not limited to, physical
therapist, occupational therapists, speech therapists, recreation therapists, orientation and
mobility specialists, as well as counselors and mental health professionals.
Environmental Modifications: modifying the environment for a child with an OI or OHI is
important to ensure that the child has easy access to materials in the school, as well as is
provided with adaptive materials. A child may need better access to the task or activity, altering
the way the teacher is presenting the instruction, as well as changing how the tasks can be
completed. Some examples of adaptation include:
Example 1: adjusting a desks height so that a child who is in a wheel chair can sit
comfortably at a desk.
Example 2: a student who cannot speak, a teacher can let a child write their responses instead
of verbally speaking the answer.
Assistive Technology: according to the IDEA, assistive technology consists of both devices

and services that are used to help a student with a certain task.
Assistive technology device: according to IDEA, an assistive technology device, is any item
(e.g., computer, equipment etc.) that is altered/modified/changed so that a child can use the
device. For example: a child who cannot speak may use a speech device to communicate.
Assistive technology service: according to IDEA, an assistive technology service is when a
child is provided with assistance in finding a device based on their needs.
All assistive technology is used to promote independence and access to opportunities.
Children with OI and OHI utilize assistive technology devices that improve their mobility and
communication. Mobility devices are any device used to help the child move around
independently. Devices that are most commonly used include: adaptive wheelchairs that makes
moving around easier because the designs make the wheelchairs stronger and lighter. Some
wheelchairs are powered by levers, so an individual does not have to manually move the wheels
with their hands. Communication devices are used by individuals who as a result of their
physical disability, may have trouble speaking and communicating. Example: voice input/output
technological devices allow a child to expressively communicate. The child can speak to others
and can respond to others by using the device to answer questions.
Animal Assistance: animals can help a child with a physical disability in many ways.
Service animals, most commonly a service dog, can help a child with a physical disability with
tasks such as mobility (e.g., help a child propel their wheelchair, or help a child balance when
they stand up etc). Service dogs can help a child with everyday simple tasks such as turning on
lights, opening a door, or picking up the phone and bringing it to the child. Service dogs are also
important in providing the child with emotional and social support. Dogs, as well as animals in
general, are therapeutic. They provide companionship and unconditional love, which is important
for child, with or without a disability.
Special Health Care Routines: a child with a physical disability will often times have to
take care of important health relate needs throughout the day. Health care tasks could include
taking medications, getting insulin injections, cleaning/caring for their trach, as well as other
respiratory care (e.g., ventilators). A child with a specific health care need will have that need
addressed in an individualized health care plan (IHCP) in addition to their IEP. The IHCP is
important because it provides teachers and other school personnel with special instructions on
how to help with any health care procedures, physical management strategies, and other health
care procedures. Although the IHCP states the help a child might need, it is encouraged to allow
the child to take care of their own medical needs in order to promote independence and decrease
dependence of others to care for them. Health care routines must be evaluated to make sure that
the task can be completed in a short amount of time to decrease risk of injury, as well as making
sure that the child does not injure themselves while performing the task (e.g., when tube feeding,
a child might attach the syringe to their G-tube without removing their G-tube first).
Ambulatory Assistance (e.g., positioning, seating, and movement): a child with a physical
disability require help repositioning and moving in order to improve comfort, increase strength
of muscles, and improve appearance. Changing a child position should be done frequently.
Example: helping a child adjust how they are sitting can improve stability in the upper body,
improve posture, and help distribute their weight evenly to prevent sores.
Positioning, movement, and seating: Helping the child sit property is important in ensuring
that the childs circulation is not compromised, that their muscles do not get tight, or they do not
get pressure sores on their body. Some important things to be aware of include; what direction
the childs face and body are positioned (i.e., their face, abdominal region, and shoulders should

always be in the midline position), the childs hips should be positioned where their hips are as
far back in their chair as possible and they should have even weight on either side of their
buttock. Some children may need seatbelts, straps, and foot pedals which all need to be attached
properly to ensure safety.
A child with a physical disability may not be able to move a body part that is susceptible to
rubbing and therefore sores can develop which can lead to infection. Continuous movement and
readjusting the childs position frequently helps prevent sores.
Children may require braces and splints which can also rub and pinch if not correctly placed
or improperly fit. A childs skin under their braces and splints should be examined to look for red
areas that indicate improper fit or rubbing. A child may also do their own checks using a mirror
to increase independence.
Lifting and Transferring: a child may need to be moved and transferred out of their
wheelchair to ensure that pressure sores do not develop. A teacher will be required to help lift
and transfer a child who is in a wheel chair.
How to transfer: 1. Make contact with the child 2. Telling the child what is going to happen
3. Preparing the child for the transfer 4. Letting the child be an active participant in the transfer.
Independence and Self-Esteem: children with physical disabilities need to develop
independence and improve their self-esteem. Teachers can help a child feel more independent by
requiring the child to behave in a certain way and require the child to meet standards of
performance just like any other student. The child needs to develop a good sense of self and this
can be accomplished with the help and encouragement of their teachers. Teachers need to treat
the child with respect, accept the child for how they are, and attend to their needs. A student
should be provided with ways to accept their disability, as well as provided with coping skills to
deal with their disability.
Independence: a child with a physical disability needs to be allowed the opportunity to
perform tasks on their own, without the help of teachers and other individuals. When a child can
perform tasks on their own, they develop a sense of autonomy, which will improve their selfesteem and self-worth.
Self-esteem: acceptance of their disability, learning ways to cope with their disability,
realizing that they are not their disability, as well as learning ways to explain their disability to
others will help a child improve their self-esteem and self-worth. Sometimes introducing a child
to a support group can be beneficial in developing independence and self-worth. Support groups
help a child and their family with information and support regarding their disability. Support
groups can be a powerful tool to help the child learn how to be more independent, how to
advocate for themselves, understanding the supports and adaptive devices available, as well as
providing them with the opportunity to make social connections with others who share the same
disability.
5. Find a peer-reviewed or evidence-based article regarding students with one of these
disabilities as it relates to your major (early childhood, secondary education, therapeutic
recreation, and/or instructional strategies). ** READ the article and highlight
critical/interesting information to share with class. Attach the complete article with highlights
of what you found important or interesting. Upload the article to TRACS Drop Box.
6. Provide the article citation in APA format and a brief 2-3 sentence summary.

Article: Effect of Hippotherapy on Gross Motor Function in Children with Cerebral Palsy:
A Randomized Controlled Trial.
Article summary: The study looked at whether horseback riding improved the gross motor
function of children who had spastic cerebral palsy. All the children in the study showed an
improvement in their overall gross motor function. The movement of the horse helped
increase trunk strength and improve overall balance. As a result of increased balance and core
strength, children showed improvements in their ability to crawl, kneel, sit, stand, walk, run,
and jump.
Kwon, J., Chang, H. J., Yi, S., Lee, J. Y., Shin, H., & Kim, Y. (2015). Effect of hippotherapy on
gross motor function in children with cerebral palsy: A randomized controlled trial.
Journal Of Alternative & Complementary Medicine, 21(1), 15-21.
7. Website with helpful academic (i.e., science, reading, math, organization, socialization)
Information for students with one of this chapters disabilities:
ADD/ADHD:
1. Parents:
Website: CHADD-The National Resource on ADHD
Link: http://www.chadd.org/Understanding-ADHD/For-Parents-Caregivers.aspx
Resources:
Understanding characteristics of ADHD
Tips on how to help your child at home
Access to support networks
Information on treatment options
ADHD in teenagers
2. Teachers:
Website: Help Guide
Link: http://www.helpguide.org/articles/add-adhd/teaching-students-with-adhd-attentiondeficit-disorder.htm
Resources:
Classroom management techniques
Tips on dealing with disruptive behaviors in the classroom
Classroom accommodations (e.g., seating arrangements, information delivery
techniques, organization/classroom arrangement etc.)
3. Youth:
Website: Living with ADHD
Link: http://www.livingwithadhd.co.uk/teens-home
Resouces:
Tips on dealing with ADHD at home and at school (e.g., organization skills,
taking breaks, reminders etc)
Taking negative aspects of ADHD and turning it into something positive (e.g.,

Im hyperactive-negative I have a lot of energy-positive)

Information on what to do when feeling a particular emotion (e.g., what do I do
when I feel excited? Answer: Take a break, go somewhere quiet to calm down.)
Treatment options and how to access help from professionals.
Various links to other ADHD websites

8. Find and share a fact about students with one of this chapters disabilities in various
countries/cultures. For example: Are this disability recognized? Are they served in schools
(segregated or inclusion?)? How do families deal with the knowledge their child has a learning
challenge?
New Zealands thoughts and beliefs about ADHD:
Causes:
ADHD behaviors are a direct result of a child reacting to academic struggles and learning
challenges.
Medications:
Teachers did not find medication management an effective tool in treating individuals with
ADHD. Using medications to treat ADHD was not perceived as acceptable. This is thought to
be because children with ADHD in New Zealand are rarely prescribed medications. Teachers in
New Zealand believe that children in the US are over medicated and that medications are a first
line of treatment for children with ADHD.
Using daily report cards and a classroom lottery system as interventions in the classroom:
Teachers in New Zealand believed that childrens response to these interventions were based on
what gender the child is. Using a classroom lottery system was more effective for girls with
ADHD than boys and daily report cards were more effective for boys. This is the opposite for US
teachers.
Reasons for differences in perceived effectiveness of classroom lottery system and daily
report cards by teachers in New Zealand?
Teachers in New Zealand reported less interactions with children with ADHD and reported that
having a child with ADHD in the classroom was rare.
Teachers in New Zealand are not as experienced teaching students with ADHD as US teachers
are. Teachers in NZ stated that they were not as familiar with the specific characteristics of
ADHD. This is due to the prevalence of ADHD in New Zealand. Estimates only 1-2% of
children have ADHD in New Zealand versus 3-5% in the US.

Teachers in New Zealand do not typically recommend using interventions in the classroom
because they believe that it is implying their entire classroom has a problem not just the students
with ADHD.
Treatment for ADHD?
Teachers in New Zealand believe that since ADHD behaviors are a result of a child struggling to
learn, the first course of action is providing the student with academic interventions over using
behavioral or medical interventions.
Curtis, D. F., Pisecco, S., Hamilton, R. J., & Moore, D. W. (2006). Teacher perceptions of
classroom interventions for children with ADHD: A cross-cultural comparison of teachers
in the United States and New Zealand. School Psychology Quarterly, 21(2), 171-196.
doi:10.1521/scpq.2006.21.2.171