ORTHOPEDIC

IMPAIRMENTS
TLSE 457-Section 1
Summer 2004

By Andy J. Arison & Kristen Barco-Kida

What is an orthopedic impairment?

Our textbook defines orthopedic

impairments as diseases or
disorders that are related to the
bones, joints, and/or muscles.
An orthopedic impairment is
covered under IDEA if it
adversely affects educational
performance.

A few of the orthopedic impairments

that we will discuss today include:
Cerebral Palsy;
Muscular Dystrophy;
Spinal Cord Injuries;

and
Spina Bifida.

What is cerebral palsy?

Cerebral palsy is a physical impairment

that affects movement.

The four types of cerebral palsy are:
1) spastic;
2) athetoid or dyskinetic;
3) ataxic; and
4) any combination of the those above.

Presumed causes of cerebral palsy

Before birth:
Failure of a part of the brain to develop,
blocked blood vessel, complications during
labor, extreme prematurity, multiple births,
STDs, poor nutrition, effects of anesthetics or
analgesics
Early childhood:
Head injury, near drowning, poison ingestion,
illness/infection, genetics

Prevalence/Incidence Rates
It affects 1 in every 400 births.
It is estimated that 500,000 people in the

United States currently have cerebral

palsy.
It is the most common orthopedic
impairment among students in public
schools.

How can cerebral palsy be diagnosed?

Test an infants motor skills.
Examine the mothers and infants medical

histories.
Test the infants reflexes and early
development of hand preference.
Look for signs of slow development,
abnormal muscle tone, and unusual
posture.

What are some characteristics of

students with cerebral palsy?
Difficulty with fine motor tasks, maintaining

balance, and chewing and swallowing

Involuntary movements
Abnormal reflexes
Weak or tight muscles
Poor coordination
Speech difficulties

What is muscular dystrophy & what

causes it?
Muscular dystrophy is a disease that weakens

the muscles.
There are 43 types of muscular dystrophy, most
of which are caused by alterations in specific
genes.
The most common type is Duchenne muscular
dystrophy, and it only affects boys.
It is a genetic disease passed from mother to son
or it can arise in a young boy due to a
spontaneous genetic mutation.

Prevalence/Incidence Rates
In the United States, it is

estimated that between 50250,000 people are affected

each year.
That number is on the rise
due to technological
advancements and earlier
testing.

How can muscular dystrophy be

diagnosed?
Muscular dystrophy can be

diagnosed through an EMG

(electromyogram), blood
test, and/or a muscle
biopsy.
If a blood test is performed
and it reveals high levels of
creatine kinase, this
indicates that the muscles
are damaged.

What are some characteristics of

students with muscular dystrophy?
Between two and six years of age:
Frequent falling;
Difficulty getting up from sitting or lying position;
Waddling gait; and
Fattening of the leg muscles.
Later on in life:
Wheelchair by age 12; and
By the late teens or early 20s, respiratory and
cardiovascular problems develop and ultimately result
in death.

What is spinal cord injury?

Spinal cord injuries occur when a traumatic

event results in damage to cells within the
spinal cord or severs the nerves that relay
signals up and down the spinal cord. It
causes paralysis, loss of sensation, and
loss of reflex function.
Spinal cord injuries occur suddenly and
without warning.
The four types of spinal cord injuries are:
1) compression;
2) contusion;
3) lacerations; and
4) central cord syndrome.
Terms for the types of paralysis:
1) paraplegia; and
2) quadraplegia.

What causes spinal cord injury?

Traumatic injury:
Car accidents;
Falls;
Diving accidents;
Shotgun wounds;
Horse, motorcycle, sporting
event-related; and
Various other types.
Alcohol plays a significant role
in many of these.

Prevalence/Incidence Rates
In the United States, there are approximately

10,000 new spinal cord injuries each year.

There are over 250,000 people currently
affected.
Spinal cord injuries can happen to anyone at any
time of life.
The typical case is a man age 19-26.

How is spinal cord injury diagnosed?

Diagnosis occurs after a

traumatic injury by a medical

professional.

What are some characteristics of

students with spinal cord injury?

Varying degrees of paralysis

What is spina bifida?

Spina bifida is a birth defect where an abnormal opening

in the spinal column results in some degree of paralysis.

Spina bifida literally translates to cleft or split spine.
There are 3 types of spina bifida:
[1]-Spina bifida occulta; and
Spina bifida cystica ([2]-meningocele; & [3]-myelomeningocele)

What causes spina bifida?

There are environmental as well as genetic

factors:
Lack of folate/folic acid in the mother during
pregnancy; and
Heredity.

Prevalence/Incidence Rates

Approximately 4 in every 1,000 births are

affected.
There are many thousands of people
currently affected.

How is spina bifida diagnosed?

Ultrasound
Amniocentesis, checking for

increased levels of alphafetoprotein.

After birth, it is physically apparent
if a baby has spina bifida.
There may be a buildup of fluid
around the brain (hydrocephalus)

What are some characteristics of

students with spina bifida?

Muscle weakness
Paralysis
Incontinence
Poor short term memory
Easily distracted
Poor attention, organization, sequencing, time,
generalization, motivation, left-right
discrimination, and coordination.

What are some assistive technologies that can be

used for students with orthopedic impairments?
Altered pencils and pens
Altered keyboards (BAT)

Standing table
Easels

Powerpads
Eye-controlled input

Adjustable seats and

systems (cyberlink)
Touch screens
Track ball
Foot mice
*A website that includes several
examples is located here

desks
Portable reading racks
Speech-controlled input
systems (dragon-dictate
and write-away)
Icon-driven
communication (dynavox)

Some instructional ideas & resources

for teachers:

Please see handout

References
Bigge, J.L., & ODonnell, P.A. (1976). Teaching individuals with physical and multiple disabilities. Columbus: Charles E. Merrill
Publishing Company.
Calhoun, M.L., & Hawisher, M. (1979). Teaching and learning strategies for physically handicapped students. Baltimore: University
Park Press.
Friend, M. & Bursuck, W.D. (2002). Including students with special needs: A practical guide for classroom teachers. Boston: Allyn
and Bacon.
The Irish Association for Spina Bifida and Hydrocephalus (2004). What is spina bifida? Retrieved May 24, 2004 from
http://www.iasbah.ie.
Muscular Dystrophy Family Foundation (2002). Muscular dystrophy family foundation. Retrieved May 24, 2004 from
http://www.mdusa.org.
National Information Center for Children and Youth with Disabilities (2004). National dissemination center for children with
disabilities. Retrieved May 25, 2004 from http://www.nichcy.org.
National Institute of Neurological Disorders and Stroke (2001). Spinal cord injury information page. Retrieved May 24, 2004 from
http://www.ninds.nih.gov.
Ohlone College (2004). Students with physical disabilities. Retrieved May 25, 2004 from http://www.ohlone.cc.ca.us/org.
Texas Pediatric Surgical Associates (n.d.). Spina bifida neurological issues. Retrieved May 24, 2004 from http://www.pedisurg.com.
United Cerebral Palsy (2001). Cerebral palsy facts and figures. Retrieved May 24, 2004 from http://www.upc.org.
West Virginia University (1999). Strategies for teaching students with motor/orthopedic impairments. Retrieved May 25, 2004 from
http://www.as.wvu.edu.