Chapter Fourteen

Individuals With Physical Disabilities, Health

Disabilities, and Related Low-Incidence Disabilities
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 Brief History of the Field
• Brief History of the Field
– Early history: Babies were often left to die if they were physically
“defective”
– Middle Ages: Religious influences resulted in more humane care
– 1890: First U.S. institution for children with physical disabilities
(Industrial School for Crippled and Deformed Children), Boston
originally planned for treatment and training, it deteriorated into a
custodial care facility that segregated individuals with disabilities from
society.
– Emergence of public education: Beattie v. State Board of Education
(1919) stated that students with physical disabilities could be excluded
from school because they produced a “depressing and nauseating
effect” on other students!
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 Prevalence of Physical Disabilities, Health
Disabilities, and Related Low-Incidence Disabilities
School-age children receiving special education by
disability during the 2011-2012 school year:
‒ Orthopedic impairments (54,410 children)
‒ Traumatic brain injury (24,886 children)
‒ Other health impairments (734,348 children)
‒ Multiple disabilities (125,150 children)
‒ Deaf-blindness (1,378 children)
The first four categories represent approximately 16% of
students receiving a special education with a range of .42%
(TBI) to 12.68% (OHI).
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• Federal Definitions Pertaining to Physical or
Health Disabilities and Deaf-Blindness
– Deaf-blindness means concomitant hearing and visual
impairment, the combination of which causes such
severe communication and other developmental and
educational needs that students cannot be
accommodated in special education programs solely
for children with deafness or children with blindness.
– Multiple disabilities means concomitant impairments
(such as mental retardation–blindness, mental
retardation–orthopedic impairment, etc.), the
combination of which causes such severe educational
needs that students cannot be accommodated in
special education programs solely for one of the
impairments. The term does not include deaf-
blindness.
– Orthopedic impairment means a severe orthopedic
impairment that adversely affects a child’s educational
performance. The term includes impairments caused by
congenital anomaly (e.g., clubfoot, absence of some
member, etc.), impairments caused by disease (e.g.,
poliomyelitis, bone tuberculosis, etc.), and impairments
from other causes (e.g., cerebral palsy, amputations, and
fractures or burns that cause contractures).
– 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 education environment that
• 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
• Adversely affects a child’s educational performance.
• Traumatic brain injury means an acquired injury to the
brain caused by an external physical force, resulting in
total or partial functional disability or psychosocial
impairment, or both, that adversely affects educational
performance. The term applies to open or closed head
injuries resulting in impairments in one or more areas,
such as cognition; language; memory; attention;
reasoning; abstract thinking; judgment; problem-
solving; sensory, perceptual, and motor abilities;
psychosocial behavior; physical functions; information
processing; and speech. The term does not apply to
brain injuries that are congenital or degenerative, or to
brain injuries induced by birth trauma
Etiology of Physical Disabilities, Health
Disabilities, and Related Low-Incidence
Disabilities
Chromosomal and genetic causes
– Muscular dystrophy, sickle cell anemia, hemophilia, cystic
fibrosis
– CHARGE Association (syndrome) and Usher syndrome are the
two examples of genetic causes of deaf-blindness
Teratogenic causes
– TORCH – toxoplasmosis, other, rubella, cytomegalovirus, and
herpes.
Prematurity and pregnancy complications
– Neurological conditions, cerebral palsy, vision or hearing loss,
intellectual disability
Acquired causes
– Traumatic brain injury (TBI), child abuse, environmental toxins
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 Categories of Students with Orthopedic
Impairments
• Neuromotor impairments
– Cerebral palsy (CP)
• Four most common forms: spastic, athetoid,
ataxic, and mixed
• Classified according to which limbs are affected
– Spina biffida
• Degenerative diseases
– Duchenne Muscular Dystrophy (MD)
• Orthopedic and Musculoskeletal disorders
– Juvenile idiopathic arthritis (JRA)
– Limb deficiency
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 Characteristics of Students
with Multiple Disabilities
Multiple Disabilities is an umbrella term that refers to
individuals with concomitant impairments whose
needs cannot be met in a special education program
designed solely for one impairment.
Examples:
• Intellectual disabilities and spina bifida
• Cerebral palsy and seizures
• Muscular dystrophy and behavior disorders
• Deafness and AIDS
• Learning disabilities and asthma

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Characteristics of Students with Traumatic
Brain Injury (TBI)
• Traumatic brain injury:
– Temporary or permanent injury to the brain
– Often mild, varies by area of brain injury
– May impair cognition and social/behavioral
functioning
• Added as a separate disability category under IDEA in
1990
• Often requires rehabilitative services

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Characteristics of Students with Other Health
Impairments (OHI)
Major Health Impairments
• Seizure Disorders
– Absence seizures (formerly petit-mal)
• Loss of consciousness, appears trancelike
– Complex partial seizure
• Impaired consciousness, involuntary movements
– Tonic-clonic seizures (formerly grand-mal)
• Convulsive seizure, loss of consciousness
• Asthma

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 Characteristics of Students with
Other Health Impairments (OHI)
Infectious Diseases
• Acquired immune deficiency syndrome (AIDS)
– Human immunodeficiency virus (HIV) destroys
immune system

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Characteristics of Students with Deaf-
Blindness
• Students with deaf-blindness represent an
extremely heterogeneous population.
• Students with deaf-blindness may exhibit
cognitive deficits, physical impairments, and
complex health needs
• Additional considerations
‒ Speech and language development
‒ Social and behavior skills

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 Assessment of Physical Disabilities, Health
Disabilities, and Related Low-Incidence
Disabilities
• Medical evaluation
– Physician confirms diagnosis of physical or health
condition
• Educational evaluations
– Team determines if the disability negatively
impacts educational performance
• Students with deaf-blindness
– Developmental, rather than standardized,
assessments are used in conjunction with informal
observations
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 Impact on School Performance
School performance of individuals with physical or
health disabilities is impacted by the type of
disability and its functional effects, in addition to
psychosocial and environmental factors.

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Insert Table 14.4 from page 514

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Educational Considerations for Students
with Physical or Health Difficulties
 Physical/health monitoring
 Modifications and adaptations of
instruction, assessment,
communication, physical environment,
class participation, and use of assistive
technology
 Specialized instructional strategies
 Specialized expanded curriculum areas
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 Educational Considerations for
Students Who are Deaf-Blind
• Communication
• Orientation and mobility
• Collaborative efforts

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 Services for Young Children with Physical
Disabilities, Health Disabilities, and
Related Low-Incidence Disabilities
Early intervention services address:
• Collaborative services
• Motor development
• Communication development
• Use of augmentative communication
• Building of experiences

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 Transition into Adulthood
Transition planning typically addresses:
• Career planning
• Post-secondary education
• Employment opportunities
• Daily living skills
• Independent living
• Use of technology

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 Adults with Physical Disabilities,
Health Disabilities, and Related
Low-Incidence Disabilities
• Community acceptance and supports
• Preventative medical care
• Medical and technological support
• Terminal illnesses

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 Family Issues
• Coping with stress
• Daily living activities
• Medical interventions
• Terminal illness

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 Issues of Diversity
Physical, health, and related low-incidence
disabilities occur in individuals from all backgrounds,
cultures, and economic levels.
• Lack of cultural bias in diagnosis
• Cultural differences in coping with illness and
disability

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 Technology and Individuals with Physical
Disabilities, Health Disabilities, and
Related Low-Incidence Disabilities
• Computer access
• Assistive technology
• Augmentative communication
• Positioning and seating devices
• Mobility devices
• Environmental control and assistive technology
for daily living
• Assistive technology for play and recreation
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– Computer assistive technology: Input, output, and processing
aids allow computer adaptations
– Augmentative communication: Forms of language that are used
to supplement oral language
– Positioning and seating devices: Provide proper positioning and
seating for optimal learning
– Mobility devices: Assistance in moving from one location to
another
– Environmental control and assistive technology for daily living.
Devices that control electronic appliances, modified daily items
(toothbrush, hairbrush, utensils, dressing aids, etc.)
– Assistive technology for play and recreation devices used to
access toys, adapted sports teams
 Trends, Issues, and Controversies
• Assessing capabilities and needs
• Specialized technology, adaptations, instructional
strategies
• Appropriate curriculum

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