Severe Physical Handicaps

1
Severe Physical Handicaps

• By Andrea Opel, Sondra Deurloo,
• Caitlin Robles, and Danielle Harrington

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Definition and Eligibility
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IDEA Definition/Eligibility

• Americans with Disabilities Act (ADA) a person
  is considered physically handicapped if he or she
  has an impairment that substantially limits one
  or more of lifes daily activities.
• IDEA 2004
• A person with an orthopedic impairment, brain
  injury, or other health impairment who, by reason
  of that impairment, needs special education and
  related services is considered to have a physical
  disability.
• The condition must interfere with or
  substantially limit the childs ability to take
  part in routine school activities.
• A physical disability or health condition need
  not limit activity instead, it may involve other
  restrictions, such as a special diet (i.e.
  celiac-disease) or the students need to use
  medical equipment.

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Special Education Eligibility (cont.)

• When physical disabilities adversely affect
  academic performance, the following special
  education eligibility categories may be
  considered
• Orthopedic Impairment
• Other Health Impairment
• Multiple Disabilities
• Traumatic Brain Injury

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Anatomy of Severe Physical Handicaps
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The Nervous System

• A network of specialized cells (neurons) that
  coordinate the actions of an animal and transmit
  signals between different parts of the body
• Facts to know
• Peripheral nervous system,the
• sympathetic nervous system fight or flight
• parasympathetic nervous system rest and
  digest
• Ventricles open spaces in the brain which are
  filled with Cerebrospinal Fluid (CSF)
• The left half of the body is controlled by the
  right side of the brain and vice versa.
• Sodium and Potassium are vital to neural
  operations.

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Parts of the Brain
Occipital Lobe
Occipital Lobe
Frontal Lobe The ability to concentrate and
attend, elaboration of thought, abstract
reasoning, problem solving, judgment, muscle
memory. Also includes Brocas area. Parietal
Lobe Touch perception and goal directed voluntary
movements Temporal Lobe Hearing ability, memory
acquisition and long-term storage (hippocampus),
sense of identity, behavior and emotions
(amygdala). Also includes Wernickes area.
Occipital Lobe Primary visual reception
area Brain Stem Involuntary responses and
actions (breathing, heart rate, swallowing,
startle response). Damage here can affect level
of alertness and ability to sleep. Cerebellum Reg
ulation and coordination of movement and
balance
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Neurological Disorder Terms

• Aphasia Language impairment usually due to left
  hemisphere damage to Brocas (impairing
  expression) or Wernickes (impairing
  understanding).
• Agnosia Cant recognize every day objects
• Ataxia lack of gross motor coordination
• Apraxia inability to carry out directed motor
  functions even though directions are understood

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Musculoskeletal System

• Composed of bones, muscles, cartilage, tendons,
  ligaments, joints and other connective tissue
• Provides form, support, stability and movement
  to the body

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Musculoskeletal System (cont.)

• Elements of the musculoskeletal system
• Bones provide support for the body, protect
  body organs, produce blood cells, store minerals
• Cartilage a firm substance that prevents bone
  to bone contact
• Tendons attach the muscle to the bone
• Ligaments attach bone to bone
• Skeletal Muscles attached to the bone by
  tendons move bones through contracting
• Type 1 slow/endurance
• Type 2 fast/sprint

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Useful Root Words for reading Medical Records Useful Root Words for reading Medical Records
A- Away or not eg. Ataxia (not ordered)
Distal Away from the center eg. Fingers are distal to the body
Dorsal Towards the back eg. Ears are dorsal to the nose
Hemi- Half eg. Hemiplegic (paralyzed from the waist down)
Hyper- Over or above eg. Psuedo-hypertrophy (fake muscle mass increase)
Hypo- Under or below eg. Hypoxia (not enough oxygen)
Myo Muscles - eg. Fibromyalgia (muscle pain)
Para- To one side eg. Paraplegic (paralyzed on one side of the body
Proximal Towards the center eg. Shoulders are proximal to the body
Quad- Four eg. Quadriplegic (paralyzed in all four limbs)
Ventral- Towards the front eg. Chest is ventral to the back.
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Causes of Severe Physical Handicaps

• Physical disabilities and health conditions are
  classified as either congenital or acquired.
• Congenital either are born with physical
  difficulties or develop them soon after birth
• Acquired developed through injury or disease
  while the child is developing normally. The age
  at which a condition develops often determines
  its impact on the child.

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Causes (cont.)
Cause Meaning
Trauma Trauma means injury. Many people become injured through accidents. In these cases the skeletal, muscular or nervous systems may become damaged. Trauma usually happens after birth.
Illness There are many illnesses that can cause damage to body systems that control movement and may lead to physically disabilities. Many illnesses are caused by a variety of bacteria and viruses. Some illnesses may be inherited and there are some illnesses for which scientists still don't know the cause.
Congenital Something that is "congenital" means present when a person is born. In these cases, a person is born with a physical disability doesnt have to be genetic.
Genetic Genetic means that something is inherited from a persons parents. This means that one or both parents passed a gene that carried that disease or disability. Genetic disorders can sometimes be caused by a mutation of a gene. Scientist usually don't know why these mutations happen and when they can happen.
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Convulsive Disorders
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Convulsive DisordersDefinition

• Characterized by having seizures
• Seizures occur when a burst of electrical
  impulses in the brain escape their normal limits.
  They spread to other areas and create an
  uncontrolled storm of electrical activity. The
  electrical impulses can be transmitted to the
  muscles, causing jerking or convulsions.
• Though seizures can be concomitant with other
  disorders, but when it occurs alone, it is
  considered epilepsy

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Convulsive DisordersCauses

• In 70 of cases, the cause of epilepsy is
  unknown.
• When the cause is known it is usually due to a
  brain injury of some kind.
• Other possible causes hypoxia, stroke, abnormal
  levels of substances (e.g., sodium, blood sugar)
  that temporarily deprive the brain of required
  nutrients
• About 30 of those with epilepsy are children

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Convulsive Disorders Types

• There are two main categories of seizures
  Generalized Seizures and Partial Seizures
• Two most common types of seizures
• Grand Mal seizures (loss of consciousness,
  collapse, violent jerking) Video Clip
• Absence seizures (mostly in children, brief loss
  of consciousness, no jerking, may occur several
  times a day) Video Clip
• There are other types of seizures however,
  these two are the most common

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Convulsive DisordersAcademic Implications
Academic Implications Common medication side effects
Inattention/Concentration problems Hyperactivity Memory problems Excessive fatigue Depression Physical aggression/rage/tantrums/irritability Cognitive impairment related to injuries and scarring in the brain Tiredness Speech slurring Balance issues, clumsiness Dizziness and nausea Mood changes Memory loss Irritability Vision disturbances Hyperactivity
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Convulsive DisordersRecommendations

• Social Skills Groups
• Structure and consistent schedule
• Frequent breaks
• Clear and consistent rules at home and at school
  with consequences for behavior
• Check for understanding frequently
• Be aware absence seizures may be occurring
  throughout the day, which may affect memory

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Cerebral Palsy
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Cerebral PalsyDefinition and Causes

• Cerebral palsy is a condition, sometimes thought
  of as a group of disorders, that can involve
  brain and nervous system functions such as
  movement, learning, hearing, seeing, and
  thinking.
• Caused by injuries or abnormalities of the brain
• Usually occurs during pregnancy
• Risk Factors premature birth, infections, severe
  jaundice, hypoxia, traumatic brain hemorrhage,
  toxicity

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Cerebral PalsySymptoms

• Most common symptoms
• Muscles that are very tight and do not stretch.
• Abnormal walk (gait)
• Joints are tight and do not open up all the way
• Paralysis
• May affect one arm or leg, one side of the body,
  both legs, or both arms and legs

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Cerebral PalsySymptoms

• Other Symptoms
• Speech problems
• Seizures
• Cognitive Impairment (around 50 have ID)
• Hearing/vision problems
• Difficulty swallowing

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Cerebral PalsyAcademic Implications/
Recommendations

• Due to physical limitations and speech problems,
  the following accommodations/modifications are
  usually necessary
• Physical therapy
• Occupational therapy
• Speech therapy
• Communication devices/computer technology
• Special Day Classes, depending on the cognitive
  and communication level of the student
• Video clip

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Fredreichs Ataxia
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Fredreichs AtaxiaDefinition and Causes

• Genetic disorder caused by a defect in the gene
  Frataxin (FXN), which causes the body to produce
  too much of part of the DNA called trinucleotide
  repeat (GAA).
• Symptoms are caused by the wearing away of areas
  of the brain and spinal cord that control
  coordination, muscle movement, some sensory
  functions, and may also affect the heart.

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Fredreichs AtaxiaSymptoms

• Common symptoms include
• Abnormal speech
• Changes in vision, particularly color vision
• Hearing loss - occurs in about 10 of patients
• Jerky eye movements
• Loss of coordination and balance, which leads to
  frequent falls
• Muscle weakness
• Unsteady gait and uncoordinated movements
  (ataxia)
• Muscle problems (can lead to scoliosis)
• Heart disease
• Diabetes (later stages)

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Fredreichs AtaxiaAcademic Implications/
Recommendations

• Speech therapy
• Physical therapy
• Occupational therapy
• Walking aids or wheelchairs
• Access to keyboard or computer
• May need to alter PE requirements
• Longer time for tests and in class assignments
• Use of a scribe
• Letting the student leave a few minutes early for
  lunch or between classes to miss crowds

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Neural Tube Defects
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Neural Tube DefectsDefinition and Causes

• Neural tube defects are birth defects of the
  brain, spinal cord, or vertebrae.
• Causes environmental (e.g., diabetes, obesity,
  drugs), nutritional components (e.g., folic acid
  deficiencies

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Neural Tube DefectsTypes

• Anencephaly Most of the brain does not develop.
  Most fetuses spontaneously abort and those that
  are born rarely survive.
• Encephalocele The bones of the skull do not
  completely close and a sac like formation with
  brain tissue and spinal fluid protrudes outside
  the head skull.
• Spina bifida the fetal spinal column doesnt
  close completely during the first month of
  pregnancy. There is usually nerve damage that
  causes at least some paralysis of the legs.

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Neural Tube DefectsTypes of Spina Bifida

• Spina bifida occulta The bones of the spine do
  not close but the spinal cord and meninges remain
  in place and skin usually covers the defect.
  Mildest form.
• Meningoceles The tissue covering the spinal cord
  sticks out of the spinal defect but the spinal
  cord remains in place. Rarest form.
• Myelomeningocele is a birth defect in which the
  backbone and spinal canal do not close before
  birth. Most severe form.

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Neural Tube DefectsSymptoms/Academic Implications

• Symtpoms
• Varying degrees of paralysis of the lower limbs
• Most children will have some form of a learning
  disability
• Possible bowel and bladder complications
• May have hydrocephalus
• Academic Implications
• May need a bladder management program
• Difficulties with attention
• Trouble expressing or understanding language
• Problems with reading or math
• Depending on cognitive level, may benefit from
  more intense services such as placement in an SDC
  class

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Muscular Dystrophy
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Muscular DystrophyDefinition and causes

• Also called Inherited Myopathy or MD
• Muscular dystrophy is a group of inherited
  disorders that involve muscle weakness and loss
  of muscle tissue, which get worse over time.
• Incidence about 1 in 651,450 persons in the
  United States.
• May occur in childhood or adulthood
• The more severe forms tend to occur in early
  childhood.

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Muscular DystrophyTypes

• There are many different types of muscular
  dystrophy. They include
• Becker muscular dystrophy
• Duchenne muscular dystrophy
• Emery-Dreifuss muscular dystrophy
• Facioscapulohumeral muscular dystrophy
• Limb-girdle muscular dystrophy
• Myotonia congenita
• Myotonic dystrophy
• Duchennes and Beckers muscular dystrophies
  affect males almost exclusively.
• Severity depends on type. Duchenne MD is deadly,
  while others can cause little disability.

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Muscular DystrophySymptoms

• Different types of MD present different symptoms
  and affect specific muscle groups.
• All of the muscles may be affected (including the
  heart). Or, only specific groups of muscles may
  be affected, such as those around the pelvis,
  shoulder, or face.
• Reading disabilities are common
• Mental retardation is present in some types of
  the condition

Symptoms Symptoms
Muscle weakness that slowly gets worse Delayed development of muscle motor skills Difficulty using one or more muscle groups Eyelid drooping (ptosis) Frequent falls Loss of strength in a muscle or group of muscles as an adult Loss in muscle size Problems walking (delayed walking) Drooling
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Muscular DystrophyAcademic Implications/Recommend
ations

• There are no known cures for the various muscular
  dystrophies. The goal of treatment is to control
  symptoms.
• In some cases, surgery on the spine or legs can
  improve functioning
• Treatment may include
• Physical therapy
• Orthopedic appliances such as braces and
  wheelchairs
• Corticosteroids (especially for children)
• Maintaining an active lifestyle

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Traumatic Paraplegia and Quadriplegia
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Traumatic Paraplegia and QuadriplegiaDefinition
and Prevalence

• Traumatic injury Characterized by damage to
  the bones of the spine that surround the spinal
  cord, often resulting in damage to the nerves
  inside the spinal column.
• Traumatic quadriplegia Spinal cord or nerve root
  deficit not involving the cranial nerves above
  and including C8, T1 roots.
• Traumatic paraplegia Spinal cord or nerve root
  deficit below and including T2.
• Complete Complete motor and sensory deficit
  below the level of the injury.
• Incomplete Any sensory or motor sparing below
  the level of injury including perianal sensation.

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Traumatic Paraplegia and QuadriplegiaCommon
Causes

• Broken neck or back neck caused by
• Vehicular accidents 37
• Violence 28
• Falls 21
• Sports-related 6
• Other 8 (e.g., complications following surgery)
• SCI can also be caused by so-called
  non-traumatic cord injury, such as
• Infection of the spinal nerve cells
• Cysts or tumours pressing on the spinal cord
• Interruption of the blood supply to the spinal
  cord
• Congenital medical conditions (e.g., spina
  bifida)

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Traumatic Paraplegia and QuadriplegiaSymptoms

• Common symptoms include
• Loss of sensation and motor function
• Dysfunction of the bowel and bladder
• Impaired or lost sexual functioning
• Men may have their fertility affected, while a
  women's fertility is generally not affected.
• Low blood pressure
• Reduced control of body temperature
• Inability to sweat below the level of injury
• Chronic pain.

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Level Abilities Functional Goals
C1-C3 Limited movement of head and neck Breathing Ventilator or implant Communication Talking can be difficult, very limited or impossible. Daily tasks Needs assistive technology for independence Mobility Can operate an electric wheelchair with head mouth, or chin
C4 Usually has head and neck control. May shrug their shoulders. Breathing May initially require a ventilator for breathing Communication Normal, may have weaker voice projection Daily tasks May have limited independence with specialized equipment
C5 Typically has head and neck control, can shrug shoulder and has shoulder control. Can bend his/her elbows and turn palms face up. Daily tasks Need some specialized equipment but will have independence with some daily activities (e.g., eating, drinking, grooming) Mobility Power wheelchair with hand controls. Driving may be possible.
C6 Has movement in head, neck, shoulders, arms and wrists. Can shrug shoulders, bend elbows, turn palms up and down and extend wrists. Daily tasks Can perform some daily tasks using specialized equipment (e.g., feeding, bathing, grooming, personal hygiene, dressing, and light housekeeping) Mobility Can use a manual or power wheelchair. Some independent transfer.
C7 Has similar movement as an individual with C6, with added ability to straighten his/her elbows. Daily tasks Able to perform household duties. Need fewer adaptive aids. Health care Able to do wheelchair push ups for pressure relief. Mobility Daily use of manual wheelchair. Can transfer with greater ease.
C8-T1 Has added strength and precision of fingers that result in limited or natural hand function. Daily tasks Can live independently without assistive devices in daily living. Mobility Uses manual wheelchair. Can transfer independently.
T2-T6 Has normal motor function in head, neck, shoulders, arms, hands and fingers. Has increased trunk control. Daily tasks Should be totally independent with all activities. Mobility Possible limited walking with extensive bracing. Requires high energy, offers no functional advantage, and can lead to damage of upper joints.
T7-T12 Has added motor function from increased abdominal control. Daily tasks Able to perform unsupported seated activities Mobility Same as T2-T6. Health care Has improved cough effectiveness.
L1-L5 Has additional return of motor movement in the hips and knees. Mobility Walking can be a viable function, with the help of specialized leg and ankle braces. Lower levels walk with greater ease with the help of assistive devices.
S1-S5 Depending on level of injury, there are various degrees of return of voluntary bladder, bowel and sexual functions. Mobility Increased ability to walk with fewer or no supportive devices
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Traumatic Paraplegia and QuadriplegiaAcademic
Implications Recommendations

• Functioning will vary based on location of damage
  and severity of symptoms
• Many require assistance for personal care
• Physical therapy
• Occupational therapy
• Counseling
• Adapted power wheelchairs
• Tape recorders
• Computers
• Page turners
• Mouth control (sip and puff) units
• Voice activation, chin control, head control,
  eyebrow control, or eye blink
• Balanced forearm orthosis (brace) for forearm and
  wrist stability

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Connective Tissue Disease
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Connective Tissue DiseaseDefinition Causes

• Mixed connective tissue disease (MCTD) uncommon
  autoimmune disorder that features the connective
  tissues as a primary target for pathology.
• Connective tissues The structural portions of
  our body that essentially hold the cells of the
  body together.
• Characterized as a group by the presence of
  spontaneous overactivity of the immune system
  which results in the production of extra
  antibodies into the circulation. Leads to
  inflammation in tissues.
• Classified under autoimmune disorders
• Most commonly diagnosed in women in their 20s
  and 30s
• Some are inherited (e.g., Marfan Syndrome,
  Ehlers-Danlos syndrome) others have no known
  cause or are believed to be triggered by
  infection

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Connective Tissue DiseaseTypes

• Causes overlapping features of primarily three
  connective tissue diseases
• lupus
• scleroderma
• polymyositis
• May also have features of rheumatoid arthritis
• Each can be identified by a blood test and
  distinctive, classic symptoms
• Can be undifferentiated at first, as symptom
  onset can be gradual
• Pediatric MCTD occurs in children under the age
  of 16. MCTD is three times more frequent in girls
  than boys.
• 93 of children with pediatric MCTD have
  arthritis

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Connective Tissue DiseaseSymptoms

• Symptoms
• Raynaud's disease blood vessel spasms that
  interrupt blood flow to the fingers, toes, ears
  and nose
• Fatigue
• General feeling of being unwell (malaise)
• Muscle pains (myalgias)
• Joint pains (athralgias)
• Mild fever
• Joint swelling
• Swollen hands and puffy fingers
• Shortness of breath and chest pain (uncommon but
  dangerous could be pulmonary hypertension)
• Often begins with fever, decreased energy, and
  weakness
• Can range from mild to life-threatening

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Connective Tissue DiseaseAcademic Implications
Recommendations

• Can be treated with medication may require only
  for flare-ups, or all the time
• Prognosis can vary some go into remission, and
  others have more serious, long-lasting symptoms
  but can still lead an active, productive life
• Pay attention to medication side effects (e.g.,
  nausea, weight gain, hair loss)
• Recommendations will vary by symptoms

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Resources

• Epilepsy.com www.epilepsy.com
• Epilepsy Foundation www.epilepsyfoundation.org
• Spina Bifida Asspciation www.spinabifidaassociati
  on.org
• The Nemours Foundation. Provides information for
  kids, teens, and parents Kidshealth.org
• United Cerebral Palsy www.ucp.org
• 4MyChild www.cerebralpalsy.org
• The Friedreichs Ataxia Research Alliance
  www.curefa.org
• Muscular Dystrophy Association www.mdausa.org
• American Autoimmune Related Diseases Association,
  Inc. www.aarda.org

51
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