Learning Disabilities

1
Learning Disabilities

• Implications for Physical Education

2
Definition

• Disorder in one or more basic processes such as
  understanding or using language, spoken or
  written, that may cause problems in ability to
  listen, think, speak, read, write, spell, or
  mathematics.
• Does not include children who have learning
  problems as a result of visual, hearing, or motor
  disabilities, or mental retardation, or other
  disadvantage (i.e. cultural, economic)

3
Terminology

• Dyslexia
• Developmental Aphasia
• Dysgraphia
• Dyscalculia
• Apraxia

4
Prevalence

• Approximately 2million students in U.S. w/ LD
  (47 spec ed.)
• Growing 1 to 2 per/year
• 3x as many boys than girls
• Other disabilities (CP / SHI) typically have LD
• Educational Placement - 60 resource rooms / 20
  regular ed / 20 self-contained
• Physical Education Placement ???

5
Typical and Possible Problems Associated with LD

• Body Image
• a) finger agnosia
• b) inability to identify body parts / surfaces
• c) inability to make right / left discriminations
• d) judgment difficulties about body size, shape,
  proportions

6
Typical and Possible Problems Associated with LD

• Activities for remediation (body image)
• a) use of actions songs, dances, games, and
  exercises that refer to body parts
• b) problem solving activities
• body size/shape
• c) use of mirrors, videotape

7
Typical and Possible Problems Associated with LD

• Spatial Coordination
• a) difficulties in n-s-e-w directions
• b) right and left directions
• c) difficulties in estimating distance, height,
  width

8
Typical and Possible Problems Associated with LD

• Activities for remediation (spatial)
• a) games involving
• obstacle courses
• mazes
• maps / orienteering
• treasure hunting

9
Typical and Possible Problems Associated with LD

• Motor Proficiency
• a) balance
• b) bilateral coordination / cross-lateral
  integration
• c) fine-motor visual-control
• d) rhythm
• Typically, the body does not do what the mind
  says to do- processing problem

10
Typical and Possible Problems Associated with LD

• Activities for remediation (motor)
• a) balance activities
• b) rhythm activities
• c) bilateral coordination activities
• jumping while clapping hands
• aquatics (breast stroke)

11
Typical and Possible Problems Associated with LD

• Clumsiness and Apraxia
• Difficulties in motor planning or sequencing
• Inability to perform normative act. w/
  age-expected proficiency
• Examples
• motor timing and rhythm
• balance
• sequential activities
• dissociation

12
Typical and Possible Problems Associated with LD

• Activities for remediation (apraxia)
• Depends upon problem area-
• a) dissociation- difficulties in whole / part
  relationships whole part synthesizing
• R- use whole first watch me!
• b) figure-background problems- inability to
  discriminate objects in complex background
• R- bright color balls / contrasting colors /
  pinnies for team games / sounds and visual cues

13
Typical and Possible Problems Associated with LD

• c) motor planning sequencing - difficulties in
  initiating movement - terminating movement - put
  parts in correct order
• R- games, dances, gymnastics - chained movements
  to be remembered
• d) timing / rhythm - difficulty in timing of body
  movements for accuracy, speed, force
• R- moving in time w/ externally imposed rhythms
• ex. Mr. Hollands Opus

14
Instructional Strategies

• Vary instructional strategies
• Typical - imitation / verbal instruction
• Variation - movement exploration / creative
  games, dance, activities
• Modality based instruction
• Typical - mixed modality
• Variation - use modality of choice

15
Instructional Strategies

• Self-talk / Verbal rehearsal
• Talking oneself through activity or sequence
• Saying aloud parts of planned movement before
  execution (teacher prompting verbal response)

16
Instructional Strategies

• ADHD considerations
• Inattention
• Impulsive
• Hyperactive
• Perseveration
• transition difficulties
• ball bouncing
• laughing
• repeating phrase or topic of conversation

17
Instructional Strategies

• Specifically for ADHD
• use optimal structure / routines
• reduce space clearly identify lanes, boundaries
• eliminate irrelevant stimuli
• enhance the stimulus value of the equipment or
  instructional material

18
Final Considerations

• For all students with LD
• Class structure should emphasize cooperative
  behaviors, social competence, and self-esteem
• Most students with LD require APE services to
  self-actualize their motor, fitness, and leisure
  potential

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Mental Retardation

• Implications for Physical Education

20
Mental Retardation

• AAMR definition Four criteria
• 1) Sub-average intellectual functioning (I.Q.)
• 2) Substantial limitations in personal
  capabilities
• 3) Disability in 2 or more adaptive skill areas
• communication, home living, community use, work,
  health/safety, social skills, self-care,
  self-direction, functional academics, leisure
• 4) Begins before age 18

21
Intelligence Quotients (I.Q.)

• MR - 2 standard deviations below the mean (70)
• Below 97 of pop.
• 4 classifications
• 52-70 mild
• 36-51 moderate
• 20-35 severe
• 19- profound
• 1992 (2 classifications)
• mild
• severe

22
Incidence

• 8-10 million persons with MR in U.S.
• 3rd largest disability group receiving special
  education services
• Mild - most common
• Placement
• 6 general
• 22 1/2 1/2
• 60 separate class
• 10 segregated school
• 1-2 home/hospital

23
Etiology

• 30 to 40 percent No know cause
• Other causes include two factors Biological and
  Environmental
• Most common cause of MR in the United States
  Fetal Alcohol Syndrome (FAS)
• Oldest known cause of developmental disabilities
• How Old?

24
Fetal Alcohol Syndrome

• Bible (Judges 133-4) Behold now, thou art
  barren and barest not but thou shalt conceive
  and bear son. Now therefore beware, I pray thee,
  and drink not wine nor strong drink

25
Fetal Alcohol Syndrome

• Characteristics
• born to term, but small, childhood thin and
  short, adolescent may be normal ht and wt
• microcephalic (small head)
• strabismus (cross or wall eyed)
• increased incidence of heart defects
• I.Q. b/w 60-70
• ADHD, autistic tendencies
• Causes of MR linked to time periods

26
MR Causes Time Related

• Prenatal
• Chromosomal Anomaly
• Hydrocephalus, Microcephalus
• Metabolic Disorders
• Maternal Disease
• Parental Blood Incompatibility
• Maternal Self Abuse

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MR Causes Time Related

• Perinatal
• Premature birth, post mature birth
• Low birth weight
• Difficult labor delivery
• Elevated Billy Ruben (Treatment?)

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MR Causes Time Related

• Postnatal
• Head trauma
• Disease
• Environmental Deprivation
• Poisoning
• Late Onset Metabolic Disorders
• Malnutrition
• Seizure Disorders

29
MR Causes Time Related

• Combined Occurrence (before, during, or after
  birth)
• Accident
• Cerebral Anoxia
• Tumors
• Syphilis
• Idiopathic Conditions

30
Scope

• By definition (using IQ only), 3 of population
  has mental retardation (i.e. 8-10 million people)
• About every five or six minutes, a child is born
  with MR (9,000 a month)
• 90 mild
• 6 moderate
• 5 severe/profound
• SES major factor in MR prevalence

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Etiology (Overview)

• 1) Infections / toxins / trauma
• 2) Metabolism / nutrition / unknown prenatal
• 3) Chromosomal anomalies
• Examples
• 1) Chemicals (crack)/poisons/MVA/ STDs
• 2) PKU / Tay-sachs / Hurlers syndrome
• 3) Down Syndrome / Angelman / PraderWillie

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Down Syndrome (Trisomy 21)

• Appearance
• Short stature, short limbs (hands, feet),
• Almond shaped slanted eyes
• Flat face/head, short neck
• Small oral cavity (protruding tongue)
• Hypotonic
• Lax ligaments
• Mean age for walking 4.2yrs

33
Down Syndrome

• Weaknesses
• balance
• reflex integration
• delayed emergence of standing, walking, throwing
  objects
• obesity / hypotonic
• Atlantoaxial syndrome/instability

34
Down Syndrome

• Strengths
• Flexibility
• Rhythm - aerobics
• Early emergence of reaching-grasping, object
  manipulation

35
Mental Retardation

• Motor ability / performance
• Typically developmentally delayed
• Onset of maturational abilities
• Perceptual motor deficits
• (Rarick - Knowledge Base)

36
Key Points with respect to KB

• I.Q. correlated with Motor Deficieny
• Challenge attention and comprehension
• Highest skill correlates with I.Q. are balance
  and fine motor coordination
• Motor development programs need variability in
  practice for transferability of skills (motor
  schema)

37
Fitness and Mental Retardation

• 1 concern and factor related to motor
  performance
• (Roswall, 1991) Low fitness for MR 6-21
• Issue congenital heart disease
• Best practice?

38
Physical Disabilities

• Cerebral Palsy
• Paralysis and Spinal Cord Injury
• Amputations
• Other Physical Conditions

39
Cerebral Palsy

• Definition, Causes, and
• Characteristics

40
Cerebral Palsy

• Medical term that refers to one of a series of
  motor disorders that stem from brain malfunction
• Damage to the immature brain
• Damage to motor centers (motor cortex, basal
  ganglia, brain stem, or cerebellum)
• Damage is commonly associated with retention of
  primitive reflexes
• 4 Diagnostic Criteria for Reflex Problems

41
Cerebral Palsy Causes and Characteristics

• Non-hereditary, non-contagious, and
  non-progressive
• Disease, injury, and malformation of brain cells
  can all produce effects identical to those of
  cerebral palsy
• Exact cause is not known
• Typically, causes are associated by time of
  onset. For example

42
Cerebral Palsy Causes and Characteristics

• Prenatal
• Functional disturbances of the mother (may
  produce hemorrhages in fetal brain)
• Rh incompatibility
• Infection
• Diseases

43
Cerebral Palsy Causes and Characteristics

• Natal
• Prolonged or difficult labor
• Anoxic conditions
• Premature birth
• Postnatal
• Brain infections
• Poisoning
• Head trauma

44
Cerebral Palsy Causes and Characteristics

• Specific common prenatal (90) causes include
• AIDS, rubella, herpes, cytomegalovirus
• Alcohol, tobacco, street drugs
• Trauma to mother that effects fetal brain
  development
• Maternal age (under 20 over 34)
• Oxygen deprivation deliveries (anoxia, hypoxia,
  asphyxia)

45
Cerebral Palsy Causes and Characteristics

• Specific common acquired (10) causes include
• Some type of damage to immature brain
• Encephalitis, meningitis, pertusis
• Accidents
• Child abuse
• Cerebral stroke
• Gunshot wounds
• Gas, lead, radon poisoning

46
Types of Cerebral Palsy

• Mild to severe
• Based on muscle tone and limbs involved
• 7 distinct types of CP
• 5 anatomical classifications of limbs involved
• Four Main Types
• Spastic
• Athetoid
• Ataxic
• Hypotonia

47
Spastic Cerebral Palsy

• Occurs in over 1/2 of all cases (i.e. most common
• Damage to cortical tracts
• Characterized by high muscle tone (hypertonus)
• Hyperactive reflexes and contracted flexor
  muscles
• Contractures
• Often associated with mental retardation

48
Athetoid Cerebral Palsy

• Occurs in about 1/4 of all cases
• Damage to basal ganglia
• Characterized by puposeless, involuntary movement
• Varying degrees of muscle tone (hyper to
  hypotonic)
• Constant squirming and wriggling

49
Ataxic Cerebral Palsy

• Less common type of cerebral palsy (10)
• Usually acquired postnatally
• Characterized by deficient sense of balance,
  coordination, and kinesthesis
• Voluntary movements are usually uncoordinated and
  clumsy
• Swagger Gait similar to an intoxicated person
• Typically poor muscle tone

50
Hypotonia

• Damage deep in cerebellum
• Affects motor cortex and brain stem action
• Low muscle tone
• Problems
• Poor head/trunk control
• Absent postural and protective reflexes
• Shallow breathing
• Joint laxity

51
Anatomical Classification for Limbs Involved

• Monoplegia -
• Diplegia -
• Hemiplegia -
• Triplegia -
• Quadriplegia -
• Other associated characteristics include speech
  disorders, seizures, visual/hearing deficits, and
  perceptual motor difficulties

52
Paralysis and Spinal Cord Injury

• Definition, Causes, and
• Characteristics

53
Spinal Cord

• Spinal cord 31 pairs of spinal nerves
• Protected by vertebral column
• 24 movable
• 7 cervical
• 12 thoracic
• 5 lumbar
• Spinal cord injuries result form some type of
  trauma
• Most common ? Most common sport? Gender?

54
Spinal Cord Injury Classification

• Five-point grading system for extent of injury
  (lesion to spinal cord)
• 1. Complete
• 2. Incomplete with sensation only
• 3. Incomplete with nonfunctional motor ability
• 4. Incomplete with motor function
• 5. Complete recovery

55
Paralysis and Spinal Cord Injury

• Two categories of paralysis
• paraplegia
• quadriplegia
• Higher lesions less function
• C1 or C2 most devastating (Iron Lungs)
• Other associated complications

56
Amputations

• Causes, Incidence, and Characteristics

57
Amputations Classifications

• 4 classifications of causes
• Limb Deficiencies
• 1. Congenital
• Acquired Amputations
• 2. Tumor
• 3. Trauma
• 4. Disease

58
Amputations

• Incidence
• Approximately 400,000 people in U.S.
• 2 other categories of differences in amputations
• dysmelia
• phocomelia
• Prosthetics

59
Other Physical Conditions

• Traumatic Brain Injury
• Muscular Dystrophy
• Multiple Sclerosis
• Spina Bifida

60
Traumatic Brain Injury

• Permanent Damage
• Due to either concussion, contusion, or
  hemorrhage (accidents, assaults, falls, etc.)
• Closed-head injuries
• Leading cause of death under 35
• Glasgow Coma Scale (GCS)
• 3 to 15 points (8 - coma) (5-7 death/veg)

61
Muscular Dystrophy

• Degenerative muscular condition
• Weakening of respiratory muscles and
  immunosuppressed
• Three main types
• Duchenne
• Facio-scapular-humeral
• Limb girdle

62
Duchenne Muscular Dystrophy

• Most severe and most common
• Fatal, inherited form of MD
• Sex linked disorder (mostly males affected)
• Muscle fibers degenerate in gluteals, abs,
  erector spinae, and anterior tibialis
• Frequent falls, contractures, body imbalance
• Gradual reduction in motor ability, wheelchair
  use, and then ultimately death

63
Facio-Scapular-Humeral MD

• Most common in adults
• Equal gender affliction
• Progressive weakness of face, shoulder, and arm
  muscles (hence the name)
• Usually, non-fatal

64
Limb Girdle MD

• Slow muscle degeneration of shoulder girdle and
  hip and thigh muscles
• Equal gender affliction usually after 10 years
  old
• Least common form of MD

65
Multiple Sclerosis

• Inflammatory disease of the CNS
• Demyelination bouts that last 1 to 3 months
• Leaves some degree of disability
• Followed by periods of remission
• More common in women
• Age of onset 20 to 40

66
Spina Bifida

• Second in prevalence to cerebral palsy for
  orthopedic defects in school-aged children
• Congenital anomaly resulting in,
• Failure of of one or more vertebral arches to
  properly develop and close
• Usually occurs in the lumbar region
• Three types (levels of severity) of Spina Bifida

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Spina Bifida

• Spina Bifida Occulta
• Least severe
• Defect in the fusion of the posterior neural arch
• Usually asymptomatic, does not cause paralysis or
  muscle weakness

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Spina Bifida

• Meningocele
• More severe, requires surgery
• Characterized by a sac containing (meninges or
  spinal cord covering) protruding out of the open
  neural arch
• Spinal fluid leaks into sac. Rupture can lead to
  meningitis
• Otherwise, usually no neurological defects

69
Spina Bifida

• Meningomyelocele
• Most severe and most common
• Always associated with some degree of
  neurological deficit
• Both the meninges and part of the spinal cord
  itself protrude into a sac
• Location of spinal cord lesion determines
  involvement and associated disabilities
• 90 of cases have hydrocephalus

70
Deafness and Hearing Impairment

• Definition, Causes, and Characteristics

71
Deafness and Hearing Impairment

• P.L. 101-476 defines Hearing Impairment
• an impairment in hearing, whether permanent or
  fluctuating, that adversely affects a childs
  educational performance but that is not included
  under deafness in this section
• P.L. 101-476 defines Deafness

72
Deafness and Hearing Impairment

• Deafness is defined as
• hearing impairment that is so severe that the
  child is impaired in processing linguistic
  information through hearing, ...that adversely
  affects a childs educational performance
• Very few students are deaf most are hearing
  impaired

73
Sound Characteristics

• Two primary characteristics of sound
• loudness / intensity
• frequency / pitch
• Loudness is measured by decibels (dB)
• Ex. Normal speech at 10ft away is 45 to 65 dB
  loud. A freight train 10ft away is 90 to 120 dB
  loud
• 5 classifications for hearing loss in (dB)

74
Classifications for Hearing Loss

• Slight 25-40 dB loss
• Mild 41-55 dB loss
• Marked 56-69 dB loss
• Severe 70-90 dB loss
• Profound 91 dB or greater loss
• A 70 dB loss is the cut-off between hard of
  hearing and deaf
• Frequency is measured in hertz (Hz) or cycles per
  second

75
Frequency (Hz)

• Frequency is basically high and low pitch
• Piano example lowest key is 30 Hz and highest
  key is 4,000 Hz
• Normal range 20 Hz and 20,000 Hz
• Daily communication is between 100 and 10,000 Hz
• Two main types of hearing loss
• conductive
• sensorineural

76
Types of Hearing Loss

• Conductive hearing loss - originates in outer or
  middle ear
• Sound traveling through air passages is
  obstructed
• ex. Put finger in ear canal (25 dB loss)
• Conductive loss results in hard of hearing
  condition, NOT deafness

77
Types of Hearing Loss

• Sensorineural hearing losses are more serious,
  occurring in the inner ear
• Damage to auditory nerve, nerve fibers, or one of
  the structures of the inner ear
• Causes disruption in conversion of sound waves
  into neural impulses for translation
• Balance problems typically associated
• Generally irreversible loss
• Incidence over 16 million (2 million deaf)

78
Visual Impairments

• Definition, Causes, and Characteristics

79
Visual Impairments

• Legal Blindness Definition
• Less than 20/200 vision with best correction, or
• Less than 20 degree visual field with best
  correction
• Incidence - 1 in 3,000
• 25 total blindness
• 25 partial blindness
• 50 can read enlarged type

80
Structure of the Eye

• LIGHT CORNEA and LENS
• Retina
• Optic Nerve
• Brain

81
Blindness

• Causes
• anoxia
• intrauterine infections
• head trauma
• retinoblastoma
• nutrition disorders (vitamin A deficiency)
• Two types
• cortical - problem along visual pathway
• retinal - eye structure itself