This chapter provides the IDEA definitions for students with deaf-blindness, multiple disabilities, orthopedic impairments, other health impairments, and traumatic brain injury. Traditionally individuals with some of these disabilities did not live very long but now students with these disabilities are served by the public schools under IDEA. The different prevalence data for these different disabilities are presented and their prevalences are compared. Chromosomal, genetic, teratogenic, postmaturity, complications of prematurity, and acquired etiologies are reviewed as are characteristics of individuals in the different disability categories covered in this chapter. Assessment tools and procedures used with students are described. Placement data are presented for students with physical and health disabilities as well as for students with deaf-blindness. The functional limitations of the disabilities and their impacts upon school performance are presented as is information about meeting students’ educational needs. The special needs of young children, transition-aged youth, and adults with these disabilities are discussed as are family and diversity issues. The application of technology includes a discussion of the many purposes that technology can serve for this population. Important trends, issues, and controversies include assessing the abilities of students with severe disabilities; specialized technology, instruction, and adaptations; and the implementation of appropriate curricula. 

Learning Objectives:

• List the disabilities associated with physical impairments.
• Identify disabilities associated with other health impairments.
• Define deaf-blindness.
• Summarize society’s reaction to and treatment of persons with physical or health impairments.
• Provide examples of common causes of physical disabilities and health impairments.
• Outline representative conditions associated with orthopedic impairments, multiple disabilities, traumatic brain injury, other health impairments, and deaf-blindness.
• Describe the impact of a physical or health impairment on school performance.
• Explain the procedures that teachers and other professionals use to meet the educational needs of pupils with physical/health disabilities and deaf-blindness.
• Summarize educational services for individuals with physical or health impairments across the life span.
• Give examples of how technology benefits individuals with a physical or health disability. 

Lecture Outline:

1. Federal Definitions Pertaining to Physical or Health Disabilities and Deaf-Blindness
   
   1. 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.
   2. 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.
   3. 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).
   4. 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
      
      1. 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
      2. Adversely affects a child’s educational performance.
   5. 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.
2. Examples of Physical and Health Disabilities
   
   1. Physical disabilities
      
      1. Orthopedic Impairment
         1. Neuromotor impairments
            
            1. Cerebral palsy
            2. Spina bifida
         2. Degenerative diseases
            
            1. Muscular dystrophy
         3. Musculoskeletal disorders
            
            1. Juvenile idiopathic arthritis
            2. Limb deficiency
      2. Multiple Disabilities
         1. Physical disability plus another disability
      3. Traumatic Brain Injury
         1. Physical disability resulting from traumatic brain injury
   2. Health Disabilities
      
      1. Other Health Impairments
      2. Major health impairments
         1. Seizure disorders
         2. Asthma
      3. Infectious diseases
         1. AIDS
3. Brief History of the Field
   
   1. Early history: Babies were often left to die if they were physically “defective”
   2. Middle Ages: Religious influences resulted in more humane care
   3. 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.
   4. 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!
4. Prevalence of Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities
   
   1. School-age children receiving special education by disability category during the 2011-2012 school year (U.S. Department of Education):
      
      1. Orthopedic impairments (54,410 children)
      2. Multiple disabilities (125,150 children)
      3. Traumatic brain injury (24,886 children)
      4. Other health impairments (734,348 children)
      5. Deaf-blindness (1,378 children)
5. Etiology of Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities
   
   1. Chromosomal and genetic causes
      
      1. Muscular dystrophy, sickle cell anemia, hemophilia, cystic fibrosis, deaf-blindness, intellectual disability
   2. Teratogenic causes
      
      1. Fetal alcohol syndrome, syphilis, rubella, herpes
   3. Prematurity and pregnancy complications
      
      1. Neurological conditions, cerebral palsy, vision or hearing loss, intellectual disability
   4. Acquired causes
      
      1. Traumatic brain injury (TBI), meningitis
6. Categories of Students with Orthopedic Impairments
   
   1. Neuromotor impairments
      
      1. Damage to the brain, spinal cord, or nerves
      2. These impairments are not progressive meaning they do not worsen over time
      3. Cerebral palsy
         1. Individuals with cerebral palsy may have limited motor control any may not be able to control their limbs
      4. Spina bifida
         1. Spina bifida develops in the early stages of pregnancy causing the spinal cord and brain to develop atypically.
   2. Degenerative diseases
      
      1. Affects muscles and motor development
      2. Often fatal due to degenerative nature of the disease
      3. Muscular dystrophy (MD)
         1. Group of inherited disorders characterized by progressive muscle weakness and degeneration (although intelligence remains intact). MD is terminal and students, families, and teachers need to deal with the inevitably of an early death.
   3. Orthopedic and Musculoskeletal disorders
      
      1. Juvenile rheumatoid arthritis (JRA)
         1. Joint stiffness and pain
      2. Limb deficiency
         1. Limb may be partially or totally missing
7. Characteristics of Students with Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities
   
   1. 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:
      
      1. Intellectual disabilities and spina bifida
      2. Cerebral palsy and seizures
      3. Muscular dystrophy and behavior disorders
   2. Students with Traumatic Brain Injury (TBI)
      
      1. Acquired brain injury often mild, varies by area of brain injury
      2. May impair cognition and social/behavioral functioning
      3. Added as a separate disability category under IDEA in 1990
      4. Often requires rehabilitative services
   3. Students with Other Health Impairments (OHI)
      
      1. Seizure Disorders
         1. Absence seizures (formerly petit-mal): Loss of consciousness, appears trancelike
         2. Complex partial seizure: Impaired consciousness, involuntary movements
         3. Tonic-clonic seizures (formerly grand-mal): Convulsive seizure, loss of consciousness
      2. Asthma
      3. Infectious diseases
   4. Students with Deaf-Blindness
      
      1. Students with deaf-blindness may exhibit:
         1. Cognitive deficits (66%)
         2. Physical impairments (57%)
         3. Complex health needs (38%)
         4. Additional considerations
         5. Speech and language development
         6. Social and behavior skills
8. Assessment of Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities
   
   1. Medical evaluation: Physician confirms diagnosis of physical or health condition
   2. Educational evaluations: Team determines if the disability negatively impacts educational performance
   3. Students with deaf-blindness: Developmental, rather than standardized, assessments are used
9. Educational Considerations
   
   1. Placement varies based on disability and its impact
   2. Impact on School Performance
      
      1. Functional Effects of a Disability:
         1. Atypical movements and motor abilities: Inability to control bodily movements
         2. Sensory loss: Lack of sensation, hearing, vision
         3. Communication impairments: Impaired ability to express and receive language
         4. Fatigue, lack of endurance: Affects concentration and attendance
         5. Health factors: Students may experience pain or require medication or medical services
         6. Experiential deficits: Limited background knowledge of concepts due to sensory deficits
         7. Cognitive impairments, processing deficits: Delayed or impaired learning
      2. Psychosocial and Environmental Factors:
         1. Motivation
         2. Self-concept
         3. Self-advocacy
         4. Behavioral and Emotional Functioning
         5. Social Environment and Social Competence
         6. Physical and Technological Environments
         7. Learning and Attitudinal Environments
      3. Educational Considerations for Students with Physical or Health Difficulties
         1. Physical/health monitoring
         2. Modifications and adaptations of instruction, assessment, communication, physical environment, participation
         3. Specialized instructional strategies
         4. Specialized expanded curriculum areas
      4. Educational Considerations for Students Who are Deaf-Blind
         1. Communication
         2. Highly individualized and specialized instruction
         3. Orientation and mobility
         4. Collaborative efforts
         5. Most students who are deaf-blind use their residual vision or hearing to learn
10. Services for Young Children with Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities
    
    1. Services designed for young children with physical or health disabilities and related low incidence disabilities are designed to assist them in developing their motor and communication skills and help to provide experiences that support future learning. Many professionals collaborate to provide services. The use of augmentative communication devices or other forms of assistive technology can be of great benefit.
11. Transition into Adulthood
    
    1. Career preparation: Preparation for employment includes considerations of supported employment or job coaching. Unemployment rates for people with physical and health disabilities remain dismally high.
    2. College: Colleges and universities typically offer accommodations and accessibility support for students with physical or health disabilities although students may be reluctant to leave a familiar environment.
    3. Technology: Technology has made many jobs available for individuals with physical and health disabilities.
12. Adults with Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities
    
    1. Many adults with physical or health disabilities or related low incidence disabilities successfully transition into the adult world.
    2. Community acceptance and supports are essential. Many adults with physical or health disabilities or related low incidence disabilities do not have access to preventative medical care which can contribute to medical and health issues.
    3. Also, many disabilities within this category may shorten the lives of the individuals and they will need to deal with this knowledge with their families.
13. Family Issues
    
    1. Families may need support as they learn to accept and support their child who has a physical or health disability or related low incidence disability.
    2. Families may experience a great deal of stress juggling the demands of medical interventions, providing support, uncertainties about the future, and health concerns.

Families with children with terminal illnesses will also need support to deal with these issues.

• Diversity Issues
  
  1. Lack of cultural bias in diagnosis
  2. Cultural differences in coping with illness and disability
• Technology and Individuals with Physical Disabilities, Health Disabilities, and Related Low-Incidence Disabilities
  
  1. Computer assistive technology: Input, output, and processing aids allow computer adaptations
  2. Augmentative communication: Forms of language that are used to supplement oral language
  3. Positioning and seating devices: Provide proper positioning and seating for optimal learning
  4. Mobility devices: Assistance in moving from one location to another
  5. Environmental control and assistive technology for daily living. Devices that control electronic appliances, modified daily items (toothbrush, hairbrush, utensils, dressing aids, etc.)
  6. Assistive technology for play and recreation devices used to access toys, adapted sports teams
• Trends, Issues, and Controversies
  
  1. Assessing capabilities and needs: Typical assessment methods may be ineffective due to the nature of the disability. It is important to consider reliable ways for the individual to respond to assessment measures.
  2. Specialized technology, adaptations, instructional strategies. Barriers to attaining special technology can include funding issues, appropriate assessments, selection of devices, training to use the devices, and ongoing technical support.
  3. Appropriate curriculum: Some students with physical or health disabilities will require a functional curriculum while others will learn an academic curriculum. High expectations for achievement are essential.