The federal government considers physical disabilities and health disabilities as separate special education categories. IDEA '04 uses the term orthopedic impairments to refer to conditions that in this text we call physical disabilities. Students with physical disabilities have problems with the structure or the functioning of their bodies. The federal government, through IDEA '04, uses the term other health impairments to describe, collectively, conditions and diseases that create special health care needs or health disabilities for students. These two special education categories are not as separate or discrete as their definitions make them seem. For example, some conditions typically grouped under physical disabilities or orthopedic impairments also result in long-term health problems. One student with cerebral palsy may face physical challenges and need considerable assistance from a physical therapist (PT) to learn how to control movement, and yet have no special health care needs. Another student also with cerebral palsy may have both physical limitations and serious health care needs. Many children with health-related disabilities also have limitations to their physical well-being and require ongoing medical attention. And some combine major health issues with speech or language impairments (Owens, Metz, & Haas, 2003). Many of them present special needs at school. However, possibly more than is true of any other group, many students with physical or health problems require accommodations to participate in general education environments but do not require special education services.

Although we discussed attention deficit hyperactivity disorder (ADHD) in a separate chapter, note that IDEA '04 includes this condition as part of the "other health disabilities" category. In this text, we present information about conditions more traditionally considered physical or health disabilities.

Physical Disabilities

The two major groups of physical disabilities are

  1. Neuromotor impairments
  2. Muscular/skeletal conditions

Some diseases, such as polio, are now prevented in the United States. Others, such as multiple sclerosis, are found in adults but seldom seen in children; and some, such as muscular dystrophy and spina bifida, have extremely low prevalence rates. Other conditions, such as epilepsy and cerebral palsy, are more prevalent, and teachers should have knowledge about these conditions because they might teach students who have special needs as a consequence of them. Neuromotor impairments are conditions caused by damage to the central nervous system (the brain and the spinal cord). The resulting neurological impairment limits muscular control and movement. Muscular/skeletal conditions are impairments that affect the limbs or muscles. Individuals with these conditions usually have trouble controlling their movements, but the cause is not neurological. Some need to use special devices and technology even to do simple tasks—such as walking, eating, or writing—that most of us take for granted. And, because physical disabilities are often so obvious, it is easy to overlook the associated difficulties many of these individuals have with social skills (Coster & Haltiwanger, 2004).

When responsible educators encounter diseases and conditions they know little about, they seek out all the information they need to provide an appropriate education to students involved. Educators also understand that these disabilities range in severity from mild to severe. And, in many cases, they are only one of multiple conditions an individual must face (Kennedy & Horn, 2004; McDonnell, Hardman, & McDonnell, 2003). For example, epilepsy is frequently found in children with mental retardation. But remember never to make the terrible error of associating health or physical disabilities with a cognitive disability. They do not always go hand in hand. Now, let's focus on some specific physical disabilities.

Neuromotor Impairments

Estimates are that some 315,000 students between age 6 through 14 have epilepsy; many of these students have other disabilities or conditions (e.g., mental retardation, cerebral palsy) as well (Epilepsy Foundation of America [EFA], 2005a). Epilepsy, also called seizure disorders or convulsive disorders, is a condition where the individual has recurrent seizures resulting from sudden, excessive, spontaneous, and abnormal discharge of neurons in the brain. Seizures can be accompanied by changes in the person's motor or sensory functioning and can also result in loss of consciousness. Today, medication helps control and even "cure" seizure disorders (EFA, 2005b). For some 70 percent of those affected, medication ends the occurrence of seizures. For those with other coexisting conditions, such as mental retardation and cerebral palsy, the rate of successful treatment through medication is much lower.

Another neuromotor impairment encountered in schools is cerebral palsy: Cerebral palsy is not a disease but, rather, a nonprogressive and noninfectious condition that affects body movement and muscle coordination. It is a result of damage, usually because of insufficient oxygen getting to the brain. Cerebral palsy that occurs before or during the birth process is called congenital cerebral palsy and accounts for some 70 percent of cases (United Cerebral Palsy Association [UCP], 2001). Acquired cerebral palsy occurs after birth but during early childhood and is usually caused by brain damage resulting from accidents, brain infections, or child abuse. Regrettably, once it is acquired, it cannot be cured (at least today).

Muscular/Skeletal Conditions

One of the muscular/skeletal conditions most commonly seen in children is limb deficiencies. Limb deficiencies can be the result of a missing or nonfunctioning arm or leg and can be either acquired or congenital. Regardless of when the impairment occurred, the result is a major impediment to normal physical activity and functioning. Although the root of the disability is physical, many individuals with a limb deficiency have difficulty adjusting to their situation. The attitudes of teachers and classmates, and of course the support given by family members, can be major contributors to their psychological health. Robotics—the science and technology that develop computer-controlled mechanical devices, including artificial arms and legs—now provides much assistance to those with missing limbs. A good example is the prosthetic arm designed by Hanger Prosthetics and Orthotics for surfer Bethany Hamilton who lost her arm to a shark attack. Artificial legs (such as the C-leg developed by Otto Boch and the Boston Digital Arm developed by Liberating Technologies) also use microprocessors, hydraulics, and electronic sensors to allow a freedom of movement thought to be impossible only a few years ago (except, of course, by screenwriters who created characters like Robo-cop).

A relatively common muscular/skeletal condition affecting joints and the function of muscles is juvenile arthritis. Some 300,000 students have juvenile arthritis (Arthritis Foundation of America [AFA], 2005). Just over one-fourth of students with juvenile arthritis qualify for special education services; most of the others receive accommodations through Section 504. Although there are many different forms of this disease, it is typically chronic and painful. Juvenile arthritis usually develops in early childhood and can cause many absences from school. These children often need help keeping up with their classmates because they miss so much class instruction. Teachers must understand that their ability to move may be inconsistent (better at different times of the day) and that sitting for extended periods of time can cause them to become stiff and to experience considerable pain. These children need to be allowed to move around a lot. Those who have a high rate of absences probably need tutoring and extra help to keep up with their peers (AFA, 2005). Some promising medical treatments can reduce the amount of disability from the disease. However, such medications can have side effects that alter some aspects of personality and physical appearance.

Health Disabilities

The two types of health disabilities are

  1. Chronic illnesses
  2. Infectious diseases

Study Table 9.3. It includes definitions of illnesses and diseases seen in children. Of course, some general principles apply to all children who are sick, whatever the cause. All children have episodes of illness during childhood, but most of these are of short duration and not very serious. For a small number, however, their illnesses are chronic, lasting for years or even a lifetime. Students with chronic illnesses often do not feel well enough to consistently focus their attention on the instruction or may not be at school when important content is presented.

For many years the term medically fragile was used to describe all children with special health care needs, but it is now more selectively applied. Medically fragile is a status; it is not assigned to any specific condition but, rather, reflects the individual's health situation. Students can move in and out of fragile status. It is important to understand that because of medical technology, a greater number of medically fragile children now survive health crises. In the past, many of these youngsters would not have lived long enough to go to school. Others would have been too sick to attend their neighborhood schools and would have received most of their schooling through hospital-based or home-based instruction. Even though many are now stable enough to attend school, they require ongoing medical management. For most, it is necessary for teachers to be familiar with procedures that must be followed if an emergency occurs. The "if, thens" must be carefully outlined and planned in collaboration with doctors and the medical profession (Emory University Medical School. 2003; Heller et al., 2000). Although the contingencies for the "worst case scenarios" must be arranged, in most cases the accommodations required for these students are not terribly dramatic. (However, not having backup power for a student' ventilator could have disastrous results.)

Chronic Illnesses

The most common chronic illness among children is asthma, a pulmonary disease causing labored breathing that is sometimes accompanied by shortness of breath, wheezing. and a cough. It is the leading cause of school absences and hospitalizations of children (Asthma Foundation, 2005: National Institute of Environmental Health Sciences [NIEHS], 2005). A combination of three events causes the wheezing: (1) tightening of the muscles around the bronchial tubes, (2) swelling of the tissues in these tubes, and (3) an increase of secretions in these tubes. Years ago, many people believed asthma to be a psychological disorder. It, is not; its origin is physical. Many factors (such as chalk dust, dirt in the environment, dust mites, and pollen) can trigger an asthma attack, as can physical activity or exertion. Many students who have asthma are unable to participate in sports or even in physical education activities. As IDEA '04 points out, few of these students actually need special education, but they might need special accommodations so that their illness does not hinder their learning.

Infectious Diseases

In part because they are so frightening and in part because they are so dangerous. infectious diseases catch our attention. However, in many instances, occurrence is rare and the public reaction to those who contract the disease is irrational. Here's an example. The human immunodeficiency virus (HIV) is a very serious disease and a potentially fatal viral infection that is transmitted primarily through the exchange of bodily fluids in unprotected sex or by contaminated needles. Before blood-screening procedures were instituted, the virus was also transmitted in blood transfusions. HIV is the virus responsible for acquired immunodeficiency syndrome (AIDS), a deadly disease that destroys the immune system and can be communicated to an unborn child by an infected mother. From the beginning of the epidemic through 2002, a total of 9,300 American children were infected with HIV/AIDS (National Institute of Allergy and Infectious Disease, 2004). Because of its very low prevalence among children, few teachers have a student with AIDS; We mention the disease here because of the significant media attention devoted to it. The effects of the infection in children include central nervous system damage additional infections, developmental delay, motor problems, psychosocial stresses and death. HIV/AIDS is an infectious disease, but unlike most others, such as flu and the common cold, it is serious and life-threatening. For many years, parents and educators were concerned that noninfected children could catch the disease from a classmate. It is now clear that this is highly unlikely. With proper precautions (the use of gloves when bandaging a child's cut finger and normal sanitary procedures such as frequently washing your hands), everyone at school is safe and will not catch this disease.