The characteristics of students with physical or health disabilities are as unique to the individuals as the conditions that created their special needs. The health care needs of some children are so consuming that everything else becomes secondary. Other students, such as some with physical disabilities, require substantial alterations to the physical environment, so that learning is accessible to them, but are quite similar to their typical classmates in many learning characteristics. For still others, their health situation requires intense special accommodations at some points in time, but less so at other times.
The education professionals who make a real difference in the academic lives of these students are first and foremost responsive to the individual learning needs they bring to school. Thus, instead of making generalizations about these students, here we will discuss three of the more common conditions seen at schools. (Remember, however, that both physical and health disabilities are low incidence special education categories.) We will look more closely, then, at
- Cerebral palsy
- Sickle cell anemia
Seizures may involve the entire brain (generalized seizures) or only a portion of the brain (partial seizures). The frequency of seizures may vary from a single isolated incident to hundreds in a day. Some individuals actually anticipate their seizures because they experience a preictal stage, or an aura, and have heightened sensory signals of an impending seizure, such as a peculiar smell, taste, vision, sound, or action. Others might experience a change in their behavior. Knowing about an aura pattern is helpful, because it enables the person to assume a safe position or warn the teacher and companions before a seizure begins.
The Epilepsy Foundation of America (2005a) identifies four main types of seizures:
- Absence seizures
- Simple partial seizures
- Complex partial (psychomotor) seizures
- Generalized tonic-clonic seizures
Some seizures are difficult for the individual involved and others to recognize. For example, absence seizures or petit mal seizures are characterized by short lapses in consciousness. Because absence seizures are not dramatic, a teacher might wrongly assume that the child is merely daydreaming or not paying attention. Simple partial seizures, which cause people affected to think that their environments are distorted and strange and that inexplicable events and feelings have occurred, can also be difficult to identify. With these seizures, teachers might incorrectly believe that the student is acting out or exhibiting bizarre behavior patterns. Complex partial seizures (also called psychomotor or focal seizures) are short in duration, and the individual returns to normal activities quickly. Sometimes, teachers interpret the child's behavior during this type of seizure as misbehavior or clowning. This situation can be confusing to the child, who is unaware of the episode. Generalized tonic-clonic seizures (formerly referred to as grand mal seizures) are the most serious type of seizure and result in convulsions and loss of consciousness. The dramatic behaviors exhibited during a tonic-clonic seizure may at first be frightening to the teacher and to other students in the class. The student may fall to the floor and experience a stiff (tonic) phase, in which the muscles become rigid, followed by a clonic phase, in which the individual's arms and legs jerk.
The severity of the condition depends on the precise location of brain damage, the degree of brain damage, and the extent of involvement of the central nervous system (UCP, 2001). Individuals with cerebral palsy whose motor functioning is affected show these characteristics alone or in combination: jerky movements. spasms, involuntary movements, and lack of muscle tone. Often, individuals with cerebral palsy have multiple disabilities, probably resulting from the same damage to the brain that caused the cerebral palsy. For example, many individuals who have severe difficulties in motor functioning also have trouble mastering oral speech. These individuals have speech impairments and physical disabilities. Although some degree of mental retardation is present in about half of the children with cerebral palsy, others are intellectually gifted. It is a tragic mistake to assume that cerebral palsy and mental retardation always occur in combination. There are four ways in which areas of the body can be affected by cerebral palsy: monoplegia, paraplegia. hemiplegia, and quadriplegia.
Another way in which cerebral palsy is classified is in terms of how the individual's movement is affected:
- Spastic cerebral palsy: Movements are very stiff.
- Athetoid cerebral palsy: Involuntary movements are purposeless or uncontrolled, and purposeful movements are contorted.
- Ataxia cerebral palsy: Movements such as walking are disrupted by impairments of balance and depth perception.
Many individuals with cerebral palsy have impaired mobility and poor muscle development. Even if they can walk, their efforts may require such exertion and be so inefficient that they need canes, crutches, or a wheelchair to get around. Students with cerebral palsy may also need braces to help support the affected limbs and make them more functional or to prevent contractures that would eventually lead to bone deformities and further mobility limitations. Proper positioning of the body also must be considered. Many children need wedges, pillows, and individually designed chairs and worktables so that they can be comfortable; breathe easier; avoid injuries. contractures, and deformities; and participate in group activities.
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