ORTHOPEDIC IMPAIRMENTS

1
ORTHOPEDIC IMPAIRMENTS
TLSE 457-Section 1 Summer 2004

• By Andy J. Arison Kristen Barco-Kida

2
What is an orthopedic impairment

• Our textbook defines orthopedic impairments as
  diseases or disorders that are related to the
  bones joints and/or muscles.
• An orthopedic impairment is covered under IDEA if
  it adversely affects educational performance.

3
A few of the orthopedic impairments that we will
discuss today include

• Cerebral Palsy
• Muscular Dystrophy
• Spinal Cord Injuries and
• Spina Bifida.

4
What is cerebral palsy

• Cerebral palsy is a physical impairment that
  affects movement.
• The four types of cerebral palsy are
• 1) spastic
• 2) athetoid or dyskinetic
• 3) ataxic and
• 4) any combination of the those above.

5
Presumed causes of cerebral palsy

• Before birth
• Failure of a part of the brain to develop
  blocked blood vessel complications during labor
  extreme prematurity multiple births STDs poor
  nutrition effects of anesthetics or analgesics
• Early childhood
• Head injury near drowning poison ingestion
  illness/infection genetics

6
Prevalence/Incidence Rates

• It affects 1 in every 400 births.
• It is estimated that 500000 people in the United
  States currently have cerebral palsy.
• It is the most common orthopedic impairment among
  students in public schools.

7
How can cerebral palsy be diagnosed

• Test an infants motor skills.
• Examine the mothers and infants medical
  histories.
• Test the infants reflexes and early development
  of hand preference.
• Look for signs of slow development abnormal
  muscle tone and unusual posture.

8
What are some characteristics of students with
cerebral palsy

• Difficulty with fine motor tasks maintaining
  balance and chewing and swallowing
• Involuntary movements
• Abnormal reflexes
• Weak or tight muscles
• Poor coordination
• Speech difficulties

9
What is muscular dystrophy what causes it

• Muscular dystrophy is a disease that weakens the
  muscles.
• There are 43 types of muscular dystrophy most of
  which are caused by alterations in specific
  genes.
• The most common type is Duchenne muscular
  dystrophy and it only affects boys.
• It is a genetic disease passed from mother to son
  or it can arise in a young boy due to a
  spontaneous genetic mutation.

10
Prevalence/Incidence Rates

• In the United States it is estimated that
  between 50-250000 people are affected each year.
• That number is on the rise due to technological
  advancements and earlier testing.

11
How can muscular dystrophy be diagnosed

• Muscular dystrophy can be diagnosed through an
  EMG (electromyogram) blood test and/or a muscle
  biopsy.
• If a blood test is performed and it reveals high
  levels of creatine kinase this indicates that
  the muscles are damaged.

12
What are some characteristics of students with
muscular dystrophy

• Between two and six years of age
• Frequent falling
• Difficulty getting up from sitting or lying
  position
• Waddling gait and
• Fattening of the leg muscles.
• Later on in life
• Wheelchair by age 12 and
• By the late teens or early 20s respiratory and
  cardiovascular problems develop and ultimately
  result in death.

13
What is spinal cord injury

• Spinal cord injuries occur when a traumatic event
  results in damage to cells within the spinal cord
  or severs the nerves that relay signals up and
  down the spinal cord. It causes paralysis loss
  of sensation and loss of reflex function.
• Spinal cord injuries occur suddenly and without
  warning.
• The four types of spinal cord injuries are
• 1) compression
• 2) contusion
• 3) lacerations and
• 4) central cord syndrome.
• Terms for the types of paralysis
• 1) paraplegia and
• 2) quadraplegia.

14
What causes spinal cord injury

• Traumatic injury
• Car accidents
• Falls
• Diving accidents
• Shotgun wounds
• Horse motorcycle sporting event-related and
• Various other types.
• Alcohol plays a significant role in many of these.

15
Prevalence/Incidence Rates

• In the United States there are approximately
  10000 new spinal cord injuries each year.
• There are over 250000 people currently affected.
• Spinal cord injuries can happen to anyone at any
  time of life.
• The typical case is a man age 19-26.

16
How is spinal cord injury diagnosed

• Diagnosis occurs after a traumatic injury by a
  medical professional.

17
What are some characteristics of students with
spinal cord injury

• Varying degrees of paralysis

18
What is spina bifida

• Spina bifida is a birth defect where an abnormal
  opening in the spinal column results in some
  degree of paralysis.
• Spina bifida literally translates to cleft or
  split spine.
• There are 3 types of spina bifida
• 1-Spina bifida occulta and
• Spina bifida cystica (2-meningocele
  3-myelomeningocele)

19
What causes spina bifida

• There are environmental as well as genetic
  factors
• Lack of folate/folic acid in the mother during
  pregnancy and
• Heredity.

20
Prevalence/Incidence Rates

• Approximately 4 in every 1000 births are
  affected.
• There are many thousands of people currently
  affected.

21
How is spina bifida diagnosed

• Ultrasound
• Amniocentesis checking for increased levels of
  alpha-fetoprotein.
• After birth it is physically apparent if a baby
  has spina bifida.
• There may be a buildup of fluid around the brain
  (hydrocephalus)

22
What are some characteristics of students with
spina bifida

• Muscle weakness
• Paralysis
• Incontinence
• Poor short term memory
• Easily distracted
• Poor attention organization sequencing time
  generalization motivation left-right
  discrimination and coordination.

23
What are some assistive technologies that can be
used for students with orthopedic impairments

• Altered pencils and pens
• Altered keyboards (BAT)
• Powerpads
• Eye-controlled input systems (cyberlink)
• Touch screens
• Track ball
• Foot mice

• Standing table
• Easels
• Adjustable seats and desks
• Portable reading racks
• Speech-controlled input systems (dragon-dictate
  and write-away)
• Icon-driven communication (dynavox)

A website that includes several examples is
located here
24
Some instructional ideas resources for teachers

• Please see handout

25
References

• Bigge J.L. ODonnell P.A. (1976). Teaching
  individuals with physical and multiple
  disabilities. Columbus Charles E. Merrill
  Publishing Company.
• Calhoun M.L. Hawisher M. (1979). Teaching
  and learning strategies for physically
  handicapped students. Baltimore University Park
  Press.
• Friend M. Bursuck W.D. (2002). Including
  students with special needs A practical guide
  for classroom teachers. Boston Allyn and Bacon.
• The Irish Association for Spina Bifida and
  Hydrocephalus (2004). What is spina bifida
  Retrieved May 24 2004 from http//www.iasbah.ie.
• Muscular Dystrophy Family Foundation (2002).
  Muscular dystrophy family foundation. Retrieved
  May 24 2004 from http//www.mdusa.org.
• National Information Center for Children and
  Youth with Disabilities (2004). National
  dissemination center for children with
  disabilities. Retrieved May 25 2004 from
  http//www.nichcy.org.
• National Institute of Neurological Disorders and
  Stroke (2001). Spinal cord injury information
  page. Retrieved May 24 2004 from
  http//www.ninds.nih.gov.
• Ohlone College (2004). Students with physical
  disabilities. Retrieved May 25 2004 from
  http//www.ohlone.cc.ca.us/org.
• Texas Pediatric Surgical Associates (n.d.). Spina
  bifida neurological issues. Retrieved May 24
  2004 from http//www.pedisurg.com.
• United Cerebral Palsy (2001). Cerebral palsy
  facts and figures. Retrieved May 24 2004 from
  http//www.upc.org.