Sunday, April 19, 2009

Low Incidence Disabilities: Severe/Multiple Disabilities, Deaf-Blindness, and Traumatic Brain Injury


None of the disabilities listed under low-incidence disabilities generally exceed 1% of the school-aged population at any given time. The relative rarity of students with these disabilities in public schools often poses significant challenges for local schools struggling to meet their needs. Since they encounter these students so infrequently, most local schools have little if any knowledge of how to best educate these students, of what technologies are available to assist them, and of how to obtain needed and appropriate support services from outside agencies. All students with low-incidence disabilities thus experience a commonality: they are difficult to serve in current local public school programs. People with severe disabilities are those who traditionally have been labeled as having severe to profound cognitive impairments or mental retardation. Although, there is growing understanding that any and all disabilities may affect individuals along a scale of minimal or mild to severe. It is possible to have a mild learning disability or a severe one; mild or severe autism, without a clearcut diagnosis of intellectual disability. The greater the severity or impact on an individual, there is a greater likelihood for increased need for supports. Often, individuals with a severe disability require ongoing, extensive support in more than one major life activity in order to enjoy the quality of life available to people with fewer or no disabilities and to participate in integrated community settings. They may also have additional significant disabilities, including movement difficulties, sensory losses, and/or behavior problems.
Deaf-blindness is a combination of vision and hearing loss. It is rare that an individual with deaf-blindness would be completely blind and completely deaf. Individuals who have a combined vision and hearing loss have unique communication, learning, and mobility challenges due to their dual sensory loss. Deaf-blindness is a unique and diverse condition due to the wide range of sensory capabilities, possible presence of additional disabilities, and the age of onset for the vision and hearing loss. A child with deaf-blindness would include the infant who has a diagnosis of Retinopathy of Prematurity (a retinal condition that is associated with premature birth) and has an acquired hearing loss due to meningitis at age two. Another person with deaf-blindness may have been born with a profound hearing loss and developed a later vision loss such as retinitis pigmentosa. Deaf-blindness occurs in three of 100,000 births. In Colorado, just over 110 children and youth (ages birth through 21 years) have been identified as having both a vision and hearing loss. These individuals are eligible for free technical assistance through the Colorado Services for Children with Combined Vision and Hearing Loss Project, located at the Colorado Department of Education.

Traumatic brain injury is usually the result of a sudden, violent blow to the head — which launches the brain on a collision course with the inside of the skull. This collision can bruise the brain, tear nerve fibers and cause bleeding. Traumatic brain injury may also be caused by objects such as bullets or even a shattered piece of the skull entering brain tissue. The severity of traumatic brain injury can vary greatly, depending on the part of the brain affected and the extent of the damage. A mild traumatic brain injury may cause temporary confusion and headache, but a serious one can be fatal. Your brain has the consistency of gelatin. It's cushioned from everyday jolts and bumps by the cerebrospinal fluid in which it floats inside your skull. A violent blow to your head can cause your brain to slide forcefully against the inner wall of your skull. Even the sudden stop of a car crash can bounce your brain against your skull. This can result in bleeding in or around your brain and the tearing of nerve fibers.

B. Educational Implications:

In order to effectively address the considerable needs of individuals with serve and/or multiple disabilities, educational programs need to incorporate a variety of components, including language development, social skill development, functional skill development (i.e., self-help skills), and vocational skill development. Related services are of great importance,and the appropriate therapists (such as speech and language, occupational, physical, behavioral and recreational therapists) need to work closely with classroom teachers and parents. Best practices indicate that related sevices are best offered during the natural routine of the school and community, rather than by removing the student from class for isolated therapy. Students with multiple disabilities do not learn as easily by incidental learning as do less disabled and nondisabled persons. Therefore, instruction in even the most basic skills must be carefully structured and planned. As a regular elementary educator a certain amount of regimental external structure must be provided if the student with multiple disabilities is to be productive in the classroom. Assignments should be broken down into small units, and frequent feedback and redirection should be offered. Children with severe concentration problems benefit from timed sessions. This helps them organize themselves. When assigning timed units of work, regular education teachers should take into account the student’s slower writing speed. Students with multiple disabilities can sometimes be stubborn; they need firm exceptions and a structured program that teaches them compliance with rules leads to positive reinforcement. As a regular elementary educator I will seat the students with multiple disabilities at the front of the class (if possible) and direct frequent questions to him/her to help maintain attention to the learn. I will work out a nonverbal signal with the student with multiple disabilities (e.g., a gentle pat on the shoulder) for times when he/she in not paying attention. Another thing I will do as a regular elementary educator I will provide a highly individualized academic program engineered to offer consistent successes. The student with multiple disabilities needs great motivation. Learning must be rewarding and not anxiety-provoking. Last I will always allow the students with multiple disabilities enough time to respond, since it may take longer to interpret my request, organize response and produce it. If a response is produced, it may not be in the form of speech. The regular elementary teacher may need to learn how to read gestures, slight changes in muscle tone or posture and different types of body language. There is a lot to take into consideration when dealing with students who have low incidence disabilities and as teachers we will have to teach and learn what works best.

C. Technology-

Boardmaker with Speaking
Dynamically ProBoardmaker with Speaking Dynamically Pro builds on the capabilities of Boardmaker Plus! by adding natural-sounding voices, word prediction and abbreviation expansion to support augmentative and alternative communication
 Present low tech pictures representing answer choices to student on eye gaze board or velcro board
 Use a Step by Step to answer
– Record a single answer or a series of answers on a Step by Step and gives to the student to activate.
 Use a Go Talk 20, TechSpeak or TechTalk with an overlay prepared with Boardmaker symbols representing answer choices
 Dynamic Display devices with core or content specific vocabulary that they can navigate to independently
 The TechMatrix is a powerful tool for finding educational and assistive technology products for students with special needs.

D. Reference

Bowser, G. & Reed, P.R. (1995). Education TECH Points for assistive technology planning. Journal of Special Education Technology, 12(4), 325-338
ECEA Regulations on Eligibility as a Learner with Deafblindness (combined vision and hearing loss) (PDF)
Including All Students by Ben Clay

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