Orthopedic Impairments

A. Definition of Orthopedic Impairments-
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., club foot, absence of some member, etc.) impairments caused
by disease (poliomyelitis, bone tuberculosis, etc) and impairments from other causes
(e.g., amputations and fractures or burns that cause contrachures). Orthopedic impairments are impairment of movement, speech, vision, and muscle use caused by birth defects, injury or disease. Actually, the dictionary definition of orthopedic has to do with deformities of the skeletal system. If you are the federal government, though, you can make up your own definitions, since you control the budget. Some of the diagnoses that fall under this category really are not impairments of the skeletal system, for example, cerebral palsy.
Orthopedic impairments affect the motion and motor skills that we depend on every day of our lives. A physical disability may feel as if it takes away all independence, yet there is often a way to get through it and still live an active life.
Four of the more common physical disabilities are cerebral palsy, spina bifida, epilepsy and muscular dystrophy.
Cerebral palsy is a condition that affects the brain’s ability to send messages to the body, thus affecting the use of muscles. Cerebral palsy is evident early in life, usually in the first year or two. Depending on the specific case, the disability can be mild to severe, and may be accompanied by mental disabilities. Because cerebral palsy affects muscle control, a person with this disability often has difficulty walking. A person with cerebral palsy may also have trouble speaking not due to mental retardation but rather because he or she cannot control well the muscles that produce speech. Physical therapy can be used to improve muscle control, in some cases. For more information on cerebral palsy, click here.
Spina Bifida is a disability that is present at birth. It occurs when there is damage to the spinal cord and the column does not close completely, causing an impairment of lower body movements and functions such as bladder/rectal troubles and even paralysis.
Muscular dystrophy is not one disorder, but rather, a group of diseases. All of these diseases have in common that the muscles become weaker and waste away over time. Diseases like this are called degenerative or progressive diseases. In this, muscular dystrophy is different from cerebral palsy or spina bifida, which are disorders that do not become progressively worse.
There are many other types of physical disabilities, for example, absence of limbs due to birth defects, accidents or illness, loss of muscle control as a result of stroke. Some of these disabilities may be present at birth and others, such as stroke, can occur at any time.

B. Educational Implications-

As with most students with disabilities, the classroom accommodations for students with orthopedic impairments will vary dependent on the individual needs of the student. Since many students with orthopedic impairments have no cognitive impairments, the general educator and special educator should collaborate to include the student in the general curriculum as much as possible.
In order for the student to access the general curriculum, the student may require these accommodations:
• Special seating arrangements to develop useful posture and movements
• Instruction focused on development of gross and fine motor skills
• Securing suitable augmentative communication and other assistive devices
• Awareness of medical condition and its affect on the student (such as getting tired quickly)
Because of the multi-faceted nature of orthopedic impairments, other specialists may be involved in developing and implementing an appropriate educational program for the student. These specialists can include:
• Physical Therapists who work on gross motor skills (focusing on the legs, back, neck and torso)
• Occupational Therapists who work on fine motor skills (focusing on the arms and hands as well as daily living activities such as dressing and bathing)
• Speech-Language Pathologists who work with the student on problems with speech and language
• Adapted Physical Education Teachers, who are specially trained PE teachers who work along with the OT and PT to develop an exercise program to help students with disabilities
• Other Therapists (Massage Therapists, Music Therapists, etc.)

It is helpful for teachers to understand that students with orthopedic impairments performing many of the physical tasks necessary for them to benefit from classroom instruction. In addition to adapting the instructional environment to accommodate obvious motor deficits, it is important for teachers to understand that motor deficits can negatively impact both the speed and the safety of students in the school environment. Finally, health issues are common, so teachers should understand the symptoms of relevant medical conditions and the side effects of medications taken by their students. Obvious motor deficits might result in a diminished ability to write, speak, sort, organize materials, sit, walk, climb stairs, eat or drink independently, participate in learning games, or participate in athletic activities. It is also possible for some students to experience problems that are less obviously related to their physical needs. Examples include difficulty with reading, written expression, social‐emotional behavior, or communication. Even though many children with orthopedic impairments have no additional disabilities, it is important to learn whether or not individual children need support in other domains of school performance.

Orthopedic impairments often cause students to move more slowly than other students. The negative impact of slow speeds applies not only to large motor movements (e.g., walking, running, or repositioning oneself in a chair), but also to smaller motor movements, such as those required for speaking, eating, handwriting, or keyboarding. Speed may also be a relevant consideration when questioning students. Teachers may need to wait longer for children with orthopedic impairments to respond—allowing more time to process a question, form a response, and execute that response. Speed is also relevant when planning for the safety of individual students. Students may not be able to respond quickly enough to avoid a collision with a moving object or person. Beyond speed, students may simply need environmental adaptations (e.g., ample space, rounded or soft edges, or equipment to provide support and stability) to move safely between desks, in hallways, and on school property.
Finally, students with orthopedic impairments might have medical conditions that impact them in the school environment. Perhaps they are easily fatigued, develop sores or experience pain if left in one position for too long, or are unable to eat certain types of food. It is important for teachers to understand the nature of each student’s disability and the content of his or her IEP (Individualized Educational Plan).




C. Technology-

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used. As with any student with a disability, the assistive technology would need to address a need of the student to be able to access the educational curriculum. For students with orthopedic impairments, these fall into three categories:
Devices to Access Information: These assistive technology devices focus on aiding the student to access the educational material. These devices include:
• speech recognition software
• screen reading software
• augmentative and alternative communication devices (such as communication boards)
• academic software packages for students with disabilities
Devices for Positioning and Mobility: These assistive technology devices focus on helping the student participate in educational activities. These devices include:
• canes
• crutches
• wheelchairs
• specialized exercise equipment
• specialized chairs, desks, and tables for proper posture development


D. Resources-

search.barnesandnoble.com/The-Inclusive-Early-Childhood-Classroom
Gargiulo, R.M. (2006). Special education in contemporary society: An introduction to exceptionality. Belmont, CA: Thomson Wadsworth.
Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives: Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall
www.tcsea.org