1. Chapter 17 Other Health-Impaired Conditions 17 Other Health-Impaired Conditions Francis M. Kozub C H A P T E R

2. Outline for Discussion of Other Health Impaired (OHI) Background information on OHI Conditions covered under OHI Assessment of children with OHI Inclusion of children with OHI

3. Background Information Consider Jesse’s story at the beginning of the chapter: Necessary modifications? Related services? Exclude the child on some days?

4. OHI as Defined by IDEA Limited strength, vitality, alertness Chronic or acute health problems Educational performance adversely affected Conditions are listed, but –Other conditions not listed may be used to gain services under OHI. –Tourette syndrome was added in last reauthorization.

5. Potential Conditions Asthma Diabetes Epilepsy Heart conditions Hemophilia Lead poisoning Leukemia Nephritis Rheumatic fever Sickle cell anemia Potentially others

6. Impact on Education Is Key All of these conditions can exist, but there is no need for services based on IDEA. –Kids missing school –Unable to participate in general offerings (unique motor needs) –Unable to attend to lessons and so on Parents sometimes have been placated using OHI (Grice, 2002).

7. Conditions Covered in Chapter 17 Diabetes Seizure disorders Asthma Cancer Cardiovascular disorders Anemia AIDS and HIV Tourette syndrome

8. Diabetes Type 1 –Kids –Insulin dependent –Requires constant monitoring Type 2 –Older adults –Not always insulin dependent –Related to weight gain

9. Physical Education and Diabetes (Type 1) Be aware of warning signs. Many factors affect blood glucose: –Diet –Exercise –Stress –Hormones and periods of growth Foot care is important. Plan exercise with respect to diet and insulin concerns. Proper fluid intake is important.

10. Seizure Disorders Epilepsy—repeated seizures require medication. Grand mal is most common form. Many kids have triggers or common factors that cause seizures: –Flashing lights –Fatigue or stress –Pain Exercise normalizes electrical function in the brain (Colson Bloomquist, 2003).

11. Physical Education and Epilepsy Condition is not under control: –Avoid heights. –Practice appropriate first aid (don’t put anything in the mouth). –Monitor duration and other key factors. Condition is under control: –Use the buddy system in the pool. –All other age-appropriate and monitored physical activities are recommended (Lang, 1996).

12. Asthma Chronic condition that can be life threatening to some if not cared for properly On the rise in the United States As is true of seizures, there are various triggers: –Exercise induced (EIA) –Viral induced

13. Physical Education and Asthma Exercise can be beneficial (raises threshold). Have inhalers and emergency plan on hand. –Some young kids need help administering inhaler. –Help nurse and parents monitor doses. (continued)

14. Physical Education and Asthma (continued) Humidity and other factors might affect incidence. Communicate with parents. Be sensitive to fears of not breathing.

15. Cancer Second leading cause of death in individuals under age 14. Many types and symptoms: –Loss of limb –Can affect any part of the body –Tumors Treatments can be as serious and affect motor skill as much as the actual disease.

16. Physical Education and Cancer Physical activity and play are appropriate for kids with cancer. Communicate with medical personnel to determine intensity and general activity appropriateness. Exercise is a key component in recovery. A loss of physical function might have psychological effects.

17. Cardiovascular Disorders Include anything affecting heart, veins, or lymphatic system: –Acquired (caused by disease, such as rheumatic fever) –Congenital (heart defect) Appropriate prescriptions of movement and general physical activity benefit people with even the most serious heart conditions.

18. Physical Education and Cardiovascular Disorders Basic weight-bearing and large muscle movements are important in recovery. Intensity, frequency, and duration are important to monitor and consult with a physician. Set realistic fitness and movement goals at the IEP meeting.

19. Anemia Sickle cell anemia is a common condition affecting mainly African Americans. Defective hemoglobin results from a genetic abnormality. Fatigue, bone and joint pains, and sores on legs are common symptoms that might affect physical activity.

20. Physical Education and Sickle Cell Anemia Many individuals with sickle-cell anemia participate at high levels of sport. Modify activities based on the individual’s symptoms. Might have to reduce impact activities given the issues with joint inflammation. Hot weather and high altitudes might worsen condition. Close contact between educational personnel and physician is needed.

21. AIDS and HIV Primarily the result of factors other than the child’s poor choices: –Mother infected –Blood transfusion (hemophiliacs) AIDS and HIV are not synonymous. –HIV positive—has virus but not showing symptoms –Varied symptoms Understanding the condition (by the teacher) is important to successfully program for the child.

22. Physical Education and AIDS and HIV Children with HIV can participate in the same activities as their peers. Practice universal precautions for attending to bleeding and other types of situations. Children with AIDS might have activity restrictions once symptoms begin to show. Exercise can affect side effects, such as fatigue from medications.

23. Tourette Syndrome Exact cause unknown Tics Many comorbid conditions Potential visual motor deficits Medication side effects are numerous Physical activity modifications are for the most part not necessary Social considerations from peers

24. Physical Education and Tourette Syndrome Educate peers about tics. Tics can have triggers: –Stress –Anxiety Activity modifications may not be necessary. (continued)

25. Physical Education and Tourette Syndrome (continued) Comorbid conditions: –Obsessive–compulsive disorder –Behavior problems and attention deficits –Visual–motor integration issues

26. Assessment Generic category, so children with a suspected disability might be able to be assessed using similar formats as those for peers without disabilities. Content-referenced testing might be most appropriate. Physical educators are part of the multifactored evaluation.

27. Inclusion Modifications in intensity within an inclusive class might be needed. Social and physical benefits of physical education must be considered. Avoid overemphasis on medical aspects. Work with parents. Including physical educators on the IEP team is critical to ensure appropriate programming.

28. Summary OHI is a broad category that can include any number of conditions and children with diverse learning characteristics. Medical aspects separate OHI from other disability conditions. The impact on education is critical in determining if a child fits into the category of OHI.