1. Chapter 12
Low-Incidence Disabilities: Multiple Disabilities, Deaf-Blindness, and Traumatic Brain Injury
Developed by:
Blanche Jackson Glimps
Tennessee State University

2. Chapter Objectives
Define multiple disabilities, deaf-blindness, and traumatic brain injury (TBI).
Describe the characteristics of individuals with multiple disabilities, deaf-blindness, and TBI.
State why it is difficult to identify the exact number of students with severe disabilities.
List some of the biological causes of severe disabilities.

3. Chapter Objectives
Explain why a curriculum based on typical developmental stages and milestones is inappropriate for students with severe and multiple disabilities.
List advantages and disadvantages of regular classroom placement for students with severe disabilities.
Identify the skills and dispositions a teacher needs to work with individuals with severe disabilities.

4. Definitions: Multiple Disabilities
Concomitant impairments, the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments
Severe disabilities refers to significant impairments in intellectual, motor, and/or social functioning; IQ scores of 35 to 40 or 40 to 55
Profound disabilities requires continuous monitoring and functions at a level no higher than that of a typically developing 2 year old in cognition, communication, social skills, mobility, and activities of daily living; IQ scores of 20 to 25 and below

5. Definitions: Deaf-Blindness
Concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness
The majority of children with deaf-blindness have some functional hearing, vision, or both.

6. Definitions: TBI
An acquired injury to the brain caused by an external force, resulting in total or partial functional disability or psychosocial impairment, or both that adversely affects a child’s educational performance
Applies to open or closed head injuries
Closed head injuries are the most common type
The effects of TBI on learning and behavior are determined by severity of the injury and the part of the brain that sustained damage.

7. Traumatic Brain Injury
A mild brain injury results in a concussion which is a brief loss of consciousness without any subsequent complications or damage.
Contusions usually accompany a moderate brain injury which lasts from 30 minutes to 24 hours followed by days or weeks of confusion.
Hemaoma
Coma, in which a person cannot be awakened and makes no meaningful response to external stimulation, results from severe head trauma
Anoxia

8. Characteristics: Multiple and Severe
Most students with severe disabilities
Exhibit significant deficits in intellectual functioning
Have more than one disability
Most students with profound disabilities are
nonambulatory, unresponsive to sensory stimuli, need round-the-clock support and care
The one defining characteristic of students with the most significant disabilities is they exhibit significant and obvious deficits in multiple life-skill or developmental areas.
These students require extensive repeated individualized instruction and support

9. Characteristics: Multiple and Severe
Slow acquisition of new skills.
Poor generalization and maintenance of new skills.
Limited communication skills.
Impaired motor development

10. Characteristics: Multiple and Severe
Deficits in self-help skills.
Infrequent social interaction and constructive behavior.
Stereotypic behavior.
Challenging behavior.

11. Characteristics: Deaf-Blindness
Many students who are deaf and blind exhibit some of the same characteristics as those with multiple and severe disabilities.
More than 90% have one or more additional disabilities
49% also have physical disabilities
76% have cognitive impairments
Cognitive abilities range from giftedness to profound intellectual disabilities
59% have complex health care needs
Many engage in self-stimulatory behavior

12. Characteristics: TBI TBI is complex.
Symptoms vary by severity of the injury, extent and site of injury, age of child at time of injury, and time passed since the injury.
Three categories of impairments
Physical and Sensory Changes
Cognitive Impairments
Social, Behavioral, and Emotional Problems

13. Prevalence of Low-Incidence Disabilities
Multiple Disabilities-no accurate and uniform figures on prevalence exist
Deaf-Blindness-only about 1,000 received special education in 2012 to 2013 school year
TBI-leading cause of death in children; most common acquired disability in childhood
In 2012 to 2013, 26,000 received special education

14. Causes of Low-Incidence Disabilities
Multiple and Severe Disabilities-in most cases a brain disorder is involved; some are born with chromosomal abnormalities; may also develop later in life from head trauma from accidents, assaults, falls, or abuse.
TBI-common causes of closed head injuries are accidents, falls, and sports accidents
Deaf-Blindness-congenital or acquired causes; CHARGE syndrome and Usher syndrome

15. Educational Approaches
Curriculum
Functionality
Age-Appropriateness
Curriculum Areas
Self-care
Communication
Literacy
Recreation and Leisure
Making Choices
Access to the General Education Curriculum

16. Selecting and Prioritizing Instructional Targets
Two strategies for combining functional and academic content are
Embedding core academic content into functional activities
Adding functional applications to instructional objectives based on core content standard
A functional Approach a Priority in Curriculum

17. How Should Students Be Taught?
Select and prioritize instructional targets that are meaningful for students and their families.
Instruction must be carefully planned, systematically executed, continuously monitored for effectiveness.
The following are components of an instructional program:
The student’s current level of performance must be assessed.
The skill must be defined clearly and actively engage the student.

18. Instructional Methods
The skill may need to be broken down into smaller component steps.
The teacher must determine how the student can actively participate, provide a clear prompt, and gradually withdraw the prompt.
The student must receive immediate feedback.
The teacher must use strategies that promote generalization and maintenance.
The student’s performance must be directly and frequently assessed.

19. Instructional Methods
Partial Participation
Positive Behavioral Support
Functional Assessment
Small-Group Instruction
Students with Deaf-Blindness
Tactile teaching techniques
Students with TBI
Curricular and instructional approaches for students with severe/multiple disabilities are appropriate

20. Placement Options
13% of students with multiple disabilities receive instruction in the regular classroom, 16% receive instruction in a resource room, 46% receive instruction in special schools or other settings
21% of students who are deaf-blind receive instruction in regular classrooms, 12% in resource rooms, 34% in separate classes, and 33% in special schools and other settings
49% of students with TBI receive instructions in the regular classroom, 22% resource rooms, 20% in separate classrooms, and 9% in special schools or other settings

21. Placement Options Benefits of the neighborhood school and inclusion
Peers without disabilities are more likely to function responsibly as adults in a pluralistic society
Integrated schools are more meaningful instructional environments
Parents and families have greater access to school activities when children are attending their home schools
Helps develop range of relationships with peers without disabilities
Benefits of inclusion on social skills and relationships have the most extensive empirical support

22. How Much Time In the Regular Classroom?
A major challenge for both special and general educators:
Develop strategies for including students with severe disabilities in general education without sacrificing their opportunities to acquire, practice, and generalize the functional skills they need most.
Allow them to attend the same schools and classrooms they would attend if they did not have a disability

23. The Challenge and Rewards of Teaching
Teaching students with severe disabilities is difficult and demanding. It requires teachers to:
be well organized, firm, and consistent
be knowledgeable about one-to-one and small group instructional formats
be able to work cooperatively with other teachers and related service professionals
maintain accurate records and constant planning for future needs of students

24. The Challenge and Rewards of Teaching
be sensitive to small changes in behavior
be consistent and persistent in evaluating and changing instruction to improve learning and behavior
not be too quick to remove difficult tasks or requests that result in noncompliance or misbehavior
Teaching students who require instruction at its very best can be a highly rewarding teaching experience.