1. TEACHING STUDENTS WITH PHYSICAL AND HEALTH IMPAIRMENTS
CHAPTER FIFTEEN
TEACHING STUDENTS WITH PHYSICAL AND HEALTH IMPAIRMENTS

2. INTRODUCTION
Teachers often believe that they should create a protective environment for student with physical and health impairments. However, such an environment discourages the development of skills necessary for independence. Dependence is one of the greatest problems of these students, and teachers must take care not to add to this difficulty.

3. STUDENTS WITH PHYSICAL AND HEALTH IMPAIRMENTS
It is estimated that students with physical and health impairments make up approximately 0.9% of the school-aged population; they account for only about 10% of the students with disabilities who receive special education services.
The presence of a medical condition does not automatically signal the need for special education services.

4. Students with Physical and Health Impairments (cont’d)
Heward (2006) reported that 1 out of 500 students of school age is hospitalized each year because of a traumatic head injury. In addition, “traumatic brain injury is the leading cause of death in children … and the most common acquired disability in childhood.”

5. Students with Physical and Health Impairments (cont’d)
Cerebral palsy is one of the most complex of all physical impairments because it results from damage to the brain; other areas of functioning including speech, vision, hearing, and intelligence can also be affected. However, there is no relationship between the extent of physical impairment and intellectual performance; individuals with severe motor involvement may be intellectually gifted.

6. Students with Physical and Health Impairments (cont’d)
By the end of 2000, more than 9,000 students under the age of 13 to 19 had been diagnosed as having acquired immunodeficiency syndrome (AIDS) in the United States.
For children, the most common chronic illness is asthma.

7. Students with Physical and Health Impairments (cont’d)
Different, and relatively new, diseases such as Lyme disease, Tourette syndrome, or Reye’s syndrome appear periodically.
Most students with physical and health impairments spend the majority of the school day in the general education classroom; many of these (cont’d)

8. Students with Physical and Health Impairments (cont’d)
… students receive special education services from a resource teacher or other specialist(s), such as a physical therapist, occupational therapist, or adapted physical education teacher.

9. Students with Physical and Health Impairments (cont’d)
Famous people:
Theodore Roosevelt (asthma)
Franklin Delano Roosevelt (polio)
John F. Kennedy (back problems)

10. INDICATORS OF PHYSICAL AND HEALTH IMPAIRMENTS
In the general education classroom, a range of possible adaptations may be necessary:
Additional instruction for students with frequent absences
Modification of the physical environment to allow mobility
Adaptations of instructional materials and activities

11. Indicators of Physical and Health Impairments (cont’d)
With the movement toward including a greater number of students with more severe special needs or multiple disabilities in general education, an increasing number of students who are medically fragile are likely to be placed in the general education classroom.
(cont’d)

12. Indicators of Physical and Health Impairments (cont’d)
Teachers in these general education classrooms:
Should participate in the IEP meetings for the student and have a clear understanding of their specific responsibilities when the student is placed in their classroom.
Should be provided information on the full range of related services required to (cont’d)

13. Indicators of Physical and Health Impairments (cont’d)
… meet the student’s educational and medical needs and be aware of the other professionals and support personnel who are assigned the responsibility for implementing this part of the IEP.
Another important consideration is the use of universal precautions when handling blood or other bodily fluids in the classroom.

14. ASSESSMENT PROCEDURES
The procedures used differ from student to student and in many cases health professionals and other specialists must be included as part of the assessment team:
Physical therapists
Occupational therapists
Adapted physical education teachers
School nurses
Physicians

15. Assessment Procedures (cont’d)
Other team members who play critical roles in assessment are:
General education teacher
Special educators
Speech-language pathologist
School psychologist

16. Assessment Procedures (cont’d)
Sirvis (1988) suggested that assessment should focus on the following areas:
Activities of daily living
Mobility
Physical abilities and limitations
Psychosocial development
Communication
Academic potential
Adaptations for learning
Transition skills

17. Assessment Procedures (cont’d)
Sirvis (1988) warned that standardized tests should be used cautiously with students with physical impairments. Communication problems or poor motor coordination can affect a student’s ability to respond within the test’s time limits or to provide adequate verbal responses.

18. Assessment Procedures (cont’d)
Criterion-reference tests that compare a student’s performance to the goals of the curriculum rather than to the performance of others are especially useful with this group of students with special needs.
Direct observation is another useful technique.

19. SPECIAL SERVICES
Most students with physical and health impairments spend the majority of their day in the general education classroom and only attend a resource room for academic assistance or visit a specialist for some other type of necessary service.
Special classes and schools are available for students with severe or multiple disabilities.

20. CLASSROOM ADAPTATIONS
The areas in which modifications are usually required are:
The arrangement of the physical environment
Format and structure of instructional activities and assignments

21. MEETING PHYSICAL AND HEALTH NEEDS
Students with identified physical and health impairments often require special diets, have restrictions placed on their physical activities, take medication during the school day, or require other health-related services (e.g., seizure, nutrition, glucose monitoring, transfer and lifting) that are provided by the school nurse or other qualified person.

22. Meeting Physical and Health Needs (cont’d)
The teacher’s first step in meeting special physical and health needs is to learn as much as possible about each student’s limitations and capabilities.
Sources of information:
Assessment data
Medical personnel (school nurse, student’s physician

23. Meeting Physical and Health Needs (cont’d)
When teachers are fully aware of the needs of students with physical and health impairments, the next step is consideration of what information to provide to other students in the class.
Present information factually, with emphasis not only on the student’s problems but also on his or her abilities.

24. MODIFYING THE PHYSICAL ENVIRONMENT
Guidelines that should help ensure that the physical environment is suitably arranged to accommodate students with disabilities.
Evaluate the school and classroom for accessibility.
Arrange the classroom to facilitate mobility.
(cont’d)

25. Modifying the Physical Environment (cont’d)
Guidelines:
Make all areas and activities within the classroom accessible to students with mobility problems.
Consider the seating arrangement for students with special needs.
Provide storage space for students’ aids and equipment.

26. Modifying the Physical Environment (cont’d)
Guidelines:
Be sure that special equipment is kept in good working order.
For students with crutches, Glazzard (1982) suggested chairs with wheels to facilitate movement about the classroom.
Students with limited strength or poor coordination may need easy access to work equipment.

27. ADAPTING INSTRUCTIONAL ACTIVITIES
In addition to meeting physical and health needs and modifying the classroom environment, it may also be necessary to adapt instructional activities and procedures.
Many of the technological aids available to assist students with physical and health impairments in the general education program help compensate for the effects of their disabilities on mobility, communication, and academic learning.

28. Adapting Instructional Activities (cont’d)
Some students with physical and health impairments may require further adaptations in order to keep pace in the general education classroom.
Students who miss school because of illness
Students who work slowly
Students who have difficulty speaking or writing
Students with traumatic brain injury

29. THINGS TO REMEMBER
The special needs of students with physical and health impairments are diverse and vary with each individual. Some students require no educational adaptations, some require modification of the physical environment because they have limited energy or mobility, and others require modification of instructional activities. Medically fragile students may have special health management needs. However, the major goal for all of these students is circumvention of the restrictions imposed by their physical or health impairments.

30. THING TO REMEMBER (cont’d)
There are a great many conditions that can produce special physical and health needs. Among the most common are traumatic brain injuries, epilepsy, cerebral palsy, diabetes, and asthma.
Some physical and health impairments are congenital, whereas others occur after birth and are due to injury, accident, or disease.

31. THINGS TO REMEMBER (cont’d)
The primary purpose of assessing physical and health impairments is to gather information about the impact of the disabilities on education performance and participation in instructional activities. It is also important to consider the effect of the disabilities on the development of social, vocational, and leisure skills. Medical information is useful only when it is interpreted in relation to classroom functioning and special health needs.

32. THINGS TO REMEMBER (cont’d)
One primary need of students with physical and health impairments is the opportunity to develop independence. Students should be encouraged to learn the skills necessary to assume responsibility for their own needs.
In the general education classroom, the teacher provides for physical and health needs, ensures an accessible environment, and accommodates learning difficulties by adapting instruction.