Education of Persons with Physical and Health Related ...



UNIVERSITY OF GONDARSCHOOL OF EDUCATIONDEPARTMENT OF SPECIAL NEEDS AND INCLUSIVE EDUCATIONEducation of Persons with Physical and Health Related Impairments (SNIE 1023) Reading Material Unit 1: Introduction1.1 The Human Physiology and MovementIn the locomotion of human body, three kinds of systems are involved. These are nervous system, skeletal system, and muscular system. The nerves system The nervous system has three basic functions. These are: (i) it senses changes (stimuli) within the body, this is its sensory function; (ii) it analysis the sensory information, stores some of it, and make decisions regarding appropriate behaviour, this is its integrative function; and (iii) it responds to stimuli by initiating action in the form of muscular contractions or glandular secretions, this is its motor function. The nervous system also has two principal divisions, such as the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS consists of brain (protected by the cranium, cerebrospinal fluid and the connective tissue coverings called the meninges) and spinal cord (protected by vertebral column, meninges, cerebrospinal fluid and vertebral ligaments). Within the CNS, many different kinds of incoming sensory information are integrated and correlated, thoughts and emotions are generated, and memories are formed and stored. Most nerve impulses that stimulate muscle to contract and glands to secret originate in the CNS. The CNS is connected to sensory receptors, muscles and glands in the peripheral parts of the body by the PNS. The PNS consists of cranial nerves (12 pairs) that arise from the brain and spinal nerves (31 pairs) that emerge from the spinal cord. These nerves carry nerve impulses into and out of the CNS. The input component of the PNS consists of nerve cells (neurons) called sensory or afferent neurons. They conduct nerve impulses from sensory receptors in various parts of the body to the CNS and end within the CNS. The output component consists of nerve cells called motor or efferent neurons. They originate within the CNS and conduct nerve impulses from the CNS to muscles and glands. The neurons called association neurons (interneuron) carry nerve impulses from sensory to motor neurons and are located in the CNS. The PNS subdivided further into a somatic nervous system (SNS) and an autonomic nervous system (ANS). The SNS consists of (i) sensory neurons that convey information from special sense receptors primarily in the head, body walls and limbs to the CNS and (ii) motor neurons from the CNS that conduct impulses to the skeletal muscles only. Because these motor responses can be consciously controlled, this portion of the SNS is voluntary. The ANS consists of mostly motor neurons from the CNS that conduct impulses to smooth muscle, cardiac muscle and glands. Since its motor responses are not normally under conscious control, the ANS is involuntary. The motor portion of the ANS consists of two branches, such as the sympathetic division and the parasympathetic division. Usually, the two divisions have opposing actions. For example, sympathetic neurons speed the heart beat while parasympathetic neurons slow it downMuscular System Muscular system in which there are three types of muscle tissue: skeletal muscle tissue, cardiac muscle tissue and smooth muscle tissue. Skeletal muscle tissue is a type of muscle which is attached to bones and it moves parts of the skeleton. Skeletal muscle is voluntary because it can be made to contract and relax by conscious control. Cardiac muscle tissue forms the bulk of the wall of the heart. It is involuntary i.e., its contractions are not under conscious control. Smooth muscle tissue is involved with internal processes in the walls of hollow internal structure, such as blood vessels, the stomach, and the intestines. It is involuntary.Skeletal systemSkeletal system forms the basic framework of levers to which muscles are attached. The skeletal system consists of specialized tough connective tissues such as tendons and ligaments are parts of, both of which have a great tensile strength. Tendons attach muscles to bones and ligaments attach bones to bones. 1.2. Definition of Physical Disabilities Physical disabilities are problems that result from conditions affecting the central nervous system or loss of limbs or other body systems and their related functions. These conditions affect motor functions or how children use their bodies. Physical disabilities are classified into mild, moderate and severe. In the mild category, a child can ambulate, use arms, and communicate well enough for her/his own needs. In the moderate category, a child has difficulties in locomotion, self help, and communication but is not totally disabled; a child requires some special help. In the severe category, the child is incapacitated and usually confined to a wheelchair; complete rehabilitation may not be possible. A severe physical disability is persistent and significantly restricts an individual’s normal physical development, mobility, body coordination, movements, performance of daily living activities, etc. Accompanying sensory, intellectual, behavioral, learning, and medical problems often occur that may impact the student’s ability to access his/her educational program. Students may need support to pursue the district’s core curriculum (with or without adaptations) or the alternate curriculum. Physical impairment is a disability category that comprises hundreds of conditions and diseases having high incidence disabilities. Therefore, persons with physical disabilities are extremely varied populations. So it is impossible to define all of them with a single set of characteristics. The broad categories include: (a) orthopedic impairment which refers to damage to or incomplete development of a child’s skeletal system (bones), joints, and associated muscles; (b) neurological impairment which refers to problems related to brain or spinal cord, they involve the nervous system affecting a child’s ability to move, feel, use, or control certain parts of the body, speak; and (c) health impairment which refers to chronic illness or acute diseases, etc. 1.3. Prevalence of Physical Disabilities Due to advance in medical technology, more children are surviving with previously fatal health conditions and as a result, the numbers of children with chronic health conditions are increasing, according to the 1994 National Health Interview survey, up to 31 percent of children have health impairment. Asthma, diabetes, epilepsy, heart disease, cerebral palsy, and cancer are the most frequently diagnosed afflictions in children. No formal census was done to know the prevalence of people with disabilities in general and children with physical impairments in particular except the baseline data by Institute of Educational Research (IER). WHO estimates disability in Ethiopia about 10% whereas the baseline data by IER showed about 3%. WHO had strong justification for this figure like drought, famine, war, nutrition, health etc? Unit 2: Types and Causes of Physical Disabilities2.1. Major Categories of Physical Disabilities?Although physical impairments/disabilities can be classified into many specific categories, it can also be divided into three general categories as follows:Neurological Impairments: These are disabilities commonly caused by damage to or incomplete development of the CNS (brain or spinal cord).? They involve the nervous system affecting a person’s ability to move, feel, use, or control certain parts of the body. Some of the most common neurological conditions are cerebral palsy, epilepsy, spinal bifida, and traumatic brain injury. Orthopedic Impairments: This refers to damage, disease, or lack of development of the bones, muscles, or joints (tendons and ligaments) of the body. Some of the common orthopedic conditions are muscular dystrophy, and absence or loss of all or part of a limb.Health Impairments: This covers anything else caused by acute or chronic disease. This is a very broad category but generally the difference is that the condition is usually not affecting movement of motor coordination directly. Some health conditions include asthma, diabetes, cystic fibrosis, or sickle cell anemia. Many students in this category may not need extensive support in their ability to learn, speak, or walk. They may need minor accommodations such as modification of curricula such as physical education or need of the teacher to be aware of medication requirements or effects. Control of the muscles in the oral area (tongue), normal functioning of the vocal tract and respiration tract are necessary for normal speech. An individual may not be able to imitate or reproduce speech sounds. This makes it difficult to communicate regarding everyday or usual matters. It also affects social relationships i.e. unfortunately; it is not unusual for someone to assume that a person whose speech is incomprehensible is mentally retarded even though the person is of normal intellect.? People with speech problems due to physical disabilities often use graphic display boards such as picture boards. Some people use computer systems which produce synthetic speech. Other activities of daily life which may be difficult for a person with physical disabilities include eating, dressing, bathing and toileting.? They may need a personal assistant to help with some tasks or have extended time or accommodations to finish things by themselves. Emotional and social development concerns may develop along with physical disabilities. Children dealing with acute and chronic medical conditions may have great physical discomfort and hospitalizations. They may have terminal illnesses or losses of body functions from which they may never fully recover. They may not be easily accepted by their peers due to their physical differences or undesirable side effects such as drooling or incontinence. This is likely to affect general disposition and personality. Clinical depression or excessive acting out, low self-esteem or feelings of rejection may develop. Physical impairments can be classified into many specific categories/ types as follows:2.2. Cerebral PalsyCerebral palsy (CP) is an umbrella term for a group of disorders affecting body movement, balance, and posture. Loosely translated, cerebral palsy means brain paralysis. Cerebral palsy is caused by abnormal development or damage in one or more parts of the brain that control muscle tone and motor activity (movement). The resulting impairments first appear early in life, usually in infancy or early childhood. Infants with cerebral palsy are usually slow to reach developmental milestones such as rolling over, sitting, crawling, and walking. Common to all individuals with cerebral palsy is difficulty controlling and coordinating muscles. This makes even very simple movements difficult.Cerebral palsy may involve muscle stiffness (spasticity), poor muscle tone, uncontrolled movements, and problems with posture, balance, coordination, walking, speech, swallowing, and many other functions. Mental retardation, seizures, breathing problems, learning disabilities, bladder and bowel control problems, skeletal deformities, eating difficulties, dental problems, digestive problems, and hearing and vision problems are often linked to cerebral palsy. The severity of these problems varies widely, from very mild and subtle to very profound. It can be treated but not curedIt does not get progressively worse as a child ages. It is not fatal and, in the great majority of cases, it is not inherited. Types of Cerebral Palsy Spastic (pyramidal): Increased muscle tone is the defining characteristic of this type. The muscles are stiff (spastic), and movements are jerky or awkward. This type is classified by which part of the body is affected: diplegia (both legs), hemiplegia (one side of the body), or quadriplegia (the entire body). This is the most common type of CP, accounting for about 70% to 80% of cases. Dyskinetic (extrapyramidal): This includes types that affect coordination of movements. There are two subtypes. Athetoid: The person has uncontrolled movements that are slow and writhing. The movements can affect any part of the body, including the face, mouth, and tongue. About 10% to 20% of cerebral palsy cases are of this type. Ataxic: This type affects balance and coordination. Depth perception is usually affected. If the person can walk, the gait is probably unsteady. He or she has difficulty with movements that are quick or require a great deal of control, such as writing. About 5% to 10% of cases of cerebral palsy are of this type. Mixed: This is a mixture of different types of cerebral palsy. A common combination is spastic and athetoid. ? Locations of Cerebral PalsyQuadriplegia: When all four limbs of the children's body are affected by CP. When diagnosed with quadriplegia, most children have a hard time eating and talking because facial muscles are also paralyzed. Triplegia: is when three limps are affected.Hemiplegia: when one side of a child's body is affected with CP due to brain damage in only one part of the brain, one side may be perfectly normal while the other side has no control over muscles.Diplegia: When only the lower two limbs of the body are affected with CP. Children with diplegia have complete control of their arms and hands but no control of their lower limbs. Paraplegia: indicates a motor impairment of the legs only.Monoplegia: is a less frequent form of involvement of only one limb. Many individuals with cerebral palsy have normal or above average intelligence. Their ability to express their intelligence may be limited by difficulties in communicating. All children with cerebral palsy, regardless of intelligence level, are able to improve their abilities substantially with appropriate interventions. Most children with cerebral palsy require significant medical and physical care, including physical, occupational, and speech/swallowing therapy.Despite advances in medical care, cerebral palsy remains a significant health problem. The number of people affected by cerebral palsy has increased over time. This may be because more and more premature infants are surviving. In the United States, about 2 to 3 children per 1,000 have cerebral palsy. As many as 1,000,000 people of all ages are affected. Cerebral palsy affects both sexes and all ethnic and socioeconomic groups. Causes of Cerebral Palsy Cerebral palsy results from damage to certain parts of the developing brain.This damage can occur early in pregnancy when the brain is just starting to form, during the birth process as the child passes through the birth canal, or after birth in the first few years of life. In many cases, the exact cause of the brain damage is never known. At one time, problems during birth, usually inadequate oxygen, were blamed for cerebral palsy.We now know that fewer than 10% of cases of cerebral palsy begin during birth (perinatal). In fact, current thinking is that at least 70% to 80% of cases of cerebral palsy begin before birth (prenatal). Some cases begin after birth (postnatal). In all likelihood, many cases of cerebral palsy are a result of a combination of prenatal, perinatal, and postnatal factors. Risk factors linked with cerebral palsy include the following:Infection, seizure disorder, thyroid disorder, and/or other medical problems in the mother Birth defects, especially those affecting the brain, spinal cord, head, face, lungs, or metabolism Rh factor incompatibility, a difference in the blood between mother and fetus that can cause brain damage in the fetus (Fortunately, this is almost always detected and treated in women who receive proper prenatal medical care.) Certain hereditary and genetic conditions Complications during labor and delivery Premature birth Low birth weight (especially if less than 2 pounds at birth) Severe jaundice after birth Multiple births (twins, triplets) Lack of oxygen (hypoxia) reaching the brain before, during, or after birth Brain damage early in life, due to infection (such as meningitis), head injury, lack of oxygen, or bleeding Cerebral Palsy SymptomsThe signs of cerebral palsy are usually not noticeable in early infancy but become more obvious as the child's nervous system matures. Early signs include the following: Delayed milestones such as controlling head, rolling over, reaching with one hand, sitting without support, crawling, or walking Persistence of infantile or primitive reflexes, which normally disappear 3 to 6 months after birth Developing handedness before age 18 months: This indicates weakness or abnormal muscle tone on one side, which may be an early sign of CP. Problems and disabilities related to CP range from very mild to very severe. Their severity is related to the severity of the brain damage. They may be very subtle, noticeable only to medical professionals, or may be obvious to the parents and other caregivers.Abnormal muscle tone: Muscles may be very stiff (spastic) or unusually relaxed and floppy. Limbs may be held in unusual or awkward positions. For example, spastic leg muscles may cause legs to cross in a scissor-like position. Abnormal movements: Movements may be unusually jerky or abrupt, or slow and writhing. They may appear uncontrolled or without purpose. Skeletal deformities: People who have cerebral palsy on only one side may have shortened limbs on the affected side. If not corrected by surgery or a device, this can lead to tilting of the pelvic bones and scoliosis (curvature of the spine). Joint contractures: People with spastic cerebral palsy may develop severe stiffening of the joints because of unequal pressures on the joints exerted by muscles of differing tone or strength. Mental retardation: Some, although not all, children with cerebral palsy are affected by mental retardation. Generally, the more severe the retardation, the more severe the disability overall. Seizures: About one-third of people with cerebral palsy have seizures. Seizures may appear early in life or years after the brain damage that causes cerebral palsy. The physical signs of a seizure may be partly masked by the abnormal movements of a person with cerebral palsy. Speech problems: Speech is partly controlled by movements of muscles of the tongue, mouth, and throat. Some individuals with cerebral palsy are unable to control these muscles and thus cannot speak normally. Swallowing problems: Swallowing is a very complex function that requires precise interaction of many groups of muscles. People with cerebral palsy who are unable to control these muscles will have problems sucking, eating, drinking, and controlling their saliva. They may drool. An even greater risk is aspiration, the inhalation into the lungs of food or fluids from the mouth or nose. This can cause infection or even suffocation. Hearing loss: Partial hearing loss is not unusual in people with cerebral palsy. The child may not respond to sounds or may have delayed speech. Vision problems: Three-quarters of people with cerebral palsy have strabismus, which is the turning in or out of one eye. This is due to weakness of the muscles that control eye movement. These people are often nearsighted. If not corrected, strabismus can lead to more severe vision problems over time. Dental problems: People with cerebral palsy tend to have more cavities than usual. This results from both defects in tooth enamel and difficulties brushing the teeth. Bowel and/or bladder control problems: These are caused by lack of muscle control.e) Research Studies on Cerebral PalsyBabies with low birth weight are generally more likely to have CP. Children with birth weight in the 97 percentile of weights were not found to have CP in most studies. Babies who were exposed to infection in mother’s womb are more likely to develop CP. Study shows that babies having chorioamnionitis was four times more common in children with CP. Chorioamnionitis is a bacterial infection of the placental membranes which enclose the amniotic fluid bathing the developing fetus. f) Treatment of Cerebral Palsy There is no cure for cerebral palsy. With early and ongoing treatment, however, the disabilities associated with cerebral palsy can be reduced. Many different therapies are available, most under the supervision of a medical specialist or other allied professional. Not all of these therapies are right for every person with cerebral palsy. The therapy regimen for a specific individual with cerebral palsy should be tailored to meet the needs of that individual. A treatment may work for one child but not for another. The parents and the child's care team work together to choose only those treatments that offer some benefit to the child.While specific therapies help a child develop specific skills and abilities, the overall goal of treatment is to help the individual with cerebral palsy reach his or her greatest potential physically, mentally, and socially. This is accomplished with a variety of different approaches managed by a team of professionals. Care for people with cerebral palsy is complicated, requiring a number of different services and specialists. In some areas, care is available through a single multidisciplinary clinic that oversees all aspects of the child's therapy.Rehabilitation: A comprehensive rehabilitation program may include physical therapy, use of special equipment, and spasticity treatment. Physical therapy involves stretching, physical exercises, and other activities that develop muscle strength, flexibility, and control. The goal is to maximize function and minimize disabling contractures. The focus is on developing specific skills such as holding the head up, sitting unsupported, or walking. Braces, splints, and casts may be used to help reach these goals. Special equipment that may be helpful to people with CP includes walkers, positioning devices, customized wheelchairs, scooters, and tricycles. Spasticity may be treated by injections into the muscles or by medications. Reduction of spasticity can improve range of motion, reduce deformity, improve response to occupational and physical therapy, and delay the need for surgery.Occupational therapy: The occupational therapist helps the individual learn physical skills he or she needs to function and become as independent as possible in everyday life. Examples are feeding, grooming, and dressing.Speech/language therapy: This therapy helps the child overcome communication problems. Many children with cerebral palsy have problems speaking because of poor tone or uncontrolled movements in the muscles of the mouth and tongue. Speech therapy helps develop those muscles, improving speech. Speech therapy also benefits children with hearing loss. Children who cannot speak may be able to benefit from communication technologies such as a computerized voice synthesizer.Vision problems: An ophthalmologist is consulted for children who have strabismus and visual problems.Medical therapy: This encompasses treatment for all medical problems whether related to CP or not. Various specialists may be called upon to deal with specific problems.Seizures: Seizure disorders are common in people with cerebral palsy. These are not always well controlled with medication. A specialist in conditions of the nervous system (neurologist) may be consulted for help in selecting an appropriate regimen. Feeding and digestive problems: Individuals with cerebral palsy often have gastroesophageal reflux or GERD (severe heartburn and related symptoms caused by regurgitation of acid from the stomach) as well as swallowing and feeding problems. A team consisting of a doctor who specializes in digestive diseases (gastroenterologist), a nutritionist, and a feeding and swallowing therapist can assess nutritional status and treat problems. Swallowing therapy helps the child eat and drink independently and helps prevent aspiration. The child's diet must be customized to accommodate limitations in swallowing. Children with severe swallowing problems require feeding through a tube. Breathing problems: People with cerebral palsy may have breathing problems because the muscles that control expansion and contraction of the lungs are disabled. A specialist in lung disorders (pulmonologist) should be consulted for management of the resulting lung disease.Educational services: Many children with cerebral palsy, even those of average or above-average intelligence, are challenged in cognitive processes such as thinking, learning, and memory. They can benefit from the services of a specialist in learning disabilities.Such specialists can identify the child's specific learning disabilities, direct early interventions and preparation for school, and monitor his or her progress. In the United States, these services are provided for children younger than 3 years by an established early intervention system. Representatives of the appropriate agencies will work with parents to develop an Individualized Family Services Plan, or IFSP. This plan describes the child's needs and the services the child will receive to address those needs. Educational services for school-aged children are provided by the public school system. The staff at the child's school will work with the parents to develop an Individualized Education Plan (IEP) for the child. This may include services besides classroom teaching. Navigating all of these different services can be difficult for parents. The child's health care professional can refer parents to a medical social worker who can help them find and enroll in the services their child needs. Many children with cerebral palsy develop emotional problems, behavior problems, or both. They can benefit from sessions with a psychologist or counselor. Personal computers and related technologies offer wonderful opportunities for communication, social interaction, education, entertainment, and employment for people with cerebral palsy.The overall goal for ongoing care of individuals with CP is to help them reach their full physical, mental, and emotional potential. Generally, this includes living as much as possible in the mainstream of their society and culture. People with CP tend to be happiest and most productive when they can go to school with, live with, and work with their peers. Children with CP require regular sessions with their physical, occupational, and speech/language therapists, as well as frequent checkups with their medical and surgical teams. The exact schedule of visits is determined by the severity of the child's condition and his or her response to treatment. A multidisciplinary CP clinic allows for frequent and complete care with the minimum of inconvenience.Helping with daily routines: Each person with CP has unique strengths and areas of difficulty. But most people with CP need ongoing help with: Feeding and eating: Cerebral palsy can affect jaw control and interfere with the ability to chew, suck, and swallow. Special utensils, such as plates that stick to a surface; properly positioning your child at meals; and serving soft or semi-solid foods, such as oatmeal, may be helpful. Using the toilet: Some people with cerebral palsy have stiff hip joints or similar problems that make using a toilet difficult. Others do not have dependable bladder control. Special undergarments and training by an occupational therapist are common ways to help treat this condition.Bowel elimination: People with CP often become constipated, making stools difficult to pass. Stool softeners and mild laxatives are frequently used for this problem. For information about preventing and treating constipation. Assistive Bowling Ramp: Bathing and grooming: People with cerebral palsy who do not have control of their hands or arms usually are unable to groom themselves. Others can be taught some level of self-grooming through regular practice. Dressing. Provide clothing and shoes that are easy to put on and take off, such as those that zip or button in the front (not the back) or that have large buttons, ties, or Velcro fasteners. Dental care. Cerebral palsy can affect the jaw muscles, make teeth improperly positioned and prone to decay, and cause sensitivity in the mouth and tongue. Also, many people with CP find it difficult to use a toothbrush. You can help your child by providing special equipment, such as a mechanized teeth-cleaning water spray or electric toothbrush; buying toothpaste for sensitive gums; and making sure he or she has regular dental cleanings.Skin care. Drooling is common in people with CP, which can cause skin irritation around the chin, mouth, and chest. You can help prevent skin irritations and protect your child's skin by blotting rather than wiping drool, using absorbent cloths to cover the chest, and applying lotions or corn starch to areas that are prone to irritation. Speaking. Some people with CP have problems with the muscles in their jaws and mouth as well as hearing loss. These problems, alone or in combination, can make it difficult to form words. Try to speak slowly, look directly at your child, and use pictures or objects as you talk. Also, read with your child a lot, and use picture books to help your child express himself or herself. Keeping active: Your child needs to move his or her limbs to help keep muscles strong and joints flexible. Have him or her move and play as much as possible. Involve other family members too. Ask the doctor, physical therapist, or other parents for ideas.Safety. People with CP are prone to falls and other accidents, especially if they are affected by seizures. You can take general safety measures at home—such as having heavy, sturdy furniture or not polishing floors—to help your child avoid accidents. Also, use common sense and care around sharp objects. And never leave a person who has CP alone while he or she is bathing. Support Groups and Counseling: Clearly, children with cerebral palsy may have very substantial problems, but almost all have the potential to learn, achieve, succeed, and create a happy life for themselves. This cannot happen without effort, and they need the help of their families. Having a child with cerebral palsy brings many challenges. It is understandable, then, that parents and siblings of a child with cerebral palsy may have significant stress. A parent may feel guilt, anger, anxiety, and/or hopelessness. The parent may feel alone and uncertain about what he or she should do. Before parents can help themselves or their child, they need to develop appropriate expectations and get organized. Only then can parents learn practical ways to cope with the child's problems and put these methods into practice. But making changes is not always easy. Sometimes it helps to have someone to talk to.This is the purpose of support groups. Support groups consist of people in similar situations. They come together to help each other and to help themselves. Support groups provide reassurance, motivation, and inspiration. They help parents see that their situation is not unique and not hopeless, and that gives them power. Support groups also provide practical tips on coping with cerebral palsy and navigating the medical, educational, and social systems that parents will rely on for help for themselves and their child. Being in a cerebral palsy support group is recommended by most mental health professionals. Support groups meet in person, on the telephone, or on the Internet. To find a support group that works, contact the following organizations. Parents can also ask a member of their child's care team or go on the Internet. If parents do not have access to the Internet, they should go to the public library.Cerebral Palsy PreventionOften the cause of cerebral palsy is not known, and nothing can be done to prevent it. However, some important causes of cerebral palsy can be prevented in many cases, including premature birth, low birth weight, infections, and head injuries.Seek appropriate prenatal care as early as possible in the pregnancy. Many women schedule a prepregnancy visit so they can be properly prepared for a healthy pregnancy. Appropriate care is available from physicians, physician assistants, nurse practitioners, and certified nurse-midwives. Avoid using cigarettes, alcohol, and illicit drugs during pregnancy; these increase the risk of premature delivery. Rubella (measles) during pregnancy or early in life is a cause of cerebral palsy. Testing for rubella immunity before a woman becomes pregnant allows her to be immunized, which protects both the woman and the baby from contracting this potentially devastating illness. Appropriate prenatal care includes testing for Rh factor. Rh incompatibility is easily treated but can cause brain damage and other problems if untreated. Routine vaccinations of babies can prevent serious infections such as meningitis that can lead to cerebral palsy. Make sure that the child is restrained in a properly installed car seat and wears a helmet when riding on a bicycle.2.3. Spina BifidaSpina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect. Spina bifida can happen anywhere along the spine if the neural tube does not close all the way. The backbone that protects the spinal cord does not form and close as it should. This often results in damage to the spinal cord and nerves. Spina bifida might cause physical and intellectual disabilities that range from mild to severe. The severity depends on: the size and location of the opening in the spine and whether part of the spinal cord and nerves are affected.77787594615The Above Diagram Shows the Details of the Structure of the Spina Bifida Types of Spina BifidaThe three most common types of spina bifida are:Myelomeningocele: When people talk about spina bifida, most often they are referring to myelomeningocele. Myelomeningocele is the most serious type of spina bifida. With this condition, a sac of fluid comes through an opening in the baby’s back. Part of the spinal cord and nerves are in this sac and are damaged. This type of spina bifida causes moderate to severe disabilities, such as problems affecting how the person goes to the bathroom, loss of feeling in the person’s legs or feet, and not being able to move the legs.Meningocele: Another type of spina bifida is meningocele. With meningocele a sac of fluid comes through an opening in the baby’s back. But, the spinal cord is not in this sac. There is usually little or no nerve damage. This type of spina bifida can cause minor disabilities.Spina Bifida Occulta: Spina bifida occulta is the mildest type of spina bifida. It is sometimes called “hidden” spina bifida. With it, there is a small gap in the spine, but no opening or sac on the back. The spinal cord and the nerves usually are normal. Many times, spina bifida occulta is not discovered until late childhood or adulthood. This type of spina bifida usually does not cause any disabilities. For further understanding of the three types of spina bifida, one can see the following diagrams. Causes and Prevention of Spinal BifidaWhat Causes Spina Bifida? The exact cause of spina bifida remains unknown. No one knows what disrupts complete closure of the neural tube, causing a malformation to develop. Scientists suspect that the cause is multifaceted: genetic, nutritional, and environmental factors play a role. Research studies indicate that insufficient intake of folic acid -- a common vitamin B -- in the mother's diet is a key factor in causing spina bifida and other neural tube defects. Prenatal vitamins that are prescribed for the pregnant mother typically contain folic acid as well as other vitamins. Identification and Assessment of Spina BifidaSpina bifida can be diagnosed during pregnancy or after the baby is born. Spina bifida occulta might not be diagnosed until late childhood or adulthood, or might never be diagnosed/ detected. During PregnancyDuring pregnancy there are screening tests (prenatal tests) to check for spina bifida and other birth defects. Talk with your doctor about any questions or concerns you have about this prenatal testing. AFP - AFP stands for alpha-fetoprotein (sounds like: al-fa–fee-toe-pro-teen), a protein the unborn baby produces. This is a simple blood test that measures how much AFP has passed into the mother’s bloodstream from the baby. A high level of AFP might mean that the baby has spina bifida. An AFP test might be part of a test called the “triple screen” that looks for neural tube defects and other issues.Ultrasound - An ultrasound is a type of picture of the baby. In some cases, the doctor can see if the baby has spina bifida or find other reasons that there might be a high level of AFP. Frequently, spina bifida can be seen with this test.Amniocentesis (sounds like: am-knee-oh-sin-te-sus; hear how “amniocentesis” sounds) - For this test, the doctor takes a small sample of the amniotic fluid surrounding the baby in the womb. Higher than average levels of AFP in the fluid might mean that the baby has spina bifida.After the Baby Is BornIn some cases, spina bifida might not be diagnosed until after the baby is born. Sometimes there is a hairy patch of skin or dimple on the baby’s back that is first seen after the baby is born. A doctor can use an image scan, such as an X-ray, MRI, or CT, to get a clearer view of the baby’s spine and the bones in the back. Sometimes spina bifida is not diagnosed until after the baby is born because the mother did not receive prenatal care or an ultrasound did not show clear pictures of the affected part of the spine.Signs and Symptoms of Spina BifidaThe symptoms of spina bifida vary from person to person, depending on the type and level of involvement. Closed neural tube defects are often recognized or identified early in life due to an abnormal cluster of hair or a small dimple or birthmark on the skin at the site of the spinal malformation. Meningocele and myelomeningocele generally involve a fluid-filled sac -- visible on the back -- protruding from the spinal canal. In meningocele, the sac may be covered by a thin layer of skin. In most cases of myelomeningocele, there is no layer of skin covering the sac and an area of abnormally developed spinal cord tissue usually is exposed. Complications of spina bifida range from minor physical problems to severe physical and mental disabilities. It is important to note, however, that most people with spina bifida are of normal intelligence. Children with myelomeningocele and/or hydrocephalus (excess cerebrospinal fluid in and around the brain) may have learning disabilities, including difficulty paying attention, problems with language and reading comprehension, and trouble learning math.Spina bifida's impact is determined by the size and location of the malformation, whether it is covered by skin, and which spinal nerves are involved. All nerves located below the malformation are affected to some degree. Therefore, the higher the malformation occurs on the back, the greater the amount of nerve damage and loss of muscle function and sensation. Spina bifida can range from mild to severe. Some people have little or no noticeable disability. Others are limited in the way they can move or function. They even might be paralyzed (unable to walk or move parts of the body). Even so, with the right care, most people affected by spina bifida will be able to grow up to lead full and productive lives.In addition to abnormal sensation and paralysis, another neurological complication associated with spina bifida is Chiari II malformation -- a condition common in children with myelomeningocele -- in which the brain stem and the cerebellum (hindbrain) protrude downward into the spinal canal or neck area. This condition can lead to compression of the spinal cord and cause a variety of symptoms, including difficulties with feeding, swallowing, and breathing control; unpleasant; and changes in upper extremity function (stiffness, swelling). Chiari II malformation may also result in a blockage of cerebrospinal fluid, causing hydrocephalus. The buildup of fluid puts damaging pressure on the structures. Hydrocephalus is commonly treated by surgically implanting a shunt -- a hollow tube -- in the brain to drain the excess fluid into the abdomen. Some newborns with myelomeningocele may develop meningitis, an infection in the meninges. Meningitis may cause brain injury and can be life-threatening. Additional problems such as latex allergies, skin integrity breakdown, gastrointestinal conditions, disorders of sleep regulation, and depression may occur as children with spina bifida get older. We do not know all of the causes of spina bifida. The role those factors, such as genes and the environment, play in causing spina bifida need to be studied further. However, we do know that there are ways before and during pregnancy for women to reduce the risk of having a baby with spina bifida. For pregnant woman or a woman could get pregnant, use the following tips to help prevent the baby from having spina bifida:Let her to take 400 micrograms of folic acid every day. Folic acid prevents most, but not all, cases of spina bifida.If a woman has a medical condition―such as diabetes or obesity―be sure it is under control before you become pregnant.Avoid overheating her body, as might happen if she uses a hot tub or sauna.Treat any fever she has.Spina bifida happens in the first few weeks of pregnancy, often before a woman knows she’s pregnant. Although folic acid is not a guarantee that a woman will have a healthy pregnancy, taking folic acid can help reduce a woman's risk of having a pregnancy affected by spina bifida. Treatment for Children with Spina BifidaThere is no cure for spina bifida. The nerve tissue that is damaged or lost cannot be repaired or replaced, nor can function be restored to the damaged nerves. Treatment depends on the type and severity of the disorder. Generally, children with the mild form need no treatment, although some may require surgery as they grow. The key early priorities for treating myelomeningocele are to prevent infection from developing through the exposed nerves and tissue through the spine defect, and to protect the exposed nerves and structures from additional trauma. Typically, a child born with spina bifida will have surgery to close the defect and minimize the risk of infection or further trauma within the first few days of life.Some individuals with spina bifida require assistive mobility devices such as braces, crutches, or wheelchairs. The location of the malformation on the spine often indicates the type of assistive devices needed. Children with a defect high on the spine and more extensive paralysis will often require a wheelchair, while those with a defect lower on the spine may be able to use crutches, leg braces, or walkers. Beginning special exercises for the legs and feet at an early age may help prepare the child for walking with braces or crutches when he or she is older.Children with spina bifida can lead relatively active lives. Prognosis, activity, and participation depend on the number and severity of abnormalities and associated personal and environmental factors. Many children with the disorder have normal intelligence and can walk, usually with assistive devices. If learning problems develop, early educational intervention is helpful. 2.4. Children with EpilepsyThis is disturbance of movement, sensation, behavior and/or consciousness caused by abnormal electrical activity in the brain. Causes of children with epileptic seizureThe specific causes of epilepsy are not clearly known. It is likely that people become seizure prone when a particular part of the brain becomes electrically unstable. This condition may result from an underlying lesion caused by scar tissue from head injury, a tumor or un interruption in blood supply to the brain. In many cases, the origin of seizure activity can’t be traced to a particular incident.Classification of children with epileptic seizure: The three major types of epileptic seizure are grandmal seizure, petitmal seizure and psychomotor seizure. Grandmal Seizure: The most evident and serious type of epileptic seizure which can be disturbing and frightening to someone who has never seen once. It has the following characteristics: No warning about seizure is to occurThe person looses consciousness and falls to the floorSaliva may be forced from the mouthLegs and arms may jerkThe bladder and bowels become emptied The entire body shakes violently as the muscle alternatively contract and relaxAfter a few minutes, the contractions diminish and the child either goes to sleep or regains consciousness in a confused or drowsy stateEducational Interventions for Children with Grandmal Seizure: Teachers are expected to apply the following techniques in case a grandmal seizure occurs in the classroom:Ease the child to floor and loosen his/her collar, you can’t stop the seizure. Let it turn its course and do not try to revive the child.Remove hard, sharp or hot objects that may injure the child but do not interfere with movements.Don’t force anything between the child’s teeth.Turn the head to one side for the release of salivaWhen the child regains his/her consciousness, let him/her rest if he/s wishes.Petitmal Seizure: less severe than grandmal seizure but may occur much more frequently as often as 100 times a day in some children. Usually, there is a brief loss of consciousness, letting anywhere from a few seconds to half a minute or so. It has the following characteristics: The child with petitmal seizure May stare blankly and blink his/her eyes Drop whatever he/s is holding May be mistakenly viewed as daydreaming or not listeningMay or may not be aware that he/s has the seizureNo special first aid is necessary. But the teacher should advise of seizure activity and it is helpful to explain it to the child’s classmates. Psychomotor seizure: It may appear as brief period of inappropriate or purposeless activities. The child may smack his/her lips, walk around aimlessly or shot. It may last for a few minutes but gone as long as several hours in some cases. An observant teacher can be instrumental in detecting the presence of this kind of seizure and in referring the child for appropriate medical help. 2.4. Muscular Dystrophy (MD) Muscular Dystrophy (MD) is a rare genetic disease that affects persons of all races around the world and is characterized by weakness and wasting of muscle tissue; in some cases this may also include the heart. There are nine types of this impairment, some of which affect one or both genders at varying stages of life. The different types of this disease are: Becker, Duchenne, congenital, distal, Emery-Dreifuss, facioscapulohumeral, myotonic, limb-girdle, and oculopharyngeal. MD is an inherited disease usually caused by an abnormal gene that can be passed on to children by either one or both parents. Duchenne MD and Becker MD, for example, are both passed on by an X chromosome from the mother, while oculopharyngeal MD and limb-girdle MD are passed on by both the mother and father. Although most of the varying forms of the disease are slow to progress and will worsen in time, those who suffer from them in most cases will have a normal life expectancy. Children who suffer from Duchenne MD and congenital MD, however, may have a higher mortality rate. Becker Muscular Dystrophy (BMD): BMD is a form of MD that is characterized by a gradual weakening of the lower body muscles. Depending on the rate of deterioration, some men may eventually need the assistance of a wheelchair or cane as they get older. BMD is an inherited disease that occurs predominately in males, with an average onset around the age of 12 years old. Similar to Duchenne MD, BMD is caused by an abnormal gene on the X-chromosome that causes a decreased production of the protein dystrophic. Duchenne Muscular Dystrophy (DMD): DMD is the most recognized type of muscular dystrophy in children. Males are generally the only ones afflicted with the disease, however, it is females who carry the defective gene and will have a 50% chance of passing it on to her children. If a male child is affected he will usually show signs of the disease no later than seven or eight years old and will likely require the use of a wheelchair by the age of 12. Like BMD, there is weakening and wasting of the muscles, starting with those of the lower body. Eventually all muscles including the heart will be affected. There is no cure at this time and survival beyond the age of 30 is rare. Congenital Muscular Dystrophy (CMD): As a congenital disease, CMD is present at birth and can affect both male and female infants. It is characterized by muscle weakness and contractures that can cause joint problems and deformities. Often children with CMD develop brain abnormalities and even seizures. Distal Muscular Dystrophy (DD): Perhaps the least severe of the forms of Muscular Dystrophy, DD affects the hands, feet, lower legs, and forearms. There are several different forms of this disorder that are caused by different gene abnormalities. The onset for DD is usually later in life, occurring around the ages of 40 to 60 and is slow progressing. Both men and women are affected by this disease.Emery-Dreifuss Muscular Dystrophy (EDMD): This is a slow progressing form of MD with outward signs developing around the age of 10. Some of the first noticeable indications are stiffness in the heels and difficulty in bending the arms at the elbows. Cardiac problems are quite common and will usually manifest in early adulthood. While the progression of muscle weakness is slow, cardiac problems can be life threatening and often result in treatment with medications or in some cases a pacemaker is required. Facioscapulohumeral Muscular Dystrophy (FSHD): FSHD is the third most common form of MD in children and adults. It is characterized by a progressive weakening of the upper body, usually starting with the facial muscles. It is a disorder that affects roughly 5 out of 100,000 people, both men and women. Although those who suffer from FSHD may experience complications such as decreased hearing or mobility, the long term prognosis is generally good.Limb-Girdle Muscular Dystrophy (LGMD): LGMD is the name given to 18 different types of Muscular Dystrophy. Persons affected by this disease will first notice muscle weakness of the hips and shoulders. Generally, the abnormal gene which results in LGMD is passed by both the mother and father. There is currently no known cure and treatment is generally the management of symptoms.Myotonic Muscular Dystrophy (MMD): MMD is a late-onset form of Muscular Dystrophy, usually occurring as a teenager or adult. There are two types of this disease caused by a repeated section of DNA on one of two chromosomes. Type 1, or MMD1, is a result of a defect in chromosome 19 and is the most common. Type 2, or MMD2, is a result of an abnormal chromosome 3 and is both less common and less severe. Some of the symptoms include weakness, muscle wasting, and delayed muscle relaxation.Oculopharyngeal Muscular Dystrophy (OPMD): A slow progressing form of Muscular Dystrophy that usually begins in the 40's or 50's. OPMD can be inherited by one or both parents and is caused by a faulty gene which causes the formation of clumps in the muscle cells. The first signs of the disease are a weakness in the throat and the lids of the eyes. There is, at this time, no treatments for the OPMD and management is primarily for the symptoms of drooping eyelids and difficulty swallowing2.5. Club Foot What is clubfoot? Club foot is a common disorder in which one or both of a baby's feet are turned inward and downward and can't easily be moved into a normal position. It is much more common for a baby to have a foot turned inward due to positioning, but these feet are very flexible and can easily be straightened with gentle manipulation. Clubfoot is a general term used to describe a range of unusual positions of the foot. Each of the following characteristics may be present, and each may vary from mild to severe:The foot (especially the heel) is usually smaller than normal.The foot may point downward.The front of the foot may be rotated toward the other foot.The foot may turn in, and in extreme cases, the bottom of the foot can point up.Most types of clubfoot are present at birth (congenital clubfoot). Clubfoot can happen in one foot or in both feet. In almost half of affected infants, both feet are involved. Although clubfoot is painless in a baby, treatment should begin immediately. Clubfoot can cause significant problems as the child grows. But with early treatment most children born with clubfoot are able to lead a normal life.Causes of ClubfootWhat causes clubfoot? In some cases, clubfoot is just the result of the position of the baby while it is developing in the mother's womb (postural clubfoot). But more often clubfoot is caused by a combination of genetic and environmental factors that is not well understood. If someone in your family has clubfoot, then it is more likely to occur in your infant. If your family has one child with clubfoot, the chances of a second infant having the condition increase. Clubfoot present at birth can point to further health problems because clubfoot can be linked with other conditions such as spina bifida. For this reason, as soon as clubfoot is noticed, it's important that the infant be screened for other health conditions. Clubfoot can also be the result of problems that affect the nerve, muscle, and bone systems, such as stroke or brain injury. Symptoms of ClubfootWhat are the symptoms of clubfoot? Clubfoot is painless in a baby, but it can eventually cause discomfort and become a noticeable disability. Left untreated, clubfoot does not straighten itself out. The foot will remain twisted out of shape, and the affected leg may be shorter and smaller than the other. These symptoms become more obvious and more of a problem as the child grows. There are also problems with fitting shoes and participating in normal play. Treatment that begins shortly after birth can help overcome these problems.Ultrasound done while a baby is in the womb can sometimes detect clubfoot. It is more common for your doctor to diagnose the condition after the infant is born, though, based on the appearance and mobility of the feet and legs. In some cases, especially if the clubfoot is due just to the position of the growing baby (postural clubfoot), the foot is flexible and can be moved into a normal or nearly normal position after the baby is born. In other cases, the foot is more rigid or stiff, and the muscles at the back of the calf are very tight. X-rays may not be helpful to confirm the diagnosis. Some of the baby's foot and ankle bones are not fully ossified (filled in with bony material) and do not show well on X-ray. Treatment for Children with Clubfoot When treatment for clubfoot starts soon after birth, the foot grows to be stable and positioned to put up with weight for standing and moving comfortably. Nonsurgical treatments such as casting or splinting are usually tried first. The foot (or feet) is moved (manipulated) into the most normal position possible and held (immobilized) in that position until the next treatment. This manipulation and immobilization procedure is repeated every 1 to 2 weeks for 2 to 4 months, moving the foot a little closer toward a normal position each time. Some children have enough improvement that the only further treatment is to keep the foot in the corrected position by splinting it as it grows. Usually, the inward direction of the front of the foot is corrected first. If the foot is not responsive, major surgery is performed to further straighten the foot. If a few months of progressive manipulation and immobilization don't move the foot into a more normal position, your child's doctor may suggest surgery. Splinting or casting is usually used after surgery to keep the foot in the correct position during healing.After either nonsurgical or surgical treatment, your child usually wears splints for a period of time to keep the clubfoot from starting to form again. Your child should also have regular check-ups until he or she stops growing. If your child had surgery, he or she may also need physical therapy. A mild recurrence of clubfoot is common, even after successful treatment. Also, the affected foot will continue to be somewhat smaller and stiffer than the unaffected foot, and the calf of the leg will be smaller. Newborns with a club foot are often treated with bracing, physical therapy, casting, and/or surgery. The left image is a baby with club foot and casted. The right is Newborn with bilateral clubfoot deformity. All clubfeet are not of the same severity, although all have the same general appearance. The feet are twisted inward so that the top of the foot is where the bottom should be. There is often a deep crease (fold) on the bottom of the mid-foot.Left, Note the weight bearing surface of the foot is on the side and top of the foot in this child with bilateral clubfeet. Right, Note the deep crease on the bottom of the mid-foot in this child with a unilateral clubfoot. Picture of a child in bilateral long leg plaster casts for clubfoot correction.Clubfoot may occur as an isolated disorder (idiopathic) or in combination with various disabilities and other associated anomalies such as arthrogryposis and myelodysplasia. Medical examinations by your doctor or blood tests should be able to determine whether your baby's clubfoot is idiopathic. Clubfoot can be mild or severe and all cases require treatment. Clubfoot will not resolve without treatment. The clubfoot is not painful to the infant who does not yet walk. The incidence of idiopathic clubfoot is estimated to be one to two per 1000 live births. It has a male predominance of 2:1 and occurs in both feet about 50 percent of the time. There is a much higher incidence if the patient has a positive family history for clubfoot. There is a positive family history of clubfoot in approximately 25 percent of all patients, suggesting a genetic basis for this disorder. If one child in the family has clubfoot, the chance of a second child being born with clubfoot is around 5 percent. When one parent is affected with clubfoot, there is a 3 percent to 4 percent chance that the offspring will also be affected. However, when both parents are affected, their children have a 15 percent chance of being born with clubfoot.Generally, a child with an untreated clubfoot will walk on the outer edge of the foot instead of the sole, develop painful calluses, be unable to wear shoes and have lifelong painful feet that often severely limit activity and employment. Nonsurgical modalities include serial manipulation and casting, taping, physical therapy and splinting, and continuous passive motion with a machine. Surgical treatment is extensive and requires release of soft tissue and joint contractures, tendon lengthening, and temporary pin fixation of joints in the foot. The initial treatment of clubfoot, regardless of severity, is nonsurgical. The majority of clubfeet can be corrected in infancy in about six to eight weeks with the proper gentle manipulations and plaster casts. Ponseti, I.V. Treatment of Congenital Clubfoot. [Review] [72 refs] J Bone Joint Surgery - Am 74(3): 448-54, 1992 Mar. The technique requires training, experience, and practice.There are several different braces that are commonly prescribed. All braces consist of a bar (the length of which is the distance between the child's shoulders) with either shoes, sandals, or custom-made orthoses attached at the ends of the bar in about 70 degrees of external rotation. The bar can be either solid (both legs move together) or dynamic (each leg can move independently). The brace is worn 23 hours a day for three months and then at nighttime for three to four years. The brace consists of a bar (the length of which is the distance between the child's shoulders) with high top open-toed shoes attached at the ends of the bar in about 70 degrees of external rotation. In children with only one clubfoot, the shoe for the normal foot is fixed on the bar in 40 degrees of external rotation. Bracing is critical in maintaining the correction of the clubfeet. If the brace is not worn as prescribed there is a near 100 percent recurrence rate. Dobbs MB, Rudzki JR, Purcell DB, et al: Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet. J Bone Joint Surg 2004;86(Am): 22-27. Babies might get fussy for the first few days after receiving a brace, and will require time to adjust. It is important to check your child's feet several times a day after initiating the bracing to ensure no blisters are developing on the heel.A small percentage of children develop relapses despite proper bracing. The more severe and rigid the initial deformity was, the greater the risk of recurrence. Recurrences may be treated a series of manipulations and casting followed by occasional tendon transfers to maintain correction. 2.6. Amputation What is an amputation? Amputation is an acquired condition that results in the loss of a limb, usually from injury, disease, or surgery. Congenital (present at birth) limb deficiency occurs when an infant is born without part or all of a limb. In the U.S.,?82 percent of amputations are due to vascular disease. Nearly 70 percent of amputations due to trauma involve the upper limbs. About?2 million individuals in the U.S. are living with a loss of a limb, with more than 185,000 amputations performed each year according to the National Limb Loss Information Center.a) Causes AmputationsThe causes for amputation may include any of the following:Diseases such as blood vessel disease (called peripheral vascular disease or PVD), diabetes, blood clots, or osteomyelitis (an infection in the bones).Injuries especially of the arms. Seventy-five percent of upper extremity amputations are related to trauma.Surgery to remove tumors from bones and muscles. b) Types of AmputationsAmputations are classified as being either minor or major. Minor amputations are those that involve a digit, such as a toe or finger, or a minor part of the body being removed, such as a small part of the foot. Major amputations include removal of all or part of an extremity, such as removal of an arm or hand, or the portion of the leg below the knee.?Major amputations are extensive operations that have greater possibilities of infections or complications following the procedure. Major amputations typically also require rehabilitation therapy and the amputee may be a candidate for a prosthetic device. The main difference among the different types of amputation is where the amputation is located. Here are the different types of amputations: Lower Body Foot Amputations: This is most commonly a toe amputation caused by frostbite. This type of amputation will affect walking and balance. Ankle Disarticulation: This is an amputation of the entire ankle. However, even without the ankle, a person can move around without prosthesis. Below-Knee Amputation: This is an amputation above the ankle, but below the knee. Full knee use is retained, but it is hard for these amputees to put weight on the stump. Knee-Bearing Amputation: This is a complete removal of the lower leg. The stump left is able to hold weight on it, but it is difficult to create a prosthetic device for the stump. Above Knee Amputation: This is an amputation in the thigh. The whole body weight can't be held on the stump, but a person is able to sit with this amputation. Hip Disarticulation: This involves removing the entire leg bone, but surgeons like to leave the upper femur for stability and a place or a prosthetic device. Upper Body Amputation of Individual Digits: The thumb is the most common single digit loss. The loss of a thumb inhibits grasping ability. When other fingers are amputated, the hand still grasps, but with less precision. Multiple-Digit Amputation: When more than one finger is amputated, surgical procedures are used to reconstruct muscles to help aid grasping capabilities. Metacarpal Amputation: This is amputation of the whole hand with the wrist still intact. The amputee is completely unable to grab. Wrist Disarticulation: This is a removal of the hand, but at the wrist joint. Plastic sockets are now made to serve as wrists. Forearm Amputation: Forearm amputations are classified by the length of the stump left. As the stump gets smaller, so does the pronation ability. Elbow Disarticulation: This is the removal of the whole forearm at the elbow. This amputation creates a bulb shaped stump that can hold weight. Above-Elbow Amputation: This is a removal of the arm above the elbow. However, if the stump is long enough, this type of amputee can be fitted just like the elbow disarticulation amputee. Shoulder Disarticulation and Forequarter Amputations: This is the removal of the entire arm. Just like the Hip Disarticulation surgeons like to leave some length to the bone for stability and fitting a prosthetic device.c) Rehabilitation after AmputationLoss of a limb produces a permanent disability that can impact a patient's self-image, self-care, and mobility (movement). Rehabilitation of the patient with an amputation begins after surgery during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun. The success of rehabilitation depends on many variables, including the following:Level and type of amputationType and degree of any resulting impairments and disabilitiesOverall health of the patientFamily supportIt is important to focus on maximizing the patient's capabilities at home and in the community. Positive reinforcement helps recovery by improving self-esteem and promoting independence. The rehabilitation program is designed to meet the needs of the individual patient. Active involvement of the patient and family is vital to the success of the program. The goal of rehabilitation after an amputation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life--physically, emotionally, and socially. In order to help reach these goals, amputation rehabilitation programs may include the following:Treatments to help improve wound healing and stump careActivities to help improve motor skills, restore activities of daily living (ADLs), and help the patient reach maximum independenceExercises that promote muscle strength, endurance, and controlFitting and use of artificial limbs (prostheses)Pain management for both post-operative and phantom pain (a sensation of pain that occurs below the level of the amputation)Emotional support to help during the grieving period and with readjustment to a new body imageUse of assistive devicesNutritional counseling to promote healing and healthVocational counselingAdapting the home environment for ease of function, safety, accessibility, and mobilityPatient and family education d) Amputation Rehabilitation TeamRehabilitation programs for patients with amputations can be conducted on an inpatient or outpatient basis. Many skilled professionals are part of the amputation rehabilitation team, including any/all of the following: Orthopaedists/ orthopaedic surgeons, physiatrist, internist, other specialty doctors, rehabilitation specialists, physical therapist, occupational therapist, orthotist, prosthetist, social worker, psychologist/psychiatrist, recreational therapist, case manager, chaplain, and vocational counselor. e) Types of rehabilitation programs for amputationsThere are a variety of treatment programs, including the following: acute rehabilitation programs, outpatient rehabilitation programs, day-treatment programs and vocational rehabilitation programs. 2.1.7. PoliomyelitisPoliomyelitis is an acute disease that inflames nerve cells of the spinal cord or brain stem and leaves a residual paralysis or muscular atrophy. It is communicable disease caused by the polio virus. It is also muscular atrophy and even fatal motor paralysis. 2.1.8. LeprosyLeprosy is a chronic disease which damages the nerve cells around the different parts of the body affecting the motor behavior both in fine and gross motors. The mutilating effect of the disease generates great fear and horror from people. 2.2. Children with Health ImpairmentThese are extremely varied medical disabilities which have one thing in common. There are many conditions that can affect a child’s health permanently or temporarily or intermittently. The most chronic health impairments are Epilepsy, Diabetics, Allergy, Heart disorder, Asthma and HIV/AIDS. Please gather relevant data about Epilepsy, Diabetes, Allergy, Heart disorder Asthma and HIV/AIDS from relevant sources and identify what their characteristics are their classification, potential symptoms and appropriate support service and/or medication provided to them. 2.2.1. Children with Diabetes A diabetic is a metabolic disorder that occurs when the individual body is unable to utilize and properly store sugar. The condition is a result of inability of the pancreas to produce a sufficient amount of hormones such as insulin and glucagon. Although a diabetic is most commonly seen in adults, in some cases, it may occur in school age children and can become a serious problem if proper treatment procedures are not adhered to. Characteristics: Frequent urination, abnormal thirst and extreme hunger; changes in weight, drowsiness, and general weakness; possible visual disturbance and skin infections like boils and itching.Educational Implications: The classroom teacher should be aware of several potential problems such as insulin reaction and diabetic coma. An insulin reaction may result from anything that increases the metabolic rates such as too much exercise, too much insulin, too little food or nervous tension. Keep candy raisers, or sugar handy in case students need; be certain to inform colleagues that there is a student in that class with diabetic problem; and encourage the parents to have their child’s vision routines checked.2.2.2. Children with Allergy Definition: An allergy is an adverse sensitivity or intolerance to a specific substance that may not be to other individuals. When an allergic student comes in contact with the substance to which he/s is sensitive, he/s developed a reaction or irritation. The reaction may take many forms, such as sneezing, watering, eyes, running nose, tiredness, itching, or a rash. Causes: Inhalants (pollen, smoke, dust, and perfume); foods (eggs, chocolates, wheat, pork, strawberry nut); infectious agents (bacteria and fungi); substances that can be in contact with the skin (fur, leather, animal hair and dyes); drug (vaccine, serums and antibiotics). Implications: Don’t enforce students to involve in the activities that they are allergic; help students being aware of their allergic problem. 2.2.3. Children with AsthmaAsthma is a chronic respiratory condition characterized by repeated episode of breathing difficulties, especially while exhaling. It may be an inherited condition and people with close relatives who are asthmatic are likely to be asthmatic themselves. When people have asthma, there is a tendency for airways to narrow. Asthma is a common lung disease mainly occurs during childhood and difficulty in breathing system. It is characterized obstruction to air flow and clinically found as developmentally cough and wheezing which also affect pulmonary system and it is genetically transmitted.Causes: Asthma can be caused by obstruction in the flow of air, genetic factors, environmental pollutions, contraction of muscles, emotional factors, respiratory infection, viral infections (common cold, influenza). Things in the person are allergic (air born pollen, molds, house dust, animal dander, feather, pillow, smokes, animal hair etc.Classifications: Intrinsic/perennial asthma- the symptom is clear all-round the year-frequent occurrence. Extrinsic/seasonal asthma- this occurs in certain seasons of the year.Characteristics: dry and persistent cough, increased heart beat, emotional stress, shallow breathing, prolonged expiration, increased blood pressure, worsened by activities like laugh, lying down, breathing accompanied by wheezing and tight chest. Educational and Social AdaptationsThe teacher should keep the psychological status of asthmatic studentsThe teacher should be aware of the factors that arose asthmaStudents should be advised to experience breathing exercisesThe student should use hot drinks like hot water and teaThe asthmatic student a lot of water – to loosen mucus and breathing easierAdvise students to make short warm ups and daily exercises 2.2.4. Children with Heart DisordersHeart disorder is a condition that is characterized by improper circulation of blood by the heart. Some students may have heart valve disorder; others may have disorder of the blood vessels. Causes: genetic factor, different heart diseases (rheumatic heart disease), problems related to birth and pregnancy. Classifications: generally heart disorder can be classified into two major categories as: Congenital heart disorder – present at birth; and acquired heart disorder – occurred after birth. Characteristics Hypertension / high blood pressure Weakness of the heart muscle Murmurs of the stomach Deficiency of sucking and eating Difficulty in breathing Pain on the center of the chest The heart valves becoming narrowComplain of severe tightDifficulty in speaking for a long period of time Unable to think more abstractlyWalking slowly Low verbal and physical performanceDifficulty of doing physical exercises, etc. Educational ImplicationsTeachers are expected to make close relations with the student and his/her parentsIdentify the activities which are appropriate to themStudents should not participate in competent athleticsSuggest some more intervention mechanisms for these children. 2.2.5. Cystic FibrosisCystic fibrosis is the most common fatal hereditary disease. It is a recessive genetic disorder that results from an inborn error of metabolism. It is a generalized disorder affecting the endocrine glands, often causing severe respiratory and digestive problems. The mucus normally produced by these glands is thin, slippery, and clear. However, in children with cystic fibrosis, the mucus is thick and sticky. This thick mucus blocked the bronchial tubes and if not removed can lead to recurrent lung infections, lung damage, digestive difficulty, and occasionally cirrhosis of the liver. As the condition progresses, more mucus remains and areas of the lungs become blocked. Treatments: inhalation treatment, postural drainage (patting the back in certain areas to loosen the thick mucus) is used to ease the breathing of the child with cystic fibrosis. In the past children with cystic fibrosis often did not survive beyond the primary grades. Today, because of advanced medical treatment procedures, many may live normal adult lives. Educational Implications: Teachers should consider several factors if they have a student with cystic fibrosis in their classroom: 1. Students may cough frequently. Cystic fibrosis is not contagious; therefore there is no need to keep the other students away during a coughing episode. In fact, students with cystic fibrosis should be encouraged not to try to hide the cough, because coughing clears the mucus from the lungs. 2. They may need to take medication during school hours.3. Because frequent absences may be common for the student with cystic fibrosis, teachers must work diligently with hospital and homebound personnel to ensure the best possible education. 4. The most important consideration is that the teacher should assume responsibility for knowing exactly what the student can and cannot do. This is best accomplished by close communication among parents, resource personnel, and the regular teacher. 2.2.6. Acquired Immune Deficiency Syndrome (AIDS)AIDS is a condition wherein a microscopic – size virus is introduced into the body and attached to the helper T cell, which is the coordinator of the body’s immune system. HIV (Human Immunodeficiency Virus)/ AIDS (Acquired Immunodeficiency Syndrome) is the problem in education system. The effects of the problem in children include CNS damage, infection, developmental delay, motor problems, psychological stress, and death. The ways of transmissions are bodily fluid, blood contact, blood transfusion, sharp contaminated materials. Unit 3: Prevention of Physical disabilities 3.1. Primary Prevention (left as individual assignment & class presentation) 3.2. Secondary Prevention (left as individual assignment & class presentation) 3.3. Tertiary Prevention (left as individual assignment & class presentation)Unit 4: Developmental Profiles of people with Physical DisabilitiesWhat cognitive, academic, physical, communication and social characteristics do people with physical and health impairments show? Discuss them with one or more of your classmates. Can you add some more characteristics of children with physical disabilities? Some of the major characteristics of children with physical disabilities are:4.1. Cognitive CharacteristicsStudents with motor difficulties often have no cognitive impairments. However, the limitation of movements can affect the cognitive development of the child adversely.4.2. Academic Characteristics Students with medical and physical disability are more likely to experience academic difficulties than their peers without disabilities. The problems are not always a function of academics skills, but of limited learning opportunities. Because of their impairment a lot of academic content may be missed due to absence from class. Physical CharacteristicsMotor dysfunctions are the primary difficulties faced by children with physical disabilities or with health impairments. Their disorders may mean chronic illness, weakness or pain. These symptoms may be present only during acute phases.4.4. Socio-emotional Characteristics The reactions of parents and other caregivers as well as teachers and students do influence the social and emotional behavior the children exhibit in schools, at home, and in the community. Like other students with disabilities, children with physical or medical problems have to deal with the attitudes and expectations of others. When those expectations are low, their social and emotional development can be inhibited. Most psychologists recognize the importance of movement in the development of social and emotional behaviors, Young children must move about to learn to be independent and to interact with other young children. Limited motor skills, with limited self-help and self-care skills can limit student’s social interactions. 4.5. Communication Characteristics Communication disorders may result depending on the type and severity of the impairment; however, their speech and language skills are normal. Still, they must use special assistive augmentative, and/or alternative systems to communicate. Limited language and communication skills can restrict their social and emotional interactions with others. Unit 5: Identification, Assessment and Intervention What strategies do teachers and parents use to identify, assess and intervene with the difficulties of children with Physical and health impairments? Exchange your views with your classmates? 5.1. Identification and AssessmentLet us see the identification and assessment sections first, and then the intervention measures later.Identification: Teachers or parents can use the following hints to identify children with motor impairments. They have poor motor control or coordinationThey walk with a limp with awkwardnessThey show signs of pain during exerciseThey have jerky or shaky motionsThey have defects which interfere with normal function of the bones, muscles or joints.Symptoms for children with health problems are:Easily fatigued Excessively restless and overactive Usually breathless after exerciseExtremely inattentiveExcessively hungry and thirstyFaints easilyAssessment: Children with congenital disabilities should be assisted as early as possible and followed up regularly until school age and at critical periods. The method of assessment depends on the child’s age and difficulties and on the purpose of assessment for each child has a different combination of assets and liabilities. For instance, in assessing a child with cerebral palsy, the setting of testing and the positioning of the child should be given due attention. Assessment is a global term for observing, gathering, recording, and interpreting information to answer questions and make legal and instructional decisions about students. What types of questions do teachers and parents have? Teachers of young children and parents wonder if the child is developing typically in one or more of the following developmental areas:Communication development. Should a student be talking more now that s/he is 4 years old?Cognitive development. Is a student experiencing difficulty performing many activities that the other children can do quite easily?Physical development. Does a student have problems with fine and gross motor activities? Does s/he have difficulty seeing? Hearing? Adaptive development. Should a student be able to feed himself and take care of toileting needs? Social-emotional development. Does a student have difficulty getting along with other children? Will s/he "outgrow" this?Teachers and parents of older children frequently have questions about a student's achievement, ability, or skills in one or more areas: Academic area. Does a student have a reading problem? Overall achievement. Why doesn't a student do better in school?General intelligence. Will a student be able to learn how to compute a math problem?Transition. What transition service needs does a student have?Social-emotional status. a student has difficulty making friends. How can s/he be helped? A student seems sad and depressed; what is causing this behavior?Vision, hearing, or motor ability. Can a student hear students speaking during class discussions? A student frequently walks on tiptoes; does this indicate a problem?Communication. A student can hear the speaker but doesn't seem to understand; what could be the cause of his difficulty? Assessment Steps and Purposes: In working with students with disabilities or who may have disabilities, professionals ask questions and make decisions during each of the assessment steps: screening, referral, determining eligibility, program planning, program monitoring, and program evaluation. Decision points allow the team to use the information to make decisions regarding the needs of the student. Step 1. ScreeningIdentifying children and youth who need special education services is a collaborative effort among teachers in the schools and personnel who work in agencies that serve children and families. The assessment question focuses on "Is there a possibility that the student may have a disability?" The purpose of screening is to determine whether students may have disabilities and to refer them for further assessment. Screening is designed to assess large numbers of students efficiently and economically. Based on the information collected during screening, evaluators decide whether to refer the student to the team for further assessment. Screening approaches differ, depending on whether the student is a preschooler or of school age.Preschool children:? In many communities, children under age 6 come to the assessment process as a result of Child Find activities. Child Find directs parents to screening services in their community that are open to infants, toddlers, and preschoolers and that are free of charge. Comprehensive screening of young children includes several components: parent concerns; medical history (often given through parental reports or completed by parents using a checklist); vision and hearing tests; and the use of commercial screening instruments and observation reports in the areas of general development, abilities, and skills. Screening instruments are generally inexpensive and are designed so they may be completed in a short amount of time, 30 minutes or less.School-age students:? Children who are entering public school for the first time or transferring to a new school require screening. One or more individuals, such as the special education teacher or general education teacher, conduct the screening, which involves various approaches. An educator often begins by reviewing past work and test scores of the incoming student or by asking the new student a set of questions. In the classroom, teachers observe and collect information about the student's work and performance. Teachers may observe that the student is having trouble seeing a computer screen, understanding and following directions, working with others, reading, or comprehending. Parents utilize screening approaches, too. They may have concerns about their child when they see their child in relation to other children in the neighborhood or when they compare their child to their knowledge about growth and development.School personnel conduct a variety of other screening activities. The school nurse arranges for students to have regular vision and hearing screenings. Educators review student attendance records and follow up on students who are not attending school on a regular basis. Classroom teachers administer group tests of school achievement and screen student scores to identify those students who show they are having difficulty. When screening flags children, the process moves to the next step.Step 2. Making a ReferralPrereferral decisions:?Questions about a student are referred to an assistance team, which usually comprises regular classroom teachers and special educators in the school building. The team may be a student assistance team (SAT), teacher assistance team, or intervention assistance team. In addition to questions about individual student behaviors or academic work, this team enables teachers, both regular and special education, to help one another with general academic or discipline concerns including making accommodations to instruction and assessment. During this stage, response to intervention (RTI) activities, usually occur, depending on the student's needs. When interventions are not successful, teachers document the interventions tried and the student responses in a written referral.Referral decisions: The IEP team, which is different from the assistance team, receives the written referral form. Based on the referral information about the student, the team recommends specific assessment approaches or assessment instruments to be used in determining eligibility.Step 3. Determining EligibilityTo determine student eligibility for special education services, the assessment questions focus on "Does the student have a disability? What disability does the student have? Does the student meet the criteria for services?" The purpose of this step is to examine the assessment information to make a determination regarding the student's eligibility for special education and related services according to state and federal (IDEA) guidelines for children and youth. As specified in IDEA, a multidisciplinary team conducts assessment for the purposes of eligibility. Thus, a student's assessment covers all areas related to the suspected disability including, if appropriate, health, vision, hearing, social and emotional status, general intelligence, academic performance, communication, and motor abilities. For example, a student who is nonverbal may have a multidisciplinary evaluation that includes meeting with (1) an audiologist to determine the extent, if any, of a hearing loss; (2) a speech and language pathologist to assess understanding of language (receptive language) and communication skills; (3) a special educator to assess academic and functional skills; (4) a vocational rehabilitation counselor to identify interests and abilities; and (5) a psychologist to determine intellectual functioning. The team will use various approaches, including, for example, observations, norm-referenced instruments, and performance assessments. The team will ask the student's parent(s) to provide information, too. All of these individuals work together to view and analyze the assessment information, with all contributing expertise from their respective disciplines.Team members share the assessment information during the IEP meeting and determine the student's eligibility to receive special education and related services. As active members of the team, parents may have questions and collect various types of information such as medical records or developmental history.Because the team bases its decisions on assessment information and data, they must choose and use appropriate assessment approaches carefully. Evaluators must have appropriate training, take responsibility in evaluating the adequacy of the approach, follow professional standards and ethical principles, and be knowledgeable about the limitations of specific approaches. In the chapters that follow we will discuss these approaches in more detail.Step 4. Program PlanningIn program planning, the assessment questions focus on "What should be included in the student's individualized program? If behavior impedes learning, what strategies, including positive behavioral interventions, should the team write in the plan? What supplemental aids, services, and assistive technology does the student need? What types of accommodations and/or modifications should team members make to the curriculum? Where should instruction begin? What supports for school personnel does the student need?" The purposes are to (1) determine the student's current level of functioning and (2) plan the instructional program. Much of the information gathered in Step 4 will be useful in planning the instruction and developing realistic goals. What should program planning include? Program planning includes assessing the student's current level of functioning and determining where instruction should begin. Members of the IEP team identify the special education and related services they will include in the student's program. The team plans accommodations and/or modifications to the curriculum and to the classroom environment. Team members utilize commercially published norm-referenced and criterion-referenced tests, checklists, observations, or curriculum-based assessments, as well as other assessment approaches.Connecting assessment with instruction: Connecting assessment with instruction is part of both program planning and Step 5, monitoring individual progress. Connecting assessment with instruction provides rich, ongoing information about a student's current level of achievement, which allows the teacher to make informed decisions regarding the student's instructional program. A teacher uses this type of assessment in planning daily teaching and learning activities to address the special needs of students. Good classroom assessment tells us more than knows it; doesn't know it.' It also tells us why. Connecting assessment with instruction is one of the most important aspects of the assessment process. In later chapters we will examine a variety of assessment approaches that link instruction with assessment.Step 5. Monitoring Individual ProgressThe purposes of this step are to determine (1) if the student is making progress and (2) whether to modify instruction if the student is not making progress. Teachers should assess the student's progress frequently. Information from this assessment step allows the IEP team members to modify interventions, teaching procedures, or materials if the student's progress is lagging.Step 6. Evaluating the ProgramProgram evaluation is a process used to assess (1) the progress the student has made and (2) the overall quality of the school program. To evaluate the student's progress, the IEP team focuses on the student's IEP. They ask, "Is the student meeting the goals of the individualized education program?" To address the overall evaluation of special education services, the questions focus on the achievement, as a group, that students accomplish in the program; the degree of satisfaction with the program as expressed by teachers, administrators, and parents; and the effectiveness of the program. The following section examines these two types of evaluation questions in more detail.Student evaluation:?This type of assessment helps evaluators make decisions about the success of the instructional program for individual students. The IEP team reviews the student's IEP at least annually to address any lack of expected progress, the results of any reevaluation, information about the student provided to or by the parents, or the student's anticipated needs. For children receiving services under an IFSP, family and evaluators must review the program every six months (or more frequently, if appropriate) and conduct the full evaluation annually.IDEA requires a reevaluation of the student's performance and educational needs at least every three years, or more frequently if conditions warrant a reevaluation or if the child's parent or teacher requests a reevaluation. The team reviews existing assessment information including (1) evaluations and information provided by the parent; (2) current classroom-based, local, or state assessments and classroom-based observations; and (3) observations by teachers and related services providers and considers the following questions: "Does the student continue to need special education and related services? What is the student's present level of performance and educational need? Does the student need any additions or modifications to the special education and related services to meet the annual goals?" On the basis of the review, and with input from the student's parents, the team decides what additional information it needs and what assessment approaches to use.Program evaluation: Program evaluation involves evaluating the overall services provided to groups of students or programs. Educators need to examine the success of programs offered to students, to replicate strong programs, and to refine or change programs that are not effective. Evaluation questions include: "Is the program successful? Are goals being met? Do parents feel satisfied with the services?" Information is collected in a variety of ways including aggregating assessment results of students who participate or have participated in the program; asking teachers, students, and parents to complete checklists or rating scales; interviewing current students in the program and their parents; or asking graduates of the school or program and their employers to complete questionnaires. 5.2. Psychosocial InterventionsPsychological Problems: children with motor and health impairments face tremendous amounts of stress as they begin to understand their impairment and how it will impact their future. Fear, anger, and uncertainty are common reaction and can result in psychological disorders such as depression.Social problems: children with motor and health impairments are subject to social alienation from their peers and often have difficulty developing and maintaining friendship. Because of frequent school absence, treatment side effects, and negative peer perceptions children with medical conditions often face tremendous social obstacles. Peer relationships require both opportunity and social skill. However, students with health impairments often have fewer opportunities to socialize with their peers as a result of time away from school. When they miss school, they also miss opportunities to establish social network and classroom connections. Upon returning to school, students with health impairments often feel segregated from the school culture. Furthermore, without peer interaction, children fail to develop appropriate social skill, making them less appealing to other children. The school counsellor, teachers, students without disabilities, their parents should work in cooperation to maximize the psychosocial functioning of students with motor and health impairments. 5.3. Educational Interventions Children with motor and health impairments are served in a wide variety of education settings, ranging from regular classrooms to homes and hospitals. Generally, the educational programs of children with motor and health impairments are often similar to those of the non-disabled. Modifying the environment: Teachers of children with motor and health impairments should adapt equipments, schedules, or settings so that their students can participate in educational and recreational activities. The following are some of the adaptation techniques which are applicable to schools setting.Changing desk and table tops to appropriate heights for students who are very short or use wheelchairs.Adding adaptive devices (rubber bands, plastic wedges, plastic tubing) to writing instruments to make them easier to grip.Moving a class or activity to an accessible part of a schools building so that a student with a physical impairment can be included. Adapting Instruction: Some of the suggested common modifications that teachers can make to help students respond to academic tasks. These include: Writing in a loose-leaf notebook, spiral-bound notebook, or pad of paper, rather than on a single loose sheetSecuring papers to work areas with tape, clipboards, or magnets.Placing rubber strips of pads on work materials (rulers, calculators, science equipment) or private slipping during use.Adding adaptive devices (rubber bands, plastic wedges plastic tubing) to writing instruments to make them easier to grip. 5.4. Physical InterventionsSpecial devices and appliances: May children with physical disabilities use special orthopedic devices to increase their mobility and help their bone, joints and muscles develop. Some of the important special devices include:A. Prosthesis: - are artificial replacements of missing body part (arm or leg).B. Orthosis: - is a device that enhances partial functioning of a body part such as long brace.C. Wheelchair locomotion:- is prescribed by a physician for individuals who are unable to ambulate or for those whose ambulation is unsteady or unsafe.D. Adaptive devices: - these are special eating utensils such as forks and spoons with custom designed handle, or straps. Teachers and school administrative bodies are expected to provide support services for children with physical disabilities by doing each of the following. Make the classrooms, play grounds, the school compound and other service areas accessible for students with physical disabilities. Encourage and motivate students who use wheelchair, brace and other adaptive devices that may replace body functions. Avoiding actions that taught feelings of them easily; advise them to take some physical exercises; and give them chance for participation in the classroom and other social aspects Design adaptation in buildings, furniture, household appliances, and clothing can make it possible for someone with a physical disability to function as efficiently as a nondisabled person in home, school, or community. Children with physical disabilities may be educated in any one of several settings, depending on the type and severity of the condition, the services available in the community, and the medical prognosis for the condition, be most are in regular education setting. Today, most children with disabilities are begin integrated into the public schools because of advances in medical treatment; new developments in bioengineering; allowing them greater mobility and functional movement; decrease in or removal of architectural barriers and transportation problems; and the movement toward public education for all children. But in our country the above mentioned indicated environmental conditions are not improved. It requires high public awareness and government and nongovernment organization emphasis in all construction to admit all physical disabilities. 5.5. Evaluation of the above Intervention Practices in Ethiopia (Left as self exercise)Unit 6: Students with physical Impairments in the Regular Schools(Left as group assignment written report and presentation about Ethiopian school practices for the treatment of students with physical disabilities) ................
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