Orthopedic Impairments

By: Melanie Tangunan


Sandra, an energetic seven year old, has been wheel chair bound for most of her life. Unlike many other kids her age, she longs to be able to run, walk, and participate in many physical activities. Her mobility is dependent on assistive devices such as her wheelchair. She enjoys school is able to cognitively learn like many of her other classmates.

An Orthopedic impairment is the term used to define any sort of bodily impairment, regardless of cause, that is severe enough to negatively affect a child’s lifestyle and academic performance.
Orthopedic impairments are divided into three main categories:
  • neuromotor impairments – damage or abnormality to one’s brain, spinal chord, or nervous system. (Examples: cerebral palsy, spina bifida)
  • degenerative diseases – various diseases that affect motor development (Example: muscle dystrophy)
  • musculoskeletal disorders – a variety of conditions that result in physical limitations (Example: juvenile rheumatoid arthritis)

In the United States, approximately 68,000 students, receive special education services based on a classification of orthopedic impairments.

Describe Characteristics of Students
Because of the wide variety of orthopedic diagnosis, impairments have a wide range of characteristics. Some characteristics may include:
  • slurred speech
  • body pain and discomfort
  • fatigue
  • poor sleep quality
  • constant absence from class
  • limping
  • limited or lack of ability to accomplish a particular motor movement

Types and Severity of Orthopedic Impairments
There are a variety of orthopedic impairments. Each impairment has varying degrees of severity. Generally, students with orthopedic impairments have limited physical mobility,: sensory or coordination problems, muscle weaknesses, and speech impairments. Listed below is a list of are some common orthopedic impairments:
  • Cerebral Palsy - A disorder caused by damage to the bran that affects both gross and fine motor skills.
  • Muscular Dystrophy - This disorder happens when muscles progressively weaken until they cannot function.
  • Spinal Muscular Atrophy – This diseases affects the spinal chord and causes the degeneration of the motor nerve cells. Characteristics of Spinal Muscular Atrophy include fatigue and clumsiness.
  • Polio – A disease caused by a viral infection that leads to paralysis
  • Spinal Cord Injuries – This condition is caused by accidents that can lead to paralysis.
  • Spina Bifida – A congenital defect that occurs when of parts of the sine do not grow together.
  • Multiple Sclerosis - A progressive disorder that impacts the muscles. In this condition, nerve impulses sent to the muscles are short circuited due to scar tissue. A person may experience problems that include visual impairment, speech disorder, loss of bowel and bladder control, and paralysis.
  • Rheumatoid Arthritis – This condition is characterized by fatigue and joint aches.

How do these learners receive their education?
Many students with orthopedic impairments are able to gain an education similar to most learners. Accommodations must be made in the classroom. Depending on the learner’s disease diagnosis, frequent visits to health professionals are necessary.

Assessments doing_homework.jpg
It can be difficult to evaluating children who have orthopedic impairments because there are so many different types of impairments and causes: Some assessments conducted are as follows:
  • A thorough medical evaluation of the child's orthopedic impairment that assess specific motor and gross functions, neuromuscular development, and senses. Usually, in order to be considered an orthopedic impairment, symptoms and disabilities must last atleast 60 days.
  • Documentation of observations of a orthopedic impairment symptoms and how they affect a child’s ability to learn, move around, and conduct daily activities. These documentations may be in the form of checklists, inventories, rating scales, and interviews with those who know the child best.

What are best educational practices? Strategies for Curriculum and Instruction:
The best practices to apply when teaching a student with an orthopedic impairment is to teach using sense that has not been affected by his/her disability. This will allow students to be able to experience the process of learning and be able to attain new information in method that is comfortable. Educators need to be aware of the students’ physical limitations and proactively enable classroom accommodations suitable for his/her needs.

  • Ensuring enough room for the student to move freely or sit comfortably in the classroom
  • Focusing instruction that helps to develop their motor and gross skills
  • Utilizing appropriate communication and assistive devices.
  • Taping lectures/class discussions.
  • Being aware of a student’s medical condition, how it affects the student, and accommodating their specific needs.
  • Securing suitable augmentative communication and other assistive devices
  • Awareness of medical condition and its affect on the student (such as getting tired quickly)
  • Working with physical therapists, occupational therapists, speech-language pathologists, and other various therapists to develop an education program beneficial to the student.
Inclusive Practices
  • Peer/buddy system
  • Arrange additional personnel to assist the student in the classroom
  • Use alternate exercises
  • Allow more time for homework/class work completion.
  • Attain assistive devices
  • Ensure easy access for student materials
  • Include the student
  • Use ramps when necessary
  • Lower the chalkboard/dry erase board
  • Use visual, audible, or tactile cues
  • Provide a continuum of severity or extent possible in youngsters

Listen to Utawna Leap talk about her seven year old daughter's Cerebral Palsy and how teachers include her in the general education classroom: Lianna's Cerebral Palsy

Special Challenges for General Education
Due to the many natures that characterize orthopedic impairments, students can face numerous educational challenges. Orthopedic impairments greatly affect one’s fine and gross motor skills making which can make it very difficult for students to navigate around the classroom, perform simple classroom tasks, and participate in many activities. Additionally, one may experience pain and/or fatigue making it difficult to sit in class.

Accommodations: Assistive Technology
  • Screen reading software
  • Speech recognition software
  • Communication devices
  • Specialized exercise equipment
  • Specialized chairs, desks, tables, etc

Meet Shelby Nurse, a 19-year old university student with cerebral palsy, whose life has changed due to the use of assistive technology: Shelby Nurse: Assistive Technology that Changes Lifes

Wraparound Services:
Adaptive services are available through community health or educational programs.

Impact: Is this a school issue or life issue - Why?
Orthopedic Impairments are both school and life issues. The use of fine and gross motor skills affect every facet of life. In any situation, students with orthopedic impairments will have to face their limitations use adaptive measures to experience the world, learn, and carry on daily life activities.

Impact: How does this affect home?
Orthopedic impairments affect the home in similar ways that it affects the school environment. At home, adaptive measures need to be made to ensure that that individuals are able be as independent as possible. At home, individuals will still need to be able to navigate around and have access to their needs. Pain and fatigue will occur even at home and impact one’s ability to function.

Name of someone who has achieved greatness
  • President Franklin Roosevelt (January 30, 1882 – April 12, 1945) – The 32nd U.S. President. The only president to be elected for more than two terms. He suffered from polio.
  • Stephen Hawkins- (Born 1942) A world renowned physicist, professor, and author. He is currently the Director of Research at the Centre for Theoretical Cosmology in the Department of Applied Mathematics and Theoretical Physics at the University of Cambridge. He suffers from Lou Gehrig’s Disease, a condition that has left him almost paralyzed.
  • Joni Erickson Tada – A current Christian evangelist, author, and speaker. She suffered a spinal chord injury due to a diving accident when she was 17. She has been a quadriplegic since.
  • joni_erickson.jpg

What can you do to make a difference for the child?
  • Offer aid to a student needing it.
  • Help educate others so that they can understand orthopedic impairments and learn to and accept physically disabled students
  • Be familiar with safety and assistive devices.
  • Allow students to participate in all activities, including field trips, special events, and projects.
  • Ensure that students have full access to classrooms, walkways, etc.
  • To ensure their full participation in the class, make sure they have full access to the classroom; be aware of common items that can be barriers, such as a narrow walkway or a heavy door.
  • Remember that most orthopedic impairments do not impair one’s intelligence

What can you do to support parents?
  • Communicate frequently
  • Be educated about organizations dedicated to helping support and give assistance to parents.
  • Provide a quality education for students using accommodations
  • Understanding the categories of orthopedic impairments
  • Utilizing resources to help students achieve success.
Links and Resources
Special Needs Parenting
Orthopedic Impairments
Education.com http://www.education.com/reference/article/orthopedic-impairments/s
Disabled World

Strategies for Teaching Students with Motor/Orthopedic Impairments
Project IDEAL http://projectidealonline.org/orthopedicImpairments.php