GUIDE FOR TEACHERS

DEALING WITH CHILDREN WITH

MOTOR DEFICIENCY

FOREWORD

The consequences of motor deficiency are varied and so are its causes. Contrary to popular opinion, people with motor deficiency are not automatically confined to wheelchairs or limited by their physical problems. Motor deficiency affects the educational as well as social and professional life. It requires careful observation and attention to the children or teenagers who are concerned, a regular dialogue with the parents and collaborations between the different professionals (teachers, nurses, educators, re-educators). These are for better integration of students in the schools, designed for the inclusion of all and for their future participation in a social, civic, economic and cultural life. When we want to adapt the school to these children, we immediately think, in general, of easing the physical constraints, which can cause problems, for example, to access some parts of the school. Because we lack information, we are less aware of the obstacles motor-deficient children must overcome during their studies. In fact, the perceptive, cognitive or psycho-affective difficulties caused by the problems associated to motor deficiency are not obvious. But, they concern a large number of these students, particularly the ones with cerebral lesion.

The objective of this guide is to sensitize the teacher to these questions and to offer adaptations to solve the problems caused by these pupils. This supposes to present a large number of difficulties they might meet. The listing of these mustn’t let us think they are inescapable. When they exist, they can be great but in many cases, they are discreet or transitory and even more so when they have been taken into account at an early stage. In addition to the diversity of pathologies comes the diversity of people: each child or teenager is different, irreducible to a typical portrait. Furthermore, the nature of the child’s problems doesn’t allow us to prejudice exactly his chances of success because they depend, for him as for the others, on his abilities, the situations he faces, the experiences he lives and the tasks he’s asked to do. It’s advisable to promote the possible adaptation to overcome the negative effects of motor deficiency and to favour the highest possible level of school success in ordinary schools for pupils with such deficiency.

Contents

Characteristics of motor deficiency ......................................................…p. 51. Motor attacks……………………………………………………….p.61.1 Motor-deficiencies with a cerebral origin………………………..p.61.2 Motor-deficiencies with medullar and/or neuro-muscular origin ………………………………………………………………………p.8

1.3 Motor-deficiencies with osteo-articular origin…………………..p.102. Problems linked to motor-deficiency……………………………....p.11

2.1 Epilepsy…………………………………………………………….p.112.2 Neuro-psychological problems……………………………………p.112.3 Psycho-affective aspects…………………………………………...p.12

Elements to take into account when planning school integration………p.141Contributions to install……………………………………………p.141.1 Professionals in charge of care, rehabilitation and specialised education…………………………………………………p.141.2 Specialised teachers in charge of supporting integration……...p.151.3 Integration auxiliaries and educational assistants……………..p.161.4 Other actors’………………………………………………………p.162. Developments to foresee………………………………………….p.161.1Transports………………………………………………………..p.161.2 Moving around the school……………………………………….p.171.3 Installation in the classroom…………………………………….p.171.4 Material used…………………………………………………….p.181.5 School time ………………………………………………………p.181.6 Testing……………………………………………………………p.182Support through computers……………………………………..p.193.1 IT to increase the pupil’s autonomy……………………………p.193.2 IT to prepare adapted pedagogic documents………………….p.203Elaboration of the individual integration project……………...p.213.1Characteristics of the individual integration project………….p.213.2Individual project and integration convention…………………p.213.3Questions to ask yourself before elaborating individual project……………………………………………….p.21

Adaptation of the teaching…………………………………………..p.231. Common adaptations to teaching situations……………………….p.233.4Class activities needing skilled gesture………………………….p.233.5Complex visual information uptake…………………………….p.24

3.6 Work organisation………………………………………………p.252. Fundamental learning…………………………………………….p.272.1 Reading……………………………………………………………p.272.2 Writing. …………………………………………………………..p.282.3 Counting and calculating………………………………………..p.323. Physical education and fine arts…………………………………p.353.7Physical education……………………………………………….p.353.8Musical education………………………………………………..p.393.9Fine arts…………………………………………………………..p.41

Further information1. Books4Specialised magazines5Pedagogic articles6Films7Associations8Internet sites9Other sources of information10Where to find material

CHARACTERISTICS OF MOTOR DEFICIENCY

Motorbility is the function, which maintains posture and produces movement: voluntary, automatic and reflexes.Its alteration affects very diverse areas of activity. As a result the problems for a child with motor deficiency are not always limited to moving around, posture, the picking up and manipulation of objects, or writing. They can equally manifest themselves in important circumstances in education, for example, to explain orally or to look at someone or something attentively. In fact, motor activity is present when we speak. Speech engages a series of precise movements in the vocal cords, larynx, glottis, and the tongue and in the action of looking, because it is the eye movements, which allow the reading child to understand a text or an image.

The global prevalence of child motor deficiency seems to remain constant. It is estimated, in France, at 3.24 per thousand, but it only includes the deficiencies of children and teenagers who are dealt with by the Departmental Commission of Special education (CDES): ref. the educational guide for teaching handicapped children or teenagers. They do not therefore take into account mild deficiencies.

Motor deficiency is the loss or alteration of a mental or physical structure or function.It can result from an attack on the nervous system, which can affect the central nervous system, comprising the encephalon and the bone marrow or the peripheral nervous system, which links the spinal cord to the organs, especially muscles via the peripheral nerves. Motor deficiency can be an attack on the muscles or the skeleton.

Disability, which is a consequence of deficiency, is the reduction, to a greater or lesser extent, of conscious and voluntary motorbility, causing a partial or total reduction in the ability to accomplish a task: for example, the inability to move around without a wheelchair, to read or write without a technical aid.

Disadvantage, caused by the deficiency and the disability, comes through the limitation or inability to achieve a normal social role: to work, to have leisure, etc.

According to the international classification of handicaps, the handicap is the result of three elements: deficiency, disability and disadvantage. But handicap isn’t independent of the environment to which the person with motor deficiency is confronted. Whereas rehabilitation, apparatus or surgical interventions reduce the

inability, the teaching, by adapting the situations and pedagogic stages, contributes to reducing the child’s handicap.

1. Motor attacks

The attacks on the motor function are variable: sometimes unnoticeable, sometimes leading to impotence, can be present at birth or be noticed sooner or later, be changing or stable. We can add those that cause the deficiency, the diversity of the problems associated to motor attacks, as well as the peculiar way which each child or teenager lives and experiences his handicap. Therefore, the different motor deficiencies constitute a heterogeneous group, which can be described by numerous criteria: - According to when the lesion happened: genetic or acquired deficiency- According to the cause: by malformation, traumatic injury, and illness...- According to the changing or not character of the deficiency- According to the nature of the attack. This criterion, which we retain here, allows distinguishing 3 major types of motor deficiency: The motor deficiencies with cerebral origins, those with a medullar origin and those caused by osteo-articular lesion.

1.1 Motor deficiencies with a cerebral originThey are caused by very early lesions of the brain region which leads to motor disabilities with a brain origin properly called (IMC, IMOC), or they are due to attacks happening much later, through cranial trauma, brain blood clots or brain tumors. Neurological attacks, once fixed, do not change anymore. Only the nervous command and the regulations are wrong at the beginning, leading to problems of muscle tone, of the automatic regulation of movements and their voluntary control- paralysis, involuntary movements. The motor performers (muscles and skeletons) are not affected but they can suffer from secondary deformation linked to growth. It is the prevention of the subsequent aggravations, which motivates numerous apparatus and surgical interventions until the end of the growth.

Cerebral motor disabilities:According to a survey done by the Departmental commission on Special Education, cerebral motor deficiencies resulting from an attack taking place before, during or slightly after birth, have a rate of 1.12 per 100 births.We can distinguish 3 clinical types: spasticity, athetosis and ataxic syndromes.

Spasticity:

It’s characterised by the lack of control of motor reflexes normally controlled by the pyramidal cortex which is damaged. Difficulties to stand, to contract or relax muscles lead to a greater or lesser slowness of movements. Passive stretching, the cold and the emotions worsen the inflexibility. There are 3 predominant spastic attacks: - Quadriplegia: this is often a serious attack of the 4 limbs and the trunks. - Diplegia: or LITTLE syndrome, often caused by premature birth. The motor disorder is predominantly on the lower limbs. - Infantile cerebral hemiplegia: this is a unilateral cerebral attack- a leg and an arm on the same side.

Athetosis:It results from an attack on the grey matter. It’s characterised by involuntary movements, low, rhythmic irregular and of small range. The movements are particularly problematic when they affect the face and disturb the speech. On a disturbed muscle base, the athetosic subject has difficulties to develop an intentional adopted movement- the range is exaggerated or blocked by contractions.

Ataxia:More rare, it is due to a lesion of the cerebellum. It’s characterised by problems of balance and walking as well as problems of co-ordination.

It’s necessary to add to the diversity of the categories usually described, the diversity of the individuals. Thus, the neuro-motor problems, which affect them, are sometimes intricate: spasticity and athetosy can for example join together in remarkable ways. Equally, the term describing the type of attack can hide a more complex reality: the hemiplegia of a child can be accompanied by smaller problems on the other half of the body and the diplegia does not necessarily affect the 2 lower limbs in the same way. As a result, there are strong individual differences. One child can have little difficulty to walk while another has to use a wheelchair. Neuro-motor problems are often associated with neuropsychological problems or even psycho-affective ones. See pages 11 and 12.

Cranial trauma:Every year, hundreds of children and teenagers are victims of serious cranial traumas, as a result of traffic, sport or domestic accidents. Because of the bone structure, the localised cerebral lesions by failures or contusions are less frequent than the diffuse attacks due to shock to the brain mass.

Violent shocks generally provoke a loss of consciousness and coma. The prognostic for recuperation varies according to the severity of each diffuse lesion and their link but also according to the duration and depth of the coma. Usually, there are four evolution steps:- The coma itself: the child or teenager is in intensive care.- The awakening: he’s then transferred to the rehabilitation service. His attention fluctuates; he’s tired and very easily tired. He usually shows problems with superior functions and motor difficulties.- Recuperation: following rehabilitation, we notice a regression of motor problems, varied but still more important than that of neuropsychological problems.- The check-up: done less than 2 years after the accident. After a period of progress, follows a phase where he doesn’t recuperate anymore: his situation is steady. The after-effects are established and he must learn again with them. The after-effects are very different from one person to another. In most cases, the motor recuperation is good. Psycho-affective problems often linked to neurological defects, can lead to behavioural and mood problems. See page 13.

1.2. Motor disabilities with medullar and/or neuro-muscular origin- Medullar lesions due to a trauma or an illness:They can result from a spinal cord trauma or a lesion with an infectious, vascular or tumorous cause. The defects are due to problems with the conduction of motor and sensorial impulses.The paralysis of the limbs, which is the inability to make voluntary movements, increases when the level of damage to the spinal cord is high. If the subject is affected at the level of the upper limbs, he’s tetraplegic; in the lower limbs, he’s paraplegic. When the spinal cord is completely damaged, the impulses from the brain to the muscle are blocked: paralysis of the muscles below the lesion is complete. If the spinal cord is not completely destroyed, impulses may pass to a greater or lesser extent depending on the severity of the lesion. Sphincter problems, needing regular urinary catheters and problems of sensitivity, causing bedsores, are characteristics of disabilities with medullar origin.

- Medullar lesion due to genetic malformation:This is an abnormality in the development of the spinal column present in 0.5 cases per 10,000 births in France.

It results in a bone malformation characterised by a fault in the closure of the rear part of the vertebra, dorsal or lumber, which leads to a hernia of the meninges and of the extremity of the spinal cord, which is called myelocele. We note that:- The motor nervous fibres travel to the skin instead of going to the muscles of the lower limbs, which causes a paraplegic paralysis as well as of the sphincters, which can lead, more or less, to incontinence. - The sensitive nervous fibres are not connected to the skin receptors or to the profound organ receptors. Someone who’s insensitive in the areas under the spinal bifid, is subjected to bedsores. The abnormality located in the lower part of the spinal column frequently comes with another malformation situated at the base of the skull leading to a defect in the flowing of the spinal cephalon. This can lead to hydrocephalus if a catheter and a valve allowing circulation are not put in place at an early stage. In this case, cognitive disturbances can occur.

- Neuro-muscular illnesses:Today, they gather a dozen diseases, which are mainly of genetic origins. They are changing diseases, which, for most of them, lead to a progressive reduction of the contraction force of the voluntary muscles, that is a loss of muscular strength. The affected children or teenagers are easily tired. The motor deficiencies they lead to are associated to problems in the motor unit linking the motor neuron, the synapse and muscular fibre. (See figure below). There are attacks of the muscular fibres- myopathy- of the muscular junction- myasthenia- of the peripheral motor nerve- Charcot-Marie-Tooth diseases- and of the shaft of the motor nerve- motoneuron- situated in the anterior horn of the spinal cord- infantile spinal muscular atrophy. If taken in hand early and using technical aids, it limits the vital and functional consequences of these diseases, which lead to various problems: orthopedic deformities, respiratory and sometimes heart failure, deglutition and digestive problems.

(Figure) The motor unit and neuro-muscular diseases.

Muscular distrophy of Duchenne de Boulogne It’s a hereditary disease, which only attacks males. It’s the most severe and most frequent of muscular dystrophies- 1 cases per 3,500 male born.

It can be the result of a genetic mutation, but more often results from the transmission of a pathological gene carried by unaffected mothers to their son. The illness is characterised by an absence of a protein, the dystrophin, which normally consolidates the fibres of the muscular membrane. As a result, damaged muscles cannot repair and the muscles progressively atrophy. Walking problems appear around the age of 3. The motor disability progressively worsens. Little by little, the child can’t get up by himself, climb stairs and walking becomes impossible at 10-12 years old. The muscle weakness, first limited to the root of the lower limbs, affects the trunks and the upper limbs. Movements must be by electric wheelchair and writing with the help of a computer. At an advanced stage, respiration is made possible by a respiratory rehabilitation and assisted pulmonary ventilation. Treatment calls on medicines, appliances, and multiple rehabilitations, including physiotherapy to limit severe skeleton deformity.Life expectancy is tied to cardiac complications more than to respiratory attack, which is maintained through care. There is a very similar illness on a psychological and genetic scheme called Becker dystrophy, which appears later and develops at a slower pace.

1.3. Motor deficiencies with osteo-articular origin They can result from malformation (absence or abnormality of a limb, malformation of joint), from a problem in the bone formation (imperfect osteogenesis...), from rheumatism lesion (rheumatoid arthritis), form infectious lesions (osteitis...), from spinal deviation (scoliosis, kypho-scoliosis), from accidents, leading to imputation, intra-joint hemorrhage for the homophiles. These motor deficiencies, sometimes severe and painful, don’t have neurological after-effects.

The imperfect osteogenesisIt’s a genetic disease characterised by brittle bones. It leads to early apparition of many spontaneous fractures with different after-effects. Imperfect osteogenesis has many names: glass-bone disease, Lobstein disease or Porak and Durante disease. It has many different forms of severity. It affects girls as much as boys, 1 case per 15,000 births. It’s due to the absence of collagen, the main protein for the formation of the bones. Sometimes, it occurs at birth. More often, it comes when learning to walk. The falls, due to these first trials and which have no consequence for other children, lead to repeated and severe fractures needing surgery, immobilisation and rehabilitation. The children are quite often thin and small, but their situation

improves with their age as the frequency of the fractures decreases progressively with puberty. It’s estimated that 80% of the fractures happen before 18 years old.

Apart from these 3 types of motor deficiencies, with cerebral, medullar and/or neuro-muscular and osteo-articular origins, they are other motor deficiencies, which can’t be classified because linked to many origins, for example, multiple genetic arthrogryposis.

2. Problems linked to motor deficiencies

At school, the learning difficulties for motor-deficient children or teenagers are more linked to the deficiency than to the physical disability as such. These problems, which are not proportional to the visible motor attacks come mostly with deficiencies of a cerebral origin. Apart from slowness in schoolwork, there are problems due to epilepsy and also due to neuropsychological or psycho-effective

2.1 EpilepsyIt’s a disorder of cerebral excitement, which can generate convulsive crisis. The cerebral lesions can cause a lower threshold of nervous excitement. Physiologic or physiological stress can create a large and synchronised neuronic discharge: this is the epileptic crisis. To avoid it, some pupils must take anti-convulsive medication daily.

2.2 Neuropsychological problemsThey can result from cranial trauma with the loss of some functions already in place. They can be development disorders due to the difficulty to put a function in place because of an early brain lesion in the case of motor cerebral deficiency. These disorders, in this particular field, shouldn’t be understood as intellectual deficiency.They are mainly:-Praxic problems, that is to say gestures that make the child clumsy especially to manipulate objects, to write or draw.-Neurovisual problems, which can effect:* visual motorbility. They are particularly noticeable in an IMC premature child. They are major characteristics of visually- spatial dispraxy- see p.12* visual recognition of people, objects and images.-Language disorder, written and spoken, which disturb schooling and socialising.-Memory disorder: frequent with children and teenagers who have had cranial trauma.

-Problems with cognitive functions, which are the execution functions, used to make and control difficult tasks. They imply defining objectives, planning the actions in space and time, adapting strategies, keeping attention and control to lead the actions to their goal.

Visually spatial dyspraxia

This is a poorly known disease affecting mainly IMC formerly premature children. The symptoms give false interpretations: the learning difficulties it induces cannot be taken for intellectual deficiency or explained by psycho-effective problems. We have to look into praxic problems and more specifically to visual-spatial problems to find solutions.We can’t talk about mental retard ness for these children but about cognitive dis- associations: they fail gesture and spatial tests but perform normally, according to their age, in verbal, memory, conceptual tests, requiring reasoning.

Praxic difficultiesPraxic problems affect the ability to program and plan movements, which make a complex gesture. Activities requiring manual skill and meticulous co-ordination, such as writing, tracing or cutting, are a source of difficulties.

Visio-spatial problemsThe eye- sight has an essential in the spatial construction, particularly for topological relations, allowing the location of one object in relation to another.The problems of sight organisation are characterised by a difficulty to stare at an object, to explore a visual field, and to follow a series without discontinuity. For these children, these eye-motor dysfunctions result in a different visual perception: as if this visual information was taken randomly. They have difficulty to find a link between all these « flashes » and scattered elements to make a coherent globality.

2.3 Psycho-affective aspectsMotor deficiencies are likely to have psycho-affective consequences and some are specific to a particular attack:*The IMC are emotional.*The paraplegic might have problems because of his sphincter situation and its constraints: insecurity, loss of self-confidence linked to the social effect of uncontrolled urination as well as affective dependence linked to care dependence.*In cranial traumas, the psycho-affective problems linked to neurological problems can lead to depression or, on the contrary to excitement or instability. There are

also in adapted behaviours, such as isolation, anger, loss of emotional control, misplaced speech and gesture.The deficiency’s reactional disorders and the painful memory of the accident can generate, in a child or teenager, many defense mechanisms like withdrawal or denial of realities.Cranial trauma can lead to major psychological shock when the child or teenager realises he’s different and to mood changes as well as loss of control- bad language for example.

Generally, only trauma, which break the normal existence can lead to psychological difficulties and possibly be worsened by the separation from the family.It would be a mistake to try to associate to each type of deficiency some specific psychological characteristics, shared by all the disabled, as much as to give a universal psychological portrait of someone with motor deficiency. But, not being able to do the same as the able bodied (not being able to run) and to be dependent is difficult to live with. Also, the future is a source of concern, the choice of job for example. In the world, the motor deficient person meets obstacles and the impotence can lead to frustration, insecurity and incompetence. Self-confidence is often lacking.But the psychological consequences of deficiency are not the same according to the people because they are linked to personality, individual history, and the relationships with surroundings, especially the family. The role of professionals and of teachers in particular is essential: with understanding of the child or teenager’s difficulties and possibilities and with their competencies, they can contribute to the success of schooling and the individuals development.

Motor deficient pupils are heterogeneous. We can however define some common characteristics:-the importance of early diagnosis and beginning of therapeutic care can influence the future.-the frequent worsening of motor problems, linked to growing during adolescence, independent of the natural development of the pathology. Adolescence is in fact a particularly difficult passage physically and psychologically.- the frequent association of neuropsychological and neuro-affective problems.- the fair place of care and rehabilitation which has consequences on daily and school life leading to greater or lesser tiredness.- slowness to move around and accomplish school tasks.- the presence of intellectual abilities allowing learning, with adaptations at a standard level, despite motor deficiency.

-generally the consequences of the deficiency in the child and families’ life especially in serious and changing diseases.- finally, hope in the school implies a commitment to the integration, which doesn’t exist without effort from the child or teenager and from his family.

ELEMENTS TO TAKE INTO ACCOUNT WHEN PLANNING SCHOOL INTEGRATION

In ordinary schools, as much at primary level as at secondary, the reception of pupils with motor disabled pupils is widespread. They are proportionally more often integrated than other types of handicap, sensorial or mental.The success of the integration demands advanced and continued collaboration between the different people involved. It equally needs to take into consideration the particular constraints on the daily life of the integrated student to guarantee the quality of the reception. In fact, it is important to anticipate development aids for each case, adapted to the child or teenager’s situation and to the character of the school, which receives him.Beyond these developments, we should underline the fundamental role taken by information technology for the population concerned. These are the elements, certainly not exhaustive, which constitute the factors governing successful integration and which must be taken into account in the integration of each pupil.

1. Contributions to install

The introduction of a child with motor disability does not just involve the teacher or team of teachers who receive him in their class. It concerns the whole school establishment, under the responsibility of the director, principal or headmaster. It needs a plan and the continued commitment of the educational team (ref. Handiscol’ guide for the education of disabled teenagers and children). We will mention here the essential role of the doctor, school nurse, and in secondary school the main teacher. But other collaborators are important.

1.1 Professionals in charge of care, rehabilitation and specialised education.Specialised or general doctors, physiotherapists, occupational therapists, speech therapists, eye therapists, specialised teachers and psychologists can help the child or teenager. Either in special education and homecare, SSESAD, (ref. Handiscol’ guide for the education of disabled teenagers and children), or in a medical or medic-educational establishment, or even, for others, in a free setting, asked for by the families.

They participate in thinking out a better reception, preparing appropriate adaptations and developments, contributing to determining the priorities, evaluating the constraints and resources generated by the disabilities and competences of the child or teenager. They are under the particularity of professional secrets.

1.2 Specialised teachers in charge of supporting integration.Frequently, specialist teachers, holders of CAAPSAIS option C, can be involved to benefit a better integration. They are linked to an SESSAD or to an AIS inspection of the National Education. For the students or teachers, they have the roles:- to inform on the consequences of disability in the child’s school as well as his daily and social life- to give practical advice concerning development of the premises, the place of the pupil in the class in relation to different sources of information, technical aids, adaptation of documents-to propose developments in the tasks and work rhythm-to promote pedagogic developments-to practice support, on methodology or apprenticeship in particular-to give advice as to the educative attitude to build in relation to the child and his family-to actively participate in the development of the individual project for each pupil-to promote information exchange and thought between the different professionals, as well as the coordination of their activities.

1.3 Integration auxiliaries and educational assistantsIntegration auxiliaries, recruited by local associations or collectives, intervene when human aid is needed to accomplish certain tasks in daily life, such as moving around, taking notes, going to the toilet.The integration auxiliary accompanies and helps the pupil in the school and extra- school activities. They contribute to promoting his socialisation and autonomy and ensure that he benefits from the optimal conditions of comfort and safety to study (ref. Handiscol’ guide for the scolarisation of disabled children and teenagers).They promote complementation and cooperation with all involved. Their place is delicate, because they must neither build a wall between the child or teenager and his family or teachers, nor replace them, but offer necessary sufficient support.

Educational assistants, recruited by the National Education in the framework of young employee contracts, can be asked to help with integration, individual or collective, of disabled pupils. Their mission of support can go beyond school time, during breaks, meals, outings and extra-curricular activities.

We must in all cases take into account that many disabled children or teenagers only need a third party punctually or for limited periods.

1.4 Other actorsAll students are encouraged to welcome those with motor deficiencies. The relations of reciprocity and solidarity, which they maintain with them, constitute a concrete exercise of their citizenship. Far from being damaged by the presence of this pupil, they can, on the contrary, benefit from certain pedagogic developments introduced for their classmate.The parents of the child live daily, sometimes painfully, with his handicap. That leads them to play the role of material and moral support always determining and allows them to know the difficulties that he encounters and the resources he has. From this point of view, they strongly contribute to the success of integration. It is therefore essential to provide the parents with all necessary explanation, to listen to them- as to the pupils- and to try to understand their anxieties and questions. When for example, after a positive nursery school integration, there are associated problems, which might block learning, it is normal that parents’ worries are as big as the hopes they have put in the school.Moreover, collaborators can establish with locally identified resources (ref. other sources of information, p.47 of this guide).

2. Developments to foresee

Material aspects deserve particular attention because they drive the reception. They are considered from a double point of view:-that of lifting fundamental obstacles- hindrance of transport school/ home, access to the school, following of care, access to toilets, comfortable working conditions- without which the presence of the child in the school would be impossible.-that of the development of autonomy and social interaction.

2.1 TransportFollowing the general guidelines of the Handiscol’ guide into the schooling of handicapped children and teenagers, three solutions are possible for transport from home to school:- access to collective methods of transport- individual or collective use of adapted vehicles- transport by parents, with the aid of CDES or department.It is important, wherever possible, to assure regular and reliable transport and avoid extra fatigue.

2.2 Moving around the schoolThe lack of autonomy in moving around or the need for adaptation is often obstacles to reception.Even if, because of the layout of the building or the nature of the handicap, the building is more or less accessible, the adaptations needed are often achievable- transfer of the pupil’s class to the ground floor, installation of a ramp..... These adaptations must be anticipated early enough so that the move from one school to another can be done better, for example during transition from nursery to primary school.We must pay attention to the access to communal locations (library, dining hall, gymnasium) and specialised rooms. The solutions must be made case by case, respecting safety rules.For the toilets, an adapted toilet must be considered, with bars, a swing door and an accessible light switch. Human assistance needs to be considered if necessary.We also note that the transport of school material between classes, or home and school, as well as sorting the school bag can become difficult or impossible. The help of a friend or an educational assistant, buying two sets of books, having material on disk, can provide solutions.

2.3 Installation in the classroom*Situation of the pupil in the classroomThe pupil must be in front of the board- even if in a wheelchair- not isolated from his friends, and able to get the teacher’s attention. These constraints have to be reconciled with those technical aids provided- adapted tables, computers. In the case of small group work, the position of the child must help exchanges with other pairs.*Work areaWorking with an occupational therapist, from for example SESSAD, allows the best possible adaptation of the pupils work area. A good installation, comfort is essential, has consequences for school performance and often depends on a ‘ detail’ (height and angle of work area, position of head rest.......). The adaptations imply certain modifications for the pupil, he must accept, planned and organised.

2.4 Material usedAdjustable tables, height and angle- even a lectern- adapted chairs, can be indispensable. Beyond these materials that contribute to good installation of pupils,

a large variety of small materials can be necessary: adapted pens, highlighters, an anti-slip ruler, etc.

2.5 School timeChildren or teenagers with motor deficiency are sometimes also sick. Their school time is therefore dictated by their health. Care and rehabilitation sessions, also sometimes take up a lot of their daily life. We are therefore confronted with difficulties of time management, added to motor difficulties, which lead to a big slow down in the achievement of school tasks. Taking this into account, we can plan to adapt tasks to the students’ rhythm.In case of absence due to surgery, care or illness (ref. Handiscol’ guide for the education of disabled children and teenagers), we can imagine solutions to compensate, sending lessons, schooling at hospital, at home or by correspondence- working with friends, care services, parents- respecting the real possibilities for the pupil in this period and this particular context.In case of permanent partial absence, an adapted schooling can be offered, for example, half time, cycle adapted with extra year, provisionally leave certain subjects, resort to the service of CNED (correspondence courses)..........

2.6 Testing*Testing during controls and dailyIt is important that the results are not seen as too benevolent. In fact, when they are overestimated and don’t allow a continuation of studies at the level hoped for, the risk of deception of the pupil and family is great.Having said this, reference to the norm is not an excuse for refusing to adapt the tests and daily exercises. Extra-time, a task, which takes less time, material or human aid are the conditions, which must be given if necessary.For students who are slow or have difficulty with tasks, we can use the planned arrangements for the exams (ref. see after). They imply that the pupils learn the situation for better success. Many pupils with motor deficiency, confronted by constraints, are driven to make big efforts to overcome. However they often lack self-confidence. We know therefore they are sensitive to encouragement and appreciation, which shows explicitly their progress.

* Adaptation of examsAccording to the circular of 30 August 1985, ‘Particular arrangements are planned to allow handicapped pupils to be present at all exams in adapted conditions: the aid of a third person, increased time in exams, the use of specialised material’ (ref.

Handiscol’ guide for the education of disabled children and teenagers).The rules of the Baccalauréat exam take into account the problems of school curriculum: handicapped pupils who don’t obtain an average sufficient in the whole exam can keep during five consecutive sessions the benefit of a mark superior to the average, and therefore only retake those subjects he has failed.Concerning physical education, adapted PE exams are possible for disabled pupils (see circular 94- 137, 30/03/1994). To be allowed to take these exams the candidate must have a medical certificate of disability.At the beginning of the year the school doctor or CDES, in agreement with the pupil and teacher, classes the pupil in a category, which corresponds to his physical capacities. A large range of exams is possible for each group. They are not exhaustive.The PE teacher plans an individual project with the pupil at the beginning of the year.The evaluation is done through continuous tests or during a test with replacement activities. If one is medically allowed but can’t be organised in the establishment, it’s possible to prepare in another structure- other school, sport association.

3. Support through computers

For a motor deficient pupil, it is often an essential tool for his school integration and can be used as much at school as at home. It’s essential to put a computer to his service, when necessary and to establish and maintain continuity between the school tools and the homes’ to keep a coherence of technological aids.The teacher can find two major interests in using computers: to increase the child’s autonomy, therefore his efficiency, and to prepare adapted pedagogic materials. These interests are for motor deficient children but can also concern all the others.

3.1 I.T. to increase the pupil’s autonomyThe benefits expected from using a computer are not valid if the furniture and work area not adapted to the child’s possibilities and are then sources of discomfort and tiredness. The adaptation, undertaken with the occupational therapist, prepares for an increase in autonomy and efficiency.

*To access the computer’s functions:Depending on the deficiency, the pupil may need:- a substitute to the mouse adapted to his motor deficiency: pointing out with a control ball (trackball), tactile area (track pad), joystick, head pointing or key pointing.

- an adapted keyboard-finger guided keyboard, big or small modular keyboard, and maintop-specialised keyboard.- additional software: pointing through automatic screen scanning (cross scanner), virtual keyboards (on-screen or keinx), and glossary by abbreviations, predictor system (wivik).He can also use access software with current operating systems- Windows since ‘95 version, MAC OS.

*For written expressionHandwriting is sometimes difficult or even impossible to produce by pupils and often hard to read for the teacher. Using a computer brings flexibility, work comfort, esthetic quality and saves effort. We can write better, faster, with being less tired so for longer. The pupils generally use an ordinary word processor- in the computer- possibly completed by a keyboard. The computer will obviously have a printer.

*Tracing and drawingDepending on the child’s abilities and the task, we can use general drawing tools, more specific didactic software- in geometry for example- fine art tools- graphic-table and software with virtual and traditional supports: paper, brushes, chalks, pens etc........

*Search for and exchange informationBeing able to surf the web, to consult documents, I.T. represents a major factor in autonomy to access information, especially for the children who can’t easily go to the library. It allows them to get in touch with others, to correspond via e-mail.

3.2 I.T. to prepare adapted pedagogic documentsIntegrating a motor-deficient pupil requires that the teacher prepares adapted activities or documents for his abilities. In case of neuro-visual problems linked to motor deficiency, he must pay particular attention to the readability of the written documents. For this, using an enlarging copier, from the library for example, can be useful but the teacher sometimes has to increase the line or word spacing of a text without increasing the type to make the text accessible. In this case it is advisable to use a scanner to capture the documents through software able to recognise the characters, then write with word-processing software or computer assisted publication, to adapt this digital document.In some cases, the teacher can use software to conceive and make adapted pedagogic activities, such as Kindo or Genex, which can also be used by able children.

4. Elaboration of the individual integration project

4.1 Characteristics of the individual integration projectThis organises the child’s schooling.- It’s individual: it takes into account the abilities and difficulties of each child or teenager regarding the resources and constraints of the establishment receiving him.- It comes through discussion. Not only the pupil and the teacher are involved. To take into account the specific needs of the pupil, all the partners contribute, respecting each other’s roles, to the coherence of pedagogic, educational or therapeutic interventions.- It’s evolving: it is necessary to evaluate and revise it regularly.- It’s continuous: which allows the anticipation of the future of the pupil beyond the receiving school: surgery, school at home, orientation in a specialised field, professional orientation.

4.2 Individual project and integration convention.The individual project can be linked to an integration convention. This for judicial and financial reasons is compulsory every time, financial or material aids supplied by out of school partners are necessary.Therefore, local integration services, collectives, liberal partners can contractually intervene in a state school. The convention underlines the material conditions for schooling and determines each partner’s responsibility. These aspects shouldn’t hide what involves the teachers daily, which is the pedagogic and educative dimensions of the individual integration project.

4.3 Questions to ask you before elaborating the individual project.According to the common staging of the project, there are three categories of questions. In the table below, we give a few involving the pedagogic aspects. Other questions are possible and even to be planned, in particular for the evaluation and its criteria.Analysis of the situation:-About the pupil: Where is his knowledge, what are the competences (what he can

do alone or with help and how does he proceed to do this activity)?What are his resources (physical, perceptive, cognitive and affective)?Which difficulties or impossibilities does he encounter?What are his interests and needs?

- About resources and constraints of the school and the project:

Accessibility?Adaptations?Material and human help?External or internal resources?

- Definitions of the objectives: What is the knowledge to acquire and what are the competences

to develop? Which ones are prioritised?What is the level of demand aimed at?

- Means: Which group to put the pupil in? What are the necessary means? Is an adaptation of the task necessary? (realisation time, special material...)Is the help of a person needed? In which cases?

ADAPTATION OF THE TEACHING

Adapting the teaching is an important condition for the success of all pupils. It is also more important in the case of a child with motor-deficiency and facing particular problems. But the concern to adapt the contents and process of teaching mustn’t cause a deficit of requirements. This can only hold up the learning and competences, which are the factors of personal development and social integration. Therefore, towards these pupils, it’s necessary to avoid an attitude of over-protection and to maintain the highest ambitions compatible with his possibilities. The pedagogic adaptations which are proposed in this guide are not exhaustive, which doesn’t mean they are all easy to understand and put in place by a non-specialised teacher. They call, therefore, for collaboration with people who know well the characteristics of the population concerned and the approach to take. In this situation, the recourse to a specialised teacher in charge of supporting integration, as well as to the professionals responsible for education and rehabilitation, constitutes the resources to mobilise. That said, you can’t expect ‘formula’ from these collaborations, which could be applied, to such or such a type of pupil, without distinction or adjustment. The pertinence of the adaptations are always supported by attentive observation of the child in the learning situation, not only to evaluate the results, but also to understand how he processes and to identify the obstacles he meets and the resources he uses for the tasks proposed. From this analysis, we note that the problems described for a pupil- for example, ‘lack of attention’, ‘memory blackouts’, ‘reasoning problems’- aren’t independent of the situation. These can only stimulate the teacher to make the optimal adaptation of tasks and their conditions of realisation.

1. Common adaptations to teaching situations.

The adaptations proposed don’t only concern teaching but the activities which have in common to mobilise the capacities or competencies relative to the 3 following areas: skilled gestures, uptake of complex visual information, notably when he has to recognise geometric figures and to read schemes or tables, and organising work.

1.1 Class activities needing skilled gesture* Possible problems: For some pupils, motor problems appear each time they use a skilled gesture. This is obvious for pupils with noticeable handicap, as for young people with upper-

body paralysis, but is less for those where the appearance of normality masks dyspraxic problems. The problems create, in nursery school, awkwardness in cube games, Legos, puzzles and during cutting, folding or gluing activities... They continue later to appear during the use of usual class objects, to make a diagram, etc. In geometry, some pupils have difficulties to trace and build figures. A lot of IMC pupils struggle to draw complex geometric figures because of the fine motor skills required using mathematic tools (rulers, set squares, compass, etc.)* Adaptations:We can sometimes help the child or have him helped during the tasks, which demand manual skills, without stress on this type of activity, especially in nursery school. Developing the instrumental constraints by putting at the disposition of the pupils modified tools. For example, in geometry: a ruler with a handle for better grip, a ruler made of heavy material or with a Velcro band which grips a carpeted table, a set square without a hole in the middle, non transparent, with marks for the sides and angles- for example, the coloured stickers, or names inscribed on the summit of the triangle which repeats the set square. In a general manner, the recourse to the computer must be envisaged whenever possible to improve the possibilities of graphic production. Thus, we can put at the pupils’ disposition a programme for geometric construction: in the construction phase, the computer tool considerably supplements his weak perception and allows the control of the reasoning. Depending on the software, the pupils use prosthetic geometric instruments or they control the machine. In this later case, he indicates precisely the mathematical properties of the figure, which he must construct and the machine produces a correct design, reliable, and certain to his eyes. Clearly, the technical aspects can thus be used, entirely with geometry, properties of figures and reasoning. If the production of maps, schemes and designs becomes too problematic despite aids, we can leave them out.

1.2 Complex visual information uptake* Possible problems: To find one’s place in the picture, read geographic maps, situate one with the other different elements in a scheme, of a puzzle, of a geometric figures: there are the tasks which can be particularly difficult for a pupil with visio-spatial problems. In geometry, for example, he encounters problems of recognition of figures, to see a straight line in its continuity, to perceive oblique lines or to determine the extremities of a segment.

The pupil is often very slow to find the information he needs (in a lesson, in a book...). He can ‘get lost’ in a text and lose his marks in the change of plan, of material or of zone on the paper. Sometimes, he cannot respond to written questions, giving the impression that he doesn’t understand. * Adaptations:- Be attentive to the graphic presentation of tasks:The graphic presentation is very important. We must avoid the diversity and the dispersion of information on the same support (walls of classroom, pictures, page) as well as strange layout. Favour a simple presentation, spaced out, structured and as regular and as predictable as possible. Choose an adapted typeface and possibly limit to one exercise per page. Avoid, whenever possible, the activities which expect the pupils to match elements with arrows: for example, in grammar, to match the subject to the verb, or in math, to match a number to a line in a scheme. - Ease the take-up of visual marks:To locate himself in a table: we can, for example, colour the horizontal lines and position the ruler in the other direction. To locate in a text: make points, underline in a first exploration of the exercise with the pupil. Encourage him to use this aid himself in all new tasks and to verbalise his location. To recognise a geometric figure: develop the knowledge of geometric vocabulary and concepts and promote reasoning. In fact, if by giving the pupil the corresponding geometric vocabulary and notions we ask him to analyse a figure, we improve most markedly his possibility to organise the space and to represent his organisation. The use of locators linked to the properties of geometric objects can allow him to compensate for his spatial problems. it is also easier for him to think of a square as a figure with 4 right angles and 4 equal sides than to see it drawn in his notebook. In all cases: lead the pupil to continue to call on his personal strategies to overcome the difficulties, for example, underlining the most important parts of a text, or reading the questions before the text. With different coloured highlighters, he locates the extracts related to each question before reading.

1.3 Work organisation* Possible difficultiesWe note that certain pupils, notably among those who have a cerebral lesion, struggle to deal simultaneously with the different elements of a task, to coordinate multiple information.

They can meet difficulties with organising work in a methodological way and according to a relevant strategy. In geometry, for example, they are often unable to plan and organise a complex construction according to an ordered continuity of elementary actions.When the pupil fails to put in place the strategies to do his work well, he tends to look for ways, which are in effect inappropriate to respond to the diversity of tasks with which he is confronted.The problems of work organisation can be due to attention or memory problems. More precisely, memory problems present themselves in two principle forms:- the pupil has problems to register new memories.- he has problems to use memories he had before a trauma-cranial in occurrence-, notably to mobilise school knowledge.* AdaptationsIt is important to improve the strategies of information uptake and the work organisation of the pupils guiding him here again, in the elaboration of personal progress. More precisely, it’s necessary to suggest a/some procedure(s) to do the proposed tasks well and to accompany his thinking. In all areas, the student must be guided to think about the methods he uses to understand the mechanisms of his errors and of his successes. This thought implies verbalisation, spoken and then internalised, to put into words the strategies put into use. When the pupil fails a task he tried to achieve in its globality, we can break it up into more elementary tasks, which at first appeared too complex for him. Moreover, a good work organisation can help managing the diary, different folders and homework. Particularly with pupils with cranial trauma, attention problems can be taken into account: - propose activities, which require gradual attention- maintain the pupils’ attention on the activity by regular questions: attract his attention on this or that part of the task, ask questions...- give enough time to complete the task, if not it places the pupil in front of a constraint too difficult to support.

Memory problems, which can be linked to attention problems, necessitate the teacher to repeat the instructions and knowledge. Varying the information, offering a clear and structured work area, and encouraging diverse procedures (mental images, memory techniques, rituals...) assure the recollection and focus on the tasks to do.

2 Fundamental learning

2.1. Reading Learning to read and write is closely linked. That’s why some difficulties and adaptations identified for one also concern the other. Moreover, some adaptations to make reading easier become relevant more than beyond its learning as such. They continue later to favour an easier reading for some pupils. * Possible problems:Essentially, pupils with brain damage might have specific reading difficulties. The children affected by spatial dyspraxy might stagnate at a decodable stage more or less efficient or laborious because of their sight disturbances. The child might, for example:- mix up the letters because of their shape (h,n,r) or their orientation (p/q, b/d). The confusion may also come from the shape of the letters according to previous or following letters. An agnesia, which is the recognition of pictures or conventional written signs, can contribute to morphological confusion between certain letters.- having reading difficulties for complex sounds or syllables. - reading by missing out on words or lines.But, these difficulties don’t prevent many children to reach high reading performances using personal strategies induced by the teacher. * Adaptations: - Adapting the text:Give a text where the space between the words is increased. Space out the compound-words or use the space in Pictop software. Segmenting the text in unity-words can be done, circling the words. Make sure the graphics has the right visual contrast, especially when photocopying. Increase the line spacing.- Favour continuous reading with marks:The child can follow what’s being read with his finger and point every beginning of a line, or put a finger after each word to space out the written words. Coloured visual marks can also be used. We could have, for example, a green dot for the beginning of the line and a red one for the end, or the lines could be highlighted with different colours. - Allow the child to be conscious that his visual field is reduced. If a child has a reduction of his visual field, it’s necessary to encourage him to explore the space he neglects. This adaptation is more often spontaneous. - Stress on talking:For all pupils, resorting to language, via the teacher or themselves is an essential aid allowing them to get the sense of what’s written, to locate in a text or to pay attention to such or such aspect. For a child with visio-spatial dyspraxia, talking is particularly important. This way, when he learns to read, it can be relevant to

describe the shape of a letter so that he understands what’s the difference with the similar letters. We can also make the mental representation easier through comparisons: for example, ‘c’ is a bitten apple. It can also be judicious for the child to work on a computer with voice-recognition software, such as Pictop, to favour the link between writing and speaking as well as a better control of what’s written. - Use, as much as needed, analytical procedures without missing out the sense of what’s being read. For children with visio-spatial problems, the graphic-phonetic coding/decoding activities must be given a methodic work. Masking the words or the syllables, to read words after words or syllable after syllable can be relevant at the beginning. But being able to read needs other competences: the sense of what is read doesn’t come from the ability to identify the letters, the syllables or the words. To understand a written text, the child shouldn’t just focus on decoding and miss out the content. Reinforcing and maintaining the desire to read is fundamental. For this, we’ll give, as often as possible, the child real texts, short enough which constitute a unity and provokes this desire, for example, short tales.Beyond initial learning of reading, make sure that despite their motor-deficiency, the children can access significant writing. This access can be guaranteed through diverse means: lectern, books on computers, books on tape...

2.2. WritingThe quick production of legible graphic signs properly arranged in a page with a writing tool involves many information-processing abilities, visio-spatial and perceptivo-motor. But learning to write is not limited to perceptive and praxic aspects. As for any other activity, it entirely mobilises the pupil. Therefore, it’s important that the pedagogy of graphics is designed for the child to give a sense to the traces produced. From this point of view, it’s necessary to underline the link between writing and fine arts. Both require graphics. In 3.3 of this guide, there are elements leading the child to a motivated production of varied graphics. * Possible problems: Motor difficulties: Physical deficiency can have consequences on the acquisition of writing because of inadequate body position, weak muscles, contractions preventing the fluidity of movement, poor pressure control, difficulties to co-ordinate relaxing and contracting movement of antagonist muscles, involuntary and interfering movements and because of a light motricity poorly controlled which disturbs when making circles or letters.

Perceptive difficulties: Some children, who have a proper position and don’t seem to have any gestual or tonic problems, can’t write easily. Their difficulties are more linked to their poor perceptive abilities than to their motricity. - Reduction of visual field, especially if in the lower or lateral part, can lead to visual neglect. The child, not seeing for example half of the visual space, will only copy half of the model. - Sight disturbances lead to difficulties to locate in a space: For topology: the child poorly situates one object with respect to the others. It’s difficult to link 2 points because the space between them is not well seen, to follow a line with his finger or to see 2 parallel lines. For the orientation of objects with respect to bi-dimensional axis: the child has difficulty to see an oblique line, a graph, scheme...In case of sight problems, particularly for children with visio-spatial dispraxia, we note that the pupil has problems reproducing graphics when trying to copy a model (under his eyes). Consequently, spelling can be difficult. * Adaptations: The movement of his hand is linked to the arm and the body, which requires a good position and coordination of movements. We can offer, when praxic troubles are high, motor activities usually for dysgraphic children. But more specific adaptations need to be planned. - Be attentive to the position of the child at the desk. The stability of the trunk and the quality of the position are essential to give a good support for the writing movement. The height of the table, its shape (for example, hollow at the chest to give a better support for the forearms), the seat (make sure the feet touch the ground or are on a foot support), the position towards the board, are major elements. For children with a reduced visual field, it’s advised to respect their favourite or spontaneous position since they correspond in many cases, to gradual position adaptations. These adaptations, thought of with an occupational therapist, are even more relevant when we listen to the child’s opinion about his comfort.- Adapt the writing support: The choice of the work surface: an inclined desk is better than a flat one, especially for children with visual disturbances, because it gives a better visual coverage of the page. Equally, working on a vertical surface at a large scale can help the child to integrate the movement of the letters by living it physically. The nature of support: Using a slate, especially a white one, allows mistakes since it’s possible to erase unsatisfactory productions. The position of the page: if using paper, be careful with the position of the page. It can be left to the choice of the child. In fact, some pupils put their piece of paper in

a particular position to compensate for the visual problems. Once the position is chosen, the page can be fixed (on a magnetic or rubber surface) to prevent the child form holding the page while writing. The presentation of the page: children without problems can write on traditional notebooks. It’s different for children with visio-spatial dyspraxia. For them, big and small squared pages are to be avoided because they disturb the visual information up-take; children are unable to respect the size of the letters imposed by the pre-established notebook. They often don’t see the beginning and the end of the page and don’t see one line from the other. In this case, don’t impose the same notebook as all the others but choose a white page with simple and adapted lining. It’s also possible to make the lines between which the child has to write more visible by stressing on the darker lines. Coloured marks can help the child in spatial orientation, for example to allow locating the top and the bottom left and right. A child with a reduced visual field on the left side will know that he can start working when he sees a green dot on the left. - Adapt the writing tool: The tool will change according to the child, to his abilities to understand, to the pressure, to the tracing. Adapt the size and thickness of the tool- use, for example, a pen-enlarger- the roughness or smoothness of the extremity, the sliding or resistance, etc. A thick felt pen can also be used. Pencils allow correction, resist pressure due to spasms and its shape gives a good hold. The teacher can offer different writing tools, which the child will choose from according to his possibilities and to the writing to be produced. - Adapt the writing style: For some pupils, cursive writing can be functional. Once controlled, it allows fast and flexible gesture. For children with visio-spatial dyspraxia, printed writing can be better for a while, for praxic reasons, given the gestual difficulties to link the letters and for perceptive reasons because the attached letters in cursive create another drawing than the one of the letter alone. Because of their difficulties to see oblique lines, capital letters can cause problems. Make sure the space between the words is bigger than the one between the letters. - Solicit visual memory: It means favour the learning of the spelling, to copy a word after having ‘taken a global picture’ of it. - Graduate the difficulties of visual perception: Soliciting the language: especially for children with visio-spatial dyspraxia, going round the visual canal avoiding direct copying exercises and use the aural verbal canal as much as possible. This means associating the movement to verbal description: ‘we’re going up, turning left, going down, turning right.’ Mastering the spatial vocabulary is a precious aid and allows the child to trace and situate these traces in the space of the page.

Later, the child can write papers in which spelling is essential. At this level, do a real work of breaking up and of memorisation. Favouring the kinesthetic memory: make sure the letters are always done the same way. Manipulating letters on a large scale and in-relief, which the child can follow with gesture, contributes to giving kinesthetic clues. We can help by guiding the hand for some movements. Using a computer, which gives diverse aids, for example to make the difference between the font and the layout, to vary the shininess of the graphs, the shape and size of the letters. -Limit handwriting if needed: Learning to write shouldn’t be a source of massive long effort. If difficulties are too great, handwriting must be limited as much as possible and using a keyboard as soon as nursery school must be encouraged. The child must have a computer handy. If using the mouse is difficult, use special contactors, which allow the pupil to be operational, it be the tip of the finger, a head sign or a knee movement...If needed, we can use software showing the keyboard on the screen. If the child doesn’t have a computer, we can use, in some cases, a magnetic board or stickers- big to be easily understood and with double-sided Sello-tape to stick on the carpet, or even mobile letters. Even if the gesture is clumsy and the child controls the use of the keyboard, he can enjoy writing. But he might be disappointed by his writing and be discouraged. We need to consider for each case if it’s relevant to continue teaching to write. However, if making sure we don’t force a learning, which is too difficult, we have to offer the child the possibility to acquire, during his schooling, a sufficient control of handwriting to face the future social situations requiring its use. - Tolerate a clumsy handwriting if it’s legible: Encourage the quality of handwriting, a good presentation, more than the rapidity of execution and legibility. - Limit note taking: Give the pupils photocopies or scanned texts if possible. Possibly allow the use of a tape player. Encourage note-taking with abbreviations. The difficulties met shouldn’t encourage the teacher to limit the written production. The pupil must be able to produce long enough writings if the necessary adaptations have been planned to avoid tiredness and failure. For example, allow extra-time and the use of a computer which efficient use necessitates a real learning from the pupil.

2.3. Counting and calculatingThe solidity of the first digital learning is fundamental:

- to control and use math operations at primary school- to understand literal calculations and algebraic variables at secondary school. It’s important then to tackle these mathematics notions rigorously so that each pupil can build a conception of numbers, which would be as operating as possible all along his schooling. When the basic knowledge is not built according to their signification, the future mathematical learning could be disturbed. Children will have difficulties, not only in the elaboration of new notions based on these bases, but also when developing logical reasoning. In these conditions, they might aligned or mix nonsense knowledge, without being able to link them logically. * Possible problems: - Counting collections:Managing complex co-ordinations: Counting a collection requires to co-ordinate several actions: Following with the eyes the elements of the collection. Pointing out of each object, once and only once, without forgetting any or pointing out twice. The oral singing of nursery rhymes with the conventional words/numbers; All these activities must be synchronised since the eye-movement must direct the gesture of pointing out at the same time as the voice. Moreover, counting requires the ability to answer the question: ‘ How many/much are there?’Children with visio-spatial -dyspraxia often have difficulties with this activity because their sight and spatial problems often lead to poor processing of this correspondence. It’s difficult to count a quantity of grouped objects: ‘the first time, they count 7, the second 5’. Therefore, counting isn’t a reliable tool and involves an imaginary conception of numbers: ‘Once it works, once it doesn’t ’. Or his poor counting has perverse effects, like destabilizing relevant and founded knowledge. For example, they might change the rhyme to cancel a mistake. Establish a link between the different understandings of numbers. There’s another way to understand quantities, which consists of evaluating them with a global perception, at first sight, without counting. The link between the results obtained through this evaluation- called ‘subitising’- and the first counting/ pointing out activities can consolidate the first digital intuition.However, some children with motor-cerebral deficiency have major problems there. When they have sight problems, they can not trust the information taken from visual data because they are not stable: they can evaluate globally a collection by staring at a part first, and during another exploration, get another part.

In total, some of them, whether subitising or counting don’t reach the same conclusions. These instabilities prevent some pupils from ‘conquering the numbers’.Then, because of the non-control of required complex co-ordinations, of the lack of link between the conclusions obtained through different procedures of evaluation and because of the non-stability of results, the repetition of ‘wrong’ numbering can have a very bad influence on the elaboration of the concept of number. - Numbering:Some children can have difficulties to remember the words/numbers of the rhyme, to read and write these words with figures. For example, reading the words/numbers between 11 and 17 can systematically fail for a long time. Writing these numbers can also be a source of errors: dyspraxic children tend to write the figures as in a mirror or the numbers backwards. Some children, particularly the ones with language problems, make frequent lexical or syntax mistakes. For example, 14 can be written 40 because we hear 4 first. - Calculations: At primary school, we’re used to ‘putting’ the operation down. This mean we teach the children to place the numbers according to a spatial configuration, which is, in fact, a table without materialised boxes. This activity of calculation systematically put dyspraxic children in failure. They can’t see properly what’s on their right or left or they don’t line the column of figures properly. * Adaptations- To count collections:Use moveable collections of objects: the pupils might fail if offered a counting of drawn objects, as is often the case in files. In fact, their movements are ‘imprisoned’ in a space too narrow to stare at or point out the object. On the contrary, if the objects are moveable, we can teach the child to organise the collection:- in line- with a space big enough between the objects to avoid double-pointing. - with a space small enough to avoid counting the space. Suggest strategies: we can teach them to: - slow down or accelerate the rhyme- systematically put aside the objects already counted (on the side or in a box)- say a word/number when the object is touched or hit on the table. In general, these elementary precautions already improve their performances. They involve making the child feel conscious of his handicap for this activity and his need to implement a different strategy from his classmates. Use the classmates’ competences: We shouldn’t forget the possibility or these children to be helped by adults or other pupils. It’s very interesting, when a child

fails to count reliably and constantly, that a schoolmate, more ‘expert’ than him in this activity, does this task or part of it. For example, one points, the other says the rhyme. Some IMC children can fail in simple numbering tasks but succeed in other more complex ones such as calculations. They manage to represent quantities and to make an operation without systematic and numerous counting. - Numbering: Use supports to help memorisation: we can help the pupils to memorise the words/numbers by giving written supports like a digital line or a corresponding table between the words and the figures. To improve the recognition of reading and writing numbers, we can give spatial marks with coloured dots. ‘To write, you start from the green dot and aim at the red dot’. Develop the knowledge of algorhythm of a digital series: The oral and written series are built according to different rules. We should insist on these differences and stress on the organisation of the figures in the written series. Understanding the role of the figure in a number allows the pupil to avoid that the written translation of this word is too close to the oral. Knowing this system of construction of written series allows the pupil with difficulties to use the numbers in their calculation functions, without the oral connection. - Calculation: Limit the operations in column: Writing the operation in a column is justified when there are many numbers to add and/or they are big. In this case, it’s possible to use a calculator. On the other hand, to understand the principles of an operation, its rules, it’s necessary to have this presentation. The aim of teaching calculation is for pupil to add or subtract. It seems that these children perform better when they are free from the spatial organisation of the written operations. We can make them write in a line, or not write at all, encouraging mental calculation. Develop the learning of calculation and its rules: it’s necessary to train systematically these pupils to mental calculation explaining the most used rules. When the calculations are bigger, they can use calculators. Today, there are some with big screen and keys and are legible even with visual problems. We can also teach them to do approximate calculations to estimate the range of the result.

3. Physical education and fine arts 3.1. Physical education

‘ The rules, without foreseeing any compulsory medical check-up, have for principle that all pupils have the aptitude to attend this subject’ (Circular # 90-107, 17/05/90). Those with motor-deficiency can’t do all the activities in the same conditions as their able schoolmates. The GP or the school doctor (who can be asked to examine the child) gives a medical certificate to precise the functional mobilities (taking into account the model annex to the quoted circular). We notice that almost all pupils can do a type of activity, even in an electric wheelchair, that they can improve as well as enjoy it when we pay attention to adapt the teaching. * Possible problems: - About the perception, some pupils, especially those with cerebral damage can have problems: because of sight problems, which make movement perception difficult (a ball for example) or difficulty to recognise colours, etc. Moreover, superficial sensitivity disturbances can affect the tact and profound problems alter the position of corporal segments in the space. - About the motor-movements, some pupils suffer from a strong reduction of the articular movements or are clumsy because of an in adapted position due to a faulty tonic organisation, or because of poor gesture coordination.For praxic subjects, the difficulties of position adjustment and of contraction/de-contraction lead to a lesser or greater body slowness or the stiffness worsens due to passive stretching or the cold. The athetosic child has problems developing an adapted voluntary movement. It’s exaggerated or blocked by contractions. Paraplegics or tetraplegics have difficulties adapting the effort, their maximum oxygen consumption decreasing when the neurological level of the lesion rises. * Adaptations: - Precautions to take:The doctor’s opinion is essential to know the precautions to be taken. It can concern, for example:- a particularly position to respect- the temperature to control (room temperature or water of swimming-pool). If too cold, it worsens the muscular hypertonia of IMC children, which is restricted for myopath or for paraplegic or tetraplegic pupils, whose thermo-regulation is faulty. - the repetition of force exercise to avoid for young spastic IMC- taking care of pupils likely to have epileptic problems during risked activities (swimming, for example)- the authorised level of muscular solicitation for those with a neuro-muscular illness- getting tired for neuro-muscular pupils or those with a lesion in the spinal cord at a high neurological level

- risks of bed-sores for paraplegic and tetraplegic children- making sure the incontinent children urinate before the effort. - Principles of pedagogic actions: Take into account the particularity of each child: When a pupil can do the same activity as the others, but with particular conditions, the tasks to be accomplished are, if needed, less constraining than for his classmates or his opponents during pair or collective activities. This way, he can play badminton on a court with reduced dimensions preventing him from running, his opponent having a normal court. The difficulties of a motor-deficient pupil imply that the teacher adapts his evaluation criteria. If we refer to a particular person and not to the norm of young people of the same age, the results are far from being small and require a different process (see annex, the table with examples of differences). With easily tired children, the teacher accepts the rest times they need during seemingly light efforts but which is a limit for them not to go over. The pedagogic differences imply admitting for ones what is refused to others. Mix tolerance and demand: tolerance, necessary towards poorly performing pupils in PE, compared to young and healthy children, and demand, which is important to maintain in order to lead them towards progress, are 2 complementary faces of a process to adapt the teaching to the individual differences. Consequently, the progress of the pupil results from a double exchange, from the activity to the pupil and from the pupil to the activity. * Modalities of grouping pupils: It’s to determine with which schoolmates the motor-deficient pupil participate in the PE class: pupils from his class or not? Several group organisations are possible: - individual integration: he goes to PE lessons with his class whenever possible, or even with another class when the proposed activities are better. - collective integration: all the motor-deficient pupils of the school, for example, the pupils of an integration class (see the handiscol’ guide...) are integrated in a same class for a continuous cycle of activities or for some punctual and regular sessions. - reverse integration: the motor-deficient pupils join able pupils who are volunteers for extra-classes or for punctual events, for example a basketball wheelchair for all the pupils of the school. - introduction of pupils with difficulties belonging to different classes who join the motor-deficient pupils for shorter sessions. - separation from able children: the motor-deficient pupils of the school are exclusively together for specific sessions. * Tasks conditions:- Settling the pupil: In some static positions, it’s important to take care of his physical integration, in case some positions are restricted, and of this comfort. Whether in a wheelchair, using a ‘rollator’, on mats free from prosthesis or

particular machines, the pupil will be in lesser or greater good conditions to do some activities. - Manipulating objects: The object used must present weight, volume and material characteristics allowing the pupils who might have difficulties to catch, throw or hit. For the youngest, use for example small bags with seeds, or inflatable balloons...For racket games, the handle characteristics (diameter, length) and the reduced weight of the racket can help holding it. Moreover, a large enough contact surface will give more tolerance when hitting a ball which is not centred. For pupils who can’t move the higher limbs and who are in an electric wheelchair, throwing a ball (big enough not to go under the chair and make the child fall backwards) can be done from the chair. With a little speed, it’s possible to hit the ball and therefore to take part in numerous games. - The environment: the organisation will be done so that the uptake of information is optimal. We’ll pay attention to: - the clarity of marks: bright coloured ball, contrasted with the environment, visible limits of the field and other marks. - the speed of movements for pupils with visio-spatial problems: for racket games, it’s easier to play with soft tennis balls or even foam balls, to participate in a game similar to volley-ball with inflatable balloons...Make sure to adapt the constraints linked to motor actions: - gestual precision: in gymnastics, the surface of movement requires a more or less precise balance whether moving on a beam or a larger surface, the target can be of different dimensions for a target game... - energetic resources (strength, cardio-pulmonary abilities...): change for example the slope to go up to in a wheelchair. - The rules of the activity: We can sometimes change them to make it easier. - The duration of the activity: It mobilises the energetic resources of easily tired pupils. - The evaluation criteria: They are adapted to the possibilities of each, as planned by the modalities of exam evaluation (see the organisation of physical education exams).

EXAMPLES OF DIFFERENCES FOR PE ACTIVITIES PROPOSED TO A MOTOR-DEFICIENT PUPIL

Type of The child Elements of difference

activity works.......Pair and collective activities

.....with other pupils

The pupil has the same role as the others but under adapted conditions.His badminton court is smaller than his adversary’s, or his adversary is not allowed to block when he attempts a throw in basketball.He has a specific role.He is a goalkeeper, during a hockey match, if he can not run.

......next to others He does a specific activity while his classmates take part in an activity he can not do.He does a stretching or muscle building activity, or juggling to complement work on the theme of circuses, which he realises with his classmates at another time.

Individual activities

......on an identical task

He does a task where the goal and conditions are the same but the evaluation criteria are adapted.In swimming he does the same distance as his classmates, with special organisation, but the evaluation of his performance is adapted (time realised) and the method (technical aspect).

......on a partly different task

He does a task where the goal is similar but the conditions are different.He has a larger surface when balancing, or he does an obstacle course in a wheelchair by going over ropes instead of hurdles.

.......on completely different tasks

He does a specific task alongside his classmates who are doing an activity he can not.He trains to improve his wheelchair handling on difficult terrain, or still in a wheelchair he does gymnastic figures.

3.2 Musical EducationThe musical activity of a motor deficient person, whether it is vocal, instrumental, or also in listening, can be different. It is not less musical. In all pedagogy, we take into account and value the individual as he is, without disowning the treasures of the culture in this domain.

Listening* Possible problemsCertain pupils can present aural problems to a lesser or greater extent.*AdaptationsTo improve listening comfort put the student near the sound source, use good methods of diffusion, avoid background noise or interference and check the equipment works.Musical listening is better in a context of silence, of well- being and calm, which is essential for attention. Consequently the pupils, with or without deficiency, can be familiarised with the use of codes allowing them to communicate sometimes without speaking.We can use gesture, graphics (very visible for all, with big shapes, lively colours and/ or contrasts) or objects, or even light effects.

Vocal gestures* Possible problemsCertain pupils:-language problems-breathing difficulties-swallowing problems-phonation problems ( possibly with faulty vocal cords as a result of a tube)-motor problems cause difficulties to relax physically- easily tired* Adaptations-Ensure that the pupils acquire the ‘positioning reflexes’ of the voice, which evolve by progressive consciousness, instruction of interpretation and sometimes by their state of health.- Propose work, which allows everyone to develop at his rhythm and manner. For example, when singing, a pupil who has difficulty can sing in his head or wait and make sounds when he chooses.-Develop vocal games, which use the pupils’ vocal competencies and allow him to be valued.-Use media tools, which allow:- to conduct his voice to others or a microphone, with a tube for example,- to hide, transform his voice and then accept a different voice, for example, with acoustic instruments (kazoos, glass, tubes…) or electronic ones (effects, delays, echoes…)- to amplify his voice with a microphone and an amplifier to put it at the same sound level as the others.

Instrumental gesture* Possible problemsSome pupils have posture and gesture difficulties, which can affect the amplitude, the strength, and the orientation in space, the fastness and regularity of gesture. More precisely, they concern:

1the accessibility to some musical instruments2the taking and upholding of musical instruments and accessories (sticks,

bows…)3the instrumental precision in space (to play a precise note on a keyboard), in

time to produce rhythm.* AdaptationsTaking into account the difficulties of the pupil, the choice of the instruments according to different criteria of:- solidity and stability to resist brutal and uncoordinated gestures.- accessibility: the size of the keyboard must be adapted to the precision of the gesture produced. Manipulating the instruments or the accessories must be easy and require a minimum of physical effort. For this, all the corporal abilities used have to be taken into account. For example, the gesture can be produced with the hand, the foot, the head or the elbow. - sound quality: think about the pupils with aural deficiency who usually hear percussion and bass better. -weight: have light instruments for pupils with little strength. Adaptations can also be made to facilitate the access to instruments.-organize stands and holds so that the instruments are within reach.- build a system (Velcro, ropes…) to fix the instruments to the hands and other parts of the body. - use microphones and amplifier to listen to low level sound productions.

Interactions with other children for collective musical practice* Possible problemsSome pupils have problems being autonomous, taking initiative, being part of a group. *AdaptationsFavour the pupil’s commitment in their role linked to musical activities: The teacher has to see that each pupil finds the opportunity to discover the different roles possible in an orchestra (conductor, soloist, accompanist) and in a music project (listener, critic, creator, player…). The objective is that the pupil gives his choice of place for future musical activities. Facilitate the communication between pupils:

This means to implement a collective musical practice integrating:- sound communication systems built from various relations (dialogues, imitations, variations, contrasts, questions-answers…) and done from diverse functioning (exchange between people, groups…)- the complementarities of know-how by collective production of music from the competences of each person and their organisation- choose for example to mix measured and non-measured music- or homogeneity to work from ‘orchestral masses’, which finds unity thanks to homogeneous sounds- for example, an ensemble of bamboo percussion, which are played differently.

3.2 Fine artsMotor difficulties shouldn’t forbid this subject designed for artistic expression. With ingenuity, we can offer adapted material and situations giving a large range of plastic effects. * Possible problemsWhen the body is paralysed or partially confined in a shell or maintained in a vertical or horizontal position, the children aren’t supple and mobile enough to make fine gesture.Some have problems holding their head up reducing the global vision field and the space to explore. - Upper limbs: The trace is sometimes hesitant, jerky, the movements are difficult to control because of a poorly controlled motricity or interfering movements. The pressure of the tool used for graphics can be too strong or too weak. Some children don’t always have enough strength to hold and guide a writing tool on a support, so using it can be impossible. In some cases, small amplitude of the gesture prevents the child from exploiting all the space available. - Lower limbs: Problems to move around hinder the exploration of the space, especially for large-scale works. - Space problems: The sight disturbances lead to difficulties to locate oneself in space and to reproduce graphic models. * Adaptations- Settling the pupil:The pupil often sits or is in a vertical position with his trunk well-placed thanks to a supporting belt. For some pupils, we can use a hollow desk for the support of the upper limbs. - Support: Supports are varied in their shape and arrangements. Format: a big panel on the wall leads to big gestures and moving around whereas a piece of paper on a desk requires precise and controlled gestures.

Work surface: Vertically the child has more freedom of the upper limbs. Horizontally, both arms can be put on the desk to insure the necessary stability. But this position disturbs work when the shape and the size of the page require more movements. Working on the ground can be the solution for children able to move around the support with the wheelchair. Inclined position is better for children whose visual field is amputated in its lower part and with high vertebral stiffness. Stability: For pupils who poorly control their gesture, the page is fixed with Sello-tape, blue-tack or pins. The organization of graphic space: For those with small amplitude, the graphic space can be thin and precise, thick and covering, simple or multiple, random…- Varied tools adapted to young children:Offer multiple writing tools to the child with problems with upper limbs. He’ll keep the one that suits him best. For example, the child with strong finger contractions will use a sponge better than a cotton bud. Another finds it easier to use a thick brush than a thin felt pen. The variety of writing tools (sponge, sticks, corks, stamps, feathers, rolls, brushes, felt pens…) implies their exploration with possible ways to hold them (full hand, tip of the finger…) and examine their different traces with different actions such as rubbing, hitting, brushing.The basic brushes: We can use brushes of different sizes, shapes or textures: school brushes, painters’ brushes, straight Japanese brushes, flexible ones for Chinese calligraphy, personalized ones…All brushes can be used as such or transformed…Adding an extension to the brush handle: If needed, holds can extend to the brushes. Their length, toughness and weight depend on the child’s ability and the effect wanted (a light bamboo handle to stroke the paper or a heavy one to press). We can use extensions to work on the ground or on a desk. Work done on a support on the ground by a pupil seriously handicapped in an electric wheelchair: When a pupil is in an electric wheelchair and he has a serious cerebral or cervical stiffness, we can use a long handle so that he sees the extremity of the tool and visually controls his work. Depending on his strength, the material is more or less light, aluminum tube, fiberglass, bamboo, etc.If the child has difficulties to take it, holding it with both hands can be completed with a shoulder support. Work done on a table by a pupil whose arm movements have small amplitude: An extension allows him to get to the middle of the table and to work on the whole page. - Transformed brushes:

When working on a table with a brush with an extension, we can add stabilizers or ‘foot-rests’ made of iron strings at the end of the hair so that the child can move it by sliding it. In other contexts, we can fix a particular system to make a ‘rake-brush’ making many traces like strips with 3 parallels brushes attached together. - Other writing tools:For instance, to fill in surfaces: paint rolls, brooms fixed at the hand of a handle. Some tools are better depending on the abilities of the pupil. For those with irrepressible movements, shivers, spasms, try to make up for the gesture with an ingenious trace (multiple, random…) Tools limiting poorly controlled movements: We’ll use templates, to hide a part, stencils or small rulers... Diverse tools can be put on anti-sliding surface to avoid falls. Plan supports for brushes, felt pens and others to be able to find them again. - Colour: It’ll be obtained preferably with acrylic paints of varied nuances. Conditioning is done for the required fluidity in containers corresponding to the size of the tools, with a lid. The pots can be held in a plastic basin to avoid spilling. A large range of colour is available to the pupil. Pleasant to the eye, this paint has the advantage of being solvable in water, and indelible after drying. It allows, contrary to gouache, the superposition of successive coats without mixing inferior coats.- Computer tools: They offer many possibilities for a pupil with motor-deficiency. The ideal work situation is to have: - a scanner to have access to digital images, - a computer strong enough to manipulate images, - a image manipulation software, - a colour printer. *Adaptations for pupils with spatial-spatial problems- Speak: ‘say’ the space by sequential instructions, precise, which describe the spatial characteristics of the image and which must be done. - Ban images with blurred contours. - Resort, sometimes, to kinesthetic aid to guide the hand, without writing tools, to assimilate certain conventional directions and link several gestures. - Eventually, place location coloured dots, well seen, in relief, to perceive better with the hand or the writing tool.

FURTHER INFORMATION

1. Books- Association of the Paralysed people in France, The perceptive difficulties with the IMC child and the prematurely born child: clinical approach, Paris, APF, 1990.- Association of the Paralysed people in France, Motor deficiencies and handicaps: social psychological, motor, medical technical and legal aspects, linked problems, Paris, APF, 1996.- Association of the Paralysed people in France, Cerebral motor deficiency, UNESCO Colloquium Acts, Paris, 1996.- Association of the Paralysed people in France, Cranial traumatized, UNESCO Colloquium Acts, Paris, 1998.- De Barbot F., Meljac C., Truscelli D. (et al), for a better school integration of IMC children: the importance of the first math learning, Paris, CTNERHI,1989- Cahier de l’intégration # 3, the education of young motor-deficient in a normal class, Paris, CNDP, 1985.- PE file (Dossier EPS) #23, physically handicapped and partially disabled in physical education, Ed. Revue EPS (11, avenue du Tremblay, 75012), Paris, 1995.- Garel J.P (dir), Physical education and motor deficiency, Paris, Nathan, 1996- HI/Handicap International, neuro-psychological check-up and pedagogic adapted processes, Lyon, Handicap International, 2000.- Mazeau M., Visio-spatial deficiencies and child’s dyspraxias: from problems to rehabilitation, Paris, Masson, 1995.- Mazeau, M., Dysphases, memory problems, child’s front syndromes: from problems to rehabilitation, Paris, Masson, 1999.

2. Specialised magazines - ANAE, PDG Communication, 30 rue d’Armaillé, 75017 PARIS.- Déclics, handicaps et familles, Association Handicap International, 14,Avenue Berthelot, 69361 LYON cedex 07.- Etre, handicap et information, 5, villa Wagram-St Honoré, 75008 PARIS.- Faire face, Association of the paralysed people in France, 17 Bld Blanqui, 75013 PARIS.- Handicaps and inadaptations, Les cahiers du CTNERHI, 236bis, rue de Tolbiac, 75013 PARIS- Le Courrier de Suresnes, CNEFEI (National centre for studies and training for disables youth), 58-60, aveue des Landes, 92150 SURESNES (last issue in 1998 ; magazine replaced by La Nouvelle Revue). - La Nouvelle Revue, CNEFEI, 58-60, av. des Landes, 92150 SURESNES.- Motricité cérébrale, CESJM, BP 22 41354, Vineuil cedex.

- Réadaptation, 12 Mail Barthélémy-Thimonnier, BP 86, Lognes, 77423 Marne la Vallée cedex 2.- Vaincre la myopathie (VLM), French association against myopathy, BP 59, 91002 Evry cedex

3. Pedagogic articles- Duquesnes F., ‘ How can didactic help IMC children in their maths learning?’ Le Courrier de Suresnes, 1996, #68. - Sagot J. (Dir), ‘Information technology for the education of young motor-deficients’, Le Courrier de Suresnes, 1993, # 59.- Sarralie C., ‘ Motor and maths handicaps’, La Nouvelle Revue de l’AIS, June 1998, #1, 2.- ‘Looking for pedagogic strategies, procedures, and tools for the IMC and cranial traumatised children’, Le Courrier de Suresnes, 1995, # 64.

4. Films- ‘ Physical education for all at secondary school: from the integration of disabled children to taking into account the pupils with specific needs’, J.P. Garel, M.Imberty, CNEFEI, 1999.- ‘ Reading and writing, writing and communicating’, M.Imberty, G.Gautheron et J.Sagot, CNEFEI, 1998.- ‘ Problems with the upper functions: recognising them to better accompany the person with cerebral lesion’, M.Beauderon, J.E. Lhuissier, G.Gautheron, J.Sagot, 2001.

5. Associations- APAJH, Association, 28, rue du chemin vert, 75541, Paris cedex 11. Tel : 0033.1.48.07.25.88- AFM, French Association against Myopathies, BP 29, 91002 Evry, cedexTel: 0033.1.69.47.28.28- APF, Association for Paralysed people in France, 17 bld Blanqui, 75013 Paris Tel: 0033.1.40.78.69.00- ASEI, Association for the protection of disabled children, 4 Avenue Europe, Parc technologique du canal, 31526 Ramonville St-Agne. Tel: 0033.5.62.19.30.30- Fédération Française Handisport, (French Federation of Handicapped Sports), 42 rue Louis Lumière, 75020 Paris, Tel: 0033.1.40.31.45.00- GHP, Group for the Insertion of Physically Handicapped People, 10 rue Georges de Porto-Riche, 75014 Paris, Tel: 0033.1.43.95.66.36- L’ADAPT, League for the Adaptation of Physically Impaired at Work, Infoservices, Tour d’Essor 93, 14-16 rue Scandicci, 93508 Paris cedex,

Tel: 0803.03.4000- UNAFTC, National Association of the Families of cranial traumatised, 236 bis rue de Tolbiac, 75013 Paris, Tel: 0033.1.53.80.66.03

6. Internet siteswww.education.gouv.frTo know the different services of the ministry of education, to get the reference texts concerning integration, and find addresses related to the education of motor deficient children.

www.ac-versailles.fr/cnefeiTo discover the resources of the national centre for studies and training of disabled youth.

www.apf.asso.frTo get information about the Association of the Paralysed people in France, its structures, its services, its publications and announcements.

www.afm-france.orgTo discover the French Association against Myopathies, to get information on its services and to know better the neuro-muscular, rare diseases and the therapeutic advances.

7. Technical aids- APF-RNT Network of new Tecnologies, 64 rue de la liberté, BP 2, 59651 Villeneuve d’Ascq cedex, Tel: 0033.3.20.34.00.01- CNEFEI, IT service, National Centre for Studies and Training of Disabled Youth, 58-60 av des Landes, 92150 Suresnes, Tel : 0033.1.41.44.31.26

8. Other sources of information- Handiscol: 0801.55.55.01. This service, in place at the CNEFEI, is for the families of handicapped or sick children who often have difficulties at school and for the teacher dealing with such children. - Ministry of national education, Direction of school teaching, 110 rue de Grenelle, 75357 Paris cedex 07.- AGEFIPH, Association of Fund Management for Professional Insertion, 192 avenue Aristide Briand, 92226 Bagneux cedex, Tel: 0033.1.46.11.00.11 ( aid possible for 16+).- CNED, National Centre for distance Learning, 3 allée Antonio Machado, 31100 Toulouse, Tel: 0033.5.62.11.88.00

- CNEFEI, National Centre for Studies and Training of Disabled Youth, 58-60 av des Landes, 92150 Suresnes, Tel: 0033.1.41.44.31.00- CICAT, Information Centre on Technical Aids, 236 rue de Tolbiac, 75013 Paris, Tel : 0033.1.53.80.66.66- CNRH, National French Liaison Committee for the rehabilitation of handicapped, 236 rue de Tolbiac, 75013 Paris, Tel: 0033.1.53.80.66.66- CNTERHI, Technical National Centre for Studies and Research on Handicaps and inadaptations, 236 rue de Tolbiac, 75013 Paris, Tel: 0033.1.45.65.59.00- GIHP, Group for the Insertion of Physically Handicapped People, 10 rue Georges de Porto-Riche, 75014 Paris, Tel: 0033.1.43.95.66.36- ONISEP, National Office of Information on Professions, 168 bld Montparnasse, 75014 Paris, Tel: 0033.1.43.35.15.98

4To get some materialFor indoor or outdoor games, adapted to motor deficient children:FH, 11 rue St Germain, 78230 Le Pecq, Tel: 0033.1.30.61.49.00

For technological material :- CLAV, 54 Parabole du Clos, 14780 Bretteville sur Odon, Tel: 0033.2.31.74.11.47- CREE, ZI du Recou, 69520 Grigny, Tel : 0033.4.72.24.08.99- DMI-APF Industrie, 2 rue du Dr. Picquenard, ZI de l’Hippodrome, 29000 Quimper, Tel : 0033.2.98.52.23.30- PROTEOR, 11 rue des buttes BP 704, 21078 Dijon cedex, Tel : 0033.3.80.78.42.42- SUPPLEANCE, 13 avenue de la gare, 78180 Montigny le Bretonneux, Tel : 0033.1.39.44.96.00- VOCALISIS, 7 rue Hoche, 78000 Versailles, Tel : 0033.1.39.53.00.63

The Handiscol’ Guide for the schooling of handicapped children and teenagers gather the complementary information to this guide necessary to the parents, in order to help them knowing their rights and the process. This guide is available in the academic inspections, the Centres for nursery protection, the direction of social affairs, the departmental commissions for specialised education and from the national Handiscol’ service at the CNEFEI.