ORTHOPEDIC ORTHOPEDIC IMPAIRMENTSIMPAIRMENTS

By Andy J. Arison & Kristen Barco-KidaBy Andy J. Arison & Kristen Barco-Kida

TLSE 457-Section 1Summer 2004

What is an orthopedic impairment?What is an orthopedic impairment?

Our textbook defines orthopedic Our textbook defines orthopedic impairments as diseases or impairments as diseases or disorders that are related to the disorders that are related to the bones, joints, and/or muscles.bones, joints, and/or muscles.

An orthopedic impairment is An orthopedic impairment is covered under IDEA if it covered under IDEA if it adversely affects educational adversely affects educational performance.performance.

A few of the orthopedic A few of the orthopedic impairments that we will discuss impairments that we will discuss

today include:today include:

Cerebral Palsy;Cerebral Palsy;Muscular Dystrophy;Muscular Dystrophy;Spinal Cord Injuries; Spinal Cord Injuries;

andandSpina Bifida.Spina Bifida.

What is cerebral palsy?What is cerebral palsy?

Cerebral palsy is a physical impairment Cerebral palsy is a physical impairment that affects movement.that affects movement.

The four types of cerebral palsy are:The four types of cerebral palsy are:

1) spastic;1) spastic;

2) athetoid or dyskinetic;2) athetoid or dyskinetic;

3) ataxic; and3) ataxic; and

4) any combination of the those 4) any combination of the those above.above.

Presumed causes of cerebral palsyPresumed causes of cerebral palsy

Before birth:Before birth:Failure of a part of the brain to develop, Failure of a part of the brain to develop,

blocked blood vessel, complications during blocked blood vessel, complications during labor, extreme prematurity, multiple births, labor, extreme prematurity, multiple births, STDs, poor nutrition, effects of anesthetics or STDs, poor nutrition, effects of anesthetics or analgesicsanalgesics

Early childhood:Early childhood:Head injury, near drowning, poison ingestion, Head injury, near drowning, poison ingestion,

illness/infection, geneticsillness/infection, genetics

Prevalence/Incidence RatesPrevalence/Incidence Rates

It affects 1 in every 400 births.It affects 1 in every 400 births.It is estimated that 500,000 people in the It is estimated that 500,000 people in the

United States currently have cerebral United States currently have cerebral palsy.palsy.

It is the most common orthopedic It is the most common orthopedic impairment among students in public impairment among students in public schools.schools.

How can cerebral palsy be How can cerebral palsy be diagnosed?diagnosed?

Test an infant’s motor skills. Test an infant’s motor skills. Examine the mother’s and infant’s medical Examine the mother’s and infant’s medical

histories.histories.Test the infant’s reflexes and early Test the infant’s reflexes and early

development of hand preference.development of hand preference.Look for signs of slow development, Look for signs of slow development,

abnormal muscle tone, and unusual abnormal muscle tone, and unusual posture.posture.

What are some characteristics of What are some characteristics of students with cerebral palsy?students with cerebral palsy?

Difficulty with fine motor tasks, maintaining Difficulty with fine motor tasks, maintaining balance, and chewing and swallowing balance, and chewing and swallowing

Involuntary movementsInvoluntary movementsAbnormal reflexesAbnormal reflexesWeak or tight musclesWeak or tight musclesPoor coordinationPoor coordinationSpeech difficultiesSpeech difficulties

What is muscular dystrophy & what What is muscular dystrophy & what causes it?causes it?

Muscular dystrophy is a disease that weakens Muscular dystrophy is a disease that weakens the muscles.the muscles.

There are 43 types of muscular dystrophy, most There are 43 types of muscular dystrophy, most of which are caused by alterations in specific of which are caused by alterations in specific genes.genes.

The most common type is Duchenne muscular The most common type is Duchenne muscular dystrophy, and it only affects boys.dystrophy, and it only affects boys.

It is a genetic disease passed from mother to It is a genetic disease passed from mother to son or it can arise in a young boy due to a son or it can arise in a young boy due to a spontaneous genetic mutation.spontaneous genetic mutation.

Prevalence/Incidence RatesPrevalence/Incidence Rates

In the United States, it is In the United States, it is estimated that between 50-estimated that between 50-250,000 people are 250,000 people are affected each year.affected each year.

That number is on the rise That number is on the rise due to technological due to technological advancements and earlier advancements and earlier testing.testing.

How can muscular dystrophy be How can muscular dystrophy be diagnosed?diagnosed?

Muscular dystrophy can be Muscular dystrophy can be diagnosed through an diagnosed through an EMG (electromyogram), EMG (electromyogram), blood test, and/or a muscle blood test, and/or a muscle biopsy.biopsy.

If a blood test is performed If a blood test is performed and it reveals high levels of and it reveals high levels of creatine kinase, this creatine kinase, this indicates that the muscles indicates that the muscles are damaged. are damaged.

What are some characteristics of What are some characteristics of students with muscular dystrophy?students with muscular dystrophy?

Between two and six years of age:Between two and six years of age:Frequent falling;Frequent falling;Difficulty getting up from sitting or lying position;Difficulty getting up from sitting or lying position;Waddling gait; andWaddling gait; andFattening of the leg muscles.Fattening of the leg muscles.

Later on in life:Later on in life:Wheelchair by age 12; andWheelchair by age 12; andBy the late teens or early 20s, respiratory and By the late teens or early 20s, respiratory and

cardiovascular problems develop and ultimately result cardiovascular problems develop and ultimately result in death.in death.

What is spinal cord injury?What is spinal cord injury? Spinal cord injuries occur when a Spinal cord injuries occur when a

traumatic event results in damage to cells traumatic event results in damage to cells within the spinal cord or severs the nerves within the spinal cord or severs the nerves that relay signals up and down the spinal that relay signals up and down the spinal cord. It causes paralysis, loss of cord. It causes paralysis, loss of sensation, and loss of reflex function.sensation, and loss of reflex function.

Spinal cord injuries occur suddenly and Spinal cord injuries occur suddenly and without warning.without warning.

The four types of spinal cord injuries are:The four types of spinal cord injuries are:1) compression;1) compression;2) contusion;2) contusion;3) lacerations; and3) lacerations; and4) central cord syndrome.4) central cord syndrome.

Terms for the types of paralysis:Terms for the types of paralysis:1) paraplegia; and 1) paraplegia; and 2) quadraplegia.2) quadraplegia.

What causes spinal cord injury?What causes spinal cord injury?

Traumatic injury:Traumatic injury:Car accidents;Car accidents;Falls;Falls;Diving accidents;Diving accidents;Shotgun wounds;Shotgun wounds;Horse, motorcycle, sporting Horse, motorcycle, sporting

event-related; andevent-related; andVarious other types.Various other types.Alcohol plays a significant role Alcohol plays a significant role

in many of these.in many of these.

Prevalence/Incidence RatesPrevalence/Incidence Rates

In the United States, there are approximately In the United States, there are approximately 10,000 new spinal cord injuries each year.10,000 new spinal cord injuries each year.

There are over 250,000 people currently There are over 250,000 people currently affected.affected.

Spinal cord injuries can happen to anyone at any Spinal cord injuries can happen to anyone at any time of life.time of life.

The typical case is a man age 19-26.The typical case is a man age 19-26.

How is spinal cord injury How is spinal cord injury diagnosed?diagnosed?

Diagnosis occurs after a Diagnosis occurs after a traumatic injury by a medical traumatic injury by a medical professional. professional.

What are some characteristics of What are some characteristics of students with spinal cord injury?students with spinal cord injury?

Varying degrees of paralysisVarying degrees of paralysis

What is spina bifida?What is spina bifida?

Spina bifida is a birth defect where an abnormal opening Spina bifida is a birth defect where an abnormal opening in the spinal column results in some degree of paralysis.in the spinal column results in some degree of paralysis.

Spina bifida literally translates to “cleft” or split spine.Spina bifida literally translates to “cleft” or split spine. There are 3 types of spina bifida:There are 3 types of spina bifida:

[1]-Spina bifida occulta; and[1]-Spina bifida occulta; and Spina bifida cystica ([2]-meningocele; & [3]-myelomeningocele)Spina bifida cystica ([2]-meningocele; & [3]-myelomeningocele)

What causes spina bifida?What causes spina bifida?

There are environmental as well as There are environmental as well as genetic factors:genetic factors:Lack of folate/folic acid in the mother during Lack of folate/folic acid in the mother during

pregnancy; andpregnancy; andHeredity.Heredity.

Prevalence/Incidence RatesPrevalence/Incidence Rates

Approximately 4 in every 1,000 births are Approximately 4 in every 1,000 births are affected.affected.

There are many thousands of people There are many thousands of people currently affected.currently affected.

How is spina bifida diagnosed?How is spina bifida diagnosed?

UltrasoundUltrasoundAmniocentesis, checking for Amniocentesis, checking for

increased levels of alpha-increased levels of alpha-fetoprotein. fetoprotein.

After birth, it is physically After birth, it is physically apparent if a baby has spina apparent if a baby has spina bifida.bifida.

There may be a buildup of fluid There may be a buildup of fluid around the brain (hydrocephalus)around the brain (hydrocephalus)

What are some characteristics of What are some characteristics of students with spina bifida?students with spina bifida?

Muscle weaknessMuscle weaknessParalysisParalysis IncontinenceIncontinencePoor short term memoryPoor short term memoryEasily distractedEasily distractedPoor attention, organization, sequencing, time, Poor attention, organization, sequencing, time,

generalization, motivation, left-right generalization, motivation, left-right discrimination, and coordination.discrimination, and coordination.

What are some assistive technologies that can be What are some assistive technologies that can be used for students with orthopedic impairments?used for students with orthopedic impairments?

Altered pencils and pensAltered pencils and pens Altered keyboards (BAT)Altered keyboards (BAT) PowerpadsPowerpads Eye-controlled input Eye-controlled input

systems (cyberlink)systems (cyberlink) Touch screensTouch screens Track ballTrack ball Foot miceFoot mice

Standing tableStanding table EaselsEasels Adjustable seats and Adjustable seats and

desksdesks Portable reading racksPortable reading racks Speech-controlled input Speech-controlled input

systems (dragon-dictate systems (dragon-dictate and write-away)and write-away)

Icon-driven Icon-driven communication (dynavox)communication (dynavox)

*A website that includes several examples is located here

Some instructional ideas & Some instructional ideas & resources for teachers:resources for teachers:

Please see handoutPlease see handout

ReferencesReferencesBigge, J.L., & O’Donnell, P.A. (1976). Bigge, J.L., & O’Donnell, P.A. (1976). Teaching individuals with physical and multiple disabilities. Teaching individuals with physical and multiple disabilities. Columbus: Charles E. Columbus: Charles E.

Merrill Publishing Company.Merrill Publishing Company.

Calhoun, M.L., & Hawisher, M. (1979). Calhoun, M.L., & Hawisher, M. (1979). Teaching and learning strategies for physically handicapped students. Teaching and learning strategies for physically handicapped students. Baltimore: Baltimore: University Park Press.University Park Press.

Friend, M. & Bursuck, W.D. (2002). Friend, M. & Bursuck, W.D. (2002). Including students with special needs: A practical guide for classroom teachers. Including students with special needs: A practical guide for classroom teachers. Boston: Boston: Allyn and BaconAllyn and Bacon..

The Irish Association for Spina Bifida and Hydrocephalus (2004). The Irish Association for Spina Bifida and Hydrocephalus (2004). What is spina bifida?What is spina bifida? Retrieved May 24, 2004 from Retrieved May 24, 2004 from http://www.iasbah.iehttp://www.iasbah.ie..

Muscular Dystrophy Family Foundation (2002). Muscular Dystrophy Family Foundation (2002). Muscular dystrophy family foundation. Muscular dystrophy family foundation. Retrieved May 24, 2004 from Retrieved May 24, 2004 from http://www.mdusa.orghttp://www.mdusa.org. .

National Information Center for Children and Youth with Disabilities (2004). National Information Center for Children and Youth with Disabilities (2004). National dissemination center for children with National dissemination center for children with disabilities. disabilities. Retrieved May 25, 2004 from Retrieved May 25, 2004 from http://www.nichcy.orghttp://www.nichcy.org. .

National Institute of Neurological Disorders and Stroke (2001). National Institute of Neurological Disorders and Stroke (2001). Spinal cord injury information page. Spinal cord injury information page. Retrieved May 24, 2004 Retrieved May 24, 2004 from from http://www.ninds.nih.govhttp://www.ninds.nih.gov. .

Ohlone College (2004). Ohlone College (2004). Students with physical disabilities. Students with physical disabilities. Retrieved May 25, 2004 from Retrieved May 25, 2004 from http://www.ohlone.cc.ca.us/orghttp://www.ohlone.cc.ca.us/org..

Texas Pediatric Surgical Associates (n.d.). Texas Pediatric Surgical Associates (n.d.). Spina bifida neurological issues. Spina bifida neurological issues. Retrieved May 24, 2004 from Retrieved May 24, 2004 from http://www.pedisurg.comhttp://www.pedisurg.com..

United Cerebral Palsy (2001). United Cerebral Palsy (2001). Cerebral palsy facts and figures. Cerebral palsy facts and figures. Retrieved May 24, 2004 from Retrieved May 24, 2004 from http://www.upc.orghttp://www.upc.org. .

West Virginia University (1999). West Virginia University (1999). Strategies for teaching students with motor/orthopedic impairments. Strategies for teaching students with motor/orthopedic impairments. Retrieved May 25, 2004 Retrieved May 25, 2004 from from http://www.as.wvu.eduhttp://www.as.wvu.edu. .