Children with physical and health impairments

A physical impairment is a condition that interferes with a person's ability to move, use, feel, or control one or more parts of the body. A health impairment is a condition that requires some form of medical treatment. Children may be physically impaired, health impaired, have both physi­cal and health impairments simultaneously, or may be multiple handicapped (e.g., the addition of a learning disability, mental retardation, behavioral disorder, commu­nication disorder, or other disorder). Physical impairments are classified as mild, moderate, or severe, depending on the extent to which children can use their bodies. If a child can walk alone, he or she is usually considered only mildly impaired. If a child needs crutches or other aids to walk, the impairment is usually moderate. Children in wheel­chairs are usually considered severely physically im­paired.

Physically impaired children may have a body part disabled by either a neurological cause or an orthopedic cause. A neurological impairment involves an injury or dysfunction in a part of the brain or spinal cord resulting in a loss of some bodily movements. An orthopedic impair­ment involves an injury or dysfunction in a part of the skeletal system resulting in a loss of some bodily move­ments. The difficulties in body movement, sensation, perception, or control may be identical with either neuro­logical or orthopedic causations. Prefixes such as mono (one), di (two), tri (three), or quadri (four) are often placed before plegia (paralysis) to designate the number of limbs (arms and legs) that are affected. Hemiplegia is used to designate the loss of movement of one side of the body. Paraplegia is often used to designate the loss of move­ment of both legs.

Children with health impairments must have some form of medicine or medical attention in order to attend school. Health impairments are classified as mild, moderate, or severe, depending on duration (temporary or chronic) and limitations to activity (normal stamina or debilitated and weak). Most of the health impairments that qualify for special educational services under PL 94-142 are chronic and/or debilitating illnesses. Some examples are cancer, diabetes, epilepsy, sickle cell anemia, asthma, AIDS, heart defects, eating disorders, and pregnancy.

Intervention for children with physical or health prob­lems should begin as soon as the impairment is diag­nosed. Special educational services, as well as medical services, may be initiated at birth. Preschools now provide multidisciplinary services to children with physical or health impairments. Public schools must supply equal opportunities for children with disabilities to participate in school activities, transitional services, and free and appro­priate education. The reforms and restructuring of special education, mandated by the courts, have opened public school doors to many physically and/or health-impaired children who were formerly taught at home, in hospitals, in residential institutions, or in special schools.

The age at which a child acquires a physical or health impairment is an important area to consider when devel­oping the individualized education program (IEP). A child who is born with a disability usually has permanent, severe limitations but has grown up adjusting to the restrictions imposed by immobility or medical attentions. A child who acquires the impairment later in childhood may have a greater chance of partial or complete recov­ery. However, this child has had no time to learn to cope with the disability. Children who have just developed physical or health impairments may go through periods of denial, mourning, and depression before they accept the limitations imposed by their conditions. Their lEPs should include short-term goals for helping them adjust. They usually need to be motivated to comply with physical or occupational therapy, or medicines and medical pro­cedures. Medical social workers often participate in the development of individualized family service plans (IFSPs) or lEPs with suggestions for special services aimed at helping the students and their families adjust to the impairments.

The visibility of the physical or health impairment is another important consideration when developing short-and long-term goals for children who are debilitated. Children with very obvious disabilities not only look differ­ent but also feel different because of all the attention their handicap receives. They may have to struggle to develop positive self-images and self-esteem. Children with less obvious impairments (e.g., diabetes, sickle cell anemia, asthma, epilepsy) may be asked to participate in more activities than they can handle, or in forbidden activities. They have to constantly explain that they are different, even if they do not look different. They may be accused of being lazy or hypochondriacal.

Teachers have a responsibility to help establish positive interactions between children with disabilities and their abled peers. It is important that teachers and other school personnel become acquainted with the special situations of each physically or health-impaired child. They should understand limitations, needs, treatments, and/or medica­tions. In addition, they should discuss each child's condi­tion openly with his or her classmates. Peers are more willing to accept special arrangements or time given to children with physical or health impairments if the need for them has been made clear from the beginning.

Teachers of children with physical or health impair­ments may be called on to do some extraordinary pro cedures. Judicial rulings have established life support services as legitimate duties of schools with regular edu­cation classes. For example, if a child needs urinary catheterization during the school day, the school staff must provide this service. If a school nurse is not avail­able, a teacher may be asked. Teachers may be asked to supervise ambulatory kidney dialysis, oxygen administra­tion, intravenous feedings, or ventilators. They may need to learn how to handle diabetic shock, asthmatic attacks, and epileptic seizures. In addition to medical special services, the teacher must also educate the children appropriately and challenge them to work up to their highest levels of ability. Sympathy assignments, or sym­pathy grades, are detrimental to all children.

The first article in this unit discusses three health impairments: cancer, medical fragility, and at-risk birth status. Special services should be initiated as soon as the conditions are diagnosed. The second article presents the danger that some physically and health-impaired children face: child abuse. Teachers need to be aware of the implications of the research in this area. The next selection addresses the question of the appropriateness of enrolling students with physical or health impairments in regular classes. Both the "up"side and the "down"side are presented along with a discussion of supplementary aids and services. The last article provides a summary of educational adaptations for children with physical and health impairments in inclusive classrooms. The tips in the article are designed both to help teachers and to raise their awareness of the positive aspects of inclusion.

Looking Ahead: Challenge Questions

What modifications of school curriculum should be made for children who survive life-threatening illnesses?

How can we help prevent the abuse of children with physical or health impairments? How can we help support their families?

Is inclusion appropriate for children with physical and health impairments?

What can teachers do to make inclusion of physically impaired children a more pleasant, nonthreatening experi­ence?