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What is Physical Health Disabilities, and related Low-Incidence Disabilities?

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What is Physical Health Disabilities, and related Low-Incidence Disabilities?

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Students who have physical and health disabilities comprise one of the most diverse categories of students receiving special education services.
-Depending on their daintily, they may come under one of the four IDEA categories: orthopedic impairment, multiple disabilities, traumatic brain injury, and other health impairments
-Individuals with the concomitant loss of both vision and hearing are referred to as having deaf-blindness

Source: Textbook, Special Education in a Contemporary Society, chapter 14

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Some common characteristics include:

Multiple disabilities: intellectual disabilities and spina bifida, cerebral palsy and seizures, and muscular dystrophy and behavior disorders

Students with Traumatic brain injury: acquired brain injury often mild, varies by area of brain injury, may impair cognition and social/ behavioral functioning, added as a separate disability category under IDEA in 1990, and often requires rehabilitative services

Students with Other Health Impairments: seizure disorders: Absence seizures: Loss of consciousness, appears trancelike, Complex partial seizure: impaired consciousness, involuntary movements, Tonic-clonic seizures: convulsive seizure, loss of consciousness

Asthma

Infectious diseases

Students with deaf-blindness: cognitive deficits (66%), physical impairments (57%), complex health needs (38%), additional considerations, speech and language development, and social and behavioral skills

Source: Textbook, Special Education in a Contemporary Society, chapter 14

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Some of the most common causes resulting in physical and health disabilities are genetic and chromosomal defects, teratogenic causes, prematurity and complications of pregnancy, and acquired causes.

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Individuals with Physical, Health, and Other Low-Incidence Disabilities

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There are many challenges in the classroom for students the have

some examples I may see in my classroom are:

having reliable communication skills and forms. Students with TBI, ASD, or multiple disabilities may not communicate in traditional ways

It is also hard for students to navigate the school and classroom if they have a wheelchair or other handicap device

It also might be hard for me to help teach friendship skills between the students. Students with limited social skills can unwittingly jeopardize potential friendships by putting other students off with stereotypical behavior. It is important that I provide students with a "safe place" to practice friendship skills with support. By working with the school counselor or other therapists, a student can have the chance to engage in role-playing or structured activities for practicing skills, which can increase the likelihood of social acceptance.

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Miranda is a beautiful 8-year-old brunette who happens to be deafblind. She attends her neighborhood school, where she spends part of her day in an inclusive classroom and part of it receiving one-on-one tutoring. While she's in the general education classroom, an interpreter works with her using tactile sign language to help her access the environment. Although Miranda is using her cane to travel more independently, she still relies on the interpreter to guide her most of the time. Jane is a classmate who is fascinated with Miranda's form of communication and watches her from across the room. Although Jane would like to talk to Miranda, she feels unsure of how to approach her. Because of scheduling challenges, there is limited time for Miranda to socialize and the teacher is challenged to prepare students for upcoming statewide testing. Miranda is the first deafblind student to be served by this district, and though the educational team is striving to meet her needs, she spends most of her day working with adults, leaving little time to socialize with peers and build friendships.

"Miranda" and "Jane" are both composites of real students and real friendship challenges that are taking place around the country. While this particular story is based on multiple students' experiences, it serves to illustrate some of the realities that individual students with low-incidence disabilities must navigate in being socially included.

Fostering friendships between students with disabilities and typical peers may be one of the most rewarding roles for teachers and family members to play in encouraging student development, achievement, and quality of life. In particular, students with low-incidence disabilities face specific challenges forming positive relationships with peers because of disability-specific hurdles in mobility, or in accessing communication as well as environmental information. At the same time, barriers may exist in schools that serve as obstacles to students in forming friendships.

First, let's define what is meant by the term "low-incidence." In a practical sense, it has been used to designate students who have disability diagnoses that are not prevalent. Such categories have included students with hearing impairments, visual impairments, deafblindness, traumatic brain injury (TBI), orthopedic impairments, multiple disabilities, complex health needs, and those with Autism Spectrum Disorders (ASD). Within this grouping, there is great diversity of functioning, abilities, and needs. Parents and family members, particularly in rural environments, may struggle to find local services and disability-specific support groups. Fortunately, there are ways that teams can meaningfully support students as well as promote school cultures that support diverse types of friendships. The following seven suggestions are a start:

Teach communication skills directly to students and include peers. One of the biggest challenges for most students with low-incidence disabilities can be having reliable communication skills and forms. Students with TBI, ASD, or multiple disabilities may not communicate in traditional ways. Also, students may use augmentative forms of communication such as pictures, voice-output devices or sign language. Strengthening a student's communication ability and facility is one of the greatest gifts a team can provide. In order to build communication with peers, it is necessary for peers to understand that communication can happen in diverse ways, using multiple forms. Teachers and parents can empower would-be friends by showing them how to communicate with a student directly in a relaxed and even playful way. As students tend to love the use of technology, pictures, or sign language, developing these skills with a friend by playing a game or engaging in a preferred activity can put both students at ease, as well as build bridges through a shared system of communication.

Teach mobility strategies and supports to peers. If a student uses a wheelchair, needs a human guide or uses another mobility device, work with peers to understand how an individual travels. If appropriate, adults can help students learn to safely guide an individual with visual impairments or push someone's wheelchair. A student with a disability may prefer a peer's support to an adult's. These decisions should be made with qualified professionals involved, such as physical therapists or certified orientation and mobility specialists.

Teach friendship skills in low-risk settings. For some students from low-incidence disability groups, social skills are not learned incidentally but are acquired through direct practice and coaching. At the same time, students with limited social skills can unwittingly jeopardize potential friendships by putting other students off with stereotypical behavior. It is important to provide students with a "safe place" to practice friendship skills with support. By working with the school counselor or other therapists, a student can have the chance to engage in role-playing or structured activities for practicing skills, which can increase the likelihood of social acceptance.

Connect students with disabilities through summer camps or weekends. Students with rarer disabilities have fewer opportunities to meet other students that share their type of disability experience. Studies have shown that having the chance to meet individuals with similar access needs can build a sense of identity and self-esteem (Miner, 1997). Having a stronger sense of confidence as an individual can help build friendships.

Allow time for friendship development. With the demands of the school curriculum, it is important to schedule time to develop friends. If a student has less access to the environment or takes longer to communicate, giving needed access through after-school friendship clubs or lunch groups provides individuals needed time for richer social interactions.

Help students with disabilities to assume valued roles in school. Culture is highly driven by imagery, dress, and social values; each community promotes specific styles of clothes or social roles (Wolfensberger, 1992). Educators and parents can help students with disabilities by studying the school's subtle and more obvious cultural values. Assisting students by working with peers to select styles that are flattering as well as valued can go a long way in helping students with disabilities be more accepted. Helping a student with an interest in sports, theater, or leadership take on these valued roles can promote students with disabilities as respected members of the community.

Implement a culture of friendship diversity. Just as savvy schools have become more accepting of ethnic and linguistic diversity, disability can be promoted by school staff as another type of diversity. Posters of successful adults with disabilities, such as musicians, athletes, political figures, and scientists can be shared in public ways that help all students recognize people with disabilities as members of society. Inviting regional or national speakers with disabilities to celebrate diversity is another means of building this accepting culture. Finally, highlighting the strengths of diversity through theater, poetry, song, and other art forms can be a means of transforming schools into places where many types of friendship can thrive.

Of the many things that can be done to engender genuine friendships, making peer relationships a priority in the educational program may be the most critical. Often social and communication skills that are taught through authentic relationships with peers do more to increase the student's quality of life and sense of belonging than what may be offered through structured adult teaching sessions alone.

In the opening scenario of this article, a possible next step would be for Miranda's team to use a collaborative process to create some goals for integrating an iPad with several sign language applications into classroom activities. The classroom teacher could use activities like peer-interviewing as a part of literacy instruction for the entire class. Miranda, with the support of her inclusion teacher and interpreter, could design interview questions for learning about her peers. Jane could be allowed to use an iPad to search for relevant sign language responses as a part of her writing assignments and to practice them with Miranda directly. Later, Miranda's general education teacher could design social studies lessons that feature the life of Helen Keller. Miranda, with support, would then have an opportunity to teach the entire class some sign language and show them how she's learning to use her cane to travel. Miranda's mom could work with the team to develop play dates with Jane, integrating opportunities to share activities as well as technology to build direct communication.

Through team support, creativity, and technology, a natural spark of friendship between Miranda and Jane could be encouraged. For both girls, the gifts of friendship would make school and life much more meaningful.

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Impact | Volume 24, Number 1 | Supporting Friendship Development For Students with Low-Incidence Disabilities

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Miranda is a beautiful 8-year-old brunette who happens to be deafblind. She attends her neighborhood school, where she spends part of her day in an inclusive classroom and part of it receiving one-on-one tutoring. While she's in the general education classroom, an interpreter works with her using tactile sign language to help her access the environment.

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Throughout my classroom there are a few ways that I would help my students.

Some ideas include:

Computer assistive technology: input, output, and processing aids allow computer adaptations

Augmentative communication: forms of language that are used to supplement oral language.

Positioning and seating devices: I'd provide proper positioning and seating for optimal learning

I would have environmental control and assistive technology for daily living. Devices that control electronic appliances, modified daily items

I would also include assistive technology for play and recreation devices used to access toys, adapted sports teams

I would also consider reliable ways for the individual to respond to assessment measures

Source: Textbook, Special Education in a Contemporary Society, chapter 14

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In my classroom I think despite the challenges there are strengths as well. Having students like this in my classroom would allow everyone to connect in different ways despite their differences. It would also allow my students to learn about each other and see how everyone is unique. I would make sure all my students understand that there are positives that come from our differences.