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(Medium Incidence)

Intellectual disability (ID) is a term used when there are limits to a person’s ability to learn at an expected level and function in daily life. Levels of intellectual disability can vary greatly among people. Those with intellectual disability may have difficulty communicating their wants and needs and taking care of themselves. Intellectual disability can cause a person to learn and develop more slowly than others, taking longer to learn skills like speaking, walking, dressing, or eating without assistance. They may also face challenges with academic learning.

Reference:

1. Centers for Disease Control and Prevention. (2022). Facts About Intellectual Disability. Retrieved March 3, 2023, from https://www.cdc.gov/ncbddd/developmentaldisabilities/facts-about-intellectual-disability.html

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Interventions for Intellectual Disability (ID) can vary depending on the severity of the disability and the individual's specific needs. Here are some examples of interventions that may be used for people with ID:

1. Education: Education is critical for individuals with ID. Special education programs, tailored to the individual needs of the person with ID, can help them learn basic life skills, social skills, and communication skills.

2. Behavioral Interventions: Behavioral interventions can be used to help individuals with ID manage challenging behaviors. These interventions can include positive reinforcement, behavioral therapy, and cognitive-behavioral therapy.

3. Occupational Therapy: Occupational therapy can help individuals with ID develop their fine motor skills, sensory processing, and coordination. This can help them be more independent and successful in their daily activities.

4. Speech Therapy: Speech therapy can help individuals with ID improve their communication skills, including speech, language, and social communication. This can improve their ability to interact with others and express their needs and wants.

5. Physical Therapy: Physical therapy can help individuals with ID improve their physical strength, coordination, balance, and mobility. This can help them be more independent and participate in physical activities.

6. Social Skills Training: Social skills training can help individuals with ID learn and practice social skills such as turn-taking, initiating conversations, and making friends. This can help them build meaningful relationships and participate in social activities.

7. Assistive Technology: Assistive technology, such as communication devices, mobility aids, and computer software, can help individuals with ID communicate, learn, and participate in activities more effectively.

Overall, interventions for individuals with ID should be tailored to their specific needs and goals, and should aim to improve their quality of life and help them live as independently as possible.

References:

1. UK Essays. (November 2018). Accommodations for the Intellectually Disabled. Retrieved March 4, 2023, from https://www.ukessays.com/essays/teaching/accommodations-intellectually-disabled-7542.php

2. Oliver, C., & Richards, C. (2007). Interventions for challenging behaviour in intellectual disability. Advances in Psychiatric Treatment, 13(1), 58-70. doi: 10.1192/apt.bp.105.001735.  Retrieved March 4, 2023, from https://www.cambridge.org

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Challenging behaviour in individuals with intellectual disability is a complex but common problem that can present diagnostic and management challenges for healthcare professionals. All behaviour serves a purpose, has an origin and meaning, and is therefore produced by an interaction between an individual and their environment. Challenging behaviour is a socially constructed, dynamic concept in that for a displayed behaviour to be considered challenging another person will have interpreted it as being dangerous, frightening, distressing or annoying ( Royal College of Psychiatrists 2007). Consequently, what is defined as challenging may vary across cultures or settings.

Clinically, challenging behaviour refers to persistent and pervasive maladaptive behaviour(s) that has a significant adverse effect on the quality of life and/or health and safety of the individual or others. The term can include a range of behaviours, for example physical aggression towards objects or people, self-injury, sexually inappropriate behaviour, offending behaviour (such as arson or stealing), mannerisms or rituals ( Royal College of Psychiatrists 2007). If the behaviour threatens the quality of life or physical safety of others, it can result in the individual's exclusion from services or community activities or provoke restrictive and aversive responses that may be socially or morally unacceptable. Hence, trying to understand and, where appropriate, reduce the occurrence of challenging behaviour is of utmost importance. Challenging behaviour can be an attempt to communicate unmet needs, so strategies that are proactive and flexible in addressing these should be put in place, positive behavioural development should be promoted and the response of professionals and carers to challenging behaviour should be socially enabling rather than restricting ( Royal College of Psychiatrists 2007).

Epidemiology

Reported prevalence of challenging behaviour in adults with intellectual disability varies depending on the definition used for ascertainment, study methodology, settings and populations. It has previously been reported to range between 6.1% in the community and 40% in long-stay hospitals ( Reference EmersonEmerson 1995). In the total intellectual disability population the incidence of 'serious challenging behaviour' was found to be around 10% ( Reference Lowe, Allen and JonesLowe 2007) and that of any type of challenging behaviour was 10-15% ( Reference Emerson, Kiernan and AlborzEmerson 2001a). A community-based epidemiological study found a prevalence of 4.9% for self-injurious behaviour ( Reference Cooper, Smiley and AllanCooper 2009a) and of 9.8% for aggression ( Reference Cooper, Smiley and JacksonCooper 2009b). Challenging behaviour appears to be even more pervasive in individuals with profound intellectual disability and multiple disabilities, with a prevalence of 82% for self-injurious and stereotypical behaviour and 45% for aggressive/destructive behaviour ( Reference Poppes, van der Putten and VlaskampPoppes 2010).

In a meta-analytic study of markers of challenging behaviour in people with intellectual disability, aggressive behaviour was associated with male gender; self-injurious behaviour was more likely in those with severe or profound intellectual disability and those with receptive or expressive communication difficulties; and a diagnosis of autism was associated with self-injury, aggression and disruption to the environment ( Reference McClintock, Hall and OliverMcClintock 2003).

Aetiology

The causes of challenging behaviour ( Box 1 and Box 2) are complex and multifactorial, and should be understood from a biopsychosocial perspective. Biological factors contributing to challenging behaviour include genetic disorders associated with behavioural phenotypes (e.g. Prader-Willi syndrome and aggression; Lesch-Nyhan syndrome and severe self-injury), physical illness (e.g. epilepsy) and associated symptoms such as constipation, pain, urinary incontinence and visual impairment ( Reference De Winter, Jansen and Evenhuisde Winter 2011), and side-effects of medication, including anti-epileptics. Recent advances in genetics suggest that rare chromosomal abnormalities such as microdeletions or duplications may be associated with intellectual disability and challenging behaviour ( Reference Vissers, De Vries and VeltmanVissers 2010).

Annette has autism, severe intellectual disability and is non-verbal. She lives at home with her parents. Her mother reports that she has started to repetitively bang her head against the wall and to bite her hand. She has bruises on her head and deep injuries on her hand and arms. Her appetite has decreased and she has lost 12 kg in weight. She is also up at night, pacing up and down her room. Following discussion with her family, she is admitted, under Section 2 of the Mental Health Act 1983, to an assessment and treatment unit for people with intellectual disability. She refuses to have blood tests and investigations.

The initial working diagnosis was that of a depressive disorder and her psychiatrist started her on an antidepressant, but she failed to respond even when the dose was increased. A trial dose of risperidone was then initiated but had minimal effect. Owing to concerns about her physical health, and her lack of capacity to make decisions about her treatment, a best interests meeting was held to discuss whether an MRI of her brain and other investigations should be conducted under sedation. Her family and the professionals agreed that this was the best course of action. An MRI revealed that she had a brain tumour. She was urgently referred to the neurosurgeons and, following treatment under her best interests, she made a steady recovery over the next 6 months.

Psychological factors include psychological trauma, mental illness and neuropsychiatric disorders such as autism. Social factors may include family discord and economic deprivation ( Reference Emerson and EinfieldEmerson 2001b), negative life events ( Reference Esbenson and BensonEsbenson 2006), bereavement ( Reference Dodd, Dowling and HollinsDodd 2005) and communication difficulties.

Individuals often use challenging behaviour as a form of communication when they would like to gain access to a particular object or activity, or avoid or escape an activity or person ( Reference Fox, Dunlap, Buschbacher, Wetherby and PrizantFox 2000). It may also serve to communicate dissatisfaction with their environment or lack of support due to poorly trained staff or inadequately resourced day services.

Challenging behaviour and mental illness

The relationship between challenging behaviour and mental illness is complex and not fully understood (for a review see Reference Thakker, Bamidele and AliThakker et al 2012). Mental illness is more common in people who exhibit challenging behaviour than in those who do not ( Reference Moss, Emerson and KiernanMoss 2000). Several factors have been suggested as potential causes of coexisting mental illness and challenging behaviour in people with intellectual disability. ( Reference Emerson and EinfieldEmerson 2001b). Challenging behaviour may be an atypical presentation of core symptoms of a specific disorder (e.g. self-injury such as repetitive skin picking may be part of an underlying obsessive-compulsive disorder); it may occur as a secondary feature of mental illness (e.g. self-injury and aggression may be a feature of depression); and it may be reinforced by the symptoms of a mental illness. More than one mechanism may contribute to challenging behaviour in some individuals.

Diagnostic problems

Establishing the cause of challenging behaviour is rarely straightforward. In particular, the diagnosis of mental illness in individuals with intellectual disability and challenging behaviour can pose significant problems for clinicians. For example, if the patient is unable to communicate, the clinician must rely on whether changes in biological symptoms (e.g. sleep and appetite) have occurred. Diagnosis of mental illness may also be complicated if atypical symptoms are present, or if there are inconsistencies in the reports given by informants ( Reference Moss and BourasMoss 1999). The presence of autism may also complicate the presentation of psychiatric symptoms. Agitation and inappropriate sexual behaviour in a young man with autism may be mistaken for hypomania; a young woman with autism observed talking to herself or engaging in concrete thinking may be incorrectly diagnosed with psychosis. At times of stress, individuals with autism may also present with transient psychotic-like symptoms such as anxiety, thought disorder and persecutory ideas, particularly if they are asked to stop an activity that they are engaged in or asked to begin a new activity ( Reference BerneyBerney 2000).

Diagnostic overshadowing ( Reference Reiss, Levitan and SzyskoReiss 1982) may occur, meaning that a symptom or behaviour is attributed to the person's intellectual disability or environmental factors when it is in fact due to mental or physical illness ( Reference Palucka, Nyhus and LunskyPalucka 2003).

Assessment of challenging behaviour: functional analysis

The initial stage of assessment of challenging behaviour involves gathering information about the problem behaviour from a number of sources, including the patient, relatives and paid carers. A detailed psychiatric history, mental state examination, physical examination and direct observations in a number of settings, alongside appropriate medical investigations, may reveal an underlying psychiatric or physical illness as the cause of the behaviour. Where there is no obvious underlying physical or psychiatric cause, the next stage requires a functional analysis of the behaviour.

In functional analysis, the individual and their environment are examined to determine what purpose the behaviour may be serving for the individual and what factors in the environment may increase or diminish the behaviour. There may be clear triggers for the behaviour, or factors that maintain or reinforce it. In addition, the behaviour may be more likely to occur in the presence of particular personal, biological or environmental aspects, referred to as 'setting events' ( Reference Bijou and BaerBijou 1978). For example, tiredness, poor lighting or the number of people in the room may increase the likelihood of the behaviour ( Reference Carter and DriscollCarter 2007).

Carrying out a functional analysis

The process involved in carrying out a functional analysis is outlined in Box 3. Direct observations and baseline data about the frequency and duration of the behaviour are essential. Events and observed behaviour can be recorded on an ABC chart for subsequent analysis of the antecedents (A), behaviour (B) and associated consequences (C). In addition, questionnaires and rating scales such as the Motivation Assessment Scale ( Reference Durand and CrimminsDurand 1992) may be used to gather information about the possible function of the behaviour. Ideally, the formulation should lead to an intervention or a further period of assessment and analysis, including manipulation of the antecedents or consequences (for a review see Reference Hanley, Iwata and McCordHanley et al 2003). Any interventions that are implemented will need to be evaluated for effectiveness and modified if necessary.

A meta-analysis has shown that functional analysis is important in achieving a positive outcome of behavioural interventions for people with intellectual disability ( Reference Carr, Horner and TurnbullCarr 1999).

Management of challenging behaviour

Approaches for managing challenging behaviour include psychosocial interventions as well as medication. A survey of psychiatrists suggested that non-pharmacological interventions are the first-choice treatment for aggression where no psychiatric condition is confirmed ( Reference Unwin and DebUnwin 2008). The consensus was that pharmacological interventions are considered if other treatment is unsuccessful owing to the frequency or severity of the aggressive behaviour, or when there is a risk of harm to self or others. The evidence base for some of these treatment options will be considered here.

Psychosocial interventions

Numerous psychosocial interventions have been proposed to address challenging behaviour in people with intellectual disability and the available evidence base for these varies greatly between treatments. In this section we consider some of these treatments and the support for their efficacy.

Pharmacological interventions

Current NHS service delivery models

A locally based service model for the management of challenging behaviour in people with intellectual disability has been recommended by several UK government policies ( Department of Health 2007; Commission of Social Care Inspection 2009), but progress towards this has been slow ( Reference Allen, James and EvansAllen 2005). The behaviour can usually be managed in a community setting with the help of community intellectual disability teams. For individuals presenting with more severe or ongoing challenging behaviour, input from a specialist challenging behaviour team may be helpful, but service provision does vary in different areas.

Individuals with intellectual disability presenting with severe challenging behaviour that cannot be managed in the community because of the risk to the individual or others will require admission to hospital. If the person has an underlying mental illness, then where possible, admission should be to a generic mental health ward. However, if the needs are more complex, admission to a specialist hospital for people with intellectual disability (an assessment and treatment or A&T unit), may be required.

Following the exposure of widespread physical and emotional abuse at one A&T unit, Winterbourne View hospital, the Department of Health (2012) set out a programme to reform these services. Admission should occur only in exceptional circumstances, the reason should be clearly documented and families should be involved in the decision-making process. The time spent in such units should be brief and should focus on the attainment of specific goals. Out-of-area placements should be avoided as they can have deleterious effects on relationships and continuity of care and may contribute to challenging behaviour. Commissioners are expected to work more closely with local service providers to ensure that appropriate local placements and skilled care are available.

Conclusions

There is very little support for use of pharmacological treatments for people with challenging behaviour and intellectual disability in the absence of coexisting mental illness. However, medication may be required in the presence of high arousal and severe aggressive behaviour. There is emerging interest in behavioural interventions for reducing challenging behaviour, including positive behavioural support, a values-led approach that is person centred. The increasing proliferation of treatment approaches for challenging behaviour and the ongoing improvement in study design, including randomised controlled trials, are cause for optimism regarding the enhancement of evidence-based care for individuals with intellectual and developmental disabilities and challenging behaviour.

MCQs

Select the single best option for each question stem

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Interventions for challenging behaviour in intellectual disability | Advances in Psychiatric Treatment | Cambridge Core

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Challenging behaviour in individuals with intellectual disability is a complex but common problem that can present diagnostic and management challenges for healthcare professionals. All behaviour serves a purpose, has an origin and meaning, and is therefore produced by an interaction between an individual and their environment.

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1. Assistive technology: Assistive technology such as communication devices, computer software, and mobility aids can help individuals with ID communicate, learn, and participate in activities more effectively.

2. Visual aids: Visual aids such as pictures, diagrams, and videos can help individuals with ID understand and learn new concepts.

3. Modified curriculum: A modified curriculum can help individuals with ID learn at their own pace and in a way that is tailored to their individual needs.

4. Alternative assessment methods: Alternative assessment methods such as performance-based assessments and oral exams can help individuals with ID demonstrate their knowledge and skills.

5. Peer tutoring: Peer tutoring can be an effective way for individuals with ID to receive additional support and guidance from their peers.

6. Lerning Environment: Some students with ID may also have a visual, hearing, and/or physical diasabilities. Seating plans, classroom arrangements, behavior expectations, and classroom procedures may need to be adjusted.

It is important to note that accommodations for individuals with ID should be tailored to their individual needs and goals, and should aim to improve their quality of life and help them live as independently as possible.

References:

1. UK Essays. (November 2018). Accommodations for the Intellectually Disabled. Retrieved March 3, 2023, from https://www.ukessays.com/essays/teaching/accommodations-intellectually-disabled-7542.php

2. TherapyTravelers. (n.d.). Strategies for Teaching Students with Intellectual Disabilities. Retrieved March 3, 2023, from https://www.therapytravelers.com/strategies-teaching-students-intellectual-disabilities/

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Special Education Talks: Identifying Students for Accommodations

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(High Incidence)

Speech/Language Impairment (SLI) is a communication disorder that affects a person's ability to produce speech sounds accurately, use language appropriately, or understand spoken language.

Individuals with SLI may have difficulty with one or more aspects of communication, such as:

1. Articulation: Difficulty producing speech sounds accurately, resulting in speech that may be difficult to understand.

2. Fluency: Difficulty speaking smoothly, resulting in stuttering or hesitation in speech.

3. Voice: Difficulty producing speech with appropriate volume, pitch, or quality.

4. Language: Difficulty using or understanding language, including difficulty with vocabulary, grammar, and sentence structure.

SLI can be caused by a variety of factors, including developmental delays, genetic factors, or neurological conditions such as cerebral palsy or autism spectrum disorder.

SLI can affect a person's ability to communicate effectively, participate in social interactions, and succeed academically or professionally. Speech therapy and other interventions can help individuals with SLI improve their communication skills and overcome the challenges associated with the disorder.

Reference:

1. Parent Center Hub. (n.d.). Speech and Language Impairment. Retrieved March 3, 2023, from https://www.parentcenterhub.org/speechlanguage/

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Speech Language Impairment: Students with Disabilities

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Interventions for Speech/Language Impairment (SLI) can vary depending on the specific needs of the individual. Here are some examples of interventions that may be used:

Verbal Interventions

Auditory Stimulation Training

Used to improve the auditory processing in individuals with SLI

The software which challenges a person’s linguistic and cognitive abilities

Consists of different tasks which manipulate speech style, language components, and stimuli

Fast ForWord is a commonly used intervention software

Repetition

A study done by Horst in 2017

Tested three-year-old children with and without SLI

Parents read children’s book repeatedly to their children

Results found that children with SLI did worse remembering words initially but performed the same remembering the words a week later

Written Communication Interventions

Domain-Specific Approaches

A structure of interventions that can focus on individual areas of language development deficiencies

Follows either a top-down or bottom-up approach, which is either focusing on general details with working up to bigger and bigger components of speech or the other way around

When using this structural form, it is important to use the individual’s language strengths as the base for determining the sequential order

Allows for co-dependencies of language, which is understanding how to process information based on making associations and representations throughout language

Probe-Based Exercises

Introducing situations that encourage the individual to use the targeted area of language (i.e. promoting the use of the “-ed” suffix)

These exercises usually involve toys or props of some sort.

Promotes the use of different morphemes within language, which can be applied to increasing grammatical and literacy skills

Storytelling

Can be approached from multiple angles including in a group setting, in a more one-on-one setting, retelling a story, or coming up with a personal story narrative

Allows individuals to increase their narrative abilities, or their ability to tell a story in a clear and organized fashion.

Allows for a better understanding of components like reading text, sentence comprehension, as well as other semantic processes

Other  Interventions

Speech Therapy: Speech therapy is a common intervention for SLI. A speech-language pathologist (SLP) can work with the individual to improve their speech and language skills. Therapy may include exercises to improve articulation, language comprehension, or social communication skills.

Augmentative and Alternative Communication (AAC): For individuals who have significant difficulty with verbal communication, AAC devices or strategies may be recommended. These can include picture boards, communication apps, or speech-generating devices.

Parent Training: Parents and caregivers can be involved in the intervention process to help support their child's communication skills at home. A speech-language pathologist may work with parents to teach them strategies for facilitating their child's language development.

Social Skills Training: Individuals with SLI may benefit from social skills training to improve their ability to interact with peers and build relationships. This may involve teaching specific social skills or providing opportunities for social interaction in a structured setting.

Educational Support: In a school setting, accommodations such as modified curriculum, assistive technology, or one-on-one support from an aide or teacher may be provided to help the individual with SLI succeed academically.

References:

1. Vanderbilt University. (2020). Specific Language Impairment. Retrieved March 6, 2023, from https://my.vanderbilt.edu/speds2430/2020-topics/specific-language-impairment/

2. American Speech-Language-Hearing Association. (n.d.). Speech and Language Disorders. Retrieved March 6, 2023, from https://www.asha.org/public/speech/disorders/

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SLI Interventions (Focus Learning Project)

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1. Preferential seating: Providing preferential seating can help individuals with SLI better hear and understand the teacher or speaker.

2. Visual aids: Using visual aids such as pictures, diagrams, or videos can help individuals with SLI understand and remember new information.

3. Assistive technology: Assistive technology such as speech-to-text or text-to-speech software can help individuals with SLI communicate or access information more effectively.

4. Extended time: Providing extended time on assignments, exams, or tasks can help individuals with SLI complete their work at their own pace.

5. Simplified language: Using simplified language, breaking down complex instructions or concepts into smaller parts, or providing concrete examples can help individuals with SLI understand new information.

6. Multimodal instruction: Using a variety of teaching methods, including visual, auditory, and kinesthetic activities, can help individuals with SLI learn new information in different ways.

7. Speech therapy: Providing speech therapy sessions in school can help individuals with SLI improve their speech and language skills.

NOTE: Overall, accommodations for individuals with SLI should be personalized to their specific needs and goals. Accommodations should aim to improve their communication skills, help them participate in social interactions, and support their academic or professional success.

References:

1. Newman, L., Wagner, M., Knokey, A. M., Marder, C., Nagle, K., Shaver, D., ... Wei, X. (2018). Preparing for Life after High School: The Characteristics and Experiences of Youth in Special Education. Findings from the National Longitudinal Transition Study 2012. Volume 1: Comparisons with Other Youth (Full Report). Minneapolis, MN: National Center on Educational Outcomes, University of Minnesota. Retrieved March 5, 2023, from https://nceo.umn.edu/docs/OnlinePubs/NCEOReport430.pdf

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1. Simplify language: Use clear and concise language, and break down complex concepts into smaller, more manageable parts.

2. Use visual aids: Visual aids such as pictures, diagrams, or videos can help individuals with SLI understand and remember new information.

3. Repeat and reinforce: Repeat instructions or concepts as needed, and reinforce learning with praise or positive feedback.

4. Encourage questions: Encourage individuals with SLI to ask questions and seek clarification when they do not understand something.

5. Model language: Model proper grammar and pronunciation, and use correct vocabulary to help individuals with SLI learn new words and concepts.

6. Use context cues: Use context cues such as gestures or facial expressions to help individuals with SLI understand the meaning of new words or concepts.

7. Provide opportunities for practice: Provide opportunities for individuals with SLI to practice their communication skills in a safe and supportive environment.

8. Be patient and supportive: Be patient and understanding, and provide emotional support as needed to help individuals with SLI build their confidence and communication skills.

Reference:

1. Do2Learn. (n.d.). Speech and Language Impairment Strategies. Retrieved March 3, 2023, from https://do2learn.com/disabilities/CharacteristicsAndStrategies/SpeechLanguageImpairment_Strategies.html

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It is important to implement strategies that address the needs of the individual. We recommend that you apply these strategies across home, school, and community contexts.
Go to the Site Map for a full list of resources and activities!

Language

Focus on interactive communication.

Use active listening.

Incorporate the student's interests into speech.

Ensure that the student has a way to appropriately express their wants and needs.

Reinforce communication attempts (e.g. their gestures, partial verbalizations) when the student is non-verbal or emerging verbal.

Paraphrase back what the student has said or indicated.

Use storybook sharing in which a story is read to student and responses are elicited (praise is given for appropriate comments about the content).

Ask open-ended appropriate questions.

Use linguistic scaffolding techniques that involve a series of questions.

Use language for social interaction and to resolve conflicts.

Emphasize goals and tasks that are easy for the student to accomplish.

Work at the student's pace.

Present only one concept at a time.

Have speech therapist present language units to the entire class.

Use computers in the classroom for language enhancement.

Encourage reading and writing daily.

Use tactile and visual cues (e.g., pictures, 3-D objects).

Incorporate vocabulary with unit being taught.

Provide fun activities that are functional and practical.

Be aware of the student's functioning level in auditory skills, semantics, word recall, syntax, phonology, and pragmatics (and how they affect academic performance).

Speech

Develop a procedure for the student to ask for help.

Speak directly to the student.

Be a good speech model.

Have easy and good interactive communication in classroom.

Consult a speech language pathologist concerning your assignments and activities.Be aware that students may require another form of communication.

Encourage participation in classroom activities and discussions.

Model acceptance and understanding in classroom.

Anticipate areas of difficulty and involve the student in problem-solving.

Provide assistance and provide positive reinforcement when the student shows the ability to do something unaided.

Use a peer-buddy system when appropriate.

Devise alternate procedures for an activity with student.

Use gestures that support understanding.

Model correct speech patterns and avoid correcting speech difficulties.

Be patient when student is speaking, since rushing may result in frustration.

Academics & Behavior

Reduce unnecessary classroom noise as much as possible.

Be near the student when giving instructions and ask the student to repeat the instructions and prompt when necessary.

Provide verbal clues often.

Provide a quiet spot for the student to work if possible.

Speak clearly and deliberately.

Provide visual cues - on the board or chart paper.

Redirect the student frequently and provide step by step directions - repeating when necessary.

Allow students to tape lectures.

Allow more time for the student to complete activities.

Modify classroom activities so they may be less difficult, but have the same learning objectives.

Allow more time for the student to complete assignments and tests.

Design tests and presentations that are appropriate for the student (written instead of oral).

Divide academic goals into small units, utilizing the same theme.

Provide social and tangible reinforcers.

Focus on the student's strengths as much as possible.

Have the student sit in an accessible location to frequently monitor their understanding.

Allow extra time to complete work because of distractions, slow handwriting, or problems in decoding text.

Have routines that students can follow.

Use a visual reminder of the day's events to help with organization.

Establish communication goals related to student work experiences and plan strategies for the transition from school to employment and adult life.

Physical

Be aware that because of the way thebrain develops, it is easier to acquire language and communicationskills before the age of five.

Be aware that if children have muscular disorders, hearing problems, or developmental delays, their acquisition of speech, language, and related skills may be affected.

Use augmentative communication systems to ensure that nonverbal students and students with severe physical disabilities have effective ways to communicate.

Ensure that the student has access to their (portable) communication system across all contexts, all of the time.

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picture exchange communication system cards

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Do2Learn: Educational Resources for Special Needs

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picture communication cards, songs, games and learning activities for autism, aspergers, fetal alcohol syndrome and disabilities

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1. Augmentative and alternative communication (AAC) devices: AAC devices such as tablets or specialized communication devices can help individuals with SLI to communicate their ideas and participate in social activities more effectively.

2. Speech-to-text and text-to-speech software: These software programs can help individuals with SLI to write and speak more effectively. Speech-to-text software converts spoken language into text, while text-to-speech software converts written text into spoken language.

3. Electronic organizers and reminders: Electronic organizers and reminders can help individuals with SLI keep track of their schedules and stay organized.

4. Voice recognition software: Voice recognition software can help individuals with SLI to control their computer or other electronic devices using their voice.

5. Language learning apps: Language learning apps can help individuals with SLI to learn new words and practice their language skills in a fun and interactive way.

6. Hearing aids: For individuals with hearing impairment as part of their SLI, hearing aids can help them to hear and understand spoken language more effectively.

7. Visual aids: Visual aids such as picture boards, diagrams, or videos can help individuals with SLI to understand and remember new information.

References

1. Autism Parenting Magazine. (2018). How Assistive Technology Helps Children With Speech and Language Disorders. Retrieved March 4, 2023, from https://www.autismparentingmagazine.com/assistive-technology-speech-language-disorders/

2. The Speech-Language Impairment Project. (n.d.). Low-Tech and High-Tech Devices for Students With Speech-Language Impairment. Retrieved March 4, 2023, from https://sites.google.com/site/speechlangimpairment/low-tech-and-high-tech-devices

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Speech pathologists and assistive technology

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1. Individualized instruction: Students with ID may benefit from individualized instruction that is tailored to their specific needs and goals. This can include the use of specialized instruction, such as differentiated instruction or modified curriculum.

2. Multi-sensory instruction: Multi-sensory instruction can help students with ID learn new information by engaging multiple senses. This can include visual aids, hands-on activities, and verbal instruction.

3. Positive reinforcement: Positive reinforcement can help students with ID feel motivated and encouraged to learn. This can include verbal praise, small rewards, and recognition for their efforts and achievements.

4. Task analysis: Task analysis involves breaking down a task into smaller, more manageable steps. This can help students with ID understand and complete tasks more effectively.

5. Visual aids: Visual aids such as pictures, diagrams, and videos can help students with ID understand and learn new concepts.

6. Repetition: Repetition can be helpful for students with ID to learn and retain new information. Repeating instructions or concepts can help reinforce their learning.

7. Peer tutoring: Peer tutoring can be an effective way for students with ID to receive additional support and guidance from their peers.

8. Assistive technology: Assistive technology such as communication devices, computer software, and mobility aids can help students with ID communicate, learn, and participate in activities more effectively.

References:

1. TherapyTravelers. (n.d.). Strategies for Teaching Students with Intellectual Disabilities. Retrieved March 5, 2023, from https://www.therapytravelers.com/strategies-teaching-students-intellectual-disabilities/

2. AllPlayLearn. (n.d.). Intellectual Disability. Retrieved March 5, 2023, from https://allplaylearn.org.au/primary/teacher/intellectual-disability/

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"My mama always said, 'Life was like a box of chocolates. You never know what you're gonna get.'"
Sounds familiar? Yes, that's the famous line from the award-winning movie, "Forrest Gump." Is it 23 years ago already when it hit the theaters? Along with remarkable quotes we can still remember to today was Tom Hanks convincing portrayal of the main character. However, the film itself gained divided critics - many critics either love or totally hated the movie. But let's save criticizing the movie some other time. For now, let's discuss what makes the "Forrest Gump" interesting!

"Stupid is as stupid does." That was his famous answer when somebody asked him, "Are you stupid?"

Forrest is slow-witted and has an IQ of 75. Although Forrest is just a fictional character, in today's real world he is considered suffering from intellectual disability. Children with intellectual disabilities may qualify for special education services under the Individuals with Disabilities Education Act, or IDEA. Students who are eligible for IDEA receive an Individualized Education Plan, or IEP, in which a specialized education plan is made for the child based on her educational needs.

Intellectual disability, formerly labeled "mental retardation," is defined by the Individuals with Disabilities Education Act (IDEA) as "significantly subaverage general intellectual functioning, existing concurrently [at the same time] with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child's educational performance." There are two key components within this definition: a student's IQ and his or her capability to function independently, usually referred to as adaptive behavior.
An intellectual disability is not a disease. You can't catch an intellectual disability from anyone. It's also not a type of mental illness, like depression. There is no cure for intellectual disabilities. However, most children with an intellectual disability can learn to do many things. It just takes them more time and effort than other children.
Intellectual disability is one of the most common developmental disability, more than 425,000 children (ages 3-21) have some level of intellectual disability and receive special education services in public school under this category in IDEA. In fact, 7% of the children who need special education have some form of intellectual disability.

Signs of Intellectual Disability

sit up, crawl, or walk later than other children;

learn to talk later, or have trouble speaking,

find it hard to remember things,

not understand how to pay for things,

have trouble understanding social rules,

have trouble seeing the consequences of their actions,

have trouble solving problems, and/or

have trouble thinking logically.

"Mama always had a way of explaining things so I could understand them."- Forrest
Although Forrest received little to no support at all, and his resources were insufficient, he was blessed with a wise, sassy and loving mom. I remember a scene in which no school would like to accept him. But her mom was so determined to get him in in a regular school. So she moved mountains. Hmm... I guess we don't want to talk about it here again. Anyway, that's no longer the case of today's education.

Educational Considerations

A child with an intellectual disability can do well in school but is likely to need the individualized help that's available as special education and related services. The level of help and support that's needed will depend upon the degree of intellectual disability involved.

General education. It's important that students with intellectual disabilities be involved in, and make progress in, the general education curriculum. That's the same curriculum that's learned by those without disabilities. Be aware that IDEA does not permit a student to be removed from education in age-appropriate general education classrooms solely because he or she needs modifications to be made in the general education curriculum.

Supplementary aids and services. Given that intellectual disabilities affect learning, it's often crucial to provide support to students with ID in the classroom. This includes making accommodations appropriate to the needs of the student. It also includes providing what IDEA calls "supplementary aids and services." Supplementary aids and services are supports that may include instruction, personnel, equipment, or other accommodations that enable children with disabilities to be educated with nondisabled children to the maximum extent appropriate.

Thus, for families and teachers alike, it's important to know what changes and accommodations are helpful to students with intellectual disabilities. These need to be discussed by the IEP team and included in the IEP, if appropriate.

Adaptive skills. Many children with intellectual disabilities need help with adaptive skills, which are skills needed to live, work, and play in the community. Teachers and parents can help a child work on these skills at both school and home. Some of these skills include:

communicating with others;

taking care of personal needs (dressing, bathing, going to the bathroom);

health and safety;

home living (helping to set the table, cleaning the house, or cooking dinner);

social skills (manners, knowing the rules of conversation, getting along in a group, playing a game);

reading, writing, and basic math; and

as they get older, skills that will help them in the workplace.

Transition planning. It's extremely important for families and schools to begin planning early for the student's transition into the world of adulthood. Because intellectual disability affects how quickly and how well an individual learns new information and skills, the sooner transition planning begins, the more can be accomplished before the student leaves secondary school.

IDEA requires that, at the latest, transition planning for students with disabilities must begin no later than the first IEP to be in effect when they turn 16. The IEP teams of many students with intellectual disabilities feel that it's important for these students to begin earlier than that. And they do.

(An excerpt from parentcenterhub.org: Intellectual Disabilities)

See TherapyTravelers Special Education Teacher Jobs

Modification for Students with Intellectual Disabilities

Children with intellectual disabilities need some additional support and modifications in their environment, as well as in the type of activities they do. Here are a few modifications for students with an intellectual disability that will help them to learn better.

Using this space only for studying also will help the child get into a routine of studying and also understand that when he is sitting there, he is supposed to concentrate on the activity or task, and not play.

Teach practical things that will be useful, such as how to boil an egg or how to find their way to their friend's house.

Repetition of Concepts Over the Day

Children with intellectual disabilities need to learn a concept in different ways and have the opportunity to practice it many times in order to learn and remember it.

These children require additional support and guidance as they work on their activities. Ideally, there should be at least 1 teacher for every 3 children with intellectual disabilities.

Using all the senses to learn also helps them learn and retain information better.

Sharp scissors, knives, etc. must be kept out of reach. Harmful liquids like cleaning liquids must also be kept away. Medicines must be kept out of reach. In addition to this, make sure that none of the children can lock themselves up in any room. Small beads or other toy parts that the children could put in their mouth must be kept away if a child has a tendency to do that. If the child has seizures, you may need to look at padding the corners of furniture to avoid injury.

The schedule must have short activity times and must alternate between physical and sitting down activities. The schedule must also try and incorporate some aspects of self-care so that children start becoming more independent in putting on or taking off shoes, going to the toilet, or feeding themselves.

(Access full article here: Special Ed: Modification for Students with Intellectual Disabilities by brighthubeducation.org)

Teaching Practical Tips for Special Education Teachers

Recognize that you can make an enormous difference in this student's life!

Learn more about intellectual disabilities in general and your student in particular.

Be an active participant in the student's IEP team.

The IEP is developed by the student's parents and school personnel-and, often, the student, too. As this student's teacher, you have a great deal to contribute to what's included in the IEP, including supports for you as the teacher.

Provide accommodations and supports that help students with intellectual disabilities.

Accommodations are often made in five main areas:

1. scheduling (e.g., giving the student extra time to complete an assignment or test)

2. setting (e.g., having the student work in a small group or with a partner)

3. materials (e.g., providing the student with teacher notes or taped lectures)

4. instruction (e.g., breaking a lesson up into smaller parts, having the student work with a tutor)

5. student response (e.g., allowing the student to respond orally or on a computer)

An effective teaching method is to demonstrate what you mean in addition to giving verbal directions. With new information shared verbally, also show a picture. And rather than just showing a picture, provide the student with hands-on materials and experiences and the opportunity to try things out.

Break longer, new tasks into small steps. Demonstrate the steps. Have the student do the steps, one at a time. Provide assistance, as necessary. Give the student multiple opportunities to practice each individual step by itself and all the steps together.

Immediately providing feedback helps the students make a connection between their answers, behaviors, or questions and the information you're presenting as the teacher.

Schools play an important part in helping students with ID learn these life skills, which include health and safety, personal hygiene, manners, getting along with others, basic math and reading, money management, and skills for the workplace.

Address the social aspects of the school.

Students with intellectual disabilities often have trouble with social skills, which can make it difficult for them to interact appropriately with their peers and become involved in the social activities going on at school. They are also often a target for bullying, which simply cannot be allowed. Teachers can play a positive role in supporting the inclusion of students with intellectual disabilities in classrooms and throughout the school.

Communicate with your student's parents.

Regularly exchange information with parents and work with them (and other members of the IEP team) to create and implement an IEP tailored to meet the student's needs.

(Source: Intellectual Disabilities in Your Classroom: 9 Tips for Teachers)

5 Tips for Success

This term is intended to encourage teachers to break down their lessons into simple, easier-to-manage steps. This will keep frustration levels down and enable learning to take place. Wait until the student masters the baby step before moving onto the next one.

Introduce new ideas in a physical, hands-on approach. Use manipulatives when teaching math. Take field trips to the grocery store or post office to give students a meaningful experience. When students are able to make real connections to the world around them, or physically explore a concept, the knowledge will stick with them.

Positive feedback will encourage the student to keep on trying. If a student masters a concept or meets a goal it is important to reward or applaud the student immediately.

Music is a wonderful motivator among all children and particularly ones with intellectual disabilities. Making a simple, catchy song to go along with a concept is a fun way to engage the student and help them remember information.

Students with certain disabilities can be unpredictable in what they can learn and what might set off a certain behavior. What might appear to be a temper tantrum is often the student's way of telling you, "This is too hard. I am frustrated," or "I am tired. I need a break." Take the time to learn the individual child's needs and who they are. If you are feeling overwhelmed and cannot relate to the student it is OK to stop the lesson and resume when both student and teacher can handle the lesson pace. It may take a while for students to make some progress, but if you are patient it will be priceless when they do.

(Source: Five Tips for Teaching Students with Intellectual Disability by brighthubeducation.org)

Other Helpful Links for Teaching Students with Intellectual Disabilities

GUIDE FOR PARENTS OF CHILDREN WITH INTELLECTUAL DISABILITIES
Help for Babies and Toddlers
When a baby is born with an intellectual disability, his or her parents should know that there's a lot of help available-and immediately. Shortly after the diagnosis of ID is confirmed, parents will want to get in touch with the early intervention system in their community. We'll tell you how in a moment.

Early intervention is a system of services designed to help infants and toddlers with disabilities (until their 3rd birthday) and their families. It's mandated by IDEA. Staff work with the child's family to develop what is known as an Individualized Family Services Plan, or IFSP. The IFSP will describe the child's unique needs as well as the services he or she will receive to address those needs. The IFSP will also emphasize the unique needs of the family, so that parents and other family members will know how to help their young child with intellectual disability. Early intervention services may be provided on a sliding-fee basis, meaning that the costs to the family will depend upon their income.

To access early intervention services in your area, ask your child's pediatrician for a referral or call the local hospital's maternity ward and ask for contact information for your local services program.
Help for School-Aged Children
School staff will work with the child's parents to develop an Individualized Education Program or IEP. The IEP is similar to an IFSP. It describes the child's unique needs and the services that have been designed to meet those needs. Special education and related services are provided at no cost to parents.

To access special education services for a school-aged child in your area, get in touch with your local public school system. Calling the elementary school in your neighborhood is an excellent place to start.
Tips for Parents

Learn about intellectual disability.

Be patient, be hopeful.

Encourage independence in your child.

Give your child chores.

Give your child frequent feedback.

Find out what skills your child is learning at school.

Find opportunities in your community for social activities.

Talk to other parents whose children have an intellectual disability.

Meet with the school and develop an IEP to address your child's needs.

Take pleasure in your beautiful one.

(Read the entire article here: Intellectual Disability by parentcenterhub.org)

We are not affiliated with all the organization and educators mentioned in this article. We just couldn't help but share their wonderful inputs and goals in making lives of students with intellectual disability a little better. Because people, especially intellectual disabled children need to meet a person who will touch their lives in every way or the other to be the best that they can be. Just like Jenny, Lt. Dan, and Mrs. Gump in Forrest's life.
"I don't know if we each have a destiny, or if we're all just floatin' around accidental-like on a breeze. But I, I think maybe it's both." - Forrest Gump

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Strategies for Teaching Students with Intellectual Disabilities

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"My mama always said, 'Life was like a box of chocolates. You never know what you're gonna get.'" Sounds familiar? Yes, that's the famous line from the award-winning movie, "Forrest Gump." Is it 23 years ago already when it hit the theaters? Along with remarkable quotes we can still remember to today was Tom [...]

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(High Incidence)

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects communication, social interaction, and behavior. ASD is considered a "spectrum" disorder because the symptoms and severity can vary widely among individuals.

People with ASD may have difficulty with social interactions, such as making eye contact, understanding nonverbal communication, and developing friendships. They may also have difficulty with communication, both verbal and nonverbal. Some individuals with ASD may engage in repetitive behaviors, have narrow interests, and become distressed when routines are disrupted.

ASD is usually diagnosed in early childhood, and symptoms can range from mild to severe. It is important to note that every individual with ASD is unique, and there is no one "typical" presentation of the disorder.

While the exact cause of ASD is unknown, research suggests that a combination of genetic and environmental factors may play a role. There is currently no known cure for ASD, but early intervention and treatment can greatly improve outcomes and quality of life for individuals with the disorder.

Reference

1. Centers for Disease Control and Prevention. (2022). Signs and Symptoms of Autism Spectrum Disorders. Retrieved March 4, 2023, from https://www.cdc.gov/ncbddd/autism/signs.html.

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Centers for Disease Control and Prevention

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Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention. It is important to note that some people without ASD might also have some of these symptoms. But for people with ASD, these characteristics can make life very challenging.
Learn more about ASD
Social Communication and Interaction Skills

Social communication and interaction skills can be challenging for people with ASD.

Examples of social communication and social interaction characteristics related to ASD can include

Avoids or does not keep eye contact

Does not respond to name by 9 months of age

Does not show facial expressions like happy, sad, angry, and surprised by 9 months of age

Does not play simple interactive games like pat-a-cake by 12 months of age

Uses few or no gestures by 12 months of age (for example, does not wave goodbye)

Does not share interests with others by 15 months of age (for example, shows you an object that they like)

Does not point to show you something interesting by 18 months of age

Does not notice when others are hurt or upset by 24 months of age

Does not notice other children and join them in play by 36 months of age

Does not pretend to be something else, like a teacher or superhero, during play by 48 months of age

Does not sing, dance, or act for you by 60 months of age

Restricted or Repetitive Behaviors or Interests

People with ASD have behaviors or interests that can seem unusual. These behaviors or interests set ASD apart from conditions defined by problems with social communication and interaction only.

Examples of restricted or repetitive behaviors and interests related to ASD can include

Lines up toys or other objects and gets upset when order is changed

Repeats words or phrases over and over (called echolalia)

Plays with toys the same way every time

Is focused on parts of objects (for example, wheels)

Gets upset by minor changes

Has obsessive interests

Must follow certain routines

Flaps hands, rocks body, or spins self in circles

Has unusual reactions to the way things sound, smell, taste, look, or feel

Other Characteristics

Most people with ASD have other related characteristics. These might include

Delayed language skills

Delayed movement skills

Delayed cognitive or learning skills

Hyperactive, impulsive, and/or inattentive behavior

Epilepsy or seizure disorder

Unusual eating and sleeping habits

Gastrointestinal issues (for example, constipation)

Unusual mood or emotional reactions

Anxiety, stress, or excessive worry

Lack of fear or more fear than expected

It is important to note that children with ASD may not have all or any of the behaviors listed as examples here.
Learn more about screening and diagnosis of ASD Learn more about treating the symptoms of ASD

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Signs & Symptoms | Autism Spectrum Disorder (ASD) | NCBDDD | CDC

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Autism Spectrum Disorder (ASD) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges. CDC is working to find out how many children have ASDs, discover the risk factors, and raise awareness of the signs.

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There are many interventions that can be helpful for individuals with Autism Spectrum Disorder (ASD). These interventions can help to address the unique challenges that individuals with ASD may face in communication, social interaction, and behavior. Here are some examples of interventions for ASD:

1. Behavioral Therapy: Behavioral therapy is a type of intervention that focuses on teaching new skills and behaviors, and reducing unwanted behaviors. Applied Behavior Analysis (ABA) is a specific type of behavioral therapy that is often used for children with ASD.

2. Social Skills Training: Social skills training can help individuals with ASD learn how to navigate social interactions, such as making eye contact, understanding social cues, and developing friendships.

3. Speech and Language Therapy: Speech and language therapy can help individuals with ASD develop communication skills, such as improving speech clarity and understanding nonverbal communication.

4. Occupational Therapy: Occupational therapy can help individuals with ASD improve their motor skills, sensory processing, and daily living skills.

5. Medication: Some medications, such as antidepressants and antipsychotics, may be used to manage symptoms of ASD, such as anxiety or aggression. However, medication should always be used in conjunction with other interventions, and under the supervision of a healthcare professional.

6. Parent Education and Support: Parent education and support can help parents and caregivers better understand and manage the challenges of raising a child with ASD.

Reference

1. Centers for Disease Control and Prevention. (2022). Autism Spectrum Disorder (ASD): Treatment. Retrieved March 4, 2023, from https://www.cdc.gov/ncbddd/autism/treatment.html.

2. The Spectrum. (n.d.). Autism Strategy. Retrieved March 4, 2023, from https://thespectrum.org.au/autism-strategy/.

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1. Sensory processing accommodations can help individuals with ASD regulate their sensory input and reduce anxiety or overwhelm. Here are some examples of sensory processing accommodations for ASD:

Sensory Breaks: Providing a quiet space or sensory room where an individual can take a break to regulate their sensory input. This may include providing sensory toys or objects for tactile stimulation, calming music or noise-cancelling headphones for auditory stimulation, or dimmed lighting for visual stimulation.

Adjusting Lighting and Sound Levels: Adjusting the lighting levels in a room to reduce glare or brightness, or reducing background noise levels to minimize auditory stimulation.

Sensory-Friendly Materials: Providing sensory-friendly materials, such as soft fabrics or weighted blankets, for individuals with ASD who may be sensitive to touch or pressure.

Visual Aids: Using visual aids, such as picture schedules or visual cues, to help individuals with ASD understand what is expected of them and reduce anxiety.

Sensory Integration Therapy: Sensory integration therapy is a type of therapy that uses specific sensory experiences to help individuals with ASD process sensory information more effectively. This therapy may include activities such as swinging, bouncing on a ball, or playing with textured materials.

2. Behavioral supports are accommodations can help individuals with ASD learn new behaviors, manage challenging behaviors, and achieve their goals. Here are some examples of behavioral supports for ASD:

Positive Reinforcement: Using positive reinforcement, such as rewards or praise, to encourage desired behaviors and motivate individuals with ASD.

Applied Behavior Analysis (ABA): ABA is a type of therapy that uses positive reinforcement and other techniques to teach new skills and behaviors, and reduce unwanted behaviors.

Structured Routines and Schedules: Providing a structured routine or schedule can help individuals with ASD manage their time and reduce anxiety.

Visual Supports: Using visual supports, such as picture schedules or social stories, can help individuals with ASD understand what is expected of them and reduce anxiety.

Self-Monitoring: Teaching individuals with ASD to monitor their own behaviors and provide feedback to themselves can help them regulate their behavior and achieve their goals.

Functional Behavioral Assessment (FBA): FBA is a process for identifying the causes and functions of challenging behaviors, and developing strategies to address those behaviors.

3. Comprehension accommodations can help individuals with ASD understand information more effectively and reduce anxiety or frustration. Here are some examples of comprehension accommodations for ASD:

Visual Aids: Using visual aids, such as pictures, diagrams, or videos, to help individuals with ASD understand information more effectively.

Simplified Language: Using simplified language and avoiding abstract or figurative language can help individuals with ASD understand information more easily.

Repeat and Clarify: Repeating and clarifying information can help individuals with ASD process information more effectively and reduce anxiety.

Written Instructions: Providing written instructions or a visual schedule can help individuals with ASD understand what is expected of them and reduce anxiety.

4. Reading and written expression accommodations can help individuals with ASD access information more effectively, express themselves more clearly, and achieve their goals. Here are some examples of reading and written expression accommodations for ASD:

Text-to-Speech Software: Text-to-speech software can read written materials aloud to individuals with ASD who may have difficulty reading or comprehending written information.

Audiobooks: Audiobooks can provide an alternative way for individuals with ASD to access information and engage with literature.

Extended Time: Providing extended time for reading and writing assignments can help individuals with ASD process information more effectively and reduce anxiety.

Visual Supports: Using visual supports, such as graphic organizers or mind maps, can help individuals with ASD organize their thoughts and express themselves more clearly in writing.

Simplified Language: Using simplified language and avoiding abstract or figurative language can help individuals with ASD understand written materials more easily.

5. Executive functioning accommodations can help individuals with ASD manage their time, prioritize tasks, and achieve their goals. Here are some examples of executive functioning accommodations for ASD:

Structured Routines and Schedules: Providing a structured routine or schedule can help individuals with ASD manage their time and reduce anxiety.

Visual Supports: Using visual supports, such as calendars or checklists, can help individuals with ASD organize their tasks and manage their time more effectively.

Breaks: Providing frequent breaks can help individuals with ASD maintain their attention and reduce anxiety.

Task Analysis: Breaking down complex tasks into smaller, manageable steps can help individuals with ASD understand what is expected of them and reduce anxiety.

Executive Functioning Coaching: Executive functioning coaching is a type of therapy that can help individuals with ASD develop and strengthen their executive functioning skills.

6. Social interaction accommodations can help individuals with ASD develop social skills, build relationships, and engage in social activities. Here are some examples of social interaction accommodations for ASD:

Social Skills Training: Social skills training can help individuals with ASD learn how to navigate social interactions, such as making eye contact, understanding social cues, and developing friendships.

Peer Mentors: Pairing individuals with ASD with peer mentors who can provide guidance and support in social situations.

Social Stories: Using social stories, which are short stories that describe social situations and appropriate social behaviors, can help individuals with ASD understand what is expected of them and reduce anxiety.

Structured Activities: Providing structured activities, such as group outings or game nights, can help individuals with ASD engage in social activities and build relationships.

Visual Supports: Using visual supports, such as picture schedules or cue cards, can help individuals with ASD understand social expectations and reduce anxiety in social situations.

7. Emotional and self-regulation accommodations can help individuals with ASD manage their emotions, reduce anxiety, and engage in activities more effectively. Here are some examples of emotional and self-regulation accommodations for ASD:

Sensory Breaks: Providing a quiet space or sensory room where an individual can take a break to regulate their sensory input and emotions.

Visual Supports: Using visual supports, such as emotion charts or mood meters, can help individuals with ASD understand and communicate their emotions more effectively.

Deep Pressure or Weighted Objects: Providing deep pressure or weighted objects, such as a weighted blanket or lap pad, can help individuals with ASD regulate their emotions and reduce anxiety.

Social Stories: Using social stories, which are short stories that describe social situations and appropriate social behaviors, can help individuals with ASD understand how to regulate their emotions in different situations.

Mindfulness and Relaxation Techniques: Teaching individuals with ASD mindfulness and relaxation techniques, such as deep breathing or guided imagery, can help them manage their emotions and reduce anxiety.

Positive Reinforcement: Using positive reinforcement, such as rewards or praise, to encourage positive behaviors and emotions can help individuals with ASD learn how to regulate their emotions and achieve their goals.

References

1. xMinds. (n.d.). Accommodations. Retrieved March 5, 2023, from https://xminds.org/accommodations.

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Improving Education for Autistic Students in Montgomery County, MD

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1. Communication devices: Communication devices can help students with ID communicate their needs and wants more effectively. These devices can include speech-generating devices, picture boards, or apps that translate text to speech.

2. Computer software: Computer software such as text-to-speech programs, speech recognition software, or word prediction software can help students with ID to read and write more effectively.

3. Augmentative and alternative communication (AAC) devices: AAC devices such as tablets or specialized communication devices can help students with ID to communicate their ideas and participate in social activities more effectively.

4. Electronic organizers and reminders: Electronic organizers and reminders can help students with ID keep track of their schedules and stay organized.

5. Assistive listening devices: Assistive listening devices such as headphones or hearing aids can help students with ID to hear and understand verbal instructions more effectively.

6. Adaptive equipment: Adaptive equipment such as special chairs, pencil grips, or weighted blankets can help students with ID to be more comfortable and engaged in learning activities.

7. Sensory integration tools: Sensory integration tools such as fidget toys, textured materials, or sensory tables can help students with ID to manage sensory input and improve their focus.

References:

1. NumberDyslexia. (2021). Assistive Technology for Students with Intellectual Disabilities. Retrieved March 4, 2023, from https://numberdyslexia.com/assistive-technology-for-students-with-intellectual-disabilities/

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How Assistive Technology Supports Students With Disabilities

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1. Visual Supports: Using visual supports, such as picture schedules or social stories, can help individuals with ASD understand what is expected of them and reduce anxiety.

2. Positive Reinforcement: Using positive reinforcement, such as rewards or praise, to encourage positive behaviors can help individuals with ASD learn new skills and behaviors.

3. Applied Behavior Analysis (ABA): ABA is a type of therapy that uses positive reinforcement and other techniques to teach new skills and behaviors, and reduce unwanted behaviors.

4. Social Skills Training: Social skills training can help individuals with ASD learn how to navigate social interactions, such as making eye contact, understanding social cues, and developing friendships.

5. Sensory Integration Therapy: Sensory integration therapy is a type of therapy that uses specific sensory experiences to help individuals with ASD process sensory information more effectively.

6. Assistive Technology: Using assistive technology, such as text-to-speech software or speech-to-text software, can help individuals with ASD access information more effectively and express themselves more clearly.

7. Executive Functioning Coaching: Executive functioning coaching is a type of therapy that can help individuals with ASD develop and strengthen their executive functioning skills.

References

1. National University. (2019, April 18). 7 Autism Behavior and Communication Strategies. Retrieved March 5, 2023, from https://www.nu.edu/resources/7-autism-behavior-and-communication-strategies/.

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Adapting teaching strategies for students with ASD

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1. Communication Apps: Communication apps, such as Proloquo2Go or TouchChat, can help individuals with ASD who have difficulty with verbal communication express themselves more effectively.

2. Text-to-Speech Software: Text-to-speech software, such as Read&Write or NaturalReader, can read written materials aloud to individuals with ASD who may have difficulty reading or comprehending written information.

3. Speech-to-Text Software: Speech-to-text software, such as Dragon NaturallySpeaking or Google Voice Typing, can help individuals with ASD who have difficulty with written expression to express themselves more clearly.

4. Sensory-Friendly Apps: Sensory-friendly apps, such as Sensory Speak Up or Calm Counter, can help individuals with ASD regulate their sensory input and reduce anxiety.

5. Social Skills Apps: Social skills apps, such as Social Stories Creator & Library or Model Me Going Places, can help individuals with ASD develop and practice social skills.

6. Virtual Reality Training Programs: Virtual reality training programs, such as Floreo or VizZle, can help individuals with ASD practice real-world skills, such as navigating social situations or job interviews, in a safe and controlled environment.

References:

1. Autism Speaks. (n.d.). Technology and Autism. Retrieved March 5, 2023, from https://www.autismspeaks.org/technology-and-autism.

2. The Assistive Technology Center. (2021, May 10). Podcast: It's All About Independent Functioning: Using Technology to Develop Critical Life Skills for Students With Autism Spectrum Disorder. Retrieved March 5, 2023, from https://www.assistivetechnologycenter.org/

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Vision impairment means that a person’s eyesight cannot be corrected to a “normal” level.

Vision impairment may be caused by a loss of visual acuity, where the eye does not see objects as clearly as usual. It may also be caused by a loss of visual field, where the eye cannot see as wide an area as usual without moving the eyes or turning the head.
Courtesy of Center for Disease Control and Prevention (CDC).
http://ophthalmology.pitt.edu/vision-impairment/what-vision-impairment#:~:text=Vision%20impairment%20means%20that%20a,objects%20as%20clearly%20as%20usual.

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Vision impairment means that a person's eyesight cannot be corrected to a "normal" level.

Vision impairment may be caused by a loss of visual acuity, where the eye does not see objects as clearly as usual. It may also be caused by a loss of visual field, where the eye cannot see as wide an area as usual without moving the eyes or turning the head.

There are different ways of describing how severe a person's vision loss is. The World Health Organization defines "low vision" as visual acuity between 20/70 and 20/400, with the best possible correction, or a visual field of 20 degrees or less. "Blindness" is defined as a visual acuity worse than 20/400, with the best possible correction, or a visual field of 10 degrees or less.

Someone with a visual acuity of 20/70 can see at 20 feet what someone with normal sight can see at 70 feet. Someone with a visual acuity of 20/400 can see at 20 feet what someone with normal sight can see at 400 feet. A normal visual field is about 160-170 degrees horizontally.

Vision impairment severity may be categorized differently for certain purposes. In the United States, for example, we use the term "legal blindness" to indicate that a person is eligible for certain education or federal programs. Legal blindness is defined as a visual acuity of 20/200 or worse, with the best possible correction, or a visual field of 20 degrees or less.

Visual acuity alone cannot indicate how much a person's life will be affected by vision loss. It is important to also assess how well a person uses the vision they have. Two people may have the same visual acuity, but one may be able to use his or her vision better to do everyday tasks.

Most people who are "blind" have at least some usable vision that can help them move around in their environment and do things in their daily lives. A person's functional vision can be evaluated by observing them in different settings to see how they use their vision.

A functional vision evaluation can answer questions such as these:

Can the person scan a room to find someone or something?
What lighting is best for the person to do different tasks?
How does the person use his or her vision to move around in a room or outside?

Vision Impairment in Children

Vision impairment changes how a child understands and functions in the world. Impaired vision can affect a child's cognitive, emotional, neurological, and physical development by possibly limiting the range of experiences and the kinds of information a child is exposed to.

Nearly two-thirds of children with vision impairment also have one or more other developmental disabilities, such as mental retardation, cerebral palsy, hearing loss, or epilepsy. Children with more severe vision impairment are more likely to have additional disabilities than are children with milder vision impairment.

References

Batshaw ML. Children with disabilities (4th edition). Baltimore, MD: Paul H. Brookes Publishing Co.; 1997.

Day S. Normal and abnormal visual development. In: Taylor D, editor. Paediatric ophthalmology (2nd edition). Malden, MA: Blackwell Science; 1997, p 13-28.

Holbrook MC (Editor). Children with visual impairments: a parents' guide. Bethesda, MD: Woodbine House; 1996.

Kaminer RK, McMahon E. Blindness and visual impairment. Pediatrics in Review 1995;16:77-8.

Puckett CD. The educational annotation of ICD-9-CM (4th edition). Reno, NV: Channel Publishing, Ltd., 2001, p. 641.??

Sonksen PM, Petrie A, Drew KJ. Promotion of visual development of severely visually impaired babies: evaluation of a developmentally based programme. Developmental Medicine and Child Neurology 1991;33:320-35. Date: October 29, 2004 ?Content source: National Center on Birth Defects and Developmental Disabilities

Courtesy of Centers for Disease Control and Prevention (CDC).

Vision impairment means that a person's eyesight cannot be corrected to a "normal" level.

Vision impairment may be caused by a loss of visual acuity, where the eye does not see objects as clearly as usual. It may also be caused by a loss of visual field, where the eye cannot see as wide an area as usual without moving the eyes or turning the head.

There are different ways of describing how severe a person's vision loss is. The World Health Organization defines "low vision" as visual acuity between 20/70 and 20/400, with the best possible correction, or a visual field of 20 degrees or less. "Blindness" is defined as a visual acuity worse than 20/400, with the best possible correction, or a visual field of 10 degrees or less.

Someone with a visual acuity of 20/70 can see at 20 feet what someone with normal sight can see at 70 feet. Someone with a visual acuity of 20/400 can see at 20 feet what someone with normal sight can see at 400 feet. A normal visual field is about 160-170 degrees horizontally.

Vision impairment severity may be categorized differently for certain purposes. In the United States, for example, we use the term "legal blindness" to indicate that a person is eligible for certain education or federal programs. Legal blindness is defined as a visual acuity of 20/200 or worse, with the best possible correction, or a visual field of 20 degrees or less.

Visual acuity alone cannot indicate how much a person's life will be affected by vision loss. It is important to also assess how well a person uses the vision they have. Two people may have the same visual acuity, but one may be able to use his or her vision better to do everyday tasks.

Most people who are "blind" have at least some usable vision that can help them move around in their environment and do things in their daily lives. A person's functional vision can be evaluated by observing them in different settings to see how they use their vision.

A functional vision evaluation can answer questions such as these:

Can the person scan a room to find someone or something?
What lighting is best for the person to do different tasks?
How does the person use his or her vision to move around in a room or outside?

Vision Impairment in Children

Vision impairment changes how a child understands and functions in the world. Impaired vision can affect a child's cognitive, emotional, neurological, and physical development by possibly limiting the range of experiences and the kinds of information a child is exposed to.

Nearly two-thirds of children with vision impairment also have one or more other developmental disabilities, such as mental retardation, cerebral palsy, hearing loss, or epilepsy. Children with more severe vision impairment are more likely to have additional disabilities than are children with milder vision impairment.

References

Batshaw ML. Children with disabilities (4th edition). Baltimore, MD: Paul H. Brookes Publishing Co.; 1997.

Day S. Normal and abnormal visual development. In: Taylor D, editor. Paediatric ophthalmology (2nd edition). Malden, MA: Blackwell Science; 1997, p 13-28.

Holbrook MC (Editor). Children with visual impairments: a parents' guide. Bethesda, MD: Woodbine House; 1996.

Kaminer RK, McMahon E. Blindness and visual impairment. Pediatrics in Review 1995;16:77-8.

Puckett CD. The educational annotation of ICD-9-CM (4th edition). Reno, NV: Channel Publishing, Ltd., 2001, p. 641.??

Sonksen PM, Petrie A, Drew KJ. Promotion of visual development of severely visually impaired babies: evaluation of a developmentally based programme. Developmental Medicine and Child Neurology 1991;33:320-35. Date: October 29, 2004 ?Content source: National Center on Birth Defects and Developmental Disabilities

Courtesy of Centers for Disease Control and Prevention (CDC).

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Vision impairment means that a person's eyesight cannot be corrected to a "normal" level. Vision impairment may be caused by a loss of visual acuity, where the eye does not see objects as clearly as usual.

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Encourage the student to use visual aids/resources that have been prescribed (e.g. glasses, magnifiers, big-print books and or braille). I would arrange an appropriate seat in the classroom for the impacted student (e.g. in the middle towards the front). I would offer to adjust the lighting where possible. Lastly I would ensure to eliminate the risk of glare from the desk and whiteboard.

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Students with visual impairments face unique challenges in the educational environment, However there are great tools that can help them prosper. There is technology for reading, writing, Math, Social studies and Science, computer access , Support Orientation and Mobility and lastly but not least, there is technology to assist with Art, Music and Physical Education. Please find attached document that explains in detail.

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Understanding Vision Impairment in Children - Lily-Grace, My understanding in this video is that when special education is implemented properly, it is a great tool for kids. Lily- Grace is very independent and can tell a story very well.

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Understanding Vision Impairment in Children - Lily-Grace

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https://www.pathstoliteracy.org/strategies-teaching-students-who-are-blind-or-visually-impaired/

https://www.weareteachers.com/teaching-blind-students-visually-impaired/

http://ophthalmology.pitt.edu/vision-impairment/what-vision-impairment#:~:text=Vision%20impairment%20means%20that%20a,objects%20as%20clearly%20as%20usual.

https://www.youtube.com/watch?v=7wGP_k_UP9c
Understanding Vision Impairment in Children - Lily-Grace

A Resource Guide to Assistive Technology for
Students with Visual Impairment Lisa R. Tebo, M.Ed.

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https://www.cde.state.co.us/cdesped/sd-multiple#:~:text=Definition%3A%20A%20child%20with%20Multiple,shall%20be%20an%20intellectual%20disability.

A child with Multiple Disabilities usually have two or more areas of significant impairment. A unique impairment is created by the combination of these conditions, as shown by the multitude of extremely complex educational requirements that prohibit the child from benefiting reasonably from general education.

For example, one child with multiple disabilities may have an intellectual disability and deafness. Another child may have cerebral palsy and autism. Sharon, above, had three different disabilities.

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Definition: A child with Multiple Disabilities shall have two or more areas of significant impairment, one of which shall be an intellectual disability. The other areas of impairment include: Orthopedic Impairment, Visual Impairment including Blindness, Hearing Impairment including Deafness, Speech or Language Impairment, Serious Emotional Disability, Autism Spectrum Disorders, Traumatic Brain Injury, or Other Health Impaired. The combination of such impairments creates a unique condition that is evidenced through a multiplicity of severe educational needs which prevent the child from receiving reasonable educational benefit from general education.

Other Disability Categories

For more information about Multiple Disabilities, contact:

Gina Herrera
Phone: (303) 866-6605
Email Gina Herrera

Having trouble with this webpage?

If you have problems with broken links or accessing the content on this page, please contact the Exceptional Student Services Unit at ESSU@cde.state.co.us. Please copy the URL link for this page into the email when referencing the problem you are experiencing.

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Definition: A child with Multiple Disabilities shall have two or more areas of significant impairment, one of which shall be an intellectual disability. The other areas of impairment include: Orthopedic Impairment, Visual Impairment including Blindness, Hearing Impairment including Deafness, Speech or Language Impairment, Serious Emotional Disability, Autism Spectrum Disorders, Traumatic Brain Injury, or Other Health Impaired.

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After researching a bit more, I have noticed that no two students with multiple disabilities have the exact same challenge. As a result of the interaction of the many disabilities, age, level of educational intervention, and environmental factors. We should not provide generic approaches, we must adjust our approach/ solution to suit specific needs and situations.

According to an article published by Perkins (school of the blind), These are strategies to promote literacy development in students with multiple disabilities:

Promote development of cognitive skills

Focus on establishing a recognized means of communication

Vocabulary should be familiar to the child and should be presented in a way that is clear and consistent

Provide exposure to a wide variety of literacy materials, using real objects and adaptations to make them as accessible as possible to an individual student.

Avoid miniature representations, as these are often not meaningful to children with visual impairments and additional disabilities. For example, a section of a seat belt may be a better representation of a car than a small, matchbox car.

Create routines that sequence events with a clear beginning, middle, and ending.  These can be routines of daily living, such as brushing teeth, or they can be activities, such as making a snack.

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Assistive technology provides students with disabilities endless opportunities to live a healthier more engaged life Wise, 2012.

In the attached video a student (Alex Wilder) had a disability that was not visible until his special education teacher assisted in checking what was going on. Alex needed support in articulating his thoughts. He used assistive technology for his impairment, he went from struggling to construct a sentence to being a top writing student.

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How Assistive Technology Supports Students With Disabilities

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https://www.cde.state.co.us/cdesped/sd-multiple#:~:text=Definition%3A%20A%20child%20with%20Multiple,shall%20be%20an%20intellectual%20disability.

https://www.pathstoliteracy.org/instructional-strategies-students-multiple-disabilities/

Youtube video: Understanding Multiple Disabilities
https://www.youtube.com/watch?v=xKqN21OdsLQ

Allen, Emily, "Assistive Technology for Students with Multiple Disabilities" (2015). Education Masters.
Paper 299.

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The combination of hearing loss and vision impairment known as deaf and blindness impairs a person's ability to communicate, access information, and navigate their environment , thus limiting access to both auditory and visual information.

A deafblind person won't usually be totally deaf and totally blind, but both senses will be reduced enough to cause significant difficulties in everyday life.

Deaf-blindness may seem to mean that a person is completely unable to see or hear. However, in reality deaf-blindness is a condition in which the combination of hearing and visual losses in children and youth cause "such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness or multiple disabilities. In order to guarantee that children with this handicap have the chance to attain their full potential, deaf-blind children are given special consideration in the educational system. This is because visual and auditory impairments necessitate careful and distinctive instructional approaches.

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If you are teaching a child who is deafblind about a particular object or toy, use the hand-under-his-hand technique to lead him to the item, place your hand on it, and let the child follow your movements. Then, gently remove your hand from the object and give the child time to explore it on his or her own. It takes time to communicate a concept effectively. Spend some time investigating each phase and the overall idea.

Example: Before introducing braille Lego, play with them first.

Demonstrate how to install and detach braille Lego while holding the child's hands so he may understand you.

Keep in mind that knowledge is restricted to a person's tactile range and/or visual field; many fundamental procedures may require modelling.

Offer the braille Lego and let the child take them as they choose. You may tell whether a child is interested in investigating or taking control of the object by keeping your hands under his.

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These guidelines were developed from decades of experience learning from Seattle's adult deafblind community and from working with non-linguistic children who are deafblind. Following these steps, we can avoid teaching cue dependence and tactile defensiveness; unfortunate byproducts of continuously engaging a child's startle reflex and moving too quickly for successful tactile processing.
Jennifer White

NOTE: If the child is new to deafblind etiquette, after tapping, slide your hand from the shoulder, keeping contact with his body, down the back of his arm and place your hand under his. Do this each time you enter his space to begin communication. Soon the child, when tapped, will lift his hand to find you. At this point, stop moving down his arm and move directly under his hand after the shoulder tap.

1. Identify yourself every time. Do not assume that because the child has some sight or because you wear the same ring or smell the same every day, he knows who you are. Use a name sign to identify yourself every time. (Search: ASL name signs to find more information).

2. Don't rush conversation. Even if a child signs fast, receiving information is slower. If he experiences any type of cognitive challenge on top of the dual sensory loss, processing time can take 4-5 times as long. SLOW DOWN, our pace is impossible for a child organizing tactually or with limited vision.

3. Tracking more than one speaker requires information and a slow pace. As a teacher, you may be distracted by many adults and children needing your attention. When you need to disengage, let your deafblind student know. Using the sign "wait" to leave briefly and come back. Reintroduce yourself when you return (unless he has enough vision to identify you clearly). As often as possible, allow your student to follow your attention to the new speaker. Using your pointer finger, point at the speaker and turn your head slowly to follow the direction of your point Allow the student to find the new speaker visually or tactually before beginning your converssation. Do not move his head; instead allow him to learn to track visual information, providing the information needed for him to be successful.

4. If you are teaching about an object/toy, use your hand-under-his-hand, guide him to the object and put your hand on the object, letting the child who is deafblind follow your movement, then gently move your hand away and let the child who is deafblind take time to explore the object. It takes time to get a concept across tactually. Allow time to explore each step and the larger concept.

EXAMPLE: If introducing LegosTM, first play with the Legos yourself,

* Model how the LegosTM attach and detach, with the child's hands on yours so he can "watch" how it is done.
* Remember knowledge is limited to his/her tactile reach and/or visual field; many basic steps and routines may need modeling.
* Offer the LegosTM up and allow the child to take them when he/she wants.
* Keeping your hands under his allows you to notice when a child is interested in exploring or taking over with the object.

5. When teaching an action or task requiring steps to completion, first offer a completed model, then "show" how to achieve completion by modeling steps with the child's hand on yours, moving at a pace that allows them to take in the process.

6. When explaining something, talk in the order that events happen. EXAMPLE: Instead of saying, "Clean up the toys after you play." Say, "First play. Second, clean up." or "Play finish? Clean up."

7. Beware of the "Magic Wand" when things appear and disappear from the child's space. Connect the dots as often as possible, from storage to use to clean up and back to storage with the child involved. Once objects are in his reach . . . DO NOT remove them without the child's knowledge.

8. If you need to leave for a few minutes, tell the child who is deafblind that you are leaving and when you will come back. If the child does not have formal language, devise a method of communicating these concepts. Using the ASL signs, "Hello," "Goodbye," and "Wait" are sound ways to communicate these concepts.

9. Individuals who are deafblind communicate in a variety of ways. In general, finger spelling is not as effective as signing concepts.

10. For people who do not have formal language, tactile symbols, gestures, sequence boxes, and consistency can be helpful. It is vital to gather as much history about a child's life and communication as possible.

Reprinted with permission from Alaska Dual Sensory Impairment Project.

More information

Reviewed: 8/2022

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Deafblind Fact Sheet: Guidelines for Working with Children Who Are Deafblind

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These guidelines were developed from decades of experience learning from Seattle's adult deafblind community and from working with non-linguistic children who are deafblind. Following these steps, we can avoid teaching cue dependence and tactile defensiveness; unfortunate byproducts of continuously engaging a child's startle reflex and moving too quickly for successful tactile processing.

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The TCTC technology allows students to communicate better, it ca change audio to test so they can understand the teacher.  A specialised microphone can be used by the teacher to communicate. Sign language can be used as well to communicate with some of the students.

Assistive Technologies for Deafblind students are:

Graphic Organizers

Speech to text

Text to speech

Word prediction programs

To assess deaf and blind students, the teacher will need to :

Provide choice for assignments

Allow use of assistive technology

Provide additional time

There is a book recommended for teachers: :Assistive Technology for the hearing- impaired, Deaf and Deafblind" by Marion A Hersh , revised by Michael A Johnson

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Assistive Technology for the Deaf and Hard of Hearing

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https://www.nationaldb.org/info-center/deaf-blindness-overview/

https://www.nhs.uk/conditions/deafblindness/#:~:text=Deafblindness%20is%20a%20combination%20of,%22multi%2Dsensory%20impairment%22.

https://www.cde.state.co.us/cdesped/sd-db_factsheetwp_guidelines_workingwithchildren#:~:text=If%20you%20are%20teaching%20about,time%20to%20explore%20the%20object.

https://www.youtube.com/watch?v=GkthqXO9IQM

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Attention deficit hyperactivity is characterized by pervasive developmentally inappropriate difficulties with attention, impulsivity and hyperactivity (American Psychiatric Association, 2000). ADHD symptoms cause significant impairments at home and in school and are associated with a number of behavior difficulties such as aggression and non compliance. Research also suggests that children with ADHD are more likely than typically developing classmates to be rejecting socially and to have greater difficulties with their peers.
Assistive technology MOBERO – A MOBILE TOOL TO ESTABLISH HEALTHY MORNING AND BEDTIME ROUTINES MOBERO. MOBERO,is a mobile system that supports families of children with ADHD to change their family practices around morning and bedtime routines. Findings suggest that the positive changes in family practices related to parent rated frustration and conflict level around their child’s morning and bedtime routines, which MOBERO established in the intervention period, still positively affected the families one month after MOBERO had been taken away.

-George J. DuPaul, Lisa L. Weyandt, Grace M. Janusis; Theory into Practice, Vol. 50, No. 1, Current Perspectives on Learning Disabilities and ADHD (Winter 2011), pp. 35-42

-Arthur D. Anastopoulos, Terri L. Shelton, George J. DuPaul, and David C. Guevremont. 1993. Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning. Journal of Abnormal Child Psychology 21, 5: 581--596. http://doi.org/10.1007/BF00916320

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Understanding ADHD (for ages 7-12) - Jumo Health

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https://www.youtube.com/watch?v=yfOYlqlEgP4

"Emotional disability can be described as Inappropriate types of behavior or feelings under normal circumstances; A general pervasive mood of unhappiness or depression; or. A tendency to develop physical symptoms or fears associated with personal or school problems".

There are four specific tools that may be used by both teachers and students to assist them with the task of monitoring behavior during assigned classroom tasks. These include (a) stop watches, (b) hand-held counters, (c) Palm devices, and (d) computer devices.
1. A stop-watch can relieve the burden of having to deal with time management, thus allowing him/ her to focus more directly on the academic task at hand.
2. Hand-held counters can assist with the cognitive task of counting words, paragraphs, math problems, and other tasks related to academic assignments.
3. A variety of Palm devices are currently available that enable a range of monitoring strategies for numerous classroom behaviors. These hand-held devices can be programmed with a series of questions related to the performance of a specific academic task, coupled with feedback to the student who responds to the question. For example, a Palm device could be programmed to present a series of steps to the student for completion of a classroom assignment. In each step, the student would (a) receive information regarding what was required, (b) be prompted to get additional information if there were questions, (c) input information/data regarding his/her performance of the task, (d) receive textual and auditory feedback regarding completion of the task, and (e) present the student with a record of his/her performance for that assignment and compare it to performance over time.
4. A software application enabling a student to measure his/her behavior while completing academic tasks is available using Microsoft® Excel. Teachers can create spreadsheets that allow students to enter performance data as it is obtained, and have charts or graphs displayed immediately, such that, student progress can be visually presented.

Assistive Technology Tools:
1. Reading- http://www.readplease.com http://www.softplatz.com/software/text-to-sp eech-software http://www.magnifiers.org/links/Download_ Software/Text-To-Speech_software/

2. Writing- http://www.donjohnston.com/catalog/writout d.htm http://atto.buffalo.edu/registered/Tutorials/IT 2/index.php http://www.synapseadaptive.com/textHELP/ TT/type_&_talk_1.htm

3. Speech recognition- http://www.speechstudio.com/commercial/spee ch.htm ://www.speechstudio.com/commercial/spee

- Howard P. Parette, Jr. E. Paula Crowley Brian W. Wojcik ;Reducing Overload in Students with Learning and Behavioral Disorders: The Role of Assistive Technology;Published in TEACHING Exceptional Children Plus Volume 4, Issue 1, September 2007 .

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A person who is not able to hear as well as someone with normal hearing – hearing thresholds of 20 dB or better in both ears – is said to have hearing loss. Hearing loss may be mild, moderate, severe, or profound. It can affect one ear or both ears and leads to difficulty in hearing conversational speech or loud sounds.

Reference:
https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss

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Overview

Over 5% of the world's population - or 430 million people - require rehabilitation to address their disabling hearing loss (432 million adults and 34 million children). It is estimated that by 2050 over 700 million people - or 1 in every 10 people - will have disabling hearing loss.

'Disabling' hearing loss refers to hearing loss greater than 35 decibels (dB) in the better hearing ear. Nearly 80% of people with disabling hearing loss live in low- and middle-income countries. The prevalence of hearing loss increases with age, among those older than 60 years, over 25% are affected by disabling hearing loss.

Hearing loss and deafness

A person who is not able to hear as well as someone with normal hearing - hearing thresholds of 20 dB or better in both ears - is said to have hearing loss. Hearing loss may be mild, moderate, severe, or profound. It can affect one ear or both ears and leads to difficulty in hearing conversational speech or loud sounds.

'Hard of hearing' refers to people with hearing loss ranging from mild to severe. People who are hard of hearing usually communicate through spoken language and can benefit from hearing aids, cochlear implants, and other assistive devices as well as captioning.

'Deaf' people mostly have profound hearing loss, which implies very little or no hearing. They often use sign language for communication.

Causes of hearing loss and deafness

Although these factors can be encountered at different periods across the life span, individuals are most susceptible to their effects during critical periods in life.

Prenatal period

genetic factors including hereditary and non-hereditary hearing loss

intrauterine infections - such as rubella and cytomegalovirus infection.

Perinatal period

birth asphyxia (a lack of oxygen at the time of birth

hyperbilirubinemia (severe jaundice in the neonatal period)

low-birth weight

other perinatal morbidities and their management.

Childhood and adolescence

chronic ear infections (chronic suppurative otitis media)

collection of fluid in the ear (chronic nonsuppurativeotitis media)

meningitis and other infections.

Adulthood and older age

chronic diseases

smoking

otosclerosis

age-related sensorineural degeneration

sudden sensorineural hearing loss.

Factors across the life span

cerumen impaction (impacted ear wax)

trauma to the ear or head

loud noise/loud sounds

ototoxic medicines

work related ototoxic chemicals

nutritional deficiencies

viral infections and other ear conditions

delayed onset or progressive genetic hearing loss.

The impact of unaddressed hearing loss

When unaddressed, hearing loss impacts many aspects of life at individual level:

communication and speech

cognition

education and employment: In developing countries, children with hearing loss and deafness often do not receive schooling. Adults with hearing loss also have a much higher unemployment rate. Among those who are employed, a higher percentage of people with hearing loss are in the lower grades of employment compared with the general workforce.

social isolation, loneliness and stigma

impact on society and economy

effects on years lived with disability (YDLs) and disability adjusted life years (DALYs).

WHO estimates that unaddressed hearing loss poses an annual global cost of US$ 980 billion. This includes health sector costs (excluding the cost of hearing devices), costs of educational support, loss of productivity, and societal costs. Of these costs, 57% are attributed to low- and middle-income countries.

Prevention

Many of the causes that lead to hearing loss can be avoided through public health strategies and clinical interventions implemented across the life course.

Prevention of hearing loss is essential throughout the life course, from prenatal and perinatal periods to older age. In children, nearly 60% of hearing loss is due to avoidable causes that can be prevented through implementation of public health measures. Likewise, most common causes of hearing loss in adults, such as exposure to loud sounds and ototoxic medicines, are preventable.

Effective strategies for reducing hearing loss at different stages of the life course include:

immunization;

good maternal and childcare practices;

genetic counselling;

identification and management of common ear conditions;

occupational hearing conservation programmes for noise and chemical exposure;

safe listening strategies for the reduction of exposure to loud sounds in recreational settings; and

rational use of medicines to prevent ototoxic hearing loss.

Identification and management

Early identification of hearing loss and ear diseases is key to effective management.

This requires systematic screening for detection of hearing loss and related ear diseases in those who are most at risk. This includes:

newborn babies and infants

pre-school and school-age children

people exposed to noise or chemicals at work

people receiving ototoxic medicines

older adults.

Hearing assessment and ear examination can be conducted in clinical and community settings. Tools such as the WHO "hearWHO" app and other technology-based solutions make it possible to screen for ear diseases and hearing loss with limited training and resources.

Once hearing loss is identified, it is essential that it is addressed as early as possible and in an appropriate manner, to mitigate any adverse impact.

Measures available to rehabilitate people with hearing loss include:

the use of hearing technologies, such as hearing aids, cochlear implants and middle ear implants;

the use of sign language and other means of sensory substitution,such as speech reading, use of print on palm or Tadoma, signed communication; and

rehabilitative therapy to enhance perceptive skills and develop communication and linguistic abilities.

The use of hearing assistive technology, and services such as frequency modulation and loop systems, alerting devices, telecommunication devices,captioning services and sign language interpretation, can further improve access to communication and education for people with hearing loss.

WHO response

WHO's work on ear and hearing care is to promote integrated people-centred ear and hearing care (IPC-EHHC).

WHO's work is guided by the recommendations of the WHO World report on hearing (2021) and the World Health Assembly resolution on prevention of deafness and hearing loss.

WHO's work includes:

guiding, assisting and supporting Member States to increase awareness on EHC issues;

facilitating data generation and dissemination of ear and hearing care related data and information;

providing technical resources and guidance to facilitate planning and health systems capacity building for ear and hearing care;

supporting heath workforce training in ear and hearing care;

promoting safe listening to reduce the risk of recreational noise-induced hearing loss through the WHO Make Listening Safe initiative;

observing and promoting World Hearing Day as an annual advocacy event;

building partnerships to develop strong hearing care programmes, including initiatives for affordable hearing aids, cochlear implants and services; and

advocating for ear and hearing care through the World Hearing Forum.

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Deafness and hearing loss fact sheet from WHO: providing key facts and information on causes, impact, prevention, identification, management and WHO response.

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Acoustics. When a teacher stays in one place, children who are deaf/hard of hearing can be placed close to them. But they still may not hear other students across the room, or pinpoint where a sound is coming from.

Background Noise. For kids with mild to moderate hearing loss, background noise can be their biggest enemy. Since many classrooms are now a hum of busy activity all day long, it’s much more likely these kids will miss or have difficulty hearing instructions or feedback.

Back-lighting. For students who lip-read or work with a sign language interpreter, sitting facing a window or other strong light source makes it hard or impossible to see what’s being said.

Note-taking. Taking notes while a teacher talks is a nearly futile task for children who are deaf/hard of hearing.

Make eye contact, speak clearly and normally, but don’t shout.
Always be sure you have the lip readers’ attention. Ask if it’s okay to touch their arm if you need them to look at you. Form your words clearly, and if you’re a fast talker, make an effort to slow down just a bit. (All your students will benefit from this.) Talk in a normal tone of voice; shouting can actually distort your mouth.

Lip readers should be able to see all the faces in the classroom during discussions.

Give hearing-impaired students a moment to identify who is speaking.
During discussions, new speakers should allow a moment for those who are deaf/hard of hearing to turn their way before talking. Avoid talking over one another so they can focus on one person at a time.

References:
https://www.weareteachers.com/children-deaf-hard-of-hearing/

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Here's a statistic that might surprise you: according to the CDC, as many as 15% of school age children have significant hearing loss in at least one ear. Hearing loss in children can vary from mild, where a child might have difficulty hearing over background noise, to severe, rendering a child completely deaf. Students who are deaf/hard of hearing (DHH) face special challenges in the classroom, but given the right accommodations, they can succeed academically. Here's what teachers need to know.

Know the signs of potential hearing loss in kids.

Severe hearing loss is usually identified before a child enters school. However, mild to moderate hearing loss may not be recognized until a child is older. Hearing loss due to injury, illness, or disease can begin later in life too. Teachers should know what signs of hearing loss to look for in their classroom and recommend a hearing screening as needed.

Kids are often reluctant to speak up when they can't hear well, so watch for patterns of behavior including the signs shown above. If a student regularly asks you to repeat instructions, misunderstands questions, or doesn't hear when you call their name, check in privately to ask if they're having trouble hearing. Even if they say they're not, continue to watch for signs and don't hesitate to talk with their parents.

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Recognize the challenges children who are deaf/hard of hearing face in the classroom.

Most teachers no longer use a traditional teaching style, facing the class while they lecture from the front. This is terrific for accommodating a variety of learning styles, but makes life in the classroom much harder for children who are deaf/hard of hearing, as they often cannot see the teacher's lips or hear them well when they move around the classroom. Here are some other ways hearing loss causes challenges in school.

Background Noise. For kids with mild to moderate hearing loss, background noise can be their biggest enemy. Since many classrooms are now a hum of busy activity all day long, it's much more likely these kids will miss or have difficulty hearing instructions or feedback.

Acoustics. When a teacher stays in one place, children who are deaf/hard of hearing can be placed close to them. But they still may not hear other students across the room, or pinpoint where a sound is coming from.

Back-lighting. For students who lip-read or work with a sign language interpreter, sitting facing a window or other strong light source makes it hard or impossible to see what's being said.

Note-taking. Taking notes while a teacher talks is a nearly futile task for children who are deaf/hard of hearing.

Difficulty Collaborating. Group work is common and helpful in most classrooms. But students who are deaf/hard of hearing find this difficult, as they often can't understand others. If they aren't comfortable asking for help, they're likely to be left out.

Social Concerns. Those same problems apply to social situations like lunch or recess. Kids with hearing loss can become isolated and have difficulty making friends.

Find more information about challenges facing students who are deaf/hard of hearing here.
Adjust your classroom and teaching style to help lip readers.

Children with any level of hearing loss may use lip-reading to get by. But lip-reading is not only a difficult skill to acquire; it also relies heavily on guesswork. In fact, it's estimated that only about 30-60% of words are seen clearly by lip readers. For the rest, it's like putting together a puzzle without having all the pieces. But teachers can make it easier for lip readers in the classroom.

Make eye contact, speak clearly and normally, but don't shout.

Always be sure you have the lip readers' attention. Ask if it's okay to touch their arm if you need them to look at you. Form your words clearly, and if you're a fast talker, make an effort to slow down just a bit. (All your students will benefit from this.) Talk in a normal tone of voice; shouting can actually distort your mouth.

Arrange seats in a horseshoe or circle.

Lip readers should be able to see all the faces in the classroom during discussions. When possible, a circle or horseshoe is ideal. If not possible, place them close to the front of the room in a seat of their choice, and always repeat any questions or comments from students they may not be able to see.

Reduce back-lighting concerns.

When a teacher or other students are lit from behind, their faces are much harder to see. Close curtains and use overhead lights to ensure everyone is equally well-lit during class.

Give hearing-impaired students a moment to identify who is speaking.

During discussions, new speakers should allow a moment for those who are deaf/hard of hearing to turn their way before talking. Avoid talking over one another so they can focus on one person at a time.

Learn to work with a sign language interpreter.

One way to accommodate kids who are deaf/hard of hearing is the use of a sign language interpreter during class. These interpreters are skilled experts who can make things better for both teacher and student, but you'll need to work closely with them to get the most benefit.

Seat the student close to and facing both the teacher and the interpreter.

Make sure the student can see both of you, and that you're both properly lit. (See concerns about back-lighting above.)

Speak clearly and use specifics.

Sign language interpreters can keep pace with most speakers, but they'll appreciate it if you talk clearly and at a regular pace. Make sure to use specifics when giving directions (for instance, say "put your name in the top left corner" instead of "put your name here".)

Provide vocabulary lists in advance when possible.

In classes like science, kids are always learning new vocabulary words. Sign language interpreters might have to learn them too, if the subject isn't one that's familiar to them. Provide them a list in advance of words relevant to the current topic, so they can see if corresponding signs exist and teach them to their student. When signs don't exist, interpreters will need to use fingerspelling, and they may need assistance with more complicated terms and subject jargon.

Talk directly to the student during class, not the interpreter.

Always interact directly with the student when asking or responding to questions or comments. You don't need to acknowledge the interpreter each time they speak for the student. Let them do their job while you do yours.

Make additional accommodations for children who are deaf/hard of hearing.

Along with lip-reading and interpreters, students may use technology like hearing aids, assistive listening devices, and captioning or transcription. With or without this technology, teachers can also make a variety of accommodations to help these students learn. In many cases, an IEP will detail the adaptations needed.

Face students when speaking, and be sure you have their attention.

This is a good tip for all teachers, in every class. Make eye contact with students so you know you have their attention. Avoid giving instructions while passing out papers or moving around the room. Speak clearly and at a normal speed. For students who are deaf/hard of hearing, ask how they'd like you to get their attention before speaking.

Provide study guides and pre-written notes.

Taking notes while listening to a lecture isn't an ideal way to learn for kids who are deaf/hard of hearing, even if they lip read or have an interpreter. Providing a general outline or pre-written notes, preferably in advance, is better. This allows them to pay attention and interact in class.

Allow time for students to review slides or handouts before speaking.

Slideshows are a great way to help all students follow along in a lecture. When you flip to a new slide, allow a minute for everyone to read what's there before talking. Students who are deaf/hard of hearing can't read a whiteboard at the same time they're trying to lip-read or look at their interpreter. The same goes for handouts or other visual aids.

Check frequently for understanding and questions.

Students who are deaf/hard of hearing might be unwilling to interrupt when they don't understand. Give them more opportunities by pausing more frequently to check for understanding (something else your whole class can benefit from). Additionally, make it very clear when you're about to change topics and move on to something else, and allow some time for final notes or processing.

Use technology to help you out.

We live in a brave new world! Take advantage of speech-to-text technology. Use detailed slideshows and chat/messaging programs. Show streaming movies with closed captioning turned on. Always be on the lookout for new ways technology can improve learning.

Teach other students to communicate with those who are deaf/hard of hearing.

One of the major drawbacks for children who are deaf/hard of hearing is that they can suffer socially. Open up a better, brighter world for them by encouraging your other students to learn how to best interact with them. Teach your class basics signs and fingerspelling. Help them learn the best ways to talk to a lip-reader. Seek out playground games that don't involve hearing. Pair a kid who is deaf/hard of hearing with a friendly buddy classmate who can assist them as needed. Plan field trips that all your students can enjoy. Above all, don't let a student who is deaf/hard of hearing feel isolated and avoid singling them out whenever you can. They really just want to be "normal" kids, so help them feel that way when you're able.

Resources
Books: Online: How do you help students who are deaf/hard of hearing succeed? Come share on the WeAreTeachers HELPLINE Facebook page. Vision loss can also cause students to suffer academically. Learn the 9 signs that could mean your student has a vision problem here.

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A Teacher's Guide to Hearing Impairment in Children

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Know how to recognize and accommodate children who are deaf/hard of hearing in your classroom. Learn how to work with lip readers, interpreters, and more.

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*The simplest AAC device is a picture board or touch screen that uses pictures or symbols of typical items and activities that make up a person’s daily life.

*Keyboards, touch screens, and sometimes a person’s limited speech may be used to communicate desired words. Some devices employ a text display. The display panel typically faces outward so that two people can exchange information while facing each other. Spelling and word prediction software can make it faster and easier to enter information.

*Speech-generating devices go one step further by translating words or pictures into speech.

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https://youtu.be/iHkFfq_174w

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EDUC3026 - Hearing Impairment and Deafness Teaching Strategies

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https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss

https://youtu.be/iHkFfq_174w

https://www.nidcd.nih.gov/health/assistive-devices-people-hearing-voice-speech-or-language-disorders

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https://www.youtube.com/watch?v=5t88zBJkWLI

"Children with developmental delays, including those with related neurobehavioral disorders such as autism spectrum disorder and attention deficit hyperactivity disorder, often also have social, emotional, or behavioral delays." Due to differences in brain development, they may process information or react to their environment differently than children of the same age. These delays can have an impact on a child’s ability to learn, communicate, and interact with others.

It is common for children with developmental delays to have difficulty with social and emotional skills. For example, they may have trouble understanding social cues, initiating communication with others, or carrying on two-way conversations. They may also have difficulty dealing with frustration or coping with change. When the environment becomes too socially or emotionally demanding, children with developmental delays may have prolonged tantrums and take longer than other children to calm down. This behavior can be a signal that the child needs more support by modifying his or her environment or learning skills to cope with social and emotional challenges.

Some speech delays are receptive language disorders, in which a child has difficulty understanding words or concepts. Children with this type of speech delay may have trouble identifying colors, body parts, or shapes. Others are expressive language disorders, in which a child has a reduced vocabulary of words and complex sentences for his or her age. A child with this type of speech delay may be slow to babble, talk, and create sentences. Often, a child with a speech delay has a combination of receptive and expressive delays.

Assistive technology  is one of the core strategies schools use to help with learning and thinking differences. Some adaptive tools are low-tech and some are pretty fancy. Here are some common examples.

1. Audio players and recorders

It may help your child to be able to listen to the words while reading them on the page. Many e-books have audio files, and smartphones and tablet computers come with text to speech software that can read aloud anything on your child’s screen. If kids struggle with writing or taking notes, an audio recorder can capture what the teacher says in class so they can listen to it again at home.
2.Timers can be used as visual aids to show how much time is left to complete an activity. If kids have difficulty transitioning from task to task, timers can help them mentally prepare to make the switch.
3.
Reading guides are good tools for kids who have trouble with visual tracking or who need help staying focused on the page. The plastic strip highlights one line of text while blocking out surrounding words that might be distracting. The strip is also easy to move down the page as your child reads.
4. An inflatable seat cushion can help kids with sensory processing  and attention issues. The cushion can provide enough movement and stimulation to help a child maximize focus without having to get up and walk around.
5. If a child has trouble with writing, they can use plastic pencil grips or a computer. Basic word processing programs come with features that can help with spelling and grammar issues. For students whose thoughts race ahead of their ability to write them down, different kinds of software can help. With word prediction software, your child types the first few letters and then the software gives word choices that begin with that letter. Speech recognition software allows your child to speak and have the text appear on the screen.

-The Effects of Developmental Delay on Sustained Attention in Young Children; Joanne B. Krakow, Claire B. Kopp
.Child Development, Vol. 54, No. 5, Infants at Risk (Oct., 1983), pp. 1143-1155. Accessed: March 6, 2023.
- https://nyulangone.org/conditions/developmental-delays-in-children/types- Accessed March 6th 2023.

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What Do You Need To Know About Developmental Delays?

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Orthopedic impairment is defined as a child’s disability relating to a bone, joint, or muscle, that is severe enough to directly affect the child’s educational performance. It can be caused by many different factors including genetic abnormalities, disorders such as cerebral palsy, or an injury that has caused a missing limb or has impaired a muscle.

The extent to which a child’s education is affected can vary greatly, depending on the level of impairment. Many children with an orthopedic impairment do still have normal cognitive abilities, so these children require mainstream education wherever possible and in the least restrictive environment as appropriate.

Reference:
https://www.drbillhefley.com/what-is-an-orthopedic-impairment/

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Orthopedic impairment is defined as a child's disability relating to a bone, joint, or muscle, that is severe enough to directly affect the child's educational performance. It can be caused by many different factors including genetic abnormalities, disorders such as cerebral palsy, or an injury that has caused a missing limb or has impaired a muscle.

The extent to which a child's education is affected can vary greatly, depending on the level of impairment. Many children with an orthopedic impairment do still have normal cognitive abilities, so these children require mainstream education wherever possible and in the least restrictive environment as appropriate.

Causes of Orthopedic Impairment

Some of the main reasons why children have orthopedic impairments include the following:

Musculoskeletal Disorders

Orthopedic disorders include defects or disorders of the bones and muscles, such as a limb deficiency. A child may be missing part or all of a limb due to trauma, disease, or a birth disorder such as clubfoot.

Clubfoot is a fairly common birth defect in which a baby is born with their foot or feet pointing downward and inward, with the soles of the feet facing inward toward one another, due to shortened tendons. In about 50% of all cases of clubfoot, both feet are affected. Early treatment for clubfoot is recommended before the baby is walking.

Neuromotor Impairments

A neuromotor impairment involves the central nervous system (brain and spinal cord). The impairment affects the child's ability to move, feel, or use certain parts of the body. Spina bifida, cerebral palsy, and spinal injuries are types of neuromotor impairments.

The most common motor and movement disability in children is cerebral palsy. This actually refers to a group of permanent conditions that affect movement and coordination, and it can develop before, during, or soon after birth. Symptoms are usually not obvious at birth but become more apparent within 2-3 years.

Degenerative Diseases

Degenerative diseases such as muscular dystrophy affect motor movement, and they are characterized by the structure or function of a body tissue progressively worsening. Muscular dystrophy refers to a group of genetic disorders that cause a loss of muscle mass and progressive weakness over time. There are treatments available to help many people manage their muscular dystrophy.

Orthopedic Impairments from Other Causes

An orthopedic impairment can also result from other factors such as an amputation, injury due to an accident, or severe burns that have resulted in damage to the bones and muscles.

Joint deformities such as developmental dysplasia of the hip (DDH) is a birth defect resulting in the ball-and-socket joint not developing properly in babies and young children. This causes the hip joint to be loose and, in some cases, leads to hip dislocation. If left untreated, it can prevent the hip joint from developing properly and lead to hip pain, reduced function, and osteoarthritis in the child.

Orthopedic Care in Little Rock, Arkansas

If you have an orthopedic impairment or a musculoskeletal issue that is impacting your quality of life, contact board-certified orthopedic surgeon Dr. William Hefley for an evaluation and to discuss your treatment options. Dr. Hefley treats a broad range of orthopedic conditions and injuries, and he specializes in treating shoulder, hip, and knee conditions.

While Dr. Hefley is highly experienced in performing arthroscopic and minimally invasive joint replacement surgery, he also uses an array of nonsurgical modalities - including stem cell and PRP (platelet-rich plasma) therapy - to treat orthopedic injuries and conditions. The medical staff at Bowen Hefley Orthopedics is here to improve your quality of life and get you moving again.

If you would like more information about our services, or to schedule an appointment with Dr. Hefley at one of our convenient locations, call us today at (800) 336-2412, or you can use our convenient online appointment request form. We look forward to seeing you here!

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What Is an Orthopedic Impairment? | Bowen Hefley Orthopedics

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Orthopedic impairment is defined as a child's disability relating to a bone, joint, or muscle, that is severe enough to directly affect the child's educational performance. It can be caused by many different factors including genetic abnormalities, disorders such as cerebral palsy, or an injury that has caused a missing limb or has impaired a muscle.

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As with most students with disabilities, the classroom accommodations for students with orthopedic impairments will vary dependent on the individual needs of the student. Since many students with orthopedic impairments have no cognitive impairments, the general educator and special educator should collaborate to include the student in the general curriculum as much as possible.

In order for the student to access the general curriculum, the student may require these accommodations:

Special seating arrangements to develop useful posture and movements

Instruction focused on development of gross and fine motor skills

Securing suitable augmentative communication and other assistive devices

Awareness of medical condition and its affect on the student (such as getting tired quickly)

Because of the multi-faceted nature of orthopedic impairments, other specialists may be involved in developing and implementing an appropriate educational program for the student. These specialists can include:

Physical Therapists who work on gross motor skills (focusing on the legs, back, neck and torso)

Occupational Therapists who work on fine motor skills (focusing on the arms and hands as well as daily living activities such as dressing and bathing)

Speech-Language Pathologists who work with the student on problems with speech and language

Adapted Physical Education Teachers, who are specially trained PE teachers who work along with the OT and PT to develop an exercise program to help students with disabilities

Other Therapists (Massage Therapists, Music Therapists, etc.)

Reference:
http://www.projectidealonline.org/v/orthopedic-impairments/

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Definition

Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

Prevalence

The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 1.1%, or 68,188 students, received special education services based on a classification of orthopedic impairments.

Characteristics

The IDEA category of orthopedic impairments contains a wide variety of disorders. These can be divided into three main areas: neuromotor impairments, degenerative diseases, and musculoskeletal disorders. The specific characteristics of an individual who has an orthopedic impairment will depend on both the specific disease and its severity, as well as additional individual factors.

A neuromotor impairment is an abnormality of, or damage to, the brain, spinal cord, or nervous system that sends impulses to the muscles of the body. These impairments are acquired at or before birth, and often result in complex motor problems that can affect several body systems. These motor problems can include limited limb movement, loss of urinary control, and loss of proper alignment of the spine. The two most common types of neuromotor impairments are cerebral palsy and spina bifida.

Cerebral palsy refers to several nonprogressive disorders of voluntary movement or posture that are caused by malfunction of or damage to the developing brain that occurs before or during birth or within the first few years of life. Individuals with cerebral palsy have abnormal, involuntary, and/or uncoordinated motor movements. The four most common types of cerebral palsy include:

Spastic (very tight muscles occurring in one or more muscle groups that result in stiff, uncoordinated movements)

Athetoid (movements are contorted, abnormal, and purposeless)

Ataxic (poor balance and equilibrium in addition to uncoordinated voluntary movement)

Mixed (any combination of the types)

Cerebral palsy is also classified by which limbs (arms and legs) are affected. Major classifications include hemiplegia (left or right side), diplegia (legs affected more than arms); paraplegia (only legs), and quadriplegia (all four limbs).

Spina bifida is a developmental defect of the spinal column. Spina bifida is characterized by an abnormal opening in the spinal column and frequently involves some paralysis of various portions of the body. It may or may not affect intellectual functioning. Spina bifida is usually classified as either spina bifida occulta or spina bifida cystica. Spina bifida occulta is a mild condition while spina bifida cystica is more serious.

Degenerative diseases are composed of various diseases that affect motor development. The most common degenerative disease found in the school population is muscular dystrophy. Muscular dystrophy is a group of inherited diseases characterized by progressive muscle weakness from degeneration of muscle fibers.

Musculoskeletal disorders are composed of various conditions that can result in various levels of physical limitations. Two examples of musculoskeletal disorders include juvenile rheumatoid arthritis and limb deficiency.

Impact on Learning

The specific impact on learning of an individual is contingent upon the disease, its severity, and individual factors. Two individuals with identical diagnoses may be quite different in terms of their capabilities.

Many students with orthopedic impairments have no cognitive, learning, perceptual, language, or sensory issues. However, individuals with neuromotor impairments have a higher incidence of additional impairments, especially when there has been brain involvement. For most students with orthopedic impairments, the impact on learning is focused on accommodations necessary for students to have access to academic instruction.

Teaching Strategies

As with most students with disabilities, the classroom accommodations for students with orthopedic impairments will vary dependent on the individual needs of the student. Since many students with orthopedic impairments have no cognitive impairments, the general educator and special educator should collaborate to include the student in the general curriculum as much as possible.

In order for the student to access the general curriculum, the student may require these accommodations:

Special seating arrangements to develop useful posture and movements

Instruction focused on development of gross and fine motor skills

Securing suitable augmentative communication and other assistive devices

Awareness of medical condition and its affect on the student (such as getting tired quickly)

Because of the multi-faceted nature of orthopedic impairments, other specialists may be involved in developing and implementing an appropriate educational program for the student. These specialists can include:

Physical Therapists who work on gross motor skills (focusing on the legs, back, neck and torso)

Occupational Therapists who work on fine motor skills (focusing on the arms and hands as well as daily living activities such as dressing and bathing)

Speech-Language Pathologists who work with the student on problems with speech and language

Adapted Physical Education Teachers, who are specially trained PE teachers who work along with the OT and PT to develop an exercise program to help students with disabilities

Other Therapists (Massage Therapists, Music Therapists, etc.)

Assistive Technology

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used. As with any student with a disability, the assistive technology would need to address a need of the student to be able to access the educational curriculum. For students with orthopedic impairments, these fall into three categories:

Devices to Access Information: These assistive technology devices focus on aiding the student to access the educational material. These devices include:

speech recognition software

screen reading software

augmentative and alternative communication devices (such as communication boards)

academic software packages for students with disabilities

Devices for Positioning and Mobility: These assistive technology devices focus on helping the student participate in educational activities. These devices include:

canes

walkers

crutches

wheelchairs

specialized exercise equipment

specialized chairs, desks, and tables for proper posture development

Organizations

United Cerebral Palsy Associations, Inc.

1660 L Street NW, Suite 700
Washington DC 20036

Web: www.ucp.org

United Cerebral Palsy of Texas

The national organization and its nationwide network of affiliates strive to ensure the inclusion of persons with disabilities in every facet of society-from the Web to the workplace, from the classroom to the community. As one of the largest health charities in America, the mission of United Cerebral Palsy is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network.

1016 La Posada, Suite 145
Austin, TX 78752

Email: info@ucptexas.org
Web: www.ucptexas.org

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Easter Seals--National Office

Easter Seals offers help, hope and answers to more than a million children and adults living with autism and other disabilities or special needs and their families each year. Services and support are provided through a network of more than 550 sites in the U.S. Each center provides exceptional services that are individualized, innovative, family-focused and tailored to meet specific needs of the particular community served.

230 West Monroe Street, Suite 1800
Chicago, IL 60606-4802

Web: www.easter-seals.org

March of Dimes Birth Defects Foundation

The March of Dimes mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. They carry out this mission through research, community services, education and advocacy to save babies' lives. March of Dimes researchers, volunteers, educators, outreach workers and advocates work together to give all babies a fighting chance against the threats to their health: prematurity, birth defects, low birthweight.

1275 Mamaroneck Avenue
White Plains, NY 10605

Phone: 914-428-7100; 888-663-4637
Email: askus@marchofdimes.com
Web: www.marchofdimes.com

National Rehabilitation Information Center (NARIC)

The core mission of the Center is to collect and disseminate the results of research funded by the National Institute on Disability and Rehabilitation Research (NIDRR). NARIC staff members have been dedicated to providing direct, personal, and high-quality information services to anyone throughout the country.

4200 Forbes Boulevard, Suite 202
Lanham, MD 20706

Email: naricinfo@heitechservices.com
Web: www.naric.com

Spina Bifida Association of America

The Spina Bifida Association (SBA) serves adults and children who live with the challenges of Spina Bifida. Since 1973, SBA has been the only national voluntary health agency solely dedicated to enhancing the lives of those with Spina Bifida and those whose lives are touched by this challenging birth defect. Its tools are education, advocacy, research, and service.

4590 MacArthur Boulevard, N.W., Suite 250
Washington, DC 20007

National Institute of Neurological Disorders and Stroke (NINDS)

The mission of NINDS is to reduce the burden of neurological disease - a burden borne by every age group, by every segment of society, by people all over the world. NINDS conducts, fosters, coordinates, and guides research; operates research projects, program projects, and research center grants; and collects and disseminates research information related to neurological disorders.

National Institutes of Health
National Institue of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824

Web: www.ninds.nih.gov

References

Gargiulo, R.M. (2006). Special education in contemporary society: An introduction to exceptionality. Belmont, CA: Thomson Wadsworth.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives: Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

# data[].attributes.attachment_link.description
Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

# data[].attributes.body
Assistive Technology

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used. As with any student with a disability, the assistive technology would need to address a need of the student to be able to access the educational curriculum. For students with orthopedic impairments, these fall into three categories:

Devices to Access Information: These assistive technology devices focus on aiding the student to access the educational material. These devices include:

speech recognition software

screen reading software

augmentative and alternative communication devices (such as communication boards)

academic software packages for students with disabilities

Devices for Positioning and Mobility: These assistive technology devices focus on helping the student participate in educational activities. These devices include:

canes

walkers

crutches

wheelchairs

specialized exercise equipment

specialized chairs, desks, and tables for proper posture development

Reference:
http://www.projectidealonline.org/v/orthopedic-impairments/

# data[].attributes.attachment_link.readable_text
Definition

Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

Prevalence

The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 1.1%, or 68,188 students, received special education services based on a classification of orthopedic impairments.

Characteristics

The IDEA category of orthopedic impairments contains a wide variety of disorders. These can be divided into three main areas: neuromotor impairments, degenerative diseases, and musculoskeletal disorders. The specific characteristics of an individual who has an orthopedic impairment will depend on both the specific disease and its severity, as well as additional individual factors.

A neuromotor impairment is an abnormality of, or damage to, the brain, spinal cord, or nervous system that sends impulses to the muscles of the body. These impairments are acquired at or before birth, and often result in complex motor problems that can affect several body systems. These motor problems can include limited limb movement, loss of urinary control, and loss of proper alignment of the spine. The two most common types of neuromotor impairments are cerebral palsy and spina bifida.

Cerebral palsy refers to several nonprogressive disorders of voluntary movement or posture that are caused by malfunction of or damage to the developing brain that occurs before or during birth or within the first few years of life. Individuals with cerebral palsy have abnormal, involuntary, and/or uncoordinated motor movements. The four most common types of cerebral palsy include:

Spastic (very tight muscles occurring in one or more muscle groups that result in stiff, uncoordinated movements)

Athetoid (movements are contorted, abnormal, and purposeless)

Ataxic (poor balance and equilibrium in addition to uncoordinated voluntary movement)

Mixed (any combination of the types)

Cerebral palsy is also classified by which limbs (arms and legs) are affected. Major classifications include hemiplegia (left or right side), diplegia (legs affected more than arms); paraplegia (only legs), and quadriplegia (all four limbs).

Spina bifida is a developmental defect of the spinal column. Spina bifida is characterized by an abnormal opening in the spinal column and frequently involves some paralysis of various portions of the body. It may or may not affect intellectual functioning. Spina bifida is usually classified as either spina bifida occulta or spina bifida cystica. Spina bifida occulta is a mild condition while spina bifida cystica is more serious.

Degenerative diseases are composed of various diseases that affect motor development. The most common degenerative disease found in the school population is muscular dystrophy. Muscular dystrophy is a group of inherited diseases characterized by progressive muscle weakness from degeneration of muscle fibers.

Musculoskeletal disorders are composed of various conditions that can result in various levels of physical limitations. Two examples of musculoskeletal disorders include juvenile rheumatoid arthritis and limb deficiency.

Impact on Learning

The specific impact on learning of an individual is contingent upon the disease, its severity, and individual factors. Two individuals with identical diagnoses may be quite different in terms of their capabilities.

Many students with orthopedic impairments have no cognitive, learning, perceptual, language, or sensory issues. However, individuals with neuromotor impairments have a higher incidence of additional impairments, especially when there has been brain involvement. For most students with orthopedic impairments, the impact on learning is focused on accommodations necessary for students to have access to academic instruction.

Teaching Strategies

As with most students with disabilities, the classroom accommodations for students with orthopedic impairments will vary dependent on the individual needs of the student. Since many students with orthopedic impairments have no cognitive impairments, the general educator and special educator should collaborate to include the student in the general curriculum as much as possible.

In order for the student to access the general curriculum, the student may require these accommodations:

Special seating arrangements to develop useful posture and movements

Instruction focused on development of gross and fine motor skills

Securing suitable augmentative communication and other assistive devices

Awareness of medical condition and its affect on the student (such as getting tired quickly)

Because of the multi-faceted nature of orthopedic impairments, other specialists may be involved in developing and implementing an appropriate educational program for the student. These specialists can include:

Physical Therapists who work on gross motor skills (focusing on the legs, back, neck and torso)

Occupational Therapists who work on fine motor skills (focusing on the arms and hands as well as daily living activities such as dressing and bathing)

Speech-Language Pathologists who work with the student on problems with speech and language

Adapted Physical Education Teachers, who are specially trained PE teachers who work along with the OT and PT to develop an exercise program to help students with disabilities

Other Therapists (Massage Therapists, Music Therapists, etc.)

Assistive Technology

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used. As with any student with a disability, the assistive technology would need to address a need of the student to be able to access the educational curriculum. For students with orthopedic impairments, these fall into three categories:

Devices to Access Information: These assistive technology devices focus on aiding the student to access the educational material. These devices include:

speech recognition software

screen reading software

augmentative and alternative communication devices (such as communication boards)

academic software packages for students with disabilities

Devices for Positioning and Mobility: These assistive technology devices focus on helping the student participate in educational activities. These devices include:

canes

walkers

crutches

wheelchairs

specialized exercise equipment

specialized chairs, desks, and tables for proper posture development

Organizations

United Cerebral Palsy Associations, Inc.

1660 L Street NW, Suite 700
Washington DC 20036

Web: www.ucp.org

United Cerebral Palsy of Texas

The national organization and its nationwide network of affiliates strive to ensure the inclusion of persons with disabilities in every facet of society-from the Web to the workplace, from the classroom to the community. As one of the largest health charities in America, the mission of United Cerebral Palsy is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network.

1016 La Posada, Suite 145
Austin, TX 78752

Email: info@ucptexas.org
Web: www.ucptexas.org

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Easter Seals--National Office

Easter Seals offers help, hope and answers to more than a million children and adults living with autism and other disabilities or special needs and their families each year. Services and support are provided through a network of more than 550 sites in the U.S. Each center provides exceptional services that are individualized, innovative, family-focused and tailored to meet specific needs of the particular community served.

230 West Monroe Street, Suite 1800
Chicago, IL 60606-4802

Web: www.easter-seals.org

March of Dimes Birth Defects Foundation

The March of Dimes mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. They carry out this mission through research, community services, education and advocacy to save babies' lives. March of Dimes researchers, volunteers, educators, outreach workers and advocates work together to give all babies a fighting chance against the threats to their health: prematurity, birth defects, low birthweight.

1275 Mamaroneck Avenue
White Plains, NY 10605

Phone: 914-428-7100; 888-663-4637
Email: askus@marchofdimes.com
Web: www.marchofdimes.com

National Rehabilitation Information Center (NARIC)

The core mission of the Center is to collect and disseminate the results of research funded by the National Institute on Disability and Rehabilitation Research (NIDRR). NARIC staff members have been dedicated to providing direct, personal, and high-quality information services to anyone throughout the country.

4200 Forbes Boulevard, Suite 202
Lanham, MD 20706

Email: naricinfo@heitechservices.com
Web: www.naric.com

Spina Bifida Association of America

The Spina Bifida Association (SBA) serves adults and children who live with the challenges of Spina Bifida. Since 1973, SBA has been the only national voluntary health agency solely dedicated to enhancing the lives of those with Spina Bifida and those whose lives are touched by this challenging birth defect. Its tools are education, advocacy, research, and service.

4590 MacArthur Boulevard, N.W., Suite 250
Washington, DC 20007

National Institute of Neurological Disorders and Stroke (NINDS)

The mission of NINDS is to reduce the burden of neurological disease - a burden borne by every age group, by every segment of society, by people all over the world. NINDS conducts, fosters, coordinates, and guides research; operates research projects, program projects, and research center grants; and collects and disseminates research information related to neurological disorders.

National Institutes of Health
National Institue of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824

Web: www.ninds.nih.gov

References

Gargiulo, R.M. (2006). Special education in contemporary society: An introduction to exceptionality. Belmont, CA: Thomson Wadsworth.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives: Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

# data[].attributes.attachment_link.description
Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

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https://youtu.be/qDLzN33CiHE

# data[].attributes.attachment_link.title
Special needs of Orthopedically Impaired Children |B.ed, creating an inclusive school| Anil Kashyap

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What is traumatic brain injury?

Traumatic brain injury (TBI) happens when a sudden, external, physical assault damages the brain. It is one of the most common causes of disability and death in adults. TBI is a broad term that describes a vast array of injuries that happen to the brain. The damage can be focal (confined to one area of the brain) or diffuse (happens in more than one area of the brain). The severity of a brain injury can range from a mild concussion to a severe injury that results in coma or even death.

What are the different types of TBI?

Reference:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury

Brain injury may happen in one of two ways:

Closed brain injury. Closed brain injuries happen when there is a nonpenetrating injury to the brain with no break in the skull. A closed brain injury is caused by a rapid forward or backward movement and shaking of the brain inside the bony skull that results in bruising and tearing of brain tissue and blood vessels. Closed brain injuries are usually caused by car accidents, falls, and increasingly, in sports. Shaking a baby can also result in this type of injury (called shaken baby syndrome).

Penetrating brain injury. Penetrating, or open head injuries happen when there is a break in the skull, such as when a bullet pierces the brain.

# data[].attributes.attachment_link.readable_text
What is traumatic brain injury?

Traumatic brain injury (TBI) happens when a sudden, external, physical assault damages the brain. It is one of the most common causes of disability and death in adults. TBI is a broad term that describes a vast array of injuries that happen to the brain. The damage can be focal (confined to one area of the brain) or diffuse (happens in more than one area of the brain). The severity of a brain injury can range from a mild concussion to a severe injury that results in coma or even death.

What are the different types of TBI?

Brain injury may happen in one of two ways:

Closed brain injury. Closed brain injuries happen when there is a nonpenetrating injury to the brain with no break in the skull. A closed brain injury is caused by a rapid forward or backward movement and shaking of the brain inside the bony skull that results in bruising and tearing of brain tissue and blood vessels. Closed brain injuries are usually caused by car accidents, falls, and increasingly, in sports. Shaking a baby can also result in this type of injury (called shaken baby syndrome).

Penetrating brain injury. Penetrating, or open head injuries happen when there is a break in the skull, such as when a bullet pierces the brain.

What is diffuse axonal injury (DAI)?

Diffuse axonal injury is the shearing (tearing) of the brain's long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull. DAI usually causes coma and injury to many different parts of the brain. The changes in the brain are often microscopic and may not be evident on computed tomography (CT scan) or magnetic resonance imaging (MRI) scans.

What is primary and secondary brain injury?

Primary brain injury refers to the sudden and profound injury to the brain that is considered to be more or less complete at the time of impact. This happens at the time of the car accident, gunshot wound, or fall.

Secondary brain injury refers to the changes that evolve over a period of hours to days after the primary brain injury. It includes an entire series of steps or stages of cellular, chemical, tissue, or blood vessel changes in the brain that contribute to further destruction of brain tissue.

What causes a head injury?

There are many causes of head injury in children and adults. The most common injuries are from motor vehicle accidents (where the person is either riding in the car or is struck as a pedestrian), violence, falls, or as a result of shaking a child (as seen in cases of child abuse).

What causes bruising and internal damage to the brain?

When there is a direct blow to the head, the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-contrecoup. A bruise directly related to trauma at the site of impact is called a coup lesion (pronounced COO). As the brain jolts backward, it can hit the skull on the opposite side and cause a bruise called a contrecoup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels leading to internal bleeding, bruising, or swelling of the brain.

What are the possible results of brain injury?

Some brain injuries are mild, with symptoms disappearing over time with proper attention. Others are more severe and may result in permanent disability. The long-term or permanent results of brain injury may need post-injury and possibly lifelong rehabilitation. Effects of brain injury may include:

Can the brain heal after being injured?

Most studies suggest that once brain cells are destroyed or damaged, for the most part, they do not regenerate. However, recovery after brain injury can take place, especially in younger people, as, in some cases, other areas of the brain make up for the injured tissue. In other cases, the brain learns to reroute information and function around the damaged areas. The exact amount of recovery is not predictable at the time of injury and may be unknown for months or even years. Each brain injury and rate of recovery is unique. Recovery from a severe brain injury often involves a prolonged or lifelong process of treatment and rehabilitation.

What is coma?

Coma is an altered state of consciousness that may be very deep (unconsciousness) so that no amount of stimulation will cause the patient to respond. It can also be a state of reduced consciousness, so that the patient may move about or respond to pain. Not all patients with brain injury are comatose. The depth of coma, and the time a patient spends in a coma varies greatly depending on the location and severity of the brain injury. Some patients emerge from a coma and have a good recovery. Other patients have significant disabilities.

How is coma measured?

Depth of the coma is usually measured in the emergency and intensive care settings using a Glasgow coma scale. The scale (from 3 to 15) evaluates eye opening, verbal response, and motor response. A high score shows a greater amount of consciousness and awareness.

In rehabilitation settings, here are several scales and measures used to rate and record the progress of the patient. Some of the most common of these scales are described below.

Rancho Los Amigos 10 Level Scale of Cognitive Functioning. This is a revision of the original Rancho 8 Level Scale, which is based on how the patient reacts to external stimuli and the environment. The scales consist of 10 different levels and each patient will progress through the levels with starts and stops, progress and plateaus.

Disability Rating Scale (DRS). This scale measures functional change during the course of recovery rating the person's disability level from none to extreme. The DRS assesses cognitive and physical function, impairment, disability, and handicap and can track a person's progress from "coma to community."

Functional Independent Measure (FIM). The FIM scale measures a person's level of independence in activities of daily living. Scores can range from 1 (complete dependence) to 7 (complete independence).

Functional Assessment Measure (FAM). This measure is used along with FIM and was developed specifically for people with brain injury.

The Brain Injury Rehabilitation Program

Rehabilitation of the patient with a brain injury begins during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun. The success of rehabilitation depends on many variables, including the following:

Nature and severity of the brain injury

Type and degree of any resulting impairments and disabilities

Overall health of the patient

Family support

It is important to focus on maximizing the patient's capabilities at home and in the community. Positive reinforcement helps recovery by improving self-esteem and promoting independence.

The goal of brain injury rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life- physically, emotionally, and socially.

Areas covered in brain injury rehabilitation programs may include:

Self-care skills, including activities of daily living (ADLs): feeding, grooming, bathing, dressing, toileting, and sexual functioning

Physical care: nutritional needs, medicines, and skin care

Mobility skills: walking, transfers, and self-propelling a wheelchair

Communication skills: speech, writing, and alternative methods of communication

Cognitive skills: speech, writing, and alternative methods of communication

Socialization skills: interacting with others at home and within the community

Vocational training: work-related skills

Pain management: medicines and alternative methods of managing pain

Psychological testing and counseling: identifying problems and solutions with thinking, behavioral, and emotional issues

Family support: assistance with adapting to lifestyle changes, financial concerns, and discharge planning

Education: patient and family education and training about brain injury, safety issues, home care needs, and adaptive techniques

The Brain Injury Rehabilitation Team

The brain injury rehabilitation team revolves around the patient and family and helps set short- and long-term treatment goals for recovery. Many skilled professionals are part of the brain injury rehabilitation team, including any or all of the following:

Types of Brain Injury Rehabilitation Programs

There are a variety of brain injury treatment programs, including the following:

Acute rehabilitation programs

Subacute rehabilitation programs

Long-term rehabilitation programs

Transitional living programs

Behavior management programs

Day-treatment programs

Independent living programs

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Acquired brain injury hapens when a sudden, external, physical assault damages the brain. It is one of the most common causes of disability and death in adults.

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http://www.projectidealonline.org/v/orthopedic-impairments/

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Definition

Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

Prevalence

The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 1.1%, or 68,188 students, received special education services based on a classification of orthopedic impairments.

Characteristics

The IDEA category of orthopedic impairments contains a wide variety of disorders. These can be divided into three main areas: neuromotor impairments, degenerative diseases, and musculoskeletal disorders. The specific characteristics of an individual who has an orthopedic impairment will depend on both the specific disease and its severity, as well as additional individual factors.

A neuromotor impairment is an abnormality of, or damage to, the brain, spinal cord, or nervous system that sends impulses to the muscles of the body. These impairments are acquired at or before birth, and often result in complex motor problems that can affect several body systems. These motor problems can include limited limb movement, loss of urinary control, and loss of proper alignment of the spine. The two most common types of neuromotor impairments are cerebral palsy and spina bifida.

Cerebral palsy refers to several nonprogressive disorders of voluntary movement or posture that are caused by malfunction of or damage to the developing brain that occurs before or during birth or within the first few years of life. Individuals with cerebral palsy have abnormal, involuntary, and/or uncoordinated motor movements. The four most common types of cerebral palsy include:

Spastic (very tight muscles occurring in one or more muscle groups that result in stiff, uncoordinated movements)

Athetoid (movements are contorted, abnormal, and purposeless)

Ataxic (poor balance and equilibrium in addition to uncoordinated voluntary movement)

Mixed (any combination of the types)

Cerebral palsy is also classified by which limbs (arms and legs) are affected. Major classifications include hemiplegia (left or right side), diplegia (legs affected more than arms); paraplegia (only legs), and quadriplegia (all four limbs).

Spina bifida is a developmental defect of the spinal column. Spina bifida is characterized by an abnormal opening in the spinal column and frequently involves some paralysis of various portions of the body. It may or may not affect intellectual functioning. Spina bifida is usually classified as either spina bifida occulta or spina bifida cystica. Spina bifida occulta is a mild condition while spina bifida cystica is more serious.

Degenerative diseases are composed of various diseases that affect motor development. The most common degenerative disease found in the school population is muscular dystrophy. Muscular dystrophy is a group of inherited diseases characterized by progressive muscle weakness from degeneration of muscle fibers.

Musculoskeletal disorders are composed of various conditions that can result in various levels of physical limitations. Two examples of musculoskeletal disorders include juvenile rheumatoid arthritis and limb deficiency.

Impact on Learning

The specific impact on learning of an individual is contingent upon the disease, its severity, and individual factors. Two individuals with identical diagnoses may be quite different in terms of their capabilities.

Many students with orthopedic impairments have no cognitive, learning, perceptual, language, or sensory issues. However, individuals with neuromotor impairments have a higher incidence of additional impairments, especially when there has been brain involvement. For most students with orthopedic impairments, the impact on learning is focused on accommodations necessary for students to have access to academic instruction.

Teaching Strategies

As with most students with disabilities, the classroom accommodations for students with orthopedic impairments will vary dependent on the individual needs of the student. Since many students with orthopedic impairments have no cognitive impairments, the general educator and special educator should collaborate to include the student in the general curriculum as much as possible.

In order for the student to access the general curriculum, the student may require these accommodations:

Special seating arrangements to develop useful posture and movements

Instruction focused on development of gross and fine motor skills

Securing suitable augmentative communication and other assistive devices

Awareness of medical condition and its affect on the student (such as getting tired quickly)

Because of the multi-faceted nature of orthopedic impairments, other specialists may be involved in developing and implementing an appropriate educational program for the student. These specialists can include:

Physical Therapists who work on gross motor skills (focusing on the legs, back, neck and torso)

Occupational Therapists who work on fine motor skills (focusing on the arms and hands as well as daily living activities such as dressing and bathing)

Speech-Language Pathologists who work with the student on problems with speech and language

Adapted Physical Education Teachers, who are specially trained PE teachers who work along with the OT and PT to develop an exercise program to help students with disabilities

Other Therapists (Massage Therapists, Music Therapists, etc.)

Assistive Technology

Due to the various levels of severity of orthopedic impairment, multiple types of assistive technology may be used. As with any student with a disability, the assistive technology would need to address a need of the student to be able to access the educational curriculum. For students with orthopedic impairments, these fall into three categories:

Devices to Access Information: These assistive technology devices focus on aiding the student to access the educational material. These devices include:

speech recognition software

screen reading software

augmentative and alternative communication devices (such as communication boards)

academic software packages for students with disabilities

Devices for Positioning and Mobility: These assistive technology devices focus on helping the student participate in educational activities. These devices include:

canes

walkers

crutches

wheelchairs

specialized exercise equipment

specialized chairs, desks, and tables for proper posture development

Organizations

United Cerebral Palsy Associations, Inc.

1660 L Street NW, Suite 700
Washington DC 20036

Web: www.ucp.org

United Cerebral Palsy of Texas

The national organization and its nationwide network of affiliates strive to ensure the inclusion of persons with disabilities in every facet of society-from the Web to the workplace, from the classroom to the community. As one of the largest health charities in America, the mission of United Cerebral Palsy is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network.

1016 La Posada, Suite 145
Austin, TX 78752

Email: info@ucptexas.org
Web: www.ucptexas.org

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Easter Seals--National Office

Easter Seals offers help, hope and answers to more than a million children and adults living with autism and other disabilities or special needs and their families each year. Services and support are provided through a network of more than 550 sites in the U.S. Each center provides exceptional services that are individualized, innovative, family-focused and tailored to meet specific needs of the particular community served.

230 West Monroe Street, Suite 1800
Chicago, IL 60606-4802

Web: www.easter-seals.org

March of Dimes Birth Defects Foundation

The March of Dimes mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. They carry out this mission through research, community services, education and advocacy to save babies' lives. March of Dimes researchers, volunteers, educators, outreach workers and advocates work together to give all babies a fighting chance against the threats to their health: prematurity, birth defects, low birthweight.

1275 Mamaroneck Avenue
White Plains, NY 10605

Phone: 914-428-7100; 888-663-4637
Email: askus@marchofdimes.com
Web: www.marchofdimes.com

National Rehabilitation Information Center (NARIC)

The core mission of the Center is to collect and disseminate the results of research funded by the National Institute on Disability and Rehabilitation Research (NIDRR). NARIC staff members have been dedicated to providing direct, personal, and high-quality information services to anyone throughout the country.

4200 Forbes Boulevard, Suite 202
Lanham, MD 20706

Email: naricinfo@heitechservices.com
Web: www.naric.com

Spina Bifida Association of America

The Spina Bifida Association (SBA) serves adults and children who live with the challenges of Spina Bifida. Since 1973, SBA has been the only national voluntary health agency solely dedicated to enhancing the lives of those with Spina Bifida and those whose lives are touched by this challenging birth defect. Its tools are education, advocacy, research, and service.

4590 MacArthur Boulevard, N.W., Suite 250
Washington, DC 20007

National Institute of Neurological Disorders and Stroke (NINDS)

The mission of NINDS is to reduce the burden of neurological disease - a burden borne by every age group, by every segment of society, by people all over the world. NINDS conducts, fosters, coordinates, and guides research; operates research projects, program projects, and research center grants; and collects and disseminates research information related to neurological disorders.

National Institutes of Health
National Institue of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824

Web: www.ninds.nih.gov

References

Gargiulo, R.M. (2006). Special education in contemporary society: An introduction to exceptionality. Belmont, CA: Thomson Wadsworth.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives: Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

# data[].attributes.attachment_link.description
Orthopedic impairment is defined as a severe orthopedic impairment that adversely affects a child's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

# data[].attributes.body
CLASSROOM

Have student sit near the instructor.

Maintain eye contact during instructions.

Avoid areas near doors, windows, and traffic patterns.

Organize the work area by reducing clutter of furniture, supplies, and décor.

Reduce background noise by experimenting with ear plugs, ear muffs/phones, or introducing background sound such as, white noise or a walkman with soft music.

Reduce environmental and situational triggers (changes in routine, structure, noise, clutter, activity, fatigue, stress, frequent transitions, etc.).

Have a buddy, aide, or tutor assist the student with strategies.

Provide opportunities for the student to take breaks.

Use a written or picture schedule and check off progress.

LECTURE

Connect new learning to prior knowledge.

Use clearly defined, meaningful objectives.

Increase interest with new, stimulating activities.

Break assignments into smaller and shorter segments.

Limit the amount of information on worksheets, notes, etc.

Use verbal and visual cues.

Shorten the length of communication to the student, focusing on the essential or most important parts.

Give time after a long direction or between parts of a direction for the student to “digest” what you have said.

If the student appears “blank” or is not doing what you have asked, repeat the main points. Do not elaborate or add details.

Use real materials and hands-on activities as much as possible to supplement written or lecture material.

Use multi-sensory or multi-modal techniques.

While maintaining a degree of confidentiality, assist the student by identifying a classmate to share notes. Make E-notes available on your website.

Have your syllabus available at your website and ensure that the assignment schedule and calendar is listed.

EXAMS

Offer practice tests that will reflect the type of questions that will be asked on quizzes and exams.

Provide a study guide in advance that reflects the format as well as the content of the exam.

Extended time for in-class assignments or exams (time and one half is reasonable).

Allow testing in a quiet room. Be aware that distractions while taking the test in the classroom are due to students finishing early, getting up to turn in exams, and then packing up to leave.

Reference:
https://www.ccaurora.edu/mycca/web/accessibility/teaching-strategies/tbi

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Speech Generating Devices

GoTalks
GoTalks are a type of speech generating devices. GoTalks are offered with various amounts of communication options and sizes.

Recording Devices
Many smartphones have recording capabilities, but often the sound recordings are not high quality. Other options include:

Sony ICD-UX530 Series Voice Recorder
This discrete voice recorder has a built in USB for easy transfer of audio recordings.

TASCAM DR-05X Portable Digital Recorder
One benefit of this recording device is it does not change pitch when the playback speed is changed.

Writing Assistance

Dragon Naturally Speaking
This speech-recognition software can assist those whose oral skills are more advanced than their writing skills. Dragon NaturallySpeaking allows users email, post on social media, dictate homework, and more.

Co:Writer Universal
Co:Writer is a word prediction program that can be used across multiple devices and in word processing applications. Word prediction helps users expand their vocabulary and more easily express their thoughts through writing by predicting what word the user will write next and giving them multiple options.

Reference:
https://guides.library.illinois.edu/c.php?g=497977&p=3409451

# data[].attributes.attachment_link.readable_text
The Technology Related Assistance to Individuals with Disabilities Act of 1988 described an assistive technology device as "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities."

Assistive technologies can be "high tech" and "low tech:" from canes and lever doorknobs to voice recognition software and augmentative communication devices (speech generating devices).

# data[].attributes.attachment_link.title
LibGuides: Traumatic Brain Injury (TBI): Common Assistive Technologies

# data[].attributes.attachment_link.description
The Technology Related Assistance to Individuals with Disabilities Act of 1988 described an assistive technology device as "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities."

# data[].attributes.body
https://youtu.be/dVRc0hVcGg0

# data[].attributes.attachment_link.title
What Schools Need to Know About Children with Brain Injury

# data[].attributes.body
https://guides.library.illinois.edu/c.php?g=497977&p=3409451

https://www.ccaurora.edu/mycca/web/accessibility/teaching-strategies/tbi

https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury

# data[].attributes.attachment_link.readable_text
The Technology Related Assistance to Individuals with Disabilities Act of 1988 described an assistive technology device as "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities."

Assistive technologies can be "high tech" and "low tech:" from canes and lever doorknobs to voice recognition software and augmentative communication devices (speech generating devices).

# data[].attributes.attachment_link.title
LibGuides: Traumatic Brain Injury (TBI): Common Assistive Technologies

# data[].attributes.attachment_link.description
The Technology Related Assistance to Individuals with Disabilities Act of 1988 described an assistive technology device as "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities."