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A child or student is defined as being medically fragile if he/she/they have an illness or medical condition that requires medical care, medical technology or interventions and specialized care administered by a nurse or specialized professional in order to thrive in daily life or education. The Agenda with Steve Paikin provides a great and very brief explanation of medically fragile, which can be viewed here.

Medically fragile conditions are typically a result of abuse, neglect, illness, congenital disorder or brain injury. Regular interventions can include; assistance with a feeding tube or intravenous therapies, cardiorespiratory monitoring, administration of medications and urinary catheterization.

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Symptoms and treatments to support the needs of medically fragile children can vary greatly. Some symptoms and/or examples are those that have physical and developmental defects, such as facial or physical abnormalities, developmental disorders causing learning, language, behavioral and physical difficulties, spina bifida, causing deformation of the spine, legs and feet, Cancer, AIDS, epilepsy resulting in seizures, downs syndrome, and chronic respiratory diseases resulting in difficulty breathing, such as severe asthma attacks, to name a few.  Regular treatments can include; assistance with a feeding tube or intravenous therapies, cardiorespiratory monitoring, administration of medications and urinary catheterization.

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Mentally fragile children often need constant or near-constant supervision and care and are very limited, both physically and mentally when it comes to interacting with peers. In some cases, students may be confined to a wheelchair, or use support assistance such as crutches, they may need help using the toilet, eating, or doing any daily activity that non-disabled children may do. Students with severe or multiple disabilities may be equally challenged physically and developmentally, making reading, writing, speaking, or recognizing social cues very difficult if not impossible without assistance. Due to these reasons, engaging and interacting with peers in a classroom can be difficult.

While these students do typically come with dedicated individuals to assist them throughout the day, thereby ensuring that other students’ learning is not deeply impacted, there is still some concern that intensive students require more support, which takes away from the support for average students (MentalHelp.net).  Some say that the mere presence of severe needs students in the general classroom can be distracting and can impact students' learning, but the more beneficial view is that their presence encourages diversity in the classroom and acceptance among peers through all differences.

A final concern about the impact on peers is that should there be emergency situations that occur, which is inevitable at some point, these one-off scenarios can be difficult for students to understand and may even be traumatic to experience. An example of this would be elementary students experiencing a classmate's seizure during class.

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Medically Fragile students should be incorporated into an inclusive classroom every day, even if only for a short time. Interaction with other peers is very important for their overall growth and social development and can actually improve their health (Zenner, 2006). However, a more restrictive environment may prove more effective for these students with intensive needs due to the intensive care that is required as well as the risks potentially involved with being in an inclusive classroom. This is due to safety concerns more than it is an ability or learning concern.

IEP’s should be created for these students just as you would any other disabled child, however, the goals set would ideally be much more basic and at a much lower threshold. Examples of some strategies or goals might be the students' ability to visually identify an item, visually track/follow an object from one side to another, hold the gaze of an item for a specified amount of time, can match simple items by touch, or can recognize their name or the first letter of their name (Simply SpecialEd).  Utilizing “I can” statements in goal achievement can be useful in this situation.

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There are a number of programs available for children that are medically fragile and have severe disabilities. One thing that was consistent in my research is the toll that constant care can have on families. These programs offer respite for families, giving families the support they need and a break from the demands of caring for children with such high needs. A Rosie Place was just one of the programs I came across.
https://youtu.be/ArHvdgTsSCE

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Parents of Medically Fragile Children Speak

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The Individuals with Disabilities Education Act (IDEA) defines “visual impairment including blindness” as an impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness.
According tohttps://www.adcet.edu.au/inclusive-teaching/specific-disabilities/blind-vision-impaired It is important to note that there is no Typical blind Student. Blindness can effect a student in various degrees. The affects can range from sensitivity to light , color blindness, lazy eye to seeing shadows only, to complete blindness.

Distance vision impairment:

Mild –visual acuity worse than 6/12 to 6/18

Moderate –visual acuity worse than 6/18 to 6/60

Severe –visual acuity worse than 6/60 to 3/60

Blindness –visual acuity worse than 3/60

Near vision impairment:

Near visual acuity worse than N6 or M.08 at 40cm.

(Vision Impairment and Blindness, 2021)

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Symptoms

not be able to see objects at a distance, like on a whiteboard or blackboard

having trouble reading (or learning to read) and participating in class

not be able to focus on objects or follow them, may squint often and rub their eyes a lot, have chronic eye redness or sensitivity to light

bump into things often

not being able to see at all

(kidshealth.org (ND)).

Causes

Injury to the eyes

Inherited conditions of blindness and vision impairment

Infections of the eyes

Amblyopia- Lazy eye

Cataract

Diabetic retinopathy

Glaucoma

Age related Macular degeneration

AIDS related visual impairment

Cancer of the eye

(Mandal, 2019)

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Students

Students with vision impairment may access information in a variety of ways, for example Braille, audio-tape, or enlarged print. Braille readers cannot skim read and may take up to three times as long as other students to read a text. Students with some vision may be large-print readers. Many will be unable to read examination questions and handouts in standard print or read their own handwriting when answering examination questions.  They may also be unable to take their own notes. Extra time is needed to carry out some tasks, such as locating words in a text when shifting from one reading medium to another.

Students who need information put into alternative formats must wait, often up to six to eight weeks, for the material to be produced for them. This means that they will often fall behind other students in the class.

Students with vision impairment may feel isolated in the learning environment, which can  have an impact on learning.

Headaches often result from eyestrain. This may reduce considerably the study time available to these students.

Participation and interaction in tutorials may be limited. It is difficult for students who cannot see the body language and interactions of others to feel comfortable about participating. Judging when it is appropriate to interrupt or to take a turn in discussion is particularly difficult.

(Inclusive Teaching: Blind and Vision Impaired, n.d.)

Peers

There may be social missteps between sighted and un sighted peers. There may be lack of eye contact, possible lack of smiling, and frequent passivity or constant tactual exploration in less than ideal locations(Willinings, 2019). Having reduced vison makes it difficult to for students with vison impairments to read facial features/expressions and body language and therefore they miss out a lot of social cues, it is imperative that they are taught social skills to prepare them for all their life long social interactions(Willinings, 2019).

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It is important to create an environment that promotes literacy for all students regardless of how they access the material(Strategies for Teaching Students Who Are Blind or Visually Impaired, n.d.).

Strategies

Provide a variety of hands-on, meaningful experiences.  Children learn best through real-world experiences in which they can have a direct, first-hand understanding of something and not just a verbal explanation.

Talk about these experiences with the child beforehand, as well as while the experience is happening, and afterwards when you get home or with other people.  Use words to label objects, people, and experiences that are appropriate to the child’s developmental level.

Offer many opportunities for the child to explore and interact with a wide range of materials and real objects.  This helps to compare size, shape, texture and other attributes, while also helping the child to develop basic concepts and an understanding of same and different.

Encourage daily purposeful, fun movement activities to build gross motor and fine motor abilities. These are necessary precursors for many life skills, including the tactile discrimination needed for functional use of object and tactile symbols or braille.

Support the child to interact with others in safe and comfortable environments.  Playful experiences and exposure to others with reciprocal give and take helps to build the foundation for communication and social development.

Create a literacy-rich environment, in which the child is aware that others are reading and writing.

Provide accessible labels in the environment on the child’s chair, table, cubby and any location where print labels are found.  These should be in the child’s preferred format (large print, braille, objects, tactile symbols).  At home, label rooms in the house, light switches, controls on appliances, and other places where print is found.

Read aloud using stories and books that are interesting and appropriate for the child. Use real objects and personal experiences to increase understanding.  Link to story boxes

Do not avoid "sighted" words

(Strategies for Teaching Students Who Are Blind or Visually Impaired, n.d.)

Reading Strategies

Determine what medium is best for an individual child through the Learning Media Assessment (LMA).  This may be braille, print, dual media, auditory strategies, objects, symbols, or some combination.

Provide books and literacy tools in a format that is accessible to the child.

Paper strategies, including print, magnification and braille; E-text strategies, including tracking, auditory support and refreshable braille; Auditory strategies, including readers and auditory books.

(Strategies for Teaching Students Who Are Blind or Visually Impaired, n.d.)

Typical Accommodations

Audiotaped, Brailed, or electronically formatted lecture notes, handouts, and texts

Verbal descriptions of visual aids

Raised-line drawings and tactile models of graphic materials

Braille lab signs and equipment labels; auditory lab warning signals

Adaptive lab equipment ( i.e. talking thermometers )

Computer with optical character reader, voice output, Braille screen display and printer output

(What Are Typical Accommodations for Students with Blindness? | DO-IT, 2021)

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https://www.youtube.com/watch?v=xQPHNGvfc2E

https://www.youtube.com/watch?v=7wGP_k_UP9c

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School Helps Visually Impaired Students Reach New Horizons

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Inclusive Teaching: Blind and Vision Impaired. (n.d.). ADCET. Retrieved April 21, 2022, from https://www.adcet.edu.au/inclusive-teaching/specific-disabilities/blind-vision-impaired

Mandal, A., MD. (2019, May 31). Causes of visual impairment. News-Medical.Net. Retrieved April 21, 2022, from https://www.news-medical.net/health/Causes-of-visual-impairment.aspx

Strategies for Teaching Students Who Are Blind or Visually Impaired. (n.d.). Paths to Literacy. Retrieved April 21, 2022, from https://www.pathstoliteracy.org/strategies-teaching-students-who-are-blind-or-visually-impaired

Vision impairment and blindness. (2021, October 14).

Blindness and Vision Impairment. Retrieved April 21, 2022, from https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment

Visual Impairment Support. (2022). Special Education Services. Retrieved April 21, 2022, from https://www.iu1.org/departments/special-education-services/visual-impairment-support#:%7E:text=The%20Individuals%20with%20Disabilities%20Education,affects%20a%20child’s%20educational%20performance

Visual Impairments Factsheet (for Schools) (for Parents) - Nemours KidsHealth. (n.d.). Kid’s Health. Retrieved April 21, 2022, from https://kidshealth.org/en/parents/vision-factsheet.html#:%7E:text=not%20be%20able%20to%20see,redness%20or%20sensitivity%20to%20light

What are typical accommodations for students with blindness? | DO-IT. (2021, April 9). DO-IT Disabilities, Opportunities, Internetworking, and Technology. Retrieved April 21, 2022, from https://www.washington.edu/doit/what-are-typical-accommodations-students-blindness

Willinings, C. (2019, June 9).

Social Interaction Skills for Students who are Blind or Visually Impaired. Teaching Students with Visual Impairments. Retrieved April 21, 2022, from https://www.teachingvisuallyimpaired.com/social-interactions.html

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Intellectual disability (used to be Cognitive Disability) is a term used when a person has certain limitations in mental functioning and in skills such as communicating, taking care of themselves-, and social skills. These limitations will cause a child to learn and develop more slowly than a typical child. IDEA defines a intellectual disability as "significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child's educational performance." (The Office of Special Education Programs, 2022).

Intellectual functioning, or IQ, is usually measured by a test called an IQ test. The average score is 100. People scoring below 70 to 75 are thought to have an intellectual disability. To measure adaptive behavior, professionals look at what a child can do in comparison to other children of their age. Certain skills are important to adaptive behavior. These are:

daily living skills, such as getting dressed, going to the bathroom, and feeding one's self;

communication skills, such as understanding what is said and being able to answer;

social skills with peers, family members, adults, and others.

To diagnose an intellectual disability, professionals look at the person's mental abilities (IQ) and their adaptive skills. Both of these are highlighted in the definition of intellectual disability provided between the lines below. This definition comes from the Individuals with Disabilities Education Act (IDEA).
(Students with an intellectual disability, 2019).

In order for students to be diagnosed with a cognitive disability, they must have impairments in intellectual functioning and adaptive behavior. Additionally, the symptoms must be present before a child becomes 18 years old.

Intellectual functioning refers to a person's ability to plan, comprehend, and reason. A child's intellectual functioning can be assessed by an intelligence test. The most common intelligence test that you've probably heard of is the IQ test. Generally, a child with scores of 70-75 or lower is classified as having a cognitive disability.

Adaptive behavior refers to an individual's ability to apply social and practical skills in everyday life. Examples of adaptive behavior can include personal care, social problem-solving skills, dressing and eating skills, using money, and following rules.

(What are Cognitive Disabilities? - Definition, Types & Examples, 2016).

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The characteristics and impact of a person’s intellectual disability will vary depending on the cause.  There are a number of common characteristics that may have a significant impact on an individual’s learning, including:

difficulty understanding new information

difficulties with communication and social skills

slow cognitive processing time

difficulty in the sequential processing of information

difficulties comprehending abstract concepts.

(Australian Government Department of Education, Skills and Employment, 2022).

Early warning signs:

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.

(The Office of Special Education Programs, 2022).

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Doctors have found many causes of intellectual disabilities. The most common are:

Genetic conditions. Sometimes an intellectual disability is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Examples of genetic conditions are Down syndrome, fragile X syndrome, and phenylketonuria (PKU).

Problems during pregnancy. Intellectual disabilities can result when the baby does not develop inside the mother properly. For example, there may be a problem with the way the baby's cells divide as it grows. A woman who drinks alcohol or gets an infection like rubella during pregnancy may also have a baby with intellectual disabilities.

Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, they may have an intellectual disability.

Health problems. Diseases like whooping cough, the measles, or meningitis can cause intellectual disabilities.  This can also be caused by extreme malnutrition (not eating right), not getting enough medical care, or by being exposed to poisons like lead or mercury. (The Office of Special Education Programs, 2022).

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Because ID is a blanket term – similar to autism spectrum disorder in the classroom – children with this disability can require higher levels of support and resources or none at all.

For students with an intellectual disability, this is often not the only factor as to why they struggle to work in a mainstream school environment. Between 40-60% of students with ID are also on the spectrum, leading to further difficulties in effective communication and learning.
(Students with an intellectual disability, 2019).

An article published in 2019 found that , the experience of people with intellectual disabilities in society is often characterized by strong discrimination and stigma, as this is one of the most stigmatized groups, which is generally more socially excluded than other groups in society. When compared to other types of disability, the peers of those with intellectual disabilities have characterized them as the most undesirable for building friendships with, the most unfavorably described, and those regarded with the least positive attitudes. It goes on to state that, previous research has shown that the experience of those with intellectual disabilities in school, as in other spheres of society, is strongly influenced by discrimination. Pupils with intellectual disabilities and other disabilities are more socially isolated than those without disabilities and experience bigger social distance from their peers. These views have a negative effects. The same article explains that, "different studies have shown that people with intellectual disabilities are aware of the stigma and the discrimination that comes with the label of intellectual disability. The awareness of this stigmatized label has been shown to be related to an array of negative consequences for those with intellectual disabilities, such as self-stigma, lower self-esteem  and more negative self-evaluations and social comparisons. (Valentim, 2019).

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There is a range of inclusive teaching strategies that can assist all students to learn but there are some specific strategies that are useful in teaching a group which includes students with intellectual disability:

Provide an outline of what will be taught - highlight key concepts and provide opportunities to practice new skills and concepts.

Provide reading lists well before the start of a course so that reading can begin early.

Consider tailoring reading lists and provide guidance to key texts. Allow work to be completed on an in-depth study of a few texts rather than a broad study of many.

Whenever you are introducing procedures or processes or giving directions, for example in a laboratory or computing exercise, ensure that stages or sequences are made clear and are explained in verbal as well as written form.

Students may benefit from using assistive technology.

Use as many verbal descriptions as possible to supplement material presented on blackboard or overhead

Use clear, succinct, straightforward language.

Reinforce learning by using real-life examples and environments.

Present information in a range of formats – handouts, worksheets, overheads, videos – to meet a diversity of learning styles.

Use a variety of teaching methods so that students are not constrained by needing to acquire information by reading only. Where possible, present material diagrammatically - in lists, flow charts, concept maps etc.

Keep diagrams uncluttered and use color wherever appropriate to distinguish and highlight.

Ensure that lists of technical/professional jargon which students will need to learn are available early in the course.

Recording lectures will assist those students who have handwriting or coordination problems and those who write slowly as well as those who have a tendency to mishear or misquote.

Students will be more likely to follow correctly the sequence of material in a lecture if they are able to listen to the material more than once.

Wherever possible, ensure that key statements and instructions are repeated or highlighted in some way.

One-to-one tutoring in subjects may be important; this can include peer tutoring.

Students may benefit from having oral rather than written feedback on their written assignments.

It may be helpful for students with intellectual disability to have an individual orientation to laboratory equipment or computers to minimize anxiety.

Allow extensions to assignment deadlines

Use technology to record students work, e.g. digital photography, tape and video.

Students may take longer to organize thoughts and sequence material. They will benefit from discussing their outlines, with particular attention being paid to appropriate relationships and connections between points.

Encourage the student to submit an early draft of assignments to allow the opportunity for feedback to the student as a formative process.

Students with an intellectual disability will need extra time in an examination for reading and analyzing questions and for planning their answers.

Some students will request that examination questions be read to them. Some students may prefer to dictate their answers to a scribe. They will need a venue which is quiet and distraction-free.

Keep short your written examination instructions and sentences within examination questions. Questions using bullet points, lists or distinct parts are more likely to be correctly interpreted.

Because students with intellectual  disability find it difficult to read multiple choice questions in a way that allows them to appreciate subtle changes in the arrangement of words, short answer questions will be a better test of their knowledge.

Students may benefit from an exam timetable that features a number of days between exams to assist in exam preparation.

Many students with intellectual disability are chronic misspellers and use dictionaries only with great difficulty.

(Australian Government Department of Education, Skills and Employment, 2022).

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resources for parents (also in Spanish):
https://www.parentcenterhub.org/intellectual/

Quick overview video:

https://www.youtube.com/watch?v=zQNASuTNtVw&ab_channel=TeachingsinEducation

Teaching Strategies:
https://www.youtube.com/watch?v=Dd62-eL0JYI&ab_channel=insideadhd

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Intellectual Disability | Center for Parent Information and Resources

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Link checked and current as of June 2017

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Copy of my draft:
https://docs.google.com/document/d/1z3mnlUtQPCn0R_h-FnPMkPOCyqK4GFCyzPF3Wzm5ReU/edit?usp=sharing

Australian Government Department of Education, Skills and Employment . (2022). Inclusive teaching: Intellectual disability. ADCET. Retrieved April 21, 2022, from https://www.adcet.edu.au/inclusive-teaching/specific-disabilities/intellectual-disability

The Office of Special Education Programs (OSEP). (2022). Cognitive Disability Resources. Cognitive disability resources. Retrieved April 21, 2022, from https://www.ocecd.org/CognitiveDisabilityResources.aspx

Students with an intellectual disability (5 methods to help). Classful. (2019, April 17). Retrieved April 21, 2022, from https://classful.com/students-with-an-intellectual-disability/

Valentim, A., & Pires Valentim, J. (2019, December 29). What I think of school: Perceptions of school by people with intellectual disabilities. Taylor & Francis Online. Retrieved April 21, 2022, from https://www.tandfonline.com/doi/full/10.1080/09687599.2019.1702507

What are Cognitive Disabilities? - Definition, Types & Examples. Study.com . (2016, April 6). Retrieved April 21, 2022, from https://study.com/academy/lesson/what-are-cognitive-disabilities-definition-types-examples.html.

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5 IEP Goals for Severe-Profound Teachers. (n.d.). Simply Special Ed. Retrieved from: https://www.simplyspecialed.com/how-to-work-with-students-that-are-medically-fragile/

Kohl’s Building Blocks (n.d.) Penfield Children’s Center. Retrieved from: https://penfieldbuildingblocks.org/medically-fragile/what-is-medically-fragile/

Recommendations for School Accommodations: Physical and Occupational Therapy (n.a.). Muscular Dystrophy Association. Retrieved from: https://www.mda.org/sites/default/files/Teachers_Guide_PT_flyer.pdf

The Choice of Educational Settings: The Pros and Cons of Mainstreaming Children With Intellectual Disabilities (n.a.). MentalHelp.net. Retrieved from: https://www.mentalhelp.net/intellectual-disabilities/educational-settings-the-pros-and-cons/

Zenner, A. (January 2006). Sending children who are medically fragile to school.  University of Northern Iowa. Retrieved from: https://scholarworks.uni.edu/cgi/viewcontent.cgi?article=2566&context=grp

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"Deaf" usually refers to a hearing loss so severe that there is very little or no functional hearing. "Hard of hearing" refers to a hearing loss where there may be enough residual hearing that an auditory device, such as a hearing aid or FM system, provides adequate assistance to process speech." (washington.edu, 4/9/21)

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According to Healthline.com, symptoms of hearing loss can include:

feeling like speech and other sounds are quiet or muffled

having trouble hearing other people, particularly in noisy surroundings or when more than one person is speaking

frequently needing to ask others to repeat themselves or to speak more loudly or slowly

having to turn the volume up on your TV or headphones

In children and babies

Children and babies with hearing loss may show different symptoms than adults. Symptoms in children can include:

having unclear speech or talking very loudly

often replying with “huh?” or “what?”

not responding to or following directions

a delay in speech development

turning up the volume too high on the TV or headphones

Some symptoms in babies include:

not being startled by a loud noise

only noticing you when they see you and not when you say their name

appearing to hear some sounds but not others

not responding to or turning toward a sound source after they’ve reached 6 months of age

not saying simple single words by 1 year of age

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According to readingrockets.org, There are four major ways in which hearing loss affects children:

1. It causes a delay in the development of receptive and expressive communication skills (speech and language).

2. The language deficit causes learning problems that result in reduced academic achievement.

3. Communication difficulties often lead to social isolation and poor self-concept.

4. It may have an impact on vocational choices.

Academic Challenges:

Children with hearing loss have difficulty with all areas of academic achievement, especially reading and mathematical concepts.

Children with mild to moderate hearing losses, on average, achieve one to four grade levels lower than their peers with normal hearing, unless appropriate management occurs.

Children with severe to profound hearing loss usually achieve skills no higher than the third- or fourth-grade level, unless appropriate educational intervention occurs early.

The gap in academic achievement between children with normal hearing and those with hearing loss usually widens as they progress through school.

The level of achievement is related to parental involvement and the quantity, quality, and timing of the support services children receive.

Socialization:
Children with profound hearing loss may feel isolated and have difficulty making friends, especially when they have limited interaction with other children that are deaf or hard of hearing.
Although they may be supported in classroom instructions, children that are deaf or hard of hearing and their peers may find it difficult to communicate in day-to-day school functions such as lunchroom or class discussions.
According to the Journal of deaf studies and deaf education, students that are deaf or hard of hearing are most successful in a classroom where they are fully accepted by their peers.

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Whittier Area Cooperative Special Education Program suggests the following:
- Classroom Amplification (FM speaker will be provided if stated on the student’s IEP)
- Seating Arrangement: Position the student in the front of the class or close proximity to the teacher/sound source.
- Visual support / Visual Presentation of Materials
- Allow extra time for the student to respond
- Repeat directions/questions if necessary
- Frequently check for the student’s understanding
- Allow extra time on tests
- Assign a note-taker to share their notes with the DHH student

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How are the terms deaf, deafened, hard of hearing, and hearing impaired typically used? How are the terms deaf, deafened, hard of hearing, and hearing impaired typically used? | DO-IT. (n.d.). Retrieved April 21, 2022, from https://www.washington.edu/doit/how-are-terms-deaf-deafened-hard-hearing-and-hearing-impaired-typically-used

DHH accommodations and strategies - WACSEP. (n.d.). Retrieved April 23, 2022, from https://www.wacsep.org/cms/lib4/CA01001768/Centricity/Domain/57/DHH%20Accommodations%20and%20Strategies.pdf

Academic.oup.com. (n.d.). Retrieved April 23, 2022, from https://academic.oup.com/jdsde/

Effects of hearing loss on development. Reading Rockets. Retrieved April 23, 2022, from https://www.readingrockets.org/article/effects-hearing-loss-development

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Students with multiple impairments have more than one disability in cognitive, physical, and/or functional abilities. They typically require intensive intervention and support for activities of daily living.

Multiple disabilities mean a student has more than one serious disability which may affect mobility, behavior, emotion, or sensory abilities. Some characteristic challenges of individuals with severe multiple impairments are:

Limited communication or speech impairment

Problems with physical mobility

Cognitive impairments

(Severe Multiple, n.d.)

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The IDEA's Special Education Categories: Multiple Disabilities

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The IDEA's Special Education Categories: Multiple Disabilities

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The IDEA's Special Education Categories: Multiple Disabilities

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People with severe or multiple
disabilities may exhibit a wide range
of symptoms, depending on the
combination and severity of disabilities, and the person’s age. There are, however, some traits they may share,
including:
• Limited speech or communication;
• Difficulty in basic physical
mobility;
• Tendency to forget skills through
disuse;
• Trouble generalizing skills from
one situation to another;
• A need for support in major life
activities, e.g., domestic, leisure,
community use, vocational.
(Severe/Multiple Disabilities, 2004)

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Individuals

Difficulty in basic physical mobility

May experience fine-motor deficits that can cause penmanship problems

May have slow clerical speed.

May tend to forget skills through disuse

May have trouble generalizing skills from one situation to another

May lack high-level thinking and comprehension skills

May have poor problem-solving skills

Ability to engage in abstract thinking is limited

May be a poor test taker due to limiting factors of the disabilities

May have difficulty locating the direction of the sound

May have speech that is characterized by substitution, omissions

May have difficulty learning about objects and object relationships

May lack maturity in establishing career goals

May face problems in socializing with peers

Peers

Requires a lot of patience with individuals with multiple disabilities.

Basic knowledge of the individual's disabilities.

Effort is needed to ensure safety. Compassion is needed

(Multiple Disabilities, 2021)

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A look inside the Multiple Disabilities Program

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A look inside the Multiple Disabilities Program

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A look inside the LCS Multiple Disabilities Program

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A multi-disciplinary team consisting of the student's parents, educational specialists, and medical specialists in the areas in which the individual demonstrates problems should work together to plan and coordinate necessary services.

Involvement of the appropriate professionals (E.g. occupational therapists, speech/language therapist etc.)

The arrangement of places school and homes must be easily accessible.

Have a buddy system that ensures their needs are heard and that they get aid when needed.

Give Simple and Specific and Systematic instructions to what you exactly want the person to do.

Use visual aids when communicating with the child.

Engage the child regularly in oral language activity.Strategies and accommodations

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Orthopaedic Impairment: Orthopaedic impaired children are those who suffer from defects, deformities and disturbances related to muscles, joints and skeletal system. These impairments can occur because of various causes and could be treatable but not curable.

-       As per Idea – any condition that interferes with a student’s ability to use his or her body and thus severely and adversely affecting their educational performance.

-       Orthopaedic impairments involve the skeletal system (bones, joints, limbs, and associated muscles)

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Neurological: Affects a child’s ability to move, use, feel, or control a few parts of the body.

Epilepsy: Is an abnormal discharge of electrical activity by one or more cells in the brain. This discharge disrupts the normal functioning of the brain causing altered consciousness, unusual motor activity, hallucinations, and sometimes problems or inappropriate behaviors.

Traumatic Brain Injury: traumatic brain injuries are often acquired injuries, occurring after birth and throughout the lifespan. This can affect physical, cognitive, and behavioral disturbances.

Physical effects of TBI- Sleep disturbance, headache, lack of senses, seizures, loss of motor skills.

Behavioral effects of TBI: Mood swings, anxiety, depression, impulsivity, lack of social skills

Cognitive effects of TBI: Repetition, memory loss, attention deficiency, processing disorder.

Cerebral Palsy: Cerebral palsy is a non-progressive disorder of the central nervous system (brain and spinal column) that is a result of an injury to the developing brain. The injury causes muscle weakness or paralysis, affecting a child's abilities to regulate muscle tone, initiate movement, and maintain their posture.

Spinal cord injury: SCI is complete or partial damage to the spinal cord that causes permanent changes in sensation and loss of voluntary control. Patients who suffer from SCI experience pain and numbness, inability to move, inability to feel pressure, muscles spasms, loss of bowel control, and difficulty breathing.

Musculoskeletal: Injuries and disorders that affect the human body’s movement.

Muscular Dystrophy: Is muscle weakness caused by poorly nourished muscles due to degeneration. Children with muscular dystrophy walk late, waddle, have weak legs and muscles and have poor movement.

Congenital Malformations: this condition could be the result of genetic abnormalities.

Limb Malformation like Clubfoot: This abnormality happens in the womb and children are born with twisted feet. This can now be cured with surgery but requires long-term physiotherapy to correct it.

Limb Deficiency: Is the absence of a limb or part of a limb due to injury. Sometimes children are born with genetic abnormalities that stop limbs from forming in the womb

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Considerations: Children who share similar diagnosis will still have different physical, emotional, and intellectual capabilities. Many students with orthopedic impairments may not have a learning disability.

Social/Behavioral Challenges:

Limited social interaction

Poor self-advocacy

Difficulty making friends

Awkwardness

Isolation/withdrawal

Lack of motivation

Depression

Strong sense of fear and lack of confidence

Physical Challenges:

Poor balance

Poor coordination

Limited mobility

Problems with motor skills

Speech impairment and multiple disabilities

Academic  Challenges:

Poor school attendance due to doctor’s visits, hospitalization, and challenging health condition

Although certain children do well in general education, others require special teaching methods due to intellectual and sensory disorders.

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Strategies to Support students with OI at school and at home

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Strategies to Support students with OI at school and at home

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- Physical therapist- improve gross motor skills

- Occupational therapist- improve fine motor skills

- Speech and language pathologist – improve speech and language difficulties

- Individualized education program – to help achieve academic goals.

- Accessible transportation – wheelchair accessible, walkers, canes, and crutches accessible.

- Modifications to classroom and school environment to make maneuvering easy.

- Special chair and table for posture improvement

- Assistive Technology- Devices such as screen reading software, augmentative and alternative communications devices assist students to access educational material

- Specialised exercise equipment

- Special chair and table for posture improvement

- Provide necessary braces, prosthetics, and orthotic devices

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Thomas C. Weiss. (2009, October 9). Children and Orthopedic Impairments. Disabled World. Retrieved April 22, 2022 from www.disabled-world.com/disability/children/orthopedic-impairments.php

Heller, K.W., & Swinehart-Jones, D. (2003). Supporting the

Educational Needs of Students with Orthopedic Impair-

ments. Physical Disabilities: Education and Related Services

Disabled World. (2022, April 5). Disability Benefits, Facts, Statistics, Resources. Disabled World. Retrieved April 22, 2022 from www.disabled-world.com/disability/

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As I will just be starting out in my first year of actual teaching (not as an assistant) I see some real value in these resources, as with many of the other resources we have reviewed in these past weeks. I am thankful for the way in which we’ve compiled the information so that it is centrally located in one document/presentation format, making it easy to access when I need to find specific information.  As a new teacher in a new field (somewhat new to me) there is such an overwhelming amount of information related to the wide range of disabilities, symptoms, strategies, accommodations modifications, and resources available, that having an easily accessible set of documents will make things so much easier to quickly reference when needed. I think that this information is also really great to have on hand to share with parents and families of students with disabilities.  Yina’s resources included a video about multiple disability children and had some really great clarifying tips for parents, providing a great definition of the term as well as some pointers on things to focus on when searching for assistance.  Within my own resources, I found information on programs that support families of children with medically fragile and severely profound diagnosis and the wonderful services they offer to provide support and respite for the families. Having this information available for sharing can make such a profound difference in a students life, as well as their families. I personally feel that I would use these resources often, especially in the beginning, simply as a way to review symptoms against my own students. It would be so helpful in that way. But if I am being completely honest, the chances of my using these resources often in the current school setting we are in is highly unlikely, mostly because we do not have students with such or proud needs. This may change in the future as we have begun to take on students with more intensive needs, but until then, this will remain a tool in my tool kit.

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I think the greatest advantage of doing this a as a group is that we have established quite the library of information that we can easily access at any time with out having to be an expert with every issue that comes across our path.  Now we have of list with complete definitions, symptoms and widely used accommodations and modifications at out finger tips.

Having this my first year of teaching would have been a lot easier. I tended to start with symptoms and back track to causes. only ever seeming to treat the symptoms. It would have saved me hours of research both on google and the old fashioned way. It most certainly would have been more accurate and it would have sped the process of getting students the help they need.

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"Cerebral palsy (CP) is a group of disorders that affect a person's ability to move and maintain balance and posture. CP is the most common disability in childhood. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles." (CDC, 2021) All people with CP have difficulty with movement and posture. Many also have related conditions, such as cognitive impairments, seizures, blindness, deafness, scoliosis, etc.

Cerebral palsy might vary in degree, from mild (can walk with some awkwardness) to severe (might not be able to walk and needs lifelong care). CP does not worsen over time, however the symptoms might change with age.

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Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:

Stiff muscles (spasticity)

Uncontrollable movements (dyskinesia)

Poor balance and coordination (ataxia)

From these come the four categories of CP.

1. Spastic Cerebral Palsy (SCP)
80% of people with CP are affected by Spastic Cerebral palsy. People with SCP have increased muscle tone, which means the muscles are stiff and cause "awkward" movements.  There are three types of SCP. First one  affects only legs, with little to no effect to arms, second affects one side of the body, where typically the arm will be affected more than the leg, third is the most severe, affecting all four limbs, face, and trunk. The third one typically occurs together with developmental disabilities, hearing loss, blindness and seizures.

2. Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

People with dyskinetic CP struggle with controlling movement of hands, arms, feet, and legs, making it difficult to sit and walk. The movement are uncontrollable, slow, rapid and/or jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that changes either from day to day, or throughout the day.

3. Ataxic Cerebral Palsy

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control (ex. writing).

4. Mixed Cerebral Palsy

Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

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Symptoms of CP

Movement and coordination

Stiff muscles and exaggerated reflexes (spasticity)

Variations in muscle tone, such as being either too stiff or too floppy

Stiff muscles with normal reflexes (rigidity)

Lack of balance and muscle coordination (ataxia)

Tremors or jerky involuntary movements

Slow, writhing movements

Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling

Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait

Difficulty with fine motor skills, such as buttoning clothes or picking up utensils

Speech and eating

Delays in speech development

Difficulty speaking

Difficulty with sucking, chewing or eating

Excessive drooling or problems with swallowing

Development

Delays in reaching motor skills milestones, such as sitting up or crawling

Learning difficulties

Cognitive / Intellectual deficits

Delayed growth, resulting in smaller size than would be expected

Other problems

Damage to the brain can contribute to other neurological problems, such as:

Seizures (epilepsy)

Difficulty hearing

Problems with vision and abnormal eye movements

Abnormal touch or pain sensations

Bladder and bowel problems, including constipation and urinary incontinence

Mental health conditions, such as emotional disorders and behavioral problems

(Mayo Clinic, 2021)

Causes of CP

The causes of CP are "outside factors" and does not have a genetic predisposition.

Some causes of CP are:

1. Gene mutations
2. Maternal infections
3. Fetal stroke
4. Bleeding into the brain
5. Infant infections
6. Traumatic head injury
7. Lack of oxygen

(Mayo Clinic, 2021)

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How Cerebral Palsy affects the student and their peers?

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How Cerebral Palsy affects the student and their peers?

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The answer to this questions depends on the severity of CP.

In mild CP the symptoms might be less prevalent, affecting the student in a lesser way. For example, a student with mild spasticity in their legs (and no other impairments) will only be affected with walking "awkwardly", meaning academic education will most likely not be affected. However, the peers might be "mean" to the student, due to a physical difference of the student with CP. It is key for the teacher to speak and teach their students about inclusivity in order to avoid bullying.

In medium severity, children with CP might be able to accomplish everyday tasks without much support, however might struggle with writing and drawing, sitting in a "typical"chair for the whole day (their body might get tired from having to hold up a proper posture), might also require some/ all day one-on-one support. Additionally, children with medium severity would benefit from seeing an occupational therapist and/or physical therapist and/or speech & language pathologist in order to work on skills necessary for school and life.

Children with more severe CP might not be able to stay in the school for the whole day and/or might require a special-education or self-contained classroom (even though CP is not classified as 1 of the 13 categories for these options, the impairments that come with CP might qualify under various other categories). Those with the most severe needs and require round-the-clock care would most likely be placed in a residential program.

In regards to peers, some practical tasks for students with CP might require peer support due to gross motor challenges. Additionally, it is important that the teacher ensures the student with CP is involved in peer activities and does not get singled out.

(Slaughter,2018; Proctor, 2022)

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Strategies for teachers

Talk about and celebrate differences. Students with CP want to be accepted like everyone else. But sometimes they’re targeted by others who see them as “different.” Be mindful of bullying, and keep a zero-tolerance policy for that behavior.

Regularly check in with the student with CP to help them achieve set goals. Once they’ve reached it, set a new one.

A team of professionals with disability specific knowledge regarding CP and the functional impact of the disability will be invaluable in supporting the individual needs of each student. Check in with them on how you can support the child with CP in your classroom. As CP presents itself in unique ways in each person, professionals might help you pinpoint how you can support the specific student in your class.

Provide copies of notes or use student writers if handwriting is difficult.

Provide clear expectations, consistency, structure and routine for the entire class. Rules should be specific, direct, written down and applied consistently.

If the student uses an alternative form of communication, like a communication book or device, make sure it is available to him or her at recess and lunchtime. Teach peers how interact with the student using the communication device or book.

Be aware of physical considerations during practical tasks and provide subtle support.

Have variety when teaching (UDL approach). Variety is especially important for a child with cerebral palsy who may struggle in ways other children do not. Use direct instruction, small group discussions, hands-on experimentation, quiet reading, videos and computer learning, and all types of strategies to reach each child.

Accommodations for classrooms and lessons

Keep walkways open. Make your classroom easy to move through and free of obstacles. Students may need extra help moving around or reaching things.

Be aware of seating arrangements, and adjust if they aren’t working. Kids with CP who are self-conscious of uncontrolled movements or other differences may want to sit in the back or away from others. Try to put kids near other students who encourage them to be involved in activities.

Give extra time, if needed (this should also be in the ILP). Some kids may need more time to travel between classes, complete assignments or activities, and take tests. They might need extra bathroom breaks too. Talk to the student and parent to find out what’s best. To help with comprehending and processing instructions, allow the student more time with transitions and tasks. Understand that students with CP are prone to anxiety and unrealistic time limits are likely to heighten it.

To help students who struggle with handwriting, consider technological solutions such as an eye-gaze computer navigation system or speech-to-text, particularly if the focus of the lesson is not on handwriting.

Specialised seating may be required if student uses a wheelchair. Additionally, "comfortable" seating might be necessary if the student is struggle with posture control. Potentially a "break" area, where the student can rest in a bean bag chair.

Tips for teachers working with children with CP

Be prepared for medical emergencies by planning ahead with parents. Know what to do and who to call if a student with CP has a medical emergency or event, like a seizure.

Schedule bathroom breaks or allow student to leave class just prior to other students to avoid the rush. There is a potential for a toileting accident, make sure you are aware of what to do and who to contact for help in the school if this happens (typically health office).

(Hirsch, 2021; NCCD, n.d.; teaching for inclusion, n.d.;

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Link with specific curriculum and other considerations when working with a student with CP. 

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Link with specific curriculum and other considerations when working with a student with CP. 

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About cerebral palsy

Cerebral palsy describes a disorder that affects the way a person moves. Cerebral palsy occurs when there is damage to the brain when it is developing, and it affects a child's ability to control their muscles. It is the most common form of physical disability in childhood.

A child with cerebral palsy may face challenges with muscle weakness and stiffness. Some children might have trouble with slowness or shakiness, and they may not be able to control their movement. Balance, coordination and walking can be also be difficult. Cerebral palsy can affect different parts of the body. Some children may have trouble with motor control on one side of their body, some may have challenges with both sides, and some may have challenges that affect only the lower part of their body.

About one third of children with cerebral palsy also have epilepsy, which means that they have recurring seizures. There are different types of epilepsy, and they affect children in different ways. Some children may stare blankly or look as if they are daydreaming during a seizure. For some children, a seizure may involve stiffness or jerking movements. Some children will benefit from medication, which means that seizures may be rare. If a child in your group has epilepsy, ask the child's parents and support team about how you can recognise a seizure and what to do.

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Cerebral palsy describes a disorder that affects the way a person moves. Cerebral palsy occurs when there is damage to the brain when it is developing, and it affects a child's ability to control their muscles. It is the most common form of physical disability in childhood.

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In this video, Christopher Albrecht tells a story of a child with CP, who was struggling in class and was also struggling to run. Getting motivation to run, while working with an OT, PT and his teacher, the student became more motivated and skilled in other areas of his life (for example when writing). I think this video really shows the importance of motivation for a positive and productive learning experience, as well as how we as teachers can help a child with SEN find their motivation.

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On working with a student with cerebral palsy... 2018 NY Teacher of the Year, Christopher Albrecht

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This resource is an incredible tool for us as future (licensed) special education teachers, as it provides basic information on different Low Incidence disabilities, as well as important strategies and resources. This means that when we are faced with a student who has one of these low incidence disabilities, instead of spending hours researching/ recalling what it is, we can come here for most of the necessary information.

Even though I somewhat knew about these different conditions, impairments and disabilities, I have not fully thought about how each one might have a different impact on the class and peers, as well as specific classroom accommodations. Additionally, I was aware of the conditions, but did not know the specifics of each one.

When I started in OT, I had some knowledge about ADHD, ASD, brain injury, CP, from a psychological point of view. However, I have not studies these disabilities from an educational point of view. Hence, I had to do a lot of research on each child and their condition in order to understand what approaches to use when working with them. This resource would have been very useful and would have given me a good head start.

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IDEA defines TBI as: an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech.

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Symptoms associated with the disability & how the disability impacts the student and peers:

Physical symptoms: Dizziness, Weakness, Changes in balance, Headaches, Changes in vision, Changes in hearing, Sleep disturbance, Fatigue

Cognitive/communication Challenges: with memory, executive function, attention, concentration, and processing speed can negatively affect a child’s ability to learn and perform in school.

Behavioral challenges: impulsivity, and emotional issues, Irritability, quick to anger, decreased motivation, may comment on or react to things that seem random and hurtful to peers.

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Strategies and accommodations the teacher can employ to meet the needs of students who have TBI:
Demonstrate new tasks, and provide examples, charts, and other graphic cues when possible to illustrate ideas and concepts. State instructions clearly and go over each step to make sure the student understands instructions. Paraphrase information to help with recall. Review and summarize often. Repeat all key points. Provide ample time for task completion. Students with traumatic brain injuries often need extra time to process information and complete tasks as well as to respond to verbal cues and instructor questions. Encourage the use of schedules, checklists, and notebooks to assist in organizing daily information. Break assignments into smaller parts. Break complex tasks down into steps.

Be prepared for reduced stamina and increased fatigue. Allow students to tape record lectures. Assist students in obtaining a note taker. Have the student sit in the front of the class: this helps with attention, concentration, and also minimizes distractions.

Video Source for added information: https://study.com/academy/lesson/teaching-students-with-traumatic-brain-injury.html

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Nagele, D., Hooper, S., Hildebrant, K., McCart, M., Dettermen, J., & Glang, A. (2019). Physical Disabilities. Education and Related Services. Retrieved April 24, 2022, from https://files.eric.ed.gov/fulltext/EJ1093573.pdf

Walters State Community College. (n.d.). About learn about our college. Walters State the Great Smoky Mountains Community College. Retrieved April 24, 2022, from https://www.ws.edu/student-services/disability/teaching/brain.shtm

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This activity gives me a better understanding of low incidence disabilities, the types, the definition, symptoms, and the challenges. The information and resources are useful for my teaching through many strategies and accommodations. I think the strategies and accommodations are not only beneficial for low incidence disabilities students, but also for the whole class. For example, using a variety of teaching methods, presenting material diagrammatically, using technology, etc, will increase the engagement of the whole class. Even if general students, their learning styles are different, providing options will advocate their learning experience. I hope I can use those strategies, and keep practicing differentiation to help students succeed in their learning.

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Completing this assignment and looking over the other Low Incidence Disabilities made me realize how many different types of disabilities can be found within a classroom. It is insane to think that teachers are expected to be familiar with so many different disabilities and know how to make the classroom environment appropriate for all students. It reaffirms my belief that ALL teachers, not just special education, should receive this type of education. Even with the resources and information we have been given, it would still be difficult for special education teachers to know how to best meet the needs for all students and all disabilities. This is a great resource for any teacher, especially one that isn’t too familiar with these Low Incidence Disabilities. It’s a great introduction to the disability and has some great resources where to find more information. My cohort members also did a great job adding great lists of accommodations and teaching strategies for each disability. I think that part would be the most useful for me and I could see myself referring to it when making lesson plans.

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CDC. (2021). What is cerebral palsy? Retrieved April 24, 2022, from https://www.cdc.gov/ncbddd/cp/facts.html

Hirsch, L. (Ed.). (2021, March). Cerebral Palsy Factsheet (for Schools) (for parents) - nemours kidshealth. Retrieved April 24, 2022, from https://kidshealth.org/en/parents/cp-factsheet.html

Mayo Clinic. (2021). Cerebral palsy. Retrieved April 24, 2022, from https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999

NCCD. (n.d.). Classroom adjustments: Cerebral palsy. Retrieved April 24, 2022, from https://www.nccd.edu.au/professional-learning/classroom-adjustments-cerebral-palsy#:~:text=Some%20students%20with%20cerebral%20palsy,frame%20or%20assistance%20to%20walk.

Physical · Cerebral Palsy. (n.d.). Retrieved April 24, 2022, from http://web1.modelfarms-h.schools.nsw.edu.au/disabilities.php?page=cerebral-palsy

Proctor, K. (2022). Special education for children with cerebral palsy (CP). Retrieved April 24, 2022, from https://www.cerebralpalsyguide.com/community/special-education/

Slaughter, L. (2018). A detailed look at the different types of special education. Retrieved April 24, 2022, from https://www.soliant.com/blog/a-detailed-look-at-the-different-types-of-special-education/